Elective Shoulder Surgery in the Opioid Naïve: Rates of and Risk Factors for Long-term Postoperative Opioid Use.

Background: Little is known regarding the rates and risk factors for long-term postoperative opioid use among opioid-naïve patients undergoing elective shoulder surgery.

Purpose: To identify (1) the proportion of opioid-naïve patients undergoing elective shoulder surgery, (2) the rates of postoperative opioid use among these patients, and (3) the risk factors associated with long-term postoperative opioid use.

Study Design: Cohort study; Level of evidence, 3.

The frequency and risk factors for subsequent surgery after a simple elbow dislocation.

Introduction: Simple elbow dislocations treated by closed reduction are thought to result in a satisfactory return of function in most patients. Little, however, is known about how many patients ultimately proceed to subsequent surgical treatment due to the low patient numbers and significant loss to follow-up in the current literature. The purpose of this study was to establish the rate of and risk factors for subsequent surgical treatment after closed reduction of a simple elbow dislocation at a population level.

The application of wearable technology in surgery: ensuring the positive impact of the wearable revolution on surgical patients.

Wearable technology has become an important trend in consumer electronics in the past year. The miniaturization and mass production of myriad sensors have made possible the integration of sensors and output devices in wearable platforms. Despite the consumer focus of the wearable revolution some surgical applications are being developed.

Total elbow arthroplasty in obese patients.

Background: The prevalence of obesity in the United States has increased in recent decades. The aim of this study was to evaluate the influence of obesity in patients undergoing primary total elbow arthroplasty.

Methods: From 1987 to 2006, 723 primary semiconstrained, linked total elbow arthroplasties were performed in 654 patients.

Factors that influence the choice to undergo surgery for shoulder and elbow conditions.

Background: Knowledge of the factors that influence the willingness of patients considering elective orthopaedic surgery is essential for patient-centered care. To date, however, these factors remain undefined in the orthopaedic population with shoulder and elbow disorders.

Questions/purposes: In a cohort of patients seeking surgical consultation for shoulder or elbow conditions, we sought to identify factors that influenced the willingness and decision to undergo surgery.

Use of fresh osteochondral glenoid allograft to treat posteroinferior bone loss in chronic posterior shoulder instability.

We report our experience with the use of fresh glenoid osteochondral allograft in the treatment of a chronic posttraumatic posterior subluxation of the shoulder associated with glenoid bone loss in a 54-year-old recreational football player. Based on the pathoanatomy of the lesion and availability of a bone bank providing fresh allograft, we opted for an open anatomic reconstruction using a fresh glenoid allograft. A posterior approach was used; the prepared allograft was placed in the appropriate anatomic position and fixed with 2 small fragment screws with washers.

Reconstruction of the proximal humerus for bone neoplasm using an anatomic prosthesis-bone graft composite.

This study assesses function after limb sparing bone tumour resections of the proximal humerus. Twenty-seven patients had an intraarticular resection with reconstruction using an anatomic prosthesis-bone graft composite with average clinical follow-up of 63 years (range: 13-15.8 years).

Survivorship of the humeral component in shoulder arthroplasty.

Background: Loosening of the humeral component is rarely a cause for revision. This study was conducted to determine long-term survivorship of humeral components and investigate the risk factors associated with humeral component removal or revision.

Materials And Methods: From 1984 to 2004, 1423 patients underwent 1584 primary Neer and Cofield shoulder arthroplasties.

Drilling sounds are used by surgeons and intermediate residents, but not novice orthopedic trainees, to guide drilling motions.

Background: The purpose of our study was to investigate the impact of distracting noise on the performance on a simulated orthopedic bone drilling skill when that noise blocks routine auditory feedback associated with the sounds of the drill.

Methods: Medical students (n=11), intermediate residents (postgraduate years 3-5, n=10) and surgeons (n=8) each drilled 20 bicortical holes in a femur bone from a lamb: 10 holes without and 10 holes with the presence of distracting noise. We quantified surgical outcome in the form of plunge depth using computer-assisted objective methods.

A multicenter, prospective, randomized, controlled trial of open reduction--internal fixation versus total elbow arthroplasty for displaced intra-articular distal humeral fractures in elderly patients.

We conducted a prospective, randomized, controlled trial to compare functional outcomes, complications, and reoperation rates in elderly patients with displaced intra-articular, distal humeral fractures treated with open reduction-internal fixation (ORIF) or primary semiconstrained total elbow arthroplasty (TEA). Forty-two patients were randomized by sealed envelope. Inclusion criteria were age greater than 65 years; displaced, comminuted, intra-articular fractures of the distal humerus (Orthopaedic Trauma Association type 13C); and closed or Gustilo grade I open fractures treated within 12 hours of injury.

Linked elbow replacement: a salvage procedure for distal humeral nonunion.

Background: Nonunion is a challenging and not uncommon complication of distal humeral fractures. Our long-term experience with linked semiconstrained total elbow arthroplasty as a salvage procedure for patients with distal humeral nonunion not amenable to internal fixation was investigated.

Methods: Ninety-one consecutive patients (ninety-two elbows) underwent total elbow arthroplasty for the treatment of a distal humeral nonunion, and the results were reviewed at a mean of 6.

Olecranon fractures.

Approximately 10% of fractures about the adult elbow consist of fractures of the olecranon process of the ulna and range from simple nondisplaced fractures to complex fracture-dislocations of the elbow. Several treatment options for internal fixation have been described, including tension-band wiring, plate fixation, intramedullary screw fixation, and triceps advancement after fragment excision. The method of internal fixation is chosen based primarily on fracture type.

Growth factors--BMPs, DBMs, and buffy coat products: are there any proven differences amongst them?

Advances in the understanding of bone repair and improved biotechnology have led to the introduction of new strategies for orthopedic surgeons to control and modulate bone healing using growth factors. However, many orthopedic surgeons are uncertain about the current levels of evidence supporting the use of materials that possess these properties and their therapeutic role in the management of skeletal problems such as fracture, long-bone nonunion, and spine fusion. In particular, the differences amongst osteoinductive factors synthesized by recombinant gene technology, or derived from demineralized bone matrix or platelet rich plasma requires clarification.

Survivorship analysis and radiographic outcome following tantalum rod insertion for osteonecrosis of the femoral head.

Background: For early stages of osteonecrosis, preservation of the femoral head is the primary objective; however, there has not been a consensus on how best to achieve this goal. Core decompression alone is associated with a lack of structural support with inconsistent outcomes, whereas vascularized fibular grafting requires an extensive surgical procedure with high donor-site morbidity and prolonged rehabilitation. The adjunctive use of a porous tantalum implant offers the advantages of core decompression, structural support, minimally invasive surgery, and no donor-site morbidity.