Distal Radius Fracture Therapy Utilization Following Traditional Open Reduction and Internal Fixation and Dorsal Bridge Plate Fixation.

Background Many distal radius fractures are treated with a volar locking plate, but a minority undergo dorsal bridge plate fixation. This study's primary purpose was to compare therapy utilization following distal radius fractures treated with traditional open reduction and internal fixation (ORIF) versus dorsal bridge plate fixation. Secondary outcomes were time to first and last therapy visits and therapy costs. Methods Patients over 18 years old who underwent distal radius ORIF between January 2021 and August 2022 at a single regional orthopedic practice were identified. Patients who underwent post-operative hardware removal were retrospectively reviewed to identify dorsal bridge plate fixation patients. This resulted in "traditional ORIF" and "dorsal bridge plate" groups. Therapy visit number, cost, and payor (insurance type including Medicare, private insurance, worker's compensation, automobile policy, and private pay) were collected. Results In total, 1,376 patients met the inclusion criteria. Of these, 713 of the 1,283 (55.6%) patients in the traditional ORIF group and 25 of the 44 patients (56.8%) in the dorsal bridge plate group attended therapy at our institution. Traditional ORIF and dorsal bridge plate patients averaged 12.6(±10) and 24(±18.7) therapy visits in the one-year following ORIF, respectively. Time to last therapy visit was 90.9(±60) and 175.2(±72.1) days in the traditional ORIF and dorsal bridge plate groups, respectively. Total therapy cost was $1,219(±$1,314) and $2,015(±$1,828) in the traditional ORIF and dorsal bridge plate groups with similar out-of-pocket costs. Conclusions Dorsal bridge plate fixation patients attended a greater number of therapy sessions, had a longer time from surgery until therapy end, and had a higher therapy total cost relative to traditional ORIF, but both groups had similar patient out-of-pocket therapy costs.

A Nine-Year Follow-Up of Stage II Preiser's Disease Treated With a Temporary Dorsal Wrist-Spanning Plate: A Case Report.

Preiser's disease, also known as avascular necrosis of the scaphoid, is a rare condition that is incompletely understood in regard to pathophysiology, diagnosis, and management. There have been numerous case reports and case series evaluating a variety of conservative and operative interventions, but optimal treatment has not been well established. We describe the case of a 20-year-old female with stage II Preiser's disease that was managed with a vascularized bone graft from the 1,2 intercompartmental supraretinacular artery, in addition to temporary dorsal wrist-spanning bridge plate fixation. At the nine-year follow-up, the patient had near full wrist range of motion, no pain, and radiographs showing preserved carpal alignment and a scapholunate angle within normal range. Our findings suggest that this surgical technique is a viable option for restoring scaphoid vascularity, preserving carpal alignment, and halting disease progression.

Abnormal Patterns of Biceps and Triceps Co-Contraction Following Elbow Surgery May Result in Elbow Stiffness.

Objectives: This study examines the pattern of muscular contraction and the intensity of this contraction of the biceps and triceps following elbow surgery. Methods: We performed a prospective electromyographic study of 16 patients undergoing 19 surgical procedures on the elbow joint. We measured the resting EMG signal intensity of the biceps and triceps of the operated and the normal sides at 90 degrees. We then calculated the peak EMG signal intensity during passive elbow flexion and extension of the operated side. Results: Seventeen of 19 elbows (89%) displayed a co-contraction pattern of the biceps and triceps near the end of flexion and extension during the passive range of motion. The co-contraction pattern was observed near the end of the range of motion in both flexion and extension. In addition to the observed co-contraction patterns, we detected higher contraction intensities for the biceps and triceps muscles in all patients in both flexion and extension for the elbows, which had been treated surgically. Further analysis suggests an inverse correlation between the biceps contraction intensity and the arc of motion measured at the latest follow-up. Conclusion: The co-contraction pattern and increased contraction intensity of periarticular muscle groups may result in internal splinting mechanisms, contributing to the development of elbow joint stiffness, which is frequently observed following elbow surgery.

Pickleball- and Paddleball-Related Injuries to the Upper Extremity.

