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Orthopedics

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https://www.readbyqxmd.com/read/28934544/conjoint-tendon-release-in-direct-anterior-total-hip-arthroplasty-no-impact-on-patient-outcomes
#1
Reina Yao, James L Howard, Brent A Lanting
The direct anterior (DA) approach for total hip arthroplasty (THA) has become increasingly popular. However, femoral access can be more technically challenging in difficult cases as compared with other approaches. Conjoint tendon release can improve proximal femoral exposure, but its effect on patient function and pain has not been studied. This study evaluated the effect of conjoint tendon release on length of stay (LOS), inpatient pain medication requirements, and functional outcomes of patients undergoing DA THA...
September 21, 2017: Orthopedics
https://www.readbyqxmd.com/read/28934543/long-term-results-of-intercalary-endoprosthetic-short-segment-fixation-following-extended-diaphysectomy
#2
Nicholas S Tedesco, Alexandra L Van Horn, Robert M Henshaw
Intercalary endoprosthetic reconstruction following diaphyseal resection of osseous tumors offers functional advantages through preservation of native joints adjacent to the resected defect. Use of such implants is restricted by the amount of bone available for stem fixation adjacent to the defect. This study aimed to determine whether short osseous segment fixation with acceptable outcomes and complication rate can be reliably achieved with a customized intercalary endoprosthesis following extended diaphysectomy...
September 21, 2017: Orthopedics
https://www.readbyqxmd.com/read/28934542/complications-associated-with-pelvic-external-fixation
#3
Christopher McDonald, Reza Firoozabadi, M L Routt, Conor Kleweno
An external fixator is an essential tool for treating unstable pelvic ring injuries but its use carries risks, including pin-site infections and injury to the lateral femoral cutaneous nerve (LFCN). Surgeons currently lack data regarding these risks for patient counseling. This study aimed to identify the incidence of and risk factors for superficial and deep pin-site infection and LFCN damage. Fifty-two patients who underwent pelvic external fixation with anterior pin placement as part of definitive treatment for unstable pelvic ring disruption were retrospectively evaluated to identify factors associated with the development of infection...
September 21, 2017: Orthopedics
https://www.readbyqxmd.com/read/28934541/contact-dermatitis-reaction-to-2-octyl-cyanoacrylate-following-3-orthopedic-procedures
#4
Nicholas H Lake, Brian T Barlow, James E Toledano, Johannah Valentine, Lucas S McDonald
Two-octyl cyanoacrylate is a popular skin adhesive used for closing surgical incisions. Since Food and Drug Administration approval in 1998, the few reports of adverse reactions following its use have primarily been limited to the nonorthopedic literature. The authors present a case series of contact dermatitis associated with 2-octyl cyanoacrylate following orthopedic surgery and a review of the literature on the diagnosis and treatment of this complication. All 3 patients presented with blistering around their incisions within 2 weeks of surgery and responded to treatment involving removal of the offending agent and use of oral diphenhydramine and hydroxyzine and topical triamcinolone...
September 21, 2017: Orthopedics
https://www.readbyqxmd.com/read/28934540/safe-positioning-for-sexual-intercourse-after-proximal-femoral-replacement
#5
Cory G Couch, Richard W Nicholas, Corey O Montgomery
Hip arthroplasty is a common procedure used for the treatment of fractures and degenerative processes affecting the hip. Proximal femoral replacement is an uncommon type of hip arthroplasty used for reconstruction after extensive bone loss. Proximal femoral replacement is used most commonly after the resection of the proximal femur for malignancies and for extensive bone loss encountered in revision hip arthroplasty and occasionally for extensive bone loss after fractures. The authors present a case of a female patient who sustained a prosthetic dislocation of her proximal femoral replacement during sexual intercourse...
September 21, 2017: Orthopedics
https://www.readbyqxmd.com/read/28934539/popliteal-artery-entrapment-syndrome-bilateral-lower-extremity-involvement
#6
Havalee T Henry, Lauren K Szolomayer, Bauer E Sumpio, Karen M Sutton
Popliteal artery entrapment syndrome is a condition in which compression of the popliteal neurovascular structures results in symptoms of lower extremity claudication by way of a constricting anatomic structure or a hypertrophied surrounding musculature. This diagnosis is often missed or misdiagnosed because popliteal artery entrapment syndrome has a presentation similar to that of exertional compartment syndrome. Popliteal artery entrapment syndrome may result in persistent disability or unnecessary morbidity or prevent athletes' return to sport...
