Autonomic nervous system maturation in the premature extrauterine milieu.

Background: In premature infants, we investigated whether the duration of extrauterine development influenced autonomic nervous system (ANS) maturation.

Methods: We performed a longitudinal cohort study of ANS maturation in preterm infants. Eligibility included birth gestational age (GA) < 37 weeks, NICU admission, and expected survival.

Management of Posttraumatic Ankle Arthritis: Literature Review.

Purpose Of Review: Trauma is the principle cause of osteoarthritis in the ankle, which is associated with significant morbidity. This review highlights the current literature for the purpose of bringing the reader up-to-date on the management of posttraumatic ankle arthritis, describing treatment efficacy, indications, contraindications, and complications.

Recent Findings: Recent studies on osteoarthritis have demonstrated variability among anatomic locations regarding the mechanisms and rates of development for posttraumatic osteoarthritis, which are attributed to newly discovered biological differences intrinsic to each joint.

Resurfacing of the Metatarsal Head to Treat Advanced Hallux Rigidus.

Advanced stages of hallux rigidus are usually treated with various arthroplasties or arthrodesis. Recent results with resurfacing of the metatarsal head have shown promising results and outcomes similar or superior to those of arthrodesis. In this article, the authors show their preoperative decision making, surgical techniques, postoperative management, results, and a comparative literature review to identify metatarsal head resurfacing as an acceptable technique for the treatment of advanced hallux rigidus in active patients.

Subtalar coalitions in the adult.

Tarsal coalitions, while relatively uncommon, are typically identified in adult patients during an evaluation for ankle instability, sinus tarsus pain, and/or pes planovalgus. The true incidence of tarsal coalition is unknown with estimates ranging from 1% to 12% of the overall population. The most common area of involvement of the subtalar joint is the middle facet, and heightened awareness should be present in adult patients with limited motion of the subtalar joint.

Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures.

Background: The optimal method for treating intra-articular fractures of the calcaneus remains controversial. Extensile approaches allow excellent fracture exposure, but high rates of wound complications are seen. Newer minimally invasive techniques for calcaneus fracture fixation offer a potentially lower wound complication rate, but long-term clinical results are not available.

Metatarsal head resurfacing for advanced hallux rigidus.

Background: Advanced stages of first metatarsophalangeal (MTP) arthritis have traditionally been treated with various arthroplasties or arthrodesis. Studies suggest the outcomes of arthrodesis are superior to those of metallic joint replacement; however, complications and suboptimal outcomes in active patients still remain with arthrodesis of the first MTP joint. This study reports results of patients with advanced MTP arthritis who underwent metallic resurfacing of the metatarsal side of the MTP joint.

Optimizing therapeutic hypothermia for neonatal encephalopathy.

Objective: Therapeutic hypothermia (TH) for neonatal encephalopathy is becoming widely available in clinical practice. The goal of this collaborative was to create and implement an evidence-based standard-of-care approach to neonatal encephalopathy, deliver consistent care, and optimize outcomes.

Methods: The quality improvement process identified and used the Model for Improvement as a framework for improvement efforts.

Early complications following the operative treatment of pilon fractures with and without diabetes.

Background: An increased rate of complications has been clearly shown in diabetic patients undergoing operative treatment for displaced ankle fractures. To date, no studies have specifically looked at the complication rates following the operative management of pilon fractures in this difficult patient population. We performed a retrospective review to determine the rates of complications in diabetic patients undergoing operative fixation of tibial pilon fractures compared with a control group of patients without diabetes.

Arthroscopic treatment of multidirectional shoulder instability in athletes: a retrospective analysis of 2- to 5-year clinical outcomes.

Background: There are few reports in the literature detailing the arthroscopic treatment of multidirectional instability of the shoulder.

Hypothesis: Arthroscopic management of symptomatic multidirectional instability in an athletic population can successfully return athletes to sports with a high rate of success as determined by patient-reported outcome measures.

Study Design: Case series; Level of evidence, 4.

Thrombopoietin following transfusion of platelets in preterm neonates.

Thrombocytopenia is common in the neonatal intensive care unit. Transfusion of platelets is often required. The purpose of our study was to determine changes in thrombopoietin (Tpo) following transfusion of platelets in preterm neonates.

The management of ankle fractures in patients with diabetes.

Patients with diabetes mellitus have higher complication rates following both open and closed management of ankle fractures. Diabetic patients with neuropathy or vasculopathy have higher complication rates than both diabetic patients without these comorbidities and nondiabetic patients. Unstable ankle fractures in diabetic patients without neuropathy or vasculopathy are best treated with open reduction and internal fixation with use of standard techniques.

Tunnel expansion after anterior cruciate ligament reconstruction with autogenous hamstrings: a comparison of the medial portal and transtibial techniques.

Purpose: The purpose of this study was to evaluate the effects of 2 techniques of drilling the femoral tunnel in anterior cruciate ligament (ACL) reconstruction (medial portal v transtibial) on tunnel expansion.

Methods: Autogenous hamstring ACL reconstructions performed by the senior author between July 1998 and July 2004, with a minimum 6-month radiographic follow-up, using the transtibial technique (41 patients) and the medial portal technique (34 patients), were evaluated. All procedures were performed via an endoscopic technique with identical postoperative rehabilitation and graft fixation.

Single-bundle versus double-bundle posterior cruciate ligament reconstruction: scientific rationale and surgical technique.

Despite many recent advances in the understanding of the posterior cruciate ligament (PCL) and its function, the optimal treatment of PCL injuries remains controversial. Although it now is well known that the PCL is made up of two distinct bundles, each of which plays a vital role in achieving knee stability, questions abound regarding the need for double-bundle reconstruction rather than single-bundle techniques. Currently, the reconstruction technique is selected based on the injury pattern.

