Coping with Non-COVID-19 Health Problems Through Communicative Action in Cyberspace.

This study investigated how the online health information behaviors of U.S. adults with illnesses unrelated to COVID-19 virus infection affected their coping with health problems and concerns during the COVID-19 pandemic. Guided by the cybercoping model (Kim & Lee, 2014), the study examined associations between these patients' online information behaviors (information seeking and information forwarding) and coping outcomes (health problems and affective states). The study further explored the mediating roles of health coping processes (problem-and emotion-focused) in the associations between these information behaviors and coping outcomes. Survey data from 687 participants were analyzed using structural equation modeling. The results highlighted the significance of information forwarding in enhancing both coping processes and outcomes, while information seeking enhanced problem-focused coping and health-problem coping outcomes alone. These associations were more pronounced among U.S. adults without chronic conditions than among those with chronic illnesses. These findings' implications, the study's limitations, and suggestions for future research were also addressed.

Subchondral Radial and Ulnar K-Wire Positioning With Cancellous Bone Graft Shortens Union Time in Scaphoid Waist Nonunion.

BACKGROUND: Bone grafting in patients with scaphoid waist nonunion can present several technical challenges. In this study, we aimed to present a modified surgical technique for scaphoid waist nonunion, which consisted of subchondral radial and ulnar K-wires positions with cancellous bone graft, and to compare the clinical outcome of this modified technique with the conventional method. METHODS: We retrospectively reviewed 72 patients with scaphoid waist nonunion who had been surgically treated between January 2011 and December 2020. Of these, 34 patients were treated with the modified method and 38 with the conventional method. Debridement of the nonunion site was performed using a curette, rongeur, and microburr. Two or 3 K-wires were inserted along the cancellous portion of the scaphoid in the conventional method. In the modified method, 2 K-wires were inserted along the ulnar and radial subchondral portion of the scaphoid to increase the space for bone grafting in the cancellous portion of the scaphoid. The autologous cancellous bone grafted in both the methods. Demographic, radiological, and clinical outcomes were reviewed and compared between the groups. RESULTS: There were no significant differences in demographics and characteristics of nonunion between the 2 groups of patients. The modified method group showed significantly shorter union time than the conventional method group (conventional group: 13.0 ± 1.3 weeks, modified group: 11.4 ± 1.1 weeks; P < 0.001). The bony union rate was 97.1% for the modified method and 89.5% for the conventional method. Satisfactory clinical outcomes (excellent and good Mayo wrist scores) were achieved in 27 cases (81.8%) using the modified method and 22 cases (64.7%) using the conventional method. CONCLUSION: Subchondral radial and ulnar K-wire positioning with cancellous bone graft (modified method) can improve the union time with satisfactory clinical outcomes in the treatment of scaphoid waist nonunion.

Age-dependent Sagittal Plane Remodeling of Pediatric Supracondylar Fractures.

BACKGROUND: Current treatment guidelines for pediatric supracondylar fractures have not fully accounted for age-related variations in the remodeling potential. This study aimed to explore age-dependent sagittal plane remodeling in supracondylar fractures by assessing cases with residual deformities after treatment. METHODS: This study included 62 patients under 16 years of age treated for supracondylar fractures at our institution from 2002 to 2022. The distance between the posterior and anterior aspects of the capitellar ossific nucleus (CON) was defined as the CON size, while the distance from the anterior humeral line to the posterior aspect of CON was termed DAP-CON. The value obtained by subtracting the DAP-CON on the unfractured side from the DAP-CON on the fractured side was divided by the CON size and multiplied by 100 and termed the displacement of CON (d-CON). The absolute value of the difference between d-CON after intervention and d-CON at the last follow-up was denoted as sagittal plane remodeling. RESULTS: For this patient cohort, the mean age was 5.5 years (range, 1.4 to 14.6 years), and the mean follow-up period was 30.4 months (range, 12.0 to 137.1 months). Sagittal plane remodeling was more pronounced in children younger than 5 years (group I) compared with those older (group II) (P<0.001). In multiple regression analysis, only age at the time of injury was found to be a significant variable (P<0.001). The receiver operating characteristic curve analysis identified 4.2 years as the cutoff age for predicting >33% sagittal plane remodeling, with an area under the curve of 0.975. CONCLUSIONS: Children below the age of 5 years exhibit sagittal plane remodeling, with a cutoff age identified at 4.2 years for achieving >33% of d-CON. This indicates that mild deformities (16.5%

Localization of osteomyelitis lesions for operative eradication of chronic osteomyelitis of the lower extremities by bone SPECT/CT: a feasibility study.

