Cast selection and non-union rates for acute scaphoid fractures treated conservatively: a systematic review and meta-analysis.

Cast selection for conservatively treated acute scaphoid fractures remains controversial. Cast options include short arm versus long arm, and those that include the thumb or leave it free. We sought to investigate the role of how cast choice affects nonunion rates after conservative management of scaphoid fractures. We searched PubMed, Embase, and Google Scholar from inception through July 14, 2020, according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. We extracted information of interest, including cast type, and non-union rates at the end of the treatment period. We then performed a meta-analysis using the random-effects model. We identified seven relevant studies. Non-union was observed in 15 out of 156 (9.6%) with short-arm cast and 13 out of the 124 (10.5%) with long-arm cast (OR = 0.79, 95% CI [0.19, 3.26], p = 0.74). Non-union was observed in 18 out of 174 (10.3%) with thumb immobilization cast and 18 out of the 179 (10.1%) without thumb immobilization (OR = 0.97, 95% CI [0.49, 1.94], p = 0.69). In our study, short arm casting was proven non-inferior to long arm casting. Similarly, casts without thumb immobilization were equally as effective as casts with thumb immobilization in terms of non-union rates for acute scaphoid fractures treated non-operatively.

Traumatic Complex Scaphoid Dislocation With Radial Carpal Disruption: A Case Report.

Background. Scaphoid dislocation with radial carpal disruption constitutes an extremely rare injury, and there are no clear guidelines for treatment. This article reviews a delayed presentation of this injury and its surgical management.

Acute Ulnar Neurapraxia and Carpal Tunnel Syndrome in the Context of a Distal Radius Fracture.

Distal radius fractures, carpal tunnel syndrome, and ulnar nerve compression are common causes of symptoms that result in patients presenting for hand evaluation. This is a unique case of a distal radius fracture leading to both carpal tunnel syndrome and ulnar nerve compression requiring urgent operative management.

Financial impact of hand surgery programs on academic medical centers.

BACKGROUND: This study analyzes the financial performance of hand surgery in the Department of Surgery at the University of Michigan. This analysis can serve as a reference for other medical centers in the financial evaluation of a hand surgery program. METHODS: Fiscal year 2004 billing records for all patients (n = 671) who underwent hand surgery procedures were examined. The financial data were separated into professional revenues and costs (relating to the hand surgery program in the Section of Plastic Surgery) and into facility revenues and costs (relating to the overall University of Michigan Health System). Professional net revenue was calculated by applying historical collection rates to procedural and clinic charges. Facility revenue was calculated by applying historical collection rates to the following charge categories: inpatient/operating room, clinic facility, neurology/electromyography, radiology facilities, and occupational therapy. Total professional costs were calculated by adding direct costs and allocated overhead costs. Facility costs were obtained from the hospital's cost accounting system. Professional and facility incomes were calculated by subtracting costs from revenues. RESULTS: The net professional revenue and total costs were 1,069,836 and 1,027,421 dollars, respectively. Professional operating income was 42,415 dollars, or 3.96 percent of net professional revenue. Net facility revenue and total costs were 5,500,606 and 4,592,534 dollars, respectively. Facility operating income was 908,071 dollars, or 16.51 percent of net facility revenues. CONCLUSIONS: While contributing to the academic mission of the institution, hand surgery is financially rewarding for the Department of Surgery. In addition, hand surgery activity contributes substantially to the financial well-being of the academic medical center.

Neurovascular transfer does not cause skeletal muscle fiber degeneration.

BACKGROUND: The mechanisms responsible for the incomplete recovery of muscle function after microneurovascular transfer have not been fully determined. Because fiber degeneration and regeneration can impact muscle mechanical function, the authors tested the null hypothesis that ischemia-induced fiber degeneration is not responsible for the force deficits observed after neurovascular muscle transfer. METHODS: Rats were assigned to one of three groups: orthotopic, nonvascularized grafting of the extensor digitorum longus muscle (STD group); orthotopic, neurovascular transfer of the extensor digitorum longus muscle with no intraoperative ischemia (NV-0 group); or orthotopic, neurovascular transfer of the extensor digitorum longus muscle with 3 hours of intraoperative ischemia (NV-3 group). At 1 and 2 weeks, extensor digitorum longus muscle cross-sections were labeled for developmental myosin heavy chain isoforms, markers of fiber regeneration. RESULTS: In extensor digitorum longus muscles from animals in the STD group, many small cells strongly labeled for developmental myosin heavy chain were observed and identified as myoblasts, indicating recent muscle fiber necrosis with subsequent regeneration. Extensor digitorum longus muscles from rats in the NV-0 and NV-3 groups contained no cells labeled for developmental myosin heavy chain. CONCLUSIONS: After neurovascular muscle transfer (with ischemia times up to 3 hours), ischemia-induced muscle fiber degeneration and regeneration does not occur. Muscle fiber degeneration is not responsible for the force deficits observed after microneurovascular skeletal muscle transfer.

Forearm musculofasciocutaneous flap to cover glenohumeral arthrodesis hardware during reconstruction of the flail upper extremity.

SUMMARY: For selected patients with flail upper extremities after brachial plexus injury, glenohumeral arthrodesis, above-the-elbow amputation, and fitting of an above-the-elbow prosthesis are effective reconstructive options. In such situations, soft-tissue thinning at the shoulder, especially deltoid atrophy, presents the potential problem of shoulder fusion hardware causing pain or even eroding overlying soft tissue. The authors have used a pedicled forearm musculofasciocutaneous flap, elevated just before above-the-elbow amputation and subsequently transposed to the shoulder, to provide high-quality soft-tissue coverage of the arthrodesis hardware. Preliminary results with three patients suggest that this procedure may be useful for preventing tenderness and breakdown of tissue overlying glenohumeral arthrodesis hardware. In all three patients, the forearm flap remained well perfused, and all wounds healed fully with no subsequent problems with skin breakdown. All three patients had long-term benefit from prosthesis fitting.