Late tibial interference screw extrusion following anterior cruciate ligament reconstruction: A case report.

Introduction: Interference screws are used as back-up fixation in anterior cruciate ligament reconstructions. Historically these were composed of metal, but recently surgeons have switched to using bioabsorbable screws as they cause less symptoms and are biomedically advantageous. Usually these screws are absorbed by the body within one to two years after surgery.

Is Self-reported Return to Duty an Adequate Indicator of Return to Sport and/or Return to Function in Military Patients?

Background: In the military, return-to-duty status has commonly been used as a functional outcome measure after orthopaedic surgery. This is sometimes regarded similarly to return to sports or as an indicator of return to full function. However, there is variability in how return-to-duty data are reported in clinical research studies, and it is unclear whether return-to-duty status alone can be used as a surrogate for return to sport or whether it is a useful marker for return to full function.

The Effect of Subcritical Bone Loss and Exposure on Recurrent Instability After Arthroscopic Bankart Repair in Intercollegiate American Football.

Background: There is no consensus on the optimal method of stabilization (arthroscopic or open) in collision athletes with anterior shoulder instability.

Purpose: To examine the effect of "subcritical" bone loss and football-specific exposure on the rate of recurrent shoulder instability after arthroscopic stabilization in an intercollegiate American football population.

Study Design: Case-control study; Level of evidence, 3.

Intra-articular risks of suprapatellar nailing.

To determine the risks to local anatomy near the starting point for tibial nailing during suprapatellar nailing, 15 fresh-frozen hemipelvis specimens were nailed using a suprapatellar technique. After nail passage, the menisci and articular surfaces, anterior cruciate ligament (ACL) insertion, intermeniscal ligament, and fat pad were assessed for injury. The distance from the entry portal to the menisci, articular surfaces, and ACL insertion was determined.

Acute compartment syndrome of the thigh in combat casualties.

Acute compartment syndrome of the thigh is a rare clinical entity often caused by high-energy trauma and presenting with a spectrum of associated injuries. Service members in combat are at risk for these causative mechanisms. This study presents a large cohort of thigh compartment syndrome combat casualties and investigates the injury mechanisms, associated mortality, and complications related to fasciotomies.

Current recommendations for anterior cruciate ligament bracing: when to use.

Braces are often used during various stages of recovery from an anterior cruciate ligament tear despite there being sparse definitive research supporting their use. This article reviews the literature on brace use for patients with anterior cruciate ligament tears in order to provide a guide for clinicians. There is evidence to support immediate postoperative bracing, with the goals of maintaining full extension and decreasing effusion.

Bacterial adherence to titanium, poly-L-lactic acid, and composite hydroxyapatite and poly-L-lactic acid interference screws.

This study investigates a potential site of bacterial adherence, the implant surface, comparing titanium, poly-L-lactic acid (PLLA), and composite hydroxyapatite and poly-L-lactic acid (PLLA-HA) interference screws using a bioluminescent in vitro model. Interference screws of three materials, titanium (Arthrex, Naples, FL), bioabsorbable poly-L-lactic acid (BIORCI, Smith & Nephew, Andover, MA), and bioabsorbable composite hydroxyapatite and poly-L-lactic acid (BIORCI-HA, Smith & Nephew, Andover, MA) were immersed in a broth of bioluminescent Staphylococcus aureus. The screws were irrigated and then imaged with a photon-capturing camera system yielding a total photon count correlating with residual adherent bacteria.

Publication rates of abstracts presented at the annual meeting of the Society of Military Orthopaedic Surgeons.

Previous studies have reported publication rates of abstracts presented at orthopaedic meetings from 22 to 68 percent. The objective of this study was to determine the publication rate of papers presented at the Society of Military Orthopaedic Surgeons (SOMOS) meetings from 1999 to 2003. A database was created including all abstracts presented at SOMOS meetings from 1999 to 2003 as listed in official program books.

Characteristics and impact of animal models used for sports medicine research.

Animal models are commonly used for translational research despite evidence that the methodology of these studies is often inconsistent and substandard. This study describes the characteristics and impact of published research using animal models in the American Journal of Sports Medicine (AJSM). Peer-reviewed articles published in the AJSM between January 1990 and January 2010 using animal models were identified using MEDLINE.

Bacteria on external fixators: which prep is best?

Background: There are no established guidelines for the surgical prep of an external fixator in the operative field. This study investigates the effectiveness of different prep solutions and methods of application.

Methods: Forty external fixator constructs, consisting of a rod, pin, and pin to rod coupling device, were immersed in a broth of Staphylococcus aureus (lux) for 12 hours.

The safe zone for external fixator pins in the femur.

Objective: To define the anatomic "safe zone" for placement of external fixator half pins into the anterior and lateral femur.

