Does Weightbearing Affect Radiographic or Clinical Outcomes in Distal Radius Fractures Treated With Dorsal Bridge Plate Fixation?

Background: Dorsal wrist spanning plate (DWSP) fixation in distal radius fractures (DRFs) has been proposed to allow earlier mobilization in polytraumatized patients by enabling early weightbearing (WB) through the injured wrist. The purpose of this study is to compare radiographic and clinical outcomes in patients who bore weight through the injured wrist within the early postoperative period with patients who did not bear weight.

Methods: Patients who underwent DWSP fixation at a single institution were retrospectively identified.

The Mini-Open Dorsal Approach to the Scaphoid.

Background: Scaphoid fractures are a common, yet challenging, injury to treat. The mini-open dorsal approach to the scaphoid is a simple, yet effective, approach that allows for improved visualization and more accurate screw placement in the setting of scaphoid fracture fixation.

Description: An approximately 2-cm longitudinal incision is made centered over the dorsal radiocarpal joint, just ulnar to the Lister tubercle.

Biomechanical Comparison of 1- and 2-Tunnel Suture Suspensionplasty Constructs for Basilar Thumb Arthritis.

Background: Trapeziectomy with suture button suspensionplasty (SBS) is a common treatment for thumb carpometacarpal (CMC) osteoarthritis. This study aimed to evaluate the effect of bone tunnel configuration and suture count on the construct stability.

Methods: Twelve matched specimens underwent trapeziectomy and randomization to either a 2-strand 1-tunnel (single SBS) or divergent 4-strand 2-tunnel suture button (crossed dual SBS) construct.

The Effect of Bridge Plate Duration on Range of Motion: A Breakpoint Modelling Approach for Distal Radius Fractures Treated With Dorsal Wrist Spanning Bridge Plate.

Background: Dorsal wrist spanning plate (DWSP) fixation is a technique used to treat distal radius fractures with severe metaphyseal comminution, diaphyseal extension, and other complex fracture patterns. One concern of this technique is the potential risk of stiffness due to prolonged immobilization. The purpose of our study was to examine the association of DWSP duration on range of motion (ROM) outcomes after plate removal.

Management of Severe Elbow Arthritis in a Young Patient.

Elbow osteoarthritis is occasionally primary and most often post-traumatic. Nonoperative treatment is frequently the best course of action. Available surgical options are governed by the location of cartilage deterioration, bone structure, and preoperative joint instability.

Sagittal and Coronal Plate Position Is Not Associated With Flexor Tendon Irritation, Rupture, or Need for Plate Removal After Volar Locking Plate Fixation of Distal Radius Fractures.

Background: Whether sagittal and coronal plate placement influences the risk of flexor tendon complications after volar plating of distal radius fractures is debated. In this study, we tested the null hypothesis that sagittal and coronal plate position is not associated with flexor tendon irritation, rupture, or plate removal.

Methods: We performed a retrospective review of 144 patients treated for distal radius fractures with a volar locking plate by 4 fellowship-trained hand surgeons.

Pitch Types and Their Influence on Elbow Varus Torque and Spin Rate in Professional Baseball Pitchers.

Background: Elbow injuries are prevalent among professional baseball pitchers as nearly 25% undergo ulnar collateral ligament reconstruction. Pitch type, ball velocity, and spin rate have been previously hypothesized to influence elbow varus torque and subsequent risk of injury, but existing research is inconclusive.

Purpose: To examine elbow varus torque, cumulative torque, and loading rate within professional pitchers throwing fastball, curveball, change-up, and slider pitches, as well as to identify potential influences of ball spin on the elbow.

Low Complication Rates in Olecranon Fracture Fixation With Dual Plating.

Background: Most olecranon fractures are intra-articular, affecting the extensor mechanism of the elbow, and are treated surgically with dorsal plate fixation or tension band. Due to shortcomings of dorsal plates related to prominence, insufficient fixation of sagittal fracture lines, and difficulty matching proximal ulna dorsal angulation (PUDA), dual medial and lateral plating (DP) has been developed. We hypothesized that olecranon fractures treated with DP would have low complication rates and low incidence of hardware removal compared with those treated with traditional methods of fixation.

