RESUMO

PURPOSE: The purpose of the study was to determine if perioperative prescription anticoagulant (AC) or antiplatelet (AP) medication use increases the rate of revision surgeries or complications following wide-awake hand surgery performed under local anesthesia. METHODS: All patients who underwent outpatient wide-awake hand surgery under local anesthesia without a tourniquet by two fellowship-trained orthopedic hand surgeons at a single academic practice over a 3-year period were included. Prescription history was reviewed to determine if any prescriptions were filled for an AC/AP drug within 90 days of surgery. All cases requiring revision were identified. Office notes were reviewed to determine postoperative complications and/or postoperative antibiotics prescribed for infection concerns. The number of revisions, complications, and postoperative antibiotic prescriptions were compared between patients who did, and did not, use perioperative AC/AP drugs. RESULTS: A total of 2,162 wide-awake local anesthesia surgeries were included, and there were 128 cases (5.9%) with perioperative AC/AP use. Of the 2,162 cases, 19 cases required revision surgery (18 without AC/AP use and one with AC/AP use). Postoperative wound complications occurred in 42 patients (38 without AC/AP use and four with AC/AP use). Of the wound complications, four were related to postoperative bleeding, one case of incisional bleeding, and three cases of incisional hematomas (three without AC/AP use and one with AC/AP use). None of these patients required additional intervention; their incisional bleeding or hematoma was resolved by their subsequent office visit. Sixty-five patients received postoperative antibiotics for infection concerns (59 without AC/AP use and six with AC/AP use). CONCLUSIONS: Prescription AC/AP medication use in the perioperative period for wide-awake hand surgery performed under local anesthesia was not associated with an increased risk for revision surgery or postoperative wound complications. This study demonstrates the safety of continuing patients' prescribed AC/AP medications during wide-awake hand surgery. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognosis IV.

RESUMO

Purpose: Injury to the scapholunate (SL) interosseous ligament (SLIL) is a common cause of carpal instability. Internal brace augmentation has been used in various ligament repair procedures; however, further investigation of its outcomes in hand surgery is needed. This study aimed to examine outcomes for patients who underwent SLIL repair with internal brace augmentation. Methods: Patients who underwent SLIL repair with the internal brace technique and had at least 1 year of follow-up were contacted. Available patients returned for an in-person evaluation with new radiographs and physical examination. If patients could not be contacted but had x-rays and physical examinations performed at greater than 1 year after surgery, these data were collected from their medical records. Participating patients completed the QuickDASH and Patient-Rated Wrist Evaluation surveys and rated their satisfaction with the surgery. Outcomes assessed included wrist range of motion, grip strength, scaphoid shift test, SL gap, SL angle, and radiographic evidence of radiocarpal arthritis. Results: We collected outcomes for 14 SLIL repairs among 13 patients (12 male). Mean length of the follow-up was 41 months (n = 14, 17-64). Mean QuickDASH and Patient-Rated Wrist Evaluation scores were 6.1 (0-43.2) and 9.6 (0-65), respectively. Radiographic measurements remained stable from immediate to latest follow-up, and no radiocarpal arthritic changes were noted. However, SL gap decreased from a mean of 5.33 mm (3.4-6.7) before surgery to 3.34 mm (2-4.6) at the latest follow-up, and SL angle decreased from a mean of 79.5° (67°-97°) before surgery to 67.3° (51°-85°) at the latest follow-up. All scaphoid shift tests were stable. Conclusions: Therefore, SL internal brace augmentation has favorable short-term results with improvements in pain, function, satisfaction, and carpal alignment at greater than 1 year postoperatively. This technique can be an effective option for the management of SL instability in the short term. Type of study/level of evidence: Therapeutic IV.

