Study DesignRetrospective, case series.PurposeThe purpose of this study is to determine morbidity, complications, and patient reported outcomes from minimally invasive sacroiliac joint (SIJ) fusion.Overview of LiteratureLumbar back pain emanating from the SIJ can be surgically treated via a percutaneous approach in the appropriately selected patient with minimal morbidity and acceptable functional outcomes.MethodsPatients diagnosed by >2 physical examination maneuvers and subjective relief from a computed tomography–guided lidocaine-bupivacaine-steroid injection underwent SIJ fusion after failing conservative management with a combination of oral anti-inflammatory medications, physical therapy, and pelvic belt stabilization. Perioperative data collected include estimated blood loss (EBL) and operative time. Oswestry disability index, 12-item short form health survey (SF-12), visual analogue score, and functional status were analyzed. All complications were noted.ResultsThe study cohort of 45 cases (69% female) achieved postoperative survey follow-up at 9.9 and 32.3 months. SF-12 physical component summary statistically improved while all other scores were equivalent. Mean EBL and operative time were 22 mL and 36 minutes, respectively. Initial survey showed that 64% of patients discontinued narcotics (29/45), 71% do not use an assistive device (32/45), and 15.6% do not work due to pain (7/45). 73% of patients stated they would have the surgery again (33/45). For the second survey, 65% of patients discontinued narcotics (26/40), 70% did not use an assistive device (28/40), and 17.5% did not work due to pain (7/40). A history of thoracolumbar instrumentation (16/45) did not significantly affect outcomes. Three complications described by screw malposition with neurologic deficit (6.7%) were treated with screw repositioning (1 case) and removal of a single superior implant (2 cases) with time to revision of 2.2 months. All three ultimately had resolution of radicular pain.ConclusionsPercutaneous SIJ fusion offers minimal morbidity and acceptable functional outcomes. While women and those with a prior history of lumbar instrumentation may be at increased risk of having SIJ dysfunction requiring surgical intervention, it was not found to affect postoperative functional outcomes when compared to the non-instrumented group.

Background: A thumb interphalangeal (IP) joint arthrodesis is typically performed in 0° to 30° of flexion; most daily activities involve increased flexion at the IP joint to facilitate pinch and grip. This study evaluates the preferred thumb IP joint position with certain tasks of daily living to determine a more satisfactory angle. Methods: Twenty-eight healthy volunteers were splinted at various degrees (0°, 15°, 30°, 45°, bilaterally) with thumb orthotics, leaving the tip free, to mimic various angles of IP fusion. Participants underwent power tasks (pouring from a gallon jug, opening/closing a tight jar, lifting a heavy glass, and opening a door), timed precision tasks (writing, buttoning/unbuttoning a shirt, translating coins, zipping/unzipping a jacket, and opening/closing Velcro), as well as pinch and grip strength testing. All tasks were performed both at baseline (without any splinting) and with the thumb splinted in each angle. Participants used a 10-point Visual Analogue Scale (VAS) to rate the ease of each task as well as their overall satisfaction at baseline and at each of the various angles for their dominant and nondominant hand. Wilcoxon signed rank tests were conducted for outcomes, with P < .05 denoting statistical significance. Results: Power tasks were best accomplished at 0° for the nondominant hand and 0° to 30° for the dominant hand. Precision tasks were preferred at 15° for both dominant and nondominant hand. Grip strength was best at 15° and 0° for the nondominant and dominant hand, respectively. Pinch was equivocal between 0° and 30° for the nondominant hand and from 15° to 30° for the dominant hand. VAS ratings were most similar to baseline at a fusion angle of 15° followed by 30° for the dominant thumb and 30° followed by 15° for the nondominant thumb. Conclusions: A thumb IP fusion angle of 15° to 30° is a functional and preferred angle of thumb IP joint positioning for various activities of daily living.

Study Design: This was a retrospective chart review. Objectives: Computed tomography (CT) does not aid in determination of compression fracture chronicity and contributes to higher cost and radiation exposure. An examination of extraneous imaging will help to guide appropriate workup. Summary of Background Data: Cost for osteoporotic fracture treatment has been estimated at $17 billion annually; future costs are anticipated to increase by at least 50%. Materials and Methods: A chart review evaluated patients who received kyphoplasty or vertebroplasty as part of compression fracture treatment. The primary end point of the study was analysis of unnecessary imaging obtained during workup. The secondary outcome was excess radiation exposure incurred from unneeded imaging studies. Results: There were 104 instances (40.2% of n=259 workups) where patients underwent only magnetic resonance imaging (MRI) or bone scan after radiographs. There were 28 instances (10.8%) where patients underwent only radiographs with a comparison study. There were a total of 76 instances (29.3%) where patients underwent extraneous CT scans and 13 instances (5%) where patients underwent both MRI and bone scan, causing an average of 979.4 mGy cm additional radiation exposure. Conclusions: We recommend an algorithm that favors radiographs with comparison study or acquiring either MRI or bone scan to determine acuity. If these are available, CT scan becomes unnecessary and incurs increased costs and radiation exposure.

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