The Use of Nitinol Staples as Reduction Aids in Fixation of Forearm Diaphyseal Fractures: Surgical Technique and Case Series.

Forearm diaphyseal fractures are common orthopedic injuries that typically require surgical intervention using various implants and approaches. Maintaining reduction while simultaneously achieving compression in radial and/or ulnar shaft fractures during compression plate application can be challenging, particularly with unstable segmental and/or transverse fracture patterns. Nitinol compression staples have become increasingly used as a reduction aid because of their ability to provide continuous compression between the staple legs at the fracture site, low profile, and ease of application.

Reliability of Wrist Arthroscopy in the Diagnosis and Treatment of Triangular Fibrocartilage Complex Tears.

Purpose: Wrist arthroscopy is considered the gold standard for diagnosis of intra-articular wrist conditions including triangular fibrocartilage complex (TFCC) tears; however, the ability to reliably diagnose TFCC pathology during wrist arthroscopy is unclear. The purpose of this study was to assess the reliability of the diagnosis of TFCC tears on wrist arthroscopy videos.

Methods: Five hand surgeons reviewed 43 cases on a secure web-based platform at two time points separated by 4-6 weeks.

Cost-Effectiveness Analysis of Early versus Late Debridement of Superficial Triangular Fibrocartilage Complex Tears.

Background: While initial nonoperative management is the conventional approach for superficial triangular fibrocartilage complex (TFCC) tears, a substantial portion of these cases go on to require surgery, and the optimal duration of nonoperative treatment is unknown. In this study, we evaluate the cost-effectiveness of early versus late arthroscopic debridement for the treatment of superficial TFCC tears without distal radioulnar joint (DRUJ) instability.

Methods: We created a decision tree to compare the following strategies from a healthcare payer perspective: immediate arthroscopic debridement versus immobilization for 4 or 6 weeks with late debridement as needed.

The Role of 3D Custom Implants in Upper Extremity Surgery.

As the technology of three-dimensional (3D) printing becomes more refined and accessible, multiple applications of its use are becoming more commonplace in upper extremity surgery. 3D-printed models have been beneficial in preoperative planning of complex cases of acute trauma or malunions, contributing to spatial understanding or even contouring of implants. Custom guides can also be created to assist intraoperatively with precise placement of osteotomies or arthroplasty implants.

Comparison Between Intramedullary Nail and Percutaneous Pin Fixation in Proximal Phalanx Fractures.

Background: Percutaneous pinning has been the predominant technique for fixation of proximal phalanx fractures, but stiffness is a reported complication. The introduction of intramedullary (IM) nail fixation of proximal phalanx fractures provides a stronger biomechanical fixation for amenable fracture patterns with the added benefit of not tethering the soft tissue. The goal of this study was to compare the surgical outcomes of IM nail and percutaneous pin fixation in isolated proximal phalanx fractures.

Usability of Nerve Tape: A Novel Sutureless Nerve Coaptation Device.

Purpose: Microsuture neurorrhaphy is technically challenging and has inherent drawbacks. This study evaluated the potential of a novel, sutureless nerve coaptation device to improve efficiency and precision.

Methods: Twelve surgeons participated in this study-six attending hand/microsurgeons and six trainees (orthopedic and plastic surgery residents or hand surgery fellows).

Forearm Nonunions-From Masquelet to Free Vascularized Bone Grafting.

Forearm fractures present a unique challenge due to the anatomic relationship of the radius relative to the ulna. Associated with the complexity of the treatment for these fractures is the management of nonunion and malunion of the radius and ulna. Evaluation and management of forearm nonunions require a critical evaluation of contributing factors prior to surgical intervention.

The Use of Patient-Specific Implants for the Treatment of Upper Extremity Fractures.

In this article, we discuss the use of three-dimensional (3-D) printed patient-specific implants in the management of upper extremity fractures. Traditional fracture fixation methods involve the use of standard-sized implants, which may not adequately address the needs of every patient, particularly those who have complications related to fracture nonunion or malunion and those who have significant bone loss. The benefits and limitations of this technology are also discussed, along with considerations for implementation in clinical practice.

