Comparison of Fusion Rates/Complications Between Different Types of Thumb Metacarpophalangeal Fusion Techniques.

Background: Thumb metacarpophalangeal (MP) fusion is generally successful; however, complications have been reported to occur in 0% to 30% of cases, whereas nonunion rates vary by method but, overall, are reported to occur in 0% to 15% of cases. Many fixation techniques have been described, but there is no consensus on the optimal fusion technique. Our goal was to compare complication and union rates of different thumb MP arthrodesis techniques.

Dorsal Approach for Management of Proximal Interphalangeal Joint Flexion Contracture.

Proximal interphalangeal (PIP) joint contracture is a common, difficult clinical problem that can arise from minor trauma. Management is difficult because outcomes are unpredictable and often poor, due to residual flexion deformities postoperatively. The dorsal approach for flexion contracture of the PIP joint is not discussed in present literature.

Effect of Capitolunate Positioning on Outcomes in Scaphoid Excision and 4-Bone Fusion Patients.

Background: Scaphoid excision and 4-bone fusion (4BF) is a surgical procedure to treat scapholunate advanced collapse. Some surgeons align the lunate over the capitates, whereas others leave the capitate in its uncovered native position. The capitolunate angle may affect long-term outcomes.

A Logistic Regression Analysis of Factors Associated with Guarded Outcome after Carpal Tunnel Release in Symptomatic Carpal Tunnel Syndrome.

Background: The Boston Carpal Tunnel Questionnaire (BCTQ) is a validated measurement tool to assess the severity of carpal tunnel syndrome, and improvements in the BCTQ after carpal tunnel release (CTR) have been demonstrated to influence patient satisfaction. The authors hypothesized that patient-related factors influence response in BCTQ subscales, including the Symptom Severity Scale and the Functional Status Scale, after CTR.

Methods: Patients who underwent surgery with follow-up BCTQ were identified from a prospectively maintained database.

Comparison of Patient-Reported Outcomes With or Without Prophylactic Carpal Tunnel Release After Distal Radius Fracture Stabilization.

Distal radius fractures (DRFs) are frequently complicated by acute carpal tunnel syndrome (CTS), which, if unrecognized, can cause permanent median neuropathy. Some surgeons recommend "prophylactic" carpal tunnel release (CTR) during open reduction and internal fixation (ORIF) of DRF. Patient-reported outcomes (PROs) and safety data regarding prophylactic vs symptomatic CTR strategies during DRF fixation are lacking.

Mesenchymal PLAG1 Tumor With PCMTD1-PLAG1 Fusion in an Infant: A New Type of "Plagoma".

In the past decade, there have been major advances in knowledge related to mesenchymal tumors, and new genetic alterations are being delineated. We report a mesenchymal spindle cell neoplasm harboring a novel gene fusion in an infant. Histopathologically, the neoplasm shared some features with sclerosing perineurioma, but immunohistochemically, EMA was negative, whereas GLUT1, NK1-C3, and BCOR were positive.

Does Patient Sex Affect Ultrasound Cutoff Values for Severity Grading of Carpal Tunnel Syndrome?

Purpose: A growing body of evidence supports ultrasound (US) as an alternative first-line confirmatory test for carpal tunnel syndrome (CTS). Recent studies have demonstrated a correlation of US cross-sectional area with electrodiagnostic (EDX)-determined severity; however, it is unclear whether patient sex affects the cutoff values used for determining severity. The purpose of this study was to determine if patient sex affects US graded severity when using EDX as the reference standard.

Changes in Nerve Conduction Studies After Distal Radius Fracture Fixation Using a Volar Approach and Locked Plate.

Purpose: To determine whether there are changes in nerve conduction studies (NCS) of the median nerve after distal radius fracture (DRF) and to determine how operative fixation through a volar approach with a locking plate contributes to nerve conduction changes. We hypothesized that a considerable percentage of patients would have electrodiagnostic evidence of median neuropathy at the wrist after fracture, but fixation with a volar locked plate would not worsen the electrodiagnostic findings.

