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Kelechi R Okoroha, Nima Mehran, Jonathan Duncan, Travis Washington, Tyler Spiering, Michael J Bey, Marnix Van Holsbeeck, Vasilios Moutzouros
Ultrasound and magnetic resonance imaging (MRI) are both capable of diagnosing full-thickness rotator cuff tears. However, it is unknown which imaging modality is more accurate and precise in evaluating the characteristics of full-thickness rotator cuff tears in a surgical population. This study reviewed 114 patients who underwent arthroscopic repair of a full-thickness rotator cuff tear over a 1-year period. Of these patients, 61 had both preoperative MRI and ultrasound for review. Three musculoskeletal radiologists evaluated each ultrasound and MRI in a randomized and blinded fashion on 2 separate occasions...
October 18, 2016: Orthopedics
Brendan M Patterson, Scott M Eskildsen, R Carter Clement, Feng-Chang Lin, Christopher W Olcott, Daniel J Del Gaizo, Joshua N Tennant
Clinic wait time is considered an important predictor of patient satisfaction. The goal of this study was to determine whether patient satisfaction among orthopedic patients is associated with clinic wait time and time with the provider. The authors prospectively enrolled 182 patients at their outpatient orthopedic clinic. Clinic wait time was defined as the time between patient check-in and being seen by the surgeon. Time spent with the provider was defined as the total time the patient spent in the examination room with the surgeon...
October 18, 2016: Orthopedics
Mhamad Faour, Joshua T Anderson, Arnold R Haas, Rick Percy, Stephen T Woods, Uri M Ahn, Nicholas U Ahn
The use of opioids among patients with workers' compensation claims is associated with tremendous costs, especially for patients who undergo spinal surgery. This study compared return-to-work rates after single-level cervical fusion for degenerative disk disease between patients who received opioids before surgery and patients who underwent fusion with no previous opioid use. All study subjects qualified for workers' compensation benefits for injuries sustained at work between 1993 and 2011. The study population included 281 subjects who underwent single-level cervical fusion for degenerative disk disease with International Classification of Diseases, Ninth Revision, and Current Procedural Terminology code algorithms...
October 18, 2016: Orthopedics
Jon Hedgecock, P Christopher Cook, John Harrast, Judith F Baumhauer, Brian D Giordano
Hip preservation surgery encompasses various surgical procedures that have the goal of decreasing the progression of osteoarthritis, preserving normal hip function, and delaying the need for arthroplasty. These procedures can encompass arthroscopic, open, and combined techniques. This study investigated the trends and complications associated with open hip preservation surgery performed by candidates undergoing Part II of the American Board of Orthopaedic Surgery examination. The American Board of Orthopaedic Surgery Part II surgeon case database was queried from the years 2003 to 2013 for Current Procedural Terminology (CPT) codes related to open hip preservation surgery in patients 10 years and older...
October 18, 2016: Orthopedics
Wataru Ando, Kengo Yamamoto, Tsuyoshi Koyama, Yoshichika Hashimoto, Takashi Tsujimoto, Kenji Ohzono
Idiopathic osteonecrosis of the femoral head (ONFH) can be correctly diagnosed in accordance with the established criteria. However, some general orthopedic physicians have misdiagnosed patients as having ONFH. The goal of this study was to clarify the radiologic and clinical features of misdiagnosed patients. This study included 50 patients who were referred to the authors' hospital by general physicians with a diagnosis of ONFH. The correct diagnosis was made based on the Japanese Investigation Committee diagnostic criteria for ONFH...
October 18, 2016: Orthopedics
Steven T Hendrix, Austin M Barrett, Bopha Chrea, William H Replogle, Josie M Hydrick, Gene R Barrett
Is there a correlation between increased posterior-inferior tibial slope angle and noncontact anterior cruciate ligament (ACL) injury? Does increasing the posterior-inferior tibial slope angle increase the risk of bilateral ACL injury? A computerized relational database (Access 2007; Microsoft Inc, Redmond, Washington) was used to conduct a retrospective review of patients undergoing bilateral or unilateral ACL reconstruction surgery or treatment by a single surgeon between 1995 and 2013. Included in the study were patients with bilateral and unilateral ACL injuries and patellofemoral pain syndrome with no associated ACL deficiency...
