Cognitive Assessment in Grappling Athletes Following Choke versus Nonchoke Submissions.

Purpose: Participation in Brazilian jiu-jitsu and mixed martial arts has increased over the last three decades. These sports feature submission attacks, including strangles. These strangles, termed "chokes" in this context, primarily limit blood flow to the brain via compression of neck vasculature.

MPFL Reconstruction and Implant-Mediated Guided Growth in Skeletally Immature Patients With Patellar Instability and Genu Valgum.

Background: There is a higher rate of failure of isolated MPFL reconstruction in skeletally immature patients with patellar instability compared to skeletally mature patients. Genu valgum is a known risk factor for patellar instability. There is potential for concomitant surgical correction of genu valgum to achieve better clinical outcomes and to decrease failure rates of MPFL reconstruction.

Decision-making in the treatment of radial head fractures: Delphi methodology.

Background: The treatment of partially displaced radial head fractures is determined not only by the type of fracture but also by patient characteristics such as age, occupation, hand dominance, mechanism of injury, and concomitant injuries and comorbidities. The goal of this study was to employ the Delphi method to achieve consensus on the management of patients with radial head fractures, utilizing the experience of the ASES Elbow Fracture-Dislocation Multicenter Study Group and Mayo Elbow Club surgeons.

Methods: The initial survey was sent to participants, which included consent to participate in the study and questions about their experience, knowledge, and interest in participating in the Delphi method.

Coronal Shear Fractures of the Distal Humerus.

Coronal shear fractures of the distal humerus are rare, frequently comminuted, and are without consensus for treatment. The aim of this paper is to review the current concepts on the diagnosis, classification, treatment options, surgical approaches, and complications of capitellar and trochlear fractures. Computed Tomography (CT) scans, along with the Dubberley classification, are extremely helpful in the decision-making process.

Vaccine Safety Datalink infrastructure enhancements for evaluating the safety of maternal vaccination.

Background: Identifying pregnancy episodes and accurately estimating their beginning and end dates are imperative for observational maternal vaccine safety studies using electronic health record (EHR) data.

Methods: We modified the Vaccine Safety Datalink (VSD) Pregnancy Episode Algorithm (PEA) to include both the International Classification of Disease, ninth revision (ICD-9 system) and ICD-10 diagnosis codes, incorporated additional gestational age data, and validated this enhanced algorithm with manual medical record review. We also developed the new Dynamic Pregnancy Algorithm (DPA) to identify pregnancy episodes in real time.

An intraoperative laterally placed distractor for gradual load sharing correction of severe spastic neuromuscular spinal deformity.

Purpose: To analyze the overall deformity correction for severe neuromuscular scoliosis using laterally placed intra-operative distraction and compare to those receiving standard surgical technique.

Methods: This was a retrospective, IRB-approved, cohort study of patients with GMFCS 4 or 5 spastic cerebral palsy with neuromuscular scoliosis, age greater than 10 years, who underwent posterior spinal fusion from 2007 to 2019. All patients had vectored cervical traction with Gardner-Wells tongs, with hips flexed in a relative sitting position.

Safety of Arthroscopic Versus Open or Combined Heterotopic Ossification Removal Around the Elbow.

Purpose: To analyze the complications of arthroscopic heterotopic ossification (HO) excision and compare them with those of open removal of HO or a combined open-arthroscopic approach.

Methods: We performed a retrospective review of elbow HO removal cases performed by a single surgeon from 1997 to 2014. In all cases studied, the intention was to restore range of motion owing to the presence of HO causing functional impairment.

Performance of Dynamic Automated CT Annular Measurements Compared to Standard Manual Measurements for Transcatheter Aortic Valve Replacement Sizing.

Purpose: We sought to determine the performance of an automated computed tomography (CT) software that provides dynamic annular measurements of all available cardiac phases for transcatheter aortic valve replacement (TAVR) sizing as compared to the standard single manual measurement.

Materials And Methods: In 60 TAVR patients (84±7 years, 60% male) who underwent pre-procedural CT scans, we measured the aortic annular diameters, perimeter, and area using (1) the dynamic automated CT measurements and (2) standard single manual measurement from the cardiac phase of maximum systolic opening by visual estimate.

Results: The automated software was successful in providing annular measurements in 43/60 (72%) of cases, with the remainder requiring semi-automated contours.

Data Quality Assessment and Multi-Organizational Reporting: Tools to Enhance Network Knowledge.

Objective: Multi-organizational research requires a multi-organizational data quality assessment (DQA) process that combines and compares data across participating organizations. We demonstrate how such a DQA approach complements traditional checks of internal reliability and validity by allowing for assessments of data consistency and the evaluation of data patterns in the absence of an external "gold standard."

Methods: We describe the DQA process employed by the Data Coordinating Center (DCC) for Kaiser Permanente's (KP) Center for Effectiveness and Safety Research (CESR).

Impact of Baseline Features and Risk Factor Control on Cognitive Function in the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Trial.

Background: Cerebrovascular disease is an important cause of cognitive impairment. The aim of this study is to report the relationship between cognitive function and risk factors at baseline and during follow-up in the Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) trial.

Methods: Subjects in the SAMMPRIS trial were included in this study.

Loss of pronation-supination in patients with heterotopic ossification around the elbow.

Background: Heterotopic ossification (HO) is a well-recognized cause of limited flexion-extension, but it can also limit pronation-supination. There is a paucity of literature concerning restriction of pronation-supination due to HO.

Methods: We conducted a retrospective review of patients who had undergone elbow surgery for HO removal between January 1, 2003, and September 27, 2013.

Posteromedial rotatory incongruity of the elbow: a computational kinematics study.

