Eric P. Hofmeister

The Surgical Treatment of External Coxa Saltans (the Snapping Hip) by Z-plasty of the Iliotibial Band

Purpose A snapping hip (coxa saltans) secondary to a tight iliotibial band rarely needs surgical intervention. The purpose of this study is to present the surgical results of refractory external-type snapping hip by Z-plasty of the iliotibial band. Materials and Methods Nine symptomatic snapping hips in 8 consecutive patients (1 bilateral) from August 1997 through March 2002 who underwent an iliotibial band Z-plasty were reviewed. Results Eight of the 9 hips were in active-duty military and 1 was a civilian, with an average age of 25.6 years (range, 21 to 38 years). Mean duration of symptoms prior to surgical intervention was 25.2 months (range, 16 to 39 months) with an average follow-up of 22.9 months (range, 7 to 38 months). All patients had complete resolution of the snapping hip, and all but 1 returned to full unrestricted activities. The 1 failure had persistent groin pain but no residual snapping. Conclusions Patients with snapping hip of the iliotibial band refractory to conservative treatment are rare. The surgical results of Z-plasty are excellent and predictable. Careful screening is necessary to preclude other confounding diagnoses. Z-plasty is recommended as an effective surgical treatment of the refractory snapping hip secondary to iliotibial band tightness.

Comparison of 2 methods of immobilization of fifth metacarpal neck fractures: a prospective randomized study.

PURPOSE The objective of this study was to prospectively compare the effectiveness of 2 methods of cast immobilization for fifth metacarpal neck fractures with respect to the time required for cast application, durability and tolerability of the cast, efficacy of maintaining reduction, and postimmobilization range of motion. METHODS After closed reduction, 81 predominately young, active-duty patients were prospectively randomized to a short-arm cast with volar outriggers (SAC-VOR) or to a short-arm cast extended to the proximal interphalangeal joint with a 3-point mold (MCP-ext). Radiographs were obtained before reduction and after reduction at 1 and 4 weeks. Outcome measures (Disabilities of the Arm, Shoulder, and Hand questionnaire), cast durability, radiographic parameters, and complications were evaluated at each visit. Final range of motion and grip strengths were obtained at the 3-month follow-up. RESULTS The average time for cast application was less for the MCP-ext group compared with that of the SAC-VOR group. An equal number of casts in each group (7) required replacement during treatment. There were no statistically significant differences in range of motion or final grip strength between the 2 techniques. Radiographic callus was seen in all patients at 4 weeks, and there was no difference in the 4-week postreduction angulation in the lateral or posteroanterior planes. In comparing the maintenance of the reduction, there was no difference in alignment in either the posteroanterior or lateral planes based on cast type. CONCLUSIONS There was no difference between the 2 groups on maintaining the reduction on final lateral radiographs. Stiffness was not a complication of either group. Advantages of the MCP-ext cast include quicker application and, to a much lesser degree, better tolerability, range of motion, and final grip strength.

Treatment of Advanced Carpometacarpal Joint Disease: Trapeziectomy and Hematoma Arthroplasty

Some surgical treatment options of painful basal joint arthritis do not require complex arthroplasty or suspensionplasty techniques. Simple trapeziectomy with temporary pinning of a slightly overdistracted thumb metacarpal can provide reliable pain relief, good motion, and functional stability. Recent literature supports alternative options when compared with formal ligament reconstruction or suspensionplasty procedures. Simple trapeziectomy is associated with less morbidity due to shorter operative times and the lack of need for graft harvest and ligament reconstruction.

Percutaneous Fixation of Stable Scaphoid Fractures

The increased awareness of scaphoid fractures and their complications has prompted early aggressive treatment to prevent the sequelae of nonunions and degenerative changes in the carpus. Despite this, many fractures require prolonged immobilization, often resulting in diminished motion and time lost in sports or employment. In an effort to diminish the time to union and decrease prolonged immobilization, percutaneous fixation techniques have been described and recently popularized by several authors. The indications and contraindications, technique, complications, and rehabilitation of treatment of both dorsally and volarly placed percutaneous screw fixation of stable scaphoid fractures will be the focus of this paper.

Anterior and Posterior Interosseous Neurectomy for the Treatment of Chronic Dynamic Instability of the Wrist

