Idiopathic Avascular Necrosis of the Capitate Treated with a Medial Femoral Trochlea Vascularized Osteochondral Flap: A Case Report.

Case: Capitate avascular necrosis should be entertained in a differential diagnosis of young, active adults with midcarpal wrist pain. We present a case study of a 30-year-old laborer who developed avascular necrosis (AVN) of his right proximal capitate. Grip strength and wrist motion were limited on examination, with advanced imaging confirming AVN.

Treatment and Outcomes of Missed Perilunate Dislocations: A Case Series.

 Perilunate dislocations are devastating injuries that occur relatively rarely, accounting for only 7% of injuries to the carpus. Unfortunately, approximately 25% of these injuries are missed on initial evaluation. Acutely diagnosed perilunate dislocations may be successfully treated with ligament and osseous repair, depending on the injury pattern.

The Impact of Social Determinants of Health on the Treatment of Distal Radius Fracture.

Background: Disparities in social determinants of health (SDH) have been shown to play an increasingly important role in the equitable delivery of health care. Distal radius fractures (DRFs) are among the most common upper-extremity injuries encountered. This study aims to examine the influence of economic, educational, social, environmental, and healthcare disparities on management of these injuries.

Timing of Olecranon Fracture Fixation Does Not Affect Early Complication or Reoperation Rates.

Purpose: Surgical fixation of olecranon fractures can lead to soft-tissue complications and return to the operating room for hardware removal. While some risk factors of complications after olecranon fracture fixation have been described, the effects of fixation timing on complications and reoperation have not been evaluated. The purpose of the present study was to assess whether the timing of olecranon fracture fixation affects complication and reoperation rates.

Is This Going to Hurt, Doc? Predicting Pain with Corticosteroid Injections for Upper Extremity Conditions.

Unlabelled: Corticosteroid injections (CSIs) are used in a wide variety of upper extremity pathologies for both diagnostic and treatment purposes. Many patients ask about pain associated with the procedure before agreeing to proceed. The purpose of this study was to correlate perceived pain tolerance and resilience with patient-reported injection pain during and immediately after injection.

Successfully Treated Upper-Extremity Necrotizing Fasciitis Caused by .

Necrotizing fasciitis is a soft-tissue infection associated with significant morbidity and mortality. The bacteria most associated with necrotizing fasciitis include (group A), species, species, and species. (), formerly known as , is a halophilic, gram-negative bacillus known to infect marine organisms in warm coastal waters.

Peripherally Inserted Central Line Catheters following Hand and Wrist Infections.

Unlabelled: Hand and wrist infections may cause varying degrees of morbidity requiring antibiotic therapy of variable duration and often operative intervention. Peripherally inserted central line catheters (PICCs) are placed when an extended course of intravenous antibiotics is anticipated. The present study aims to analyze utilization and impact of PICC placement on the management of hand, wrist, and forearm infections.

Arthrodesis of the First to Second Metacarpal for Definitive Management of Failed Thumb Carpometacarpal Arthroplasty: A Case Series.

Thumb carpometacarpal (CMC) arthroplasty with resection of the trapezium and soft tissue interposition, with or without ligament reconstruction, has historically proven to be an efficacious treatment for thumb CMC arthritis. The incidence of failure following primary thumb CMC arthroplasty is low; however, the evaluation and management of a patient experiencing an unsatisfactory outcome following CMC arthroplasty is challenging. If symptoms are refractory to conservative measures, then revision surgical treatment may be indicated.

Magnetic Resonance Arthrography of the Wrist: The Impact on Operative Management of Wrist Injuries.

 There is no consensus on the utility of arthrography in the evaluation of wrist injuries. This study evaluates ordering trends of different types of magnetic resonance imaging (MRI) of the wrist and compares rates of surgery following these imaging modalities.  A national claims-based database was used to identify patients who underwent MRI within 90 days of a first-instance diagnosis of wrist injury from 2010 to 2018.

A Series of Nontuberculous Mycobacterial Flexor Tenosynovitis Infections and Cost of Treatment.

 Nontuberculous mycobacteria (NTM) are rare but potentially devastating causes of musculoskeletal infection and impairment in immunocompetent patients.  Given the sparse body of literature surrounding these infections, we describe a series of patients with and the cost of treatment of upper extremity NTM infections.  In a retrospective review of seven patients with NTM infections of the upper extremity treated at a university hospital from 2010 to 2019, we assessed patient demographics, exposures, infection characteristics, management course, outcomes, and costs of treatment.

Flexor Tenosynovitis: A Case Report.

