Complications and Revision Surgery of Forearm Fractures.

Nonunion or malunion of forearm fractures may result in restricted range of motion or persistent pain, leading to limitations in activities of daily living. Complications may also present in the form of ectopic bone growth or persistent infections. A systematic method to evaluate complications resulting from forearm fractures is helpful to both determine the cause for the failure and plan for adequate reconstruction.

Investigating Patient-Level Radiation Exposure in Hand and Wrist Fracture Surgery.

Background: Although occupational exposure to radiation has been previously studied in the hand surgery literature, there is a paucity of studies looking at radiation exposure to the patient during fluoroscopy-guided hand surgery. We aimed to describe the level of radiation experienced by patients undergoing common hand and wrist fracture fixation and to identify risk factors for increased radiation exposure.

Methods: We performed a retrospective review of patients at a single institution who underwent fracture fixation of the hand, wrist, or forearm requiring mini c-arm fluoroscopic guidance from 2016 to 2020.

Distal Radius Fracture and the Distal Radioulnar Joint.

In this article, we discuss the incidence and types of injuries to the distal radioulnar joint (DRUJ) that occur in the setting of a distal radius fracture. We review the anatomy of the distal radioulnar joint, which is critical to understanding its biomechanics, and how injury could cause symptomatic incongruency and instability. We highlight how patients with an injury to the distal radioulnar joint might present both at the time of injury and after treatment of a distal radius fracture, the appropriate workup, the available treatment options, and the evidence-based literature.

Four-Year Follow-Up of the World's First Pediatric Bilateral Hand-Forearm Transplants: Do They Grow as Expected?

Background: In 2015, the first bilateral pediatric hand-forearm transplant was performed in an 8-year-old boy. The growth rate of the transplanted upper extremities was unknown at the time.

Methods: Forearm and hand radiographs were obtained annually.

Comparison of Magnetic Resonance Imaging and Ultrasound Evaluations of Zone II Partial Flexor Tendon Lacerations: A Cadaveric Study.

Objectives: Surgical intervention for zone II high-grade partial flexor tendon lacerations is often required when more than half of the tendon width is torn. Reliable noninvasive tests are critical for optimizing clinical decision making. Our team previously investigated the use of ultrasound (US) for identification of high-grade zone II flexor digitorum profundus lacerations.

Bilateral Plexiform Neurofibromas of the Posterior Interosseous Nerve Mimicking Dorsal Wrist Ganglions.

A 33-year-old woman presented with bilateral dorsal wrist masses associated with pain and limited range of motion. On initial presentation, the masses were believed to be ganglion cysts and the patient opted for observation. Three years later, she was found to have a chest wall mass diagnosed by biopsy to be a neurofibroma.

18-month outcomes of heterologous bilateral hand transplantation in a child: a case report.

Background: Although heterologous vascular composite allotransplantation has become a burgeoning treatment option for adult amputees, there have been no successful cases previously reported in children. Here, we describe the surgical, immunological, and neurorehabilitation details with functional outcomes 18 months after heterologous bilateral hand and forearm transplantation in an 8-year-old child with quadrimembral amputations and a previous kidney transplant.

Methods: 2 years of extensive preparation by medical and surgical teams preceded the hand-forearm transplantation of this child.

Logistics in Coordinating the First Adult Transatlantic Bilateral Hand Transplant: Lessons Learned.

Hand transplantation requires precise preoperative planning and surgical execution. Coordinating a transplant team-including surgeons, anesthesiologists, nurses, and supporting staff-is a time-sensitive challenge when a donor-recipient match is confirmed. International human limb transplantation occurs when the recipient and donor are in separate countries.

The Effect of Computed Tomography Scans Oriented Along the Longitudinal Scaphoid Axis on Measurements of Deformity and Displacement in Scaphoid Fractures.

