High-Pressure Refrigerant Gas Injection Injury to the Hand.

High-pressure injection injuries, although rare, are commonly discussed orthopaedic surgical emergencies. In many cases, high-pressure injection injuries can have detrimental effects on the patient. However, there are rare instances where surgical intervention may be more harmful than helpful.

Demographics and Outcomes of Glenohumeral Dislocations in Individuals With Elevated Body Mass Index.

Introduction: No specific study has investigated the characteristics and outcomes of anterior shoulder dislocations in morbidly obese individuals. The purpose of this study was to describe shoulder dislocations in patients with body mass index (BMI) greater than 40.

Methods: A retrospective review was conducted to identify patients aged 18 years and older with a BMI ≥40 who presented with a shoulder dislocation in a single institution from 2000 to 2020.

Short-term outcome of unicortical, intramedullary repair of distal biceps ruptures - A retrospective cohort study.

Background: Modern distal biceps reconstruction techniques generally have satisfactory outcomes, but are not without complications. Posterior interosseous nerve (PIN) palsy is a rare but potentially devastating complication of bicortical metal button fixation. Recently, a unicortical, intramedullary, repair technique utilizing a suture anchor has been described.

Pyoderma Gangrenosum Affecting the Dorsal Hand: A Case Report.

Pyoderma gangrenosum is an uncommon neutrophilic dermatosis characterized by an ulcerative lesion with a violaceous border. Most frequently, these lesions present in the lower extremity and are associated with underlying immune-mediated comorbidities. Infrequently, these lesions may present in the upper extremity, which presents difficult challenges for upper extremity surgeons as the lesions are frequently misdiagnosed as an infectious process.

Industry-specific Patterns in the Disclosure of Conflicts of Interest in Hand and Upper Extremity Surgery: A Review of the Nerve Allograft Industry.

Introduction: Industry funding in medicine enhances physician training but can create bias influencing accurate reporting of outcomes. High rates of conflict of interest (COI) disclosure have been found in orthopaedic surgery. However, industry-specific disclosures have not been investigated and small-value compensations previously excluded.

Triceps tongue versus olecranon osteotomy for intra-articular distal humeral fractures: a matched-cohort study.

Background: There are various approaches to the distal humerus when managing a distal humeral fracture, and controversy exists regarding which approach is optimal. The purpose of this study was to report the outcomes of the triceps tongue (TT) approach when used for osteosynthesis of AO type 13-A, B, and C distal humeral fractures. Secondarily, we aimed to compare the outcomes of the TT approach vs.

Intramedullary, unicortical repair of distal biceps tendon rupture.

Historically-used bicortical repair of distal biceps tendon rupture are at risk for posterior interosseous nerve palsy. Here we present a technique, and associated case report, utilizing unicortical repair with a suture cortical button device for this injury. The described technique provides robust fixation and avoids the rare, but potentially devastating complication of posterior interosseous nerve palsy.

Acute compartment syndrome of the deltoid: a case report and systematic review of the literature.

Background: Deltoid compartment syndrome is a rare entity. The purpose of this study was to report a recent case and perform a systematic literature review.

Methods: Patient data were gathered from chart review and clinical encounters.

Emergency Department Utilization After Outpatient Hand Surgery.

Background: The purpose of this study was to identify the utilization rate and most common reasons for presentation to the emergency department (ED) after elective outpatient hand surgery and to determine preoperative risk factors for these ED visits.

Methods: Patients who underwent elective hand surgery at an ambulatory surgery center between 2014 and 2015 were retrospectively evaluated using the New York and Florida State Databases. The primary outcome was all-cause 7- and 30-day ED utilization rates.

Complications and functional outcomes after transolecranon distal humerus fracture.

Background: Transolecranon distal humerus fractures are uncommon injuries. This is the first multipatient case series to describe outcomes and complications following transolecranon distal humerus fractures in the adult population.

Method: Design: retrospective; setting: single level 1 trauma center; patients/participants: 16 patients; intervention: surgical management of transolecranon distal humerus fracture; main outcome measurement: Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire after a minimum of 12 months.

A cadaveric study of radial and ulnar bowing in the sagittal and coronal planes.

Background: This study provides a comprehensive, full-length assessment of radial and ulnar bowing in anteroposterior (AP) and sagittal planes.

Methods: Radial and ulnar AP and lateral bowing were assessed using orthogonal digital photographs of 211 randomly selected cadaveric bilateral forearms (422 radius, 422 ulna bones) from a well-preserved osteologic collection.

Results: In the radial AP plane, an apex-radial bow was present at a mean of 58% of bone length (slightly distal to midpoint), with a mean depth of 1.

A Comparison of 30-Day Perioperative Complications for Open Operative Care of Distal Upper-Extremity Fractures Treated by Orthopedic Versus Plastic Surgeons: A Study of the National Surgical Quality Improvement (NSQIP) Database.

Purpose: To determine whether surgeon specialty affects complications after open operative care of distal upper-extremity fractures.

Methods: We performed a retrospective cross-sectional study using the American College of Surgeons National Surgical Quality Improvement Database from 2005 to 2016. Patients were included if they received open operative treatment by an orthopedic or a plastic surgeon for distal radius/ulna, carpal, metacarpal, or phalangeal fracture.

Prevalence of Bennett lesions based on sex, ancestry, and age in an osteologic collection of 5,662 scapulae.

