Morel-Lavallée Lesion Diagnosed by Point-of-Care Ultrasound: A Case Report and Review of Treatment Strategies.

Background: Morel-Lavallée lesions, also known as an internal degloving injuries, occur hours to months after high-speed shearing trauma, usually in the peri-trochanteric region. These are uncommon injuries, and are often missed as part of the trauma examination. Failure to diagnose or treat these lesions may result in complications, such as infected seromas, chronic cosmetic deformities, capsule formation, or skin necrosis.

Performance and return to sport after injury in professional mixed martial arts.

Background: Mixed Martial Arts (MMA) is an increasingly popular combat sport incorporating striking and grappling that results in a high incidence of injuries.

Objectives: The purpose of this study was to analyze the impact of injuries on the return to sport and post-injury performance of professional MMA athletes. We hypothesize that increased age is associated with lower probability of return to sport and diminished post-injury performance.

Ultrasound-Guided Retroclavicular Approach to the Infraclavicular Region (RAPTIR) Anesthesia for Challenging Upper Extremity Reductions.

Background: Upper-extremity injuries are frequently seen in the emergency department (ED), yet traditional analgesic methods are often ineffective (e.g., hematoma blocks) or associated with prolonged ED duration and nontrivial risk (e.

Management of acute urinary retention in the emergency department.

Etiologies of acute urinary retention fall into 4 broad categories: structural, medication/ toxicologic, neurologic, and infectious. Although two-thirds of cases in men are related to prostatomegaly, there is also a high burden of concomitant morbid pathology. Acute urinary retention can also result from trauma, drug toxicity, infection, or compressive or demyelinating neurologic pathology, and these must be ruled out, particularly in women, children, and elderly patients.

A prospective study of the incidence of intracranial hemorrhage in survivors of out of hospital cardiac arrest.

Aim: Intracranial Hemorrhage (ICH) is an important cause of out-of-hospital cardiac arrest (OHCA), yet there are no United States (US), European, or Australian prospective studies examining its incidence in patients who sustained OHCA. This study aims to identify the incidence of ICH in US patients with OHCA who obtain return of spontaneous circulation (ROSC).

Methods: We prospectively analyzed consecutive patients with OHCA who achieved ROSC at a single US hospital over a 15-month period.

Ultrasound-guided analgesic injection for acromioclavicular joint separation in the emergency department.

We present the first documented case of an emergency clinician treating the pain of an acute Acromioclavicular (AC) joint separation through ultrasound (US) guided injection of an anesthetic agent. A 41 year old male presented with an acute traumatic grade III AC joint separation after falling off a scooter, and his pain was not significantly improved with oral medication. The AC joint was located by US, and bupivacaine was injected into the joint effusion under US guidance, yielding near complete resolution of pain.

Concussion management in combat sports: consensus statement from the Association of Ringside Physicians.

Various organisations and experts have published numerous statements and recommendations regarding different aspects of sports-related concussion including definition, presentation, treatment, management and return to play guidelines. To date, there have been no written consensus statements specific for combat sports regarding management of combatants who have suffered a concussion or for return to competition after a concussion. In combat sports, head contact is an objective of the sport itself.

The Thrower's Shoulder.

Overhead athletes subject their shoulders to extreme repetitive torque, compression, distraction, and translation stresses, resulting in adaptive changes of the soft tissues and osseous structures within and around the glenohumeral joint. These anatomic adaptations result in biomechanical enhancements, which improve performance. Understanding the difference between necessary and adaptive changes and pathologic findings is critical when making treatment decisions.

The Weight-Bearing Shoulder.

The shoulder achieves a wide spectrum of motion, and in a subset of patients, including those who use manual wheelchairs and upper extremity walking aids, the shoulder also serves as the primary weight-bearing joint. Because the weight-bearing shoulder is subject to considerable joint reaction forces and overuse, a broad spectrum of pathology can affect the joint. The combination of muscle imbalance and repetitive trauma presents most commonly as subacromial impingement syndrome but can progress to other pathology.

Outcomes After Arthroscopic Bankart Repair: Patients With First-Time Versus Recurrent Dislocations.

Background: The young athletic population makes up the largest portion of shoulder instability and, when treated nonoperatively, has a recurrent dislocation rate as high as 71%. It is unknown how the outcomes of those who have a recurrent dislocation are affected versus those who have a stabilization procedure after a first-time dislocation.

Purpose: To report the postoperative outcomes of patients with first-time dislocations versus patients with recurrent dislocations before surgery.

