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Article: Periarticular distal radius fractures and complex ligamentous injury: The role of arthroscopic evaluation.

Crowe, Christopher S / Kakar, Sanjeev

2023 Volume 42, Page(s) 6–12

Abstract: Purpose: Distal radius fractures are associated with a high incidence of concomitant soft tissue injuries, including lesions of the triangular fibrocartilage complex and intercarpal ligaments. While advanced imaging has allowed for greater ... ...

Abstract	Purpose: Distal radius fractures are associated with a high incidence of concomitant soft tissue injuries, including lesions of the triangular fibrocartilage complex and intercarpal ligaments. While advanced imaging has allowed for greater identification of such tears, discerning which lesions pose a functional consequence remains a challenge for the hand surgeon. A review and guideline for arthroscopic evaluation of suspected combined injuries is presented. Results: Arthroscopic evaluation of distal radius fractures provides several unique advantages in such instances. Articular reduction can be performed via direct visualization with improvement in step-off and gapping. Furthermore, ligamentous injuries and carpal alignment can be directly assessed and treated. Conclusions: Subtle features of combined ligamentous trauma may be overlooked in the presence of more obvious fracture patterns. Wrist arthroscopy allows not only for a gold-standard method of evaluating of these soft tissue injuries, but also a means of treatment.
Language	English
Publishing date	2023-06-19
Publishing country	India
Document type	Journal Article
ZDB-ID	2240839-3
ISSN	0972-978X
ISSN	0972-978X
DOI	10.1016/j.jor.2023.06.006
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Global trends and outcomes of nerve transfers for treatment of adult brachial plexus injuries.

Crowe, Christopher S / Spinner, Robert J / Shin, Alexander Y

The Journal of hand surgery, European volume

2024 , Page(s) 17531934241232062

Abstract: The presentation, management and outcomes of brachial plexus injuries are likely to be subject to regional differences across the globe. A comprehensive literature search was performed to identify relevant articles related to spinal accessory to ... ...

Abstract	The presentation, management and outcomes of brachial plexus injuries are likely to be subject to regional differences across the globe. A comprehensive literature search was performed to identify relevant articles related to spinal accessory to suprascapular, intercostal to musculocutaneous, and ulnar and/or median nerve fascicle to biceps and/or brachialis motor branch nerve transfers for treatment of brachial plexus injuries. A total of 6007 individual brachial plexus injuries were described with a mean follow-up of 38 months. The specific indication for accessory to suprascapular and intercostal to musculocutaneous transfers were considerably different among regions (e.g. upper plexus vs. pan-plexal), while uniform for fascicular transfer for elbow flexion (e.g. upper plexus +/- C7). Similarly, functional recovery was highly variable for accessory to suprascapular and intercostal to musculocutaneous transfers, while British Medical Research Council grade ≥3 strength after fascicular transfer for elbow flexion was frequently obtained. Overall, differences in outcomes seem to be inherent to the specific transfer being utilized.
Language	English
Publishing date	2024-02-19
Publishing country	England
Document type	Journal Article
ZDB-ID	2272801-6
ISSN	2043-6289 ; 1753-1934
ISSN (online)	2043-6289
ISSN	1753-1934
DOI	10.1177/17531934241232062
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Zs.A 1940: Show issues

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Article ; Online: Anconeus Muscle Transfer to Correct or Prevent Wrist Radial Deviation in Radial and Posterior Interosseous Nerve Injuries.

Bertelli, Jayme A / Shah, Harsh R / Crowe, Christopher S

The Journal of hand surgery

2024

Abstract: Purpose: Wrist radial deviation is a possible complication of tendon transfer for restoration of wrist extension in cases of radial nerve paralysis. In posterior interosseous nerve (PIN) injury, this is because of the imbalance caused by the intact ... ...

