Full-Thickness Skin Graft From an Amputated Part: Review of Successful Treatment of Class III Ring Avulsion Injury at Bedside in the Emergency Department.

Urbaniak class III ring avulsion injuries involve significant soft tissue and bone loss. Management typically focuses on immediate, temporary soft tissue coverage followed by a planned trip to the operating room for either amputation or replantation. While soft tissue coverage is of utmost importance, maintenance of digital length, functionality, and cost-effectiveness of viable treatment options should also be considered.

Physical Therapy-Induced Fracture After Reverse Shoulder Arthroplasty: A Case Report.

Case: We present a case of a physical therapy-induced fracture of the proximal humerus, presumably caused by forceful shoulder flexion and external rotation, after reverse total shoulder arthroplasty (RTSA) in a 70-year-old woman with underlying osteopenia, systemic lupus erythematosus, long-term glucocorticoid use, and common variable immunodeficiency.

Conclusion: This case of a physical therapy-induced greater tuberosity fracture after RTSA presents an example of an early postoperative complication with no impact on eventual successful surgical outcomes. Special consideration should be given to tailor the postoperative rehabilitation after RTSA in patients with increased risk of fractures.

Ulnohumeral joint static cartilage compression is affected by radial head implant size.

Introduction: Radiocapitellar joint arthroplasty is a commonly performed procedure, which often leads to early failure or instability. Few studies assess the effect of radiocapitellar joint arthroplasty on the ulnohumeral joint. We hypothesized that static forces of contact (compressing cartilage, or cartilage relaxation contact force) would reveal the effect of varying radial head implant size and elbow position on the ulnohumeral joint.

Factors considered in ranking orthopedic shoulder and elbow fellowship applicants: a survey of program directors.

Background: Orthopedic fellowship positions continue to be increasingly competitive, with most orthopedic residency graduates pursuing fellowship after completion of residency. Shoulder and elbow fellowship training represents an increasingly competitive and relatively smaller cohort of applicants than other subspecialties; there are only 29 programs with a total of 40 offered positions. The purpose of this survey is to identify and rank factors considered most important by shoulder and elbow fellowship directors when identifying potential fellowship candidates.

Anterior Ankle Incision Wound Complications Between Total Ankle Replacement and Ankle Arthrodesis: A Matched Cohort Study.

The anterior incision is commonly used for total ankle replacement (TAR) and ankle arthrodesis. Historically, the anterior incision has demonstrated a high incidence of complications. The purpose of this study was to evaluate anterior incisional healing and soft tissue complications between TAR and ankle arthrodesis with anterior plate fixation.

High Energy Midfoot Fracture-Dislocations: Does Staged Treatment with External Fixation Help?

This study analyzes the outcomes of patients treated for high energy midfoot injuries with temporary stabilization (TS) prior to definitive operative fixation compared to a control group (C) treated initially with splint only. Three Level 1 trauma centers reduced and temporized high energy Lisfranc injuries. A matched control group was compared with the intervention group.

Gunshot Wounds to the Hip: Doomed to Failure?

The purpose is to evaluate hip fractures due to gunshot wounds (GSW) to the hip, which are treated surgically, and the complications. Patients who sustained a low velocity GSW with fracture to the femoral head/neck and intertrochanteric/peritrochantric region at three Level 1 Trauma Centers were eligible. There were 69 patients (63 males-91%), with an average age of 29 (18-60).

Rate of infection following revision anterior cruciate ligament reconstruction and associated patient- and surgeon-dependent risk factors: Retrospective results from MOON and MARS data collected from 2002 to 2011.

Infection is a rare occurrence after revision anterior cruciate ligament reconstruction (rACLR). Because of the low rates of infection, it has been difficult to identify risk factors for infection in this patient population. The purpose of this study was to report the rate of infection following rACLR and assess whether infection is associated with patient- and surgeon-dependent risk factors.

The Effect of ACDF or Arthroplasty on Cervicogenic Headaches: A Post Hoc Analysis of a Prospective, Multicenter Study With 10-Year Follow-up.

