The age specific performance of elbow hemiarthroplasty: A systematic review.

Background: Compared to total elbow arthroplasty, elbow hemiarthroplasty (EHA) does not have an ulnar component or a hinge/link which eliminates complication risk due to polyethylene wear and ulnar loosening. There are notable gaps in the existing EHA literature. Patient age is often identified as an important determinant when deciding to treat with EHA; however, there is limited age-based evidence.

Evaluation of the Distal Extent of Visualization Using Volar Approaches for Fixation of Distal Radius Fractures.

Purpose: Distal radius fractures may include difficult-to-treat fractures of the volar ulnar corner, colloquially termed as the "critical corner." These fragments are problematic because they are often missed, and their fixation is difficult. We aimed to compare the distal extent of the exposure of the volar surface of the distal radius between the classic Henry approach and the extended flexor carpi radialis (EFCR) approach.

The performance of cruciate-retaining implants for primary total knee arthroplasty in valgus deformed knees: A systematic review.

Background: Valgus deformity of the knee comprises upwards of 15 % of the deformities in primary total knee arthroplasty (TKA) patients. 1,2 The two implants most commonly used in valgus deformed knees are posterior stabilizing (PS) and cruciate-retaining (CR) implants. CR implants may offer a more advantageous construct due to the retention of the PCL for proprioception and less bony resection compared to PS implants.

Body Mass Index is Not an Appropriate Proxy for the Condition of Peri-Incisional Adiposity in Primary Total Joint Arthroplasty Patients.

Background: The American Academy of Orthopaedic Surgeons defined the acceptable threshold for elective safe surgery as a body mass index (BMI) under 40 due to the increased risk of complications. A consequence of this recommendation has been a hard cutoff based on BMI, which restricts access to care for an increasingly large and diverse population. There is an improved understanding that excess adipose tissue confers additional risk for postoperative complications, including infection, through mechanical and physiologic mechanisms.

Intramedullary Nail Fixation for Metacarpal Fracture: A Case Report and Review of the Clinical and Biomechanical Evidence.

We present two cases of complex metacarpal fractures treated with an intramedullary locking nail. This is an emerging fixation method that minimizes tissue insult, provides sufficient stability, and allows early mobilization. Locking nails accommodate the capture of fractured fragments in complex unstable patterns and provide longitudinal and rotational stability.

Dual-mobility with modular components for primary total hip arthroplasty in bilateral bony ankylosis of the hips: A case report.

Introduction And Importance: Primary total hip arthroplasty (THA) is a procedure performed in the United States for a variety of indications, with operation rates slated to increase over 275 % by 2040 when compared to 2014 (Thilak et al., 2015). Dual-mobility (DM) implants have gained popularity in the United States since gaining approval in the early 2010s (Heckmann et al.

Reverse Essex-Lopresti and Other Forms of Longitudinal Forearm Instability.

Longitudinal forearm instability is a consequence of interosseous ligament complex disruption. Radiographic identifiers should alert the surgeon to the disrupted structures. Understanding the injury pattern can simplify the treatment process.

The Essex-Lopresti Injury.

The classic Essex-Lopresti injury (ELI) pattern is a radial head fracture and disruption of the central band, which compromises the longitudinal radioulnar relationship. Delayed recognition and inappropriate treatment of ELI can be devasting to a patient's function. The recent literature has demonstrated an improved understanding of the mechanism of ELI.

Distal Radioulnar Joint Instability.

The distal radioulnar joint (DRUJ) is vital to the stability and function of the wrist and forearm. The osseous morphology is variable and provides little stability. A complex of confluent soft tissues is the primary stabilizer; however, the contribution of each component has yet to be elucidated.

Characterizations of Capsule Closure in Hip Arthroscopy Are Infrequently and Incompletely Reported: A Systematic Review.

Purpose: To review the recent literature to provide an updated characterization of capsule closure techniques in hip arthroscopy and to determine if the characteristics of closure impacted clinical outcomes.

Methods: In keeping with the Preferred Reporting in Systematic Reviews and Meta Analyses (PRISMA) guidelines, a systematic review was performed with the following eligibility criteria: patients over 18 years of age who underwent primary hip arthroscopy with reporting of patient reported outcome measures or revision/failure, and a sufficiently detailed description of capsule closure. The GRADE framework evaluated study quality, and ROBINS-I evaluated the risk of bias.

Clinical outcomes for linked fixation of distal humerus fractures: a multicenter study.

Background: O'Driscoll popularized the principle of linked column fixation for distal humerus fractures. Despite the linked column concept being widely accepted, there are few reported techniques to accomplish this goal. A novel device was designed based on the principles of linked columns.

