Use of Compressive Osseointegration Endoprostheses for Massive Bone Loss From Tumor and Failed Arthroplasty: A Viable Option in the Upper Extremity.

Background: Endoprostheses using principles of compressive osseointegration have shown good survivorship in several studies involving the lower extremity; however, no series to our knowledge have documented the use of this technology in the management of massive bone loss in the upper limb.

Questions/purposes: (1) What proportion of upper extremity implants using compressive osseointegration fixation principles achieved durable short-term fixation, and what were the modes of failure? (2) What surgical complications resulted from reconstruction using this technique?

Methods: A multiinstitutional retrospective review identified nine patients (five women; four men) who underwent 13 endoprosthetic replacements between 2003 and 2014 using compressive osseointegration (Compliant Pre-stress Device [CPS]; Biomet Inc, Warsaw, IN, USA) in the upper extremity, including two proximal humeri, two humeral diaphyses, seven distal humeri, and two proximal ulna. During the early part of that period, the indication for use of a compressive prosthesis in our centers was revision of a previous tumor reconstruction (allograft-prosthetic composite or stemmed endoprosthetic reconstruction) (three patients; five implants), or revision arthroplasty with massive bone loss (three patients, four implants); more recently, indications became somewhat more permissive and included posttraumatic bone loss (one patient, one implant), primary bone sarcoma, and resections with very short remaining end segments after diaphyseal resections (two patients, three implants).

Radioulnar space available at the level of the biceps tuberosity for repaired biceps tendon: a comparison of 4 techniques.

Hypothesis: It is unknown whether certain methods of distal biceps tendon repair lead to an increased propensity of impingement of the repaired tendon. The purpose of this study was to evaluate various repair techniques in a cadaveric model to determine the radioulnar space available for the repaired biceps tendons.

Methods: Nine matched pairs of quartered, fresh-frozen cadaveric arms were transected at the level of the humeral mid shaft and the distal radiocarpal joint.

Reprioritization of research for combat casualty care.

Since the beginning of the conflicts in Iraq and Afghanistan more than a decade ago, much has been learned with regard to combat casualty care. Although progress has been significant, knowledge gaps still exist. The seventh Extremity War Injuries symposium, held in January 2012, reviewed the current state of knowledge and defined knowledge gaps in acute care, reconstructive care, and rehabilitative care in order to provide policymakers information on the areas in which research funding would be the most beneficial.

Orthopaedic outcomes: combat and civilian trauma care.

Important advances have been made in the management of complex trauma through careful scientific analysis of outcomes. Outcomes analysis in combat extremity trauma is exemplified and highlighted by scholarly work in the treatment of catastrophic lower extremity trauma. The success of this line of research in civilian trauma is exemplified by the Lower Extremity Assessment Project (LEAP) study on the outcomes of civilian lower extremity trauma.

Partial allograft replacement of the radial head in the management of complex fracture-dislocations of the elbow.

Background: There have been reports of total radial head allografts showing variable outcomes. This case series reports the novel use of an allograft for partial radial head replacement in the treatment of elbow fracture-dislocation.

Methods: Eight patients underwent partial radial head allograft reconstruction to restore stability for complex fracture-dislocations involving fractures of the coronoid and radial head, with collateral ligament disruption.

Description of a technique for vacuum-assisted deep drains in the management of cavitary defects and deep infections in devastating military and civilian trauma.

Background: Deep soft-tissue defects often present in high-energy trauma and during the surgical treatment of infection. Injuries caused by high-velocity projectiles can create deep soft-tissue defects that are challenging to manage. Persistent, deep wound cavities have been associated with infection and prolonged wound healing.

Isolated avulsion of the medial head of the triceps tendon: an anatomic study and arthroscopic repair in 2 cases.

Purpose: The purpose of this study was to determine the area and characteristics of the triceps tendon footprint on the olecranon, with special attention to the medial head insertion. The secondary goal was to report 2 cases of isolated avulsions of the medial head of the triceps tendon treated successfully with arthroscopic repair.

Methods: Fifteen cadaveric upper extremities were examined to investigate the triceps tendon insertion, and two case reports of an arthroscopic repair technique are described.

Precontoured parallel plate fixation of AO/OTA type C distal humerus fractures.

