Metacarpal and Phalangeal Malunions-Is It all About the Rotation?

Metacarpal and phalanx fractures are common injuries that can often be managed nonoperatively with satisfactory clinical outcomes. However, loss of normal finger alignment including malrotation and severe angulation as well as intra-articular deformities can lead to functional deficits which may benefit from operative intervention. There are numerous surgical options to correct malunions and the correct choice varies based on the injury pattern, concurrent injuries/complications, and surgeon's preference.

Proximal Interphalangeal Joint Arthroplasty for Fracture.

Proximal interphalangeal joint arthroplasties can be performed in the setting of acute comminuted fracture, chronic fracture presentations, and posttraumatic arthritis. These surgeries provide excellent pain relief and patient satisfaction but patients should be cautioned not to expect an improvement in motion postoperatively. Despite high rates of minor complications and radiographic loosening, these implants have good rates of long-term survival with most revisions occurring in the early postoperative period.

Proximal Interphalangeal Joint Fractures: Various Approaches to Fixation.

There are numerous operative and nonoperative options for the management of proximal interphalangeal joint fractures and fracture dislocations. The treatment of choice should be guided by the fracture pattern and joint stability. The authors highlight a contemporary option for open reduction and internal fixation techniques, but all the techniques presented are viable options under the right circumstances.

Failure of humeral shaft fixation: construct characteristics.

Purpose: Fixation failure following open reduction and internal fixation (ORIF) of humeral shaft fractures can be a challenging complication. We aimed to identify the modes of failure and characteristics of failed fixation constructs.

Methods: We queried our institutional database for patients > 18 years old with fixation failure after ORIF with single plate and screw constructs of humeral shaft fractures from 2006 to 2017.

Social Disparities in the Management of Trigger Finger: An Analysis of 31 411 Cases.

Background: Cost and compliance are 2 factors that can significantly affect the outcomes of non-operative and operative treatment of trigger finger (TF) and both may be influenced by social factors. The purpose of this study was to investigate socioeconomic disparities in the surgical treatment for TF.

Methods: Adult patients (≥18 years old) were identified using International Classification of Diseases 9 and 10 Clinical Modification diagnostic codes for TF and Current Procedural Terminology (CPT) procedural codes (CPT: 26055) in the New York Statewide Planning and Research Cooperative System database.

Radial Sided Triangular Fibrocartilage Complex Tears: A Comprehensive Review.

When evaluating the available literature on the diagnosis and management of triangular fibrocartilage complex tears (TFCC), ulnar tears comprise the major focus of TFCC literature. Radial-sided (Class 1D) tears are seldom researched or discussed. The purpose of this study was to review the methods for identifying and treating radial-sided TFCC lesions, by examining the anatomy of the TFCC, the pathology of its radial portion, diagnostic techniques, and both surgical and nonoperative treatments.

Cost Drivers in Carpal Tunnel Release Surgery: An Analysis of 8,717 Patients in New York State.

Purpose: The annual high volume of carpal tunnel releases (CTRs) has a large financial impact on the health care system. Validating the cost drivers related to CTR in a large, diverse patient population may aid in developing cost reduction strategies to benefit health care systems.

Methods: Adult patients with carpal tunnel syndrome who underwent CTR were identified in the New York Statewide Planning and Research Cooperative System database from 2016 to 2017.

Rates of and Risk Factors for Trigger Finger after Open Carpal Tunnel Release.

 We have anecdotally noticed a higher rate of trigger fingers (TFs) developing in patients who have undergone carpal tunnel release (CTR).  Is the rate of TFs after CTR greater compared to the nonoperative hand? Is the thumb more commonly involved postoperatively compared with spontaneous TFs? Do particular associated comorbidities increase this risk?  We queried our institutional database for patients who had undergone open CTR during a 2-year period and recorded the development of an ipsilateral TF after a CTR or a contralateral TF in the nonoperative hand. Patient demographics, comorbidities, concurrent initial procedures, time to diagnosis, and finger involvement were recorded.

Weight-Bearing Restrictions With Distal Radius Wrist-Spanning Dorsal Bridge Plates.

Purpose: The fixation of comminuted distal radius fractures using wrist-spanning dorsal bridge plates has been shown to have good postoperative results. We hypothesized that using a stiffer bridge plate construct results in less fracture deformation with loads required for immediate crutch weight bearing.

Methods: We created a comminuted, extra-articular fracture in 7 cadaveric radii, which were fixed using dorsal bridge plates.

Nuances of Radiographic Assessment of Distal Radius Fractures to Avoid Missed Fragments.

Distal radius fractures, like many articular and periarticular fractures, can make it difficult to determine the true number, location, and orientation of fracture fragments. This article should help the reader work through imaging interpretation starting from the initial, often displaced radiographs to postreduction imaging and determination if further 3-dimensional imaging is necessary.