September 21, 2017: Orthopedics
https://www.readbyqxmd.com/read/28934538/predictability-of-early-postoperative-ultrasonography-after-arthroscopic-rotator-cuff-repair
#7
Joo Han Oh, Joon Yub Kim, Sae Hoon Kim, Nam Yun Chung
The predictability of early postoperative ultrasonography (USG) for evaluating the structural integrity of repaired rotator cuffs is still unclear. The aim of this study was to compare the predictability of early USG performed 3 and 6 months postoperatively with magnetic resonance imaging (MRI) performed 1 year after arthroscopic cuff repair for structural failure. Among 213 patients who had arthroscopic rotator cuff surgery in 2013, one hundred thirty-eight patients who underwent USG between 3 and 6 months postoperatively and MRI at 1 year postoperatively were enrolled; the postoperative MRI findings were the reference standard used for the comparison...
September 21, 2017: Orthopedics
https://www.readbyqxmd.com/read/28934537/effect-of-retroperitoneal-pelvic-packing-on-pelvic-cavity-pressure-a-cadaveric-study
#8
Yukio Sato, Kazuhiko Sekine, Takayuki Shibusawa, Kosuke Tajima, Junichi Sasaki, Nobuaki Imanishi, Sadakazu Aiso, Shingo Hori
Limited clinical evidence demonstrates the effectiveness of direct retroperitoneal pelvic packing for hemorrhage control in pelvic fractures due to the difficulty in measuring pressure on the pelvic walls within the pelvic cavity after retroperitoneal pelvic packing. Using a cadaver model, the authors aimed to assess whether retroperitoneal pelvic packing generates pressure that exceeds the venous return and arterial pressure in the pelvis. The pressure on the pelvic wall was measured in 5 fresh Japanese cadavers...
September 21, 2017: Orthopedics
https://www.readbyqxmd.com/read/28934536/glomus-tumor-of-the-sciatic-nerve-an-extraspinal-cause-of-sciatica
#9
Basilia Onyinyechukwu Nwankwo, Robert M Henshaw, Dhruv Kumar
Glomus tumors are small, benign tumors that arise from glomus bodies, structures found normally within the dermis that assist in temperature regulation via their vasoconstrictive response to sympathetic stimuli. Glomus tumors are found typically in the hand and are classically a cause of focal pain and temperature sensitivity. They often present as a small blue lesion seen under the nail bed of a finger or a toe and cause point tenderness. Glomus tumors of peripheral nerves are exceedingly rare and can lead to disability akin to compressive neuropathy when present...
September 21, 2017: Orthopedics
https://www.readbyqxmd.com/read/28934535/quantification-of-imaging-error-in-the-measurement-of-cup-position-a-cadaveric-comparison-of-radiographic-and-computed-tomography-imaging
#10
Ran Schwarzkopf, Jonathan M Vigdorchik, Theodore T Miller, Eric A Bogner, Jeffrey M Muir, Michael B Cross
Postoperative radiographs remain the standard for assessment of component placement following total hip arthroplasty (THA), despite the known limitations of radiographs. Computed tomography (CT) scanning offers improved accuracy, but its costs and radiation exposure are prohibitive. The authors performed a cadaver study to compare the error associated with radiographs with that of CT scans following THA. The authors also compared imaging with a novel mini-navigation system. Three board-certified orthopedic surgeons each performed 4 THA procedures (6 cadavers, 12 hips) via the posterior approach using a mini-navigation tool to assist with component placement...