Introduction While pickleball and paddleball are rapidly growing as popular sports in the United States, research on the incidence of hand and upper extremity injuries and treatments in outpatient clinics are lacking. This study evaluates the incidence rates and treatment options, both surgically and nonsurgically, for patients presenting with pickleball/paddleball-related injuries. Methods A retrospective database search of our multispecialty, multilocation electronic medical record (EMR) system from 2015 to 2022 identified 204 patients with outpatient pickleball- and paddleball-related injuries. The data from these patients' charts were reviewed for injury incidences, treatment trends, and demographics. Results  The majority of patients suffered wrist fractures due to a fall/dive and were treated nonsurgically. The most common surgical treatment, when required, was open reduction and internal fixation of the distal radius. We found that pickleball and paddleball players who sustained wrist fractures required surgery at a higher rate than the general population if above the age of 65. Conclusion As pickleball and paddleball continue to gain popularity, hand surgeons should be aware of the types of injuries that can occur and, when possible, counsel patients accordingly to try to prevent them. Additionally, hand surgeons should recognize the common treatments and outcomes that arise from pickleball/paddleball-related injuries.

All-Inside Versus Outside-in Repair of Triangular Fibrocartilage Complex Peripheral Tears.

PURPOSE: Triangular fibrocartilage complex (TFCC) peripheral tears with persistent wrist pain can be treated with arthroscopic surgical repair owing to vascularization of the peripheral region. The safety and efficacy of all-inside repair has been shown in prior case series. The purpose of this study was to compare two methods of arthroscopic peripheral TFCC repair: all-inside vertical mattress and outside-in horizontal mattress. METHODS: A 5-year retrospective review was performed on patients treated from 2016 to 2021 with wrist arthroscopy and TFCC repair for Palmer 1B tears. Patients with ulnar extrinsic ligament repair, distal radioulnar joint instability, concomitant ulnar shortening osteotomy, and extensor carpi ulnaris instability were excluded. Patient therapy and office visit records were reviewed. Outcomes including Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH); range of motion; grip strength; immobilization time; complications; and need for revision procedures were compared. RESULTS: Fifty-two patients were included in the study, 32 in the outside-in group and 20 in the all-inside group. The average follow-up length was 24.8 weeks, with similar range of motion and strength in both groups. The average postoperative QuickDASH score was 13 in the outside-in group and 9 in the all-inside group at 43.5 months, compared with the preoperative QuickDASH scores of 47 and 50, respectively. Mean immobilization time was longer for outside-in than for all-inside (5.25 vs 2.0 weeks, respectively). CONCLUSIONS: All-inside arthroscopic peripheral TFCC repair showed range of motion, grip strength, complications, revisions, and postoperative improvement in QuickDASH scores similar to those with the outside-in technique. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV; retrospective comparative study.

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.

Do Postoperative Telehealth Visits Require a High Rate of Redundant In-Person Evaluation After Upper Extremity Surgery?

Background Telehealth platforms may save resources for patients and providers, but the precise impact of their incorporation during the postoperative period is not well understood. The goal of this study is to determine whether telehealth incorporation in the postoperative period leads to an overall increase in healthcare utilization after upper extremity surgery. Methodology Patients seen for a postoperative telehealth visit after upper extremity surgery were randomly selected and retrospectively enrolled. Complications and the total number of postoperative visits before clinical discharge were recorded and compared to controls matched by surgery type and surgeon. Results A total of 56 patients were seen for 60 telehealth visits. The most common surgical procedures were distal radius open-reduction internal fixation (n = 8), open carpal tunnel release (n = 8), and endoscopic carpal tunnel release (n = 6). One telehealth visit (1.7%) required conversion to in-person evaluation due to suspected superficial infection necessitating in-person physical examination. The average number of postoperative visits prior to clinical discharge was 2.6 in the telehealth group compared to 2.7 in matched controls (p = 0.886). Complication rates were similar between groups. Conclusions The rate of necessary in-person evaluation after postoperative telehealth visits was less than 2%. The incorporation of telehealth visits did not appear to increase healthcare utilization after upper extremity surgery. Accordingly, the postoperative period is likely an ideal application for safe and effective telehealth implementation.

Radiographic Incidence and Functional Outcomes of Distal Radius Fractures Undergoing Volar Plate Fixation With Concomitant Scapholunate Widening: A Prospective Analysis.

