Pedro K. Beredjiklian’s research while affiliated with Thomas Jefferson University and other places

Introduction: While previous research has evaluated surgical outcomes following open carpal tunnel release (CTR) in obese patients, there is relatively minimal literature regarding outcomes in patients who have previously undergone bariatric surgery prior to open CTR. The purpose of this study is to compare the postoperative functional and surgical outcomes in patients who undergo open CTR with or without a history of bariatric surgery. Methods: Adult patients with a documented history of bariatric surgery undergoing open CTR surgery between 2015 and 2022 were propensity matched with control open CTR patients with no bariatric surgery history. Patients were matched based on age, sex, race, body mass index (BMI), Charlson Comorbidity Index (CCI), smoking status, and history of diabetes mellitus. A retrospective chart review was performed to collect demographic data, preoperative nerve conduction studies (NCS), surgical characteristics, complications, further treatment, and patient-reported outcome measures (PROMs). Results: A total of 42 patients having undergone bariatric surgery prior to CTR and 84 control CTR patients with no history of bariatric surgery were included. More bariatric surgery patients demonstrated mild carpal tunnel syndrome (CTS) on preoperative NCS. The overall minor complication rate was similar between patients with and without bariatric surgery history. There were no differences in postoperative Physical Component score (PCS-12) and Mental Component score (MCS-12) as well as no change in PCS-12 scores (ΔPCS-12) between preoperative and one-year postoperative scores. Conclusions: Patients with a history of bariatric surgery tended to have a larger benefit from open CTR in comparison to the control cohort; however, this was not statistically significant. The current literature regarding CTR outcomes as it relates to obesity and bariatric surgery is limited, and therefore, the association should be explored further with larger patient cohorts.

Introduction: Previous literature has detailed a potential relationship between carpal tunnel syndrome (CTS) and heart failure (HF), indicating that patients with CTS are more likely than the general population to have cardiomyopathy during their lifetime. Amyloid deposition leading to CTS may be prodromal for the development of amyloid cardiomyopathy. We hypothesized that patients undergoing surgery would have an increased risk of HF compared to patients with CTS who did not undergo surgery. Methods: The TriNetX database was retrospectively queried on June 24th, 2024. The patient population was identified using the primary ICD-10 code for CTS. Patient were included if they had surgical treatment for CTS reported as endoscopic carpal tunnel release, open carpal tunnel release, or median nerve release. The primary outcome of the analysis was heart failure. Propensity scoring was used to mediate age and gender effects. Ultimately, 125,304 patients were analyzed in the study with 62,652 patients in both the operative and nonoperative groups. statistical analyses were performed through TriNetX and p-values were used to determine statistical significance. Statistical significance was set at p < 0.05, and odds ratios were calculated at 95% confidence intervals (CI). Results: The incidence of HF in patients who underwent CTR 3.30%, 5.50%, 6.20%, and 6.30% at five, ten, fifteen, and twenty years postoperatively, respectively. When compared to nonsurgical patients, the risk difference of 0.6 (95% CI: 0.3, 0.8) became statistically significant at ten years (p < 0.001) with an increased risk ratio (RR) of 1.119 (95% CI: 1.067, 1.175) for surgical patients. At fifteen years, the risk difference was 0.7% (95% CI: 0.4, 1.10) with an RR of 1.127 (1.077, 1.179). The risk difference peaked at 0.9 (95% CI: 0.6, 1.2) at the twenty-year mark with an RR of 1.168 (95% CI: 1.116, 1.222). Conclusion: This study demonstrates that at ten, fifteen, and twenty-year time points, patients who underwent CTR were more likely to have progressed to heart failure and other cardiac complications than propensity score-matched controls managed nonoperatively. In CTS patients at higher risk for cardiac amyloidosis, hand surgeons can play a critical role in early diagnosis by performing tissue biopsy during CTR, helping to decrease the incidence of adverse cardiac outcomes.

Ulnar nerve compression is commonly seen at the elbow at the cubital tunnel and the wrist at the Guyon canal but is rarely seen in the hand. This case report describes an 18-year-old male presenting with seven months of atraumatic hand weakness and atrophy associated with heavy weightlifting. Exam demonstrated isolated interosseous muscle atrophy mostly sparing the abductor digiti minimi with intact sensation and negative nerve compression tests including Tinel at carpal and ulnar tunnels, Froment sign, Wartenberg test, cross finger test, and Spurling test. Electromyography and nerve conduction studies demonstrated prolonged distal latency, low amplitude potential, and large amplitude fibrillations with severely reduced motor unit firing in the first dorsal interosseous muscle consistent with ulnar nerve deep motor branch compromise. Magnetic resonance imaging revealed a ganglion cyst between the third metacarpal shaft and the flexor profundus tendon. Given the progressive symptoms, ganglion cyst excision and ulnar motor nerve branch neurolysis were performed.

