Spontaneous Rupture of the Extensor Pollicis Longus Tendon: A Systematic Review.

BACKGROUND: Extensor pollicis longus (EPL) rupture and tenosynovitis of the third dorsal compartment is often described in association with a history of rheumatoid arthritis or in the setting of a distal radius fracture. However, the literature suggests multiple other potential factors that may lead to a seemingly spontaneous rupture. METHODS: We performed a systematic review following guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search consisted of headings and keywords related to tendon injuries, tendinopathy, hand surgery, tendon transfer, and injections, as published in reports and studies. Citations were screened by title and abstract against predetermined inclusion and exclusion criteria by 2 independent reviewers, with a third reviewer resolving discrepancies. To be eligible, articles had to meet the following inclusion criterion: describe cases of spontaneous EPL rupture or tenosynovitis of the third dorsal compartment. The exclusion criterion was any history of distal radius fracture or rheumatoid arthritis. RESULTS: We identified 29 articles that met the inclusion criterion. CONCLUSIONS: A myriad of prodromal events or predisposing factors ultimately led to EPL rupture or tenosynovitis of the third compartment. Methods of reconstruction described included primary repair, tendon grafting, and tendon transfer techniques; all with generally good outcomes. These results highlight the inherent fragility of this tendon and support the historical recommendation for early release of the EPL tendon in the setting of tenosynovitis of the third dorsal compartment.

A Technical Guide for Sciatic Nerve Targeted Muscle Reinnervation in a Transfemoral Amputee.

There are approximately 2 million people living with the loss of a major limb in America. It is estimated that 95% of these will have some form of pain associated with their amputation. Phantom limb pain, related to symptomatic neuromas, contributes to amputation morbidity and can be difficult to treat. Studies have shown that targeted muscle reinnervation (TMR), by giving symptomatic neuromas "somewhere to go and something to do," can be an effective therapy. However, a large proportion of surgeons still treat symptomatic neuromas by burying them in nearby tissue. Methods: We treated a patient with previous above-the-knee amputation, complicated by a symptomatic neuroma, with TMR. We identified and described nine steps to the procedure. Our description is accompanied by illustrative, intraoperative photographs and technical pearls. Results: This article provides a description of TMR technique involving a neuroma of the sciatic nerve and its branches, to treat an above-the-knee amputation, with the aim of making this approach more accessible. At 9-month follow-up, the patient had active firing of the recipient muscles with donor nerve stimulation indicating successful reinnervation. The patient continued to report stump pain, but with intermittent pain-free days. Conclusions: TMR has proven potential as a therapy for amputation-related, neuropathic pain. With this technical guide to TMR, surgeons should feel more comfortable adding this technique to their armamentarium, to be utilized either at the time of amputation or as a secondary measure.

Distal Radius Fractures in the Elderly: Use of the Volar Bearing Plate.

BACKGROUND: Distal radius fractures represent some of the most common injuries to the upper extremity, yet current evidence demonstrates great variability in the management of this injury. Elderly patients, in particular, stand to benefit from the early mobilization provided by operative fixation with a volar bearing plate. METHODS: We conducted a retrospective chart review on all patients 65 years or older who underwent unilateral open reduction internal fixation of distal radius fractures using a volar bearing plate at a single institution between January 2014 and January 2016. We excluded patients with bilateral injuries, multiple fractures, and major injuries to the same extremity. RESULTS: Fifty-five patients met criteria for this study. By AO classification, we repaired 17 type A, 24 type B, and 14 type C fractures. At final radiographic measurements, average radial height compared with ulna measured -0.31 mm, average radial inclination measured 20.45 degrees, and average volar tilt measured 7.11 degrees. On discharge, 36 patients had wrist range-of-motion data consistent with a functional wrist. Four patients had limitations in the flexion/extension plane, 8 with radial-ulnar deviation, and 7 had limitations in both planes. CONCLUSIONS: Distal radius fractures in the elderly may successfully be treated with a volar bearing plate. Useful strategies include supraperiosteal dissection of the radius from the pronator quadratus, use of a longer plate for stronger proximal fixation in osteoporotic bone, and regional block. This methodology allows for a safe procedure facilitating the early return of hand and wrist function.

Increased Complications in Trapeziectomy With Ligament Reconstruction and Tendon Interposition Compared With Trapeziectomy Alone.

BACKGROUND: In the treatment of basal joint arthritis of the thumb, recent studies suggest equivalent outcomes with regard to long-term pain, mobility, and strength, in patients undergoing either trapeziectomy alone or trapeziectomy with ligament reconstruction and tendon interposition (LRTI). The goal of this study was to investigate risk factors for complications in carpometacarpal (CMC) arthroplasty. METHODS: We conducted a retrospective chart review of 5 surgeons at a single institution performing CMC arthroplasties from November 2006 to November 2012. A total of 200 thumbs in 179 patients underwent simple trapeziectomy with or without LRTI and with or without Kirschner wire stabilization, or a Weilby procedure. The average follow-up was 11.6 months (range = 1-69 months). Data collection included sex, age, history of smoking or diabetes, and any other surgeries performed on the hand at the time of arthroplasty. Furthermore, we collected outcomes involving any adverse events, paying attention to those necessitating reoperation, antibiotics, or those who developed complex regional pain syndrome. RESULTS: Seventy hands had a postoperative complication. Ten of these complications were considered major, defined as requiring antibiotics, reoperation, or other aggressive interventions. On multivariate analysis, risk of total complications was significantly greater only in patients undergoing either trapeziectomy with LRTI or Weilby procedure in comparison with trapeziectomy with K-wire stabilization (odds ratio = 4.30 and 6.73, respectively). CONCLUSIONS: Patients undergoing trapeziectomy with LRTI or Weilby had a greater incidence of reported complications when compared with trapeziectomy alone. These results suggest an advantage of simple trapeziectomy; however, further study is warranted.