Background: Scapholunate (SL) ligament injuries can occur concomitantly with distal radius fractures (DRFs), and the management of acute SL injury in the setting of DRFs remains controversial. The purpose of the study is to identify the radiographic incidence of SL widening in DRF treated with volar plate fixation and to determine the functional outcomes of DRF with concomitant radiographic SL-widening. Methods: One hundred and seventeen patients with DRFs, with and without radiographic SL-widening, and treated with volar locked plating, were prospectively enrolled. No SL ligament repairs or reconstructions were performed in any cases. Patients with DRFs with radiographic criteria for SL widening were compared to those without. Patients were evaluated at 3 months and 1 year postoperatively with Quick Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation (PRWE) questionnaires. Results: Thirty-one patients (26.5%) were found to have radiographic evidence of SL widening. Patients with concomitant SL widening had less wrist extension at 3 months (52.4 degrees vs 60.8, P = .034) and at 1 year (64.5 degrees vs 71.8, P = .023). The group with SL widening had greater articular step off at 3 months (0.33 vs 0.06, P = .042), but no difference at 1 year (0.11 vs 0.05, P = .348). There were no differences in wrist flexion, supination, pronation, volar tilt, radial inclination, radial height, ulnar variance, PRWE scores, and Quick Dash scores at 3 months and 1 year. Conclusions: Radiographic SL-widening is a common finding associated with DRFs undergoing surgical repair. There are similar clinical outcomes between those with untreated SL widening compared to those without an SL widening at 1-year postoperatively.

Post-operative Opioid, Benzodiazepine and Sedative Usage in Medicare versus Commercial Insurance Hand Surgery Patients.

BACKGROUND: Opioid usage has increased in recent years. The purpose of this study is to assess post-operative opioid, sedative, and benzodiazepine usage in a Medicare population. METHODS: Consecutive patients undergoing elbow, wrist, and hand surgery by hand surgeons at one academic outpatient surgical center were prospectively enrolled. Patients were excluded if they were minors or if they underwent more than one surgical procedure during the study period. There were 269 patients enrolled, and this group was divided by insurance type into younger commercial insurance (CI) and older Medicare (MC) groups. The Pennsylvania Physician Drug Monitoring Program website was used to document all prescriptions of controlled substances filled six months prior to and after the surgical procedure. RESULTS: The mean age in the CI group was 45.8 years (range: 16-88) and 69.2 years (range: 43-91) in the MC group. Postoperatively, the CI patients filled significantly less opioid prescriptions than the MC group, 1.10 vs. 1.79. Patients in the CI group were given an average of 0.3 benzodiazepine prescriptions before surgery and 0.2 after surgery. Patients in the MC group were given 0.6 prescriptions before and 0.5 prescriptions of benzodiazepines after surgery. The CI group was given an average of 0.1 sedative/hypnotic prescriptions before surgery and 0.1 after surgery. The MC group was given 0.7 prescriptions before and 0.4 prescriptions of sedative/hypnotics after surgery.There were 0.17 prescriptions per patient in the CI group and 0.75 per patient in the MC group (P <.05). Twenty-two of 208 (10.6%) of CI and 16/61 (26.2%) of MC patients filled a prescription between 3-8 months post-operatively. CONCLUSION: Prolonged use of opioid, benzodiazepine and sedative medications is common after upper extremity surgical procedures. Older patients are also at risk, and may be even more likely than younger patients to use these medications post-operatively.

A Prospective Evaluation of Postoperative Readmissions After Outpatient Hand and Upper Extremity Surgery.

