Safety and feasibility of a novel bi-directional portal vein access kit during transjugular intrahepatic portosystemic shunt creation.

Background: Transjugular intrahepatic portosystemic shunt (TIPS) creation remains as one of the more technically challenging endovascular procedures. Portal vein access from the hepatic vein often requires multiple needle passes, which increases procedure times, risk of complications, and radiation exposure. With its bi-directional maneuverability, the Scorpion X access kit may be a promising tool for easier portal vein access.

Endovascular Management of Intracranial Vertebral Artery Dissection: Technical Nuances for the Preservation of Posterior Inferior Cerebellar Artery and Basilar Artery.

Background: The treatment of intracranial vertebral artery dissection (VAD) can be challenging.

Objective: To evaluate the clinical presentation, endovascular treatment techniques, and prognostic outcome of patients diagnosed with intracranial VAD at our institution.

Methods: A retrospective analysis of 35 patients who were diagnosed with VAD at our institution over 17-yr period (2001-2017) is presented.

Lateral femoral cutaneous nerve palsy following shoulder surgery in the beach chair position: a report of 4 cases.

Neuropathy of the lateral femoral cutaneous nerve can present as pain, decreased sensation, and/or burning or tingling on the anterolateral thigh. We present 4 cases of lateral femoral cutaneous nerve palsy following shoulder surgery in the beach chair position, all of which occurred in obese patients. This complication, to our knowledge, has never been reported in conjunction with the beach chair position.

A novel technique for reducing intertrochanteric hip fractures.

Intertrochanteric hip fractures typically become deformed by the muscular and gravitational forces acting on the 2 main bony fragments. Traditional use of a fracture table for anatomical reduction normally corrects for the varus angulation, external rotation, and posterior sag that can occur, but, in select unstable and comminuted fractures, reduction may not be possible because of posterior sag and external rotation of the proximal fragment. These aspects of malreduction have been addressed in multiple ways, including use of unscrubbed assistants, crutches, internal rotation of the distal fragment by internal rotation of the foot, bumps and pads, and even intraoperative techniques.

Management of malunion of the proximal humerus: current concepts.

Proximal humerus fractures remain one of the most common orthopaedic injuries, particularly in the elderly. Displaced fractures often require surgery, and management can be challenging because of comminution and poor bone quality. Despite advances in surgical technique and implant design, reoperation for malunion or nonunion of the tuberosity (arthroplasty) or screw penetration (open reduction and internal fixation) remains problematic.

Workers' compensation and outcomes of upper extremity surgery.

Clinical outcomes following upper extremity surgery among workers' compensation patients have traditionally been found to be worse than those of non-workers' compensation patients. In addition, workers' compensation patients take significantly longer to return to their jobs, and they return to their preinjury levels of employment at a lower overall rate. These unfavorable prognoses may stem from the strenuous physical demands placed on the upper extremity in this group of patients.

Management of cartilage defects in the shoulder.

Articular cartilage lesions of the glenohumeral joint are an especially difficult clinical problem to manage, particularly in the younger, more active patient. Left untreated, these lesions may progress in the long-term, leading to further pain and disability. While shoulder arthroplasty remains a viable option in older patients with glenohumeral arthritis, concerns over component longevity and loosening in younger patients make it less attractive in that age group.