Rheumatoid arthritis is associated with higher 90-day systemic complications compared to osteoarthritis after total shoulder arthroplasty: a cohort study.

Background: Total shoulder arthroplasty (TSA) in patients with rheumatoid arthritis (RA) can present unique challenges. The aim of this study was to compare both systemic and joint-related postoperative complications in patients undergoing primary TSA with RA versus those with primary osteoarthritis (OA).

Methods: Using the TriNetX database, Current Procedural Terminology and International Classification of Diseases, 10th edition codes were used to identify patients who underwent primary TSA.

Patients With Mild Osteoarthritis Are Less Likely to Achieve a Clinically Important Improvement in Pain or Function After Anatomic Total Shoulder Arthroplasty.

Background: The severity of glenohumeral osteoarthritis (OA) as demonstrated by preoperative radiographs and patient-reported pain plays an important role in the indication for anatomic total shoulder arthroplasty (aTSA). In hip and knee research, data about the effect of the severity of preoperative radiographic OA on the outcome of total joint arthroplasty have been mixed. For shoulder replacement, we are unsure of the effects of radiographic severity on outcomes.

Establishing maximal medical improvement following aseptic revision of shoulder arthroplasty.

Background: Shoulder arthroplasty surgery volume continues to increase yearly. As the prevalence of shoulder replacement continues to rise, there will be a growing number of revision surgeries performed for a variety of indications. Understanding patient outcomes and recovery time following these procedures is critical, particularly as it relates to revision surgery, which generally has worse outcomes and longevity than primary arthroplasty.

Postoperative stiffness after reverse total shoulder arthroplasty.

Purpose: The purpose of this study was to evaluate the rate and risk factors for stiffness after reverse shoulder arthroplasty and the ramifications on the patient-reported outcomes.

Method: A consecutive series of patients who underwent reverse shoulder arthroplasty were prospectively followed for one year. Passive range of motion was measured preoperatively and at regular intervals postoperatively.

Preoperative Single Assessment Numeric Evaluation Score Predicts Poor Outcomes After Reverse Shoulder Arthroplasty for Massive Rotator Cuff Tears Without Arthritis.

Limited clinical evidence is available to help to predict poor outcomes after reverse shoulder arthroplasty (RSA) among patients with massive rotator cuff tears without glenohumeral arthritis. A retrospective case-control study was performed for patients who underwent RSA for massive rotator cuff tear without glenohumeral arthritis (Hamada score ≤3) and had a minimum of 2 years of follow-up. Preoperative risk factors for poor outcomes were subsequently analyzed.

Modified Weaver-Dunn Technique Using Transosseous Bone Tunnels and Coracoid Suture Augmentation.

Introduction: A modified Weaver-Dunn procedure for the management of acromioclavicular joint injuries that uses transosseous bone tunnels and coracoid suture augmentation is described with associated clinical results.

Methods: A retrospective review of 39 consecutive patients who underwent a primary mWD procedure by a single surgeon from January 2013 to July 2019 was conducted. Patient charts and radiographs were reviewed for clinical course, complications and management, and radiographic evaluation.

Radiographic Severity May Not be Associated with Pain and Function in Glenohumeral Arthritis.

Background: Despite the routine use of plain radiographs to stratify the severity of glenohumeral osteoarthritis, little is known about the relationship between radiographic measures and patient-perceived pain and function.

Questions/purposes: (1) What radiographic findings are associated with worse pain and function in patients with glenohumeral osteoarthritis? (2) What demographic factors are associated with worse pain and function in patients with glenohumeral osteoarthritis?

Methods: This retrospective study included patients presenting for an initial office visit for primary glenohumeral osteoarthritis. Patients with other concurrent shoulder pathologic findings, prior surgery, lack of pain and functional scores, recent injection, or inadequate radiographs were excluded.

Is There a Critical Radiographic Angle That Portends Poor Functional Outcome Scores in Nonoperative Treatment of Isolated Humeral Shaft Fractures?

Our purpose was to evaluate radiographic alignment of nonoperatively treated humerus fractures and determine if there is a critical angle associated with worse outcomes. All patients with humeral shaft fractures that were prospectively followed as part of a larger multicenter trial were reviewed. These patients were selected for nonoperative management based on shared decision making.

Structures Endangered During Minimally Invasive Plate Osteosynthesis of the Upper Extremity.

Minimally invasive plate osteosynthesis is a surgical technique that is becoming increasingly common because radiographic images and implant technologies advance in capabilities. It is imperative for surgeons to enhance their understanding of the surgical anatomy related to new approaches for fracture fixation. While performing minimally invasive plate osteosynthesis, there is a danger of injuring structures in the common percutaneous and submuscular pathways.

Outcomes of rotator cuff repair with concurrent microfracture of focal glenohumeral osteoarthritis.

Background: The benefit of rotator cuff repair (RCR) in patients with concurrent osteoarthritic changes remains unclear. RCR has the theoretical potential to increase the compressive force across the glenohumeral joint, further exacerbating osteoarthritis pain. The purpose of this study is to investigate pain relief and patient-reported outcomes of patients undergoing simultaneous RCR and microfracture of focal glenohumeral osteoarthritis.

Three-dimensional measures of posterior bone loss and retroversion in Walch B2 glenoids predict the need for an augmented anatomic glenoid component.

Hypothesis: The purpose of this study is to evaluate whether the amount of measured posterior bone loss on 2- and 3-dimensional (2D and 3D) imaging of Walch B2 glenoids can reliably predict the plan for an augmented anatomic glenoid component.

