Cortical Venting: A Simple Surgical Adjunct for the Treatment of Long Bone Nonunion.

Nonunions are a vexing problem for the orthopedic surgeon. Herein, we describe an adjunct to the standard exchange nailing procedure adapted from an established limb lengthening technique in which cortical vents are drilled adjacent to the nonunion site. These transcortical drill tunnels facilitate local dispersion of the osteogenic intramedullary reamings around the nonunion site during the exchange nailing, whereby the extruded reamings serve as autograft for the nonunion.

Utilization of a Clinic-Based Hand Surgery Procedure Room in the US Military Health System: A Performance Improvement Analysis of Resource Savings and Patient Satisfaction.

Purpose: Recent studies examining the implementation of clinic-based procedure rooms (PRs) for wide-awake hand surgery have reported cost reduction, decreased burden on hospital systems, and improved patient satisfaction. This study evaluates other resource savings, primarily time spent by patients in the hospital.

Methods: Thirty-two patients were enrolled in a PR or the operating room group for prospective evaluation.

Bilateral Chronic Quadriceps Tendon Ruptures Treated with Hamstring Autograft Reconstruction: A Case Report.

Case: A 30-year-old semiprofessional football player presented with chronic bilateral quadriceps tendon ruptures. Both quadriceps tendon ruptures were unsuitable for isolated primary repair because of tendon retraction and immobility. A novel reconstruction technique using semitendinosus and gracilis tendon autografts was performed to restore both lower extremities' disrupted extensor mechanisms.

A Longitudinal Perspective on Conversion to Amputation for Combat-Related Extremity Injuries Treated With Flap-Based Limb Salvage.

Objectives: To define the rate and primary drivers behind early and late amputation after flap-based limb salvage in the setting of combat extremity trauma.

Design: Retrospective review.

Setting: Level II trauma center.

Functional Limb Restoration Through Amputation: Minimizing Pain and Optimizing Function With the Use of Advanced Amputation Techniques.

Objective: To demonstrate the role of advanced orthoplastic techniques in harnessing the full potential of elective amputation as a functionally restorative procedure.

Summary Of Background Data: Once considered the unfortunate consequence of failed reconstructive efforts, recent outcomes studies have prompted a re-evaluation of the role of amputation in the management of complex extremity trauma. However, even as amputation is appropriately afforded greater consideration as part of the reconstructive algorithm, reconstructive techniques that are commonly utilized in pursuit of limb salvage are rarely applied to amputation.

The Incidence of Posterior and Combined AP Shoulder Instability Treatment with Surgical Stabilization Is Higher in an Active Military Population than in the General Population: Findings from the US Naval Academy.

Background: Anterior instability has consistently been shown to be the most common type of glenohumeral instability. Recent studies have demonstrated a higher percentage of posterior and combined (anterior and posterior) instability than had previously been reported; however, this work has not been replicated recently in a particularly young military population, which may be representative of an especially athletic or high-demand group.

Question/purpose: What proportion of arthroscopic shoulder stabilization procedures are performed to address isolated anterior instability, isolated posterior instability, and combined instability in a young, military population?

Methods: Between August 2009 and January 2020, two sports medicine fellowship-trained surgeons performed arthroscopic shoulder surgery on 543 patients at a single institution.

The Incidence, Risk Factors, and Complications Associated With Surgical Delay in Multilevel Fusion for Adult Spinal Deformity.

Study Design: Retrospective database review.

Objectives: The incidence and risk factors for surgical delay of multilevel spine fusion for adult spinal deformity (ASD), and the complications corresponding therewith, remain unknown. The objectives of this study are to assess the incidence and risk factors for unexpected delay of elective multilevel spinal fusions on the date of surgery as well as the postoperative complications associated with these delays.

Synchronous Multifocal Necrotizing Fasciitis: A Case Report.

