Objectives: Electronic sports (esports) have grown tremendously in the past decade with an estimated market value of $493 million in 2017 and an expected growth to $2.3 billion dollars by the end of 2022. Additionally, colleges are embracing this growing culture with over 200 varsity esports programs as of May 2022, up from 7 varsity programs just two years earlier. Despite its growing success, little has been studied on the injuries of these athletes. Prior studies have noted that injuries to professional esports players have forced them to miss significant time and in some instances, into an early retirement. Due to poor posture, a sedentary lifestyle, and repetitive hand motions, the most common injuries to esports athletes include injuries to the hand, wrist, back and neck. The purpose of this study is to investigate the prevalence of injuries sustained through collegiate esports players and explore the injuries’ impacts on their careers. The authors hypothesized that athletes who spend more time practicing and playing competitively in esports will report an increased history of musculoskeletal injury. Methods: A list of collegiate esports athletes was collected from publicly available sources. Athletes with available contact information were sent a self-reporting questionnaire. The questionnaire examined variables including length of time playing esports, hours/day playing esports, esports-related injury history, surgeries needed, and missed competition time. Demographic and workload data were then compared between injured and uninjured athletes. Results: Overall, 153 collegiate esports athletes (88% male, aged 18-42 years) were included, with 41 (26.8%) having experienced at least one injury from esports. As demonstrated in Table 1, of the 41 injured athletes, 3 (7.3%) required surgery, 17 (41.5%) had multiple injuries, and 7 (17.1%) missed competition time for an average of 3.0 ± 2.3 weeks. Athletes who have been on their respective college team longer (1.7 ± 0.9 vs. 2.0 ± 1.0 years, p=0.026) and who spent more hours per day practicing had a higher injury incidence (p=0.012). There was no difference in current age, sex, age at which athletes began competing in esports, and scholarship status between groups (all p>0.05). When analyzing the 41 athletes who experienced an injury, the most common injury was to the wrist with 25 total injuries. There were 11 neck, 10 back, 9 finger, 8 hand, 6 elbow, and 4 thumb injuries. Conclusions: Collegiate esports players who trained for more hours per day and played competitive collegiate esports for more years were more likely to have experienced an esports-related injury. Interestingly, while hours per day was a significant risk factor for injury, the number of days per week had was not a significant risk factor for injury, possibly indicating that injuries are sustained through continuous and excessive playing rather than intermittent playing over a longer period. The three most common injury locations were to the wrist, back, and neck, while shoulder and thumb injuries were the least common. Fortunately, only a small portion of athletes who experienced an injury were forced to miss competition time, and even fewer required surgery. With this being the largest investigation into collegiate esports-related injuries, future medical research can help collegiate and professional programs place a greater emphasis on the management and prevention of esports-related injuries.

Purpose Although carpal tunnel syndrome (CTS) can be diagnosed clinically with the Carpal Tunnel Syndrome 6 (CTS-6) evaluation tool, the relationship between disease severity and CTS-6 score has not been elucidated. The purpose of our study was to determine the correlation of the CTS-6 score and other physical examination maneuvers with the carpal tunnel severity grade by electrodiagnostic testing (EDT). We hypothesized that the CTS-6 score, Durkan test, and Semmes Weinstein Monofilament Testing (SWMT) positively correlate with EDT severity. Methods We prospectively enrolled 105 consecutive patients who presented to the office with suspected CTS, excluding those with previous surgery, previous EDT from an outside facility, or concomitant neuropathy. Four fellowship-trained hand surgeons obtained the CTS-6 score, time to obtain a positive Durkan compression test, and SWMT of the thumb, index, and middle fingers. All patients were sent for EDT. Hand surgeons were blinded to the results of the EDT, and the elec-trodiagnosticians were blinded to the clinical data. We used the Bland criteria (0-6) to grade CTS severity on EDT. This grade was compared with the CTS-6 score, Durkan time, and SWMT results. Results Using Spearman correlation coefficients, we found a weakly positive correlation between a higher CTS-6 score and a higher severity grade on EDT. The mean CTS-6 score based on EDT grading were the following: (1) 14.8 (grade 0), (2) 16.0 (grade 1), (3) 14.8 (grade 2), (4) 16.7 (grade 3), (5) 18.7 (grade 4), (6) 18.3 (grade 5), and (7) 22.4 (grade 6). We also found a sta-tistically significant association between the SWMT and a higher CTS-6 score as well as a higher severity grade on EDT. Durkan compression test did not appear to correlate with the EDT grade. Conclusions The CTS-6 and SWMT show a positive correlation with EDT severity in CTS on the basis of the Bland criteria. The time to a positive Durkan test did not show any correlation. (J Hand Surg Am. 2023;48(4):335-339. Copyright (c) 2023 by the American Society for Surgery of the Hand. All rights reserved.)

