Since its popularization in the early 2000s, reconstruction of the middle phalanx after proximal interphalangeal joint dorsal fracture-dislocation has increased in popularity. In a 2019 study, laser scanning technology of the dorsal distal hamate articular surface was used to demonstrate the lack of similarity in shape between the volar middle phalangeal base and the articular surfaces of the dorsal distal hamate.¹ The study authors urged a detailed understanding of hamate morphology before using this reconstructive technique. In a 2020 study, direct measurement of 40 hands (160 phalanges and 40 hamates) was used to observe that the middle phalangeal base and distal articular surface of the hamate are not anatomically identical; these differences may prevent anatomic reconstruction² (Figure 1). Variation in morphology of the hook of the hamate has been noted, especially in Caucasian females.³ Taken together, these studies add to the understanding of the utility of middle phalangeal reconstruction following irreducible dorsal fracture-dislocations, and to the understanding of the osteology of the hamate palmarly and dorsally.

Investigators in the Netherlands used four-dimensional CT to assess proximal carpal row motion in patients with Madelung deformity and documented decreased lunate and triquetrum motion during in vivo wrist motion. This 2021 study demonstrated the usefulness of four-dimensional CT in the evaluation of carpal motion, and also increased the understanding of carpal motion in patients with Madelung deformity.⁴

Osteology of the radius and ulna, especially as related to forearm rotation, was evaluated in a 2020 study by several Canadian surgeons using CT evaluation of cadaver forearms. They found that rotational anatomy varies significantly between individuals but demonstrated similar anatomy side-to-side, allowing for its use in the correction of malunions, or in the treatment of patients with traumatic bone loss.⁵

In a 2019 study, micro-CT angiographic scanning of the scaphoid was used to assess internal vascularity. Two distinct scaphoid types (full and slender) were found to exist, and the vascular supply for each was dissimilar. It was proposed that central axis interfragmentary screw insertion is best in terms of minimizing disruption of vascularity, and that antegrade insertion (dorsal to volar) was also of substantial benefit.⁶

Investigators at the University of Buenos Aires used dissection of 52 fresh-frozen cadaver proximal interphalangeal joints to investigate proximal interphalangeal neuroanatomy and found consistent articular neuroanatomy at the palmar aspect of the joint. They hypothesized that denervation techniques for the proximal interphalangeal joint based on these studies might improve results (perhaps of nonanatomic hemihamate autografts)⁷ (Figure 2).

A 2020 study that will be of use for hand surgeons treating patients with acute injury involved 24 fresh-frozen cadavers that were dissected to demonstrate a new surface landmark for the location of bifurcation of the radial and ulnar digital nerves of the thumb. This study’s usefulness lies in its assistance in the evaluation of patients with penetrating injuries to the thenar eminence as well as providing a guide for surgical exploration of the radial and ulnar digital nerves of the thumb⁸ (Figures 3 and 4).

Anatomy Also related to anatomy of the palm of the hand is a review article that described current understanding of the anatomy of the retinacular elements of the hand (the palmar fascia).⁹ A coherent and consistent nomenclature is outlined for the palmar, palmodigital, and digital fascia, as well as the transverse carpal ligament and the flexor retinacula of the thumb and fingers.