"Stress taper" fixation increases torsional failure strength in a cadaveric femur model.

Background: To potentially limit peri-implant fractures our institution commonly implements a "stress-taper" fixation construct in which the screw lengths towards the proximal end of a construct are incrementally decreased, in order to avoid a focal stress-riser when loaded. To assess this construct, we asked: 1) Does the stress taper strategy increase torsional strength than the bicortical locking construct when biomechanically tested in a cadaveric femur model? 2) Does it fail in a less comminuted fracture pattern?

Methods: Seven matched pairs of cadaveric femora were randomly assigned to one of two distal femur fixation groups: plating with stress taper strategy or bicortical fixation. Specimens were first cyclically loaded, then axially rotated to failure under 800 N of compression.

Modifying the RAPT Score to Reflect Discharge Destination in Current Practice.

Background: The Risk Assessment Prediction Tool (RAPT) is a validated 6-question survey designed to predict primary total joint arthroplasty (TJA) patients' discharge disposition. It is scored from 1 to 12 with patients stratified into high-, intermediate-, and low-risk groups. Given recent advancements in rapid-discharge protocols and increasing utilization of home services, the RAPT score may require modified scoring cutoffs.

Management of Post-Amputation Pain.

Introduction: The prevalence of amputation and post-amputation pain (PAP) is rising. There are two main types of PAP: residual limb pain (RLP) and phantom limb pain (PLP), with an estimated 95% of people with amputations experiencing one or both. Medical Management: The majority of chronic PAP is due to phantom limb pain, which is neurogenic in nature.

Shoulder and elbow injuries in NCAA football players, 2009-2010 through 2013-2014.

: Although football is one of the most popular collegiate sports, the epidemiology of and risk factors for shoulder and elbow injuries in this population not been recently described. We aimed to characterize this incidence in National Collegiate Athletic Association (NCAA) football players, determine risk factors, and establish outcomes after injury. : All shoulder and elbow injuries in men's football occurring during the 2009-2010 through 2013-2014 academic years were retrospectively identified in the NCAA Injury Surveillance Program database.

Evidence-based update on the surgical treatment of pediatric tibial shaft fractures.

Purpose Of Review: To describe surgical treatment options for pediatric tibial shaft fractures which are the third most common pediatric long bone fracture. Management of these injuries is dictated by fracture location, fracture pattern, associated injuries, skeletal maturity, and other patient-specific factors. Although most pediatric tibial shaft fractures can be treated nonoperatively, this review provides an update on surgical treatment options when operative intervention is indicated.

Evaluation, Management, and Outcomes of Lunate and Perilunate Dislocations.

Lunate and perilunate dislocations are potentially devastating injuries that are often unrecognized at initial evaluation. Prompt recognition and treatment is necessary to prevent adverse sequelae, including median nerve dysfunction, carpal instability, posttraumatic arthritis, reduced functionality, and avascular necrosis. In patients who are surgical candidates, operative intervention is warranted to restore carpal kinematics and provide optimal outcomes.

Incidence, Timing, and Risk Factors for Secondary Revision After Primary Revision of Traumatic Digit Amputations.

Purpose: Primary revision amputation is the most common treatment method for traumatic digit amputations in the United States. Few studies have reported secondary revision rates after primary revision amputation. The primary aim of our study was to identify risk factors for secondary revision within 1 year of the index procedure.

Shoulder and elbow injuries in soccer goalkeepers versus field players in the National Collegiate Athletic Association, 2009-2010 through 2013-2014.

Objectives: Examination of the incidence of shoulder and elbow injuries in the collegiate soccer player population is limited, as is comparison between goalkeepers and field players. We hypothesized that goalkeepers would have a higher incidence of shoulder and elbow injuries than field players. Furthermore, we sought to determine the incidence of shoulder and elbow injuries among National Collegiate Athletic Association (NCAA) soccer players, and to determine injury risk factors.

Ulnar Collateral Ligament Injuries of the Elbow in the Throwing Athlete.

This article was updated on February 26, 2018, because of a previous error. On pages 1 and 7, in the author byline section, the authors' names that had read "Andrew Harris" and "Brett Owens" now reads "Andrew P. Harris" and "Brett D.

The Trapezium Dislocation: Case Presentation, Review of the Literature, Radiographic Analysis, Proposed Classification, and Treatment.

Background: Trapezium dislocations are rare injuries.

Methods: A PubMed search of the term "trapezium dislocation" was conducted. Publications reporting a complete trapezium dislocation were included in the review.

A Review of Brachial Plexus Birth Palsy: Injury and Rehabilitation.

Brachial plexus injuries during the birthing process can leave infants with upper extremity deficits corresponding to the location of the lesion within the complex plexus anatomy. Manifestations can range from mild injuries with complete resolution to severe and permanent disability. Overall, patients have a high rate of spontaneous recovery (66-92%).