Internal Joint Stabilization for Recurrent Nontraumatic Elbow Dislocation in a Skeletally Immature Patient.

Case: A 14-year-old adolescent boy with SCN1B mutation experienced frequent seizures and recurrent elbow dislocation, occurring up to 30 times per day. Following failed conservative treatment, the decision was made to surgically repair the lateral collateral ligament complex and stabilize the elbow with the internal joint stabilizer (IJS). At more than 3 years postoperatively, the patient has not had a dislocation event and will retain the device for the foreseeable future to maintain predictable elbow stability.

Addressing the Central Band in Acute and Chronic Essex-Lopresti Injury: A Case Report and Technique Description.

Case: A 34-year-old man was acutely treated with radial head arthroplasty and central band repair following Essex-Lopresti injury. A 38-year-old man presented with chronic longitudinal instability following failed radial head arthroplasty, which was performed for failed fixation. Treatment with revision radial head arthroplasty and central band reconstruction restored longitudinal stability.

Comparing internal and external stabilization for traumatic elbow instability: a systematic review.

Background: Despite surgical reestablishment of the supporting structures, instability may often persist in traumatic elbow injury. In these cases, a temporary internal or external fixator may be indicated to unload the repaired structures and maintain joint concentricity. Aggregate data are needed to characterize the risk of complication between external fixation (ExFix) and the internal joint stabilizer (IJS) when used for traumatic elbow instability.

The impact of anatomic alignment on radiocapitellar pressure following radial head arthroplasty.

Background: The incidence of radial head fractures is increasing, and radial head arthroplasty (RHA) is being more frequently used as treatment for irreparable fractures. Our objective was to compare radiocapitellar pressure between the native joint and 2 radial head prosthesis conditions: (1) a prosthetic head that was aligned to the forearm axis of rotation and (2) the same prosthesis with an axisymmetric nonaligned head.

Methods: Ten cadaveric specimens received a pressfit radial head prosthesis (Align; Skeletal Dynamics) for both prosthetic testing conditions.

The Contribution of the Distal Oblique Band to Distal Radioulnar Joint Stability.

Purpose: The distal radioulnar joint (DRUJ) is supported by an array of dynamic and static stabilizers, of which the triangular fibrocartilage complex (TFCC) is the most important, and the distal interosseous ligament is next in importance. The distal oblique band (DOB) is an identifiable component of the distal interosseous ligament, found in a subset of the population. Our objective was to determine the contribution of the DOB to DRUJ stability in the presence of a disrupted TFCC.

The Internal Joint Stabilizer of the Elbow: A Systematic Review of the Clinical and Biomechanical Evidence.

Purpose: The goal of surgical management for unstable elbow injuries is the restoration of joint concentricity and stability. After internal fixation, concerns may exist regarding instability or durability of the fixation construct. Historically, these scenarios were treated with options such as transarticular pinning or external fixation.

Consideration for Limb Salvage in Place of Amputation in Complex Tibial Fracture With Neurovascular Injury: A Case Report.

High-energy tibial fractures often present with associated soft tissue injuries, including neuro-vascular damage, complicating the treatment decision. A 33-year-old male presented with Gustilo Anderson type IIIA fracture of the left distal tibia and fibula with associated closed calcaneus fracture and tibial nerve transection. Amputation was discussed, but the decision was made for limb salvage with nerve allograft.

The Performance of Primary Dual-Mobility Total Hip Arthroplasty in Patients Aged 55 Years and Younger: A Systematic Review.

Background: Dual-mobility (DM) total hip arthroplasty (THA) combines the stabilization advantage provided by large head articulation with the low friction advantage provided by small head articulation. There is momentum for DM to be used in a wider selection of patients, with some advocating for DM to be the routine primary total hip construct. Further investigation is needed to determine whether the use of DM in younger adults is validated by aggregate data.

Local adiposity may be a more reliable predictor for infection than body mass index following total knee arthroplasty: a systematic review.

Purpose: Improved understanding of the factors that predispose TKA patients to infection has considerable economic and medical impact. BMI is commonly used as a proxy for obesity to determine the risk of postoperative infection. However, this metric appears to be fraught with inconsistency in this application.

A Dual Center Experience with a Locking Intramedullary Nail for Wrist Fusion.

 In aggregate, there is varied efficacy for total wrist fusion (TWF) with a locking intramedullary (IM) nail which indicates the need for further investigation. It remains unclear whether preparation of the third carpometacarpal joint (CMCJ) will reduce the risk of complications including distal screw loosening.  Our objectives were (a) to report clinical outcomes for wrist arthrodesis using a locking IM nail and (b) to determine whether maintenance of the native third CMCJ articulation would contribute to short-term complications.