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American Journal of Orthopedics

Colin Y L Woon, Vincent M Moretti, Brian E Schwartz, Benjamin A Goldberg
There is controversy regarding whether total hip arthroplasty (THA) or hemiarthroplasty (HA) is the treatment preferred for displaced intracapsular femoral neck fractures (FNFs). Using the US National Hospital Discharge Survey, we found that, of 12,757 patients admitted for FNF between 2001 and 2010, 4.6% underwent THA and 52.5% underwent HA. More of both procedures were performed over time. Mean age was higher for HA patients. Hospitalization duration and blood transfusion rates were higher for THA. There were region-based differences in frequency of THA and significant hospital-size-based differences in frequency of HA, possibly because of differences in regional training and subspecialist availability...
November 2017: American Journal of Orthopedics
Steven Magister, Seth Yarboro
Patella fractures, although uncommon in the context of corresponding long bone fractures, carry a disproportionately high degree of morbidity, and are often challenging to treat. As such, this study sought to evaluate the efficacy of a Krackow suture augment when compared to standard tension band fixation and cerclage suture augment in patella fracture repair. Cadaveric patella extensor mechanisms were used for biomechanical testing. Specimens were divided among 3 groups, each with a different repair technique: modified anterior tension band (MATB), MATB plus cerclage suture, and MATB plus Krackow suture...
November 2017: American Journal of Orthopedics
Kofi Agyeman, Juan Pretell-Mazzini, Ty Subhawong, Darcy A Kerr, Jean Jose
Gorham disease, a rare condition of unknown etiology, presents as skeletal lucency on radiographs, prompting the classic eponym of vanishing bone disease. Initial clinical presentation varies considerably but typically involves prolonged soreness in the affected region and, rarely, acute pathologic fracture. The nonspecific nature of complaints, lack of markers of systemic illness, and rarity of the disease contribute to delayed diagnosis. Several imaging studies (eg, plain radiographs, computed tomography, magnetic resonance imaging, nuclear studies) provide nonspecific findings, but frank cortical destruction and true "disappearance" of bone with extensive soft-tissue edema are evident...
November 2017: American Journal of Orthopedics
Carmen E Quatman, John H Alexander, Paul E Wakely, Joel L Mayerson
In this article, we report a case of transformation of a benign giant cell tumor (GCT) of the calcaneus into an epithelioid angiosarcoma. The patient presented to our service in 2003 and was followed until 2014. Transformation occurred 11 years after curettage, cryotherapy, cementation, and a well-documented disease-free interval. Longitudinal radiographs, magnetic resonance imaging, and histopathology were evaluated by the same medical team. There are only a few case reports and case series of malignancy associated with GCT of bone...
November 2017: American Journal of Orthopedics
David M Levy, Brandon J Erickson, Joshua D Harris, Bernard R Bach, Nikhil N Verma, Anthony A Romeo
As isolated fractures of the greater tuberosity present a therapeutic challenge, we systematically reviewed all studies of greater tuberosity fracture management. Inclusion criteria were level I to IV evidence and 2-year follow-up. Thirteen studies and 429 shoulders were included in our analyses, which compared 3 paired groups: treatment type (nonoperative vs operative), fracture displacement amount (<5 mm vs >5 mm), and surgery type (open vs arthroscopic). Concomitant anterior glenohumeral instability was documented in 28...
November 2017: American Journal of Orthopedics
Charles F Land, William J Rosenblum, Justin Kennon
The mainstay of complex open lower extremity fractures and dislocations is the temporizing external fixator. We propose the use of external fixator attachments that allow for the reduction of fractures and dislocations intraoperatively. By using external fixator carbon fiber rods, the surgeon is able to create a capital "T" (sweet T) shaped attachment and connect this to a Schanz pin. Simultaneously, the external fixator carbon fiber rods can be configured into the shape of a capital Greek letter pi (Cherry II) and applied to an external fixator pin...