September 21, 2017: Orthopedics
https://www.readbyqxmd.com/read/28877329/comparison-of-knee-stability-and-synovial-fluid-alterations-in-anterior-cruciate-ligament-reconstruction-with-a-hamstring-autograft-or-an-allograft
#11
Rui Yang, Haiquan Deng, Jingyi Hou, Yi Ouyang, Zhong Chen, Bin Song, Yunfeng Zhou, Weiquan Tan, Weiping Li, Huiyong Shen
This study compared knee stability and alterations in the composition of synovial fluid among patients who underwent arthroscopic anterior cruciate ligament (ACL) reconstruction with either a hamstring autograft or a hamstring allograft. This prospective cohort study enrolled 175 patients. Of these patients, 90 underwent hamstring tendon autograft ACL reconstruction. The remaining patients (n=85) underwent hamstring tendon allograft ACL reconstruction. All of the patients had a minimum of 1 year of follow-up (mean, 2...
September 6, 2017: Orthopedics
https://www.readbyqxmd.com/read/28877328/procedural-sedation-with-ketamine-versus-propofol-for-closed-reduction-of-pediatric-both-bone-forearm-fractures
#12
Todd Morrison, Chris Carender, Brendan Kilbane, Raymond W Liu
Effective treatment of pediatric both bone forearm fractures consists of timely restoration of anatomic alignment with manipulation and immobilization, often accomplished with the aid of procedural sedation in the emergency department setting. The current lack of consensus regarding a safe and optimal regimen may result in inadequate sedation, compromised quality of reduction, or patient harm. The current study was conducted to answer the following questions for pediatric both bone forearm fractures treated with closed reduction with either ketamine or propofol procedural sedation: (1) Is there a difference in the rate of unacceptable alignment 4 weeks after reduction? (2) Is there a difference in the rates of major sedation-related complications? Medical records, data on procedural sedation, and radiographs of 74 skeletally immature patients with diaphyseal or distal metaphyseal both bone forearm fractures treated with manipulation were reviewed (ketamine sedation, 26; propofol sedation, 48)...
September 6, 2017: Orthopedics
https://www.readbyqxmd.com/read/28877327/advances-in-computer-aided-technology-for-total-knee-arthroplasty
#13
Ahmed Siddiqi, W Mack Hardaker, Krishna Kiran Eachempati, Neil P Sheth
Technology such as computer-assisted navigation systems, robotic-assisted systems, and patient-specific instrumentation has been increasingly explored during the past decade in an effort to optimize component alignment and improve clinical outcomes. Computer-assisted navigation accurately restores mechanical-axis alignment, but clinical outcome data are inconsistent. Computer-assisted navigation gap balancing has shown early promise in establishing mechanical-axis alignment with improved functional outcomes...
September 6, 2017: Orthopedics
https://www.readbyqxmd.com/read/28877326/upper-extremity-deep-venous-thrombosis-prophylaxis-after-elective-upper-extremity-surgery
#14
Kunal K Sindhu, Brian Cohen, Travis Blood, Joseph A Gil, Brett Owens
Historically, upper extremity deep venous thromboses (DVTs) have been rare; however, their incidence has increased as awareness has increased. Patients who develop upper extremity DVTs often have multiple comorbidities. However, in the past decade, studies have found a small risk of upper extremity DVTs associated with orthopedic procedures involving the upper extremity. The risk of complications following a DVT, including postthrombotic syndrome and pulmonary embolism, is substantially higher with a DVT of the upper extremity compared with a DVT of the lower extremity...
September 6, 2017: Orthopedics
https://www.readbyqxmd.com/read/28877325/perioperative-blood-loss-during-total-hip-arthroplasty-among-patients-with-ankylosing-spondylitis
#15
Yong Hu, Wei-Zhou Jiang, Zhi-Fa Huang, Tahsin Tarik Torsha, De-Sheng Yang, Jun Xiao
Intraoperative blood loss is frequently an overarching concern during total hip arthroplasty (THA) for patients who have ankylosing spondylitis with hip involvement. However, the factors that affect blood loss have not been identified. The goal of this study was to investigate these factors among patients with ankylosing spondylitis. Patients in the authors' department who had ankylosing spondylitis and underwent unilateral THA from 2011 to 2016 were studied retrospectively. Demographic characteristics, perioperative laboratory values, intraoperative data, transfusion rate, transfusion volume, and data on hemostatic use were collected and analyzed statistically...
