Intramedullary Screw Fixation of Olecranon Fractures Reduces the Risk of Early Unplanned Reoperation: A Retrospective Review of 556 Patients.

Objectives: To determine the effect of intramedullary screw-based fixation on early postoperative complications after olecranon fractures. We hypothesized that intramedullary screw-based fixation results in decreased need for reoperation compared with plate and screw-based and tension band-based fixation.

Design: Retrospective cohort.

Four Ways Plastic Surgeons Can Fight Climate Change.

Unlabelled: The climate crisis demands that surgeons reduce their environmental impact. Operating rooms are resource-intensive and are often wasteful. This makes them fitting targets for climate-conscious decision making.

Repaired Flexor Tendon Excursion with Half a Fist of True Active Movement Versus Full Fist Place and Hold in the Awake Patient.

Supplemental Digital Content is available in the text.

The Effect of Malnutrition on Postoperative Complications Following Surgery for Distal Radius Fractures.

Purpose: Malnutrition is known to negatively affect outcomes after arthroplasty, hip fracture, and spine surgery. Although distal radius fracture surgery may be considered in a similar patient cohort, the effect of malnutrition in this scenario is unknown. We hypothesized that admission serum albumin level, as a marker for malnutrition, would correlate with the rate of postoperative complications following surgery for distal radius fracture.

Ten Tips to Simplify the Spaghetti Wrist.

Hand surgeons refer to deep lacerations of the volar distal forearm as "spaghetti wrists." Given that multiple tendons, vessels, and nerves often require repair, this injury may be intimidating. We review management of spaghetti wrists and summarize with 10 simplifying tips.

The Multidisciplinary Approach to the Diagnosis and Management of Nonobstetric Traumatic Brachial Plexus Injuries.

Objective: Nonobstetric traumatic brachial plexus injuries can result in significant morbidity and chronic disability if not managed in a timely manner. Functional arm recovery is possible, but it requires a multidisciplinary approach toward the diagnosis and management of such injuries.

Conclusion: This article provides an overview of the clinical, electrophysiology, and diagnostic imaging knowledge needed for accurate imaging interpretation and to participate in multidisciplinary discussions aimed at expediting optimal patient management.

Use of a 5-Item Modified Frailty Index for Risk Stratification in Patients Undergoing Surgical Management of Distal Radius Fractures.

Purpose: Compared with cast treatment, surgery may expose patients with distal radius fractures to undue risk. Surgical intervention in this cohort may offer less benefit than previously thought and appropriate patient selection is imperative. The modified Frailty Index (mFI) predicts complications after other orthopedic surgeries.

Ulnar Artery Aneurysm in a 6-Month-Old: A Case Report.

Background: Pediatric ulnar aneurysms are rare and, unlike their adult counterparts, cannot be explained by repetitive trauma to the palm. A small number of case reports describe diagnostic difficulty with these lesions and different treatments.

Methods: We present the case of a 6-month-old with an ulnar artery aneurysm of unknown cause.

Viability of Hand and Wrist Photogoniometry.

Background: No goniometric technique is both maximally convenient and completely accurate, although photogoniometry (ie, picture taking to facilitate digital angle measurement) shows promise in this regard. Our purpose was to test the feasibility and reliability of a photogoniometric protocol designed to measure wrist and digit range of motion in general.

Methods: Two independent observers examined a sample of joints in both normal and abnormal hands according to a photogoniometric protocol.

Computed tomographic analysis of the internal structure of the metacarpals and its implications for hand use, pathology, and surgical intervention.

The variation of bone structure and biomechanics between the metacarpals is not well characterized. It was hypothesized that their structure would reflect their common patterns of use (i.e.

Efficient Construction of Volar Wrist Splints: A Biomechanical Study Comparing Splints of Different Material, Thickness, and Design.

