An Anterior Inferior Iliac Spine Avulsion Fracture in a 14-Year Old Boy on Human Growth Hormone.

We present the case of a young man with an anterior inferior iliac spine (AIIS) avulsion fracture who was taking human growth hormone (HGH) at the time his injury was diagnosed. He presented with chronic hip pain and no traumatic event. Physical exam revealed symptoms of hip impingement. Upon imaging, he was diagnosed with an AIIS avulsion fracture and underwent surgical repair. He returned to full activity six months post-operatively. At 18-months post-operatively, he was pain-free and performing all activities without difficulty. The role of HGH in his injury or recovery is not well understood and must be studied with large database studies.

Ligamentum Teres Tears and Femoroacetabular Impingement: Prevalence and Preoperative Findings.

PURPOSE: To determine prevalence of ligamentum teres (LT) injuries identified during hip arthroscopy for treatment of femoroacetabular impingement (FAI) and to identify physical examination findings or radiographic characteristics specific to patients with complete LT tears that could possibly assist in a preoperative diagnosis. METHODS: Between October 2006 and June 2015, prospective data were collected on consecutive hip arthroscopies. Inclusion criterion was primary hip arthroscopy in patients aged 18 years or older. All patients in the study were treated for chondrolabral dysfunction associated with FAI. Patients with prior hip surgery were excluded. A total of 2,213 out of 3,158 hip arthroscopies met the inclusion criterion. RESULTS: Of the 2,213 hips, 233 (11%) had a normal LT, 1,947 (88%) had frayed/partially torn, and 33 (1.5%) had a torn LT. A higher prevalence of torn LT was seen in female subjects. Patients with torn LT had lower body mass index (BMI) (22.5 v 24.7; P < .01) than those with hips with normal LT. On radiographs, patients with torn LTs had a lower center edge angle and had increased odds of having a center edge angle less than 25°. Isolated cam or isolated pincer were seen more often in hips with torn LT than in hips with normal LT. Hips with torn LT were 3.1 times more likely to have a chondral defect on the femoral head than were hips with normal LT (95% confidence interval [CI], 1.2-8.7) and were 3.6 times more likely to have capsular laxity diagnosed at hip arthroscopy than were hips with normal LT (95% CI, 1.4-9.4). CONCLUSIONS: Among patients with FAI and labral pathology, complete tears of the LT were rare and were more likely to be seen in women and those with lower BMI and low center edge angles at arthroscopy. LT tears were associated with hip laxity and chondral defects of the femoral head. LEVEL OF EVIDENCE: Level IV, prognostic case series.

Predictive Value of 3-T Magnetic Resonance Imaging in Diagnosing Grade 3 and 4 Chondral Lesions in the Hip.

PURPOSE: To assess the diagnostic capability and predictive value of 3-T magnetic resonance imaging (MRI) in detecting grade 3 and 4 cartilage lesions in the hip. METHODS: From August 2010 to April 2015, patients who underwent 3-T MRI and hip arthroscopy were included in the study. Data were prospectively collected and retrospectively reviewed. A radiologist prospectively documented MRI findings, and the surgeon documented cartilage damage at arthroscopy using the Outerbridge grading system. Arthroscopy was considered the diagnostic gold standard. This study was approved by the institutional review board. RESULTS: The study group comprised 606 patients, with 354 men (58%) and 252 women (42%). The mean patient age was 34 years (range, 18 to 71 years). For femoral head defects, the sensitivity was 61% (95% confidence interval [CI], 53% to 68%), specificity was 58% (95% CI, 55% to 62%), positive predictive value was 29% (95% CI, 25% to 33%), and negative predictive value was 84% (95% CI, 81% to 87%). For chondral defects of the acetabulum, the sensitivity was 80% (95% CI, 75% to 84%), specificity was 41% (95% CI, 38% to 44%), positive predictive value was 42% (95% CI, 39% to 45%), and negative predictive value was 79% (95% CI, 74% to 84%). CONCLUSIONS: The results of this study showed that 3-T MRI had sensitivity, as well as specificity, for identifying chondral defects that is similar to what has been previously reported. MRI showed increased sensitivity when identifying acetabular defects compared with femoral head defects. With a low positive predictive value, MRI may be most useful in ruling out cartilage lesions. LEVEL OF EVIDENCE: Level III, diagnostic study.

