Management of the Septic Wrist: A Systematic Review of Etiology and Therapeutic Strategies.

Septic arthritis of the wrist can have severe deleterious effects on cartilage and bone if not promptly addressed. Expedient diagnosis and early medical intervention are important. The most effective strategy involves immediate arthrocentesis of the infected joint, enabling precise antibiotic selection based on joint fluid analysis. Diagnostic imaging is important in excluding fractures and identifying abscesses. This review explores the etiologic factors underlying septic wrist joint, identifying risk factors, and delineating optimal diagnosis and treatment approaches. The overarching goal is to impart valuable insights and guidance in the management of septic wrist joint, ensuring the highest quality patient care and optimal clinical outcomes.

The Septic Elbow Joint: Treatment Approaches for Improved Patient Outcomes.

Septic arthritis of the elbow is a serious problem requiring prompt, accurate diagnosis and urgent surgical intervention. Achieving successful patient outcomes depends heavily on early diagnosis and efficient streamlined surgical treatment. Essential tactics for treating the septic elbow joint include immediate joint irrigation and debridement in addition to administration of appropriate antibiotics. This comprehensive review delves into the cause of the septic elbow joint, identifies associated risk factors, and provides a comprehensive approach encompassing the diagnosis and treatment of the septic elbow. The aim of this review is to optimize patient care and outcomes.

Mini All-Suture Anchors for Repairing the Central Slip of the Extensor Tendon at the Proximal Interphalangeal Joint: A Biomechanical Investigation.

PURPOSE: This study evaluated 1.0-mm mini suture anchors for repairing the central slip of the extensor mechanism at the proximal interphalangeal joint. Studies have reported a requirement for central slip fixation to withstand 15 N during postoperative rehabilitation exercises and 59 N during forceful contraction. METHODS: Index and middle fingers from 10 matched pairs of cadaveric hands were prepared with 1.0-mm mini suture anchors with 2-0 sutures or threaded with 2-0 sutures through a bone tunnel (BTP). In total, 10 index fingers from unmatched hands were prepared with suture anchors and fixed to the extensor tendons to evaluate the tendon/suture interface response. Each distal phalanx was secured to a servohydraulic testing machine, and ramped tensile loads were applied to suture or tendon until failure. RESULTS: All anchors for the all-suture bone tests failed because of pullout from the bone (Mean failure force = 52.5+/-17.3 N). Three anchors from the tendon-suture pull out test failed by pullout from the bone and seven failed at the tendon/suture interface (Mean failure force = 49.0+/-10.1 N). CONCLUSIONS: The 1.0-mm mini suture anchor provides enough strength for early short-arc motion, but it may not be adequate for forceful contraction in the early postoperative rehabilitation stage. CLINICAL RELEVANCE: The site of fixation, the type of anchor, and the type of suture used are key factors to consider for early range of motion, after surgery.

Simultaneous Limited Incision Carpal Tunnel Release and Flexor Digitorum Superficialis Opponensplasty Using a Transverse Carpal Ligament Pulley: Surgical Technique and Case Series.

Severe thenar muscle atrophy resulting in dysfunctional thumb abduction and opposition is a well-documented finding associated with long-standing severe carpal tunnel syndrome. This problem has been addressed in the past through various opposition tendon transfers. Historically, the Camitz procedure, or its modifications using the palmaris longus tendon, were recommended. However, this procedure requires a long incision in the palm, extensive dissection including the wrist area, and may not produce active thumb pronation. Our surgical technique describes an open limited palmar-only carpal tunnel release with ring finger flexor digitorum superficialis opponensplasty using a slit through the released transverse carpal ligament as a pulley and dual insertion of the tendon in both the extensor hood and the tendon of the abductor pollicis brevis. The Kapandji evaluation of thumb opposition was used to determine the outcome after surgery.

Percutaneous fixation of the scaphoid through a dorsal approach: an anatomic study.

PURPOSE: Percutaneous surgical treatment of nondisplaced scaphoid fractures is becoming more common. Although the surgical anatomy at risk has been well described for the volar approach to the scaphoid, we have not found articles elucidating the dangers with a percutaneous dorsal approach. Additionally, direct placement of the screw is not possible with a percutaneous approach, and there is a risk of not seating the screw below the subchondral bone. The purpose of this study was to delineate the anatomy at risk using a dorsal percutaneous approach to the scaphoid and to determine the accuracy of using fluoroscopy to seat the screw flush with the subchondral surface. METHODS: Cannulated, headless screws were placed into the scaphoids of 12 fresh-frozen cadavers in standard percutaneous fashion through a dorsal approach. Fluoroscopy was used to seat the screw just below the subchondral surface. The wrists were then dissected and the distance from the guide wire to various anatomic structures was measured. The distance that the screw was protruding above or buried below the subchondral bone was also measured. RESULTS: The distances from the guide wire to the posterior interosseous nerve, to extensor digitorum communis to the index, and to extensor indicis proprius were 2.2 mm, 2.2 mm, and 3.1 mm, respectively. These structures were most at risk. The screw was prominent (above the subchondral bone) in 2 of 12 specimens and flush with or buried in the remaining 10 specimens. CONCLUSIONS: The results of this study show that there are anatomic structures at risk of injury with dorsal percutaneous placement of a headless screw into the scaphoid. Despite using live and static fluoroscopy views, we incorrectly placed the screw above the subchondral bone in 2 of the specimens. We support use of a limited incision when internally fixing a scaphoid from the dorsal approach.

Two potential causes of EPL rupture after distal radius volar plate fixation.

Rupture of the extensor pollicis longus tendon can occur after volar plate fixation of dorsally comminuted distal radius fractures. We attempted to identify the etiology of extensor pollicis longus tendon injury after volar plate fixation of the distal radius and potential solutions to this problem. After describing two case reports, we examine six cadaveric specimens and retrospectively review 10 selected patients to evaluate possible technique refinements to minimize damage to the extensor pollicis longus tendon during volar plating of the distal radius. We identify specific screw holes in three commercially available volar distal radius plates that direct the drill bit or prominent screw tips into the third extensor compartment. In addition, after reduction and plate fixation, bone fragments or dorsal gapping may predispose the extensor pollicis longus tendon to injury. We recommend either using shorter screw lengths or leaving the implicated plate holes unfilled. In addition, we suggest consideration of an open assessment of the third extensor compartment, if indicated, as performed through a small dorsal incision ulnar to Lister's tubercle.

Management of posttraumatic segmental bone defects.

Because of difficulty in managing posttraumatic segmental bone defects and the resultant poor outcomes, amputation historically was the preferred treatment. Massive cancellous bone autograft has been the principal alternative to amputation. Primary shortening or use of the adjacent fibula as a graft also has been used to attempt limb salvage. Of more recent methods of management, bone transport with distraction osteogenesis has been suggested as the leading option for defects of 2 to 10 cm, but problems include delayed union at the docking site and prolonged treatment time. Free vascularized bone transfer has been suggested as the leading option for defects of 5 to 12 cm, but hypertrophy of the graft is unreliable and late fracture, common. Bone graft substitutes continue to be developed, but they have not yet reached clinical efficacy for posttraumatic segmental bone defects. Although each of the new techniques has shown some limited success, complications remain common.