Triceps Tendon Ruptures Requiring Surgical Repair in National Football League Players.

BACKGROUND: Complete triceps tendon ruptures are relatively rare in the general population but slightly more prevalent in professional football. One prior study found 11 complete ruptures over a 6-season period. HYPOTHESIS: Triceps ruptures occur more commonly in football linemen due to forced elbow flexion during an eccentric contraction and may occur more commonly with the increasing size and speed of professional players. Surgical repair allows full return to sports, but with a lengthy recovery time. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A search of the National Football League Injury Surveillance System (NFLISS) found a total of 37 triceps tendon ruptures requiring surgical repair from the years 2000 to 2009. Data were obtained for setting of injury, player position, activity causing injury, play type, time of game when injury occurred, height, weight, body mass index (BMI), and number of days lost from football. RESULTS: There were 37 players requiring surgical repair for triceps tendon ruptures over the 10-season period. The average height, weight, and BMI of the players were 75 inches, 292 pounds, and 36.5 kg/m(2), respectively. The majority of players were linemen (86%): 16 defensive, 15 offensive, and 1 tight end. The injury took place while blocking or being blocked in 29 players (78%) and while tackling or being tackled in 5 players (14%). Players missed an average of 165 days (range, 49-318 days) from football as a result of their injury and surgery. CONCLUSION: Triceps tendon tears requiring surgical repair are more common in professional football players than in the general population and are occurring more commonly than previously reported. Surgical repair allows return to play. CLINICAL RELEVANCE: Our study identifies the rate of triceps tendon tears requiring repair in the NFL according to position, identifying which players may be most at risk for this injury.

Inaccuracies in the assessment of femoral anteversion in proximal femoral replacement prostheses.

Accurately judging anteversion of proximal femoral replacement prostheses (PFRPs) during insertion can be difficult and may affect performance/stability. We designed a gravity goniometer jig, which attaches directly to the prosthesis, to improve rotational placement. Our hypotheses were that surgeons cannot accurately estimate anteversion in the context of a PFRP and that our jig would improve rotational placement. In our model, a 15-centimeter PFRP was placed in a saw-bones femur set in a lateral position. The prosthesis could rotate into anteversion/retroversion while the femur was fixed. Orthopedic residents and surgeons made 2 attempts to place the prosthesis into 15 degrees of anteversion; first without, then with the jig. Each attempt was recorded by photograph and angle-measuring jig. Nineteen surgeons and 28 residents participated. Without the jig, the mean PFRP anteversion was 18.3 degrees (range, 1 degrees -50.5 degrees ; SD, 9.6) compared to 14.3 degrees (range, 12.5 degrees -15.5 degrees ; SD, 0.7) using the jig (P = .006). Without a jig, the mean anteversion of resident-placed endoprosthesis was 18.4 degrees (range, 3 degrees -36 degrees ; SD, 8.1) compared to 18.1 degrees (range, 1 degrees -50.5 degrees ; SD, 12.1) (P = .91) recorded for attending physicians. The angle measurements from the jig and photographs were statistically equal. The placement of the PFRP into proper anteversion was more accurate with the aid of the jig. Simple jigs, such as the one developed for this study, may improve rotational placement of PFRPs.

Bipolar proximal femoral replacement prostheses for musculoskeletal neoplasms.

While bipolar proximal femoral replacement prostheses (PFRP) have become a common treatment for tumors of the proximal femur, long-term results are not specified in the literature. The objective was to determine the complication and revision rates of bipolar PFRP and compare them to historical controls of bipolar hemiarthroplasties for nontumor indications. Information was retrospectively collected on 62 patients who received bipolar PFRP with cemented diaphyseal stems for primary or metastatic disease of the proximal femur from 1981 to 2003. Mean followup was 5 years. Twelve of 62 (19%) bipolar PFRPs underwent revision. Aseptic loosening was the most common complication with six (10%) undergoing revision. None were converted to THA due to acetabular erosion. Three patients (5%) had problems with dislocation and three (5%) had deep infections. Mean MSTS functional rating was 71% of normal function. The limb salvage rate was 98% and the 5-year event-free prosthetic survival was 79%. Bipolar PFRPs were found to have higher revision, dislocation, and deep infection rates compared to bipolar hemiarthroplasty for nontumor indications, but a lower rate of conversion to THA due to acetabular erosion. Bipolar PFRPs have good long-term durability with some complications, but are able to preserve the limb and provide good function for patients.

Clinical utility of percutaneous biopsies of musculoskeletal tumors.

UNLABELLED: Percutaneous biopsies are frequently used for musculoskeletal lesions. We suspect published accuracy rates (80-97%) overestimate clinical utility. We retrospectively reviewed 120 consecutive percutaneous biopsies performed by interventional radiologists at our institution. Patients underwent core biopsy, fine-needle aspiration (FNA), or both. The biopsy interpretations were considered clinically useful if they allowed proper treatment to proceed and not useful if they were nondiagnostic or if surgical specimens disagreed with percutaneous specimen. Patients were categorized by biopsy type, tissue type, and tumor type. Ninety of 120 percutaneous biopsies were clinically useful, 27 were nondiagnostic, and three were incorrect; in these latter 30 patients we proceeded to open biopsy. Patients with both biopsies had clinically useful results (80.6%) more often than FNA or core alone(68.0% and 66.7%, respectively). Biopsies of bone lesions were clinically useful more often than those of soft tissue. Myxoid histology was associated with decreased clinical accuracy. Clinical utility was independent of tumor type. No single characteristic predicted increased probability of open biopsy. The clinical utility rate was acceptable, but below published accuracy rates. The combination of both biopsies was better than FNA alone. Myxoid findings rarely helped to guide definitive treatment. Treatment decision making requires balancing biopsy results with clinical data. LEVEL OF EVIDENCE: Diagnostic study, level IV.

Postembolization paralysis in a man with a thoracolumbar giant cell tumor.

Giant cell tumors are hypervascular tumors that represent approximately 5% of all primary bone neoplasms. Vertebral tumors often require surgery to maintain spinal stability or to relieve spinal cord and nerve root compression. However, surgical resection of hypervascular tumors like giant cell tumors can be hazardous because of the risk of excessive intraoperative hemorrhage. Preoperative embolization can be useful to decrease perioperative blood loss in primary and metastatic vertebral tumors, and preoperative embolization for vertebral tumor surgery is relatively safe. We report a patient who had the unusual but serious complications of paralysis and paresthesia at the T12 vertebra and below as a result of preoperative embolization. At 6 months followup, the patient was disease-free but without neurologic function from T12 and below. Therefore, it is imperative physicians be aware of the possible preoperative embolization complication of cord infarction and the safety measures proposed in this article to avoid this complication.

Case reports: an unusual complication of radiofrequency ablation treatment of osteoid osteoma.

Osteoid osteoma is a benign bone tumor traditionally treated nonoperatively or by operative excision. However, radiofrequency ablation is being used increasingly for treatment, as there are several reports supporting its effectiveness. Radio-frequency ablation is precise, minimally invasive, safe, effective, and associated with minimal complications and reduced use of healthcare resources. We report a patient treated with radiofrequency ablation for tibial osteoid osteoma and thermal necrosis of the skin.