Hip Strength Deficits in Patients With Symptomatic Femoroacetabular Impingement and Labral Tears.

PURPOSE: To determine the prevalence of hip strength deficits in a consecutive cohort of patients with unilateral femoroacetabular impingement (FAI) compared with the asymptomatic contralateral hip. METHODS: Fifty consecutive patients undergoing hip arthroscopy for symptomatic FAI underwent preoperative hip strength dynamometer measurements and were included in the study. Manual isometric hip strength measurements were performed with a handheld dynamometer and included measurements of various hip strengths (flexion, extension, adduction, abduction, internal rotation, and external rotation). Weakness greater than or equal to 10% for any given measurement was defined as a strength deficit in this study. Clinical data including age, gender, size of labral tear, and preoperative outcome scores were recorded. Outcome scores included the modified Harris Hip Score and Short Form 12 Physical Component. RESULTS: The mean age of patients in the study was 32.0 years (range, 18.1 to 49.8 years). There were 32 male and 18 female patients. Hip abduction strength deficits were seen in 46% of patients and flexion strength deficits in 42% of patients. An 8% decrease in strength of the involved hip was seen in flexion, and an 8.7% decrease was seen in abduction. Patients with hip flexion strength deficits had a loss of function (mean modified Harris Hip Score, 57.8 v 66.1; P = .021) and larger labral tears (mean, 39 mm v 28 mm; P = .003). Hip flexion strength deficits correlated with loss of hip flexion (r = 0.373, P = .008). CONCLUSIONS: Hip strength deficits were common in patients presenting with unilateral symptomatic FAI and occurred most commonly in hip abduction and flexion. Strength deficits in hip flexion were associated with decreased function, loss of motion, and larger labral tears in patients with FAI and labral tears. LEVEL OF EVIDENCE: Level IV, prognostic case series.

Preoperative diagnosis of pathologic conditions of the ligamentum teres: is MRI a valuable imaging modality?

PURPOSE: The purpose of this study was to determine the accuracy of 3-Tesla magnetic resonance imaging (MRI) in detecting ligamentum teres (LT) lesions in patients before they undergo hip arthroscopy for the treatment of femoroacetabular impingement. METHODS: From 2010 to 2011, data were prospectively collected on all patients presenting for treatment of hip pain. All patients underwent MRI followed by arthroscopic surgery. A radiologist prospectively documented MRI findings, and the surgeon recorded the findings at arthroscopy. Radiologic and surgical data included classification of the LT as not torn, hypertrophic, partially torn, or completely torn. All MR images were read by a single radiologist, and all surgery was performed by a single surgeon. Arthroscopy was considered the diagnostic gold standard. RESULTS: One hundred forty-two patients with a mean patient age of 35 years (range, 19 to 73 years) met the inclusion criteria. Only one complete LT tear was found in the study. The accuracy of MRI for the diagnosis of LT partial tears was 64%. The sensitivity and specificity of MRI for diagnosing partial tears of the LT were 9% and 91%, [corrected] respectively. The positive predictive value and negative predictive value were 31% and 67%, [corrected] respectively. The sensitivity and specificity of MRI for diagnosing hypertrophic LT were 32% and 78%, respectively. CONCLUSIONS: In this patient population, MRI demonstrated sensitivity and specificity of 34% and 50%, [corrected] respectively, in identifying any pathologic process of the LT. MRI is capable of ruling out [corrected] partial tears of the LT with high sensitivity (91%) and negative [corrected] predictive value (67%). LEVEL OF EVIDENCE: Level II, development of diagnostic criteria on basis of consecutive patients with universally applied gold standard.

