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.

Factors influencing infection rates after open fractures of the radius and/or ulna.

Purpose: To investigate factors associated with the development of deep infection in patients with open fractures of the radius and/or ulna.

Methods: We retrospectively reviewed 296 open fractures of the radius and/or ulna. Of these patients, 200 had at least 6-month follow-up and were included in this study.

Irreducible posterolateral elbow dislocation.

Elbow dislocations are a high-energy traumatic event resulting in loss of congruence of a stable joint. The majority of elbow dislocations can be reduced by closed means and treated conservatively. We present a case of an irreducible elbow dislocation with reduction blocked by the radial head buttonholed through the lateral ligamentous complex.

Medical malpractice in hand surgery.

The rise in medical malpractice claims over the past few decades has altered physicians' practice patterns and has had a considerable financial impact on the medical community as a whole. While numerous studies have analyzed the content and effect of these claims, only a handful of articles have addressed specifically the issue of medical malpractice in hand surgery. This article outlines the available literature on malpractice in hand surgery, offers guidance to hand surgeons on managing medical malpractice claims, and discusses preventative measures they might take to limit such claims from being filed in the future.

Late repair of combined extensor carpi radialis longus and brevis avulsion fractures.

Concomitant avulsion fractures of the extensor carpi radialis longus and brevis tendons are relatively rare injuries. The usual injury mechanism is forced hyperflexion to an actively extended wrist. No consensus exists regarding the appropriate management of this injury, with some surgeons advocating closed treatment and others favoring operative fixation.

Reliability and accuracy of templating humeral and ulnar components for total elbow arthroplasty.

We conducted a study to examine intraobserver reliability, interobserver reliability, and accuracy of preoperative templating in approximating humeral and ulnar component sizes in total elbow arthroplasty (TEA). Twenty-two patients underwent cemented TEA with 1 of 2 commonly used implants. Four independent reviewers performed templating in 2 separate sessions spaced a minimum of 2 weeks apart.

Rate of clinically significant posttraumatic arthritis after small finger intra-articular carpometacarpal fractures.

Although small finger intra-articular carpometacarpal joint fractures are relatively common hand injuries, few studies in the orthopedic literature report their clinical outcomes. The goal of this study was to analyze the rate of symptomatic posttraumatic arthritis following small finger intra-articular carpometacarpal joint fractures. The authors performed a chart review of 82 consecutive patients with a small finger intra-articular carpometacarpal fractures treated at their institution over a 5-year period.

The most cited articles in hand surgery over the past 20-plus years: a modern-day reading list.

Purpose: To create a current reading list of the hand surgery articles most commonly cited in the last 20-plus years.

Methods: Using the Web of Science Citation Index Search, we searched "hand" and "wrist" in the orthopedic, surgery, and sport sciences research areas. We then reviewed the articles and chose the 50 most commonly cited articles related to hand surgery.

Prevalence of labral tears in the elderly.

Background: The prevalence of SLAP (superior labrum antero-posterior) tears in the general population is not well known. The purpose of this study is to determine the prevalence of SLAP tears in the elderly using a cadaveric population.

Methods: One hundred two embalmed cadaveric shoulders were dissected by a single, experienced orthopaedic shoulder surgeon (D.

Immobilization in supination versus neutral following surgical treatment of Galeazzi fracture-dislocations in adults: case series.

Purpose: The goal of this study was to investigate whether immobilization in supination is necessary to prevent recurrent distal radioulnar joint (DRUJ) instability in patients older than 18 years with a Galeazzi fracture-dislocation and a stable DRUJ following open reduction and internal fixation of the radius.

Methods: We performed a retrospective chart review of 10 consecutive patients who were immobilized in either supination or a neutral position following surgical treatment of a Galeazzi fracture-dislocation in which the DRUJ was noted to be stable immediately after fixation of the radius. Group 1 consisted of 5 patients who were immobilized in supination for a period of 4 weeks, and group 2 consisted of 5 patients who were immobilized in neutral for 2 weeks, followed by functional bracing.

Case report: pseudotendon formation after a type III flexor digitorum profundus avulsion.

Background: Avulsion of the flexor digitorum profundus tendon is a common injury to the hand that virtually always requires surgical repair for restoration of normal finger function.

Case Description: We report a case of a Type III flexor digitorum profundus tendon avulsion in which the patient refused surgery yet attained nearly full active ROM and an excellent functional result via the formation of a pseudotendon, as observed on MRI obtained 2.5 years after the initial injury.

Efficacy of median nerve recurrent branch neurectomy as an adjunct to ulnar motor nerve neurectomy and wrist arthrodesis at the time of superficialis to profundus transfer in prevention of intrinsic spastic thumb-in-palm deformity.

Purpose: The superficialis to profundus (STP) tendon transfer is an effective procedure to correct a spastic clenched fist deformity in a nonfunctional upper extremity. An intrinsic thumb-in-palm (TIP) deformity, caused by increased activity in the adductor pollicis and flexor pollicis brevis muscles, commonly becomes apparent after an STP procedure. The goal of this study was to investigate the efficacy of median nerve recurrent branch neurectomy, done at the time of STP and in concert with an ulnar motor nerve neurectomy and wrist arthrodesis, in the prevention of an intrinsic TIP deformity caused by spastic thenar muscles.

Sporotrichosis of the upper extremity.

This article presents a case of a chronic, nonhealing thumb wound in a patient with diabetes mellitus. A 67-year-old right-hand-dominant man presented with progressive erythema and swelling of the right thumb several months after sustaining a paper cut along the eponychium. The patient had already completed an extensive laboratory evaluation, including bacterial and fungal cultures, as well as a punch biopsy that was inconclusive.

Intraobserver and interobserver agreement in the measurement of displaced humeral medial epicondyle fractures in children.

Background: Fractures of the humeral medial epicondyle occur frequently in children. The decision to pursue operative or nonoperative treatment often hinges on the amount of perceived fracture displacement. This study was performed to assess both intraobserver and interobserver agreement in the measurements of displacement of these fractures on radiographs by orthopaedic surgeons with various levels of training.

Treatment of posterior sternoclavicular dislocation with locking plate osteosynthesis.

Posterior dislocations of the sternoclavicular joint are rare injuries, representing approximately 3% of all major insults to the shoulder girdle. Despite their relative infrequency, they must be diagnosed and treated early because of the proximity of the sternoclavicular joint to sensitive anatomic structures in the superior mediastinum. Physical examination can yield limited findings, and a high index of suspicion is warranted for this injury pattern especially with impingement signs and symptoms: dyspnea, dysphagia, dysphonia, brachial plexus injury, and vascular alterations.

Level of evidence in orthopaedic journals.

Background: The American edition of The Journal of Bone and Joint Surgery (JBJS-A) has included a level-of-evidence rating for each of its clinical scientific papers published since January 2003. The purpose of this study was to assess the type and level of evidence found in nine different orthopaedic journals by applying this level-of-evidence rating system.

Methods: We reviewed all clinical articles published from January through June 2003 in nine orthopaedic journals.