Impaction Syndromes About the Wrist.

Purpose Of Review: Impaction syndromes are frequently a source of ulnar-sided wrist pain and patient disability. Differentiating between these entities can be difficult due to significant overlap in their clinical presentations. This manuscript reviews the diagnosis and treatment of three different impaction syndromes: (1) ulnar impaction syndrome, (2) hamate arthrosis lunotriquetral ligament syndrome, and (3) triquetrohamate impaction syndrome.

Reliability of Assessing Distal Radius Fractures on a Smartphone Versus PACS.

Background: Communication between health care providers is becoming more intertwined with technology. During the pandemic, telehealth strategies grew exponentially. Remote viewing of imaging on a smartphone may offer efficient communication; however, the reliability of injury assessment when compared with traditional methods is not known.

Statin/ezetimibe combination therapy vs statin monotherapy for carotid atherosclerotic plaque inflammation.

It remains uncertain whether statin/ezetimibe combination therapy serves as a useful and equivalent alternative to statin monotherapy for reducing atherosclerotic plaque inflammation. The aim of the present study was to compare the effects of statin/ezetimibe combination therapy and statin monotherapy on carotid atherosclerotic plaque inflammation using 18F-fluorodeoxyglucose (18FDG) positron emission tomography (PET)/computed tomography (CT) imaging. Data were pooled from 2 clinical trials that used serial 18FDG PET/CT examination to investigate the effects of cholesterol-lowering therapy on carotid atherosclerotic plaque inflammation.

Comparison of High-Dose Rosuvastatin Versus Low-Dose Rosuvastatin Plus Ezetimibe on Carotid Atherosclerotic Plaque Inflammation in Patients with Acute Coronary Syndrome.

We compared the effects of ezetimibe/rosuvastatin 10/5 mg versus rosuvastatin 20 mg on carotid atherosclerotic plaque inflammation measured by FDG PET/CT. Fifty patients with acute coronary syndrome (ACS) were randomly assigned to the ezetimibe/rosuvastatin 10/5 mg and rosuvastatin 20 mg groups. The primary outcome was the percent change in the target-to-background ratio (TBR) of the index vessel in the most diseased segment (MDS), as assessed by FDG PET/CT at baseline and at 6 months.

Endoscopic Versus Open Carpal Tunnel Release.

Purpose Of Review: Carpal tunnel syndrome is the most common compressive neuropathy encountered by hand and upper extremity surgeons. The predominant presentation includes symptomatic paresthesias in the median nerve distribution of the affected hand, frequently causing nocturnal disturbances. Surgical treatment requires division of the transverse carpal ligament, which can be performed through open and endoscopic means.

Effects of ezetimibe/simvastatin 10/10 mg versus Rosuvastatin 10 mg on carotid atherosclerotic plaque inflammation.

Background: Using F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) imaging, we examined the effects of ezetimibe/simvastatin 10/10 mg versus rosuvastatin 10 mg on carotid atherosclerotic plaque inflammation. Whether the combination therapy of ezetimibe with low-dose statin is as effective as potent statin monotherapy in attenuating carotid atherosclerotic plaque inflammation remains unclear.

Methods: In this 2-by-2 factorial trial, 50 patients with FDG uptake (target-to-background ratio [TBR] ≥1.

Smart Hybrid Nanocomposite for Photodynamic Inactivation of Cancer Cells with Selectivity.

Photodynamic therapy has been efficiently applied for cancer therapy. Here, we have fabricated the folic acid (FA)- and pheophorbide A (PA)-conjugated FA/PA@FeO nanoparticle (smart hybrid nanocomposite, SHN) to enhance the photodynamic inactivation (PDI) of specific cancer cells. SHN coated with the PDI agent is designed to have selectivity for the folate receptor (FR) expressed on cancer cells.

Emerging Technologies in Distal Radius Fracture Fixation.

Purpose Of Review: To provide an overview of emerging fixation constructs and materials used in the operative management of distal radius fractures.

Recent Findings: The indications, advantages, and disadvantages of relatively new implants and devices used to treat distal radius fractures are discussed. These include the intramedullary nail, intramedullary cage, radiolucent volar locking plate, distal radius hemiarthroplasty, and bone graft substitutes.

