Correlation of Carpal Tunnel Syndrome 6 Score and Physical Exam Maneuvers With Electrodiagnostic Test Severity in Carpal Tunnel Syndrome: A Blinded Prospective Cohort Study.

PURPOSE: Although carpal tunnel syndrome (CTS) can be diagnosed clinically with the Carpal Tunnel Syndrome 6 (CTS-6) evaluation tool, the relationship between disease severity and CTS-6 score has not been elucidated. The purpose of our study was to determine the correlation of the CTS-6 score and other physical examination maneuvers with the carpal tunnel severity grade by electrodiagnostic testing (EDT). We hypothesized that the CTS-6 score, Durkan test, and Semmes Weinstein Monofilament Testing (SWMT) positively correlate with EDT severity. METHODS: We prospectively enrolled 105 consecutive patients who presented to the office with suspected CTS, excluding those with previous surgery, previous EDT from an outside facility, or concomitant neuropathy. Four fellowship-trained hand surgeons obtained the CTS-6 score, time to obtain a positive Durkan compression test, and SWMT of the thumb, index, and middle fingers. All patients were sent for EDT. Hand surgeons were blinded to the results of the EDT, and the electrodiagnosticians were blinded to the clinical data. We used the Bland criteria (0-6) to grade CTS severity on EDT. This grade was compared with the CTS-6 score, Durkan time, and SWMT results. RESULTS: Using Spearman correlation coefficients, we found a weakly positive correlation between a higher CTS-6 score and a higher severity grade on EDT. The mean CTS-6 score based on EDT grading were the following: (1) 14.8 (grade 0), (2) 16.0 (grade 1), (3) 14.8 (grade 2), (4) 16.7 (grade 3), (5) 18.7 (grade 4), (6) 18.3 (grade 5), and (7) 22.4 (grade 6). We also found a statistically significant association between the SWMT and a higher CTS-6 score as well as a higher severity grade on EDT. Durkan compression test did not appear to correlate with the EDT grade. CONCLUSIONS: The CTS-6 and SWMT show a positive correlation with EDT severity in CTS on the basis of the Bland criteria. The time to a positive Durkan test did not show any correlation. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic II.

Analysis of Musculoskeletal Injuries Among Collegiate Varsity Electronic Sports Athletes.

Background Collegiate electronic sports (esports) in the United States has grown from seven varsity programs in 2016 to over 200 today. Despite its growing success, little has been studied on the injuries of these athletes. In this study, we aimed to investigate the prevalence of injuries sustained by collegiate esports players and explore the injuries' impacts on their careers. The authors hypothesized that athletes who spend more time practicing and playing competitively in esports will report an increased history of musculoskeletal injury. Methodology This was a cross-sectional study, level IV evidence. A list of collegiate esports athletes was collected from publicly available sources. Athletes with available contact information were sent a self-reporting questionnaire. The questionnaire examined variables including length of time playing esports, hours/day playing esports, esports-related injury history, surgeries needed, and missed competition time. Results Overall, 153 collegiate esports athletes (88% male, aged 18-42 years) were included, with 41 (26.8%) having experienced at least one injury from esports. Of the 41 injured athletes, three (7.3%) required surgery, 17 (41.5%) had multiple injuries, and seven (17.1%) missed competition time for an average of 3.0 ± 2.3 weeks. Athletes who have been on their respective college team longer (2.0 ± 1.0 vs. 1.7 ± 0.9 years, p = 0.03) and who spent more hours per day practicing had a higher injury incidence (p = 0.01). There was no difference in the current age, sex, age at which athletes began competing in esports, and scholarship status between groups (all p > 0.05). When analyzing the 41 athletes who experienced an injury, the most common injury was to the wrist with 25 total injuries. There were 11 neck, 10 back, nine finger, eight hand, six elbow, and four thumb injuries. Conclusions Collegiate esports players who trained for more hours per day (31.7% of injured players vs. 10.7% of uninjured players practiced more than five hours/day, p = 0.01) and played competitive collegiate esports for more years (2.0 ± 1.0 vs. 1.7 ± 0.9 years, p = 0.03) were more likely to have experienced an esports-related injury. Fortunately, only a small portion of athletes who experienced an injury was forced to miss competition time or require surgery. With this being the largest investigation into collegiate esports-related injuries, future medical research regarding the incidence, management, and prevention of its injuries can help collegiate and professional programs place a greater emphasis on the health of their athletes.

