Purpose The purpose of this study was to determine whether patients who had an intraarticular corticosteroid injection into the thumb carpometacarpal (CMC) joint for the treatment of arthritis within the 3 months before CMC joint arthroplasty or arthrodesis were at increased risk for wound complication/infection and/or repeat surgery for wound complication/infection in comparison with patients who did not receive an injection within 6 months or who received an injection between 3 and 6 months before surgery.Methods We identified 5,046 patients in the Humana claims database who underwent surgery for CMC joint arthritis. The patients were stratified into 3 groups: (1) no thumb injection within 6 months of CMC joint surgery, (2) thumb injection between 3 and 6 months before CMC joint surgery, and (3) thumb injection within 3 months before CMC joint surgery. The primary outcome was wound complication/infection within 90 days after surgery. The secondary outcome was repeat surgery for wound complication/infection within 90 days after surgery. Multivariable logistic regression was performed to assess the associations between the timing of injection and wound complication/infection and repeat surgery for wound complication/infection. ResultsThe rates of wound complication/infection within 90 days after surgery were similar among the 3 study groups. However, patients who received an intra-articular corticosteroid injection within 3 months before surgery had a 2.2 times greater likelihood of repeat surgery for a wound complication/infection compared with patients who did not have an injection within 6 months before surgery.Conclusions Patients who receive an intra-articular corticosteroid injection within the 3 months before surgery for CMC joint arthritis may be at increased risk of repeat surgery to treat a wound complication/infection in the 90-day postoperative period.

Background The objective of this study was to evaluate factors associated with postoperative opioid use after open treatment of distal radius fractures. Methods The Humana insurance claims database was queried for open treatment of distal radius fractures by Current Procedural Terminology codes. The search was further refined to identify patients who filled an opioid prescription within 6 weeks after their surgery. The study’s outcomes were: (1) limited postoperative opioid use, defined as filling a prescription once in the 6-week to 6-month period after surgery; and (2) persistent postoperative opioid use, defined as filling a prescription more than once in the 6-week to 6-month period after surgery. Logistic regression models were performed to identify factors associated with limited and persistent postoperative opioid use. Subgroup analyses were performed among opioid-naïve patients and those with open fractures. Results This study identified 9141 of 19 220 total patients with limited and persistent opioid use. Significant risk factors included nonhome discharge, inpatient surgical setting, long-term pain, tobacco abuse, and age less than 65 years. Of note, both preoperative opioid use within 1 month before surgery (odds ratio [OR], 2.6; 95% confidence interval [CI], 2.2-2.9) and preoperative opioid use between 1 and 6 months before surgery (OR, 4.0; 95% CI, 3.7-4.4) were significantly associated with persistent postoperative opioid use. Conclusions This study has identified numerous risk factors associated with postoperative opioid use after open treatment of distal radius fractures. Understanding these risk factors is the first step toward reducing postoperative opioid use.

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Complex dislocation of the metacarpophalangeal joint of the index finger is rare and often requires surgical intervention. Here, we present a case of an index finger metacarpophalangeal joint dislocation requiring open reduction due to obstruction by a displaced volar plate and the intra-articular entrapment of a sesamoid bone. Surgical approach was performed dorsally, allowing easy visualization of the volar plate and sesamoid bone as well as minimizing risk to the radial digital nerve to the index finger. Postoperatively, the patient reported good functional return despite the delay in definitive management.

Introduction: The aim of this study was to analyze the use of and charges related to physical therapy (PT) after multiligament knee surgery across different postoperative time points and to identify factors related to increased utilization. Methods: The Humana Claims Database was queried for all patients who underwent a multiligament knee reconstruction procedure. We identified patients with a PT-related Current Procedural Terminology (CPT) code at 14 days, 30 days, 90 days, and 6 mo postoperatively. The mean charge per patient and mean number of billed encounters were analyzed. Chi-square and linear regression analysis were used to identify factors related to increased PT utilization. Results: Data for 497 patients undergoing multiligament knee reconstruction surgery was available. The number of patients utilizing PT at 14 days, 30 days, 90 days, and 6 mo after surgery was 315, 423, 484, and 497, respectively. The mean cost of PT in these groups were $315.65, $580.05, $1490.55, and $1796.52, respectively. The mean number of visits were 6, 12, 32, and 38, respectively. Patients with subsequent surgery for arthrofibrosis had significantly higher mean cost ($3528.40 vs. $1546.43; P<0.001) and higher mean number of visits (73 vs. 35; P<0.001) than those without. When compared with patients without a diagnosis of knee dislocation, patients with a knee-disclocation diagnosis had significantly higher mean cost ($2204.85 vs. 1627.45; P<0.001) and higher mean number of visits (43 vs. 31; P<0.001). Finally, privately insured patients had higher mean cost ($1933.07 vs. $1051.70) and mean number of visits (40 vs. 25) than publicly insured patients. Regression coefficients were $-390.86 for obesity, $409.50 for knee dislocation, $807.53 for private insurance, and $1845.00 for surgery for arthrofibrosis. Conclusions: There was increased utilization of PT among patients who had a diagnosis of knee dislocation, those who required surgery for arthrofibrosis, and those who had private insurance after multiligament knee reconstruction surgery. Level of Evidence: Level III.