News Updates
Nonacute Treatment of Elbow Fracture with Persistent Ulnohumeral Dislocation or Subluxation
Source: The Journal of Bone & Joint Surgery
- There are patterns of traumatic elbow instability that help a surgeon to anticipate which structures are injured.
- Patients treated for persistent subluxation or dislocation of the elbow more than two weeks after injury regain less motion and experience more adverse events.
- The primary goal of treatment is stable reduction of the ulnohumeral joint and functional elbow motion.
- Motion and pain are affected by contracture and scarring of the soft tissues, malalignment of the joint, fracture malunion, damage to the articular surface, and ulnar neuropathy.
The Biceps Tendon: From Proximal to Distal
Source: The Journal of Bone & Joint Surgery
The function of the long head of the biceps tendon (LHB) in shoulder glenohumeral biomechanics is unclear. However, there is agreement that the biceps can develop tendinopathy resulting in pain over the anterior aspect of the shoulder, specifically in the bicipital groove1,2. With recent advancements in arthroscopy and more detailed imaging, selection of appropriate management for proximal biceps disorders is important.
Lack of Benefit of Physical Therapy on Function Following Supracondylar Humeral Fracture
Source: The Journal of Bone & Joint Surgery
Background: The goal of the study was to evaluate the efficacy of physical therapy in restoring function and mobility after a pediatric supracondylar humeral fracture.
Methods: The study included sixty-one patients from five to twelve years of age with a supracondylar humeral fracture that was treated with casting or with closed reduction and pinning followed by casting. Patients were randomized to receive either no further treatment (no-PT group) or six sessions of a standardized hospital-based physical therapy program (PT group).
The Dorsal Tangential X-Ray View to Determine Dorsal Screw Penetration During Volar Plating of Distal Radius Fractures
Source: Journal of Hand Surgery
To evaluate whether the dorsal tangential view (DTV) allows for reliable and valid in vivo measurement of the distance between screw tips and the dorsal radial cortex (STCD) during volar plating of distal radius fractures.
Anterior Glenohumeral Joint Stabilization in Tetraplegic Patients by Medializing the Anterior Head of Deltoid Muscle
Source: Journal of Hand Surgery
To improve control of the upper limb in high-level tetraplegic patients, the proximal shoulder must be the first consideration. Medialization of the anterior part of the deltoid muscle provides stabilization and is then an antagonist to the posterior deltoid when a pectoralis major palsy exists. It can also be performed in isolation in high-level tetraplegia even when there is little hope of distal extremity reconstruction to stabilize the shoulder. It also precedes the ability to restore elbow extension and perform further reconstructive hand surgery. We describe the surgical technique and report a clinical case.
Availability of accessible and high-quality information on the Internet for patients regarding the diagnosis and management of rotator cuff tears
Source: Journal of Shoulder and Elbow Surgery
In the era of informed patient decision-making, educated patients are vital contributors. The Internet provides a vast information source that patients will access. It is imperative that this information be relevant and understandable. Various treatments, each with advantages and disadvantages, are available. We sought to examine the standard of information about the diagnosis and management of rotator cuff tears available to patients on the Internet.
Increased horizontal shoulder abduction is associated with an increase in shoulder joint load in baseball pitching
Source: Journal of Shoulder and Elbow Surgery
Soft tissues of the shoulder undergoes substantial stresses due to humeral head movement, and this may contribute to throwing shoulder injuries in baseball pitchers. Prevention and management of throwing shoulder injuries critically rely on reduction of shear force at the shoulder joint. However, the amount and direction of the force applied to the shoulder during the throwing motion have not been clarified. The purpose of this study was to analyze forces applied to the shoulder during a baseball pitch.
Decreased blood flow in the throwing arm of professional baseball pitchers
Source: Journal of Shoulder and Elbow Surgery
As a consequence of the repetitive forces placed on the throwing arm of a baseball player, various bony, capsuloligamentous, and muscular adaptations occur and have been identified. However, no research has identified whether adaptations also exist in the vasculature of the upper extremity in the competitive baseball player.
A preoperative scoring system to select patients for arthroscopic subacromial decompression
Source: Journal of Shoulder and Elbow Surgery
This study investigated the clinical and radiographic factors that influence outcome after arthroscopic subacromial decompression (ASAD) for shoulder impingement syndrome. The goal was to develop a new preoperative scoring system to identify patients who would have a prompt and sustained benefit from ASAD.
The return of subscapularis strength after shoulder arthroplasty
Source: Journal of Shoulder and Elbow Surgery
During shoulder arthroplasty, the subscapularis tendon is released and repaired. Whether subscapularis strength subsequently returns to normal is poorly understood. This study's purpose was to determine whether subscapularis strength returns to normal after shoulder replacement and whether any preoperative factors predict the return of strength postoperatively.
