Forearm and Arm Tourniquet Tolerance.

Background: In distal upper extremity surgeries, there can be a choice to use an upper arm or forearm tourniquet. This study examines discomfort and tolerance in healthy volunteers to determine whether one is more comfortable.

Methods: Forty healthy, study participants were randomized to an upper extremity laterality and site.

Increased Pulmonary Complications Associated with Intramedullary Fixation of Intertrochanteric Fractures: An Analysis of 13,276 Hips.

Introduction: Intramedullary devices are being used more frequently to treat intertrochanteric (IT) femur fractures but without clear benefit in several clinical trials. This study determines differences in complication rates in patients with IT fractures treated with intramedullary versus extramedullary devices.

Methods: Using the National Surgical Quality Improvement Program database, patients aged ≥55 years with an isolated IT fracture and an American Society of Anesthesiologists score of <5 were identified.

The Effect of Obesity on Operative Times and 30-Day Readmissions After Anterior Cruciate Ligament Reconstruction.

Purpose: To understand the effect of obesity on operative times and 30-day readmission rates after arthroscopic anterior cruciate ligament reconstruction (ACLR).

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried using Current Procedural Terminology billing codes to identify all patients aged 18 years and older who underwent ACLR between 2007 and 2014. The Student t test was used for continuous variables, and the χ-square or Fisher exact test was used for categorical variables.

Washer and Post Augmentation of 90/90 Wiring for Proximal Interphalangeal Joint Arthrodesis: A Biomechanical Study.

Purpose: To describe a novel construct for proximal interphalangeal (PIP) joint arthrodesis using headless cannulated screws as an intramedullary washer to augment 90/90 intraosseous wiring and compare the biomechanical properties of this construct with those of the 90/90 intraosseous wiring without headless screw augmentation.

Methods: Biomechanical evaluation of augmented 90/90 intraosseous wiring with headless cannulated screws (group 1) or 90/90 intraosseous wiring without augmentation (group 2) for PIP joint arthrodesis was performed in 3 matched-pair cadaveric specimens (12 digits per group). Each group was loaded to 10 N in the sagittal and coronal planes and the resultant stiffness from the load-displacement curve was calculated.

Distal Scaphoid Excision in Treatment of Symptomatic Scaphoid Nonunion: Systematic Review and Meta-analysis.

Current treatment options for persistent scaphoid nonunion are limited to salvage procedures such as proximal row carpectomy (PRC) or 4-corner fusion (4CF). Several small studies have demonstrated that distal scaphoid excision may provide a simpler alternative with faster recovery. The purpose of this study was to determine the efficacy of distal scaphoid excision as a treatment option for symptomatic scaphoid nonunion.

Risk Factors for 30-Day Readmission Following Shoulder Arthroscopy.

Purpose: The purpose of this study was to evaluate a large population of shoulder arthroscopy cases in order to provide insight into the risk factors associated with readmission following this common orthopaedic procedure.

Methods: The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried using current procedural terminology (CPT) billing codes to identify all patients older than 18 years of age who underwent shoulder arthroscopy between 2011 and 2013. Univariate and multivariate analyses were conducted to identify factors associated with 30-day readmission.

Surgical management of midshaft clavicle nonunions is associated with a higher rate of short-term complications compared with acute fractures.

Background: Little is known about the perioperative complication rates of the surgical management of midshaft clavicle nonunions. The purpose of the current study was to report on the perioperative complication rates after surgical management of nonunions and to compare them with complication rates of acute fractures using a population cohort.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients who had undergone open reduction-internal fixation of midshaft clavicle fractures between 2007 and 2013.

Risk of tendon entrapment under a dorsal bridge plate in a distal radius fracture model.

Purpose: To determine the risk of iatrogenic damage to the extensor tendons and sensory nerves under a bridge plate along the second versus third metacarpal.

Methods: Using 6 paired (left-right) cadaver forearms-wrists and via a volar approach, we created a distal radius fracture with metaphyseal comminution. We then applied a dorsal distraction plate to either the second or third metacarpal.

Traumatic shoulder instability involving anterior, inferior, and posterior labral injury: a prospective clinical evaluation of arthroscopic repair of 270° labral tears.

Background: Traumatic labral tears involving the anterior, inferior, and posterior aspects of the glenoid fossa represent a unique subpopulation of shoulder instability.

Purpose: This study was undertaken to evaluate prospectively the clinical results of patients who underwent arthroscopic repair of 270° labral tears.

Study Design: Case series; Level of evidence, 4.

Successful replantation of the leg in a pre-ambulatory infant.

The authors report the first successful replantation of a below-knee amputation in a 7-month-old infant prior to the development of a standing and walking gait. Seven years following surgery, the child demonstrates excellent ankle and knee range of motion, has regained plantar sensation, and is able to walk, run, and jump without needing a brace. Despite a leg-length discrepancy of 5.

Healing of a scaphoid nonunion using human bone morphogenetic protein.

A chronic nonunion of a proximal pole fracture of the scaphoid was treated by curettage of the nonunion, single K-wire fixation, and implantation of 50 mg of human bone morphogenetic protein followed by 12 weeks of cast immobilization without any conventional corticocancellous bone grafting or rigid screw fixation. Radiographs showed signs of bony healing by 12 weeks and a magnetic resonance imaging scan 6 years after surgery showed no signs of avascular necrosis. The potential future applications of human bone morphogenetic protein in hand surgery are discussed.

Lateral-entry pin fixation in the management of supracondylar fractures in children.

Background: There has been controversy regarding the optimal pin configuration in the management of supracondylar humeral fractures in children. A crossed-pin configuration may be mechanically more stable than lateral pins in torsional loading, but it is associated with a risk of iatrogenic injury to the ulnar nerve. Previous clinical studies have suggested that lateral pins provide sufficient fixation of unstable supracondylar fractures.