A novel technique for subscapularis repair in total shoulder arthroplasty.

Anatomic total shoulder arthroplasty, when used for treatment of primary glenohumeral arthritis, is historically very successful. We propose a novel technique for subscapularis repair during closure of a deltopectoral approach to the shoulder with subscapularis peel. Our technique allows for early motion following surgery and also provides for improved subscapularis repair integrity and resilience during postoperative rehabilitation.

Effectiveness of an Orthopaedic Trauma Research Fellowship to Produce Successfully Matching Residents.

Objective: Orthopaedics is becoming increasingly competitive. Approximately 25% of applicants to orthopaedic surgery go unmatched each year. The mean US Medical Licensing Examination step scores and average publication numbers have increased markedly in recent years.

Immediate Weightbearing After Operative Treatment of Bimalleolar and Trimalleolar Ankle Fractures: Faster Return to Work for Patients with Nonsedentary Occupations.

The goal of this study was to compare immediate weightbearing (IWB) and traditional weightbearing (TWB) postoperative protocols in unstable ankle fractures, as this has not been compared in prior works. We hypothesize that an immediate weightbearing protocol after ankle fracture fixation will lead to an earlier return to work. An ankle fracture registry was reviewed for operatively treated unstable bimalleolar and trimalleolar ankle fractures at an ambulatory surgery center and followed up at associated outpatient clinics.

Operative Management of Rib Synostosis and Malunion: A Case Report.

Case: We present a complex case of a 56-year-old man with multiple left-sided rib pathology including nonunion, rib heterotopic ossification (HO) forming a rib-to-rib synostosis, and rib malunion. After a major forequarter trauma and failed conservative management, followed by scapula reconstruction and rib recontouring, the surgical resection of the rib synostosis, reconstruction of a rib nonunion, and contouring of rib malunions are described. The patient was followed up clinically for 1 year after the final procedure and demonstrated marked improvement in functional outcome.

Early resection of ectopic bone in patients with heterotopic ossification about the hip after trauma.

Objectives: Heterotopic ossification (HO) is a common complication in patients who have sustained high-energy trauma to the hip region. Traditionally, resection is performed after ectopic bone maturation. We hypothesized that early HO resection in patients with hip ankylosis after trauma can be performed with little chance of recurrence.

Patient-Level Value Analysis: An Innovative Approach to Optimize Care Delivery.

Background: An increasing emphasis has been placed on developing value-based care delivery systems in orthopaedics to combat rising health care costs. The goal of these systems is to both measure and improve the provisional value of care. Patient-level value analysis creates a mechanism to quantify and optimize value within a procedure, in contrast to traditional methods, which only measures value.

Minimally Invasive Endoscopic-Assisted Technique for Implant Removal After Pelvic Bridge Plating.

Subcutaneous internal plate fixation for anterior pelvic ring injuries has become more common, but implants require removal, usually by 12 weeks. The purpose of this article is to report a novel, minimally invasive, endoscopic-assisted technique for the removal of subcutaneous anterior pelvic plates safely and atraumatically without violating the underlying fascia.

Posterior Scapula Approaches: Extensile and Modified Judet.

The Extensile Judet has been widely used in the management of scapula fractures. An enhanced understanding of these injuries, however, has allowed for the strategic development of alternative methods in which soft tissues may be better spared. The purpose of this video is to highlight the indications and techniques for 2 posterior approaches to the scapula: The Extensile Judet and the Modified Judet.

Minimally invasive anterior pelvic internal fixation: An anatomic study comparing Pelvic Bridge to INFIX.

Objectives: Anterior external fixation for pelvic ring fractures has shown to effectively improve stability and reduce mortality. However, these fixators can be associated with substantial morbidity such as pin tract infection, premature loss of fixation, and decreased quality of life in patients. Recently, two new methods of subcutaneous anterior pelvic internal fixation have been developed; the INFIX and the Pelvic Bridge.

Anatomic Study of Subcoracoid Morphology in 418 Shoulders: Potential Implications for Subcoracoid Impingement.

Background: Subcoracoid impingement has been implicated as a cause of anterior shoulder pain and subscapularis tendon tears.