Introduction Hand and upper extremity surgeries are largely performed in free-standing ambulatory surgery centers (ASCs). Rates of unexpected hospitalizations or visits to the urgent care or emergency departments in the month following hand and upper extremity surgery have been widely varied in the literature. We prospectively followed patients after hand and upper extremity outpatient surgery to determine the rate of unplanned health care utilization with the hypothesis that hospital admissions, emergency room visits, and urgent care center visits would be higher than the rates currently reported by retrospective studies. Methods All patients undergoing outpatient hand and upper extremity surgery by five hand surgeons were prospectively followed to monitor for hospital readmissions, emergency room visits, and urgent care presentations. The patients' postoperative course was evaluated for direct transfers from the surgical center to the hospital. In addition, any urgent care or emergency room visits and hospital admissions for the first month after surgery were tabulated. Points of review of the patients' postoperative course included the following: (1) phone contact on the first postoperative day, (2) routine ASC postoperative phone calls two to three days postoperatively, (3) first postoperative office at approximately one to two weeks, and (4) phone contact or office evaluation one-month postoperatively based on surgeon preference for follow-up. Results A total of 583 patients were identified for participation, of whom 22 patients were excluded; thus, 561 patients were included for evaluation, with 47.2% women (n=265) and 52.8% men (n=296). The average age was 54 years (range: 14-102 years). Nine (1.6%) patients presented postoperatively for further evaluation at an urgent care or hospital (95% C.I. 0.8-3.1%). Five patients presented to an emergency room and four patients presented to an urgent care facility. Of those patients, two were admitted to the hospital due to shortness of breath (0.35%; 95% CI: -0.08 to 1.4%). Emergency room and urgent care visits that did not lead to admission accounted for 1.25% (95% CI: 0.6-2.6%). No patients were transferred from the ASC to the hospital or emergency room. Conclusion There was a low rate of postoperative utilization of urgent care and emergency room services with hand and upper extremity surgery performed at free-standing, ASCs. Hospital readmissions were rare, and no patients required transfer from an ambulatory care center to the hospital. Outpatient hand and upper extremity surgery is safe in an ambulatory care center, with low postoperative transfers and readmissions in the month following surgery.

Predictive Factors for Return to Driving following Volar Plate Fixation of Distal Radius Fracture.

Background A common query by patients undergoing distal radius fracture (DRF) repair is when (s)he can resume driving postoperatively. A prospective cohort analysis was performed to assess fracture and patient factors on a patient's self-reported ability to return to driving to better inform patients and surgeons. Methods Consecutive patients undergoing DRF repair with locking volar plate were enrolled. Preoperative demographic and radiographic characteristics, and postoperative time to return to driving were collected. Data collected included age, sex, hand dominance, body mass index (BMI), level of education, concomitant ulnar fracture, fracture setting prior to surgery, and AO fracture classification. Results A total of 131 patients were enrolled (108 women, 23 men) with 36 AO type A, 22 AO type B, and 73 AO type C DRFs, with an average age of 59.5 years. Fracture severity by classification did not significantly affect time to return to driving. However, BMI, sex, and age were found to significantly affect time to return to driving. Patients aged 19 to 59 years, 60 to 75 years, and over 75 years returned to driving 13.1, 15.4, and 30.1 days following surgery, respectively ( p < 0.01). Classified by BMI, patients that were normal weight, overweight, and obese returned to driving 11.5, 13.1, and 21.0 days following surgery, respectively ( p < 0.05). Men returned to driving 8.8 days and women 17.3 days postoperatively ( p = 0.001). Conclusion Patients severity of fracture as determined by AO fracture type did not affect time to driving, while increased BMI, female sex, and increased age were found to be significant factors in patients' return to driving time after distal radius fracture repair. Level of Evidence This is a Level II, prospective cohort study.

Telehealth for Upper Extremity Conditions: Perceptions of the Patient and Provider.

The recent coronavirus pandemic has prompted providers to adopt telehealth as a way to maintain contact with their patients on an unprecedented scale. The purpose of this study was to evaluate the perception of care for both patients and physicians using telehealth visits for the management of upper extremity orthopaedic conditions. This study consisted of the analysis of surveys sent to both physicians and patients immediately after the completion of a telehealth visit for an upper extremity condition. Eighty percent of patients responded as "very satisfied" with their encounter. Satisfaction scores were similar for patients seen for a new issue or an existing issue. The use of a video platform was preferable to patients compared with a telephone call. Physicians would have requested a radiograph or offered a steroid injection during a new patient evaluation in 77% of cases. Physicians were less satisfied with the use of telemedicine, particularly when evaluating a new patient. A large majority of patients and physicians alike felt telehealth visits have a role in patient management, acknowledging they would both choose to incorporate "some" of their visits as telehealth evaluations for any particular issue.

Splinting after Distal Radius Fracture Fixation: A Prospective Cohort Analysis of Postoperative Plaster Splint versus Soft Dressing.