Background: Our objective was to analyze the effect of different anteromedial coronoid fracture patterns with different combinations of ligamentous repairs. We hypothesized that smaller fractures would be sufficiently treated with ligamentous repair alone but that larger fragments would require a combination of ligament and bony repair versus reconstruction.

Methods: Two multibody models were created from cadaveric specimens in the ADAMS program.

Joint Contact Changes With Undersized Prosthetic Radial Heads.

Objective: To evaluate the effect of intentional undersizing of prosthetic radial head implant diameters on joint contact pressures.

Methods: Eight fresh-frozen cadaveric elbows were aligned in neutral extension and loaded with 100 N using a custom testing apparatus. Radiocapitellar contact pressures were recorded using a Tekscan thin-film pressure sensor.

Effects of axial forearm instability on force transmission across the elbow.

Background: The interosseous membrane (IOM) and distal radioulnar joint (DRUJ) provide axial stability to the forearm. Our hypothesis was that injury to these structures alters force transmission through the elbow.

Methods: A custom-designed apparatus that applies axial loads from the wrist to the elbow was used to test 10 cadaveric upper limbs under the following simulated conditions (1) intact, (2) DRUJ injury, (3) IOM injury, or (4) IOM + DRUJ injury.

Articular Contact Area and Pressure in Posteromedial Rotatory Instability of the Elbow.

Background: Joint incongruity in posteromedial rotatory instability (PMRI) has been theorized to determine early articular degenerative changes. Our hypothesis was that the articular contact area and contact pressure differ significantly between an intact elbow and an elbow affected by PMRI.

Methods: Seven cadaveric elbows were tested under gravity varus stress using a custom-made machine designed to simulate muscle loads and allow passive elbow flexion (0° to 90°).

Axial load transmission through the elbow during forearm rotation.

Background: Forearm rotation is closely associated with the axiorotational force transmission through the elbow joint. A technique has been developed to study the transmission of force across the radiocapitellar and ulnotrochlear joints during forearm rotation.

Methods: Ten human cadaveric upper limbs were prepared on a custom-designed apparatus that permits the application of extrinsic axial loads across an intact cadaveric elbow joint.

Coronoid reconstruction using osteochondral grafts: a biomechanical study.

Hypothesis: The purposes of this study were to test the hypothesis that coronoid deficiency in the setting of posteromedial rotatory instability (PMRI) must be reconstructed to restore articular contact pressures to normal and to compare 3 different osteochondral grafts for this purpose.

Methods: After creation of a anteromedial fracture, six cadaveric elbows were tested under gravity varus stress using a custom-made machine designed to simulate muscle loads and to passively flex the elbow. Mean articular surface contact pressure data were collected and processed using TekScan sensors and software.

Role of the lateral collateral ligament in posteromedial rotatory instability of the elbow.

Background: Posteromedial rotatory instability (PMRI) of the elbow consists of an anteromedial coronoid fracture with lateral collateral ligament (LCL) and posterior bundle of the medial collateral ligament (PMCL) tears. We hypothesized that the LCL tear is required for elbow subluxation/joint incongruity and that an elbow affected by an anteromedial subtype 2 coronoid fracture and a PMCL tear exhibits contact pressures different from both an intact elbow and an elbow affected by PMRI.

Materials And Methods: Six cadaveric elbows were tested under gravity varus stress using a custom-made machine designed to simulate muscle loads and to passively flex the elbow from 0° to 90° and measure joint contact pressures.

Current concepts in elbow arthroplasty.

Distal humeral replacement and the total elbow are two commonly-used arthroplastiesEach prosthesis has evolving indications and surgical techniquesRecent changes in device design and implantation methods are due to biomechanical and clinical outcome-based researchNew prostheses and methods provide: better elbow kinematics, more durable bearings and longer-lasting joint replacement potential Cite this article: 2017;2:83-88. DOI: 10.1302/2058-5241.

Is There Benefit from Stenting on Cognitive Function in Intracranial Atherosclerosis?

Background: Revascularization of stenotic cerebral arteries is hypothesized to improve cognition by increasing cerebral perfusion.

Aims: We compared cognition impairment among patients treated with percutaneous angioplasty and stenting (PTAS) and aggressive medical management (AMM) versus AMM alone in the Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (SAMMPRIS) Trial.

Methods: In SAMMPRIS, 451 patients with recent transient ischemic attack or stroke attributed to 70-99% intracranial stenosis were randomized to PTAS plus AMM or AMM alone.

The Safety of Using Proximal Anteromedial Portals in Elbow Arthroscopy With Prior Ulnar Nerve Transposition.

Purpose: To report the safety of using the proximal anteromedial portal, using a simplified ulnar nerve management strategy derived from an earlier study, in a series of patients with previously transposed ulnar nerves.

Methods: A retrospective review of all elbow arthroscopies performed by a single surgeon from 2009 to 2014 was performed. The following techniques were used if, by palpation, localization of the ulnar nerve was considered to be certain (group 1) or uncertain (group 2): In group 1 (certain) the proximal anteromedial portal was established in the normal antegrade fashion.

Reverse-total shoulder arthroplasty cost-effectiveness: A quality-adjusted life years comparison with total hip arthroplasty.

Aim: To compare reverse-total shoulder arthroplasty (RSA) cost-effectiveness with total hip arthroplasty cost-effectiveness.

Methods: This study used a stochastic model and decision-making algorithm to compare the cost-effectiveness of RSA and total hip arthroplasty. Fifteen patients underwent pre-operative, and 3, 6, and 12 mo post-operative clinical examinations and Short Form-36 Health Survey completion.