Open research questions in Orthopedic Surgery and Rehabilitation

What the literature leaves open

• 1-4 Despite advances in surgical techniques, the optimal treatment strategy for intra-articular fractures remains controversial, particularly regarding the balance between anatomical restoration and minimally invasive approaches. 7 emphasized that less invasive methods may reduce perioperative morbidity, although functional superiority remains uncertain.

  Balancing Function and Cost: Kirschner Wire Fixation Versus Volar Plating in Intra-Articular Distal Radius Fractures · 2026 · DOI

• In addition, due to the limited soft tissue contrast of CT, the median nerve could not be reliably isolated; therefore, the relative contributions of carpal tunnel area and median nerve area to the development of CTS could not be evaluated sepa- rately.

  A multimodal imaging approach to predict carpal tunnel syndrome after distal radius fractures · 2026 · DOI

• Repetitive forceful gripping, sustained wrist loading, and awkward joint postures inherent to construction, manufacturing, and heavy industry may predispose workers to progressive scapholunate ligament compromise; however, the specific biomechanical mechanisms underlying dynamic grip force transmission in symptomatic laborers remain poorly characterized.

  Biomechanical Analysis of Dynamic Gripping in Manual Laborers Exhibiting Work-Related Scapholunate Instability Signs · 2026 · DOI

• The in outcomes of non-surgical multiple metacarpal fractures remain unclear (6,16). Current evidence is limited to a few small case series that combine isolated and multiple metacarpal fractures and typically advocate either surgical or conservative management.

  Comparison of K-Wire and Plate Applications in Multiple Metacarpal Fractures · 2026 · DOI

• 4,6,10 The clinical impact and effectiveness of a second reduction attempt in this group, both radiologically and functionally, remain poorly defined. 18-23 Despite this, these thresholds are generally established based solely on initial post- traumatic radiographs, and there is insufficient data describing how fracture alignment evolves during the follow-up period. In particular, studies focusing on patients who develop secondary displacement and subsequently undergo repeat closed reductions remain scarce and lack systematic, measurement-based analyses.

  Does Re-Reduction Improve Outcomes in Fifth Metacarpal Neck Fracture? A Matched Cohort Study · 2026 · DOI

• 11 radiographic classification systems. The conclusions This paper represents a non-systematic narrative review and does not provide formal evidence synthesis. Included studies varied in methodology and rehabilitation protocols. Some recommendations discussed in this article reflect commonly accepted clinical practice in addition to published evidence. This review focused on practical rehabilitation issues rather than detailed surgical decision- making or therefore represent educational guidance rather than a formal clinical guideline.

  Rehabilitation After Distal Radius Fracture in Older Patients: A Practical Narrative Review for Clinicians · 2026 · DOI

• Although many researchers have emphasized the importance of various ligamentous structures, there is no consensus on the second- ary stabilizer most critical for preventing dorsal intercalated segment instability (DISI) deformities.

  Kinematic Analysis of Three Different Reconstruction Techniques for Scapholunate Dissociation: A Cadaveric Biomechanical Study · 2026 · DOI

• Abstract Purpose Optimal fixation for complex AO/OTA 2R3C intraarticular distal radius fractures remains debated, particularly the role of dorsal bridge plating (DBP) alone or in combination with volar plating (VP).

  Dorsal bridge plating, volar plating, or both? A retrospective analysis of clinical and radiographic outcomes of intraarticular distal radius fracture fixation techniques · 2026 · DOI

• Transfer of the extensor indicis proprius (EIP) tendon to the EPL is one of the most common reconstructive procedures, but prospective outcome data are limited.