Methods: This was a prospective cohort study of 14 neurologically asymptomatic patients who underwent surgical treatment of an isolated DRF using a volar plate.

Accuracy of Surgeon Diagnosis in Predicting Carpal Tunnel Syndrome.

The utility of electrodiagnostic studies (EDX) continues to be a point of debate in the diagnosis of carpal tunnel syndrome (CTS). If surgeons can predict the results of EDX with high accuracy, it may suggest that ordering the test is unnecessary from a diagnostic standpoint. Two surgeons with subspecialty training in hand surgery were asked to classify hands into "definitely having or not having CTS" or into an "unclear category" when presented with patients having a chief complaint of hand paresthesias.

False-Positive Rates for Nerve Conduction Studies and Ultrasound in Patients Without Clinical Signs and Symptoms of Carpal Tunnel Syndrome.

Purpose: The purpose of the study was to determine the rate of false positives for nerve conduction studies (NCSs) and ultrasound (US) in a population without signs and symptoms of carpal tunnel syndrome (CTS) using a CTS-6 score of 0 as the reference standard.

Methods: Patients were included in this study if they were referred for NCSs for a reason other than CTS (cubital tunnel syndrome and/or cervical radiculopathy) and they had a CTS-6 score of 0. An US measurement of the cross-sectional area (CSA) of the median nerve at the level of the carpal tunnel inlet was performed by a certified ultrasound technician.

A Comparison of Barbed Suture Versus Traditional Techniques for Muscle Belly Repair.

Background: The use of barbed sutures in wound closure and tendon repair has been previously been studied with improved results over traditional suture material. We examine the use of barbed suture in muscle belly repair in a custom configuration, comparing it with traditional configurations and a control.

Methods: Twenty-five matched porcine psoas muscles were assigned to 5 different test groups: Mason-Allen with #1 Ethibond, Figure of Eight Allen with #1 Ethibond, Modified Kessler with #1 Ethibond, Custom Configuration with #2 Barbed PDS, Custom Configuration with #1 Ethibond.

Lipofibromatous Hamartoma of the Palmar Cutaneous Branch of the Median Nerve.

Lipofibromatous hamartoma (LFH) is a benign tumor of peripheral nerves, most commonly reported in the median nerve, and often associated with carpal tunnel symptoms. There have been nearly 200 reported cases of LFH in the median nerve, but to the authors' knowledge, this 10-year-old girl represents the first case report involving the palmar cutaneous branch. An excisional biopsy of the mass was performed via a standard midline palmar incision.

Prevalence of Carpal Tunnel Syndrome in a Hand Surgeon's Practice.

Additional methods of diagnosing carpal tunnel syndrome (CTS) are increasingly being investigated, such as ultrasound or diagnostic tools such as carpal tunnel syndrome 6 (CTS-6), and the sensitivity and specificity of these tests are determined by the pretest probably and thereby the prevalence of a condition. It is critical that the prevalence used in these calculations accurately reflects the population undergoing these tests for a true assessment of their quality. Orthopaedic surgeons and, specifically, upper extremity specialists are most often studying these diagnostic methods, and given referral patterns, these physicians likely have a greater prevalence of CTS in their clinics than previously published for only the general population (5%).

Ultrasonography Findings in Severe Carpal Tunnel Syndrome.

Increasing severity of carpal tunnel syndrome (CTS), as graded by nerve conduction studies (NCS), has been demonstrated to predict the speed and completeness of recovery after carpal tunnel release (CTR). The purpose of this study is to compare the cross-sectional area (CSA) of the median nerve in patients with severe and nonsevere CTS as defined by NCS. Ultrasound CSA measurements were taken at the carpal tunnel inlet at the level of the pisiform bone by a hand fellowship-trained orthopedic surgeon.

