Patient Risk Factors Associated With Postoperative Complications After Common Hand Procedures.

BACKGROUND: Carpal tunnel syndrome (CTS), trigger finger (TF), and De Quervain tenosynovitis (DQ) are 3 common pathologies of the hand often treated with relatively simple surgical procedures. However, outcomes from these procedures can be compromised by postoperative complications. The aim of this study was to evaluate the association between diabetes, tobacco use, and obesity and the incidence of postoperative complications. METHODS: We reviewed 597 patients treated surgically for CTS, TF, or DQ from 2010 to 2015. We used bivariate and multivariate analyses to assess independent associations between diabetes, tobacco use, obesity, and surgical complications and compared the incidences with healthier patients without these comorbidities. We also looked at patients with overlapping diagnoses of these comorbidities. RESULTS: Bivariate analysis showed that patients with diabetes and smokers were more likely to have a surgical complication. Multivariate analysis showed diabetes and tobacco use as independent predictors of complications. The disease states or combinations placing patients at the highest risk of a postoperative complication were the diabetic-smoker-obese, diabetic-smoker, diabetic-obese, diabetic, and smoker-obese groups. The diabetic-smoker-obese patient population had a 42.02% predicted rate of postoperative complications. CONCLUSIONS: Diabetes and tobacco use are independent risk factors for complications after operative treatment of CTS, TF, and DQ. Obesity when coexisting with diabetes mellitus (DM) and/or tobacco use increased the risk of complications. When the 3 patient factors evaluated, DM, obesity, and tobacco use, were present, the rate of complications was 42.02%. Careful assessment and discussion should occur before proceeding with operative treatment for simple hand conditions in patients with the risk factors studied.

Transfer of the Dorsal Cutaneous Branch of the Ulnar Nerve for Restoration of Median Nerve Sensation: A Cadaveric Study.

The use of dorsal cutaneous branch of the ulnar nerve (DCBUN) transfer for median nerve (MN) sensory restoration has not been evaluated anatomically and histologically in humans. The purpose of this study was to evaluate the feasibility of DCBUN to MN transfer for sensory restoration with respect to nerve branch pattern, length, and fascicle count match.Using seven fresh frozen cadaveric upper limb specimens, the DCBUN and its branch patterns, lengths, and sizes were recorded. The MN was exposed within the carpal tunnel and dissected distally to identify the common digital nerves (CDN). Simulated nerve transfer was performed with palmar coaptation of the DCBUN branches with the CDNs. Histological analysis of each nerve branch was performed. The seven specimens had a mean of 3.57 branches (range 2-4) off the DCBUN. The longest branch innervated the dorsal 4th web space, on average reaching 7.6 cm distal to the wrist crease. Transferring the DCBUN branches palmarly did not substantially change their maximum distance distal to the wrist crease. The MN CDNs and DCBUN branches had mean cross-sectional areas of 6.37 and 1.99 mm2 , respectively, and mean fascicle counts of 10.4 and 4.05, respectively. The DCBUN provides 2-4 branches suitable for tension-free end-to-end transfer to the MN CDNs. The individual size of the DCBUN branch is smaller than CDN; however, combining two or more branches of the DCBUN would overcome the fascicle and size mismatch to reconstruct the 1st web space CDN for critical sensory restoration. Clin. Anat. 31:1006-1012, 2018. © 2018 Wiley Periodicals, Inc.

Comparison of Femoral Head Rotation and Varus Collapse Between a Single Lag Screw and Integrated Dual Screw Intertrochanteric Hip Fracture Fixation Device Using a Cadaveric Hemi-Pelvis Biomechanical Model.

OBJECTIVE: This study compared the stabilizing effect of 2 intertrochanteric (IT) fracture fixation devices in a cadaveric hemi-pelvis biomechanical model. METHODS: Eleven pairs of cadaveric osteopenic female hemi-pelves with intact hip joint and capsular ligaments were used. An unstable IT fracture (OTA 31-A2) was created in each specimen and stabilized with a single lag screw device (Gamma 3) or an integrated dual screw (IDS) device (InterTAN). The hemi-pelves were inverted, coupled to a biaxial apparatus and subjected to 13.5 k cycles of loading (3 months) using controlled, oscillating pelvic rotation (0-90 degrees) plus cyclic axial femoral loading at a 2:1 body weight (BW) ratio. Femoral head rotation and varus collapse were monitored optoelectonically. For specimens surviving 3 months of loading, additional loading was performed in 0.25 × BW/250 cycle increments to a maximum of 4 × BW or failure. RESULTS: Femoral head rotation with IDS fixation was significantly less than the single lag screw construct after 3 months of simulated loading (P = 0.016). Maximum femoral head rotation at the end of 4 × BW loading was 7× less for the IDS construct (P = 0.006). Varus collapse was significantly less with the IDS construct over the entire loading cycle (P = 0.021). CONCLUSIONS: In this worst-case model of an osteopenic, unstable, IT fracture, the IDS construct, likely owing to its larger surface area, noncylindrical profile, and fracture compression, provided significantly greater stability and resistance to femoral head rotation and varus collapse.