A common treatment modality for various orthopedic pathologies is cast or splint immobilization. Fiberglass and plaster are the materials most commonly used in cast or splint immobilization. Three-dimensional printed custom patient-specific splints offer an effective means of immobilization and compliance with hygiene recommendations. Polylactic acid (PLA) is a polymeric material used for three-dimensional printed custom patient-specific splints or casts. The three-dimensional printed splints or casts have been reported to be more comfortable than their alternatives, which has yielded improved cleanliness, avoidance of skin problems, and better function.1–3 Given these advantages, we wanted to understand whether mechanical properties of the three-dimensional printed splints compare with those of conventional fiberglass and plaster splints. Thirty splints were tested under axial compression to fail to three-point bending with 10 samples each in the PLA, plaster, and fiberglass groups. Each sample was positioned on holders and tested in uniaxial compressive cyclic loading using three-point bending fixtures (Fig. 1). Compressive force, displacement, and time were measured using an MTS electrodynamic testing machine with a 3kN load cell (Fig. 2). One-way analysis of variance was used to determine whether there were any significant differences among the three materials with a P value less than 0.05 considered statistically significant.Fig. 1.: Plaster-based ulnar gutter splint made failing to three-point bending when subjected to force-controlled axial compression.Fig. 2.: Acumen 3 (MTS) axial/torsion electrodynamic test system with an integrated electromechanical tensile tester.We found that the compressive yield strength at which fiberglass, plaster, and PLA yielded was 85.4 N, 21.6 N, and 195.2 N, respectively (p < 0.001). The ultimate compressive strength of fiberglass, plaster, and PLA splints was 431.5 N, 309.2 N, and 198.1 N, respectively (p < 0.001). Fiberglass, plaster, and PLA failed at an average of two, one, and 26.3 stable loading cycles, respectively. All 10 samples of both fiberglass and plaster failed when loaded cyclically between 50 and 100 N and 50 and 200 N. One PLA sample failed between 50 and 100 N; the other samples failed between 50 and 200 N. The post hoc analysis showed a significant increase in the number of stable loading cycles to failure for PLA (p <0.001) compared with fiberglass and plaster (Table 1). Table 1. - Failure Properties of Fiberglass, Plaster, and PLA When Compressively Loaded and Ability to Be Cycled at Their Failure Force Material Samples Passed in 50–100 N Cyclic Loading Samples Failed in 50–100 N Cyclic Loading Samples Passed in 50–200 N Cyclic Loading Samples Failed in 50–200 N Cyclic Loading Average Compressive Load at Failure, Mean (SD) Average Cycle at Failure (50 Cycles), Mean (SD) Fiberglass (n = 10) 0/10 10/10 0/10 10/10 431.5 (32.4) 2 (0) Plaster (n = 10) 0/10 10/10 0/10 10/10 309.2 (45.7) 1 (0) Polylactic acid (n = 10) 9/10 1/10 0/9 9/9 198.1 (5.7) 26.3 (0.8) P <0.001 <0.001 NaN NaN <0.001 <0.001 Post hoc P values (Bonferroni method) Fiberglass versus plaster NaN NaN — — <0.001 <0.001 Fiberglass versus polylactic acid <0.001 <0.001 — — <0.001 <0.001 Plaster versus polylactic acid <0.001 <0.001 — — <0.001 <0.001 NaN, not a number. With advances in three-dimensional printing, its utility in custom-made orthoses as an alternative to plaster or fiberglass-based splints or casts is gaining popularity. Three-dimensional printed casts have been found to be functionally noninferior to traditional casting techniques and superior in terms of patient satisfaction, comfort, and perceived function.3 We found that PLA-based three-dimensional printed splints demonstrated more stability in cyclic compressive loading compared with fiberglass and plaster. Based on our results, three-dimensional printed splints are not inferior to fiberglass or plaster splints. The fiberglass and plaster splints failed at higher compression forces than their plastic counterparts. PLA was the only material that withstood being cycled multiple times within the force ranges we examined without yielding or deforming. Patient-specific three-dimensional printed casts are an appropriate option for immobilization, especially during a global pandemic when attempting to minimize direct physician–patient contact time, and to allow basic hand washing and hygiene practices, as the material is water-resistant. ACKNOWLEDGMENT Research reported in this publication was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under award R01AR069044 to J. Patrick O’Connor. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

