Twelve patients with mallet fractures treated by open reduction and internal fixation with small screws were reviewed at an average of 31 months after surgery. The indication for surgery was a fracture involving more than one-third of the distal phalanx articular surface or with subluxation of the distal interphalangeal joint. Loss of reduction occurred in one patient and in another one screw loosened slightly without loss of reduction. There were no nail deformities, infections, or secondary procedures. The mean range of motion was from 6 degrees (range, 0-30 degrees ) (extensor lag) to 70 degrees (range, 60-90 degrees ) flexion. Ten patients had no evidence of degenerative changes, one had minor joint space narrowing and one had significant deformity. Open reduction and screw fixation with small screws can lead to satisfactory outcome in appropriate patients.

Ice application is one of the most extensively used treatments for athletic injuries. Frostbite is a recognized danger. Five cases of nerve palsy resulting from ice application are reported here. These palsies were temporary. They usually resolve spontaneously without any significant sequelae. This complication can be avoided by not using ice for more than 30 minutes and by guarding superficial nerves in the area.

The impact of Hurricane Katrina on 4 senior New Orleans-based psychologists, both professionally and personally, is described. The authors are pediatric, adult, and family therapists and neuropsychologists; by employment, they are medical center academics, independent practitioners, administrators, and staff/consulting psychologists at medical and psychiatric hospitals. Their diverse experiences following Katrina are similar to the experiences of many individuals in the professional community of the Gulf Coast. In the face of the storm, they departed New Orleans and afterward returned at varying intervals. The homes of all of the 4 New Orleans authors were damaged or destroyed. All of their practice locations were closed for varying periods, and 2 were closed permanently. Of the 4 who returned to New Orleans, only 2 remained 18 months after the storm; the others had relocated to other states. This article reflects on their collective experience as mental health professionals living in New Orleans after Katrina and lessons learned from that experience.

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