Effect of elbow flexion on the proximity of the PIN during 2-incision distal biceps repair.

The posterior interosseous nerve (PIN) is at risk for injury during surgical dissection for distal biceps repair, yet the optimal position of elbow flexion to avoid a PIN injury has never been established for the 2-incision approach. The purpose of this study was to determine the proximity of the PIN to the radial tuberosity during surgical dissection in different degrees of elbow flexion. Ten cadaveric specimens with an intact elbow and forearm were dissected in full pronation using a modified Boyd-Anderson approach. Half of the dissections were completed in 90° of flexion and the other half were completed in maximal flexion. To simulate the location of the PIN during a single-incision biceps repair, the distance of the PIN to the radial tuberosity was recorded in full extension and supination. Results from these measurements were assessed for differences using paired t tests, with differences deemed significant for P values less than .05. The PIN was not identified in any of the 2-incision surgical dissections. Based on these findings, the proximity of the PIN to the radial tuberosity is not significantly affected by the degree of elbow flexion in the muscle-splitting 2-incision approach. In addition, a safe zone exists for avoiding PIN injury in a single-incision technique for distal biceps repair because a drill bit exiting the radial tuberosity greater than 1 cm in a distal-radial direction would place the PIN at risk.

Marine debris from the Oregon Dungeness crab fishery recovered in the Northwestern Hawaiian Islands: identification and oceanic drift paths.

Two Dungeness crab trap tags and floats lost off the State of Oregon, USA during the 2006-2007 fishing season were recovered 4years later in the Northwestern Hawaiian Islands (NWHI): on Lisianski Island on July 15, 2010; and on Kure Atoll on December 10, 2010. This is the first documented recovery of marine debris from Oregon fisheries in the NWHI. We simulate the oceanic drift tracks of the derelict fishing gear with the Ocean Surface Current Simulator (OSCURS) model using estimated loss dates in Oregon based on interviews with the crab trap owners and known recovery sites and dates in the NWHI. These data confirm the US Pacific Northwest as a source of marine debris deposited in the NWHI and provide enhanced understanding of the oceanic drift pathways of marine debris in the North Pacific Ocean.

Catastrophic polyethylene failure diagnosed with magnetic resonance imaging in a painful total knee arthroplasty.

Determining the etiology of a painful knee after arthroplasty can be extremely challenging. Traditionally, orthopedists relied mainly on physical examination, laboratory results, serial radiographs, and 3-phase bone or indium-labeled white blood cell scans; however, recent advances in magnetic resonance imaging (MRI) software have given orthopedists another powerful tool in their diagnostic armamentarium. We provide the MRI software modification technique for metallic artifact reduction as well as present a novel case in which MRI was used to diagnose catastrophic polyethylene postfailure in a posterior cruciate ligament substituting knee. Although the role for MRI in the postarthroplasty knee has yet to be clearly defined, its utility in working up a painful arthroplasty when history, physical examination, and other diagnostic utilities fail to provide answers is clearly demonstrated in this case.