Hand conditions as sequelae of infection with COVID-19: a literature review.

Patients have attended our clinics with various hand pathologies after contracting COVID-19 or receiving vaccination. We postulate the virus stimulates a systemic inflammatory response that triggers these pathologies and conducted a search of the literature for associated conditions. Twenty publications were included for this review. Three studies identified skeletal muscle inflammation, and several identified reactive arthritis post-infection. Rheumatoid arthritis post-infection was also recognized, along with crystalline arthropathy. Carpal tunnel syndrome was seen in two cases. There is a current paucity in published scientific material regarding COVID-19 sequalae in the hand. This review aims to stimulate discussion in how a virus can induce pathological processes causing common hand pathologies.

Orthopaedics and the gender pay gap: A systematic review.

AIMS: Gender pay gaps are present in a wide range of industries, with the medical profession being no exception. The aim of this systematic review was to analyse the peer-reviewed literature to identify whether there is a gender pay gap in orthopaedics. METHODS: A systematic review was conducted by searching the following databases: MEDLINE, Health & Medical Collection, Nursing & Allied Health Database, Publicly Available Content Database, Consumer Health Database and Healthcare Administration Database. Original research papers pertaining to the earnings of male and female orthopaedic surgeons were included for review. RESULTS: Of 745 papers acquired through the database search, 12 were eligible for inclusion. These were published in the USA, Canada and Taiwan. 6 looked at the relationship between sex and annual income, 4 studied industry payments, one analysed hourly earnings and one compared payments per case between males and females. Men were found to earn significantly higher annual incomes than women, even when confounding factors such as rank, practice setting and subspeciality were accounted for. Men also receive significantly higher payments from industry, and earn more per hour than women. CONCLUSION: This systematic review has demonstrated that there is a gender pay gap in orthopaedics, with women commonly earning significantly less than their male colleagues. The reasons for this, however, remain unclear, and deserve further investigation. It is incumbent upon orthopaedic departments, healthcare providers and orthopaedic associations to raise awareness and ensure that men and women are paid the same for equal work.

Skin Graft Review in Dermofasciectomy for Dupuytren's Contracture within 48 Hours: Challenging Historical Practice.

Introduction Early review of skin graft following dermofasciectomy with skin grafting for Dupuytren's disease is not standard practice because of the potentially adverse effects on inosculation and neovascularization process of the skin grafting. The purpose of this retrospective case series was to observe whether early review of grafts postoperatively at 48 hours adversely affects graft survival and surgical outcomes. Materials and Methods Forty-nine primary and revision procedures were retrospectively analyzed for treatment outcomes, postoperative complications, functional hand scoring, and satisfaction rates postoperatively. Results Thirty-eight patients were treated successfully with no postoperative contracture. There were three treatment failures and two graft failures, with two amputations within these failures. Paired pre- and postoperative Unité Rhumatologique des Affections de la Main scoring demonstrated significant improvement in hand function for primary procedures, with a mean satisfaction score of 7.7 out of 10. Conclusion We have shown early graft review following dermofasciectomy and full-thickness skin grafting to be safe, allowing early mobilization and splinting, with our postoperative failure and complication rate being within published literature.

The what, why and when of wide awake local anaesthesia no tourniquet surgery.

Wide awake local anaesthesia no tourniquet, also known as WALANT, is the practice of performing surgery under local anaesthetic in the absence of a tourniquet. This technique uses the vasoconstrictive effects of adrenaline and the local anaesthetic effects of lignocaine to establish a Bier block with haemostatic control. Permitting active patient participation intraoperatively, wide awake local anaesthesia no tourniquet surgery improves patient compliance with rehabilitation and yields higher patient satisfaction. With reduced cost and equipment requirements, this method improves accessibility for patients and productivity for healthcare institutions. This is of particular benefit within the current COVID-19 climate, as wide awake local anaesthesia no tourniquet technique provides a means of overcoming restrictions to theatre access and anaesthetic support. This review delves into the current uses of wide awake local anaesthesia no tourniquet surgery, outlining the initial conception of the practice by Canadian surgeons. The advantages and disadvantages are considered, and potential future applications of this technique are discussed.

Management of acute scaphoid fractures: a pragmatic approach for the non-specialist.

Scaphoid fractures are common and can cause significant morbidity if treated incorrectly. Thus, a working knowledge of the initial assessment and management of scaphoid fractures by non-specialists is crucial to allow quick diagnosis and avoid potentially catastrophic complications of scaphoid fracture. This article summarises the anatomy of the scaphoid, discusses methods to assess for scaphoid fractures and delineates management plans (conservative or operative) for fractures of the scaphoid based on location of vascular compromise. This article can also help the clinician predict which fractures may not unite with conservative management and therefore need referral to a specialist orthopaedic surgeon for possible surgery.

Postoperative Outcomes of Volar Plate Fixation in Cases of Scaphoid Deformity or Nonunion: A Case Series.

Background Fractures through the waist of scaphoid are a common injury, resulting in deformity or nonunion. Recently, a locking plate has been shown to fix deformity or nonunion of scaphoid, with limited observation of functional postoperative outcomes. Objectives We present a case series of 16 patients, with the disabilities of the arm, shoulder, and hand (DASH) score evaluation in primary fixation of scaphoid fractures with humpback deformity ( n = 11) and revision open reduction internal fixation (ORIF) for nonunion ( n = 5), using the Medartis TriLock 1.5 scaphoid plate and bone grafting. Patients and Methods DASH scores were obtained preoperatively and postoperatively at 3, 6, and 12 (if required) months. Patient demographics, smoking status, employment type, and grip strengths were recorded. Results Thirteen patients attended follow-up. Union was clinically and radiologically assessed with 13 achieving union. The mean preoperative DASH score was 34.0 ( n = 16) and at treatment completion (discharge or DNA) was 11.5 ( n = 13), with mean reduction of 18.5 ( p = 0.03). At treatment completion, mean reduction in DASH score of revision ORIF was 13.7 ( p = 0.27; n = 4), compared with 20.7 ( p < 0.01; n = 9) in primary fixation with plate. Conclusions Deformity correction, reduction in DASH score, and rate of union make the plate system useful in the management of scaphoid fractures with humpback deformity and revision for nonunion. Level of Evidence This is a Level IV study.

