Hyperbaric oxygen therapy modulates serum OPG/RANKL in femoral head necrosis patients.

Hyperbaric oxygen therapy (HBOT) has beneficial effects on avascular necrosis of femoral head (ANFH), but its mechanism of action is still unclear. We investigated if HBOT upregulates serum osteoprotegerin (OPG) and/or inhibits osteoclast activation. 23 patients with unilateral ANFH at stage I, II and III consented to the study: the patients received standard HBOT.

Variability in Flexion Extension Radiographs of the Lumbar Spine: A Comparison of Uncontrolled and Controlled Bending.

Background: While low back pain is one of the most prevalent, if not the most prevalent reasons for visits to physicians, a majority of patients with low back pain cannot be given a definitive diagnosis. While there have been substantial advances in imaging technologies over the past 30 years, relatively little has changed in the methodologies for evaluating functionality of the lumbar spine. The current standard of care for function assessment of the lumbar spine focuses on uncontrolled patient directed motion which results in increased inter-patient variability.

Ketorolac Administered in the Recovery Room for Acute Pain Management Does Not Affect Healing Rates of Femoral and Tibial Fractures.

Objectives: To determine whether ketorolac administered in the immediate perioperative period affects the rate of nonunion in femoral and tibial shaft fractures.

Design: Retrospective comparative study.

Setting: Single Institution, Academic Level 1 Trauma Center.

Articular Cartilage Injury and Potential Remedies.

Osteoarthritis affects millions of people worldwide, is associated with joint stiffness and pain, and often causes significant disability and loss of productivity. Osteoarthritis is believed to occur as a result of ordinary "wear and tear" on joints during the course of normal activities of daily living. Posttraumatic osteoarthritis is a particular subset of osteoarthritis that occurs after a joint injury.

Comparison of Ocular Radiation Exposure Utilizing Three Types of Leaded Glasses.

Study Design: Anthropomorphic phantoms were used to measure radiation exposure to the surgeon phantom's eye. Groups analyzed were: Group 1-no glasses (None); Group 2-leaded lenses without lead sides (WOLS); Group 3-leaded lenses with lead sides (WLS); and Group 4-sport wraparound leaded glasses (Sport). Glasses were 0.

Seasonal variations in posttraumatic wound infections after open extremity fractures.

Background: The vast majority of the orthopedic trauma literature has dealt with risk of infection as a function of time to debridement and severity of open fracture. The goal of this analysis was to determine if either the incidence or causative organism of posttraumatic infection varies with the season in which the open fracture occurred. No such study has been previously published.

Reduction of the posterior column in displaced acetabulum fractures through the anterior intrapelvic approach.

The anterior intrapelvic approach can be used for the reduction and fixation of displaced fractures of the acetabulum. Reduction techniques and options for placement of fixation deviate to some degree from those used with the traditional ilioinguinal approach secondary to the surgeon's perspective and available vectors. Here, we present several techniques for the application of reduction clamps, reduction techniques, and fixation options for the posterior column in displaced fractures of the acetabulum treated through the anterior intrapelvic approach.

Arthroscopic Repair of Full-Thickness Rotator Cuff Tears With and Without Acromioplasty: Randomized Prospective Trial With 2-Year Follow-up.

Background: Acromioplasty is commonly performed during arthroscopic rotator cuff repair, but its effect on short-term outcomes is debated.

Purpose: To report the short-term clinical outcomes of patients undergoing arthroscopic repair of full-thickness rotator cuff tears with and without acromioplasty.

Study Design: Randomized controlled trial; Level of evidence, 2.

Functional Performance Testing After Anterior Cruciate Ligament Reconstruction: A Systematic Review.

Background: When to allow an athlete to return to unrestricted sporting activity after anterior cruciate ligament (ACL) reconstruction remains controversial.

Purpose: To report the results of functional performance testing reported in the literature for individuals at differing time points following ACL reconstruction and to examine differences between graft types.

Study Design: Systematic review; Level of evidence, 4.

A cadaveric radiographic analysis on the effect of extreme lateral interbody fusion cage placement with supplementary internal fixation on indirect spine decompression.

Study Design: Cadaveric Biomechanical and Radiographic Analysis.

Objective: The purpose of this study was to quantify the changes in intervertebral height and lateral and central recess areas afforded by lateral interbody fusion cages with 2 supplemental forms of internal fixation in cadaveric specimens.

Background Data: When conservative treatment for symptomatic lumbar stenosis fails, traditional intervention has been direct posterior decompression.

Prognosis for recovery of posterior interosseous nerve palsy after distal biceps repair.

Background: There is very little information on the incidence of and usual recovery period for posterior interosseous nerve (PIN) palsies after distal biceps repair. This study examined the incidence and the time to resolution of PIN palsies in a large consecutive series of primary distal biceps repairs.

Materials And Methods: A retrospective review was performed of a consecutive series of patients treated by 34 fellowship-trained upper extremity surgeons with primary distal biceps repair through a single anterior incision technique.

