Force in the Scapholunate Interosseous Ligament During Active Wrist Motion.

PURPOSE: To examine the force experienced by the scapholunate interosseous ligament (SLIL) during movements of the wrist. METHODS: Six fresh-frozen cadaveric wrists were freed of soft tissue and tested in a computer controlled, servohydraulic simulator. Each wrist was tested cyclically through simulated active arcs of flexion-extension and dart throw motion. Tensile forces were recorded across the scapholunate joint with the SLIL cut through a cable placed through the scaphoid to the lunate and fixed to a force transducer external to the wrist. RESULTS: The average recorded maximal tensile force across the scapholunate joint during all tested motions was 20 N. During wrist flexion-extension and the dart throw motion, SLIL force was greater at maximum extension than at maximum flexion. No significant differences among the different motions at maximum flexion or extension or for maximal force during motion were found. CONCLUSIONS: Forces during the flexion-extension and dart throw motions were significantly higher in extension than in flexion. However, during simple unresisted wrist motions, the force did not exceed 20 N. CLINICAL RELEVANCE: This information can be used to evaluate surgical methods used for SLIL repairs and thus provide better outcomes for patients.

Safety of bilateral total knee arthroplasty in morbidly obese patients.

There has been an increase in the prevalence of morbid obesity and the demand for total knee arthroplasty (TKA). Physicians must help patients with bilateral knee arthritis to make informed decisions regarding whether to undergo staged, sequential, or simultaneous TKA. The purpose of this study was to evaluate the perioperative complications of 2-team simultaneous bilateral TKA in the morbidly obese. The authors performed a retrospective review of the records at a single tertiary hospital from 1997 to 2007 and identified 35 morbidly obese (body mass index [BMI] greater than 40 kg/m(2)) patients who had undergone unilateral TKA, as well as 42 morbidly obese and 79 nonobese (BMI less than 30 kg/m(2)) patients who underwent simultaneous bilateral TKA. Clinical, operative, and postoperative variables and complication rates were recorded. Clinical variables were similar between the morbidly obese TKA patients. The bilateral group had significantly increased operative times (132.4 vs 115.5 minutes; P<.01), intravenous fluids (2556.1 vs 2114.7 mL; P=.03), percentage transfused (64.2% vs 11.4%; P<.01), days in the hospital (3.6 vs 3.2 days; P=.03), and discharge rates to rehabilitation facility (72.7% vs 48.6%; P=.01). Major and minor complications were few and comparable, with the need for manipulation under anesthesia in unilateral TKA (11.4%; P=.04) as the only significant difference between groups, including when comparing bilateral nonobese TKAs with bilateral morbidly obese TKAs. The authors feel that morbidly obese patients may undergo 2-team simultaneous bilateral TKA after careful discussion regarding some of the differences in short-term outcomes.

Perioperative morbidity and mortality of 2-team simultaneous bilateral total knee arthroplasty.

Total knee arthroplasty (TKA) has a well-established track record for relieving pain associated with arthritis of the knee joint. The total rate of bilateral TKA has doubled over the past 2 decades, and the rate in women has tripled over that same time period. In patients with bilateral knee arthritis, a decision must be made whether to operate at 2 different settings (staged), a single setting with 1 surgeon (sequential simultaneous), or a single setting with 2 surgeons (2-team simultaneous). The purpose of this study was to examine the perioperative morbidity and mortality of 2-team simultaneous bilateral TKA. Two hundred twenty-seven consecutive 2-team simultaneous bilateral TKA and 216 consecutive unilateral TKA patients were reviewed. Major (deep infection, death, cerebrovascular accident, myocardial infarction, pulmonary embolism, revision within the 1-year follow-up) and minor (all other) complications were compared. No deaths occurred, and the major and minor complication rates were not statistically significantly different between the 2 groups, but a trend toward higher rates of both major and minor complications existed in the bilateral TKA group. Two-team simultaneous bilateral TKA offers the potential benefits of decreased overall recovery time, decreased overall cost, decreased number of anesthetic administrations, and simultaneous correction of significant deformity. It remains an appropriate option in select patients.

