Anterolateral Drawer Versus Anterior Drawer Test for Ankle Instability: A Biomechanical Model.

Background: The addition of unconstrained internal rotation to the physical examination could allow for detection of more subtle degrees of ankle instability. We hypothesized that a simulated anterolateral drawer test allowing unconstrained internal rotation of the ankle would provoke greater displacement of the lateral talus in the mortise versus the anterior drawer test.

Methods: Ten cadaveric lower extremities were tested in a custom apparatus designed to reproduce the anterior drawer test and the anterolateral drawer test, in which the ankle was allowed to internally rotate about the intact deep deltoid ligament while being subluxed anteriorly.

Distal femoral fracture during primary total knee arthroplasty.

Purpose: To review 6 cases of periprosthetic distal femoral fracture during total knee arthroplasty (TKA).

Methods: Of 778 women and 691 men who underwent primary TKAs using posterior-stabilised (n=1240), cruciate-retaining (n=165), or semiconstrained (n=64) implant, 5 women and one man with a mean age of 73.3 years and a mean body mass index of 31.

Recurrence of hallux valgus: a review.

Recurrence of hallux valgus deformity can be a common complication after corrective surgery. The cause of recurrent hallux valgus is usually multifactorial, and includes patient-related factors such as preoperative anatomic predisposition, medical comorbidities, compliance with postcorrection instructions, and surgical factors such as choice of the appropriate procedure and technical competency. For a successful outcome, this cause must be ascertained preoperatively.

Spinal anesthesia: should everyone receive a urinary catheter?: a randomized, prospective study of patients undergoing total hip arthroplasty.

Background: The objective of this randomized prospective study was to determine whether a urinary catheter is necessary for all patients undergoing total hip arthroplasty under spinal anesthesia.

Methods: Consecutive patients undergoing total hip arthroplasty under spinal anesthesia were randomized to treatment with or without insertion of an indwelling urinary catheter. All patients received spinal anesthesia with 15 to 30 mg of 0.

Near-anatomic allograft tenodesis of chronic lateral ankle instability.

Background: Current operative treatment options for chronic lateral ankle instability include anatomic repairs utilizing existing local tissue and nonanatomic reconstructions sacrificing the peroneus brevis tendon to mechanically stabilize the ankle. Recent studies have modified these techniques to create an anatomic reconstruction utilizing allograft tendons. The purpose of this study was to retrospectively examine the clinical outcomes of a near-anatomic ligament reconstruction utilizing an allograft tendon for recurrent or complex lateral ankle instability.

Conversion arthrodesis for failed first metatarsophalangeal joint hemiarthroplasty.

Background: Arthrodesis is currently the most commonly performed surgical procedure for the treatment of arthritis of the first metatarsophalangeal (MTP) joint. Hemiarthroplasty of the first MTP joint has been shown to have inferior clinical results and higher revision rates. The objective of this study was to assess the clinical outcome of the salvage of failed hallux phalangeal hemiarthroplasty with conversion to arthrodesis.

Accuracy of digital templating in total knee arthroplasty.

Preoperative planning is an important aspect of total joint arthroplasty. Although significant attention has been given to how total hip arthroplasty templates are magnified, total knee arthroplasty (TKA) digital templating magnification methods have not been compared. In this study, 50 patients undergoing TKA by the same surgeon were digitally templated using 2 common digital magnification methods to determine if there is any difference in accuracy or precision.

Risk factors for wound complications after ankle fracture surgery.

Background: The overall rate of complications after ankle fracture fixation varies between 5% and 40% depending on the population investigated, and wound complications have been reported to occur in 1.4% to 18.8% of patients.

Outcome of modified Kidner procedure with subtalar arthroereisis for painful accessory navicular associated with planovalgus deformity.

Background: Type II accessory naviculars are frequently associated with planovalgus deformity. Operative treatment for patients recalcitrant to nonoperative treatment involves resection, with or without takedown, and reattachment of the tibialis posterior tendon as described by Kidner. This does not address the planovalgus deformity.

Effect of work-hour restrictions and resident turnover in orthopedic trauma.

The resident 80-hour workweek and the July phenomenon have raised concern regarding the continuity of care of orthopedic patients in teaching institutions and its effect on postoperative complications and mortality. This study examined the effect of resident work-hour restrictions and the July phenomenon on patient outcomes after hip fracture at a large academic institution. Seven hundred twenty-two patients (mean age, 76.

Terrible triad of the shoulder in a competitive athlete.

The terrible triad injury to a shoulder consists of shoulder dislocation, rotator cuff tear, and brachial plexus palsy. We present a case of a high velocity shoulder dislocation in an athlete with concomitant massive rotator cuff tear and incomplete infraclavicular brachial plexus injury. In this injury, most neurologic symptoms resolve, prompt surgical intervention is warranted, and comprehensive physical therapy is integral to recovery.

Nonagenarian hip fracture: treatment and complications.

Background: Hip fracture is a common yet serious injury sustained by the elderly patient and represents one of the major healthcare challenges today. The aim of this study was to better define the unique characteristics of treating nonagenarian peritrochanteric hip fractures and their subsequent complications during hospital stay.

Methods: Seven hundred twenty-two patients underwent surgery for isolated fracture around the femoral neck.

Conversion total hip arthroplasty: a reason not to use cephalomedullary nails.

Previous studies have yet to compare outcomes of conversion to hip arthroplasty from screw and side plate vs cephalomedullary nail. Seventy-six patients at our institution underwent hip conversion after fixation failure. We performed a retrospective chart review to compare perioperative outcomes in these 2 groups.

Total knee arthroplasty component templating: a predictive model.

Preoperative planning is essential to total knee arthroplasty (TKA); however, TKA templating is historically inaccurate. To improve on templating accuracy and streamline preoperative planning, we set out to predict component sizes based on patient characteristics without radiographs. A total of 123 consecutive patients undergoing unilateral TKA were identified and included in the model study.

Multimodal pain management after total joint arthroplasty.

Adequate postoperative pain control in patients who have undergone total joint arthroplasty allows faster rehabilitation and reduces the rate of postoperative complications. Multimodal pain management involves the introduction of adjunctive pain control methods in an attempt to control pain with less reliance on opioids and fewer side effects. Current research suggests that traditional nonsteroidal anti-inflammatory drugs (NSAIDs) and the associated cyclooxygenase type-2 (COX-2) inhibitors improve pain control in most cases.

Dermabond efficacy in total joint arthroplasty wounds.

The goals of wound closure are a low infection rate and timely healing. Total joint arthroplasty (TJA) requires mobile recovery, and, therefore, a high-tension wound care environment. We conducted a study to compare the efficacy of high-viscosity Dermabond (Ethicon, Somerville, New Jersey) and the efficacy of surgical staples in healing high-tension, mobile surgical sites of TJA.