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Anatomical Considerations in Percutaneous Fixation of the Pelvis and Acetabulum
Hadeed, Michael MD; Heare, Austin MD; Parry, Joshua MD; Mauffrey, Cyril MD, FRCS, FACS
doi : 10.5435/JAAOS-D-21-00066
October 1, 2021 - Volume 29 - Issue 19 - p 811-819
Reduction and fixation techniques of the pelvis and acetabulum continue to evolve. There has been increased use of percutaneous and minimally invasive techniques in the past several decades. Although offering many advantages to traditional open techniques, percutaneous techniques still place nearby structures at risk, making a thorough understanding of the applied surgical anatomy essential.
Preoperative Peripheral Nerve Blocks in Orthopaedic Trauma Surgery: A Guide to Diagnosis-Based Treatment
Kandemir, Utku MD; Cogan, Charles J. MD
doi : 10.5435/JAAOS-D-20-01325
October 1, 2021 - Volume 29 - Issue 19 - p 820-826
Perioperative pain management remains an important focus of both patient and provider attention in orthopaedic trauma surgery. There is a constant effort to improve pain management while decreasing opioid consumption, and peripheral nerve blocks are a safe and effective way to achieve these two goals. This is particularly relevant because more procedures are being done in outpatient surgery centers, and the need to safely provide analgesia without the systemic risk of opioid medications is paramount. The primary goal of this article was to describe the diagnosis-based approach for the utilization of preoperative peripheral nerve blocks in perioperative care for orthopaedic trauma surgery procedures based on the experience and current practice at our center.
Incidence, Injury Mechanisms, and Recovery of Iatrogenic Nerve Injuries During Hip and Knee Arthroplasty
Patel, Nirav K. MD, FRCS; Krumme, John MD; Golladay, Gregory J. MD
doi : 10.5435/JAAOS-D-21-00122
October 1, 2021 - Volume 29 - Issue 19 - p e940-e949
Iatrogenic nerve injury is a rare but potentially devastating complication in total joint arthroplasty of the hip and the knee. Multiple previous studies have evaluated the incidence, mechanisms of injury, recovery, and potential treatments for this complication. Injury in total hip arthroplasty generally involves direct injury of sensory nerves from the incision, direct or traction injury of during exposure, or limb lengthening. Injury in total knee arthroplasty generally involves direct injury of sensory nerves from incision, injury due to errant placement of retractors, during balancing, or from traction because of deformity correction. Treatment of iatrogenic nerve injuries has ranged from observation, intraoperative prevention by nerve monitoring, limb shortening postoperatively, medications, and decompression. The orthopaedic surgeon should be versed in these etiologies to advise their patients on the incidence of injury, to prevent occurrence by understanding risky intraoperative maneuvers, and to select appropriate interventions when nerve injuries occur.
All-Suture Anchors in Orthopaedic Surgery: Design, Rationale, Biomechanical Data, and Clinical Outcomes
Trofa, David P. MD; Bixby, Elise C. MD; Fleischli, James E. MD; Saltzman, Bryan M. MD
doi : 10.5435/JAAOS-D-20-01224
October 1, 2021 - Volume 29 - Issue 19 - p e950-e960
All-suture anchors (ASAs) are a relatively new alternative to traditional suture anchors, comprised of sutures, suture tapes, or ribbons woven through a soft sleeve. These novel anchors are typically smaller than traditional anchors, allowing for more anchors to be used in the same amount of space or for use when bone stock is limited, for example, in revision settings. They can be inserted through curved guides to reach more challenging locations, and they have thus far had similar loads to failure during biomechanical testing as traditional anchors. However, these benefits must be weighed against new challenges. When using ASAs, care must be taken to fully deploy and seat the anchor against cortical bone for optimal fixation and to prevent gap formation. Furthermore, decortication, often performed to enhance the biologic environment for soft-tissue healing, may weaken the cortical bone on which ASA fixation depends on. The purpose of this article is to provide insight on the designs, advantages, and potential disadvantages associated with ASAs, as well as review the available biomechanical and clinical data.
Does Velocity Increase From Flat-Ground to Mound Work During a Lighter Baseball Training Program?
Hadley, Christopher BS; Atlee, Thomas R. BS; Chalmers, Peter N. MD; Bassora, Rocco MD; Bishop, Meghan E. MD; Romeo, Anthony A. MD; Erickson, Brandon J. MD
doi : 10.5435/JAAOS-D-19-00876
October 1, 2021 - Volume 29 - Issue 19 - p 827-831
There has been recent interest in throwing from flat-ground versus the mound regarding stress on the elbow. Typical throwing progression programs begin with flat-ground work and progress to mound work.
