Rupture of the distal triceps brachii muscle is a relatively rare, but potentially troublesome injury. Recent literature has increased awareness of the injury and highlighted the importance of accurate diagnosis and prompt appropriate treatment of these injuries. The history, physical examination findings, and imaging studies are key to determine complete versus partial rupture of the distal triceps. We propose a treatment algorithm based on the chronicity of the injury and associated tendon quality. Such a guide can help surgeons navigate the most appropriate treatment and be equipped with the surgical tools to provide the best surgical result.

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Providing orthopedic care to rural communities is challenging. Delivering adequate orthopedic care is challenged by delay in presentation, underestimation of urgency, need for subspecialty services, and deficiencies in local support services. Collaboration efforts, peer-to-peer consultations, outreach clinics, virtual consults, electronic consults, and telemedicine are useful strategies. Individual treatment strategy must accommodate the burden on the patient, and patient education is important. Treatment options that require frequent travel should be avoided. Orthopedic surgery is in high demand in rural communities but unfortunately is limited in availability. Strategies are available for improving access to orthopedic care in rural areas. [ Orthopedics . 2019; 42(4):e350–e355.]

Scant information on healthcare delivery to inmates is available in the medical literature. Healthcare provision to inmates has different rules than that for the general population and presents particular challenges for orthopaedic surgeons because of the nature of this population and restrictions imposed by their confinement. This population is typically of a lower socioeconomic status and is less well educated, has accumulated injuries over a lifetime, and has a considerable prevalence of communicable and blood-borne diseases, along with a high prevalence of smoking and high-risk behavior, such as drug-seeking, abuse, and self-inflicted injury. These variables add levels of complexity of care, including the determination of medical necessity for orthopaedic referral, the logistics of transportation and follow-up, access to durable medical equipment and ancillary services, and the choices the orthopaedic provider must make to optimize care within these limitations.

Introduction:Prescribing opioids for postoperative pain has increased steadily, and hand surgery has been no exception. Current hand surgery literature does not describe the efficacy of pain self-management postoperatively. The purpose of this study is to describe our experience with over-the-counter (OTC), narcotic-free, postoperative pain management.Methods:We have done a retrospective chart review at an academic tertiary-care facility. Patients who underwent soft-tissue hand surgery in an office-based procedure room between January 1, 2018, and March 1, 2019, done using wide-awake local anesthesia only with no tourniquet were included.Results:Eighty-one continuous patients met the inclusion and exclusion criteria. The procedures included carpal tunnel release, cubital tunnel release, trigger finger release, first dorsal compartment release, dorsal wrist ganglion cyst excision, hand or finger mass excision, percutaneous needle fasciotomy, flexor tendon repair, and extensor tendon repair. Two patients (2.4%) received a prescription for pain medication within 1 day and 4 within 1 week after discharge (total 5.6%). Nine patients were already on chronic narcotics, and four were on short-term narcotics before the surgery date. No other patients requested or received opioid prescriptions after surgery, and no complaints were reported.Discussion:This study indicates that patients can successfully self-manage their postoperative pain with OTC analgesics. They rarely request prescriptions for pain control after soft-tissue hand surgery. Our findings support current literature suggesting that narcotic prescriptions can be eliminated in select hand and upper extremity procedures and suggest that OTC postoperative pain management is sufficient.