Little finger carpometacarpal arthroplasty technique and result in 3 cases.

PURPOSE: To present our surgical technique and results for the treatment of posttraumatic arthritis of the little finger carpometacarpal (CMC) joint. METHODS: We performed a retrospective review of 3 patients who underwent our surgical technique. All patients had previously sustained intra-articular fractures of the base of the little finger metacarpal and presented with painful posttraumatic arthritis of the fifth metacarpal-hamate joint. Patients were treated with little finger CMC arthroplasty and extensor carpi ulnaris suspensionplasty. RESULTS: We observed the 3 patients in the office over a mean of 21 months and by telephone for a mean for 51 months postoperatively. They had improvements in wrist motion and grip strength. Finger motion remained stable. Pain and tenderness at the little finger CMC joint were eliminated. CONCLUSIONS: Our technique provided satisfactory pain relief and motion preservation for posttraumatic arthritis of the little finger CMC joint. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Soft Tissue Reconstruction of the Proximal Tibiofibular Joint by Using Split Biceps Femoris Graft with 5-Year Clinical Follow-up.

Instability of the proximal tibiofibular joint (PTFJ) is a rare clinical condition that presents unique challenges to treatment. We present the case of an active 26-year-old woman with a 4-year history of recurrent PTFJ subluxations, treated surgically at our institution using a split biceps femoris tendon graft for PTFJ reconstruction. She underwent several attempts at nonoperative management until we decided to proceed with surgical intervention. A split biceps femoris graft was used to restore stability of the PTFJ. Approximately 5 years postoperatively, she achieved full range of motion as well as functional and clinical Knee Society Scores of 94 and 90 points, respectively. To the best of our knowledge, this is the first case report of PTFJ instability treated surgically with long-term follow-up. Future studies should focus on the long-term satisfactory outcomes of soft tissue stabilization of a chronically unstable PTFJ.

The Most Cited Original Articles on Anterior Cruciate Ligament Injuries in the Past 20 Years.

Anterior cruciate ligament (ACL) injuries continue to be a major focus in sports medicine research. With so many changes to our understanding of ACL anatomy and with rapid advances in reconstruction techniques and rehabilitation protocols within the past 20 years, it is important to identify the landmark research that has laid the foundation for current ACL treatments. Using the Web of Science citation index, a search was carried out for the 30 most cited articles on ACL injury published in the last 20 years. The generated list was sorted from highest to lowest citation number. Clinical studies were subcategorized as therapeutic, prognostic, diagnostic, or economic/decision analysis and assigned a level of evidence. Basic science articles were designated anatomic, animal, biomechanical, or clinical. The number of citations per year (citation density) was calculated. The search yielded 6,345 articles. The total number of citations among the top 30 ranged from 188 to 611. Citation density ranged from 10.1 to 66.2. Nineteen articles were clinical, 8 were basic science, and 3 were video analyses. Clinical articles were most commonly therapeutic (18 of 19; 95%). Basic science articles were most commonly biomechanical (7 of 8; 88%). The most common level of evidence was Level II (10 of 19; 53%). More than half of the articles in the top 30 (16 of 30; 53%) were published in The American Journal of Sports Medicine. Many of these articles have played a large role in shaping current clinical practice regarding ACL injuries. We hope that by compiling this list we can draw attention to the continued need for studies of the highest level of evidence.

Detection of Total Knee Arthroplasties at Airport Security Checkpoints: How Do Updated Security Measures Affect Patients?

