The Evolution of the Treatment of Distal Radius Fractures How We Got to Now.

Distal radius fractures are one of the most common fractures in adults and historically have frequently led to significant disability. Originally described over 5,000 years ago, until recently these fractures were almost exclusively treated by closed methods. Since the introduction of osteosynthesis in 1907, followed by the founding of the AO in 1958, and more recently the development of the volar locked plate in the early 2000s, over the past century the surgical treatment of these fractures has evolved greatly. While technological advancements have changed management for specific fracture patterns, closed treatment still has an important role and is definitive for many patients. The following review provides a historical perspective for current treatment strategies as well as an overview of the important factors that must be considered when treating patients with these injuries.

Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Injuries: Management and Biomechanical Evaluation.

First described in 1955 as "gamekeeper's thumb," injuries to the ulnar collateral ligament (UCL) of the thumb metacarpophalangeal joint are common and can cause pain and instability, especially during key pinch and grasp. Although primarily diagnosed on physical examination, stress radiographs, ultrasonography, and magnetic resonance imaging can be used to diagnose UCL injuries and distinguish partial from complete tears. If complete rupture occurs, the adductor aponeurosis can become interposed between the retracted UCL stump and its insertion on the proximal phalanx, known as a "Stener lesion." When instability persists after a trial of nonsurgical management or in the setting of complete rupture, there are various methods of repair or reconstruction. Biomechanically, there are no treatments of repair or reconstruction using native tissues that provide equivalent strength to the preinjured ligament. Recently, suture tape augmentation has been used for the repair or reconstruction with excellent short-term results and earlier return to function, although there is a paucity of literature on longer term outcomes. The various methods of surgical treatment yield excellent outcomes with a low incidence of complications.

A Brief History of Tendon Transfer and, Specifically, the Opposition Tendon Transfer.

The development of tendon transfers is it relatively recent evolution in orthopedic surgery. Drobnik performed the first upper extremity tendon transfer in 1894 for a patient with radial nerve palsy, which marks the beginning of a field that developed rapidly. By 1918, Steindler had performed his now famous "opponensplasty" in which he rerouted the flexor pollicis longus tendon to the radial base of the proximal pha- lanx. In the subsequent decades, numerous surgeons offered alternative methods to restore thumb opposition. Names now synonymous with hand surgery, such as Huber, Littler, Howell, Camitz, Royle, Bunnell, and Burkhalter, would all leave a mark on the history of opposition transfers. In this review we discuss the history of tendon surgery and trans- fers, focusing on the procedure of thumb opposition transfer.

Low dose aspirin is effective in preventing venous thromboembolism in patients undergoing primary total knee arthroplasty.

INTRODUCTION: Venous thromboembolism (VTE) is a known complication after total knee arthroplasty (TKA) with well-established morbidity, mortality, and significant healthcare expenditure. However, no standard form of prophylaxis against VTE currently exists. METHODS: A retrospective review was performed identifying 12,866 TKA cases and post-operative VTE events using either 325 mg aspirin or 81 mg aspirin twice daily (BID). RESULTS: 133 VTE cases were diagnosed of the 9413 TKA on 325 mg aspirin BID compared to 8 VTE cases out of 3453 TKA on 81 mg aspirin BID (1.41% vs. 0.23%, p < 0.001). CONCLUSION: 81 mg aspirin BID significantly improved post-operative VTE rates over 325 mg aspirin BID.

DeNovo NT Particulated Juvenile Cartilage Implant.

Biological repair of focal chondral defects represents a significant clinical challenge as cartilage lacks intrinsic healing ability. Although it can be difficult to measure the objective success of cartilage repair techniques, the primary objective is symptom relief leading to less pain and improved function for the patient. Likely, the most important key to success is proper clinical indications. Second to this, the type of cartilage treatment utilized should be based on lesion location, size, depth, and other patient factors. One such treatment is DeNovo Natural Tissue. This method relies on the ability of juvenile chondrocytes to migrate from cartilage explants after being secured in a cartilage defect. Although approximately 8700 cases have been performed since 2007, long-term clinical outcomes are not yet available. However, basic science and early clinical data are promising.