Bone Grafting in Total Wrist Arthrodesis With Large Bone Defects Using the Reamer-Irrigator-Aspirator: A Case Study of 2 Patients.

Total wrist arthrodesis, fusion of the carpus to the radius, is a well-established and commonly performed procedure for the management of pancarpal degenerative arthritis, trauma, and other severe diseases of the wrist. A well-known complication of this is radiocarpal nonunion, with a rate of 4.4%. Commonly, bone grafting is done at the time of the surgery using local bone, iliac crest bone graft, or cancellous allograft bone. The Synthes Reamer-Irrigator-Aspirator (RIA) is a flexible reamer originally designed as a single-pass intramedullary reamer that can be used in reaming of long bone fractures prior to insertion of an intramedullary nail. Recently, its use has been expanding to the harvesting of bone graft. We present a case study of 2 patients who had total wrist arthrodesis after severe trauma to the wrist resulting in severe bone loss, in whom we used an RIA to obtain bone graft, and both patients went on to union. The first patient is a 17-year-old male who sustained a blast injury from a firework resulting in a mangling injury to the wrist with soft tissue and severe bone loss of his carpus. After being treated with multiple debridements with an external fixator, he was definitively treated with a wrist fusion with RIA bone graft. He went on to osseous union by his 4-month follow-up. Our second patient is a 53-year-old woman who sustained a gunshot wound to the wrist resulting in massive bone loss of the distal radius. After being initially treated with multiple debridements and external fixation, she was treated with a wrist fusion with RIA bone graft and went on to osseous fusion by her 3-month follow-up. Neither patient had complications from the RIA procedure.

Patient Attitudes Toward Local Anesthesia With or Without Sedation for Minor Hand Procedures.

The purpose of this study was to assess patient preferences in this population with respect to anesthesia for minor hand procedures. This prospective cohort study assessed 183 patients undergoing minor hand surgery to determine their preferences for local-only anesthesia with or without sedation and the reasons for their choices. Fifty-six percent of patients preferred local anesthesia with sedation, 43% preferred local-only anesthesia, and 2% had no preference. Caucasian patients were 2.7 times more likely to choose local-only anesthesia. Other than race, no other demographics showed statistical significance with respect to anesthesia preference. Patients with a prior history of local-only anesthesia were half as likely to choose it again for future surgeries. Use of an IV and awareness of procedure were the most consistent factors affecting patient decisions. Nearly half of the patients preferred local-only anesthesia. Further prospective studies evaluating outcomes and patient satisfaction with these two types of anesthesia are necessary. (Journal of Surgical Orthopaedic Advances 27(4):317-320, 2018).

Complications of hip and knee joint replacement in solid-organ transplant patients.

This study investigated complication rates for 68 solid-organ transplant patients who had undergone 94 primary hip or knee joint replacements at a single institution from 1995 to 2008. There was a deep infection rate of 6.8% in the transplant patients compared to a 1.9% deep infection rate for all primary joint replacement patients at the Medical University of South Carolina over the same time period (odds ratio 4.48). All four infections in the transplant group occurred in diabetic patients. The joint revision rate for transplant patients was 13% (deep infection 6.8%, aseptic loosening 5.1%, instability 1.7%). Other complications included superficial infections (5.1%), deep venous thromboses (3.4%), and a nonfatal pulmonary embolus (1.7%). The deep infection rate for joint replacement in solid-organ transplant patients was higher than rates reported by most similar studies, and diabetic patients may be at particular risk.

Ultrasonography-guided de Quervain Injection: Accuracy and Anatomic Considerations in a Cadaver Model.

INTRODUCTION: Confirmation of pertinent anatomy and accurate needle placement for de Quervain injection may improve outcomes and limit complications. We evaluated the accuracy of the first extensor compartment in regard to the following: (1) anatomic assessment, (2) needle placement without imaging guidance, and (3) ultrasonography-guided injection with priority for the extensor pollicis brevis subcompartment. METHODS: Anatomic assessment and ultrasonography-guided first extensor compartment injection was completed in 50 cadaver specimens. Initial needle placement was done without the guidance of ultrasonography; its final position was evaluated with ultrasonography. Then, using ultrasonography, 1 mL of India ink was injected into the extensor pollicis brevis compartment. Open evaluation confirmed pertinent anatomy and injection accuracy. RESULTS: A subcompartment of the first extensor compartment was identified in 27 of 50 wrists; 18 of 27 compartments were complete and 9 of 27 were incomplete, with ultrasonographic evaluation having an accuracy rate of 94%. Accurate needle placement occurred in 26 of 50 wrists (52%) when ultrasonography was not used, but only 2 of 27 needles (7%) were located within the extensor pollicis brevis subcompartment. Ultrasonography-guided injection was 100% accurate (50 out of 50) and extensor pollicis brevis injection was 96% accurate (26 of 27) when two compartments were present. Minimal extravasation was identified in 6 of 50 wrists (12%). DISCUSSION: Ultrasonography-guided de Quervain injection improves injection accuracy through the visualization of compartmental anatomy and needle placement and may improve clinical outcomes by minimizing complications associated with extra-compartmental injection.