Elbow synovium as the initial site of colon adenocarcinoma metastasis: diagnosis by arthroscopic biopsy.

An acutely painful and swollen isolated joint has a broad differential. We present the case of an elderly male with four-month progressive, painful swelling of the right elbow. After an initial workup for inflammatory arthropathies was nondiagnostic and a trial of conservative management failed to relieve his pain, a diagnostic arthroscopy was performed.

Psoas impingement causing labrum tear: a series from three tertiary hip arthroscopy centers.

Background: The term hip impingement is usually associated with psoas impingement after arthroplasty or femoroacetabular impingement (FAI). A recently, less commonly described mechanism of impingement and labrum pathology is the psoas tendon applying pressure to the acetabular labrum more medial to the typical FAI labrum lesion. Much is still unkown about the anatomy, pathology, and treatment of this entity.

Human cartilage repair with a photoreactive adhesive-hydrogel composite.

Surgical options for cartilage resurfacing may be significantly improved by advances and application of biomaterials that direct tissue repair. A poly(ethylene glycol) diacrylate (PEGDA) hydrogel was designed to support cartilage matrix production, with easy surgical application. A model in vitro system demonstrated deposition of cartilage-specific extracellular matrix in the hydrogel biomaterial and stimulation of adjacent cartilage tissue development by mesenchymal stem cells.

Abdominal fluid extravasation during hip arthroscopy.

Hip arthroscopy has gained popularity in recent years as an alternative to open treatment for several conditions including bursitis, acetabular labral tears, synovitis, arthritis, extraction of loose bodies, and femoroacetabular impingement. Complications during hip arthroscopy are rare in the current literature, but reports include venous thromboembolism, peripheral nerve injury, septic arthritis, instrument failure, and various problems associated with joint traction. Extravasation of fluid into the abdomen during hip arthroscopy is another rare but known complication.

Improvement in documentation of compartment syndrome with a chart insert.

To improve documentation of compartment syndrome, an educational program was instituted and a chart insert consisting of a preprinted checklist of history and physical examination parameters for at-risk patients was created. From October 2004 to May 2005, a total of 45 consecutive at-risk patients were identified. Progress notes were divided into group 1 (educational program alone) and group 2 (educational program and checklist).

Type III acromioclavicular separation: rationale for anatomical reconstruction.

Treatment of acute type III acromioclavicular separation is controversial. In some patients, nonoperative treatment is associated with pain, weakness, and stiffness. Many acromioclavicular joint reconstructions are associated with complications and results not substantially better than those of nonoperative treatment.

Treatment of osteoarthritis of the knee with microfracture and rehabilitation.

Microfracture is a single stage arthroscopic procedure that can be used in conjunction with other arthroscopic treatments for the treatment of osteoarthritis of the knee. It has a well-documented and successful track record and when used with the appropriate rehabilitation techniques can be very effective for pain relief and functional improvement. It has proven clinical benefit and is our technique of choice for the initial surgical treatment of osteoarthritis.

Assessment of tissue repair in full thickness chondral defects in the rabbit using magnetic resonance imaging transverse relaxation measurements.

The purpose of this study was to determine if the noninvasive and nondestructive technique of magnetic resonance imaging could be used to quantify the amount of repair tissue that fills surgically-induced chondral defects in the rabbit. Sixteen 4-mm diameter full-thickness chondral defects were created. A photopolymerizable hydrogel was used to seal the defects as a treatment modality.

Posterior only versus combined anterior and posterior approaches to lumbar scoliosis in adults: a radiographic analysis.

Study Design: Retrospective study.

Objective: To compare the radiographic lumbar curve correction between a posterior only and combined anterior-posterior approach in patients with adult spinal deformity.

Summary Of Background Data: In adolescent idiopathic scoliosis correction, posterior only has been compared with the combined anterior-posterior approach; however, there have been no corollary studies in adult scoliosis.

Multifunctional chondroitin sulphate for cartilage tissue-biomaterial integration.

A biologically active, high-strength tissue adhesive is needed for numerous medical applications in tissue engineering and regenerative medicine. Integration of biomaterials or implants with surrounding native tissue is crucial for both immediate functionality and long-term performance of the tissue. Here, we use the biopolymer chondroitin sulphate (CS), one of the major components of cartilage extracellular matrix, to develop a novel bioadhesive that is readily applied and acts quickly.

Tip of the trade: a method of splinting for surgeons.

Mallet fingers are difficult to treat, especially in surgeons, who need to sterilize their hands continuously and who have constant strains placed on their fingers. We successfully treated a nondominant, fifth-digit, nonbony mallet finger in a surgical resident with a splint method composed of a bent, semitubular, small-fragment plate and Steri-strips (3-M, St. Paul, MN).

Spinal fusion after revision surgery for pseudarthrosis in adult scoliosis.

Study Design: A retrospective study. OBJECTIVE.: To decipher the incidence, characteristics, functional outcomes, and complications of spinal fusion after revision surgery for recurrent pseudarthrosis in adult patients with scoliosis.

Compartment syndrome: time from diagnosis to fasciotomy.

A definitive safe time to fasciotomy for compartment syndrome has not been established. Therefore, the records of 28 patients who had a fasciotomy for compartment syndrome at two trauma centers (18 level I, 10 level II) were reviewed to determine time from diagnosis to fasciotomy and clinical outcome. Average times at the two trauma centers (level I: 160 minutes, range, 50-315 minutes; level II: 105 minutes, range, 51-185 minutes) were significantly different.

Documentation of acute compartment syndrome at an academic health-care center.

Background: Documentation of the clinical course of a compartment syndrome is critical to effective treatment; however, such documentation often is found to be inadequate.

Methods: Notes and consent forms for thirty consecutive patients with adequate follow-up who had undergone fasciotomy for the treatment of compartment syndrome were reviewed for legibility, notation of the time and date, and documentation of the presence of core physical examination and history findings, including pain, paresthesias, tenseness, pain on passive stretch, sensory deficit, motor deficit, pulses, compartment pressures, and diastolic blood pressure.

Results: Documentation was inadequate for twenty-one patients (70%): the notes and consent forms were not timed or not dated (or both) for nine patients (30%), and the notes were at least partially illegible for sixteen patients (53%).

Resection and reconstruction of a massive femoral hemophilic pseudotumor.

Hemophilic pseudotumor is a rare, but well-known, complication of hemophilia. We describe a 50-year-old man with mild hemophilia A, but with no previous need for Factor VIII supplementation, who presented with a pathologic fracture of the right femoral neck and shaft caused by a large hemophilic pseudotumor. Initial nonoperative therapy with factor replacement and skeletal traction resulted in radiographic evidence of fracture healing, but the patient's pain persisted.

Return to play after anterior cruciate ligament reconstruction.

The goal of knee ligament reconstruction is to return the athlete to the previous level of function as quickly and as safely as possible. The appropriate level of aggressiveness in returning the athlete to sport remains controversial. Information in the literature regarding safe return to play has been dominated by the anterior cruciate ligament (ACL) reconstruction literature.

A mechanical comparison and review of transverse, step-cut, and sigmoid osteotomies.

Successful incorporation of massive allografts for the treatment of bone deficiency demands maximizing biologic and mechanical factors. These factors have yet to be mastered, as evidenced by the 8% to 17% nonunion and the 5% to 20% fracture rate. The current study addresses the allograft incorporation process by examining the three construct geometries: transverse, step-cut, and sigmoid.