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Cory K Mayfield, Kenneth A Egol
Arm wrestling places significant torque on the humeral shaft. A spiral distal humeral shaft fracture is an unusual but significant injury that can result. Of 93 patients who presented between 2009 and 2017 with closed humeral shaft fractures that were managed nonoperatively, 9 sustained the fractures while arm wrestling. Outcomes were compared with those of all other patients with nonoperatively managed humeral shaft fractures sustained through other mechanisms. The Student's t test was used to compare cohorts...
January 8, 2018: Orthopedics
Joseph T Moskal, Ronald Driesen, Baris B Koc, Jonathan Yerasimides, Kristoff Corten
A modified extensile Smith-Petersen approach was used to access the acetabulum and pelvis in cases with complex acetabular defects requiring extensive reconstructions. Between 2010 and 2014, a total of 49 hips (48 patients) with a variety of acetabular defects were reconstructed using highly porous hemispherical acetabular cups and different reconstruction methods. Preoperative diagnoses included isolated aseptic loosening of the acetabular component, aseptic loosening of both acetabular and femoral components, infection, and other...
January 8, 2018: Orthopedics
Kyle Fink, Neil Kaushal, Jordan Gross, Himanshu Patel, Damon Delbello
Bucket-handle meniscal tears are extremely rare injuries in the pediatric population. Given the known sequelae of meniscal tears and the development of osteoarthritis, early diagnosis and treatment of pediatric meniscal tears are essential. The communication barrier between physicians and pediatric patients, however, creates difficulties in making the correct diagnosis of meniscal pathology. Providers should have a low threshold for obtaining further confirmatory advanced imaging if patients present with prolonged knee pain and swelling, with associated locking mechanical symptoms...
January 8, 2018: Orthopedics
Hannah H Lee, Kwesi St Louis, John R Fowler
Measurement of finger range of motion is critical in clinical settings, especially for outcome analysis, clinical decision making, and rehabilitation/disability assessment. Although goniometer measurement is clinically considered the gold standard, its accuracy compared with the true radiographic measurements of the joint angles remains questionable. The authors compared 3 smartphone applications and visual inspection measurements of the finger joints with the radiographic measurements and determined interrater reliability for these measurement tools...
January 8, 2018: Orthopedics
Taebyeong Kang, Jin Kyu Lee
The purpose of this study was to determine the prognostic factors related to the outcome of lavage surgery in patients with septic arthritis of the knee. A total of 55 patients with acute septic arthritis who underwent arthroscopic lavage were enrolled in the study. Host factors, including age, medical comorbidities, and medication use, were evaluated according to the Musculoskeletal Infection Society staging system, and patients were then stratified into 3 types: type A, no compromising factors; type B, 1 to 2 compromising factors; and type C, more than 2 compromising factors...
January 8, 2018: Orthopedics
Joshua C Rozell, Matthew Chin, Derek J Donegan, Michael W Hast
There currently exists an array of operative strategies to manage Lisfranc injuries. Modular fixation systems present surgeons with a choice between fully threaded solid cortical (FSC) and partially threaded cannulated cancellous (PCC) bone screws when using a transarticular screw approach. It is currently unknown how screw design influences fixation strength in Lisfranc reconstructions. The purpose of this study was to evaluate the biomechanical differences of FSC and PCC screws using a cadaveric model of a simulated Lisfranc injury and controlled benchtop experiments...
January 8, 2018: Orthopedics
Morteza Meftah, Peter B White, Ahmed Siddiqi, Vinayak S Perake, Ira H Kirschenbaum
Despite advances in thromboprophylaxis, the relationship between preexisting deep venous thromboses (DVTs) and postoperative thromboembolic complications is not fully established. The aim of this study was to assess the utility of selective and nonselective preoperative lower extremity venous Doppler screening protocols as tools in reducing the incidence of thromboembolic events (DVT/pulmonary embolism [PE]) after total joint arthroplasty. In the 2-year period from August 2013 to August 2015, a total of 455 consecutive elective primary total joint arthroplasties were identified from the authors' database...
