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Distal radius fractures (DRFs) are common injuries among older adults and can result in substantial disability. Current evidence regarding long-term outcomes in older adults is scarce. To compare outcomes across treatment groups at 24 months among adults with DRFs who participated in the WRIST trial. The Wrist and Radius Injury Surgical Trial (WRIST) randomized, international, multicenter trial was conducted from April 1, 2012, through December 31, 2016. Participants were adults aged 60 years or older with isolated, unstable DRFs at 24 health systems in the US, Canada, and Singapore. Data analysis was performed from March 2019 to March 2021. Participants were randomized to open reduction and volar locking plate system (VLPS), external fixation with or without supplementary pinning (EFP), and percutaneous pinning (CRPP). The remaining participants chose closed reduction and casting. The primary outcome was the 24-month Michigan Hand Outcomes Questionnaire (MHQ) summary score. Secondary outcomes were scores on the MHQ subdomains hand strength and wrist motion. A total of 304 adults were recruited for the study, and 187 were randomized to undergo surgery, 65 to VLPS, 64 to EFP, and 58 to CRPP; 117 participants opted for closed reduction and casting. Assessments were completed at 24 months for 182 participants (160 women [87.9%]; mean [SD] age, 70.1 [8.5] years). Mean MHQ summary scores at 24 months were 88 (95% CI, 83-92) for VLPS, 83 (95% CI, 78-88) for EFP, 85 (95% CI, 79-90) for CRPP, and 85 (95% CI, 79-90) for casting, with no clinically meaningful difference across groups after adjusting for covariates (χ23 = 1.44; P = .70). Pain scores also did not differ across groups at 24 months (χ23 = 2.64; P = .45). MHQ summary scores changed from 82 (95% CI, 80-85) to 85 (95% CI, 83-88) (P = .12) between 12 and 24 months across groups. The rate of malunion was higher in the casting group (26 participants [59.1%]) than in the other groups (4 participants [8.0%] for VLPS, 8 participants [17.0%] for EFP, and 4 participants [9.8%] for CRPP; χ23 = 43.6; P < .001), but malunion was not associated with the 24-month outcome difference across groups. The study did not find clinically meaningful patient-reported outcome differences 24 months after injury across treatment groups, with little change between 12 and 24 months. These findings suggest that long-term outcomes need not necessarily be considered in deciding between treatment options. Patient needs and recovery goals that fit to relative risks and benefits of each treatment type will be more valuable in treatment decision-making. ClinicalTrials.gov Identifier: NCT01589692.

Background and Objectives: Distal upper limb injuries are frequent in winter sports, but their functional impact is often underestimated. This study aimed to describe the epidemiology, mechanisms, and risk factors for injuries involving the forearm, wrist, hand, and fingers sustained during two consecutive winter seasons in the Italian Dolomites. Materials and Methods: All adult and willing patients presenting to the Emergency Department of Brixen Hospital after ski- or snowboard-related accidents between December 2023 and March 2025 completed a standardized 23-item questionnaire on demographics, experience level, environmental factors, equipment, and trauma mechanism. For the aim of this study only distal upper limb injuries were extracted and analyzed. Statistical analyses compared fracture versus non-fracture injuries, “good” versus “bad” fractures (AO classification and surgical complexity), and isolated ulnar collateral ligament (UCL) injuries. Results: A total of 195 patients were analyzed: 96 (49.2%) sustained a fracture and 33 (16.9%) presented with isolated UCL lesions. Fractures occurred more frequently on blue slopes (56.2% vs. 33.3%, p < 0.001), whereas non-fracture injuries predominated on red and off-piste slopes. Age, BMI, and skill level did not differ significantly between groups. Surgically classified complex distal forearm fractures were significantly more frequent in females (p < 0.005) but were not associated with environmental factors. UCL injuries occurred mainly on red slopes (54.5%) and were often related to pole entrapment during falls. None of the injured patients reported the use of protective wrist or thumb supports. Conclusions: Distal upper limb injuries are a common pattern of alpine sports trauma, with wrist fractures and skier’s thumb being predominant lesions. Low-speed falls on easy slopes are associated with wrist fractures, while UCL injuries are linked to intermediate slopes. Preventive strategies should include fall technique education, protective gloves, and improved pole ergonomics.

