Cannabis-Related Disorders Are Associated with Increased Early Postoperative Opioid Prescriptions and Delayed Emergency Department Visits Following Open Carpal Tunnel Release.

Background: The effect of cannabis on pain management following open carpal tunnel release (CTR) surgery is unknown. The purpose of this study is to compare outcomes for patients with cannabis-related disorder (CRD) undergoing open CTR to a propensity-matched cohort of patients without CRD (no cannabis-related disorder [NCRD]).

Methods: The TriNetX Research Network was queried to identify patients undergoing primary open CTR between January 2010 and December 2022.

Brodie's abscess as a late complication of external fixation of the distal radius: A case report.

Case: A 41-year-old male presented with an insidious onset of pain and swelling about the dorsal wrist, and was found to have a Brodie's abscess in the distal radius. The patient had a history of a distal radius fracture, treated with external fixation, nineteen years prior, which we believe contributed to the infection. The patient was treated surgically with abscess irrigation, debridement, bony curettage, bioactive glass S53P4 allograft, with concurrent antibiotic therapy.

Isolated Palsy of the Anterior Interosseous Nerve to Flexor Pollicis Longus, Magnetic Resonance Imaging and Clinical Correlation: A Case Report.

Case: Anterior interosseous nerve (AIN) palsy is an uncommon, though well-described, clinical entity. When isolated to the thumb, it can be confused with atraumatic rupture of the flexor pollicis longus (FPL) tendon. A 57-year-old man experienced atraumatic onset of difficulty flexing the distal interphalangeal thumb joint.

Minimally Invasive Cubital Tunnel Release Utilizing Lighted Retractors: A Study of Residents Novel to this Technique Utilizing a Cadaveric Model.

The purpose of this study was to evaluate whether a minimally-invasive cubital tunnel release using lighted retractors could be performed safely and completely by residents with no prior training in this technique. Ten residents participated in the study. Postoperative dissection of the specimens was performed utilizing a detailed checklist and global rating scale to evaluate the completeness of release as well as presence of neurologic injury.

Zone I Revision Finger Amputations Performed in the Emergency Department Compared With Those Performed in the Operating Room.

Finger amputations are commonly encountered. These may be revised in the emergency department (ED) or the operating room (OR). Previous studies have demonstrated the cost-effectiveness associated with procedures performed in the ED.

Cutaneous Sarcoidosis in Bilateral Carpal Tunnel Release Scars: A Case Report.

Case: A 58-year-old woman with a history of systemic sarcoidosis, 2 years in remission, presented 6 years after bilateral carpal tunnel release with a 3-month history of nodularity, erythema, and tenderness to her bilateral incisions. Histopathology demonstrated noncaseating granulomas without evidence of foreign material or organisms, consistent with infiltrative scar sarcoidosis. Treatment included 4 intralesional corticosteroid injections over 5 months, with progressive resolution of symptoms and no evidence of systemic sarcoidosis reoccurrence.

Post-traumatic Stress Disorder as an Independent Risk Factor for Increased Opioid Use Following Carpal Tunnel Surgery.

Background: Carpal tunnel release (CTR) is one of the most common hand surgeries. Studies have highlighted a mental-physical connection to hand pathologies and psychological connections to postoperative pain burden. Post-traumatic stress disorder (PTSD) has been identified as a medical-psychological comorbidity like other mental health disorders such as generalized anxiety disorder (GAD).

Trapezoid Stress Fracture in an Olympic-Level Gymnast: A Case Report.

Case: A 23-year-old elite-level gymnast presented with insidious-onset pain near the base of the second metacarpal. The patient was found to have a trapezoid stress fracture and was treated nonoperatively in a thumb spica cast for 4 weeks. He resumed gymnastics without limitations 8 weeks from the time of diagnosis.

Reawakening Neuritis of the Median Nerve after Carpal Tunnel Release: Defining and Predicting Patients at Risk.

Background: Patients with long-standing carpal tunnel symptoms may develop transient and, paradoxically, worsened neuropathic pain immediately following release. The authors have termed this "reawakening phenomenon." The purpose of this study was to compare the characteristics of patients with this phenomenon to those with a standard postoperative course.

Osteoid osteoma of the hook of the hamate presenting as ulnar-sided wrist pain: A case report.

Osteoid osteomas are benign, typically intracortical lesions most often affecting the diaphyses of long bones. We describe a case involving a 26-year-old male laborer who presented with the insidious onset of ulnar-sided wrist pain. He was diagnosed with and successfully treated with surgical excision for an osteoid osteoma involving the hook of the hamate.

Biomechanical Stability of Volar Plate Only Versus Addition of Dorsal Ulnar Pin Plate: A Dorsal Ulnar Fragment, C-3-Type, Distal Radius, Cadaver Fracture Model.

Objective: To determine if the addition of a dorsal ulnar pin plate provides improved stability characteristics in the management of intra-articular distal radius fractures with an associated dorsal ulnar fragment.

Methods: OTA/AO type C3 fractures, with a dorsal ulnar fragment of one-third or one-half the width of the distal radius, were simulated in 9 matched pairs of fresh-frozen cadaveric arms randomized between fixed-angle volar plate only versus volar plate with addition of a dorsal ulnar pin plate. Prepared specimens were mounted in a custom load frame and loaded in extension with stepwise cyclic load increase.

Choice of Corticosteroid Solution and Outcome After Injection for Trigger Finger.