Background: Bennett lesions represent an extra-articular ossification on the posteroinferior aspect of the glenoid fossa and a potential source of posterior shoulder pain and limitation. The prevalence of Bennett lesions in the general population is unknown.

Materials And Methods: A total of 5,662 scapulae from 2,831 individual cadaveric specimens greater than 18 years of age at the time of death were examined.

Pediatric Supracondylar Humerus Fractures: AAOS Appropriate Use Criteria Versus Actual Management at a Pediatric Level 1 Trauma Center.

Objectives: The purpose of this study was to characterize management of supracondylar humerus fractures (SCHFs) at a level 1 trauma center and identify factors contributing to divergence in management from American Academy of Orthopedic Surgeons (AAOS) the Appropriate Use Criteria (AUC) recommendations.

Methods: A query revealed 556 patients with diagnoses of SCHF between 2013 and 2015 at a pediatric level 1 trauma center. Patients were excluded if they were younger than 2 years of age, older than 12 years of age, were polytrauma patients, or if there was not sufficient clinical or radiographic documentation, resulting in 449 patients.

International Survey: Factors Associated With Operative Treatment of Distal Radius Fractures and Implications for the American Academy of Orthopaedic Surgeons' Appropriate Use Criteria.

Objectives: Through an international survey, we assessed whether deciding to operatively treat an intra-articular distal radius fracture (DRF) is guided by identifiable patient and surgeon factors. In addition, we compared surgeons' treatment decisions with the American Academy of Orthopaedic Surgeons' Appropriate Use Criteria (AUC) treatment recommendations.

Methods: This cross-sectional survey asked 224 surgeons to operatively or nonoperatively treat 28 hypothetical patients with radiographs of an intra-articular DRF.

Fixation of a Type 3 Flexor Digitorum Avulsion Injury.

This article describes a novel technique for flexor digitorum profundus (FDP) avulsion injuries, useful for Leddy Packer type 3, 4, and 5 injuries. Multidirectional stability is achieved with combination pull-out suture, which neutralizes the deforming force of FDP, and cerclage wire, which holds the bone fragment in an anatomic position and provides interfragmentary compression. Traditional techniques such as interosseous wires, Kirschner wires, or plating risk fragment comminution and loss of reduction due to proximal pull of FDP as demonstrated in this case report of failed Kirschner-wire fixation.

Predicting Discharge Disposition After Shoulder Arthroplasty in the United States.

Introduction: Postdischarge management for shoulder replacement continues to be performed on a case-by-case basis, with no uniform guidelines dictating management. The goal of this study was to develop a nomogram to preoperatively predict a patient's discharge disposition after elective shoulder arthroplasty.

Methods: Patients who underwent elective shoulder arthroplasty between 2012 and 2015 were identified in the National Surgical Quality Improvement Program database.

Small Finger to Ring Finger Ray Transposition: Modern Surgical Technique and Case-based Review of the Literature.

Ray transposition for central digital amputation has been performed following traumatic injury to the hand for decades. Small finger to ring finger ray transposition has been well described in the literature, with good functional and aesthetic outcomes reported. Originally described by Bunnell, the fourth metacarpal can be disarticulated and the fifth metacarpal base transposed with reconstruction of the intermetacarpal ligament allowing progressive closure between the third and fifth rays.

Transfer of a Radial Nerve Branch to the Brachialis Nerve for Restoration of Elbow Flexion.

Nerve transfers for brachial plexus reconstruction and the treatment of peripheral nerve injury have demonstrated excellent clinical outcomes and may be superior to nerve grafting. Previously described nerve transfers for restoration of elbow flexion include the Oberlin (ulnar to musculocutaneous) and double fasicular (median to biceps and ulnar to brachialis) transfers. However, these transfers cannot be performed in patients with loss of elbow flexion and concomitant high median and ulnar nerve injury.

Distal Radius Fractures: AAOS Appropriate Use Criteria Versus Actual Management at a Level I Trauma Center.

Background: The aim of this study is to determine whether the American Academy of Orthopaedic Surgeons' (AAOS) Appropriate Use Criteria (AUC) for distal radius fractures correlates with actual treatment by orthopedic hand surgeons at a level I trauma center.

Methods: ICD-9 codes were used to retrospectively identify patients who presented with wrist fractures over 1 year. Patients with isolated distal radius fractures were evaluated using the AAOS AUC application for distal radius fractures.

An unusual knee mass in a soccer player.

Introduction: Non-traumatic knee joint effusion and fullness is a relatively common presenting complaint among athletes and non-athletes. Due to its broad differential diagnosis, a comprehensive evaluation beginning with history and physical examination are recommended. Imaging including plain radiography, magnetic resonance imaging (MRI), and in some cases ultrasound are preferred modalities.

Evaluation of utility in shoulder pathology: Correlating the American Shoulder and Elbow Surgeons and Constant scores to the EuroQoL.

Aim: To study whether health utility scores can be derived from shoulder-specific scores.

Methods: Authors investigated two questions: (1) do the American Shoulder and Elbow Surgeons (ASES) score and the Constant score correlate with the EuroQoL (EQ-5D), a measure of health utility? (2) can the ASES and Constant scores be obtained from a complete study sample without bias? Thirty subjects with various shoulder diagnoses completed ASES, Constant, and EQ-5D instruments. Pearson correlations were calculated to assess the associations between EQ-5D score and ASES and Constant scores.