Gluteal compartment syndrome and superior gluteal artery injury as a result of simple hip dislocation: a case report.

Gluteal compartment syndrome as a result of hematoma from a ruptured superior gluteal artery is exceedingly rare; to date, one similar case in a pelvic fracture model has been reported. We report a case of acute gluteal compartment syndrome from a ruptured superior gluteal artery resulting from a simple posterior hip dislocation in an otherwise healthy young male. Timely surgical exploration, evacuation of the hematoma, and achievement of hemostasis allowed for an excellent outcome at follow-up. We review the gluteal compartments as well as treatment protocols for this injury.

Achieving educational excellence: a strategic initiative to enhance orthopedic resident academic performance.

Orthopedic resident training involves not only the hands-on learning of surgery but also should equally involve instructing the core knowledge of musculoskeletal medicine. Our program has developed a strategy that enhances resident educational performance; the educational curriculum entails conferences daily. Conferences include gross and surgical anatomy, orthopedic basic science, multidisciplinary trauma, radiology, pathology, journal club, and orthopedic subspecialty conferences. The primary purpose of the conference schedule is to provide the residents with a comprehensive education in orthopedic surgery. It is not geared toward taking the Orthopaedic In-Training Examination (OITE). The OITE is administered annually by the American Academy of Orthopaedic Surgeons (AAOS) and serves as an objective measure of knowledge acquisition. There has been a scientifically validated correlation between performance on the OITE and passage of the American Board for Orthopaedic Surgery Part I Examination. As a collective program, we have achieved at or above the 98th percentile nationally from 2004 to 2009. This academic success has not impacted the total surgical case volume negatively or interfered with Residency Review Committee (RRC) policies.

Perioperative safety of two-team simultaneous bilateral total knee arthroplasty in the obese patient.

BACKGROUND: Although the rates of perioperative morbidity and mortality with simultaneous bilateral total knee arthroplasty remain a concern, multiple studies have shown the procedure to be safe in selected patient populations. Evidence also remains mixed regarding the outcomes of total knee arthroplasty in obese patients. The purpose of this paper is to compare the rates of perioperative morbidity and mortality in consecutive obese patients undergoing two-team simultaneous bilateral total knee arthroplasty and unilateral total knee arthroplasty. METHODS: The records on all two-team simultaneous total knee arthroplasties and unilateral total knee arthroplasties from October 1997 to December 2007 were reviewed. A total of 151 patients with a body mass index (BMI) >30 undergoing two-team simultaneous total knee arthroplasty and 148 patients with a BMI >30 undergoing unilateral total knee arthroplasty were retrospectively reviewed and analyzed to determine perioperative morbidity and mortality as well as one-year mortality rates. RESULTS: Preoperative patient characteristics did not show any significant differences between groups. The simultaneous bilateral group had significantly longer operative times (127.4 versus 112.7 minutes, p < 0.01), estimated blood loss (176.7 versus 111.6 mL, p = 0.01), percentage of patients requiring blood transfusion (64.9% versus 13.9%, p < 0.01), length of hospital stay (3.72 versus 3.30 days, p < 0.01), and percentage of patients requiring extended care facility usage at discharge (63.6% versus 27.8%, p < 0.01). No significant difference between unilateral and bilateral groups was seen in regards to total complication rate, major or minor complication subgroup rate, or any particular complication noted. Doubling the variables in the unilateral group for a staged total knee arthroplasty scenario did create significant increases over the simultaneous data in almost every data category. CONCLUSIONS: Two-team simultaneous total knee arthroplasty appears to be safe in obese patients, with similar complication rates as compared to unilateral procedures. Two-team simultaneous total knee arthroplasty also appears to have potential benefits over a staged procedure in the obese patient, although more study is required regarding this topic.