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Andrew Freiberg, MD
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Fourth Session
Moderator: Andrew Freiberg, MD
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| Maximillian C. Soong, MD |
Brandon Earp, MD |
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Ulnar Nerve Palsy Associated with Fracture of the Distal Radius
Maximillian C. Soong, MD
Discussor: Brandon Earp, MD
Advisor: David Ring, MD
Dr. Soong described a series of five patients with complete motor and
sensory ulnar nerve palsy associated with a distal radius fracture. Four of
these patients were treated by open reduction and internal fixation and one
by external fixator. Three patients had exploration and release of the ulnar
nerve. At an average follow-up of 17 months, 4 patients had complete or
near-complete recovery of ulnar nerve function and one patient had moderate
motor and mild sensory dysfunction. He concluded that acute ulnar
nerve palsy may occur in association with widely displaced, high-energy
distal radius fractures and that these are usually neurapraxic injuries that
recover to normal or near-normal strength and sensation.
Dr. Earp explained that Dr. Soong’s study showed that there is still
significant value in case series, even in today’s push to publish randomized
controlled trials. She asked whether or not Dr. Soong felt there was a role for
delayed exploration of the ulnar nerve in these injuries. Dr. Soong reported
that while their data doesn’t give enough information for a definitive answer
one way or the other that perhaps when pooled with data from the few other
studies on the subject there could be some modest improvement in outcomes
with early exploration.
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| Michael A. Vasquez, MD |
Mitchel B. Harris, MD |
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Time to Union of Distal Radius Fractures in Patients on Bisphosphonates
Michael A. Vasquez, MD
Discussor: Mitchel B. Harris, MD
Advisor: Tamara Rozental, MD
The purpose of Dr. Vasquez’s study was to determine the healing rates
in patients with distal radius fractures on bisphosphonate therapy at the time
of injury and compare time to union to control fracture patients. He found
that patients on bisphophonate therapy had a mean time to union of 58 days
compared to 49 days in control patients and that this difference was not
clinically significant. He concluded that bisphosphonate therapy can be continued
after fracture without significant deleterious effects on bony healing.
Dr. Harris thanked Dr. Vasquez for his hard work and pointed out the
importance of his data. He then asked if Dr. Vasquez had a chance to look
at secondary fragility fractures in follow-up. Dr. Vasquez explained that they
did start to look at hip fractures and the like but found that there were none
in patients aged 65 years and younger.
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| Brian Forsythe, MD |
Thomas J. Gill, MD |
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Concomitant Arthroscopic SLAP Lesion and Rotator Cuff Repair Versus Isolated Rotator Cuff Repair: A retrospective Analysis
Brian Forsythe, MD
Discussor: Thomas J. Gill, MD
Advisor: Scott Martin, MD
The objective of Dr. Forsythe’s study was to evaluate the efficacy of
concomitant arthroscopic SLAP lesion and rotator cuff repair versus isolated
rotator cuff repair. Patients were dividing into two groups: Group one consisted
of patients undergoing concomitant SLAP and rotator cuff repair and
Group two consisted of patients undergoing isolated arthroscopic rotator
cuff repair. At an average follow-up of 23.8 and 25.6 months respectively, he
found that range of motion scores were not significantly different between
the two groups.
Dr. Gill thanked Dr. Forsythe for explaining and further clarifying a
somewhat contentious topic. He pointed out that he often repairs the two together
without any ill-effects, even though some orthopaedic surgeons have
been concerned about potential shoulder stiffness. Now with Dr. Forsythe’s
data, he stated that he can do so with clear science backing this decision. He
asked about the short term results of the joint repair; specifically if patients
were any stiffer in the first six months. Dr. Forsythe explained that it didn’t
appear as though they were, however the short term follow-up was not complete
enough to make broader statements.
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