Study Design: This was a post hoc analysis of a prospective FDA-IDE study.

Objective: The purpose of this study is to determine the effectiveness of a 2-level anterior cervical discectomy and fusion (ACDF) or cervical disk arthroplasty (CDA) at relieving headaches associated with cervical radiculopathy or myelopathy at 10 years postoperative.

Background: To our knowledge, there is no large, prospective study that has examined the efficacy of cervical spine surgery for relieving headaches associated with radiculopathy or myelopathy at 10 years postoperative.

Women in Orthopedics and their Fellowship Choice: What Influenced their Specialty Choice?

Background: Female orthopedic surgeons have different life choices, experiences, and influences that may alter their decisions when choosing a fellowship. There is no data that describes why women choose their specialty and if it is related to their mentorship, athletic background, family, family planning, physical attributes needed, location, practice setting, or discrimination.After a five year orthopedic residency, what influences their specialty choice to work in a specific field?Questions/ purposes: To understand why women in orthopedics chose a certain fellowship and if they are influenced by any specific factor.

Residency Program Reputation Influences the American Association of Hip and Knee Surgeons Match Results.

Background: No data evaluate the impact that an applicant's residency program reputation has on the outcome of the American Association of Hip and Knee Surgeons (AAHKS) fellowship match. This study sought to determine if an applicant's residency program ranking was associated with where the applicant matched on their rank list.

Methods: We included all the US applicants from the "San Francisco Match" regarding AAHKS applicant data and match results from 2014 to 2018.

The Central-Splitting Approach for Achilles Insertional Tendinopathy and Haglund Deformity.

Unlabelled: Insertional Achilles tendinopathy causes posterior heel pain at the insertion of the Achilles tendon, often in combination with a calcaneal exostosis, or Haglund deformity. Insertional Achilles tendinopathy often presents with a posterior osseous prominence and leads to calcification of the Achilles tendon. Nonoperative treatment of these conditions includes activity modification, nonsteroidal anti-inflammatory agents, heel lifts, shoe modification, physical therapy focused on eccentric strengthening exercises, iontophoresis, and shock wave therapy.

Evaluation of callus formation in distal femur fractures after carbon fiber composite versus stainless steel plate fixation.

Introduction: Carbon-fiber-reinforced polyetheretherketone (CFR) composite plates have a more favorable stress modulus than stainless steel (SS) plates that may confer an advantage to bridge plating. The purpose of this study was to compare callus formation after CFR and SS plating of distal femur fractures.

Methods: A retrospective review identified distal femoral fractures treated with CFR (n = 10) and SS (n = 21) plate fixation.

Clinical experience with the use of a spherical bioactive glass putty for cervical and lumbar interbody fusion.

Background: A retrospective clinical case series study was conducted to evaluate the use of a novel, spherical bioactive glass bone graft (BioSphere Putty) as a graft material for cervical and lumbar interbody fusion.

Methods: Data was collected from a single surgeon using BioSphere Putty along with standardized hardware in anterior cervical decompression and fusion (ACDF), transforaminal lumbar interbody fusion (TLIF), and anterior lumbar interbody fusion (ALIF) surgical procedures. BioSphere Putty was used in combination with cancellous allograft (ACDF and ALIF) or in combination with autograft (TLIF).

Management of Pain Associated with Fractures.

Purpose Of Review: The purpose is to review current literature on pain management strategies from initial presentation to postoperative care on common fracture types.

Recent Findings: - Hip fractures benefit from use of multimodal pain control for early mobility and decreased narcotic requirement. - Distal radius fracture pain during reduction can be managed with hematoma block.

Ultrasound-Guided Percutaneous Tenotomy for Gluteal Tendinopathy.

Background: Gluteal tendinopathy is a common cause of lateral hip pain. Percutaneous ultrasonic tenotomy (PUT) has been used successfully for the treatment of tendinopathy of the elbow, knee, and ankle, but its use in the hip has not been described.

