Factors Influencing Surgical Decision Making in Trapeziometacarpal Osteoarthritis.

Purpose: With trapeziometacarpal osteoarthritis (TMC OA), the relationship between disease severity and pretreatment dysfunction, patient expectations, and preferred patient treatment and management remains unclear. This study aimed to assess the association between functional status, pretreatment expectations, and demographic and clinical characteristics of TMC OA patients who decide to undergo operative management.

Methods: Patients diagnosed with TMC OA (n = 96) were administered the Thumb Arthritis Expectations Survey and the Brief Michigan Hand Questionnaire (bMHQ) during their initial office visit.

Technique of Tendon Interposition Arthroplasty for Chronic Volar Dislocation of the Distal Radioulnar Joint.

Volar distal radioulnar joint (DRUJ) dislocations are uncommon wrist injuries. Failed diagnosis or treatment can result in irreversible damage to the articulating surfaces and ultimately lead to chronic degenerative arthritis. When the DRUJ is reducible, and the cartilage is preserved, ligament reconstruction and ulnar osteotomy are surgical options for residual wrist instability or pain.

Micro Screw Fixation for Small Proximal Pole Scaphoid Fractures with Distal Radius Bone Graft.

 Achieving adequate fixation and healing of small proximal pole acute scaphoid fractures can be surgically challenging due to both fragment size and tenuous vascularity.  The purpose of this study was to demonstrate that this injury can be managed successfully with osteosynthesis using a "micro" small diameter compression screw with distal radius bone graft with leading and trailing screw threads less than 2.8 mm.

Cadaveric Testing of a Novel Scapholunate Ligament Reconstruction.

 Existing scapholunate interosseous ligament (SLIL) reconstruction techniques include fixation spanning the radiocarpal joint, which do not reduce the volar aspect of the scapholunate interval and may limit wrist motion.  This study tested the ability of an SLIL reconstruction technique that approximates both the volar and dorsal scapholunate intervals, without spanning the radiocarpal joint, to restore static scapholunate relationships.  Scapholunate interval, scapholunate angle, and radiolunate angle were measured in nine human cadaveric specimens with the SLIL intact, sectioned, and reconstructed.

What Demographic and Clinical Characteristics Correlate With Expectations With Trapeziometacarpal Arthritis?

Background: Pretreatment variables have been shown to be associated with the fulfillment of patient expectations, yet in treating thumb trapeziometacarpal osteoarthritis (OA) it remains unclear how patient expectations correlate with the effectiveness of treatment. An increased understanding of the variables that affect patient expectations enables tailored patient education and patient-provider communication.

Questions/purposes: (1) Is there a correlation between patient demographics and clinical characteristics, and the expectations the patients have when seeking treatment for trapeziometacarpal OA? (2) What factors are independently associated with the total expectations score and frequency of expecting "back to normal" among patients treated for trapeziometacarpal OA?

Methods: Between March 2011 and October 2013, 89 patients of all 96 eligible patients seeking treatment for trapeziometacarpal OA were approached and agreed to participate in this study.

Evaluation of Physical Examination Tests for Thumb Basal Joint Osteoarthritis.

Background: We compare the ability of 3 diagnostic tests to reproduce the pain of basilar joint arthritis (BJA): the grind test, the lever test (grasping the first metacarpal just distal to the basal joint and shucking back and forth in radial and ulnar directions), and the metacarpophalangeal extension test.

Methods: Sixty-two patients with thumb BJA were enrolled. The 3 tests were performed in a random order on both hands of each patient.

Patients With Thumb Carpometacarpal Arthritis Have Quantifiable Characteristic Expectations That Can Be Measured With a Survey.

Background: Although patient expectations associated with major orthopaedic conditions have shown clinically relevant and variable effects on outcomes, expectations associated with thumb carpometacarpal (CMC) arthritis have not been identified, described, or analyzed before, to our knowledge.

Questions/purposes: We asked: (1) Do patients with thumb CMC arthritis express characteristic expectations that are quantifiable and have measurable frequency? (2) Can a survey on expectations developed from patient-derived data quantitate expectations in patients with thumb CMC arthritis?

Methods: The study was a prospective cohort study. The first phase was a 12-month-period involving interviews of 42 patients with thumb CMC arthritis to define their expectations of treatment.

Operative Treatment of Acute Scaphoid Fractures.

Optimal treatment of acute scaphoid fractures is a necessary goal for many reasons. One is that the scaphoid is the most commonly fractured carpal bone. Another is that a missed diagnosis of an acute scaphoid fracture leads to the more challenging situation of a delayed union, non-union and risk for premature radiocarpal arthrosis.

Biomechanical Analysis of Scapholunate Ligament Repair Techniques.

Purpose: To evaluate the biomechanical properties of 3 scapholunate repair techniques.

Methods: In 51 cadavers, the scapholunate ligament was exposed through a dorsal approach, incised at its scaphoid insertion, and repaired using 1 of 3 techniques: 2 single-loaded suture anchors, 2 double-loaded suture anchors, or 2 transosseous sutures. Twenty-four repaired specimens underwent load to failure (LTF) testing using tensile distraction on a servo-hydraulic machine.

Neurotization to innervate the deltoid and biceps: 3 cases.

Purpose: To describe our experience using direct muscle neurotization as a treatment adjunct during delayed surgical reconstruction for traumatic denervation injuries.

