Randomized trials evaluating volar locking plates against casting of distal radius fractures are statistically fragile: A systematic review.

Introduction: Despite randomized controlled trials (RCTs) largely supporting volar locking plates (VLPs) for the management of distal radius fractures (DRFs), surgeons often opt for non-invasive interventions such as casting. This study used the fragility index (FI), reverse fragility index (rFI), and fragility quotient (FQ) to assess the statistical robustness of RCTs assessing the efficacy of VLP in DRF management.

Methods: PubMed, Embase, and MEDLINE were queried for RCTs evaluating VLP versus casting for DRFs published from January 1st, 2000-June 30, 2024.

Successful Diagnosis and Treatment of Traumatic Radiocarpal Translocation.

Radiocarpal fracture translocations are uncommon injuries without well-defined treatment. This case report presents a patient with this injury that was treated with repair of the volar and dorsal structures and dynamic external fixation. Eight weeks after the procedure, the external fixation device was unlocked to allow wrist flexion and extension only.

Catheter-Directed Thrombolysis for Acute Digit Ischemia in the Setting of Heterozygous Factor V Leiden Mutation: A Case Report and Review of Literature.

Case: We are reporting the successful treatment of a patient with a heterozygous factor V Leiden mutation who presented with spontaneous thrombotic ischemia of ring and small fingers. Microcatheter-directed administration of thrombolytics at the level of common and proper digital arteries resulted in the salvage of the ring finger to the level of the distal tuft and the entirety of the small finger.

Conclusion: Heterozygous factor V Leiden mutation is an extremely unusual etiology for thrombotic digital ischemia.

Two Cases of Delayed Flexor Tendon Rupture Decades After Reconstruction.

Two patients are presented with late-term ruptures of their flexor tendon grafts 10 and 40 years, respectively, after reconstruction. Both occurred from low-energy mechanisms. Their ruptures were intratendinous and not at the proximal or distal insertions.

Second Harmonic Generation Microscopy as a Novel Intraoperative Assessment of Rat Median Nerve Injury.

Purpose: Nerves that are functionally injured but appear macroscopically intact pose the biggest clinical dilemma. Second Harmonic Generation (SHG) Microscopy may provide a real-time assessment of nerve damage, with the ultimate goal of allowing surgeons to accurately quantify the degree of nerve damage present. The aim of this study was to demonstrate the utility of SHG microscopy to detect nerve damage in vivo in an animal model.

Applications of Vascular Imaging and Interventional Radiology Modalities in the Upper Extremity: A Review.

Hand and upper extremity (HUE) vascular disorders are encountered frequently by hand surgeons in clinical practice. A wide array of imaging and vascular interventional radiology modalities exists for the diagnosis and treatment of HUE vascular disorders, some of which may not be familiar to the HUE surgeons. In this review article, we summarize the vascular imaging and vascular interventional radiology modalities and their relative advantages, disadvantages, and indications with respect to HUE pathology.

Optimizing Volar Tilt Restoration and Plate Position in Distal Radius Fractures.

Purpose: Distal radius fractures are common and often treated surgically with a volar plate. A complication of volar plating includes tendonitis or rupture of the flexor pollicis longus (FPL) tendon. We hypothesize that failure to restore the volar tilt of the distal radius results in increased pressure on the FPL tendon.

Mid-term outcomes after reverse total shoulder arthroplasty with latissimus dorsi transfer.

Background: Reverse total shoulder arthroplasty is a common treatment for patients with rotator cuff arthropathy who have failed a prior rotator cuff repair. Latissimus dorsi transfer can be performed simultaneously to reverse total shoulder arthroplasty for patients with preoperative external rotation deficiency. Current literature is limited with several studies providing functional and pain improvements at short-term follow-up; however, there is a deficit in data regarding mid-term outcomes.

Open Reduction Internal Fixation of Simple Versus Comminuted Radial Head Fractures: Comparison of Clinical Outcomes.

Purpose: Current teaching suggests that modified Mason type III and IV fractures of the radial head involving more than 3 fragments should be treated with radial head arthroplasty. The purpose of this study was to compare the outcome of simple (2 or fewer intra-articular pieces) versus comminuted (3 or more intra-articular pieces) radial head fractures treated with open reduction internal fixation (ORIF).

Methods: This was a retrospective review of 35 patients with modified Mason type III and IV fractures treated with ORIF.

Two Parallel Headless Compression Screws for Scaphoid Fractures: Radiographic Analysis and Preliminary Outcome.

Background: Despite surgical fixation, the scaphoid nonunion rate remains at 3% to 5%. Recent biomechanical studies have demonstrated increased stability with 2-screw constructs. The objective of our study is to determine the preliminary union rate and anatomic feasibility of 2-screw surgical fixation for scaphoid fractures.

The Outcomes of Intra-Articular Distal Humerus Open Reduction and Internal Fixation Using Parallel Precontoured Plates in the Elderly.

Purpose: Inconsistent outcomes have been reported in several prior studies of elderly patients with distal humerus fractures treated with open reduction and internal fixation (ORIF). We evaluated the outcomes of ORIF using modern precontoured plates exclusively in a parallel orientation.