PURPOSE: This study was performed to investigate the feasibility of bone single-photon emission tomography/computed tomography (SPECT/CT) for pre-operative planning of chronic osteomyelitis (COM) of the lower extremities by localization of osteomyelitis lesions. METHODS: From January 2016 to January 2020, we surgically treated ten adult patients with Cierny-Mader type III COM in the tibia or femur for a mean duration of 24.4 months (range 7.0-70.0 months). We conducted pre-operative planning by bone SPECT/CT and localization of osteomyelitis lesions. The treatment consisted of intra-operative eradication of the infective focus and antibiotic administration. The clinical and radiological outcomes were retrospectively analyzed after a minimum of one year of follow-up. RESULTS: The patients were surgically treated by thorough debridement, dead space management, and appropriate antibiotics without bone transport or an external fixator. The location of the hot uptake region on bone SPECT/CT coincided with that of the osteomyelitis lesion, which was confirmed intra-operatively in all patients. At an average of 16.5 ± 4.3 months (range, 13.0-25.0 months), clinical eradication of osteomyelitis was achieved in nine of the ten patients. One patient required amputation due to recurrence of osteomyelitis. A successful clinical outcome was achieved in eight patients; one suffered persistent ankle pain due to a destructive change in the ankle joint despite eradication of the infection. CONCLUSION: Bone SPECT/CT is a feasible method for the localization and eradication of osteomyelitis lesions in COM of the lower extremities and has favourable clinical outcomes. It can also be applied in cases of distorted bony structures caused by previous trauma or surgery, or in the presence of implants.

Difference in Joint Stability Between Small Posterior Malleolar Fragments With Fixation and Those Without Fixation: A Biomechanical Cadaver Study.

The indication for the surgical treatment of ankle fractures that involve a posterior malleolar fragment remains controversial. This cadaver study assessed the biomechanical results of rotation stiffness of Haraguchi type 1 posterior malleolar fragments with or without cannulated screw fixation. Twelve anatomic lower-extremity specimens from 6 cadavers were tested. Six right legs were subjected to posterior malleolus osteotomy (Haraguchi type I) followed with (group A; n = 3) or without (group B; n = 3) fixation using a cannulated screw. Ankle joint stability was measured under both external rotation force and axial loading, and the passive resistive torque was measured in both groups. The mean torque value in group A was 0.1093 Nm/º, while that in group B was 0.0537 Nm/º. There was a significant intergroup difference (p = .004). In group B, the torque value was further increased in the latter rotation period (about 40-60 degrees). Group A proved more stable under experimental conditions than group B. Fixation in type I posterior malleolar fragments produced improved stability in ankle rotation, even for posterior malleolar fragments involving <25% of the articular surface, and has been considered an effective aid in treatment.

Outcomes of Flexor Tendon Repair in Patients With Concurrent Neurovascular Injuries of Multiple Digits in Zone 1.

