Bipolar Pedicled Latissimus Dorsi Flap for Soft-Tissue Coverage and Restoration of Elbow Function.

Bipolar latissimus dorsi transfer has been considered a viable option for the restoration of elbow flexion in patients with large traumatic defects of the anterior arm compartment. Advantages of bipolar transfer of the latissimus include stabilization of the anterior shoulder joint in addition to recreating the biceps for a direct line of pull in restoring elbow flexion with minimal donor site morbidity. Previous literature in bipolar latissimus transfer has demonstrated good outcomes in elbow flexion against gravity, range of motion, and patient satisfaction.

Technique for All-Inside Anterior Cruciate Ligament Reconstruction Using Quadrupled Semitendinosus and Gracilis Autograft.

Anterior cruciate ligament (ACL) injuries are common to athletes and non-athletes alike. Whereas the literature has historically supported bone-patellar tendon-bone as the gold standard for active patients who elect to undergo ACL reconstruction, other studies have suggested that soft-tissue grafts do not increase the risk of rerupture. Because graft diameter has a direct effect on revision rates, we share a technique for all-inside ACL reconstruction using quadrupled semitendinosus and gracilis autograft that allows for a predictable, robust graft.

Teres Major and Latissimus Dorsi Repair With Biceps Tenodesis Utilizing Cortical Suspensory Fixation Buttons.

Teres major (TM) and latissimus dorsi (LD) ruptures are relatively rare in the general population and have primarily been observed in overhead throwing athletes. Although the gold standard of care has traditionally been nonoperative, surgical repair of TM and LD tendon ruptures has become increasingly prevalent in high-level athletes who fail to return to play. Literature is scarce regarding operative repair of these tendon ruptures.

Quadriceps Tendon Reconstruction With Achilles Tendon Bone Block Allograft.

Chronic quadriceps tendon ruptures are relatively uncommon albeit debilitating injuries to the knee extensor mechanism. Previous literature demonstrates worse reported outcomes with delayed surgical intervention, and no gold-standard technique currently exists for managing chronic quadriceps tendon ruptures. The goal of this technique is to provide orthopaedic surgeons an additional option that may provide a greater mechanical load to failure and greater allograft acceptance for cases with large tendon gapping or poor tissue quality that may not be viable to other lengthening techniques.

Triple Tendon Transfer of the Levator Scapulae, Rhomboid Major, and Rhomboid Minor to Reconstruct the Paralyzed Trapezius.

Trapezius paralysis is a relatively uncommon condition that orthopaedic surgeons may encounter. Despite the paucity, it presents as a debilitating condition with sequelae of poor function and deconditioning. Conservative management often fails, and patients are left with limited surgical options.

A Case of Lyme Carditis With Variable Heart Block Successfully Treated With Oral Doxycycline.

A 39-year-old male without significant past medical history presented with three weeks of worsening fatigue, migratory arthralgia, rash, and unilateral facial weakness after spending three months in Vermont. Serology showed positive Lyme titers 1:64 for both IgM and IgG. EKG on presentation showed a P-R interval of 384 ms, and the patient was admitted for concern of Lyme carditis.

Revision Achilles Tendon Repair Using Posterior Tibial Tendon Allograft and Flexor Hallucis Longus Transfer.

Achilles tendon ruptures are common injuries seen by orthopaedic surgeons. A myriad of surgical options have been used in the management of Achilles tendon ruptures, but currently no gold standard exists. Re-rupture of Achilles tendon injuries occurs 1.

Patient Utilization of Online Information and its Influence on Orthopedic Surgeon Selection: Cross-sectional Survey of Patient Beliefs and Behaviors.

Background: Patient attitudes and behavior are critical to understand owing to the increasing role of patient choice. There is a paucity of investigation into the perceived credibility of online information and whether such information impacts how patients choose their surgeons.

Objective: The purpose of this study was to explore the attitudes and behavior of patients regarding online information and orthopedic surgeon selection.

Achilles Tendon Rip-Stop SpeedBridge Repair.

Achilles tendon injuries have been on the rise secondary to our increased participation in sports, increase in societal obesity rates, and the growing elderly population. There has been disagreement in recent years about whether to treat injuries such as Achilles tendon ruptures operatively or nonoperatively with aggressive functional rehabilitation. For those opting to surgically manage Achilles tendon ruptures, insertional Achilles tendonitis, or augment the described SpeedBridge Achilles tendon repair, we propose a modified rip-stop technique.

Bicortical Titanium Tenodesis Button With Double-Row Fixation for the Treatment of Proximal Rectus Femoris Avulsion: Review of Literature and Surgical Technique.

