Faculty Bibliography

The scoliometer is an inclinometer commonly used in scoliosis screening. The device is used during an Adam's forward bend test, in which a patient bends forward at the hips to measure deformity of the rib cage and spinal column. If a sufficient angle of rotation is measured, then the appropriate referrals and x-rays can be made and taken. This ubiquitous screening tool allows for a quick and simple scoliosis screening and is a mainstay of scoliosis management. With the advent and rapid improvement of smart phone technology, many scoliometer applications have become readily accessible. Our study was designed to test the accuracy, precision, and calibration of several scoliometer applications available on both the Apple iPhone and Samsung Galaxy platforms. Application cost was also analyzed to assess the plausibility of using a smartphone scoliometer application in place of a traditional scoliometer in a traditional scoliosis screening. Our data show that available smart phone applications can be used effectively and that, in a controlled environment, some applications performed better than a traditional scoliometer. Application price was not correlated with effectiveness; the cost-free application performed better than the for-purchase application.

BACKGROUND:Fractures of the radial shaft with disruption of the distal radial ulnar joint (DRUJ) or Galeazzi fractures are treated with reduction of the radius followed by stability assessment of the DRUJ. In rare instances, the reduction of the DRUJ is blocked by interposed structures requiring open reduction of this joint. The purpose of this study is to review all cases of irreducible Galeazzi fracture-dislocations reported in the literature to offer guidelines in the diagnosis and management of this rare injury. METHODS:A search of the MEDLINE database, OVID database, and PubMed database was employed using the terms "Galeazzi" and "fracture." Of the 124 articles the search produced, a total of 12 articles and 17 cases of irreducible Galeazzi fracture-dislocations were found. RESULTS:The age range was 16 to 64 years (mean = 25 years). A high-energy mechanism of injury was the root cause in all cases. More than half of the irreducible DRUJ dislocations were not identified intraoperatively. In a dorsally dislocated DRUJ, a block to reduction in most cases (92.3%) was secondary to entrapment of one or more extensor tendons including the extensor carpi ulnaris, extensor digiti minimi, and extensor digitorum communis, with the remaining cases blocked by fracture fragments. Irreducible volar dislocations due to entrapment of the ulnar head occurred in 17.6% of cases with no tendon entrapment noted. CONCLUSIONS:In the presence of a Galeazzi fracture, a reduced/stable DRUJ needs to be critically assessed as more than half of irreducible DRUJs in a Galeazzi fracture-dislocation were missed either pre- or intraoperatively.

BACKGROUND:Obesity is an often-cited cause of surgical morbidity. As a result, many institutions have required screening prior to "clearing" obese individuals for surgery. However, it remains unclear whether such testing is warranted for obese patients prior to upper extremity procedures. This study reviews surgical outcomes to determine if obesity does predict operative morbidity following upper extremity surgery. METHODS:The National Surgical Quality Improvement Program was queried for 18 Current Procedural Terminology codes, representing upper extremity fracture and arthroplasty procedures. Patients' body mass index (BMI) and medical histories were examined as predictors for postoperative complications. Both individual and combined incidences of complications were compared between patients stratified as normal-weight (BMI < 30); obese (BMI 30-40); and morbidly obese (BMI> 40). RESULTS:A total of 8,477 patients were identified over the 5-year study period; 5,303 had a BMI <30, 2,565 a BMI of 30 to 40 and 585 a BMI >40. With the exception of postoperative blood transfusions, there were no significant increases in the incidence rates of any complication event as a function of BMI class. The overall incidence of complications was 2.70 % for BMI <30; 2.74 % for BMI 30 to 40; and 1.54 % for BMI >40. CONCLUSIONS:Obesity is not a reliable predictor of complications following upper extremity surgery. Thus, requiring preoperative screening for obese patients may constitute an unnecessary burden on medical resources. Further study is needed to identify specific demographics that might serve as more accurate predictors of poor outcomes in obese patients undergoing surgery of the upper extremity.