  Functional results after extensor indicis proprius to extensor pollicis longus tendon transfer for ruptures associated with distal radius fractures · 2026 · DOI

• 1. Clinical practice: MRI should be obtained for all suspected complete UCL tears where surgical management is being considered, as the identification of a Stener lesion is an indication for operative repair. 2. Imaging protocols: Institutions should standardize thumb UCL MRI protocols to include coronal T1 and PD-FS sequences, axial images optimized for adductor aponeurosis visualization, and use of 3T magnet with dedicated hand coil when available. 3. Interpretation: Radiologists should specifically comment on tear location (proximal, mid- substance, distal), tear completeness (partial vs complete, with estimated percentage of fiber involvement), presence of Stener lesion (with measurement of gap size and relationship to adductor aponeurosis), and associated findings (bone marrow edema, avulsion fractures, joint subluxation). 4. Chronic injuries: For patients with chronic symptoms and negative MRI, clinical stress testing and dynamic ultrasound should be performed before concluding that significant pathology is absent. 5. Future research: Prospective multicenter studies with standardized MRI protocols and blinded interpretation are needed to confirm diagnostic accuracy in community practice settings. Longitudinal studies correlating specific MRI findings with clinical outcomes The International Journal of Medical Science and Health Research Downloaded from theInternationalmedicaljournal.org. For personal use only. No other uses without permission. Copyright © International Medical Journal Corp. Ltd. All rights reserved 131 Research Article Volume 48, Issue No. 02. 2026 E-ISSN : 3048-1368 P-ISSN : 3048-1376 following both operative and non-operative management would strengthen evidence-based treatment algorithms. REFERENCES 1. Ye W, Zhan H, Bai R, et al (2015) [MRI of the thumb collateral ligament at the metacarpophalangeal joint: anatomy and injuries]. Zhonghua yi xue za zhi. https://doi.org/10.3760/CMA.J.ISSN.0376-2491.2015.17.004 2. Madan SS, Pai D, Kaur A, Dixit R (2014) Injury to Ulnar Collateral Ligament of Thumb. Orthopaedic Surgery. https://doi.org/10.1111/os.12084 3. Knisely B, Noland SS, Melville DM (2023) Ultrasound versus MRI in the evaluation of the thumb metacarpophalangeal joint.

  MRI Manifestations in Isolated Ulnar Collateral Ligament Injury of the Thumb (Gamekeeper's Thumb) : A Systematic Review · 2026 · DOI

• A major strength of this study is the use of real patient data derived from a randomized clinical trial. This allowed us to avoid constructing hypothetical cases and instead base our findings on actual clinical scenarios. Furthermore, we deliberately selected the best- and worst-performing patients from each treatment group (ORIF and casting) to create maximum contrast between profiles with good and poor outcomes. We believe that this approach, maximizing the difference in outcome extremes, should facilitate the decision-making process. If surgeons are unable to accurately predict outcomes in such clearly contrasting cases, it is even less likely that they would succeed in predicting more subtle variations in clinical outcomes. Several limitations of the study should also be acknowledged. First, the survey included an equal number of profiles with good and poor outcomes (four for each treatment), which does not reflect typical clinical practice where the majority of patients tend to have favorable outcomes. This artificial balance may have affected participants’ expectations and decisionmaking. Second, the outcome predictions were based on PRWE scores, which are difficult to estimate based solely on written patient information and radiographs. As discussed earlier, radiographic findings are known to correlate poorly with final functional outcomes. Moreover, translating a real clinical presentation into a numerical PRWE estimate over a 1-year period is probably very challenging for any clinician. Third, the study is subject to potential selection bias. The relatively high proportion of hand surgeons among respondents (47.9%) may not accurately reflect the broader population of surgeons treating distal radius fractures and could influence generalizability. It is however unlikely that the broader population of surgeons would be better in estimating treatment outcomes. Fourth, complications can have a substantial impact on treatment outcomes and are often difficult to predict. In our study, complications were present in three of the selected patient profiles. For two of the surgically treated patients with poor outcomes a complication was registered. One required surgical denervation of the posterior interosseous nerve because of persistent pain, which may not be considered a complication since it is a results of symptoms rather than a cause. Another underwent hardware removal because of severe dorsal redisplacement in spite of surgical fixation which resulted in the flexor tendons contacting the volar plate.

