A novel classification of intraoperative ulnar nerve instability to aid transposition surgery.

Hypothesis: The purpose of this study was to compare inter- and intraobserver agreement of a novel intraoperative subluxation classification for patients undergoing ulnar nerve surgery at the elbow. We hypothesize there will be strong inter- and intraobserver agreement of the 4-category classification system, and reviewers will have substantial confidence while reviewing the classification system.

Methods: Four blinded fellowship-trained orthopedic hand surgeons reviewed 25 videos in total on 2 separate viewings, 21 days apart.

Proximity of the Ulnar Neurovascular Structures in Endoscopic Carpal Tunnel Release Surgery: A Cadaveric Study.

Purpose: To evaluate the proximity of the ulnar neurovascular structures to the endoscopic blade during endoscopic carpal tunnel release (CTR).

Methods: Ten fresh-frozen cadaver hands were used to perform endoscopic CTR using devices from two manufacturers. The skin was excised from the palm, and the endoscopic carpal tunnel blade was deployed at the distal edge of the transverse carpal ligament (TCL).

Anatomic Relationship of Hand Intrinsic Tendons at the Metacarpal Head as It Relates to the Diagnosis of Saddle Syndrome: A Cadaveric Study.

Purpose: The purpose of this cadaveric study was to investigate the intrinsic anatomy surrounding the metacarpal head and the relationship between the interosseous-lumbrical junction (ILJ) and transverse metacarpal ligament (TML) as it pertains to saddle deformity-posttraumatic adhesions at the ILJ that cause impingement during intrinsic activation.

Methods: Ten fresh frozen cadaveric arms underwent dissections, identifying the intrinsic musculature within the second through fourth webspaces. The TML and ILJ, or "true tendon," were identified.

Reliability of Routine Radiographs for Conservatively Treated Metacarpal Shaft and Neck Fractures.

Background: To investigate the reliability of orthopedic hand surgeons to evaluate radiographic healing in initial and follow-up radiographs of the conservatively treated metacarpal shaft and neck fractures. The rationale for this study was to reduce the rate of unnecessary, routine radiographs when treating metacarpal fractures.

Methods: Forty sets of digital x-rays, twenty at the initial visit and twenty at the 4-week follow-up, were randomly selected and reviewed.

Isolated Nerve Palsy of the Flexor Pollicis Longus After a Radial Shaft Fracture: A Case Report.

We present the case of a patient who developed an isolated palsy of the flexor pollicis longus (FPL) branch of the anterior interosseous nerve (AIN) following a fracture of the right radial shaft. The diagnosis of AIN palsy in this setting is rare, especially involving partial neuropathies of only the FPL branch. Clinical presentation in this scenario can be mistaken for other musculoskeletal pathology, and electrodiagnostic studies can be helpful in confirming the diagnosis.

Benzodiazepines and Related Drugs in Orthopaedics.

➤: Benzodiazepines are among the most commonly prescribed drugs worldwide and are often used as anxiolytics, hypnotics, anticonvulsants, and muscle relaxants.

➤: The risk of dependence on and abuse of these medications has recently gained more attention in light of the current opioid epidemic.

➤: Benzodiazepines can increase the risk of prolonged opioid use and abuse.

Anterior Interosseous Nerve to Ulnar Nerve Transfers: A Systematic Review.

 There has been an increasing utilization of end-to-end (ETE) and reverse "supercharged" end-to-side (SETS) anterior interosseous nerve (AIN) to ulnar nerve transfers (NTs) for treatment of high ulnar nerve injury. This study aimed to review the potential indications for, and outcomes of, ETE and SETS AIN-ulnar NT.  A literature review was performed, and 10 articles with 156 patients who had sufficient follow-up to evaluate functional outcomes were included.

Surgical Outcomes Following Fixation of Peri-Implant Distal Radius Fractures: A Case Series.

Purpose: The purpose of this study was to evaluate surgical outcomes following fixation of peri-implant distal radius fractures.

Methods: A retrospective chart review was conducted of peri-implant distal radius fractures treated surgically at a large academic practice over 18 years. Patients were included if they had previously undergone open reduction and internal fixation of a distal radius fracture; subsequently sustained a fracture at, or adjacent to, the existing hardware; and then undergone revision fixation with the removal of hardware.

Increasing Multidrug Antibiotic Resistance in MRSA Infections of the Hand: A 10-Year Analysis of Risk Factors.

Methicillin-resistant (MRSA) is the most common pathogen isolated from hand abscesses. The purpose of this study was to understand trends and changes in longitudinal antibiotic resistance profiles and risk factors for these infections to better guide empiric treatment of hand infections. : We performed a retrospective review of culture-positive hand infections over a 10-year period at an urban academic institution from 2005 to 2014.

MRSA Incidence and Antibiotic Trends in Urban Hand Infections: A 10-Year Longitudinal Study.

Methicillin-resistant (MRSA) is the most reported pathogen in hand infections at urban medical centers throughout the country. Antibiotic sensitivity trends are not well known. The purposes of this study were to examine and determine the drug resistance trends for MRSA infections of the hand and to provide recommendations for empiric antibiotic treatment based on sensitivity profiles.

Forearm Compartment Syndrome: Evaluation and Management.

Compartment syndrome of the forearm is uncommon but can have devastating consequences. Compartment syndrome is a result of osseofascial swelling leading to decreased tissue perfusion and tissue necrosis. There are numerous causes of forearm compartment syndrome and high clinical suspicion must be maintained to avoid permanent disability.

Obturator Artery Injury Resulting in Massive Hemorrhage From a Low-Energy Pubic Ramus Fracture.

Pelvic ring fractures are common in the elderly population and are usually a result of low-energy trauma, such as falls from standing. In most cases, low-energy pelvic ring injuries can be treated with appropriate analgesia and early mobilization. Arterial injury resulting in hemodynamic instability from a low-energy pelvic ring injury is rare but, given the poor compliance of vessels in the elderly population, possible.