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Matthew C Sweet, Gabriel J Sheena, Serena Liu, Felicity E Fisk, Jonathan R Lynch, Stephanie J Muh
Septic arthritis of the native glenohumeral joint is rare, and there is little information available regarding the natural progression and long-term joint outcomes of this pathology. The authors performed a retrospective analysis of 97 patients with culture-positive glenohumeral septic arthritis between 1995 and 2015 at their institution with a mean clinical follow-up of 83.1 months. Patient records were reviewed to document demographic and laboratory data, clinical presentation, postoperative complications, recurrences, and subsequent shoulder arthroplasty...
December 31, 2018: Orthopedics
Eric Alyea, Tara Gaston, Luke S Austin, Charles Wowkanech, Bret Cypel, Manuel Pontes, Gerald Williams
Venous thromboembolic disease (VTED) is a rare complication following arthroscopic rotator cuff repair (RCR). The American Academy of Orthopaedic Surgeons and the American College of Chest Physicians have no prophylaxis guidelines specific to shoulder arthroscopy, yet many surgeons prescribe aspirin following RCR. The purpose of this study was to evaluate the effectiveness of aspirin and mechanical prophylaxis compared with mechanical prophylaxis alone in preventing VTED following RCR. A total of 914 patients underwent RCR between January 2010 and January 2015...
December 31, 2018: Orthopedics
Jad M El Abiad, Keith Aziz, Adam S Levin, Edward M McCarthy, Carol D Morris
Osseous metastases to the hands and feet (acrometastases) are exceedingly rare. Historically, the most common primary cancer observed has been lung carcinoma, treated either nonoperatively or with amputation. The aim of this study was to describe the clinical characteristics associated with acrometastases. This was a retrospective review of 28 patients with histologically proven osseous metastatic disease to the hands and feet. Variables recorded included primary cancer histology, age at diagnosis of primary and acrometastases, location of acrometastases, burden of disease, treatment, and age at death...
December 31, 2018: Orthopedics
Ruipeng Zhang, Yingchao Yin, Shilun Li, Lin Jin, Jialing Guo, Zhiyong Hou, Yingze Zhang
Satisfactory fixation for displaced acetabular fractures involving the quadrilateral surface remains difficult to obtain with conventional reconstruction plates. To achieve minimally invasive management of fractures of the quadrilateral surface, the authors designed a type of anatomic quadrilateral surface plate (AQSP). A retrospective study to assess the therapeutic results of the AQSP was performed at their institution. A total of 26 patients with quadrilateral surface fractures fixed with an AQSP through the Stoppa approach from February 2014 to February 2015 were included in this study...
December 31, 2018: Orthopedics
Colin Y L Woon, Ritesh R Shah, Brandon M Pardi, Brian E Schwartz, Jeffrey M Goldstein, Nancy E Cipparrone, Wayne M Goldstein
Thromboembolic events after total joint arthroplasty are potentially devastating complications. This study evaluated the efficacy of 4 different anticoagulants in preventing deep venous thrombosis and pulmonary embolism after total joint arthroplasty. The demographics and anticoagulant use (warfarin, enoxaparin, and aspirin with and without outpatient mechanical pumps) for patients who underwent primary unilateral total joint arthroplasties performed by a single surgeon from January 2013 to October 2014 were retrospectively reviewed...
December 31, 2018: Orthopedics
David S Casper, Gregory D Schroeder, Benjamin Zmistowski, Jeffery A Rihn, D Greg Anderson, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler
Two major forms of physician reimbursement include Medicare (MCR; federally funded) and Medicaid (MCD; state funded). The only oversight provided to individual states for setting MCD reimbursement is that it must provide a standard payment that does not negatively affect patient care. The goals of this study were to determine the variability of MCD reimbursement for patients who require orthopedic procedures and to assess how this compares with regional MCR reimbursement. Medicaid reimbursement rates from each state were obtained for total knee arthroplasty, total hip arthroplasty, anterior cruciate ligament repair, rotator cuff repair, anterior cervical decompression and fusion, posterior lumbar decompression, carpal tunnel release, distal radius open reduction and internal fixation, proximal femur open reduction and internal fixation, and ankle open reduction and internal fixation...
