Open Versus Percutaneous Fixation of Trigger Finger: Meta-Analysis of Clinical Outcomes.

PURPOSE: With variable and conflicting results to date, it remains unclear whether the percutaneous or open surgical A1 pulley release technique is superior regarding safety and efficacy. The goal of this meta-analysis was to compare the two techniques. METHODS: PubMed, Cochrane, and Google Scholar (pages 1-20) were searched through August 2023. Eight randomized controlled trials met the inclusion criteria and were included in this meta-analysis. RESULTS: Of the eight included studies and 548 total patients, there were 278 subjects in the percutaneous release group and 270 subjects in the open release group. There was no significant difference between the two surgical techniques in postoperative rates of revision, complications, or pain. CONCLUSIONS: This meta-analysis found no significant difference between open and percutaneous techniques regarding the need for revision procedures, complications, or postoperative pain. Therefore, both open and percutaneous releases are appropriate. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.

Prevalence of asymptomatic TFCC tears on MRI: A systematic review.

BACKGROUND: Recent studies show a high prevalence of triangular fibrocartilage complex (TFCC) tears in asymptomatic wrists. While a TFCC tear may be identified when evaluating ulnar sided wrist pain, this could be incidental and not the true cause of pain. The purpose of this review was to (1) examine the frequency of which TFCC tears are diagnosed on MRI in asymptomatic versus symptomatic wrists and (2) determine whether rates of asymptomatic TFCC tears are higher in two important subgroups commonly at risk for this pathology: elderly patients and high-impact athletes. METHODS: Articles of level IV or higher evidence were selected from PubMed, Ovid MEDLINE, and Cochrane Central Register of Controlled Trials Database to compare patient demographics, study parameters, and clinical outcomes. RESULTS: Seven studies met inclusion criteria with a total of 501 wrists (205 symptomatic and 296 asymptomatic). All studies included asymptomatic patients with wrist MR imaging and included information on the structural integrity of the TFCC. Variability in outcome measures reported across studies prevented the conduction of a meta-analysis. CONCLUSIONS: TFCC abnormalities are present in patients of all ages, symptomatology, and levels of involvement in high-impact sports. Although, there are differences in tear and abnormality prevalence when comparing these three factors, the difference was not significant. Given these findings, using MRI to assess ulnar-sided wrist pain should be fortified with clinical suspicion, physical exam, and physician judgment.

Variability of the femoral mechanical-anatomical axis angle and its implications in primary and revision total knee arthroplasty.

Aims: Distal femoral resection in conventional total knee arthroplasty (TKA) utilizes an intramedullary guide to determine coronal alignment, commonly planned for 5° of valgus. However, a standard 5° resection angle may contribute to malalignment in patients with variability in the femoral anatomical and mechanical axis angle. The purpose of the study was to leverage deep learning (DL) to measure the femoral mechanical-anatomical axis angle (FMAA) in a heterogeneous cohort. Methods: Patients with full-limb radiographs from the Osteoarthritis Initiative were included. A DL workflow was created to measure the FMAA and validated against human measurements. To reflect potential intramedullary guide placement during manual TKA, two different FMAAs were calculated either using a line approximating the entire diaphyseal shaft, and a line connecting the apex of the femoral intercondylar sulcus to the centre of the diaphysis. The proportion of FMAAs outside a range of 5.0° (SD 2.0°) was calculated for both definitions, and FMAA was compared using univariate analyses across sex, BMI, knee alignment, and femur length. Results: The algorithm measured 1,078 radiographs at a rate of 12.6 s/image (2,156 unique measurements in 3.8 hours). There was no significant difference or bias between reader and algorithm measurements for the FMAA (p = 0.130 to 0.563). The FMAA was 6.3° (SD 1.0°; 25% outside range of 5.0° (SD 2.0°)) using definition one and 4.6° (SD 1.3°; 13% outside range of 5.0° (SD 2.0°)) using definition two. Differences between males and females were observed using definition two (males more valgus; p < 0.001). Conclusion: We developed a rapid and accurate DL tool to quantify the FMAA. Considerable variation with different measurement approaches for the FMAA supports that patient-specific anatomy and surgeon-dependent technique must be accounted for when correcting for the FMAA using an intramedullary guide. The angle between the mechanical and anatomical axes of the femur fell outside the range of 5.0° (SD 2.0°) for nearly a quarter of patients.

Adult Spinal Deformity Correction in Patients with Parkinson Disease: Assessment of Surgical Complications, Reoperation, and Cost.