A Prospective Evaluation of the Prevalence of Persistent Median Artery in Patients with Carpal Tunnel Syndrome.

Background: The median artery is an embryonic structure that typically regresses during gestation. Occasionally, the artery remains and is then termed a persistent median artery (PMA). A PMA can be associated with other anatomic anomalies, and has been known to contribute to carpal tunnel syndrome (CTS). Recent literature has observed an increase in PMA prevalence, speculated to indicate microevolutionary change. We performed a prospective observational study to investigate the current prevalence rate of PMA in patients undergoing carpal tunnel release (CTR). Methods: Institutional review board approval was obtained. From October 2020 to January 2021, patients ≥18 years old undergoing open CTR by 9 orthopaedic hand surgeons were included in analysis. Patients undergoing endoscopic CTR were excluded. Intraoperatively, the carpal tunnel was evaluated for the presence of a PMA, median nerve anomalies, or any other anatomic anomalies. If a patient underwent bilateral CTR during the study, only one side was included in analysis as determined randomly. Results: Three hundred and sixty open CTRs in 327 patients were performed during the study. Twenty-seven PMAs were identified, for an overall prevalence rate of 8.3%. The average age of patients with a PMA was 63.6 years (SD 13.3 years), consisting of 15 men and 12 women. There were no statistical differences in age, gender, or laterality between patients that did and did not have a PMA. Thirty-three patients underwent bilateral CTR during the study, with 3 being found to have a PMA unilaterally, and zero having a PMA bilaterally. Two bifid median nerves (0.6%) were also identified. Conclusion: This study represents the highest prevalence rate of PMA directly observed in CTR patients reported to date (8.3%). A PMA is not a rare finding, and it should be recognized and protected during CTR. Occasionally, a PMA can be the cause of an acute presentation of CTS.

Tramadol Versus Codeine in Hand Surgery.

Introduction Tramadol and codeine are both commonly prescribed in the setting of surgery or injury to the upper extremity. Despite their comparable strength in terms of opioid receptor affinity, the drugs differ pharmacologically and thus are not completely interchangeable. Methods This study analyzes all prescriptions for codeine and tramadol by a group of hand surgeons over a one-year period and tests the central hypothesis that the prescribing and refill patterns of these two drugs would be similar. Results Despite similar prescription amounts in terms of morphine equivalents, patients receiving tramadol required prescription refills at a significantly higher amount than those receiving codeine, and these individuals tended to be older. Additionally, patients treated nonoperatively were prescribed significantly more tramadol than those treated surgically. Conclusion Our findings suggest that codeine and tramadol are not equivalent in managing upper extremity pain. Further study is needed to articulate the situations in which physicians and patients are better served by tramadol versus codeine.

Incidence of Operating Room Fires During Hand Surgical Procedures.

Background: The purpose of the present study is to report the incidence of operating room fires during hand surgical procedures. Methods: The clinic and OR electronic medical records of seven fellowship-trained orthopedic hand surgeons at a single, large practice were retrospectively reviewed. All upper extremity procedures performed between June 2014 to June 2019 in both hospital and surgery center settings were included in the review. Demographic data was collected. The incidence of operating room fires was determined. Results: A total of 18,819 hand and upper extremity surgical procedures were included. There were 16,767 (89.1%) cases performed in a surgery center, while 2,052 (10.9%) of cases were performed in a hospital. There were 12,691 (67.4%) soft tissue procedures and 6,127 (32.6%) bony procedures performed. Chlorhexidine gluconate preparation solution was used in 9607 cases (51%). Chloraprep solution was used in 6280 cases (33.4%). Betadine was used in 2,932 cases (15.6%). One surgeon has monopolar electrocautery only available during cases. Five surgeons have bipolar available, and one has both mono and bipolar electrocautery available. There were no fires (0%) identified during the study period. Conclusion: The incidence of operating room fires during hand surgical procedures is extremely low. While hand surgeons can be reassured that the likelihood of an operating room fire is minimal, surgeons should not become complacent and should maintain a high level of vigilance to prevent these potentially devastating occurences.

