Sociodemographic Disparities in Postoperative Nausea and Vomiting.

Background: Postoperative nausea and vomiting (PONV) prophylaxis is consistently considered a key indicator of anesthesia care quality. PONV may disproportionately impact disadvantaged patients. The primary objectives of this study were to examine the associations between sociodemographic factors and the incidence of PONV and clinician adherence to a PONV prophylaxis protocol.

Enhanced Recovery After Surgery: Intraoperative Fluid Management Strategies.

Ideal fluid management is a critical component of enhanced recovery after surgery protocols and should be considered throughout the perioperative period. The goal of preoperative fluid management is for the patient to arrive to the operating room euvolemic. Intraoperative goals of fluid management are to preserve intravascular volume and minimize salt and water uptake through intravenous crystalloid infusions.

Pediatric hand dressing: technical report.

A compressive or conforming dressing is an important aspect of hand surgery, particularly the role of uniform pressure to the entire hand. Pediatric hand patients require special considerations with respect to appropriate postoperative dressing to maintain equal limb compression and to maintain the dressing during the postoperative period. This article describes a specific upper-limb hand dressing that can be used in the infant and young child.

Symptomatic carpal collapse after trapeziectomy and partial trapeziodectomy: report of two cases.

We present 2 cases of symptomatic nondissociative dorsal intercalated segment instability (CIND-DISI) collapse after trapeziectomy and partial trapezoidectomy for pantrapezial arthritis. Preoperative radiographs showed normal carpal alignment in 1 case and a mild DISI alignment in the other. After surgery both developed increased CIND-DISI and carpal symptoms that differed from their original thumb-base problems.

Congenital duplication of the thumb.

Duplication or polydactyly of the thumb is among the most common congenital deformities that involve the hand. The purpose of this presentation is to review the Mayo Clinic experience with thumb duplication and to present preferred operative procedures to achieve the best clinical outcome and esthetic appearance for the hand. We propose that a combination or "best of parts", utilizing the components of both duplicates with retention of the ulnar duplicate as the base for reconstruction will provide the most functional clinical result.

Dynamic carpal stability.

The term carpal instability is commonly used, but what carpal stability actually is has not been defined. Much of the mechanically complex wrist's versatility is due to the intercalated three bone proximal carpal row. Landsmeer described the collapse tendency associated with intercalated segments.

Trispiral tomographic staging of Kienböck's disease.

Trispiral tomography enhances the staging of Kienböck's disease and aids in surgical planning. The clinical records, plain x-rays, and trispiral tomograms of 105 patients with Kienböck's disease were reviewed. When tomograms were used, upward revision of the classification stage was indicated in 73% of patients with stage I or stage II disease and in 10% of those with stage III disease.

Radial recession osteotomy for Kienböck's disease.

Sixty-eight patients underwent radial recession osteotomy for avascular necrosis of the lunate were retrospectively evaluated after an average follow-up period of 52 months. Twenty-five patients had undergone 1 or more additional procedures concurrently for treatment of Kienböck's disease. Pain diminished in 93% of patients, grip strength improved, and wrist motion was preserved; 75% of patients continued in their original occupations, including heavy labor.

A short history of the wrist joint.

From the standpoint of descriptive anatomy and function, the wrist has been somewhat neglected when compared to other joints. This article tries to describe the major contributions to this subject, many of which were overlooked before the recent era of markedly increased interest.

Radial opening wedge osteotomy in Madelung's deformity.

Radiopalmar opening wedge osteotomy was used in 11 female patients (12 wrists) with Madelung's deformity who ranged in age from 9 to 31 years. Five patients met the radiographic criteria for generalized dyschondrosteosis. Clinically, there was dissatisfaction with the appearance of the wrist.

Carpal instability non-dissociative.

A retrospective study of 45 patients with symptoms of wrist pain and weakness with clinical evidence of instability is presented. These patients had normal intrinsic interosseous ligaments demonstrated arthrographically or surgically. They were followed for a minimum of 18 months and an average of 5.