Sleep disturbance and response to surgical decompression in patients with carpal tunnel syndrome: a prospective randomized pilot comparison of open versus endoscopic release.

Background: Sleep disturbance is a common complaint of patients with carpal tunnel syndrome (CTS). While carpal tunnel release (CTR) surgery has been shown to relieve subjective sleep-related complaints, data is lacking on the global effect on sleep using validated sleep measures. Additionally, it is not known if open (OCTR) or endoscopic release (ECTR) produce differing degrees of sleep-symptom relief.

Self-Reported Postoperative Opioid-Prescribing Practices Following Commonly Performed Orthopaedic Hand and Wrist Surgical Procedures: A Nationwide Survey Comparing Attending Surgeons and Trainees.

Background: Although orthopaedic surgeons have been shown to prescribe excessive amounts of opioid analgesics postoperatively, the degree in which surgical trainees contribute to this trend is unknown. The purpose of this study was to compare self-reported opioid-prescribing behavior, factors influencing this behavior, and perceptions of patient opioid utilization and disposal between hand surgeons and trainees.

Methods: Attending hand surgeons and trainees in hand, orthopaedic, and plastic surgery programs were invited to participate in a web-based survey including demographic characteristics; self-reported prescribing behavior specific to 4 procedures: open carpal tunnel release, trigger finger release, thumb carpometacarpal arthroplasty, and distal radial fracture open reduction and internal fixation; and perceptions and influencing factors.

Target-oriented photofunctional nanoparticles (TOPFNs) for selective photodynamic inactivation of Methicillin-resistant Staphylococcus aureus (MRSA).

To inactivate methicillin-resistant Staphylococcus aureus (MRSA) with minimum damage to host cells and tissue, target-oriented photofunctional nanoparticles (TOPFNs) were fabricated and characterized. MRSA is a predominant infective pathogen even in hospital and non-hospital environments due to its ability to develop high levels of resistance to several classes of antibiotics through various pathways. To solve this major problem, photodynamic inactivation (PDI) method applies to treat antibiotic-resistant bacteria.

Prognostic Variables for Patient Return-to-Work Interval Following Carpal Tunnel Release in a Workers' Compensation Population.

Background: We hypothesize that depressive and anxiety disorders, chronic pain conditions, and work-related factors are significant determinants of the time interval for return to work (RTW) in the workers' compensation (WC) population following carpal tunnel release (CTR) surgery.

Methods: We retrospectively reviewed records of all WC patients who underwent open CTR surgery over a 5-year period by 1 of 3 fellowship-trained hand surgeons. One hundred fifty-two wrists in 108 patients (64 unilateral, 44 bilateral) met the inclusion criteria.

Eradication of Plasmodium falciparum from Erythrocytes by Controlled Reactive Oxygen Species via Photodynamic Inactivation Coupled with Photofunctional Nanoparticles.

We investigated the antimalarial effect of photodynamic inactivation (PDI) coupled with magnetic nanoparticles (MNPs) as a potential strategy to combat the emergence of drug-resistant malaria and resurgence of malaria after treatment. Because the malarial parasite proliferates within erythrocytes, PDI agents need to be taken up by erythrocytes to eradicate the parasite. We used photofunctional MNPs as the PDI agent because nanosized particles were selectively taken up by Plasmodium-infected erythrocytes and remained within the intracellular space due to the enhanced permeability and retention effect.

Wrist Arthroscopy for Athletic Injuries.

Management of hand and wrist injuries for athletes often places emphasis on an expeditious return to sport. Arthroscopic techniques have the advantage of directly visualizing joint derangements and correcting them via a minimally invasive approach. This article discusses the evaluation and management of common wrist injuries treated with arthroscopy in athletes, including scapholunate and lunotriquetral injury, triangular fibrocartilage complex tears, hamatolunate impingement, and arthroscopic-assisted reduction of wrist fractures.

Geographic and Age-Based Variations in Medicare Reimbursement Among ASSH Members.