 Nontuberculous mycobacterial (NTM) flexor tenosynovitis represents a rare but potentially devastating manifestation of upper extremity infection. We present a novel case of NTM flexor tenosynovitis in which was found to be the causative agent.  The patient presented with pain and insidiously progressive swelling and required multiple operative interventions and a complex antimicrobial regimen based on susceptibility profiles.

Ventricular tachycardia with epicardial and pericardial fibrosis 6 months after resolution of subclinical COVID-19: a case report.

Background: Coronavirus disease 2019 (COVID-19) has been shown to have extensive effects on the cardiovascular system. Its long-term cardiac manifestations, however, remain unclear.

Case Presentation: We report the case of a Caucasian patient with a mild and self-limited presentation of COVID-19, with subsequent development, months later, of exertional dyspnea and non-sustained ventricular tachycardia, long after resolution of his illness and after returning to aerobic exercise.

Motion and Strength Analysis of 2-Tine Staple and K-Wire Fixation in Scapholunate Ligament Stabilization in a Cadaver Model.

Purpose: Previous studies have demonstrated the benefits of 2- and 4-tine staple fixation in scapholunate interosseous ligament (SLIL) reconstruction, including improved rotational control and avoidance of the articular surface. This study compared scaphoid and lunate kinematics after SLIL fixation with traditional Kirschner wire (K-wire) fixation or 2-tine staple fixation.

Methods: Eight fresh frozen cadaver arms with normal scapholunate (SL) intervals were included.

MRI and Arthroscopic Correlation of the Wrist.

Since its introduction in 1979, the practice of and indications for wrist arthroscopy in the diagnosis and treatment of pathologic conditions in the wrist continues to grow. Magnetic resonance imaging (MRI) is another commonly used tool to noninvasively examine the anatomy and pathology of the wrist joint. Here, we review the normal wrist anatomy as seen arthroscopically and through MRI.

The Extended Flexor Carpi Radialis Approach for Concurrent Carpal Tunnel Release and Volar Plate Osteosynthesis for Distal Radius Fracture.

Purpose: To determine the relative benefits of an extended flexor carpi radialis (FCR) (eFCR) approach with prophylactic carpal tunnel release at the time of volar plate osteosynthesis for distal radius fracture via a single incision into the traditional volar Henry (VH) approach.

Methods: This was a prospective cohort comparison of preoperative and postoperative median nerve function of 27 patients (15 eFCR and 12 VH) with unilateral, isolated distal radius fractures requiring open reduction internal fixation without preoperative acute carpal tunnel syndrome. Patients were operated on via either the eFCR or VH approach.

Obesity is associated with increased postoperative complications after operative management of distal humerus fractures.

Background: Distal humerus fractures commonly require surgical intervention, including open reduction and internal fixation (ORIF) and, more recently in elderly, low-demand individuals, total elbow arthroplasty (TEA). The association of obesity with complications after either of these procedures has not previously been examined.

Methods: A national insurance database was queried for ORIF or TEA for management of a distal humerus fracture using procedural and diagnostic codes.

Osteochondral autograft plug transfer for treatment of osteochondritis dissecans of the capitellum in adolescent athletes.

Background: Osteochondritis dissecans (OCD) of the capitellum is a condition most commonly seen in adolescents involved in repetitive overhead sports and can profoundly affect ability to return to play and long-term elbow function. Treatment of large, unstable defects in the elbow with osteochondral autograft plug transfer has not been adequately studied.

Methods: We retrospectively identified 11 teenaged patients with large (>1 cm(2)) capitellar OCD treated with osteochondral autograft plug transfer.

Evaluation and treatment of jersey finger and pulley injuries in athletes.

The flexor tendon system in the finger is complex and can be difficult to treat. Closed injuries to the flexor tendon or pulley system are not uncommon in high-level athletes. Their treatment can be complicated by in-season play, position, and the number of people involved in the patient's care.

Injury tolerance of the wrist and distal forearm to impact loading onto outstretched hands.

Background: The wrist/forearm complex is one of the most commonly fractured body regions, yet the impact tolerance of the wrist is poorly understood. This study sought to quantify the injury tolerance of the adult male forearm-wrist complex under loading simulating axial impact to an outstretched hand.

Methods: Fifteen isolated cadaveric forearm/wrist specimens were tested.

Secondary flexor tendon reconstruction, a review.

As techniques have improved, primary repair of flexor tendon lacerations, including zone II injuries, have become more common. Secondary reconstruction, whether in 1 or 2 stages, remains an important and useful technique for the treatment of these injuries. Current indications and methods, including delayed treatment and 1-stage and 2-stage reconstruction, are reviewed.

An intra-articular knee cyst in a 2-year-old associated with an aberrant anterior cruciate ligament.

Intra-articular ganglia of the knee occur infrequently, with an overall incidence estimated to be from 0.2 to 1.9%.