Background: Flexor tendon lacerations in the fingers are challenging injuries that can be repaired using the wide-awake local anesthesia no tourniquet (WALANT) technique or under traditional anesthesia (TA). The purpose of our study was to compare the functional outcomes and complication rates of patients undergoing flexor tendon repair under WALANT versus TA. Methods: All patients who underwent a primary flexor tendon repair in zone I and II without tendon graft for closed avulsions or open lacerations between 2015 and 2019 were identified. Electronic medical records were reviewed to record and compare patient demographics, range of motion, functional outcomes, complications, and reoperations. Results: Sixty-five zone I (N = 21) or II (N = 44) flexor tendon repairs were included in the final analysis: 23 WALANT and 42 TA. There were no statistical differences in mean age, length of follow-up, proportion of injured digits, or zone of injury between the groups. The final Quick Disabilities of the Arm, Shoulder, and Hand score in the WALANT group was 17.2 (SD: 14.4) versus 23.3 (SD: 18.5) in the TA group. There were no statistical differences between the groups with any final range of motion (ROM) parameters, grip strength, or Visual Analog Scale pain scores at the final follow-up. The WALANT group was found to have a slightly higher reoperation rate (26.1% vs 7.1%; P = .034) than the TA group. Conclusions: This study represents one of the first clinical studies reporting outcomes of flexor tendon repairs performed under WALANT. Overall, we found no difference in rupture rates, ROM, and functional outcomes following zone I and II flexor tendon repairs when performed under WALANT versus TA.

Background:To investigate the reliability of orthopedic hand surgeons to evaluate radiographic healing in initial and follow-up radiographs of the conservatively treated metacarpal shaft and neck fractures. The rationale for this study was to reduce the rate of unnecessary, routine radiographs when treating metacarpal fractures. Methods:Forty sets of digital x-rays, twenty at the initial visit and twenty at the 4-week follow-up, were randomly selected and reviewed. Three hand surgeons evaluated the x-rays for (1) fracture location, (2) radiograph timing, (3) healing status, (4) percentage healed, (5) angulation, and (6) confidence in healing status. Observers reviewed studies in random order and evaluated the same set of radiographs one month after the initial review. Intra- and interobserver agreements were analyzed using Fleiss' kappa (κ) for all parameters and all possible observer pairings. Results:Interobserver and intraobserver reliability was highest when evaluating fracture location and lowest when assessing the percentage healed. The interobserver reliability was fair for radiograph timing and healing status and fair-to-moderate for angulation. The intraobserver reliability was moderate for radiograph timing and healing status and moderate-to-substantial for angulation. Observers correctly differentiated initial vs. follow-up images 62% of the time and reported to feel somewhat certain in their evaluation of healing status. Conclusion:When evaluating initial and 4-week follow-up radiographs, hand surgeons were somewhat confident in their assessment of healing but had less than substantial intra- and interobserver reliability following radiographic evaluation. Due to their poor reproducibility, routine radiographs may be unnecessary when evaluating conservatively treated metacarpal fractures. Further studies and guidelines that identify clear indications for the use of routine imaging in metacarpal fracture care are warranted.