Reliability of Routine Radiographs for Conservatively Treated Metacarpal Shaft and Neck Fractures.

Background: To investigate the reliability of orthopedic hand surgeons to evaluate radiographic healing in initial and follow-up radiographs of the conservatively treated metacarpal shaft and neck fractures. The rationale for this study was to reduce the rate of unnecessary, routine radiographs when treating metacarpal fractures. Methods: Forty sets of digital x-rays, twenty at the initial visit and twenty at the 4-week follow-up, were randomly selected and reviewed. Three hand surgeons evaluated the x-rays for (1) fracture location, (2) radiograph timing, (3) healing status, (4) percentage healed, (5) angulation, and (6) confidence in healing status. Observers reviewed studies in random order and evaluated the same set of radiographs one month after the initial review. Intra- and interobserver agreements were analyzed using Fleiss' kappa (κ) for all parameters and all possible observer pairings. Results: Interobserver and intraobserver reliability was highest when evaluating fracture location and lowest when assessing the percentage healed. The interobserver reliability was fair for radiograph timing and healing status and fair-to-moderate for angulation. The intraobserver reliability was moderate for radiograph timing and healing status and moderate-to-substantial for angulation. Observers correctly differentiated initial vs. follow-up images 62% of the time and reported to feel somewhat certain in their evaluation of healing status. Conclusion: When evaluating initial and 4-week follow-up radiographs, hand surgeons were somewhat confident in their assessment of healing but had less than substantial intra- and interobserver reliability following radiographic evaluation. Due to their poor reproducibility, routine radiographs may be unnecessary when evaluating conservatively treated metacarpal fractures. Further studies and guidelines that identify clear indications for the use of routine imaging in metacarpal fracture care are warranted.

Acute Septic Carpal Tunnel Syndrome in a Rock Climber.

INTRODUCTION: Rock climbing is an increasingly popular sport in the United States. Acute and chronic upper extremity injuries related to rock climbing are frequently reported and include flexor pulley ruptures and hamate stress fractures. Deep space hand infections after indoor rock climbing are a sport-related pathology that has yet to be reported. Our purpose is to describe an acute septic carpal tunnel syndrome following rock climbing at an indoor climbing gym in a patient who required urgent irrigation and debridement. CASE REPORT: A 33-year-old Caucasian male presented with an acute septic carpal tunnel syndrome 4 days after rock climbing at an indoor gym. On physical examination, he exhibited numbness over the fingers, significant tenderness to palpation, and pain with passive range of motion. His inflammatory markers were markedly elevated and deep space hand infection was confirmed with computed tomography scans. The patient was taken for urgent exploration, irrigation and debridement, and carpal tunnel release. CONCLUSION: We theorize that the patient had an abrasion on the finger or palm that created an entryway for a pathogen. We are unaware of another report of a deep space hand infection associated with rock climbing activities. This case report will hopefully spread awareness of this clinical entity to improve evaluation and prevention of hand infections in rock climbers, as well as providing guidelines for appropriate and timely treatment of the condition.

Female Sex is Associated With Increased Reported Injury Rates and Difficulties With Use of Orthopedic Surgical Instruments.

