bluuebunny/crossref_metadata_2025 huggingface dataset:
Multiplanar Osteotomies Guided by Navigation in Chondrosarcoma of the Knee
Authors: Aponte-Tinao Luis A. , Ritacco Lucas E. , Ayerza Miguel A. , Muscolo D. Luis , Farfalli Germán L.
Published: August 2014

Surgical resection with adequate margins is the treatment of choice in chondrosarcoma. However, well-circumscribed lesions can be completely resected by performing multi-planar osteotomies guided by computer-assisted navigation. This type of resection had been recently described in select patients with sarcomas; however, these osteotomies are technically demanding to plan and perform intraoperatively. The use of navigation to assist in surgery is becoming more frequently described in orthopedic oncology.

The authors performed multiplanar osteotomy resections guided by navigation and reconstruction with intercalary allografts in 5 patients with chondrosarcoma around the knee. All the patients were women, with a mean age of 56 years. Four tumors were located in the distal femur and 1 in the proximal tibia. The 5 surgical anatomic specimens were 3-dimensionally reconstructed postoperatively and superimposed on a preoperative plan to check whether the resected specimen was consistent with the preoperative planned resection. At final follow-up, no patient experienced a local recurrence or metastasis. Four osteotomies each were performed in 3 patients, and 3 osteotomies each were performed in 2 patients, so 18 planes were evaluated. Mean difference in distance between preoperative vs final planes was 2.43 mm. Average functional score was 29 points. All patients resumed activities of daily living without restriction. This study’s results show that navigation with adequate preoperative planning allows surgeons to intraoperatively reproduce the planned resection with accuracy in complex multiplanary resections.
Comparison of Quality of Life Between Elderly Patients Undergoing TKA
Authors: Alentorn-Geli Eduard , Leal-Blanquet Joan , Guirro Pau , Hinarejos Pedro , Pelfort Xavier , Puig-Verdié Lluís
Published: August 2014

The purpose of this study was to compare the short-term changes in quality of life for patients younger than 80 years with those 80 years and older undergoing total knee arthroplasty (TKA). It was hypothesized that patients 80 years and older had a similar quality of life after TKA compared with those younger than 80 years.

All consecutive patients undergoing primary TKA were enrolled in this prospective, comparative, prognostic (level I evidence) study and were stratified into 2 groups based on their age (younger than 80 years and 80 years and older). Data on quality of life assessed using the Short Form 36 health survey were obtained preoperatively and 1 year postoperatively (short-term follow-up) and were compared between groups. A total of 328 (83.89%) patients younger than 80 years (mean age, 70.7 years) and 63 (16.11%) patients 80 years and older (mean age, 82.1 years) were included. No significant differences in preoperative quality of life were observed between groups. Postoperative physical function, vitality, social function, and physical component summary were lower in patients 80 years and older. Older patients had a lower difference between pre- and postoperative values in Short Form 36 physical function and role–emotional scores.

Patients 80 years and older had a similar improvement in quality of life 1 year after TKA compared with patients younger than 80 years. Therefore, changes in quality of life justify TKA as a treatment option for elderly patients with end-stage knee osteoarthritis.
Delamination of Tantalum Porous Coating From a TKA Due to Regional Dissemination of Debris
Authors: Bonutti Peter M. , Pivec Robert , Issa Kimona , Kapadia Bhaveen H. , Banerjee Samik , Mont Michael A. , Bauer Thomas W.
Published: August 2014

Metallic debris from metal-on-metal bearings is a recognized mode of failure that may lead to implant loosening and periprosthetic soft tissue reactions. The sequelae of metallosis have been most commonly reported with respect to total hip arthroplasty. The authors report a rare case of metallosis following a hybrid metal-on-polyethylene total knee arthroplasty that used a porous tantalum tibial knee component. A total knee arthroplasty patient who presented with knee pain but normal radiographs was found to have delamination of her tibial component that resulted in marked periprosthetic soft tissue metallosis.
Computer-assisted Navigation in Orthopedic Surgery
Authors: Mavrogenis Andreas F. , Savvidou Olga D. , Mimidis George , Papanastasiou John , Koulalis Dimitrios , Demertzis Nikolaos , Papagelopoulos Panayiotis J.
Published: August 2014

Educational Objectives

1.

Identify the available types of computer-assisted navigation in orthopedic surgery.

2.

Summarize the clinical applications of computer-assisted navigation in orthopedic surgery.

3.

Review the results of related series using computer-assisted navigation in orthopedic surgery.

4.

Recognize the disadvantages and pitfalls of computer-assisted navigation in orthopedic surgery.