  Surgeon Preferences and Outcome Predictions for Displaced Distal Radius Fractures in Elderly Patients: A Survey of 151 Surgeons Making 4,832 Treatment Predictions Based on Patient Profiles and Radiographs · 2026 · DOI

• As with a majority of studies analyzing deidentified aggregate data from a large database, researchers are restricted to a limited subset of information on each patient. For example, this presents a barrier to further evaluating the cause or introduction of an infection. With additional information, such as a patient’s history of present illness or physical exam findings, this might provide further insight regarding independent risk factors or the cause of infection. Another limitation to utilizing large retrospective patient databases is that the data recorded does not allow the researcher to perform granular analyses. For instance, this conglomerate database does not provide further details regarding the severity of infection or a surgeon's threshold to operate versus continuing with IV antibiotics. Specifically, it does not capture the number of Kanavel signs, the presence of an abscess on imaging, or the Michon stage - the variables that most directly inform the decision to operate - and these could not be incorporated into the propensity-score model. Therefore, this information limits the explanatory nature of certain outcomes measured in this study. Despite the limitations of this study, an attempt to control for potential confounders was made. This included propensity score matching of patients by age, gender, race, and ethnicity to ensure the comparison between cohorts was as fair and unbiased as possible, given the observational nature of the data.

  Trends in the Management of Acute Pyogenic Flexor Tenosynovitis of the Hand: A Comprehensive Analysis · 2026 · DOI

• A key limitation in this study is the small sample size (30 patients), while it was sufficient to detect signifi- cant difference between the two groups at 6 months, it may have been under-powered to detect a difference at the earlier time point and restricts generalizabil- ity with patients with varying degrees of trigger finger and co-morbidities. However, implementation may be limited by the need for ultrasound equipment and trained radiologists.

  Trigger finger: US guided combined dry needling and steroid injection provides better long term results than non-guided steroid injection · 2026 · DOI

• CONCLUSION: The findings with respect to mobility, functionality, and quality of life at 12 months provide marginal and inconsistent evidence for the superiority of volar angle-stable plate osteosynthesis over closed reduction and casting in the treatment of intra-articular distal radius fractures.

  The Treatment of Displaced Intra-articular Distal Radius Fractures in Elderly Patients · 2014 · DOI

• Many studies show that gloves may have negative effects on manual dexterity, tactile sensitivity, handgrip strength, muscle activity and fatigue and comfort, while further research is needed to determine glove effects on pinch strength, forearm torque strength and range of finger and wrist movements.

  Methodology for evaluating gloves in relation to the effects on hand performance capabilities: a literature review · 2012 · DOI

• Abstract Radiographic parameters of the distal radius, such as radial inclination and palmar tilt, are crucial for wrist assessment, yet correlations with carpal alignment in radiographically normal-appearing adult wrists remain underexplored.

  Correlations between the Inclination of the Distal Radius and Carpal Alignment on Plain Radiographs · 2026 · DOI

• The patient did engage in sports activity; however, this was limited to a recreational level with low frequency and was therefore considered insufficient to generate the cumulative repetitive microtrauma typically implicated in overuse-related tendon rupture.

  Rupture of the Extensor Digitorum Tendon of the Fifth Toe Caused by the Use of Press-Tack Needle Acupuncture During Sports Activity: A Case Report · 2026 · DOI

• Surgical outcome using patient-reported outcome measurements (PROMs) from national registers with large surgically treated population have rarely been reported.

  Surgically treated metacarpal fractures in adults: a study with 3286 cases based on the Swedish National Quality Registry for Hand Surgery · 2026 · DOI

• 5 Flexor tendon injuries associated with forearm fractures are rarely reported but may occur due to sharp fracture fragments or direct traumatic laceration.

  A rare combination of comminuted distal ulna fracture with flexor tendons injury, median nerve injury and ulnar artery injury managed by staged fixation: a case report · 2026 · DOI

• Past studies have characterized common causes and injury patterns of pediatric hand fractures, but literature is lacking whether socioeconomic factors affect the causes, types, and treatment of these fractures.

  Pediatric Hand Fractures: Socioeconomic Disparities In Causes, Injury Patterns, And Treatment · 2026 · DOI

• Accordingly, the results of this study may not be applicable to other clinical settings, including those involving different sur- geons, implant designs, or graft materials.