INTRODUCTION: Orthopedic instrumentation is generally made as one-size-fits-all. The purpose of this study was to evaluate the effects of hand size and sex on ease of use and injury rates from orthopedic tools and surgical instruments. METHODS: An anonymous 21-item online survey was distributed to orthopedic trainees and attendings. Questions regarding demographics, physical symptoms and treatment, perceptions, and instrument-specific concerns were included. The analysis included statistics comparing responses based on sex, height, and glove size, with significance as p<0.05. RESULTS: There were 204 respondents: 119 female and 84 male. Male and female respondents differed significantly in height (mean difference 5.4 in, p<0.001) and glove size (median size 6.5 size for females, size 8 for males, p<0.001). While 69.8% of respondents reported physical discomfort or symptoms they attributed to their operating instruments, female surgeons were significantly more likely to endorse symptoms (87.3% female vs. 45.2% male, p<0.001). Of those reporting symptoms, 47.7% had undergone treatment, with no significant difference by surgeon sex (p=0.073). Female surgeons were significantly more likely than their male counterparts to have negative attitudes toward orthopedic surgical instruments and to report specific surgical instruments as difficult or uncomfortable to use. CONCLUSION: Female orthopedic surgeons are more likely than their male counterparts to report physical symptoms attributed to orthopedic surgical instruments, to have negative attitudes toward instruments, and to identify a larger number of common instruments as difficult or uncomfortable to use. Further emphasis on ergonomic instrument design is needed to allow all orthopedic surgeons to operate as safely and effectively as possible.

The Use of 3D Printed Customized Casts in Children with Upper Extremity Fractures: A Report of Two Cases.

3D printing is an evolving technology which has a potential application in the treatment pediatric forearm fractures. Very little has been published with regard to 3D casting in children. We present two cases in which upper extremity fractures in pediatric patients were treated by wearing a custom made 3D printed cast. At latest follow-up at least one year post-injury, the clinical outcomes were excellent. Orthopaedic surgeons may benefit from familiarizing themselves with the potential of 3D printing technology and utilizing its current applications, as well as devising future applications, in clinical practice.

Comparison of the Costs of Reusable Versus Disposable Equipment for Endoscopic Carpal Tunnel Release Procedures Using Activity-Based Costing Analysis.

PURPOSE: Guidelines for sterilization of reusable equipment (eg, arthroscopes, surgical equipment) have recently been established. These guidelines are supported by the U.S. Food and Drug Administration and affect costs for sterilization. The current analysis was undertaken to understand if reusable or disposable endoscopic carpal tunnel release (ECTR) equipment is a less-expensive option. METHODS: An activity-based cost analysis was undertaken to determine the costs of reusable versus disposable equipment for ECTR. Costs of disposable equipment were obtained from manufacturers. Costs of processing reusable equipment including labor, time, cost of operating room time, and sterilization supplies and equipment were obtained from the literature and from recent reports identifying these costs. Infection rates and costs of infection were also factored in. Decision analysis software was used to determine the expected costs of each option (disposable vs reusable). A sensitivity analysis was undertaken on those variables that were determined to have the greatest effect on the overall costs of the procedure and sterilization. RESULTS: Costs for each option when totaled were $917 for disposable and $1,019 for reusable equipment, resulting in cost savings of $102 with disposable equipment. Reusable equipment was the least costly option when the following costs/events occurred: cost of a disposable arthroscope, >$452; cost of disposable ECTR, >$647; costs of operating room time, <$28.63/min; set up time, <6.8 minutes for reusable equipment; and cost of disposable ECTR blade used with reusable equipment, <$160. CONCLUSIONS: When considering the cost of operating room time, preparation, and processing of reusable equipment for ECTR, the disposable equipment for this procedure is less costly. TYPE OF STUDY/LEVEL OF EVIDENCE: Economic Analysis II.

The Reliability of Determining the Presence of Surgical Site Infection Based on Retrospective Chart Review.