BACKGROUND: Parkinson disease (PD) is a neurodegenerative disorder that manifests with postural instability and gait imbalance. Correction of spinal deformity in patients with PD presents unique challenges. METHODS: The PearlDiver database was queried between 2010 and 2020 to identify adult patients with spinal deformity before undergoing deformity correction with posterior spinal fusion. Two cohorts were created representing patients with and without a preoperative diagnosis of PD. Outcome measures included reoperation rates, surgical technique, cost, surgical complications, and medical complications. Multivariable logistic regression adjusting for Charlson Comorbidity Index, age, gender, 3-column osteotomy, pelvic fixation, and number of levels fused was used to assess rates of reoperation and complications. RESULTS: In total, 26,984 patients met the inclusion criteria and were retained for analysis. Of these patients, 725 had a diagnosis of PD before deformity correction. Patients with PD underwent higher rates of pelvic fixation (odds ratio [OR], 1.33; P < 0.001) and 3-column osteotomies (OR, 1.53; P < 0.001). On adjusted regression, patients with PD showed increased rates of reoperation at 1 year (OR, 1.37; P < 0.001), 5 years (OR, 1.32; P < 0.001), and overall (OR, 1.33; P < 0.001). Patients with PD also experienced an increased rate of medical complications within 30 days after deformity correction including deep venous thrombosis (OR, 1.60; P = 0.021), pneumonia (OR, 1.44; P = 0.039), and urinary tract infections (OR, 1.54; P < 0.001). Deformity correction in patients with PD was associated with higher 90-day cost (P = 0.007). CONCLUSIONS: Patients with PD undergoing long fusion for deformity correction are at significantly increased risk of 30-day medical complications and revision procedures after 1 year, controlling for comorbidities, age, and invasiveness. Surgeons should consider the risk of complications, subsequent revision procedures, and increased cost.

Does Research Training lead to Academic Success in Orthopedic Surgery? An Analysis of U.S Academic Orthopedic Surgeons.

BACKGROUND: Academic surgeons are invaluable for scientific advancement and training the next generation of orthopedic surgeons. OBJECTIVE: This study aimed to describe a cohort of academic orthopedic surgeons currently in practice with common academic metrics. METHODS: ACGME-accredited orthopedic surgery programs with a university affiliation were identified. The primary independent variable in this study was formal research training as defined by a research fellowship or attainment of a PhD. Outcomes included academic rank, h-index attained, number of publications, and funding by the National Institutes of Health (NIH). RESULTS: 1641 orthopedic surgeons were identified across 73 programs. 116 surgeons (7.07%) received formal academic research training. The academic training group and non-academic training group had a similar completion rate of clinical fellowship programs (93.97% vs 93.77%, p=0.933), attainment of other advanced degrees (10.34% vs 8.46%, p=0.485), and years since completion of training (17.49-years vs 16.28-years, p=0.284). Surgeons completing academic research training had a significantly higher h-index (18.46 vs 10.88, p<0.001), higher publication number (67.98 vs 37.80, p<0.001), and more likely to be NIH funded (16.38% vs 3.15%, p<0.001). Surgeons completing academic training were more likely to be associate professors (34.48% vs 25.77%), professors (25.00% vs 22.82%), and endowed professors (10.34% vs 2.43%) (p<0.001). On regression analysis, formalized research training was independently associated with h-index and NIH funding (p<0.001 for both). CONCLUSION: Formalized research training, either as a research fellowship or PhD, is associated with an increased h-index and likelihood of NIH funding, although this association was not found for academic rank after adjusted regression analysis.

Transient Quadriplegia: A Case-Based Approach to Cervical Trauma.

INTRODUCTION: Spinal cord injuries are a common reason for presentation to the emergency department (ED). Sports-related spinal injuries are one of the least common spinal injuries, falling behind vehicular accidents, acts of violence, and falls. CASE REPORT: This case report describes a case of transient quadriplegia in a 17-year-old male who presented to the ED after a helmet-to-helmet collision while participating in football. CONCLUSION: Emergency physicians should be cognizant of potential spinal cord injury using clinical decision tools and radiologic imaging to properly disposition a patient presenting with cervical spine injury.

Range of Normal and Abnormal Syndesmotic Measurements Using Weightbearing CT.

BACKGROUND: Early recognition of syndesmotic instability is critical for optimizing clinical outcome. Injuries causing a more subtle instability, however, can be difficult to diagnose. The purpose of this study was to evaluate both distal tibiofibular articulations using weightbearing computed tomography (CT) in patients with known syndesmotic instability, thereafter comparing findings between the injured and uninjured sides. We also aimed to define the range of normal measurement variation among patients without syndesmotic injury. METHODS: Patients with unilateral syndesmotic instability requiring operative fixation (n = 12) underwent preoperative bilateral ankle weightbearing CT. A separate cohort of patients without ankle injury who also underwent bilateral ankle weightbearing CT were included as comparative controls (n = 24). For each weightbearing CT, a series of 7 axial plane tibiofibular joint measurements, including 1 angular measurement, were utilized to evaluate parameters of the syndesmotic anatomy at a level 1 cm above the tibial plafond. Values were recorded by 2 independent observers to assess for interobserver reliability. RESULTS: Among those with unilateral syndesmotic instability, values differed between the injured and uninjured sides in 4 of the 7 measurements performed including the syndesmotic area: direct anterior, middle, and posterior differences, and sagittal translation (P < .001, < .001, < .001, and < .001, respectively). In the control population without ankle injury, no differences were identified between any of the bilateral measurements (P value range, .172-.961). CONCLUSION: This study highlights the ability of weightbearing CT to effectively differentiate syndesmotic diastasis among patients with surgically confirmed syndesmotic instability from those without syndesmotic instability. It underscores the substantial utility and importance of using the contralateral, uninjured side as a valid internal control whenever the need for confirming potential syndesmotic instability arises. Prospective studies are necessary to fully understand the accuracy of weightbearing CT in diagnosing occult syndesmotic instability among patients for whom the diagnosis remains in question. LEVEL OF EVIDENCE: Level III, comparative diagnostic study.