Atraumatic Index Finger Flexor Tendon Rupture as a Presenting Sign of Capitate Osteonecrosis: A Report of 2 Cases.

CASE: We present 2 cases of spontaneous index finger (IF) flexor tendon ruptures because of previously undiagnosed osteonecrosis (OA) of the capitate. Imaging revealed fragmentation of the capitate, and patients were treated with excision or fixation of the bony fragments with tendon repair. At the final follow-up, both patients had functional digital range of motion. CONCLUSIONS: OA of the capitate is relatively rare and may present as atraumatic (IF) flexor tendon ruptures because of attritional wear when associated with bony fragmentation.

The effect of tendon rotation on distal biceps repair.

BACKGROUND: The distal biceps tendon externally rotates from proximal to distal before inserting onto the radius. Our hypothesis is that an externally rotated (anatomic) repair would re-create native supination moment arm and flexion force, whereas an internally rotated (nonanatomic) repair would result in reduced force transmission. METHODS: The mechanical tests performed in this study measured isometric moment arms and elbow flexion force using a validated elbow simulator as previously published. Mechanical testing was performed on 8 native cadaveric elbows (61 ± 15 years). The distal biceps tendons in all specimens were then incised from their footprint and repaired with anatomic and nonanatomic tendon rotations. After each repair, the specimens were retested. The repair sequence was randomly assigned. RESULTS: Gross observation showed repair site bunching with the nonanatomic repairs. There was no statistical difference in the moment arms between the native, anatomic, and nonanatomic rotations for the 3 forearm angles (P ≥ .352). Analysis showed no statistical difference in flexion force ratio for the elbow at 90° (P ≥ .283). DISCUSSION: The study showed that biceps tendon rotation does not play a role in supination moment arm or flexion force. Twisting the distal biceps tendon around the tendon axis does not change the direction of its applied force on the tuberosity. Tendon bunching in nonanatomic reattachments increases repair site width, which may lead to tendon-ulnar impingement during forearm rotation.

Safety of Outpatient Shoulder Surgery at a Freestanding Ambulatory Surgery Center in Patients Aged 65 Years and Older: A Review of 640 Cases.

INTRODUCTION: With increasing utilization of surgery centers, it is important to demonstrate the safety of outpatient shoulder surgery in freestanding ambulatory surgery centers. No studies have specifically looked at the Medicare-age population and the rate of outpatient shoulder procedure complications in these patients at an ambulatory surgery center. METHODS: Six hundred forty patients were included in our study between 2000 and 2015. The incidence of major complications was identified, including acute infection requiring intravenous antibiotics or irrigation and débridement, postoperative transfer to a hospital, wrong-site surgical procedures, retention of a foreign object, postoperative symptomatic thromboembolism, medication errors, and bleeding/wound complications. RESULTS: There was a total of seven occurrence reports in seven patients, for a reported adverse event rate of 1.01%. CONCLUSIONS: Our findings are consistent with currently reported outpatient hospital-based data and illustrate the safety of outpatient shoulder procedures at a freestanding ambulatory surgery center in Medicare-age patients.

Intertrochanteric Femur Fracture Stability: A Surrogate for General Health in Elderly Patients?

INTRODUCTION: Intertrochanteric (IT) femur fractures are common in elderly patients who are often in poor general health. Intertrochanteric fractures are classified as stable or unstable, taking into account fracture morphology and involvement of the posteromedial calcar. The purpose of this study is to determine whether IT fracture stability can be used as a marker for general health or as a predictor of postoperative medical complications in elderly patients. MATERIALS AND METHODS: We reviewed the records of all patients treated for IT fractures at our institution over the past 7 years. We excluded patients who were younger than 60 years, polytraumatized, involved in high-energy mechanisms of injury, managed nonoperatively, with hardware from previous surgery, or missing preoperative radiographs. Ninety-three patients were included in the present series. Three orthopedic surgeons independently reviewed all preoperative radiographs and classified each fracture as either stable or unstable. Interrater reliability was .77 (substantial) and consensus designation was assigned by majority. We reviewed charts for age, gender, time to surgery, length of hospital stay, type of surgery, estimated blood loss, American Society of Anesthesiologists (ASA) classification, and postoperative medical complications. Univariate and multivariate statistical analyses were conducted to determine the relationship of fracture stability on ASA class and medical complications. RESULTS: Intertrochanteric fracture stability had no detectable relationship with ASA class (P = .497). On univariate analysis, stability was not significantly related to medical complications (P = .421). Our multivariate analysis found that only ASA was related to medical complications (P = .004), and fracture stability was not related to complications (P = .538). CONCLUSION: Intertrochanteric fracture stability does not appear to be a marker for poor general health or to predict postoperative medical complications in elderly patients in this limited study. ASA class was predictive of medical complications. Interestingly, medical complications were 8% greater in patients with unstable fractures than in patients with stable fractures.

Can we trust studies published by authors with financial conflicts? Using the decline of metal-on-metal total hip arthroplasty to investigate.

The objective of our study was to determine if authors with conflicts of interest are less likely to report negative study outcomes in metal-on-metal total hip arthroplasty. We performed a systematic review of 3 major orthopedic journals for articles related to metal-on-metal total hip arthroplasty over 12 years. A total of 64 studies reported clinical outcomes and were included. Reviewers assigned a positive, neutral, or negative label. Each study was noted for the presence of absence of a financial conflict. There was a significant trend from positive to negative study outcomes over time (P = .015). A similar negative trend was seen in studies written by authors with financial disclosures (P = .021). Authors with financial conflicts have contributed to the increase in negative outcomes reported in the literature.

Engineering an improved acellular nerve graft via optimized chemical processing.

The long-term goal of our research is to engineer an acellular nerve graft for clinical nerve repair and for use as a model system with which to study nerve-extracellular matrix interactions during nerve regeneration. To develop this model acellular nerve graft we (1) examined the effects of detergents on peripheral nerve tissue, and (2) used that knowledge to create a nerve graft devoid of cells with a well-preserved extracellular matrix. Using histochemistry and Western analysis, the impact of each detergent on cellular and extracellular tissue components was determined. An optimized protocol was created with the detergents Triton X-200, sulfobetaine-16, and sulfobetaine-10. This study represents the most comprehensive examination to date of the effects of detergents on peripheral nerve tissue morphology and protein composition. Also presented is an improved chemical decellularization protocol that preserves the internal structure of native nerve more than the predominant current protocol.