The purpose of this study was to investigate how American Society for Surgery of the Hand (ASSH) members' Medicare reimbursement depends on their geographical location and number of years in practice. Demographic data for surgeons who were active members of the ASSH in 2012 were obtained using information publicly available through the US Centers for Medicare and Medicaid Services (CMS). "Hand-surgeons-per-capita" and average reimbursement per surgeon were calculated for each state.

Stenosing Tenosynovitis Due to Excessive Texting in an Adolescent Girl: A Case Report.

We present a case report of stenosing tenosynovitis of the flexor pollicis longus tendon in an adolescent girl who required surgical release after failing conservative measures. The patient had no other risk factors, aside from her excessive texting, which we postulate led to her condition. Although there have been a few reports of tendinitis and tenosynovitis secondary to texting, we believe this is the first in the literature to report trigger thumb requiring surgical release in an adolescent.

Variables Prognostic for Delayed Union and Nonunion Following Ulnar Shortening Fixed With a Dedicated Osteotomy Plate.

Purpose: To examine potential risk factors for the development of delayed or nonunion following elective ulnar shortening osteotomy using a dedicated osteotomy plating system.

Methods: We performed a retrospective review of all patients who underwent elective ulnar shortening using the TriMed single osteotomy dynamic compression plating system by 1 of 2 fellowship-trained hand surgeons over a 5-year period. Demographic data and medical, surgical, and social histories were reviewed.

Management of complications of wrist arthroplasty and wrist fusion.

The human wrist joint is unique from functional and anatomic standpoints. Numerous articulations exist within the wrist that allow for many options for partial wrist fusion and arthroplasty. In cases of pancarpal disease, fusion or arthroplasty of the entire wrist joint can be performed.

Mini-open versus extended open release for severe carpal tunnel syndrome.

Background: This study aims to compare surgical outcomes of severe carpal tunnel syndrome (CTS) treated with mini-incision versus extensile release.

Methods: The method employed in this study was a retrospective review of patients with severe CTS, defined by electrophysiologic studies showing non-recordable distal sensory latency of the median nerve. Patients underwent either a mini-incision (2 cm) release of the transverse carpal ligament (group 1) or extensile release proximal to the wrist flexion crease (group 2).

Functional manipulation of dendritic cells by photoswitchable generation of intracellular reactive oxygen species.

Reactive oxygen species (ROS) play an important role in cellular signaling as second messengers. However, studying the role of ROS in physiological redox signaling has been hampered by technical difficulties in controlling their generation within cells. Here, we utilize two inert components, a photosensitizer and light, to finely manipulate the generation of intracellular ROS and examine their specific role in activating dendritic cells (DCs).

Treatment preferences for trigger digit by members of the American Association for Hand Surgery.

Background: Trigger digit is a common pathology encountered by hand surgeons, but there is a lack of evidence-based guidelines. We investigated the treatment preferences of hand surgeons and explored whether geographic location, type of residency training, or clinical experience is associated with differences in practice.

Methods: An online survey was distributed via email by the American Association for Hand Surgery to 615 members.

One-stage Integra coverage for fingertip injuries.

Background: We hypothesize that one-stage Integra skin coverage is an effective treatment modality for the treatment of fingertip defects.

Methods: Nine patients who sustained fingertip injuries were treated with one-stage Integra coverage. In all cases, Integra was placed directly on bone.

Minimally invasive partial fasciectomy for Dupuytren's contractures.

Background: Numerous options exist for the treatment of Dupuytren's contracture. This study describes the technique and early results of partial fasciectomy through a mini-incision approach as an additional treatment option for Dupuytren's disease.

Methods: This procedure involves the excision of diseased Dupuytren's tissue with the use of multiple 1 cm transverse incisions.

Treatment of carpal tunnel syndrome by members of the American Association for Hand Surgery.

Background: Carpal tunnel syndrome (CTS) is the most common compressive neuropathy affecting the upper extremity, yet evidence-based guidelines for its diagnosis and treatment are lacking. We set out to expose any potential discrepancies in CTS practice attitudes based on surgeon's academic background, residency training, clinical experience, and other factors.

Methods: This was an online survey-based study.