Safety of Intra-Articular Implantation of Oligo[Poly(ethylene glycol) Fumarate] Scaffolds into the Rabbit Knee.

Implantable biomaterials supporting extended release of pharmacologic agents may permit localized intra-articular delivery of drugs that modulate the fibrotic response to injuries and surgery. Oligo[poly (ethylene glycol)] fumarate (OPF) is an attractive organic carrier, but its safety profile within synovial joints remains unclear. Here, we assessed the safety of OPF sponges using a validated in vivo model of knee arthrofibrosis. A cohort of 102 rabbits was divided into five groups: arthrotomy only (24), arthrotomy with OPF scaffold placement (24), surgically induced contracture (24), surgically induced contracture with OPF scaffold placement (24), and control without any surgical intervention (6). Six rabbits per surgical group were sacrificed at 72 h, 2, 8, and 24 weeks. Outcomes included biomechanical testing of range of motion, histologic analysis of synovial and cartilage tissues, and scaffold degradation. Cartilage histology and biomechanical measurements were comparable between groups with and without OPF. Synovial inflammation scores were similar among most groups with a minimally elevated score in the rabbits with arthrotomy and OPF versus those with arthrotomy alone. Scores for synovial tissues in rabbits with contracture and OPF were clinically equivalent to those with contractures alone. Most animals (92%) retained scaffold fragments at 24 weeks. Thus, OPF scaffolds implanted into native or arthrofibrotic rabbit knees neither induce nor aggravate cartilage damage, synovial inflammation, or contractures. The apparent safety of OPF scaffolds suggests that they are suitable carriers for the controlled delivery of reagents into the intra-articular joint space to treat arthrofibrosis.

Does Ankle Aspiration for Acute Ankle Fractures Result in Pain Relief? A Prospective Randomized Double-Blinded Placebo Controlled Trial.

OBJECTIVES: Does ankle aspiration help with pain control in patients with ankle fractures? DESIGN: Prospective, double-blind, randomized, placebo-controlled trial. SETTING: Level 1 Academic Medical Center. PATIENTS/PARTICIPANTS: Consecutive skeletally mature patients with ankle fractures. INTERVENTION: Randomized between ankle aspiration and sham procedure. MAIN OUTCOME MEASUREMENTS: Pain scores for 72 hours after injury and pain medicine usage. RESULTS: Comparison between study subjects receiving ankle aspiration and sham procedure showed no significant differences in pain scores acutely in the emergency department or within 3 days after injury. There were also no statistically significant differences in pain medicine usage within 3 days after injury. Secondary outcomes, including lower leg volume, 6-month functional outcome scores, and complication rate, also showed no significant differences between subjects receiving aspiration and the sham procedure. CONCLUSIONS: Aspiration of acute ankle fractures does not result in decreased pain scores or opioid usage after aspiration. Aspiration of acute ankle fractures does not provide measurable clinical benefit. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Preliminary experience with a new total distal radioulnar joint replacement.

This study reports the intermediate-term results of four patients from a series eight patients who have had an insertion of a new complete distal radioulnar joint (DRUJ) prosthesis. A retrospective review was performed for all patients who underwent DRUJ joint replacement with the STABILITY Sigmoid Notch Total DRUJ System between the years of 2003 and 2008. To be included in this report, all patients had to have more than 24 months of follow-up and hand examination by the senior author. From the eight patients with this procedure, four patients met the inclusion criteria. These included one patient with painful posttraumatic arthritis, two patients with failed hemiarthroplasty, and one patient with a failed Sauvé-Kapandji procedure. Mean age at the time of surgery was 42.5 years (range: 35 to 51 years) and mean follow-up was 46 months (range: 36 to 66 months). Preoperative and postoperative assessment included range of motion, grip strength, visual analog pain scale, patient satisfaction, and radiographic evaluation. There was a successful replacement of the DRUJ in all four patients. Final range of motion showed mean pronation of 80 degrees (range: 60 to 90 degrees) and mean supination of 64 degrees (range: 45 to 90 degrees). Final grip strength on the operated extremity was 25.5 kg and averaged 73% of contralateral side. This was an improvement from preoperative grip strength of 14.5 kg visual analog pain scale decreased from 8 to 2.5 following surgery (scale: 1 to 10). Patient satisfaction was 100%. One patient returned to manual labor, one patient returned to office work, and two patients remained off work. Postoperative radiographs depict appropriate alignment of the DRUJ, and there have been no cases of subluxation or dislocation. Implant survival has been 100%. Total DRUJ joint replacement with sigmoid notch resurfacing and distal ulna replacement is an alternative to ulnar head resection in cases of DRUJ arthritis. Total DRUJ arthroplasty with this resurfacing design may provide a means of decreasing pain and restoring DRUJ stability and motion following severe trauma, failed hemiarthroplasty, or failed Sauvé-Kapandji procedure. More experience is needed with this implant to confirm these initial encouraging results. The level of evidence for this study is IV (therapeutic, case series).

