Percutaneous Threaded Pin Fixation of Distal Radius Fracture in the Athlete.

BACKGROUND: The purpose of this study was to examine the outcomes and return to play with early rehabilitation in athletes who sustained unstable extra-articular distal radius fractures treated with a purpose-designed threaded pin technique. METHODS: This prospective study examined athletes with displaced and unstable distal radius fractures treated surgically with purpose-designed threaded pins. Patients were enrolled in an early rehabilitation protocol, with formal therapy initiated on postoperative days 1 to 3. Range of motion and strength measurements were documented throughout the postoperative period, noting the time until return to athletic competition. These results were compared with historical values using other forms of fixation. RESULTS: Nineteen athletes, average age of 35 years, were treated with threaded pin technique with early rehabilitation; all had complete healing and maintained alignment based on radiographic evaluation. The average time span between surgery and release to competition was 8 weeks, with all but 1 patient returning to sport within 12 weeks of injury. Average postoperative flexion measured 58°, extension was 57°, pronation was 81°, and supination was 74°. JAMAR grip strength in position 3 measured 25.22 kg, which equated to 73% of the uninjured side's grip strength at the time of release to play. CONCLUSIONS: Surgical fixation using a purpose-designed threaded pin is a useful alternative to volar plating for isolated radial styloid and extra-articular distal radius fractures in athletes. The purpose-designed threaded pin may afford athletes rapid recovery during the early postoperative period, preserving strength and dexterity and minimizing time lost before return to play.

Dorsal Coaptation for the Treatment of Digital Neuroma.

PURPOSE: The formation of a symptomatic neuroma after digital tip amputation presents a vexing problem. There is currently no procedure that completely and consistently prevents hypersensitive neuroma formation. This report presents the results of a technique designed to limit axon regeneration and mechanical irritation by neuroma excision, dorsal transposition, and coaptation with the corresponding digital nerve. METHODS: A retrospective chart review was conducted to assess the effectiveness of neuroma excision with dorsal transposition and epineurial coaptation for postamputation symptomatic digital neuromas. Neuromas were excised using a midlateral fish-mouth incision. Digital nerves were mobilized to the dorsum of the digital tip and coapted using 9-0 nylon epineurial suture. The procedure was modified to salvage viable fingernails or to avoid excessive tension. Mass et al's criteria system was used to evaluate effectiveness. RESULTS: Twenty-four patients with painful neuromas of the radial and ulnar digital nerves after traumatic amputation were included. Thirty-two digits underwent dorsal coaptation. This procedure was associated with a result considered good or excellent in 28 of 32 digits. Twenty-seven of 32 digits registered no pain or stump anesthesia after dorsal coaptation. Twenty-five of 32 digits demonstrated no interference with activities of daily living. Twenty-one of 24 patients returned to work. CONCLUSIONS: Neuroma excision with dorsal transposition and epineurial coaptation is an effective treatment for postamputation symptomatic digital neuroma. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Threaded Pin and Volar Plate Fixation of Distal Radius Fractures: Early Functional Recovery.

Purpose: To assess the results of threaded pin fixation and volar plate fixation of extra-articular distal radius fractures. Methods: A retrospective case comparison study of patients undergoing operative fixation of distal radius fracture and postoperative therapy at 1 hand clinic was performed. Clinical variables included implant type along with the assessment of the volar tilt; radial height; postoperative wrist flexion, extension, pronation, and supination; key pinch; and grip strength. The duration of postoperative hand therapy was recorded. An independent Student t test was used to compare the 2 groups. Results: Forty-three patients were identified (21 threaded pin and 22 volar plate). The mean ages were 46 years and 54 years for the threaded pin and the volar plate groups, respectively. Preoperative and postoperative radiographic parameters were similar for both the groups. No loss of reduction was observed. There were no statistically significant differences for postoperative range of motion or pinch and grip strength at the time of discharge from therapy. The threaded pin group had a mean duration of 65 days of therapy, and the volar plate group had a mean duration of 132 days of therapy. Conclusions: Both groups achieved equivalent range of motion and functional recovery; however, the threaded pin group required significantly less therapy than the volar plate group. At the time of discharge from therapy, radiographic and clinical outcomes were similar for both types of implants, but the patients treated with a threaded pin required significantly less therapy and were discharged from therapy an average of 67 days sooner than the patients undergoing volar plate fixation. Type of study/level of evidence: Therapeutic IV.

Distal Radius Fracture Fixation With the Specialized Threaded Pin Device.