Computer-assisted navigation has a role in some orthopedic procedures. It allows the surgeons to obtain real-time feedback and offers the potential to decrease intra-operative errors and optimize the surgical result. Computer-assisted navigation systems can be active or passive. Active navigation systems can either perform surgical tasks or prohibit the surgeon from moving past a predefined zone. Passive navigation systems provide intraoperative information, which is displayed on a monitor, but the surgeon is free to make any decisions he or she deems necessary. This article reviews the available types of computer-assisted navigation, summarizes the clinical applications and reviews the results of related series using navigation, and informs surgeons of the disadvantages and pitfalls of computer-assisted navigation in orthopedic surgery.
Local Application of Free Antibiotic Powder in the Treatment of Osteomyelitis in a Rat Model
Authors: Garcia E’Stephan J. , Sieg Ryan N. , Abdelgawad Amr A.
Published: August 2014

To date, several strategies have been developed to provide local antibiotic therapy in the treatment of osteomyelitis, such as antibiotic-loaded bone cement, antibiotic-impregnated collagen sponges, polymethylmethacrylate beads, antibiotic-loaded bone graft, antibiotic-loaded synthetic bone substitutes, and antibiotic-coated implants. The optimum carrier for local antibiotic therapy has not been identified. Tibial osteomyelitis using methicillin-sensitive
Staphylococcus aureus
was created in a rat model. Rats were assigned to 3 treatment groups: group A, systemic antibiotics only; group B, systemic antibiotics plus surgical debridement; and group C, systemic antibiotics, surgical debridement, and application of cefazolin. Infection was assessed using gross tissue analysis, radiographs, quantitative bacteriology, and histopathology. One-half of the rat tibias were randomly chosen for histological evaluation and the other half were used for microbiological analysis. Radiographs were reviewed and graded by 4 blinded board-certified radiologists. Histology slides were reviewed and graded by a blinded board-certified pathologist. Gross tissue analysis of treatment groups B and C demonstrated a statistically significant improvement in soft tissue infection clearance compared with group A (
P
<.05). No difference was found between treatment groups B and C. No significant difference existed in gross tissue, radiographic, microbiologic, or histopathologic analyses among the 3 groups for osteomyelitis. The results of this study demonstrated that the local application of free antibiotic powder is as effective as local debridement alone in treating soft tissue infection associated with tibial osteomyelitis in a rat model.
AO X-shaped Midfoot Locking Plate to Treat Displaced Isolated Greater Tuberosity Fractures
Authors: Chen Yun Feng , Zhang Wen , Chen Qiang , Wei Hai Feng , Wang Lei , Zhang Chang Qing
Published: August 2014

Although various implants exist for 3- and 4-part fractures, few implants are appropriate for isolated greater tuberosity fractures. This retrospective study evaluated the efficacy of AO X-shaped midfoot locking plates for greater tuberosity fractures.

Between May 2008 and September 2009, nineteen patients with displaced greater tuberosity fractures were treated with open reduction and internal fixation using AO X-shaped midfoot locking plates. Postoperatively, radiographs, functional results, and complications were evaluated. All patients were followed up for a mean 33.2 months (range, 24–42 months). Mean healing time was 9.4 weeks (range, 8–14 weeks). Mean Constant score was 90.6±4.0 points (range, 77–95 points). Excellent results were obtained in 16 cases, good in 2 cases, moderate in 1 case, and poor in 0 cases. The excellent-good rate was 94.7%. No recurrence of dislocation occurred in the 11 cases with shoulder dislocation. All fractures healed without the complications of wound infection, skin numbness, subacromial impingement syndrome, nonunion, secondary displacement, and implant loosening.

The described technique is an effective, simple, and inexpensive method with a short learning curve.
Uniextrapedicular Kyphoplasty for the Treatment of Thoracic Osteoporotic Vertebral Fractures
Authors: Ge Zhaohui , Ma Rong , Chen Zhen , Zhang Huiyong , Ding Huiqiang , Liang Siming , Suo Zhigang
Published: August 2014

Osteoporotic vertebral compression fractures are common and cause pain and disability. Most osteoporotic vertebral compression fractures occur in the lower thoracic and thoracolumbar spine. Percutaneous balloon kyphoplasty through a transpedicular approach is a classic procedure performed to treat osteoporotic vertebral compression fractures. However, due to the slender morphology of the pedicles, small pedicle size, and the angular severity of thoracic kyphosis, performing kyphoplasty in middle and high thoracic levels is technically challenging. The purpose of this retrospective study was to evaluate the clinical outcomes of single-balloon kyphoplasty for the treatment of thoracic osteoporotic vertebral compression fractures via an extrapedicular approach. Between July 2004 and May 2008, thirty-eight patients with thoracic osteoporotic vertebral compression fractures underwent percutaneous kyphoplasty via a unilateral extrapedicular approach. Average patient age was 60.3 years. Symptomatic levels ranged from T4 to T12. All affected vertebrae were identified via physical examination, magnetic resonance imaging, and radiographs. Pain relief, vertebral height restoration, and kyphosis correction were compared pre- and postoperatively using the visual analog scale and radiographs. The operation was successful in all patients. Average injected bone cement volume was 3.2±1.4 mL. Mean follow-up was 9.5 months. Visual analog scale pain score improved in 36 of 38 patients postoperatively. Mean visual analog scale pain score was 8.92±0.682 preoperatively and 2.40±0.31 postoperatively and remained at 2.80±0.34 until last follow-up. Mean middle body height correction ratio was 50.9%±34.6%. No lateral wedging was found in the coronal alignment of the treated vertebrae. Three (7.9%) patients sustained cement extravasation with no adverse events. Kyphoplasty through a unilateral extrapedicular approach can achieve convergent and proper cement filling in the affected vertebrae to effectively restore stiffness, relieve pain, and correct kyphosis in fractured vertebrae.
Knotless Single-row Rotator Cuff Repair: A Comparative Biomechanical Study of 2 Knotless Suture Anchors
Authors: Efird Chad , Traub Shaun , Baldini Todd , Rioux-Forker Dana , Spalazzi Jeffrey P. , Davisson Twana , Hawkins Monica , McCarty Eric
Published: August 2014

