For patients sustaining DRF, we report a 30-day readmission rate of 7% with 20% of patients having UHC. Patients with depression or anxiety were more likely to be both readmitted and have UHC. Identifying risk factors for readmission during initial presentation may help reduce readmissions. Improving pain relief strategies early may aid in decreasing the burden of UHC.

Case: A 23-year-old female athlete presented with postoperative hip pain and laxity following 3 arthroscopic hip procedures. Conclusions: Open reconstruction of the anterior hip capsule with Achilles allograft can correct arthroscopy-induced hip laxity.

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Background: A systematic review and meta-analysis of case-control animal model studies will help clarify the vascular effects of botulinum toxin (BTX). Methods: Preferred Reporting Items of Systematic reviews and Meta-Analyses guidelines were used to identify all animal case-control studies published before September 13, 2020, evaluating the vascular effects of BTX. Primary parameters included the following: perfusion, flap survival, arterial and venous dilation, and arterial and venous thrombosis. Results: Thirty-six studies with 1032 animals met the systematic review inclusion criteria. Twenty-nine studies had quantifiable data for statistical analysis. Statistically significant increases in perfusion with BTX over saline were detected within 1 day and sustained up to 8 weeks. The following represent weighted mean data from the meta-analysis. The administration of BTX has a 26% increase in both random pattern and pedicled flap survival area over controls. Botulinum toxin causes vasodilation. Botulinum toxin increases vessel diameter in arteries by 40% and in veins by 46% compared with saline controls. The administration of BTX reduces thrombosis by 85% in arteries and by 79% in veins compared with saline controls. Vascular effects were consistent across both BTX-A and BTX-B serotypes, multiple animal species, and various doses. No clear relationships between vascular effects and BTX pretreatment time were identified. Conclusions: Perivascular BTX administration intraoperatively or as a chemical delay pretreatment several days before surgery in multiple animal species and models shows multiple changes to the vascular system. Extrapolation of lessons learned from this systematic review and meta-analysis of animal models could expand research and clinical use of BTX in human vascular disease and surgery.

up, 2 years) were selected retrospectively. Seven patients underwent distal radius pedicled VBG (group A) and 5 patients underwent reconstruction with the induced membrane technique (group B) (Figure 68-2). Mean follow-up was 34 months. The time between the original injury and the index procedure was 16 months (range, 11e20). The mean age was 42 years (range, 26e64). Patients were evaluated clinically and radiographically. The number of previous surgeries was recorded. Elbow and wrist range of motion, visual analog scale (VAS) for pain, the Quick-DASH questionnaire, and Mayo Elbow Perfomance Score (MEPS) were assessed. Complications and the need for reoperations were recorded. Results: All nonunion were healed at final follow-up. The average defect size was 5.3 cm (range, 4.2e6). The average number of previous surgeries in the VBG group was 4.2 (range, 3e7) and in the IMT group was 2.8 (range, 2e5). The average time to union was 3.8 months (range 3e6) for group A, and 4.6 (range 4e6) for group B. Active ROM did not differ significantly between groups. Average QuickDASH was 13, and average MEPS was 83. At the 2-year follow-up, there were no significant differences in the VAS pain score (1.3 in group A; 0.9 in group B). There were 2 complications. In the VBG group, one patient required implant removal, and in the IMT group, 1 nonunion required autogenous iliac crest bone graft. Final results were satisfactory for both. No fracture or persistent donor site pain was observed in the VBG group. Summary Points:In this limited series, both techniques showed favorable results and could be considered surgical alternatives for the treatment of infected ulnar nonunion. Pedicled VBG showed a shorter time to union compared with induced membrane.