RESUMO

Purpose: Distal radius fractures (DRFs) are among the most common fractures and occur among all age groups. Carpal tunnel syndrome (CTS) is a known sequela of DRFs, but its incidence is poorly understood. This study was undertaken to determine the incidence of CTS following a DRF, with the hypothesis being that CTS occurs more commonly after nonsurgical treatment of a DRF. Methods: The TriNetX US Collaborative Network was queried for all patients diagnosed with DRFs from January 2016 to December 2022. Cohorts were defined by inclusion and exclusion of the procedure Current Procedural Terminology codes into surgical and nonsurgical groups and subsequent ICD-10 diagnosis codes of CTS. Statistical analysis was performed to determine differences in management across the study period. Results: A total of 39,603 patients met inclusion with a diagnosis of a DRF. The incidence of CTS within one year of a DRF was 5.3%. Among all DRF cases, 10,279 (26%) patients underwent surgical treatment, whereas 29,324 (74%) patients underwent nonsurgical treatment. The incidence of CTS in the surgical group was 1194 (12%), whereas the incidence of CTS in the nonsurgical group was 915 (3%). Patients undergoing surgical treatment for a DRF had a 9% risk of developing CTS, whereas patients undergoing nonsurgical treatment had a 5% risk. Among all the patients having been diagnosed with CTS, 63% of those with an operatively treated DRF underwent surgical release, whereas 23% of those with a nonoperatively treated DRF underwent surgical release for CTS. Conclusions: Patients having undergone surgical treatment for DRF had a four times higher rate of developing CTS, compared with those having undergone nonsurgical treatment. Among patients who underwent surgical treatment of a DRF with the subsequent development of CTS, there was a nearly three times higher rate of surgical release of CTS. Type of study/level of evidence: Prognostic III.

RESUMO

Purpose: Forearm shaft fractures of the radius and/or ulna are typically repaired with plates and screws, with 3.5 mm nonlocking screws being generally recommended. However, smaller plates and screws, either nonlocking or locking, can also be applied. The purpose of this study was to retrospectively review whether fracture healing rates and related complications are affected by plate size and type. Methods: Patient demographic and descriptive data were retrospectively collected for all patients with a forearm shaft fracture treated with repair of the radial shaft and/or ulna shaft between 2017 and 2021 at a multiprovider and multilocation single institution. Inclusion criteria involved use of a locking plate with a minimum radiographic follow-up of 60 days and/or until fracture union was confirmed. Results: A total of 110 patients met inclusion criteria. There were 45 (40.9%) females and 65 (59.1%) males included with the mean age at time of injury being 47 years (± 22). There were 34 (30.1%) isolated radius fractures, 50 (45.5%) isolated ulna fractures, and 26 (23.6%) both bone forearm fractures. Screw sizes consisted of 3.5 mm (small fragment) screws in 57 (52%) cases, whereas 2.7 mm/2.5 mm/2.4 mm (mini fragment) screws were used in 53 (48%) cases. Fracture union was confirmed in 108 (98%) cases. Among the two nonunion cases, one case (50%) involved a small fragment, and one case (50%) involved a mini fragment plate. Conclusions: This study confirms that fracture union is high following any size plate fixation of radius and/or ulna fractures. Moreover, smaller screw sizes did not affect fracture union rates. Choice of plate type and screw diameter should be based on patient characteristics and surgeon preference and need not be limited to only 3.5 mm plate and screws. Type of Study/Level of Evidence: Prognosis IIb.

RESUMO

Purpose: Intramedullary screw fixation has emerged as a popular approach for the treatment of displaced metacarpal fractures. The purpose of this study was to investigate the functional and radiographic outcomes of a newly designed, headless noncompressive fully threaded intramedullary nail (TIMN) for the treatment of metacarpal fractures. Methods: A retrospective chart review was performed on patients who were treated with the INnate TIMN (ExsoMed) at a single academic institution with a minimum of 1-year follow-up. Patient-reported functional outcomes included Quick Disabilities for the Arm, Shoulder, and Hand (QuickDASH) questionnaires, return to work and physical activity time, and overall satisfaction. Radiographs were retrospectively reviewed to determine radiographic union, change in angulation, and metacarpal shortening. Results: A total of 49 patients (58 fractures) with a mean age of 36 years (range: 17-75 years) were included. The mean follow-up time was 2.7 years (range: 1.4-4.3 years). Overall, the mean patient satisfaction rating was 4.9 of 5 (range: 3-5). The mean return to work time was 7.2 weeks (range: 0.14-28 weeks), and the mean return to sport or activity was 8.3 weeks (range: 1-28 weeks). Average QuickDASH scores across all patients were 4 (range: 0-56.9). The median radiographic healing time was 6.1 weeks (range: 4.7-15.4 weeks). Mean postoperative shortening in the fifth metacarpal fracture was 3 mm (range: -4.2 to 8 mm) at the initial postoperative visit and 3.6 mm (range: -3.3 to 7.9 mm) at the final radiographic follow-up. Subgroup analysis showed that postoperative shortening was similar, regardless of the fracture pattern. The following four complications were reported: one case of persistent pain and stiffness, one case of carpal tunnel syndrome, one nonunion, and one fractured intramedullary nail. Conclusions: Our findings suggest that the TIMN allows for a reliable return to work and physical activity, high patient satisfaction, low complication rate, and minimal shortening at the final radiographic follow-up. Type of study/level of evidence: Therapeutic IV.