Airport security measures continue to be updated with the incorporation of the new body scanners and automatic target recognition software. The purpose of this study was analyze the incidence of: (1) triggering the security alarm; (2) extra security searches; (3) perceived inconvenience; and (4) presence of other surgical hardware in those who underwent total knee arthroplasty (TKA) and passed through airport security. A questionnaire was given to 125 consecutive patients with a TKA. Those who passed through airport security after January 2014 were considered for inclusion. A questionnaire was administered that addressed the number of encounters with airport security, metal detector activation, additional screening procedures, and perceived inconvenience. Out of the 125 patients, 53 met inclusion criteria. Out of the 53 patients, 20 (38%) reported that their prosthesis triggered a metal detector. Out of the 20 patients, 8 (40%) who reported triggering of metal detectors also reported the presence of surgical hardware elsewhere in the body. Eighteen of the 53 patients (34%) believed having a TKA was inconvenient for airplane travel. Compared with the historical cohort, alarms were triggered in 70 of 97 patients (p = 0.0001) and 50 of 97 reported inconvenience when traveling (n = 50 of 97 patients; p = 0.04). The incidences of those who underwent TKA triggering alarms and perceiving inconvenience when passing through airport security have decreased from previously published studies. This is most likely due to the recent updates and modifications to screening. As these security measures are modified and implant designs continue to evolve, this is an area of investigation that should continue.

Management of Nasal Fractures in Sports.

Nasal fractures represent approximately 60% of all maxillofacial injuries that occur in athletic activities; however, there are no current guidelines regarding immediate sideline management of these injuries. Therefore, the purpose of this article was to (1) summarize the anatomy, etiology, and incidence of nasal fractures, and (2) evaluate the current body of literature regarding immediate on-field and subsequent outpatient management. It is imperative to establish that the athlete's airway is not compromised and there are no other severe concomitant injuries, such as a concussion, ocular injury, or leakage of cerebrospinal fluid. Immediate closed reduction should not be attempted unless there is airway compromise or the practitioner has experience in performing it. The majority of athletes with these injuries in isolation may return to play; however, in our practice, we recommend they wear a face mask for 6 weeks after their injury. Despite our recommendations, we know there is a paucity of clinical studies on immediate sideline and longer-term management. Future studies should focus on establishing therapeutic algorithms that will allow physicians to make treatment recommendations to patients with strong evidence to support their decision.

Distal Radius Fracture Fixation With the Specialized Threaded Pin Device.

This study investigated the outcomes of extra-articular distal radius fractures and simple intra-articular radial styloid fractures stabilized with a novel threaded cannulated device. This was a retrospective study of 24 distal radius fractures treated with the T-Pin device (Union Surgical LLC, Philadelphia, Pennsylvania), with a minimum of 1 year of postoperative follow-up. Outcome data included wrist range of motion, grip strength, and pinch strength. Radiographs were analyzed to determine volar tilt and radial height. At final follow-up, patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. At an average of 2 years after surgery (range, 1-4 years), flexion was 89%, extension was 96%, supination was 99%, and pronation was 100% of contralateral wrist motion. Grip strength was 93% (range, 40%-137%) and lateral pinch strength was 99% (range, 48%-130%) of the contralateral upper extremity. The average final DASH score was 4.4 (range, 0-35). One patient lost 6 mm of radial height from the initial postoperative radiograph to the final follow-up radiograph. One patient elected to have the quiescent threaded pins removed, and 1 patient had tenderness with wrist range of motion that resolved after pin removal. After hardware removal, neither patient had further symptoms. No postoperative soft tissue complications occurred, and this was an expected benefit of the minimally invasive approach and intramedullary placement of the device. The stability of fixation allows patients to begin active range of motion early in the postoperative course. The threaded pin offers reliable fracture fixation for the treatment of extra-articular and simple articular distal radius fractures.

Arthroscopic Trapeziectomy With Suture Button Suspensionplasty: A Retrospective Review of 153 Cases.

