Scapholunate advanced collapse is a predictable form of wrist arthritis resulting from longstanding scapholunate instability. Four-corner fusion and scaphoid excision is a reliable procedure used to treat scapholunate advanced collapse wrist that improves pain and preserves range of motion. Multiple methods of achieving fixation have been described for the procedure including K-wires, staples, and headless compression screws. In previously described techniques, the compression screws are inserted in an antegrade manner, breaching the articular surface of the lunate. Even small areas of chondral damage may undermine the long-term durability of the radiocarpal joint. Given the 4-corner fusion relies on the integrity of the radiolunate articulation for success, it would seem advantageous to preserve the articular cartilage of the lunate. The technique described here involves retrograde insertion of headless compression screws to achieve a 4-corner fusion. Although it is still early, we anticipate that this procedure will result in similar fusion rates to other forms of fixation.

Background: Improvements in surgical fixation to repair distal biceps tendon ruptures have not fully translated to earlier postoperative mobilization; it is unknown whether earlier mobilization affords earlier functional return to work. This parallel-arm randomized controlled trial compared the impact of early mobilization versus 6 weeks of postoperative immobilization following distal biceps tendon repair. Methods: One hundred and one male participants with a distal biceps tendon rupture that was amenable to a primary repair with use of a cortical button were randomized to early mobilization (self-weaning from sling and performance of active range of motion as tolerated during first 6 weeks) (n = 49) or 6 weeks of immobilization (splinting for 6 weeks with no active range of motion) (n = 52). Follow-up assessments were performed by a blinded assessor at 2 and 6 weeks and at 3, 6, and 12 months. At 12 months, distal biceps tendon integrity was verified with ultrasound. The primary outcome was return to work. Secondary outcomes were pain, range of motion, strength, shortened Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) score, and tendon integrity. Intention-to-treat analysis was performed. A linear mixed model for repeated measures was used to compare pain, range of motion, strength, and QuickDASH between the groups over time; return to work was assessed with use of independent t tests. Results: The groups were similar preoperatively (p ≥ 0.16). The average age (and standard deviation) was 44.7 ± 8.6 years. Eighty-three participants (82%) were followed to 12 months. There were no differences between the groups in terms of return to work (p ≥ 0.83). Participants in the early mobilization group had significantly more passive forearm supination (p = 0.04), with passive forearm pronation (p = 0.06) and active extension and supination (p = 0.09) trending toward significantly greater range of motion in the early mobilization group relative to the immobilization group. Participants in the early mobilization group had significantly better QuickDASH scores over time than those in the immobilization group (p = 0.02). There were no differences between the groups in terms of pain (p ≥ 0.45), active range of motion (p ≥ 0.09), or strength (p ≥ 0.70). Two participants (2.0%, 1 in each group) had full-thickness tears on ultrasound at 12 months (p = 0.61). Compliance was not significantly different between the groups (p = 0.16). Conclusions: Early motion after distal biceps tendon repair with cortical button fixation is well tolerated and does not appear to be associated with adverse outcomes. No clinically important group differences were seen. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Background/Objectives: Osteomyelitis and implant-associated bone infections remain difficult to treat because of persistent bacterial colonization, biofilm formation, limited antibiotic exposure in infected bone, and antimicrobial resistance. Bisphosphonate conjugation has been explored for bone-targeted antibiotic delivery, but targeting a β-lactamase inhibitor itself to our knowledge has not been established. This study aimed to synthesize and evaluate an ester-linked bisphosphonate–tazobactam (BP-Tazo-ester) conjugate as a putative bone-targeted β-lactamase inhibitor prodrug. Methods: BP-Tazo-ester (compound 5) was synthesized and characterized by nuclear magnetic resonance spectroscopy and mass spectrometry. β-lactamase inhibition was assessed using a nitrocefin-based in vitro assay. Hydroxyapatite binding was evaluated using a sample derived from compound 5. Piperacillin combinations were evaluated against β-lactamase-producing Escherichia coli HS and planktonic Staphylococcus aureus CCUG 25925. The same S. aureus strain was used in an ex vivo bone-slice early-colonization model. Results: Compound 5 was obtained in 61% yield and retained measurable β-lactamase inhibitory activity, although its observed activity was lower than that of free tazobactam. TMSBr-treated material derived from compound 5 exhibited high apparent hydroxyapatite binding. Compound 5 supported piperacillin-mediated growth inhibition against E. coli HS. Against S. aureus CCUG 25925, piperacillin–compound 5 and piperacillin–tazobactam showed the same observed MIC, both lower than that of piperacillin alone, while compound 5 alone exhibited limited antibacterial activity. In the bone-slice model, piperacillin–compound 5 reduced recoverable S. aureus counts below the assay limit of detection during 24 h of treatment co-initiated with inoculation. Conclusions: These findings provide preliminary proof-of-concept for a bisphosphonate-based strategy targeting a β-lactamase inhibitor rather than the antibiotic partner. Further research on linker-cleavage kinetics, bone biodistribution, pharmacokinetics, and in vivo efficacy is warranted.