Open reduction and internal fixation (ORIF) versus ORIF and primary subtalar arthrodesis for complex displaced intraarticular calcaneus fractures: An expected value decision analysis.

Objectives: To determine the optimal patient-oriented treatment between open reduction and internal fixation (ORIF) with or without primary subtalar arthrodesis (PSTA) for patients with displaced intraarticular calcaneus fractures (DIACFs, OTA 82-C3 and C4).

Design: Expected value decision analysis.

Setting: Academic military treatment facility.

The Burden of Fingertip Trauma on the US Military.

Fingertip injuries in the military are common and often hinder the fighting force and support personnel. Injuries range from small subungual hematomas to proximal finger amputations. Treatment modalities are dictated by injury patterns, anatomic considerations, and the need to return to duty.

Occupational Outcomes and Return to Running After Operative Management of Lisfranc Injuries in a High-Demand Population.

Literature evaluating outcomes following operative fixation of Lisfranc injuries has demonstrated high rates of chronic disability, particularly in those returning to prior levels of physical function. The purpose of this study is to evaluate the occupational outcomes and return to running after open reduction and internal fixation (ORIF) or arthrodesis for Lisfranc fracture-dislocations in a moderate- to high-demand military cohort. All active-duty servicemembers undergoing ORIF or primary arthrodesis (Current Procedural Terminology 28615 and 28730, respectively) for confirmed Lisfranc fracture-dislocations (International Classification of Diseases, Ninth Revision codes 838.

Outcomes and Predictors of Postoperative Pain Improvement Following Particulated Juvenile Cartilage Allograft Transplant for Osteochondral Lesions of the Talus.

Background: Particulated juvenile cartilage allograft transfer (PJCAT) is an emerging treatment option for management of osteochondral lesions of the talus (OCLTs). This series reports on outcomes and identifies predictors for success following PJCAT for isolated OCLTs.

Methods: We reviewed 33 consecutive patients who underwent PJCAT by a single surgeon from 2013 to 2017.

Return to Weightbearing and High-Impact Activities Following Jones Fracture Intramedullary Screw Fixation.

Background: Although the benefit of primary intramedullary (IM) screw fixation of fifth metatarsal Jones fractures in athletes is clear, limited data support its use in conventional patient populations. This study evaluated radiographic and functional outcomes following primary IM screw fixation in a series of Jones fractures to determine if similar excellent outcomes were achievable.

Methods: We reviewed the data of 32 consecutive patients who underwent Jones fracture primary IM screw fixation by a single surgeon.

Orthopaedic and Plastic Surgery Training Differences Manifested in the Analysis of Distal Radius Fracture Fixation.

All patients undergoing open reduction and internal fixation of a distal radius fracture (DRF) between the years 2010 and 2015 were isolated from the National Surgical Quality Improvement Program database. Patient demographics, respective surgical volume, outcome variables, and complications were extracted. The primary outcomes were surgical time, hospital length of stay, and unplanned reoperation.

Outcome measures after medial ulnar collateral ligament reconstructions in a military population.

Background: Medial ulnar collateral ligament (MUCL) reconstruction outcomes are well described in competitive throwers but not in nonthrowers. This investigation elucidated epidemiologic variables, functional outcomes, and prognostic factors after MUCL reconstruction in young active patients.

Methods: United States military service members undergoing MUCL reconstruction were isolated using the Management Analysis and Reporting Tool (M2) database from 2009 to 2016.

Predictors of Acute Complications Following Traumatic Upper Extremity Amputation.

Current literature is deficient in its description of acute complications following major traumatic upper extremity amputations (UEAs). This study sought to identify acute complications following major UEAs by the 2009-2012 National Trauma Databank to extract demographics, comorbidities, concomitant injuries, and surgical characteristics for major traumatic UEA patients. Multivariate analyses identified significant predictors of mortality and major systemic complications.

Biomechanical comparison of a novel C1 posterior U-construct with four other techniques in a C1-C2 fixation model.

Background: Compare the biomechanical stability of a novel "U" posterior cervical fixation construct to four other posterior cervical atlantoaxial fixation constructs.

Methods: Eight fresh frozen human cadaver spines were tested after a simulated odontoid fracture, and following stabilization with each construct.

Results: All constructs significantly decreased flexion-extension and axial rotation compared to the destabilized spine.

Accuracy of radiographic determination of the posterior femoral wall integrity in anterior cruciate ligament reconstruction.

Objective: To evaluate the accuracy of radiographs in determining integrity of the posterior femoral cortex following ACL reconstruction.

Methods: Fifty adult volunteers undergoing primary arthroscopic transtibial ACL reconstructions were prospectively enrolled into this study. Plain radiographs and fine-cut CT of the operative knee were obtained post-operatively.

Perilunate Dislocations and Perilunate Fracture Dislocations in the U.S. Military.

 Perilunate dislocations and perilunate fracture dislocations (PLDs/PLFDs) are rare and often associated with poor outcomes. Heretofore, these outcomes have not been evaluated in a high-demand military population.  The purpose of this study was to evaluate the outcomes in a young, active population after sustaining PLD/PLFD injuries.

The Shift to Same-Day Outpatient Joint Arthroplasty: A Systematic Review.

Background: Hip and knee arthroplasties length of stay continues to shorten after advances in perioperative and intraoperative management, as well as financial incentives. Some authors have demonstrated good results with outpatient arthroplasty, but safety and general feasibility of such procedures remain unclear. Our hypothesis is that outpatient arthroplasty would demonstrate higher readmission and complication rates than inpatient arthroplasty.