Purpose: Reformatting computed tomography (CT) scans along the scaphoid longitudinal axis improves the ability to detect scaphoid fractures compared with reformats along the wrist axis. However, it remains unclear whether scaphoid axis reformats affect measurements of displacement or deformity, which are factors that drive the clinical decision to perform open reduction internal fixation. Our null hypothesis was that reformatting CT scans along the scaphoid axis does not affect measurements of fracture displacement and deformity.

Partial Hand Transplant: Lessons Learned From Cadaveric Dissection Studies.

As the field of vascularized composite allotransplantation continues to expand, new upper extremity transplant candidates are being considered. We recently evaluated a bilateral amputee who had a mid-forearm amputation and a contralateral metacarpal hand amputation. In the latter limb, a "partial" hand transplant that preserved the majority of the patient's existing hand, including a partially severed thumb with intact thenar muscle function, was proposed.

Deferring Routine Wrist Radiography Does Not Affect Management of de Quervain Tendinopathy Patients.

 Obtaining wrist radiographs prior to surgeon evaluation may be wasteful for patients ultimately diagnosed with de Quervain tendinopathy (DQT).  Our primary question was whether radiographs directly influence treatment of patients presenting with DQT. A secondary question was whether radiographs influence the frequency of injection and surgical release between cohorts with and without radiographs evaluated within the same practice.

Ultrasonographic Evaluation of Zone II Partial Flexor Tendon Lacerations of the Fingers: A Cadaveric Study.

Objectives: Accurate assessment of zone II partial flexor tendon lacerations in the finger is clinically important. Surgical repair is recommended for lacerations of greater than 50% to 60%. Our goal was to evaluate ultrasonographic test characteristics and accuracy in identifying partial flexor tendon lacerations in a cadaveric model.

Patient- and Disease-Specific Factors Associated With Operative Management of de Quervain Tendinopathy.

Purpose: It remains unclear which factors, patient- or disease-specific, are associated with electing to undergo operative management for de Quervain tendinopathy. Our null hypothesis was that no patient- or disease-specific factors would be associated with the choice of surgical treatment of de Quervain tendinopathy.

Methods: We performed a retrospective review of consecutive patients diagnosed with de Quervain tendinopathy over 3 years by 1 of 3 fellowship-trained hand surgeons at an urban academic institution.

Acute Deep Infections of the Upper Extremity: The Utility of Obtaining Atypical Cultures in the Presence of Purulence.

Purpose: In the setting of acute deep upper extremity infections, evidence is lacking to guide the decision whether to send atypical cultures (fungal and acid-fast-bacillus [AFB]) during surgical debridement, especially in the presence of purulent fluid that is commonly observed with typical bacterial infections. Our purpose was to determine the frequency of positive atypical cultures and the frequency with which they alter treatment, and identify factors associated with positive atypical cultures.

Methods: We retrospectively identified 100 adult patients undergoing surgical debridement of acute deep infections of the upper extremity in which fungal and/or AFB cultures were sent.

Hematoma of the Flexor Tendon Sheath Mimicking Acute Septic Tenosynovitis: A Case Report.

Case: We report a case of a 65-year-old woman receiving chronic anticoagulation who presented with acute onset of severe long finger pain and was supratherapeutic on Coumadin. Her examination was consistent with early septic flexor tenosynovitis. She was treated with antibiotics and tendon sheath incision and drainage.

Carpal Ligament Anatomy and Biomechanics.

A fundamental understanding of the ligamentous anatomy of the wrist is critical for any physician attempting to treat carpal instability. The anatomy of the wrist is complex, not only because of the number of named structures and their geometry but also because of the inconsistencies in describing these ligaments. The complex anatomy of the wrist is described through a review of the carpal ligaments and their effect on normal carpal motion.

Management of complications of flexor tendon injuries.

Innovations in operative techniques, biomaterials, and rehabilitation protocols have improved outcomes after treatment of flexor tendon injuries. However, despite these advances, treatment of flexor tendon injuries remains challenging. The purpose of this review is to highlight the complications of flexor tendon injuries and review the management of these complications.

