OrthoCarolina

Surgical and technological advancements have revolutionized myoelectric prosthetic options for patients with upper extremity amputations, but partial hand amputations have remained a challenge. The Starfish procedure is a novel surgical technique that involves transferring intrinsic hand muscles to a subcutaneous location to allow immediate signal detection and independent digital control of a myoelectric prosthesis. We report the outcomes of our cohort of patients treated with this procedure. Twenty-one patients underwent the Starfish procedure between 2015 and 2021. All patients had a postoperative evaluation with an Ottobock Myoboy to determine if they had viable signals from interossei transfers. All patients completed a specialized survey for amputees, depression, and PTSD surveys. All patients had recordable myoelectric signals at each muscle transfer. Three patients were lost to follow-up and three patients were multi-extremity amputees and therefore their DASH scores were not included given the confounding associated injuries thus 15 patients were available for outcomes data. 14 out of 15 remaining patients (93%) obtained a myoelectric prosthesis. Patients reported using their prosthesis an average of 5.5h per day and 5.5 days per week. The average DASH score prior to surgery was 67.9 and after surgery was 40.5 (p=0.014). VAS Pain scores were 3.8 for residual limb pain and 2.7 for phantom pain. Mean follow-up was 2.1 years. 71% of patients reported being "extremely" or "very" satisfied with the overall function of their prosthesis. The most common functional activities that the prosthesis allowed patients to perform include dressing, housework, meal preparation and eating. 73% of previously working patients were able to return to employment. The Starfish procedure provides immediately detectable superficial myoelectric signals that allow intuitive and independent finger control. At 2-year follow up, patients have a high satisfaction rate, consistent myoelectric prosthetic use, improved DASH scores, and a high rate of return to work.

Objectives:Identify treatment and describe outcomes and complications of acute anterior and posterior sternoclavicular joint dislocation.Design:Retrospective case series.Setting:Twelve level-one trauma centers.Patient/Participants:One hundred twenty-five patients with acute sternoclavicular joint dislocation, most were male (67%), White (61%), 18–29 years old (57%), involved in a motorized collision (60%), with anterior (35%) or posterior (65%) sternoclavicular joint dislocation treated by operative or nonoperative technique.Main Outcome Measurements:Outcomes and complications of joint instability, post-traumatic arthritis, neurovascular injury, chronic pain, and cosmetic deformities after operative and nonoperative treatment of anterior and posterior acute sternoclavicular joint dislocation are reported.Results:Thiry-nine (48%) posterior dislocations received surgery as initial management, whereas 5/44 (11%) of the anterior dislocations received acute surgery. The most common fixation techniques included suture fixation repair (39%), plate fixation (30%), percutaneous reduction (18%), and graft reconstruction (9%). Fifty-four (43%) patients from the entire cohort had complications after initial treatment. Eighteen complications occurred among the operative group (41%) and 36 in the nonoperative group (44%). The most common complications were pain (20%), decreased range of motion (14%), and joint instability (10%) requiring secondary fixation.Conclusion:Both operative and nonoperative management of sternoclavicular joint dislocations had a high rate of complications among anterior and posterior joint dislocations. However, a similar incidence of complications and outcomes occurred comparing anterior or posterior injuries with or without operative treatment. Therefore, clinicians need to evaluate each patient individually taking into account, patient factors, injuries, symptoms, and risks to determine if surgery is required.Level of Evidence:Therapeutic Level III.

Background: Midsubtance Achilles tendon ruptures remain the most common tendon injury within the lower extremity. While the incidence continues to rise, changing immobilization protocols, surgical techniques, and surgeon preferences have evolved over the past few decades. Purpose: To compare the overall complication rate among 3 major surgical techniques (open, percutaneous, and suture anchor) across a large, heterogeneous orthopaedic group in a major metropolitan area. Study Design: Case series; Level of evidence, 4. Methods: Achilles tendon repairs (Current Procedural Terminology code 27650) performed from January 2018 through December 2022 with a minimum 2-month follow-up were identified and retrospectively reviewed. Patients were excluded if they had chronic tears that required reconstruction, underwent a revision repair/reconstruction, or were initially treated nonoperatively. A total of 1035 acute midsubstance Achilles tendon ruptures met inclusion criteria. The primary outcome measure was total complication rate, which consisted of major complications (reoperation, deep infection, tendon rerupture, and loss of Achilles tension requiring reoperation) and minor complications (sural neuritis, superficial infection, delayed wound healing, heel pain, painful repair site, and loss of Achilles tension not requiring reoperation). Total, major, and minor complication rates by surgical technique were recorded. Standard demographic data were noted. Descriptive statistics and multivariate regression were utilized. Results: The overall complication rate was 15.7%, with 3% (n = 31) having major complications. Patients were significantly more likely to encounter any complication (26.3% complication rate with suture anchor, 14.3% with percutaneous, and 14.4% with open) (P = .004) or minor complication (P = .0304) with suture anchor fixation (20.2% rate) compared with the percutaneous (10.8%) or open (12.3%) technique. Patients with suture anchor fixation were more likely to experience clinically significant heel pain (10.5%; P < .001). There was no difference between incidence of sural neuritis with open (1.4%), percutaneous (3.2%), and suture anchor fixation (0.9%) (P = .104). Conclusion: Acute Achilles tendon repair is associated with a major complication rate of 3% requiring reoperation. Patients undergoing suture anchor fixation of Achilles tendon injuries experience all complications and minor complications at a significantly higher rate than those undergoing percutaneous or open procedures.

