Operative Management of Atypical Femur Fractures.

VIDEO AVAILABLE AT: https://ota.org/education/ota-online-resources/video-library-procedures-techniques/operative-management-atypical#/+/0/score,date_na_dt/desc/.

Transverse Pedicle Angle Is Associated With Pelvic Incidence and Increased in Lumbar Isthmic Spondylolisthesis.

STUDY DESIGN: Retrospective radiographic review. OBJECTIVES: Investigate and quantify transverse pedicle angle (TPA), the medial-to-lateral pedicle angulation, and its potential association with pelvic incidence (PI) in patients with isthmic lumbar spondylolisthesis (ISLS) and compare to those with degenerative lumbar spondylolisthesis (DSLS) and controls. METHODS: A total of 200 patients (64 ISLS, 70 DSLS, 66 control) were included. TPA was calculated at the L3-5 vertebral levels using axial computed tomography slices. PI was measured on lateral radiographs. Two independent observers completed the measurements. As a sensitivity analysis, TPA was also measured at the most cranial and caudal aspects of the L3-5 vertebral levels of a subset of participants (29 ISLS, 31 DSLS, 35 control) and the cranial to caudal change (ΔTPA) was calculated. RESULTS: TPA values (mean ± SD) at L4 and L5 for ISLS (L4: 17.3° ± 3.7°, L5: 26.0° ± 5.2°) were significantly higher than those for the DSLS (L4: 14.3° ± 3.8°, L5: 22.2° ± 5.0°) and control (L4: 14.5° ± 3.9°, L5: 20.7° ± 3.8°) groups. TPA in the DSLS group was significantly higher than controls at L5, but not L4. High PI predicted wider TPA at L5 in both DSLS and ISLS. ΔTPA (mean ± SD) increased sequentially proceeding through the L3-5 spinal levels for the ISLS (L3: 6.8° ± 4.4°, L4: 8.7° ± 5.2°, L5: 15.6° ± 9.0°), DSLS (L3: 8.2° ± 6.0°, L4: 8.3° ± 5.9°, L5: 18.3° ± 7.2°), and control (L3: 6.8° ± 4.4°, L4: 8.2° ± 4.7°, L5: 17.7° ± 7.0°) groups. CONCLUSIONS: TPA was significantly increased in ISLS compared with DSLS and controls. High PI significantly predicted high TPA at the L5 vertebral level in ISLS and DSLS. ΔTPA increased sequentially proceeding through the lumbar spine across groups.

The epidemiology of indoor and outdoor rock climbing injuries presenting to USA emergency departments.

BACKGROUND: The popularity of both indoor and outdoor rock climbing has dramatically increased over the last decade. The purpose of this study is to evaluate trends in USA climbing injury rates as well as assess specific injury characteristics, especially in the context of indoor and outdoor climbing. METHODS: The National Electronic Injury Surveillance System database was queried (2010-2019) to compare national weighted injury estimates and compare various injury characteristics from climbers presenting to USA emergency departments. RESULTS: The annual national estimates of rock climbing-related injuries presenting to USA emergency rooms increased significantly (P=0.030) from 2010 (N.=2381; CI 1085-3676) to 2019 (N.=4596; CI 492-8699). About 58.7% of the injuries in this study that could be classified by location occurred climbing outdoors. Ankle injuries were 2.25 times more likely (CI 1.03-3.08) to occur indoors than outdoors. Outdoor climbers were 2.25 times more likely to sustain an injury via falling and 13.8 times more likely to be injured by being struck by an object than indoor climbers (CI 1.05-2.42 and CI 10.67-17.78, respectively). CONCLUSIONS: Indoor and outdoor rock climbing are associated with different injury characteristics and risks. Therefore proper safety precautions, equipment, and training specific to terrain should be observed by all climbers in order to help decrease the rising trend of rock climbing-related injuries in the USA.

Use of the Sports Concussion Assessment Tool 3 in Emergency Department Patients With Psychiatric Disease.