Background:The median artery is an embryonic structure that typically regresses during gestation. Occasionally, the artery remains and is then termed a persistent median artery (PMA). A PMA can be associated with other anatomic anomalies, and has been known to contribute to carpal tunnel syndrome (CTS). Recent literature has observed an increase in PMA prevalence, speculated to indicate microevolutionary change. We performed a prospective observational study to investigate the current prevalence rate of PMA in patients undergoing carpal tunnel release (CTR).Methods:Institutional review board approval was obtained. From October 2020 to January 2021, patients ≥18 years old undergoing open CTR by 9 orthopaedic hand surgeons were included in analysis. Patients undergoing endoscopic CTR were excluded. Intraoperatively, the carpal tunnel was evaluated for the presence of a PMA, median nerve anomalies, or any other anatomic anomalies. If a patient underwent bilateral CTR during the study, only one side was included in analysis as determined randomly.Results:Three hundred and sixty open CTRs in 327 patients were performed during the study. Twenty-seven PMAs were identified, for an overall prevalence rate of 8.3%. The average age of patients with a PMA was 63.6 years (SD 13.3 years), consisting of 15 men and 12 women. There were no statistical differences in age, gender, or laterality between patients that did and did not have a PMA. Thirty-three patients underwent bilateral CTR during the study, with 3 being found to have a PMA unilaterally, and zero having a PMA bilaterally. Two bifid median nerves (0.6%) were also identified.Conclusion:This study represents the highest prevalence rate of PMA directly observed in CTR patients reported to date (8.3%). A PMA is not a rare finding, and it should be recognized and protected during CTR. Occasionally, a PMA can be the cause of an acute presentation of CTS.

Retained or missed foreign bodies are a common complication associated with penetrating wounds. Ideal management includes immediate removal of the foreign material without any further damage to local tissues. However, removal is often difficult if the foreign body is small or has penetrated deeply. In this setting, the emergency room is a suboptimal environment for removal. Ultrasound utilized at the time of removal improved our ability to localize the foreign body, however this requires surgeon familiarity with the equipment. We describe the use of preoperative ultrasound guided foreign body localization with careful topographic skin marking to guide intraoperative foreign body removal with increased yield and obviating the need for ultrasound at the time of removal.

Background: The purpose of the present study is to report the incidence of operating room fires during hand surgical procedures. Methods: The clinic and OR electronic medical records of seven fellowship-trained orthopedic hand surgeons at a single, large practice were retrospectively reviewed. All upper extremity procedures performed between June 2014 to June 2019 in both hospital and surgery center settings were included in the review. Demographic data was collected. The incidence of operating room fires was determined. Results: A total of 18,819 hand and upper extremity surgical procedures were included. There were 16,767 (89.1%) cases performed in a surgery center, while 2,052 (10.9%) of cases were performed in a hospital. There were 12,691 (67.4%) soft tissue procedures and 6,127 (32.6%) bony procedures performed. Chlorhexidine gluconate preparation solution was used in 9607 cases (51%). Chloraprep solution was used in 6280 cases (33.4%). Betadine was used in 2,932 cases (15.6%). One surgeon has monopolar electrocautery only available during cases. Five surgeons have bipolar available, and one has both mono and bipolar electrocautery available. There were no fires (0%) identified during the study period. Conclusion: The incidence of operating room fires during hand surgical procedures is extremely low. While hand surgeons can be reassured that the likelihood of an operating room fire is minimal, surgeons should not become complacent and should maintain a high level of vigilance to prevent these potentially devastating occurences.

Background Collegiate electronic sports (esports) in the United States has grown from seven varsity programs in 2016 to over 200 today. Despite its growing success, little has been studied on the injuries of these athletes. In this study, we aimed to investigate the prevalence of injuries sustained by collegiate esports players and explore the injuries’ impacts on their careers. The authors hypothesized that athletes who spend more time practicing and playing competitively in esports will report an increased history of musculoskeletal injury. Methodology This was a cross-sectional study, level IV evidence. A list of collegiate esports athletes was collected from publicly available sources. Athletes with available contact information were sent a self-reporting questionnaire. The questionnaire examined variables including length of time playing esports, hours/day playing esports, esports-related injury history, surgeries needed, and missed competition time. Results Overall, 153 collegiate esports athletes (88% male, aged 18-42 years) were included, with 41 (26.8%) having experienced at least one injury from esports. Of the 41 injured athletes, three (7.3%) required surgery, 17 (41.5%) had multiple injuries, and seven (17.1%) missed competition time for an average of 3.0 ± 2.3 weeks. Athletes who have been on their respective college team longer (2.0 ± 1.0 vs. 1.7 ± 0.9 years, p = 0.03) and who spent more hours per day practicing had a higher injury incidence (p = 0.01). There was no difference in the current age, sex, age at which athletes began competing in esports, and scholarship status between groups (all p > 0.05). When analyzing the 41 athletes who experienced an injury, the most common injury was to the wrist with 25 total injuries. There were 11 neck, 10 back, nine finger, eight hand, six elbow, and four thumb injuries. Conclusions Collegiate esports players who trained for more hours per day (31.7% of injured players vs. 10.7% of uninjured players practiced more than five hours/day, p = 0.01) and played competitive collegiate esports for more years (2.0 ± 1.0 vs. 1.7 ± 0.9 years, p = 0.03) were more likely to have experienced an esports-related injury. Fortunately, only a small portion of athletes who experienced an injury was forced to miss competition time or require surgery. With this being the largest investigation into collegiate esports-related injuries, future medical research regarding the incidence, management, and prevention of its injuries can help collegiate and professional programs place a greater emphasis on the health of their athletes.

