Medial posterior tibial slope measurements are overestimated on long radiographs and 3D CT compared to measurements on short lateral radiographs.

Purpose: This study assessed the measurements of the medial posterior tibial slope (MPTS) using long radiographs and three-dimensional (3D) computed tomography (CT) scans and compared them to measurements taken on short lateral knee radiographs. The study aimed to identify whether the at-risk slope measurements previously defined on the short radiographs would be similar to long radiographs and 3D CT scans.

Methods: A retrospective radiological review of 52 cases, who underwent planning for a slope-changing high tibial osteotomy and had short and long lateral radiographs and 3D CT scans of the tibia.

Learning Data-Driven Patient Risk Stratification Models for Clostridium difficile.

Background: Although many risk factors are well known, Clostridium difficile infection (CDI) continues to be a significant problem throughout the world. The purpose of this study was to develop and validate a data-driven, hospital-specific risk stratification procedure for estimating the probability that an inpatient will test positive for C difficile.

Methods: We consider electronic medical record (EMR) data from patients admitted for ≥24 hours to a large urban hospital in the U.

Endoscopically guided chitosan nasal packing for intractable epistaxis.

Background: The purpose of this study was to evaluate the effectiveness and safety of endoscopically guided chitosan packing in controlling intractable epistaxis. A prospective case series was performed.

Methods: This is a prospective clinical study conducted in a tertiary rhinology fellowship training hospital between January 2009 and November 2009.

Laparoscopic repair of a perineal hernia.

Introduction: Perineal hernias are rare occurrences with statistics ranging from <1 to 3% incidence after open abdominoperineal resection (APR). The incidence of perineal hernia after laparoscopic APR is less certain due to the relatively recent advent of laparoscopic proctectomy. Here we discuss an occurrence of a perineal hernia after a laparoscopic APR and its subsequent laparoscopic repair with mesh.

Is MRI adequate to detect lesions in patients with ankle instability?

Background: Chondral lesions, peroneal tendon tears, and other disorders in patients with chronic ankle instability may not be detected by preoperative MRI. Also, MRI often is obtained and interpreted at the referring institution, leading to variability in reading.

Questions/purposes: We assessed the accuracy of the radiologists' and orthopaedic surgeon's reading of preoperative MRI for diagnosing ankle lesions in patients with ankle instability warranting surgery.

Sciatic nerve injury in total hip resurfacing: a biomechanical analysis.

The condition of the gluteal sling was a significant factor in determining the pressure experienced by the sciatic nerve during acetabular exposure in total hip resurfacing via a posterior approach. The position of the knee did not play a significant role at this stage of the procedure. Average pressures were not elevated above a predefined injury level during positioning for femoral preparation.

Gap formation in transpatellar patellar tendon repair: pretensioning Krackow sutures versus standard repair in a cadaver model.

Background: Postfixation loosening within the Krackow stitch-tendon construct may be associated with gap formation in patellar tendon repair.

Hypothesis: Pretensioning the Krackow stitch-tendon construct decreases postfixation gap formation in transpatellar patellar tendon repair.

Study Design: Controlled laboratory study.

Design and implementation of a home-based exercise program post-hip fracture: the Baltimore hip studies experience.

Objective: The objectives are to describe for the first time a home-based exercise intervention for frail elderly hip fracture patients and to describe the feasibility of this exercise program.

Design: A home-based exercise program was used in a randomized controlled trial in which the authors investigated exercise intervention versus no exercise intervention in patients after hip fracture.

Setting: This program was implemented at the patients' own home or place of residence after discharge.

Longitudinal and axial stability of a cementless metaphyseal versus a fully porous coated cylindrical femoral stem.

Immediate full weightbearing after total hip arthroplasty can potentially lead to faster recovery. This cadaver study demonstrated that a proximally coated taper stem and a fully porous coated cylindrical stem did not differ in axial and torsional stability at failure under simulated full weightbearing with force directed both along the stem axis and perpendicular to the plane of the prosthesis. Both the taper stem and the cylindrical stem showed adequate stability for an immediate weightbearing protocol with respect to gross failure in osteoporotic bone.

Ligamentous laxity of the knee during childhood and adolescence.

Background: There is little age- and sex-specific objective data concerning anterior knee translation in school-aged children. We aimed to establish age- and sex-specific baseline data for anterior knee translation of the knee in girls and in boys in grades 5 to 12. We also investigated whether a correlation exists between anterior knee translation and global joint laxity in girls in grades 5 to 12.

Patellofemoral contact area and pressure after medial patellofemoral ligament reconstruction.

Background: It is not known whether nonisometric femoral graft attachment diminishes the effectiveness of medial patellofemoral ligament reconstruction.

Purpose: To determine whether a nonisometric femoral attachment point is associated with differences in contact area and pressure in the patellofemoral joint as compared with an isometric attachment point.

Study Design: Controlled laboratory study.