In adult populations, rectus femoris avulsions are reported in professional soccer and football players but are noted to be exceptionally rare. No gold standard or recommendations exist for this injury; however, in cases of avulsion at the anterior inferior iliac spine, positive outcomes appear to result from rest, immobilization, and rehabilitation. Surgery is typically reserved for cases with large retractions of bone fragments or unsuccessful nonoperative treatment.

Treatment of Severe Ankle and Hindfoot Deformity: Technique Using Femoral Head Allograft for Tibiotalocalcaneal Fusion Using a Cup-and-Cone Reamer.

Limb shortening due to structural bone loss in tibiotalocalcaneal arthrodesis is a concern that can negatively impact the patient's gait and weight-bearing. To aid in preventing the risk of limb shortening, the use of a femoral head allograft and intramedullary nail in tibiotalocalcaneal arthrodesis has been shown to successfully preserve limb length in patients with structural bone deficits. We present our technique using a femoral head allograft with a cup-and-cone reamer for the treatment of severe ankle and hindfoot deformity.

Low-Profile, Suture Anchor Tension Band Construct for Olecranon Fractures and Osteotomies.

Olecranon fractures are common and frequently require surgical intervention when they are displaced or unstable. Treatment is largely dictated by fracture type and surgeon preference. Traditional methods of fixation, including tension band wiring and locking plate fixation, have adequate union rates; however, both techniques are associated with increased reoperation rates due to symptomatic hardware.

Identifying Intra-Articular Pathology With Arthroscopy Prior to Open Ankle Fracture Fixation.

Purpose: To assess the prevalence of intra-articular findings with ankle arthroscopy in patients undergoing operative fixation for ankle fractures.

Methods: This is a retrospective review of ankle fractures that were treated with arthroscopy and open reduction and internal fixation by a single surgeon. Between August 2016 and July 2018, operative reports, office notes, and images were reviewed to identify intra-articular pathology and fracture type.

An Alternative One-Stage Exchange Arthroplasty Technique: For the Chronic Infected Total Hip.

Background There are various algorithms for the treatment of prosthetic joint infections (PJI). Currently, a two-stage hip exchange is considered the "gold standard" of care for treatment of chronic hip PJIs. However, there has been recent debate whether a one- or two-stage exchange offers the correct treatment.

Anatomic relationship of the sural nerve when performing Achilles tendon repair using the percutaneous Achilles repair system, a cadaveric study.

Background: Minimally invasive techniques for Achilles tendon repair are increasing due to reports of similar rerupture rates using open and percutaneous techniques with fewer wound complications and quicker recovery with percutaneous methods. The goal of this study was to investigate quantitatively the relationship and risk of injury to the sural nerve during Achilles tendon repair when using the Percutaneous Achilles Repair System (PARS) (Arthrex®, Naples, FL), by recording the distance between the passed needles and the sural nerve as well identifying any direct violation of the nerve with needle passage or nerve entrapment within the suture after the jig was removed. The hypothesis of the study is that the PARS technique can be performed safely and without significant risk of injury to the sural nerve.

Ulnar Collateral Ligament Reconstruction Technique Utilizing Suture Tape Augmentation.

The prevalence of ulnar collateral ligament injuries and reconstructions among overhead throwing athletes has significantly risen in recent years. Surgical reconstruction has become the main treatment modality for athletes who have failed conservative treatment and wish to return to their sport. There has been an increased interest in graft augmentation in ligament reconstruction surgeries as surgeons search for ways to decrease the chance of graft failure.

Patellar Tendon Graft Anterior Cruciate Ligament Reconstruction Technique With Suture Tape Augmentation.

Suture tape augmentation for repair and in combination with reconstruction with grafts has been described for multiple procedures. To date, no description of a patellar tendon graft anterior cruciate ligament reconstruction with an augmented graft has been published. This Technical Note details a technique we developed to incorporate a cross-linked suture tape into a patellar tendon graft.

Staged Treatment of Infected Tibiotalar Fusion Using a Combination Antibiotic Spacer and Antibiotic-Coated Intramedullary Nail.

Pilon fractures are notoriously difficult injuries to treat. The current published data on salvage procedures after failed pilon fractures includes both total ankle arthroplasty (TAA) and tibiotalar fusion, each with its own specific indications. However, no acceptable treatment algorithm addressing the complications of these limb salvage procedures is available.

Self-powered therapeutic release from conducting polymer/graphene oxide films on magnesium.

Magnesium's complete in vivo degradation is appealing for medical implant applications. Rapid corrosion and hydrogen bubble generation along with inflammatory host tissue response have limited its clinical use. Here we electropolymerized a poly (3,4-ethylenedioxythiophene) (PEDOT) and graphene oxide (GO) film directly on Mg surface.