Background: The first aim of this study was to determine the rate of revision carpal tunnel release in five urban hospitals over a period of 14 years. The secondary aim was to assess what demographic, condition-related, and treatment-related factors are associated with revision carpal tunnel release. Methods: Between 2002 and 2015, 7464 patients underwent carpal tunnel release. After manually reviewing the medical records, the authors identified 113 patients who underwent revision surgery. Multivariable logistic regression analysis was performed to study association with demographics (age, sex, and race), unilateral or bilateral treated wrist(s) (including carpal tunnel release performed simultaneously and separately), and type of surgery (open or endoscopic). To gain further insight into these factors, a matched case-control analysis in a 1:3 ratio was performed. Results: One hundred thirteen of 7464 patients (1.5 percent) underwent revision carpal tunnel surgery. The median (interquartile range) time to revision surgery was 1.23 years (0.47 to 3.89 years). In multivariable logistic regression analysis, older age, male sex, bilateral carpal tunnel release, and endoscopic carpal tunnel release were independently associated with higher odds for revision surgery. Multivariable conditional logistic regression of the matched case-control cohort showed that smoking and rheumatoid arthritis were independently associated with revision carpal tunnel release. Splint treatment before the initial surgery was independently associated with single carpal tunnel release. Conclusion: Endoscopic release, male sex, smoking, rheumatoid arthritis, and undergoing staged or simultaneous bilateral carpal tunnel release are risk factors for revision surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Background: The purpose of this study was to look for differences in mechanism, radiographic findings, and treatment between mallet fractures of the thumb and mallet fractures of the index through small fingers. Methods: This retrospective study included 24 mallet fractures of the thumb and 392 mallet fractures of other digits. We compared demographics, injury factors (side, dominant hand, time between injury and first visit, and injury mechanism), subluxation, fragment size, treatment, and time from injury to final evaluation between the 2 groups. Results: Mallet fractures of the thumb presented for treatment sooner after injury (2.9 vs 13 days on average), had less fragment displacement (27% vs 33%), and less articular involvement (39% vs 46% on average). None of the mallet fractures of the thumb had radiographic evidence of subluxation, whereas 25% of mallet fractures of other fingers had initial or later subluxation. Conclusions: Mallet fractures of the thumb are not likely to subluxate.

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Diagnostic IV.

Background: To describe the rate and predictors of pathologic fractures in benign neoplasms of the finger, as variables from prediction models for pathologic fractures of the long bones of the extremities are not necessarily applicable to the bones of the hand. Methods: In this retrospective chart review, 69 histologically confirmed neoplasms affecting the bones of the fingers, 49 phalanges and 20 metacarpals, were identified in patients presenting at 2 urban hospitals over a 24-year period. Different variables were studied as possible predictors of pathologic fractures. Results: Forty-nine percent of the tumors presented as a pathologic fracture. The small finger was independently associated with pathologic fractures compared to the other fingers. Tumors of the metacarpal bones were the least likely to fracture compared to other bones. Conclusions: Almost half of neoplasms affecting the bones of the fingers presented initially with a pathologic fracture, most commonly the small finger. Therefore, a lower threshold for surgical treatment of a bone neoplasm affecting the small finger may be reasonable.