Percent articular exposure of the distal humerus with triceps fascial tongue approach compared with olecranon osteotomy.

BACKGROUND: Distal humerus fractures are common and can be difficult to treat. No one approach to the distal humerus has been shown to be superior to another; however, the olecranon osteotomy remains the gold standard for complex, intra-articular fractures. Understanding the percent of articular exposure with approaches to the distal humerus is important for success. The goal of this study is to show the percent of articular exposure of the triceps fascial tongue approach as compared with the olecranon osteotomy. METHODS: Twelve fresh frozen cadavers were separated randomly into 2 groups of 6 each. The first group of 6 specimens was allocated to the triceps fascial tongue approaches with the collaterals maintained and with the collaterals released off the ulna and elbow dislocated. The second group of 6 was allocated to the triceps fascial tongue approach while maintaining the collaterals followed by an olecranon osteotomy. The articular exposure was marked after performing each approach, and the percent of articular exposure was quantified by using 3D scanning. Standard deviations were calculated for each. RESULTS: The average percent visualization of the distal humerus articular surface in the fascial tongue approach while maintaining the collaterals was 36% in the first cohort and 37% in the second cohort with a standard deviation of 5% in both cohorts. The average percent of the distal humerus articular surface exposed in the fascial tongue approach with the collaterals released off the ulna and elbow dislocated was 85.09% with a standard deviation of 4%. The average percent of the distal humerus articular surface exposed in the olecranon osteotomy group was 57.9% with a standard deviation of 5%. CONCLUSION: The triceps fascial tongue approach allows for visualization of about one-third of the joint, which may be adequate for many intra-articular distal humerus fractures. For added exposure of the articular surface, the collaterals may be elevated from the ulna and the elbow dislocated allowing for a substantial increase in percent of articular exposure compared with the collateral retaining fascial tongue approach and the olecranon osteotomy.

A Case of 14-Year-Old Male with Fibroma of Tendon Sheath of the Hand with Novel Chromosomal Translocation 4;10.

Fibroma of tendon sheath (FTS) is an uncommonly encountered soft tissue mass, which is morphologically distinct from the more commonly seen giant cell tumor of tendon sheath (GCTTS). Initially described in 1936, FTS is typically a slow growing, painless, firm mass with a predilection for the upper extremity, frequently involving the hand. Cases of associated triggering or compression neuropathies have been described when underlying tendons or nerves are affected. Currently, the literature on FTS is sparse and largely limited to case reports. More recently, few reports of cytogenetic analysis on FTS have been reported in the literature. Cellular and chromosomal analysis of FTS tissue revealed chromosomal translocations with yet unknown clinical significance. Here, we present a case report of FTS in a 14-year-old male with a painless enlarging mass on the palmar side of the left hand treated by excision. Subsequent karyotypic analysis revealed a chromosomal translocation t(4;10) (p16;q24), add (10)(q22)[24]. To our knowledge, this is the first description of this chromosomal aberration in the literature.

The Incidence of Snow Blower-Related Injuries to the Hand in the United States.

BACKGROUND: Snow blowers represent a highly preventable and increasingly common mechanism of hand injury. This study examines current safety features and their impact on decreasing the incidence of snow blower-related injuries. METHODS: The National Electronic Injury Surveillance System was queried to look for injuries related to the use of snow throwers or blowers between 2001 and 2016. From all of the injuries related to snow blowers, we collected information on identifying characteristics, location of injury, and type of injury (i.e., avulsion). Chi-squared tests were used for categorical variable comparisons, and Student t tests were used for continuous variable comparisons. Data analysis was performed using SAS statistical software, version 9.3 (SAS Institute, Inc., Cary, NC). The Consumer Product Safety Commission's provided SAS algorithm was used to calculate all national injury estimates and variances. Statistical significance was determined based on P < 0.05. RESULTS: Within the study period, there were 3,550 reported injuries. The extrapolated national incidence was 92,799, with an average annual incidence of 5,800 or 1.9 injuries per 100,000 US population per year. The most commonly injured body part was the finger followed by the hand. Most common types of injuries were fractures, lacerations, and amputations. CONCLUSIONS: The incidence of snow blower injuries increased from 2001 to 2016. Unlike with other power tools, Consumer Product Safety Commission-mandated guidelines for safer operation and improvements in equipment have not been successful in producing a decrease in the incidence of snow blower injuries to the upper extremity. Based on this, further equipment modifications are necessary and should be aimed at preventing operators from placing their hand into the exit chute while the machine is still running. Physicians should take an active role in their practice as well as in their professional societies to educate and counsel patients to prevent further injury.

