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Andrew Freiberg, MD
Fourth Session
Moderator: Andrew Freiberg, MD

Maximillian C. Soong, MD Brandon Earp, MD
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.

Michael A. Vasquez, MD Mitchel B. Harris, MD
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.

Brian Forsythe, MD Thomas J. Gill, MD
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.