BACKGROUND: Arthroscopic trapeziectomy with suture button suspensionplasty (ATBS) is a relatively new surgical option for the treatment of thumb carpometacarpal (CMC) osteoarthritis. Although ATBS has many potential benefits over alternative surgical treatments for CMC arthritis, little data exist regarding its safety and complication rates. The purpose of this study was to demonstrate that ATBS is associated with a low risk of complications within 1 year of surgery. METHODS: A retrospective review of patients treated with ATBS by one senior hand surgeon over a span of 3 years was performed. RESULTS: A total of 153 cases of ATBS were performed in 136 patients. Ninety-seven cases involved arthroscopic hemitrapeziectomies, and 56 involved arthroscopic complete trapeziectomies. There were 44 males and 92 females with a mean age of 62. Thirty-eight percent of the cases were graded as Eaton stage IV, 46% stage III, and 14% stage II CMC arthritis, while 3 cases (2%) were performed as revisions. Mean follow-up duration was 58 weeks. Mean preoperative key pinch strength of the affected versus the unaffected side was 92% compared with 95% postoperatively. Revision surgery was performed in 9 out of 153 cases (<6%). Of those 9 cases, 5 had additional minor bony debridement with subsequent improvement in pain, 3 had the implant repositioned due to button prominence, and 1 patient presented with osteomyelitis of the first and second metacarpals that was successfully treated with button removal and an antibiotic regimen. CONCLUSIONS: ATBS is a safe, minimally invasive procedure for treatment of symptomatic stages II through IV thumb CMC arthritis.

Single Incision Distal Biceps Repair With Hemi-Krackow Suture Technique: Surgical Technique and Early Outcomes.

BACKGROUND: Many surgical methods exist for distal biceps repair. We present the technique and early outcomes of a series of distal biceps repairs completed with a novel suturing technique utilizing a hemi-Krackow locking stitch at the tendon-bone interface. METHODS: A retrospective review was performed of patients who underwent primary distal biceps repair using a single anterior incision with 2 suture anchors utilizing a hemi-Krackow stitch. With both anchors, a locking stitch along the tendon edge was complimented by the other strand passing through the central aspect of the distal tendon and advanced to pull the tendon edge down to the bone with appropriate tension. Patients with revision surgery and the use of allograft were excluded. Clinical outcomes included elbow range of motion and grip strength. All patients completed a Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire and reported satisfaction level, pain level, and any postoperative complications. RESULTS: Fourteen patients with an average age of 51.3 years (range, 27.8-66.4 years) were included in the study. The dominant arm was injured in 9 cases. At an average of 16.4 months' follow-up (range, 6.8-34.3 months), all patients had elbow range of motion of 0° to >130°, and grip strength was 101.5% of the uninjured arm (range, 70.6%-121.4%). The Average QuickDASH score was 6.5 (range, 0-36.5). CONCLUSION: Single incision biceps repair with suture anchor fixation using our hemi-Krackow stitch provided a strong repair allowing easy tensioning of the biceps tendon to bone and showed satisfactory functional outcomes at early follow-up. No patients required revision surgery, and there was only 1 case of transient nerve complaints.

Arthroscopic Partial Meniscectomy for Meniscal Tears: A Review and Commentary on a Study by NEJM.

Arthroscopic partial meniscectomy (APM) has been demonstrated to be effective when performed in the appropriately indicated patient. However, a recent study published in the New England Journal of Medicine (NEJM) questioned whether or not the procedure actually had any clinical benefit whatsoever. Despite being a prospective, Level 1, randomized study, there are several aspects of the study that must be taken into consideration when interpreting the findings, including but not limited to the patient selection criteria, limited sample size, and lack of information regarding meniscal tear patterns. This study will critically review the recently published NEJM article, as well as analyze and assess the current body of APM literature.

Mini-open versus extended open release for severe carpal tunnel syndrome.