Examination under anesthetic for occult pelvic ring instability.

Objective: To describe the technique and results of stress examination with fluoroscopy under anesthesia (EUA) to determine stability and the need for operative stabilization of traumatic pelvic ring injuries.

Design: Retrospective chart and radiographic review.

Setting: Level I trauma center.

Clamp-assisted reduction of high subtrochanteric fractures of the femur.

Background: Subtrochanteric fractures can be a treatment challenge. The substantial forces that this region experiences and the fact that the proximal fragment is frequently displaced make accurate reduction and internal fixation difficult. The purpose of this study was to evaluate a series of patients who had undergone clamp-assisted reduction and intramedullary nail fixation to determine the impact of this technique on fracture union rates and reduction quality.

Salvage of failed treatment of femoral neck fractures.

The number of patients treated for femoral neck fractures continues to increase. Although most fractures will heal, reported rates of nonunion and osteonecrosis are cause for concern; therefore, implementation of effective salvage strategies is important. The choice of salvage strategy generally is guided by patient age, remaining bone quality, the status of the articular surface of the hip joint, and the viability of the femoral head.

Results of polyaxial locked-plate fixation of periarticular fractures of the knee. Surgical technique.

Background: Locked-plate fracture-fixation techniques and designs continue to evolve. Polyaxial locking plates that allow screw angulation and end-point locking have become available; however, there are no clinical data documenting their strength and efficacy, to our knowledge. The purpose of this study was to evaluate the clinical performance of a variable-axis locking plate in a multicenter series of periarticular fractures about the knee.

In vitro and finite element analysis of glenoid bone/baseplate interaction in the reverse shoulder design.

We developed biomechanical and finite element models, using high-strength polyurethane foam blocks, to represent the glenoid bone/baseplate junction to determine if increasing the distance between the glenoid bone and the center of rotation of the glenosphere increases baseplate motion during static loading in the reverse shoulder design. Although there was a general trend toward increased baseplate motion with increasing distance from the glenoid to the center of rotation, in vitro mechanical testing revealed no significant difference between the 7 glenosphere types tested, with average baseplate motion during 1000 load cycles ranging from 90 mum to 120 mum. Results from the finite element analysis strongly correlated with the in vitro mechanical testing.

Results of polyaxial locked-plate fixation of periarticular fractures of the knee.

Background: Locked-plate fracture-fixation techniques and designs continue to evolve. Polyaxial locking plates that allow screw angulation and end-point locking have become available; however, there are no clinical data documenting their strength and efficacy, to our knowledge. The purpose of this study was to evaluate the clinical performance of a variable-axis locking plate in a multicenter series of periarticular fractures about the knee.

Preoperative planning for revision total knee arthroplasty:avoiding chaos.

Use of preoperative planning is important in avoiding an unstable revision total knee arthroplasty. Physical examination should determine the status of the collateral ligaments so that implants with appropriate constraint are made available. Radiographic examination should determine if bone loss is present and whether primary or revision implants will be needed.

Functional results after revision of well-fixed components for stiffness after primary total knee arthroplasty.

Between 1990 and 2001, 16 well-fixed, aseptic, primary total knee arthroplasties were revised in 15 patients for a diagnosis of stiffness. Patients were followed for a mean of 42 months (range, 2-6 years). Of 15 patients, 10 (66%) were satisfied with the results of the procedure.

Salvage of failed treatment of hip fractures.

Typically, patients with failed internal fixation of a hip fracture have marked pain and disability. These patients may present treatment challenges. Salvage is tailored to the anatomic site of the nonunion, the quality of the remaining bone and articular surface, and patient factors such as age and activity level.

Total knee arthroplasty for salvage of failed internal fixation or nonunion of the distal femur.

Seventeen patients with a mean age of 66 years had total knee arthroplasty (TKA) performed to salvage failed internal fixation or nonunion of the distal femur. Two patients died at less than 2 years, both of whom were unrevised. The remaining 15 were followed for a mean of 5 years.

Innovations in locking plate technology.

Plating techniques remain the mainstay for managing most periarticular and selected long bone fractures. However, movement toward more biologically appropriate plating techniques is occurring in an attempt to minimize soft-tissue stripping, decrease the need for bone grafting, and improve union rates. Internal fixation with locking plates creates a toggle-free, fixed-angle construct.

Surgical management of metastatic spinal neoplasms.

Object: In this study the authors retrospectively review outcomes in patients treated for metastases to the spine. Surgery for metastatic tumors to the spine remains an important part of the treatment armamentarium. Maximum tumor resection with a minimum number of complications is one of the goals of surgery.

The use of spring plates in the internal fixation of acetabular fractures.

The spring plate, a modified one third tubular plate, can be a viable and durable option for fixation of periarticular acetabular fractures. The use of the spring plate in acetabular fractures is demonstrated.