Discharging Mrs. Fox: A Team-Based Interprofessional Collaborative Standardized Patient Encounter.

Introduction: In 2003, the Institute of Medicine recommended that interprofessional education be incorporated into the training programs of health care professionals. However, many logistical challenges hinder formal interprofessional learning in health care profession programs.

Methods: This resource is a 3-hour interprofessional small-group session designed for health professions student teams to engage in a standardized patient encounter, each team member contributing a profession-specific perspective to create a collaborative care plan across five discharge decisions.

Evaluation of Malassezia and Common Fungal Pathogens in Subtypes of Chronic Rhinosinusitis.

Background: Fungal hypersensitivity and fungal microbiome dysbiosis are possible etiologies of chronic rhinosinusitis. The sinus fungal microbiome is not well characterized; novel sinus-associated fungi, including Malassezia, have only recently been described. The goals for this study were to verify Malassezia as a dominant component of the sinus microbiome, to speciate sinus Malassezia, and to compare select fungal species in chronic rhinosinusitis (CRS) subtypes with known fungal association to chronic rhinosinusitis with polyps (CRSwNP) and healthy controls.

Frequency and complications after operative fixation of clavicular fractures.

Background: The purpose of this study was to analyze whether a recent trend in evidence supporting operative treatment of clavicular fractures is matched with an increase in operative fixation and complication rates in the United States.

Methods: The American Board of Orthopaedic Surgery database was reviewed for cases with Current Procedural Terminology (American Medical Association, Chicago, IL, USA) code 23515 (clavicle open reduction internal fixation [ORIF]) from 1999 to 2010. The procedure rate for each year and the number of procedures for each candidate performing clavicle ORIF were calculated to determine if a change had occurred in the frequency of ORIF for clavicular fractures.

Retrieval analysis of nonmodular constrained tibial inserts after primary total knee replacement.

Large angular deformities can be a challenge when performing primary total knee replacement. Some investigators have advocated the use of increased component constraint in these settings. The goal of this study was to determine the location and extent of damage to a consecutive series of retrieved constrained tibial inserts used in primary arthroplasty.

Shoulder function and pain level after revision of failed reverse shoulder replacement to hemiarthroplasty.

Background: The reverse total shoulder replacement has become a popular treatment option for cuff tear arthropathy and other shoulder conditions requiring arthroplasty in the setting of a deficient rotator cuff. Despite a revision rate of as much as 10%, to date, there are few reports of reverse replacement conversion to hemiarthroplasty, and none specifically examining shoulder function.

Materials And Methods: Six patients with a reverse replacement that was dislocated, infected or loose were revised an average of 9.

Percutaneous neuromodulation pain therapy following knee replacement.

A new device (Deepwave) utilizing percutaneous neuromodulation technology has been developed with preliminary studies demonstrating superior pain inhibition compared with transcutaneous electrical nerve stimulation. We hypothesize that the use of Deepwave is efficacious in reducing the severity of acute pain and opioid use in patients following total knee replacement (TKR) surgery. We conducted a randomized controlled trial on 23 patients who underwent primary TKR.

Early range of motion of the scorpio non-restrictive geometry cruciate-retaining total knee system.

Flexion following total knee arthroplasty in the US population generally falls between 100° and 120°. Because of these relatively low flexion arcs, total knee arthroplasty prosthetic designs emerged allowing "high flexion" (≥125°). We hypothesized that a high-flexion implant design, Scorpio Non-Restrictive Geometry cruciate-retaining knee prosthesis, would allow clinical early maximum flexion of at least 125°.

The pathology of the end-stage osteoarthritic lesion of the knee: potential role in cartilage repair.

The purpose was to explore whether there were any pathological characteristics of the end-stage osteoarthritic sclerotic lesion that have potential to participate in cartilage repair. Specimens harvested following total knee surgery were examined for gross pathology including staining with Safranin O. Multiple small sections of the lesion were placed in tissue culture for 6 weeks.

Distal clavicular osteolysis: a review of the literature.

Acute distal clavicular osteolysis was first described in 1936. Since then, distal clavicular osteolysis (DCO) has been separated into traumatic and atraumatic pathogeneses. In 1982 the first series of male weight trainers who developed ADCO was reported.

Outcomes after arthroscopic rotator cuff repairs.

Recently, advances in arthroscopic techniques have allowed shoulder surgeons to perform fully arthroscopic repair of full-thickness tears. Outcome data have shown that improvement is inconsistent between studies. We performed a retrospective review of 105 consecutive patients who underwent arthroscopic rotator cuff repair from 1999 to 2002.