Evaluation of panoramic images in the assessment of mandibular second molar impaction.

Background: To examine the relationship of various mandibular skeletal features determined from assessment of a panoramic image to the impaction of mandibular second molars in children with late mixed to early permanent dentition.

Material And Methods: Thirty-six panoramic radiographs were collected from two private orthodontic offices of consecutively screened patients in the late mixed to early permanent dentition. Gonial angle, space ratio, ramus ratio and occlusal plane to posterior ramus ratio were analyzed for any significant relationship with mandibular second molar impaction.

Private Equity: An Emerging Practice Model.

Private equity acquisitions are increasing among orthopedic practices. The concepts and vocabulary surrounding these deals may be foreign to physicians. There are both potential risks and potential benefits to physicians at the center of these complex deals, and a clear understanding of any proposed private equity acquisition is crucial.

Arterial Anatomy of the Posterior Tibial Nerve in the Tarsal Tunnel.

Background: Both vascular and compression etiologies have been proposed as the source of neurologic symptoms in tarsal tunnel syndrome. Advancing the understanding of the arterial anatomy supplying the posterior tibial nerve (PTN) and its branches may provide insight into the cause of tarsal tunnel symptoms. The purpose of this study was to describe the arterial anatomy of the PTN and its branches.

Posttraumatic Boutonnière and Swan Neck Deformities.

Boutonnière and swan neck deformities of the finger can be the result of trauma. The complex anatomy of the extensor mechanism of the finger makes understanding the pathomechanics of these deformities challenging. These posttraumatic deformities should not be confused with those associated with inflammatory arthritis because the treatment options are often very different.

Accuracy of MRI-based Diagnoses for Distal Upper Extremity Soft Tissue Masses.

Unlabelled: To determine the accuracy of the pre-operative MRI-based diagnosis of soft tissue masses in the forearm, wrist, and hand, the records of 144 patients who underwent an MRI followed by excision of a soft tissue mass in the forearm, wrist, or hand were reviewed. The MRI-based diagnosis was compared to the histological diagnosis, which was considered the gold standard. The sensitivity, specificity, positive predictive value, and negative predictive value of the MRI-based diagnosis were calculated.

Arterial anatomy of the tibialis posterior tendon.

Background: Tibialis posterior tendon dysfunction is a common disorder leading to pain, deformity, and disability, although its pathogenesis is unclear. A vascular etiology has been proposed, but there is controversy regarding the existence of a hypovascular region that may render the tendon vulnerable. The purpose of this study was to provide a description of the arterial anatomy supplying the tibialis posterior tendon.

Intraosseous and extraosseous blood supply to the medial cuneiform: implications for dorsal opening wedge plantarflexion osteotomy.

Background: Osteotomies of the medial cuneiform are commonly used to correct forefoot deformity. Bone healing occurs despite periosteal stripping of the dorsal and medial surfaces of this widely articulated bone followed by osteotomy in the midsection of the bone. The objective of this study was to characterize the blood supply of the medial cuneiform.

Ligamentous hyperlaxity and dorsal wrist ganglions.

Purpose: To determine whether symptomatic dorsal wrist ganglions are associated with generalized ligamentous hyperlaxity.

Methods: Ninety-six patients (61 females) presenting to hand surgeons for a symptomatic dorsal wrist ganglions were prospectively enrolled in this case-control investigation. Beighton scores were calculated to quantify generalized ligamentous laxity in each patient, and a scaphoid shift test (scapholunate capsuloligamentous laxity evaluation) was performed.

Ulnar collateral ligament injuries of the thumb: phalangeal translation during valgus stress in human cadavera.

Background: The clinical diagnosis of thumb ulnar collateral ligament disruption has been based on joint angulation during valgus stress testing. This report describes a definitive method of distinguishing between complete and partial ulnar collateral ligament injuries by quantifying translation of the proximal phalanx on the metacarpal head during valgus stress testing.