Many techniques for injection of trigger fingers exist. The purpose of this study was to determine whether the type of steroid or technique used for trigger finger injection altered clinical outcomes. Six hand surgeons at a single institution were surveyed regarding their injection technique, preferred steroid used, and protocol for repeat injection or indication for surgery for symptomatic trigger finger.

Effect of Metacarpal Fixation Configuration on Strength and Fracture Gap Displacements in a Cadaveric Model of Externally Fixed Distal Radius Fractures.

The purpose of the study was to determine the biomechanical effect of distal pin configuration in unilateral external fixation of distal radius fracture in a cadaveric model. A standardized 2-part extra-articular distal radius fracture model with dorsal comminution was created in 6 matched pairs of cadaveric upper extremities. Specimens within each matched pair were randomly assigned to either 4 or 6 cortices of distal pin metacarpal fixation.

Volar Vascularized Strut Graft for Avascular Scaphoid Nonunion Using the 1,2 Intercompartmental Supraretinacular Artery.

In this retrospective study, we report the preliminary results of a novel technique for volar vascularized strut grafting to treat avascular scaphoid nonunion by using the 1,2 intercompartmental supraretinacular artery through a single incision. Forty-three of 45 patients with avascular scaphoid nonunion healed at a mean of 13 weeks (range, 3 to 10 mo). Complications consisted of 1 pin tract infection that resolved with oral antibiotics and 4 cases of transient dysesthesia of the radial sensory nerve.

Digital Tomography for Detection of Acute Occult Scaphoid Fractures.

Diagnosis of occult scaphoid fractures remains a challenge. Traditional management consisting of 2 weeks of immobilization and repeat radiographs results in unnecessary immobilization of many patients without fracture. Magnetic resonance imaging (MRI) is sensitive but expensive.

Restoring Volar Tilt in AO Type C2 Fractures of the Distal Radius With Unilateral External Fixation.

Purpose: To determine whether unilateral external fixation using a staged multiplanar reduction technique restores anatomic volar tilt in a distal radius fracture model.

Methods: We used radiographic images to obtain baseline measurements in 20 fresh-frozen cadaveric wrists. Through a standard dorsal approach to the radius, we performed osteotomies to simulate displaced AO/ASIF type C2 fractures.

Self-Reported Outcomes for Patients Undergoing Revision Carpal Tunnel Surgery With or Without Hypothenar Fat Pad Transposition.

Background: Carpal tunnel surgery is the most common surgical procedure performed on the hand. Although complications are rare, recurrent or persistent carpal tunnel syndrome can be a significant problem after primary decompression. Various procedures have been described for the treatment of these patients including repeat decompression and hypothenar fat pad transposition.

Muscle Atrophy at Presentation of Cubital Tunnel Syndrome: Demographics and Duration of Symptoms.

The purpose of this study is to describe the demographics and duration of symptoms of patients with cubital tunnel syndrome who present with muscle atrophy. We identified 146 patients who presented to the hand surgery clinic at a single institution over a 5-year period with an initial diagnosis of cubital tunnel syndrome based on history and physical examination. Medical records were retrospectively reviewed to determine if there was a difference in demographic data, physical examination findings, and duration of symptoms in patients who presented with muscle atrophy from those with sensory complaints alone.

Multiplanar wrist joint proprioception: The effect of anesthetic blockade of the posterior interosseous nerve or skin envelope surrounding the joint.

Study Design: Randomized clinical trial.

Purpose: Contribution of the posterior interosseous nerve (PIN) and surrounding skin envelope to wrist proprioception is a topic of debate and the primary focus of this research.

Methods: We performed a double-blinded, placebo control study in which subjects underwent baseline multiplanar testing of wrist proprioception.

The Effect of Closed Reduction of Small Finger Metacarpal Neck Fractures on the Ultimate Angular Deformity.

Purpose: To assess whether or not attempted closed reduction of fifth metacarpal neck fractures results in decreased fracture angulation at final follow-up.

Methods: Retrospective chart review of all patients aged 18 and older managed for isolated fifth metacarpal neck fractures between 2004 and 2014.

Results: Sixty-six patients managed for an isolated boxer fracture met inclusion criteria.

Thumb volar plate reconstruction utilizing extensor pollicis brevis autograft: evaluation of a new technique.

Background: Sagittal plane instability of the thumb metacarpophalangeal joint is a difficult problem with numerous surgical techniques described. The purpose of the study is to demonstrate a technique in which a distally based extensor pollicis brevis tendon autograft is utilized to reconstruct the deficient volar plate.

Methods: This is a retrospective case series of four patients who were followed a minimum of 2 years after this procedure.

Radial collateral ligament injuries of the thumb metacarpophalangeal joint: epidemiology in a military population.

Purpose: The reasons for variation in the reported incidence rates between thumb metacarpophalangeal joint radial collateral ligament (RCL) and ulnar collateral ligament (UCL) injuries are unclear. Delay in diagnosis of injury to the RCL leads to greater time of patient disability. The purpose of this study was to define the demographics and presentation of patients with RCL injuries in a military health care system.

Novel technique for passing tendon grafts through bone tunnels.

Anatomic reconstruction in orthopedic surgery often requires the passage of soft tissue through bone tunnels. Difficulties may arise due to anatomic constraints surrounding the bone tunnels or the graft size. The authors present a novel technique for passing tendon grafts through bone tunnels that is simple, readily available, effective, and comparatively inexpensive.