Upper Extremity Injuries in Rock Climbers: Diagnosis and Management.

Rock climbing places substantial stress on the upper extremities and can lead to unique injuries not common to other sports. With increasing popularity of the sport, hand surgeons are expected to see more patients with these pathologies. An understanding of the sport, accurate diagnoses, and appropriate treatment protocols are critical to maintain climbers' competitive abilities.

Magnitude, Direction, Temporal Patterns, and Frequency of Loss of Distal Radius Fracture Reduction in Women 50 Years and Older.

PURPOSE: To determine the magnitude, direction, temporal patterns, and frequency of reduction loss following nonsurgical, closed treatment of distal radius fractures in women 50 years and older and correlate these observations with bone mineral density and age. METHODS: We reviewed registry data on 1,148 patients 50 years and older with distal radius fractures managed by closed reduction and cast immobilization. Radial inclination (RI), ulnar variance (UV), and radial tilt (RT) were measured immediately and at 1, 2, 3, 6, 9, and 12 weeks after reduction. Magnitude, direction, frequency, and patterns of change were compared at each time point and correlated with bone mineral density T-scores and age using paired t tests in a mixed effects model. RESULTS: Over 12 weeks, RI decreased by 3° ± 5°, the majority occurring in the first 2 weeks and significantly correlated with bone mineral density T-score and age. Unexpectedly, RI increased over time in 5% of patients. Ulnar variance increased by 2.3 ± 1.7 mm, the majority occurring in the first 3 weeks and correlated with age. Radial tilt changed by 7° ± 11° in those displacing dorsally and 8° ± 12° in those displacing volarly at 12 weeks, with the majority occurring in the first 3 weeks and significantly correlating with age. Ulnar variance and RT continued to change by small increments between weeks 3 and 6. Nearly 90% of our cohort experienced measurable loss of reduction and 50% changed at least 5° RI, 11° RT, and 2 mm UV. CONCLUSIONS: Most distal radius fracture managed with closed reduction and casting have some loss of reduction, the majority occurring in the first 3 weeks and correlated with increased age and osteoporosis. This guides clinicians in informing patients about expected reduction loss, frequency of clinical and radiographic follow-up, and timing of discussions regarding the need for surgery. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

The Unsalvageable Radial Head in Patients Aged 30 Years and Younger.

PURPOSE: Concern exists regarding the use of radial head arthroplasty (RHA) in younger patients. This study assessed clinical, functional, and radiographic outcomes of RHA in patients aged 30 years and younger. METHODS: A retrospective review identified 26 elbows that underwent a smooth stem modular RHA in patients aged 30 years and younger at a median follow-up of 3.3 years clinically and 2.9 years radiographically. The mean age was 24 ± 5 years. Indications were acute trauma in 13 patients and chronic pathologies in the remaining 13, and these 2 groups were evaluated separately. Patients underwent clinical, functional, and radiographic evaluation. RESULTS: Average arc of motion was 137° ± 16° in the cohort with acute trauma and 120° ± 24° in the cohort with chronic pathologies. Mean Patient-Rated Elbow Evaluation scores were 23 ± 18 (acute) and 31 ± 19 (chronic). Mean Quick Disabilities of the Arm, Shoulder, and Hand scores were 18 ± 15 (acute) and 23 ± 20 (chronic). Average Mayo Elbow Performance Index scores were 90 ± 9 (acute) and 80 ± 13 (chronic). Severe capitellar erosion was present in 1 patient (4%) in the cohort with chronic pathologies. Radiographic stem lucency was seen in all cases with 10 of these (38%) graded as severe. Moderate-to-severe ulnohumeral arthritis developed in 4 patients (15%), 3 of whom were in the chronic reconstruction group. Two patients (8%) required reoperation, 1 for persistent instability and 1 for stiffness, both in the cohort with chronic pathologies. CONCLUSIONS: For acute trauma and challenging chronic conditions involving the radial head in patients aged 30 years and younger, a smooth stem modular RHA is an option. Although reoperation rates based on this series are low, osteoarthritis is common when used for posttraumatic conditions and severe radiographic stem lucency was seen in greater than one-third of patients. These concerning features warrant close follow-up, and further long-term outcomes are needed. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

The Effect of Personalized Patient Videos on Patient Satisfaction After Arthroscopic Shoulder Surgery.

Dissatisfaction after shoulder arthroscopy may be influenced by the information that patients receive. Multimedia is an emerging modality of information delivery. The goal of this study was to evaluate whether providing patients with a personalized video of their arthroscopic shoulder surgery improved satisfaction through a multisurgeon randomized controlled study. Patients undergoing arthroscopic shoulder decompression, rotator cuff repair, or labral repair were randomized to either the intervention group, receiving a video recording of their surgery, or the control group, not receiving a video. Patients who had previous ipsilateral shoulder arthroscopy or who could not participate in follow-up were excluded. Patient satisfaction was assessed at 3 months with a visual analog scale (VAS), Likert scale, and Quick Disabilities of the Arm, Hand and Shoulder (QuickDASH) score. The intervention group included 50 participants, and the control group included 47 participants, with 18% loss to follow-up. Mean control group VAS score was 8.5±2.2 and intervention group VAS score was 9.0±1.5, a difference that was not significantly different (P=.27). No statistically significant differences were noted for Likert scale scores and QuickDASH scores. A subgroup analysis of age group, sex, surgeon, and surgical procedure showed no significant differences. Based on these findings, personalized patient videos do not appear to improve satisfaction with surgery. Surgeons should investigate other means to improve patient satisfaction in the small group of dissatisfied patients. [Orthopedics. 2021;44(3):e331-e336.].

Variability in Outcome Reporting for Operatively Managed Anterior Glenohumeral Instability: A Systematic Review.

PURPOSE: The purpose of this study was to quantify the degree of variability in outcomes assessed after surgery for anterior shoulder instability in recent high-impact literature. METHODS: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, an extensive review of the literature during a 5-year period from January 2011 through December 2015 was performed across 6 orthopaedic journals with high impact factors to identify all studies investigating outcomes after anterior shoulder instability. Studies reporting clinical outcomes for patients with anterior glenohumeral instability after surgical treatment with at least 1-year follow-up were included. Several metrics were collected from each manuscript: (1) range of motion (ROM), (2) quantitative strength, (3) physical examination testing, (4) imaging, (5) patient-reported outcomes (PROs), (6) complications (including recurrent instability), (7) patient satisfaction, and (8) return to preinjury level of activity or sport. Variability in outcome measures was then qualitatively assessed. RESULTS: Sixty-eight studies were included for final analysis ranging from Level I to IV evidence. Fifty-nine percent reported ROM, and 18% measured strength. Other clinical exam maneuvers were assessed in 44%, with 40% assessing apprehension. Imaging was used in 62%, including X-rays, magnetic resonance imaging, and computed tomography scans. On average, 2.25 PROs were assessed. In total, 28 different PROs were used to assess outcomes. The 3 most commonly reported PROs were the Rowe scale at 46%, the Western Ontario Shoulder Instability Index at 31%, and the Constant Shoulder Score at 26%. Twenty-five percent included patient satisfaction in their assessment of outcomes. Recurrence was assessed by 59%, and return to preinjury level of activity was reported by 37% of the studies. CONCLUSIONS: There is substantial variability in outcome reporting for high-impact anterior shoulder instability literature with 28 different outcome tools used, making it difficult to compare outcomes between studies. Agreeing upon a uniform measure to assess outcomes would allow for clearer interpretation of the literature as well as the potential to draw conclusions from pooled data. LEVEL OF EVIDENCE: Level IV, systematic review of Level I to IV studies.