<p><strong>Objective. </strong>To determine the effectiveness of diagnostic ultrasound (US) at evaluating the condition of the radial nerve in the setting of humeral shaft fractures.</p><p><strong>Materials and Methods. </strong>An observational study was performed of 18 patients with radial nerve palsy associated with humeral shaft fractures who underwent US examination to assess the condition of the radial nerve.</p><p><strong>Results. </strong>Six patients with humeral shaft fractures treated nonoperatively in a functional brace had US findings consistent with contusion or stretch radial nerve injury. Twelve patients ultimately underwent surgery either because US showed an entrapped or lacerated radial nerve, or for other operative indications. There was a 92% concordance (11/12 patients) between US and intraoperative findings with regards to the condition and location of the radial nerve, with the remaining case being complicated by delayed surgical treatment secondary to patient factors.</p><p><strong>Conclusion. </strong>Our study demonstrates that US is an effective diagnostic tool in evaluating radial nerve injuries in the setting of humeral shaft fractures and can aid in clinical decision making by differentiating between patients with nerve laceration or entrapment who may benefit from surgery from those with neurapraxia managed nonoperatively.</p>

IntroductionElective hand surgery encompasses a large volume of orthopaedic cases annually. Carpal tunnel syndrome, ganglion cysts, and trigger digits are some of the most common pathologies treated by hand surgeons. In the midst of the COVID-19 pandemic, patient's interest in elective hand surgery for these conditions is uncertain. The objective of this study is to use Google Trends to track online interest in elective hand surgery in the United States during the COVID-19 pandemic. MethodsOnline search trends regarding elective orthopaedic hand surgery were obtained via Google Trends from November 2019 to November 2020. Three common hand pathologies in lay terms ("carpal tunnel," "'ganglion cyst' + 'wrist cyst,'" and "trigger finger") and three hand surgery-specific keywords ("hand surgery," "carpal tunnel surgery," and "trigger finger surgery") were used as search terms. The search volume index (SVI) graphs for the United States for both sets of search terms were then generated from the Google Trends data and compared to the seven-day average of new COVID-19 cases per day as reported by the CDC. A separate SVI graph was then created for the search term "coronavirus" and was compared against both sets of search terms as above. ResultsSearch trends for all elective hand pathologies and surgery-specific keywords remained constant from November 2019 to the beginning of March 2020 and then decreased significantly within a one-month period following the peak in COVID-19 cases the week of March 15, 2020. Search trends for these keywords increased to baseline levels over the next few months. The search trend for "coronavirus" demonstrated a small search volume index peak of 13 during January 2020 followed by the maximum peak of 100 during the week of March 15, 2020, corresponding to the decrease in search trends of elective hand surgery at that time. ConclusionsOnline interest in elective hand surgery remained constant prior to the COVID-19 pandemic; however, there was a marked decrease in search trends of elective hand surgery with the rise in daily reported COVID-19 cases, suggesting that patient's interest in elective hand surgery decreased with the onset of the pandemic.

Introduction: The mainstay of trigger finger treatment is a corticosteroid injection of the affected digits and is associated with a very high success rate. However, some patients do not respond to nonsurgical management and undergo subsequent surgical release. The purpose of this study is to investigate the comorbidities that predispose patients to progressing from injection to surgical release. Methods: Patient data were obtained from a national insurance database. All patients aged 20 years or older who underwent trigger digit injection were included. Any injection that did not specify the digit was excluded. Subsequent procedures, including repeat injection and surgical release, were identified using relevant Current Procedural Terminology codes. A multivariate model was constructed to evaluate potential risk factors for requiring release after prior injection of the same digit. Stepwise backward selection was used to retain significant variables. Results: A total of 42,537 trigger digits were identified in 31,830 patients, most of whom were female. The right hand was affected more commonly than the left. The middle and ring fingers were the most commonly affected digits. Over 80% of all trigger digits underwent only a single injection, and approximately 90% of injected digits did not require subsequent release. In the multivariate model, factors associated with higher risk of release were male sex, involvement of additional digits, multiple injections of the same digit, chronic pulmonary disease, HIV/AIDS, obesity, alcohol abuse, and depression. The model also found small fingers to be less likely to progress to release. Discussion: Patients with the risk factors identified in this study are more likely to progress to surgical release after trigger finger injection. Although prospective studies are required, the information may be beneficial in counseling patients and their treatment options.

Physicians are often faced with managing difficult conditions such as chronic lower back pain. Intervertebral disk herniation typically occurs horizontally, leading to impingement of the spinal cord which can potentially cause radicular symptoms or other spinal cord pathologies; however, disk herniations can also occur vertically and extend through the endplate of an adjacent cranial or caudal vertebra: a phenomenon known as a Schmorl’s node. Although Schmorl’s nodes can be seen in many asymptomatic individuals, they can be a cause of degenerative disk disease and low back pain. An 18-year-old female with a history of trauma presented to urgent care with increasing lower back pain for the past six weeks. Four months prior, she was struck by a motor vehicle while riding her bicycle, and she had residual back pain since then. Plain radiography at the time of the accident showed no acute abnormalities. She had no other associated symptoms. On presentation, her vital signs were within normal limits, and her physical examination was largely unremarkable except for point tenderness along the lumbar (L4-L5) region of the spine. A complete blood count showed no leukocytosis and plain radiography of the lumbosacral spine showed a Schmorl’s node in the inferior endplate of L5. The patient was diagnosed with a trauma-induced Schmorl’s node and was treated with physical therapy, ice packs, and non-steroidal anti-inflammatory drugs. Her symptoms improved over the next several months. For patients with a history of axial load trauma and persistent back pain, clinicians should consider the possibility of a trauma-induced Schmorl’s node. Plain radiography or magnetic resonance imaging can help with the diagnosis and guide further management.

Necrotizing fasciitis is a devastating infectious disease process that is characterized by extensive soft tissue necrosis along deep fascial planes, systemic toxicity, and high mortality. Ultrasound imaging is a rapid and non-invasive tool that can be used to help make the diagnosis of necrotizing fasciitis by identifying several distinctive sonographic findings. The purpose of this study is to describe the construction of a realistic diagnostic training model for necrotizing fasciitis using fresh frozen cadavers and common, affordable materials.Presently, fresh non-embalmed cadavers have been used at medical institutions for various educational sessions including cadaver-based ultrasound training sessions. Details for the preparation and construction of a necrotizing fasciitis cadaver model are presented here. This paper shows that the images obtained from the cadaver model closely imitate the ultrasound appearance of fluid and gas seen in actual clinical cases of necrotizing fasciitis.Therefore, it can be concluded that this cadaver-based model produces high-quality sonographic images that simulate those found in true cases of necrotizing fasciitis and is ideal for demonstrating the sonographic findings of necrotizing fasciitis.