Methods: Sixty-two cadaveric thumbs underwent standardized valgus stress testing under fluoroscopy with the ulnar collateral ligament intact, following an isolated release of the proper ulnar collateral ligament, and following a combined release of both the proper and the accessory ulnar collateral ligament (complete ulnar collateral ligament release).

The intraosseous and extraosseous vascular supply of the fifth metatarsal: implications for fifth metatarsal osteotomy.

Background: Osteotomies of the fifth metatarsal may disrupt the nutrient artery and result in nonunion. The location of the nutrient artery foramen relative to the location of common osteotomies has not been described. The goal of this study was to describe the vascular supply of the proximal fifth metatarsal, including the artery of origin of the nutrient artery and the location of the nutrient artery foramen.

Intraosseous and extraosseous arterial anatomy of the adult navicular.

Background: The etiology of navicular stress fractures is a topic of interest due to the implications in high-level athletes. Previous studies suggest an avascular zone in the central one-third of the bone as a potential causative factor. This study investigated the extraosseous and intraosseous arterial anatomy of the adult navicular.

Vascular anatomy of the tibiofibular syndesmosis.

Background: Injuries to the tibiofibular syndesmosis commonly cause prolonged ankle pain and disability. Syndesmotic injuries are associated with slower healing rates compared with rates for other ankle ligament injuries and typically result in longer time away from sports. To our knowledge, the vascular supply to the syndesmosis and its clinical implication have not previously been studied.

Stress fracture of the radius diaphysis in a skeletally immature wrestler.

Stress fractures in the forearm are rare events. Failure to detect a nondisplaced stress fracture could lead to further injury or fracture displacement. We present a case of a 15-year-old male wrestler without overt risk factors, who presented with a transverse stress fracture in the middle third of the radial diaphysis.

Immobilization after pinning of supracondylar distal humerus fractures in children: use of the A-frame cast.

Background: Circumferential casts can contribute to elevated compartment pressures in the setting of acute swelling. We have developed a novel casting method (A-frame cast) that allows cast placement while leaving the antecubital fossa free of casting material. The purpose of this study was to evaluate the safety, efficacy, and complications associated with acute placement of this definitive cast after closed reduction percutaneous pinning (CRPP) of acute supracondylar distal humerus fractures.

Dorsal fixation of intra-articular distal radius fractures using 2.4-mm locking plates.

Displaced, unstable intra-articular distal radius fractures are usually treated with reduction and fixation to allow early motion and minimize the potential for development of posttraumatic arthritis. The dorsal surgical approach allows direct visualization of the articular surface to ensure an anatomic reduction. Low profile, locked plates have minimized the unacceptable complication rates previously associated with dorsal plates.

Extra-articular steroid injection: early patient response and the incidence of flare reaction.

Purpose: To evaluate the timing of improvement after extra-articular steroid injection, the incidence of a postinjection pain flare (a delayed postinjection transient increase in pain), and the role of the injection acidity in the postinjection flare.

Methods: One hundred twenty-five patients with trigger finger (88 patients) or de Quervain's tenosynovitis (37 patients) were prospectively randomized in this double-blind study to receive either an injection of steroid, lidocaine, and bupivacaine alone (standard injection, acidic pH) or an injection of steroid, lidocaine, bupivacaine, and bicarbonate (balanced injection, neutral pH). All patients completed a visual analog scale for pain before and immediately after the injection, daily for 7 days, and then again at 6 weeks.

Use of routine histologic evaluation of carpal ganglions.

Purpose: Although histologic evaluation is performed routinely on tissue removed during the excision of carpal ganglions, the necessity of this evaluation is uncertain. We evaluated the use of routine histologic evaluation of excised carpal ganglions and performed a cost-benefit analysis.

Methods: A retrospective review identified 160 consecutive carpal ganglion (102 dorsal, 58 volar) excisions performed over the past 7 years by 2 surgeons.