Perioperative Patient Experience in Office-Based Wide-Awake Hand Surgery.

Purpose: Office-based surgery, is a safe, well-tolerated option associated with high patient satisfaction. However, some patients remain hesitant due to concerns of being awake during surgery. Preoperative anxiety may be linked to poorer postoperative outcomes.

Comparing the Intensity of Pain and Incidence of Flare Reaction Following Trigger Finger Injections Using Betamethasone and Methylprednisolone: A Double-Blinded, Randomized Controlled Trial.

Background: Considerable evidence supports corticosteroid injection as an effective treatment for trigger finger. One common side effect, the flare reaction, is a well-documented phenomenon of increased pain following steroid injections. Its incidence and intensity may be related to steroid composition.

Distal Ulna Fracture Fixation with the Specialized Threaded Pin.

Purpose: Distal ulna fractures can often be treated nonsurgically; however, many surgeons consider significant displacement or instability, especially following fixation of an associated distal radius fracture, an indication for surgical fixation because of potential problems associated with malunion of these fractures. Traditionally, these fractures have been addressed with plate fixation but hardware in this location is often prominent and associated with a high rate of symptomatic hardware and subsequent hardware removal. We proposed a method of intramedullary fixation using a specialized threaded pin.

Is Grit Associated with Burnout and Well-being in Orthopaedic Resident and Faculty Physicians? A Multi-institution Longitudinal Study Across Training Levels.

Background: Grit has been defined as "perseverance and passion for long-term goals" and is characterized by maintaining focus and motivation toward a challenging ambition despite setbacks. There are limited data on the impact of grit on burnout and psychologic well-being in orthopaedic surgery, as well as on which factors may be associated with these variables.

Questions/purposes: (1) Is grit inversely correlated with burnout in orthopaedic resident and faculty physicians? (2) Is grit positively correlated with psychologic well-being in orthopaedic resident and faculty physicians? (3) Which demographic characteristics are associated with grit in orthopaedic resident and faculty physicians? (4) Which demographic characteristics are associated with burnout and psychologic well-being in orthopaedic resident and faculty physicians?

Methods: This study was an institutional review board-approved interim analysis from the first year of a 5-year longitudinal study of grit, burnout, and psychologic well-being in order to assess baseline relationships between these variables before analyzing how they may change over time.

Hand and Finger Injuries: Chronic Hand and Wrist Pathologies.

Common chronic hand pathologies seen by family physicians include carpal tunnel syndrome, trigger finger, and de Quervain tenosynovitis. Carpal tunnel syndrome is the most common compressive neuropathy of the upper extremity and is caused by compression of the median nerve at the wrist. Trigger finger, also known as stenosing tenosynovitis, is caused by a metaplasia of the A1 flexor tendon pulley and the flexor tendon causing increased friction and decreased space for tendon gliding in the flexor tendon sheath.

Hand and Finger Injuries: Tendon and Soft Tissue Injuries of the Hand.

Patients with any laceration or wound over the hand need to be evaluated for tendon and neurovascular injuries. Patients with these injuries should receive urgent wound care as well as splinting and expeditious referral for surgical repair because lacerated tendons and nerves cannot heal without surgical approximation. Conversely, ligament injuries of the hand, such as disruption of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb, can sometimes be managed nonsurgically if the joint is stable and there is no Stener lesion.

Hand and Finger Injuries: Finger Fractures and Dislocations.

Many finger fractures can be managed nonsurgically. Patients with fractures that include angulation, comminution, and malrotation must be referred expeditiously to a hand surgeon, preferably within 1 week. Some fractures, such as condylar fractures, appear nondisplaced at first but have a high propensity to displace and, therefore, also should be referred to a subspecialist.

Hand and Finger Injuries: Metacarpal Fractures.

Metacarpal fractures are common. Many metacarpal fractures without malrotation, particularly fifth metacarpal neck fractures, can be managed nonsurgically. However, intraarticular and extraarticular metacarpal fractures of the thumb are subject to tendon forces and often displace.

Excision of a Rare Triquetral Body Fracture Nonunion.

Aside from the more common dorsal avulsion fractures, isolated triquetral body fractures are a rare injury and often missed. When they are identified, conservative treatment via immobilization is often the standard of care for initial treatment. Rarely, triquetral body fractures can develop into symptomatic nonunions, causing considerable pain and disability.

Percutaneous Threaded Pin Fixation of Distal Radius Fracture in the Athlete.

Background: The purpose of this study was to examine the outcomes and return to play with early rehabilitation in athletes who sustained unstable extra-articular distal radius fractures treated with a purpose-designed threaded pin technique.

Methods: This prospective study examined athletes with displaced and unstable distal radius fractures treated surgically with purpose-designed threaded pins. Patients were enrolled in an early rehabilitation protocol, with formal therapy initiated on postoperative days 1 to 3.

Long-term Outcomes of Partial Trapeziectomy With Capsular Interposition Arthroplasty for Osteoarthritis of the Thumb Basal Joint.

The purpose of this study was to describe long-term outcomes of partial trapeziectomy with capsular interposition (PTCI) arthroplasty for patients with osteoarthritis of the basal joint of the thumb. A total of 27 patients (20 women, 7 men; 32 thumbs) with a mean age of 61 years (range, 47-74 years) agreed to return for follow-up and were included in the study. Mean postoperative follow-up was 64.

Predicting radiographic changes at the first visit following operative repair of distal radius fractures.

Purpose: To test the hypothesis that clinical assessment reliably identifies patients with radiographic changes (including loss of reduction, hardware failure, and hardware migration) at the initial visit following operative repair of distal radius fractures.

Methods: We identified 102 patients undergoing operative repair of distal radius fractures. Radiographs and clinical notes were reviewed.

Routine imaging after operatively repaired distal radius and scaphoid fractures: a survey of hand surgeons.

Background There is currently no standard of care for imaging after hand and upper-extremity procedures, and current imaging practices have not been characterized. Questions/Purposes To characterize current imaging practices and to compare those practices to the best available evidence. Patients and Methods A survey was distributed to attending-level surgeons at a regional hand and upper-extremity surgery conference in the United States in 2013.

Eosinophilic fasciitis: case report.

A 16-year-old healthy boy presented with an acute claw hand and signs of flexor tenosynovitis or possible necrotizing fasciitis of all 4 fingers in 1 hand. After an operative incision and drainage and treatment with antibiotic, the patient improved; cultures were negative. He relapsed shortly after completing the 10-day course of antibiotics.