Ruptured Bilobed Basilar Artery Fenestration Aneurysm Treated with a WEB Device.

Objective: To describe the technique of using a Woven Endo Bridge (WEB) device to treat a ruptured bilobed blister-like aneurysm (BLA) at the basilar artery (BA) fenestration.

Case Presentation: A previously healthy 66-year-old female presented at the emergency room with subarachnoid hemorrhage (SAH), centered around the brainstem. Unenhanced CT and CT angiography showed a BLA of a basilar fenestration limb.

Scaphoid Fracture Patterns-Part Two: Reproducibility and Demographics of a Simplified Scaphoid Fracture Classification.

 To analyze the reproducibility, reliability, and demographics of a simplified anatomical scaphoid fracture classification based on posteroanterior radiographs using a large database of scaphoid fractures.  The study consisted of a retrospective review of electronic medical records of 871 consecutive patients. All patients presented between 2003 and 2014 at two centers.

Scaphoid Fracture Patterns-Part One: Three-Dimensional Computed Tomography Analysis.

 Using three-dimensional (3D) computed tomography models of acute scaphoid fractures, we looked for differences between volumetric size of the fracture fragments, recognizable groups, or a shared common fracture area.  We studied 51 patients with an adequate computed tomography scan of an acute scaphoid fracture using 3D modeling. Fracture surfaces were identified and fragment volumetric size of the fracture fragments was measured.

Reliability of Diagnosis of Partial Union of Scaphoid Waist Fractures on Computed Tomography.

Computed tomography (CT) is increasingly used not just to diagnose union but also to estimate the percentage of the fracture gap that is bridged by healing bone. This study tested the primary null hypothesis that there is no agreement between observers on the extent of union of a scaphoid waist fracture on CT. CT scans of 13 nondisplaced scaphoid waist fractures treated nonoperatively were rated by 145 observers.

Interobserver Variability of the Diagnosis of Scaphoid Proximal Pole Fractures.

 Fractures of the proximal pole of the scaphoid are prone to adverse outcomes such as nonunion and avascular necrosis. Distinction of scaphoid proximal pole fractures from waist fractures is important for management but it is unclear if the distinction is reliable.  A consecutive series of 29 scaphoid fractures from one tertiary hospital was collected consisting of 5 scaphoid proximal pole and 24 scaphoid waist fractures.

Does a Comparison View Improve the Reliability of Staging Wrist Osteoarthritis?

Background: Radiological grading of wrist osteoarthritis associated with scaphoid nonunion advanced collapse (SNAC) can be difficult. A comparison radiograph of the contralateral healthy wrist and an educational training in the various SNAC stages may improve reliability. Our purposes were to evaluate the difference in the reliability: (1) between observers who rate SNAC wrists with and without a comparison radiograph; and (2) between observers who receive training prior to ratings and those who do not.

Night Splinting for Idiopathic Trigger Digits.

Background: This study assessed nighttime splinting for 6 weeks as treatment for recent onset idiopathic trigger fingers.

Methods: Patients over 18 years with a Quinnell grade 1 or 2, idiopathic trigger finger or thumb causing symptoms for less than 3 months were eligible for a custom-made hand-based orthoplast night orthotic. Improvement of symptoms and/or resolution of triggering were recorded.

The Influence of Psychological Factors on the Michigan Hand Questionnaire.

Psychosocial factors help account for the gap between impairment and disability. This study examines the relationship between the Michigan Hand Questionnaire (MHQ) and commonly used psychological measures in patients with upper extremity illness. A cohort of 135 new or follow-up patients presenting to an urban academic hospital-based hand surgeon were invited to complete a web-based version of the MHQ, Abbreviated Pain Catastrophizing Scale (PCS), and two Patient-Reported Outcomes Measurement Information System (PROMIS)-based questionnaires: Pain Interference and Depression.

Vascularized Composite Allotransplantation-An Emerging Concept for Burn Reconstruction.

Vascularized composite allotransplantation (VCA) has demonstrated utility in the reconstruction of extensive soft-tissue defects following severe burns. However, pre-VCA events such as multiple transfusions, previous transplantation and pregnancies, the use of skin allografts, and mechanical support devices may result in sensitization and ultimately exclude a burn patient, who may benefit most through VCA, from a hand or face transplant. The authors sought to identify the immunologic challenges involved.

Inter-observer agreement between 2-dimensional CT versus 3-dimensional I-Space model in the Diagnosis of Occult Scaphoid Fractures.

Background: The I-Space is a radiological imaging system in which Computed Tomography (CT)-scans can be evaluated as a three dimensional hologram. The aim of this study is to analyze the value of virtual reality (I-Space) in diagnosing acute occult scaphoid fractures.

Methods: A convenient cohort of 24 patients with a CT-scan from prior studies, without a scaphoid fracture on radiograph, yet high clinical suspicion of a fracture, were included in this study.

Classifications of Acute Scaphoid Fractures: A Systematic Literature Review.

Background In the lack of consensus, surgeon-based preference determines how acute scaphoid fractures are classified. There is a great variety of classification systems with considerable controversies. Purposes The purpose of this study was to provide an overview of the different classification systems, clarifying their subgroups and analyzing their popularity by comparing citation indexes.

Tolerance induction via mixed chimerism in vascularized composite allotransplantation: is it time for clinical application?

Purpose Of Review: The present review summarizes current data on the induction of immunologic tolerance through mixed hematopoietic chimerism relevant to applying this approach to vascularized composite allotransplantation.

Recent Findings: Clinical allograft tolerance has been achieved recently for kidney transplants, using nonmyeloablative conditioning regimens and bone marrow transplantation from living donors. The mixed chimerism attained in these studies was either transient or durable, and both permitted tolerance of the renal allografts to be achieved across MHC-matched and MHC-mismatched barriers.

Case Study: Osteosynthesis, Tenodesis Effect, and Side-to-Side Tendon Repair in Hand Transplantation.

Osteosynthesis and tendon repair are essential in upper extremity transplantation to optimally restore function. Transplant surgeons should be aware of all technical issues involved in osteosynthesis, tendon balancing, and tension setting as well as repair in an effort to optimize the function of the transplanted hand. Preoperative planning is vital to achieve good functional results.

Factors associated with unplanned reoperation in perilunate dislocations and fracture dislocations.

Background Perilunate injuries are complex and uncommon injuries that are typically the result of a high-energy injury and are nearly always treated operatively. Little is known about factors associated with unplanned reoperations after surgery for perilunate injuries. Purpose To assess the rate and types of unplanned reoperation after operative treatment of a perilunate dislocation.