Transosseous Repair of Root Tears of the Lateral Meniscus: Operative Technique and Short-Term Clinical Follow-Up of 28 Patients

An avulsion of the posterior tibial insertion of the lateral meniscus occurs during rotational distortion of the knee and can be associated with a tear of the anterior cruciate ligament (ACL). We performed a follow-up of 28 patients who, following anatomical ACL reconstruction using the ipsilateral semitendinosus graft, underwent either transosseous repair of the posterior lateral meniscus root (n=14) or no intervention (n=14). The meniscus root tears were classified as Forkel I lesions. All patients were examined 6 months after surgery and undertook scoring using International Knee Documentation Committee Score (IKDC). Comparing the repair group with the no repair group the subjective IKDC 6 months after surgery was 75,72% (±1,019) and 75,56 (±1,058). Regarding the objective IKDC 8 × A (57,1%) and 6 × B (42,9%) could be ascertained in the repair group whereas 6 × A (42,9%), 6 × B (42,9%), and 2 × C (14,3%) scoring could be ascertained in the no repair group. It remains unclear if surgery on type Forkel I PLMRT provides benefits compared to the nonsurgical procedures as in both groups stability might occur. The purpose of this article was to report the outcome of surgical repair of lateral meniscus root tears.

The Influence of Psychiatric Comorbidity on Inpatient Outcomes following Distal Humerus Fractures

Background. The influence of psychiatric comorbidity on outcomes following inpatient management of upper extremity fractures is poorly understood. Methods. The National Hospital Discharge Survey was queried to identify patients admitted to US hospitals with distal humerus fractures between 1990 and 2007. Patients were subdivided into 5 groups: depression, anxiety, schizophrenia, dementia, and no psychiatric comorbidity. Multivariable logistic regression analysis identified independent risk factors for adverse events, requirement of blood transfusion, and discharge to another inpatient facility. Results. A cohort representative of 526,185 patients was identified as having a distal humerus fracture. Depression, anxiety, and dementia were independently associated with higher odds of in-hospital adverse events (P<0.001). Depression was associated with higher odds of inpatient blood transfusion (P<0.001). Depression, schizophrenia, and dementia were associated with higher odds of nonroutine discharge to another inpatient facility (P<0.001). Patients with a diagnosis of schizophrenia had a mean of 12 (P<0.001) more days of care than patients with no psychiatric comorbidity. Discussion. Patients with comorbid psychiatric illness who are admitted to hospitals with distal humerus fractures are at increased risk of inpatient adverse events and posthospitalization care.

Reducing Shoulder by Vertical Traction: A One-Man Method for Shoulder Reduction

Fifty percent of joint dislocations reported to the emergency department are of shoulder joint. Various techniques are used to reduce the shoulder and Spaso technique is the least known to the orthopaedic residents which is a simple one-man vertical traction method of shoulder reduction. We evaluated the effectiveness of vertical traction method for anterior shoulder dislocation by orthopaedic residents. Sixty consecutive patients of anterior glenohumeral dislocation attending the emergency department of our hospital were taken up for the study. The reduction was done using Spaso technique. Right shoulder was dislocated in 40 patients and 31 patients had recurrent shoulder dislocation. In 55 patients, shoulder was reduced without the use of any anaesthesia. In patients where no anaesthesia was used, the time of traction ranged from 45 seconds to 5 minutes, while under anaesthesia the time of traction ranged from 1 to 4 minutes. Twenty-one patients had associated greater tuberosity fracture which did not affect the method of reduction and all of them were reducible. No complication was reported, and all the patients were satisfied with the method. In conclusion vertical traction method is a good technique for reducing anterior shoulder dislocation with an easy learning curve among the residents and no complication has been reported so far.

Enhanced Recovery Protocol Reduces Transfusion Requirements and Hospital Stay in Patients Undergoing an Elective Arthroplasty Procedure

Background. Enhanced recovery (ER) for elective total hip or total knee replacement has become common practice. The aim of this study is to evaluate the impact of ER on transfusion rates and incidence of venous thromboembolism (VTE). Methods. A comprehensive review was undertaken of all patients who underwent primary hip or knee arthroplasty surgery electively between January 2011 and December 2013 at our institution. ER was implemented in August 2012, thus creating two cohorts: the traditional protocol (TP) group and the ER group. Outcome measurements of length of stay, postoperative transfusion, thromboembolic complications, and number of readmissions were assessed. Main Findings. 1262 patients were included. The TP group contained a total of 632 patients and the ER group contained 630 patients. Postoperative transfusion rate in the ER group was reduced with 45% (P≤0.05). There was no statistical difference in postoperative VTE complications. The length of stay was reduced from 5.5 days to 4.8 days (P<0.05). Conclusions. There was no difference in the number of readmissions. ER has contributed to a significant decrease in transfusions after elective arthroplasty surgery, with no increase in the incidence of thromboembolic events. Furthermore, it has significantly reduced inpatient length of stay.

Early Clinical Outcomes Associated with a Novel Osteochondral Allograft Transplantation System in the Knee

Background. Osteochondral defects of the knee are a common finding at the time of arthroscopic intervention. Purpose/Hypothesis. To report our outcomes after utilizing a new technique of osteochondral allograft transplantation for focal cartilage defects. Study Design. Case series. Methods. All patients treated with osteochondral allograft transplantation with a Zimmer Chondrofix plug (Zimmer Inc., Warsaw, IN) for focal cartilage defects over a 12-month period were followed up at a minimum of 24 months. Failures were documented and radiographs were evaluated. Results. 61 knees (58 patients) underwent grafting. Three cases were lost to follow-up. In the remaining 58 cases the average age was 40 (range 18–59). At a mean follow-up of 28 months (range 24–36), there were 5 failures requiring further surgery. Mean KOOS scores in the Pain, Symptoms, ADL, Sports, and Quality of Life dimensions were 82, 79, 84, 66, and 58, respectively. Radiographs demonstrated maintenance of the subchondral bone without graft absorption or subsidence. Conclusions. Our observations suggest that osteochondral allograft transplantation leads to a satisfactory activity level and function at early follow-up while avoiding the inherent complexities associated with other cartilage restoration techniques. Longer follow-up is warranted to monitor the subchondral bone, articular surface, and patient outcome measures.