Functional outcomes following lateral ulnar collateral ligament reconstruction for symptomatic posterolateral rotatory instability of the elbow in an athletic population.

Hypothesis: The purpose of this investigation was to characterize the functional and surgical outcomes following lateral ulnar collateral ligament (LUCL) reconstruction for posterolateral rotatory instability in an athletic population.

Methods: All US military service members who underwent LUCL reconstruction between 2008 and 2013 were identified. A retrospective chart review was performed, and the prospective Mayo Elbow Performance Score and QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score were obtained.

Open reduction-internal fixation versus intramedullary nailing for humeral shaft fractures: an expected value decision analysis.

Background: Previous randomized controlled studies and meta-analyses have failed to collectively favor either open reduction-internal fixation (ORIF) or intramedullary nailing (IMN) fixation. The purpose of our investigation was to elucidate the optimal decision between ORIF and IMN for acute traumatic operative humeral shaft fractures through an expected value decision analysis.

Methods: We performed an expected value decision analysis and sensitivity analysis to elucidate the difference between ORIF and IMN fixation for patients with acute traumatic humeral shaft fractures.

Outcomes Following Isolated Posterior Interosseous Nerve Neurectomy: A Systematic Review.

Background: Posterior interosseous nerve neurectomies (PINN) are an option in the treatment of chronic dorsal wrist pain. However, the literature describing PINN consists primarily of small case series, and the procedure is typically done as an adjunct treatment; therefore, the outcomes of the PINN itself are not well known. We performed a systematic review of the literature to provide characteristics of patients following a PINN.

Return to Preoperative Function After Autologous Cartilage Implantation of the Knee in Active Military Servicemembers.

Background: Autologous chondrocyte implantation (ACI) has been shown to provide adequate durability, pain relief, and improved long-term functional outcomes in the average patient, but proof of its efficacy in individuals with greater than average physical demands is scarce. Further knowledge is required to understand which patients may benefit from ACI and to identify which risk factors are associated with failure to return to the preinjury activity level.

Purpose: To determine the occupational outcomes, rates of reoperation, and variables predictive of suboptimal outcomes after ACI.

Radial Head Arthroplasty in the Active Duty Military Service Member With Minimum 2-Year Follow-Up.

Purpose: Radial head arthroplasty (RHA) is a viable treatment for complex radial head fracture. Whereas elbow stability and function is typically restored at short- to mid-term follow-up, the outcome in higher-demand populations is not well defined. We sought to characterize the functional and occupational outcomes following RHA in an active duty military population with intense upper extremity demands.

Outcomes Following Carpal Tunnel Release in Patients Receiving Workers' Compensation: A Systematic Review.

Background: Carpal tunnel syndrome (CTS) is a common occupational pathology, representing a high percentage of workers' compensation (WC) claims.

Methods: The literature was reviewed for all studies evaluating CTS outcomes including WC patients between 1993 and 2016. A total of 348 articles were identified; 25 of which met inclusion and exclusion criteria.

Outcomes Following Multilevel Cervical Disc Arthroplasty in the Young Active Population.

Background: Cervical radiculopathy is a common disorder that portends significant morbidity. The presence of radiculopathy can have a debilitating effect on patients as well as a significant economic impact. Active duty military patients with increased physical occupational demands can be significantly impacted by cervical disease.

Functional Outcomes Following Surgical Management of Femoral Neck Stress Fractures.

The Military Health System Management Analysis and Reporting Tool was queried to identify all active duty US military service members who underwent operative fixation of femoral neck stress fractures from 2011 to 2012. A total of 13 patients with 17 femoral neck stress fractures met the inclusion criteria. Average patient age was 23.

Medial Malleolar Fractures and Associated Deltoid Ligament Disruptions: Current Management Controversies.

Operative fixation of medial malleolar fractures, whether isolated or in the setting of bi- or trimalleolar fractures, remains controversial. Increasingly, anatomic reduction and internal fixation is used to treat medial malleolar fractures to avoid long-term sequelae of symptomatic nonunion and posttraumatic osteoarthritis. However, outcomes have not been significantly different between operative and nonoperative cohorts.

Variables Affecting Return to Play After Anterior Cruciate Ligament Injury in the National Football League.

Background: Anterior cruciate ligament (ACL) injuries are common in the National Football League (NFL). Limited literature exists regarding return to play (RTP) and the factors affecting RTP after ACL reconstruction in NFL players.

Purpose/hypothesis: To determine RTP rates after ACL reconstruction in NFL players and to ascertain which variables affect RTP in these players.

Predictors of Hospital Readmission After Total Shoulder Arthroplasty.

The study was conducted to determine the incidence rate, risk factors, and postoperative conditions associated with 30-day readmission after total shoulder arthroplasty (TSA). A total of 3547 patients who underwent primary TSA were identified from the 2011-2013 American College of Surgeons National Surgical Quality Improvement Program. The 30-day readmission rate was 2.

Results and Functional Outcomes of Structural Fresh Osteochondral Allograft Transfer for Treatment of Osteochondral Lesions of the Talus in a Highly Active Population.

Introduction: Structural fresh osteochondral allograft transfer is an appropriate treatment option for large osteochondral lesions of the talus (OLTs), specifically lesions involving the shoulder of the talus. Sparse literature exists regarding functional outcome following this surgery in high-demand populations.

Materials And Methods: Over a 2-year period, a single surgeon performed 8 structural allograft transfers for treatment of large OLTs in an active duty US military population.