An Updated Survey of Trends in the Surgical Management of Thumb Carpometacarpal Arthritis - The Increasing Popularity of the Suture Suspension Arthroplasty.

The purpose of this study was to conduct an updated survey of American Society for Surgery of the Hand (ASSH) membership to evaluate current preferences for surgical management of thumb CMC arthritis. Past surveys have demonstrated LRTI to be the most preferred surgical technique. We hypothesised that current surgical preferences for thumb CMC arthritis have changed over the last several years due to rising popularity of high-strength suture implants.

Orthopaedic Urgent Care Versus the Emergency Department: Cost Implications for Low-energy Fracture Care.

Introduction: This study compared costs, length of visit, and utilization trends for patients with fractures seen in an immediate care orthopaedic center (I-Care) versus the emergency department (ED) in a major metropolitan area.

Methods: A retrospective chart review of consecutive patients seen on an outpatient basis in the ED and I-Care over a 6-month period was conducted. Patient demographics, procedures done, care category, estimated costs, and disposition information were included for statistical analysis.

Telemedicine during the COVID-19 Pandemic: A Hand Surgery Perspective.

: A major consequence of the COVID-19 pandemic on the U.S. healthcare system has been the rapid transition away from in-person healthcare visits to telehealth.

Patient and Physician Satisfaction with Telehealth During the COVID-19 Pandemic: Sports Medicine Perspective.

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Patient and Surgeon Satisfaction with Telehealth During the COVID-19 Pandemic.

Background: Until recently, telehealth represented a small fraction of orthopedic surgery patient interactions. The COVID-19 pandemic necessitated a swift adoption of telehealth to avoid patient and provider exposure. This study analyzed patient and surgeon satisfaction with telehealth within the department of orthopedic surgery during the height of the COVID-19 pandemic.

Tourniquet Use for Short Hand Surgery Procedures Done Under Local Anesthesia Without Epinephrine.

Purpose: Wide-awake local anesthesia no tourniquet (WALANT) is an increasingly popular surgical technique. However, owing to surgeon preference, patient factors, or hospital guidelines, it may not be feasible to inject patients with solutions containing epinephrine the recommended 25 minutes prior to incision. The purpose of this study was to assess pain and patient experience after short hand surgeries done under local anesthesia using a tourniquet rather than epinephrine for hemostasis.

Factors Affecting Operative Duration in Isolated Open Carpal Tunnel Release.

 Open carpal tunnel release (CTR) is one of the most commonly performed operative procedures with operative duration being a primary metric of operating room efficiency. The purpose of this study was to identify factors associated with prolonged operative duration, in performing CTR.  CTR cases performed by a single surgeon from September 2013 to October 2015 were reviewed.

Radial Shaft Convergence in Distal Radius Fractures: Diagnosis and Treatment.

Radial shaft convergence in distal radius fractures is often misdiagnosed. This common deformation is often associated with a radial translation of the distal fragment. This parameter has to be corrected because of the increased risk of distal radioulnar joint instability due to detensioning of the distal interosseous membrane if there is an associated triangular fibrocartilage complex lesion.

Flexor Tendon Injuries.

Flexor tendon injuries of the hand are uncommon, and they are among the most challenging orthopaedic injuries to manage. Proper management is essential to ensure optimal outcomes. Consistent, successful management of flexor tendon injuries relies on understanding the anatomy, characteristics and repair of tendons in the different zones, potential complications, rehabilitation protocols, recent advances in treatment, and future directions, including tissue engineering and biologic modification of the repair site.

Factors Affecting Hand Surgeon Operating Room Turnover Time.

The purpose of this study was to determine the factors that affect hand surgeon operating room (OR) turnover time. We hypothesized that surgeon presence in the OR, decreased American Society of Anesthesiologists (ASA) class, smaller case type, and earlier case time, as well as other factors, decreased OR turnover time. A total of 685 hand surgery cases performed by 5 attending hand surgeons between September 2013 and December 2014 were identified.

Volar-Ulnar Approach for Fixation of the Volar Lunate Facet Fragment in Distal Radius Fractures: A Technical Tip.

The volar Henry approach is most commonly used for surgical fixation of distal radius fractures. However, this approach is limited in achieving adequate exposure for the fixation of the volar-ulnar portion of the distal radius, rendering it difficult for the ideal placement of the fixation construct. We propose the use of the extensile volar-ulnar approach for fixation of distal radius fracture involving a small volar-ulnar fragment.

Accessory Slip of the Extensor Carpi Ulnaris: A Cadaveric Assessment.