The purpose of this study was to compare the gap formation during cyclic loading, maximum repair strength, and failure mode of single-row full-thickness supraspinatus repairs performed using 2 knotless suture anchors with differing internal suture-retention mechanisms in a human cadaver model. Nine matched pairs of cadaver shoulders were used. Full-thickness tears were induced by detaching the supraspinatus tendon from the greater tuberosity. Single-row repairs were performed with either type I (Opus Magnum PI; ArthroCare, Austin, Texas) or type II (ReelX STT; Stryker, Mahwah, New Jersey) knotless suture anchors. The repaired tendon was cycled from 10 to 90 N for 500 cycles, followed by load to failure. Gap formation was measured at 5, 100, 200, 300, 400, and 500 cycles with a video digitizing system. Anchor type or location (anterior or posterior) had no effect on gap formation during cyclic loading regardless of position (anterior,
P
=.385; posterior,
P
=.389). Maximum load to failure was significantly greater (
P
=.018) for repairs performed with type II anchors (288±62 N) compared with type I anchors (179±39 N). Primary failure modes were anchor pullout and tendon tearing for type II anchors and suture slippage through the anchor for type I anchors.

The internal ratcheting suture-retention mechanism of type II anchors may have helped this anchor outperform the suture-cinching mechanism of type I anchors by supporting significantly higher loads before failure and minimizing suture slippage, potentially leading to stronger repairs clinically.
Rate of Clinically Significant Posttraumatic Arthritis After Small Finger Intra-articular Carpometacarpal Fractures
Authors: Park Min Jung , Pappas Nick , Kim John , Bozentka David
Published: August 2014

Although small finger intra-articular carpometacarpal joint fractures are relatively common hand injuries, few studies in the orthopedic literature report their clinical outcomes. The goal of this study was to analyze the rate of symptomatic posttraumatic arthritis following small finger intra-articular carpometacarpal joint fractures.

The authors performed a chart review of 82 consecutive patients with a small finger intra-articular carpometacarpal fractures treated at their institution over a 5-year period. Operative indications included irreducible small finger intra-articular carpometacarpal fractures and recurrent small finger carpometacarpal joint instability after attempted reduction. Group 1 included 66 patients with small finger intra-articular carpometacarpal fractures who were treated with cast immobilization alone for 6 weeks, whereas group 2 included 16 patients treated surgically followed by 6 weeks of cast immobilization. Clinical outcome parameters included posttreatment serial radiographs, a visual scale based on subjective pain scores (0–10) as part of a routine clinic intake form, and the need for subsequent small finger carpometacarpal arthrodesis. All patients included in the study had a minimum 12-month follow-up. In group 1, 6 (9.1%) of 66 patients developed symptomatic posttraumatic arthritis and required a subsequent small finger carpometacarpal arthrodesis. In group 2, none of the patients developed symptomatic posttraumatic arthritis or required arthrodesis. This study reports a relatively higher rate of small finger carpometacarpal arthrodesis after closed treatment alone for intra-articular small finger carpometacarpal fractures compared with open treatment, suggesting that anatomic alignment is important in this injury pattern.
Biomechanical Evaluation of Anatomical Double-bundle Coracoclavicular Ligament Reconstruction Secured With Knot Fixation Versus Screw Fixation
Authors: Staron Jeffrey S. , Esquivel Amanda O. , Pandhi Nikhil G. , Hanna Jason D. , Lemos Stephen E.
Published: August 2014

Methods to reconstruct the coracoclavicular ligaments anatomically have been described. No clear advantage of 1 technique has been elucidated. The authors’ hypothesis was that the biomechanical properties of a modified knot fixation technique would be similar to the anatomical double-bundle technique. Sixteen matched cadaveric shoulders were used for this study, and 1 additional shoulder was used in the knot fixation group only. Shoulders were randomly assigned to the anatomical double-bundle coracoclavicular ligament reconstruction technique (n=8) or a knot fixation technique (n=9). The intact coracoclavicular ligaments were tested to failure with superior displacement at a rate of 2 mm/s. Reconstruction was performed using a semitendinosus tendon allograft, and load to failure was repeated for each construct. Ultimate failure load, stiffness, and failure mode were compared using a paired
t
test (
P
<.05). No significant difference existed in load to failure between native and reconstructed ligaments or between reconstruction techniques. Stiffness decreased significantly after reconstruction in the double-bundle group (from 32.5 to 22.5 N/mm;
P
=.035) and in the modified knot fixation group (from 35.5 to 21.9 N/mm;
P
=.043). No significant difference existed in stiffness between the 2 reconstruction groups. A significant difference (
P
=.003) existed between failure modes between the 2 reconstruction techniques. Although less stiff than the native ligament, either technique used to reconstruct the coracoclavicular ligament can be performed to yield a load to failure similar to the intact ligament. The majority of failures in the double-bundle group were by means of the graft slipping at the screw-tendon interface at 1 of the clavicular drill holes. The modified knot fixation technique failed the majority of the time by graft elongation.
Outcomes of Functional Weight-bearing Rehabilitation of Achilles Tendon Ruptures
Authors: Jackson Gillian , Sinclair Victoria F. , McLaughlin Charles , Barrie James
Published: August 2014

The introduction of functional rehabilitation for patients with Achilles tendon rupture has dramatically changed treatment programs for this condition. The authors introduced a functional weight-bearing protocol for patients with an acute Achilles tendon rupture treated operatively and nonoperatively in 2002. They hypothesized that no significant differences would exist in the rerupture rates and functional outcomes between the groups.

