Necrotizing Soft Tissue Infections of the Hand and Wrist.

Necrotizing soft tissue infections of the upper extremity threaten life and limb. Their presentation is often difficult to recognize and multiple factors contribute to the varied presentation, speed of spread, and morbidity of the disease process. The only treatment to be definitively shown to improve outcomes is prompt surgical treatment. It should be expected to perform multiple debridements as well as reconstructive procedures once the infection and necrosis has been arrested. The use of a multidisciplinary team is mandatory to optimize care for these patients. Despite advances in knowledge and treatment, these infections still have high mortality and morbidity.

Three-dimensional biplanar radiography as a new means of accessing femoral version: a comparitive study of EOS three-dimensional radiography versus computed tomography.

OBJECTIVE: To validate femoral version measurements made from biplanar radiography (BR), three-dimensional (3D) reconstructions (EOS imaging, France) were made in differing rotational positions against the gold standard of computed tomography (CT). MATERIALS AND METHODS: Two cadaveric femurs were scanned with CT and BR in five different femoral versions creating ten total phantoms. The native version was modified by rotating through a mid-diaphyseal hinge twice into increasing anteversion and twice into increased retroversion. For each biplanar scan, the phantom itself was rotated -10, -5, 0, +5 and +10°. Three-dimensional CT reconstructions were designated the true value for femoral version. Two independent observers measured the femoral version on CT axial slices and BR 3D reconstructions twice. The mean error (upper bound of the 95% confidence interval), inter- and intraobserver reliability, and the error compared to the true version were determined for both imaging techniques. RESULTS: Interobserver intraclass correlation for CT axial images ranged from 0.981 to 0.991, and the intraobserver intraclass correlation ranged from 0.994 to 0.996. For the BR 3D reconstructions these values ranged from 0.983 to 0.998 and 0.982 to 0.998, respectively. For the CT measurements the upper bound of error from the true value was 5.4-7.5°, whereas for BR 3D reconstructions it was 4.0-10.1°. There was no statistical difference in the mean error from the true values for any of the measurements done with axial CT or BR 3D reconstructions. CONCLUSION: BR 3D reconstructions accurately and reliably provide clinical data on femoral version compared to CT even with rotation of the patient of up to 10° from neutral.

The role of the scapula in throwing disorders.

Shoulder injuries in the thrower can prove a challenge to diagnose and treat. Overhead throwing is an intricate motion that places considerable torque on the shoulder. The complex interplay of the scapula with the glenohumeral joint and its surrounding musculature allows elite pitchers to achieve speeds >95 miles per hour. An understanding of scapular motion is integral to diagnose and treat shoulder pathology in these athletes. Treatment is aimed at addressing the underlying cause with a physical rehabilitation program. Although nonoperative care is the most predictable and useful treatment, occasionally operative treatment is necessary. This chapter will outline normal scapular motion during throwing, the effects of common shoulder disorders on throwing mechanics, and the prevention, diagnosis, and treatment of these conditions.