Diagnosis and management of primary malignant tumors in the upper extremity.

Bone and soft tissue sarcomas of the upper extremity are relatively uncommon. In many cases, they are discovered incidentally during evaluation of traumatic injuries or common ailments such as rotator cuff tendonitis or tennis elbow. Thus, it is important for all orthopedic surgeons to understand the differential diagnosis, workup, and treatment for upper extremity lesions.

Operating Room Traffic in Total Joint Arthroplasty: One Simple Measure Toward Solving a Complex Problem.

Background: Periprosthetic joint infection remains a devastating complication of total joint arthroplasty (TJA). The literature suggests that unnecessary operating room (OR) traffic increases the risk of surgical site infection by increasing bacterial load in the OR. We attempted to determine whether the posting of "restricted access" signs on the outside and inside of OR doors during primary TJA procedures would result in a reduction of OR door openings.

Direct Visualization of the Femoral Cortical Button in Anterior Cruciate Ligament Reconstruction Helps Ensure Proper Positioning.

This study sought to postoperatively compare femoral cortical button (FCB) placement in anterior cruciate ligament (ACL) reconstruction performed using an adjustable loop cortical femoral fixation button under direct arthroscopic visualization vs indirect methods. The authors conducted a retrospective review of postoperative knee radiographs from 76 patients who had undergone ACL reconstruction with an adjustable loop cortical femoral fixation button. Operative reports were reviewed to determine the technique used for graft placement.

Neurogenic heterotopic ossification: a pictorial review.

Neurogenic heterotopic ossification is a condition whereby bone forms in an extra-skeletal site. It may occur in the context of major neurological insult involving the brain or spinal cord. It causes pain and restricts movement, most commonly at the hip joints.

Metabolic encephalopathy secondary to diabetic ketoacidosis: a case report.

Introduction: Metabolic encephalopathy is a rare but potentially devastating complication of diabetic ketoacidosis (DKA). This case highlights the dramatic cognitive decline of a young man due to metabolic encephalopathy complicating DKA. The aims of this case report are to highlight metabolic encephalopathy as a complication of DKA and to explore the current research in diabetic related brain injury.

Use of a Safety Clamp When Performing Arthroscopic Knot Tying Preserves the Suture When It Is Placed Under Excessive Tension.

The purpose of this study was to compare the location of the suture breakage between tying by hand vs with a safety clamp, needle driver. FiberWire No. 2 and 2-0 (Arthrex, Naples, Florida) were fastened onto the hook attachment of the digital force gauge.

Physician Training Ultrasound and Accuracy of Diagnosis in Rotator Cuff Tears.

Introduction: Ultrasonography offers a fast and inexpensive method to evaluate the rotator cuff in the office setting. However, the accuracy of ultrasound is highly user dependent. The purpose of this study is to investigate the learning curve of an orthopaedic surgeon in using ultrasound to diagnose rotator cuff tears.

Calcaneonavicular Coalition with Naviculocuneiform and Cuneiform-First Metatarsal Coalitions A Case Report.

Coalitions involving three joints of the midfoot are rare. To our knowledge, this is the first report of a patient having fibrocartilaginous coalition of the calcaneonavicular joint along with partial osseous fusion of the naviculocuneiform (Chopart's joint) and medial cuneiform-first metatarsal joints. These multi-coalition pathologies are challenging to address operatively as pain can persist even after recognizing and surgically addressing each coalition in a patient.

Deformation T-Cup: a new multi-anvil apparatus for controlled strain-rate deformation experiments at pressures above 18 GPa.

A new multi-anvil deformation apparatus, based on the widely used 6-8 split-cylinder, geometry, has been developed which is capable of deformation experiments at pressures in excess of 18 GPa at room temperature. In 6-8 (Kawai-type) devices eight cubic anvils are used to compress the sample assembly. In our new apparatus two of the eight cubes which sit along the split-cylinder axis have been replaced by hexagonal cross section anvils.

Biologic augmentation in rotator cuff repair--should we do it, who should get it, and has it worked?