Purpose/hypothesis: The purpose of this study was to evaluate the bony anatomy of the coracoid process and the subcoracoid space. We hypothesized that age-related changes that may contribute to subcoracoid impingement occur in the subcoracoid space.

Publication of Podium Presentations at the Orthopaedic Trauma Association Annual Meetings: 2008-2012.

Objective: To determine journal publication rates of podium presentations from the OTA Annual Meetings between 2008 and 2012.

Methods: Podium presentations from the 2008 to 2012 OTA annual meeting were compiled from the Annual Meeting archives. During December 2016, and Google Scholar were performed using individual keywords in the abstract title and content.

The Pelvic Bridge: A Subcutaneous Approach for Anterior Pelvic Fixation.

Introduction: An alternative method to external fixation for the treatment of unstable anterior pelvic ring injuries, termed the pelvic bridge technique, provides equivalent results with fewer complications and is performed using occipital cervical rods subcutaneously, with fixation into the iliac wings and parasymphyseal bone.

Step 1 Preoperative Planning: For preoperative planning, review the appropriate imaging, including radiographs and computed tomography (CT) scans, to mesh the findings on imaging to the clinical picture of the patient and ensure that the patient meets operative criteria and that none of the contraindications are present.

Step 2 Patient Positioning: Position the patient to facilitate anterior and posterior fixation.

Open Reduction and Internal Fixation of a Middle-Third Clavicle Fracture with a Superior Plate.

Open reduction and internal fixation has become a reliable technique to treat complex middle-third clavicle fractures (AO/OTA B-15). Nonoperative treatment of these fractures may result in higher rates of symptomatic malunion, nonunion, dissatisfaction with cosmetic appearance, and even dysfunction and muscular weakness. Risk factors such as substantial displacement or comminution, far lateral fractures, fractures in the elderly, open fractures, or those occurring in polytrauma scenarios are appropriate indications for surgery.

Comparison of 2 versus 3 dimensional fracture mapping strategies for 3 dimensional computerized tomography reconstructions of scapula neck and body fractures.

Fracture mapping has been used in the understanding of injury patterns in different bones. To our knowledge, there are no applications of this technique using three-dimensional (3D) morphologic fracture characteristics. Previously, scapula fractures were mapped by transferring information from 3D computed tomography to a two-dimensional (2D) template.

Calcaneocuboid Joint Arthritis of the Midfoot Precedes Tibiotalar Joint Arthritis.

Surgical models have best shown the relationship between ankle and mid-foot osteoarthritis, although findings regarding the calcaneocuboid joint have varied. To the authors' knowledge, no studies have evaluated the relationship between degenerative changes across the tibiotalar and calcaneocuboid joints. The goal of this study was to determine whether such a relationship exists and which joint degenerates first.

Ipsilateral Tibiotalar Joint Osteoarthritis Transferred to the Contralateral Tibiotalar Joint.

Classically, it is thought that pain or disability in one leg can stress the contralateral leg, leading to similar symptoms. The mechanism of action for subsequent dysfunction in the healthy limb is thought to involve compensatory changes that are used as a means to reduce stance phase time on the injured limb. This is believed to increase the forces distributed across the healthy limb, ultimately leading to injury.

Bilateral Pars Defects at the L4 Vertebra Result in Increased Degeneration When Compared With Those at L5: An Anatomic Study.

Background: Cadaveric studies have examined disc degeneration at the L4-L5 and L5-S1 motion segments; however, we are not aware of another study that has examined the relationship between bilateral spondylolysis and its effect on degenerative disc disease at those levels. This may have been overlooked by researchers owing to the majority of spondylolysis occurring at the L5 vertebra.

Questions/purposes: Using osteologic specimens from a collection that included individuals who died in one city in the USA between 1893 and 1938, we asked: (1) do specimens with bilateral spondylolysis (bilateral pars defects) have increased levels of disc degeneration, at their respective motion segments, when compared with matched controls without spondylolysis, and (2) is the finding of a bilateral pars defect associated with more severe arthritis at L4-L5 than at L5-S1?

Methods: An observational study was performed on 665 skeletal lumbar spines from the Hamann-Todd Osteologic Collection at the Cleveland Museum of Natural History (Cleveland, OH, USA).