Methods: A retrospective review was performed to identify the patients aged over 65 years who sustained an isolated distal humerus fracture between 2015 and 2019.

An Analysis of Profundus Tendon Repairs After Distal Phalanx Amputation in a Cadaveric Model of Little Finger Superficialis Deficiency.

Purpose: The flexor digitorum superficialis tendon to the little finger (FDS-5) has been observed to have a higher degree of functional and structural variation than the FDS of other digits. FDS-5-deficient individuals necessarily rely on the flexor digitorum profundus tendon to the little finger (FDP-5) for flexion in their little fingers. FDS-5 deficient patients who experience a considerable injury to their FDP-5 are therefore at a risk of losing substantial little finger flexion.

Outcomes of Arthroscopic Elbow Contracture Release: Improvement for Severe Prosupination and Flexion Contracture.

Purpose: The purpose of this study was to investigate outcomes following arthroscopic elbow contracture release to describe the use of arthroscopy for improvement in extension/flexion and pronation/supination arcs of motion at a single institution for degenerative and posttraumatic etiologies.

Methods: Consecutive arthroscopic elbow arthrolysis performed between 2003 and 2015 were retrospectively reviewed. Basic patient demographics, indications for surgery, preoperative and postoperative elbow range of motion, postoperative patient outcome score, and all complications were recorded and analyzed.

Casting Position for Distal Radius Fractures Changes Radiocarpal Joint Forces: A Cadaveric Study.

Purpose: Nonsurgical distal radius fracture treatment requires immobilization and classical teaching suggests varying cast positions. We investigated the effect of cast position on the force and pressure experienced by the articular cartilage in the scaphoid and lunate fossae.

Methods: Ten fresh-frozen cadaveric specimens were used.

[HYPERTENSION IN A PATIENT WITH AN ADEQUATELY TREATED COARCTATION OF THE AORTA - WHAT IS THE REASON FOR UNCONTROLLED HYPERTENSION?].

A 35 year old patient, who had a successful surgical repair of coarctation of the aorta in early childhood, was referred for investigation regarding the cause for resistant hypertension. He underwent a full workup which was negative. Due to elevated renin levels his medications were altered with corresponding normalization of the renin levels.

Solutions for the Unstable and Arthritic Elbow Joint.

An unstable, arthritic elbow presents a therapeutic challenge. Patients may have painful, limited range of motion, often due to trauma or progressive joint destruction from rheumatologic disease. The options for management may be particularly challenging when treating young, active patients.

Betadine-Soaked Alcohol Pad and Rigid Immobilization: An Inexpensive and Effective Method to Diminish Infections With Exposed Kirschner Wires in Hand Fractures.

This study describes a novel method of pin care with a Betadine-soaked alcohol pad in conjunction with immobilization to reduce pin site complications in hand fractures treated with exposed Kirschner wires (K-wires). We conducted a retrospective review of all phalangeal and metacarpal fractures from 2010 to 2016 treated with K-wire fixation, a Betadine-soaked alcohol pad, and immobilization in a well-moulded plaster cast. A total of 155 patients with metacarpal or phalangeal fractures were identified, of which 149 were included with 164 fractures treated with 217 exposed K-wires.

Is Wikipedia a complete and accurate source for musculoskeletal anatomy?

Purpose: Wikipedia is a popular online encyclopedia generating over 5.4 billion visits per month, and it is also a common resource for the general public and professionals for medical information. The goal of this study is to determine the accuracy and completeness of Wikipedia as a resource for musculoskeletal anatomy.

Treatment of Traumatic Elbow Instability With an Internal Joint Stabilizer.

Purpose: Current options for treating elbow instability include bony and/or ligamentous fixation with orthosis or cast immobilization, transarticular cross-pinning, temporary bridge plating, and hinged or rigid external fixation. Our purpose was to evaluate the recently developed internal joint stabilizer (IJS), which acts as an internal external fixator of the elbow. Our primary end point was to assess whether use of the device results in a stable and congruent reduction of the ulnohumeral and radiocapitellar joints in patients with acute or chronic elbow instability as a result of trauma.

Comparative strength of elbow splint designs: a new splint design as a stronger alternative to posterior splints.

Background: Musculoskeletal injuries of the upper extremity are frequently treated with temporary external immobilization. Traditionally, long arm posterior splints have been used to limit flexion/extension of the elbow. However, long arm posterior splints have been observed to fail clinically, necessitating a stronger alternative.

Arthroscopic Treatment of Lateral Elbow Pain Mimicking Lateral Epicondylitis: Long-term Follow-up of a Unique Surgical Protocol.

Hypothesis And/or Background: The failure rate of extensor carpi radialis brevis debridement for refractory lateral epicondylitis is reported around 15%. Our novel arthroscopic treatment is predicated on the hypothesis that lateral epicondylitis is an intra-articular problem related to a variation of the capsule-meniscal anatomy that impinges on the radiocapitellar joint. We report long-term outcomes of 35 patients treated with a novel arthroscopic resection of their capsulosynovial fringe.