December 31, 2018: Orthopedics
Ying-Cheng Huang, Chun-Yu Chen, Kai-Cheng Lin, Shang-Wei Yang, Yih-Wen Tarng, Wei-Ning Chang
Wide-awake local anesthesia no tourniquet (WALANT) is used for various hand surgeries, but there are no reports of its use for distal radius fractures. The authors compared perioperative variables and clinical outcomes for volar plating for distal radius fractures with WALANT vs general anesthesia with tourniquet. This retrospective study included 47 patients who presented with distal radius fractures between January 2015 and February 2017. Twenty-one underwent surgical volar plating with WALANT, and 26 underwent surgical volar plating with general anesthesia with tourniquet...
December 11, 2018: Orthopedics
Dong Hyun Kim, Seung Gi Min, Jong Pil Yoon, Ga Young Park, Jin Hyun Choi, Jae Wook Jung, Hyun Joo Lee, Hee June Kim, Seok Won Chung, Joon Yub Kim
For anatomical restoration of a repaired rotator cuff, mechanical augmentation of the repaired structure is essential. Using histological and biomechanical evaluation in a rat model, the authors sought to determine the efficacy of an absorbable alginate sheet at the supraspinatus tendon-to-bone repair site for healing of the rotator cuff tear. Forty adult (12 weeks old) male Sprague- Dawley wild-type rats were used in this study. The animals were randomly separated into 2 groups: group 1, conventional supraspinatus repair with acute repair; or group 2, supraspinatus repair with absorbable alginate sheet...
December 11, 2018: Orthopedics
Katsumi Takase
Rotator cuff tears are frequently treated in daily clinical practice. However, there have been few reports of tears around the shoulder involving the latissimus dorsi and teres major muscles. The author reports the rare case of an isolated tear of the teres major muscle with symptom onset during ordinary sports activities without a clear traumatic mechanism. The patient received conservative treatment, and satisfactory results were obtained. [Orthopedics. 201x; xx(x):xx-xx.].
December 11, 2018: Orthopedics
Hunter L Bohlen, Dominic J Gargiulo, Steven G Thon
Transient arterial injury is a common complication encountered in the management of pediatric supracondylar humerus fractures, often presenting as a pulseless hand that appears well perfused, also known as the "pink, pulseless hand." Arterial injuries in pediatric humeral shaft fractures, on the other hand, are exceedingly rare, especially in closed fractures. The authors report a rare case of a humeral shaft fracture presenting as a pink, pulseless hand. Although this complication was initially managed according to supracondylar protocol, the patient's neurologic status deteriorated...
December 11, 2018: Orthopedics
Young-Hoo Kim, Jang-Won Park, Jun-Shik Kim
No study has compared the prevalence of fretting and corrosion at the trunnion of cobalt-chrome (Co-Cr) and zirconia ceramic heads in the same patients. The authors sought to compare the prevalence of fretting and corrosion at the trunnion after total hip arthroplasty with a 32-mm Co-Cr or a 32-mm zirconia ceramic head-on-polyethylene bearing. Isolated revision of the ace-tabular components was performed in 78 patients (156 hips) for polyethylene wear and osteolysis of the acetabulum. Seventy-eight Co-Cr head-titanium alloy stem pairs were compared with 78 zirconia ceramic head-titanium alloy stem pairs in the same patients...
December 11, 2018: Orthopedics
Lili E Schindelar, Alexander J Rondon, Asif M Ilyas
Distal humerus fractures, which are challenging injuries seen in geriatric patients, are often repaired using open reduction and internal fixation or total elbow arthroplasty. This updated meta-analysis, which includes more recent open reduction and internal fixation techniques, examined outcomes following distal humerus fractures repaired using open reduction and internal fixation vs total elbow arthroplasty. Although distal humerus fractures treated with total elbow arthroplasty achieved statistically higher functional scores relative to those treated with open reduction and internal fixation, this difference was not clinically significant...
December 11, 2018: Orthopedics
Joshua A Tuck, Smith M Meads, Jordan L Ramage
Femoral nerve palsy with concomitant patellar dislocation is a rare clinical entity that has not previously been well documented. The authors present the case of a 16-year-old female ballet dancer who sustained a patellar dislocation with concomitant femoral nerve palsy. She experienced muscle weakness after the initial injury and developed neuropathic symptoms through the anterior left thigh. The patient exhibited muscle atrophy in her left lower extremity verified by circumferential thigh measurements as well as magnetic resonance imaging showing clear atrophy of the anterior compartment...
