Infection Rate in Type I Open Distal Radius Fractures Surgically Treated >24 Hours Post-Injury: A Comparison Study.

PURPOSE: To determine how time to surgical debridement and fixation affects infection and complication rate in type I open distal radius fractures by comparing patients treated within 24 hours with those treated >24 hours post-injury. METHODS: A retrospective review identified 62 patients who sustained a type I open distal radius fracture that was treated surgically. Patients were stratified into groups based on time to surgical intervention. An additional analysis was performed on patients with an isolated type I open distal radius fracture treated as an inpatient or outpatient. The primary outcome measure was infection rate. Secondary outcome measures were complications, reoperations, and readmissions. RESULTS: Thirty-eight patients underwent surgery ≤24 hours post-injury at an average of 14 hours. Twenty-four patients underwent surgery >24 hours post-injury at an average of 72 hours. There were a total of 9 complications in 8 patients (14.5%). The overall infection rate was 1.6%, with only 1 deep infection occurring in the group treated ≤24 hours post-injury. There were 7 reoperations (11.3%) and 1 readmission (1.6%). No differences were found between groups in any outcome measure. In the 27 patients with an isolated fracture, there were no differences in any outcome measure when treated as an inpatient or outpatient. CONCLUSIONS: We suggest that type I open distal radius fractures could be safely treated surgically >24 hours post-injury without increased risk of infection.

LT Ligament Tears.

Lunotriquetral (LT) ligament injuries are uncommon, however, should be considered in patients with ulnar-sided wrist pain. LT injuries are often associated with other injuries but can occur in isolation. Understanding the anatomy and pathomechanics will aid in making the diagnosis. Similar to other injuries, a thorough history and focused physical examination is critical. Radiographs may show normal findings; however, advanced imaging can support the diagnosis. Arthroscopy remains the gold standard for diagnosis. Most patients do well with conservative management; however, injury acuity and severity will direct surgical management. Anatomy, pathophysiology, and treatment options are discussed.

Generating Differential Ligamentotaxis Across the Radiocarpal Joint.

This study sought to determine if traction through the index or long finger metacarpal provided a selective distraction force through either the distal radius' radial or ulnar column. In eight specimens, the radius was cut transversely 1 cm proximal to the Lister tubercle. Index and long finger metacarpals were cut and two-hole plates were fixed to metacarpals. Traction forces were alternately applied to index, then long finger metacarpals, sequentially through each metacarpal from 4.5N to 89N. Traction loading through the index finger metacarpal resulted in significantly more distraction force transmitted through the distal radius fragment's radial column at all force intervals. Traction loading through long finger metacarpal resulted in significantly higher force transmission through distal radius' ulnar column. In both cohorts, force transmission increased linearly in response to higher loads. Selective traction force of either the index or long finger metacarpal resulted in differential tensioning of the distal radius' ulnar and radial columns. (Journal of Surgical Orthopaedic Advances 28(2):104-107, 2019).

Normal Palmar Anatomy and Variations That Impact Median Nerve Decompression.

Annually, carpal tunnel release is one of the most commonly executed orthopaedic procedures. Despite the frequency of the procedure, complications may occur as a result of anatomic variations. Understanding both normal and variant anatomy, including anomalies in neural, vascular, tendinous, and muscular structures about the carpal tunnel, is fundamental to achieving both safe and efficacious surgery. Reviewing and aggregating this information reveals certain principles that may lead to the safest possible surgical approach. Although it is likely that no true internervous plane or so-called safe zone exists during the approach for carpal tunnel release, the long-ring web space axis does appear to pose the lowest risk to important structures.

Complications of Surgical Release\break of Carpal Tunnel Syndrome: A Systematic Review.

A systematic review of the literature was performed to compare complications of endoscopic and open carpal tunnel release. Techniques were further subdivided into traditional open, limited open, single-portal endoscopic, and two-portal endoscopic. This study also compared incidence of complications in each group based on chronological periods of data collection. The study found that endoscopic release has a higher incidence of transient nerve injury. There was also an increased incidence of superficial palmar arch injuries in the endoscopic group in the 1960-1990 time period as compared with the 1991-2000 and 2001-2012 periods. No difference was found in scar complications between open and endoscopic groups. While vascular injuries have decreased over time, the rate of nerve injuries has not changed since the introduction of endoscopic release. This higher incidence of transient nerve injury and lack of increased skin complications should be weighed when deciding between open and endoscopic techniques.

Instability and Arthritis of the Distal Radioulnar Joint: A Critical Analysis Review.

Arthritis and instability represent 2 of the most common pathological processes affecting the distal radioulnar joint (DRUJ). These conditions can present in isolation or as components of a multifactorial process. Nonoperative treatment is indicated for most acute injuries to the DRUJ. The joint should be immobilized in a position of stability to allow for ligament healing. Likewise, early arthritis responds favorably to rest, immobilization, corticosteroids, and nonsteroidal anti-inflammatory drugs (NSAIDs). When DRUJ instability is refractory to nonoperative measures, native ligament repair is the preferable method of treatment. When this method is not possible, anatomical reconstruction of the distal radioulnar ligaments should be performed. For advanced DRUJ arthritis Darrach resection should be reserved for the elderly, low-demand patient. The Sauve-Kapandji procedure allows for arthrodesis of the DRUJ while maintaining forearm rotation and a stable base for the ulnar carpus. DRUJ hemiarthroplasty procedures have been associated with favorable preliminary results. These implants attempt to reproduce native biomechanics and may be used in lieu of or as a salvage procedure after resection arthroplasty. DRUJ arthroplasty should be used as a salvage procedure.

Comparison of screw trajectory on stability of oblique scaphoid fractures: a mechanical study.

PURPOSE: To determine whether a screw placed perpendicular to the fracture line in an oblique scaphoid fracture will provide fixation strength that is comparable with that of a centrally placed screw. METHODS: Oblique osteotomies were made along the dorsal sulcus of 8 matched pairs of cadaveric scaphoids. One scaphoid from each pair was randomized to receive a screw placed centrally down the long axis. In the other scaphoid, a screw was placed perpendicular to the osteotomy. Each scaphoid underwent cyclic loading from 80 N to 120 N at 1 Hz. Cyclic loading was carried out until 2 mm of fracture displacement occurred or 4,000 cycles was reached. The specimens that reached the 4,000-cycle limit were then loaded to failure. Screw length, number of cycles, and load to failure were compared between the groups. RESULTS: We found no difference in number of cycles or load to failure between the 2 groups. Screws placed perpendicular to the fracture line were significantly shorter than screws placed down the central axis. CONCLUSIONS: A perpendicularly placed screw provides equivalent strength to one placed along the central axis. CLINICAL RELEVANCE: Compared with a screw placed centrally in an oblique scaphoid fracture, a screw placed perpendicular to the fracture line allows the use of a shorter screw without sacrificing strength of fixation.