Neuroma Treatment With the Acellular Nerve Allograft Reconstruction Technique.

Treatment of a painful neuroma is a challenging problem for both the patient and the providers. Current surgical treatment options typically include excision of the neuroma and stump relation. However, with both treatment options, patients have high rates of persistent pain and rates of neuroma recurrence. We describe two patients with neuromas treated with our acellular nerve allograft reconstruction technique. This technique involves the excision of the neuroma and bridging the proximal nerve end to the surrounding tissue with an acellular nerve allograft. Both patients had immediate resolution of their neuropathic pain that was maintained at their final follow-up. Acellular nerve allograft reconstruction is a promising treatment option for the treatment of painful neuromas.

Utilizing Google Trends to Track Online Interest in Elective Hand Surgery During the COVID-19 Pandemic.

Introduction Elective hand surgery encompasses a large volume of orthopaedic cases annually. Carpal tunnel syndrome, ganglion cysts, and trigger digits are some of the most common pathologies treated by hand surgeons. In the midst of the COVID-19 pandemic, patient's interest in elective hand surgery for these conditions is uncertain. The objective of this study is to use Google Trends to track online interest in elective hand surgery in the United States during the COVID-19 pandemic. Methods Online search trends regarding elective orthopaedic hand surgery were obtained via Google Trends from November 2019 to November 2020. Three common hand pathologies in lay terms ("carpal tunnel," "'ganglion cyst' + 'wrist cyst,'" and "trigger finger") and three hand surgery-specific keywords ("hand surgery," "carpal tunnel surgery," and "trigger finger surgery") were used as search terms. The search volume index (SVI) graphs for the United States for both sets of search terms were then generated from the Google Trends data and compared to the seven-day average of new COVID-19 cases per day as reported by the CDC. A separate SVI graph was then created for the search term "coronavirus" and was compared against both sets of search terms as above. Results Search trends for all elective hand pathologies and surgery-specific keywords remained constant from November 2019 to the beginning of March 2020 and then decreased significantly within a one-month period following the peak in COVID-19 cases the week of March 15, 2020. Search trends for these keywords increased to baseline levels over the next few months. The search trend for "coronavirus" demonstrated a small search volume index peak of 13 during January 2020 followed by the maximum peak of 100 during the week of March 15, 2020, corresponding to the decrease in search trends of elective hand surgery at that time. Conclusions Online interest in elective hand surgery remained constant prior to the COVID-19 pandemic; however, there was a marked decrease in search trends of elective hand surgery with the rise in daily reported COVID-19 cases, suggesting that patient's interest in elective hand surgery decreased with the onset of the pandemic.

Ultrasound Evaluation of Radial Nerve Palsy Associated with Humeral Shaft Fractures to Guide Operative Versus Non-Operative Treatment.

OBJECTIVE: To determine the effectiveness of diagnostic ultrasound (US) at evaluating the condition of the radial nerve in the setting of humeral shaft fractures. MATERIALS AND METHODS: An observational study was performed of 18 patients with radial nerve palsy associated with humeral shaft fractures who underwent US examination to assess the condition of the radial nerve. RESULTS: Six patients with humeral shaft fractures treated nonoperatively in a functional brace had US findings consistent with contusion or stretch radial nerve injury. Twelve patients ultimately underwent surgery either because US showed an entrapped or lacerated radial nerve, or for other operative indications. There was a 92% concordance (11/12 patients) between US and intraoperative findings with regards to the condition and location of the radial nerve, with the remaining case being complicated by delayed surgical treatment secondary to patient factors. CONCLUSION: Our study demonstrates that US is an effective diagnostic tool in evaluating radial nerve injuries in the setting of humeral shaft fractures and can aid in clinical decision making by differentiating between patients with nerve laceration or entrapment who may benefit from surgery from those with neurapraxia managed nonoperatively.