November 2017: American Journal of Orthopedics
Neil S Kumar, Andre M Jakoi, Amrit S Khalsa, Andrew M Star
We conducted a study to determine if knowledge of implant cost affects fixation method choice in the management of stable intertrochanteric hip fractures. We retrospectively reviewed the cases of 119 patients treated with a sliding hip screw (SHS; Versafix), a short Gamma nail (SGN), or a long Gamma nail (LGN). Of the 119 fractures, 71 were treated before implant costs were revealed, and 48 afterward. The 2 groups were similar in age, sex, fracture types, American Society of Anesthesiologists physical status classification, and preinjury ambulatory status...
November 2017: American Journal of Orthopedics
Sarang Kasture, Raj Sakamuri
We report a rare case of translunate, transradial, transtriquetral, transtrapezoid perilunate dislocation with multiple metacarpal neck fractures in a young adult. The injury was treated with open reduction and internal fixation. Although the injury was severe, the patient had a satisfactory functional result.
November 2017: American Journal of Orthopedics
Alexander Habashy, Brandon Cook, Gonzalo Sumarriva, Robert Treuting
The peroneus quartus (PQ) muscle is a rare but sometimes missed potential etiology of ankle pain and tendon subluxation. We report the case of a 16-year-old boy who presented with lateral right ankle pain and subluxation of peroneal tendons. He had a history of non-Hodgkin lymphoma and palpable distal fibular osteochondroma. Seven months after excision of the exostosis and repair of the peroneal tendon retinaculum, the pain recurred. Imaging showed a split peroneus brevis (PB) tendon. During surgery, a PQ muscle was found and excised, and the PB tendon was repaired...
November 2017: American Journal of Orthopedics
Simon L Greenbaum, Beverly A Thornhill, David S Geller
Osseous metastases are common in advanced cancer stages. The tibia is the appendicular skeleton bone affected third most often. However, tibial metastases are not well described. We conducted a retrospective descriptive single-institution study of patients with evidence of tibial metastatic disease in order to better characterize tibial metastases in their anatomical distribution and histology, and to describe their clinical presentation and surgical management. Using proprietary research software, we searched pathology and radiology reports and cross-referenced results with Current Procedural Terminology procedure codes to identify patients with metastatic lesions of the tibia...
November 2017: American Journal of Orthopedics
Jorge Chahla, Damián Arroquy, Tomas Vilaseca, Martin Carboni, Justin J Mitchell, Chase S Dean, Mark E Cinque, Scott A Rodeo, Cecilia Pascual-Garrido
We conducted a study to determine if a minimally invasive posteromedial reconstruction technique would return medial knee stability to its intact state. Ten cadaveric knees were tested under 3 state conditions: intact, sectioned, and reconstructed. The medial compartment opening was measured on valgus stress radiographs at full extension and at 20° of flexion with a 10-N valgus load (applied with dynamometer) to assess valgus stability in the intact, sectioned, and reconstructed states. After posteromedial sectioning, mean medial gap was statistically significantly larger (P = ...
November 2017: American Journal of Orthopedics
Erick G Torres, Ashley B Anderson, Brandon Broome, Stephen P Geary, Brian Burnikel
Inadequate pain management after total knee arthroplasty (TKA) can interfere with participation in and progression of physical rehabilitation, and thereby prolong hospital stay, and increase costs and overall dissatisfaction with the procedure. At our institution, TKA traditionally has been performed with femoral nerve catheters (FNCs) for postoperative pain control. We conducted a retrospective, longitudinal, repeated -measures study to compare FNC and long-acting liposomal bupivacaine (LALB) with respect to pain control, range of motion, ability to ambulate, and hospital length of stay...
November 2017: American Journal of Orthopedics
Joseph A Buckwalter V, Robert Westermann, Brian Mooers, Matthew Karam, Brian Wolf
Talus fractures with associated dislocations are rare but have high rates of complications, including avascular necrosis (AVN). Management of these injuries involves urgent surgical reduction and fixation, although there are no definitive data defining an operative time frame for preserving the blood supply and preventing complications. To determine the effect of time to surgical reduction of talus fractures and talus fracture-dislocations on rates of AVN and posttraumatic osteoarthritis (PTOA), we retrospectively reviewed talus fractures surgically managed at a level I trauma center during the 10-year period 2003 to 2013...