Between 2002 and 2008, the authors collected data on 80 consecutive patients treated with a weight-bearing functional orthosis for complete Achilles tendon rupture. Following evidence-based counseling, 51 patients chose nonoperative treatment and 29 chose operative treatment. Outcome measures included rerupture rates, other complications, and functional scoring. The nonoperative group was a decade older (median age, 47 years [range, 27–80 years]) than the operative group (median age, 37 years [range, 24–55 years]). Rerupture was noted in 2 (4%) patients in the nonoperative treatment group and 1 (3%) patient in the operative group. Two (7%) patients in the operative group developed superficial wound infections and reported no nerve injuries. Median Achilles Tendon Total Rupture Score was 82 points in the nonoperative group and 94 in the operative group. Median Victorian Institute of Sports Assessment-Achilles tendinopathy questionnaire scores were 60 and 91 for the nonoperative and operative groups, respectively.

Both groups had low rerupture rates. Functional scores, using the newly validated Achilles Tendon Total Rupture Score, were lower in the nonoperative group.
Mechanical Axis of the Lower Extremity Determined by a New Digital Photographic Method
Authors: Simonsen Ole Højgaard , Thomsen Hanne , Skou Søren Thorgaard , Andersen Mikkel Meyer
Published: August 2014

Assessment of the mechanical axis is routine during the examination of patients with lower extremity pain. Long-leg radiographic examination is the gold standard for exact measurement, but it is associated with a significant radiation dose. An alternative method to examine the mechanical axis has been warranted. This article validates a newly developed computerized photograph method to calculate the mechanical axis using a digital photograph. The location of the center of the femoral head was calculated using ink marks on both superior iliac spines.

Twenty-five patients (10 women and 15 men) had both legs examined using the photographic method and long-leg radiography examination. The digital photograph method was found to be highly reliable. The interobserver absolute mean difference was 0.99°±0.85°, and the intraobserver absolute mean difference (day-to-day variation) was 1.04°±0.81°. The mechanical axis determined by the 2 methods was highly correlated (
R
=0.943). The long-leg radiography method was within an average of ±1.88° of the photographic method, with a 95% probability.

The photographic method appears to be an effective alternative to conventional long-leg radiography. The photographic method seems convenient in the routine examination of patients with leg pain and children with suspected axial deformity and for follow-up after treatment for malalignment. Calculation coefficients for children and a possible racial difference remain to be studied.
Electrothermal Ring Burn From a Car Battery
Authors: Sibley Paul A. , Godwin Kenneth A.
Published: August 2014

Despite prevention efforts, burn injuries among auto mechanics are described in the literature. Electrothermal ring burns from car batteries occur by short-circuiting through the ring when it touches the open terminal or metal housing.

This article describes a 34-year-old male auto mechanic who was holding a wrench when his gold ring touched the positive terminal of a 12-volt car battery and the wrench touched both his ring and the negative terminal. He felt instant pain and had a deep partial-thickness circumferential burn at the base of his ring finger. No other soft tissues were injured. He was initially managed conservatively, but after minimal healing at 3 weeks, he underwent a full-thickness skin graft. The graft incorporated well and healed by 4 weeks postoperatively. He had full range of motion.

The cause of ring burns has been controversial, but based on reports similar to the current patient’s mechanism, they are most likely electrothermal burns. Gold, a metal with high thermal conductivity, can heat up to its melting point in a matter of seconds. Many treatments have been described, including local wound care to split- and full-thickness skin grafts. Because most burns are preventable, staff should be warned and trained about the potential risks of contact burns. All jewelry should be removed, and the live battery terminal should be covered while working in the vicinity of the battery.
Outcomes of Short Stems in Total Hip Arthroplasty
Authors: Banerjee Samik , Pivec Robert , Issa Kimona , Harwin Steven F. , Mont Michael A. , Khanuja Harpal S.
Published: August 2014

Short-stem total hip arthroplasty has been proposed as a bone-conserving procedure for the younger and more active population undergoing total hip arthroplasty. Although various short stems are currently available, no studies compare the outcomes between these stems. The aim of the current study was to conduct a systematic review of the clinical and radiographic outcomes of the various short stems that have been approved for use in the United States by the Food and Drug Administration. Outcomes that were assessed included implant survivorship, Harris Hip scores, thigh pain, periprosthetic fracture, subsidence, proximal stress shielding, and the prevalence of stem malalignment and inappropriate implant sizing.
Indications for 2-incision Anterior Cruciate Ligament Surgery
Authors: Breland Ryan , Metzler Adam , Johnson Darren L.
Published: August 2014