Objectives: To determine the clinical effectiveness of precontoured parallel plating for the management of Orthopaedic Trauma Association (OTA) type C distal humerus fractures.

Design: Retrospective case series.

Setting: Level I trauma center.

The macroscopic delineation of the edge of the glenoid labrum: an anatomic evaluation of an open and arthroscopic visual reference.

Purpose: Our purpose was to evaluate the distance from the bony edge of the glenoid to the visible (or macroscopic) demarcation at the junction of the labrum and the articular cartilage.

Methods: Ten fresh-frozen cadaveric upper extremity specimens were dissected. The shoulder was disarticulated and periarticular structures were removed, leaving the glenoid with the labrum attached.

Periprosthetic humeral fractures during shoulder arthroplasty.

Background: Currently, there is little information available on the treatment and outcome of intraoperative periprosthetic humeral fractures that occur during shoulder arthroplasty. The purpose of this study was to report on the incidence, treatment, and outcome of, as well as the risk factors for, intraoperative periprosthetic humeral fractures.

Methods: Between 1980 and 2002, forty-five intraoperative periprosthetic humeral fractures occurred during shoulder arthroplasty at our institution.

The anatomy of the deltoid insertion.

Hypothesis: The deltoid muscle is in continuity with the distal arm fascia and musculature.

Materials And Methods: Ten fresh-frozen upper extremity cadaveric specimens were dissected to determine the insertional anatomy of the deltoid muscle. Measurements were made with micro-calipers and acetate grid sheets.

Classification and imaging of proximal humerus fractures.

The decision to operate and the selection of the appropriate surgical modality for proximal humerus fractures are largely based on the fracture pattern. Understanding the particular fracture pattern in each case is complicated. Most well-accepted classification systems were developed based on radiographs complemented by intraoperative findings.

Projection of the glenoid center point within the glenoid vault.

Correct identification of the center point of the glenoid surface guides glenoid component placement. It is unknown whether the center point on the glenoid surface corresponds to the center of the glenoid vault at the medial extent of the glenoid prosthesis. We reviewed 20 consecutive computed tomography scans obtained preoperatively in patients with primary osteoarthritis.

The distal biceps tendon: footprint and relevant clinical anatomy.

Purpose: There is little information in the literature describing the anatomy of the biceps tendon insertion. The purpose of this study was to map the footprint of the biceps tendon insertion on the bicipital tuberosity and to report on the relevant anatomy to assist surgeons with correct tendon orientation during surgical repair.

Methods: Fifteen fresh-frozen adult upper extremities were used in this study.

Acute deep infection after surgical fixation of proximal humeral fractures.

Acute deep infection after open reduction-internal fixation of proximal humeral fractures is uncommon. Currently, there are no reported series on the outcomes of patients treated for infection after surgery for proximal humeral fractures. The purpose of this study was to review the frequency, clinical presentation, bacteriology, treatment, and outcomes of patients with such fractures complicated by acute deep infection.

Deep infection after rotator cuff repair.

Currently, there is little information available concerning the outcome of patients with infection after rotator cuff repair. The purpose of this study was to review retrospectively the incidence, clinical presentation, bacteriology, treatment, and outcomes of patients with rotator cuff repair complicated by deep infection. Between 1975 and 2003, 39 cases of deep infection after rotator cuff repair were identified in 38 patients.

Humeral head replacement for the treatment of osteoarthritis.

Background: Humeral head replacement has been used successfully for the treatment of osteoarthritis of the shoulder for decades. The purpose of this study was to define the results of this form of treatment, the risk factors for an unsatisfactory outcome, and the rates of failure over time.

Methods: Between 1978 and 1997, sixty humeral head replacements were performed at our institution for the treatment of osteoarthritis.

The anconeus flap transolecranon approach to the distal humerus.

The transolecranon approach for the treatment of distal humerus fractures and nonunions is commonly used. A complication of the standard osteotomy is denervation of the anconeus muscle, which provides dynamic stability to the lateral side of the elbow by preventing varus and posterolateral rotatory instability. This article describes the anconeus flap transolecranon (AFT) approach, which utilizes an internervous plane to preserve the anconeus muscle and a chevron-shaped osteotomy for maximal joint exposure.