Methods: Three patients who had direct muscle neurotization were chosen from a consecutive series of patients undergoing reconstruction for brachial plexus injuries. The cases are presented in detail, including long-term clinical follow-up at 2, 5, and 10 years with accompanying postoperative electrodiagnostic studies.

Features of grade 3 giant cell tumors of the distal radius associated with successful intralesional treatment.

Purpose: The goal of this study was to identify radiographic and anatomic features of Campanacci grade 3 distal radius giant cell tumors that are associated with an acceptable rate of local recurrence after intralesional treatment.

Methods: We retrospectively reviewed 15 grade 3 distal radius giant cell tumors treated with intralesional curettage, cryosurgery, and cementation (CCC) (n = 9) or with wide en bloc excision and reconstruction (WEE) (n = 6). Success was defined as local control after CCC without conversion to wide excision, and as a recurrence rate comparable with rates in the scientific literature.

Extensor tendon centralization at the metacarpophalangeal joint: surgical technique.

Injury to the extensor hood at the level of the dorsal metacarpophalangeal joint with instability and subluxation of the extensor tendon might require surgical treatment after failing conservative methods. Surgical techniques for chronic injuries have used local tissue or nearby tendon slips as grafts for tendon realignment, with or without soft tissue release and imbrication. Here we present a technique that creates a bone tunnel for a graft that is sutured upon itself and effectively creates a new pulley.

Patients with workers' compensation claims have worse outcomes after rotator cuff repair.

Background: Previous studies have demonstrated varying correlations between Workers' Compensation status and the outcome of rotator cuff repair. However, none of those studies have formally accounted for potential confounding factors with multivariable analysis. We hypothesized that patients with Workers' Compensation claims who undergo rotator cuff repair have worse outcomes, even after controlling for confounding factors.

Arthroscopic versus open dorsal ganglion excision: a prospective, randomized comparison of rates of recurrence and of residual pain.

Purpose: The purpose of this study was to compare the postoperative rates of ganglion recurrence between arthroscopic and open techniques of dorsal ganglion (DG) excision.

Methods: A total of 72 patients had either arthroscopic or open excision of a primary, simple DG by 1 of 2 senior hand surgeons. Three prospective postoperative assessments were performed.

Patients' preoperative expectations predict the outcome of rotator cuff repair.

Background: We are not aware of any previous studies of the relationship between patients' expectations regarding rotator cuff repair and the actual outcome. We hypothesized that preoperative expectations are predictive of the outcome of rotator cuff repair.

Methods: One hundred and twenty-five patients who underwent unilateral primary repair of a chronic rotator cuff tear were included in the study.

Rupture of the radial collateral ligament of the index metacarpophalangeal joint: diagnosis and surgical treatment.

Purpose: To report the diagnosis and results of 12 surgically treated cases of isolated radial collateral ligament (RCL) tears of the index finger (IF) metacarpophalangeal (MCP) joint.

Methods: Between 1996 and 2002, there were 12 patients who were diagnosed with a tear of the index RCL based on clinical evaluation, had surgical treatment, and were followed up for a minimum of 23 months. All 12 patients sustained complete, full-thickness tears.

Early outcome of arthroscopic rotator cuff repair: a matched comparison with mini-open rotator cuff repair.

Purpose: The purpose of this study was to compare the early functional outcome of mini-open and arthroscopic rotator cuff repair.

Methods: This was a retrospective study of 128 patients with chronic small- and medium-sized rotator cuff tears who underwent mini-open rotator cuff repair (MRCR) (n=63) or arthroscopic rotator cuff repair (ARCR) (n = 65). Data were collected prospectively at baseline 1 to 2 weeks before surgery and at 3 and 6 months after surgery.

The flexor carpi radialis brevis muscle: an anomalous flexor of the wrist and hand. A case report.

The incidental finding of an aberrant wrist flexor is reported. This anomalous muscle was identified during surgical reconstruction for a distal radius fracture malunion. Distal and proximal dissection showed an independent, well-formed muscle belly with no interconnections to adjacent structures.

Effect of medical comorbidity on self-assessed pain, function, and general health status after rotator cuff repair.

Background: In a previous study, we found that medical comorbidities have a negative effect on preoperative pain, function, and general health status in patients with a chronic rotator cuff tear. In this study, we evaluated the relationship between medical comorbidities and the postoperative outcome of rotator cuff repair.

Methods: One hundred and twenty-five patients were evaluated on the basis of a history (including medical comorbidities) and use of outcome tools preoperatively and at one year after rotator cuff repair.

The effect of comorbidity on self-assessed function in patients with a chronic rotator cuff tear.

Background: The results of preoperative assessment of factors that might affect the outcome of orthopaedic surgery have rarely been studied. In this study, we evaluated the relationship between the number of medical comorbidities and the preoperative performance on outcome assessment tools in patients with a chronic rotator cuff tear.

Methods: One-hundred and ninety-nine patients (206 shoulders) with a chronic rotator cuff tear who were treated with surgery were evaluated preoperatively with a detailed history (including medical comorbidities), physical examination, and the following outcome instruments: (1) the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, (2) the Simple Shoulder Test, (3) visual analog scales (pain, function, and quality of life), and (4) the Short Form-36 (SF-36).