Top No-Nonsense Tips: The Dos and Don'ts of Managing Flexor Tendon Injuries.

Flexor tendon injury surgical repairs can be challenging for surgeons, where the timing of surgery and precision of repair matter the most. The latest evidence and basic science discoveries in flexor tendon management are provided. It is important to review how wide-awake local anesthesia no tourniquet surgery has been a paradigm shift in surgical management and pearls learned from incorporating this into practice.

Dupuytren Disease: Surgical Tips, Optimizing Outcomes, and Cost Considerations.

Dupuytren disease is associated with benign fibroproliferative changes to the palmar fascia of the hand sometimes resulting in progressive contractures of the fingers. The earliest descriptions of these contractures date back to the 18th century. Much has been learned about the condition since the clawing condition was first described; however, optimal treatment still poses significant challenges to modern-day surgeons.

Rare Presentation of Pediatric Multiple Enchondromatosis Limited to Single Ray or Single Nerve Distribution in the Hand: A Multicenter Case Series.

Background: Multiple enchondromas in the pediatric hand is a relatively rare occurrence and the literature regarding its incidence and treatment is sparse. Within this rare subset of patients, we identified a unique cohort in which lesions are confined to multiple bones in a single ray or adjacent rays within a single nerve distribution. We review the clinical and pathologic characteristics and describe the indications for and outcomes of treatment in this unique subset of patients as well as offer conjectures about its occurrence.

Nonoperative Management of Carpometacarpal Joint Arthritis.

Thumb arthritis frequently is managed nonoperatively with activity modification, orthotic use, anti-inflammatory medications (oral and/or topical), and intra-articular injections. This article reviews the current literature and touches on novel modalities and future directions in the conservative treatment of thumb arthritis.

Morphology at the Distal Radioulnar Joint: Identifying the Prevalence of Reverse Obliquity.

 Recent advances in the understanding of ulnar-sided wrist pathologies such as ulnar abutment syndrome (UAS) have brought increased attention to the anatomy of the distal radioulnar joint (DRUJ). Previous work established three anatomical variants of the sigmoid notch (parallel, oblique, and reverse oblique). The reverse oblique DRUJ poses theoretical risk of increased contact forces following ulnar shortening osteotomy, a common method of treating UAS.

Dreaded Ulnar Wrist Pain: Long-Term Results of Pisiformectomy for Painful Pisotriquetral Arthrosis.

Pisiform pathology may be a source of ulnar-sided wrist pain. This study reviews the long-term outcomes of patients treated with pisiformectomy. A retrospective study approved by the institutional review board was performed over a 27-year period of patients undergoing pisiformectomy.

Role of First Metacarpal Osteotomy in the Management of Basilar Thumb Arthritis.

This study reviews outcomes of patients undergoing Wilson extension osteotomy of the first metacarpal for treatment of carpometacarpal (CMC) joint pain and deformity. The study reviews varied indications for Wilson osteotomy outlining technique and functional outcomes. Twelve patients (11 female, 1 male) with an average age at surgery of 50 (range, 25-67) underwent osteotomy during the study period.

Buying Time: Long-Term Results of Wrist Denervation and Time to Repeat Surgery.

This study reviews long-term outcomes of partial wrist denervation focusing on need for and time to revision procedure. A retrospective study was conducted of all patients undergoing partial wrist denervation between 1994 and 2014. At average latest follow-up of 6.

Flexor Digitorum Superficialis Tenodesis for Traumatic Digit Amputation at the Level of the Proximal Phalanx.

Background: Traumatic amputation of the digit requiring revision amputation at the level of the proximal phalanx provides the opportunity to improve flexor function via tenodesis of the remaining flexor digitorum superficialis (FDS) tendon. Salvage of the remaining FDS and performing flexor tenodesis to the proximal phalanx allows increased flexion at the metacarpophalangeal (MCP) joint.

Methods: This series reviews FDS tenodesis, outlining its surgical technique with clinical and functional outcomes.

A Rare Diagnosis: Recognizing and Managing Fungal Tenosynovitis of the Hand and Upper Extremity.

Purpose: Fungal infections involving the tenosynovium of the upper extremity are uncommon and are often misdiagnosed. This study evaluates the epidemiology, diagnosis, treatment, and outcomes of patients with fungal tenosynovitis of the upper extremity over a 20-year period.

Methods: A retrospective review of all culture-confirmed cases of fungal tenosynovitis of the upper extremity treated between 1990 and 2013 at a single institution was performed.

Stabilization of Volar Ulnar Rim Fractures of the Distal Radius: Current Techniques and Review of the Literature.

Background Distal radius fractures involving the lunate facet can be challenging to manage. Reports have shown the volar carpal subluxation/dislocation that can occur if the facet is not appropriately stabilized. Literature Review Recent emphasis in the literature has underscored the difficulty in managing this fracture fragment, suggesting standard volar plates may not be able to adequately stabilize the fragment.

Volar Marginal Rim Fracture Fixation With Volar Fragment-Specific Hook Plate Fixation.

Purpose: To review the outcomes of patients treated with a volar hook plate specifically designed to capture volar marginal rim fractures.

Methods: A retrospective study was performed over 18 months of patients treated with a volar hook plate in the management of AO type B or C distal radius fractures with a volar marginal rim fragment. Clinical and radiographic outcomes were evaluated.