This study investigated the outcomes of extra-articular distal radius fractures and simple intra-articular radial styloid fractures stabilized with a novel threaded cannulated device. This was a retrospective study of 24 distal radius fractures treated with the T-Pin device (Union Surgical LLC, Philadelphia, Pennsylvania), with a minimum of 1 year of postoperative follow-up. Outcome data included wrist range of motion, grip strength, and pinch strength. Radiographs were analyzed to determine volar tilt and radial height. At final follow-up, patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. At an average of 2 years after surgery (range, 1-4 years), flexion was 89%, extension was 96%, supination was 99%, and pronation was 100% of contralateral wrist motion. Grip strength was 93% (range, 40%-137%) and lateral pinch strength was 99% (range, 48%-130%) of the contralateral upper extremity. The average final DASH score was 4.4 (range, 0-35). One patient lost 6 mm of radial height from the initial postoperative radiograph to the final follow-up radiograph. One patient elected to have the quiescent threaded pins removed, and 1 patient had tenderness with wrist range of motion that resolved after pin removal. After hardware removal, neither patient had further symptoms. No postoperative soft tissue complications occurred, and this was an expected benefit of the minimally invasive approach and intramedullary placement of the device. The stability of fixation allows patients to begin active range of motion early in the postoperative course. The threaded pin offers reliable fracture fixation for the treatment of extra-articular and simple articular distal radius fractures.

Targeting sexual health services in primary care: A systematic review of the psychosocial correlates of adverse sexual health outcomes reported in probability surveys of women of reproductive age.

BACKGROUND: Women using primary care vary in need for sexually transmitted infections (STIs) testing and contraception. Psychosocial correlates of these needs may be useful for targeting services. We undertook a systematic review to identify psychosocial correlates of STI acquisition, unplanned pregnancy (UP), abortion and risky sexual behaviours in general population samples of women of reproductive age. METHODS: We searched bibliographic databases for probability surveys of women aged 16-44 years in the European Union, USA, Canada, Australia, UK or New Zealand undertaken January 1994-January 2014. RESULTS: Eleven papers were included. Unplanned pregnancy was associated with smoking, depression, being single and sexual debut <16 years. Abortion was associated with lack of closeness to parents, leaving home at an early age, and relationship break-up. Multiple partnerships were associated with intensity of marijuana and alcohol use, and smoking. STI diagnosis was associated with relationship break-up and younger partners. Non-use of contraception was associated with smoking, obesity, relationship status, sedentary lifestyles, fatalistic pregnancy attitudes and lower alcohol use. Condom non-use was higher (at first sex) with partners 5+years older and lower (at last sex) in less stable partnerships. CONCLUSION: Psychosocial variables, particularly relationship status and smoking, may help identify women in primary care for STI testing and contraception advice and supply.

Allograft reconstruction for digital nerve loss.

PURPOSE: To investigate the outcomes of digital nerve repairs using processed nerve allograft for defects measuring 30 mm or less. METHODS: Seventeen patients with 21 digital nerve lacerations in the hand underwent reconstruction with processed nerve allograft. Outcome data for 14 patients with 18 digital nerve lacerations were available for analysis. Postoperative outcome data were recorded at a minimum of 12 months and an average of 15 months. The average nerve gap measured 11 mm (range, 5-30 mm). Outcome measures included postoperative sensory examination as assessed by Semmes-Weinstein monofilaments and static and moving 2-point discrimination. Pain was graded using a visual analog scale throughout the recovery period. In addition, patients completed the Quick Disabilities of the Arm, Shoulder, and Hand survey before and after surgery. RESULTS: Using Taras outcome criteria, 7 of 18 (39%) digits had excellent results, 8 of 18 (44%) had good results, 3 of 18 (17%) digits had fair results, and none had poor results. At final follow-up, Semmes-Weinstein monofilament testing results ranged from 0.08 g to 279 g. Quick Disabilities of the Arm, Shoulder, and Hand scores recorded at the patient's first postoperative visit averaged 45 (range, 2-80), and final scores averaged 26 (range, 2-43). There were no signs of infection, extrusion, or graft reaction. CONCLUSIONS: The data suggest that processed nerve allograft provides a safe and effective alternative for the reconstruction of peripheral digital nerve deficits measuring up to 30 mm.

Glucocorticoids do not alter developmental expression of hippocampal or pituitary steroid receptor coactivator-1 and -2 in the late gestation fetal guinea pig.

Steroid receptor coactivator (SRC) proteins interact with glucocorticoid receptors in a ligand-dependent manner to enhance transcription. Although glucocorticoids are essential for normal brain maturation, little is known about the presence or regulation of SRC proteins in the developing central nervous system. In the current study we demonstrated that SRC-1 was highly expressed in the fetal limbic system (hippocampal CA3>CA1/2>CA4>dentate gyrus) at gestational d (gd) 40 (term, approximately 70 d), whereas SRC-2 was undetectable at all time points. Hippocampal SRC-1 mRNA and protein expression were reduced in male and female fetuses with advancing gestation. In contrast, SRC-1 mRNA levels increased significantly in the dentate gyrus near term. Repeated maternal injection (1 or 10 mg/kg on gd 40, 41, 50, 51, 60, and 61) with synthetic glucocorticoid had no effect on fetal limbic SRC-1 expression at gd 62 in either sex. SRC-1 and SRC-2 mRNA expression in the anterior pituitary did not change over the second half of gestation and was unaffected by prenatal exposure to synthetic glucocorticoid. In conclusion, SRC-1 expression undergoes spatial, temporal, and region-specific regulation during development, and limbic and pituitary SRC-1 and SRC-2 are not regulated by glucocorticoids in late gestation. Developmental changes in limbic SRC-1 expression probably have important consequences on steroid receptor signaling, which is known to be critical for brain maturation in late gestation.