Acute Versus Delayed Reverse Shoulder Arthroplasty for the Primary Treatment of Proximal Humeral Fractures
Seidel, Henry D. BS; Bhattacharjee, Sarah BS; Koh, Jason L. MD; Strelzow, Jason A. MD; Shi, Lewis L. MD
doi : 10.5435/JAAOS-D-20-01375
October 1, 2021 - Volume 29 - Issue 19 - p 832-839
Reverse total shoulder arthroplasty (rTSA) is gaining popularity as a treatment option for proximal humeral fractures in elderly patients. The impact of surgical timing on outcomes of primary rTSA is unclear. This study compared the rates of revision and complication, and surgery day cost of treatment between acute and delayed primary rTSA patients.
Influence of Thoracic Kyphosis on Reverse Total Shoulder Arthroplasty Outcomes
Reintgen, Christian MD; Armington, Samuel BS; Vigan, Marie PhD; Werthel, Jean-David MD; Patrick, Matthew MD; King, Joseph MD; Wright, Thomas MD; Schoch, Bradley MD
doi : 10.5435/JAAOS-D-20-01368
October 1, 2021 - Volume 29 - Issue 19 - p 840-847
Patient dissatisfaction after primary reverse total shoulder arthroplasty (rTSA) has been reported as high as 9%. In patients with excessive thoracic kyphosis, the scapula protracts and tilts anteriorly, which may lead to early impingement with the acromion and loss of forward elevation. The primary purpose of this study was to evaluate the effect of thoracic kyphosis on overhead ROM after rTSA.
Comparison of Postoperative Anatomy Using Anatomic Total Shoulder Arthroplasty Versus Soft-Tissue Balancing Total Shoulder Arthroplasty
Truntzer, Jeremy MD; Vopat, Bryan MD; Schwartz, Joel MS; Anavian, Jack MD; Barnds, Brandon L. MD; Blaine, Theodore A. MD; Green, Andrew MD
doi : 10.5435/JAAOS-D-20-00782
October 1, 2021 - Volume 29 - Issue 19 - p 848-854
The importance of anatomic reconstruction of the proximal humerus on shoulder biomechanics and kinematics after anatomic total shoulder replacement (aTSR) has been highlighted by a number of investigations. The humeral head designs of current-generation shoulder arthroplasty emphasize either anatomic or soft-tissue balancing total shoulder arthroplasty (sbTSR) philosophies. The purpose of this study was to compare the postoperative anatomy of TSR systems used to treat primary glenohumeral osteoarthritis.
Preoperative Opioid Education has No Effect on Opioid Use in Patients Undergoing Arthroscopic Rotator Cuff Repair: A Prospective, Randomized Clinical Trial
Bloom, David A. MD; Baron, Samuel L. MD; Luthringer, Tyler A. MD; Alaia, Michael J. MD; Strauss, Eric J. MD; Jazrawi, Laith M. MD; Campbell, Kirk A. MD
doi : 10.5435/JAAOS-D-20-00594
October 1, 2021 - Volume 29 - Issue 19 - p e961-e968
The purpose of this study was to determine whether a preoperative video-based opioid education reduced narcotics consumption after arthroscopic rotator cuff repair in opioid-naive patients.
Discharge Destination After Shoulder Arthroplasty: An Analysis of Discharge Outcomes, Placement Risk Factors, and Recent Trends
Lavoie-Gagne, Ophelie BS; Lu, Yining BA; MacLean, Ian MD; Forlenza, Enrico BS; Forsythe, Brian MD
doi : 10.5435/JAAOS-D-20-00294
October 1, 2021 - Volume 29 - Issue 19 - p e969-e978
Rates of shoulder arthroplasty continue to increase. Factors influencing disposition and the effect discharge destination may have on perioperative outcomes are currently unknown. This study (1) investigates patients undergoing total shoulder arthroplasty subsequently discharged to home, skilled nursing facilities, and or independent rehabilitation facilities; (2) identifies differences in perioperative outcomes; and (3) investigates the risk of adverse events and readmission after nonhome disposition.
Low Molecular-weight Hyaluronic Acid Versus Physiotherapy for the Treatment of Supraspinatus Tendinopathy: A Randomized Comparative Clinical Trial
Rezasoltani, Zahra MD; Esmaily, Hadi PhD; Dadarkhah, Afsaneh MSc; Rousta, Mansoure MD; Mohebbi, Rezvaneh Pharm D; Vashaei, Fatemeh MD
doi : 10.5435/JAAOS-D-20-01014
October 1, 2021 - Volume 29 - Issue 19 - p e979-e992
The tendons of the rotator cuff are major sources of shoulder pain. This study aimed to compare the effects of low molecular-weight hyaluronic acid with physiotherapy (PT) in patients with supraspinatus tendinopathy (ST).