PURPOSE: We treated several patients with multiple flexor (flexor digitorum profundus; FDP) injuries accompanied by injuries to the digital nerve or vessels around the distal interphalangeal crease (zone 1). Here, we retrospectively report the outcomes and review the literature. MATERIALS AND METHODS: Between January 2010 and December 2018, 16 patients who met the study inclusion criteria were investigated. Tendons were repaired using the cross-locked cruciate (Adelaide) technique (6-strand) or modified Becker method (4-strand). The neurovascular structures were repaired under a microscope. RESULTS: Sixteen patients (47 digits) were treated. According to the criteria of Moiemen and Elliot, the lacerated areas were in zones IA and IB in 7 and 40 digits, respectively. The mean ranges of motion were 149.27 ± 7.78 and 66.43 ± 2.04 degrees according to the Strickland and modified Strickland assessments, respectively. The mean 2-point discrimination was 5.00 ± 0.63 mm. Four patients (group 1) presented with injuries to 2 digits, and 9 (group 2) and 3 (group 3) patients had 3 and 4 injured digits, respectively. The outcomes were satisfactory in terms of the mean range of motion; 2-point discrimination; cold tolerance; visual analog scale pain score; Disabilities of the Arm, Shoulder, and Hand score; and grip strength. There were no differences among the groups. CONCLUSIONS: Open multiple-finger injuries involving flexor digitorum profundus rupture with concurrent neurovascular injuries on one or both sides occasionally occur in industrial environments. Fortunately, each digit exhibits a consistent injury type in a particular anatomical location; appropriate repair yields satisfactory outcomes despite the presence of multiple injuries.

Reduction of olecranon fractures with no or minimal dorsal cortex comminution based on the contour of the posterior ulnar cortex: does it restore the greater sigmoid notch?

INTRODUCTION: When treating olecranon fractures surgically, surgeons rely on the contour of the posterior cortex of the proximal ulna. However, it is unclear whether the greater sigmoid notch (GSN) is restored anatomically by this method. We analyzed whether reduction of fractures based on the posterior ulnar cortex contour is reliable for restoration of the GSN contour in displaced olecranon fractures with no or minimal dorsal cortex comminution. MATERIALS AND METHODS: We performed a retrospective review of 23 patients with Mayo type 2 olecranon fractures with no or minimal dorsal cortex comminution who were treated surgically. We analyzed pre- and postoperative elbow CT images and measured the interfragmentary distance (IFD), articular step-off, articular gap, contour defect and GSN angle to evaluate the restoration of the GSN contour. RESULTS: The mean preoperative IFD and contour defect were 16.5 mm (range 4.3-35.6 mm) and 4.3 mm (range 0.7-13.3 mm), respectively. Postoperatively, there was no residual IFD, and the mean contour defect decreased significantly to 1.4 mm (range 0-3.7 mm). The residual articular step-off and gap were 0.2 mm (range 0-3.8 mm) and 1.0 mm (range 0-5.9 mm), respectively. Acceptable GSN restoration was achieved in 14 of 23 patients (60.9%). Sixteen patients had > 2 mm of preoperative contour defect, and 7 (43.8%) achieved acceptable GSN restoration; the remaining 7 patients (100%) who had < 2 mm of the contour defect achieved acceptable GSN restoration. Patients whose preoperative contour defect was > 2 mm had a higher risk of unacceptable GSN restoration, with an odds ratio of 2.29 (p = 0.019). CONCLUSIONS: In displaced olecranon fractures without significant dorsal cortex comminution, reduction based on the posterior ulnar cortex could be reliable for fractures with under 2 mm of preoperative contour defect, but not for those with > 2 mm of contour defect. LEVEL OF EVIDENCE: IV.

Antegrade intramedullary nailing in comminuted, open metacarpal bone fracture: maintenance of the length.

