Evaluation of the Clavicle Hook Plate for Treatment of Acromioclavicular Joint Dislocation: A Cadaveric Study.

Objectives: To describe surgical technique for proper placement of the clavicle hook plate, determine whether there is subacromial impingement caused by hook plate fixation, and evaluate the mechanical strength of the clavicle hook plate construct.

Methods: Eight fresh-frozen cadaveric shoulders with a mean age of 48 years (range, 37-69) were used. Open reduction and internal fixation of simulated Rockwood type V AC joint dislocation was performed with the clavicle hook plate.

Relative risk factors for requirement of blood transfusion after total hip arthroplasty.

One thousand thirty-five total hip arthroplasty (THA) cases were retrospectively reviewed, and the number and type (autologous and allogenic) of postoperative units of blood transfused were analyzed with respect to pre-, intra-, and postoperative variables. The most significant and consistent predictors of a blood transfusion after THA were advanced age and the use of low-molecular-weight heparin for deep venous thrombosis prophylaxis. Our recommendations for predonation are 1 unit for THA patients younger than 75 years if hemoglobin is 130 g/dL or greater and 2 units or a combination of 1 unit of predonated blood and 1 unit of directed or banked blood for THA patients older than 75 years.

Heparin-induced thrombocytopenia and thrombosis.

Heparin-induced thrombocytopenia (HIT) and heparin induced thrombocytopenia with thrombosis (HITT) ar rare complications associated with use of unfractionate heparin (UFH) or low-molecular-weight heparin (LMWH) HIT is a benign clinical condition characterized by a mil drop in platelet count with no clinical significance. HIT is an immune-mediated reaction associated with a wide spread "hypercoagulable" state resulting in arterial an venous thrombosis. There is a higher incidence of HIT with UFH use than with LMWH use.

Intramedullary nailing of the lower extremity: biomechanics and biology.

The intramedullary nail or rod is commonly used for long-bone fracture fixation and has become the standard treatment of most long-bone diaphyseal and selected metaphyseal fractures. To best understand use of the intramedullary nail, a general knowledge of nail biomechanics and biology is helpful. These implants are introduced into the bone remote to the fracture site and share compressive, bending, and torsional loads with the surrounding osseous structures.

Blisters associated with lower-extremity fracture: results of a prospective treatment protocol.

Objectives: To evaluate patient outcomes after treatment of lower-extremity fractures associated with blister formation and to assess complications after soft-tissue treatment using a prospective protocol.

Design: Retrospective evaluation of prospectively collected data.

Setting: Level I trauma center.

Midterm results of primary total knee arthroplasty using a dished polyethylene insert with a recessed or resected posterior cruciate ligament.

Use of a dished polyethylene insert in 114 total knee arthroplasties, all with the posterior cruciate ligament resected or recessed, was retrospectively studied. Patients were evaluated at a mean follow-up of 8.3 years.

Total hip arthroplasty in a patient with contralateral hemipelvectomy.

Total hip arthroplasty has evolved in regard to surgical technique, implant design, and long-term survivorship over the last several decades with excellent clinical results. Owing to these improvements, indications for surgery have expanded to include a greater variety of patients. We present the case of a 62-year-old man who underwent total hip arthroplasty 39 years after contralateral hemipelvectomy.

A comparison of immediate postreduction splinting constructs for controlling initial displacement of fractures of the distal radius: a prospective randomized study of long-arm versus short-arm splinting.

Purpose: To compare, in a prospective, randomized manner, the sugar tong splint with a short-arm radial gutter splint in terms of patient satisfaction and the ability to maintain reduction of distal radius fractures.

Methods: A total of 118 patients with displaced distal radius fractures were enrolled; 85 patients (85 fractures) were available for follow-up evaluation and were included in the study population. There were 26 men and 59 women with a mean age of 64 years.

Orthopedic surgical management of hip and knee involvement in patients with juvenile rheumatoid arthritis.

Juvenile rheumatoid arthritis is the most common arthritic disease of childhood and a leading cause of childhood disability, affecting an estimated 300,000 US children and adolescents aged < or =16 years. Approximately 10% to 30% of patients experience functional deficits resulting from both the articular and systemic manifestations of their disease, including leg length inequality and deformity, that are often more crippling than joint destruction. Surgical intervention to treat bone and soft-tissue deformity, leg length inequality, and joint destruction is indicated when medical therapy has failed.

