Influence of Bone Cement Augmentation on Complications in Cephalomedullary Nail Fixation of Geriatric Intertrochanteric Hip Fractures.

Introduction: The purpose of this study was to determine if augmentation of the helical blade with polymethylmethacrylate bone cement decreases the rates of varus cut-out and medial perforation in geriatric intertrochanteric hip fracture fixation. Methods: This was a retrospective comparative cohort study at two urban Level I trauma centers. Patients with an intertrochanteric hip fracture (classified as AO 31A1-3) who were treated with the TFN-Advanced Proximal Femoral Nailing System (TFNA) from 2018 to 2021 were eligible for the study. Medical records and post-operative radiographs were reviewed to determine procedure complications and reoperations. Results: Of the 179 patients studied, cement augmentation (CA) was used in 93 patients (52%) and no cement augmentation (NCA) was used in 86 (48%). There were no significant differences between group demographics and fracture reduction grades. Varus cut-out occurred three times in the CA group and five times in the NCA group (p = 0.48). Medial perforation occurred three times, all in the NCA group (p = 0.11). The most frequent complication was symptomatic blade lateralization from fracture collapse, with eight occurrences in the CA group compared with two in the NCA group (p = 0.10). There were 10 reoperations in the CA group and 9 in the NCA group (p = 0.99). The most common reason for reoperation was varus cut-out and the most common revision procedure was hip arthroplasty. Conclusions: Intertrochanteric hip fractures treated with the TFNA fixation system with and without cement augmentation have similar complication profiles and reoperation rates.

Acute Calcific Tendinitis of the Flexor Carpi Ulnaris Tendon Treated with Lavage and Steroid Injection: A Case Report.

Acute calcific tendinitis (ACT) is a relatively uncommon disorder that can involve the hand and wrist. ACT is frequently misdiagnosed due to a lack of familiarity with the condition and the clinical presentation that can be confused with other conditions. We report a case of acute calcific tendinitis of the flexor carpi ulnaris (FCU) tendon in a 68-year-old woman. She presented with acute left volar wrist pain, erythema, swelling, and restricted range of motion. Due to her inability to take nonsteroidal anti-inflammatory drugs (NSAIDs) and oral prednisone, she was treated with lavage and steroid injection of the calcified mass. Following the injection, there was dramatic improvement in her symptoms. Cortisone injection with lavage is an accepted treatment for rotator cuff calcific tendinitis and is another treatment option for ACT involving the hand and wrist.

Delayed Presentation of a Flexor Digitorum Profundus Avulsion Injury: A Case Report.

Avulsion of the flexor digitorum profundus (FDP) tendon is a relatively common injury in athletes. Also known as "jersey finger," it can also occur in nonathletes, and is often not initially diagnosed. Early diagnosis and repair are essential to regaining optimum return of function. We report a case of a 37-year-old woman who was seen six weeks following an undiagnosed FDP avulsion injury. Due to finger stiffness and the delayed diagnosis, she was treated with occupational therapy to maximize finger range of motion. The anatomy, classification, diagnosis, and treatment options for FDP avulsion injuries are discussed. The goal of this paper is to increase awareness for this injury, resulting in early diagnosis and prompt treatment.

Craniosynostosis - A Review for Providers.

Craniosynostosis is premature fusion of one or more sutures of the cranial vault. Craniosynostosis may occur as an isolated condition or can be syndromic involving multiple body systems. The specific suture affected results in different types of craniosynostosis, each with a characteristic head shape. Recognition of predictable head shape presentations is essential to enable prompt diagnosis and differentiation from other etiologies of cranial asymmetry. The diagnosis of craniosynostosis relies on a detailed history and physical exam as well as radiographic studies. Infants should be referred to a craniofacial center or trained specialist such as a pediatric neurosurgeon as soon as they are diagnosed. Untreated craniosynostosis may result in worsening craniofacial deformity, inhibition of brain growth, and life-threatening increased intracranial pressure. Due to the risks associated with untreated craniosynostosis, surgery is commonly performed soon after diagnosis. Current surgical methods include open calvarial remodeling and minimally invasive endoscopic procedures. Early referral allows all surgical treatment options to be explored.

Tularemia Hand Infection From a Cat Bite-A Case Report.

Tularemia is an uncommon infection caused by the bacterium Francisella tularensis. The nonspecific presentation and infrequency with which it is encountered make it a diagnostic challenge. A rare and scarcely reported mode of tularemia inoculation is a cat bite to the hand. We report a cat bite hand infection with tularemia in a 66-year-old woman. She underwent treatment for presumed polymicrobial cellulitis. Over the next 5 days, the symptoms progressed to fever, malaise, and fluctuant lymphadenitis with nodules along draining lymphatics. Cultures grew F tularensis and antibiotics were switched to doxycycline, which resolved the infection. The patient remained symptom-free after the doxycycline was discontinued. The purpose of this case study is to alert treating providers to consider tularemia infection when a hand infection persists, particularly in the context of an animal bite.