Perceptions of family members of children with cleft lip and palate in hyderabad, India, and its rural outskirts regarding craniofacial anomalies: a pilot study.

Objective : This pilot study aimed to understand cultural perspectives on cleft anomalies in the community of Hyderabad, India, and its rural outskirts. Design : Interviews focusing on perceptions of cleft lip and palate were conducted using a 21-item interview guide approved by the director of the Gosla Srinivas Reddy Institute of Craniofacial Surgery (GSR). Settings : Interviews were conducted at GSR, a specialty surgical center located in Hyderabad, India. Patients and Participants : All patients who presented to GSR with either cleft lip, cleft palate, or cleft lip and palate at the time of this study were included. Results : Of the 23 families interviewed, 12 mothers believed the cleft was caused by an eclipse, and two believed the scientific explanation their physician offered. Fourteen families were offered no explanation for the cleft lip and/or palate at the time of their first physician visit. No families practiced non-Western methods for treatment of the cleft. One family identified beliefs held in the community that their child with a cleft lip was bad luck. Conclusion : A commonly held belief in this community in India is that cleft lip, cleft palate, or cleft lip and palate are caused by an eclipse. Physicians appear to be providing families with insufficient education on cleft impairments. Data generated from studies similar to this can be used to design educational protocols that address this gap in community understanding of orofacial clefting.

The effect of fibrin sealant on the prevention of seroma formation after postbariatric abdominoplasty.

BACKGROUND: Seroma formation is one of the most common complications following abdominoplasty. Fibrin sealant/glue has shown mixed results in seroma prevention when used in a variety of procedures. Limited information is available on its effectiveness during postbariatric abdominoplasty. METHODS: A retrospective chart analysis of 65 consecutive patients who underwent postbariatric abdominoplasty over a course of 16 months by a single surgeon was performed. Two sequential groups either receiving or not receiving fibrin sealant treatment were defined. Seroma formation and initial 24 h drain output volumes were recorded. RESULTS: Three patients in group 1 (9.1%) receiving fibrin sealant developed seroma. Twelve patients in group 2 (28.1%) not receiving fibrin sealant developed seroma; this was statistically significant (P=0.006). Twenty-four hour drain output was also statistically different, with higher initial output in the fibrin sealant group (222.2 mL versus 140.0 mL; P=0.047). CONCLUSION: Fibrin sealant was a useful adjunct during surgical wound closure and significantly decreased seroma formation in patients undergoing postbariatric abdominoplasty.

HISTORIQUE: La formation de sérome est l'une des principales complications après une abdominoplastie. La colle de fibrine, utilisée dans diverses interventions, donne des résultats mitigés dans la prévention du sérome. L'information relative à son efficacité lors d'une abdominoplastie après une chirurgie bariatrique est limitée. MÉTHODOLOGIE: Les chercheurs ont procédé à l'analyse rétrospective des dossiers de 65 patients consécutifs qui, sur une période de 16 mois, ont subi une abdominoplastie après une chirurgie bariatrique. Ils ont défini deux groupes séquentiels, l'un recevant un traitement à la colle de fibrine et l'autre pas. Ils ont enregistré la formation de sérome et les volumes d'écoulement par le drain dans les 24 premières heures. RÉSULTATS: Trois patients du groupe 1 (9,1 %) qui ont reçu de la colle de fibrine ont développé un sérome. Douze patients du groupe 2 (28,1 %) qui n'en avaient pas reçu en ont également développé un, ce qui est statistiquement significatif (P=0,006). L'écoulement par le drain sur 24 heures était également différent sur le plan statistique, l'écoulement initial étant plus important dans le groupe ayant reçu de la colle de fibrine (222,2 mL par rapport à 140,0 mL; P=0,047). CONCLUSION: La colle de fibrine était un ajout utile pendant la fermeture chirurgicale de la plaie et réduisait considérablement la formation de sérome chez les patients qui subissaient une abdominoplastie après une chirurgie bariatrique.

Inexpensive alternatives for extremity cast and bandage protection.

Cast and bandage protector bags that are available commercially are often used by patients to keep their splints dry while in the shower. Garbage bags are considered a less expensive, but cumbersome alternative to these commercially available bags. We report a case of a 22-year-old man who has discovered that newspaper bags serve as easy to use covers for casts and bandages that are essentially free. Inexpensive alternatives to commercially available cast and bandage protector bags such as newspaper bags, disposable umbrella bags, and bread bags should be discussed with patients to foster compliance in keeping their devices dry.