Evaluation of Carpal Arch Widening and Outcomes After Carpal Tunnel Release.

PURPOSE: The purpose of this study was to compare the carpal arch widths between baseline and 6 months after open carpal tunnel release, and to determine whether any increase in the carpal arch width was associated with clinical outcomes of surgery. METHODS: We measured carpal arch widths in standardized carpal tunnel radiographs before, and 6 months after, open carpal tunnel release in 76 patients with carpal tunnel syndrome. Clinical outcomes were assessed for grip strength change and perceived disability using the Disabilities of the Arm, Shoulder, and Hand questionnaire at 6-month follow-up. We correlated the clinical outcomes with carpal arch width changes. RESULTS: The mean change of the carpal arch width was 1.8 mm (standard deviation, 1.4 mm; range, -0.3 to 5.2 mm). There was no significant correlation between the amount of carpal arch width widening and the clinical outcomes in terms of grip strength change and the Disabilities of the Arm, Shoulder, and Hand scores. CONCLUSIONS: This study found that the change of carpal arch width was minimal at 6 months after open carpal tunnel release, and that the increase, if any, was not associated with clinical outcomes such as grip strength change or the Disabilities of the Arm, Shoulder, and Hand scores. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

Is Botulinum Toxin Type A a Valuable Adjunct During Femoral Lengthening? A Randomized Trial.

BACKGROUND: Reduced joint ROM and distraction-induced pain are common complaints of patients who have undergone gradual femoral lengthening. Attempts to reduce the effects of lengthening on joint motion have included the use of botulinum toxin to reduce the muscle forces that restrict motion. The benefits of this approach during femoral lengthening, however, have not been conclusively established. QUESTIONS/PURPOSES: We wished to evaluate the effects of botulinum toxin type A (BtX-A) injection in the anterior thigh muscles during femoral distraction osteogenesis on adjacent joint ROM and distraction-induced pain. We asked: (1) Does injection of BtX-A in the quadriceps muscles lead to improved knee and hip motion during femoral lengthening? (2) Does injection of BtX-A reduce pain during femoral lengthening? METHODS: A single-center, double-blind, randomized placebo-controlled trial was conducted. Forty-four patients (88 femurs) undergoing bilateral femoral lengthening for familial short stature were included in the study. BtX-A (200 IU) was injected intraoperatively in the quadriceps muscles of one thigh. An equal volume of sterile normal saline was injected in the other thigh as a control. Selection of the limb receiving the toxin was randomized. Clinical evaluation included a VAS score for pain measurement, ROM evaluation of the hips and knees, and measurement of thigh circumference. Side-to-side differences were analyzed throughout the entire consolidation phase. No patients were lost to followup, leaving 44 patients (88 femurs). The mean followup was 26 months (range, 14-40 months). The distraction rate and final length of gain were similar between treated and control limbs. A priori power analysis suggested that 44 legs were required in each group to achieve statistical significance of 0.05 with 90% power to detect a 50% difference in treatment effect between treatment and control groups. RESULTS: There were no differences in hip ROM, knee ROM, or maximal thigh circumference between the two lower extremities at any time during the study period. VAS scores were no different between the patients who received BtX-A and those who received saline. CONCLUSIONS: Local injection of 200 IU BtX-A in the quadriceps muscles does not appear to reduce distraction-induced pain nor enhance ROM in the hip or knee during femoral lengthening. Additional studies are needed to evaluate the effect of larger doses or different injection methods. Based on our findings, we do not recommend routine use of botulinum injections during limb lengthening and believe any further use of this drug should only be in the context of a controlled trial. LEVEL OF EVIDENCE: Level II, therapeutic study.

Biomechanical comparison of rotational activities between anterior cruciate ligament- and posterior cruciate ligament-reconstructed patients.

PURPOSE: The purpose of this study was to compare the early functional recovery using biomechanical properties between anterior cruciate ligament (ACL)- and posterior cruciate ligament (PCL)-reconstructed patients and to determine the biomechanical deficit of PCL-reconstructed patients compared to ACL-reconstructed patients. METHODS: A motion analysis system was used to measure and calculate kinematic and kinetic data for 10 patients who underwent PCL-reconstructed patients [experimental group (group 1)], 10 ACL-reconstructed patients (group 2), and 10 healthy subjects (group 3) during 45°, 90°, 135°, and 180° cutting and turn running tasks. Groups 1 and 2 were assessed at 3 (return to daily activity) and 6 months (return to light sports) postoperatively. RESULTS: At 3 months postoperatively, compared to groups 2 and 3, group 1 showed a decrease in knee flexion angle, extension moment, valgus moment, external rotational moment, ground reaction force, and increased hamstring-quadriceps ratio. At 6 months postoperatively, results from group 1 resembled those of groups 2 and 3 over time. CONCLUSIONS: Patients who underwent PCL reconstruction showed some biomechanical deficits in performance of activities requiring rotation, compared to those who underwent ACL reconstruction. Therefore, the modification of a rehabilitation programme for patients who underwent PCL reconstruction would be necessary for improvement of the biomechanical properties during performance of dynamic activities. LEVEL OF EVIDENCE: Case-control study, Level III.

Displaced fracture of the coracoid process associated with acromioclavicular dislocation: a two-bird-one-stone solution.

We describe a surgical treatment for a displaced fracture of the coracoid process associated with acromioclavicular dislocation. This treatment involves fixing the coracoid process using a cannulated screw without acromioclavicular fixation under fluoroscopic guidance. The benefits of this treatment are that fixation with a cannulated screw simultaneously reduces both the displaced fracture of the coracoid process and the acromioclavicular joint via the intact coracoclavicular ligament, thus reducing the complications associated with transacromial pin fixation.