Outcomes After Use of the Induced Membrane Technique for Fractures of the Upper Extremity.

PURPOSE: The purpose of this study was to review a series of cases in which the induced membrane technique was used for fractures with segmental bone loss in the upper extremity. We aimed to examine patient indications, outcomes based on union rates, and complications associated with this technique. METHODS: An institutional review board-approved database at our institution was used to identify patients based on either diagnosis or procedure codes commonly used during the induced membrane treatment. The database was queried between 2003 and 2020 and included patients with segmental bone defects from acute trauma, nonunions, and infections. Demographic data, mechanism of injury, size and extent of the bone defect, treatment indication and methods along with intraoperative and postoperative complications were retrospectively reviewed. RESULTS: We identified 23 patients who met our inclusion criteria, including 15 patients with traumatic segmental bone loss and 8 patients with chronic nonunions and/or infections. Fourteen cases involving the bones of the forearm, 8 cases involving the metacarpals and 3 cases involving the phalanges were identified. Radiographic union was ultimately demonstrated in 21/23 patients (91.3%) with a median time to union of 20 weeks (range 13-29 weeks). A total of 10 patients required unplanned reoperation, with 4 nonunions requiring repeat plating and grafting procedures, and 1 patient ultimately underwent amputation for persistent infection. CONCLUSIONS: The induced membrane technique represents an effective treatment option for acute traumatic bone loss as well as chronic fracture nonunions. The technique has potential challenges, as 10 patients (43.5%) in our series required unplanned reoperations with 4 patients (17.4%) requiring a repeat intervention for persistent nonunion. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Opioid-Free Analgesia Provides Pain Control Following Thumb Carpometacarpal Joint Arthroplasty.

BACKGROUND: We hypothesized that an opioid-free (OF), multimodal pain management pathway for thumb carpometacarpal (CMC) joint arthroplasty would not have inferior pain control compared with that of a standard opioid-containing (OC) pathway. METHODS: This was a single-center, randomized controlled clinical trial of patients undergoing primary thumb CMC joint arthroplasty. Patients were randomly allocated to either a completely OF analgesic pathway or a standard OC analgesic pathway. Patients in both cohorts received a preoperative brachial plexus block utilizing 30 mL of 0.5% ropivacaine that was administered via ultrasound guidance. The OF group was given a combination of cryotherapy, anti-inflammatory medications, acetaminophen, and gabapentin. The OC group was only given cryotherapy and opioid-containing medication for analgesia. Patient-reported pain was assessed with use of a 0 to 10 numeric rating scale at 24 hours, 2 weeks, and 6 weeks postoperatively. We compared the demographics, opioid-related side effects, patient satisfaction, and Veterans RAND 12-Item Health Survey (VR-12) results between these 2 groups. RESULTS: At 24 hours postoperatively, pain scores in the OF group were statistically noninferior to, and lower than, those in the OC group (median, 2 versus 4; p = 0.008). Pain scores continued to differ significantly at 2 weeks postoperatively (median, 2 versus 4; p = 0.001) before becoming more similar at 6 weeks (p > 0.05). No difference was found between groups with respect to opioid-related side effects, patient satisfaction, or VR-12 results. CONCLUSIONS: A completely opioid-free perioperative protocol is effective for the treatment of pain following thumb CMC joint arthroplasty in properly selected patients. LEVEL OF EVIDENCE: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.