PURPOSE: Surgical site infection (SSI) can be a challenging complication after hand surgery. Retrospective studies often rely on chart review to determine presence of an SSI. The purpose of this study was to assess reliability of Centers for Disease Control and Prevention (CDC) criteria for determining an SSI as applied to a chart review. We hypothesized that interobserver and intraobserver reliability for determining an SSI using these criteria while reviewing medical record documentation would be none to minimal (κ < 0.39) based on an interpretation of Cohen's κ statistics. METHODS: We created and used a database of 782 patients, 48 of whom received antibiotics within 3 months of a surgical procedure of the hand. Three fellowship-trained orthopedic hand surgeons then evaluated the charts of those 48 patients, in which each reviewer determined whether an SSI was present or absent based on CDC criteria provided to the reviewers. Patients' charts were then reassessed 1 month later by the same reviewers. Kappa statistics were calculated for each round of assessment and averaged to determine intraobserver and interobserver reliability. RESULTS: Overall κ values were 0.22 (standard error, 0.13), indicating fair reliability. Average κ value between reviewers was 0.26 (standard error, 0.13. On average, intrarater reliability was 68.7%. CONCLUSIONS: We found poor interobserver and intraobserver reliability when using CDC criteria to determine whether a patient had an SSI, based on chart review. CLINICAL RELEVANCE: Better criteria or documentation may be needed in patients with an infection after hand surgery. Retrospective chart reviews to assess infection may be unreliable.

Treatment Outcomes in Patients Undergoing Surgical Treatment for Arthritis of the Distal Radioulnar Joint.

Objective Surgical treatment options for distal radioulnar joint (DRUJ) arthritis include distal ulnar resection (DUR), DRUJ arthrodesis, and ulnar head replacement. Ulnar convergence leading to persistent pain and clicking is a relatively common complication of complete DUR and DRUJ arthrodesis with distal ulnar segment resection (DRUJA). This led to the development of the distal ulna hemiresection (DUHR) and distal ulnar stump stabilization techniques to reduce the risk of this complication. Patients may experience incomplete relief of pain and limited range of motion (ROM) with these procedures. We hypothesized that there would be no differences in outcomes between the treatment groups, but patients undergoing DUHR, tendon interposition, or distal ulnar stump stabilization would be at lower risk of complications. Methods Records were retrospectively reviewed for 121 patients undergoing DRUJ procedures between 2000 and 2018 at a single institution to collect patient demographics, surgical details, preoperative diagnosis, and outcomes including complications, revision procedures, ROM, pain, and swelling. Patients were grouped for analysis by procedure type: DUR (Darrach procedure), DUHR (Bowers procedure), and DRUJA (Sauve-Kapandji procedure). Continuous variables were compared using an analysis of variance test and categorical variables using the Freeman-Halton extension of the Fisher's exact test. A multivariate logistic regression analysis was performed to identify significant predictors of outcomes. Results Seventy-three patients underwent a DUR procedure, while 33 patients underwent a DUHR procedure and 11 underwent a DRUJA procedure. Mean follow-up was 70.6 months. Patients undergoing DRUJA were significantly younger than those undergoing DUR or DUHR procedure (42.4 vs. 60.0 vs. 62.1, p < 0.001). No significant differences between groups were demonstrated in measured outcomes. Posttraumatic arthritis was the most common preoperative diagnosis (43.4%). Persistent pain was the most common negative outcome (25.6%) followed by limited ROM (19.7%). Five patients (4.3%) suffered postoperative complications, most common being rupture of extensor tendons. Five patients (4.3%) underwent revision procedures. Body mass index (BMI) was a significant predictor of persistent pain (odds ratio = 1.09, p = 0.031). Conclusion The results of our study suggest that outcomes are equivalent between the three distinct treatment groups. Despite the potential benefits, hemiresection, tendon interposition, and distal stump stabilization had no significant effect on outcomes in this study. More than a quarter (25.6%) of patients undergoing DRUJ procedures experience persistent pain postoperatively, while one-fifth (19.7%) experienced limited ROM. Patients with higher BMI are at a significantly greater risk of experiencing persistent postoperative pain. Level of Evidence This is a Level III, retrospective comparative study.

The Utilization of Physician Cell Phone Numbers by Patients in an Orthopaedic Surgery Practice.