The addition of lateral extra-articular augmentation procedures (LEAP) to anterior cruciate ligament reconstruction (ACLR) reduces graft failure rates in hamstring ACLR. However, their effects on return-to-sport (RTS) testing are not well understood in the setting of quadriceps (Quad) or bone-tendon-bone (BTB) autograft ACLR. The purpose was to evaluate the effects of adding LEAP to Quad or BTB autograft ACLR in young athletes, with respect to formal RTS testing outcomes. We hypothesized that the addition of LEAP to Quad or BTB ACLR would result in non-inferior outcomes as compared to isolated ACLR. A retrospective case-control analysis was performed of prospectively collected data from 93 patients under the age of 25 undergoing Quad or BTB ACLR from a single surgeon between 2021 and 2023. A control group of isolated ACLR was compared to the study group of ACLR/LEAP (either anterolateral ligament reconstruction [ALLR] or lateral extra-articular tenodesis [LET]). All patients underwent standardized RTS testing at 6 and 9 months post-surgery. The study was powered based on a priori power analysis to assess non-inferiority of the ACL/LEAP group. There were 51 patients (54.8%) in the isolated ACLR group and 42 (45.2%) in the ACLR/LEAP group. The ACL/LEAP group was non-inferior to the isolated ACLR group for the limb symmetry index (LSI) and passing rates for each of the 6- and 9-month RTS tests, as well as psychological readiness, as measured by Anterior Cruciate Ligament-Return to Sport after Injury. There was no significant difference in overall pass rate between the control and ACL/LEAP groups (33% vs. 45.2%, respectively, p = 0.273) at 9 months. Subgroup analysis showed no differences in any outcome variables at 6 or 9 months between ACL/ALLR and ACL/LET. This study confirmed our hypothesis that the addition of LEAP to Quad or BTB ACLR is non-inferior to isolated ACLR in terms of RTS testing and psychological readiness for sport at 6 and 9 months post-operatively. Level III, case-control study.

Osseointegration (OI) has revolutionized prosthetic rehabilitation for amputees. Despite its contributions, postamputation pain remains a significant problem. This study aims to investigate the role of sciatic nerve regenerative peripheral nerve interface (RPNI) in patients undergoing transfemoral OI, focusing on its impact on pain and prosthetic wear. Patients underwent OI in a staged manner with RPNI being performed at either stage I or II. Outcome measures included preoperative and postoperative numerical rating scale phantom and residual limb pain (RLP) scores, presence of Tinel sign on physical examination, opioid use, and prosthetic wear. Data were collected through interviews using a standardized script to ensure consistency. A total of 12 patients were included. The patients were reported among cohorts without comorbidities (RPNIw/oC, N = 9) and with comorbidities (RPNIwC, N = 3). The average phantom limb pain (PLP) score decreased by 3.66 in the RPNIw/oC group and 3 in the RPNIw/C group. The RLP score saw an average increase of 0.28 in the RPNIw/oC group and a decrease of 3.33 in the RPNIw/C group. The frequency of a positive Tinel sign went from 2/9 to 0/9 in the RPNIw/oC group and remained constant in the RPNIwC group at 1/3. Finally, the RPNIw/oC group saw an increase in prosthetic wear from 4 h/d preoperatively to 8.2 h/d postoperatively, and the RPNIwC group saw an increase from 2.67 h/d to 7 h/d. No patients required nerve-related revision surgery. This small case series demonstrates improvement in phantom limb pain and prosthesis wear after combined transfemoral OI and sciatic nerve RPNI.

Brachial plexus injuries (BPIs) can cause physical and psychological disability, including posttraumatic stress disorder (PTSD) and depression, though the psychological impact of BPI has received little attention. This study hypothesizes that PTSD and depression are significant in health-related quality of life. Prospectively, BPI patients completed the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, Visual Analog Pain Scale (VAS), Primary Care PTSD Screen (PC-PTSD), and Center for Epidemiologic Studies Depression Scale (CES-D) at each clinic visit. Primary endpoints included the prevalence of PTSD and depression with DASH and VAS as secondary endpoints. Eighty-five patients met inclusion criteria (average age 46.6 years; 78.8% male). Median DASH score was 56.7; median VAS score was 5/10. PTSD prevalence was 30.6% (26/85). Depression prevalence was 45.9% (35/85). Patients with PTSD were significantly more likely to exhibit depression (p < 0.0001). Concomitant PTSD and depression were seen in 23 patients (27.1%). Traumatic BPI significantly impacts physical and psychological well-being; thus, recognizing the high prevalence of PTSD and depression is critical. (Journal of Surgical Orthopaedic Advances 34(1):015-019, 2025).