A Mechanical Evaluation of Zone II Flexor Tendon Repair Using a Knotless Barbed Suture Versus a Traditional Braided Suture.

PURPOSE: To determine repair site bulk, gliding resistance, work of flexion, and 1-mm gap formation force in zone II flexor tendon lacerations repaired with knotless barbed or traditional braided suture. METHODS: Transverse zone II lacerations of the flexor digitorum profundus (FDP) tendon were created in 36 digits from 6 matched human cadaveric pairs. Repair was performed with 2-0 barbed suture (n = 18) or 3-0 polyethylene braided suture (n = 18). Pre- and postrepair cross-sectional area was measured followed by quantification of gliding resistance and work of flexion during cyclic flexion-extension loading at 10 mm/min. Thereafter, the repaired tendons were loaded to failure. The force at 1 mm of gap formation was recorded. RESULTS: Repaired FDP tendon cross-sectional area increased significantly from intact, with no difference noted between suture types. Gliding resistance and work of flexion were significantly higher for both suture repairs; however, we identified no significant differences in either nondestructive biomechanical parameters between repair types. Average 1-mm gap formation force with the knotless barbed suture (52 N) was greater than that of the traditional braided suture (43 N). CONCLUSIONS: We identified no significant advantage in using knotless barbed suture for zone II FDP repair in our primary, nondestructive mechanical outcomes in this in vitro study. CLINICAL RELEVANCE: In vivo studies may be warranted to determine if one suture method has an advantage with respect to the parameters tested at 4, 6, and 12 plus weeks postrepair and the degree of adhesion formation. The combined laboratory and clinical data, in additional to cost considerations, may better define the role of barbed knotless suture for zone II flexor tendon repair.

Are quadrilateral surface buttress plates comparable to traditional forms of transverse acetabular fracture fixation?

BACKGROUND: Several construct options exist for transverse acetabular fracture fixation. Accepted techniques use a combination of column plates and lag screws. Quadrilateral surface buttress plates have been introduced as potential fixation options, but as a result of their novelty, biomechanical data regarding their stabilizing effects are nonexistent. Therefore, we aimed to determine if this fixation method confers similar stability to traditional forms of fixation. QUESTIONS/PURPOSES: We biomechanically compared two acetabular fixation plates with quadrilateral surface buttressing with traditional forms of fixation using lag screws and column plates. METHODS: Thirty-five synthetic hemipelves with a transverse transtectal acetabular fracture were allocated to one of five groups: anterior column plate+posterior column lag screw, posterior column plate+anterior column lag screw, anterior and posterior column lag screws only, infrapectineal plate+anterior column plate, and suprapectineal plate alone. Specimens were loaded for 1500 cycles up to 2.5x body weight and stiffness was calculated. Thereafter, constructs were destructively loaded and failure loads were recorded. RESULTS: After 1500 cycles, final stiffness was not different with the numbers available between the infrapectineal (568±43 N/mm) and suprapectineal groups (602±87 N/mm, p=0.988). Both quadrilateral plates were significantly stiffer than the posterior column buttress plate with supplemental lag screw fixation group (311±99 N/mm, p<0.006). No difference in stiffness was identified with the numbers available between the quadrilateral surface plating groups and the lag screw group (423±219 N/mm, p>0.223). The infrapectineal group failed at the highest loads (5.4±0.6 kN) and this was significant relative to the suprapectineal (4.4±0.3 kN; p=0.023), lag screw (2.9±0.8 kN; p<0.001), and anterior buttress plate with posterior column lag screw (4.0±0.6 kN; p=0.001) groups. CONCLUSIONS: Quadrilateral surface buttress plates spanning the posterior and anterior columns are biomechanically comparable and, in some cases, superior to traditional forms of fixation in this synthetic hemipelvis model. CLINICAL RELEVANCE: Quadrilateral surface buttress plates may present a viable alternative for the treatment of transtectal transverse acetabular fractures. Clinical studies are required to fully define the use of this new form of fixation for such fractures when accessed through the anterior intrapelvic approach.