Background: This study aims to assess the impact of nicotine dependence on both 90-day major postoperative outcomes and 2-year implant-related outcomes in patients undergoing open reduction internal fixation (ORIF) for distal radius fractures. Methods: We queried TriNetX, a national research database that provides real-time access to deidentified medical records, for patients of all ages who underwent an ORIF of the distal radius (Current Procedural Technology codes 25607, 25608, 25609) between 2001 and 2021. Patients were categorized by nicotine dependence history (International Classification of Diseases, Tenth Revision code: F17), with groups 1:1 propensity matched for age, sex, race, ethnicity, body mass index, type 2 diabetes, hypertension, cerebrovascular disease, and chronic obstructive pulmonary disease. The primary analysis examined major postoperative complications within 90 days, while the secondary analysis assessed hardware-related issues within 2 years. Risk ratios and 95% confidence intervals were generated for each outcome. Results: Of 62 137 patients treated with distal radius ORIF, 7764 had nicotine dependence, and 54 373 did not. Each group comprised 7591 patients after 1:1 matching. Nicotine dependence was associated with increased risk of skin infections, sepsis, and wound disruption in the 90-day postoperative period ( P < .001). Within the 2-year postoperative period, nicotine dependence was associated with increased risk of mechanical complication of internal fixation device ( P < .001), nonunion ( P < .01), and surgical intervention for nonunion ( P = .009). Conclusions: Nicotine dependence is associated with increased risk of infection, sepsis, wound disruption within 90 days, and hardware complication, nonunion, and nonunion repair at 2 years. These data emphasize the importance of nicotine counseling by treating surgeons.

Background: Prior studies have investigated the use of vibratory anesthesia for injectional pain reduction in dental, ophthalmologic, and plastic surgery literature. Scarce research has been aimed at determining the effect of vibratory anesthesia on hand and upper extremity injections. It is common practice for surgeons to use vapocoolant spray prior to injection, but there is no strong evidence to support its widespread use. No prior studies have performed a head-to-head analysis of vibratory anesthesia versus vapocoolant spray effect on injectional pain. We hypothesized that both vibratory anesthesia and cold spray anesthesia decrease patient-reported pain of corticosteroid injections compared with injection without anesthesia. Methods: We performed a randomized, prospective study to compare patient-reported pain of injection when the participants were randomly assigned to 1 of the 3 groups: injection without anesthesia, injection with vapocoolant(cold) spray, and injection with vibratory anesthesia. All participants completed a preinjection survey to assess the expected pain of injection and an identical postinjection survey to assess the actual perceived pain. Results: Sixty injections were performed in each intervention, for a total of 180 injections. We found that both vapocoolant spray and vibratory anesthesia decreased patient-reported injection pain compared with no intervention, but only vibratory anesthesia reached statistical significance. Conclusion: Vibratory anesthesia is a useful adjunct for injections of the hand and upper extremity, as has been demonstrated in other specialties’ literature. Although our statistical findings on vapocoolant spray are consistent with prior studies, there may still be clinical benefit in its application.

A 64-year-old left-handed man with no history of rheumatoid arthritis or distal radius fracture presented with spontaneous loss of thumb interphalangeal joint extension. Intraoperatively, the patient was found to have a variant extensor indicis proprius with extensor digitorum brevis manus. Prior extensor digitorum communis ruptures have been reported in the literature secondary to the distal extensor digitorum brevis manus muscle belly, but there are no prior reports of extensor pollicis longus rupture. This case demonstrates a unique etiology of extensor pollicis longus rupture and highlights the alteration in the surgical plan required secondary to the absence of an extensor indicis proprius tendon.

A 70-year-old woman was referred to hand surgery after a late failure of ORIF. She subsequently failed a primary total wrist arthroplasty and underwent a revision arthroplasty with a custom implant when her pain and wrist function failed to resolve. The patient reported improved functionality of her left wrist at 2 weeks after revision arthroplasty. At 3 years after surgery, she performed daily activities without pain or difficulty.

A 70-year-old woman born and raised in India presented with Wassel type IV preaxial polydactyly of the right thumb and difficulty performing daily activities. She elected for surgical reconstruction after postponing the procedure for many years due to cultural norms. Her postoperative course was unremarkable. At her 3-month follow-up, she was diagnosed with carpal tunnel syndrome and underwent open carpal tunnel release. Preaxial polydactyly repair is unusual in patients older than 25 years. Though the duplication is considered lucky in South Asia, indications for this case were arthritic pain, cosmesis, and function. This case report details a unique indication for polydactyly reconstruction, arthritic pain, which may benefit hand surgeons when discussing the literature on adult polydactyly with their patients.

On May 7, 2020, the Coalition for Physician Accountability's released "Medical Students in the Class of 2021: Moving Across Institutions for Post Graduate Training," which comprises official recommendations on keeping programs and medical students safe during the upcoming match cycle with the challenges posed by COVID-19. In these recommendations, away rotations are discouraged, and all programs are compelled to commit to virtual interviews. Unlike employers and applicants in other industries, orthopaedic residency/fellowship programs and candidates seeking those positions have not routinely conducted virtual interviews. Without in-person interviews, applicants may perceive a limited ability to demonstrate their qualifications, judge program culture, and gauge ultimate program compatibility. Likewise, programs may perceive the inability to evaluate a candidate in real time, physically show program strengths, and ultimately judge applicant compatibility. Careful preparation and execution of a virtual interview can overcome these perceived limitations, whereas benefits, such as decreased cost for both programs and applicants, can make virtual interviews appealing. The purpose of this review was to help define a virtual interview, illustrate the benefits, and offer tips to both programs and applicants on how to prepare and perform optimally on an interview day.

We present a case of an acute fracture of the distal radius and ulna with a concurrent flexor carpi radialis tendon rupture in a 48-year-old woman with a history of liver transplant. She was treated with open reduction and internal fixation of her fractures without tendinous repair and regained wrist motion symmetric to her uninjured wrist. To our knowledge, similar injury patterns have only been reported twice in the literature. We present this case of distal radius and ulna fracture with an associated flexor carpi radialis rupture with the goal of expanding the existing literature and aiding future clinicians to navigate similar scenarios and improve patient outcomes.

Complex regional pain syndrome (CRPS) is a chronic neuropathic pain condition that is often overlooked by clinicians and typically occurs within an entire limb. There is considerable clinical variability in presentation among patients with CRPS. We report a case of extremely focal CRPS localized to the left small finger (LSF) following crush injury. A 48-year-old righthanded male presented with LSF stiffness and severe pain of three months' duration following crush injury. He endorsed severe allodynia and minimal flexion at the proximal interphalangeal and distal interphalangeal joints of the LSF. Physical examination was significant for overt shininess and edema isolated to the LSF. X-ray performed at the time of injury and three months after were devoid of any fracture or dislocation. Chronic focal pain syndrome (CFPS) may be a subset of CRPS that has yet to be documented in the literature.