An anatomical study of thenar and hypothenar soft tissue thickness in men and women.

We hypothesized that reduced thenar soft tissue thickness may be a risk factor for distal radial fractures. We assessed MRI scans of the wrist in 78 adults. The 51 men had significantly higher palmar soft tissue thickness compared to the 27 women, even after adjusting for hand size.Level of evidence: IV.

Minimally Invasive Bone-Patellar Tendon-Bone Graft Harvest Is Associated With Less Frequent Anterior Knee Pain at Rest Than Hamstring Graft Harvest After Anterior Cruciate Ligament Reconstruction at the 1-Year Follow-Up.

Purpose: To compare the incidence of postoperative anterior knee pain at rest and during "knee walking" in patients who had anterior cruciate ligament reconstruction (ACLR) surgery with hamstring tendon (HT) grafts versus bone-patellar tendon-bone (BPTB) grafts harvested using a minimally invasive double-incision technique with autografting of the bone harvest defects. Methods: Adult patients who had undergone an ACLR and had completed a questionnaire enquiring about anterior knee symptoms at a minimum of 1 year postoperatively were identified. Two groups were compared: 1) patients who had received a BPTB graft harvested using a minimally invasive double-incision technique with autografting of the bone harvest defects, and 2) patients who had received a HT graft. Results: A total of 142 adult patients were included: 88 had a BPTB graft and 54 had a HT graft. The prevalence of anterior knee pain at rest was 10% in the BPTB group and 28% in the HT group (P = .006). Overall, knee walking scores were worse in the BPTB group when compared to the HG group, but the difference in the proportions of patients who found it impossible to knee-walk was not statistically significant (17% vs 6%; P = .069). Conclusions: Our results showed that pain at rest was less in the BTPB group compared to the HT group contradicting historic literature. In addition, there was no statistically significant difference between the 2 grafts when comparing the proportion of patients who found it "impossible" to knee-walk. Level of Evidence: Level III, retrospective comparative study.

Shapes and Sizes of Common Silicone Metacarpophalangeal Arthroplasties: Clinical Implications.

Background: Silastic metacarpophalangeal joint (MCPJ) arthroplasty is a recognised treatment for painful finger arthritis. There are two commonly used, albeit different, designs; the Swanson and the NeuFlex©. Which design is optimal is unclear. The purpose of this study was to evaluate the radiological differences relative to the bones following implantation. Methods: We examined the radiological features of these implants up to 1 year of follow-up. We reviewed the postoperative radiographs of 42 patients with 113 MCPJ arthroplasties and assessed the implant body anatomical 'fit' relative to the widths of the cut metacarpals and proximal phalanges and resection lengths of the metacarpal heads. We also looked for potential axial implant rotation. Results: The Swanson implants were consistently and statistically significantly wider than the NeuFlex© implants and almost always overhung the margins of the native MCPJ. Four of 33 (12%) of the Swanson and 1 of 80 NeuFlex© implants had rotated axially, the difference was statistically significant. One NeuFlex© implant had fractured at its hinge. Conclusions: The appreciable difference in the positions of the implant bodies relative to the bones may be important. The overhang of the Swanson implants may confer some stability to the arthroplasty helping to resist lateral deviation forces, but concomitant ligament reconstruction may increase the risk of implant rotation which is likely to reduce the postoperative ranges of motion. Axial silastic implant rotation has not previously been reported. It may influence joint biomechanics; future implant designs should consider the risks of implant rotation. Level of Evidence: Level IV (Therapeutic).

The Benefit of Routine Axillary Sonographic Assessment in cN0 Breast Cancer Patients.

Objective: Axillary ultrasound (US) is often part of the routine assessment of the clinically negative axilla in primary breast cancer, which determines the extent of axillary surgery to be performed. This study aims to ascertain the burden of disease in the axilla of patients with a normal clinical examination (cN0) but with US detected metastatic axillary lymph nodes. Materials and Methods: We retrospectively identified 345 female patients who underwent axillary lymph node dissection, following a positive lymph node biopsy, between January 2015 and August 2019.Eighty-nine of those had a positive biopsy prior to surgery. They were divided into two groups: Those with clinically palpable axillary disease preoperatively, cN1 (n = 41), and those with a normal clinical axillary examination, cN0 (n = 48). We assessed the number of positive axillary lymph nodes dissected in the two groups. Results: In the cN0 group the mean value of excised disease-positive axillary lymph nodes was 3.6, while in the cN1 group it was 8.0 (p<0.01). However, further analysis showed that 25 patients of the cN0 who had T1/T2 tumors had ≥3 positive lymph nodes. Conclusion: Our study suggests that the presence of clinically palpable axillary lymph nodes appears to be correlated to a higher number of positive lymph nodes. However, in cases of non-palpable sonographically positive lymph nodes there might still be significant axillary disease, even in T1 and T2 tumors. Therefore we still support the routine use of preoperative sonographic assessment of the axilla for early breast cancer.