December 11, 2018: Orthopedics
Pieter C Geervliet, Mike Houtveen, Inger N Sierevelt, Cornelis P J Visser, Arthur van Noort
Shoulder arthroplasty is a valuable option for treating glenohumeral osteoarthritis. Revision surgery for a failed shoulder arthroplasty is associated with difficult procedures, complications, and worse outcomes. Compared with a total joint arthroplasty, a resurfacing prosthesis has the supposed advantages of limited perioperative complications and little bone loss during revision. The aim of this study was to describe patient-reported outcome measures of revision surgery from failed uncemented Global CAP (DePuy, Warsaw, Indiana) resurfacing hemiarthroplasty to total shoulder or reverse shoulder arthroplasty...
December 11, 2018: Orthopedics
Daniel A Charen, Jonathan S Markowitz, Zoe B Cheung, Douglas J Matijakovich, Jimmy J Chan, Ettore Vulcano
Metatarsalgia can be viewed as more of a symptom rather than a distinct diagnosis. Timing of forefoot pain during the gait cycle and evaluation of whether the pain is from anatomic abnormalities, indirect overloading, or iatrogenic causes can suggest a specific metatarsalgia etiology. A thorough physical examination of the lower extremity, especially evaluation of the plantar foot, and weight-bearing radiographs are critical for diagnosis and treatment. Nonoperative treatment consists of physical therapy, orthotics, shoe wear modification, and injections...
December 11, 2018: Orthopedics
John W Krumme, Madelyn F Lauer, Justin T Stowell, Nebiyu M Beteselassie, Suhel Y Kotwal
Due to its high sensitivity, low cost, accessibility, and ease of use, bone scintigraphy is used in orthopedic surgery for the diagnosis and management of varied pathology. It is commonly used for insufficiency fractures, metastatic neoplasia, staging and surveillance of sarcoma, and nonaccidental trauma. It augments diagnoses, including stress or occult fractures, musculoskeletal neoplasia or infection, and chronic regional pain syndrome, in patients presenting with normal results on radiographs. Bone scan images are resistant to metal-based implant artifact, allowing effective evaluation of failed total joint prostheses...
November 26, 2018: Orthopedics
Koan J Heindel, Gordon P Preston, Jeffrey S Tharp
Anterior cervical decompression and fusion is a commonly performed procedure for cervical pathology. Graft choices include autograft, allograft, xenograft, synthetic, or a combination. Autograft has been shown to increase fusion rate compared with allograft, yet high morbidity at the harvest site has been reported. Few studies have evaluated chronic graft site pain, and to the authors' knowledge, no study has evaluated morbidity of a pilot hole burr technique for anterior iliac crest harvest. The objective of this study was to evaluate chronic morbidity of anterior iliac crest harvest in anterior cervical decompression and fusion using a pilot hole burr technique...
November 26, 2018: Orthopedics
Samir Mehta, Matthew Chin, Jennifer Sanville, Surena Namdari, Michael W Hast
Hardware-related complications can occur when plate fixation is used to stabilize osteoporotic fractures involving the olecranon. The use of an additional nonlocking screw, placed retrograde into the proximal fracture segment, may improve stability under load. The purpose of this study was to conduct a biomechanical comparison of olecranon repair constructs with and without this additional retrograde screw. Nine matched pairs of elderly fresh-frozen cadaveric upper extremities were used. Two-part olecranon fractures were modeled, and fracture stabilization was performed...
November 26, 2018: Orthopedics
Stacey J Ackerman, Tyler Knight, Peter M Wahl
In the United States, demand for total hip arthroplasty (THA) and THA revision procedures are increasing due to an aging population, a longer life expectancy, and an increasing prevalence of osteoarthritis. This retrospective cohort study identified patients 65 years and older in the Medicare 5% Standard Analytic Files who underwent THA for osteoarthritis between January 1, 2009, and September 30, 2010. The authors estimated the 5-year cumulative revision risk (CRR) using the Kaplan-Meier method, revision-related complications, and Medicare expenditures...
November 26, 2018: Orthopedics
Joshua T Bram, Andrew J Gambone, Christopher J DeFrancesco, Brendan M Striano, Theodore J Ganley
Joint immobilization after anterior cruciate ligament (ACL) reconstruction may lead to intra-articular adhesions and range of motion deficits. Some practitioners thus advocate for the use of postoperative continuous passive motion (CPM) machine protocols. However, previous studies have failed to show CPM to be effective in increasing postoperative range of motion. Continuous passive motion has, however, been shown to reduce rates of arthrofibrosis requiring manipulation under anesthesia (MUA) in adult populations...
November 26, 2018: Orthopedics
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