Cartilage Cap in Scaphoid Nonunions: An Indication of Stability and Biology?

Purpose: Scaphoid nonunion management is controversial and is dependent upon many factors without a clear algorithm. Traditionally, open approaches involved corticocancellous, vascularized, or nonvascularized structural bone grafting with internal fixation. Recent arthroscopic techniques have improved the ability to assess the stability of fractures and the need for bone grafting while preserving blood supply.

Academic Productivity Among Hand Surgeons: Factors That Predict Future Productivity.

Introduction: Orthopaedic and plastic surgery residency applicants with strong research backgrounds are valued for their academic productivity potential. The association between research productivity during different stages of medical training and as a practicing surgeon is not well-defined. We examined the effects of research output during medical school, residency, and fellowship on future long-term academic productivity as an attending hand surgeon.

Latissimus Dorsi Reconstruction with Achilles Allograft Augmentation Through a Dual Approach for Segmental Rupture: A Case Report.

Case: We present a 55-year-old man with an isolated latissimus dorsi (LD) tendon tear in the setting of a full-thickness myotendinous tear following an acute injury. Given his poor tendon quality and quantity, we performed an LD reconstruction using Achilles tendon allograft. Postoperatively, the patient reported excellent satisfaction and returned to his preinjury levels of strength and motion without any complications.

The impact of social media for shoulder surgeons: a prevalence and correlation study with online and academic presence.

Background: Social media use has grown exponentially in the past decade and has become a powerful tool for physicians. A strong online presence can play a vital role for surgeons in patient recruitment and education and in promoting new literature. This study examines the influence of social media use on patient-reported online ratings and academic productivity among shoulder and elbow and sports medicine fellowship-trained orthopedic shoulder surgeons.

Codman maneuver for biceps tendonitis: a prospective evaluation of a forgotten examination maneuver.

Background: Many physical exam maneuvers for shoulder pain exist, but the sensitivity and specificity are repeatedly found to be subpar, even in the most utilized maneuvers. Rotator cuff tendinopathy and biceps tendonitis are common pain generators that often go undifferentiated. The purpose of this study was to examine a century-old examination maneuver to help identify biceps tendinitis in patients presenting with anterior shoulder pain.

Arthroscopic-assisted lower trapezius transfer vs. superior capsular reconstruction for treatment of massive irreparable rotator cuff tears.

Background: Superior capsular reconstruction (SCR) and arthroscopic-assisted lower trapezius transfer (aLTT) are utilized to augment partial rotator cuff repairs (RCRs) in the treatment of massive irreparable rotator cuff tears (MIRCTs), but indications are poorly characterized. SCR restores coronal glenohumeral stability through static reconstruction of the native superior capsule, while aLTT provides dynamic restoration of the posterosuperior aspect of the axial force couple by replicating infraspinatus function. This study compares outcomes between patients undergoing SCR and aLTT with partial RCR for MIRCT to better elucidate indications for each.

Identifying Diagnostic Criteria for Cubital Tunnel Syndrome.

Background: Cubital tunnel syndrome (CuTS) is the second most common compressive neuropathy of the upper extremity. We aimed to determine the importance of diagnostic criteria for CuTS.

Methods: Expert opinion previously reached a consensus on the six most important criteria for CuTS diagnosis using Delphi.

Surgical treatment of long head of biceps pathology: analyzing trends in the United States from 2010 to 2019.

Background: The long head of the biceps tendon (LHBT) is a common cause of anterior shoulder pain. A symptomatic LHBT is commonly encountered in the setting of a rotator cuff tear. The purpose of this study was to determine trends in the incidence of isolated tenotomy and tenodesis procedures for symptomatic LHBT in the setting of rotator cuff repairs (RCR).

Glenoid Bone Grafting During Primary Reverse Shoulder Arthroplasty: A Learning-Curve Analysis.

Background: Reverse shoulder arthroplasty (RSA) with structural bone grafting of the glenoid utilizing an autograft from the resected humeral head is an effective strategy to address severe glenoid bone loss. Although learning curves have been established for RSA, RSA with bone grafting is more technically challenging, with relatively higher complication rates. The number of cases needed for proficiency and the optimal learning strategies have yet to be defined for RSA with bone grafting.

Accelerating Efficiency in Arthroscopically Assisted Lower Trapezius Transfer: How Can We Shorten the Learning Curve?

Introduction: Arthroscopic lower trapezius tendon transfer (aLTT) is an effective strategy to treat massive rotator cuff tears by dynamically restoring the posterior aspect of the rotator cuff force couple and improving range of motion, strength, pain, and stability. aLTT is technically challenging with higher complication rates, and its learning curve has yet to be defined. We aimed to establish a learning curve for aLTT through trends in surgical time, postoperative outcomes, and complications.

Lower trapezius tendon transfer vs. reverse shoulder arthroplasty for massive irreparable rotator cuff tears: an in-vivo scapulohumeral rhythm dynamic radiography study.

Background: Reverse shoulder arthroplasty (RSA) and arthroscopic-assisted lower trapezius tendon (aLTT) transfer are both treatment options for massive irreparable rotator cuff tears (MIRCTs) without glenohumeral arthritis; however, the indications for each remain controversial. Although RSA is an excellent reconstructive option, preserving the joint, recentering the humeral head, and restoring in-line active external rotation with an aLTT transfer may be preferred in certain patients to better restore more normal shoulder biomechanics. In-vivo kinematics, however, have been historically difficult to evaluate.

Defining the Cost of Arthroscopic Rotator Cuff Repair: A Multicenter, Time-Driven Activity-Based Costing and Cost Optimization Investigation.