Timing of forearm arterial repair in the well-perfused limb.

The purpose of this study was to evaluate the difference in the outcomes of patients with a well-perfused hand who were taken to the operating room (OR) within 6 hours of forearm arterial injury vs patients who were treated in a semiurgent fashion. A review of 201 consecutive patients who were taken to the OR with forearm-level radial or ulnar arterial injury identified 26 patients who had a well-perfused hand at presentation in whom hemostasis was achieved within 15 minutes with manual pressure and no signs of hemodynamic instability. Outcomes of interest included short-version Disabilities of the Arm, Shoulder and Hand (quickDASH) scores and patient-reported cold intolerance.

Technical implications in proximal forearm transplantation.

The field of vascularized composite allotransplantation has developed for more than a decade. Investigators are defining patient selection criteria, transplant indications, immunologic regimens, and tolerance. The majority of the current reported hand transplantations have been for treatment of distal forearm or hand amputations.

Rate of clinically significant posttraumatic arthritis after small finger intra-articular carpometacarpal fractures.

Although small finger intra-articular carpometacarpal joint fractures are relatively common hand injuries, few studies in the orthopedic literature report their clinical outcomes. The goal of this study was to analyze the rate of symptomatic posttraumatic arthritis following small finger intra-articular carpometacarpal joint fractures. The authors performed a chart review of 82 consecutive patients with a small finger intra-articular carpometacarpal fractures treated at their institution over a 5-year period.

Immobilization in supination versus neutral following surgical treatment of Galeazzi fracture-dislocations in adults: case series.

Purpose: The goal of this study was to investigate whether immobilization in supination is necessary to prevent recurrent distal radioulnar joint (DRUJ) instability in patients older than 18 years with a Galeazzi fracture-dislocation and a stable DRUJ following open reduction and internal fixation of the radius.

Methods: We performed a retrospective chart review of 10 consecutive patients who were immobilized in either supination or a neutral position following surgical treatment of a Galeazzi fracture-dislocation in which the DRUJ was noted to be stable immediately after fixation of the radius. Group 1 consisted of 5 patients who were immobilized in supination for a period of 4 weeks, and group 2 consisted of 5 patients who were immobilized in neutral for 2 weeks, followed by functional bracing.

Case report: pseudotendon formation after a type III flexor digitorum profundus avulsion.

Background: Avulsion of the flexor digitorum profundus tendon is a common injury to the hand that virtually always requires surgical repair for restoration of normal finger function.

Case Description: We report a case of a Type III flexor digitorum profundus tendon avulsion in which the patient refused surgery yet attained nearly full active ROM and an excellent functional result via the formation of a pseudotendon, as observed on MRI obtained 2.5 years after the initial injury.

Implant arthroplasty of the carpometacarpal joint of the thumb.

Resection arthroplasty with or without ligament reconstruction for thumb trapeziometacarpal arthritis can be complicated by thumb shortening and pinch-strength weakness. Implant arthroplasties have been developed to limit loss of thumb length, improve strength, and limit postoperative convalescence. The ideal thumb carpometacarpal implant should be strong and stable, provide full range of motion, and prevent loosening.

Extensor tendon injuries.

The extensor mechanism of the fingers, hand, wrist, and forearm is extremely intricate. Disruptions to the extensor system are common and can be associated with poor patient outcomes when not treated appropriately. Although extensor tendon injuries receive much less attention in the literature than flexor tendon injuries do, several recent studies have examined this topic.

Sporotrichosis of the upper extremity.

This article presents a case of a chronic, nonhealing thumb wound in a patient with diabetes mellitus. A 67-year-old right-hand-dominant man presented with progressive erythema and swelling of the right thumb several months after sustaining a paper cut along the eponychium. The patient had already completed an extensive laboratory evaluation, including bacterial and fungal cultures, as well as a punch biopsy that was inconclusive.