September 6, 2017: Orthopedics
https://www.readbyqxmd.com/read/28877324/t786c-mutation-in-the-endothelial-nitric-oxide-synthase-gene-in-patients-with-primary-osteonecrosis
#16
Amir M Khan, Joshua Choi, Richard A Freiberg, Charles J Glueck, Naila Goldenberg, Ping Wang
Mutations in the T786C endothelial nitric oxide synthase gene (eNOS) are associated with osteonecrosis and Prinzmetal's angina. Nitric oxide is necessary for bone health and ameliorates Prinzmetal's angina. This study compared mutations of T786C eNOS in 146 patients with primary osteonecrosis, 114 patients with Prinzmetal's angina, and 83 normal control subjects. Patients with osteonecrosis had more mutant eNOS alleles than control subjects (42% vs 22%, respectively; P<.0001) but had the same number of mutant alleles as patients with Prinzmetal's angina (42% vs 41%, respectively; P=...
September 6, 2017: Orthopedics
https://www.readbyqxmd.com/read/28817163/provider-initiated-patient-satisfaction-reporting-yields-improved-physician-ratings-relative-to-online-rating-websites
#17
Benjamin F Ricciardi, Brad S Waddell, Scott R Nodzo, Jeffrey Lange, Allina A Nocon, Spencer Amundsen, T David Tarity, Alexander S McLawhorn
Recently, providers have begun to publicly report the results of patient satisfaction surveys from their practices. However, these outcomes have never been compared with the findings of commercial online physician rating websites. The goals of the current study were to (1) compare overall patient satisfaction ratings for orthopedic surgeons derived from provider-based third-party surveys with existing commercial physician rating websites and (2) determine the association between patient ratings and provider characteristics...
August 17, 2017: Orthopedics
https://www.readbyqxmd.com/read/28817162/determining-when-it-is-safe-to-remove-the-external-fixator-results-from-a-survey-of-the-limb-lengthening-and-reconstruction-society
#18
Christopher A Iobst, Waleed Mohammed, Ryan Colley
Thousands of external fixators are applied for distraction osteogenesis each year. Determining when it is safe to remove the fixator can be difficult. The purpose of this study was to survey an international group of external fixation surgeons to determine their current practice patterns surrounding external fixator removal. A 10-question, open-ended survey was emailed to members of the Limb Lengthening and Reconstruction Society. Responses were recorded, and statistical analysis was performed. Pearson's chi-square test and likelihood ratio were used when indicated...
August 17, 2017: Orthopedics
https://www.readbyqxmd.com/read/28817161/biomechanical-evaluation-of-unicortical-stress-risers-of-the-proximal-humerus-associated-with-pectoralis-major-repair
#19
David J Wilson, Brian P Milam, William F Scully, Todd P Balog, Kyong S Min, Christopher S Chen, Bryant G Marchant, Edward D Arrington
Proximal humerus fracture after pectoralis major tendon repair has been recently reported. Although this complication is rare, it may be possible to decrease such risk using newer techniques for myotenodesis. This study was designed to evaluate various unicortical stress risers created at the proximal humeral metadiaphysis during myotenodesis for repair of pectoralis major ruptures. A simulated pectoralis major myotenodesis was performed using fourth-generation Sawbones (N=30). Using previously described anatomic landmarks for the tendinous insertion, 3 repair techniques were compared: bone trough, tenodesis screws, and suture anchors (N=10 each)...
August 17, 2017: Orthopedics
https://www.readbyqxmd.com/read/28817160/extensor-mechanism-reconstruction-for-chronic-patellar-fracture
#20
Antonio Cusano, Emily J Curry, Lee N Marinko, Xinning Li
Patients with displaced patellar fractures typically present with disruption to the extensor mechanism requiring acute surgical intervention. Chronic patellar fractures with disruption of the extensor mechanism are uncommon, and few surgical options are available. The authors present a patient who sustained a fracture to the inferior pole of the patella in Africa 5 years prior that was managed conservatively with bands and a brace. He decided to pursue surgical intervention because of difficulties with leg extension, weakness, and ambulation...
August 17, 2017: Orthopedics
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