Background: Rotator cuff repair (RCR) is a frequently performed outpatient orthopaedic surgery, with substantial financial implications for health-care systems. Time-driven activity-based costing (TDABC) is a method for nuanced cost analysis and is a valuable tool for strategic health-care decision-making. The aim of this study was to apply the TDABC methodology to RCR procedures to identify specific avenues to optimize cost-efficiency within the health-care system in 2 critical areas: (1) the reduction of variability in the episode duration, and (2) the standardization of suture anchor acquisition costs.

Arthroscopic Pectoralis Minor Release and Infraclavicular Brachial Plexus Decompression for Neurogenic Thoracic Outlet Syndrome: A Novel Treatment for an Old Problem.

Background: Neurogenic thoracic outlet syndrome (nTOS) of infraclavicular etiology is a complex condition involving the compression of the brachial plexus through the interscalene triangle and costoclavicular, infraclavicular, and pectoralis minor space. New insight into nTOS of infraclavicular etiology and its association with scapular dyskinesia has enabled minimally invasive treatments: endoscopic pectoralis minor release (PMR) and infraclavicular brachial plexus neurolysis. The purpose of this study was to analyze clinical outcomes of this technique compared with historically published outcomes for open first rib resection (FRR) and/or scalenectomy.

Pedicled Pectoralis Major Transfer for Axillary Nerve Palsy and Greater Tuberosity Nonunion: A Case Report.

Case: A 46-year-old male patient presented with shoulder pain, limited range of motion, and loss of sensation for a year after undergoing hemiarthroplasty for a proximal humerus fracture. Workup demonstrated a greater tuberosity nonunion and deltoid paralysis secondary to upper trunk brachial plexopathy. The pectoralis major (PM) for deltoid transfer successfully restored shoulder function and resolved pain without requiring any subsequent intervention.

The Impact of Social Media for Hand Surgeons: A Prevalence and Correlation Study With Online and Academic Reputations.

Purpose: This study examines the influence of social media use among orthopedic and plastic-trained hand surgeons on patient-reported ratings online and academic productivity.

Methods: The American Society of Surgery of the Hand directory was queried for actively practicing orthopedic and plastic surgeons with a hand surgery fellowship. Each name was searched on various social media platforms.

Utilization of Interphalangeal Joint Arthroplasty and Arthrodesis in the United States From 2010 to 2019.

Background: Interphalangeal joint (IPJ) arthrodesis and arthroplasty are mainstay treatments for IPJ arthritis with conflicting evidence about the most efficacious choice. Our study describes case volume and incidence over the last decade (2010-2019).

Methods: The IBM MarketScan database was queried using Current Procedural Terminology codes for IPJ arthrodesis and arthroplasty from January 2010 to December 2019.

Electrodiagnostic Testing Predicts Postdecompression Outcomes in Patients With Cubital Tunnel Syndrome.

Purpose: Electrodiagnostic (EDX) testing is commonly used in conjunction with symptoms and physical examination findings to diagnose cubital tunnel syndrome (CuTS). The purpose of this study was to investigate the relationship between preoperative EDX diagnosis and the degree of Disabilities of the Arm, Shoulder, and Hand (DASH) improvement after surgery within the CuTS patient population.

Methods: A retrospective review was designed to analyze patients from a single institution who underwent a cubital tunnel release.

Revision shoulder arthroplasty: predictors of subsequent revision surgery and economic burden amongst Medicare beneficiaries.

Background: Revision shoulder arthroplasty continues to add an increasing burden on patients and the healthcare system. This study aimed to delineate long-term shoulder arthroplasty revision incidence, quantify associated Medicare spending, and identify relevant predictors of both revision and spending.

Methods: The complete 2016-2022 (Q3) Medicare fee-for-service inpatient and outpatient claims data was analyzed.

Structural bone grafting with reverse shoulder arthroplasty for osteoarthritis with severe glenoid bone loss: outcomes using a long post.

Background: Severe posterior glenoid bone loss with glenohumeral osteoarthritis with an intact rotator cuff can be managed with reverse shoulder arthroplasty but requires lateralization and version correction to avoid potential complications, such as instability, notching and implant failure. Angled bone grafting with humeral head autograft can provide durable glenoid bone stock, but results have been mixed. The purpose of this study was to evaluate patient-reported and objective outcomes as well as complication and failure rates for patients who underwent angled humeral head autografting for severe retroversion.

Determining the Optimal Intramedullary Screw Canal Fill Ratio in Length Unstable Metacarpal Fractures: A Biomechanical Investigation.

Purpose: Intramedullary (IM) screw fixation is gaining popularity in the treatment of metacarpal fractures. Despite its rapid adoption, there is a paucity of evidence regarding parameters to optimize effectiveness. This study aimed to quantify the relationship between stability, IM screw size, and canal fill using a cadaveric model.

Racial and gender disparities in utilization of outpatient total shoulder arthroplasties.

Background: Utilization in outpatient total shoulder arthroplasties (TSAs) has increased significantly in recent years. It remains largely unknown whether utilization of outpatient TSA differs across gender and racial groups. This study aimed to quantify racial and gender disparities both nationally and by geographic regions.

A preoperative risk assessment tool for predicting adverse outcomes among total shoulder arthroplasty patients.

Background: With the increased utilization of Total Shoulder Arthroplasty (TSA) in the outpatient setting, understanding the risk factors associated with complications and hospital readmissions becomes a more significant consideration. Prior developed assessment metrics in the literature either consisted of hard-to-implement tools or relied on postoperative data to guide decision-making. This study aimed to develop a preoperative risk assessment tool to help predict the risk of hospital readmission and other postoperative adverse outcomes.