Utility of Routine Blood Cultures for Upper Extremity Abscesses.

Background: Patients with skin and soft tissue infections (SSTIs) are often admitted by the emergency department for intravenous antibiotic therapy and surgical drainage of abscesses if necessary. As part of the initial diagnostic workup, blood cultures are routinely drawn at our institution in patients with SSTIs. This study seeks to identify the utility of performing blood cultures in patients with upper extremity abscesses as it relates to the number of incision and drainage (I&D) procedures performed, patient readmission rates, and length of hospital stay.

Necrotic Upper-Extremity Infections in People Who Inject Drugs: A Case Series.

Purpose: Our institution has noted an increase in severe upper-extremity infections within the last 2 years. These patients have required transhumeral amputation. This case series demonstrates some of the catastrophic outcomes of these infections in people who inject drugs, which has been postulated to be related to the addition of xylazine to injectable drugs in our community.

Larger Perioperative Opioid Prescriptions Lead to Prolonged Opioid Use After Hand and Upper Extremity Surgery: A Multicenter Analysis.

Introduction: The opioid epidemic remains an ongoing public health crisis. The purpose of this study was to investigate whether surgeons' prescribing patterns of the initial postoperative opioid prescription predispose patients to prolonged opioid use after upper extremity surgery.

Methods: This multicenter retrospective study was done at three academic institutions.

The Effect of Preoperative Benzodiazepine Usage on Postoperative Opioid Consumption After Hand Surgery: A Multicenter Analysis.

Background Prescription rates of opioids and benzodiazepines have steadily increased in the last decade with the percentage of prescription opioid overdose deaths involving benzodiazepines more than doubling during that time. Orthopaedic surgery is one of the highest-volume opioid prescribing medical specialties, but the effects of benzodiazepine use on orthopaedic surgery patient outcomes are not well understood. The purpose of the study was to utilize the state Prescription Drug Monitoring Program (PDMP) database to investigate if perioperative benzodiazepine use predisposes patients to prolonged opioid use following hand and upper extremity orthopaedic surgery.

Social Media Use Among Hand Surgeons.

Background: Recently social media use within healthcare has increased significantly. Today, it is common for patients to browse the Internet, including physicians' social media pages, to learn about their medical conditions and search for providers. The purpose of this study is to analyze the use of social media among hand surgeons, and to compare this use between academic and private surgeons.

Multiple Opioid Prescribers During the Perioperative Period Increases Opioid Consumption Following Upper Extremity Surgery: A Multicenter Analysis.

Background Opioid prescribing practices have been an area of interest for orthopedic surgeons in the wake of the opioid epidemic. Previous studies have investigated the effects of a multitude of patient-specific risk factors on prolonged opioid use postoperatively. However, to date, there is a lack of studies examining the effects of multiple prescribers during the perioperative period and their potential contribution to prolonged opioid use postoperatively.

Forearm Fractures: Diagnosis and Contemporary Treatment Strategies.

Diaphyseal forearm fractures represent a spectrum of injury patterns that include isolated radial shaft fractures, isolated ulnar shaft fractures, both-bone forearm fractures, Galeazzi fracture-dislocations, and Monteggia fracture-dislocations. Although less common than distal radius fractures, diaphyseal forearm fractures are still a frequently encountered clinical entity seen by orthopaedic surgeons, both as isolated injuries and in the patient with polytrauma. It is important to review the epidemiology of diaphyseal forearm fractures and the classification systems used to describe them, as well as to discuss the principles of the initial evaluation and management of these fractures.

Repeat Irrigation and Debridement of Upper Extremity Infections: Do Repeat Cultures Change Antibiotic Treatment Regimens?

Background: Organism identification and their antibiotic sensitivity profile are critical for the successful treatment of upper extremity infections. Although many infections resolve with antibiotics alone, some require 1 or more surgical procedures in which culture data are obtained. The purpose of this study was to determine whether repeat cultures taken at subsequent irrigation and debridement of upper extremity infections changed antibiotic treatment.

Supernumerary extensor pollicis longus tendon masking an extensor pollicis longus rupture following non-surgical treatment of a distal radius fracture.