Arthroscopic capsulolabral reconstruction for posterior instability of the shoulder: a prospective study of 100 shoulders.

Background: There are few reports in the literature detailing arthroscopic treatment of unidirectional posterior shoulder instability.

Hypothesis: Arthroscopic capsulolabral reconstruction is effective in restoring stability and function and alleviating pain in athletes with symptomatic unidirectional posterior instability. This population has significant differences in glenoid and chondrolabral versions when compared with controls.

Vascular risk associated with bicortical tibial drilling during anteromedial tibial tubercle transfer.

For select patients with persistent patellofemoral pain, the anteromedial tibial tubercle transfer (Fulkerson osteotomy) provides excellent clinical results. This procedure, indicated for patients with patellar malalignment, has become one of the most popular distal realignment procedures. One potential concern with this technique is the proximity of the posterior vascular structures during bicortical tibial drilling for screw placement.

BMP-14 deficiency inhibits long bone fracture healing: a biochemical, histologic, and radiographic assessment.

Objectives: Bone morphogenetic proteins (BMPs) represent a distinct subset of the transforming growth factor-beta family best known for their role in joint formation and bone growth, and several recent clinical trials have begun to look at their efficacy in the augmentation of fracture healing. The goal of this research is to examine the effect of BMP-14, also known as growth differentiation factor-5 and cartilage- derived morphogenetic protein-1 (GDF-5, CDMP-1) on fracture healing by studying the long bone repair process in mice with a deficiency in this signaling peptide.

Methods: The animal model used for these studies was the BMP-14 (-/-) brachypodism (bp) mouse.

Management of proximal femoral shaft fractures in osteopetrosis: a case series using internal fixation.

Osteopetrosis is a group of rare sclerosing bone dysplasias. Orthopedic concerns in osteopetrosis are principally related to the characteristic brittle "marble bone" in which fractures may be easily induced by relatively low-energy mechanisms. Femoral fractures are common in this patient population, and management presents a unique technical challenge.

The graft/tunnel angles in posterior cruciate ligament reconstruction: a cadaveric comparison of two techniques for femoral tunnel placement.

Purpose: In posterior cruciate ligament reconstruction, the tibial tunnel/graft angle (or killer turn) has been implicated in graft failure when using transtibial tunnel placement. The graft/femoral tunnel angle (or critical corner) can also contribute to shear stress and early graft failure. The purpose of this study was to quantitate the killer turn angle in flexion and extension and to compare critical corner angles using outside-in and inside-out techniques for femoral tunnel placement.

The effect of nonsteroidal anti-inflammatory agents on spinal fusion.

A large body of information suggests NSAIDS have a negative impact on the healing of bone. Although each clinical healing scenario presents a slightly different level of challenge, the healing of a posterolateral spinal fusion is one of the most difficult challenges in bony healing. Clinically, this results in a relatively high rate of nonunions using traditional fusion techniques.

In vitro analysis of rotator cuff repairs: a comparison of arthroscopically inserted tacks or anchors with open transosseous repairs.

Purpose: The purpose of this study was to employ a cyclic loading protocol to compare rotator cuff repair strengths of arthroscopically inserted cuff tacks and suture anchors with the traditional open transosseous suture repair.

Type Of Study: In vitro cadaveric analysis.

Methods: Full-thickness 1 x 3-cm rotator cuff defects were created in 25 fresh-frozen cadaveric shoulders, and were randomized to 1 of 4 repair groups: (1) open repair with transosseous sutures, (2) arthroscopic repair with 2 singly loaded suture anchors, (3) arthroscopic repair with 2 doubly loaded suture anchors, and (4) arthroscopic repair with cuff tacks.

"All-inside" meniscal repair devices: an experimental study in the goat model.

Background: Although the use of "all-inside" absorbable meniscal repair devices has become popular, numerous complications have been reported. The authors applied their well-established goat model to evaluate three "all-inside" meniscal repair devices.

Methods: A "tear" was created in the medial meniscus of both knees in 26 goats.

Meniscal repair with the Rapid Loc device: a cadaveric study.

The devices available for all-inside meniscal repair were evaluated using a cadaver model. Rapid Loc devices (Mitek, Westwood, Mass) were inserted arthroscopically into 8 fresh-frozen cadaveric knees (age range: 66-78 years) in the posterior regions of the menisci at 5- to 7-mm intervals. Forty-eight devices were placed (3 in each meniscus), and the knees were subsequently dissected to determine the location of the inserted devices.

Pitfalls associated with FasT-Fix meniscal repair.

There are several devices currently available for all-inside meniscal repair. One of the newest of these devices, the FasT-Fix (Smith & Nephew, Endoscopic Division, Andover, MA), is attractive because it combines advantages of traditional inside-out meniscal repair with an all-inside technique. We chose to critically evaluate these devices in a cadaver model.

Vascular risk associated with a posterior approach for posterior cruciate ligament reconstruction using the tibial inlay technique.

This study evaluated the risk to the popliteal artery associated with the tibial inlay technique in posterior cruciate ligament (PCL) reconstruction. Barium was injected into the femoral arteries of eight fresh-frozen cadaveric knees and anteroposterior (AP) radiographs were obtained. Dissection of the fascia overlying the gastrocnemius muscle, identification of the interval between the medial head of the gastrocnemius and the semimembranosus, and lateral retraction of the medial head of the gastrocnemius (the Burks and Schaffer approach) was performed.