Comparison of Orthosis Management Failure Rates for Mallet Injuries.

Purpose: A closed mallet injury is a common finger injury involving terminal extensor tendon avulsion from its insertion on the distal phalanx. Nonsurgical treatment with continuous extension orthosis fabrication is the preferred treatment. Our purpose was to report the failure rates of orthotic management by digit and investigate other factors that contribute to failure. Methods: This was a retrospective chart review of all patients with an isolated mallet finger injury managed at our institution from 2011 to 2019. Patient demographics, details of management, and treatment outcomes were collected. Failure rates were compared for all digits, specifically comparing the little finger versus all other digits. A categorical variable analysis was performed to identify risk factors for failure of orthosis management. Results: Out of 1,331 identified patients, 328 met the inclusion criteria. There was no statistically significant difference of failure rate between digits. There was a trend toward the little finger failing at a higher rate (n = 131, 40%) than the other digits individually (P = .08) and combined (n = 95, 29%; P = .06). An older age at injury was associated with failure. The median patient age with failure was 54 years, versus the median patient age with nonfailure of 48 years (P < .01). The failure rate was higher in tendinous versus bony mallet injuries (n = 131, 40% vs n = 66, 20%, respectively; P < .01). The orthotic type was associated with the failure rate, and failure was highest in patients treated with Stack orthoses (n = 183, 56%; P = .01). Conclusions: There was no significant difference in the orthotic management failure rate by digit for a mallet injury. Statistically significant risk factors for failure are increasing age, a tendinous injury, and the orthotic type. Further evaluation with a larger cohort is warranted to increase the statistical power of the findings. Type of study/level of evidence: Therapeutic III.

Biomechanical Testing of Scapular Spine Autograft for Anterior Glenoid Bone Augmentation.

Background: Augmentation of anterior glenoid defects with bone graft can improve shoulder stability and reduce the risk of redislocation. Several characteristics of the scapular spine may make it a suitable harvest site, avoiding the disadvantages associated with other glenoid augmentation procedures. Purpose: To evaluate the capacity of scapular spine autograft to restore the stabilizing joint-reaction forces of the shoulder in simulated scenarios of bony anterior shoulder instability. Study Design: Controlled laboratory study. Methods: We obtained 6 matched pairs of fresh-frozen cadaveric shoulders. Skin, subcutaneous tissues, and non-rotator cuff muscles were removed from the specimens, leaving intact the rotator cuff musculature and shoulder capsule. A customized testing device was used to translate the humerus 1 cm anteriorly on the glenoid under 25 N of axial compression force. The peak joint-reaction force of the glenohumeral joint was then measured under 3 conditions: (1) specimen with intact glenoid, (2) specimen after a bone defect measuring 25% of the maximal width of the glenoid was made in the anteroinferior glenoid, and (3) specimen after size-matched glenoid augmentation with a scapular spine tricortical autograft. The primary outcome was the change in peak joint-reaction forces between the defect state and augmented state. Results: One matched pair was removed from final analysis secondary to anatomic concerns that undermined the accuracy of test results. Among the 10 remaining specimens, all showed a significant decrease in peak joint-reaction force after the glenoid defect was created compared with the intact state (P < .001). All remaining specimens showed an increase in peak joint-reaction force in the augmented state compared with the defect state (P < .001). On average, the augmented state restored 81% of the peak reaction force of the glenohumeral joint compared with the intact state, a nonsignificant difference (P = .07). Conclusion: The study findings indicated that autograft harvested from the scapular spine increased the bony restraint to anterior shoulder dislocation in shoulders with glenoid bone loss. Clinical Relevance: The scapular spine is an alternative for bony augmentation of glenoid defects in shoulder instability.

Anterior cruciate ligament assessment using arthrometry and stress imaging.

Arthrometry and stress imaging are useful clinical tools for the objective assessment of anterior cruciate ligament (ACL) integrity. They are most frequently used for the diagnosis of a complete ACL tear when other workup is equivocal, in conjunction with history and clinical exam findings. Other applications include the diagnosis of partial ACL tears, injury prognosis, and post-operative monitoring. However, further studies are needed to validate these uses. Many different devices and techniques exist for objective examination, which have been compared in recent literature. Reliability and validity measures of these methods vary, and often depend upon examiner familiarity and skill. The KT series of devices is the current gold standard for arthrometry, although the newer robotic GNRB device shows promising early results. Newer methods of data interpretation have been developed for stress imaging, and portable technology may impact this field further.

Scapholunate interosseous ligament injuries: a retrospective review of treatment and outcomes in 82 wrists.

PURPOSE: To compare outcomes of treatment for scapholunate instability between acute (< 6 wk from injury) and chronic (> 6 wk) injuries, between complete and partial tears, and among surgical techniques; identify risk factors for surgical failure; and compare ligament reconstruction with repair with or without capsulodesis in the chronic period. METHODS: We performed a retrospective chart review of 82 primary scapholunate interosseous ligament surgeries, with median follow-up of 150 days. A total of 27 patients underwent surgery in the acute period and 50 in the chronic period. (In 5 patients we were unable to determine acuity or chronicity of injury.) In the chronic period, 16 patients underwent repair with or without capsulodesis, 27 underwent ligament reconstruction, and 7 underwent other procedures. RESULTS: Surgical intervention in the acute setting involved more complex injuries, most commonly used direct repair, and produced a significantly lower failure rate than chronic intervention. In the chronic setting, the most common technique was ligament reconstruction, which produced superior radiographic outcomes compared with repair with or without capsulodesis. Isolated scapholunate interosseous ligament injuries undergoing chronic surgical intervention composed the majority of failures. Workers' compensation status and chronic intervention were significant risk factors for failure. CONCLUSIONS: For chronic injuries, ligament reconstruction produced better radiographic outcomes than repair with or without capsulodesis. Acute intervention (within 6 wk) was preferable to chronic intervention for scapholunate interosseous ligament injuries, and a substantial number of isolated injuries failed to receive treatment in the acute period. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.