Abstract	Purpose: Wrist radial deviation is a possible complication of tendon transfer for restoration of wrist extension in cases of radial nerve paralysis. In posterior interosseous nerve (PIN) injury, this is because of the imbalance caused by the intact extensor carpi radialis longus and paralysis of the extensor carpi ulnaris (ECU). This deformity may also occur following transfer of the pronator teres (PT) to the extensor carpi radialis brevis (ECRB) for radial nerve palsy. To address wrist radial deviation, we propose transferring the anconeus muscle, extended by the intermuscular septum between the ECU and the flexor carpi ulnaris (FCU), to the ECU tendon. Methods: Through an incision over the ulna, the intermuscular septum between the ECU and FCU is harvested at the level of the periosteum and left attached to the anconeus proximally. The anconeus muscle is then released from the ulna, and the intramuscular septum extension is sutured to the ECU tendon under maximal tension. Anconeus muscle transfer was performed on two patients to correct chronic wrist radial deviation following PT to ECRB tendon transfer for radial nerve injury, as well as on two patients with PIN paralysis. In four patients, transfer was performed in addition to standard tendon transfers for radial nerve paralysis to prevent radial wrist deviation deformity. Results: Wrist radial deviation was corrected or prevented in all but one patient at an average follow-up of 10 months. Patients with PIN lesions and those who had anconeus transfer concomitantly with radial nerve tendon transfers were capable of active ulnar deviation. No patient experienced elbow extension weakness, pain, or instability. Conclusions: Anconeus muscle transfer extended by intermuscular septum presents a viable alternative for addressing radial deviation of the wrist in cases of PIN nerve lesions or following PT to ECRB tendon transfer in radial nerve paralysis. Type of study/level of evidence: Therapeutic V.
Language	English
Publishing date	2024-01-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	605716-0
ISSN	1531-6564 ; 0363-5023
ISSN (online)	1531-6564
ISSN	0363-5023
DOI	10.1016/j.jhsa.2023.11.025
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Zs.A 1431: Show issues

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Article ; Online: Limb spasticity and telemedicine consultation for reconstructive surgery: patient perspectives of surgical assessment.

Bardwell, Abigail / Crowe, Christopher S / Rhee, Peter C

Journal of osteopathic medicine

2024

Abstract: Context: Spasticity is characterized by increased muscle tone and stretch reflexes, often caused by an upper motor neuron (UMN) syndrome. Many patients live with their dysfunction of their upper or lower limbs for many years and are managed by a ... ...

Abstract	Context: Spasticity is characterized by increased muscle tone and stretch reflexes, often caused by an upper motor neuron (UMN) syndrome. Many patients live with their dysfunction of their upper or lower limbs for many years and are managed by a multidisciplinary team including physical medicine and rehabilitation specialists, neurologists, and/or physical therapists in an attempt to decrease their spasticity and enhance their quality of life. Reconstructive surgery is a treatment option for many patients living with spasticity. The goal of surgery is to permanently decrease their spastic tone and improve their quality of life. Spastic hemiplegia or hemiparesis is an area of orthopedic surgery that is uniquely suited to telemedicine evaluation. Telemedicine visits can lower the threshold for patients to obtain consultation, receive second opinions, and determine whether traveling for an in-person assessment might be worthwhile, particular to larger medical centers. Objectives: The objective of our study was to characterize patient perceptions of telemedicine consultation for spasticity surgery and to determine its effectiveness for indicating reconstructive procedures. Methods: An electronic survey consisting of 16 questions was distributed to all patients after the virtual consultation from April 2020 to September 2022 as part of a neuro-orthopedic evaluation. Domains of inquiry included patient demographic and diagnosis information, satisfaction with provider assessment, ease of use, appointment preference, and whether surgery was eventually performed. Identifying information was voluntarily provided by patients and allowed for survey data to be linked to the medical record. Patients were included in the study if they were diagnosed with upper and/or lower extremity spasticity, were evaluated by telemedicine visit, and were over the age of 18. They were excluded from the study if they were evaluated for any condition aside from spasticity or returned an incomplete survey. Patients who completed the survey were prospectively followed through December 2022 to determine whether a subsequent in-person visit was pursued and/or reconstructive surgery was performed. Results: A total of 19 of 36 patients completed surveys, for a response rate of 52.7 %. Nearly all (94.7 %, n=18) patients felt that the provider expressed maximal concern for patient questions/worries, included them in decisions regarding care, and appropriately discussed treatment strategies. Similarly, the majority (89.5 %, n=17) were maximally satisfied with explanations about their condition and would recommend the care provider to others. Most patients (84.2 %, n=16) also felt that the ease of communication via the virtual platform was very good. All patients were eventually indicated for and subsequently underwent reconstructive surgery for spasticity. Conclusions: Spasticity patients were overwhelmingly satisfied with their initial virtual consultation as an alternative to face-to-face visits. Telemedicine provides a clinical opportunity for seeking information about spasticity surgery and offers a cost-effective and convenient option for patients who find travel to specialty centers prohibitive.
Language	English
Publishing date	2024-03-19
Publishing country	Germany
Document type	Journal Article
ISSN	2702-3648
ISSN (online)	2702-3648
DOI	10.1515/jom-2023-0235
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Article ; Online: Combined Wrist Extensor Tenodesis and Tendon Transfers for Severe Spastic Flexed Wrist Deformity: Surgical Technique and Case Series.