PURPOSE: The purpose of this study was to evaluate the radiological and clinical outcomes of treatment of comminuted open fractures of the metacarpal bone (MCB) with associated injuries to soft tissues, tendons, and neurovascular structures using antegrade intramedullary nailing (AIN) at least 2 years postoperatively. METHODS: Between January 2008 and December 2017, a total of 27 patients who met the inclusion/exclusion criteria were included in this study. The inclusion criterion was open and comminuted fracture (with/without segmental bone defects). We evaluated simple radiograph and computed tomography (CT) findings and clinical conditions (visual analog scale [VAS] pain score and Disabilities of the Arm, Shoulder, and Hand [DASH] score), including active range of motion (ROM) at metacarpophalangeal joint (MP) and grip strength at final follow-up. RESULTS: The mean preoperative angulation was 29.63° ± 7.59° and the mean shortening was 9.30 ± 2.38 mm. Union was achieved at mean 12.3 weeks postoperatively, without any complications due to operative treatment. The dorsal angulation measured on the CT scans, shortening on simple radiographs was significantly improved (10.26 °± 3.19°, 0.52 ± 1.05 mm, respectively). The final VAS and DASH scores were 0.41 ± 0.64 and 3.6 ± 2.47, respectively, indicating satisfactory outcomes. The final ROM was 85.0° ± 3.67°. The mean final grip strength was 89.56 ± 5.69% relative to the normal side. A mean extension lag at the MP joint of 12° was noted in three patients; however, it was resolved by additional tenolysis. CONCLUSIONS: AIN is a simple method for fixation of open comminuted metacarpal fractures accompanied by soft tissue injury. The simplicity of the method is beneficial for repairing associated injured structures and healing soft tissue. Minimized additional damage around the MCB during surgery and good stability resulted in satisfactory bony union with minimal angulation, shortening, and rotation. LEVEL OF EVIDENCE: Level IV, Retrospective case series.

Inevitable nonunion after ulnar shortening osteotomy in patients with ulnar impaction syndrome and breast cancer under bisphosphonate treatment.

BACKGROUND: Nonunion after ulnar shortening osteotomy (USO) was observed at a high rate in patients undergoing long-term bisphosphonate (BP) maintenance treatment after breast cancer surgery. Here, we report the unique features of these nonunions. METHODS: In total, 485 patients who had undergone USO between March 2008 and September 2017 were screened for inclusion based on the following criteria: (1) definitive nonunion after USO; (2) prior history of or ongoing BP therapy after the diagnosis of breast cancer; and (3) no evidence of metastasis in the ulna treated with USO, as determined based on the radiological evaluation. RESULTS: Five patients with histories of breast cancer and subsequent BP treatment were identified; all (100%) of these patients showed definitive nonunion after USO. The mean age was 56.2 years, and all ulnae were on the contralateral side to that of the original breast cancer. Intravenous Ibandronate® and Zolendronate® were administrated to one and four patients, respectively. The mean period of administration was 67.8 months. Three patients exhibited suspicious lesions impending atypical fracture on their femurs, and the other two patients were treated by intramedullary nailing after the occurrence of atypical fractures. Radiological evaluation revealed no evidence of a metastatic lesion, including in the musculoskeletal system, in any patient. Osteosynthesis was performed with cancellous iliac bone graft and mean of 4.3 months after osteosynthesis, union in all cases was achieved. CONCLUSIONS: Problems associated with BP treatment are well known. Even in cases in which the agent is essential for preventing bony metastasis of breast cancer, the normal bony physiology, including bone turnover and healing, is likely to be compromised. In addition to atypical fractures of the femur and ulna, procedures such as USO are likely to be affected by BP. Furthermore, not only a primary iliac bone graft but also other method (oblique osteotomy) should be needed to avoid nonunion during plating in USO. LEVEL OF EVIDENCE: IV, Retrospective case series.

Is There a Relation Between Lateral Epicondylitis and Total Cholesterol Levels?