Effect of patient age on the radiographic outcomes of distal radius fractures subject to nonoperative treatment.

PURPOSE: Our study assessed the radiographic outcomes of nonsurgically treated distal radius fractures of patients who were 18 to 44 years old (group 1), 45 to 64 years old (group 2), and 65 years old or older (group 3). METHODS: All distal radius fractures seen in our emergency department from April 2002 to September 2004 that had nonsurgical management (either casting alone or closed reduction with immobilization) were considered for this study (n = 124; 50 casted, 74 closed reduced). Patients were further classified by age. Change in fracture alignment was assessed at the time of fracture union (approximately 8 weeks) and included measurements of angulation, articular gap/step-off, and radial shortening. RESULTS: When the fractures (n = 124) were evaluated at union, there was an overall secondary displacement rate of 64% (n = 79), with 42% in the group whose fractures were immobilized in a cast and 78% in the group whose fractures were treated by closed reduction and cast. There was an increase in displacement rate that was associated with increasing patient age. Among fractures that were only casted, there was no such age-matched increase in rates of secondary displacement. However, when considering those fractures that were subject to closed reduction (n = 74), rates of secondary displacement significantly increased with age (58% in group 1, 81% in group 2, and 89% in group 3; p = .03). CONCLUSIONS: Our study found that secondary displacement of distal radius fractures increased with increasing patient age, primarily among fractures subject to closed reduction. Older patients with these fractures require closer management after initial reduction, therefore allowing for better monitoring of expected subsequent fracture collapse. Further, given these high rates of secondary displacement after nonoperative treatment (58% to 89%), it is also important to consider that surgical treatment of these fractures may be necessary.

Outcomes of isolated glenoid labral injuries in professional baseball pitchers.

BACKGROUND: Major League Baseball (MLB) pitchers who return to competition after labral surgery show a decline in their pitching performance. DESIGN: Retrospective cohort. SETTING: Tertiary institution. PATIENTS: MLB starting or relief pitchers with isolated glenoid labral injuries. INTERVENTIONS: Open or arthroscopic surgical repair of isolated glenoid labral injuries. MAIN OUTCOME MEASUREMENTS: Individual statistics were reviewed for 42 MLB pitchers who underwent surgical repair of isolated glenoid labral injuries of their throwing shoulder between 1998 and 2003. Pertinent statistical data, including earned run average (ERA), innings pitched (IP), and walks plus hits per inning pitched (WHIP), were obtained for all players and compared before and after surgery. These statistics were evaluated for an association with demographic factors, pitching role, and rehabilitation time. RESULTS: A total of 42 MLB pitchers (26 starters, 16 relievers) were included in the study with an average age of 27.5 years for starters and 29.9 years for relievers at injury time. There were 30 right-handed pitchers and 12 left-handed pitchers. In all, 69% of pitchers returned postoperatively to MLB for at least one season; 29% pitched for three seasons or more. For both relievers and starters, there was no statistically significant postoperative change in ERA or WHIP at 1 and 3 years. Starters had significantly decreased IP at 1 year, but not at 3 years. Relievers had no significant change in IP at 1 year postoperatively, but IP were significantly decreased at 3 years. Relievers missed less time after surgery than did starters (11.4 vs. 18.4 months). CONCLUSIONS: Most pitchers who were able to return to competition after surgery showed insignificant changes in ERA and WHIP and significant decreases in IP. Age, MLB experience, and pitching role as a reliever were the most significant factors related to a successful return after surgery.