 An accessory slip arising from the extensor carpi ulnaris (ECU) tendon that inserts on the fifth metacarpal bone has been identified. We describe the frequency of this accessory slip arising from the ECU tendon and provide both qualitative and quantitative description of the slip via cadaveric examination.  Fifty (28 males and 22 females) cadaveric upper extremity specimens were examined after loupe-aided dissection of the dorsoulnar wrist and hand with identification of the ECU tendon.

Surgical Treatment of Symptomatic Congenital Type I Lunotriquetral Coalition: Technique and a Report of 4 Cases.

Lunotriquetral (LT) synchondrosis is an uncommon variant of congenital LT coalition. Unlike complete LT fusions, this incomplete pseudoarthrosis-like coalition can become symptomatic. Surgical LT arthrodesis is a described treatment for this variant of LT coalition (Minnaar type I).

Flexor Carpi Radialis to Palmaris Longus Tendon Transfer for Spontaneous Rupture of the Flexor Carpi Radialis Tendon-A Review of an Uncommon Finding and Surgical Technique for Operative Correction.

Spontaneous ruptures of the flexor carpi radialis tendon (FCR) are rare and associated with systemic inflammatory diseases, localized tendinopathy related to scaphotrapezial-trapezoidal arthritis, or chronic immunosuppression from corticosteroids. While most cases do not require operative intervention, some patients develop weakness, impaired range of motion, and persistent pain. Previously reported surgical options include synovectomy, tendon stump resection, and osteophyte removal.

Assessment of the Accuracy of Online Information Regarding Trigger Finger.

Background: Review of the recent literature suggests substantial use of the Internet by patients seeking health care information despite questionable accuracy and readability of information presented on some websites. The purpose of our study was to assess the accuracy, quality, and readability of online information regarding trigger finger.

Methods: Three terms ("trigger finger", "stenosing tenosynovitis", and "finger locking") were used to query three Internet search engines to evaluate websites regarding information about trigger finger.

Arthroscopic wafer resection for ulnar impaction syndrome: prediction of outcomes.

Twenty-six patients with mean age of 38.5 (range 18-59), from 1998 to 2005, with ulnar impaction syndrome who failed nonoperative treatments were included in our study. Patients' age, history of previous wrist fracture, presence of MRI signs and ulnar variance were recorded as variables.

The anatomic location of digital glomus tumor recurrences.

Purpose: We examined the anatomic location of recurrences of digital glomus tumors treated with surgical excision to make inferences on the causes of recurrence.

Methods: We retrospectively reviewed 12 cases of glomus tumors of the hand treated surgically over an 8-year period. Two of these patients presented with recurrences after previous glomus tumor excision surgery elsewhere.

Proliferative extensor tenosynovitis of the wrist in the absence of rheumatoid arthritis.

Purpose: Proliferative tenosynovitis in the fourth extensor compartment is common in patients with rheumatoid arthritis. It may also occur in the absence of rheumatoid arthritis; the purpose of this study is to describe this clinical condition in a series of patients, to report the results of surgical intervention, and to compare histological findings to those typically seen in rheumatoid tenosynovitis.

Methods: This study presents a retrospective case series of 11 patients who do not have rheumatoid arthritis, who had proliferative tenosynovitis of the fourth extensor compartment treated surgically.

High fusion rates with circular plate fixation for four-corner arthrodesis of the wrist.

Background: Scaphoid excision and four-corner fusion is commonly performed to reconstruct advanced scapholunate collapse and scaphoid nonunion with collapse. Metallic plates were introduced for achieving fixation of the four carpal bones. Although the developer reported high rates of fusion, several other early reports of circular plate fixation suggest higher complication rates and inferior outcomes compared with traditional fixation techniques.

Mini-incision fixation of nondisplaced scaphoid fracture nonunions.

Purpose: Scaphoid nonunions are commonly repaired by an open surgical technique involving debridement, bone grafting, and internal fixation. The purpose of our study is to describe a small subset of scaphoid nonunions that are nondisplaced and might be suitable for a more limited, minimally invasive technique that might offer good results while potentially reducing soft tissue injury.

Methods: Nine patients seen over a 3-year period by a single surgeon were identified as having scaphoid nonunions without radiographic evidence of displacement, angulation, degenerative changes, osteonecrosis, or carpal instability.

Indirect decompression of the carpal tunnel during basal joint arthroplasty of the thumb.

Purpose: In patients having basal joint arthroplasty, rates of concomitant carpal tunnel syndrome may exceed 43%. Excision of the trapezium during basal joint arthroplasty partially releases the transverse carpal ligament. The objective of this study was to determine whether indirect release of the remaining fibers of the ligament at its insertion on the scaphoid tubercle through the same incision would adequately decompress the carpal canal.