A Morphometric Analysis of Hamate Autograft for Proximal Scaphoid Reconstruction.

Objective Recently, authors have investigated using the proximal hamate as osteochondral autograft for proximal pole scaphoid reconstruction in the case of nonunion with avascular necrosis. The aim of our study was to analyze the morphology and anatomic fit of the proximal hamate compared with the proximal pole of the scaphoid using cadaveric specimens. Materials and Methods Ten cadaver specimens (five males and five females) were dissected. Scaphoid and proximal hamate bones were measured by two independent investigators using electronic calipers and radius of curvature gauges. After measurements were determined to have good correlation, the average value of the two observers' measurements were used for further analysis. Sagittal radius of curvature (ROC), coronal ROC, depth, width, and maximum graft length were compared. Results The average depth of the scaphoid proximal pole was 12.3 mm (standard deviation [SD] = 1.12) compared with 11.3 mm (SD = 1.24) for the proximal hamate ( p = 0.36). The average width was 7.8 mm (SD = 1.00) in the scaphoids compared with 8.6 (SD = 1.05) in the hamates ( p = 0.09). There was also no significant difference in the sagittal ROC between hamates (9.1 mm, SD = 1.13) and scaphoids (9.5 mm, SD = 0.84; p = 0.36). All of these average measurements were within 1 mm. There was a significant difference between the coronal ROC of the hamate (23.4 mm) and scaphoid (21.1 mm) bones in our samples ( p = 0.03). Females were on average smaller than their males, but there was no significant difference in fit based on sex alone. Conclusion The proximal pole of the hamate has similar morphology and size as the scaphoid, with similar depth, width, and sagittal ROC. It has potential as an osteochondral autograft for proximal pole scaphoid reconstruction.

Variations in Hook of Hamate Morphology: A Cadaveric Analysis.

PURPOSE: The hook of the hamate is an anatomical structure that separates the ulnar border of the carpal tunnel from Guyon's canal and serves as a landmark for surgeons. The hook of the hamate is also subject to fracture from injury. We hypothesize that there are variations in the hook of the hamate in the general population. METHODS: One thousand pairs of hamates (2,000 hamates) from the Hamann-Todd Collection at the Cleveland Natural History Museum were analyzed. The height of the hook of the hamate and the total height of the hamate bone were measured using digital calipers. The hook height ratio was defined as the hook height divided by the total height of the hamate. Statistical analysis was performed using unpaired Student's t test to determine differences in sex and race. RESULTS: The mean hook height was 9.8 ± 1.4 mm (range, 2.5-15.9 mm), whereas the mean hook height ratio was 0.42 ± 0.04 (range, 0.15-0.56). There was a 3.1% (62/2,000) incidence of abnormally small hooks, which we classified as hypoplastic and aplastic. Of the hypoplastic hooks, 55% (24/44) were bilateral, whereas 44% (8/18) of the aplastic hooks were bilateral. The incidence of variation in size in the hook of the hamate was highest in white females (9.3%) and lowest in black males (1.4%). CONCLUSIONS: Abnormalities in hook of hamate anatomy are common in the general population, especially in white females. CLINICAL RELEVANCE: Knowledge of anatomic variation in the hook of the hamate may provide additional insight into surgeons' palpation of bony anatomy, interpretation of imaging studies, and use of the hook as a landmark during surgery.

Changes in Provider Treatment Patterns for Dupuytren's Contracture: Analysis of Trends in Medicare Beneficiaries.

BACKGROUND: Collagenase Clostridium histolyticum (CCH) injection has been shown to be a safe and effective treatment option for Dupuytren's contracture. We hypothesize that the gaining popularity of CCH has resulted in a change in treatment patterns among providers, with increased utilization of CCH injections in the management of Dupuytren's contracture from 2012 to 2014. METHODS: The Medicare Provider Utilization and Payment Data Public Use Files were used to identify all surgeons who submitted claims for surgical fasciectomy, needle aponeurotomy (NA), and CCH injection. The data were analyzed for number of providers performing the procedures, number of procedures per provider, and location of practice. RESULTS: From 2012 to 2014, the number of providers performing more than 10 open fasciectomies decreased from 141 to 131. In the same time, the number of providers performing more than 10 NAs increased from 63 to 70 with mean procedures per provider decreasing from 35 to 21. In contrast, the number of providers performing more than 10 CCH injections increased from 72 to 112, with mean injections per provider going from 24 to 20. The total number of injections performed increased from 1,734 to 2,220 from 2012 to 2014. The largest increase in number of injections and number of providers performing injections occurred in the South. CONCLUSIONS: The introduction of collagenase has changed treatment patterns with more providers treating Dupuytren's contractures with CCH injections and a statistically significant decline in the number of NA procedures per provider.

Concomitant Upper Extremity Fracture Worsens Outcomes in Elderly Patients With Hip Fracture.

BACKGROUND: Elderly patients with low-energy hip fractures have high rates of morbidity and mortality, but it is not well known how often concurrent upper extremity fractures occur and how this impacts outcomes. We used the National Trauma Databank (NTDB), the largest aggregation of US trauma registry data available, to determine whether patients with concurrent upper extremity and hip fractures have worse outcomes than patients with hip fractures alone. METHODS: We accessed the NTDB to identify patients aged 65 to 100 who sustained a hip fracture. The cohort was then narrowed to include only patients who sustained their injury in a fall and had an injury severity score indicating hip fracture as the most severe injury. We then analyzed this group to assess the impact of a simultaneous upper extremity fracture on length of stay, in-hospital mortality, and discharge disposition. RESULTS: From 2007 to 2014, a total of 231,299 patients aged 65 to 100 were identified as having a hip fracture. The narrowed cohort with fall as the mechanism and hip fracture as the most severe injury included 193,862 patients. Of these, 12,618 patients sustained a concomitant upper extremity fracture (6.5%). Compared to isolated hip fractures, patients with a concomitant upper extremity fracture had higher odds of death in the hospital (odds ratio [OR] = 1.3; 95% confidence interval = 1.2-1.4), were less likely to be discharged to home as compared to a skilled facility (OR = 0.73; 95% confidence interval = 0.68-0.78), and had a significantly longer average length of stay (7.1 vs 6.4 days, P < .001). CONCLUSIONS: We found a 6.5% prevalence of concomitant upper extremity fractures in patients aged 65 to 100 with a hip fracture sustained after a fall where the hip fracture was the most severe injury. These patients had a higher risk of in-hospital mortality, were less likely to be discharged to home, and had longer average length of stay.