PURPOSE: To investigate whether high total cholesterol (TC) levels are associated with lateral epicondylitis (LE). METHODS: We retrospectively reviewed all patients with LE who presented to our institution between 2011 and 2015. The inclusion criteria were a diagnosis of LE based on clinical history and physical examination findings and age between 40 and 55 years. For healthy controls, we obtained data from a national cohort (sixth Korean National Health and Nutrition Examination Survey) aged between 40 and 55 years. We compared TC levels between the groups, determined the incidence of hypercholesterolemia (TC level ≥ 240 mg/dL) according to the occurrence of LE, and calculated odds ratios for the occurrence of LE. We also evaluated whether cholesterol levels were associated with clinical findings of LE, such as pain level, onset age, symptom duration, and number of corticosteroid injections. RESULTS: The study comprised 289 patients with LE (mean age, 47.9 years) and 1,077 healthy individuals (mean age, 47.7 years). TC levels were significantly higher in patients with LE than in healthy individuals (205.0 mg/dL vs 194.6 mg/dL, P < .001). The mean difference of 10.4 mg/dL was clinically meaningful because a change of 10 mg/dL with medical intervention is considered significant. The incidence of hypercholesterolemia was higher in LE patients than in healthy controls (16.6% vs 9.0%, P < .001). After adjustment for age, sex, body mass index, and glucose level, patients with hypercholesterolemia (TC level ≥ 240 mg/dL) were 2.47 (95% confidence interval, 1.65-3.70) times more likely to experience LE than those with normal cholesterol levels (<200 mg/dL). TC levels correlated with pain level, onset age, and number of corticosteroid injections. CONCLUSIONS: A clinically meaningful difference in TC levels was found between LE patients and healthy controls. In addition, the incidence of hypercholesterolemia was higher in LE patients than in controls. The present findings suggest a potential association between high TC levels and LE. LEVEL OF EVIDENCE: Level III, case-control study.

Supplemental Method for Reduction of Irreducible Mallet Finger Fractures by the 2-Extension Block Technique: The Dorsal Counterforce Technique.

PURPOSE: We suggest a method to achieve anatomical reduction in mallet finger fractures that are insufficiently treated by the 2-extension block wire technique. METHODS: We performed a retrospective review of 18 patients who were found to have an irreducible dorsal fragment and distal interphalangeal joint incongruence owing to rotation of the dorsal fragment in the sagittal plane. In these cases, we additionally employed a dorsal counterforce technique to supplement the 2-extension block technique. An additional K-wire was used to apply counterforce against the distal part of the dorsal fragment and control rotation in the sagittal plane. RESULTS: All 18 fractures united. Congruent joint surfaces and anatomical reduction were seen in all cases. The mean active flexion of the distal interphalangeal joints was 83.8° (range, 79°-88°) and the mean extension loss was 0.4° (range, 0°-4°). CONCLUSIONS: We believe that the dorsal counterforce technique effectively supplements the 2-extension block K-wire technique and aids control of dorsal fragment rotation in the sagittal plane. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Role of bone single photon emission computed tomography/computed tomography in managing chronic fracture-related infections: Determining the depth of infection and avoiding unnecessary bone procedures.

PURPOSE: Fracture-related infections (FRIs) encompass a broad range of infections associated with bone fractures; they remain a significant clinical challenge. Here, we aimed to investigate the viability of focusing on soft-tissue management in patients suspected of chronic FRI, who exhibit no significant bony uptake on bone single photon emission computed tomography (SPECT)/computed tomography (CT) scans. METHODS: Between January 2016 and January 2022, we managed 25 patients with chronic FRI or post-traumatic osteomyelitis using technetium 99m-methyl diphosphonate bone SPECT/CT to assess infection depth. Among them, 13 patients showing negligible bony uptake were included and categorized into two groups based on wound discharge reaching the bone/implant (Criteria 1, n = 6) or not (Criteria 2, n = 7). RESULTS: Patients in the Criteria 1 group were treated with antibiotics and soft tissue debridement without bony procedure. The average duration of antibiotic therapy was 6.7 weeks. Treatments were individualized, including implant changes, local flaps, skin grafts, and negative pressure wound therapy. No recurrence was reported in the mean follow-up of 21.3 months. Patients in the Criteria 2 group were treated with oral antibiotics (mean duration: 5.9 weeks) and daily wound dressings. No recurrence was reported in the mean follow-up of 26.0 months, and no surgical interventions were required. CONCLUSION: This study demonstrates the feasibility of focusing on soft-tissue management in patients with chronic FRI showing minimal bony uptake on bone SPECT/CT. Our treatment protocol avoided unnecessary surgical bone procedures, resulting in successful clinical outcomes with no recurrences.

Feasibility study of juxta-articular-type volar distal radius plate (ARIX Wrist System) for surgically treating marginal distal radius fractures.

