Carl M. Harper

Distal radial fractures in older men. A missed opportunity

BACKGROUND Fractures of the distal aspect of the radius are common, yet little is known about this type of fracture among older men. The purpose of this study was to compare fracture characteristics, treatment, and osteoporosis evaluation among men and women who had sustained a distal radial fracture. We hypothesized that the men would have similar patterns of injury and lower rates of evaluation for osteoporosis. METHODS We retrospectively reviewed the medical records of ninety-five men and 344 women over the age of fifty years who were treated for a distal radial fracture at a single institution over a five-year period. We assessed whether the patients had received a dual x-ray absorptiometry (DXA) scan and osteoporosis treatment within six months following the injury. Multivariate analysis identified independent predictors of bone mineral density (BMD) testing and osteoporosis treatment. RESULTS Men had less severe fractures than women (a Type-C fracture rate of 20% for men compared with 40% for women; p = 0.014). While 184 (53%) of the women had a DXA scan after injury, only seventeen (18%) of the men were evaluated (p < 0.001). Among the patients who underwent DXA scan, nine men (9% of men overall) and sixty-five women (19% of women overall) had a diagnosis of osteoporosis (p = 0.01). Male sex was an independent predictor of failure to undergo BMD testing as well as receive subsequent treatment with calcium and vitamin D or bisphosphonates (p < 0.001). CONCLUSIONS Significantly fewer men received evaluation for osteoporosis following a distal radial fracture, with rates of evaluation unacceptably low according to published guidelines.

Acute Idiopathic Blue Finger: Case Report

An acute blue finger is an uncommon but potentially serious finding with a heterogeneous etiology. A rare group of patients will present with acute, atraumatic, nonischemic blue fingers. The clinical course of these patients appears to be benign. We describe the presentation of an otherwise healthy 22-year-old woman with an acute idiopathic blue finger. We highlight the differential diagnoses and evaluation of this rare condition.

Prevention of Thumb Web Space Contracture With Multiplanar External Fixation.

Thumb web space contracture following hand trauma can be disabling with numerous reconstructive procedures existing to correct the resultant deformity. Following marked soft tissue injury to the hand we utilized the Stryker Hoffmann II Micro External Fixator System to link the first and second metacarpals by a multiplanar system using 1.6 or 2.0 mm self-drilling half-pins and 3 mm carbon fiber connecting rods. This facilitated placement of the thumb in maximal palmar abduction as well as allowed adjustment of thumb position throughout the postoperative period. This technique was performed on 5 patients. Two patients were treated with a first web space external fixator for table saw injuries to the radial aspect of the hand. An additional 2 patients were treated with a first web space external fixator following metacarpophalangeal joint capsular release in the setting of thermal burns. A fifth patient underwent second ray amputation, trapeziectomy and trapezoidectomy for squamous cell carcinoma with subsequent stabilization with the external fixator. The external fixator was left in place until soft tissues were healed (average 5.5 wk). The patients were allowed to mobilize their hand in as much as the external fixator allowed, and no device-associated complications were noted. Thumb web space was preserved with passive and supple thumb circumduction and web space abduction/adduction in all patients at an average follow-up of 5 months. The average Quick Dash Score was 35±5 and the average Modern Activity Subjective Survey of 2007 was 30±8.

The arthroscopic treatment of cyclops syndrome

BackgroundCyclops syndrome is caused by a scar tissue nodule adjacent to the tibial tunnel of the anterior cruciate ligament graft after surgery. These lesions result in pain and loss of extension with impingement of the lesion. The goal of this series is to present our 10-year experience with this condition. MethodsA retrospective chart review of our institutions sports medicine service was conducted for a 10-year period. Patients were included in the study if they had a diagnosis of cyclops lesion, had débridement of that lesion during the study period and had sufficient data for analysis. This search resulted in the identification of eight patients. Average follow-up from the index procedure to final follow-up was 21.9 months. ResultsThere was an average of 8.9 months from the index procedure to débridement of the cyclops lesion. Final postoperative range of motion was 1-129° with a 128° arc. Average range of motion improvement was 11°. Before surgery, all patients described pain and occasional swelling, with objective findings consistent with extension impingement. All patients had improvement of these symptoms at final follow-up. The average Lysholm score at final follow-up was 91.5. ConclusionsCyclops lesions should be suspected after arthroscopic intra-articular knee surgery when the patient has difficulty regaining extension concurrent with a sensation of impingement at terminal extension. These lesions can be treated successfully with arthroscopic débridement. Physical therapy should be continued after débridement to maintain and improve upon gains made in the operating room.

Open Distal Radius Fractures: Timing and Strategies for Surgical Management

Open distal radius fractures are rare injuries with few studies to guide treatment. Degree of soft tissue injury and contamination may be a primary consideration to dictate timing and operative intervention. Antibiotics should be started as early as possible and include a first-generation cephalosporin. Surgical fixation remains a matter of surgeon preference: although studies support the use of definitive internal fixation, many surgeons address contaminated injuries with external fixation. Although postoperative outcomes are similar to closed injuries for low-grade open distal radius fractures, high-grade injuries with more complex fracture patterns carry a high risk of complications, poor outcomes, and repeat surgical procedures.

Management of Proximal Interphalangeal Joint Fracture Dislocations

Fracture dislocations of the proximal interphalangeal (PIP) joint of the finger are often caused by axial load applied to a flexed joint. The most common injury pattern is a dorsal fracture dislocation with a volar lip fracture of the middle phalanx. Damage to the soft-tissue stabilizers of the PIP joint contributes to the deformity seen with these fracture patterns. Unfortunately, these injuries are commonly written off and left untreated. A late-presenting PIP joint fracture dislocation has a poor chance of regaining normal range of motion. The provider must be suspicious of these injuries. Treatment options and algorithm are reviewed.

Lunotriquetral Ligament Reconstruction Utilizing a Palmaris Longus Autograft

Injury to the lunotriquetral ligament can result in midcarpal instability, with resultant alterations in normal wrist kinematics and subsequent arthrosis. We performed a previously undescribed technique of lunotriquetral ligament reconstruction in two patients utilizing a palmaris longus tendon autograft. Average age at presentation was 24 years old with a mean follow up of 10 months. Average range of motion was 62.5° of flexion and 57.5° of extension. Total arc of motion was 83% of the contralateral uninvolved extremity. Average grip strength was 31 kg which was 91% of the contralateral extremity. Average Quick Disability of Arm, Shoulder and Hand score was 12.5 and Modern Activity Subjective Survey of 2007 was 1.5. No complications were noted.

An online system shows promise for the early detection of osteoporosis in Asian women

Commentary on : Chang SF, Hong CM, Yang RS. The performance of an online osteoporosis detection system a sensitivity and specificity analysis. J Clin Nurs 2014;23:1803–9.[OpenUrl][1][CrossRef][2][PubMed][3] Osteoporosis implications with regard to fragility fracture have been well established, causing a high cost to society and imparting significant morbidity to the patient. This study was conducted in Taiwan where the prevalence of osteoporosis in adults older than 35 years has been estimated at approximately 11%, with the female population having a nearly three times higher prevalence (14.9%) compared to … [1]: {openurl}?query=rft.jtitle%253DJ%2BClin%2BNurs%26rft.volume%253D23%26rft.spage%253D1803%26rft_id%253Dinfo%253Adoi%252F10.1111%252Fjocn.12209%26rft_id%253Dinfo%253Apmid%252F23876185%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1111/jocn.12209&link_type=DOI [3]: /lookup/external-ref?access_num=23876185&link_type=MED&atom=%2Febnurs%2F18%2F4%2F114.atom