Hand (New York, N.Y.)
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Hand (New York, N.Y.) · Jul 2019
Comparative StudyBiomechanical Analysis of Capsular Repair Versus Arthrex TFCC Ulnar Tunnel Repair for Triangular Fibrocartilage Complex Tears.
Background: This study compares the effectiveness of a peripheral capsular repair with a knotless arthroscopic transosseous ulnar tunnel repair (TR) in restoring distal radioulnar joint (DRUJ) stability and stiffness in the setting of a massive triangular fibrocartilage complex (TFCC) tear. Methods: Eight matched pairs of fresh-frozen cadaveric forearms were tested. Each forearm was tested in supination and pronation using 3-dimensional (3D) optical tracking devices prior to any intervention. ⋯ Conclusions: Arthroscopic sectioning of the TFCC resulted in DRUJ instability, as measured by stiffness and ulnar translation. TR effectively restored DRUJ stability and demonstrated no significant difference in postoperative stiffness or maximal displacement when compared with the intact specimen in pronation and supination. This study provides biomechanical evidence that an arthroscopic ulnar tunnel technique can restore stability to the DRUJ after a massive TFCC tear.
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Hand (New York, N.Y.) · May 2019
Trends in Upper Extremity Injuries Presenting to US Emergency Departments.
The purpose of this study was to identify the incidence of upper extremity injuries presenting to emergency departments (EDs) nationally. ⋯ Soft tissue contusion was the most frequent diagnosis. More than half of the patients were male, while the majority of patients were under the age of 44. Ninety-three percent of patients did not require hospital admission. Half had private insurance and the two-thirds of these patients were seen at nonteaching facilities.
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Hand (New York, N.Y.) · Mar 2019
Bone Grafting for Scaphoid Nonunions: Is Free Vascularized Bone Grafting Superior for Scaphoid Nonunion?
Nonvascularized bone grafting (NVBG) and vascularized bone grafts (VBGs) have been used to treat scaphoid nonunions. A comparison of a single institution' s experience using structural iliac crest bone graft (ICBG), 1,2-intercompartmental supraretinacular artery (1,2-ICSRA), and medial femoral condyle (MFC) grafts to treat scaphoid nonunions was undertaken. ⋯ These findings demonstrate the need for careful patient selection. In patients with the most complicated scaphoid nonunions (avascular necrosis, carpal collapse, and previous surgeries), the MFC group had the highest union rate and fastest time to union. Patients with risk factors for failure should be counseled on the outcomes and possible need for salvage fusion surgery.
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Hand (New York, N.Y.) · Mar 2019
Regional Variations of Medicare Physician Payments for Hand Surgery Procedures in the United States.
Medicare reimbursement is known to exhibit geographic variation for inpatient orthopedic procedures. This study determined whether US geographic variations also exist for commonly performed hand surgeries. ⋯ In conclusion, further research is warranted to determine why regional or geographic variations in physician payments exist in the United States for commonly performed hand surgeries.
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Hand (New York, N.Y.) · Jan 2019
Comparative StudyA Comparison of Locking Plates and Intramedullary Pinning for Fixation of Metacarpal Shaft Fractures.
Metacarpal shaft fractures that necessitate surgery are frequently fixated with either intramedullary pins or plates and screws. This study compared outcome measurements of these two techniques. ⋯ Fixation with locking plates allows earlier mobilization without need for splinting. Our study supports the use of this method over intramedullary pinning for metacarpal shaft fractures.