OBJECTIVE: The Sports Concussion Assessment Tool 3 (SCAT3) Symptom Evaluation (SE) is used in the emergency department (ED). This study aimed to examine the effects of psychiatric history on the SCAT3 SE symptom severity score (SSS). SETTING: Three US EDs. PARTICIPANTS: A total of 272 ED patients with suspected concussion. DESIGN: Prospective, nonrandomized, nonblinded study. The SCAT3 SE SSS, demographic data, medical information, and self-reported psychiatric history were obtained from patients by clinical research staff when they presented to the ED seeking standard clinical care. Concussion diagnoses were determined following a comprehensive assessment by an ED physician trained in managing concussions and adjudicated by supervising physicians. MAIN MEASURES: The primary outcome measure was SSS. The association between SSS, self-reported psychiatric disease, and concussion diagnosis was analyzed using multivariable linear regression. RESULTS: 68.4% of subjects were diagnosed with a concussion. After controlling for age, sex, race, history of previous concussion, and interval from injury to ED presentation, self-reported psychiatric history (adjusted regression coefficient (ßa): 16.9; confidence interval [CI]: 10.1, 23.6), and concussion diagnosis (ßa: 21.7; CI: 14.2, 29.2) were both independently associated with a significant increase in SSS. Subjects with a history of concussion had a significantly higher SSS (ßa: 9.1; CI: 1.8, 16.5). Interval from injury to ED presentation was also associated with a significant increase in SSS (ßa: 1.6 per 6-hour increase; CI: 0.4, 2.8). CONCLUSION: Our findings demonstrate that a history of preexisting psychiatric disease, as self-reported by patients with a suspected concussion treated in the ED, is independently associated with significantly higher scores on the SCAT3 SE. This suggests that a history of psychiatric illness may need to be accounted for when the SCAT3 SE is used in the ED for the assessment of concussion.

Does preoperative diagnosis impact patient outcomes following reverse total shoulder arthroplasty? A systematic review.

BACKGROUND: The indications for reverse total shoulder arthroplasty (rTSA) have expanded to include the treatment of a wide variety of shoulder pathologies, and there may be significant differences in patient outcomes based on preoperative diagnosis. METHODS: A systematic review of the orthopedic literature contained in the PubMed, Cochrane, and Embase databases was performed on November 14, 2019. Studies investigating rTSA indicated for 7 distinct preoperative diagnoses (massive rotator cuff tear [MCT] without glenohumeral osteoarthritis [GHOA], MCT with GHOA or cuff tear arthropathy, primary GHOA, inflammatory arthritis with MCT, failed shoulder arthroplasty, proximal humeral fracture [PHF], and sequelae following PHF) were included. The main outcomes of interest included functional outcomes (abduction, external rotation, and forward flexion) and patient-reported outcome measures (American Shoulder and Elbow Surgeons shoulder score and Constant-Murley score). Because of significant variation in measurement and reporting, data on internal rotation were not extracted. In addition, radiographic outcomes and complication rates were extracted and recorded for each of the included studies. RESULTS: In total, 47 studies, comprising 2280 patients, met the inclusion criteria. Significant improvements in functional outcomes and patient-reported outcome measures were found across the preoperative diagnostic groups. There were no significant differences between the diagnostic groups regarding improvement between preoperative and postoperative values for the outcomes of interest, with the exception that the inflammatory arthropathy group had significantly less improvement in the Constant-Murley score than the primary GHOA and revision arthroplasty groups. Although there were few differences in improvement between groups, there were significant differences regarding the level of postoperative functional performance, which was not as consistent in the context of trauma or revision operations (ie, complex PHF, fracture sequela, and revision arthroplasty groups). CONCLUSION: Reverse total shoulder arthroplasty can provide reliable improvement in clinical outcomes regardless of preoperative diagnosis, with few differences across diagnostic groups regarding preoperative to postoperative improvement. The groups with primary GHOA and MCTs with or without GHOA demonstrated the most reliable postoperative functional outcomes of the examined diagnostic groups. Postoperative outcomes were not as consistent in the context of trauma or revision operations, and these groups may benefit from a variety of modern advancements in rTSA, although further research into these modalities for these groups is needed. Finally, rTSA remains an important treatment option in the context of rheumatoid arthritis, with similar outcomes and complication rates compared with the 6 other operative indications.