BACKGROUND: This study aims to compare surgical outcomes of severe carpal tunnel syndrome (CTS) treated with mini-incision versus extensile release. METHODS: The method employed in this study was a retrospective review of patients with severe CTS, defined by electrophysiologic studies showing non-recordable distal sensory latency of the median nerve. Patients underwent either a mini-incision (2 cm) release of the transverse carpal ligament (group 1) or extensile release proximal to the wrist flexion crease (group 2). Exclusion criteria included prior carpal tunnel release, use of muscle flap, multiple concurrent procedures, or a prior diagnosis of peripheral neuropathy. Group 1 included 70 wrists (40 females, 30 males). Group 2 included 64 wrists (35 females, 29 males). Reported outcomes included pre- and post-operative grip strength as well as Boston Carpal Tunnel Questionnaires (BCTQ). RESULTS: Patients in group 1 had a 22.6 % increase in grip strength postoperatively (4.5 months ± 5.0), while patients in group 2 had a 59.3 % increase (10.0 months ± 6.9). BCTQ surveys from group 1 (n = 46) demonstrated a symptom severity score of 12.93 and functional status score of 9.39 at an average follow-up of 41.9 ± 10.6 months. Group 2 (n = 42) surveys demonstrated averages of 12.88 and 9.10 at 43.1 ± 11.6 months. One patient in the mini-incision cohort required revision surgery after 2 years, while no patient in the extended release cohort underwent revision. CONCLUSION: No significant differences between the two procedures with regard to patient-rated symptom severity or functional status outcomes were found. Both techniques were demonstrated to be effective treatment options for severe CTS.

The effect of joint space on midterm outcomes after arthroscopic hip surgery for femoroacetabular impingement.

BACKGROUND: Excellent short-term results have been reported after hip arthroscopic surgery to address femoroacetabular impingement (FAI). Purpose/ HYPOTHESIS: The purpose of this study was to determine if patients with narrow joint spaces had inferior outcomes at a postoperative minimum of 5 years and if they had a higher conversion rate to total hip arthroplasty (THA). The hypothesis was that patients with ≤2-mm joint spaces would report inferior outcomes and that patients with >2-mm joint spaces would have improved survivorship (no conversion to THA). STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Between March 2005 and January 2008, prospectively collected data were analyzed for patients older than 18 years of age undergoing hip arthroscopic surgery for FAI. Radiographic measurements of joint space were collected, and hips were grouped as having preserved (>2 mm) or limited (≤2 mm) joint space. Outcome measures included the Western Ontario and McMaster Universities Arthritis Index (WOMAC), modified Harris Hip Score (MHHS), Hip Outcome Score (HOS) for activities of daily living and sports, and Short Form-12 (SF-12). RESULTS: There were 559 patients included, 466 (83%) of whom were contacted. Fifty-four patients with limited joint spaces (86%) converted to THA, while only 63 patients with preserved joint spaces (16%) converted to THA. The mean survival time for patients with preserved joint spaces was 88 months (95% CI, 85-91 months), and the mean survival time for patients with limited joint spaces was 40.0 months (95% CI, 33.7-46.3 months) (P = .0001). Complete follow-up outcome data were available on 323 patients, none of whom had THA, with a mean follow-up of 73 months. The mean postoperative HOS for activities of daily living and sports were significantly better in patients with preserved joint spaces (82 vs. 62 [P = .012] and 77 vs. 47 [P = .003], respectively) compared with those with limited joint spaces at a mean of 73 months postoperatively (range, 60-97 months). CONCLUSION: Hip arthroscopic surgery for FAI resulted in significantly better outcomes and activity levels at minimum 5-year follow-up in patients with preserved joint spaces. Hips with limited joint spaces converted to THA earlier than did those with preserved joint spaces.

"Crevasse" Lesions: A Unique Pattern of Femoral Head Chondral Damage.

