Hand Surgical Operating Room Size Allocation: A Comparative Space Utilisation Study.

This study evaluated operating room (OR) space required for various hand surgical procedures. We analysed the size requirements for hand surgical cases divided into four settings: (1) large OR setting requiring fluoroscopy and microsurgical equipment, (2) medium-sized OR setting for cases requiring fluoroscopy, (3) smaller OR setting and (4) minor procedural room without anaesthesia with the aim to describe room size requirements for hand surgery practices. A variety of hand surgical cases were selected: large cases (microvascular digit replantation), medium-sized cases (closed reduction percutaneous pinning [CRPP] of phalangeal fractures) and smaller cases (carpal tunnel release [CTR]) with and without anaesthesia.

Management of Xylazine-Induced Soft-Tissue Necrosis: A Review of 20 Cases.

Purpose: The illicit injection of xylazine has recently been designated as an emerging public health threat. The use of this drug is associated with devastating soft-tissue necrosis that may lead to limb amputation. This study aimed to (1) report cases of soft-tissue injury from xylazine and (2) describe a staging and management algorithm for wounds related to xylazine use.

Electric Scooter-related Injuries Are Becoming More Frequent and Costly in Denver, CO.

Background: Electric scooters (e-scooters) have become a widely adopted form of transportation. Information regarding the timing, conditions, and context associated with increased frequency of e-scooter-related injuries could inform policy that may potentially reduce associated injuries and healthcare costs. However, this information is lacking, as most research to date has focused on the injury patterns sustained while using e-scooters rather than context.

Complex Elbow Fracture-Dislocations: An Algorithmic Approach to Treatment.

Elbow stability arises from a combination of bony congruity, static ligamentous and capsular restraints, and dynamic muscular activation. Elbow trauma can disrupt these static and dynamic stabilizers leading to predictable patterns of instability; these patterns are dependent on the mechanism of injury and a progressive failure of anatomic structures. An algorithmic approach to the diagnosis and treatment of complex elbow fracture-dislocation injuries can improve the diagnostic assessment and reconstruction of the bony and ligamentous restraints to restore a stable and functional elbow.

Urinary bladder matrix versus dermal regeneration template for lower extremity wound coverage.

Purpose: To compare dermal regenerative template (DRT), with and without split-thickness skin-grafting (STSG), and urinary bladder matrix (UBM) for coverage of lower extremity wounds.

Methods: A retrospective review of 56 lower extremity wounds treated with either DRT and STSG (DRT-S) (n = 18), DRT only (n = 17), or UBM only (n = 21). Patient characteristics, comorbidities, American Society of Anesthesiology (ASA) classification, injury characteristics, wound characteristics, use of negative pressure wound therapy, surgical details, postoperative care, and failure of primary wound coverage procedure were documented.

Radiocapitellar and Ulnotrochlear Pressures Increase in a Radial Head Fracture Model: A Cadaveric Biomechanical Analysis.

Background: Changes in intra-articular pressure have not been previously described in relation to the management of radial head fractures. We hypothesized that pressure within the radiocapitellar and ulnotrochlear joints would increase with progressive radial head resection, mimicking a displaced radial head fracture, in a cadaveric model.

Methods: Ten cadaveric specimens were tested.

Managing the Extra-Articular Distal Radius Malunion.

Distal radius fractures are common injuries. Satisfactory outcomes are typically achieved with appropriate nonoperative or operative treatment. A proportion of these injuries develop symptomatic malunions, which may be treated surgically with distal radius corrective osteotomy.

Attitudes About the Human Papillomavirus Vaccine Among Patients With and Without Cervical Dysplasia.

Objectives: The aims of the study are to examine the perception of the human papillomavirus (HPV) vaccine among those with and without a history of cervical dysplasia and to examine perceptions of the vaccine for their children.

Materials And Methods: Patients were recruited to complete a survey about the HPV vaccine for both themselves and their children. Patients in a colposcopy clinic with a history of abnormal cervical cytology and patients in a benign gynecology clinic without a history of abnormal cervical cytology were recruited.

Evidence-based postoperative replantation protocols.

