Adoption of reverse total shoulder arthroplasty for surgical treatment of proximal humerus fractures differs by patient race.

Background: Reverse total shoulder arthroplasty (rTSA) has gained popularity for the operative treatment of proximal humerus fractures (PHF). The purpose of this study was to compare racial differences in surgical management of PHF between open reduction and internal fixation (ORIF), hemiarthroplasty, and rTSA. Our hypothesis was that there would be no difference in fixation by race.

Shared Decision Making in Hand Surgery.

Shared decision-making (SDM) is a collaborative effort between a physician and a patient to make an informed clinical decision, as defined by each patient's preferences and values. Shared decision-making is particularly used in areas of clinical equipoise or preference-sensitive conditions, which are common in hand surgery. Although there is increased interest in SDM across health care, hand surgeons receive little formal training on SDM.

Total Talar and Navicular Extrusions: A Case Report.

Case: A 15-year-old adolescent boy sustained both talar and navicular extrusions after a dirt-bike accident. The talus and navicular were discarded during initial debridement because of contamination. Given extensive soft-tissue injury and bone loss, the patient's family opted for transtibial amputation, as described by Ertl, over limb salvage.

Interobserver and Intraobserver Reliability of Classification Systems for Radiographic Complications After Radial Head Arthroplasty.

Purpose: Although several classifications are used to assess radiographs following radial head arthroplasty (RHA), including the Popovic classification for radiolucency, the Chanlalit classification for stress shielding (SS), the Brooker classification for heterotopic ossification (HO), and the Broberg-Morrey classification for radiocapitellar arthritis, little is known about the reliability of these classification systems. The purpose of this study was to determine the interobserver and intraobserver reliability of these classifications.

Methods: Six orthopedic surgeons at various levels of training reviewed elbow radiographs of 20 patients who underwent RHA and classified them according to the Popovic, Chanlalit, Brooker, and Broberg-Morrey classifications for radiolucency, SS, HO, and RHA, respectively.

Infection and Mechanical Complications Are Risk Factors for New Diagnosis of a Mental Health Disorder After Total Joint Arthroplasty.

Background: Prior studies have demonstrated that depression is an independent risk factor for developing a prosthetic joint infection (PJI) after total joint arthroplasty (TJA). To our knowledge, there is no literature examining whether PJI or aseptic failure increases the risk of developing a new mental health diagnosis.

Methods: PearlDiver Patient Database (Colorado Springs, CO) was used to identify 80,826 patients who underwent TJA without a pre-existing diagnosis of depression, anxiety, a stress and/or adjustment disorder, and/or current use of a selective serotonin reuptake inhibitor within the year prior to surgery.

Patient outcomes and costs after isolated flexor tendon repairs of the hand.

Background: Acute flexor tendon injuries are challenging injuries for patients, surgeons, and therapists alike. There is ongoing debate about the optimal timing and amount of therapy after these injuries.

Purpose: We sought to investigate the relationship between hand therapy utilization and reoperation rates after flexor tendon repair and quantify reoperation rates and costs associated with flexor tendon repair.

Opioid Use following Open versus Endoscopic Carpal Tunnel Release: A Population Study.

Unlabelled: Open (OCTR) and endoscopic carpal tunnel release (ECTR) are both effective treatments for carpal tunnel syndrome, with similar outcomes and complication rates. Given the opioid epidemic, it is important to consider how surgical modality impacts narcotic use. We compared narcotic use after OCTR and ECTR to identify trends and risk factors for prolonged postoperative use.

Flexor Tendon Rupture After Distal Radius Malunion Associated With Electromyographic Abnormalities: A Case Report.

Case: A 63-year-old woman with a history of a malunited distal radius fracture presented with left hand pain and inability to flex her thumb, index, and middle fingers. Anterior interosseous neuropathy was suggested because of abnormal electromyography findings. However, magnetic resonance imaging later revealed flexor tendon ruptures.

Incidence of Corrective Procedures After Nonoperatively Managed Distal Radius Fractures in the Elderly.

Unlabelled: Although the majority distal radius fractures in the elderly are initially managed nonoperatively, the true incidence of subsequent corrective surgery is unknown. The purpose of this study was to determine the incidence and predictors of corrective surgery after conservative management.

Methods: and Current Procedural Terminology codes were queried from the Medicare 5% sample to select patients aged 65 years and older undergoing nonsurgical treatment of distal radius fractures with a minimum 5-year follow-up.

Wide-Awake Local Anesthesia for Minor Hand Surgery Associated With Lower Opioid Prescriptions, Morbidity, and Costs: A Nationwide Database Study.

Purpose: We sought to investigate the perioperative opioid prescription patterns, complication rates, and costs associated with wide-awake local anesthesia (WALA) techniques using a nationwide insurance claims-based database.

Methods: We used the PearlDiver Humana administrative claims database to identify opioid-naive adult patients who underwent a carpal tunnel release, trigger finger release, or de Quervain release between 2007 and 2015. Patients were divided into WALA and standard anesthesia groups by the presence or absence of anesthesia Current Procedural Terminology codes.

The Addition of Hip Arthroscopy to Periacetabular Osteotomy Does Not Increase Complication Rates: A Prospective Case Series.

Background: Previous studies on periacetabular osteotomy (PAO) reported complication and reoperation rates of 5.9% and 10%, respectively. Hip arthroscopy is increasingly utilized as an adjunct procedure to PAO to precisely treat associated intra-articular pathology.

Decompression of the superficial peroneal nerve: clinical outcomes and anatomical study.

OBJECTIVE The authors of this study sought to determine the outcomes of patients undergoing superficial peroneal nerve (SPN) release to treat lower-extremity pain and describe consistent anatomical landmarks to direct surgical planning. METHODS This retrospective cohort study examined 54 patients with pain in the SPN distribution who were treated with decompression between 2011 and 2014. Patients rated pain and the effect of pain on quality of life (QOL) on the visual analog scale (VAS) from 0 to 10.

The impact of obesity on complications of elbow, forearm, and hand surgeries.

Purpose: To compare the rates of postoperative complications in obese and nonobese patients following elbow, forearm, and hand surgeries.

Methods: This case-control study examined 436 patients whose body mass index (BMI) was over 35 and who underwent hand, wrist, forearm, or elbow surgery between 2009 and 2013. Controls were patients (n = 433) with a BMI less than 30 who had similar surgeries over the same period, and who were frequency-matched by type of surgery (ie, bony, soft tissue, or nerve), age, and sex.

Delayed environmental enrichment reverses sevoflurane-induced memory impairment in rats.

Background: Anesthesia given to immature rodents causes cognitive decline, raising the possibility that the same might be true for millions of children undergoing surgical procedures under general anesthesia each year. We tested the hypothesis that anesthesia-induced cognitive decline in rats is treatable. We also tested if anesthesia-induced cognitive decline is aggravated by tissue injury.