Background The effect of postoperative dressing and splinting after distal radius fracture (DRF) open reduction internal fixation (ORIF) is not well understood. A prospective cohort analysis was performed to assess differences in functional and radiographic outcomes with the use of plaster splinting or soft dressing following DRF ORIF. Methods All patients undergoing DRF ORIF with locking volar plates were consecutively enrolled. Preoperative demographic and postoperative radiographic and functional outcome data were collected at 2 weeks and 3 months postoperatively. Functional data included range of motion (ROM), pain on visual analog scale (VAS), Patient-Rated Wrist Evaluation (PRWE), and quick Disabilities of the Arm, Shoulder and Hand (DASH) scores. Radiographic data included loss of fracture reduction. Results A total of 139 patients were enrolled (79 plaster splinting, 60 soft dressing). By the first postoperative visit (POV), there was one case of loss of reduction with plaster splinting and one case with soft dressing with no hardware failure or revision surgery in either group, and no difference in DASH, PRWE, or VAS pain scores. By the final POV, the soft dressing group showed greater ROM in extension by 9.6, flexion by 10.9, and supination by 4.8 degrees over plaster splinting. Additionally, the soft dressing group demonstrated statistically significant improvement in PRWE and DASH scores, as well as VAS pain scores as compared with plaster splinting. Conclusions Applying only soft dressing following DRF ORIF demonstrated improvements in ROM, VAS, and functional outcomes by final follow-up, with no significant differences in radiographic outcomes. No benefit of applying a plaster splint was identified.

A Prospective Evaluation of Complications after Use of Exposed Pins in the Hand and Wrist.

BACKGROUND: Kirschner wires are commonly used during hand surgical procedures. These pins are often left exposed (protruding from the skin) for ease of removal. Complications such as loosening, migration, or infection are not uncommon (ranging from 7 to 18 percent in current retrospective studies) and can compromise surgical outcome. This study evaluated the frequency of Kirschner wire-related complications. METHODS: All patients who had Kirschner wires placed as part of their surgical procedure in the hand or wrist by one of 12 attending hand surgeons over a 6-month period were enrolled prospectively. Complications were recorded by the attending surgeon at follow-up visits. Demographics and patient comorbidities including diabetes mellitus and smoking history were recorded. RESULTS: There were 141 patients enrolled and 230 pins used, including 65 women and 76 men. The mean age was 40.7 years. Thirteen patients were smokers, and eight had a history of diabetes. There were 35 soft-tissue procedures and 106 fractures. There were 35 complications (25 percent). There was a 12 percent rate of infection (n = 17), including two cases of osteomyelitis. There were 18 other complications, nine of which were major complications (6.4 percent). Smoking, age, and location (hand/fingers versus wrist) were significantly associated with infection. CONCLUSIONS: In this study, one in four patients treated with Kirschner wires developed a minor or major complication, a rate that is substantially higher than reported in existing retrospective studies. Although Kirschner wires are often needed during hand surgery, surgeons should be aware that adverse events are frequent. Patients and surgeons should be vigilant in the perioperative period. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Outcomes of Open Reduction and Internal Fixation of Bilateral Fractures of the Distal Radius.

Background Bilateral distal radius fracture (DRF) is an uncommon injury. We described the outcomes of 10 consecutive cases of bilateral DRF treated with open reduction and internal fixation (ORIF) at our institution. Materials and Methods We retrospectively searched our electronic medical records data for all patients 18 years of age or older treated surgically for bilateral DRF over a 6-year period (2011-2016). Patient demographics, fracture classification, fixation method, postoperative complications, QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand) questionnaire scores, wrist range of motion (ROM), and radiographic measurements of X-rays at final follow-up were collected and analyzed. Results Ten patients (8 women; 2 men; mean age: 63 years) with 20 fractures were assessed. A volar approach for ORIF was used in 90% of cases. Six of 20 (30%) wrists experienced postoperative complications and required hardware removal. Mean QuickDASH score was 24.8 at final follow-up. On average, ROM reached 58-degree extension, 52-degree flexion, 75-degree pronation, and 75-degree supination. Mean measurements of radial shortening, radial inclination, and volar tilt taken from final postoperative radiographs were 1.3 mm, 21.2 degrees, and 7.8 degrees, respectively. Conclusion In bilateral DRF treated with concomitant ORIF, functional outcomes, recovery of wrist ROM, and restoration of radiographic parameters are comparable to those seen in patients with ipsilateral DRF.

An Evaluation of Digital Imaging Studies in an Outpatient Orthopedic Setting.