Postoperative care is essential to upper extremity replantation success and includes careful and frequent monitoring of the replanted part. During this period, pharmacologic agents such as antithrombotic and anticoagulants may prevent complications such as arterial thrombosis and venous congestion. Dressings and therapy can also impact short- and long-term outcomes following replantation.

Posterolateral Rotatory Instability Develops Following the Modified Kocher Approach and Does Not Resolve Following Interval Repair.

Background: The modified Kocher and extensor digitorum communis (EDC)-splitting intervals are commonly utilized to approach the lateral elbow. Iatrogenic injury to the lateral ulnar collateral ligament may result in posterolateral rotatory instability (PLRI). in the present cadaveric study, we (1) evaluated lateral elbow stability following the use of these approaches and (2) assessed the accuracy of static lateral elbow radiographs as a diagnostic tool for PLRI.

Management of Self-Inflicted Nonaccidental Amputations of the Upper Extremity: Systematic Review.

Purpose: Clinicians assessing patients with deliberate self-inflicted amputations face a problem of whether or not to replant. The objective of this study was to summarize the literature on this topic and provide recommendations regarding the acute management of patients following self-inflicted amputations in the upper extremity.

Methods: Two reviewers searched four databases using the keywords "Upper extremity," "Amputation," and "Self-Inflicted.

Proximal Hamate Reconstruction of Proximal Pole Scaphoid Nonunion: A Case Series and Analysis of Clinical Outcomes.

Background: Small proximal pole scaphoid nonunions present a clinical challenge influenced by fragment size, vascular compromise, deforming forces exerted through the scapholunate interosseous ligament (SLIL), and potential articular fragmentation. Osteochondral autograft options for proximal pole reconstruction include the medial femoral trochlea, costochondral rib, or proximal hamate. This study reports the clinical outcomes of patients treated with proximal hamate osteochondral autograft reconstruction.

The Iatrogenic Injury Potential of Self-adherent, Elastic Bandages in Finger Injuries.

Background: The use of a self-adherent, elastic bandage is a practical way to dress finger injuries. Multiple reports describe iatrogenic injuries from elastic bandages, ranging from skin necrosis to finger gangrene, necessitating amputations. This study investigated whether elastic bandages can compromise digital perfusion by occluding arterial blood flow in healthy volunteers and evaluated the utility of pulse oximetry as a monitoring tool for digital perfusion.

The safety and accuracy of various carpal tunnel injection techniques.

Purpose: Carpal tunnel (CT) syndrome continues to be a commonly treated hand pathology. We aimed to evaluate several CT injection techniques for (1) spatial accuracy within the CT and (2) risk of median nerve (MN) injury. Our purpose was to evaluate for any significant differences in accuracy of needle placement within the carpal tunnel and final distance between the needle tip and the MN with each technique.

Initial Displacement of Humeral Shaft Fractures Is Associated With Failure of Nonoperative Management.

Objectives: To determine whether the initial radiographic displacement of humeral shaft fractures is associated with failure of nonoperative management.

Design: Retrospective cohort study.

Setting: Urban level 1 trauma center.

Ligament-Sparing Volar Radiocarpal Arthrotomy During Distal Radius Fracture Repair: Biomechanical Implications on Wrist Stability in a Cadaveric Model.

Purpose: Distal radius (DR) fracture fixation with volar locked plating typically uses indirect fracture reduction without direct visualization of the articular surface in an attempt to preserve the volar radiocarpal ligaments and prevent iatrogenic radiocarpal instability. This study assessed the biomechanical stability after a volar radiocarpal arthrotomy for direct articular visualization for DR fracture repair compared to a standard trans-flexor carpi radialis approach without arthrotomy in a cadaver model.

Methods: Ten fresh-frozen upper extremity matched-pair cadaveric specimens were tested.

Classification and Radiographic Characterization of Kienböck Disease.

Robert Kienböck described radiographic changes associated with idiopathic lunate osteonecrosis in 1910. The radiographic progression of this eponymous condition has been well-described to progress from normal radiographs, to lunate sclerosis, lunate collapse, proximal capitate migration, scaphoid flexion, and pancarpal arthritis. Diagnosing early stages of the disease without radiographic changes presented a challenge.