Case: An immunocompetent 43-year-old man was diagnosed with necrotizing fasciitis of his forearm. Despite receiving appropriate treatment, his clinical condition continued to deteriorate. Further evaluation revealed subsequent proliferation of the infection to multiple noncontiguous areas of the body consistent with a rare condition known as synchronous multifocal necrotizing fasciitis.

Orthopaedic osseointegration: Implantology and future directions.

Osseointegration (OI) is the direct anchorage of a metal implant into bone, allowing for the connection of an external prosthesis to the skeleton. Osseointegration was first discovered in the 1960s based on the microscopic analysis of titanium implant placed into host bone. New bone was observed to attach directly to the metal surface.

Managing Complex Peripheral Nerve Injuries Within the Military Health System: A Multidisciplinary Approach to Treatment, Education, and Research at Walter Reed National Military Medical Center.

Introduction: Peripheral nerve injuries are a leading cause of disability within the Military Health System (MHS) patient population. Many peripheral nerve injuries (PNIs) are amenable to therapeutic intervention but require a timely diagnosis and prompt referral to a specialty center capable of intervention, as functional outcomes are directly related to the duration between injury and intervention. Even when appropriately identified, PNI management in the MHS is often challenged by the lack of an established pathway for care coordination and a limited awareness of available diagnostic and therapeutic resources.

The Inverted Free Functioning Gracilis Muscle Transfer For Restoration of Elbow Flexion Following Delayed Presentation or Failed Primary Nerve Reconstruction of Upper Trunk Injuries.

Free functional gracilis transfer is a well-established technique for restoring active elbow flexion in brachial plexus injuries following delayed presentation or failed nerve reconstruction procedures. In cases of delayed presentation or failed nerve reconstruction following upper trunk injuries, the lower trunk intraplexal median and ulnar nerves are spared, thereby making them available to reinnervate the transferred gracilis. Therefore, we have inverted the conventional free functional gracilis orientation so as to orient the flap's recipient nerve in closer proximity to donor median or ulnar nerve fascicles to enable a short, tension-free coaptation in the middle to distal arm.

Low Revision Rates at 10 years for Metal on Metal Hip Implants in a Military Population.

Introduction: Prior to being largely abandoned due to unacceptably high failure rates and the adverse physiologic reactions to metal ions, metal-on-metal (MoM) total hip arthroplasty (THA) and hip resurfacing (HR) were in widespread use throughout the USA, and the potential benefit of decreased volumetric wear rates made it of particular interest to those who serve a young active population, such as military surgeons. The aim of our study was to determine the revision rate of metal on metal hip implants performed at our military institution and obtain current patient reported outcomes from this cohort.

Materials And Methods: We conducted a retrospective review of patients who underwent MoM total hip arthroplasty (THA) or hip resurfacing (HR) at our institution from 2006 to 2012.

Proximal Femur Hounsfield Units on CT Colonoscopy Correlate With Dual-energy X-ray Absorptiometry.

Background: Quantifying bone mineral density (BMD) on CT using commercial software demonstrates good-to-excellent correlations with dual-energy x-ray absorptiometry (DEXA) results. However, previous techniques to measure Hounsfield units (HUs) within the proximal femur demonstrate less successful correlation with DEXA results. An effective method of measuring HUs of the proximal femur from CT colonoscopy might allow for opportunistic osteoporosis screening.

A Combined Distal Tibial Turn-up Plasty and Intercalary Calcaneal Osteocutaneous Fillet Flap for Salvage of a Transtibial Amputation: A Case Report.

Case: This case demonstrates the successful attempt at a combined distal tibial turn-up plasty and intercalary calcaneal osteocutaneous fillet flap to increase functional limb length in order to salvage a transtibial amputation following a high-energy blast injury.

Conclusion: A transtibial amputation is preferred over more proximal levels of amputation because of the decreased energy expenditure that is required for ambulation. In cases where there is not enough viable tibia to allow for a transtibial level of amputation, combining a calcaneal osteocutaneous fillet flap with a distal tibial turn-up plasty can be utilized to optimize residual limb length for a transtibial amputation.