January 8, 2018: Orthopedics
Xiang Li, Rui Li, Ming Ni, Wei Chai, Libo Hao, Yonggang Zhou, Jiying Chen
The reliability of the leukocyte esterase (LE) strip test needs further investigation. A total of 204 joints suspected of having periprosthetic joint infection were enrolled from July 2014 to June 2016. One drop of synovial fluid extracted by joint aspiration was applied to LE strips. The results were recorded after 2 to 3 minutes according to the 5 color grades on the color chart (-neg, 25, 27, 250, and 500). A centrifuge was used before the LE strip test when the synovial fluid was mixed with blood. Based on the Musculoskeletal Infection Society criteria, 88 joints were diagnosed as being infected and 116 as not infected...
January 8, 2018: Orthopedics
Neil Tarabadkar, Timothy Alton, Jacob Gorbaty, Sean Nork, Lisa Taitman, Conor Kleweno
The purpose of this study was to define the trends in fracture complexity and overall injury severity of orthopedic trauma patients at a level I trauma center. A retrospective review of a prospectively collected trauma database was performed to determine the Injury Severity Score (ISS) and AO/OTA classification of the most common fractures among all patients presenting from 1995 to 1999 and from 2008 to 2012. Inclusion criteria were lower extremity fractures of the femur and tibia and pelvic fractures within the years of interest...
January 8, 2018: Orthopedics
Paul M Lichstein, Scott C Wilson, William G Ward
There is no standardization of proprietary radiology viewing software platform functions allowing recorded digital radiographic imaging studies on compact discs (CDs) to be viewed in a standardized manner at subsequent institutions. Primary concerns include the following: (1) a large number of image viewing software platforms with a wide variety of features making familiarity with use difficult, (2) an inordinate amount of time required to load imaging data, (3) imaging data may not upload or be viewed with the care center's picture archiving and communication system, (4) navigation through imaging studies is inconsistent and tedious, and (5) image viewing requires additional software downloads...
December 19, 2017: Orthopedics
Gary M Kiebzak, Cristina Brea, Derek M Gonzalez, Pooya Hosseinzadeh
Management of clavicle fractures depends in part on the magnitude of shortening compared with the contralateral, intact clavicle. However, estimating prefracture length may be complicated by side-to-side asymmetry. The authors retrospectively reviewed chest radiographs using a ruler tool to measure clavicle length in 696 patients 12 to 25 years old. Absolute and relative least significant change values that represented statistically significant true biological differences were 3.54 mm and 2.44%, respectively...
December 19, 2017: Orthopedics
Thomas M Hagopian, David R Christian, David A Kulber
Peripheral schwannomas are benign tumors originating from the Schwann cells of the peripheral nerve sheath. They make up a small percentage of the overall incidence of tumors of the hand, most commonly involving the ulnar nerve. The authors report a case of a 59-year-old patient with a slowly enlarging mass over his right wrist and no other symptoms. During surgery, a schwannoma involving the palmar cutaneous branch of the median nerve was found and successfully removed. This is a rare clinical entity, with few cases reported in the literature...
December 19, 2017: Orthopedics
Matthew W Tetreault, Joshua J Jacobs, Waqas Mahmud, Denis Nam
In the 1990s, metal-on-metal (MoM) bearings were reintroduced in total hip arthroplasty (THA), having the proposed advantages of decreased wear and improved stability. However, catastrophic adverse local tissue reaction (ALTR) secondary to metal debris from both the bearing surface and the head-neck junction is a well-recognized complication. The measurement of metal ion levels in the serum is often a first-line test to identify failure of a MoM bearing. The authors describe a 70-year-old man who presented with a multiply revised MoM THA and a large periprosthetic fluid collection incidentally seen during computed tomography for renal nephrolithiasis...
December 19, 2017: Orthopedics
Andrzej Borowski, Gela Bajelidze, J Richard Bowen
Limb-length inequality is a clinical problem in children with hypertrophy associated with vascular malformations. The purpose of this study was to determine a pattern of growth, predict discrepancy at maturity, and evaluate the timing and results of epiphysiodesis. Hypertrophy with vascular malformation, follow-up from childhood until maturity, annual physical examination, and annual orthoroentgenograms and anteroposterior left hand-wrist radiographs were the inclusion criteria. The developmental pattern of the growth discrepancy was established...
