A Proposal for a Standardized Nomenclature of the C-arm Movements.

Unlabelled: No formal didactic source exists concerning terminology for movement of the C-arm in the operating room (OR). Many terminologies exist, breeding confusion among OR staff. The objective of this study was to survey the existing C-arm movement terminologies among orthopaedic surgeons and radiologic technologists and propose a standardized nomenclature moving forward.

Distal triceps transosseous cruciate versus suture anchor repair using equal constructs: a biomechanical comparison.

Background/hypothesis: Suture anchor-based repair has been advocated for repair of distal triceps avulsion, but previous models have used an unequal number of sutures across the repair site. We hypothesized that there would be no difference in triceps tendon displacement between gold standard repair with transosseous cruciate bone tunnels and suture anchor repair with an equal number of sutures in the constructs.

Methods: The triceps tendon footprint was measured in 20 cadaveric elbows (10 matched pairs), and a distal triceps tendon rupture was created.

Distal fibular malrotation and lateral ankle contact characteristics.

Background: Any amount of malreduction of the syndesmotic joint compared with the uninjured syndesmosis has been associated with an adverse effect on functional outcome. The amount of malrotation that may lead to clinically relevant pressure change in this joint has not been reported. Our purpose was to determine whether small degrees of external and internal malrotation would be associated with statistically significant changes in contact pressure in the tibiofibular and talofibular articulations.

Treatment of a Pediatric T-type Intercondylar Humerus Fracture With Hybrid Percutaneous Pinning and External Fixation.

T-type intercondylar fractures of the distal humerus are rare injuries in skeletally immature patients. Few studies are available to guide the treatment of these injuries. Small case series and expert recommendations suggest superiority of the open approach for direct reduction of the articular surface.

Iatrogenic Spinal Cord Injury Resulting From Cervical Spine Surgery.

Study Design: Retrospective cohort study of prospectively collected data.

Objective: To examine the incidence of iatrogenic spinal cord injury following elective cervical spine surgery.

Methods: A retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network was conducted.

C5 Palsy After Cervical Spine Surgery: A Multicenter Retrospective Review of 59 Cases.

Study Design: A multicenter, retrospective review of C5 palsy after cervical spine surgery.

Objective: Postoperative C5 palsy is a known complication of cervical decompressive spinal surgery. The goal of this study was to review the incidence, patient characteristics, and outcome of C5 palsy in patients undergoing cervical spine surgery.

Epidural Hematoma Following Cervical Spine Surgery.

Study Design: A multicentered retrospective case series.

Objective: To determine the incidence and circumstances surrounding the development of a symptomatic postoperative epidural hematoma in the cervical spine.

Methods: Patients who underwent cervical spine surgery between January 1, 2005, and December 31, 2011, at 23 institutions were reviewed, and all patients who developed an epidural hematoma were identified.

Rare Complications of Cervical Spine Surgery: Horner's Syndrome.

Study Design: A multicenter retrospective case series.

Objective: Horner's syndrome is a known complication of anterior cervical spinal surgery, but it is rarely encountered in clinical practice. To better understand the incidence, risks, and neurologic outcomes associated with Horner's syndrome, a multicenter study was performed to review a large collective experience with this rare complication.

Total Knee Arthroplasty after Complete Patellectomy: A Review.

The absence or dysfunction of the knee extensor mechanism accelerates degenerative joint disease and complicates knee arthroplasty. Various treatment strategies have been suggested to improve outcomes in total knee arthroplasties after patellectomy (semi- or constrained components, autograft, allograft, prosthetic reconstruction), but the optimal management of this condition is not known. The purpose of this report is to review the relevant basic biology and biomechanics of the patella and the extensor mechanism, and to review the current literature on the management of complete patellectomy during total knee arthroplasty.

Femoral nerve palsy after pelvic fracture treated with INFIX: a case series.

Objective: The treatment of some pelvic injuries has evolved recently to include the use of a subcutaneous anterior pelvic fixator (INFIX). We present 8 cases of femoral nerve palsy in 6 patients after application of an INFIX to highlight this potentially devastating complication to pelvic surgeons using this technique and discuss how it might be avoided in the future.

Design: Retrospective chart review.

Effect of bone type on clinical and radiographic outcomes of a proximally-coated cementless stem in primary total hip arthroplasties.

We determined the effect of pre-operative bone structure upon the temporal effects of remodeling after total hip arthroplasty (THA) in a series of uncemented implants. We evaluated 345 patients (375 hips), who had either Dorr Type-A (238 hips) or Type-B (137 hips) bone, and who received a proximally-coated cementless THA and were followed for a mean of 6 years. Outcomes evaluated included aseptic survivorship, Harris hip scores, and radiographic evaluation for patterns of remodeling.

Proximally coated cementless bipolar hemiarthroplasty in Dorr type C bone.

The current study was conducted to examine the clinical and radiographic outcomes of cementless bipolar arthroplasty in patients who had type C bone at the time of the procedure. A total of 87 patients (105 hips) who had type C femora and had undergone cementless bipolar hemiarthroplasty with a proximally coated cementless prosthesis for the treatment of displaced femoral neck fractures at a single institution were reviewed. Patients included 83 women and 4 men who had a mean age of 84 years (range, 72-100 years) and were followed for a mean of 6 years (range, 2-11 years).

Influencing medical student education via a voluntary shadowing program for trauma and acute care surgery.

