Orthopedic manifestations and management of patients with von Willebrand disease.

Von Willebrand Disease is the most common inherited bleeding disorder and can present challenges to orthopedic surgeons in managing perioperative bleeding and treating orthopedic problems that manifest as a result of the disease. Appropriate history taking is essential to identify these patients prior to surgery. The most effective management of von Willebrand disease will be achieved with close consultation between the surgeon, anesthesiologist, internist or pediatrician, hematologist, and patient.

The addition of rotator interval closure after arthroscopic repair of either anterior or posterior shoulder instability: effect on glenohumeral translation and range of motion.

Background: Although the use of rotator interval closure is frequently advocated as a useful supplement to shoulder instability repairs, the addition of a rotator interval closure after arthroscopic instability repair has not been fully investigated.

Purpose: The objective of this study was to investigate whether a rotator interval closure improves glenohumeral stability in an anterior and posterior instability shoulder model.

Study Design: Controlled laboratory study.

A biomechanical analysis of capsular plication versus anchor repair of the shoulder: can the labrum be used as a suture anchor?

Purpose: To determine the biomechanical strength properties of suture capsulolabral plication to an intact labrum versus glenoid bone anchor fixation.

Methods: Fourteen paired fresh frozen shoulders with intact glenoid labrum and mean age of 43.3 +/- 11.

An analysis of capsular area in patients with anterior, posterior, and multidirectional shoulder instability.

Background: Although increased capsular volume has been implicated in shoulder instability, there is a paucity of clinical evidence to quantify the size of the capsule with specific instability conditions of the shoulder.

Hypothesis: Shoulder capsular area, as measured by magnetic resonance arthrography, is increased with specific patterns of shoulder instability.

Study Design: Cross-sectional study; Level of evidence, 4.

Complications of anterior cruciate ligament reconstruction with bone-patellar tendon-bone constructs: care and prevention.

Rupture of the anterior cruciate ligament is a common injury. Correct diagnosis and patient selection, along with proper surgical technique, with careful attention to anatomic graft placement, followed by attention to proper rehabilitation, leads to predictably good to excellent results. This article reviews the recognition and avoidance of complications associated with bone-patellar tendon-bone constructs of anterior cruciate ligament reconstruction.

The outcomes of lumbar microdiscectomy in a young, active population: correlation by herniation type and level.

Study Design: Prospective longitudinal clinical study.

Objective: The purpose of our article was to investigate the clinical outcomes with type and level of disc herniation in a young, active population undergoing lumbar microdiscectomy.

Summary Of Background Data: There are few reported outcomes studies on the relationship between disc herniation level, type of disc herniation, and surgical outcomes of lumbar microdiscectomy in a young, active population.

Arthroscopic preparation of the posterior and posteroinferior glenoid labrum.

Using an anterior portal for a labral elevator and shaver instrument, with the arthroscope in the anterosuperior portal, allows the posterior and posteroinferior chondrolabral junction to be safely prepared.

Nonarthroplasty alternatives for the treatment of glenohumeral arthritis.

Although most glenohumeral cartilaginous lesions are incidental findings and well tolerated, a symptomatic cartilage injury in a young, active individual remains a challenge. The diagnosis of this symptomatic lesion is difficult, and is usually only arrived at once other shoulder comorbidities and sources of glenohumeral pain are ruled out. Once diagnosed, a variety of treatment options are available which include palliative, reparative, restorative, and reconstruction techniques.

Arthroscopic versus open rotator interval closure: biomechanical evaluation of stability and motion.

Purpose: The purposes of this study were to investigate the differences between open and arthroscopic closure of the rotator interval (RI) on glenohumeral translation and range of motion. We also sought to determine if the addition of either an open or arthroscopic RI closure increases stability of the shoulder.

Methods: Fourteen fresh-frozen (10 paired) cadaveric shoulder specimens were mounted in a custom testing apparatus, and glenohumeral translation and rotation were obtained by using an optoelectric tracking system (Optotrak Certus; Northern Digital, Ontario, Canada).

Arthroscopic stabilization in patients with an inverted pear glenoid: results in patients with bone loss of the anterior glenoid.

Background: Recent literature has demonstrated that the success rates of arthroscopic stabilization of glenohumeral instability deteriorate in patients with an anteroinferior glenoid bone deficiency, also known as the "inverted pear" glenoid.