Purpose: To evaluate the efficacy of PUT in patients who did not respond to nonsurgical management of gluteal tendinopathy.

Carbon Fiber-Reinforced PEEK Versus Titanium Tibial Intramedullary Nailing: A Preliminary Analysis and Results.

Objectives: Standard titanium nails (TN) or carbon fiber-reinforced PEEK nails (CFN) were compared to evaluate impact of material on fracture union, healing time, knee/ankle, and barometric pain.

Design: Longitudinal cohort evaluated retrospectively comparing 2 periods using 2 implant types.

Setting: Single surgeon series at one Level II Trauma Center.

Perforated ileus after L5-S1 anterior lumbar interbody fusion: a case report presentation.

Acute colonic pseudo-obstruction (ACPO) as a result of anterior lumbar spinal surgery can result in colonic perforation. ACPO is often treated successfully with conservative measures, reserving surgical intervention for severe cases. The most severe cases can result in colonic perforation with a concomitant high mortality rate.

Softer Tissue Issues in Orthopaedic Trauma.

There are number of significant issues outside of the bone and/or fracture that are important to consider in the treatment of orthopaedic trauma. Joint contractures, heterotopic bone formation, managing a traumatized soft-tissue envelope or substantial soft-tissue defects represent a few of these important issues. This article reviews these issues, including the best available evidence on how to manage them.

Ulnar Collateral Ligament Repair With Collagen-Dipped FiberTape Augmentation in Overhead-Throwing Athletes.

Background: There has been a renewed interest in ulnar collateral ligament (UCL) repair in overhead athletes because of a greater understanding of UCL injuries, an improvement in fixation technology, and the extensive rehabilitation time to return to play.

Purpose/hypothesis: To evaluate the clinical outcomes of a novel technique of UCL repair with internal brace augmentation in overhead throwers.

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

ISASS Policy 2018-Vertebral Augmentation: Coverage Indications, Limitations, and/or Medical Necessity.

The ISASS Policy Statement on vertebral augmentation has the objectives to provide a background and an update with the latest clinical evidence for the international spine community. A SpineLine Panel Review (2010) appropriately recommended an exploration of "the seeming disconnect between the conclusions of … two [Level I] PRCT's and previous experience and data" regarding vertebral augmentation. ISASS responded by supporting a comprehensive meta-analysis to help frame a cogent historical analysis of vertebral augmentation.

Open Reduction and Internal Fixation with a Locking Plate Via Deltopectoral Approach for the Treatment of Three and Four-Part and Proximal Humeral Fractures.

Open reduction and internal fixation (ORIF) via the deltopectoral approach is the gold standard for operatively treated proximal humeral fractures when joint preservation is desired. Indications include an unacceptable deformity, need for stability and early mobilization, and osteoporotic bone. (1) A 12 to 14-cm incision is made in the deltopectoral groove.

ISASS Recommendations and Coverage Criteria for Bone Graft Substitutes used in Spinal Surgery.

Autologous bone graft remains the gold standard by which bone graft substitutes are compared in spine fusion surgery. The utilization of bone graft substitutes, either as (1) an extender for spinal fusion constructs or (2) an alternative to minimize morbidity while maximizing outcomes, is changing. Moreover, current procedures technology (CPT) code 20939 became effective in 2018 defining bone marrow aspirate for bone grafting, spine surgery only.

Assessment of Inter- and Intraobserver Reliability and Accuracy to Evaluate Apical Vertebral Rotation Using Four Methods: An Experimental Study Using a Saw Bone Model.

Study Design: After placing a thoracic three-vertebra segment saw bones model on a standardized turntable, a series of anteroposterior (AP) radiographs were obtained and then set in increments to 90° rotation. Then the specimen was instrumented with 35-mm pedicle screws bilaterally and the rotation process and image acquisition were repeated.

Objective: Assess reliability and accuracy of spine surgeons evaluating apical vertebral rotation (AVR) through surgeon's visual x-ray estimation, Nash-Moe system, Upasani trigonometric method, and Upasani grading system.