Open Reduction and Internal Fixation of Displaced Supracondylar Fracture of Late Presentation in Children: A Preliminary Report

Background. In late presentation of cases there is dilemma whether to wait for osteotomy later or do open reduction on arrival. The purpose of this prospective multicentric study is to evaluate the functional outcome of open reduction and internal fixation (ORIF) with crossed Kirschner wires fixation and early joint motion in the late presentation of supracondylar fractures in children. Methods. A total of 21 children, with an average delay of 20.3 days, with displaced type III Gartland supracondylar fracture, were treated by ORIF with crossed Kirschner wires fixation and early joint motion. Average follow-up was 12 months. Results. Flynn’s criteria were used to evaluate the outcome. All of them had more functional range of motion of the injured elbow than the published reports. Conclusions. Most of the surgeons in the developing world prefer ORIF for optimal results. Thus it appears to be justifiable to go for ORIF with K-wires even in the late presentation of supracondylar fractures. The overall results are encouraging. However, the small number of cases and lack of control group are the limitations of this study. The study is ongoing and so the full report with more cases will be presented later.

Experiences of a Peripheral Unit in Using a Tripolar Constrained Acetabular Component for Recurrent Dislocations following Total Hip Joint Replacements

Primary total hip arthroplasty is a successful procedure, although complications such as dislocation can occur. In certain patient populations if this is recurrent, it can be difficult to manage effectively. We present a retrospective analysis of our experience of using a capture/captive cup over an 8-year period for frail elderly patients who presented with recurrent hip dislocations. Our findings show no redislocations in our cohort and a survival analysis demonstrates just less than half surviving at 2 years after surgery. Furthermore, Harris Hip Scores were generally calculated to be good. A constrained acetabular component provides durable protection against additional dislocations without substantial deleterious effects on component fixation. Such components should be considered especially in a group of patients with comorbidities or those who are fragile, elderly, and low-demand in nature.

Implementation of an Accelerated Rehabilitation Protocol for Total Joint Arthroplasty in the Managed Care Setting: The Experience of One Institution

Accelerated rehabilitation following total joint replacement (TJR) surgery has become more common in contemporary orthopaedic practice. Increased utilization demands improvements in resource allocation with continued improvement in patient outcomes. We describe an accelerated rehab protocol (AR) instituted at a community based hospital. All patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) were included. The AR consisted of preoperative patient education, standardization of perioperative pain management, therapy, and next day in-home services consultation following discharge. Outcomes of interest include average length of stay (ALOS), discharge disposition, 42-day return to Urgent Care (UC), Emergency Department (ED), or readmission. A total of 4 surgeons performed TJR procedures on 1,268 patients in the study period (696 TKA, 572 THA). ALOS was reduced from 3.5 days at the start of the observation period to 2.4 days at the end. Discharge to skilled nursing reduced from 25% to 14%. A multifaceted and evidence based approach to standardization of care delivery has resulted in improved patient outcomes and a reduction in resource utilization. Adoption of an accelerated rehab protocol has proven to be effective as well as safe without increased utilization of UC, ER, or readmissions.

Variation in Planned Resection of CAM FAI Based on Surgeon Experience

Introduction. Currently, there are no definitive guidelines for the resection of a cam lesion. The purpose of this study was to investigate factors indicating the potential differences in low and high volume hip arthroscopists in marking the area of resection in cam lesions using X-rays for preoperative planning. Methods. Thirty-nine surgeons with varying levels of hip arthroscopy experience participated in the study. Surgeons filled out a survey and traced the area of optimal resection on radiographs with varying amounts of cam FAI. Participants were grouped by number of hip arthroscopies performed, years of surgical experience, and number of surgeries performed. Results. Surgeons who perform osteoplasty as a high percentage of their total hip surgeries per year correlate to the total number of hip arthroscopies performed per year (r=0.412, p<0.05) and number of years of experience (r=0.72, p<0.01). Surgeons performing greater than 50 cases per year traced a larger resection area for 3 different patients’ radiographs as compared to those performing less than 50 cases per year (117%, 143%, and 173%, p<0.05). Conclusions. This study demonstrates that surgeons with less experience (decreased number of years operating and total number of surgeries) plan for resecting less cam than do experienced surgeons.

Treatment of Aseptic Hypertrophic Nonunion of the Lower Extremity with Less Invasive Stabilization System (New Approach to Hypertrophic Nonunion Treatment)

Aim. To evaluate whether aseptic hypertrophic nonunion in the long bones of the lower extremity can be treated successfully with LISS applied with closed methods without grafting. Materials and Methods. The study included 7 tibias and 9 femurs of 16 patients. All cases had hypertrophic nonunion. Initial surgical treatment was with intramedullary nailing in 14 cases, 6 of which had required an exchange of intramedullary nail. All the patients were treated with LISS plate with closed methods. Results. Union was obtained at mean 7 months in all patients. No implant loosening or breakage of the implant was observed and there was no requirement for secondary surgery. Conclusion. Cases of hypertrophic nonunion have excellent blood supply and biological potential. Therefore, there is no need for bone grafting and the addition of fracture stability is enough to achieve full union. Using a limited approach and percutaneous screw insertion, LISS provides fracture stabilization with soft tissue protection.