Variable Efficacy of Tranexamic Acid in Geriatric Hip Fractures Treated With Arthroplasty Versus Cephalomedullary Nails.

Introduction: Geriatric hip fractures are associated with high rates of disability and mortality. Many of these patients require perioperative and postoperative allogeneic blood transfusions, which carry several noteworthy risks. A growing body of literature supports the efficacy of tranexamic acid (TXA) in geriatric hip fractures, without sufficient data examining which subgroups are likely to benefit the most.

The hip fracture assessment tool: A scoring system to assess high risk geriatric hip fracture patients for post-operative critical care monitoring.

Introduction: Intensive care unit risk stratification models have been utilized in elective joint arthroplasty; however, hip fracture patients are fundamentally different in their clinical course. Having a critical care risk calculator utilizing pre-operative risk factors can improve resourcing for hip fracture patients in the peri‑operative period.

Methods: A cohort of geriatric hip fracture patients at a single institution were reviewed over a three-year period.

Bias in Care: Impact of Ethnicity on Time to Emergent Surgery Varies Between Subspecialties.

Introduction: Disparity in access to emergency care among minority groups continues to exist despite growing awareness of the effect of implicit bias on public health. In this study, we evaluated ethnicity-based differences in time between admission and surgery for patients undergoing emergent procedures at hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program.

Methods: We conducted a retrospective review of 249,296 National Surgical Quality Improvement Program cases from 2006 to 2018 involving general, orthopaedic, and vascular surgeries.

Liposomal Bupivacaine Decreases Intravenous Opioid Use in Patients with Hip Fracture: A Modification to a Novel Pain Protocol.

Introduction: The aim of this study was to determine whether the administration of liposomal bupivacaine decreased opioid use and delirium in patients sustaining a hip fracture.

Methods: A retrospective review of patients with hip fracture from September 2018 to October 2019 was performed through our institution's hip fracture registry. A liposomal bupivacaine cocktail was administered intraoperatively.

Linguistic Analysis Identifies Emergent Biomaterial Fabrication Trends for Orthopaedic Applications.

The expanse of publications in tissue engineering (TE) and orthopedic TE (OTE) over the past 20 years presents an opportunity to probe emergent trends in the field to better guide future technologies that can make an impact on musculoskeletal therapies. Leveraging this trove of knowledge, a hierarchical systematic search method and trend analysis using connected network mapping of key terms is developed. Within discrete time intervals, an accelerated publication rate for anatomic orthopedic tissue engineering (AOTE) of osteochondral defects, tendons, menisci, and entheses is identified.

Case report: vertebral body tethering for idiopathic scoliosis in a patient with bilateral phocomelia.

Purpose: The purpose of this study is to present a case report of a patient with bilateral upper extremity phocomelia with progressive scoliosis, who underwent vertebral body tethering (VBT).

Methods: This is a case report on the use of VBT in a patient with scoliosis and bilateral congenital phocomelia, with 5 year follow-up.

Results: A male patient with bilateral phocomelia had early onset scoliosis that progressed to 45° at age 10.

Nonsurgical treatment reduces tendon inflammation and elevates tendon markers in early healing.

Operative treatment is assumed to provide superior outcomes to nonoperative (conservative) treatment following Achilles tendon rupture, however, this remains controversial. This study explores the effect of surgical repair on Achilles tendon healing. Rat Achilles tendons (n = 101) were bluntly transected and were randomized into groups receiving repair or non-repair treatments.

Return to Play for Cervical and Lumbar Spine Conditions.

Although the safety of contact sports has improved over the years, participation in any sport always carries a risk of injury. When cervical or lumbar spine injuries do occur, prompt diagnosis is essential, and athletes must be held out of the sport if indicated to prevent further harm and allow for recovery. This article highlights some of the most common cervical spine pathologies (stinger/burners, strain, stenosis/cord neuropraxia, disc herniation, and fracture/instability) and lumbar spine pathologies (strain, disc degeneration, disc herniation, fracture, spondylolysis/spondylolisthesis, and scoliosis) encountered in sports and reviews the associated return to play guidelines and expectations for each condition.

The porcine accessory carpal bone as a model for biologic joint replacement for trapeziometacarpal osteoarthritis.

Given its complex shape and relatively small size, the trapezium surface at the trapeziometacarpal (TMC) joint is a particularly attractive target for anatomic biologic joint resurfacing, especially given its propensity to develop osteoarthritis, and the limited and sub-optimal treatment options available. For this to advance to clinical translation, however, an appropriate large animal model is required. In this study, we explored the porcine accessory carpal bone (ACB) as a model for the human trapezium.

Mechanical properties of the different rotator cuff tendons in the rat are similarly and adversely affected by age.

Rotator cuff tendon tears and tendinopathies are common injuries affecting a large portion of the population and can result in pain and joint dysfunction. Incidence of rotator cuff tears significantly increases with advancing age, and up to 90% of these tears involve the supraspinatus. Previous literature has shown that aging can lead to inferior mechanics, altered composition, and changes in structural properties of the supraspinatus.

Fabrication and maturation of integrated biphasic anatomic mesenchymal stromal cell-laden composite scaffolds for osteochondral repair and joint resurfacing.

Articular cartilage injury can lead to joint-wide erosion and the early onset of osteoarthritis. To address this, we recently developed a rapid fabrication method to produce patient-specific engineered cartilage tissues to replace an entire articular surface. Here, we extended that work by coupling a mesenchymal stromal cell-laden hydrogel (methacrylated hyaluronic acid) with the porous polycaprolactone (PCL) bone integrating phase and assessed the composition and mechanical performance of these constructs over time.