December 19, 2017: Orthopedics
Zhikun Li, Gengwu Li, Chao Chen, Yifan Li, Changwei Yang, Wei Xu, Xiaodong Zhu
This study evaluated the risk factors for dysphagia after anterior cervical spine surgery by multidimensional analysis and investigated the predictive values of these risk factors for dysphagia. The patients underwent anterior cervical spine surgery and were followed for at least 6 months. Sex, age, tracheal mobility, smoking history, implant type, C3 anterior vertebral soft tissue swelling, narrowest esophageal distance before internal fixation, cervical curvature, operative time, occurrence of fusion, number of operative segments, and highest vertebral segment were recorded...
December 19, 2017: Orthopedics
Takashi Yoshida, Wook-Cheol Kim, Yoshinobu Oka, Masashi Nakase, Atsushi Nishida, Hiroyoshi Fujiwara, Toshikazu Kubo
Evaluation of callus maturation and the decision to remove an external fixator depend on radiographic and clinical findings, which are subjective. Callus fracture or recurrent deformity may occur after premature removal of a fixator. The authors applied a technique to measure bioelectrical impedance to assess callus maturation. This study included 27 limbs that underwent deformity correction or callus distraction using a fixator. Mean patient age at the time of surgery was 17.2 years. Overall impedance during callus maturation was measured from after completion of correction or distraction to removal of the fixator...
December 19, 2017: Orthopedics
Kelvin Y Kim, Afshin A Anoushiravani, Ameer Elbuluk, Kevin Chen, Roy Davidovitch, Ran Schwarzkopf
As the emphasis on value-based care within total joint arthroplasty increases, this procedure is becoming more prevalent in the outpatient setting. The goals of this study were to report on the authors' early experiences with same-day discharge and to identify patient characteristics that are associated with failure to discharge after total hip arthroplasty within this program. All patients who were enrolled in the same-day discharge total hip arthroplasty program at the study institution between January 2015 and July 2016 were included...
November 30, 2017: Orthopedics
David E Hartigan, Itay Perets, Edwin O Chaharbakhshi, John P Walsh, Leslie C Yuen, Benjamin G Domb
This study compared patients who underwent femoral head microfracture with a control group of patients who did not require microfracture. Patients had more than 2 years of follow-up. The patient groups had similar demographic and radiographic features, including sex, age within 5 years, body mass index within 5 points, equal Tönnis grade, lateral center edge angle within 5°, labral treatment, and capsular closure vs release. Inclusion criteria were a minimum of 2 years of follow-up, Outerbridge grade IV cartilage damage, and femoral head marrow stimulation technique performed at the time of arthroscopy...
November 30, 2017: Orthopedics
Paul J Lanier, Joshua Speirs, Logan Koehler, Julia Bader, Amr Abdelgawad, Brian R Waterman
Patients who undergo open reduction and internal fixation of distal clavicle fractures have a high rate of hardware removal and persistence of symptoms, particularly when attempting to return to high-demand activities. This study evaluated the outcomes of military servicemembers after surgical treatment of distal clavicle fractures. The authors performed a retrospective analysis of active duty servicemembers who underwent open reduction and internal fixation of Neer type II distal clavicle fractures between October 17, 2007, and July 20, 2012, with a minimum of 2-year clinical follow-up...
November 30, 2017: Orthopedics
E Grant Sutter, Justin Orenduff, Will J Fox, Joshua Myers, Grant E Garrigues
Baseball pitching imposes significant stress on the upper extremity and can lead to injury. Many studies have attempted to predict injury through pitching mechanics, most of which have used laboratory setups that are often not practical for population-based analysis. This study sought to predict injury risk in professional baseball pitchers using a statistical model based on video analysis evaluating delivery mechanics in a large population. Career data were collected and video analysis was performed on a random sample of former and current professional pitchers...
November 30, 2017: Orthopedics
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