Methods: In 20 fresh-frozen hemipelvis specimens, the femoral nerve and all branches crossing the femur were dissected out to their final muscular locations. The location where the nerves crossed the anterior femur was measured from the anterior superior iliac spine and inferior margin of the lesser trochanter.

Time-dependent effects of chlorhexidine soaks on grossly contaminated bone.

Objective: The purpose of this study was to quantify the reduction in the bacterial burden of grossly contaminated bone segments using different chlorhexidine (CHL) solutions. We hypothesized that 4% CHL would be the most efficient decontaminate.

Methods: Fifty-four bone segments were harvested from fresh-frozen porcine legs.

Rehospitalization after combat injury.

Background: Frequency of rehospitalization and associated resource requirements are unknown for combat casualties. Differences may also exist in readmission rates for injuries to separate body regions. This study investigates rehospitalization of combat casualties with a hypothesis that extremity injuries cause the greatest number of readmissions and require the greatest resources to treat.

Silver dressings augment the ability of negative pressure wound therapy to reduce bacteria in a contaminated open fracture model.

Background: Despite a lack of evidence supporting their use, silver dressings are often used with negative pressure wound therapy (NPWT). This study investigates the effectiveness of silver dressings to reduce bacteria in contaminated wounds when used with NPWT.

Methods: Complex orthopedic wounds were created on the proximal left legs of anesthetized goats.

Bacterial adherence to high--tensile strength sutures.

Purpose: The purpose of this study was to evaluate the bacterial adherence to high--tensile strength suture materials using a bioluminescent in vitro model.

Methods: Eleven strands each of No. 2 MaxBraid (Arthrotek [Biomet], Warsaw, IN), FiberWire (Arthrex, Naples, FL), Ethibond (Ethicon, Somerville, NJ), Orthocord (DePuy Mitek, Raynham, MA), and silk (Ethicon) sutures were immersed in a broth of bioluminescent Staphylococcus aureus, which is genetically engineered to emit photons.

Battlefield orthopaedic injuries cause the majority of long-term disabilities.

Extremity injuries make up 54% of combat wounds sustained in Operation Iraqi Freedom and Operation Enduring Freedom. In a cohort of war-wounded service members, we identified the conditions secondary to battle injury that result in disqualification from continued service. The Army Physical Evaluation Board records of 464 wounded service members who were injured between October 2001 and January 2005 were reviewed to determine the codes indicating unfitting conditions.

Bacterial adherence to suture materials.

Background: Wound infections may be problematic for physicians. Whether a practitioner is managing complex penetrating trauma or a skin biopsy, there may be a need for suture closure. Suture material is an operator dependent variable and while little objective data exist to guide the choice of suture, it may play a role in wound infection.

Safety analysis of all-inside arthroscopic repair of peripheral triangular fibrocartilage complex.

Purpose: The purpose of this study was to determine whether an all-inside peripheral triangular fibrocartilage complex (TFCC) repair using the FasT-Fix device (Smith & Nephew Endoscopy, Andover, MA) is safe by measuring the proximity of the anchors to ulnar-sided anatomic structures.

Methods: Eleven fresh-frozen cadaveric wrists were thawed and placed in traction. Under direct arthroscopic visualization, an all-inside arthroscopic peripheral TFCC repair was completed by placing a single FasT-Fix device in a vertical mattress fashion.

Negative pressure wound therapy reduces pseudomonas wound contamination more than Staphylococcus aureus.

Purpose: The purpose of this study is to determine if negative pressure wound therapy (NPWT) treatment results in fewer bacteria than wet-to-dry (WTD) dressings in a contaminated open fracture wound model.

Methods: For Study 1, complex wounds were created on the proximal left leg of goats. The wounds were inoculated with Pseudomonas aeruginosa.

Prevention and treatment of infected foot and ankle wounds sustained in the combat environment.

Combat injuries to the foot and ankle are challenging to treat due to frequent high-energy mechanisms, environmental contamination, and soft tissue and bony damage. Prevention and treatment of infections in injuries to the foot and ankle are critical to achieving the goals of tissue healing and restoration of function. The guidelines for treatment of these foot and ankle injuries are similar to those in place for civilians; however, allowances must be made for the realities of combat including an often austere environment, the need for evacuation, and limitations on resources available for treatment.

Resource utilization and disability outcome assessment of combat casualties from Operation Iraqi Freedom and Operation Enduring Freedom.

Objectives: Injuries are common during combat operations. The high costs of extremity injuries both in resource utilization and disability are well known in the civilian sector. We hypothesized that, similarly, combat-related extremity injuries, when compared with other injures from the current conflicts in Iraq and Afghanistan, require the largest percentage of medical resources, account for the greatest number of disabled soldiers, and have greater costs of disability benefits.