Two-incision anterior cruciate ligament reconstruction uses an outside-in femoral drilling technique. Advantages include anatomic femoral tunnel placement and increased versatility with regard to graft position and fixation in the femoral tunnel or distal femur. The authors believe that transtibial femoral tunnel drilling is inferior because of nonanatomic femoral tunnel placement and the requirement of the posterior footprint placement of the tibial tunnel. Indications for outside-in femoral drilling include revision anterior cruciate ligament reconstruction, drilling an all-epiphyseal tunnel in skeletally immature patients, long bone-patellar tendon-bone autografts when using more than 45 mm of tendon, and cases in which the leg cannot be hyperflexed for accessory anteromedial portal drilling.
Partial ACL Tears: Anatomic Reconstruction Versus Nonanatomic Augmentation Surgery
Authors: Buda Roberto , Ruffilli Alberto , Parma Alessandro , Pagliazzi Gherardo , Luciani Deianira , Ramponi Laura , Castagnini Francesco , Giannini Sandro
Published: August 2014

Treatment of partial anterior cruciate ligament (ACL) tears requires ACL remnant preservation. The goal of this study was to compare the outcome of anatomic reconstruction of the torn bundle with nonanatomic augmentation using the over-the-top femoral route. Fifty-two athletes (mean age, 23.3 years) with partial ACL lesions underwent anatomic reconstruction (n=26) or nonanatomic augmentation (n=26). Intraoperative damage of the healthy bundle that required a standard ACL reconstruction occurred in 2 patients in the anatomic reconstruction group. International Knee Documentation Committee (IKDC) score, Tegner score, and arthrometer evaluation were used pre-operatively and at follow-up for up to 5 years postoperatively. One failure occurred in the anatomic reconstruction group. Mean IKDC subjective score at follow-up was 88.2±5.7 in the anatomic reconstruction group and 90.2±4.7 in the nonanatomic augmentation group. According to the IKDC objective score at final follow-up, 96% of knees in the nonanatomic augmentation group were normal vs 87.5% in the anatomic reconstruction group. No significative differences were observed between the 2 groups at final follow-up. Anteromedial bundle reconstruction showed significantly lower IKDC subjective and objective scores and higher residual instability values as evaluated with the arthrometer compared with posterolateral bundle reconstruction (
P
=.017). The surgical treatment of ACL partial tears is demanding. Adapted portals, perfect control of the tunnel drilling process, and intercondylar space management are required in anatomic reconstruction. The nonanatomic augmentation technique is simpler, providing excellent durable results over time with a lower complication rate. Anteromedial bundle reconstruction is associated with a poorer outcome, especially when performed with anatomic reconstruction.
Intraoperative Radiation Use by Trainees During Ankle Fracture Fixation
Authors: Kheiran Amin , Makki Daoud , Banerjee Purnajyoti , Ricketts David
Published: August 2014

Orthopedic trainees are assessed during training regarding their use of radiological screening during operative procedures. The authors investigated whether orthopedic trainees’ use of fluoroscopic screening during ankle fixation operations varied with the 2 variables of consultant supervision and trainee experience.

Data from operative fixation of isolated Weber B ankle fractures were reviewed. The intraoperative radiation dose was retrieved from radiographers’ data. Operations performed by consultants were used as a control group (n=25 patients). Trainee supervision was assessed as “trainer in operating room (OR)” and “trainer out of OR.” Regarding experience, the patients were divided into those operated on primarily by trainees in their first (n=36 patients) and in their last (n=34 patients) 3 years of formal specialist training. All trainee groups used more radiation than consultants. Supervision did not affect the radiation use of senior trainees (
P
<.05). Senior trainees used less radiation than their junior peers (
P
<.02). Junior trainees supervised by a trainer in the OR used less radiation than junior trainees supervised by a trainer outside of the OR (
P
<.05).

During open reduction and internal fixation of ankle fractures, junior orthopedic trainees use less intraoperative radiation when they are supervised by a trainer in the OR. The more experience a surgeon has, the less fluoroscopic screening is used during operative ankle fixation.
Internal Fixation of Distal Metacarpal Fractures: New Uses for an Old Plate
Authors: Sibley Paul A. , Jacoby Sidney M. , Abzug Joshua M. , Waddell Christina L. , Rivlin Michael , Bednar John M.
Published: August 2014

Certain metacarpal fracture patterns require operative fixation to restore anatomy and optimize results. Compared with dorsal plating, the width of the minicondylar blade plate buttresses the deforming volar pull of the intrinsics and provides a stronger construct. The implant provides firm fixation in the juxta-articular fragment with minimal space requirements. Therefore, the purpose of this study was to examine the outcomes following the use of a minicondylar blade plate for the treatment of distal metacarpal fractures.

Twenty-two distal metacarpal fractures in 20 patients treated with a minicondylar blade plate were retrospectively reviewed. Outcome measures collected included postoperative grip strength, range of motion, return to work, and radiographic evidence of osseous union. Average range of motion of the metacarpophalangeal joint was 62° postoperatively. Eighty-two percent (18/22) of fractures were able to flex their digits to their distal palmar crease. Seventy-one percent (12/17) of patients had at least 75% return to grip strength compared with the contralateral side. Seventeen patients returned to full activity at a mean of 2.5 months (range, 1–3 months) postoperatively; 1 patient was on disability, and data were not available for the final 2 patients. No major complications occurred.

