Targeted muscle reinnervation (TMR) is a revolutionary surgical technique that, together with advances in upper extremity prostheses and advanced neuromuscular pattern recognition, allows intuitive and coordinated control in multiple planes of motion for shoulder disarticulation and transhumeral amputees. TMR also may provide improvement in neuroma-related pain and may represent an opportunity for sensory reinnervation as advances in prostheses and haptic feedback progress. Although most commonly utilized following shoulder disarticulation and transhumeral amputations, TMR techniques also represent an exciting opportunity for improvement in integrated prosthesis control and neuroma-related pain improvement in patients with transradial amputations. As there are no detailed descriptions of this technique in the literature to date, we provide our surgical technique for TMR in transradial amputations.
Fragility fractures of the distal radius represent an opportunity to diagnose and treat osteoporosis before further fractures occur. The goal of this study was to determine the prevalence of prescriptions for calcium/vitamin D supplementation and the prevalence of dual-energy x-ray absorptiometry (DEXA) scans in patients who sustained fragility fractures of the distal radius. A further goal was to determine the prevalence of patients who received prescriptions for the treatment of osteoporosis after DEXA scans. The authors performed a retrospective review of all patients 50 years and older who sustained a fragility fracture of the distal radius and were treated by the orthopedic surgery service at the authors' institution from 2004 to 2010. After a fragility fracture of the distal radius, fewer than 25% of previously unidentified at-risk patients received a prescription for vitamin supplementation and underwent a DEXA scan. Women were 7 times more likely than men to receive calcium/vitamin D supplementation, 14 times more likely to undergo a DEXA scan for the evaluation of osteoporosis, and 25 times more likely to receive a prescription for bisphosphonates. Patients who underwent a DEXA scan were 9 times more likely to receive pharmacologic treatment than those who did not undergo this scan. More than half of patients did not receive a prescription for calcium/vitamin D supplementation and did not undergo DEXA scanning as recommended by current National Osteoporosis Foundation guidelines. Most patients who received prescriptions or underwent DEXA scans did so before rather than after fracture, indicating poor compliance with National Osteoporosis Foundation guidelines.
Duplication of the spine is a rare malformation. A neurologically intact pediatric patient with this malformation is described here. A 6-year-old girl presented to our institution for evaluation of an asymptomatic kyphotic deformity. She denied weakness, sensory changes, and bowel or bladder complaints. Physical examination revealed mild kyphosis at the thoracolumbar junction with normal gait and neurologic function. Radiographs demonstrated duplication of the lumbar spine and sacrum. Computed tomography, MRI, and abdominal ultrasound results are reported. As she is neurologically normal, we will continue to observe this patient and intervene in the case of development of neurologic impairment or worsening kyphosis. J Pediatr
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