Objectives The United States (US) population is aging with an increasing number of older adults over 90 years old. The primary purpose of this study is to evaluate trends in orthopaedic surgeries in patients 90 years old and greater over the past decade from 2014-2023. Methods Patients ≥90 years old at the time of surgery at a single orthopaedic specialty practice from 2014 through 2023 were identified. All patients that underwent nonsurgical treatment were excluded. Surgeries were categorized by musculoskeletal area and procedure type by CPT codes. Musculoskeletal areas include Shoulder, Humerus/Elbow, Forearm/Wrist, Hand/Fingers, Pelvis/Hip, Femur/Knee, Leg/Ankle, Foot/Toes, Spine, Integumentary, Nervous System, and Other. Results Over the last decade, 5,291 orthopaedic surgeries were performed on 4,807 patients 90 years old and older (age range 90-107 years old; 75% female). Of these patients, 91% underwent only one surgery while ≥90 years old, while the remaining underwent between two to five surgeries. The number of surgeries each year ranged from 180 to 680 with a positive correlation between year and number of surgeries and a greater than threefold increase in surgeries 2014-2023. The Pelvis and Hip were the primary musculoskeletal areas of surgery, accounting for 69% of surgeries overall, followed by femur and knee (11%) and nervous system (which includes carpal tunnel release, 5.2%). Most surgeries (69%) were for a fracture or dislocation. Conclusion There is an increase in volume of orthopaedic surgery on patients ≥90 years old over the last decade between 2014-2023, the majority of which were performed on the hip and pelvis and for fractures or dislocations. As older adults ≥90 years old continue to increase in the population, we project the surgical volume will continue to grow and place a large financial burden on the US healthcare system.

Fracture-related infection (FRI) is a serious orthopaedic complication and its diagnosis, particularly in the upper extremity, is difficult and poorly defined in current literature. An international consensus definition of FRI was published in 2018, and our scoping review aims to investigate FRI diagnostic tools reported in the primary literature and their biostatistical utility. A review of articles generated from the PubMed/NCBI search term “fracture-related infection” was undertaken using PRISMA methodology. The included studies were published from January 2018 to June 2022 and referred to FRI diagnosis in the upper extremity. Of 224 returned studies, 32 articles were selected for further review after fellowship-trained senior author assessment. Of these, 16 had quantitative and reportable data regarding the diagnosis of upper extremity FRI. The most common diagnostic methods reported were CRP (8 studies), WBC (7), and ESR (5), consistent with 1 of the six suggestive criteria from the consensus definition. Meta-analysis was performed. Primary literature regarding the diagnosis of upper extremity fracture-related infections is sparse and variable despite FRI’s diagnostic and therapeutic complexity. Recent literature does not reflect the proposed criteria of the 2018 consensus definition; further primary research is needed to validate these criteria and their accuracy and utility Level of Evidence: 3b

Background Lawn mower–related injuries (LMIs) represent a complex spectrum of pathology with significant public health ramifications. The purpose of this study was to analyze the epidemiological factors associated with lawn mower upper extremity amputations. Methods The National Electronic Injury Surveillance System (NEISS) database was queried from 2014 to 2023. National case estimates were established for upper extremity amputation events secondary to lawn mowers using diagnostic and injury-specific coding parameters. Documented cases from NEISS-participating hospitals were evaluated and injury data surrounding individual amputation events were analyzed. Results An estimated 17 509 upper extremity amputations occurred from 2014 to 2023 secondary to LMI in the United States. Annual case estimates and incidence rates remained relatively uniform across the 10-year study period. Most injuries were estimated to occur in 50- to 59-year-old patients. Case record review from pooled participating NEISS hospitals yielded 469 cases of upper extremity amputation directly associated with LMI from 2014 to 2023. Ninety-one percent of cases occurred in men, and most events involved the amputation of a finger (97%). Most cases of lawn mower–associated injury involved the amputation of the middle digit (41.6%) in isolation (64% of cases involved amputation of 1 digit). Conclusions Despite advances in product safety and consumer education, the estimated frequency and incidence rate of upper extremity amputations secondary to LMI has remained largely unchanged over the past 10 years. When these events did occur, 40- to 60-year-old men were most often involved, most commonly leading to amputation of the third finger in isolation.

Background: Injuries sustained from dog leashes often result in visits to hand surgeons. This study presents an analysis of dog-leash-related upper-extremity injuries at a single orthopedic practice, including treatment options for these injuries, and guidance for prevention. Methods: We identified all outpatients who presented to a hand surgeon at a single institution from 2016 to 2021 following an upper-extremity injury related to a dog leash. Charts were reviewed and demographics, injury description and mechanism, and details of treatment were recorded. Results: We identified 443 patients that presented for a dog-leash-related injury. The average time from injury to outpatient visit was 23 days. Surgery occurred following injury in 96 patients (21.6%). The most common injury locations were the ring finger, followed by the wrist, third finger, and fifth finger. Interphalangeal joint sprain was the most common injury type followed by phalangeal fracture. The majority of injuries were caused by the extremity catching in the leash while being pulled (337, 75.9%). Among the 96 patients requiring surgery, open reduction and internal fixation was the most commonly performed procedure followed by closed reduction with percutaneous pinning. For patients not requiring surgery (348, 78.4%), splinting or bracing was the most common treatment recommended. Conclusion: The majority of dog-leash injuries were caused by the patient's extremity catching in the leash as it was pulled, resulting in interphalangeal joint injures and phalanx fractures. The most common treatment required for these patients was nonoperative.