The minicondylar blade plate is a safe and effective technique for stabilizing unstable periarticular metacarpal fractures. Stable fixation allows for early range of motion, rapid return to strength, and a relatively quick return to full work duty.
Effect of Component Design in Retrieved Bipolar Hip Hemiarthroplasty Systems
Authors: Hess Matthew D. , Baker Erin A. , Salisbury Meagan R. , Kaplan Lige M. , Greene Ryan T. , Greene Perry W.
Published: August 2014

Primary articulation of bipolar hemiarthroplasty systems is at the femoral head-liner interface. The purpose of this study was to compare observed damage modes on 36 retrieved bipolar systems with implant, demographic, intraoperative, and radiographic data to elucidate the effects of component design, specifically locking mechanism, on clinical performance.

Retrieved bipolar hip hemiarthroplasty systems of 3 different design types were obtained, disassembled, and evaluated macro- and microscopically for varying modes of wear, including abrasion, burnishing, embedding, scratching, and pitting. Clinical record review and radiographic analysis were performed by a senior orthopedic surgery resident. Average bipolar hip hemiarthroplasty system term of service was 46 months (range, 0.27–187 months). All devices contained wear debris captured within the articulating space between the femoral head and liner. In 31% of patients without infection, lucency was observed on immediate prerevision radiographs. The system with a leaf locking mechanism showed significantly increased radiographically observed osteolysis (
P
=.03) compared with a system with a stopper ring locking mechanism. In addition, implant design and observed damage modes, including pitting and third-body particle embedding, were significantly associated with radiographically observed osteolysis.
Morphological Characteristics of Posterolateral Articular Fragments in Tibial Plateau Fractures
Authors: Xiang Gao , Zhi-Jun Pan , Qiang Zheng , Hang Li
Published: August 2014

Treatment of posterolateral tibial plateau fractures is controversial, and information regarding this specific fracture pattern is lacking. The purpose of this study was to elucidate the frequency and morphological features of posterolateral articular fragments in tibial plateau fractures.

A retrospective radiographic and chart review was performed on a consecutive series of patients who sustained tibial plateau fractures between May 2008 and August 2012. The articular surface area, maximum posterior cortical height, sagittal fracture angle, and amount of displacement were measured on computed tomography scans using the Picture and Archiving Communication System. Thirty-six (15%) of 242 injuries demonstrated a posterolateral fracture fragment comprising a mean 14.3% of the articular surface of the total tibial plateau (range, 8% to 32%). Mean major articular fragment angle was 23° (range, 62° to −43°), mean maximum posterior cortical height was 29 mm (range, 18 to 42 mm), and mean sagittal fracture angle was 77° (range, 58° to 97°).

The posterolateral plateau articular fracture fragment has morphological characteristics of a conically shaped fragment with a relatively small articular surface area and sagittal fracture angle. Recognizing these morphological features will help the clinician formulate an effective surgical plan.
Locking Versus Nonlocking Construct in an Osteoporotic, Segmental Fibula Defect Model
Authors: Lo Eddie Y. , Tseng Susan S. , Christiansen Blaine A. , Lee Mark A. , Yoo Brady J.
Published: August 2014

Early studies on the treatment of osteoporotic distal fibular fractures suggest that poor bone quality can compromise fixation and, therefore, clinical outcome. Multiple prior biomechanical studies evaluated length-stable fracture models with destructive load-to-failure protocols, which may not represent a clinically relevant failure mode. The current authors compared a lateral locked construct with 2 distinct nonlocked constructs in an osteoporotic, segmental fibula defect model.

Eighteen adult cadaveric ankles were randomized to a one-third tubular plate with nonlocking screws, a precontoured fibular plate with nonlocking screws, or the same pre-contoured plate with locking screws. Each was nondestructively loaded with an external rotation of 2.5 Nm for 10,000 cycles. The primary outcome was the change in construct stiffness. Secondary outcomes included maximal rotational displacement and change in insertion torques. Average increase in stiffness of the one-third tubular plate was 0.35 Nm/degree (
P
<.001), which was significantly greater than that in the nonlocking and locking precontoured plates (0.15 and 0.17 Nm/degree, respectively;
P
=.69). All 3 constructs externally rotated to 11.7°±4.6°, 8.6°±3.6°, and 10.9°±4.7°, respectively (
P
=.50). Average loss of insertion torque in the 4 proximal positions was 32.7%±19%, 41.3%±20.2%, 57.8%±19%, and 64.9%±29.2% (
P
>.05). Average loss in the 4 distal positions for nonlocking constructs (71.6%±21%, 70.4%±26.4%, 93.1%±11%, and 83.3%±35.4%) was significantly different from that for the locking construct (15%±21.4%, 11.7%±24%, 9.2%±9.2%, and 20.8%±23.3%) (
P
<.05). No evidence in the current study supports the use of a locking plate for osteoporotic specimens.
Effect of Health Insurance Type on Access to Care
Authors: Froelich John M. , Beck Ryan , Novicoff Wendy M. , Saleh K.J.
Published: August 2014

Growing orthopedic and nonorthopedic literature illustrates the point that having health insurance does not equal having access to care. The goal of this study was to evaluate the burden placed on patients to gain access to outpatient orthopedic care. For this study, burden was quantified as the distance traveled by the patient to be seen in clinic.