Methods: Patients with Walch B2 glenoids and preoperative computed tomography (CT) scans were retrospectively identified. 2D axial CT scans were reviewed and posterior bone loss was measured by 3 independent reviewers.

Bone density of first and second segments of normal and dysmorphic sacra.

Background: Iliosacral screw fixation is safe and effective but can be complicated by loss of fixation, particularly in patients with osteopenic bone. Sacral morphology dictates where iliosacral screws may be placed when stabilizing pelvic ring injuries. In dysmorphic sacra, the safe osseous corridor of the upper sacral segment (S1) is smaller and lacks a transsacral corridor, increasing the need for fixation in the second sacral segment (S2).

A Survey of High- and Low-Energy Acetabular Fractures in Elderly Patients.

Introduction: Geriatric patients represent 14% of acetabular fractures and are the fastest growing subset of patients affected by this injury in the US. Treatment outcomes have been reported as inferior to those achieved in younger patients after high-energy (HE) acetabular trauma. This study aimed to compare detailed demographic characteristics and clinical outcomes in elderly patients (≥65 years of age) treated in a tertiary North American trauma center for acetabular fractures after both high- and low-energy mechanisms of injury.

Hoffa Fragments in the Geriatric Distal Femur Fracture: Myth or Reality?

Background: Previous research reported the frequency of coronal plane (Hoffa) fractures in high-energy supracondylar femur fractures in a relatively young population. It is the purpose of this study to identify the frequency of coronal plane fractures seen in elderly patients.

Methods: All patients over the age of 18 years treated for supracondylar femur fractures at 2 level I trauma centers were reviewed over a 4-year period.

Comparing Different Surgical Techniques for Addressing the Posterior Malleolus in Supination External Rotation Ankle Fractures and the Need for Syndesmotic Screw Fixation.

Trimalleolar ankle fractures are unstable injuries with possible syndesmotic disruption. Recent data have described inherent morbidity associated with screw fixation of the syndesmosis, including the potential for malreduction, hardware irritation, and post-traumatic arthritis. The posterior malleolus is an important soft tissue attachment for the posterior inferior syndesmosis ligament.

A Patient Follow-up Program for Short-Term Surgical Mission Trips to a Developing Country.

Background: We describe a follow-up program for patients undergoing surgical procedures with documented results from short-term surgical mission trips to the developing world. The surgical procedures were all performed at a government hospital in Pucallpa, Peru, a remote city in the Amazon.

Methods: Between July 2007 and January 2012, ten surgical mission trips were completed with a mean time of six days on location and a mean number of 2.

Orthopedic Residency: Are Duty Hours Predictive of Performance?

Objective: This study examines the relationship between self-recorded resident work hours and Orthopedic In-training Examination (OITE) scores, resident clinical performance, and American Board of Orthopedic Surgery pass rates. The hypothesis of this study is that increasing duty hours would have a positive correlation with clinical and OITE performance.

Design: Total duty hours and recorded operating room hours from a single orthopedic residency program were extracted from 2006 to 2012.

Dorsal Screw Penetration With the Use of Volar Plating of Distal Radius Fractures: How Can You Best Detect?

Objectives: To evaluate the most vulnerable position at which volar plate screws may penetrate the dorsal cortex of the radius and to determine which specific intraoperative fluoroscopic images (lateral, 45 degrees supination, 45 degrees pronation, and dorsal tangential) are most useful to detect dorsal cortex penetration.

Methods: Four 2.5-mm locking screws were inserted distally using 18-, 20-, or 22-mm screws in 7 cadaveric specimens apiece.

Osteoporotic Hip and Spine Fractures: A Current Review.

Hip and spine fractures represent just a portion of the burden of osteoporosis; however, these fractures require treatment and often represent a major change in lifestyle for the patient and their family. The orthopedic surgeon plays a crucial role, not only in the treatment of these injuries but also providing guidance in prevention of future osteoporotic fractures. This review provides a brief epidemiology of the fractures, details the surgical techniques, and outlines the current treatment guidelines for orthopedic surgeons.

"The Skiver Screw": A Useful Fixation Technique for Iliac Wing Fractures.

The contour of the ilium is curved and the iliac fossa is thin, making adequate fixation for fractures involving the iliac wing challenging to achieve at times. The purpose of this article is to describe a previously unreported technique for enhancing fixation in iliac fractures using simple cortical screws.

Outcomes after operative management of symptomatic rib nonunion.

Objective: To report the outcomes of rib reconstruction after painful nonunion.

Design: Retrospective case series.

Setting: Level I trauma center.

Minimally Invasive Plate Osteosynthesis (MIPO) of Periprosthetic Femoral Fractures with Percutaneous Cerclage Wiring for Fracture Reduction: Tips and Technique.

Introduction: We describe percutaneous cerclage wiring and minimally invasive plate osteosynthesis (MIPO) for periprosthetic femoral shaft fractures.

Step 1 Preoperative Planning And Assessment Of The Length Alignment And Rotation Of The Extremity: A well-developed preoperative plan and assessment of the length, alignment, and rotation of the extremity are critical.

Step 2 Prepare The Tunnel: After making the appropriate incision, use the tunneling device anterior and posterior to the femur to create a soft-tissue tunnel.

Clinical and functional outcomes after operative management of Salter-Harris III and IV fractures of the proximal tibial epiphysis.

Pediatric proximal tibial epiphysis fractures are uncommon and have subsequently received little attention in terms of treatment and outcomes. We studied the clinical and functional outcomes of 13 patients with Salter-Harris III and IV fractures of the proximal tibial epiphysis after operative fixation. Associated meniscus, ligamentous, or neurovascular injury was present in 100% of this cohort.