An accompanying ulnar styloid fracture in patients with stable fixation of a distal radial fracture has no apparent adverse effect on wrist function or stability of the distal radioulnar joint.

Study DesignA new classification system for throacolumbar spine injury, Thoracolumbar Injury Classification and Severity Score (TLICS) was evaluated retrospectively.PurposeTo evaluate intrarater and interrater reliability of newly proposed TLICS schemes and to estimate validity of TLICS's final treatment recommendation.Overview of LiteratureDespite numerous literature about thoracolumbar spine injury classifications, there is no consensus regarding the optimal system.MethodsUsing plain radiographs, computed tomography scanning, magnetic resonance imaging, and medical records, 3 clssifiers, consisting of 2 spine surgeons and 1 senior orthopaedic surgery resident, reviewed 114 clinical thoracolumbar spine injury cases retrospectively to classify and calculate injury severity score according to TLICS. This process were repeated on 4 weeks intervals and the scores were then compared with type of treatment that patient ultimately received.ResultsThe intrarater reliability of TLICS was substantial agreement on total score and injury morphology, almost perfect agreement on integrity of the posterior ligament complex (PLC) and neurologic status. The interrater reliability was substantial agreement on injury morphology and integrity of the PLC, moderate agreement on total score, almost perfect agreement on neurologic status. The TLICS schems exhibited satisfactory overall validity in terms of clinical decision making.ConclusionsThe TLICS was demonstrated acceptable intrarater and interrater reliability and satisfactory validity in terms of treatment recommendation.

BackgroundThe aim of this study was to investigate the relationship between clinical symptoms and cross-sectional area (CSA) of the median nerve at the carpal tunnel inlet before and after open carpal tunnel release (CTR).MethodsThirty-two patients (53 hands) that underwent open CTR for idiopathic carpal tunnel syndrome were prospectively enrolled. Median nerve CSA at the carpal tunnel inlet was measured preoperatively and at 2 and 12 weeks after CTR by high resolution ultrasonography. The Boston carpal tunnel questionnaire (BCTQ) was also completed at these times.ResultsBCTQ symptom (BCTQ-S) score was significantly improved at 2 weeks postoperatively, but BCTQ function (BCTQ-F) score and CSA were significantly improved at 12 weeks postoperatively. Preoperative CSA was significantly correlated with preoperative BCTQ-S and BCTQ-F scores but was not significantly correlated with postoperative BCTQ scores or postoperative changes in BCTQ scores. Postoperative median nerve CSA was not significantly correlated with postoperative BCTQ-S or BCTQ-F scores, and postoperative changes in median nerve CSA were not significantly correlated with postoperative changes in BCTQ-S or BCTQ-F scores.ConclusionsThe study shows clinical symptoms resolve rapidly after open CTR, but median nerve swelling and clinical function take several months to recover. In addition, preoperative median nerve swelling might predict preoperative severities of clinical symptoms and functional disabilities. However, postoperative reductions in median nerve swelling were not found to reflect postoperative reductions in clinical symptoms or functional disabilities.

This study showed that the posterior plating with interbody grafting is biomechanically superior to anterior plating with locked fixation screws for stabilizing the one-level flexion-distraction injury or burst injury. More rigid postoperative external orthoses should be considered if the anterior plating is used alone for the treatment of unstable cervical injuries. It was also found that combined anterior and posterior fixation may not improve the stability significantly as compared with posterior grafting with lateral mass screws and interbody grafting.

Ischemic-reperfusion injury is thought to be a cause of idiopathic carpal tunnel syndrome (CTS). The purpose of this study was to determine whether oxidative stress caused by ischemia-reperfusion injury in subsynovial connective tissue is associated with idiopathic CTS and its symptoms. Bioptic samples of tenosynovial tissue were collected from 20 idiopathic CTS patients during surgery. Control specimens of tenosynovial tissue were collected from eight non-CTS patients. Analysis included histological and immunohistochemical examination for the distribution of endothelial nitric oxide synthase (eNOS), nuclear factor (NF)-␤, and transforming growth factor (TGF)-␤ RI in subsynovial connective tissues. Histological examinations showed a marked increase in fibroblast density and vascular proliferation in specimens from CTS patients. The expressions of eNOS, NF-␤, and TGF-␤ RI in fibroblasts and vascular endothelial cells of subsynovial connective tissues of patients were significantly higher than in those of controls. A significant positive correlation was found between the subjective symptom severity of CTS, and the immunoreactivities of eNOS and NF-␤. This study suggests that oxidative stress in subsynovial connective tissue is related to CTS and its symptoms. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J. Orthop. Res. 28: 1463Res. 28: -1468Res. 28: , 2010 Keywords: idiopathic carpal tunnel syndrome; oxidative stress; subsynovial connective tissueThe disease mechanism of idiopathic carpal tunnel syndrome (CTS) involves an elevated carpal tunnel pressure due to a reduction in the size of the tunnel or an increase in the volume of its content. 1,2 Previous studies demonstrated that no significant differences exist between patients with and without CTS in terms of transverse carpal ligament, 3,4 and, therefore, suggested that CTS is likely caused by an increase in carpal tunnel volume. This hypothesis is supported by recent MRI studies that showed evidence of tenosynovial swelling. 5,6 A number of researchers attempted to identify pathological changes in idiopathic CTS. Most reported that inflammatory cells are rare and that edema and nonspecific fibrosis are the most common histological findings of tenosynovium. 7 However, some authors pointed out that these pathological findings do not well correlate with the symptoms of CTS. 2,8 Freeland et al. 9 suggested that ischemia-reperfusion injury is an important cause of idiopathic CTS. This injury type would increase the levels of several types of proinflammatory cytokines in tenosynovium, and possibly cause the pathologic changes observed in idiopathic CTS. The purpose of our study was to seek evidence of the oxidative stress caused by ischemia-reperfusion injury in subsynovial connective tissue of idiopathic CTS and to investigate the extent of the association between oxidative stress and the symptoms of idiopathic CTS. MATERIALS AND METHODSThis study was approved by our institutional review board, and informed consent for spec...

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Level II, prognostic study.

Patients with inadequate health literacy, adverse drug events, or medical comorbidities had higher rates of non-adherence with alendronate treatment after sustaining a DRF. Further research is needed to show whether improvements in patient comprehension via informational intervention in patients with a DRF will improve adherence to osteoporosis treatment.