This study was a retrospective review of all new patient encounters at an adult orthopedic outpatient clinic in an academic tertiary referral center over 1 calendar year. All patients were stratified into 4 categories: commercial/private insurance, Medic-aid, Medicare, and uninsured/private pay. The average distance traveled by each patient to the center was then calculated based on the patient’s billing zip code. Patient visits were further stratified based on whether the patients were seen by 1 of 3 different categories of providers: general orthopedics/adult reconstruction, spine, and sports/upper extremity. The study group comprised 774 (31.1%) Medicaid patients, 653 (26.2%) Medicare patients, 917 (36.8%) commercial/private insurance patients, and 146 (5.9%) uninsured/private pay patients. The average 1-way distance traveled was 36.2 miles for Medicaid patients, 21.3 miles for Medicare patients, 24.1 miles for commercial/private insurance patients, and 25.3 miles for uninsured/private pay patients (
P
<.00). Subgroup analysis noted a statistical difference in distance traveled for the general orthopedics/adult reconstruction and sports/upper extremity groups. The study’s findings suggest that having insurance does not equal access to outpatient orthopedic care at a single institution. The specific burdens that each group faces to gain access to care are unclear.
Role of Serum Lipoprotein at the Site of Iloprost Therapy in the Treatment of Painful Bone Marrow Edema
Authors: Anagnostakos Konstantinos , Orth Patrick
Published: August 2014

The authors hypothesized that the emergence of painful bone marrow edema occurs through microembolisms in the bone marrow that may be reflected in elevated plasma parameters of hypofibrinolysis or a disturbance of the lipid metabolism and that treatment with iloprost may lead to a decrease in or normalization of the elevated serum parameters and, therefore, to pain reduction.

Twenty-one patients (12 men and 9 women; mean age, 50 years [range, 22–70 years]) with painful bone marrow edema and elevated lipoprotein(a) (Lp[a]) serum values were treated with intravenous iloprost. Before and 6 weeks after iloprost therapy, the serum concentrations of Lp(a), apolipoprotein A1 (ApoA1), and apolipoprotein B (ApoB) were determined. At 6-week follow-up, 17 patients reported complete resolution of their symptoms. For these patients, complete bone marrow edema resolution was observed on magnetic resonance imaging. Four patients reported that their symptoms were either the same or had worsened but had partial bone marrow edema resolution on magnetic resonance imaging. In these patients, Lp(a) values either increased or remained the same. Hence, the total success rate of iloprost treatment was 86% at a mean follow-up of 17 months (range, 3–45 months). Before iloprost therapy, mean ApoA1, ApoB, and Lp(a) values were 159.8, 108.3, and 69.1 mg/dL, respectively. Six weeks after iloprost therapy, mean ApoA1, ApoB, and Lp(a) values decreased to 147.6 (
P
=.011), 98.4 (
P
=.042), and 38.3 (
P
<.001) mg/dL, respectively. The results of this study indicate a possible role of hypofibrinolysis or a disturbance in the lipid metabolism in the emergence of painful bone marrow edema.
Anatomy and Histology of the Transverse Humeral Ligament
Authors: Snow Brian J. , Narvy Steven J. , Omid Reza , Atkinson Roscoe D. , Vangsness C. Thomas
Published: August 2014

The classic literature describes the transverse humeral ligament (THL) as a distinct anatomic structure with a role in biceps tendon stability; however, recent literature suggests that it is not a distinct anatomic structure. The purpose of this study was to evaluate the gross and microscopic anatomy of the THL, including a specific investigation of the histology of this ligament.

Thirty frozen, embalmed cadaveric specimens were dissected to determine the gross anatomy of the THL. Seven specimens were evaluated histologically for the presence of mechanoreceptors and free nerve endings. Two tissue layers were identified in the area described as the THL. In the deep layer, fibers of the subscapularis tendon were found to span the bicipital groove with contributions from the coracohumeral ligament and the supraspinatus tendon. Superficial to this layer was a fibrous fascial covering consisting of distinct bands of tissue. Neurohistology staining revealed the presence of free nerve endings but no mechanoreceptors.

This study’s findings demonstrate that the THL is a distinct structure continuous with the rotator cuff tendons and the coracohumeral ligament. The finding of free nerve endings in the THL suggests a potential role as a shoulder pain generator.
Anterior Interosseous Nerve Palsy as a Complication of Proximal Humerus Fracture
Authors: Tanagho Andy , Elgamal Tarek , Ansara Sameh
Published: August 2014

Anterior interosseous nerve palsy subsequent to proximal humerus fracture is rare compared with an axillary nerve injury. This article presents a case of anterior interosseous nerve palsy secondary to such a fracture in an 87-year-old woman after a simple fall onto her outstretched hand.

The patient had no sensory involvement but was unable to form an O with her thumb and index finger. She had a positive pointing index test on attempting to clasp her hand. The fracture and nerve palsy were treated conservatively. At 3-month follow-up, the patient had partial recovery; therefore, electromyography was not performed. By 6 months, she had complete recovery of anterior interosseous nerve palsy.

This case highlights the possibility of sustaining anterior interosseous nerve palsy with proximal humerus fracture with a classical clinical presentation. Because most nerve lesions after proximal humerus fracture are neurapraxia, symptoms usually resolve either partially or completely after a few months.