Outcomes after shoulder replacement: comparison between reverse & anatomic total shoulder arthroplasty
Source: Journal of Shoulder and Elbow Surgery
Anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA) are increasingly common procedures employed to treat arthritic conditions. Although TSA is a widely accepted procedure for glenohumeral arthritis with intact rotator cuff, concerns about RTSA persist because of variable complication rates and outcomes.
Comparison of perioperative complications after total elbow arthroplasty in patients with & without diabetes
Source: Journal of Shoulder and Elbow Surgery
Few studies have analyzed the effect of diabetes on outcomes after total elbow arthroplasty (TEA). We investigated the perioperative complications after TEA in patients with and without diabetes.
Comparison of Ultrasound and Electrodiagnostic Testing for Diagnosis of Carpal Tunnel Syndrome
Source: The Journal of Bone & Joint Surgery
Ultrasound examination is both accurate and cost-effective for the confirmation of a clinical diagnosis of carpal tunnel syndrome. Previous studies have shown electrodiagnostic testing and ultrasound to be similar with regard to sensitivity and specificity. The purpose of this study was to compare the sensitivity and specificity of ultrasound and electrodiagnostic testing by using a validated clinical diagnostic tool as the reference standard.
The Influence of Vitamin C on the Outcome of Distal Radial Fractures
Source: The Journal of Bone & Joint Surgery
Vitamin C has been proposed to improve outcomes after a distal radial fracture by promotion of bone and soft-tissue healing and reduction of the prevalence of complex regional pain syndrome (CRPS). Our primary aim was to examine the effect of vitamin C on functional outcome after a distal radial fracture.
Clinical Diagnostic Evaluation for Scaphoid Fractures: A Systematic Review and Meta-Analysis
Source: Journal of Hand Surgery
Purpose
To provide an overview of available clinical evaluation tests for scaphoid fractures and to compare their diagnostic accuracies
Methods
PWe performed a systematic review of all studies assessing diagnostic characteristics of clinical evaluation in scaphoid fractures by searching MEDLINE, EMBASE, Cochrane, and CINAHL databases. Only studies on clinical testing prior to radiographic evaluation and with acceptable reference standard for occult fractures were included. Thirteen relevant articles were analyzed that described a total of 25 tests. Diagnostic characteristics of the tests were used to construct contingency tables. If possible, data were pooled and summary receiver operating characteristic curves were fitted.
Management of Neglected Bennett Fracture in Manual Laborers by Tension Fixation
Source: Journal of Hand Surgery
Purpose
To report the results of open reduction and internal fixation (ORIF) of Bennett fractures in young, active patients using a K-wire and wire loop construct to achieve anatomical reduction and to allow return to manual labor.
Methods
In this prospective series, we treated 10 male manual laborers (mean age, 30 y; range, 20–44 y) with Bennett fractures diagnosed after a minimum of 12 weeks (mean, 16 wk; range, 12–18 wk). ORIF using 2 K-wires with a wire loop and a neutralizing transarticular K-wire was performed with direct articular visualization. Patients were evaluated for range of motion, grip strength, and pinch strength, and a visual analog scale score rated pain before surgery and 12 months later.
Reverse shoulder arthroplasty for malignant tumors of proximal humerus
Source: Journal of Shoulder and Elbow Surgery
Reverse shoulder arthroplasty (RSA) provides an alternative for shoulder girdle reconstruction after wide transarticular resection of the proximal humerus for malignant tumor. The aim of this study was to evaluate midterm outcomes of this therapeutic option.
Patient age is a factor in early outcomes after shoulder arthroplasty
Source: Journal of Shoulder and Elbow Surgery
Elderly and young patients alike are undergoing shoulder replacement at increased rates. In an era of outcomes reporting, risk adjustment, and cost containment, identifying patients likely to have adverse events is increasingly important. Our objective was to determine whether patient age is independently associated with postoperative in-hospital complications or increased hospital charges after shoulder arthroplasty.
Do stingers affect scapular kinematics in rugby players?
Source: Journal of Shoulder and Elbow Surgery
Scapular dyskinesis is observed in subjects with pathologic conditions of the shoulder; however, there is limited information about the factors related to scapular dyskinesis among participants in rugby. The purpose of this study was to investigate the incidence, reliability, and relationships between scapular dyskinesis and variables related to the shoulder in high-school rugby players.
Total Elbow Arthroplasty in Obese Patients
Source: The Journal of Bone & Joint Surgery
The prevalence of obesity in the United States has increased in recent decades. The aim of this study was to evaluate the influence of obesity in patients undergoing primary total elbow arthroplasty.
