Occupational hazards for pregnant or lactating women in the orthopaedic operating room.

Pregnant or lactating staff working in the orthopaedic operating room may be at risk of occupational exposure to several hazards, including blood-borne pathogens, anesthetic gases, methylmethacrylate, physical stress, and radiation. Because the use of proper personal protective equipment is mandatory, the risk of contamination with blood-borne pathogens such as hepatitis B, hepatitis C, and HIV is low. Moreover, effective postexposure prophylactic regimens are available for hepatitis B and HIV. In the 1960s, concerns were raised about occupational exposure to harmful chemicals in the operating room such as anesthetic gases and methylmethacrylate. Guidelines on safe levels of exposure to these chemicals and the use of personal protective equipment have helped to minimize the risks to pregnant or lactating staff. Short periods of moderate physical activity are beneficial for pregnant women, but prolonged strenuous activity can lead to increased pregnancy complications. The risk of prenatal radiation exposure during orthopaedic procedures is of concern, as well. However, proper lead protection and contamination control can minimize the risk of occupational exposure to radiation.

Treatment of blocked elbow flexion in congenital radioulnar synostosis with radial head excision: a case series.

BACKGROUND: Congenital radioulnar synostosis (CRUS) causes a spectrum of presentations, most commonly a restriction of forearm rotation. Because most of these children are not treated operatively, many are not followed clinically after the diagnosis has been made. This report describes that a subset of the Cleary and Omer type IV synostoses (anterior dislocation of the radial head) can present with a progressive block to elbow flexion that worsens with growth. The location of this synostosis allows the physis of the radial head to grow untethered. The enlarged radial head can impinge upon the capitellum, blocking elbow flexion and snapping on the annular ligament. We propose excision of the radial head as a method of treating the anteriorly dislocated radial head in type IV synostoses. METHODS: We evaluated 4 patients with Cleary and Omer type IV synostoses who presented with an anteriorly dislocated radial head impinging on elbow flexion with snapping of the annular ligament. Each patient was treated with excision of the radial head. RESULTS: In 4 patients excision of the radial head was performed through a lateral Kocher approach. At follow-up, all patients showed relief from their pain and mechanical symptoms, with return of baseline range of motion. One complication which occurred was transient radial nerve neuropraxia. CONCLUSIONS: Although surgery is rarely needed for CRUS, excision of the radial head may be indicated if progressive loss of elbow flexion occurs secondary to impingement of the anteriorly dislocated radial head with the distal humerus in patients with type IV synostosis. We report that excision of the radial head can successfully treat this condition. Patients with type IV CRUS should be educated about the potential for loss of elbow flexion and/or followed until skeletal maturity to evaluate for this potential condition. LEVEL OF EVIDENCE: Case series consistent with level IV evidence; therapeutic study.

Grip lock injury in male gymnasts.

BACKGROUND: Grip lock is a high bar injury in male gymnastics and occurs while the gymnast is rotating around the high bar. Its mechanism and treatment have been poorly documented. STUDY DESIGN: Case reports. RESULTS: One gymnast sustained an extensor tendon injury and ulnar styloid fracture and was treated nonoperatively. The second gymnast sustained open fracture of the radius and ulna with extensor tendon ruptures and was surgically treated. Both gymnasts healed and were able to return to collegiate gymnastics despite residual finger extensor lag. CONCLUSIONS: Grip lock is a physically and psychologically devastating injury on the men's high bar that can cause forearm fractures and extensor tendon injuries at the wrist (Zone 8), which may result in residual extensor tendon lag. Injuries may be prevented with proper grip fit, appropriate maintenance of grips, and limited duration of use, as well as education of athletes, athletic trainers, and coaches.

Extensor retinaculum impingement in the athlete: a new diagnosis.

BACKGROUND: Athletes with repetitive weightbearing hyperextension activities are predisposed to wrist pain. PURPOSE: To describe extensor retinaculum impingement of the extensor tendons as a new diagnosis for wrist pain for the athlete performing repetitive wrist hyperextension, to present cadaveric dissections to further understand the anatomical basis for extensor retinaculum impingement, and to report treatment outcomes of extensor retinaculum impingement. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A retrospective chart review was performed for athletes treated from 1987 to 2006 for wrist pain due to extensor retinaculum impingement. Eight wrists in 7 athletes were reviewed with a mean presenting age of 19.6 years. The hallmark symptom was dorsal wrist pain, and signs were extensor tendon synovitis and tenderness at the distal border of the extensor retinaculum, provoked by wrist hyperextension. Ten cadaveric wrists were dissected and examined to evaluate anatomical factors that may contribute to extensor retinaculum impingement. RESULTS: Two athletes (2 wrists) were treated with corticosteroid injections. Five patients (6 wrists) were treated operatively, with pathologic findings of thickening of the distal border of the extensor retinaculum and concomitant extensor tendon synovial thickening or, in 1 patient, tendon rupture. Partial distal resection of the extensor retinaculum was performed to eliminate impingement. All patients had complete relief of pain and full return to sport. CONCLUSION: Competitive sports that require repetitive wrist extension with an axial load predispose the athlete to extensor retinaculum impingement. Athletes with dorsal wrist pain and tenosynovial thickening worsened with wrist hyperextension should be considered for the diagnosis of extensor retinaculum impingement. When nonoperative management fails, surgical resection of the distal impinging border of the extensor retinaculum can eliminate pain and can still allow athletes to return to sport without diminishing the opportunity for significant athletic accomplishments.