Introduction Orthopaedic surgeons choose to manage communication with their patients outside of official visits and interactions in a variety of ways, with some choosing to provide their personal cell phone number in order to provide patients with direct accessibility. The objective of this prospective study is to explore to what extent patients utilize the cell phone numbers of orthopaedic surgeons in the immediate period after it is provided to them. Methods Seven fellowship-trained orthopaedic surgeons from five different subspecialties in a single private, multi-site group each provided his/her personal cell phone number to 30 consecutive patients. The surgeon's phone number was written down on a business card, and the surgeons themselves provided the card to the patient. Phone calls and voice mail messages received in the 30 days following the patient receiving the phone number were recorded, and the reasons for these calls were categorized as being "appropriate" (e.g. acute postoperative issues, unclear instructions) or "inappropriate" (e.g. administrative issues, medication refills, advanced imaging-related inquires). Results Two-hundred seven patients with an average age of 51.5 years were provided cell phone numbers. During the 30 days following administration of cell phone numbers to each patient, 21 patients (10.1%) made calls to their surgeons, for an average of 0.15 calls per patient. Six patients (2.9%) called their surgeons more than once. Seventeen calls (54.8%) were deemed appropriate, while 14 calls (45.2%) were inappropriate. Logistic regression analysis did not reveal patient age, sex, type of visit, or surgeon subspecialty to be independently associated with calling. Conclusion Our study has demonstrated a low rate of patient utilization of surgeon cell phone number when provided to them. If surgeons choose to provide their cell phone number to patients, we recommend specifying appropriate reasons to call in order to maximize the effectiveness of this communication method.

Distal Radius Malunion.

Malunion remains the most common complication of nonsurgical treatment of fractures of the distal radius and represents a common clinical entity. Symptomatic treatment often involves corrective osteotomy. Surgical correction is a challenging problem with unpredictable clinical outcomes. Prevention of malunion of a distal radius fracture is the best course of action. With maintenance of volar cortical contact and the use of volar fixed-angle devices, bone grafting may not be necessary in certain cases of malunion correction. New technologies such as 3-dimensional modeling and computer-generated osteotomy guides are likely to have a positive impact on the outcomes of surgical treatment.

The Optimal Position for Arthrodesis of the Proximal Interphalangeal Joints of the Border Digits.

PURPOSE: This study aimed to determine the functional characteristics of various arthrodesis angles of the proximal interphalangeal (PIP) joints of the border fingers. METHODS: The dominant hands of 48 volunteers were tested using custom orthoses to simulate PIP joint arthrodesis. For the index finger (IF), orthoses were made in 25°, 40°, and 55° of flexion (IF25, IF40, and IF55). For the little finger (LF), orthoses were made in 30°, 55°, and 70° of flexion (LF30, LF55, and LF70). Twenty-three volunteers performed grip and pinch (key, tripod, and pulp) strength testing with and without simulated arthrodeses and 25 volunteers performed the Jebsen Hand Function Test (JHFT) with and without simulated arthrodeses. Simulated conditions of arthrodesis were compared with the unrestricted state and with each other within the same finger. RESULTS: For grip and pinch strength, there were no significant differences between simulated arthrodesis angles. Compared with baseline, grip was significantly weaker for all 6 simulated arthrodesis angles. Pinch was tested with simulated IF arthrodesis only; key pinch was significantly weaker for all tested angles and tripod pinch for IF25 and IF40. For JHFT, the 3 experimental angles for the index or ring finger did not show any statistically significant differences for any subtest. Volunteers were slower at completion times for all simulated arthrodesis angles compared to baseline times. This was significant in 5 of 7 tasks for IF25, 3 of 7 tasks for IF40, and 4 of 7 tasks for IF55. Index finger angle of flexion of 40° was significantly faster than IF55 for writing and IF25 for lifting large, light objects. For the LF, LF30 was significantly slower than baseline for 6 of 7 tasks, LF55 for 3 of 7 tasks, and LF70 for 5 of 7 tasks. Index finger angle of flexion of 55° was significantly faster than LF70 for simulated feeding and IF30 for lifting large, heavy objects. CONCLUSIONS: No border digit PIP joint arthrodesis angle was superior for grip and pinch strength. Based on JHFT, IF40 and LF55 might be preferred arthrodesis angles. CLINICAL RELEVANCE: Intermediate arthrodesis angles may provide the best function for patients undergoing PIP joint arthrodesis of the IF and LF.

An Assessment of Online Reviews of Hand Surgeons.