Diagnosis of ulnar-sided wrist pain: a pragmatic approach for the non-specialist.

Ulnar-sided wrist pain is often unfairly labelled as the 'back pain' of the wrist. This reputation comes from the complexity of diagnosing problems related to this area of the wrist. This article summarizes the anatomy and biomechanics of the wrist and presents a logical approach to diagnosing the aetiology of the pain. The problems are categorised based on the anatomical structure from which the pain arises: either bony, soft tissue-related or arising from nerves or vascular structures. The article also outlines the relevant examination findings and the most appropriate investigation that would yield a diagnosis with any given presentation. A linked article detailing the imaging of ulnar-sided wrist pain is included in this issue (10.12968/hmed.2019.80.8.461).

Imaging of ulnar-sided wrist pain.

Ulnar-sided wrist pain is a complex entity to diagnose clinically and frequently requires imaging to help confirm or determine the diagnosis. This article reviews the imaging and the logical imaging pathway of the common causes of ulnar-sided wrist pain, and illustrates various pathologies. It also discusses appropriate imaging modalities for various conditions. The causes of ulnar-sided wrist pain are stratified according to the affected anatomical structures, such as bony, soft tissue or neurovascular aetiologies. This review provides a handy imaging framework for non-radiologist clinicians of the common conditions producing ulnar-sided wrist pain. A linked article (10.12968/hmed.2019.80.8.456) detailing the diagnosis of ulnar-sided wrist pain is included in this issue.

Methicillin Resistant Staphylococcus Aureus Sacroiliac Joint Septic Arthritis in an Adult Patient Treated with Daptomycin.

Sacroiliac joint septic arthritis is a rare disease entity representing 1-2% of all cases of septic arthritis. Establishment of the diagnosis is often challenging given the non-specific presenting features and the potential cross-over with other pathologies. We report the case of a 50 year old gentleman who suffers with psoriasis and presented with sacroiliac joint septic arthritis complicated by Methicillin Resistant Staphylococcus Aureus (MRSA) bacteraemia and an iliopsoas abscess. This was successfully treated conservatively with a course of the novel antibiotic Daptomycin.

Operative Versus Non-operative Treatment of Grade III Acromioclavicular Joint Dislocations and the Use of SurgiLig: a Retrospective Review.

BACKGROUND: Acromioclavicular joint dislocations are common shoulder girdle injuries. The treatment of grade III acromioclavicular joint dislocations is controversial. Furthermore, the literature on the use of the Sur-giligTM synthetic ligament for reconstruction of dislocations is sparse. MATERIALS AND METHODS: This retrospective review aimed to establish whether operative treatment was superior to non-operative treatment in grade III acromioclavicular joint dislocations treated at our institute over a 5-year period. We also reviewed the effectiveness of reconstruction with SurgiligTM after acute and chronic dislocations across all grades of acromioclavicular joint dislocations. RESULTS: Twenty-five patients completed full follow-up with grade III dislocations. The mean follow-up in the operated group was 3.56 years and in the non-operated group this was 3.29 years. The mean Oxford Shoul-der Score (OSS) in the operated group was 39.8, whereas the mean OSS in the non-operated group was 45.9 (p=0.01). The mean pain score in the operated group was 2.2, and in the non-operated group this was 1.6. The mean satisfaction score in the operated group was 8.2 and that in the non-operated group was 7.8. There was no statistically significant difference in pain or satisfaction scores. In respect to the cohort treated with Surg-iligTM synthetic ligament, 22 patients across all grades of dislocations had this procedure performed. The mean post-operative Oxford Shoulder Score (OSS) was 40. CONCLUSIONS: 1. Non-operative treatment is not inferior to operative treatment for grade III acromioclavicular joint dislocations. The data from this study demonstrat-ed that the non-operated group had superior Ox-ford Shoul-der Scores that were statistically significant. 2. Additionally, the use of the SurgiligTM ligament appears to be effective in treating both chronic and acute acromioclavicular joint dislocations.

Intraosseous schwannoma of D12 thoracic vertebra: diagnosis and surgical management with 5-year follow-up.

Intraosseous schwannomas or neurilemomas are rare benign neoplasms that account for less than 0.2% of primary bone tumours. Very rarely they have been observed in lumbar vertebrae. We report a neurilemoma involving the lower thoracic spine and present the clinical, radiological and histological findings with surgical management and 5-year follow-up. An 18-year-old-male presented with back pain and deteriorating locomotor function. Neurological examination revealed wasting of both calves and weakness in plantar flexion and dorsiflexion bilaterally. X-rays showed a D12 vertebral body abnormality with cystic changes and collapse of the body and pedicle. MRI showed a tumor occupying the D12 vertebrae with perivertibral protrusion compressing the thecal sac. Surgical decompression, excision and stabilisation with an extendable cage, bone graft and anterior rod system were achieved through a thoracolumbar approach. Histology results confirmed an intraosseous schwannoma with no remnants of an originating nerve. These tumors are rare but can be successfully treated with surgical excision and maintenance of spinal stability with recovery of neurological and functional change. Recurrence is uncommon.