Fracture of the ulnar sesamoid bone of the thumb with a concurrent ulnar collateral ligament tear: A case report.

While the ulnar sesamoid bone of the thumb and the ulnar collateral ligament (UCL) are in close anatomic proximity, concurrent injury to these structures has not been reported. We report a case of such an injury in a 53-year-old male after an altercation. He was treated with surgical repair of the UCL, postoperative immobilization, and a graduated rehabilitation program consisting of range of motion and strengthening exercises. After review of the literature, we recommend that clinicians consider not just a volar plate injury, but also a UCL injury, in patients presenting with radiographic evidence of a sesamoid fracture. Clinicians should have a low threshold for advanced imaging in these patients to confirm any suspected ligamentous injury.

Utilization of Electrodiagnostic Testing for Carpal Tunnel Syndrome by General Practitioners Prior to Hand Surgery Consultation.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common peripheral mononeuropathy and thus is frequently encountered by general practitioners (GPs). The aim of this study is to investigate the referral pattern of GPs with regard to electrodiagnostic (EDX) testing for suspected CTS prior to hand surgery consultation, as well as to investigate the results of EDX testing for suspected CTS when requested by GPs prior to evaluation by a hand surgeon. METHODS: We retrospectively reviewed patients referred to our hand surgery clinic over a consecutive 2-year period for suspected CTS. RESULTS: A total of 403 patients were referred to our hand surgery clinic from January 1, 2016, to December 31, 2017. Of the 403, 295 (73.2%) were referred by GPs. GPs obtained prereferral EDX testing in 198 (67.1%) of these patients. EDX testing confirmed their diagnosis in 177 patients (89.4%). There were 21 patients (10.6%) identified with normal EDX testing and a more likely diagnosis reached based on clinical examination. CONCLUSIONS: GPs make up the majority of our referrals for CTS, and they obtain EDX testing prior to consultation in two-thirds of referrals. GPs appear to accurately utilize EDX testing to confirm their diagnosis prior to referral and have a low rate of normal testing where symptoms are more readily explained by an alternative diagnosis.

Radiation Exposure to the Orthopaedic Surgeon and Efficacy of a Novel Radiation Attenuation Product.

The purpose of this study was to examine the intraoperative radiation dosage to different body parts and to determine the effectiveness of a new lightweight radiation-attenuating fabric (XPF) versus lead, the current standard. For 51 cases involving fluoroscopy, one attending orthopaedic surgeon wore a set of three dosimeters at various locations. Per each set of three, one dosimeter was shielded with a swatch of XPF, one was placed underneath the lead apron, and one was left exposed. The total dose of radiation was tabulated per body site and the percent attenuation was calculated for both XPF and lead. There was no statistically significant difference in the percent of radiation attenuation by lead and XPF (p = .47). The use of XPF produced 57.83% reduction in weight compared with lead when adjusting for total surface body area. XPF can be used for operating room personnel and patients, providing effective protection from radiation. (Journal of Surgical Orthopaedic Advances 26(4):246-249, 2017).

Ligamentous and capsular injuries to the metacarpophalangeal joints of the hand.

The mechanism of dorsal dislocation of the metacarpophalangeal (MCP) joint is with forced hyperextension of the joint and the main structure injured is the volar plate. A simple dislocation can be reduced by closed means whereas a complex dislocation cannot. Care must be taken not to put traction across the joint, which may cause the volar plate to slip into the joint, converting a simple dislocation into a complex dislocation. Volar dislocations are rare and mainly treated nonoperatively. Sagittal band injuries can be treated with extension splinting or surgical management with direct repair or reconstruction. A locked MCP joint can usually be treated with closed manipulation. This article discusses these injuries and management options.