An alternative treatment for degenerative triangular fibrocartilage complex injuries with distal radioulnar joint instability: first experience with 48 patients.

Treatment of ulnar impaction syndrome combined with distal radioulnar joint instability due to irreparable degenerative triangular fibrocartilage complex injuries can be complex. We describe the outcomes of a novel technique for restoring distal radioulnar stability due to ulnar impaction syndrome using a distally based extensor carpi ulnaris tendon strip combined with ulnar shortening osteotomy in 48 patients. Patients were assessed using standardized outcome measurements. The patient-rated wrist/hand evaluation total score improved from 66 (SD 15) at intake to 40 (SD 25) at 3 months, and 28 (SD 23) at 12 months postoperatively (p < 0.001). Wrist extension and flexion improved significantly at 12 months from 53° (SD 11) to 65° (SD 8) (p < 0.001) and from 45° (SD 10) to 56° (SD 12) (p = 0.01), respectively. Adding a distally based longitudinal extensor carpi ulnaris strip to ulnar shortening osteotomy for restoring distal radioulnar joint stability seems to be an effective treatment in patients with irreparable degenerative triangular fibrocartilage complex injuries due to ulnar impaction syndrome. Level of evidence: IV.

Multiple Compression Syndromes of the Same Upper Extremity: Prevalence, Risk Factors, and Treatment Outcomes of Concomitant Treatment.

PURPOSE: Multiple nerve compression syndromes can co-occur. Little is known about this coexistence, especially about risk factors and surgical outcomes. Therefore, this study aimed to describe the prevalence of multiple nerve compression syndromes in the same arm in a surgical cohort and determine risk factors. Additionally, the surgical outcomes of concomitant treatment were studied. METHODS: The prevalence of surgically treated multiple nerve compression syndromes within one year was assessed using a review of patients' electronic records. Patient characteristics, comorbidities, and baseline scores of the Boston Carpal Tunnel Questionnaire were considered as risk factors. To determine the treatment outcomes of simultaneous treatment, patients who underwent concomitant carpal tunnel release (CTR) and cubital tunnel release (CubTR) were selected. The treatment outcomes were Boston Carpal Tunnel Questionnaire scores at intake and at 3 and 6 months after the surgery, satisfaction 6 months after the surgery, and return to work within the first year. RESULTS: A total of 7,867 patients underwent at least one nerve decompression between 2011 and 2021. Of these patients, 2.9% underwent multiple decompressions for the same upper extremity within one year. The risk factors for this were severe symptoms, younger age, and smoking. Furthermore, the treatment outcomes of concomitant CTR and CubTR did not differ from those of CubTR alone. The median time to return to work after concomitant treatment was 6 weeks. Patients who underwent CTR or CubTR alone returned to work after 4 weeks. CONCLUSIONS: Approximately 3% of the patients who underwent surgical treatment for nerve compression syndrome underwent decompression for another nerve within 1 year. Patients who report severe symptoms at intake, are younger, or smoke are at a greater risk. Patients with carpal and cubital tunnel syndrome may benefit from simultaneous decompression. The time to return to work may be less than if they underwent decompressions in separate procedures, whereas their surgical outcomes are comparable with those of CubTR alone. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

The association between plate location and hardware removal following ulna shortening osteotomy: a cohort study.

Hardware removal after ulna shortening osteotomy is common. We evaluated the association between plate location and hardware removal rate in 326 procedures in 321 patients with a median follow-up of 4.3 years (IQR 3.3) and corrected for confounding variables and did survival analyses. Complications were scored using the International Consortium for Health Outcome Measurement complications in Hand and Wrist Conditions tool. The 1-year and 5-year reoperation rates for hardware removal were 21% and 46% in the anterior group versus 37% and 64% in the dorsal group. Anterior plate placement was independently associated with a decreased immediate risk of hardware removal. Higher age, male sex and treatment on the dominant side were also associated with a reduced risk of hardware removal. We did not find a difference in hardware removal rates between freehand or jig-guided ulna shortening osteotomies. We noted perioperative problems in 3% of the procedures and complications in 20%.Level of evidence: III.

[Claims following distal Radius Fractures]. / Behandlungsfehlervorwürfe nach distalen Radiusfrakturen.

BACKGROUND: As distal radius fractures as well as diagnostic and therapeutic options vary widely, there is an enormous potential for deficient convalescence and subsequent patient dissatisfaction. The aim of this study is the evaluation of malpractice in distal radius fracture management, which could help to draw conclusions regarding optimization and prevention as well as raising patient satisfaction and minimizing subsequent costs. MATERIAL AND METHODS: Files and patient data of all distal radius fracture complaints regarding one public hospital operator in a period between 2007 and 2017 were reviewed and subjected to descriptive statistics. RESULTS: A total of 35 cases with complaints regarding medical treatment, communication and long-term effects were identified, broken down into key issues and analyzed by means of descriptive statistics. CONCLUSION: Complications and long-term effects of distal radius fractures are not completely avoidable. It is possible, however, to prevent lack of communication and treatment delays. To achieve increased patient satisfaction, it is essential to reflect on diagnostic, therapeutic and interpersonal strategies.

The anterior LICAP flap: a design option for oncoplastic breast reconstruction.

The purpose was to describe the operation technique of an anterior lateral intercostal artery perforator (LICAP) flap and analyse outcomes and complications. An anterior LICAP flap is a good and safe alternative for direct oncoplastic breast reconstruction. It is a reliable flap that provides sufficient volume and good esthetic outcomes.

Use of remodeled femoral head allograft for tarsal reconstruction in the treatment of müller-weiss disease.

Müller-Weiss disease (MWD), spontaneous avascular necrosis of the navicular in adults, is rare. Without treatment, it can result in permanent disability. Operative treatment is often required. MWD was suspected in a 51-year-old woman with spontaneous pain in her right foot. The radiologic tests showed a comma shaped deformed navicular and severe talonavicular necrosis and sclerosis. After excision of the necrotic navicular, a 5 × 5 × 3-cm defect appeared. A femoral head bone allograft was remodeled to fit this defect precisely. Autologous cancellous bone was also used. The allograft interposition arthrodesis was stabilized with a low contact plate. The histopathologic results showed avascular osteonecrosis, supporting the diagnosis of MWD. After 12 weeks of non-weight-bearing plaster cast immobilization, the radiographs showed consolidation and no osteolysis. At 6 months after surgery, she was fully weight-bearing. The low contact plate was removed, because it impeded exercise. After 10 months, she was walking pain free. At 14 months after surgery, her radiographs still showed good consolidation, with no sign of osteolysis. The use of a bone allograft to cover a tarsal defect could be a safe and effective operative treatment of MWD that has not yet been reported in English-language studies. This treatment also results in minimal donor site morbidity.

Congenital monomelic muscular hypertrophy of the upper extremity.

Pathological muscular hypertrophy results from either muscular or neurogenic damage. Rarely, it is caused by a congenital malformation consisting of a unilateral muscular hyperplasia of the upper extremity. We report on a young woman with an enlargement of the right upper extremity. Electromyography showed polyphasic, large motor unit potentials in the affected muscles. MRI and ultrasound assessment demonstrated diffuse enlargement of muscle mass without signs of edema. Muscle biopsy revealed sections with marked variations in fiber size with no signs of inflammation or marked loss of muscle fibers. Factors assumed to be important in the pathophysiology of this phenomenon are discussed.