BACKGROUND: The purpose of this study is to evaluate the number of reviews and scores for active members of the American Society for Surgery of the Hand (ASSH) in popular physician rating websites (Healthgrades.com and Vitals.com). METHODS: A total of 433 ASSH active members were searched in two popular rating websites for a total of 866 web searches. Demographic data, overall and subcategory scores, number of reviews, and wait times were scored from each member's webpage. RESULTS: The average number of reviews per surgeon on Healthgrades.com and Vitals.com were 13.8 (range 1-108) and 9.4 (range 0-148), respectively. The average overall score for physicians was 8.1 out of 10 points. For both websites, the vast majority (80-90%) of active members of the ASSH had 20 or less reviews. Multivariate data analysis revealed no statistical differences in overall score by region (P=0.24) or gender (P=0.38). Increasing physician age negatively correlated with overall score (P=0.01). Wait time was not associated with a negative score (P=0.38). CONCLUSION: Active members of the ASSH received generally positive reviews. The average number of reviews for active members of the ASSH was exceedingly small, bringing into question the legitimacy and validity of these scores. This is especially important when taking into consideration the increasing popularity of these websites, and the reliance of patients on them to obtain physician information. The clinical implication of this study is that physicians have a vested interest in the legitimacy of the data provided by these websites and other physician rating outlets.

A Comparison of Two Sterile Solution Application Methods During Surgical Preparation of the Hand.

PURPOSE: The purpose of this study was to determine the extent of skin coverage during surgical preparation of the hand when preparation is done by 2 different methods. We hypothesized that hand preparation with commercially available prep-stick applicators (PS) would lead to more unprepared areas (UPAs) of skin compared with immersed 4 × 4 inch sterile gauze sponges (GS) used as controls. METHODS: Sixty upper extremities of 30 healthy volunteers were used for this study. The hands were prepped by 2 fellowship trained orthopedic hand surgeons as 30 matched pairs. The experimental group was prepped using a commercially available PS (ChloraPrep, Carefusion, San Diego, CA), whereas the control group was prepared with GS immersed in the prep solution and applied manually using sterile gloves. The number and location of UPAs in the hands and wrists of volunteers after preparation were recorded. In addition, the sum of UPAs relative to the total surface area of the skin was quantified with image analysis software. RESULTS: There were a total of 77 UPAs when prepping the volunteers with PS, compared with 14 in the control hands. This difference was statistically significant. Similarly, the average percentage area of UPAs relative to the total skin surface was 0.76% (range, 0.006% to 2.15%) when using PS compared with 0.15% (range, 0.005% to 0.56%) in the controls. This difference was statistically significant. CONCLUSIONS: We identified a larger numbers of UPAs with commercially available applicator sticks compared with a control using sterile GS. CLINICAL RELEVANCE: The clinical implications of these findings are unknown.

Anatomic Interosseus Membrane Reconstruction Utilizing the Biceps Button and Screw Tenodesis for Essex-Lopresti Injuries.

Longitudinal radioulnar dissociation, also known as the Essex-Lopresti lesion, is a potentially debilitating condition causing painful instability of the forearm that often results from high-injury trauma with compromise of the proximal radius, triangular fibrocartilage complex, and the interosseous membrane. Indications for reconstruction of the interosseous membrane primarily include chronic instability of the forearm. Our reconstructive technique utilizes an anatomic allograft reconstruction with intraosseous fixation, in an effort to biologically reconstruct and anatomically tension the central band of the interosseus membrane.

Dynamic Distraction External Fixation for Contracture of the Metacarpophalangeal Joint.

Metacarpophalangeal (MP) joint contractures are common after traumatic injury, and can be difficult to manage. After surgical capsulectomy, it remains challenging to maintain motion that was obtained at the time of surgery. Our group uses a novel, prefabricated digital external fixator to provide both distraction, and motion therapy across the MP joint after surgical treatment of MP contracture. The purpose of this technique is to demonstrate the effectiveness of an adjunctive dynamic distraction external fixator for the maintenance of joint motion after surgical treatment of MP contractures of the border digits.