The Role of Weightbearing Computed Tomography Scan in Hallux Valgus.

Background: Hyperpronation of the first metatarsal in hallux valgus (HV) is poorly understood by conventional weightbearing radiography. We aimed to evaluate this parameter using weightbearing computed tomography (WBCT) and to understand its association with other standard measurements.

Methods: Retrospective evaluation of WBCT and weightbearing radiographs (WBXRs) was performed for 20 patients with HV feet and 20 controls with no such deformity.

Instability After All-Cause Acetabular-Only Revision Total Hip Arthroplasty Remains a Clinical Problem.

Background: The purpose of this study is to (1) evaluate the rate of instability and reoperation after acetabular component-only revision, (2) compare instability rates across various head sizes, and (3) determine patient factors correlating with postoperative instability.

Methods: We retrospectively reviewed all isolated acetabular component revisions (n = 200) at our institution between 2007 and 2017. Patients with less than one-year follow-up were excluded.

Acetabular reconstruction in revision total hip arthroplasty.

The number of total hip arthroplasty (THA) procedures performed annually continues to rise. Specific challenges, including acetabular bone loss, are commonly encountered at the time of revision surgery, and orthopaedic surgeons must be prepared to address them. This review focuses on topics related to acetabular reconstruction, including pre-operative patient evaluation (clinical and radiographic), pre-operative planning, common causes of acetabular failure, classification of acetabular bone loss, methods of acetabular reconstruction, and clinical results based on reconstruction method.

The Saline Load Test is Effective at Diagnosing Traumatic Arthrotomies of the Shoulder.

The purpose of this study is to evaluate the fluid volume required for a saline load test to detect intra-articular involvement of the glenohumeral joint after penetrating trauma. A human cadaver study was conducted with 22 thawed, fresh-frozen forequarter amputations. A standard posterior shoulder portal was made with an 11-blade scalpel.

The application of the Nice knots as an auxiliary reduction technique in displaced comminuted patellar fractures.

Purpose: To evaluate intraoperative and early postoperative clinical outcomes using the Nice knot as an auxiliary reduction technique in displaced comminuted patellar fractures.

Methods: Thirty-nine patients with unilateral closed displaced comminuted patellar fractures received open reduction and internal fixation (ORIF), utilizing either Nice knot (the NK group, 24 patients) or traditional reduction (the TR group, 23 patients) techniques, were retrospectively reviewed in this study. Intra-operative surgical time and peri-operative hemoglobin were recorded.

Hypoalbuminemia remains an independent predictor of complications following total joint arthroplasty.

Introduction: Hypoalbuminemia (<3.5 mg/dL) is an accepted marker of malnutrition, but it was unknown if low albumin remained an independent predictor of post-operative complications following primary total hip (THA) and knee (TKA) arthroplasty.

Methods: The National Surgical Quality Improvement Program (NSQIP) database was queried for patients undergoing primary THA and TKA.

Chronic Nicotine Exposure Alters Uninjured Tendon Vascularity and Viscoelasticity.

Background: Although nicotine and tobacco use are well established to have adverse health effects, the effects on tendons are less well understood. The purpose of this study was to investigate the effect of chronic nicotine exposure on Achilles tendon (AT) and supraspinatus tendon (SS) physiologic and mechanical properties in a rodent model.

Methods: Sprague-Dawley rats (n = 20) were exposed to either 0.

Effects of immobilization angle on tendon healing after achilles rupture in a rat model.

Conservative (non-operative) treatment of Achilles tendon ruptures is a common alternative to operative treatment. Following rupture, ankle immobilization in plantarflexion is thought to aid healing by restoring tendon end-to-end apposition. However, early activity may improve limb function, challenging the role of immobilization position on tendon healing, as it may affect loading across the injury site.

The Saline Load Test is Effective at Diagnosing Traumatic Arthrotomies of the Wrist.

Background: The saline load test has previously been shown to be an effective tool to diagnose traumatic arthrotomies, but no studies have assessed the test's efficacy in the wrist. The purpose of this study was to investigate the amount of fluid required during a saline load test to detect intra-articular wrist involvement of traumatic wounds with high sensitivity.

Methods: A cadaveric study was conducted using 7 thawed, fresh-frozen forequarter amputations from 7 different donors (3 male, 4 female).

Treatment of Hip Flexion Contractures with Psoas Recession Through the Middle Window of the Ilioinguinal Approach.

Introduction: The ilioinguinal approach for psoas recession over the pelvic brim allows for direct visualization and protection of the femoral nerve while preserving hip flexion strength.

Step 1 Patient Positioning Preoperative Assessment And Draping: With the patient supine and anesthetized, perform the Thomas test, administer antibiotics, and drape to provide access to the inferior aspect of the abdomen, ilioinguinal region, and lower limb.

Step 2 Superficial Dissection: Mark the osseous landmarks, draw a line connecting the anterior superior iliac spine to the pubic tubercle, and make a bikini incision along this line.

Temporal Healing of Achilles Tendons After Injury in Rodents Depends on Surgical Treatment and Activity.

Introduction: Achilles tendon ruptures affect 15 of 100,000 women and 55 of 100,000 men each year. Controversy continues to exist regarding optimal treatment and rehabilitation protocols. The objective of this study was to investigate the temporal effects of surgical repair and immobilization or activity on Achilles tendon healing and limb function after complete transection in rodents.