Purpose: We evaluated the feasibility of a juxta-articular-type volar distal radius plate for the surgical treatment of marginal distal radius fractures. Materials and methods: Twenty marginal distal radius fractures, defined by the location of the fracture line within 10 mm of the joint line of the lunate fossa, were retrospectively reviewed between July 2020 and July 2022. The fractures were fixed using a juxta-articular-type volar plate (ARIX Wrist System). The characteristics of the implant and surgical technique, radiologic, and clinical outcomes, and related complications were evaluated. Results: Bony union was achieved in all patients within six months. Acceptable radiological alignment was achieved with no significant differences between the fractured and the normal sides. The clinical outcomes were favorable, with satisfactory functional outcomes. There was one case of post-traumatic arthritis and two cases of carpal tunnel syndrome. No implant-related complications including flexor tendon problems were observed. Conclusion: The juxta-articular distal radius plate of the Arix Wrist system is feasible for treating marginal distal radius fractures and achieves favorable clinical outcomes without implant-related complications in East Asian patients.

How long does it to achieve sagittal realignment of the displaced epiphysis in Salter-Harris type II distal radial fracture when treated by manual reduction?

This study aimed to investigate how long it takes for the dorsally displaced distal radial epiphysis to achieve realignment. We retrospectively reviewed 56 patients with dorsally displaced Salter-Harris type II distal radial epiphyseal fractures who were aged ≤15 years at the time of injury. All fractures were treated with closed reduction and immobilised using a sugar tong splint for 6 weeks. We evaluated the change in the displaced epiphysis position (%) until 12 weeks and the long-term clinical and radiological outcomes. We analysed significant differences in demographic factors and epiphyseal displacement according to the required period for epiphyseal realignment. The estimated area of the receiver operating characteristics (ROC) curve was calculated, and cut-off values were suggested to predict the required period for epiphyseal realignment. Sixteen (28.6%) and 42 (75%) patients achieved realignment of the epiphysis within 8 and 12 weeks, respectively. The cut-off values of 13.1 and 22.9% displacement at the 1-week follow-up were the best predictors of epiphyseal realignment within 8 and 12 weeks, respectively. Patients with a residual displacement of up to 51.3% in the sagittal plane at the 1-week follow-up achieved complete realignment of the epiphysis at the 6-month follow-up. From this study, we could predict the timing of epiphyseal realignment, and expect epiphyseal realignment even if re-displacement occurred up to 51.3% at the 1-week follow-up.

Use of Three-Column Reconstruction and Free Vascularized Fibular Grafts for the Repair of Large Tibial Defects after Tumor Resection.

Background: This study aimed to evaluate the clinical outcomes of three-column reconstruction of the lower leg using a single-barrel contralateral vascularized fibular graft (VFG), medial locking plate, and the ipsilateral fibula for the repair of large tibial defects after tumor resection. Methods: In this retrospective study, we reviewed 12 patients who underwent three-column reconstruction using a single-barrel contralateral VFG, medial locking plate, and the ipsilateral fibula between June 1996 and May 2020. These patients had large tibial bone defects following tumor resection. The mean age of the patients was 26.3 years (range, 11-63 years), and 7 of them were women. The mean follow-up period was 104.8 months (range, 26-284 months). The mean size of the tibial bone defect after tumor resection was 17.8 cm (range, 11-26.8 cm). The clinical and radiological outcomes were evaluated at the final follow-up. Results: All patients survived beyond the final follow-up without recurrence of the primary bone tumor. The mean time from reconstruction to bony union at both host-graft junctions was 12.9 months (range, 4-36 months). The mean Musculoskeletal Tumor Society score was 82.3% (range, 60%-97%). All tibial defects were reconstructed with adequate bone healing. There were 4 cases of stress fracture and graft failure; these were resolved by using longer plates and more screws. All patients were ambulatory without assistance and showed no permanent complications. Conclusions: Large tibial defects that occur after tumoral resection can be effectively reconstructed by three-column reconstruction using a medial locking plate, an inlay single-barrel VFG harvested from the contralateral side, and the intact ipsilateral fibula. This technique permits early weight-bearing before fibular hypertrophy and bony union.

