Fracture-dislocations of the proximal interphalangeal joint encompass a spectrum of injury severity, ranging from injuries that require little intervention to those that require advanced reconstructive surgery for optimal outcome. Three fracture-dislocation patterns are recognized: dorsal, volar, and pilon. Acceptable outcome is dependent on achieving and maintaining a well-aligned and well-reduced joint, re-establishing normal joint kinematics, and restoring motion. Anatomic articular surface reduction is desirable but not absolutely necessary for a good outcome. Treatment depends on both the type of injury and patient-dependent factors. Optimal outcome for a specific injury is predicated on expedient diagnosis and recognition of injury severity, which enables initiation of appropriate management.

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Purpose The management of distal radius fractures differs based on the nature of the fracture and the experience of the surgeon. We hypothesized that patients requiring surgical intervention would undergo different procedures when in the care of a surgeon with subspecialty training in hand surgery as compared to surgeons with no subspecialty training in hand surgery. The null hypothesis was that intervention, as measured in the American Board of Orthopaedic Surgery (ABOS) database, would be the same, independent of subspecialty training. Methods We queried the ABOS database for case log information submitted for part II of the ABOS Examination. Queries for all codes involved with distal radius fractures management were combined with associated codes for management of median nerve neropathy, triangular fibrocartilage complex tears, ulnar shaft and styloid fractures. Hand fellowship trained orthopaedic surgeons were compared to those completing other fellowships and non-fellowship trained orthopaedic surgeons during their board collection period. Results During the study period, 2317 Orthopedic surgeons reported treatment of 15,433 distal radius fractures. Of these surgeons, 411 had hand fellowship training. On a per surgeon basis, fellowship trained hand surgeons operatively treated more multi-fragment intra-articular distal radius fractures than their non-hand fellowship trained counterparts (5.3 vs 1.2). Additional procedures associated with the management of distal radius fractures were also associated with the fellowship training of the treating surgeon. Conclusions Among orthopaedic surgeons taking part II of the American Board of Orthopaedic Surgery certifying examination, differences exist in the type, management and reporting of distal radius fractures among surgeons with different areas of fellowship training. Clinical Relevance This study describes the association of hand surgery fellowship training on the choice of intervention for distal radius fractures and associated conditions.

Studies on patients with degenerative joint disease of the hip show that femoral periprosthetic bone mineral decreases following total hip arthroplasty. Scarcely any osteodensitometric data exist on femoral neck fracture (FNF) patients and periprosthetic bone remodelling. In two parallel cohorts we enrolled 87 patients (mean age, 72 AE 12 years; male:female ratio, 30:57) undergoing total hip arthroplasty for either primary osteoarthritis (OA) of the hip (n ¼ 37) or for an acute FNF (n ¼ 50) and followed them for a mean of 5.4 years. Outcomes were bone mineral density (BMD) changes in the periprosthetic Gruen zones 1-7, the incidence of periprosthetic fractures and clinical outcome. The bone mineral loss in the fracture group was more than twice that of the osteoarthritis group, À16.9% versus À6.8% (p ¼ 0.004). The incidence of periprosthetic fractures was 12% (6/50) in the fracture cohort compared with none (0%) in the OA cohort (p ¼ 0.03). Periprosthetic bone mineral loss following total hip arthroplasty is significantly greater in patients who are treated for acute FNF than in OA patients. This decrease of BMD follows a different pattern with the FNF patients losing larger proportions of bone in Gruen zones 1, 2, 6, and 7 while the OA patients tend to have larger losses only in zones 1 and 7. ß