ABSTRACT
BACKGROUND: A2 pulley release is often needed for exposure of the lacerated tendon, retrieval of retracted tendons, placement of core sutures, or to permit full motion and gliding of the repaired and edematous tendon. However, there is no agreement in the literature on the specific quantity of pulley venting that can be performed and recommendations are limited to an undefined "judicious release" of the pulleys when necessary. METHODS: Following a previously developed testing protocols, finger kinematics, tendon excursion, and bowstringing were evaluated on cadaveric hands for venting in increments of 20% of the pulley length. RESULTS: In our study, we found a statistically significant influence of venting on bowstringing, although no difference was found between fingers, and a significant difference in tendon slack, which was variable depending on the finger. Bowstringing started increasing at 20% of A2 venting and peaked at full release. Tendon slack did not start until 40% of A2 venting on the index finger, but started at 20% on the middle, ring, and small fingers. CONCLUSIONS: Venting of the A2 pulley leads to an incremental increase in tendon bowstringing and tendon slack. However, differences in metacarpophalangeal flexion angle were not observed until full A2 pulley release, and only observed in the index finger, and no differences were observed in proximal interphalangeal flexion angles. Therefore, the benefit of releasing the A2 pulley when clinically necessary will likely outweigh the risks of loss of motion or strength.
ABSTRACT
Fixation of osteochondral fractures after patellar dislocation is typically done using an open approach due to the location of the defect. This is traditionally performed through a medial parapatellar arthrotomy to allow adequate visualization. By using the joystick method, adequate visualization is achieved with a smaller arthrotomy. Careful placement of the joystick in the planned anchor site of the medial patellofemoral ligament reconstruction reduces the number of drill sites in the patella.
ABSTRACT
Background: Louisiana is historically one of the lowest-performing states in terms of health outcomes in the United States. Hurricane Katrina led to a decrease in available health care resources, with a larger impact on resources for those living below the poverty line. Subsequently, the coronavirus disease 2019 (COVID-19) pandemic has been shown to have had disproportionately large impacts on minority communities, uninsured populations, and rural communities-all of which are found in Louisiana. Methods: This review focuses on the unique challenges of health care in Louisiana, the influence of COVID-19 on physician burnout, and methods of reducing work exhaustion for those in the health care field. Results: A national survey showed that physician satisfaction decreased from June 29, 2021, through September 26, 2021, compared to before the pandemic. A critical component in the provision of the essential services of public health is the ability to build and sustain a clinically skilled and diverse physician workforce. Maintaining well-being and retaining the physician workforce are prerequisites to the equitable provision of access to health care services. Conclusion: Maintaining one's own wellness is critical to occupational sustainability, particularly when unique stressors such as those encountered during the COVID-19 pandemic are present. The future of a vital health care system depends on physicians maintaining healthy habits and seeking help when burnout symptoms are recognized, both at the individual and institutional level.
ABSTRACT
CASE: A 68-year-old woman underwent an anterior cervical discectomy and fusion for cervical radiculopathy and subsequently developed a severe contact hypersensitivity reaction in response to Dermabond Prineo, beginning 10 days postoperatively. The Dermabond Prineo mesh was removed, and the patient was treated symptomatically with diphenhydramine, systemic steroids, and oral antibiotics, with complete resolution of her symptoms. CONCLUSION: This is the first reported contact hypersensitivity reaction to Dermabond Prineo in the context of spine surgery. Surgeons should be able to recognize this presentation and treat this appropriately.
Subject(s)
Dermatitis, Contact , Spinal Fusion , Female , Humans , Aged , Cervical Vertebrae/surgery , Spinal Fusion/adverse effects , Diskectomy/adverse effectsABSTRACT
Background: Postoperative total joint arthroplasty complications place a tremendous burden on the health care system. The purpose of this study was to compare 30-day postoperative complication rates for surgeries in patients who received preoperative antiplatelet agents and/or anticoagulants to surgeries in a control group that did not receive antiplatelet agents and/or anticoagulants in the 90 days prior to undergoing a total joint arthroplasty. Methods: We retrospectively reviewed total hip or knee arthroplasties from November 2012 to March 2016. Surgeries were categorized into 4 groups depending on their preoperative antiplatelet and anticoagulant status. Complications between the groups were compared using chi-square analysis and Fisher exact test. Results: In this study, 1,726 arthroplasties in 1,544 patients were included. Superficial wound complications were the most common complication in all 4 groups (3.8% of surgeries), with no significant difference between the groups. A statistically significant difference was found in the number of prosthetic joint infections in the group of surgeries with no antiplatelets or anticoagulants compared to surgeries with both medications administered during the 90 days preoperatively (0.82% vs 5.13%, P=0.0003). No significant difference was found between the groups with regard to stroke, myocardial infarction, pulmonary embolism, or deep venous thrombosis. Conclusion: Surgeries for which both antiplatelets and anticoagulants were administered in the 90 days preoperatively had a statistically significantly higher rate of prosthetic joint infections compared to surgeries with neither medication administered preoperatively. Surgeons can use this information to better inform and risk-stratify patients prior to surgery.
