Distal biceps tendon injuries.

Distal biceps tendon ruptures present with an initial tearing sensation accompanied by acute pain; weakness may follow. The hook test is very reliable for diagnosing ruptures, and magnetic resonance imaging can provide information about the integrity and any intrasubstance degeneration of the tendon. There are subtle differences between the outcomes of single and modified two-incision operative repairs. With regard to complications, there is a higher prevalence of nerve injuries in association with single-incision techniques and a higher prevalence of heterotopic ossification in association with two-incision techniques. Fixation techniques include the use of bone tunnels, suture anchors, interference screws, and cortical fixation buttons. There is no clinical evidence supporting the use of one fixation method over another, although cortical button fixation has been shown to provide the highest load tolerance and stiffness. Postoperative rehabilitation has become more aggressive as fixation methods have improved.

Management of medial collateral ligament injuries in the knee: an update and review.

The medial collateral ligament (MCL) is the most frequently injured ligament in the knee, with mild-to-moderate tears often going unreported to physicians. Medial collateral ligament injuries can result from both contact and noncontact sporting activities. The mainstay of treatment is nonoperative; however, operative management of symptomatic grade II and grade III injuries is considered when laxity and instability persist. The timing of surgical repair in the setting of a multiligament knee injury remains an area of controversy among surgeons, with proponents of early reconstruction of the anterior and posterior cruciate ligaments and nonoperative management of the MCL versus proponents of delayed reconstruction following nonoperative treatment of the MCL. Prophylactic bracing may continue to increase and evolve as bracing technology improves and athletic cultures change.

Treatment of medial collateral ligament injuries.

The medial collateral ligament is the most frequently injured ligament of the knee. The anatomy and biomechanical role of this ligament and the associated posteromedial structures of the knee continue to be explored. Prophylactic knee bracing has shown promise in preventing injury to the medial collateral ligament, although perhaps at the cost of functional performance. Most isolated injuries are treated nonsurgically. Recent studies have investigated ligament-healing variables, including modalities such as ultrasound and nonsteroidal anti-inflammatory drugs. Concomitant damage to the anterior or posterior cruciate ligaments is a common indication to surgically address the high-grade medial collateral ligament injury. The optimal treatment of multiligamentous knee injuries continues to evolve, and controversy exists surrounding the role of medial collateral ligament repair/reconstruction, with data supporting both conservative and surgical management.

Surgical treatment of refractory tibial stress fractures in elite dancers: a case series.

BACKGROUND: Treatment of tibial stress fractures in elite dancers is centered on rest and activity modification. Surgical intervention in refractory cases has important implications affecting the dancers' careers. HYPOTHESIS: Refractory tibial stress fractures in dancers can be treated successfully with drilling and bone grafting or intramedullary nailing. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between 1992 and 2006, 1757 dancers were evaluated at a dance medicine clinic; 24 dancers (1.4%) had 31 tibial stress fractures. Of that subset, 7 (29.2%) elite dancers with 8 tibial stress fractures were treated operatively with either intramedullary nailing or drilling and bone grafting. Six of the patients were followed up closely until they were able to return to dance. One patient was available only for follow-up phone interview. Data concerning their preoperative treatment regimens, operative procedures, clinical union, radiographic union, and time until return to dance were recorded and analyzed. RESULTS: The mean age of the surgical patients at the time of stress fracture was 22.6 years. The mean duration of preoperative symptoms before surgical intervention was 25.8 months. Four of the dancers were male and 3 were female. All had failed nonoperative treatment regimens. Five patients (5 tibias) underwent drilling and bone grafting of the lesion, and 2 patients (3 tibias) with completed fractures or multiple refractory stress fractures underwent intramedullary nailing. Clinical union was achieved at a mean of 6 weeks and radiographic union at 5.1 months. Return to full dance activity was at an average of 6.5 months postoperatively. CONCLUSION: Surgical intervention for tibial stress fractures in dancers who have not responded to nonoperative management allowed for resolution of symptoms and return to dancing with minimal morbidity.

Surgical management of hip fractures: an evidence-based review of the literature. I: femoral neck fractures.

During the past 10 years, there has been a worldwide effort in all medical fields to base clinical health care decisions on available evidence as described by thorough reviews of the literature. Hip fractures pose a significant health care problem worldwide, with an annual incidence of approximately 1.7 million. Globally, the mean age of the population is increasing, and the number of hip fractures is expected to triple in the next 50 years. One-year mortality rates currently range from 14% to 36%, and care for these patients represents a major global economic burden. Surgical options for the management of femoral neck fractures are closely linked to individual patient factors and to the location and degree of fracture displacement. Nonsurgical management of intracapsular hip fractures is limited. Based on a critical, evidence-based review of the current literature, we have found minimal differences between implants used for internal fixation of displaced fractures. Cemented, unipolar hemiarthroplasty remains a good option with reasonable results. In the appropriate patient population, outcomes following total hip arthroplasty are favorable and appear to be superior to those of internal fixation.

Orthopedic surgery residents' study habits and performance on the orthopedic in-training examination.

The Orthopaedic In-Training Examination (OITE) is a tool used by residency directors to evaluate a resident's fund of orthopedic knowledge. In this study, we correlated resident study habits and preparation tools with performance on the OITE. Data analysis indicated statistically significant correlations between successful OITE performance and frequent review of current orthopedic journals (Journal of Bone and Joint Surgery-American Edition, r = .6, P < .001; Journal of the American Academy of Orthopaedic Surgeons, r = .36, P = .02), daily orthopedic reading (r = .34, P = .03), increased preparation time for OITE (r = .31, P = .04), and more hours committed to studying (r = .37, P = .01). In addition, residents who emphasized prior OITEs and self-assessment examinations when preparing had higher scores (r = .53, P < .001, and r = .64, P < .001, respectively). Our study results show that several factors, including structured study habits and use of specific study materials, contribute to residents' successful OITE performance. Adaptation of these findings by current orthopedic residents may have a positive impact on OITE performance.