From 1987 to 2006, 723 primary semiconstrained, linked total elbow arthroplasties were performed in 654 patients. The average patient age (and standard deviation) at the time of surgery was 62.3 ± 13.7 years, with 550 total elbow arthroplasties (76%) performed in women. Total elbow arthroplasties were used to treat inflammatory conditions in patients undergoing 378 total elbow arthroplasties (52%) and to treat acute traumatic or posttraumatic conditions in patients undergoing 310 total elbow arthroplasties (43%). Patients were classified as non-obese (having a body mass index of <30 kg/m2) in 564 total elbow arthroplasties (78%) and as obese (having a body mass index of ≥30 kg/m2) in 159 total elbow arthroplasties (22%). The median duration of follow-up was 5.8 years (range, zero to twenty-five years). Survivorship of total elbow arthroplasty was estimated with use of the Kaplan-Meier method.
What’s New in Orthopaedic Trauma
Source: The Journal of Bone & Joint Surgery
This update presents a synopsis of the most clinically relevant high-quality studies related to orthopaedic trauma from the past twelve months. Key methods (♦), results (➢), and take-home points (✶) for these studies are presented.
Hand Function in Adults with Radial Longitudinal Deficiency
Source: The Journal of Bone & Joint Surgery
Functional impairment in individuals with radial longitudinal deficiency can be influenced by several factors, including a short and bowed forearm, radial deviation of the wrist, a non-functional or absent thumb, limited finger motion, and impaired grip strength, but their relationship with activity and participation in adults with radial deficiency is not known.
Lack of Benefit of Physical Therapy on Function Following Supracondylar Humeral Fracture
Source: The Journal of Bone & Joint Surgery
The goal of the study was to evaluate the efficacy of physical therapy in restoring function and mobility after a pediatric supracondylar humeral fracture.
The study included sixty-one patients from five to twelve years of age with a supracondylar humeral fracture that was treated with casting or with closed reduction and pinning followed by casting. Patients were randomized to receive either no further treatment (no-PT group) or six sessions of a standardized hospital-based physical therapy program (PT group). The ASK-p (Activities Scale for Kids-performance version) and self-assessments of activity were used to assess function at one, nine, fifteen, and twenty-seven weeks after injury.
Comparison of Compression Screw and Perpendicular Clamp in Ulnar Shortening Osteotomy
Source: Journal of Hand Surgery
Purpose
To biomechanically quantify 2 techniques, compression screw and perpendicular clamp, for generating compression during ulnar shortening osteotomy (USO) in order to promote reliable primary bone healing.
Methods
Fourteen fresh-frozen cadaveric human forearms were randomly assigned to 1 of 2 groups. Group I (n = 7) underwent USO according to the traditional AO plate fixation technique using a screw placed eccentrically in an oblong hole to generate compression at the osteotomy site. Group II (n = 7) underwent USO with a commercially available USO plating system using a clamp placed perpendicular to the osteotomy site to generate compression. Both techniques involved a 2-mm resection osteotomy performed with cutting jigs to minimize variability and an interfragmentary lag screw to augment compression.
Radial Collateral Ligament Injury of the Little Finger Proximal Interphalangeal Joint in Young Pianists
Source: Journal of Hand Surgery
Purpose
To report the features of radial collateral ligament injury of the little finger proximal interphalangeal joint in young piano players.
Methods
Between 2005 and 2012, we treated 6 cases of radial collateral ligament injury of the little finger proximal interphalangeal joint in young piano players at a single referral center. We conducted a retrospective review of charts and radiographs and telephone-interviewed all patients at a mean follow-up of 33 months (range, 12–66 mo) to evaluate features of this injury.
Driving With Upper Extremity Immobilization: A Comprehensive Review
Source: Journal of Hand Surgery
Driving with upper extremity immobilization can be potentially dangerous. The aim of this article is to review current medical literature, state laws, and guidelines on driving with upper extremity immobilization and appraise the available evidence. A literature search was conducted to identify citations related to driving with upper extremity immobilization and included a law literature search.
Symptom Severity and Conservative Treatment for Carpal Tunnel Syndrome in Association With Eventual Carpal Tunnel Release
Source: Journal of Hand Surgery
Purpose
To study the relationship between the severity of carpal tunnel syndrome (CTS) symptoms and surgery for CTS and the relationship between conservative treatments and surgery for CTS.
Methods
A secondary analysis of baseline to 6-month data from a randomized controlled trial, which examined the effectiveness of orthosis/stretch combinations on the symptoms of CTS, was conducted for a total of 96 participants with CTS. Participants completed the Carpal Tunnel Questionnaire and posttreatment surveys. Statistical analyses included exploration of correlates of progression to surgery for CTS and logistical regression to examine the association between conservative treatments and CTS symptoms and progression to surgery for CTS.