Osteogenic protein-1 (bone morphogenic protein-7) combined with various adjuncts in the treatment of humeral diaphyseal nonunions.

A prospective study was conducted to determine the efficacy of using recombinant BMP-7 (rhOP-1) as an adjuvant in the treatment of diaphyseal humeral nonunions. Twenty-three consecutive patients with atrophic humeral diaphyseal nonunions were treated at seven separate institutions. All nonunions were fixed with either a compression plate or an intramedullary nail in conjunction with various bone grafting techniques.

Suture versus screw fixation of displaced tibial eminence fractures: a biomechanical comparison.

Purpose: Classification and treatment of tibial eminence fractures are determined by the degree of fragment displacement. A variety of surgical procedures have been proposed to stabilize displaced fractures using both open and arthroscopic techniques. Two common fixation techniques involve use of cannulated screws and sutures tied over an anterior tibial bone bridge.

Chronic exertional compartment syndrome: diagnosis and management.

During exercise, muscular expansion and swelling occur. Chronic exertional compartment syndrome represents abnormally increased compartment pressures and pain in the involved extremity secondary to a noncompliant musculofascial compartment. Most commonly, it occurs in the lower leg, but has been reported in the thigh, foot, upper extremity, and erector spinae musculature.

Comparison of a sliding hip screw with a trochanteric lateral support plate to an intramedullary hip screw for fixation of unstable intertrochanteric hip fractures: a cadaver study.

Background: The lateral trochanteric support plate (LSP) was developed to prevent excessive sliding of unstable intertrochanteric femur fractures fixed with a sliding hip screw (SHS). This study compared the fracture stability and screw sliding characteristics of unstable intertrochanteric femur fractures fixed with either an SHS and LSP or an Intramedullary Hip Screw (IMHS).

Methods: Six matched pairs of cadaveric human femurs with simulated, unstable intertrochanteric femur fractures were stabilized with either an IMHS or a 135-degree SHS with an attached LSP.

Stiffness after total knee arthroplasty.

Postoperative stiffness is a debilitating complication of total knee arthroplasty. Preoperative risk factors include limited range of motion, underlying diagnosis, and history of prior surgery. Intraoperative factors include improper flexion-extension gap balancing, oversizing or malpositioning of components, inadequate femoral or tibial resection, excessive joint line elevation, creation of an anterior tibial slope, and inadequate resection of posterior osteophytes.

Risks associated with blood transfusion after total knee arthroplasty.

A retrospective study of 1,402 patients who underwent primary total knee arthroplasty (TKA) (1,194 unilateral, 208 bilateral) was performed. The strongest predictors for allogenic transfusion after surgery were advancing age (P<.001), low preoperative hemoglobin (P<.

Sixteen-year follow-up of the cemented spectron femoral stem for hip arthroplasty.

Clinical and radiographic follow-up was performed on a consecutive series of 105 patients who underwent 120 total hip arthroplasties at the authors' institution from 1983 to 1988 with a straight, cobalt-chrome femoral stem implanted using a second-generation cementing technique. The mean age at the time of surgery was 68.5 years, and the mean follow-up was 16 years.

Severe ulnar neuropathy after subcutaneous transposition in a collegiate tennis player.

We report the case of an "overhead" athlete (a collegiate tennis player) who developed severe ulnar neuropathy after anterior subcutaneous transposition and placement of a fasciodermal sling. Treatment consisted of opening the sling, excising suture material, releasing all other areas of potential compression, and performing anterior submuscular transposition of the ulnar nerve deep to the flexor muscle group. Two years after surgery, subjective symptoms were significantly improved, though the patient continued to experience mild medial-side elbow discomfort and intermittent paresthesia along the ulnar nerve distribution.

Comparison of the LISS and a retrograde-inserted supracondylar intramedullary nail for fixation of a periprosthetic distal femur fracture proximal to a total knee arthroplasty.

Simulated supracondylar fractures were created proximal to posterior cruciate ligament-retaining total knee arthroplasty components in paired human cadaver femora and stabilized with either a retrograde-inserted locked supracondylar nail or the Less Invasive Stabilization System (LISS; Synthes USA, Paoli, PA). Loads were applied to create bending and torsional moments on the simulated fracture stabilized with either no gap or a 10-mm gap. The LISS exhibited less torsional stability with anterior (P<.