BACKGROUND: Distribution of radiographic images in the outpatient setting on compact discs-recordable (CD-R) is commonplace. Opening, manipulating and interpreting these can be challenging. This study evaluated the availability and ease of use of CD-R to evaluate digital images in an outpatient orthopedic setting. METHODS: 118 CD-R containing diagnostic studies were evaluated by seven board certified orthopaedic surgeons. Surgeon age and self-perceived "tech savvy" scores were tabulated using a visual analog scale (VAS). Surgeons evaluated: ability and number of computers to open, autorun, and specific reader software. Time to load was recorded in seconds, type of study, presence of "not for diagnostic use", and if the disc required additional software. Studies were graded using a VAS for ease of opening, ability to move from image to image and/or between series, to manipulate the image, and to zoom and pan. RESULTS: There were 79 radiographs, 29 MRI's, and 10 CT scans. Seven (6%) had to be manually opened and four (3%) required software installation. Thirteen (11%) contained a warning that the studies should not be used for diagnostic purposes. Six (5%) of the studies could not be opened. For the opened studies, average time from disk insertion to image was 43.7 seconds overall (range 3-350), 65.3 seconds (range 21-191) for MRI and CT, and 35.2 seconds (range 5-177) for radiographs. CONCLUSION: The present digital imaging systems include different software types and a variety of interfaces. Improving this would decrease time and effort necessary to open and evaluate these studies, and improve efficiency. LEVEL OF EVIDENCE: III.

Complications of Volar Plating of Distal Radius Fractures: A Systematic Review.

Background In recent years, there has been an increased utilization of volar locking plate fixation of distal radius fractures (DRFs). However, reported long-term complication rates with this technique remain unclear. Purpose The purpose of this systematic review was to investigate the pooled incidence of complications associated with volar locking plating of DRF. Methods A search of the Scopus database was performed from 2006 through 2016. Studies were considered eligible if they had a diagnosis of a DRF and were treated with a volar locking plate with an average of 12 months or longer follow-up. Results The literature search yielded 633 citations, with 55 eligible for inclusion in the review (total n = 3,911). An overall complication rate of 15% was identified, with 5% representing major complications requiring reoperation. The most common complication types identified included nerve dysfunction (5.7%), tendon injury (3.5%), and hardware-related issues (1.6%). Conclusion Nerve complications were reportedly higher than tendon and hardware-related complications combined. However, despite varying complication rates in the literature, this systematic review reveals an overall low complication rate associated with volar locking plating of DRF.

Complications in the Management of Distal Radius Fractures: How Do We Avoid them?

PURPOSE OF THIS REVIEW: Distal radius fractures are one of the most common fractures in the upper extremity. The purpose of this review is to outline common complications that may arise when caring for distal radius fractures and to describe the treatment strategies when faced with such complications. RECENT FINDINGS: Tendon complications are not uncommon after distal radius fractures. Recent literature highlights new plating technology for dorsal plating techniques. Moreover, new literature has outlined parameters for flexor tendon complications when using volar locking plates in an effort to avoid flexor tendon irritation and rupture. In summary, it is important to understand the various complications that can arise when treating distal radius fractures in an effort to avoid suboptimal outcomes.

Patient Satisfaction in the Preoperative Period: Preparing for Hand Surgery.

Background: The potential impact of the number and type of preoperative encounters on satisfaction rates prior to elective surgical procedures is unclear, specifically scheduling and medical clearance encounters. Methods: Questionnaires investigating satisfaction with the preoperative process were collected for 200 patients presenting for elective hand surgery. The number of telephone, surgeon, and medical clearance encounters were recorded, and satisfaction was determined for each type based on a 4-category Likert scale. All patients 18 years or older were included, while only patients providing incomplete questionnaires were excluded. Outcome data were assessed for associations between different encounter totals or types and satisfaction rates. Results: Among 200 patients, 197 completed the questionnaire and were included. Overall satisfaction with the preoperative process was 92.9%, with only 3% of patients dissatisfied. There was a significant association between satisfaction and the number of telephone and total encounters. Satisfaction fell below 90% after 4 or more telephone calls (66.6%, P = 0.005) and 5 or more total encounters (80%, P = 0.008). When considered individually, there was no significant association between satisfaction and the number of surgeon (P = 0.267) or medical office encounters (P = 0.087), or a patient's perceived health status (P = 0.14). Conclusions: Greater than 3 telephone or 4 total encounters significantly decreases patient satisfaction, while surgeon and medical office visits are not associated with satisfaction rates when considered individually. This suggests the number, not the type, of preoperative encounters impact satisfaction and highlight the importance of efficient communication between patients and providers.