Leo T. Kroonen

Cubital Tunnel Syndrome

Compression of the ulnar nerve at the elbow, or cubital tunnel syndrome, is the second most common peripheral nerve compression syndrome in the upper extremity. Diagnosis is made through a good history and physical examination. Electrodiagnostic testing can confirm the diagnosis and severity of injury to the nerve. Surgical intervention is indicated when nonoperative treatment does not relieve the symptoms. There is currently no consensus on the best surgical treatment of cubital tunnel syndrome. However, the only randomized prospective studies to compare treatment options to date indicate that simple decompression and anterior transposition yield comparable results.

The Intermetacarpal Angle Screening Test for Ulnar-sided Carpometacarpal Fracture-Dislocations

PURPOSE Ulnar-sided carpometacarpal injuries can be difficult to diagnose radiographically. We hypothesized that the resting position of the normal hand during lateral radiography provides a consistent relationship between the rays and that dorsal subluxation of the metacarpal base in fracture-dislocations increases the angle between the uninjured index and long metacarpals and the injured small metacarpal. METHODS A control group of 100 consecutive patients with normal hand radiographs and a series of 12 patients with known carpometacarpal fracture-dislocations were examined. Angles between the index and small metacarpal shaft (I-S IMA) and between the long and small metacarpal shaft (L-S IMA) were measured on the lateral hand radiograph. RESULTS In the control group, the mean I-S IMA and L-S IMA were both 6°. In the study group, the mean I-S IMA was 18°, and the mean L-S IMA was 16°. Intraobserver and interobserver reliability was good to excellent for both groups, and a statistical difference existed between the normal and study groups. Based on box-plot analysis of normal and abnormal IMAs, a natural dividing line existed at 10°. With this dividing line, the I-S IMA had a sensitivity of 92% and a specificity of 81%, and the L-S IMA had a sensitivity of 83% and a specificity of 84%. CONCLUSIONS Both the I-S IMA and the L-S IMA were useful screening measurements on lateral hand radiographs for detection of ulnar-sided carpometacarpal fracture-dislocations. When evaluating posttraumatic ulnar-sided hand pain, advanced imaging should be considered if the I-S IMA or the L-S IMA is greater than 10°.

Ablative fractional photothermolysis in the treatment of scar contractures of the wrists and forearms: a retrospective data analysis.

Funding sources: This study was supported by a grant from Hospital Cl ınic de Barcelona (Ajut a la recerca ‘‘Josep Font’’) and Red Tem atica de Investigaci on Cooperativa en C ancer (RTICC, FEDER) (RD07/0020/2004 and RD12/0036/ 0044). The research at the Melanoma Unit in Barcelona is partially funded by Spanish Fondo de Investigaciones Sanitarias grant 09/01393; CIBER de Enfermedades Raras of the Instituto de Salud Carlos III, Spain; AGAUR 2009 SGR 1337 of the Catalan Government, Spain; European Commission under the 6th Framework Programme, Contract No. LSHC-CT-2006-018702 (GenoMEL) and National Cancer Institute (NCI grant number CA83115) of the US National Institutes of Health (NIH) (CA83115).

Longitudinal Split Tear of the Extensor Pollicis Brevis Tendon: Report of 2 Cases

Two patients presented with radial-sided wrist pain and longitudinal split tears of the extensor pollicis brevis tendon. Surgical debridement and repair was performed on the first patient with good results. Early diagnosis in the second patient led to successful treatment with immobilization alone. If diagnostic maneuvers for de Quervain tenosynovitis produce pain in a location other than the radial styloid, advanced imaging should be considered to identify other anatomic causes for the pain.

The AOA-JOA 2014 Exchange Traveling Fellowship: Banzai and Beyond

The American Orthopaedic Association-Japanese Orthopaedic Association (AOA-JOA) traveling fellowship was established in 1992 as a method for creating collaboration between the American and Japanese orthopaedic communities and providing a friendly exchange of current practices and scientific endeavors. The fellowship is designed to allow early-career orthopaedic surgeons the opportunity to participate in international travel and scholarship. This years traveling fellows (Hassan Mir, Wakenda Tyler, Leo Kroonen, and Dan Zlotolow) all hail from different parts of the United States and have a variety of practice subspecialties. During the fellowship, the fellows were able to visit five academic centers that spanned the entire country of Japan as well as the JOA meeting in Kobe. The experience is one that contributed to the growth and development of each fellows practices and depth of understanding of orthopaedic surgery.