Prevalence and Subtypes of Tenosynovial Amyloid in Patients Undergoing Carpal Tunnel Release.

Purpose: The purpose of this study was to determine the prevalence and subtypes of amyloid in tenosynovial biopsies of patients undergoing carpal tunnel release (CTR).

Methods: A retrospective review was performed involving patients who underwent CTR from June 2020 to July 2021. Prior to this period, a protocol had been established to obtain routine intraoperative tenosynovial biopsies.

High-Resolution Ultrasound in the Diagnosis and Surgical Management of Ulnar Neuropathy at the Elbow.

High-resolution ultrasound (HRU) has recently demonstrated the potential to facilitate diagnosis and treatment of upper extremity compression neuropathy. The authors hypothesized that HRU can improve preoperative evaluation of ulnar neuropathy at the elbow (UNE) and that changes in ulnar nerve cross-sectional area (CSA) after cubital tunnel release may correlate with outcomes. Nineteen adult patients diagnosed with UNE who were scheduled for surgical decompression by a single hand surgeon were enrolled.

Ultrasound of the Median Nerve in the Surgical Treatment of Severe Carpal Tunnel Syndrome.

Background: High-resolution ultrasound (HRU) has demonstrated utility in the diagnosis and treatment of carpal tunnel syndrome (CTS) by measuring the cross-sectional area (CSA) of the median nerve. We investigated whether HRU could be helpful in evaluating outcomes of carpal tunnel release in patients with severe CTS.

Methods: Patients greater than 18 years of age with severe CTS on electrodiagnostic (EDX) studies and scheduled to have carpal tunnel release were enrolled.

Prospective Evaluation of an Opioid Reduction Protocol in Hand Surgery.

Purpose: We investigated whether written guidelines for surgeons and educational handouts for patients regarding safe and effective opioid use after hand surgery could reduce prescription sizes while achieving high patient satisfaction and a low refill rate.

Methods: All patients undergoing isolated carpal tunnel release or distal radius volar locked plating in a hand surgery group practice during a 6-month period were prospectively enrolled. Surgeons prescribed analgesics at their own discretion based on written guidelines.

Chronic Exertional Compartment Syndrome of the Hand: Case Report and Literature Review.

Background: Chronic exertional compartment syndrome (CECS) is characterized by activity-induced pain, swelling, and decreased muscle function due to increased pressure and decreased circulation within a confined muscle compartment. Although well-known to occur in the leg, involvement of the hand has rarely been reported in the literature.

Methods: We present a 44 year old male with CECS involving bilateral thenar and hypothenar compartments.

Radiographic and Clinical Analysis of Lateral Epicondylitis.

Purpose: The literature suggests that radiographs may be unnecessary in the initial evaluation of lateral epicondylitis because treatment is rarely altered as a result of the radiographic findings. The most commonly reported radiographic finding is calcification at the lateral epicondyle. Our goal was to perform a quantitative and qualitative analysis of this finding to determine its importance and possible relationship with various clinical factors and patient-reported measures.

Metacarpal fractures in the athlete.

To describe current evaluation and treatment of metacarpal fractures in athletes RECENT FINDINGS: Biomechanical and clinical studies involving lower-profile, locking, shorter length, and double-row or separate-dual plate configurations, as well as intramedullary screw fixation, have demonstrated the potential benefits of internal fixation with promising results. Treatment should be customized to the specific athlete and injury, and is often successful without surgery, or with percutaneous pin fixation. Internal fixation of metacarpal fractures has improved with new hardware and new techniques, and may expedite return to play, although further clinical studies are needed.

Scapholunate instability after distal radius volar plating.

Background: Prior to volar locked plating and early motion protocols, ligamentous injuries incidentally associated with distal radius fractures may have been indirectly treated with immobilization. Our goal was to determine the prevalence of scapholunate instability in our population, while identifying those who may have had progression of instability.

Methods: We retrospectively reviewed 221 distal radius fractures treated with a volar locking plate during a 6-year period.

Risk factors for complications of open trigger finger release.

Background: Open trigger finger release is generally considered a simple low-risk procedure. Reported complication rates vary widely from 1 to 43 %, mostly based on small studies. Our goal was to determine the incidence of complications in a large consecutive series, while also identifying potential risk factors.

Thumb proximal phalanx reconstruction with nonvascularized corticocancellous olecranon bone graft.

Large segmental bone defects of the phalanges reportedly have been treated with free vascularized grafts from the hand, foot, or knee, or with nonvascularized grafts from the iliac crest. A nonvascularized structural corticocancellous graft from a local site would be advantageous. The olecranon has been used as a source of both cancellous and corticocancellous graft.

Long-term results of bone-retinaculum-bone autograft for scapholunate instability.

Purpose: To report long-term follow-up of scapholunate interosseous ligament reconstruction with bone-retinaculum-bone autograft in patients with dynamic scapholunate instability.