Pino, Paula A / Crowe, Christopher S / Wu, Kitty Y / Rhee, Peter C

Techniques in hand & upper extremity surgery

2024

Abstract: Spastic wrist flexion deformities both limit the functional use of the hand for grasp and pinch producing a stigmatizing appearance. Tendon transfers and total wrist arthrodesis are treatment options for this condition depending on the patient's ... ...

Abstract	Spastic wrist flexion deformities both limit the functional use of the hand for grasp and pinch producing a stigmatizing appearance. Tendon transfers and total wrist arthrodesis are treatment options for this condition depending on the patient's characteristics, the latter the most commonly used in patients with severe wrist flexion deformities. Tendon transfers alone in this scenario have the tendency for recurrent deformity due to tenorrhaphy failure or soft tissue creep and resultant loss of tension. Total wrist arthrodesis is a more invasive procedure, which can have hardware or fusion problems and that is irreversible. We propose a novel technique that incorporates a distally based wrist extensor tendon slip and suture tape tenodesis to the distal radius. The rationale of this technique is to act as a protective, internal splint to prevent recurrent deformity after primary or revision tendon transfer for moderate to severe spastic flexed wrist deformities, avoiding the need to perform a total wrist arthrodesis.
Language	English
Publishing date	2024-03-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	2075789-X
ISSN	1531-6572 ; 1089-3393
ISSN (online)	1531-6572
ISSN	1089-3393
DOI	10.1097/BTH.0000000000000479
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Zs.A 5635: Show issues

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Article ; Online: Iatrogenic Nerve Injuries of the Upper Extremity: A Critical Analysis Review.

Crowe, Christopher S / Shin, Alexander Y / Pulos, Nicholas

JBJS reviews

2023 Volume 11, Issue 1

Abstract: Iatrogenic nerve injuries may occur after any intervention of the upper extremity.: »: Causes of iatrogenic nerve lesions include direct sharp or thermal injury, retraction, compression from implants or compartment syndrome, injection, patient ... ...

Abstract	»: Iatrogenic nerve injuries may occur after any intervention of the upper extremity. »: Causes of iatrogenic nerve lesions include direct sharp or thermal injury, retraction, compression from implants or compartment syndrome, injection, patient positioning, radiation, and cast/splint application, among others. »: Optimal treatment of iatrogenic peripheral nerve lesions relies on early and accurate diagnosis. »: Advanced imaging modalities (e.g., ultrasound and magnetic resonance imaging) and electrodiagnostic studies aid and assist in preoperative planning. »: Optimal treatment of iatrogenic injuries is situation-dependent and depends on the feasibility of direct repair, grafting, and functional transfers.
MeSH term(s)	Humans ; Compartment Syndromes ; Iatrogenic Disease ; Occupational Therapy ; Patient Positioning
Language	English
Publishing date	2023-01-06
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2329-9185
ISSN (online)	2329-9185
DOI	e22.00161
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Article ; Online: Expert consensus on the surgical evaluation and management of upper extremity spasticity in adults.

