Ligament Augmentation and Reconstruction System Failures in Repair of Grade V Acromioclavicular Joint Dislocation.

The Ligament Augmentation and Reconstruction System® (LARS®) represents a popular synthetic anatomical reduction method for acromioclavicular joint dislocation by means of coracoclavicular ligament reconstruction. To our knowledge, no early failure has been documented in the literature. We present two unusual cases of LARS failure, one at four months after implant and the other at three weeks, without obvious causes, requiring re-do reconstruction, and discuss potential contributory factors.

Accuracy of patient-reported range of elbow motion.

BACKGROUND: Patient-reported outcome meaures (PROMs) not only provide valuable insights into subjective indices of joint health, but also may provide limited objective information about range of motion (ROM). We sought to evaluate the accuracy of patient-reported range of elbow motion compared to measured ROM. METHODS: Sixty clinic patients were recruited, of whom 26 had elbow pathologies and 34 had pathologies other than at the elbow joint. Each patient independently estimated ROM for extension, flexion, pronation and supination before this was measured by a clinician using a universal goniometer, with the mean being the gold standard. RESULTS: We found that patients' ROM estimates were significantly different from measured ROM (p < 0.00001 at 95% confidence interval). There was no statistically significant difference between elbow pathology and non-elbow pathology patients' estimated ROM. CONCLUSIONS: There was great disparity between patient-estimated and measured ROM, although estimates of patients with known elbow pathology did not demonstrate any significant difference from their healthy counterparts. These differences may be too great for patient-estimated range of motion to be used as a reliable tool for assessing outcomes.

The Boyd Interval: A Modification for Use in the Management of Elbow Trauma.

Surgical exposure of the radial head, proximal radius, capitellum, and proximal ulna can be achieved through several different approaches. The most commonly used are: the Kocher, Kaplan, and extensor digitorum communis splitting. Each of these approaches has its own limitations and dangers. In this article we describe a modified version of the less commonly used Boyd approach. We have used this approach with a transosseous lateral collateral ligament and annular ligament repair for operative treatment of fractures involving the radial head, proximal radius, proximal ulna including the coronoid, capitellum, and lateral column of the distal humerus. In our experience, the approach results in superior exposure of the lateral elbow while minimizing the risk of injury to the posterior interosseous nerve.

Event-related potential evidence for separable automatic and controlled retrieval processes in proactive interference.

Interference between competing memories is a major source of retrieval failure, yet, surprisingly little is known about how competitive memory activation arises in the brain. One possibility is that interference during episodic retrieval might be produced by relatively automatic conceptual priming mechanisms that are independent of strategic retrieval processes. Such priming-driven interference might occur when the competing memories have strong pre-existing associations to the retrieval cue. We used ERPs to measure the neural dynamics of retrieval competition, and investigated whether the ERP correlates of interference were affected by varying task demands for selective retrieval. Participants encoded cue words that were presented either two or four times, paired either with the same or different strongly associated words across repetitions. In a subsequent test, participants either selectively recalled each cue's most recent associate, or simply judged how many times a cue had been presented, without requiring selective recall. Interference effects on test performance were only seen in the recall task. In contrast, ERPs during test revealed an early posterior positivity for high interference items that was present in both retrieval tasks. This early ERP effect likely reflects a conceptual priming-related N400 reduction when many associations to a cue were pre-activated. A later parietal positivity resembling the ERP correlate of conscious recollection was found only in the recall task. The results suggest that early effects of proactive interference are relatively automatic and independent of intentional retrieval processes, consistent with suggestions that interference can arise through conceptual priming.