Methods: Of the 14 patients from the previously reported cohort who had bone-retinaculum-bone autograft for dynamic instability, 6 returned for clinical examination and radiographs, 3 were reached by telephone, and 2 were lost to follow-up. The remaining 3 had salvage procedures (2 total wrist arthrodeses and 1 proximal row carpectomy) between the prior report and the current study and thus reached an endpoint, at 2 to 4 years.

Volar locking plate implant prominence and flexor tendon rupture.

Background: Flexor tendon injury is a recognized complication of volar plate fixation of distal radial fractures. A suspected contributing factor is implant prominence at the watershed line, where the flexor tendons lie closest to the plate.

Methods: Two parallel series of patients who underwent volar locked plating of distal radial fractures from 2005 to 2008 and with at least six months of follow-up were retrospectively reviewed.

Fracture of the distal radius: risk factors for complications after locked volar plate fixation.

Purpose: To identify risk factors for complications after volar locking plate fixation of distal radius fractures.

Methods: We assessed early postoperative complications in 594 patients with fracture of the distal radius repaired with a volar locking plate and a minimum 1-month evaluation in the medical record. Later complications were assessed among 321 patients as a subset of the original cohort with a minimum 6 months' evaluation.

Ring and little finger metacarpal fractures: mechanisms, locations, and radiographic parameters.

Purpose: To describe a series of ring and little finger metacarpal fractures with regard to mechanism, location, midshaft diameter, and isthmus diameter, to better define injury patterns and assist the surgeon in selection of appropriately sized implants.

Methods: We reviewed all metacarpal fractures in skeletally mature patients who presented to a single surgeon over a 2-year period. Fractures of the ring and little finger metacarpals were analyzed with regard to mechanism and fracture location.

Acute contaminated open forearm fractures treated with VersaJet Hydrosurgical Débridement.

The ideal method of irrigation and débridement for severe extremity wounds has yet to be determined. This report demonstrates the use of hydrosurgical débridement in the treatment of highly contaminated acute forearm fractures in a 22-year-old man ejected during a motor vehicle crash in a farm area. The result was rapid, selective, and effective débridement of deeply embedded material, which allowed for expeditious reconstruction with internal fixation, tendon transfers, and groin flap coverage while avoiding infection and injury to vital structures.

Neurofibromatosis contributing to carpometacarpal instability.

Neurofibromatosis is well known to orthopedic surgeons for causing spinal curvature and tibial bowing. However, skeletal abnormalities of the hand related to this condition have rarely been reported. We present a unique case of neurofibromatosis causing bony changes possibly contributing to carpometacarpal instability.

Fluoroscopic evaluation of intra-articular screw placement during locked volar plating of the distal radius: a cadaveric study.

Purpose: To evaluate specific fluoroscopic views for assessment of intra-articular screw placement during locked volar plating of the distal radius.

Methods: The distal radius of a cadaver forearm was plated with a fixed-angle volar plate according to the surgical technique guide of the manufacturer. A goniometer was used to place the specimen at various described angles in the fluoroscope including standard posteroanterior (PA), tilt PA (11 degrees ), standard lateral, and tilt lateral (15 degrees , 23 degrees , 30 degrees ) views.

Ulnar nerve palsy associated with fracture of the distal radius.

Objective: To describe the clinical features and outcome of a series of patients with complete motor and sensory ulnar nerve palsy associated with a fracture of the distal radius.

Design: Retrospective case series.

Setting: Level 1 trauma center.

Arthroscopic distal clavicle resection: a comparison of bursal and direct approaches.

Purpose: To test the hypothesis that the direct (superior) approach to arthroscopic distal clavicle resection is as safe and effective as the bursal (subacromial) approach.

Methods: All patients who had an arthroscopic distal clavicle resection in our institution between 1994 and 2002 were reviewed. Patients with a history of acromioclavicular joint (ACJ) instability, previous shoulder surgery, glenohumeral pathology, full-thickness rotator cuff tear, or other significant orthopaedic comorbidity were excluded.

Radiofrequency ablation of osteoid osteoma in the upper extremity.

Purpose: To examine the results of radiofrequency ablation (RFA) of osteoid osteoma in the upper extremity.

Methods: Twenty-nine patients with a clinical and radiographic diagnosis of an upper-extremity osteoid osteoma were referred for treatment between 1990 and 2003. All had computed tomography-guided percutaneous RFA performed by the senior investigator.

Dislocation after total hip arthroplasty.

Dislocation is one of the most common complications after total hip arthroplasty (THA). Risk factors include neuromuscular and cognitive disorders, patient non-compliance, and previous hip surgery. Surgical considerations that must be addressed include approach, soft-tissue tension, component positioning, impingement, head size, acetabular liner profile, and surgeon experience.