Contrast Enhanced Computed Tomography in the Diagnosis of Acute Pyogenic Flexor Tenosynovitis.

BACKGROUND: The diagnosis of infectious flexor tenosynovitis (FTS) has historically been made based on physical exam using Kanavel's signs. The specificity of these findings has come into question. We looked to evaluate the use of contrast-enhanced computed tomography (CT) in increasing the successful diagnosis of FTS. METHODS: Two adult cohorts were formed, one of patients with FTS confirmed in the operating room and the second of patients with ICD.10 identified finger cellulitis (FC), without concomitant FTS. Demographics, laboratory values, CT scans, and examination findings were evaluated. Axial CTs were evaluated in the coronal and sagittal planes and tendon sheath/tendon width were measured. The tendon sheath/tendon was recorded as a ratio in the coronal (CR) and sagittal (SR) planes. Continuous and dichotomous variables were analyzed and measures of sensitivity, specificity, and predictivity were calculated. Seventy patients were included, 35 in the FTS cohort and 35 with FC. RESULT: A higher number of Kanavel signs were present in the FTS group (2.9 vs. 0.5, P < .05), with CR and SR both being significantly larger in the FTS group (P < .05). CR and SR cutoffs ≥ 1.3 provided high sensitivity, specificity, and positive predictive value (PPV) for FTS. Likelihood of FTS increased 5.9% and 5.5% for every 0.1 increase in CR and SR, respectively, with a 14% increase for every additional Kanavel sign. CONCLUSION: In conclusion, CT ratios are useful in identifying FTS; and when used on their own or in combination with Kanavel's signs, CR and SR objectively improve the diagnosis of FTS.

Improved Outcomes Using a Fibular Strut in Proximal Humerus Fracture Fixation.

Proximal humerus fractures, although common, have high rates of failure after open reduction and internal fixation. The use of a fibular allograft has been explored as a means to decrease complications, particularly varus collapse and the need for revision surgery. The authors performed a retrospective review of 133 proximal humerus fractures managed surgically with locking plates (n=72) or locking plates with fibular allograft intramedullary struts (n=61). Demographic, intraoperative, and postoperative variables were collected and analyzed. The fibular allograft group was more likely to be older (P<.01), be female (P=.04), and have a history of osteoporosis (P=.01). No differences were noted in the proportions of 2-, 3-, or 4-part fractures between groups. Average follow-up was 28 weeks. Medial calcar length was longer in the locking plate only group (P=.04); however, this group demonstrated a decreased head shaft angle (P=.01) and a trend toward increased rates of varus collapse (P=.06). No significant differences were found regarding other radiographic complications, irrespective of fracture complexity. A notable decrease in fluoroscopy time was seen with strut use (P=.04), but operative time and blood loss were similar between groups. A significant decrease in revision surgery rate was found with use of an allograft strut (P=.05). Using a strut appears to preserve the radiographic head shaft angle and decrease the risk of fracture collapse in 2-, 3-, and 4-part fractures, without increasing surgical time or morbidity. Use of an intramedullary strut appears to reduce the need for revision surgery, particularly in 3- and 4-part fractures. [Orthopedics. 2020;43(5):262-268.].

Thumb Immobilization in the Treatment of an Acute Hook of Hamate Fracture: A Case Report.

A 65-year-old male presented with an acute nondisplaced hook of hamate fracture while lifting a suitcase. Conservative management was employed, and he was treated with a thumb spica cast. At the most recent follow-up, he demonstrated resolution of pain and restoration of motion. CT imaging confirmed osseous union. High nonunion rates following conservative management with short arm casting without thumb immobilization for hook of hamate fractures may be in part due to inadequate immobilization. Here, use of a thumb spica cast resulted in successful osseous union following an acute hook of hamate fracture.