Wide-awake local anesthesia no tourniquet (WALANT) is used for various hand surgeries, but there are no reports of its use for distal radius fractures. The authors compared perioperative variables and clinical outcomes for volar plating for distal radius fractures with WALANT vs general anesthesia with tourniquet. This retrospective study included 47 patients who presented with distal radius fractures between January 2015 and February 2017. Twenty-one underwent surgical volar plating with WALANT, and 26 underwent surgical volar plating with general anesthesia with tourniquet. Patients were followed for 12 months. The 2 groups were compared regarding perioperative parameters and clinical outcomes, including perioperative field pain evaluated by visual analog scale score on postoperative day 1, range of motion 12 months postoperatively, and Mayo wrist score. The WALANT group had a lower mean visual analog scale score and a shorter mean hospitalization (both P <.001), but greater mean blood loss ( P <.001). No significant differences were found regarding operative time ( P =.214) or time to union ( P =.180). At 12-month follow-up, no significant differences were found regarding wrist extension ( P =.721), wrist flexion ( P =.119), or Mayo wrist score ( P =.223). Although both techniques permitted volar plating for distal radius fractures, WALANT allowed immediate intervention and led to less postoperative pain and shorter hospitalization. Although control of blood loss was worse with WALANT, blood loss was limited to a mean of 22.62 mL and did not interfere with the surgical field. [ Orthopedics . 2019; 42(1):e93–e98.]

This retrospective study investigated adjacent segments radiologically and clinically after posterolateral fusion of the lumbar spine with instrumentation. Thirty-two patients over 60 years old with a postoperative follow-up of at least 4 years were included. These patients all met the criteria of a postoperative symptom-free period of over 2 years, evident fusion mass seen on plain radiographs, and no implant breakage or loosening. There was 81.3% excellent and good clinical results (26/32). For all patients, flexion and extension views of the lumbar spine were done preoperatively and postoperatively. Adjacent segments below the fusion, above the fusion, and cranial to the above adjacent segment were examined. Three patients each with translation > 4 mm in adjacent segments were found in both the short and long (> or = 3 segments) fusion groups. The incidence was 16.7% (3/18) in the short fusion group and 21.4% (3/14) in the long fusion group. However, no statistically significant difference (p = 0.7878) was found according to the Fisher exact test. Comparing the effect of different types of instruments, there still was no statistically significant difference (p = 0.1161) between the VSP plate and Isola rod groups in inducing degeneration of adjacent segments after posterolateral fusion of the lumbar spine. After measuring the mobility of degenerated adjacent segments, relative hypermobility was more likely responsible for the accelerated degeneration rather than the absolute increase of mobility.

The purpose of this study was to compare the parameters of perioperative course and cost-effectiveness for patients with midshaft clavicle fractures treated by dynamic compression plates or locked compression plates.This retrospective, case-controlled study involved 54 patients with midshaft clavicle fractures who received dynamic compression plates (n=21) or locked compression plates (n=33) between January 2002 and December 2008. Indications for surgery included displacement or shortening >2 cm, comminuted fractures, and skin tenting. Patients with previous malunion, nonunion, multiple injuries of the shoulder girdle, or open fractures were excluded. Preoperative demographics showed no statistically significant differences between the 2 groups. Eighteen patients with dynamic compression plates and 28 patients with locked compression plates with postoperative follow-up >1 year were included for comparison. Statistical analyses for operative time, blood loss, complication rate, hospital stay, and union rate demonstrated no statistically significant difference between the 2 groups. The only statistically significant difference was a higher rate of plate removal requests in the dynamic compression plate group. Considering medical expenditure, locked compression plates cost 6 times more than dynamic compression plates in the authors' institution (US $600 vs $100, respectively).Other than more plate removal requests in the dynamic compression plate group and greater expense in the locked compression plate group, dynamic compression plates and locked compression plates achieved satisfactory operative outcomes in treating midshaft clavicle fractures, with no statistically significant difference between perioperative course and eventual fracture union observed between the 2 groups.

Object The authors measured the range of motion (ROM) of the spine in healthy individuals by using an electromagnetic tracking device to evaluate the functional performance of the spine. Methods The authors used the Flock of Birds electromagnetic tracking device with 4 receiver units attached to C-7, T-12, S-1, and the midthigh region. Forward/backward bending, bilateral side bending, and axial rotation of the trunk were performed in 18 healthy individuals. Results The average ROM was calculated after 3 consecutive measurements. The thoracic spine generated the greatest angle in axial rotation and smallest angle in backward bending. The lumbar spine generated the greatest angle in forward bending and smallest angle in axial rotation. The hip joints generated the greatest angle in forward bending and smallest angle in backward bending. Additionally, 40% of forward-bending motion occurred in the lumbar spine and 40% occurred in the hip joints. Approximately 60% of backward bending occurred in the lumbar spine; 60% of axial rotation occurred in the thoracic spine; and 45% of side bending occurred in the thoracic spine. Conclusions The Flock of Birds electromagnetic tracking device cannot only measure the ROM of spine but also easily differentiate the 6-degree contributions by different segments.

Hemi-arthroplasty with supplemental fixation of greater trochanter is a rational option to treat failed hip screws with fracture of greater trochanter in case of destructed femoral head.