SummaryDespite their proven efficacy for secondary fracture prevention, long-term adherence with oral bisphosphonates is poor.IntroductionTo compare the effectiveness of two interventions on long-term oral bisphosphonate adherence after an upper extremity fragility fracture.MethodsCommunity-dwelling participants 50 years or older with upper extremity fragility fractures not previously treated with bisphosphonates were randomized to either a multi-faceted patient and physician educational intervention (the active control arm) vs. a nurse-led case manager (the study arm). Primary outcome was adherence (taking > 80% of prescribed doses) with prescribed oral bisphosphonates at 12 months postfracture between groups; secondary outcomes included rates of primary non-adherence and 24-month adherence. We also compared quality of life between adherent and non-adherent patients.ResultsBy 12 months, adherence with the initially prescribed bisphosphonate was similar (p = 0.96) in both groups: 38/48 (79.2%) in the educational intervention group vs. 66/83 (79.5%) in the case manager arm. By 24 months, adherence rates were 67% (32/48) in the educational intervention group vs. 53% (43/81) in case managed patients (p = 0.13). Primary non-adherence was 6% (11 patients) in the educational intervention group and 12% (21 patients) in the case managed group (p = 0.07). Prior family history of osteoporosis (aOR 2.1, 95% CI 1.0 to 4.4) and being satisfied with current medical care (aOR 2.3, 95% CI 1.1 to 4.8) were associated with better adherence while lower income (aOR 0.2, 95% CI 0.1 to 0.6, for patients with income < $30,000 per annum) was associated with poorer rates of adherence. There were no differences in health-related quality of life scores at baseline or during follow-up between patients who were adherent and those who were not.ConclusionWhile both interventions achieved higher oral bisphosphonate adherence compared to previously reported adherence rates in the general population, primary non-adherence and long-term adherence to bisphosphonates were similar in both arms. Adherence was influenced by family history of osteoporosis, satisfaction with current medical care, and income.Trial registrationClinicalTrials.gov: NCT01401556

This study investigated the hypothesis that a light eccentric exercise (ECC) that does not induce a loss of muscle function and delayed onset muscle soreness would confer a protective effect against a more strenuous ECC. Eighteen young men were randomly placed into two groups: 10–40% ( n = 9) and 40% ( n = 9). Subjects in the 10–40% group performed ECC of the elbow flexors (six sets of five reps) using a dumbbell set at 10% of maximal isometric strength (MVC) at an elbow joint angle of 90°, followed 2 days later by ECC using a dumbbell weight of 40% MVC. Subjects in the 40% group performed the 40% ECC only. Changes in MVC, range of motion (ROM), upper arm circumference (CIR), plasma creatine kinase (CK) activity and muscle soreness before, immediately after, 1–5 and 7 days following the 40% ECC were compared between groups by a two-way repeated measures ANOVA. No significant changes in any of the criterion measures were found immediately and 1–2 days after the 10% ECC. Following the 40% ECC, the 10–40% group showed significantly ( P < 0.05) smaller decreases in MVC and ROM, and smaller increases in muscle soreness compared with the 40% group, but no significant differences between groups were evident for CIR and plasma CK activity. These results suggest that the 10% ECC induced some protection against a subsequent bout of 40% ECC performed 2 days later. It appears that the light eccentric exercise preconditioned the muscles for exposure to the subsequent damaging eccentric exercise bout.

Emergency physicians often treat patients who require procedural sedation for the management of upper extremity fractures, dislocations, and abscesses (upper extremity emergencies). Unfortunately, procedural sedation is associated with several rare but potentially serious adverse effects and requires continuous hemodynamic monitoring and several dedicated staff members. The purpose of this study was to determine the role of ultrasound-guided supraclavicular brachial plexus nerve blocks in the emergency department (ED) as an alternative to procedural sedation for the management of upper extremity emergencies. In a prospective trial, a convenience sample of ED patients with upper extremity emergencies that would normally require procedural sedation were assigned to receive either procedural sedation or an ultrasound-guided supraclavicular brachial plexus nerve block. Emergency department length of stay (ED LOS) was the primary outcome measure and was analyzed using a paired 2-tailed Student t test. A total of 12 subjects were enrolled. Average ED LOS for subjects receiving the brachial plexus nerve block was 106 minutes (95% confidence interval, 57-155 minutes). Average ED LOS for subjects receiving procedural sedation was 285 minutes (95% confidence interval, 228-343 minutes). The ED LOS was significantly shorter in the nerve block group ( P < .0005). Patient satisfaction was high in both groups, and no significant complications occurred in either group. In our population, ultrasound-guided brachial plexus nerve blocks resulted in shorter ED LOS compared to procedural sedation for patients with upper extremity fractures, dislocations, or abscesses.

Purpose Animal bite injuries are often encountered in daily practice. In particular, these injuries of the upper limbs can result in severe functional impairment. We have performed early debridement of contaminated tissue and primary closure for these injuries. Methods The subjects consisted of 15 patients (6 males and 9 females) aged 1–91 years (mean 53.6 years) who visited our hospital due to animal bite injuries (dog in 9 patients, cat in 6). The bite site was the forearm in 5 patients and the hand in 10. In the operating room, contaminated tissue was removed, and primary wound closure was performed after irrigation. Results The bite penetrated to the muscle layer in 6 patients, tendon sheath in 5, joint in 1, bone in 1, and involved only the subcutaneous tissue in 3 patients. The mean period until the completion of wound treatment was 19.8 ± 8.4 days. As complications, numbness of finger, metaphalangeal joint contracture and superficial radial nerve injury were observed in each one case. In a patient with bite injury of the palmar and dorsal sides of the thumb reaching the bone, additional debridement was necessary. At the final observation, the visual analog scale was 1.2 ± 1.4, and the Quick Disabilities of the Arm, Shoulder, and Hand score was 9.7 ± 12.2. Conclusions Debridement to achieve wound closure is indispensable in patients with animal bite injuries of the upper limbs. The results of our study suggest that thorough debridement allows primary closure, even for animal bite injuries.