RESUMO

The study was designed to investigate the effect of mannan-oligosaccharide (MOS) supplementation on intestinal histomorphology, immunity against Newcastle disease virus (NDV) and productive parameters of broilers. A total of 1800, day old broiler chicks of Cobb-500 strain were selected and randomly assorted into 6 treatment groups: T1 (basal diet without antibiotics as negative control); T2 (basal diet plus antibiotics as positive control group); T3 (basal diet plus 200g/ton MOS); T4 (basal diet plus 400g/ton MOS); T5 (basal diet plus 600g/ton MOS) and T6 (basal diet plus 800g/ton MOS). Each treatment was having 6 replicates and the feed intake, body weight gain and feed conversion ratio (FCR) were recorded on weekly basis. Results showed that, MOS supplemented birds have significantly higher feed intake, weight gain and FCR (P < 0.05). Similarly, supplementation of MOS showed positive effect on villus height and crypt depth both in jejunum and ilium. Goblet cell density was unaffected by MOS addition (P < 0.05). Furthermore, birds fed with diets containing MOS, exhibited better productive performance in comparison to positive and negative control groups. In conclusion, MOS can replace antibiotic growth promoters (AGPs) as non-microbial performance-enhancing feed advocates.

O estudo foi desenhado para investigar o efeito da suplementação de mananoligossacarídeo (MOS) na histomorfologia intestinal, imunidade contra o vírus da doença de Newcastle (NDV) e parâmetros produtivos de frangos de corte. Um total de 1.800 pintos de corte de um dia da linhagem Cobb-500 foram selecionados e distribuídos aleatoriamente em 6 grupos de tratamento: T1 (dieta basal sem antibióticos como controle negativo); T2 (dieta basal mais antibióticos como grupo controle positivo); T3 (dieta basal mais 200g/ton MOS); T4 (dieta basal mais 400g/ton MOS); T5 (dieta basal mais 600g/ton MOS) e T6 (dieta basal mais 800g/ton MOS). Cada tratamento tinha 6 repetições e o consumo de ração, ganho de peso corporal e conversão alimentar foram registrados semanalmente. Os resultados mostraram que as aves suplementadas com MOS apresentam consumo de ração, ganho de peso e CA significativamente maiores (P < 0,05). Da mesma forma, a suplementação de MOS mostrou efeito positivo na altura das vilosidades e na profundidade das criptas tanto no jejuno quanto no íleo. A densidade de células caliciformes não foi afetada pela adição de MOS (P < 0,05). Além disso, as aves alimentadas com dietas contendo MOS apresentaram melhor desempenho produtivo em comparação aos grupos controle positivo e negativo. Em conclusão, o MOS pode substituir os promotores de crescimento de antibióticos (AGPs) como defensores de alimentos não microbianos que melhoram o desempenho.

Assuntos

RESUMO

Purpose: The indications for prophylactic antibiotics in hand surgery remain undefined. Current literature has focused solely on readmission and reoperation for surgical site infection, while neglecting minor infectious complications treated at outpatient follow-up in addition to complications from antibiotic therapy observed after surgery. This study sought to analyze major and minor infection rates, as well as adverse effects of preoperative antibiotics after clean hand surgery. Methods: A prospective cohort study was conducted over a 6-month period. The cohorts included patients who received preoperative antibiotic prophylaxis and those that did not. Patient details and operative data were obtained during the first postoperative visit following the index surgery. Primary outcomes assessed were as follows: (1) major infection, defined as admission or reoperation for infection; (2) minor infection, defined as use of postoperative oral antibiotics; and (3) complications of antibiotic therapy. Results: A total of 377 consecutive patients underwent operations of the upper extremity. Complications from preoperative antibiotic therapy were seen in 6.9% of patients. Overall, there were no major postoperative infections and the minor postoperative infection rate was 5.6%. The minor infection rate was 6.9% (9/131) among patients who did not receive preoperative antibiotics and 4.9% (12/246) among patients who received preoperative antibiotics (P = .57). Conclusions: A 5.6% minor infection rate was identified following clean hand surgery, with no cases of major infection. Preoperative antibiotics did not demonstrate benefit in terms of reduction of minor infections, but they did yield a 6.9% adverse reaction rate, including one case of Clostridium difficile infection warranting hospitalization. Caution is recommended while prescribing prophylactic antibiotics for clean hand surgeries, given the lack of clear benefits and the potential for adverse effects. Type of Study/level of evidence: Prognostic II.

