The "Thumbs-up" sign and trapeziometacarpal joint injection: a useful clinical indicator.

Background: Several clinical studies investigating the accuracy and efficacy of trapeziometacarpal injection exist. Some studies utilize anatomical landmarks for proper injection placement while others utilize modalities including ultrasound and fluoroscopy. The changes of limb position that occur at the time of intra-articular injection can provide valuable visual and tactile feedback to the clinician.

Distal Humeral Fracture Fixation with an Extensor Mechanism-on Approach.

Introduction: Open treatment of extra-articular and intra-articular distal humeral fractures can be effectively accomplished through an extensor mechanism-on approach.

Step 1 Preoperative Planning: Assess all images for multiplane fracture lines involving the capitellum or trochlea.

Step 2 Operative Setup: Verify with fluoroscopy that the patient and arm positions allow for adequate imaging of the distal part of the humerus.

Outcomes following distal humeral fracture fixation with an extensor mechanism-on approach.

Background: Distal humeral fractures have traditionally been managed with surgical approaches that disrupt the extensor mechanism. We hypothesized that an extensor mechanism-on approach for operative fixation of distal humeral fractures with parallel or orthogonal plate constructs would allow excellent healing, a motion arc of the elbow exceeding 100°, and maintenance of extensor mechanism strength.

Methods: Distal humeral open reduction and internal fixation (ORIF) was performed with either orthogonal or parallel plate constructs in seventy-nine elbows.