It is recommended that cases with proximal humerus fracture be evaluated carefully for median nerve and axillary nerve injury. In addition, it is recommended to perform electromyography if no signs of recovery are evident at 3-month follow-up.
Dislocated Double-layered Lateral Meniscus Mimicking the Bucket-handle Tear
Authors: Lee Kwang Won , Yang Dae Suk , Choy Won Sik
Published: August 2014

Various shapes of congenital abnormalities of the meniscus have been reported. Among them, the double-layered meniscus is rare. This article describes a 22-year-old man with a double-layered lateral meniscus who reported right knee pain with no history of trauma.

The double-layered lateral meniscus included both the upper and lower meniscus. The anterior and posterior edge of the upper meniscus was attached to the lower lateral meniscus, and its periphery was not connected to the capsule and the lower meniscus. In addition, the upper meniscus was dislocated into the intercondylar notch, mimicking a bucket-handle tear. However, the lower meniscus was normal in appearance, so a bucket-handle or horizontal tear of the meniscus was ruled out of the differential diagnosis.

Although this is a rare case, clinicians should be aware of this anomaly due to the potential for a double-layered meniscus to contribute to a bucket-handle or horizontal tear of the lower meniscus. Therefore, early diagnosis and proper treatment of a double-layered meniscus are needed before an additional injury occurs to a normal meniscus.
Placing Femoral Intramedullary Nails in Severely Bowed Femurs
Authors: Amin Nirav H. , Chakravarty Rajit , Jakoi Andre , Cerynik Douglas L. , Toossi Nader , Harding Susan P.
Published: August 2014

The authors describe a novel technique of anterograde femoral intramedullary nail fixation for hip fracture using the starting guide pin as a blocking screw. This cost-effective technique uses fluoroscopic radiography to ensure the guidewire is within the posterior aspect of the femur on a lateral view, thereby minimizing the risk of anterior cortical femoral fractures. [
Orthopedics.
2014; 37(3):179–182.]
Suture Anchor Repair of Quadriceps Tendon Rupture
Authors: Harris Joshua D. , Abrams Geoffrey D. , Yanke Adam B. , Hellman Michael D. , Erickson Brandon J. , Bach Bernard R.
Published: August 2014

Quadriceps tendon rupture is an uncommon knee injury that warrants surgical treatment. Traditional surgery has been relatively successful, using trans-patellar-drilled suture repair for tendo-osseous avulsions and simple suture repair for intra-tendinous midsubstance tears. However, recent evidence has identified a unique complication previously unreported in the literature in these patients (displaced longitudinal patellar stress fracture). Suture anchor-based repair has biomechanical strength equivalent to trans-patellar-drilled repair and avoids the potential complication of postoperative fracture. A “pulley technique” with complete footprint coverage has been used for other tendinous avulsions (eg. proximal hamstring) and is described in this article. [
Orthopedics.
2014; 37(3):183–186.]
Popliteomeniscal Fascicle Tears
Authors: Camarillo Matthew , Johnson Darren L.
Published: August 2014

Isolated popliteomeniscal fascicle tears are often unrecognized and misdiagnosed. Patients typically have vague symptoms and often-normal magnetic resonance imaging and physical examination findings. Isolated injuries are often misdiagnosed and mistreated, leading to delayed surgical treatment. Unrecognized tears can lead to continued disability, lateral meniscus tears, and chondral lesions. Appropriate diagnosis and treatment with inside-out lateral meniscus repair will allow the athlete to return to activity. [
Orthopedics.
2014; 37(3):187–190.]
Geriatric Fractures About the Hip: Divergent Patterns in the Proximal Femur, Acetabulum, and Pelvis
Authors: Sullivan Matthew P. , Baldwin Keith D. , Donegan Derek J. , Mehta Samir , Ahn Jaimo
Published: August 2014

Geriatric acetabular, pelvis, and subtrochanteric femur fractures are poorly understood and rapidly growing clinical problems. The purpose of this study was to describe the epidemiologic trends of these injuries as compared with traditional fragility fractures about the hip. From 1993 to 2010, the Nationwide Inpatient Sample (NIS) recorded more than 600 million Medicare-paid hospital discharges. This retrospective study used the NIS to compare patients with acetabular fractures (n=87,771), pelvic fractures (n=522,831), and subtrochanteric fractures (n=170,872) with patients with traditional hip fractures (intertrochanteric and femoral neck, n=3,495,742) with regard to annual trends over an 18-year period in incidence, length of hospital stay, hospital mortality, transfers from acute care institutions, and hospital charges. Traditional hip fractures peaked in 1996 and declined by 25.7% by 2010. During the same 18-year period, geriatric acetabular fractures increased by 67%, subtrochanteric femur fractures increased by 42%, and pelvic fractures increased by 24%. Hospital charges, when controlling for inflation, increased roughly 50% for all fracture types. Furthermore, transfers from outside acute care hospitals for definitive management stayed elevated for acetabular fractures as compared with traditional hip fractures, suggesting a greater need for tertiary care of acetabular fractures. Geriatric acetabular fractures are rapidly increasing, whereas traditional hip fractures continue to decline. Patients with these injuries are more likely to be transferred from their hospital of presentation to another acute care institution, possibly increasing costs and complications. This is likely related to their complexity and the lack of consensus regarding optimal management. [
Orthopedics.
2014; 37(3):151–157.]