Suture Anchor Fixation for Lunate Osteochondral Shear Fracture: A Case Report.

CASE: A 26-year-old right-hand-dominant man sustained a left transradial, translunate perilunate injury after motor vehicle collision. The proximal lunate fractured a primarily cartilaginous 15 × 15 mm osteochondral shear fragment with 40% articular surface involvement. A novel lunate fracture suture anchor fixation technique is described, which led to fracture healing. The radial styloid was treated with a single screw. CONCLUSION: Translunate perilunate injuries involving the lunate proximal articular surface are rare. Treatment recommendations are limited to case reports. Suture anchor fixation led to stable fixation and fracture healing at the final 6-month postoperative follow-up.

Assessment of Telemedicine and Phone Consultation Effects on Rate of Hand Transfers to Trauma Centers and Specialty Services Referrals.

BACKGROUND: Telemedicine consultation can increase patients' access to subspecialty care and decrease the number of unnecessary hospital transfers. In 2014, the Arkansas Hand Trauma Telemedicine Program (AHTTP) was established to extend specialized hand care throughout Arkansas. The purpose of this study is to assess whether transfers are affected when consultation with a hand specialist is performed by phone compared with using a live audiovisual consultation. METHODS: We reviewed data from the first year of the AHTTP. Data collection included type of consultation (telephone only or live audiovisual), need for transfer, and type of transfer (general orthopedic or hand specialist). RESULTS: In 2014, the first year of AHTTP there were 331 hand injuries identified; of those, 298 used the AHTTP with 195 (65%) using telemedicine and 103 (35%) using phone consultation only. The use of video when compared with phone consultation did not significantly affect the decision to transfer (P = .42) or alter the rate of transfer for general orthopedic or hand specialist care (P = .25). CONCLUSIONS: The assessment of both phone and telemedicine modalities showed that there was no significant difference in transfer rates for either consultation, highlighting that communication with a hand surgeon was the key to accurate assessment of the need for transfer.

Intraosseous Catfish Barb Treated With Cannulated Drill in a Pediatric Patient.

Catfish injuries to the upper extremity following fishing activities are common in the southern United States, especially because noodling is commonplace in this region. Noodling is when a fisher will stick their hand into an area where a catfish is guarding its eggs and grab the catfish by its mouth. Different mechanisms of injury, including envenomation and spine embedment, can occur and ultimately lead to different patient presentations, including the retention of foreign bodies or infection. Literature reviews of catfish injuries primarily report the retention of foreign bodies within soft tissues, infection, and envenomation. We present the first case report of a patient who sustained a ring finger proximal phalangeal physeal injury involving the growth cartilage caused by a penetration injury from a catfish barb. A novel method for safely extracting these barbs with no subsequent growth arrest or range of motion limitation is also presented.

Obesity is associated with larger soft-tissue sarcomas, more surgical complications, and more complex wound closures (obesity leads to larger soft-tissue sarcomas).

BACKGROUND AND OBJECTIVES: Does a link exist between obesity and soft-tissue sarcoma outcomes? We hypothesized that soft-tissue sarcomas in patients with obesity may lead to larger tumors at detection, with an increased risk for a more complex surgical excision, wound healing-related complications, higher stage at presentation, and decreased survival. METHODS: One hundred thirty-nine and patients with soft-tissue sarcoma were retrospectively evaluated over 10 years. Patients were divided into 2 cohorts based on the World Health Organization body mass index (BMI) obesity grouping. A BMI ≥ 30 kg/m2 was classified as obese and a BMI < 30 kg/m2 was classified as nonobese. RESULTS: Eighty-five nonobese and 54 obese individuals were evaluated. The median tumor diameter was 50% larger (P = .024) and the overall complication rate was 1.7-fold higher in patients with obesity (P = .0032). Patients with obesity also had a statistically significantly higher rate of complex wound closures. In multivariable logistic regression, obesity remained a highly significant factor favoring complications after the surgical treatment of soft-tissue sarcoma (odds ratio = 3.66, 95% confidence interval = 1.54-8.71; P = .0033). No statistically significant differences were noted on comparing groups for the incidence of metastatic spread or survival. CONCLUSIONS: These findings suggest that obesity is associated with larger tumors, a higher incidence of wound complications, and greater use of complex wound-closure methods.

New developments in the treatment of early-onset spinal deformity: role of the Shilla growth guidance system.

Early-onset scoliosis is a complex condition with multiple facets. The goal of treating any spinal deformity is to improve the condition of the patient with the least intervention necessary. A system that allows for continuation of natural spinal growth while correcting the deformity should be the goal of treating this complex condition. The SHILLA growth guidance system allows for continued growth of the pediatric spine while correcting and guiding the apex and guiding the future growth of the curvature. The system involves selective fusion across the apex of the curvature, and minimally invasive instrumentation is then used above and below the apex to allow for continued growth of the spine. A review of recent literature on the SHILLA growth guidance system shows promising results. Early animal models showed continued growth across unfused levels with minimal facet articular damage. Comparative studies to traditional growing rods showed significantly less total surgeries along with comparable correction and longitudinal growth. The SHILLA growth guidance system is a good option for this complex patient group. Results are comparable with other growing constructs with significantly less operative interventions. The SHILLA system allows for natural growth of the pediatric spine while correcting the scoliotic deformity in a minimally invasive method. The goal of this article is to present a comprehensive review of the SHILLA system surgical technique and the associated literature concerning this topic.