Introduction Tramadol and codeine are both commonly prescribed in the setting of surgery or injury to the upper extremity. Despite their comparable strength in terms of opioid receptor affinity, the drugs differ pharmacologically and thus are not completely interchangeable. Methods This study analyzes all prescriptions for codeine and tramadol by a group of hand surgeons over a one-year period and tests the central hypothesis that the prescribing and refill patterns of these two drugs would be similar. Results Despite similar prescription amounts in terms of morphine equivalents, patients receiving tramadol required prescription refills at a significantly higher amount than those receiving codeine, and these individuals tended to be older. Additionally, patients treated nonoperatively were prescribed significantly more tramadol than those treated surgically. Conclusion Our findings suggest that codeine and tramadol are not equivalent in managing upper extremity pain. Further study is needed to articulate the situations in which physicians and patients are better served by tramadol versus codeine.

3D printing is an evolving technology which has a potential application in the treatment pediatric forearm fractures. Very little has been published with regard to 3D casting in children. We present two cases in which upper extremity fractures in pediatric patients were treated by wearing a custom made 3D printed cast. At latest follow-up at least one year post-injury, the clinical outcomes were excellent. Orthopaedic surgeons may benefit from familiarizing themselves with the potential of 3D printing technology and utilizing its current applications, as well as devising future applications, in clinical practice.

Purpose Guidelines for sterilization of reusable equipment (eg, arthroscopes, surgical equipment) have recently been established. These guidelines are supported by the U.S. Food and Drug Administration and affect costs for sterilization. The current analysis was undertaken to understand if reusable or disposable endoscopic carpal tunnel release (ECTR) equipment is a less-expensive option. Methods An activity-based cost analysis was undertaken to determine the costs of reusable versus disposable equipment for ECTR. Costs of disposable equipment were obtained from manufacturers. Costs of processing reusable equipment including labor, time, cost of operating room time, and sterilization supplies and equipment were obtained from the literature and from recent reports identifying these costs. Infection rates and costs of infection were also factored in. Decision analysis software was used to determine the expected costs of each option (disposable vs reusable). A sensitivity analysis was undertaken on those variables that were determined to have the greatest effect on the overall costs of the procedure and sterilization. Results Costs for each option when totaled were $917 for disposable and $1,019 for reusable equipment, resulting in cost savings of $102 with disposable equipment. Reusable equipment was the least costly option when the following costs/events occurred: cost of a disposable arthroscope, >$452; cost of disposable ECTR, >$647; costs of operating room time, <$28.63/min; set up time, <6.8 minutes for reusable equipment; and cost of disposable ECTR blade used with reusable equipment, <$160. Conclusions When considering the cost of operating room time, preparation, and processing of reusable equipment for ECTR, the disposable equipment for this procedure is less costly. Copyright (C) 2021 by the American Society for Surgery of the Hand. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).)

INTRODUCTION:Orthopedic instrumentation is generally made as one-size-fits-all. The purpose of this study was to evaluate the effects of hand size and sex on ease of use and injury rates from orthopedic tools and surgical instruments.METHODS:An anonymous 21-item online survey was distributed to orthopedic trainees and attendings. Questions regarding demographics, physical symptoms and treatment, perceptions, and instrument-specific concerns were included. The analysis included statistics comparing responses based on sex, height, and glove size, with significance as p<0.05.RESULTS:There were 204 respondents: 119 female and 84 male. Male and female respondents differed significantly in height (mean difference 5.4 in, p<0.001) and glove size (median size 6.5 size for females, size 8 for males, p<0.001). While 69.8% of respondents reported physical discomfort or symptoms they attributed to their operating instruments, female surgeons were significantly more likely to endorse symptoms (87.3% female vs. 45.2% male, p<0.001). Of those reporting symptoms, 47.7% had undergone treatment, with no significant difference by surgeon sex (p=0.073). Female surgeons were significantly more likely than their male counterparts to have negative attitudes toward orthopedic surgical instruments and to report specific surgical instruments as difficult or uncomfortable to use.CONCLUSION:Female orthopedic surgeons are more likely than their male counterparts to report physical symptoms attributed to orthopedic surgical instruments, to have negative attitudes toward instruments, and to identify a larger number of common instruments as difficult or uncomfortable to use. Further emphasis on ergonomic instrument design is needed to allow all orthopedic surgeons to operate as safely and effectively as possible.