Rotator cuff tears are a common pathologic entity, and rotator cuff repairs are a frequently performed procedure. Given the high rate of structural failure of repair, biological augmentation of repairs is increasingly important. Biological augmentation primarily enhances the healing response and secondarily provides a mechanical bridge for tension free repair.

Thirty-day readmission rates as a measure of quality: causes of readmission after orthopedic surgeries and accuracy of administrative data.

The rate of unplanned 30-day readmissions to the hospital after discharge is being used as a marker to compare the quality of care across hospitals and to set reimbursement levels for care. While the readmission rate can be reported using administrative data, the accuracy of these data is variable, and defining which readmissions are unplanned and preventable is often difficult. The purpose of this study was to review readmissions to a single orthopedic hospital to identify the causes for readmission and, in particular, which readmissions are planned versus unplanned.

An analysis of causes of readmission after spine surgery.

Study Design: Retrospective review of medical records.

Objective: We reviewed all early readmissions after elective spine surgery at a single orthopedic specialty hospital to analyze the causes of unplanned readmissions.

Summary Of Background Data: Recent advances in techniques and instrumentation have made more complex spinal surgeries possible, although sometimes with more complications.

Management of failed arthroscopic rotator cuff repair.

Most patients experience pain relief and functional improvement following arthroscopic rotator cuff repair, but some continue to experience symptoms postoperatively. Patients with so-called failed rotator cuff syndrome, that is, with continued pain, weakness, and limited active range of motion following arthroscopic rotator cuff repair, present a diagnostic and therapeutic challenge. A thorough patient history, physical examination, and imaging studies (eg, plain radiography, MRI, magnetic resonance arthrography, ultrasonography) are required for diagnosis.

Diagnosis and management of pelvic fractures.

The diagnostic and therapeutic modalities utilized in the management of pelvic ring fractures depend on patient characteristics, mechanism of injury, and hemodynamic status at the time of presentation. Knowledge of the complex anatomy and biomechanics of pelvic stability may guide appropriate initial management strategies. Even with the development of specific treatment algorithms and advances in both diagnostic and operative techniques, fractures of the pelvis continue to cause significant morbidity and mortality.

Characteristics of the Flexor Carpi Radialis Brevis Tendon on Magnetic Resonance Imaging and its Use in Basal Joint Arthroplasty.

We report the incidental discovery of a flexor carpi radialis brevis tendon, a rare anatomical variant identified during a surgical procedure. Magnetic resonance imaging of the contralateral side helped to delineate the anatomy of the flexor carpi radialis tendon and to differentiate the flexor carpi radialis brevis tendon from it. We describe the use of this rare tendon in ligament reconstruction of the basal joint of the thumb.

Phase II trials of dolastatin-10 in advanced pancreaticobiliary cancers.

Background: Pancreaticobiliary malignancies respond poorly to conventional chemotherapy, and novel agents are needed. Dolatstatin-10 is a potent antimitotic pentapeptide isolated from the marine mollusk Dolabella auricularia that inhibits microtubule assembly. We conducted 2 parallel phase II trials of dolastatin-10 in patients with advanced hepatobiliary cancers and pancreatic adenocarcinoma.

Percutaneous reduction and Kirschner-wire fixation of impacted intra-articular fractures and volar lip fractures of the proximal interphalangeal joint.

We retrospectively review the cases of 5 men with closed, impacted intra-articular fractures of the middle phalanx at the proximal interphalangeal joint and describe a new technique-involving percutaneous reduction and Kirschner-wire fixation-that minimizes surgical trauma, allows fixation for early range of motion, and provides results as good as, if not superior to, those obtained with existing techniques.

Long-term outcome of surgically treated Crohn's colitis: a prospective study.

Purpose: Although bowel-sparing techniques have been published for treatment of Crohn's disease of the small bowel because of its relentless nature, extent of resection in Crohn's colitis is still a topic of debate. This study was designed to prospectively evaluate the long-term outcomes of patients with isolated Crohn's colitis to identify patients that may benefit from initial more aggressive resection.

Methods: We identified 179 patients with Crohn's disease operated on for primary colonic disease.