A Prospective Comparison of Diagnostic Tools for the Diagnosis of Carpal Tunnel Syndrome.

Purpose: Nerve conduction studies (NCS), CTS-6, Wainner, Kamath, and Lo are diagnostic tests that are used to diagnose carpal tunnel syndrome (CTS). To our knowledge, no study has compared the sensitivity and specificity of these 5 tests with one another. The purpose of this study is to compare NCS, CTS-6, Wainner, Kamath, and Lo using clinical diagnosis by a hand fellowship-trained orthopedic surgeon as reference standard.

Prospective Randomized Trial Comparing the Efficacy of Surgical Preparation Solutions in Hand Surgery.

Background: Decontamination of the skin prior to incision is part of the standard of care for any surgical procedure. Previous studies have demonstrated variable efficacy of different surgical preparation solutions based on anatomic location. The purpose of this study is to determine the effectiveness of 3 commonly used surgical preparation solutions in eliminating bacteria from the skin prior to incision for common elective soft tissue hand procedures.

Outcomes Following Radial Head Arthroplasty.

Most current series of radial head arthroplasty include small numbers of patients with short- to medium-term follow-up and significant heterogeneity in patients, treatments, and outcome measures. The purpose of this systematic review was to review outcomes for radial head arthroplasty based on injury chronicity, injury pattern, and type of implant used. The authors systematically searched electronic databases for studies containing radial head arthroplasty or radial head replacement and identified 19 studies for inclusion in the analysis.

A Comparison of Plain Radiographs and Computed Tomography for Determining Canal Diameter of the Distal Phalanx.

Purpose: To compare plain radiographs and computed tomography (CT) when determining the narrowest diameter of the medullary canal of the distal phalanx.

Methods: A database review identified 48 patients (23 male, 25 female) who underwent a CT scan of the hand and plain radiographs of the same hand. Using digital imaging software, the smallest diameter of the medullary canal was measured for each finger (index, middle, ring, little) on CT and on radiographs.

Anatomy of the flexor digitorum profundus insertion.

Purpose: To describe the anatomical insertion of the flexor digitorum profundus (FDP) on the distal phalanx.

Methods: The FDP insertion to the index, middle, ring, and little fingers were dissected in 10 fresh-frozen cadavers. The FDP tendon was dissected off the volar plate, which was elevated from proximal to distal, before the distal phalanx was disarticulated.

Biologic strategies to improve nerve regeneration after peripheral nerve repair.

Background: Peripheral nerve injuries remain a challenging problem for microsurgeons. Direct repair is the gold standard, but often the surgeon is left with a gap that prevents tension-free repair. The use of empty tubes/conduits/allograft has resulted in regeneration of some sensory and motor function, but the results remain suboptimal compared with autograft.

Curvatures of the DIP joints of the hand.

Background: The distal interphalangeal (DIP) joints of the hand are highly susceptible to osteoarthritis and trauma. Surgical treatment options mandate accurate characterization of their osseous anatomy; however, there are few studies that describe this. We describe the curvatures of the DIP joints by measuring the bone morphology using advanced imaging and modeling methods.

Long-term follow-up of first metacarpal extension osteotomy for early CMC arthritis.

Background: The purpose of this study was to evaluate long-term outcomes of first metacarpal extension osteotomy for early trapeziometacarpal arthritis.

Methods: We retrospectively reviewed 13 patients who underwent first metacarpal extension osteotomy at our institution between 1996 and 2005 and obtained subjective and objective outcome data.

Results: Mean follow-up was 9.

The transverse carpal ligament: anatomy and clinical implications.

The anatomical characteristics of the transverse carpal ligament (TCL) have recently been further clarified. Its bony insertion sites proximally to the scaphoid and pisiform are more round, whereas the distal insertion sites to the trapezium and hamate are more oblong, with reproducible areas of insertion. The thickness of the TCL varies along the path of the median nerve, with the thickest portions distal ulnarly and proximal radially.