INTRODUCTION:Rock climbing is an increasingly popular sport in the United States. Acute and chronic upper extremity injuries related to rock climbing are frequently reported and include flexor pulley ruptures and hamate stress fractures. Deep space hand infections after indoor rock climbing are a sport-related pathology that has yet to be reported. Our purpose is to describe an acute septic carpal tunnel syndrome following rock climbing at an indoor climbing gym in a patient who required urgent irrigation and debridement.CASE REPORT:A 33-year-old Caucasian male presented with an acute septic carpal tunnel syndrome 4 days after rock climbing at an indoor gym. On physical examination, he exhibited numbness over the fingers, significant tenderness to palpation, and pain with passive range of motion. His inflammatory markers were markedly elevated and deep space hand infection was confirmed with computed tomography scans. The patient was taken for urgent exploration, irrigation and debridement, and carpal tunnel release.CONCLUSION:We theorize that the patient had an abrasion on the finger or palm that created an entryway for a pathogen. We are unaware of another report of a deep space hand infection associated with rock climbing activities. This case report will hopefully spread awareness of this clinical entity to improve evaluation and prevention of hand infections in rock climbers, as well as providing guidelines for appropriate and timely treatment of the condition.

Purpose Trigger finger is a commonly occurring hand condition that presents with symptoms of pain, clicking, locking, and catching of the finger. A common non-operative management option is corticosteroid injection. The purpose of this study was to evaluate the short-term patient response to corticosteroid injections for trigger finger. Methods The patients of six fellowship-trained orthopedic hand surgeons who underwent a corticosteroid injection for trigger finger between June 2019 and October 2019 were invited to participate in this study. Patients were contacted by phone at one week, two weeks, and three weeks after the injection to complete a questionnaire regarding their pain and triggering symptoms. Medical records were also reviewed to collect basic demographic data. Results A total of 452 patients were included in the study. At the final follow-up, 82.4% of patients reported complete pain relief, 16.3% had partial relief, and 1.2% had no relief from their pain. For their triggering symptoms, 65.9% reported complete triggering relief, 30.4% had partial relief, and 3.5% had no triggering relief. It took an average of 6.6 days following injection for patients to experience complete pain relief, and an average of 8.1 days for patients to experience complete triggering relief. Conclusions This analysis found that most patients experience relief of pain and triggering at three weeks following corticosteroid injection. The majority of patients experienced some pain relief within the first week following corticosteroid injection, while improvement in triggering appeared to lag behind pain relief.

Introduction Orthopaedic surgeons choose to manage communication with their patients outside of official visits and interactions in a variety of ways, with some choosing to provide their personal cell phone number in order to provide patients with direct accessibility. The objective of this prospective study is to explore to what extent patients utilize the cell phone numbers of orthopaedic surgeons in the immediate period after it is provided to them. Methods Seven fellowship-trained orthopaedic surgeons from five different subspecialties in a single private, multisite group each provided his/her personal cell phone number to 30 consecutive patients. The surgeon's phone number was written down on a business card, and the surgeons themselves provided the card to the patient. Phone calls and voice mail messages received in the 30 days following the patient receiving the phone number were recorded, and the reasons for these calls were categorized as being "appropriate" (e.g. acute postoperative issues, unclear instructions) or "inappropriate" (e.g. administrative issues, medication refills, advanced imaging- related inquires). Results Two-hundred seven patients with an average age of 51.5 years were provided cell phone numbers. During the 30 days following administration of cell phone numbers to each patient, 21 patients (10.1%) made calls to their surgeons, for an average of 0.15 calls per patient. Six patients (2.9%) called their surgeons more than once. Seventeen calls (54.8%) were deemed appropriate, while 14 calls (45.2%) were inappropriate. Logistic regression analysis did not reveal patient age, sex, type of visit, or surgeon subspecialty to be independently associated with calling. Conclusion Our study has demonstrated a low rate of patient utilization of surgeon cell phone number when provided to them. If surgeons choose to provide their cell phone number to patients, we recommend specifying appropriate reasons to call in order to maximize the effectiveness of this communication method.