Evaluation of Online Artificial Intelligence-Generated Information on Common Hand Procedures.

Purpose: The purpose of this study was to analyze the quality and readability of the information generated by an online artificial intelligence (AI) platform regarding 4 common hand surgeries and to compare AI-generated responses to those provided in the informational articles published by the American Society for Surgery of the Hand (ASSH) HandCare website.

Methods: An open AI model (ChatGPT) was used to answer questions commonly asked by patients on 4 common hand surgeries (carpal tunnel release, cubital tunnel release, trigger finger release, and distal radius fracture fixation). These answers were evaluated for medical accuracy, quality and readability and compared to answers derived from the ASSH HandCare materials.

Medicaid and Indigent Patients Experience Delayed Fixation of Distal Radius Fractures, Resulting in Worse Consequential Radiographic Outcomes.

Distal radius fractures are the most common upper extremity injury. Patients referred to safety-net tertiary facilities following a fracture experience significant delays in treatment because of financial and language barriers as well as poor access to care at outlying community hospitals. This delay in treatment can affect postoperative functional outcomes and complication rates because of failure to restore anatomic alignment.

Impact of Time to Fixation on Outcomes of Operative Treatment of Intra-articular Distal Radius Fractures.

Background: The incidence of operative treatment of distal radius fractures (DRFs) has increased recently, but the optimal timing for surgical fixation remains unclear. We hypothesized that: (1) an increase in time to fixation of intra-articular DRFs would increase the likelihood of postoperative complications; and (2) increased time from injury to fixation would lead to longer surgical time and worse range of motion (ROM) outcomes.

Methods: We retrospectively reviewed 299 fractures in 284 adult patients who underwent open reduction and internal fixation (ORIF) of a closed, intra-articular DRF at our institution over a 10.

Complications of Early Versus Delayed Total Elbow Arthroplasty for the Treatment of Distal Humerus Fractures.

Purpose: The purpose of this study was to compare the rates of wound complications and heterotopic ossification (HO) between patients who underwent acute total elbow arthroplasty (TEA) and those who underwent delayed TEA performed for the treatment of distal humerus fractures. Our hypothesis was that delayed surgery will have fewer wound complications but a higher rate of HO.

Methods: We retrospectively reviewed 104 patients who had undergone TEA performed at 1 of 3 institutions following a distal humerus fracture.

Arthroscopic TFCC Ulnar Bone Tunnel Foveal Repair in Adult Patients.

Triangular fibrocartilage complex (TFCC) tears may cause persistent ulnar-sided wrist pain, loss of grip strength, and associated loss of function. Although the majority of TFCC tears can be treated nonoperatively, surgical repair is considered when conservative measures fail. TFCC tears with foveal disruption and instability of the distal radioulnar joint (DRUJ) require direct repair of the TFCC to the ulnar fovea.

Site of service of irrigation and debridement of open finger and hand fractures: a retrospective review of trends and outcomes.

Background: Irrigation and debridement (I&D) of open finger and hand fractures can be performed in the emergency department as opposed to the operating room (OR), though reports of postoperative infection rates vary greatly. The authors hypothesized that I&D of open finger and hand fractures in the OR would decrease over time. They also describe rates of postoperative infection, reoperation, readmission, and costs.

Ulnar Resection Length: A Risk Factor for Nonunion in Ulnar Shortening Osteotomy.

Background: Nonunion rates following ulnar shortening osteotomy (USO) are reported up to 18% with few known risk factors. While resection length is variable in practice, little is known about the prognostic implications on healing. The purpose of this study was to evaluate whether longer resection lengths increased the odds of nonunion.

Suspensionplasty for Revision Thumb Carpometacarpal Osteoarthritis Surgery: Comparing Suture Button Suspensionplasty to Ligament Reconstruction and Tendon Interposition.

Summary: Several surgical procedures have been described to treat thumb carpometacarpal osteoarthritis, including suture button suspensionplasty and ligament reconstruction and tendon interposition. To date, no single procedure has demonstrated clinical superiority. Suture button suspensionplasty has achieved favorable outcomes at 5 years in primary cases, but has not been validated in revision surgery.