Evaluation of overgrowth in pediatric radius fractures.

PURPOSE: Forearm fractures are the most frequent long bone fractures in children. There have been many reports of differences in leg length due to overgrowth in lower extremity fractures. However, reports of such overgrowth in fractures of the upper extremity are rare. The purpose of this study was to investigate the relationship between angulation and overgrowth in pediatric radius fractures. We hypothesized that more angular deformation of the fracture would result in a periosteal transection and more overgrowth. METHODS: Retrospectively, between 2013 and 2022, 14 patients under 16 years of age (mean age 9.43 years; 10 boys, four girls) with unilateral radius shaft or metaphyseal fracture without physeal injury, and a minimum follow-up of 12 months, were included. Demographic factors were analyzed; age, sex, body mass index (BMI), right or left. We evaluated the radiologic parameters; ulnar variances, degree of angularity before intervention, fracture gap and treatment options. The patients underwent conservative or surgical treatment. RESULTS: The mean follow-up period was 27.9 months (range, 13-53 months). Eight patients underwent cast treatment, and six patients underwent surgical treatment. The difference in ulnar variances between the unaffected side and fracture side were statistically significant (P < 0.001). Sex, age, left or right, height, weight, and BMI were not statistically significant. The surgical treatment group (P = 0.013) and the sum of the maximum angularity (P = 0.017) were statistically significant. When the sum of the maximum angularity(SMA) was 30° or more, the ulnar variances were statistically significant, compared with the case where the SMA was less than 30°. The clinical results evaluated at the last outpatient follow-up were good in all patients. CONCLUSIONS: First, this study implies that the degree of angulation of the fracture may affect the overgrowth of the radius in case of radius shaft or metaphyseal fracture, without physeal injury. Second, it implies that the degree of overgrowth may increase with surgical treatment, as opposed to that with conservative treatment. LEVEL OF EVIDENCE: Level IV, Retrospective study.

Grip Strength Measurement for Outcome Assessment in Common Hand Surgeries.

Grip strength has been used to evaluate the upper extremity functional status and clinical outcomes following upper extremity trauma or surgery. Understanding general recovery patterns of grip strengthening can be helpful in assessing the patients' recovery status and in assisting in preoperative consultations regarding expectations for recovery. We summarize related studies on grip strength measurement and recovery patterns in common hand conditions, including carpal tunnel syndrome, cubital tunnel syndrome, triangular fibrocartilage complex injury, and distal radius fractures.

Radiological Reversibility of Incomplete Atypical Femoral Fracture with Cessation of Bisphosphonate: Including an Early Stage of Incomplete Fracture.

Background: We found some important early findings in simple radiographs under the bisphosphonate (BP) treatment through a retrospective study. Here, we report the degree of reversibility of the early findings before overt fracture and analyze the factors affecting the differences through a retrospective case-control study. Methods: We retrospectively inspected the clinical charts of patients diagnosed with atypical femoral fracture (AFF) at our institute between March 2006 and September 2018. Among the 209 screened patients, 102 patients were ultimately divided into 3 categories: Category 1 was described as endosteal diffuse flaring (EDF, early IAFF); category 2 was typical IAFF, with a tiny/partial crack that was limited to less than half of the thickness of the cortex; and category 3 was IAFF with a crack through the entire cortex. Demographics, clinical factors, and three categories of incomplete atypical femoral fracture (IAFF) were analyzed to determine whether their radiological condition "improved" or "progressed" after cessation of BP via univariate and multivariate analyses. Results: Thirty-three, 53, and 16 were classified as categories 1, 2, and 3, respectively. Groups 1 and 2 consisted of 79 patients whose IAFF on the side of interest improved and 23 patients whose IAFF progressed, respectively. The uni/multivariate analyses of the groups demonstrated that the total period of BP (odds ratio [OR] = 1.49) and period of cessation of BP (OR = 0.24) were significant variables. In addition, prophylactic treatment for a contralateral IAFF was a strong factor for progression of the incomplete lesion on the side of interest (OR = 25.99). The rate of progression was significantly higher in patients with a mean treatment period of 43 months or longer, and in those with a mean cessation period shorter than 1.2 months. Conclusion: Early-stage IAFF was found to be a unique finding in simple radiographs before the typical features of AFF. This EDF (category 1) was definitively reversible to normal bone when administration of BP was stopped. In addition, a long period of BP treatment and recent cessation of BP adversely affected IAFF with respect to spontaneous healing. Level of Evidence: Level III, a retrospective case-control study.