  Use of an allo-cancellous chip bone graft to treat AO/OTA type C3 distal radius comminuted articular fractures: a retrospective case series · 2026 · DOI

• The present study is among the first in Thailand to explore factors associated with MSDs of the hand without regard to the participant's occupation in a health care setting. Limitations of this study include the small sample size which, due to time limitations, was less than originally planned.

  Recognition of Three Common Work-Related Hand Diseases in a Teaching Hospital · 2025 · DOI

• The present study could not interpret the results of smoking, the main factor found to be related to upper extremities MSDs in other studies. We hypothesize that this is due to the limited number of participants in the present study.

  Recognition of Three Common Work-Related Hand Diseases in a Teaching Hospital · 2025 · DOI

• Despite the multiplicity of these scales, there is no consensus on the best method of grading the severity of this disease and on the most accurate outcome measure after treatment.

  A review of scales used to assess the severity and outcome of surgery for Dupuytren’s disease · 2024 · DOI

• Radiographic contrast tenography in the standing patient can be used to identify pathology but provides limited information on the exact lesion configuration.

  Computed tomographic contrast tenography aids pre‐operative diagnosis in clinical conditions of the digital flexor tendon sheath · 2023 · DOI

Most-cited papers in Orthopedic Surgery and Rehabilitation

• Grip Strength: A Summary of Studies Comparing Dominant and Nondominant Limb Measurements · Perceptual and Motor Skills · 2003 · 102 citations
• A New Technique · The American Journal of Sports Medicine · 2004 · 91 citations
• Methodology for evaluating gloves in relation to the effects on hand performance capabilities: a literature review · Ergonomics · 2012 · 71 citations
• Changes in the incidence and treatment of distal radius fractures in adults – a 22-year nationwide register study of 276,145 fractures · Injury · 2023 · 65 citations
• Personalized 3D-printed forearm braces as an alternative for a traditional plaster cast or splint; A systematic review · Injury · 2022 · 40 citations
• The Treatment of Displaced Intra-articular Distal Radius Fractures in Elderly Patients · Deutsches Ärzteblatt international · 2014 · 32 citations
• Functional outcomes and complications after treatment of distal radius fracture in patients sixty years and over: A systematic review and network meta-analysis · Injury · 2023 · 27 citations
• A Comparative Study for Different Types of Thumb Base Osteoarthritis Injections: A Randomized Controlled Interventional Study · Ortopedia Traumatologia Rehabilitacja · 2020 · 25 citations
• Current Concepts in Management of Distal Femur Fractures · Injury · 2024 · 20 citations
• The Treatment of Primary Arthritis of the Finger and Thumb Joint · Deutsches Ärzteblatt international · 2018 · 16 citations

Most recent work

• Comparative cost-effectiveness analysis of different treatment strategies for distal radius fracture · Health Economics Review · 2026
• Comparative Efficacy of Hematoma Block Versus Circumferential Block in Pain Management for Distal Radius Fracture Reduction · European Journal of Orthopaedic Surgery & Traumatology · 2026
• Haematoma block versus sedation for manipulating distal radius fractures in the emergency department · Emergency Medicine Journal · 2026
• Triple-Modality Approach for Kienböck Disease (Stage II and IIIA): Outcomes of Distal Radius Core Decompression, Radial Shortening and Scapho-Capitate K-Wiring in 18 Patients · The Journal of Hand Surgery (Asian-Pacific Volume) · 2026
• The correlation between tendon gap measurement by ultrasound and management of flexor tendon injury zone 1, 2, and 3 · European Journal of Plastic Surgery · 2026
• Delayed Palmar Ulnar Head Dislocation after Malunion of Distal Radius Fracture · Journal of Wrist Surgery · 2026
• Pedicled distal-radius vascularized bone graft with shape-memory staple fixation for scaphoid nonunion: A modified technique · Journal of Hand and Microsurgery · 2026
• Capitate Shortening Osteotomy for Kienböck’s Disease: A Systematic Review · HAND · 2026
• Volar Distal Radioulnar Joint Dislocation With Ulnar Styloid Fracture · Cureus · 2026
• The Precision of MRI in the Diagnosis of Anterior Cruciate Ligament Injury Among Athletes in Riyadh, Kingdom of Saudi Arabia · Saudi Journal of Radiology · 2026

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