Short-term outcomes after primary reverse total shoulder arthroplasty in patients with cervical spine pathology or previous cervical spine surgery compared to those without.

BACKGROUND: Cervical spine (c-spine) and shoulder pathology have been known to cause similar symptoms and often co-exist, making an accurate diagnosis difficult, especially in an elderly population. Reverse total shoulder arthroplasty (rTSA) has been shown to decrease pain and improve quality of life when shoulder pathology is the source of pain and disability. The purpose of this study was to identify the prevalence of c-spine pathology in a cohort of patients who underwent rTSA and to compare postoperative outcome scores to a cohort without c-spine pathology. METHODS: A retrospective review was performed utilizing a single institution's operative records of primary rTSAs. Radiology reports, imaging, and operative reports were reviewed, and presence of any c-spine pathology or previous surgery were recorded. Additionally, postoperative outcome scores (American Shoulder and Elbow Surgeons [ASES], Constant Score, University of California, Los Angeles [UCLA], and Simple Shoulder Test [SST]) were evaluated at >2 years post-rTSA. RESULTS: A total of 438 primary rTSA cases were evaluated. Of these, 143 (32.6%) had documentation of prior c-spine pathology and/or history of previous c-spine surgery. After applying further exclusion criteria, a total of 50 patients with c-spine pathology and 108 patients without c-spine pathology were found to have complete medical records and postoperative outcome scores to allow comparison between groups. Patients without c-spine pathology were found to have statistically higher postoperative UCLA, ASES, and SST scores when compared to patients with c-spine pathology. Patients without c-spine pathology also demonstrated a significant improvement in the difference between their postoperative and preoperative UCLA and ASES scores. CONCLUSION: This study demonstrated a high prevalence of c-spine pathology (32.6%) in a cohort of patients who underwent primary rTSA. Additionally, short-term outcome scores of patients undergoing rTSA with concomitant c-spine pathology are significantly lower than those of patients without a history of c-spine pathology.

Type II Odontoid Fractures Case Series: History of Seizures a Risk Factor for Failure of Non-operative Treatment of Type II Odontoid Fractures.

Introduction: Odontoid fractures are one of the most common injuries to the cervical spine. Type II odontoid fracture treatment varies depending on age, co-morbidities, and fracture morphology. Treatment ranges from cervical orthosis to surgical intervention. CurrentlyAt present, fractures with high non-union rates are considered for operative management which includes displacement of >6 mm, increasing age (>40--60 years), fracture gap >1 mm, delay in treatment >4 days, posterior re-displacement >2 mm, increased angulation, and history of smoking. While re-displacement of >2 mm has been associated with increased risk of non-union;, to the best of our knowledge, no studies have looked at the risk factors for re-displacement. Case Report: We present two 26-year-old male patients who were found to have minimally displaced type II odontoid fractures initially treated in a cervical collar. These two patients were subsequently found to have displaced their odontoid fracture after having a documented seizure. Conclusion: We suggest that a history of seizures be considered a risk factor for re-displacement of non-displaced type II odontoid fractures.

Perioperative Considerations in Urgent Surgical Care of Suspected and Confirmed COVID-19 Orthopaedic Patients: Operating Room Protocols and Recommendations in the Current COVID-19 Pandemic.

By April 7, 2020, severe acute respiratory syndrome coronavirus 2 was responsible for 1,383,436 confirmed cases of Coronavirus disease 2019 (COVID-19), involving 209 countries around the world; 378,881 cases have been confirmed in the United States. During this pandemic, the urgent surgical requirements will not stop. As an example, the most recent Centers of Disease Control and Prevention reports estimate that there are 2.8 million trauma patients hospitalized in the United States. These data illustrate an increase in the likelihood of encountering urgent surgical patients with either clinically suspected or confirmed COVID-19 in the near future. Preparation for a pandemic involves considering the different levels in the hierarchy of controls and the different phases of the pandemic. Apart from the fact that this pandemic certainly involves many important health, economic, and community ramifications, it also requires several initiatives to mandate what measures are most appropriate to prepare for mitigating the occupational risks. This article provides evidence-based recommendations and measures for the appropriate personal protective equipment for different clinical and surgical activities in various settings. To reduce the occupational risk in treating suspected or confirmed COVID-19 urgent orthopaedic patients, recommended precautions and preventive actions (triage area, emergency department consultation room, induction room, operating room, and recovery room) are reviewed.

Arthroscopic Anatomic Coracoclavicular Ligament Repair Using a 6-Strand Polyester Suture Tape and Cortical Button Construct.

Acromioclavicular separations are common injuries. Low-grade separations are typically managed with nonoperative treatment. However, surgical treatment is recommended for high-grade separations, as well as for chronic low-grade separations that remain symptomatic. Multiple fixation techniques have been described over the past several decades, including Kirschner wires, hook plates, and coracoclavicular screws. More recently, a single-tunnel suture-graft repair and an anatomic reconstruction reproducing both the conoid and trapezoid ligaments have been described. All described techniques have reported complications, including implant migration, need for implant removal, clavicle or coracoid fracture, and loss of reduction. As a result, there is no single optimal method of operative fixation. We describe our technique for an arthroscopically assisted anatomic coracoclavicular repair using a 6-strand suture tape and cortical button construct.