Crowe, Christopher S / Pino, Paula A / Rhee, Peter C

The Journal of hand surgery, European volume

2023 Volume 48, Issue 10, Page(s) 986–997

Abstract: In the last decade there has been incredible interest and advancement in the surgical care of adult patients with upper motor neuron (UMN) injuries. Spasticity represents a prevalent and debilitating feature of UMN syndrome, which can result from ... ...

Abstract	In the last decade there has been incredible interest and advancement in the surgical care of adult patients with upper motor neuron (UMN) injuries. Spasticity represents a prevalent and debilitating feature of UMN syndrome, which can result from cerebral palsy, spinal cord injury, cerebrovascular accident and traumatic or anoxic brain injury. While several diagnostic tools and management strategies have been described for upper limb spasticity, evidence-based practice guidelines do not currently exist due to low patient volume and a paucity of surgeons routinely performing surgeries in UMN syndrome patients. As such, expert consensus may help provide guidance for patients, therapists and clinicians alike. In this article an expert panel was assembled, and the Delphi method was utilized to present diagnostic considerations, define operative indications, discuss surgical treatment modalities and encourage a standard set of outcome measures for patients with upper extremity spasticity.
MeSH term(s)	Humans ; Adult ; Consensus ; Upper Extremity/surgery ; Muscle Spasticity/diagnosis ; Muscle Spasticity/etiology ; Muscle Spasticity/surgery ; Stroke
Language	English
Publishing date	2023-09-17
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2272801-6
ISSN	2043-6289 ; 1753-1934
ISSN (online)	2043-6289
ISSN	1753-1934
DOI	10.1177/17531934231192843
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Article ; Online: Respiratory Failure After Supraclavicular Nerve Block in a Patient With a Contralateral Brachial Plexus Injury: A Case Report.

Crowe, Christopher S / Pulos, Bridget P / Spinner, Robert J / Shin, Alexander Y

JBJS case connector

2022 Volume 12, Issue 4

Abstract: Case: A patient with prior left-sided brachial plexus trauma and associated left phrenic nerve paralysis subsequently developed transient respiratory failure after a contralateral supraclavicular nerve block. Her known left phrenic nerve palsy secondary ...

Abstract	Case: A patient with prior left-sided brachial plexus trauma and associated left phrenic nerve paralysis subsequently developed transient respiratory failure after a contralateral supraclavicular nerve block. Her known left phrenic nerve palsy secondary to her index brachial plexus injury was rediscovered during the workup of her acute respiratory distress, which resulted in an emergent intensive care unit admission. Conclusion: The paralysis of her right phrenic nerve at the time of left-sided regional anesthesia was identified as the etiology of near-complete bilateral diaphragmatic paralysis and respiratory failure.
MeSH term(s)	Brachial Plexus/injuries ; Female ; Humans ; Nerve Block/adverse effects ; Paralysis/etiology ; Peripheral Nervous System Diseases ; Phrenic Nerve ; Respiratory Insufficiency/etiology
Language	English
Publishing date	2022-10-07
Publishing country	United States
Document type	Case Reports ; Journal Article
ISSN	2160-3251
ISSN (online)	2160-3251
DOI	e22.00331
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Article ; Online: Soft Tissue Reconstruction for Upper Extremity Necrotizing Soft Tissue Infections.

Yu, Jenny L / Crowe, Christopher S / Yesantharao, Pooja / Kennedy, Stephen A / Keys, Kari A

Annals of plastic surgery

2022 Volume 89, Issue 6, Page(s) 631–636

Abstract: Introduction: One of the main aspects of management for necrotizing soft tissue infection (NSTI) is surgical excision and debridement, which can result in large soft tissue defects. This study examined the reconstructive options and outcomes of patients ...

