Fracture of the clavicle does not affect arthritis of the ipsilateral acromioclavicular joint compared with the contralateral side: An osteological study.

In an osteological collection of 3100 specimens, 70 were found with unilateral clavicular fractures which were matched with 70 randomly selected normal specimens. This formed the basis of a study of the incidence of arthritis of the acromioclavicular joint and the effect of clavicular fracture on the development of arthritis in the ipsilateral acromioclavicular joint. This was graded visually on a severity scale of 0 to 3. The incidence of moderate to severe arthritis of the acromioclavicular joint in normal specimens was 77% (100 specimens). In those with a clavicular fracture, 66 of 70 (94%) had arthritis of the acromioclavicular joint, compared to 63 of 70 (90%) on the non-injured contralateral side (p = 0.35). Clavicles with shortening of 15 mm or less had no difference in the incidence of arthritis compared to those with shortening greater than 15 mm (p = 0.25). The location of the fracture had no effect on the development of arthritis.

Anterior-inferior capsular shift of the shoulder: a biomechanical comparison of glenoid-based versus humeral-based shift strategies.

This study compared the biomechanical effects of an anterior-inferior capsular shift based at the humeral side with one on the glenoid side of the joint on resultant multidirectional glenohumeral translation and rotation. Nine matched pairs of fresh cadaveric shoulders were placed in a testing apparatus that constrained 3 rotations but allowed simultaneous free translation of the humeral head with respect to the glenoid. The right and left shoulders of each of the matched pairs were randomized to undergo either a glenoid-based or humeral-based anterior capsular shift. The shoulders were tested vented and following the capsular shift procedure. Translational testing was performed at 0 degrees, 45 degrees, and 90 degrees of glenohumeral elevation with the humerus in neutral rotation, 30 degrees internal rotation, and 30 degrees external rotation. Sequential loads of 30 N in anterior, posterior, and inferior directions were applied while maintaining a 22-N joint compressive load. The maximum arc of internal and external rotation after application of a 1-newton-meter moment was determined for the vented specimens and then after the capsular shift procedure. Both shift strategies resulted in significant limitation of anterior, posterior, and inferior translation in all of the tested positions. No significant differences were noted between the 2 shift strategies with respect to restriction of translation in the anterior or inferior directions. The glenoid-based shift caused a significantly greater decrease in posterior translation at 45 degrees and 90 degrees of abduction. With respect to rotation, the glenoid-based shift exerted significantly greater restriction on external rotation than the humeral-based shift. This study supports the use of either a humeral-based or glenoid-based shift to control multidirectional glenohumeral instability. Greater reduction in external rotation was demonstrated after the glenoid-based shift. Specific differences demonstrated in translation control for humeral-based versus glenoid-based capsular shift procedures may be useful in tailoring a procedure for specific instability patterns.

Evaluation of the anatomy of the common peroneal nerve. Defining nerve-at-risk in arthroscopically assisted lateral meniscus repair.

A two-part study was undertaken to clarify the anatomy of the common peroneal nerve at the level of the lateral joint line and risk factors associated with arthroscopically assisted inside-out lateral meniscus repair. In part I, 70 legs in 35 preserved cadavera were dissected to evaluate the relevant anatomy of the common peroneal nerve; 7 (10%) manifested division of the common peroneal nerve into deep and superficial branches proximal to the knee joint. A cutaneous branch not previously described in the literature emanated from the common peroneal trunk in 21 of the legs (30%). In part II, arthroscopically assisted inside-out lateral meniscus repair was performed on 10 fresh-frozen cadaveric knees. Divergence between suture arms increased as suture position was sequentially posterior. Capture of a nerve branch occurred in 2 knees (20%) when posterior retraction was not used. Nerve involvement was eliminated when a retractor was employed. There was significant anatomic variability in the course and branching pattern of the common peroneal nerve at the level of the lateral joint line. During arthroscopically assisted inside-out lateral meniscus repair, risk of injuring the peroneal nerve was related to suture position because of the proximity of anatomic structures and the tendency for suture divergence with soft tissue tethering.

Arthroscopic bone peg fixation in the treatment of osteochondritis dissecans in the knee.

An arthroscopic method for the treatment of osteochondritis dissecans lesions in the knee is described. The technique involves using autogenous bone pegs for arthroscopic transfixion of femoral osteochondritis dissecans (OCD) lesions. The method represents a simple biological alternative for arthroscopic fixation of OCD lesions.

Subcutaneous pretibial cyst formation associated with anterior cruciate ligament allografts: a report of four cases and literature review.

Four clinical cases are described in which patients who had undergone anterior cruciate ligament reconstruction developed ganglion-like cysts at the external aparature of the tibial channel. All patients underwent operative treatment including curettage and bone grafting with the successful resolution of the cysts. A proposal, based on the incomplete incorporation of allograft tissues within bone tunnels, is given for the pathogenisis of these cysts, accompanied by a detailed description of the relevant literature.

Extremity gunshot injuries treated in an urban children's hospital.

In the years 1985 to 1989 75 children and adolescents presented to an urban children's hospital for treatment of 76 incidents of extremity gunshot wounds. Although the population ranged widely, the "typical" patient was a preteen or teenager (n = 70) who was shot in the lower extremity (n = 53) with a low velocity handgun (n = 74). No vascular injuries and only two transient nerve injuries accompanied the wounds. Only 30% of the shots caused fractures. Many (43%) of the patients had other relevant psychosocial or medical problems. Previous treatment for other gunshot wounds or trauma had occurred in 27 patients. Although follow-up was not good, no consequent infections were identified. Outpatient local wound irrigation with minimal debridement sufficed as treatment for entry/exit wounds without contamination or fracture. Intravenous antibiotics are necessary in these wounds only for short-term prophylactic coverage of fractures. Larger soft tissue wounds, intraarticular foreign bodies, and fracture stabilization require operative treatment.