The aim was to test the null hypothesis that splint material, thickness, or longitudinal ridging does not affect the strength of a wrist splint. Ten splints were made according to each of 7 different splint designs (resulting in 7 groups of 10 splints each). All splints were the same length and were molded to approximate the contour of the volar hand, wrist, and forearm with the wrist in neutral.

Suture-Button Reconstruction of the Interosseous Membrane.

Background: Reconstruction of the interosseous membrane (IOM) may play a role in the treatment of acute and chronic longitudinal forearm instability. Several reconstruction techniques have been proposed. Suture-button reconstruction is attractive because it obviates donor site morbidity and is relatively easy to perform.

Identifying the Risk of Swallowing-Related Pulmonary Complications in Older Patients With Hip Fracture.

To identify and potentially modify the risk of pulmonary complications in a group of older patients with hip fracture, the authors obtained speech and language pathology consultations for these patients. Then they performed a retrospective chart review of all patients 65 years and older who were admitted to their institution between June 2011 and July 2013 with acute hip fracture, were treated surgically, and had a speech and language pathology evaluation in the immediate perioperative period. The authors identified 52 patients who met the study criteria.

The hand surgery fellowship application process: expectations, logistics, and costs.

Purpose: To investigate expectations, logistics, and costs relevant to the hand surgery fellowship application process. We sought to discover (1) what both applicants and program directors are seeking, (2) what both parties have to offer, (3) how both parties collect information about each other, and (4) the costs incurred in arranging each match.

Methods: We conducted on-line surveys of hand surgery fellowship applicants for appointment in 2015 and of current fellowship program directors.

Management of adult diaphyseal both-bone forearm fractures.

Simultaneous diaphyseal fractures of the radius and ulna, often referred to as both-bone forearm fractures, are frequently encountered by orthopaedic surgeons. Adults with this injury are typically treated with open reduction and internal fixation because of the propensity for malunion of the radius and ulna and the resulting loss of forearm rotation. Large case series support the use of plate and screw fixation for simple fractures.

The biomechanical stability of salvage procedures for distal radioulnar joint arthritis.

Purpose: To test distal forearm stability after 3 surgical procedures for distal radioulnar joint (DRUJ) arthritis.

Methods: We tested 11 cadaver limbs with the DRUJ intact, after distal ulna-matched hemiresection, after Darrach distal ulna resection, and after unlinked total DRUJ arthroplasty. We evaluated distal forearm stability in neutral rotation, full pronation, and full supination in unweighted and 1-kg-weighted conditions.

Tendon versus nerve transfers in elbow, wrist, and hand reconstruction: a literature review.

Upper extremity reconstruction forces the surgeon to chose between several available procedures, among them tendon and nerve transfer. Few guidelines exist to assist the surgeon in this regard, and the authors, therefore, undertook a retrospective review of case series describing tendon and nerve transfer. The authors discovered a scarcity of robust reporting, particularly in regard to tendon transfer, making an objective comparison between the two techniques difficult.

Deep vein thrombosis and pulmonary embolism after spine surgery: incidence and patient risk factors.

Anticoagulation after spine surgery confers the unique risk of epidural hematoma. We sought to determine the incidence of and patient risk factors for deep vein thrombosis (DVT) and pulmonary embolism (PE) after spine surgery. We retrospectively reviewed the charts of 1485 patients who had spine surgery at a single tertiary-care center between 2002 and 2009.

Hand fractures: a review of current treatment strategies.

Fractures of the tubular bones of the hand are common and potentially debilitating. The majority of these injuries may be treated without an operation. Surgery, however, offers distinct advantages in properly selected cases.

Instrumented reduction of a fixed C1-2 subluxation using occipital and C2/C3 fixation: A case report.

Background: Different strategies exist for reduction of the cervical spine. Placement of C1 lateral mass screws is a powerful technique but may be impossible in a degenerative or revision setting. We report the open, posterior-only, and instrumented reduction of a fixed C1-2 subluxation using occipital and C2/C3 fixation.