Simple Osteotomy Site Repair Method for the Trans-Olecranon Approach: Tension Band Wiring with Ring Pins.

Background: The trans-olecranon approach is commonly used to treat intra-articular distal humeral fractures (DHFs). We describe an osteotomy site repair technique that is both simple and safe. Methods: We retrospectively reviewed 30 patients with intra-articular DHFs who were treated via olecranon osteotomies repaired by tension band wiring (TBW) with ring pins. Medical records and radiographs were retrospectively assessed in terms of injuries, operative characteristics, clinical outcomes, and complications, as well as any need for hardware removal. Clinical outcomes were evaluated by deriving the range-of-motion and the Mayo elbow performance score. Results: Thirty patients (nine men, 21 women; mean age, 49.7 years) with Arbeitsgemeinschaft für Osteosynthesefragen (AO) type 13-B and 13-C DHFs were included; the mean follow-up time was 49.9 months (range, 12-145 months). Anatomical reduction and bony union were achieved at all osteotomy sites. The mean elbow flexion was 121.7° (range, 100-135°) and the mean elbow extension was 11.3° (range, 0-30°). The mean Mayo elbow performance score was 90 points (range, 55-100 points); outcomes were excellent in 15 patients, good in 12 patients, fair in two patients, and poor in one patient. Olecranon implant removal was performed for 10 patients (33.3%; total removal in nine and isolated olecranon implant removal in one). Four of these patients (13.3%) complained of olecranon implant discomfort. Implants were removed during other surgical procedures from the remaining six patients (20%). No implant migration/breakage or wound complications were encountered. Conclusions: TBW with ring pins is a simple and safe method for olecranon osteotomy site repair.

Effectiveness of Percutaneous Pinning of Acute Partial Scapholunate Injury during Volar Locking Plating for Distal Radius Fractures: A Comparative Study of Pinning and Conservative Treatment.

BACKGROUD: We hypothesized that concurrent temporary fixation of scapholunate ligament (SL) injury during volar locking plate (VLP) fixation of distal radius fractures (DRFs) would improve restoration outcomes based on both radiological and clinical results. Here, we performed a prospective, comparative study investigating the effectiveness of temporary percutaneous reduction/pinning during VLP fixation in DRFs. METHODS: The first 43 consecutive SL injuries were treated concurrently after VLP fixation by closed pinning (group 1); the next 36 consecutive injuries were treated nonoperatively (group 2). Patients were followed up for at least 5 years after treatment. Basic demographic data, radiological measurements, arthroscopic findings of SL injury, and other clinical outcomes were evaluated. RESULTS: The mean follow-up period was 7.2 years. No significant differences in basic demographic data were evident between groups. Fracture patterns were not distinctively different between groups. The initial scapholunate angle measured immediately after surgery was 23° ± 3° in group 1 and 38° ± 13° in group 2, indicating a significantly hyperextended scaphoid position in group 1. The final scapholunate angles were also significantly different between groups although the final angle in group 2 (58° ± 11°) was within normal limits. Final visual analog scale scores, Disabilities of the Arm, Shoulder and Hand scores, Gartland and Werley system scores, and wrist motions were not different between groups; however, grip strength at the time of final follow-up was closer to that of the contralateral uninjured wrist in group 1. Arthrosis was less advanced in group 1. CONCLUSIONS: Temporary fixation for SL injury with a DRF can be an effective option for the maintenance of scapholunate angle. The non-fixed group exhibited a more pronounced collapse of the scapholunate angle although the angle was still within normal limits, and clinical outcomes were similar between groups regardless of the fixation status.