Several recent studies have indicated that upper extremity injuries are classified as a top common workplace injury. Therefore, upper extremity rehabilitation has become a leading research area in the last few decades. However, this high number of upper extremity injuries is viewed as a challenging problem due to the insufficient number of physiotherapists. With the recent advancements in technology, robots have been widely involved in upper extremity rehabilitation exercises. Although robotic technology and its involvement in the rehabilitation field are rapidly evolving, the literature lacks a recent review that addresses the updates in the robotic upper extremity rehabilitation field. Thus, this paper presents a comprehensive review of state-of-the-art robotic upper extremity rehabilitation solutions, with a detailed classification of various rehabilitative robots. The paper also reports some experimental robotic trials and their outcomes in clinics.

Secondary lymphedema is a very common clinical issue with millions of patients suffering from pain, recurrent skin infections, and the constant need for a decongestive therapy. Well- established because of oncologic procedures, secondary lymphedema is also a well-known phenomenon after trauma. However, precise epidemiological data of posttraumatic lymphedema upon severe extremity injuries are rare. In the present study, we analyzed a patient cohort of 223 individuals who suffered closed fractures of the upper and lower extremity between 2016 and 2020. All of them simultaneously had a soft tissue injury, of 2nd and 3rd grade according to Tscherne classification. Typical symptoms of lymphedema were recorded in a retrospective cohort analysis through patient anamnesis and compared with documented clinical examination findings. Previous illnesses and trauma-specific characteristics were determined from patient files. Of all patients, 36% showed symptoms of secondary lymphedema and 8,5% reported recurrent skin infections, indicating severe lymphedema. Furthermore, comparing patients with and without lymphedema, additional trauma-associated parameters, such as total number of surgeries, degree of soft tissue damage, localization of the fracture in lower extremity, related to lymphedema progress could be identified. According to these data, posttraumatic secondary lymphedema has even in closed fractures, especially of the lower extremity, a highly underestimated clinical prevalence. Further prospective studies are required to validate these findings, identify high-risk groups, and guide early prophylactic and therapeutic interventions.

ObjectivesTo examine injury prevention strategies and potentially modifiable risk factors (MRFs) for upper extremity (UE) injuries in female, woman and/or girl athletes (female/woman/girl).DesignSystematic review with meta-analysis, semiquantitative analyses and Grading of Recommendations Assessment, Development and Evaluation in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Data sourcesMEDLINE (Medical Literature Analysis and Retrieval System Online), CINAHL (Cumulative Index to Nursing and Allied Health Literature), APA PsycINFO (American Psychological Association Psychological Information Database), SPORTDiscus (Sports Discus Database), EMBASE (Excerpta Medica Database), and ERIC (Education Resources Information Center) (30 October 2023) and Cochrane Systematic Review Database and the Cochrane Central Register of Controlled Trials (CENTRAL) (25 November 2023).EligibilityPrimary data studies with comparison group(s) assessing the association of prevention strategies and/or MRFs for sport-related UE injury, with ≥1 female/woman/girl in each study group.Results55 studies (n=20 intervention, n=35 MRF) were included with 33 228 athletes (8642 female/woman/girl; 26%). Of these, 17 (31%) reported female/woman/girl-specific estimates and included five injury locations (n=3 general UE, n=12 shoulder, n=3 elbow, n=3 wrist/hand). One prevention strategy (n=5 shoulder-specific exercise programmes) and seven MRFs were identified, including less range of motion (n=6), less shoulder muscle strength (n=8), high training load (n=1), presence of scapular dyskinesis (n=3), high sport specialisation (n=2), equipment differences (n=1) and less sport-specific conditioning (n=1). Pooled data from three studies suggest that shoulder exercise programmes consisting of strength, stability/control and sport-specific exercises reduce shoulder injury rates by 51% (95% CI 0.30 to 079; I2 0.0%; very-low certainty evidence) across paediatric (≤18 years) and adult handball and volleyball players.ConclusionsOur understanding of female/woman/girl UE injury prevention is limited by heterogeneity across injury outcomes, interventions, MRFs and limited female/woman/girl athlete-specific data. Shoulder-specific strengthening and stability exercise programmes may be beneficial to reduce shoulder injury rates in female/woman/girl handball and volleyball players. Future research should prioritise female/woman/girl athletes to reduce the burden of UE injuries.PROSPERO registration numberPROSPERO CRD42024494967.

A significant number of adolescent athletes throughout the world participate in various throwing-dominant sports, including but not limited to baseball, cricket, handball, softball, track and field throwing events, and water polo. Due to the unique stresses placed on the throwing arm and entire body in these sports, a robust volume of literature has highlighted concerns about sport specialization in these athletes and an associated increased risk of injury, particularly to the dominant shoulder and elbow, with sport specialization. This review will highlight the evidence-based literature for this athletic niche, focusing on risk factors for injury, national and international organizations' recommendations for limiting overuse injuries, principles of conditioning and rehabilitative programs, and potential future areas of research to curb the growing incidence of throwing-related injuries among adolescent throwing athletes.