Hand Compartment Syndrome.

Acute hand compartment syndrome is a potentially devastating condition a hand surgeon may be called on to evaluate and treat. This pathophysiologic cascade of events that begins with an inciting event progresses to increased intracompartmental pressure, tissue necrosis, and resultant morbidity and potentially mortality. Many patients present with an altered sensorium, making the diagnosis challenging, requiring the clinician to rely on clinical findings and intracompartmental pressure measurements. The timing to definitive treatment with complete decompressive fasciotomies is critical to optimize patient outcomes. The goals of treatment are to prevent contracture, functional disability, and the loss of limb or life.

Intravenous administration of tranexamic acid effectively reduces blood loss in primary total knee arthroplasty in a 610-patient consecutive case series.

BACKGROUND: Tranexamic acid (TXA) has been reported to demonstrate efficacy in reducing blood loss during arthroplasty procedures. STUDY DESIGN AND METHODS: This study examines the effectiveness of TXA as a central element of a patient blood management program (PBMP) by evaluating blood loss and transfusion of red blood cells in three consecutive groups of patients undergoing routine total knee arthroplasty (TKA). Approximately 200 patients were in each group as follows: Group 1 was a control without TXA, Group 2 was intraarticular administration, and Group 3 was intravenous (IV) administration. RESULTS: The IV group demonstrated a small but significant lower blood loss compared to the two other groups measured by hemoglobin (Hb) drift and nadir Hb levels. The routine use of TXA along with the other aspects of our PBMP provided significant cost savings due to the reduction in transfusions as well as a decrease in length of stay and has been an important element of our successful implementation of a PBMP. CONCLUSION: This study demonstrates a significant benefit from the routine use of TXA for total knee arthroplasty and is one of the first studies to demonstrate a small but significant benefit for IV administration in comparison to intraarticular administration. The routine use of TXA as a central element of a PBMP provides a cost savings and can help reduce the rate of transfusions for total knee arthroplasty.

Laparoscopic-assisted versus open pancreaticoduodenectomy: early favorable physical quality-of-life measures.

BACKGROUND: We compared outcomes and postpancreatectomy quality of life (QOL) in paired cohorts of patients undergoing conventional open pancreaticoduodenectomy (OPD) or laparoscopic-assisted pancreaticoduodenectomy (LAPD). METHODS: Comparative analysis of QOL was performed in a matched cohort of 53 patients after OPD or LAPD between 2010 and 2013. The Medical Outcomes Study Short Form-36 Health Survey and the Karnofsky score were used. RESULTS: Physical component score, mental component score, and Karnofsky scores were calculated at multiple time points for OPD (n = 25) and LAPD (n = 28). Operative times, complications, and readmission rates were equivalent. Time to starting adjuvant therapy trended toward clinical importance in LAPD (61 vs 110 days, P = .0878). Duration of stay was less in LAPD (7.10 vs 9.44 days, P = .02). LAPD had a superior QOL centered on functional status compared with OPD (physical component score 49.09 vs 38.4, P = .04; Karnofsky 92.22 vs 66.92%, P = .003). These statistical differences were not observed beyond 6 months. CONCLUSION: LAPD provided a more favorable QOL within the first 6 months and shorter length of stay compared with conventional OPD. LAPD may serve as an alternative operative therapy to potentially minimize delays in receipt of and enhance tolerability of adjuvant therapies.