RESUMO

Purpose: The published revision rates after carpal tunnel release (CTR) vary from 0.3% to 7%. The explanation for this variation may not be fully apparent. The purpose of this study was to determine the rate of surgical revision within 1-5 years following primary CTR at a single academic institution, compare it with rates reported in the literature, and attempt to provide explanations for these differences. Methods: We identified all patients who underwent primary CTR at a single orthopedic practice by 18 fellowship-trained orthopedic hand surgeons from October 1, 2015, through October 1, 2020, using a combination of Current Procedural Terminology (CPT) and International Classification of Diseases (ICD), 10th Revision, codes. Patients who underwent CTR because of a diagnosis other than primary carpal tunnel syndrome were excluded. Patients who required revision CTR were identified using a practice-wide database query using a combination of CPT and ICD-10 codes. Operative reports and outpatient clinic notes were reviewed to determine the cause of revision. Data on patient demographics, surgical technique (open vs single-portal endoscopic), and medical comorbidities were collected. Results: A total of 11,847 primary CTR procedures were performed during the 5-year period on 9,310 patients. We found 24 revision CTR procedures among 23 patients, resulting in a revision rate of 0.2%. Of 9,422 open primary CTRs performed, 22 cases (0.23%) went on to undergo revision. Endoscopic CTR was performed in 2,425 cases, with 2 cases (0.08%) ultimately undergoing revision. The average length of time from primary CTR to revision was 436 days (range, 11-1,647 days). Conclusions: We noted a substantially lower rate of revision CTR within 1-5 years of primary release (0.2%) in our practice than that noted in previously published studies, although we accept that this does not account for out-of-area migration. There was no significant difference in the revision rates between open and single-portal endoscopic primary CTR. Type of study/level of evidence: Therapeutic III.

RESUMO

PURPOSE: The purpose of this study was to evaluate implant survivorship and clinical outcomes following radial head arthroplasty for fracture at long-term follow-ups. METHODS: A retrospective analysis was conducted on adult patients who underwent primary uncemented radial head arthroplasty for radial head or neck fractures between 2012 and 2015. Medical records were reviewed to collect information regarding demographics, injury characteristics, reoperations, and revisions requiring implant removal. A bivariate analysis was conducted to identify potential risk factors for reoperation. A Kaplan-Meier curve was created to determine implant survival rates. Eligible patients were contacted to confirm any reoperations and obtain Quick Disability of the Arm, Shoulder, and Hand scores at long-term follow-ups. RESULTS: A total of 89 patients were eligible for analysis and assessed at a mean of 97 months after surgery (range, 81-128). Reoperation rate was 16% (14 of 89 patients), including 5% of patients requiring implant removal or revision. However, 93% of reoperations occurred within the first 12 months of the index surgery. Fracture dislocations of the elbow had a higher rate of reoperation. A Kaplan-Meier curve demonstrated an implant survival rate of 96% at 10-year follow-up. Of the patients who responded, the mean Quick Disability of the Arm, Shoulder, and Hand score was 8.7 ± 10.3, with none requiring additional reoperations or revisions. There were otherwise similar outcome scores among patients requiring reoperation versus those who did not. CONCLUSIONS: Although radial head arthroplasty for fractures has a high potential for reoperation within the first year, survival rates with uncemented implants remain high at 10 years, and patients report excellent Quick Disability of the Arm, Shoulder, and Hand scores at long-term follow-ups, despite any need for reoperation. Fractures with associated elbow dislocation may be at a higher risk for reoperation, and it is important to provide this prognostic information to patients who are likely to require arthroplasty for more extensive injuries. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

RESUMO

[This corrects the article DOI: 10.1016/j.jhsg.2022.02.009.].