Extensor pollicis longus tendon pathology is a recognised complication following non-surgical treatment of non-displaced distal radius fractures. Tendon entrapment typically presents with pain, but preservation of thumb retropulsion during complete rupture results in loss of active thumb retropulsion and tenodesis effect. We present the case of a 52-year-old woman who developed extensor pollicis longus tendon entrapment with full active thumb extension following a non-displaced distal radius fracture.

Complications of Hand Infections.

Although most hand infections can be eradicated by appropriate management with return to normal function, complications are frequently encountered. Common complications include stiffness, osteomyelitis, and large soft tissue defects that require complex wound management. Risk factors for hand infections include an immunocompromised host state, as is the case in patients with diabetes mellitus or human immunodeficiency virus/AIDS, as well as those on immunosuppressive medications for autoimmune disorders or following organ transplantation.

A Clinical Comparison of Triceps-Sparing and Triceps-Detaching Approaches for Revision Total Elbow Arthroplasty.

Purpose: Triceps-sparing (TS) approaches have been reported to provide improved triceps strength, better patient outcomes, and a lower incidence of complications in primary total elbow arthroplasty (TEA). It remains unclear whether the advantages of this approach are similar in the revision setting, especially in cases with prior triceps detachment. The purpose of this study was to compare triceps strength and clinical outcomes between TS and triceps-detaching (TD) approaches in revision TEA.

Obturator Artery Injury Resulting in Massive Hemorrhage From a Low-Energy Pubic Ramus Fracture.

Pelvic ring fractures are common in the elderly population and are usually a result of low-energy trauma, such as falls from standing. In most cases, low-energy pelvic ring injuries can be treated with appropriate analgesia and early mobilization. Arterial injury resulting in hemodynamic instability from a low-energy pelvic ring injury is rare but, given the poor compliance of vessels in the elderly population, possible.

External Rotation Predicts Outcomes After Closed Glenohumeral Joint Reduction With Botulinum Toxin Type A in Brachial Plexus Birth Palsy.

Background: Few studies have investigated outcomes after adjunct botulinum toxin type A (BTX-A) injections into the shoulder internal rotator muscles during shoulder closed reduction and spica cast immobilization in children with brachial plexus birth palsy. The purpose of this study was to report success rates after treatment and identify pretreatment predictors of success.

Methods: Children with brachial plexus birth palsy who underwent closed glenohumeral joint reduction with BTX-A and casting were included.

Application of Tranexamic Acid in Trauma and Orthopedic Surgery.

Tranexamic acid has gained recent interest in orthopedics and trauma surgery because of its demonstrated benefit in several clinical trials. It is inexpensive and effective at reducing blood loss and blood transfusion requirements without a significant increase in morbidity or mortality. The optimal timing, dosing, and route of administration in orthopedics are yet to be elucidated.

Management of Major Traumatic Upper Extremity Amputations.

Traumatic upper extremity amputation is a life-altering event, and recovery of function depends on proper surgical management and postoperative rehabilitation. Many injuries require revision amputation and postoperative prosthesis fitting. Care should be taken to preserve maximal length of the limb and motion of the remaining joints.

Overdiagnosis of pulmonary embolism: evaluation of a hypoxia algorithm designed to avoid this catastrophic problem.

Background: We observed a substantial increase in the incidence of pulmonary embolism (PE) after total joint arthroplasty (TJA) when multidetector computerized tomography (MDCT) replaced ventilation-perfusion (V/Q) scans as the diagnostic modality of choice. We questioned whether this resulted from the detection of clinically unimportant PE with the more sensitive MDCT and in 2007 instituted a hypoxia protocol to enhance the detection of PE.

Questions/purposes: We determined whether this new hypoxia protocol increased the specificity of our workups for suspected clinically important PE in the immediate postoperative period without affecting patient morbidity and mortality.

The rat epididymal transcriptome: comparison of segmental gene expression in the rat and mouse epididymides.

Regional differences along the epididymis are essential for the establishment of the luminal environment required for sperm maturation. In the current study, 19 morphologically distinct segments of the rat epididymis were identified by microdissection. Total RNA was isolated from each segment and subjected to microarray analysis.