Collateral Ligament Reconstruction of the Proximal Interphalangeal Joint.

Proximal interphalangeal joint collateral ligament injuries are common; however, chronic instability of this joint is rare. In such cases, however, there is no consensus on optimal management. Various repairs and reconstructions have been devised, although the literature on outcomes remains scant. We present a method of reconstruction of the proximal interphalangeal joint collateral ligament using a distally based slip of the flexor digitorum superficialis tendon.

Perioperative Implications of End-stage Renal Disease in Orthopaedic Surgery.

End-stage renal disease is a prevalent condition that substantially impacts a patient's quality of life. As medical advancements improve function and rates of survival, the number of persons with end-stage renal disease will grow, with orthopaedic surgeons increasingly encountering patients with the disease in their practice. End-stage renal disease is a complex medical condition that is often associated with multiple medical comorbidities. Orthopaedic surgery in patients with this disease is associated with at least a twofold risk of complications and mortality compared with a population without end-stage renal disease. Patients are at an increased risk for cardiovascular, metabolic, hematologic, and infectious complications. Orthopaedic surgeons should be familiar with pertinent issues in the preoperative evaluation and the postoperative management of these patients and should understand the risks of surgery to better inform patients and family. Careful coordination with consulting specialists is necessary to minimize morbidity and improve outcome.

Payer status and increased distance traveled for fracture care in a rural state.

OBJECTIVES: To assess the volume and distance traveled for fracture care at a rural trauma center and how this varied over time by case type and by payer. DESIGN: A retrospective review of the electronic record. SETTING: A rural level 1 trauma center. PATIENTS/PARTICIPANTS: Adults presenting with operative orthopaedic trauma at a rural level 1 trauma center between 1990 and 2007. INTERVENTION: Not applicable. MAIN OUTCOME MEASUREMENTS: County of residence was used to calculate distances traveled to the tertiary care center. Case volume and distance traveled for care were compared by case type, early (1990-1997) and late (1998-2007) time periods, and by payer status. Injury severity score was compared by case type and time period. RESULTS: The presentation of simple injuries to the referral center increased throughout the study period without an increase in injury severity. The percentage of patients with simple injuries covered by standard Medicaid doubled from 11.8% to 21.2% between the early and late time periods. The average distance traveled by patients with simple injuries increased over time from 35.2 to 51 miles, and the distance was greater for Medicaid patients (59.7 vs 42.6 miles). Medicaid patients with emergent injuries also traveled farther for care (77.4 vs 66.1 miles). CONCLUSIONS: Increasing volume of orthopaedic trauma at a rural level 1 trauma center was associated with increasing travel distance for patients. Specifically, there was a dramatic increase in the volume of patients presenting for the care of simple orthopaedic injuries, these patients traveled greater distances with time and were more likely to beon Medicaid. Patients presenting with emergent injuries were also more likely to be on Medicaid. The appropriate triage of orthopaedic injuries requires a well-designed trauma system, including local on-call orthopaedists who can appropriately direct the care of patients with a variety of injuries. The effect of payer status on travel distance may be addressed through changes in reimbursement. Long-distance referral of orthopaedic trauma deserves further study as it affects patient outcomes, cost, and convenience of care.

A geometric morphometric analysis of heterochrony in the cranium of chimpanzees and bonobos.

Despite several decades of research, there remains a lack of consensus on the extent to which bonobos are paedomorphic (juvenilized) chimpanzees in terms of cranial morphology. This study reexamines the issue by comparing the ontogeny of cranial shape in cross-sectional samples of bonobos (Pan paniscus) and chimpanzees (Pan troglodytes) using both internal and external 3D landmarks digitized from CT scans. Geometric morphometric methods were used to quantify shape and size; dental-maturation criteria were used to estimate relative dental age. Heterochrony was evaluated using combined size-shape (allometry) and shape-age relationships for the entire cranium, the face, and the braincase. These analyses indicate that the bonobo skull is paedomorphic relative to the chimpanzee for the first principal component of size-related shape variation, most likely via a mechanism of postformation (paedomorphosis due to initial shape underdevelopment). However, the results also indicate that not all aspects of shape differences between the two species, particularly in the face, can be attributed to heterochronic transformation and that additional developmental differences must also have occurred during their evolution.