Regulation of N-methyl-D-aspartate receptor subunit expression in the fetal guinea pig brain.

N-methyl-d-aspartate receptors (NMDARs) are critical for neuronal maturation and synaptic formation as well as for the onset of long-term potentiation, a process critical to learning and memory in postnatal life. In the current study, we demonstrated that NMDAR subunits undergo spatial, temporal, and sex-specific regulation. During development, we observed increasing NR1 and NR2A expression at the same time as levels of NR2B subunits decreased in the hippocampus and cortex in the fetal guinea pig. We have also shown that glucocorticoids can modulate fetal NMDAR subunit expression in a sex-specific fashion. This is clinically important because synthetic glucocorticoids are administered to pregnant women at risk of preterm labor. Repeated exposure to exogenous glucocorticoids caused a dose-dependent decrease in NR1 mRNA levels and increased NR2A mRNA expression in the female hippocampus at Gestational Day 62. There are significant changes in NMDAR subunit expression in late gestation. It is possible that these alter NMDA-dependent signaling at this time. Prenatal exposure to exogenous glucocorticoids modifies the trajectory of NMDAR subunit expression in females but not in males.

Developmental regulation of 5-HT1A receptor mRNA in the fetal limbic system: response to antenatal glucocorticoid.

The developmental changes in 5-HT1A receptor mRNA expression associated with advancing gestational age were examined in the fetal guinea pig hippocampus and dentate gyrus (DG) by in situ hybridization. We found that 5-HT1A receptor mRNA was present in the hippocampal CA1 subfield and dentate gyrus (DG), and was significantly (P < 0.05) elevated in the DG during the period of rapid brain growth [gestational day (gd) 50; term = 70 days]. Glucocorticoids have been shown to alter 5-HT1A receptor mRNA expression in the adult, but nothing is known about their impact on the developing fetal brain. Expression of 5-HT1A receptor mRNA in the fetal hippocampus was measured following repeated maternal administration (gd40, 41, 50, 51, 60 and 61) of synthetic glucocorticoid (dexamethasone; 1 and 10 mg/kg). Levels of 5-HT1A receptor mRNA were significantly (P < 0.005) elevated in CA1 and DG following repeated exposure to high-dose glucocorticoid (10 mg/kg) in male, but not in female fetuses. Because fetal exposure to glucocorticoids programs hypothalamo-pituitary-adrenal (HPA) function, and hippocampal serotonin is known to influence glucocorticoid receptor (GR) expression, the glucocorticoid-mediated changes in 5-HT1A receptor mRNA may play a role in the programming of HPA function.

Developmental regulation of the 5-HT7 serotonin receptor and transcription factor NGFI-A in the fetal guinea-pig limbic system: influence of GCs.

Fetal exposure to excess glucocorticoids (GCs) programs the developing hypothalamo-pituitary-adrenal (HPA) axis, and may predispose offspring to adult-onset disease. During development, serotonin (5-HT) influences transcription of hippocampal GR mRNA via the 5-HT7 receptor. The effect of 5-HT on GR involves the transcription factor NGFI-A. Given the developmental changes which we have previously reported in hippocampal GR mRNA expression, we hypothesized that (1) there are progressive developmental changes in 5-HT7 receptor and NGFI-A mRNA expression in the fetal guinea-pig limbic system, and (2) repeated exposure to synthetic GC treatment will significantly modify developmental expression of these genes. 5-HT7 receptor mRNA was highly expressed in the hippocampus and thalamus at gestational day (gd) 40 (term approximately 70 days), and significantly decreased (P < 0.05) with advancing gestation. Conversely, NGFI-A mRNA expression in the hippocampus and frontal cortex was almost undetectable at gd40, but was dramatically elevated (P < 0.05; 8-fold) near term. Changes in mRNA were refelected by NGFI-A protein levels. These changes were significantly correlated to hippocampal GR expression and fetal plasma cortisol concentrations. Synthetic GC treatment increased NGFI-A mRNA levels in CA1 and the cingulate cortex, but had no effect on 5-HT7 receptor expression. In conclusion our results suggest that (1) limbic 5-HT7 receptor expression is not directly linked to maturation of hippocampal GR in late gestation; (2) the up-regulation of NGFI-A expression near term is driven by glucocorticoid; and (3) premature exposure to synthetic glucocorticoid significantly increases NGFI-A-related transcriptional activity in the fetal limbic system.