Institut Kaplan

In this insightful and candid biographical article, Professor Marc Garcia-Elias recounted his journey from surgical problem to surgical solution. This was an invited article as part of the 2025 FESSH/JHSE Special Issue on 'Technology and Innovation'. Professor Garcia-Elias attributed his achievements to the influence of mentors, the importance of cadaveric dissections and long years of clinical experience.

Much has been written about the concerns surrounding artificial intelligence (AI). This article looks positively at how AI can enhance communication and academic skills, including teaching and research. The article explains what AI, Generative Pre-trained Transformer (GPT), and chat-GPT are and highlights a few AI-based tools that are currently in use to improve communication and academic skills. It also mentions potential AI problems, such as a lack of personalization, societal biases, and privacy concerns. The future lies in the training of hand surgeons to master the skill of precise communication and academia using AI tools.

Currently Kienböck's disease remains an 'unsolved' problem in hand surgery. Different factors have been associated with the avascular necrosis of the lunate. Mechanical, vascular and biological factors, alone or in combination, may have an influence in the aetiopathogenesis and determine the progress of the disease and even the results of the treatment. This is especially relevant in the early stages, in which conservative or surgical treatment may modify the natural history of the disease, maintaining the lunate structure and thus preserving the joint surfaces. There are multiple surgical treatments for Kienböck's disease in the early stages, before lunate collapse; each one is based on one of the possible factors that can cause avascular necrosis of the lunate. The objective is not only to treat symptoms but to prevent progression. This article is a review of the most frequent treatments used in the early stages and a personal view of the authors.Level of evidence: V.

COVID-19 has affected us all. The following collection of short essays highlights various aspects of the pandemic and how it has impacted hand surgery and lessons learned, from the perspective of the Federation of European Societies for Surgery of the Hand (FESSH) Executive Committee members. A range of topics were individually chosen by each of the five committee members and presented.

Background: The development of trigger digit after carpal tunnel syndrome release surgery has been widely reported. Lluch described reconstruction of the flexor retinaculum in elongated position to prevent such complication. Methods: We conducted a retrospective review to determine whether patients who undergo reconstruction in elongated position of the flexor retinaculum have a lower incidence of trigger digit postoperatively. In total, 1050 patients were included, 865 of whom had undergone traditional carpal tunnel release and 185 flexor retinaculum reconstruction. Results: No differences were found in the incidence of trigger digit after surgery (8.7% of the patients who underwent traditional release vs 11.9% in the reconstruction group). Neither difference was found when comparing mean time with the development of trigger digit. Conclusions: In the absence of randomized long-term studies comparing traditional release and reconstruction in elongated position after carpal tunnel release, given our results, we see no reason to favor reconstruction over standard carpal tunnel release as a means to prevent postoperative triggering of digits.

Introduction: Evidence supports a direct link between psychosocial and food-related environmental risk factors, and cardiometabolic conditions. These associations remain markedly understudied at the population level in Puerto Rico (PR), despite the clear and pressing need to alleviate striking disparities in chronic disease in the island. On September 2017, Hurricane Maria devastated PR, imposing urgency for studying trends and associations of risk factors for cardiometabolic conditions under times of distress. Hypothesis and aims: We aimed to design and establish ‘PROSPECT: Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic disease Trends’ to study longitudinal associations in psychosocial, food-related, and cardiometabolic risk factors. Methods: PROSPECT was designed as an island-wide, longitudinal population cohort that is recruiting 2,000 adults ages 30-75y using a multi-frame sampling combining probabilistic plus community approaches, with examinations and interviews done in a network of partner clinics across the island. Trained interviewers are collecting comprehensive data on multiple psychosocial, dietary, and food-related factors, cardiovascular disease (CVD) biological markers, and medical record data, with follow-up at 2-years, using standardized protocols and validated questionnaires. PROSPECT emulates the goals and methods of other US and Caribbean cohorts inclusive of mainland Puerto Ricans and other Latinos for comparison. Results: Expected results include estimates of baseline and 2y prevalence and incidence of psychosocial, dietary, and food environment risk factors, and CVD biological markers; measures of associations between 2y changes in risk factors and CVD biological markers; and estimates of differences in prevalence and 2y changes in risk factors, CVD biological markers, and chronic diseases, with emphasis on CVD, by urban vs. rural area, and pre vs. post-Maria. A supplemental study is investigating how food and water shortages following Hurricane Maria may have triggered allostatic load (i.e. physiological stress) and how social connectedness moderates this in PROSPECT participants, with additional context from qualitative narrative interviews. Conclusions: Ultimately, PROSPECT will create a biorepository and participant database for prospective use, and bolster research, academic, and public health partnerships in PR and the US. The study is yielding seminal data to identify priorities on CVD-related disparities, and address them by tailoring public health programs and policy that will effectively improve cardiovascular health in PR, an island with an underserved and high-risk population, under times of distress.