The Palpable Scaphoid Surface Area in Various Wrist Positions.

PURPOSE: To determine the theoretical amount of surface area available for palpation of the scaphoid in various wrist positions and to provide a guide depicting which wrist position will expose proximal pole, waist, and distal pole fractures. METHODS: Using 3 fresh-frozen male cadaver wrists, we digitized palpable surface areas (dorsal, volar, and snuffbox) of the scaphoid in several wrist positions. The entire scaphoid was then excised and a digitized 3-dimensional reconstruction of the entire scaphoid was obtained. The 2 images were superimposed and the surface area was calculated RESULTS: The maximum palpable area of the scaphoid was achieved with the wrist in neutral extension and maximum ulnar deviation and the wrist in maximum flexion and neutral deviation. Neutral wrist extension and ulnar deviation exposed all but the most proximal portion of the proximal pole and the distal pole, which made this the ideal position to detect tenderness from a scaphoid waist fracture and larger proximal pole fractures. Maximum wrist flexion with neutral wrist deviation exposed the entire proximal pole, which made this the ideal position to detect tenderness from a proximal pole scaphoid fracture. CONCLUSIONS: Wrist position influences the amount of scaphoid surface area available for palpation and should be considered when examining a patient with a suspected scaphoid fracture. CLINICAL RELEVANCE: The scaphoid should be palpated in 3 anatomic regions with the wrist placed in different positions to maximally expose the anatomical region being palpated.

Bicolumnar 90-90 plating of low-energy distal humeral fractures in the elderly patient.

Fragility fractures of the distal humerus in elderly patients, especially the low transcondylar fracture pattern, can be difficult to optimally manage. Although the fractures are typically low energy resulting in either extra-articular or simple intra-articular patterns, gaining fixation into the distal fragments can be difficult with open reduction internal fixation (ORIF) using traditional 90-90 or parallel plating techniques. Anatomy preserving reconstruction with ORIF is preferred over total elbow arthroplasty (TEA) if possible. In this study, 15 patients were managed with a bicolumnar 90-90 plating construct as a novel method of enhancing distal fixation in these fractures. Fourteen patients went on to radiographic union at an average of 77 days after surgery with an average arc of motion of 105°. One patient was lost to follow-up. Bicolumnar 90-90 plating of distal humerus fractures in elderly patients may represent a viable alternative to traditional ORIF or TEA.

Participation in high-impact sports predicts bone mineral density in senior olympic athletes.

BACKGROUND: Loss of bone mineral density (BMD) and resultant fractures increase with age in both sexes. Participation in resistance or high-impact sports is a known contributor to bone health in young athletes; however, little is known about the effect of participation in impact sports on bone density as people age. HYPOTHESIS: To test the hypothesis that high-impact sport participation will predict BMD in senior athletes, this study evaluated 560 athletes during the 2005 National Senior Games (the Senior Olympics). STUDY DESIGN: Cross-sectional methods. The athletes completed a detailed health history questionnaire and underwent calcaneal quantitative ultrasound to measure BMD. Athletes were classified as participating in high impact sports (basketball, road race [running], track and field, triathalon, and volleyball) or non-high-impact sports. Stepwise linear regression was used to determine the influence of high-impact sports on BMD. RESULTS: On average, participants were 65.9 years old (range, 50 to 93). There were 298 women (53.2%) and 289 men (51.6%) who participated in high-impact sports. Average body mass index was 25.6 ± 3.9. The quantitative ultrasound-generated T scores, a quantitative measure of BMD, averaged 0.4 ± 1.3 and -0.1 ± 1.4 for the high-impact and non-high-impact groups, respectively. After age, sex, obesity, and use of osteoporosis medication were controlled, participation in high-impact sports was a significant predictor of BMD (R(2) change 3.2%, P < .001). CONCLUSIONS: This study represents the largest sample of BMD data in senior athletes to date. Senior participation in high-impact sports positively influenced bone health, even in the oldest athletes. CLINICAL RELEVANCE: These data imply that high-impact exercise is a vital tool to maintain healthy BMD with active aging.