Use of a locked volar plate predictably leads to better patient-reported outcomes (DASH scores) in the first three months after fixation. However, at six months and one year, the outcomes of all three techniques evaluated in this study were found to be excellent, with minimal differences among them in terms of strength, motion, and radiographic alignment.

The severity of high-pressure injection injuries to the hand is often underappreciated on initial presentation. These injuries require urgent and thorough surgical débridement. Despite the advances in our understanding of this injury type and the decline in amputation rates, the risk of long-term morbidity with diminished function and chronic symptoms remains high, and the role of systemic steroids in treatment is uncertain. Functional outcome of the hand and upper extremity following high-pressure injection injuries depends on a number of factors, including the magnitude of the initial wounding force, the chemical properties and volume of the substance injected, the presence of secondary infection, and the timing and thoroughness of débridement. Further investigation is required to determine the relative significance of these factors and the effectiveness of steroids in treatment.

Improving value in musculoskeletal health care has emerged as an important objective in both the United States and Canada. In order to achieve this objective, providers need to have a clear definition of value and an infrastructure for measuring outcomes of interest to patients and costs over the episode of care. Although national patient registries have been established in the United States and Canada, they nevertheless lag behind other registries worldwide in terms of collecting patient-reported outcomes and capturing data from a wide cross-section of hospitals and physicians. With the help of professional medical societies and the creation of national initiatives, patient-reported outcomes data collection on a large scale may be possible, but many challenges remain regarding implementation. Alternatives to the fee-for-service payment model, including pay-for-reporting and pay-for-performance, may help incentivize physicians and health-care providers to obtain and improve on patient-reported outcomes data collection. Other payment reforms, such as bundled payments, have been piloted in certain regions, but their sustainability and long-term success are unclear at this time. Novel health-care delivery strategies aimed at improving quality, coordinating multispecialty care, and enhancing patient participation in shared decision-making have shown promise in improving patient-centered outcomes, but delivery models continue to vary greatly throughout the United States and Canada. The current status of musculoskeletal health-care delivery requires substantial change before the goal of improving patient outcomes and lowering health-care costs can be achieved.

Total wrist arthrodesis remains an important technique in the surgical armamentarium of upper extremity surgeons. The procedure has evolved over time but continues to provide reliable pain relief at the expense of wrist motion. It is indicated for management of a wide variety of upper extremity conditions, including rheumatoid arthritis, posttraumatic osteoarthritis, cerebral palsy, and brachial plexus injuries, and as a salvage technique after failed implant arthroplasty. Recent studies demonstrate high levels of patient satisfaction and good functional outcomes after bilateral wrist fusion. Compared with total wrist arthroplasty, total wrist arthrodesis provides more reliable pain relief with lower rates of complications, but further studies are needed to compare functional outcomes and cost-effectiveness.

Dermal augmentation of the distal biceps is a biomechanically feasible option for patients with an attritionally thinned-out tendon.

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

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