Acute Scaphoid Waist Fracture in the Athlete.

Scaphoid fractures are the most common carpal fracture and the most challenging. Although appropriately managing acute scaphoid waist fractures is a priority, it also is of primary importance to make a diagnosis acutely. Scaphoid waist fractures can occur with low-energy trauma and lead to mild symptoms. A tendency to minimize symptoms and low level of initial disability lead to delay in diagnosis. Displaced scaphoid fractures require operative intervention uniformly. Although nondisplaced fractures can heal with nonoperative treatment, management of these injuries is affected by patient demands. In high-level athletes, operative treatment of nondisplaced injuries may lead to earlier return to sport.

Scaphoid fractures.

Scaphoid fractures are the most common carpal bone fracture, usually occurring in young men, although the incidence in women has increased over the past decade. Snuffbox tenderness and/or pain with axial loading of the thumb should be treated as a scaphoid fracture until proved otherwise and the diagnosis confirmed with serial radiographs and/or advanced imaging. Nearly all displaced scaphoid fractures should undergo operative intervention to reduce the risk of nonunion. Nondisplaced fractures have high union rates with cast treatment, but require extended periods of immobilization. Consideration may be given to operative fixation of these fractures to allow early return to sport.

Recurrent carpal tunnel syndrome.

Carpal tunnel release is a common procedure with a high rate of alleviating the patient's symptoms. The incidence of recurrent or persistent carpal tunnel syndrome is rare, although likely underestimated. Complaints of worsening numbness, tingling, or weakness should alert the physician to possible nerve injury and need for early exploration. The overall results of revision carpal tunnel procedures are less successful than primary surgery; however, surgery should be performed when indicated, as it may alleviate or improve symptoms.

Cubital tunnel syndrome.

Cubital tunnel syndrome is the second most common compression neuropathy in the upper extremity. Patients complain of numbness in the ring and small fingers, as well as hand weakness. Advanced disease is complicated by irreversible muscle atrophy and hand contractures. Ulnar nerve decompression can help to alleviate symptoms and prevent more advanced stages of dysfunction. Many surgical treatments exist for the treatment of cubital tunnel syndrome. In situ decompression, transposition of the ulnar nerve into the subcutaneous, intramuscular, or submuscular plane, or medial epicondylectomy have all been shown to be affective in the treatment of this disease process. Comparative studies have shown some short-term advantages to one or another technique, but overall results between the treatments have essentially been equivocal. The choice of surgical treatment is based on multiple factors, and a single surgical approach cannot be applied to all clinical situations. Through careful consideration of the potential sites of nerve compression and the etiologies for these local irritations, the appropriate surgical technique can be selected and a good outcome anticipated in most patients.

Autogenous osteochondral transfer in the femoral head after osteonecrosis.

Osteonecrosis of the femoral head is a major problem, especially in younger patients. Most of them need a total hip replacement. This article presents a case of a successful autologous osteochondral transfer.

Bioabsorbable implants in the treatment of hand fractures: an update.

UNLABELLED: Bioabsorbable implants have been used extensively in medicine. Many have suggested interest in these materials for hand fractures since they may lead to less implant morbidity and subsequent stiffness, and they have additional advantages: they are radiolucent, they eliminate hardware removal procedures, they limit stress shielding, and they incrementally transfer load to healing fractures. Disadvantages include weakness relative to metal implants, rapid loss of initial implant strength, higher refracture rates, and foreign body reactions. Newer polymers have led to a reduction in these complications and more stable fixation. While not yet incorporated into the armamentarium of most surgeons, there is promise that in the near future they may assist in the management of some hand fractures. LEVEL OF EVIDENCE: Level V (expert opinion).