October 18, 2016: Orthopedics
Joseph A Gil, Steven F DeFroda, Kunal Sindhu, Aristides I Cruz, Alan H Daniels
Osteogenesis imperfecta is caused by qualitative or quantitative defects in type I collagen. Although often considered a disease with primarily pediatric manifestations, more than 25% of lifetime fractures are reported to occur in adulthood. General care of adults with osteogenesis imperfecta involves measures to preserve bone density, regular monitoring of hearing and dentition, and maintenance of muscle strength through physical therapy. Surgical stabilization of fractures in these patients can be challenging because of low bone mineral density, preexisting skeletal deformities, or obstruction by instrumentation from previous surgeries...
October 13, 2016: Orthopedics
Xinning Li, Antonio Cusano, Josef Eichinger
Shoulder dislocations are a common injury, with anterior shoulder dislocation among male patients being the most common presentation. A patient with recurrent shoulder instability, anterior-superior escape, and chronic subscapularis tendon rupture following multiple shoulder stabilization surgeries presents the surgeon with a complex and challenging case. This report describes a 40-year-old man with an extensive left shoulder history that included a failed Latarjet procedure, an irreparable, chronic subscapularis tear with grade 4 Goutallier fatty infiltration, and associated anterior-superior escape...
October 13, 2016: Orthopedics
Rachel M Frank, Anthony A Romeo, Matthew T Provencher
Anterior glenoid bone loss is present in nearly all cases of recurrent anterior glenohumeral instability. Treating glenoid bone loss in the setting of recurrent instability is challenging, and often, soft tissue stabilization procedures in isolation are inadequate. The nonanatomic, incongruous joint resulting from most bony augmentation procedures has motivated investigators to find an alternative solution. Recently, the use of fresh distal tibia allograft has been reported as an anatomic, osteoarticular reconstructive option for restoring the glenoid arc and maintaining glenohumeral congruency...
October 13, 2016: Orthopedics
Augusta Whitney Kluk, Tina Zhang, Joseph P Russell, Hyunchul Kim, Adam H Hsieh, Robert V O'Toole
Orthopedic dogma states that external fixator stiffness is improved by placing 1 pin close to the fracture and 1 as distant as possible ("near-far"). This fixator construct is thought to be less expensive than placing pins a shorter distance apart and using "pin-bar" clamps that attach pins to outriggers. The authors therefore hypothesized that the near-far construct is stiffer and less expensive. They compared mechanical stiffness and costs of near-far and pin-bar constructs commonly used for temporary external fixation of femoral shaft fractures...
October 13, 2016: Orthopedics
Martin H Pham, Alexander Tuchman, Lance Smith, Andre M Jakoi, Neil N Patel, Vivek A Mehta, Frank L Acosta
Proximal junctional kyphosis is an increasingly recognized complication following long-segment posterior spinal fusion for adult spinal deformity. The authors describe a novel technique for interspinous ligament reinforcement at the proximal adjacent levels using a cadaveric semitendinosus tendon graft secured with an Ethibond No. 2 double filament (Ethicon, Somerville, New Jersey) via the Krackow suture weave. A retrospective review identified 4 patients who had received this graft. No proximal junctional kyphosis was seen at a mean short-term follow-up of 5...
October 13, 2016: Orthopedics
Ryan Urchek, Eric Miller
The typical injury pattern of a posterior hip dislocation includes posterior wall fracture, capsular injury, and muscular strain. This report presents an example of a posterior wall acetabulum fracture-dislocation associated with complete hip abductor tendon and capsular avulsion from the femur. The patient was found to have an unstable hip despite a small posterior wall fragment due to the extensive soft tissue injury. This was repaired. The patient had improvement in function initially, but ultimately required repair of the hip abductor tendons...
October 13, 2016: Orthopedics
Brett D Owens, Kenneth L Cameron, Steven L Bokshan, Kari B Clifton, Steven J Svoboda, Jennifer Moriatis Wolf
Differences in cartilage biomarkers have been noted in patients with anterior cruciate ligament tears, but little is known about any similar relationship with shoulder instability. This study evaluated the relationship between serum cartilage biomarkers and shoulder instability. The authors present a prospective cohort study of young athletes followed from 2006 to 2010. A nested case-control analysis was conducted within this cohort to evaluate the association between preinjury collagen type II cleavage (a marker for type II collagen cleavage) and procollagen II carboxy propeptide (a marker of cartilage synthesis) and the subsequent likelihood of shoulder instability during the 4-year follow-up period...
