Background The transfer of patients for hand and microsurgical emergencies to level I trauma centers is a common practice. Many of these transfers do not actually require a hand specialist and could be taken care of at most regional hospitals. In this study, we will evaluate the appropriateness of patient transfers for hand trauma and determine if there is a correlation between inappropriate transfers and undesirable factors, such as insurance status and off-hour's presentation. Methods A retrospective chart review was performed in all patients transferred to a level I trauma center for hand and microsurgical trauma over a 22-month period. Collected data included indication for transfer, mode of transfer, time and day of the week, patient demographics, insurance status, and whether the transferring facilities had surgical coverage available. A synopsis, including treatment details, of each transfer was created, and a survey was sent to a review committee who rated the appropriateness of the transfers. Statistical analysis was performed to determine whether appropriateness of transfers was influenced by nonmedical variables. Results Over a 22-month period, a total of 95 hand or microsurgical patients were transferred to a single tertiary referral center. Of these, 66 % of the transfers were considered inappropriate by the surveyed physicians. Inappropriate transfers were statistically more likely to be under insured or transferred during nonbusiness hours. Conclusion A large percentage of patients are being transferred to tertiary care centers for reasons other than medical necessity, generating a large burden on already strained medical resources.

F unctional recovery following major peripheral nerve injuries is often suboptimal despite appropriate and standard treatment. 2,23,27,34,44 Muscles may be reinnervated but remain too weakened to offer much functional benefit. Although a complex and multifactorial problem, time-related permanent changes to denervated muscle awaiting reinnervation play a significant role in these poor results. This process, referred to as denervation atrophy, involves loss of muscle mass, muscle fiber size, and contractile composition. 16,51 While research has progressed toward ways to improve nerve regeneration and to avoid or decrease the development of these muscle changes, our focus has been on strategies to optimize and augment the functional recovery of reinnervated muscles.Anabolic steroids, which have been shown to cause hypertrophy of normal muscle, delay atrophy in immobilized muscle, and to slow progression of denervation atrophy, 9,45,59 are an obvious candidate for this application. Promising preliminary data demonstrated improved muscle contraction recovery in anabolic steroid-treated rodents following the reversal of chronic denervation of hind limb muscles. 22 The purpose of this study was to confirm and further elucidate the role and mechanism by which anabolic steroids (nandrolone) improve strength and functional recovery in reinnervated muscles followEffects of nandrolone on recovery after neurotization of chronically denervated muscle in a rat model Object. Suboptimal recovery following repair of major peripheral nerves has been partially attributed to denervation atrophy. Administration of anabolic steroids in conjunction with neurotization may improve functional recovery of chronically denervated muscle. The purpose of this study was to evaluate the effect of the administration of nandrolone on muscle recovery following prolonged denervation in a rat model.Methods. Eight groups of female Sprague-Dawley rats (15 rats per group, 120 in all) were divided into 3-or 6-month denervated hind limb and sham surgery groups and, then, nandrolone treatment groups and sham treatment groups. Evaluation of treatment effects included nerve conduction, force of contraction, comparative morphology, histology (of muscle fibers), protein electrophoresis (for muscle fiber grouping), and immunohistochemical evaluation.Results. Although a positive trend was noted, neither reinnervated nor normal muscle showed a statistically significant increase in peak muscle force following nandrolone treatment. Indirect measures, including muscle mass (weight and diameter), muscle cell size, muscle fiber type, and satellite cell counts, all failed to support significant anabolic effect.Conclusions. There does not seem to be a functional benefit from nandrolone treatment following reinnervation of either mild or moderately atrophic muscle (related to prolonged denervation) in a rodent model. (http://thejns.org/doi/abs/10.3171/2013.5.JNS121837) key WorDs • anabolic steroid • denervation atrophy • nerve repair • rodent • muscle recovery • nand...

Background The transfer of patients for hand and microsurgical emergencies to level I trauma centers is a common practice. Many of these transfers do not actually require a hand specialist and could be taken care of at most regional hospitals. In this study, we will evaluate the appropriateness of patient transfers for hand trauma and determine if there is a correlation between inappropriate transfers and undesirable factors, such as insurance status and off-hour's presentation. Methods A retrospective chart review was performed in all patients transferred to a level I trauma center for hand and microsurgical trauma over a 22-month period. Collected data included indication for transfer, mode of transfer, time and day of the week, patient demographics, insurance status, and whether the transferring facilities had surgical coverage available. A synopsis, including treatment details, of each transfer was created, and a survey was sent to a review committee who rated the appropriateness of the transfers. Statistical analysis was performed to determine whether appropriateness of transfers was influenced by nonmedical variables. Results Over a 22-month period, a total of 95 hand or microsurgical patients were transferred to a single tertiary referral center. Of these, 66 % of the transfers were considered inappropriate by the surveyed physicians. Inappropriate transfers were statistically more likely to be under insured or transferred during nonbusiness hours. Conclusion A large percentage of patients are being transferred to tertiary care centers for reasons other than medical necessity, generating a large burden on already strained medical resources.

Radiofrequency devices are often used during arthroscopic surgery, most commonly of the shoulder and knee, and increasingly in hip arthroscopy. The most commonly described complication is elevation of joint temperature, leading to capsular shrinkage, chondrolysis, and nerve damage. A less commonly reported complication is that of dermal burns from the heated irrigation fluid. There are several case reports describing dermal burns after shoulder arthroscopy; however, to the authors' knowledge, there are none describing the complication in hip arthroscopy that is often performed by surgeons doing limited if any shoulder arthroscopy. The authors report this case to raise awareness that the use of radiofrequency devices can also lead to extra-articular complications because of the effect of elevated irrigant fluid temperatures on the patient's skin. Sufficiently high temperatures were generated inside the joint, causing a superficial second-degree burn from the outflow irrigant. In the course of instrument switching from sucker/shaver to radiofrequency wand, the outflow valve was inadvertently left open with no attached suction while the radiofrequency wand was in use. Most second-degree burns like the one reported require only conservative therapy with cool compresses to decrease the temperature of the wound. The authors did recommend bacitracin ointment to prevent superficial wound infection, however unlikely with no disruption of the skin. The authors continue to use radio-frequency devices in hip arthroscopy, but are vigilant to maintain dedicated suction at the outflow tubing throughout the procedure. Surgeons should take strict precautions to avoid this preventable complication and follow all manufacturer instructions on the use of such devices.