Decreasing application into trauma surgery may be attributed to decreased exposure during medical school. We instituted a voluntary trauma call program for students to provide exposure to the field. After 3 years, participants completed a survey to gauge their experience.

Reduced dislocation rates and excellent functional outcomes with large-diameter femoral heads.

The purpose of this study was to compare the dislocation rates, functional outcomes, and radiographic results between large- and small-diameter femoral head components. A total of 225 patients (248-hips) who received total hip arthroplasties with large-diameter components (36mm or greater) were compared to 501 patients (559-hips) who received smaller diameter components (less than 36mm). Rates of dislocation and revision, Harris hip score, radiographic findings, and complications were compared between the groups.

Reduced re-infection rates with postoperative oral antibiotics after two-stage revision hip arthroplasty.

Background: Surgeons are often trying to decreased reinfection rates following two-stage reimplantation arthroplasty, which range from 3.2% to 13% because multiple staged revision procedures for infection can be costly and have high morbidity. We therefore asked: (1) Did the use of postoperative oral antibiotics reduce reinfection rates after 2-staged revision of THA? And (2) how did this compare with the infection rate after aseptic revision procedures?

Methods: We identified all patients who underwent two-stage revision THA for a periprosthetic deep hip infection and found 66 patients (67 hips) who had a minimum 24 months' followup.

Inheritable risk factors for venous thromboembolism in patients undergoing lower extremity total joint arthroplasty.

Venous thromboembolism is a common and undesirable complication of both total hip and knee arthroplasty. The basic biology and major modifiable risk factors predisposing to thromboembolism are well established, but a complete understanding of the role and management of inherited coagulopathies is lacking. In this manuscript, we have attempted to review the fundamental pathophysiology of the coagulation cascade, analyze recent literature on heritable coagulopathies leading to venous thromboembolism in patients undergoing lower extremity joint arthroplasty, and discuss how an understanding of such factors may affect clinical practice.

Risk of dislocation using large- vs. small-diameter femoral heads in total hip arthroplasty.

Background: Dislocation remains a difficult problem in total hip arthroplasty. Large-diameter femoral heads may lower the incidence of dislocation by enhancing the jump distance and decreasing impingement, but their performance against small-diameter heads has not been assessed. This study compared the mid-term radiographic and functional outcomes of two matched cohorts of patients undergoing total hip arthroplasty who had a high pre-operative risk for dislocation and who received either small-diameter (26- or 28-millimeters) or large-diameter (≥36-millimeters) femoral heads.

Discrepancies between frozen and paraffin tissue sections have little effect on outcome of staged total knee arthroplasty revision for infection.

Background: Intraoperative analysis of frozen tissue samples has been used to diagnose periprosthetic joint infection in revision total knee arthroplasty, but the precision and reliability of this test throughout staged revision arthroplasty have not been well characterized. We undertook this study to determine the rate of discrepancy between frozen and permanent histopathologic samples in the diagnosis of periprosthetic infection at both the index total knee arthroplasty revision procedure and the attempted reimplantation.

Methods: Seventy-six patients who underwent staged revision of a total knee arthroplasty for apparent infection had samples for frozen and permanent sections obtained at both the index revision procedure and subsequent reimplantation attempts.

How do frozen and permanent histopathologic diagnoses compare for staged revision after periprosthetic hip infections?

Histopathologic analysis of frozen tissue samples is used to aid the intraoperative diagnosis of periprosthetic hip infections, but there are concerns about reliability. The purposes of this study were to determine the rate of concordance between diagnoses of infection made with frozen and permanent sections and to assess how discrepancies affected patient outcomes. A total of 282 samples from 62 patients were collected for frozen and permanent section analysis.

Excellent Clinical Outcomes in Total Knee Arthroplasty Performed Without a Tourniquet.

Although tourniquet use is the standard protocol for total knee arthroplasties it may lead to postoperative complications including thigh pain, compressive soft-tissue problems, and thromboembolic events. The purpose of this study was to explore the perioperative and clinical outcomes of total knee arthroplasty performed without a tourniquet. Thirty consecutive total knee arthroplasties were performed in 30 patients without a tourniquet and compared with 30 procedures (30 matched patients) performed with a tourniquet.

Total knee arthroplasty in patients over 80 years of age.

We conducted this study to review the clinical and radiographic outcomes of patients 80 years of age or older who underwent total knee arthroplasty (TKA). We identified clinical results in 60 patients (66 knees) who had a mean age of 84 years (range, 80 to 95 years) and who underwent TKA. These were compared with a non-age-matched group of 63 patients (66 knees) who had a mean age of 69 years (range, 60 to 79 years).

Dual-mobility bearings: a review of the literature.

Dislocation after total hip arthroplasty remains a major problem and hip instability is the most common reason for revision. These complications are costly to both patients and the healthcare system, and efforts to reduce them have had varied degrees of success. Although there are well documented patient and surgical risk factors for dislocation, the typical surgical solutions offered (constrained liners, large femoral heads) have the drawbacks of reduced range-of-motion and high rates of revision.

Atraumatic osteonecrosis of the distal radius and ulna: case series and review.

Purpose: Atraumatic multifocal osteonecrosis is defined as the occurrence of atraumatic osteonecrosis in 3 or more anatomic locations, and it is rare. We identified 6 patients with osteonecrotic lesions in the distal ulna, radius, or both. The purposes of this study were to describe the clinical manifestations of atraumatic multifocal osteonecrosis affecting these bones, to identify risk factors for developing the disease in these locations, and to evaluate the success of treatment by percutaneous drilling.