November 2017: American Journal of Orthopedics
Jaydev B Mistry, Abbas Naqvi, Morad Chughtai, Chukwuweike Gwam, Melbin Thomas, Carlos A Higuera, Michael A Mont, Ronald E Delanois
Surgical-site infection (SSI) after total joint arthroplasty (TJA) continues to pose a challenge and place a substantial burden on patients, surgeons, and the healthcare system. Given the estimated 1.0% to 2.5% annual incidence of SSI after TJA, orthopedists should be cognizant of preventive measures that can help optimize patient outcomes. Advances in surgical technique, sterile protocol, and operative procedures have been instrumental in minimizing SSIs and may account for the recent plateau in rising rates...
November 2017: American Journal of Orthopedics
Bryan M Saltzman, Allison Rao, Brandon J Erickson, Gregory L Cvetanovich, David Levy, Bernard R Bach, Brian J Cole
Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched the literature for tibial tubercle osteotomy (TTO) studies and systematically reviewed them for indications, clinical outcomes, complications, and reoperations. Therapeutic clinical studies that reported TTO indications, operative findings, and outcomes were included. Quality of each study was assessed with the modified Coleman methodology score (MCMS). Twenty-one studies (976 patients, 1055 knees) were included in the analysis...
November 2017: American Journal of Orthopedics
David M Levy, Joshua A Metzl, G Christian Vorys, William N Levine, Christopher S Ahmad, Louis U Bigliani
In total shoulder arthroplasty (TSA), glenoid prostheses have conforming or nonconforming designs. A hybrid glenoid was designed with dual radii of curvature: a central conforming region surrounded by an outer nonconforming region. We retrospectively reviewed the cases of 169 patients who underwent 196 hybrid glenoid prosthesis TSAs for primary glenohumeral arthritis. Clinical data, retrieved for 178 shoulders at a mean follow-up of 4.8 years, included physical examination, 36-Item Short Form Health Survey (SF-36), American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test (SST), subjective Neer criteria, and postoperative complication data...
November 2017: American Journal of Orthopedics
Ekaterina Urch, Samuel A Taylor, Prem N Ramkumar, Paul Enker, Stephen B Doty, Alex E White, Demetris Delos, Mary E Shorey, Stephen J O'Brien
In this article, we report on the differences in the healing biology of biceps tenodesis performed on either bone or soft tissue in a rat model. This work provides further insight into what may be the optimal strategy for managing biceps-labrum complex disease.
November 2017: American Journal of Orthopedics
Muriel J Solberg, Arnold B Alqueza, Tyler J Hunt, Laurence D Higgins
Shared decision-making provides patients a measure of autonomy in making choices for their health and their future. Patient-reported outcome measures (PROMs) use clinically sensitive and specific metrics to evaluate a patient's self-reported pain, functional ability, and mental state. We conducted a study to create an evidence-based clinical decision-making tool. We used PROMs to create a predictive model of a patient's outcome to help set patient expectations and facilitate a collaborative decision-making environment for patient and physician...
November 2017: American Journal of Orthopedics
Beth E Shubin Stein, Jacqueline M Brady, Brian Grawe, Yetsa Tuakli-Wosornu, Joseph T Nguyen, Elizabeth Wolfe, Marcia Voigt, Gregory Mahony, Sabrina Strickland
Patellofemoral arthroplasty (PFA) is used to treat isolated patellofemoral arthritis, but little is known about post-PFA activity levels and functional outcome scores. We reviewed 48 consecutive cases (39 patients) of PFAs performed between 2009 and 2014. Three validated patient-reported outcome measures (Kujala score, Lysholm score, International Knee Documentation Committee score) were used to evaluate knee function before and after surgery. Patient-reported outcome measures were significantly improved after surgery...
November 2017: American Journal of Orthopedics
Karen Zupko
No abstract text is available yet for this article.
November 2017: American Journal of Orthopedics
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