A comparison of débridement with and without anconeus muscle flap for treatment of refractory lateral epicondylitis.

BACKGROUND: Lateral epicondylitis is a common condition encountered by orthopedic surgeons. Whereas the majority of patients improve with conservative management, a small percentage will require surgery. The purpose of this study was to compare the clinical outcomes of surgical débridement of the common extensor origin alone with débridement combined with rotation of an anconeus muscle flap in patients who failed to respond to conservative management of chronic lateral epicondylitis. METHODS: Fifty-seven patients who failed to respond to a minimum of 5 months of conservative treatment for lateral epicondylitis were retrospectively reviewed. Patients in group 1 were treated with open débridement of the common extensor origin. Patients in group 2 were treated with open débridement combined with rotation of an anconeus muscle flap. Outcome measures included elbow range of motion, grip strength, visual analog scale (VAS) for pain score, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Statistical analyses were performed by Student's t test with 95% confidence intervals. RESULTS: At final follow-up, average DASH scores were significantly lower in group 2. There were no significant differences between the groups with regard to elbow range of motion or grip strength. VAS pain scores were significantly reduced in both groups. Preoperative VAS pain scores were significantly greater in group 2; however, at final follow-up, there was no significant difference between groups. There were no apparent complications in either group. CONCLUSIONS: In addition to débridement of the common extensor origin, the rotation of an anconeus muscle flap may improve outcomes in cases of lateral epicondylitis that require operative intervention.

Indications for operative fixation of distal radius fractures: a review of the evidence.

Operative fixation of distal radius fractures is one of the most commonly performed orthopedic procedures. However, there remains little consensus on the indications for operative versus nonoperative treatment of these injuries. The American Academy of Orthopaedic Surgeons has recently published clinical practice guidelines to help guide management of these injuries. The purpose of this paper is to review the biomechanical and clinical retrospective and prospective data pertinent to the indications for operative management of distal radius fractures. Conflicting data exists as to the optimal management of these injuries, especially in patients over the age of 55. Although there is some evidence to support operative fixation of distal radius fractures, better longterm, prospective, randomized studies with validated patient outcome measures are needed to definitively establish the optimal method of treatment for these injuries.

Ulnar variance: correlation of plain radiographs, computed tomography, and magnetic resonance imaging with anatomic dissection.

PURPOSE: Several techniques used to measure ulnar variance on a posteroanterior wrist radiograph have been described. It remains unclear whether they accurately represent the true ulnar variance of the patient. The purpose of this study was to correlate ulnar variance measurements on plain radiographs, computed tomography (CT), magnetic resonance imaging (MRI), and anatomic dissection. METHODS: Posteroanterior (PA) radiographs, coronal and sagittal CT scans, and coronal MRI scans were obtained on 8 fresh-frozen cadaver wrists. The ulnar variance was measured by 5 reviewers. The specimens were then dissected, exposing the wrist joint. The ulnar variance was measured directly on each specimen using digital calipers. The inter-rater reliability was calculated for each imaging modality. The bias for each imaging modality was calculated using the digital caliper measurements as the true ulnar variance. RESULTS: Intraclass correlation coefficients demonstrated excellent inter-rater reliability for each imaging modality. The average bias from the true variance was the following: PA radiograph, 0.77 mm; coronal CT, 0.96 mm; sagittal CT, 0.96 mm; MRI with articular cartilage, 0.73 mm; MRI excluding cartilage, 0.49 mm. The variance measured on all imaging modalities tended to underestimate the magnitude of the true variance. CONCLUSIONS: Ulnar variance measured on coronal MRI best reflected the true ulnar variance as measured directly using calipers. The CT scans demonstrated the greatest deviation from the true variance. However, differences were small and might not be clinically meaningful. All imaging modalities demonstrated excellent inter-rater reliability, with MRI being highest. All imaging modalities tended to underestimate the magnitude of the true variance. CLINICAL RELEVANCE: The imaged underestimation of true ulnar variance should be taken into account when performing surgical procedures that alter the relative lengths of the radius and ulna.

Digital intraosseous epidermoid inclusion cyst of the distal phalanx.

Epidermoid inclusion cysts (EIC) of the bone are exceedingly rare. We present a case of an atypical EIC originating at the base of the distal phalanx of the index finger following a remote history of crush injury to the finger. The differential diagnosis of expansile, lytic lesions of the phalanges remains broad, and definitive diagnosis requires tissue histopathological analysis. At latest follow-up, the patient was pain-free and obtained an excellent clinical and radiographic outcome following intra-lesional curettage and bone grafting. Differentiation of EIC from other radiolucent digital lesions remains challenging, especially when classic radiographic findings are not seen. We review the clinical, radiographic, and pathologic diagnostic features of this lesion, as well as our current treatment algorithm.