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Importance Patients with recurrent prostate cancer after previous radiotherapy typically have poor survival. Those with recurrences prostate confined might be suitable for salvage focal therapy (sFT) or salvage radical prostatectomy (sRP). sFT may offer good cancer control with comparatively less toxic effects, but outcomes beyond 5 years have not been reported, and no study has compared sFT to sRP. Objective To compare cancer control and perioperative complications among patients after sFT vs sRP. Design, Setting, and Participants In this international, multicenter cohort study of matched comparison data, patients undergoing sFT were derived from the prospective UK HIFU (high-intensity focused ultrasound) Evaluation and Treatment and International Cryotherapy Evaluation registries (9 centers; 2006-2024) and the prospective UK Focal Recurrent Assessment and Salvage Treatment cohort study (6 centers; 2014-2018). Patients undergoing sRP were derived from an international retrospective registry (12 centers in 8 countries; 2000-2021). Patients with biopsy-confirmed, localized recurrent prostate cancer postradiotherapy, either external beam radiotherapy, brachytherapy, or both, were included. Data were analyzed from March to July 2025. Exposures sFT using HIFU or cryotherapy vs sRP. Main Outcomes and Measures The primary outcome was cancer-specific survival up to 10 years. Secondary outcomes were overall survival, any perioperative complications (Clavien-Dindo grades 1-5), and major perioperative complications (Clavien-Dindo grades 3-5). Comparisons were made on matched patients following 1:1 cardinality matching within individual multiply-imputed datasets. Matching variables used were radiotherapeutic treatment, years between primary and salvage treatments, European Association of Urology recurrence risk group, and presalvage age, prostate-specific antigen, prostate volume, grade group, T stage, and androgen-deprivation therapy use. Results A total of 923 patients were eligible for matching (419 undergoing sFT and 504 undergoing sRP). Of the patients undergoing sFT, 325 (77.6%) underwent HIFU and the remainder cryotherapy, with 241 (57.5%) treated with quadrant ablation. Of patients treated with sRP, 376 (74.6%) underwent open surgery and the remainder robot-assisted surgery. For sFT vs sRP, 10-year cancer-specific survival was 92% (95% CI, 86%-98%) vs 99% (95% CI, 97%-100%), with no statistically significant difference (restricted mean time lost, −0.09 years; 95% CI, −0.22 to 0.03 years; P = .15; subdistribution hazard ratio, 0.45; 95% CI, 0.05-4.00; P = .47). There was no statistically significant difference in 10-year overall survival (restricted mean survival time, −0.13 years; 95% CI, −0.86 to 0.60 years; P = .72). Undergoing sRP was associated with statistically significant higher odds of any complication (adjusted odds ratio, 24.20; 95% CI, 12.94-45.27; P < .001) and major complication (adjusted odds ratio, 9.31; 95% CI, 3.42-25.36; P < .001). Conclusions and Relevance In this cohort study, sFT and sRP were effective for treating localized radiorecurrent prostate cancer, while sFT was associated with fewer perioperative complications. sFT may provide a favorable therapeutic ratio for many patients with localized radiorecurrent prostate cancer.

Background: This study aims to determine the trends in the treatment of distal radius fractures (DRFs) in patients aged 18 years and older. Methods: An administrative claims database of more than 100 million patients was used to identify patients aged 18 years and older with a DRF between 2005 and 2014. A total of 137 130 DRFs were identified in 135 128 patients. Results: The proportion and rate of fractures were more predominant in those aged 55 years and older compared with a decreasing incidence in patients younger than 55 years. Age-adjusted rates of surgical treatment have significantly increased in both women and men by 15.9% (absolute change, 4.8%) and 5.0% (absolute change, 1.7%) change over time, respectively. Conversely, age-adjusted rates of nonsurgical treatment have significantly decreased overtime in both women and men by 6.9% and 2.6%, respectively. Conclusions: These data provide better understanding of the epidemiology of DRF, which is important to develop preventive strategies targeting high-risk populations and to develop effective treatment strategies.

Background: Unplanned readmission following surgery is a quality metric that helps surgeons assess initiatives targeted at improving patient care. We utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to determine the rates, causes, and predictors of unplanned 30-day readmissions after outpatient elective hand and elbow surgery. Methods: The ACS-NSQIP database was queried using hand-and-elbow-specific Current Procedural Terminology (CPT) codes to retrospectively identify patients who had undergone outpatient hand or elbow surgery in 2012 and 2013. Patients who required an unplanned readmission to the hospital within 30 days were compared with those who were not readmitted. Preoperative patient characteristics, intraoperative variables, complications, and mortality were compared between the cohorts. Cox proportional hazard models were used to determine independent associations with 30-day unplanned readmission. Results: A total of 14,106 outpatient hand or elbow surgery procedures were identified between 2012 and 2013, and 169 (1.2%) of them were followed by an unplanned readmission. The leading causes of readmission included postoperative infections (19.5%), pain (4.7%), thromboembolic events (4.1%), and pulmonary complications (3.0%). The causes of approximately 1/3 of the readmissions were missing from the database, and these readmissions were likely unrelated to the principal procedure. Independent predictors of readmission included an age of 70 to 84 years (hazard ratio [HR] = 2.83, 95% confidence interval [CI] = 1.67 to 4.78), smoking (HR = 2.23, 95% CI = 1.57 to 3.18), a lower hematocrit (HR = 2.19, 95% CI = 1.38 to 3.46), renal dialysis (HR = 3.32, 95% CI = 1.60 to 6.91), and an elbow procedure (with or without a hand procedure) (HR = 2.19, 95% CI = 1.57 to 3.04). Conclusions: The prevalence of unplanned readmission following outpatient hand and elbow surgery is low. Several modifiable factors, including preoperative smoking and anemia, are associated with unplanned readmission. These data may be helpful in developing quality-control initiatives to target unplanned readmissions following hand and elbow procedures. Level of Evidence: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

We report the outcomes of ulnar head replacement with concomitant resurfacing of the sigmoid notch with a lateral meniscal allograft that attempted to recreate the palmar and dorsal radioulnar ligaments in four patients. Patients’ ranges of motion, grip strength, postoperative complications and radiographs were assessed. The mean follow-up was 20 (range 12–28) months. There was an increase in postoperative range of motion with an average increase in grip strength of 43% to the unaffected extremity. All patients experienced marked reduction in their postoperative pain. No patients reported symptoms of implant instability. Distal ulna implant arthroplasty with a lateral meniscal allograft gives favourable short-term outcomes. Level of evidence: IV

Background: Fractures of the proximal pole of the scaphoid can be difficult to heal because of its limited vascular supply. Furthermore, nonunion with avascular necrosis and secondary fragmentation makes surgical reconstruction a challenging procedure. Method: We describe a technique and report the outcome of a proximal hamate autograft to treat a proximal pole scaphoid nonunion with avascular necrosis. Results: At 3.5 years post reconstruction, the patient remains asymptomatic with union of his scaphoid reconstruction without any evidence of scapholunate instability. Conclusion: Proximal hamate autograft is a useful technique for addressing proximal pole scaphoid nonunions with avascular necrosis.