Abstract	Introduction: One of the main aspects of management for necrotizing soft tissue infection (NSTI) is surgical excision and debridement, which can result in large soft tissue defects. This study examined the reconstructive options and outcomes of patients with upper extremity NSTIs. Methods: A retrospective chart review was performed on patients from a single institution who were diagnosed with an upper extremity NSTI between 2014 and 2019. Patient characteristics, infectious etiology, surgical debridements, reconstructive procedures, and secondary procedures were analyzed. Results: There were 99 patients included in the study. The median size of the wound from the initial surgical debridement was 100 cm 2 (interquartile range, 300 cm 2 ). The mean number of debridements was 3.4. Seven patients underwent amputations, and 12 patients died. Most wounds were reconstructed via delayed primary closure (15 patients), skin grafting (16 patients), or a combination of the two (30 patients). Three patients underwent reverse radial forearm flaps, 1 patient underwent a groin flap, 3 patients underwent pedicled latissimus muscle flaps, and 2 patients underwent local flexor carpi ulnaris muscle flaps. Seven patients did not undergo any surgical reconstruction, and their wounds were managed with local wound care. Eight patients had complete or partial failure of their initial soft reconstruction requiring an additional operation, and 5 patients had secondary operations for neuromas and/or contractures. Conclusions: Overall, patients with upper extremity NSTIs survive and undergo successful reconstruction of their wounds. Few patients required additional procedures for reconstructive failure or sequela of their wounds.
MeSH term(s)	Humans ; Reconstructive Surgical Procedures/methods ; Soft Tissue Infections/surgery ; Retrospective Studies ; Surgical Flaps/surgery ; Upper Extremity/surgery ; Soft Tissue Injuries/surgery ; Treatment Outcome
Language	English
Publishing date	2022-06-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	423835-7
ISSN	1536-3708 ; 0148-7043
ISSN (online)	1536-3708
ISSN	0148-7043
DOI	10.1097/SAP.0000000000003237
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Zs.A 1419: Show issues

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Article ; Online: Management of Artery-Only Digit Replantation: A Systematic Review of the Literature.

Crowe, Christopher S / Tolley, Philip D / Mauch, Jaclyn T / Miller, Erin A / Kao, Dennis

Plastic and reconstructive surgery

2022 Volume 150, Issue 1, Page(s) 105–116

Abstract: Background: Artery-only replantation may be necessary in circumstances when venous repair cannot be performed due to their size or vessel injury. Venous congestion of the replanted part is inevitable. A systematic review was performed to identify ... ...

Abstract	Background: Artery-only replantation may be necessary in circumstances when venous repair cannot be performed due to their size or vessel injury. Venous congestion of the replanted part is inevitable. A systematic review was performed to identify techniques for mitigating congestion and analyze the outcomes of those techniques. Methods: A comprehensive literature search was performed to identify relevant articles related to artery-only replantation. An initial query identified 1286 unique articles. A total of 55 articles were included in the final review. Included studies were categorized by decongestive technique. Data from each article included the number of patients treated, level of amputation, graft use, anticoagulation or antiplatelet therapy, replant viability, and follow-up duration. Weighted averages were determined from studies that reported five or more digits. Results: A total of 1498 individual digital replantations were described. Very rarely did studies report artery-only replantation proximal to the distal interphalangeal joint. An overall survival rate of 78.5 percent was found irrespective of technique but was variable based on each particular study. Studies utilizing medicinal leech therapy were more likely to report use of intravenous anticoagulation, whereas surface bleeding techniques were more likely to report use of topical or local anticoagulant. Conclusions: Lack of a vein for anastomosis should not be regarded as a contraindication to replantation. These digits instead require a method to establish reliable drainage sufficient to allow for low resistance inflow and maintain a physiologic pressure gradient across capillary beds. The surgeon should select a decongestive technique that best suits the patient and their specific injury.
MeSH term(s)	Amputation ; Amputation, Traumatic/surgery ; Anticoagulants/therapeutic use ; Arteries/surgery ; Finger Injuries/surgery ; Fingers/blood supply ; Fingers/surgery ; Humans ; Replantation/methods
Chemical Substances	Anticoagulants
Language	English
Publishing date	2022-05-10
Publishing country	United States
Document type	Journal Article ; Systematic Review
ZDB-ID	208012-6
ISSN	1529-4242 ; 0032-1052 ; 0096-8501
ISSN (online)	1529-4242
ISSN	0032-1052 ; 0096-8501
DOI	10.1097/PRS.0000000000009185
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