Extension block splinting.

Extension block splinting (EBS) at the proximal interphalangeal joints of the fingers is a common technique for both primary treatment of reduced dorsal dislocations/fracture-dislocations at that joint and as a rehabilitation method following open reduction of such injuries. It is seldom realized that the method is a classic example of two orthopedic principles: stable arc splinting and early protected motion. As a primary treatment technique, following reduction of the dislocation, EBS is exemplary for an ideal group of cases, competitive for a marginal group of cases, and often unsatisfactory for a questionable group of cases.

Triangular fibrocartilage tears.

From a series of 56 patients with triangular fibrocartilage injury, 33 patients with peripheral rim tears not associated with instability of the distal radioulnar joint were identified by arthrography or arthroscopy. Open repair of the peripheral tear produced 11 excellent, 15 good, 6 fair, and 1 poor result (grading based on a Mayo modified Green-O'Brien wrist score). Ulnar recession improved surgical exposure and corrected ulnar variance in 11 patients.

Digital lengthening. With emphasis on distraction osteogenesis in the upper limb.

Digital lengthening, commonly practiced for hand digits of segments, seldom for those of the foot, has been much enhanced by new applications of old techniques and some surprising physiologic responses to those techniques.

[Carpal instability].

Traumatic carpal instability implies that the normal relationships of the radiocarpal and mid carpal joint are distorted either statically or during dynamic stress. Normal kinematics of the carpus are dysfunctional. The causes of carpal instability are dissociation of the intercarpal ligaments on either side of the lunate, a so-called scapholunate dissociation or a luno-triquetral dissociation.

High-pressure injection injuries of the hand: review of 25 patients managed by open wound technique.

This article reviews the outcome of injury of the hand in 25 patients treated at our institution by the open wound technique: wide débridement, drainage, open packing, and delayed closure. The results obtained are superior to those reported in the literature: Among the patients, 84% of the involved hands or fingers were salvaged, 64% had essentially normal hand function at the time of final follow-up, and 92% were able to return to their previous jobs. We propose that aggressive treatment by the open wound technique improves the outcome of high-pressure injection injuries of the hand.

Treatment of scapholunate dissociation. Rotatory subluxation of the scaphoid.

The treatment of scapholunate dissociation remains controversial. Although good to excellent results have been reported using a variety of surgical techniques, they have often not been confirmed by other authors. Limited wrist mobility and the likelihood that degenerative changes will progress appear to be inherent in most approaches.

Digital nerve compression.

A review of the relatively small body of literature about digital nerve compression injuries has been supplemented by the author's experience and interest of over 40 years. The principal lesions involved are of two types: (1) fibrosis about, around, and in the nerve; and (2) reactive hyperplasia of the nerve support elements and sometimes of special end organs, Pacinian corpuscles, and even of the nerve fibers themselves. Nerve signs and symptoms often accompanied by a mass in chronic cases are diagnostic.

Anomalies of the fingers and toes associated with Klippel-Trenaunay syndrome.

Klippel-Trenaunay syndrome is a rare congenital malformation characterized by a large angiomatous nevus; hypertrophy of soft tissue or overgrowth of bone, or both; and venous varicosities. The cases of 108 patients who had a diagnosis of this syndrome between 1956 and 1990 were reviewed. One hundred and twenty-six anomalies were found in twenty-nine patients, each of whom had one to thirteen malformations of the fingers or toes, or both.

Cumulative trauma disorder of the upper limb.

The current status of cumulative trauma disorder of the upper limb is examined from the standpoint of its long history, its current controversies, and the philosophic basis of the present laws, which control management of the condition. The future needs that should permit cumulative trauma disorders to be better understood, better managed, and better legislated are also addressed.

Concomitant scapholunate dissociation and Kienböck's disease.

Six men had concurrent scapholunate dissociation and Kienböck's disease, a finding suggestive of a common cause. Five patients attributed the onset of wrist pain to a single traumatic event. Three had x-ray evidence of scapholunate dissociation before the onset of lunate osteonecrosis.