Subtalar arthroereisis: a new exploration of an old concept.

Subtalar arthroereisis as an adjunct procedure may hold promise for patients who have mild and more severe variants of posterior tibial tendon dysfunction (PTTD). The biomechanics of the implant function have not been fully elucidated, and questions remain about the best clinical indications for the device. This article reviews the limited existing literature and describes the author's personal experience testing subtalar arthroereisis in the laboratory and using the implant clinically for correction of adult flexible flatfoot.

Cold face test: adrenergic phase.

The cold face test (CFT) evokes reflex bradycardia and pressor responses. Bradycardia has been used to assess vagal function. This study evaluated two aspects of physiology and clinical applicability of the pressor response.

Experimental induction of panic-like symptoms in patients with postural tachycardia syndrome.

Patients with postural tachycardia syndrome (POTS) might be misdiagnosed with panic disorder due to shared clinical features. The first aim of our study was to investigate the relationship between symptoms of POTS and panic disorder. The second aim was to delineate clinical features distinguishing symptoms of POTS from panic disorder.

Peroneal nerve branching suggests compression palsy in the deformities of Charcot-Marie Tooth disease.

Altered expression of the PMP-22 protein may be implicated in Charcot-Marie-Tooth disease and the much rarer disease, hereditary liability to pressure palsy. An element of chronic pressure palsy may explain the unique distribution of motor imbalance in patients with Charcot-Marie-Tooth disease. If this is the case, innervation of the lateral leg motor units should show sufficient anatomic segregation to explain the variable disease patterns.

Headache in patients with baroreflex failure.

Two cases of baroreflex failure presented with tension-type/exertional headache. The usefulness of noninvasive physiological tests in diagnosing baroreflex failure and the role of baroreceptors in trigeminal nociception are discussed.

Esophageal conduit necrosis.

A cumulative review of the prevalence of esophageal conduit necrosis is summarized in Table 4. The spectrum of conduit ischemia is broad and includes cases in which there is anastomotic leak or stricture as well as cases in which there is frank graft necrosis. Many of the studies that the authors reviewed do not specify the exact nature of postoperative ischemic complications or how they are defined.

The cold face test: a non-baroreflex mediated test of cardiac vagal function.

Application of cold to the face evokes potent bradycardia and a pressor response, similar to the diving reflex. However, the role of the baroreceptors in this response is unclear. Ten healthy controls and two patients with baroreflex impairment were recruited.

Treatment of stage II posterior tibial tendon deficiency with flexor digitorum longus tendon transfer and calcaneal osteotomy.

Background: To assess the efficacy of surgical correction of stage II tibial tendon deficiency with medial translational calcaneus osteotomy and flexor digitorum longus tendon transfer to the navicular, the authors retrospectively reviewed results of treatment of stage II posterior tibial tendon deficiency in 129 patients for whom surgery was performed between 1990 and 1997.

Methods: The indication for surgery included tendon weakness, flexible deformity, and foot pain refractory to nonsurgical treatment. All patients had a painful flexible flatfoot without fixed forefoot supination deformity (stage II).

Joint contact characteristics in agility total ankle arthroplasty.

High component contact pressures in total joint prostheses can lead to particle wear debris and prosthesis loosening. The contact pressures in the Agility total ankle prosthesis have not been investigated. In the current study, a cadaveric model was used to evaluate contact characteristics (average contact area, contact pressure, and contact peak pressures) for the Agility total ankle system.

Radiographic and biomechanical support for fibular plating of the agility total ankle.

Syndesmosis nonunion with the Agility total ankle system has been associated with adverse radiographic findings such as radiolucency and migration. We analyzed radiographs and biomechanical data to determine whether the addition of a fibular plate was associated with improved findings related to syndesmosis union compared with results when two syndesmosis screws alone were used. Radiographs for 40 consecutive ankles with the Agility total ankle system with two syndesmosis screws were compared with radiographs for the subsequent 40 consecutive total ankle replacements with an added fibular plate.

Efficacy of a new pressure-sensitive alarm for clinical use in orthopaedics.

The current study evaluated a new pressure alarm and compared the ability of subjects to limit weightbearing to 20 lb with and without the alarm. The 28 subjects were divided into four groups (Group 1, n = 7, mean age, 33 years, with normal sensation; Group 2, n = 7, mean age, 59 years, with normal sensation; Group 3, n = 6, mean age, 56 years, without protective lower limb sensation, and Group 4, n = 8, mean age, 39 years, with transtibial amputation). All subjects were instructed in partial weightbearing ambulation and then practiced weight shifting onto a scale set at 20 lb for 2 minutes.

Revision peripheral nerve surgery.

The treatment of chronic neuropathic pain with revision surgical procedures can be beneficial. A thorough evaluation can help to guide treatment to optimize outcome. With an increasing understanding of the pain-generating mechanisms and the appropriate application of surgical interventions, quality of life and function continues to be improved in patients who have otherwise significant disability.