OBJECTIVE: The purpose of this article is to report on a distinctive pattern of linear femoral head chondral lesions that were observed in 7 patients who underwent hip arthroscopy for the treatment of mixed-type femoroacetabular impingement (FAI). DESIGN: Between 2010 and 2012, 702 patients were treated with hip arthroscopy at our institution for symptomatic FAI. Among those patients, 7 were found to have a unique vertical chondral fissure located on the posterior femoral head. A retrospective review of the preoperative history, physical examination, and radiographic findings in addition to the intraoperative findings and surgical procedures performed was carried out for each patient. RESULTS: All patients were diagnosed with mixed-type FAI by dynamic examination intraoperatively. The femoral head cartilage lesions were noted to be both linear and deep and resembled the appearance of a crevasse. Three of the 7 patients in whom these lesions were identified reported an acute event preceding their pain. Of the other 4 patients, 3 were involved in sports that involved vigorous rotational hip movements: golf, tennis, and wrestling. Notably, none of these lesions were identifiable on preoperative 3-T MRI scans. CONCLUSIONS: This series reports on a previously undefined femoral head cartilage lesion. It is hypothesized that increased pathologic translational movements and perching of the femoral head on the posterior rim of the acetabulum create this pattern of chondral damage. Recognition of this pattern of damage on the femoral head is important in the setting of mixed-type FAI.

Four-corner arthrodesis with a radiolucent locking dorsal circular plate: technique and outcomes.

BACKGROUND: Scaphoid excision and four-corner arthrodesis (FCA) is an acceptable motion sparing procedure used to treat wrist arthritis. Recently, a locking dorsal circular plate composed of polyether-ether-ketone has been introduced (Xpode®; TriMed Inc.). The purpose of this study is to assess the efficacy of this specific plate design with regard to FCA. METHODS: A retrospective chart review of all patients who underwent FCA with an Xpode® between January 1, 2008 and December 31, 2012 was conducted. Patients were contacted and asked to return to clinic for clinical and radiographic follow-up. Patient demographics, range of motion, grip strength, and complications were collected from medical records. Patients completed a patient-rated wrist evaluation (PRWE). A paired t test was used to compare means, and p values <0.05 were considered statistically significant. RESULTS: Twenty-six procedures (24 patients) were identified. One patient required full wrist fusion following the initial procedure. Of the 25 remaining wrists, arthrodesis was successfully achieved in 20 (80 %). Eleven patients (13 wrists, 52 %) returned to clinic for an average follow-up of 28 months. Mean wrist extension improved from 30 to 47°, and flexion decreased from 33 to 23°. Average grip strength was 77 % of the uninjured side. The mean PRWE scores for pain and function were 19.7 and 17.1, respectively. Five patients underwent additional operations (two hardware removals, two contracture releases, and one distal radial ulnar joint arthroplasty). CONCLUSIONS: FCA with the Xpode® yielded reasonable results for pain and function and demonstrated a fusion rate of 80 %.

Treatment preferences for trigger digit by members of the American Association for Hand Surgery.

BACKGROUND: Trigger digit is a common pathology encountered by hand surgeons, but there is a lack of evidence-based guidelines. We investigated the treatment preferences of hand surgeons and explored whether geographic location, type of residency training, or clinical experience is associated with differences in practice. METHODS: An online survey was distributed via email by the American Association for Hand Surgery to 615 members. The survey consisted of 17 questions related to conservative and operative management of trigger digits. RESULTS: One hundred thirty-nine unique responses were received (22.6 %). Geographic distribution of respondents encompassed the entire USA and was not associated with variations in practice. Of the respondents, 56.8 % were trained in orthopedic surgery while 37.4 % had plastic surgery training. In regards to duration of practice, 8.6 % were in practice for up to 5 years, 29.5 % for 6-15 years, 33.8 % for 16-25 years, and 28.1 % for more than 25 years. Notably, the great majority of respondents preferred corticosteroid injections for initial treatment. Those who were willing to give three or more injections prior to surgery were more likely to be plastic surgeons in practice for 16 years or more. A large minority of surgeons utilized splinting in their conservative management. Orthopedic surgeons were more likely to perform tenolysis during pulley release and more likely to use monitored anesthesia care. CONCLUSIONS: Variation exists between the treatment algorithms of hand surgeons when managing a trigger digit. Some of these differences may be attributable to the type of training or the duration of clinical practice.