The purpose of this study was to determine the results of combined anterior and posterior interosseous neurectomy (AIN/PIN) in patients with chronic wrist pain secondary to dynamic instability, and to determine the predictability of selective AIN/PIN blocks with respect to pain relief, grip strength, and outcome of the neurectomy. A prospectively accrued chronic wrist pain registry was undertaken. Inclusion criteria were patients with arthroscopically confirmed dynamic wrist instability who had undergone a diagnostic AIN/PIN injection, followed by a single dorsal incision neurectomy. All patients completed Disabilities of the Arm, Shoulder and Hand outcome questionnaires preoperatively and at intervals postoperatively. Pre- and postoperative range of motion, grip strength, and percentage pain relief were recorded. Over a 3-year period, 50 wrists (48 patients) were enrolled: average follow-up was 28 months (range: 24–42 months). The average improvement in grip strength after denervation was 16% (p = 0.076), the average improvement in subjective pain rating was 51% (p < 0.0001), and the average improvement in Disabilities of the Arm, Shoulder, and Hand scores was 15 points (p = 0.0039). Improvement of pain from diagnostic injections was not predictive of final improvement of pain; however, improvement in grip strength after diagnostic injections did correlate with improved grip strength after surgery. Lack of improvement in subjective pain rating or grip strength after diagnostic injection approached statistical significance. There was no decrease in range of motion postoperatively. Fourteen patients (16 wrists) failed as defined by need for subsequent surgery. The results of AIN/PIN neurectomy demonstrate that it may be an effective alternative to wrist salvage or reconstructive procedures within the first few years of follow-up.

Zone I Rupture of the Flexor Digitorum Profundus Tendon Caused by Blunt Trauma: A Case Report

Traumatic ruptures of flexor tendons as a result of blunt trauma without an associated pathologic condition are rare. This is a case of a midsubstance flexor tendon rupture as a result of closed direct trauma. The patient sustained a flexor digitorum profundus (FDP) rupture 1 cm proximal to its insertion on his right ring finger without any accompanying laceration. Additionally, this case highlights the utility of ultrasound in diagnosing ruptured flexor tendon, which has been demonstrated in prior studies.

Hypersensitivity to Polymethylmethacrylate Following Shoulder Hemiarthroplasty

Acrylic resins have been used for many years in several health-related applications due to their ease of use, favorable material properties, and relative cost. Cements containing polymethylmethacrylate (PMMA), in particular, have been widely accepted for use in orthopedic surgery, as well as in other fields of medicine. Although relatively rare, the potential for acrylic resins such as PMMA to induce hypersensitivity reactions via cutaneous or mucosal exposures has been reported; however, comparatively few cases have been described of patients reacting adversely to acrylic resins used as permanent cements during surgical procedures. This article reports a hypersensitivity reaction to PMMA cement applied in a right shoulder hemiarthroplasty, which initially presented as a possible postoperative infection. It is believed to be the first case in the literature of such a reaction occurring in an upper extremity prosthesis.

Operative Grafting of a Pseudoaneurysm of the Radial Artery After a Pediatric Both-bone Forearm Fracture

Complications following reductions of forearm fractures in children include loss of reduction, malunion, stiffness, nerve injury, and arterial damage. Vascular complications following pediatric both bone forearm fractures are rare. This article presents a case of a closed both-bone forearm fracture in a child treated with closed reduction and casting.

Erratum to: 6-week radiographs unsuitable for diagnosis of suspected scaphoid fractures (Arch Orthop Trauma Surg, (2016), 136, (771-778), 10.1007/s00402-016-2438-4)

Wint, John M. Erickson, John McAuliffe, John T. Capo, John Taras, Jose A. Ortiz, Julie Adams, Karl-Josef Prommersberger, Kevin M. Rumball, Kyle D. Bickel, Lior Paz, Lisa Lattanza, Louis Catalano III, M. Jason Palmer, Marc J. Richard, Marco Rizzo, Maurizio Calcagni, Maximillian Soong, Megan M. Wood, Michael Baskies, Michael Behrman, Michael Darowish, Michael Nancollas, Michael W. Grafe, Michael W. Kessler, Miguel A. Pirela-Cruz, M. P. Bekerom, Naquira Escobar Luis Felipe, Nathan Hoekzema, Oleg M. Semenkin, Patrick W. Owens, Philip Blazar, Ralph M Costanzo, Ramon de Bedout, Renato M. Fricker, Richard L. Hutchison, Richard S. Gilbert, Rick Papandrea, Robert R. Slater, Robert R. L. Gray, Ryan Klinefelter, Ryan P. Calfee, Sander Spruijt, Sanjeev Kakar, Saul Kaplan, Seth Dodds, Stephen A. Kennedy, Steven Beldner, T. Apard, Taizoon Baxamusa, Thomas G. Stackhouse, Todd Siff, W. Arnnold Batson, Warren C. Hammert. Erratum to: Arch Orthop Trauma Surg (2016) 136:771–778 DOI 10.1007/s00402-016-2438-4

Frontline Orthopedic Care for Hand Injuries

Injuries to the hand in the combat environment can range from trivial, small lacerations to extensive-, explosive-type injuries, leaving the hand and upper extremity mangled. With the improved personal protective equipment and advances in vehicles, morbidity and mortality on the battlefield have been greatly improved. However, the extremities remain vulnerable to injury. Although many of these injuries can appear quite daunting on first inspection, it is important to keep a very systematic approach to examining the hand. The goal of initial treatment is to: