Clinical Acuity in the Emergency Department and Injury Severity Determine Hospital Admission of Older Patients with Low Energy Falls: Outcomes from a Prospective Feasibility Study.

Background: Low energy falls (LEF) in older adults constitute a relevant cause for emergency department (ED) visits, hospital admission and in-hospital mortality. Patient-reported outcome measures containing information about patients' medical, mental and social health problems might support disposition and therapy decisions. We investigated the value of a tablet-based (self-)assessment in predicting hospital admission and in-hospital mortality.

Distal Biceps Tendon Repair Using a Modified Double-Incision Technique: Patient-Reported Outcomes With 10-Year Follow-up.

Background: In the setting of complete distal biceps tendon rupture, surgical repair has become the standard of care to restore optimal elbow function, but the optimal approach and method of tendon fixation are still subjects of debate and have remained controversial for more than half a century.

Purpose: To evaluate patient-reported long-term outcomes after distal biceps tendon repair using a modified double-incision technique.

Study Design: Case series; Level of evidence, 4.

Correlation between Oxford Elbow Score and Single Assessment Numeric Evaluation: Is one simple question enough?

Background: The aim of this study is to evaluate the correlation between the Oxford Elbow Score (OES) and Single Assessment Numeric Evaluation (SANE). To date, there has been no study investigating a correlation between this patient-reported outcome measure and SANE.

Methods: Between December 2018 and February 2019, all patients who underwent consultation for elbow pathology and completed the OES and SANE were retrospectively analyzed.

Axillary Artery Dissection and Thrombosis after Closed Proximal Humerus Fracture - a Rare Interdisciplinary Challenge.

Background: Proximal humerus fractures account for 4 - 6% of all fractures and are a common result of low-energy trauma in the elderly. Concomitant neurovascular injury of the neighboring axillary artery and brachial plexus is a rarity, but has enormous impact on therapy, rehabilitation and prognosis. Diagnosis of axillary artery injury may be delayed due to its varied clinical presentation and lead to prolonged ischemia, distal necrosis and even loss of limb.

Monocortical fixation of the coracoid in the Latarjet procedure is significantly weaker than bicortical fixation.

Purpose: A crucial step of the Latarjet procedure is the fixation of the coracoid process onto the glenoid. Multiple problems associated with the fixation have been described, including lesions of the suprascapular nerve due to prominence of the screw or bicortical drilling. The purpose of the present study was to evaluate whether monocortical fixation, without perforating the posterior glenoid cortex, would provide sufficient graft stability.

[Tendinopathies of the shoulder and elbow].

Background: Tendinopathies of the shoulder and elbow joint are a common problem. According to the current state of knowledge tendinopathies can be separated into acute and chronic tendinitis as well as degenerative tendinosis.

Origin: The causes of tendinopathy can be intrinsic, extrinsic or a combination of both.

The lasso-loop, lasso-mattress and simple-cinch stitch for arthroscopic rotator cuff repair: are there biomechanical differences?

Purpose: Various stitching techniques have been described to facilitate arthroscopic repair of rotator cuff tears. The aim of the present study was to compare the biomechanical properties of the lasso-loop, lasso-mattress and simple-cinch stitch for rotator cuff repair.

Methods: Twelve infraspinatus tendons were harvested from sheep and split in half.

Biomechanical evaluation of the simple cinch stitch for arthroscopic rotator cuff repair.

Background: The tissue-suture interface is described as the most vulnerable and susceptible area in the muscle-tendon-bone construction of arthroscopic rotator cuff repair. Various stitching techniques have been described to enhance the strength, fixation and stability of the repair, but technical and biomechanical challenges remain. Purpose was to examine the biomechanical properties of the simple cinch stitch in comparison to other stitches commonly used for rotator cuff repair.

Case Report of a Traumatic Atlantoaxial Rotatory Subluxation with Bilateral Locked Cervical Facets: Management, Treatment, and Outcome.

The aim was to report a rare case of isolated traumatic atlantoaxial rotatory subluxation without ligamentous injury. Management consisted of analgesia, sedation, and application of a halo skull traction device. After removing halo skull traction, full reduction and recovery were achieved without instability.

The Anatomic Basis for the Arthroscopic Latarjet Procedure: A Cadaveric Study.

Background: The Latarjet technique is a reliable treatment option for recurrent anterior shoulder instability. However, the complication rate has been reported to be as high as 30%, with 1.6% of patients suffering a nerve injury.

The Simple Cow Hitch Stitch Technique for Arthroscopic Rotator Cuff Repair and Stabilization Using Knotless Suture Anchors.

The tissue-suture interface is the most vulnerable and challenging part of adequate restoration and fixation in rotator cuff repair. We describe a simple stitch technique for arthroscopic rotator cuff repair using knotless suture anchors based on the cow hitch. The simple cow hitch stitch technique is easy to perform, especially under difficult conditions, and provides excellent initial fixation strength as required for integration of the reinserted cuff and for shoulder stabilization.

Intraoperative imaging of the shoulder: A comparison of two- and three-dimensional imaging techniques.

Background: Isocentric three-dimensional C-arms allow for more effective intraoperative fracture reduction control compared to two-dimensional imaging techniques. However, this design is not appropriate for shoulder scanning.

Objective: To assess the feasibility of using a newer generation variable isocentric flat detector 3D C-arm for intraoperative glenohumeral and acromioclavicular joint assessment and to compare the accuracy of its intraoperative 3D imaging technology to a standard two-dimensional (2D) flat detector fluoroscope.

Conversion of hemi into reverse shoulder arthroplasty: implant design limitations.

