Capitate and Lunate Morphology in Normal Wrist Radiographs-A Pilot Study.

BACKGROUND: Morphology may provide the basis for the understanding of wrist mechanics. METHODS: We used classification systems based on cadaver dissection of lunate and capitate types to evaluate a normal database of 70 wrist radiographs in 35 subjects looking for associations between bone shapes. Kappa statistics and a log-linear mixed -effects model with a random intercept were used. RESULTS: There were 39 type-1, 31 type- 2 lunates, 50 spherical, 10 flat and 10 V-shaped capitates. There was a significant difference in lunate and capitate shape between the hands of the same individual p <0.001. This may be due to different loads on the dominant vs. nondominant hands in the same individual. CONCLUSION: Further study to better understand the development of radiographic parameters of the midcarpal joint may aid in our understanding of the morphology and mechanics of the wrist.

Does the gatekeeper model work in hand surgery?

BACKGROUND: Most managed care plans use a physician "gatekeeper" to control referrals to hand surgeons. The appropriateness of this model for upper extremity complaints has never been challenged. The purpose of this study was to evaluate the prior management of patients with elective hand disorders who present to a hand surgery clinic. METHODS: All patients presenting to a tertiary, academic medical center for a new-patient hand surgery evaluation from February 3, 2011, to June 15, 2011, were prospectively enrolled. Patients were evaluated for prior provider, diagnosis, treatment, and complications. Actual diagnosis, recommended workup, and appropriate treatment were determined independently by two experienced hand examiners. Traumatic injuries and surgeon disagreements in diagnosis and treatment were excluded, leaving 125 patients. RESULTS: Ninety-eight percent of patients had been evaluated by a primary care provider. Overall, the correct diagnosis was established 34 percent of the time. Nerve compression syndromes were diagnosed with the greatest accuracy (64 percent), whereas stenosing tenosynovitis was diagnosed correctly only 15 percent of the time. Before presentation, 74 percent of patients had undergone a study or intervention. On review, 70 percent of studies/interventions were deemed unnecessary. Advanced imaging was unwarranted in 90 percent of patients who received it. Seventeen percent of patients experienced a complication. Most (67 percent) were caused by a delay in diagnosis, whereas 33 percent resulted from an intervention. CONCLUSIONS: Health care providers less familiar with an examination of the hand often misdiagnose and mistreat common problems. A referral system may not be the most efficient means of delivering care to patients with elective hand maladies.

Therapeutic modalities--an updated review for the hand surgeon.

The number of therapeutic modalities available to the hand surgeon has greatly increased over the past several decades. A field once predicated only on heat, massage, and cold therapy now uses electrical stimulators, ultrasound, biofeedback, iontophoresis, phonophoresis, mirror therapy, lasers, and a number of other modalities. With this expansion in choices, there has been a concurrent effort to better define which modalities are truly effective. In this review, we aim to characterize the commonly used modalities and provide the evidence available that supports their continued use.

Surgical and technical aspects of hand transplantation: is it just another replant?

The ultimate goal of hand allotransplantation is to achieve graft survival and useful long-term function. To achieve these goals, selection of the appropriate patient, detailed preoperative planning, and precise surgical technique are of paramount importance. Transplantation should be reserved for motivated consenting adults in good general heath, who are psychologically stable and have failed a trial of prosthetic use. While the key surgical steps of transplantation are similar to those of replantation, there are major differences. This article describes the steps in hand allotransplantation, and the importance of patient selection as well as preoperative and postoperative care.

Current status of grafts and implants in rhinoplasty: Part II. Homologous grafts and allogenic implants.

LEARNING OBJECTIVES: After reading this article, the participant should be able to: 1. Understand the challenges in restoring volume and structural integrity in rhinoplasty. 2. Identify the appropriate uses of various homologous grafts and allogenic implants in reconstruction, including: (a) freeze-dried acellular allogenic cadaveric dermis grafts, (b) irradiated cartilage grafts, (c) hydroxyapatite mineral matrix, (d) silicone implants, (e) high-density polyethylene implants, (f) polytetrafluoroethylene implants, and (g) injectable filler materials. 3. Identify the advantages and disadvantages of each of these biomaterials. 4. Understand the specific techniques that may aid in the use these grafts or implants. SUMMARY: This review specifically addresses the use of homologous grafts and allogenic implants in rhinoplasty. It is important to stress that autologous materials remain the preferred graft material for use in rhinoplasty, owing to their high biocompatibility and low risk of infection and extrusion. However, concerns of donor-site morbidity, graft availability, and graft resorption have motivated the development and use of homologous and allogenic implants.

Current status of grafts and implants in rhinoplasty: part I. Autologous grafts.

LEARNING OBJECTIVES: After reading this article, the participant should be able to: 1. Understand the challenges in restoring volume and structural integrity in rhinoplasty. 2. Identify the appropriate uses of various autografts in aesthetic and reconstructive rhinoplasty (septal cartilage, auricular cartilage, costal cartilage, calvarial and nasal bone, and olecranon process of the ulna). 3. Identify the advantages and disadvantages of each of these autografts. SUMMARY: This review specifically addresses the use of autologous grafts in rhinoplasty. Autologous materials remain the preferred graft material for use in rhinoplasty because of their high biocompatibility and low risk of infection and extrusion. However, these advantages should be counterbalanced with the concerns of donor-site morbidity, graft availability, and graft resorption.

Strain differences in autotomy in mice after peripheral nerve transection or repair.

The purpose of this study was to identify the optimal murine model for the study of peripheral nerve injury and nerve and limb transplantation. The degree of self-mutilation (autotomy) following sciatic and saphenous nerve injury was assessed in four mouse strains, Balb/C, C57BL/6J, C57BL/10J, and C3HEB, commonly used in surgical research. Experimental groups included sciatic and saphenous nerve transection with repair (n = 9) or without repair (n = 9), as well as housing arrangements favoring social interaction vs. isolation. Autotomy was most prevalent in the Balb/c and C3H strains at 56% and 89% overall, respectively, and was much less frequently seen in the C57Bl/10 and C57Bl/6 strains (22% and 11%, respectively). Autotomy was found to correlate most strongly with mouse strain, and with social contact as well. Two strains, C57BL/6J and C57BL/10J, were found to be highly resistant to self-mutilation, and are thus ideal animal models for peripheral-nerve and whole-limb transplant studies.