September 29, 2016: Orthopedics
John Schwappach, Sara M Dryden, Kristin M Salottolo
This study was conducted to investigate the safety and efficacy of 3 intraarticular injections of the low-molecular-weight fraction of 5% human serum albumin (LMWF-5A) administered every 2 weeks for knee pain as a result of osteoarthritis. This single-center, randomized, vehicle-controlled, double-blind, phase II study was designed to ensure the safety of multiple intra-articular injections of LMWF-5A and to explore its efficacy in reducing pain as a result of knee osteoarthritis. Patients were randomized 1:1 to receive 3 biweekly intra-articular knee injections of either 4 mL LMWF-5A or vehicle control (saline), administered at weeks 0 (baseline), 2, and 4...
September 29, 2016: Orthopedics
Peter T McCunniff, Hojun Yoo, Charles Yu, Navkirat S Bajwa, Jason O Toy, Uri M Ahn, Nicholas Ahn
This study examined the effect of bilateral and unilateral L5 pars defects on the degree of disk degeneration at the L5-S1 level in cadaveric specimens. An observational study was performed of 690 cadaveric specimens selected at random. These specimens represent individuals who died between 1893 and 1938. The study included 558 male and 132 female cadavers. Of the 120 specimens with L5 spondylolysis, 95 cases were bilateral and 25 were unilateral. The remaining 544 specimens were used as the control cohort...
September 29, 2016: Orthopedics
Claire M McDaniel, Ryan W Churchill, Evan Argintar
Preoperative skin preparation with antimicrobial agents decreases the risk of surgical site infection, but concerns have been raised about the visibility of a common surgical preparatory agent (ChloraPrep; Becton, Dickinson & Co, Franklin Lakes, New Jersey), depending on skin pigmentation. Poor visibility may lead to failure to identify inadequately prepared skin, increasing the risk of surgical site infection. This study was conducted to determine whether different tints of ChloraPrep and different skin pigmentations affect the ability of orthopedic surgeons to identify the adequacy of skin preparation...
September 29, 2016: Orthopedics
Georgios I Vasileiadis, Yodhiaki Itoigawa, Derek F Amanatullah, Luis Pulido-Sierra, Jeremy R Crenshaw, Christine Huyber, Michael J Taunton, Kenton R Kaufman
The most widely used radiologic classification system for heterotopic ossification after total hip arthroplasty (THA) is the Brooker scale. In 2002, Della Valle et al proposed a modified rating system for heterotopic ossification to increase intraobserver reliability and interobserver agreement. To date, no study comparing these 2 classification systems has been conducted. Moreover, these studies were grossly underpowered. In the current study, 3 clinicians reviewed the charts of 236 patients with documented radiographic heterotopic ossification at least 2 months after THA and independently graded the amount of heterotopic ossification according to the Brooker and Della Valle classification systems...
September 29, 2016: Orthopedics
Kang Chen, Ping Li, Huakun Zhao, Xiaoyan Yan, Yanhong Ma
Mechanical stress plays an important role in preserving the integrity of bone and ligament. Stress shielding reduces mechanical load on bone or tendons, resulting in tissue degradation. Previous studies showed that deterioration of the tendon structure during stress shielding is associated with elevated expression of tumor necrosis factor (TNF)-α. This study examined the therapeutic potential of the TNF inhibitor etanercept in preventing morphologic deterioration of the Achilles tendon after stress shielding...
September 29, 2016: Orthopedics
Erich M Gauger, Lauren L Casnovsky, Erica J Gauger, Deborah C Bohn, Ann E Van Heest
This study reviewed the clinical history and management of acquired growth arrest in the upper extremity in pediatric patients. The records of all patients presenting from 1996 to 2012 with radiographically proven acquired growth arrest were reviewed. Records were examined to determine the etiology and site of growth arrest, management, and complications. Patients with tumors or hereditary etiology were excluded. A total of 44 patients (24 boys and 20 girls) with 51 physeal arrests who presented at a mean age of 10...
September 29, 2016: Orthopedics
Justin Stull, Suneel Bhat, Andrew J Miller, Ryan Hoffman, Mark L Wang
Compartment syndrome is an orthopedic emergency with a multitude of etiologies. Although it is most commonly associated with trauma to the extremity, hematoma and infection are 2 rare etiologies of insidious compartment syndrome. Proteus mirabilis is an opportunistic gram-negative species that can infect the respiratory tract, urinary tract, and open wounds. The authors present the case of a 69-year-old woman who developed tissue necrosis and compartment syndrome secondary to an untreated hematoma infected by P mirabilis...
September 29, 2016: Orthopedics
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