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With nearly 36% of hand fractures occurring at the metacarpal, a variety of treatment interventions have been developed. Although many nondisplaced metacarpal fractures can be treated with conservative management, displaced, unstable, open, and extra-articular fractures require surgical attention. Compared with open reduction with plate fixation, closed reduction with intramedullary fixation has shown advantages of a simplified technique, minimal soft tissue dissection, and reduced tendon irritation and scar formation. The current study reports on the improved surgical technique associated with the use of novel instrumentation for the closed reduction and intramedullary fixation of extra-articular metacarpal fractures. The design and surgical technique of the premeasured Secure Intramedullary Nail improves fracture fixation, minimizing rotation and backing out, while reducing concerns for soft tissue irritation complications at the base of the metacarpal. Our reported case series suggests procedural efficiency, a low complication rate, and fast recovery for those with indicated extra-articular fractures., (© 2020 The Authors.)

Purpose: Endoscopic cubital tunnel release (ECuTR) is an effective procedure to alleviate cubital tunnel syndrome. To improve patient outcomes and lessen concerns regarding ulnar nerve subluxation (UNS) after ECuTR, the current study proposes an intraoperative UNS classification system and subsequent treatment protocol. We present a preliminary report of patients treated under these guidelines., Methods: We retrospectively reviewed 87 patients (100 ECuTRs). Nerve mobility was classified during surgery, in which grade 1 = no movement or partial subluxation; deep retrocondylar groove and/or no generalized hypermobility (no further intervention); grade 2 = partial subluxation; shallow retrocondylar groove and/or inherent generalized hypermobility (required medial epicondylectomy); and grade 3 = complete anterior dislocation (required medial epicondylectomy or anterior transposition). Clinical outcomes at final follow-up (mean ± SD, 34 ± 20.3 weeks; range, 5-89 weeks) were collected and included Disabilities of the Arm, Shoulder, and Hand questionnaires, visual analog scale pain score, grip and pinch strength, 2-point discrimination, and range of motion., Results: We report 37 patients (42 cases), grade 1 (n = 30), grade 2 (n = 1), and grade 3 (n = 11). Gross grip strength, lateral, 3-jaw chuck, and precision pinch strength recovered 87%, 90%, 105%, and 87%, respectively. Wrist and elbow range of motion returned to normal limits, 2-point discrimination improved to normal scores at final follow-up, Disabilities of the Arm, Shoulder, and Hand scores were reduced from 59.8 before to 29.9 after surgery, and visual analog scale pain score improved from 7.2 before to 2.5 after surgery ( P < .001)., Conclusions: To our knowledge, this is the first study to classify UNS after ECuTR and describe a guideline for ensuing treatment. Our preliminary report of patients shows satisfactory outcomes, which suggests that our intraoperative UNS classification system has promise in preventing adverse complications of ulnar nerve hypermobility after ECuTR., Type of Study/level of Evidence: Therapeutic IV., (© 2020 The Authors.)