Sixty-seven patients with symptomatic knee osteoarthritis (OA) (26 male, 42 female, mean age 62.7 years) have been followed prospectively for a mean of 67.3 months (range 60-72 months). Hand radiographs were obtained at entry and at follow-up. Scintigraphic images of the hands were obtained at entry, and the predictive value of scan abnormalities for subsequent radiographic change was examined. Forty-six of 203 scan-positive joints at entry showed radiographic change, compared with 41 of 2075 scan-negative joints (P < 0.0001). The thumb base was more often involved than other joints and scintigraphy was a better predictor of change at this site than at other joints in the hand. This study confirms the predictive value of scintigraphy in hand OA and suggests that thumb base and interphalangeal joint OA behave differently.

Background: Patellar tendon ruptures have a reported incidence of 0.68 per 100,000 person-years in the general population. The epidemiology of surgically treated patellar tendon ruptures in the US military has yet to be reported, which would provide opportunity for identification of risk factors for these otherwise healthy and active patients. Purpose: To determine the incidence of patellar tendon rupture in the Military Health System (MHS) population and to analyze demographic patterns, surgical fixation methods, and rerupture rates. Study Design: Case-control study; Level of evidence, 3. Methods: We utilized the MHS Data Repository (MDR) to identity active-duty military servicemembers surgically treated for patellar tendon rupture between 2010 and 2015. Records were reviewed for demographic information, injury characteristics, fixation technique, and occurrence of rerupture. Risk factors for rupture were calculated using Poisson regression based on population counts and demographic data obtained in the MDR. Risk factors for rerupture and return to duty were analyzed via univariate analysis and multivariate regression. Results: A total of 504 operatively treated primary patellar tendon repairs in 483 patients were identified, with an overall incidence of 6 per 100,000 person-years. Mean age was 33.6 years (range, 17-54 years) and 98% of patients were male. Fixation method was 81% bone tunnels and 7% suture anchors, and 12% were unknown. Black race had a higher relative rate ratio for rupture compared with the race categories White (9.21; P < .0001) and Other (3.27; P < .0001). The rupture rate was higher in 35- to 44-year-old patients compared with those aged 18 to 24 years ( P < .0001), 25 to 34 years ( P < .0001), and 45 to 64 years ( P = .004). Return to full previous level of activity occurred in 75.8% of patients, 14.6% returned to activity with limitations, and 9.5% were medically separated. The rerupture rate was 3%. Fixation method, tobacco usage, body mass index, and race were not significant risk factors for rerupture. Conclusion: The incidence of patellar tendon rupture in the US military population is substantially higher than has been reported in the civilian population. Among military personnel, men, Black servicemembers, and those aged 35 to 44 years were at highest risk for patellar tendon rupture. Three-quarters of patients were able to return to full activity without limitations. The rerupture rate was low and unaffected by fixation method.

Case: A 30-month-old boy with a displaced medial condyle fracture and no history of an elbow dislocation was found to have an entrapped median nerve. Conclusion: Entrapment of the median nerve is a potential consequence of a displaced medial condyle fracture, even when there are no neurologic deficits on presentation. This provides additional support for open reduction of these fractures rather than percutaneous treatment or nonoperative management. Prompt identification and extraction of an interposed ulnar or median nerve is imperative to prevent the catastrophic consequences of an upper-extremity nerve palsy in children, as well as to optimize fracture-healing and elbow growth and development.