Distal Ulna Fracture Fixation with the Specialized Threaded Pin.

Purpose: Distal ulna fractures can often be treated nonsurgically; however, many surgeons consider significant displacement or instability, especially following fixation of an associated distal radius fracture, an indication for surgical fixation because of potential problems associated with malunion of these fractures. Traditionally, these fractures have been addressed with plate fixation but hardware in this location is often prominent and associated with a high rate of symptomatic hardware and subsequent hardware removal. We proposed a method of intramedullary fixation using a specialized threaded pin. As this fixation is intramedullary, it avoids many of the problems associated with traditional surgical treatment methods for this fracture. We present a series of nine patients treated in this manner, all of whom had associated distal radius fractures. Methods: Preoperative and postoperative radiographs were reviewed, after which patients were contacted via phone. Patient-reported outcome measures, including QuickDASH and visual analog scale scores, were assessed. Results: The average QuickDASH score was 13.6 (range, 0-100), with a median of 9.1. Three patients reported occasional ulnar-sided wrist pain, with an average visual analog scale score of 1.3 (range, 0-10) and a median of 0.5. All patients returned to all activities except one patient who could not resume playing musical instruments because of stiffness. No patient required removal of the threaded pin, but one patient underwent removal of the radial volar plate. No other patients underwent secondary procedures. Conclusions: Threaded pin fixation is a viable alternative to existing options for distal ulnar neck fractures and may have an advantage over plate fixation because of a lack of hardware prominence. Type of study/level of evidence: Therapeutic IV.

Arthroscopic Biceps to Subscapularis Tenodesis: A Surgical Technique.

A wide variety of techniques are available for tenodesis of the long head of the biceps tendon, and current literature does not favor any one in particular. We present a simple method for arthroscopic soft tissue biceps tenodesis that uses the subscapularis tendon as the anchor. This 5-step technique is time-efficient, technically simple, cost effective, and does not require powered instruments or specialized implants.

Excision of a Rare Triquetral Body Fracture Nonunion.

Aside from the more common dorsal avulsion fractures, isolated triquetral body fractures are a rare injury and often missed. When they are identified, conservative treatment via immobilization is often the standard of care for initial treatment. Rarely, triquetral body fractures can develop into symptomatic nonunions, causing considerable pain and disability. Multiple classification schemes have been described to categorize triquetrum fractures; however, distal triquetrum fractures fit into none of the established models. There is scarce literature describing treatment of triquetral body fracture nonunions. The few reports that exist often use a variation of open reduction internal fixation with or without grafting as treatment. We present the case of an unusual triquetral body fracture nonunion that was successfully treated via surgical excision of the ununited distal fragment.