Andrew D. Sobel

Pediatric thoracolumbar spine trauma.

Abstract Thoracolumbar spine trauma is an important cause of morbidity and mortality in pediatric patients. Special attention to this population is necessary because several unique features of the growing pediatric spine separate these patients from adult patients. These injuries are frequently associated with high‐energy trauma and concurrent thoracic or abdominal injuries that require coordinated multidisciplinary care. Thoracolumbar spine trauma in pediatric patients may lead to compression fractures, burst fractures, flexion‐distraction injuries (ie, Chance fracture), fracturedislocation injuries, apophyseal fractures/herniations, and spinous process and transverse process fractures. Depending on the nature of the injury and the patients level of skeletal maturity, thoracolumbar spinal injuries may have substantial ability to heal and remodel. Because the impact of thoracolumbar spinal injury on pediatric patients can be devastating, appropriate early diagnosis and management, as well as long‐term follow‐up, are imperative.

Pediatric Orthopedic Hoverboard Injuries: A Prospectively Enrolled Cohort

&NA; Hoverboards pose a significant risk of musculoskeletal injury to pediatric riders. A prospectively enrolled cohort yielded 9 pediatric patients injured while riding hoverboards in 2016. Eight of the injuries involved the upper extremity, and one involved the lower extremity. No riders wore any safety equipment and injury patterns modeled those seen in skateboard riders.

Tennis and Golfer’s Elbow (Epicondylitis)

Lateral and medial epicondylitis are common upper extremity tendinopathies that are frequently studied. A thorough understanding of the pathologic processes, examination findings, and treatment strategies is important for orthopedic surgeons as well as general practitioners in order to deliver effective patient care.

Flexor Tendon Injuries

Flexor tendon injuries are potentially debilitating injuries with developing strategies for treatment. A solid understanding of flexor tendon and flexor pulley anatomy, discerning examination maneuvers, and operative treatment is important for improving outcomes.

Utility of Prolotherapy for Upper Extremity Pathology

Prolotherapy is a method of treatment of painful musculoskeletal conditions whereby a sclerosing agent is injected into an area of tendinosis or osteoarthritis to strengthen and repair painful connective tissue. It is a safe, effective, and relatively inexpensive nonsurgical treatment modality. This article provides a history of prolotherapy, discusses its proposed mechanisms of action, and provides a review of the existing literature on prolotherapy as a treatment for upper extremity pathologies, specifically, hand osteoarthritis, lateral epicondylitis, and rotator cuff disease.

Cost-Effective Management of Stenosing Tenosynovitis

PURPOSE Stenosing tenosynovitis (STS) is a common condition treated by hand surgeons. Limited evidence exists to support the nonsurgical management of STS. The purpose of this study was to prospectively evaluate a cohort of patients with STS, and to determine the strategy for treating patients with this condition that is most cost effective in terms of dollars reimbursed by payers. METHODS Prospective data were collected on patients diagnosed with STS between March 2014 and September 2014. All patients were initially treated with a corticosteroid injection. Patients with persistent symptoms were given the option of injection or surgery. A maximum of 3 injections were offered. All patients were evaluated every 6 months through office appointments or phone calls. A cost analysis was performed in our cohort using actual reimbursement rates for injections, initial and established patient visits, and facility and physician fees for surgery, using the reimbursement rates from the 6 payers covering this patient cohort. Cost savings were calculated based on offering 1, 2, and 3 injections. RESULTS Eighty-eight digits in 82 patients were followed for an average of 21.9 months (range, 18.7-22.7 mo) after an initial corticosteroid injection. Thirty-five digits went on to surgical release, whereas 53 digits were treated nonsurgically. Had all patients initially undergone surgery, the cost would have totaled

Adult Carpal Injuries

169,088.98 (

Soft Tissue Injuries of the Hand

1,921 per digit). Offering up to 3 injections yielded a potential savings of

Adult Forearm Fractures

72,730 (

Adult Digital and Metacarpal Injuries

826 per digit) or 43% of the total cost. For the 33 patients who underwent more than 1 injection, offering a second injection yielded potential savings of