Purpose: This study was conducted to assess the outcomes of arthroscopic stabilization for recurrent anterior shoulder instability in patients with a mean anteroinferior glenoid bone deficiency of 25% (range, 20%-30%).

Study Design: Cohort study; Level of evidence, 3.

[Comorbidity in generalized anxiety disorder: prevalence and course after cognitive-behavioural therapy].

Objective: To evaluate the prevalence and course of Axis I concurrent disorders in a population of patients who underwent cognitive-behavioural therapy (CBT) to treat their generalized anxiety disorder (GAD).

Method: This study is a secondary analysis combining patients from 3 treatment studies done at Université Laval. A total of 90 patients with a DSM-IV consistent GAD diagnosis received from 12 to 16 CBT sessions to treat GAD.

The underestimation of a glass injury to the hand.

This study sought to ascertain the differences between what is found on an orthopedic preoperative examination of a glass injury to the hand and the actual intraoperative deficiencies noted in the operating room. The cases of 34 patients who presented to our institution for a shattered glass laceration to the hand, forearm, or wrist between 1998 and 2001 were reviewed. The preoperative examination significantly underestimated the amount of damage to tendons, arteries and nerves.

The modified Bristow procedure for anterior shoulder instability: 26-year outcomes in Naval Academy midshipmen.

Background: Many procedures have been proposed for the correction of anterior shoulder instability. Some of these procedures address the problem anatomically, such as the Bankart procedure, and some prevent instability nonanatomically, such as the Bristow-Latarjet procedure. A modified Bristow procedure was the procedure of choice for anterior shoulder instability among midshipmen at the United States Naval Academy from 1975 to 1979.

Arthroscopic treatment of posterior shoulder instability: results in 33 patients.

Background: Posterior shoulder instability is a relatively rare condition and a surgical challenge. Arthroscopic techniques have allowed for a potential improvement as well as diagnosis and management of this condition.

Purpose: To evaluate the outcomes of arthroscopic posterior shoulder stabilization and to evaluate preoperative and intraoperative variables as predictors of success.

Awareness promotion about excessive gambling among video lottery retailers.

This paper describes and evaluates "As luck would have it," an awareness program completed by retailers in Quebec Province. This program, which is presented as a two-hour awareness promotion workshop, aimed to inform retailers about excessive gambling. More specifically, it provided answers to the following questions: (1) What is chance and randomness? (2) Is there a link between misunderstanding the concept of chance and excessive gambling? (3) How does one recognise the symptoms of this disorder? (4) How should retailers intervene if they decide to do so? Results showed that retailers developed a better understanding of problem gambling, could recognise its main symptoms, felt more capable of coping with excessive gamblers, and of choosing the most appropriate moment to do so.

The surgical treatment of external coxa saltans (the snapping hip) by Z-plasty of the iliotibial band.

Purpose: A snapping hip (coxa saltans) secondary to a tight iliotibial band rarely needs surgical intervention. The purpose of this study is to present the surgical results of refractory external-type snapping hip by Z-plasty of the iliotibial band.

Materials And Methods: Nine symptomatic snapping hips in 8 consecutive patients (1 bilateral) from August 1997 through March 2002 who underwent an iliotibial band Z-plasty were reviewed.

Group cognitive-behavioral therapy for generalized anxiety disorder: treatment outcome and long-term follow-up.

A recently developed cognitive-behavioral treatment for generalized anxiety disorder (GAD) targets intolerance of uncertainty by the reevaluation of positive beliefs about worry, problem-solving training, and cognitive exposure. As previous studies have established the treatment's efficacy when delivered individually, the present study tests the treatment in a group format as a way to enhance its cost-benefit ratio. A total of 52 GAD patients received 14 sessions of cognitive-behavioral therapy in small groups of 4 to 6 participants.

An analysis of orthopaedic liability in the acute care setting.

The risk of litigation in the emergency room is not directly proportional to the severity of injury. In fact, the risk of initiation of legal action is greater in cases of relatively modest permanent and partial disability. In these cases, failure to obtain and document informed consent, failure to effectively communicate with the patient and family, and failure to assure followup and prompt assessment of complications are the factors that have most frequently led to litigation.