The findings of the present study are relevant to the clinical practice of examining motions of the cervical spine in three dimensions and to the understanding of spinal trauma and degenerative diseases.

The cervical pedicle is a complex, three-dimensional structure exhibiting extensive variability in internal morphology. Characteristics of the cervical pedicle at different spinal levels must be noted before transpedicular screw fixation.

We have evaluated the clinical outcomes of simple excision, ulnar lengthening and the Sauvé-Kapandji procedure in the treatment of deformities of the forearm in patients with multiple hereditary osteochondromas. The medical records of 29 patients (33 forearms) were reviewed; 22 patients (22 forearms) underwent simple excision (four with ulnar lengthening) and seven the Sauvé-Kapandji procedure. Simple excision increased the mean supination of the forearm from 63.2 degrees to 75.0 degrees (p = 0.049). Ulnar lengthening did not significantly affect the clinical outcome. The Sauvé-Kapandji technique improved the mean pronation from 33.6 degrees to 55.0 degrees (p = 0.047) and supination from 70.0 degrees to 81.4 degrees (p = 0.045). Simple excision may improve the range of movement of the forearm but will not halt the progression of disease, particularly in younger patients. No discernable clinical or radiological improvement was noted with ulnar lengthening. The Sauvé-Kapandji procedure combined with simple excision of osteochondromas can improve stability of the wrist, movement of the forearm and the radiological appearance.

Comprehensive quantitative anatomic data of the middle and lower cervical vertebral bodies have been obtained. This may be useful in improving the understanding of the three-column and other vertebral-fracture theories, the fidelity of the finite element models of cervical spine, and the designs of surgical instrumentation.

Background: Although orthopaedic surgeons have been shown to prescribe excessive amounts of opioid analgesics postoperatively, the degree in which surgical trainees contribute to this trend is unknown. The purpose of this study was to compare self-reported opioid-prescribing behavior, factors influencing this behavior, and perceptions of patient opioid utilization and disposal between hand surgeons and trainees. Methods: Attending hand surgeons and trainees in hand, orthopaedic, and plastic surgery programs were invited to participate in a web-based survey including demographic characteristics; self-reported prescribing behavior specific to 4 procedures: open carpal tunnel release, trigger finger release, thumb carpometacarpal arthroplasty, and distal radial fracture open reduction and internal fixation; and perceptions and influencing factors. Analgesic medications were converted to morphine milligram equivalents and were compared across groups of interest using independent t tests or analysis of variance for each procedure. Results: A total of 1,300 respondents (266 attending surgeons, 98 fellows, 708 orthopaedic residents, and 228 plastic surgery residents) were included. Surgeons reported prescribing fewer total morphine milligram equivalents compared with residents for all 4 procedures. Personal experience was the most influential factor for prescribing behavior by surgeons and fellows. Although residents reported that attending surgeon preference was their greatest influence, most reported no direct opioid-related communication with attending surgeons. Conclusions: Residents self-report prescribing significantly higher morphine milligram equivalents for postoperative analgesia following commonly performed hand and wrist surgical procedures than attending surgeons. Poor communication between residents and attending surgeons may contribute to this finding. Residents may benefit from education on opioid prescription, and training programs should encourage direct communication between trainees and attending surgeons.

PURPOSE 5To examine potential risk factors for development of delayed or nonunion following 6 elective ulnar shortening osteotomy using a dedicated osteotomy plating system. 7 8 METHODS 9We performed a retrospective review of all patients who underwent elective ulnar 10 shortening using the TriMed single osteotomy dynamic compression plating system 11 by one of two fellowship-trained hand surgeons over a five-year period. 12Demographic data and medical, surgical, and social histories were reviewed. Time to 13 bony union was determined radiographically by a blinded reviewer. Bivariate 14 statistical analysis was performed to examine the effect of explanatory variables on 15 the time to union and the incidence of delayed or nonunion. Those variables 16 associated with the development of delayed or nonunion were used in a 17 multivariate logistic regression model. Complications, including the need for 18 additional surgery, were also recorded. 19 20 RESULTS 21Seventy-two ulnar shortening osteotomy procedures were performed in 69 22 patients. Delayed union, defined as ≥ 6 months to union, occurred in 8/72 cases 23 (11%). Four of 72 (6%) surgeries resulted in nonunions, all of which required 24 additional surgery. Hardware removal was performed in 13/72 (18%) of cases. 25Time to union was significantly increased in smokers (6+/-3 months) versus non-26 smokers (3 +/-1 months). On multivariate analysis, diabetics and active smokers 27 demonstrated a significantly higher risk of developing delayed union or nonunion. 28Patient age, sex, body mass index, thyroid disease, workers compensation status, 29 alcohol use, and amount smoked daily did not have an effect on the time to union or 30 the incidence of delayed or nonunion. 31 32 CONCLUSIONS 33Despite the use of an osteotomy-specific plating system, smokers and diabetics were 34 at significantly higher risk for both delayed union and nonunion following elective 35 ulnar shortening osteotomy. Other known risk factors for suboptimal bony healing 36were not found to have a deleterious effect. 37 38 LEVEL OF EVIDENCE 39Prognostic Level III 40

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Purpose of Review Carpal tunnel syndrome is the most common compressive neuropathy encountered by hand and upper extremity surgeons. The predominant presentation includes symptomatic paresthesias in the median nerve distribution of the affected hand, frequently causing nocturnal disturbances. Surgical treatment requires division of the transverse carpal ligament, which can be performed through open and endoscopic means. Endoscopic techniques have evolved significantly since they were first introduced in the late 1980s. This manuscript reviews the literature to summarize the current state of carpal tunnel surgery. Recent Findings While endoscopic techniques have demonstrated superior early functional outcomes and a more rapid recovery, there are lingering concerns over the potential for nerve, vessel, and tendon injuries. These concerns have not been validated by the hand surgery literature, which ascribes similar rates of complications for both open and endoscopic surgical approaches. Moreover, patients report greater satisfaction with endoscopic surgical approaches compared with open techniques. Summary In summary, the debate between proponents of open versus endoscopic carpal tunnel surgery continues. While surgeons who employ endoscopic techniques appear to be in the minority, there is a plethora of evidence to suggest that both approaches are comparably safe and equally effective.