Intraoperative Challenges in Hand Surgery.

A wide array of intraoperative issues can arise during surgery involving the hand and upper extremity. An understanding of the common pitfalls within hand surgery may help practicing hand surgeons circumvent such issues. Within this manuscript, we first identify problems with the increasingly popular technique of wide-awake local anesthesia no tourniquet (WALANT).

Intramedullary Threaded Nail Fixation Versus Plate and Screw Construct in Metacarpal Neck Fractures: A Biomechanical Study.

Background: Indicated surgical management of metacarpal neck fractures varies with techniques, including Kirschner wire fixation, plate fixation, intramedullary fixation, and headless compression screw fixation, without demonstrated superiority. This study compares intramedullary threaded nail (ITN) fixation with a locking plate construct.

Methods: Index through small finger metacarpals were harvested from 10 embalmed cadavers.

Quantifying the Impact of COVID-19 on Hand and Wrist Surgery Procedural Volume: A National Analysis of 381,046 Cases.

Purpose: To quantify and describe the impact of the COVID-19 pandemic on procedural volume trends in hand and wrist surgery from 2020 to early 2022 at multiple centers.

Methods: In this retrospective comparative study, a real-time, national, federated research database was used to identify patients of interest from 56 health care organizations across the United States. Patients were queried from March 1, 2018, to February 28, 2022.

Is Grit Associated with Burnout and Well-being in Orthopaedic Resident and Faculty Physicians? A Multi-institution Longitudinal Study Across Training Levels.

Background: Grit has been defined as "perseverance and passion for long-term goals" and is characterized by maintaining focus and motivation toward a challenging ambition despite setbacks. There are limited data on the impact of grit on burnout and psychologic well-being in orthopaedic surgery, as well as on which factors may be associated with these variables.

Questions/purposes: (1) Is grit inversely correlated with burnout in orthopaedic resident and faculty physicians? (2) Is grit positively correlated with psychologic well-being in orthopaedic resident and faculty physicians? (3) Which demographic characteristics are associated with grit in orthopaedic resident and faculty physicians? (4) Which demographic characteristics are associated with burnout and psychologic well-being in orthopaedic resident and faculty physicians?

Methods: This study was an institutional review board-approved interim analysis from the first year of a 5-year longitudinal study of grit, burnout, and psychologic well-being in order to assess baseline relationships between these variables before analyzing how they may change over time.

Biomechanical Strength of Scaphoid Partial Unions.

 It remains unknown how much force a partially united scaphoid can sustain without refracturing. This is critical in determining when to discontinue immobilization in active individuals.  The purpose of this study was to test the biomechanical strength of simulated partially united scaphoids.

Charcot shoulder and elbow: a review of the literature and update on treatment.

Charcot arthropathy of the shoulder and elbow is a rare disease process initially described in the 1700s; however, it was not until the 19th century that physicians understood its association with other disease processes such as cervical spine pathology and diabetes. A primary complaint is painful or painless joint dysfunction, meaning the orthopedic surgeon is regularly the first physician to evaluate the patient. Frequently, the condition of these patients is misdiagnosed.

Can facet joint fluid on MRI and dynamic instability be a predictor of improvement in back pain following lumbar fusion for degenerative spondylolisthesis?

Purpose: To investigate the relationship between lumbar facet fluid and dynamic instability in degenerative spondylolisthesis (DS), as well as the relationship between facet fluid and patient-reported outcomes following a posterior lumbar fusion.

Methods: We analyzed consecutive patients with degenerative spondylolisthesis undergoing single level posterior lumbar fusion from December 2010 to January 2013 at a single academic institution. We investigated the relationship between fluid in the facet joint as measured on axial MRI and the presence of dynamic instability.

Intramedullary Nailing Compared with Spica Casts for Isolated Femoral Fractures in Four and Five-Year-Old Children.

Background: Flexible intramedullary nailing (IMN) is a valuable tool in the treatment of femoral fractures in school-age children, whereas spica cast immobilization has been the standard of care for younger children. We compared these treatment modalities in a group of preschool-age children (four to five years of age).

Methods: A retrospective cohort of consecutive patients, four to five years of age, with an isolated, complete femoral shaft or subtrochanteric fracture treated with intramedullary nailing or early spica cast immobilization and followed until fracture-healing were identified from two centers.

Incidence and reasons for hardware removal following operative fixation of distal radius fractures.

Purpose: To determine the incidence and reasons for hardware removal after operative fixation of distal radius fractures.

Methods: We retrospectively reviewed 33 patients who underwent removal of a volar distal radius plate from 2007 to 2013. We recorded the primary reason for plate removal, patient sex, body mass index, AO fracture type, and plate manufacturer.

Olecranon fractures: factors influencing re-operation.

Purpose: We evaluated factors influencing re-operation in tension band and plating of isolated olecranon fractures.

Methods: Four hundred eighty-nine patients with isolated olecranon fractures who underwent tension band (TB) or open reduction internal fixation (ORIF) from 2003 to 2013 were identified at an urban level 1 trauma centre. Medical records were reviewed for patient information and complications, including infection, nonunion, malunion, loss of function or hardware complication requiring an unplanned surgical intervention.

Flexor tendon repair rehabilitation protocols: a systematic review.

Purpose: To systematically review various flexor tendon rehabilitation protocols and to contrast those using early passive versus early active range of motion.

Methods: We searched PubMed and Cochrane Library databases to identify articles involving flexor tendon injury, repair, and rehabilitation protocols. All zones of injury were included.

Upper extremity myonecrosis caused by Edwardsiella tarda resulting in transhumeral amputation: case report.

Necrotizing soft tissue infections are rapidly progressive infections with a high rate of mortality. One type of necrotizing soft tissue infection is caused by marine gram-negative bacteria and commonly occurs in immunocompromised hosts. These types of infections are more common in patients with chronic liver disease, possibly because of impaired iron metabolism.

Mitochondrial permeability transition in liver ischemia and reperfusion: role of c-Jun N-terminal kinase 2.

The mitochondrial permeability transition (MPT) mediates hepatic necrosis after ischemia and reperfusion (I/R). Here, we studied the role of c-Jun N-terminal kinase 2 (JNK2) in MPT-induced liver injury. Wildtype (WT) and JNK2 knockout (KO) mice underwent 70% liver ischemia for 1 hr followed by reperfusion for 8 hr, after which hepatocyte injury and animal survival was assessed.