Distal Humerus Fractures in Adults: Comorbidity Patterns and Demographic Trends in Treatment.

The purpose of the study was to (1) assess the prevalence of comorbidities and (2) compare demographics of surgically and non-surgically treated distal humerus fracture patients. Retrospective review of data from a national database was performed. The primary outcome was comorbidities; the secondary outcome was demographic trends between treatment groups. Distal humerus fractures are associated with cerebrovascular disease, dementia, diabetes mellitus, heart disease, hyperlipidemia, hypertension, hypothyroidism, kidney disease, liver disease, and lung disease. Those undergoing surgery are more likely to be obese, under the age of 40 years, female, Medicare recipients with fewer comorbidities, who reside in a rural setting, and who seek care at urban/teaching hospitals within the Southern United States. They are also more likely to have a shorter hospital stay, to be discharged to home, and to have improved survival. (Journal of Surgical Orthopaedic Advances 32(1):017-022, 2023).

Metacarpophalangeal Joint Denervation in the Treatment of Dieterich Disease: A Case Report.

Avascular necrosis of the metacarpal head, known as Dieterich disease, is rare. The underlying pathogenesis of the disease is not clearly understood, and there are few cases reported in the literature. Nonoperative treatment with rest and nonsteroidal anti-inflammatory drugs is often successful, but surgical management is sometimes indicated. The case outlined here describes a novel application of the known technique of metacarpophalangeal joint denervation to relieve pain while maintaining joint mechanics and grip strength.

Medial Epicondyle Fracture With Concomitant Flexor-Pronator Mass Avulsion From the Fracture Fragment: A Case Report.

CASE: We present a case of a pediatric patient who sustained a medial humeral epicondyle fracture with avulsion of the ulnar collateral ligament and flexor-pronator mass from the ossific nucleus fracture fragment. Treatment included excision of the medial epicondyle ossific nucleus and repair of the soft tissues. At 1-year, the patient had no pain, no elbow instability, and full and symmetric elbow range of motion. CONCLUSION: Excellent short-term pain and function outcomes can be observed in the pediatric patient after medial epicondyle fragment excision when there is concomitant avulsion of the ulnar collateral and flexor-pronator origins from the fracture fragment.

Caring for the surgically anxious patient: a review of the interventions and a guide to optimizing surgical outcomes.

BACKGROUND: Preoperative surgical anxiety is an unpleasant and common reaction exhibited by patients who are scheduled for surgical procedures. Beyond emotional effects on the patient, it can also have negative repercussions on the surgery including longer hospital stays and poorer outcomes. Given the widespread impacts of preoperative anxiety, it is critical for surgeons to gain a better understanding of how to identify and reduce surgical anxiety in their patients. DATA SOURCES: This study used the PubMed database to review the current literature to evaluate screening tools and interventions for surgically anxious patients. CONCLUSIONS: Psychiatric anxiety surveys are currently the most appropriate form of assessment for surgical anxiety. Patient education is important for preventing and reducing anxiety levels in patients. Both nonpharmacological and pharmacological interventions have been shown to be effective in reducing patient anxiety and treatment should be based on patient preference, resources available, and the surgeon's experience.

Biomaterial hypersensitivity: is it real? Supportive evidence and approach considerations for metal allergic patients following total knee arthroplasty.

The prospect of biomaterial hypersensitivity developing in response to joint implant materials was first presented more than 30 years ago. Many studies have established probable causation between first-generation metal-on-metal hip implants and hypersensitivity reactions. In a limited patient population, implant failure may ultimately be related to metal hypersensitivity. The examination of hypersensitivity reactions in current-generation metal-on-metal knee implants is comparatively limited. The purpose of this study is to summarize all available literature regarding biomaterial hypersensitivity after total knee arthroplasty, elucidate overall trends about this topic in the current literature, and provide a foundation for clinical approach considerations when biomaterial hypersensitivity is suspected.

Patient demographics and risk factors in pediatric distal humeral supracondylar fractures.

The literature on distal humeral supracondylar fractures does not systematically define relationships between patient characteristics and the severity or complications of these injuries. This study evaluated age, sex, height, and body mass index (BMI) in relation to fracture severity and posttreatment complications in a pediatric population. The medical records of 382 pediatric patients treated for distal humeral supracondylar fractures over a 5-year period at 1 institution were included. Variables included age, sex, height, weight, injury mechanism, fracture severity (Gartland Classification), treatment, follow-up duration, and treatment complications. Body mass index and BMI-for-age percentile were calculated. Descriptive statistics with univariate analyses and logistic regression analysis with odds ratios and 95% confidence intervals were used. Children sustaining Gartland type 3 fractures were significantly older and taller than those sustaining Gartland type 1 and 2 fractures. No significant difference existed in fracture occurrence between boys and girls. Fracture severity did not differ significantly due to sex, BMI, or BMI-for-age percentile. Severe fractures were associated with increased posttreatment complications. Complication rates did not vary significantly by age, sex, height, BMI, or BMI-for-age. Taller children aged 5 to 6 years were at the greatest risk for Gartland type 3 distal humeral supracondylar fractures. Severe fractures are associated with an increased complication risk. Sex, BMI, and BMI-for-age percentile had no effect on fracture severity or complication rates.