Rater Variation in Ultrasound Detection of Dorsal Cortex Screw Protrusion in Fixed-Angle Volar Plating of the Distal Radius.

This study evaluates rater accuracy and variation for the purpose of using intraoperative ultrasound (US) imaging to detect dorsal screw protrusion during fixed-angle volar plating of distal radius fractures. Stabilizing volar plates and screws with varying lengths of dorsal protrusion were applied to 10 cadaver wrist pairs. After a brief training session, seven surgeons without prior ultrasound experience assessed screw protrusion on two separate occasions using a diagnostic ultrasound machine. Screw protrusions were visually confirmed after data collection was completed. Statistical analyses included percent agreement and Cohen's kappa for accuracy and intra- and inter-rater reliability, sensitivity, specificity, and positive and negative predictive values. Only two out of seven raters met acceptable levels of accuracy and consistency. Our findings inform us that accuracy and consistency of ultrasound-guided detection of dorsal screw protrusion are negatively impacted by rater variation. Further investigations are needed to improve rater effectiveness. (Journal of Surgical Orthopaedic Advances 28(4):260-267, 2019).

Computed Tomography Analysis of Postsurgery Femoral Component Rotation Based on a Force Sensing Device Method versus Hypothetical Rotational Alignment Based on Anatomical Landmark Methods: A Pilot Study.

Rotation of the femoral component is an important aspect of knee arthroplasty, due to its effects on postsurgery knee kinematics and associated functional outcomes. It is still debated which method for establishing rotational alignment is preferable in orthopedic surgery. We compared force sensing based femoral component rotation with traditional anatomic landmark methods to investigate which method is more accurate in terms of alignment to the true transepicondylar axis. Thirty-one patients underwent computer-navigated total knee arthroplasty for osteoarthritis with femoral rotation established via a force sensor. During surgery, three alternative hypothetical femoral rotational alignments were assessed, based on transepicondylar axis, anterior-posterior axis, or the utilization of a posterior condyles referencing jig. Postoperative computed tomography scans were obtained to investigate rotation characteristics. Significant differences in rotation characteristics were found between rotation according to DKB and other methods (P < 0.05). Soft tissue balancing resulted in smaller deviation from anatomical epicondylar axis than any other method. 77% of operated knees were within a range of ±3° of rotation. Only between 48% and 52% of knees would have been rotated appropriately using the other methods. The current results indicate that force sensors may be valuable for establishing correct femoral rotation.

Electronic measurement of soft-tissue balancing reduces lateral releases in total knee arthroplasty.

Soft tissue balancing during total knee arthroplasty (TKA) has a direct affect on patello-femoral tracking and knee range of motion, which are necessary for a well functioning TKA postoperatively. We report on the use of an electronic pressure sensing instrument for soft tissue balancing of the knee before completion of all intraoperative bone cuts, as a way to improve patellar tracking. In a retrospective study of 99 consecutive TKAs, with intraoperative electronic instrument guided soft tissue balancing performed, a reduction in the incidence of lateral patellar retinacular release was found, as compared with the 100 consecutive TKAs prior to its use (5.5% v 12%, respectively). Electronic measurement of soft tissue balancing during TKA reduced the need for lateral patellar retinacular release.

Direct anterior approach to total hip arthroplasty using computer navigation.

UNLABELLED: The incorporation of computer navigation in total hip arthroplasty (THA) has been much slower than for total knee arthroplasty (TKA). One reason for this is that a majority of THAs are performed with the patient in the lateral position through a posterior or lateral approach, making the tracker placement and the registration process cumbersome. In the direct anterior approach, the patient is in the supine position, which accommodates pelvic tracker placement and markedly facilitates the registration process. At our institution, we use the direct anterior approach and computer navigation on all of our primary THAs. We hypothesized that computer navigation improves cup placement without increasing operative time. MATERIALS AND METHODS: This was a retrospective study comparing a consecutive series of 150 computer navigated THAs to a consecutive series of 150 non-navigated hips. The two groups were similarly matched by age, gender, and body mass index. Postoperative anteroposterior pelvic radiographs and operative times were analyzed. RESULTS: The navigation group mean cup inclination was 41° (range, 32° to 54°), compared to 36° (range, 19° to 52°) for the non-navigated group. The mean surgical time for the navigation group was 56 minutes (range, 34 to 91 minutes) and 61 minutes (range, 33 to 119 minutes) for the non-navigated group. CONCLUSION: The results suggest that computer navigation is easy to incorporate when utilizing a direct anterior approach and in our series shortens the operative time. The accuracy and precision of cup angle placement is comparable to our non-navigated method but appears to be slightly improved with computer navigation. Although more work is needed for progress with this promising technology, we believe that incorporating computer navigation for hip arthroplasties in the supine position is straightforward and of great value.

Direct anterior approach for hip resurfacing: surgical technique and complications.

BACKGROUND: The direct anterior approach (DAA) for hip resurfacing arthroplasty is a technically difficult approach but theoretically reduces the soft tissue trauma to the hip because it does not require muscle detachments from the bone. Furthermore, the patient is in the supine position facilitating fluoroscopy to control component placement. However, the complications associated with the learning curve and functional outcome scores are not well defined in the literature. QUESTIONS/PURPOSES: We therefore asked how our first 57 operations using the anterior approach and special table extension compared with that in the literature with regard to (1) complication rate; (2) functional outcome scores; (3) component placement; and (4) length of stay. METHODS: We retrospectively reviewed 51 patients who underwent 57 hip resurfacing procedures using a DAA. There were 45 men and six women with an average age of 51 years (range, 31-63 years) and a body mass index of 28.7 kg/m(2) (range, 19.7-42.0 kg/m(2)). The minimum followup was 0.3 months (mean, 8.7 months; range, 0.3-24.9 months). RESULTS: There were three atraumatic (5%) and one posttraumatic (1.8%) femoral neck fractures. Average HOOS scores were equal to or better than averages reported for total hip arthroplasty. Average cup inclination was 36.5° (range, 25°-48°). The average length of stay was 2.11 days (range, 1-4 days). CONCLUSIONS: The surgical approach for anterior hip resurfacing is technically difficult but may have some clinical benefits. Surgeons interested in using the DAA for hip resurfacing should be very familiar with the DAA for total hip arthroplasty and with hip resurfacing.

Discharging to a nursing home: not a terminal event--a follow-up study of senior motor vehicle crash patients.

Discharge to a nursing home (NH) because of chronic debilitating diseases or old age is generally a terminal event. The purpose of this study was to evaluate the NH outcome of senior citizens injured in motor vehicle crashes (MVC) discharged to a NH. From 2000 through 2004, 157 patients 75 years and older were admitted to the hospital for MVC. Of these, 32 patients were discharged to a NH, and these patients or their proxies were interviewed by telephone in June 2005 to request information as to driving status before and after the MVC, feeding, expression, and locomotion status, and/or date of death. After discharged from the NH, 72 per cent (23/32) of the patients lived at home, 52.2 per cent (12/23) among the drivers returned to drive, and those with functional impairments (excluding the five NH deaths and four still remaining in a NH) at the time of hospital discharge had 100 per cent or partial improvement in three functional independent measures at the time of the interview: 5 cases in feeding, 2 in expression, and 20 in locomotion. Eleven of the 20 individuals dependent or partially dependent in locomotion status were fully independent. The majority of the senior patients discharged to a NH after a MVC returned to a normal life by going back home, driving again, and regaining functional activities after NH discharge. Discharge to a NH for elderly MVC trauma patients may be regarded as a stepping-stone to independent living rather than a final resting place.