Objective: To determine whether intramedullary nail (IMN) size and its relation to the canal diameter [nail-canal (NC) diameter] impacts the union rate or time to union in the treatment of femoral shaft fractures. Design: Retrospective review. Setting: Two Level 1 and 1 Level 2 trauma centers. Patients: Two hundred eighty-seven patients met the criteria and were included in the study. Intervention: Patients were treated with either an antegrade or retrograde IMN. Comparisons were first performed comparing 10- versus 11- versus 13-mm nails. Patients were then divided into 3 groups based on the difference between the size of the femoral canal at the isthmus and the IMN (NC diameter). Group 1: <1.0 mm, group 2: >1.0 and <2.0 mm, and group 3: >2.0 mm. Main Outcome Measurements: Nonunion rates, mean time to union. Results: Two hundred eighty-seven patients with a minimum of 12-month follow-up, who were treated with size with IMN for femoral shaft fractures, were assessed for fracture characteristics, time to union, and union rate. When comparing IMN size, no statistical difference was found when comparing time to union or overall union rate. When comparing NC diameter, no significant difference was found in union rate and time to union when comparing between the groups. Conclusion: Similar rate of union and time to union were exhibited regardless of nail size or NC diameter. This can correlate to the standard utilization of a reamed, titanium 10-mm IMN with 5.0-mm interlocking screws in the treatment of femoral shaft fractures, offering potentially less reaming, shorter operative times, and removing unnecessary stock from inventory. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Abstract Objective Surgical treatment options for distal radioulnar joint (DRUJ) arthritis include distal ulnar resection (DUR), DRUJ arthrodesis, and ulnar head replacement. Ulnar convergence leading to persistent pain and clicking is a relatively common complication of complete DUR and DRUJ arthrodesis with distal ulnar segment resection (DRUJA). This led to the development of the distal ulna hemiresection (DUHR) and distal ulnar stump stabilization techniques to reduce the risk of this complication. Patients may experience incomplete relief of pain and limited range of motion (ROM) with these procedures. We hypothesized that there would be no differences in outcomes between the treatment groups, but patients undergoing DUHR, tendon interposition, or distal ulnar stump stabilization would be at lower risk of complications. Methods Records were retrospectively reviewed for 121 patients undergoing DRUJ procedures between 2000 and 2018 at a single institution to collect patient demographics, surgical details, preoperative diagnosis, and outcomes including complications, revision procedures, ROM, pain, and swelling. Patients were grouped for analysis by procedure type: DUR (Darrach procedure), DUHR (Bowers procedure), and DRUJA (Sauve–Kapandji procedure). Continuous variables were compared using an analysis of variance test and categorical variables using the Freeman–Halton extension of the Fisher's exact test. A multivariate logistic regression analysis was performed to identify significant predictors of outcomes. Results Seventy-three patients underwent a DUR procedure, while 33 patients underwent a DUHR procedure and 11 underwent a DRUJA procedure. Mean follow-up was 70.6 months. Patients undergoing DRUJA were significantly younger than those undergoing DUR or DUHR procedure (42.4 vs. 60.0 vs. 62.1, p < 0.001). No significant differences between groups were demonstrated in measured outcomes. Posttraumatic arthritis was the most common preoperative diagnosis (43.4%). Persistent pain was the most common negative outcome (25.6%) followed by limited ROM (19.7%). Five patients (4.3%) suffered postoperative complications, most common being rupture of extensor tendons. Five patients (4.3%) underwent revision procedures. Body mass index (BMI) was a significant predictor of persistent pain (odds ratio = 1.09, p = 0.031). Conclusion The results of our study suggest that outcomes are equivalent between the three distinct treatment groups. Despite the potential benefits, hemiresection, tendon interposition, and distal stump stabilization had no significant effect on outcomes in this study. More than a quarter (25.6%) of patients undergoing DRUJ procedures experience persistent pain postoperatively, while one-fifth (19.7%) experienced limited ROM. Patients with higher BMI are at a significantly greater risk of experiencing persistent postoperative pain. Level of Evidence This is a Level III, retrospective comparative study.