Purpose Evidence for the superiority of in situ simple decompression (SD) versus ulnar nerve transposition (UNT) for cubital tunnel syndrome remains controversial. The purpose of this study was to compare the clinical improvement, complication rate, and revision rate of SD versus UNT using the available evidence. Materials and Methods We performed a literature search of relevant publications using PubMed, SCOPUS, Cochrane Library, and Springer Link. Inclusion criteria included (1) adult patients >18 years of age, (2) idiopathic cubital tunnel syndrome, (3) primary comparison studies including both SD versus UNT with discrete data for each procedure, (4) average follow-up of at least 2 months, and (5) a full English language manuscript available. Odds ratios of improvement, complications, and revision surgery after SD compared with UNT were calculated. Data were analyzed using both fixed and random effects models, and studies were assessed for publication bias and heterogeneity. Results A total of 1,511 articles from 1970 to 2017 were identified before inclusion, and exclusion criteria were applied. Ultimately 17 studies met the inclusion criteria and included 2,154 procedures. Of these, 1,040 were SD, and 1,114 were UNT procedures. Study heterogeneity was low. Odds ratios of clinical improvement and revision surgery with SD versus UNT were not significantly different. The odds ratio of complications with SD versus UNT was 0.449 (95% confidence interval [CI] of 0.290–0.695) and 0.469 (95% CI of 0.297–0.738) for fixed and random effect models, respectively. The difference in complications between SD versus UNT was significant (P < 0.001). Conclusion There is no statistically significant difference in clinical outcomes or rate of revision surgery between SD versus UNT. However, there were significantly more complications with UNT. The current body of evidence regarding cubital tunnel syndrome lacks prospective, randomized, controlled trials, uniform reporting of indications, and standardized outcome scoring.

Although numerous epigenetic modifications have been associated with addiction, little work has explored the turnover of histone variants. Uniquely, the H3.3 variant incorporates stably and preferentially into chromatin independently of DNA replication at active sites of transcription and transcription factor binding. Thus, genomic regions associated with H3.3-containing nucleosomes are particularly likely to be involved in plasticity, such as following repeated cocaine exposure. A recently developed mouse line expressing a neuron-specific hemagglutinin (HA)-tagged H3.3 protein was used to track transcriptionally active sites cumulatively across 19 d of cocaine self-administration. RNA-seq and H3.3-HA ChIP-seq analyses were performed on NAcc tissue collected following cocaine or food self-administration in male mice. RNA sequencing revealed five genes upregulated in cocaine relative to food self-administering mice: Fosb, Npas4, Vgf, Nptx2, and Pmepa1, which reflect known and novel cocaine plasticity-associated genes. Subsequent ChIP-seq analysis confirmed increased H3.3 aggregation at four of these five loci, thus validating H3.3 insertion as a marker of enhanced cocaine-induced transcription. Further motif recognition analysis of the ChIP-seq data showed that cocaine-associated differential H3.3 accumulation correlated with the presence of several transcription factor binding motifs, including RBPJ1, EGR1, and SOX4, suggesting that these are potentially important regulators of molecular cascades associated with cocaine-induced neuronal plasticity. Additional ontological analysis revealed differential H3.3 accumulation mainly near genes involved in neuronal differentiation and dendrite formation. These results establish the H3.3-HA transgenic mouse line as a compelling molecular barcoding tool to identify the cumulative effects of long-term environmental perturbations, such as exposure to drugs of abuse.

The scaphoid is predisposed to nonunion after fracture because of its tenuous blood supply and propensity for delayed diagnosis. Many surgical techniques exist and continue to be developed to treat scaphoid non-unions. However, with variability in patient presentation, differences in nonunion location and type, and multiple bone graft sources and fixation options, selecting a surgical strategy proves a difficult task. The goal of this article is to provide an updated review of surgical strategies used to treat scaphoid nonunions. Particular attention is paid to methods of fixation as well as the ongoing debate over indications for structural and vascularized bone grafting. [ Orthopedics . 2022;45(5):e235–e242.]

Objective The current understanding of revision rates following surgery for the primary surgical treatment of idiopathic cubital tunnel syndrome (CuTS) remains unclear. The purpose of this study was to describe and compare the rate of revision surgery following in situ decompression (SD) versus anterior transposition (AT) after the surgical treatment of idiopathic CuTS and examine possible predicting variables for revision. Materials and Methods A retrospective cohort study was performed at a single institution by querying records for all CuTS surgeries performed between January 2010 and December 2015. The initial query resulted in 1,967 cases. Exclusion criteria included acute trauma, concurrent unrelated primary elbow procedure, revision surgery, incomplete records, and age younger than 18 or older than 89 years. A total of 1,384 surgeries met criteria for study inclusion. A case–control study was then performed with 39 cases of revision and a group of 76 control cases that did not undergo revision surgery. Bivariate analysis followed by multivariate logistic regression was performed to evaluate predictors of revision. Results Of the 1,384 procedures, 979 were SDs (70.7%) and 405 were ATs (29.3%). Among the 1,384 total procedures, there were 39 primary cubital tunnel surgeries resulting in a revision surgery (2.8%). The revision rate for SD was 3.1% and the revision rate for AT was 2.2%. Predictors of revision were younger age, increased nerve conduction velocity, and decreased duration of symptoms. Conclusion In the surgical treatment of idiopathic CuTS, the overall revision rate is low (2.8%). This study found no significant difference in revision rate between SD and AT, but that risk for revision surgery overall was associated with younger age, increased nerve conduction velocity, and decreased duration of symptoms. Level of Evidence This is a therapeutic, level III study.