Purpose: Cranial migration of shoulder hemiarthroplasties due to rotator cuff insufficiency typically requires conversion into a reverse total shoulder arthroplasty. This study was conducted to analyze differences between the height and offset of six implants designed to enable conversion of a hemiarthroplasty into a reverse system.

Methods: Anteroposterior radiographs of 40 shoulders were taken.

A cadaver study comparing intraoperative methods to analyze lower limb alignment.

Background: Conventional intraoperative determination of lower limb alignment is essential for orthopedic surgical treatment. Current methods include the cable, alignment rod, and axis board methods.

Question/purposes: Are there differences in accuracy and reliability? What are the individual differences in applicability and radiation exposure?

Methods: Twenty legs from 12 fresh-frozen cadavers were randomly selected.

Laser method for intraoperative evaluation of lower extremity alignment: comparison of a novel technique to CT and a conventional method.

Introduction: Accurate restoration of mechanical alignment is an important factor in reconstructive surgery of the lower extremity. Conventional intraoperative methods, such as using an electrocautery cable, provide only a momentary evaluation of alignment. In this study, we evaluated a novel technique using a laser emitter, which projected the mechanical axis of the lower extremity, providing continuous intraoperative information on alignment.

3D navigated implantation of the glenoid component in reversed shoulder arthroplasty. Feasibility and results in an anatomic study.

Background: Reversed shoulder arthroplasty is an alternative to total shoulder arthroplasty for various indications. The long-term results depend on stable bone fixation, and correct positioning of the glenoid component. The potential contribution of image guidance for reversed shoulder arthroplasty procedures was tested in vitro.

Navigated vs arthroscopic-guided drilling for reconstruction of acromioclavicular joint injuries: accuracy and feasibility.

Background: Anatomical reconstruction of the coracoclavicular ligaments is a relatively new technique for acromioclavicular (AC) joint injuries.

Methods: Eighteen procedures (nine non-navigated, nine navigated) of anatomical reconstruction were performed minimally invasively, using the Tight Rope system, on cadaveric shoulders. Two Kirschner wires were placed, freehand under fluoroscopic control (non-navigated) or 3D C-arm navigated.

Navigated versus conventional transfixation of AC joint injuries: feasibility and accuracy.

Objective: Transfixation of the acromioclavicular (AC) joint is a well-established technique for treating Rockwood IV to VI lesions. However, several complications, including pin breakage or pin migration due to incorrect placement, have been reported in the literature. A cadaveric study was performed to investigate whether the use of 3D navigation might improve the accuracy of AC joint transfixation.

Arthroscopic arthrolysis for recalcitrant frozen shoulder: a lateral approach.

Purpose: The purpose of this study was to evaluate a new all-arthroscopic technique in the management of recalcitrant globally stiff frozen shoulders. This adopts an initial extra-articular approach followed by intra-articular entry to perform a 360° capsular release.

Methods: Ten patients with global adhesive capsulitis were prospectively evaluated.

Arthroscopic latarjet procedure.

Although soft tissue stabilization procedures in the shoulder yield good results, arthroscopy and radiological investigations have identified more complex soft tissue and bony lesions that can be successfully treated using a Latarjet procedure. The authors have advanced this technique to make it possible arthroscopically, thereby conferring all the benefits that arthroscopic surgery offers. This article describes how and why the arthroscopic Latarjet procedure is a valuable tool in the treatment of complex shoulder instability and how the procedure can be introduced into practice.

The relation between tunnel widening and bone mineral density after anterior cruciate ligament reconstruction: an experimental study in sheep.

Purpose: The aim of this study was to analyze the relation between bone mineral density (BMD) and femoral tunnel enlargement (TE) in a previously validated sheep model of soft-tissue anterior cruciate ligament (ACL) reconstruction.

Methods: Thirty sheep underwent ACL reconstruction by use of a soft-tissue graft at the age of 4 months. Graft fixation was achieved with the EndoButton (Smith & Nephew Endoscopy, Andover, MA) and Suture Washer (Smith & Nephew Endoscopy).

Insufficient bone regenerate after intramedullary femoral lengthening: risk factors and classification system.

Background: Control of distraction rate with an intramedullary skeletal kinetic distractor (ISKD) may be problematic and a high distraction rate may result in insufficient bone regenerate.

Questions/purposes: Are distraction problems preventable when using the ISKD, and what are the risk factors for and radiologic types of insufficient bone regenerate during ISKD lengthening?

Patients And Methods: We analyzed 37 consecutive ISKD femoral lengthening procedures in 35 patients with a mean age 33 ± 11 years and minimum followup of 12 months (average, 27 ± 9 months; range, 12-55 months). The average length gain was 42.

Collagen type I hydrogel allows migration, proliferation, and osteogenic differentiation of rat bone marrow stromal cells.

Hydrogels are potentially useful for many purposes in regenerative medicine including drug and growth factor delivery, as single scaffold for bone repair or as a filler of pores of another biomaterial in which host mesenchymal progenitor cells can migrate in and differentiate into matrix-producing osteoblasts. Collagen type I is of special interest as it is a very important and abundant natural matrix component. The purpose of this study was to investigate whether rat bone marrow stromal cells (rBMSCs) are able to adhere to, to survive, to proliferate and to migrate in collagen type I hydrogels and whether they can adopt an osteoblastic fate.

An animal model to study ACL reconstruction during growth.

Controversy exists in the literature regarding the most appropriate treatment for anterior cruciate ligament (ACL) ruptures in the skeletally immature patient. To study the histological and biomechanical stages following ACL reconstruction during growth, it is necessary to establish an equivalent model to replicate the situation of an immature skeleton. In the present study we evaluated a large animal model of ACL reconstruction during growth using skeletally immature sheep.