Treatment of Osteochondral Fractures After Acute Patellofemoral Instability: A Critical Analysis Review.

¼: An osteochondral fracture (OCF) of the patella or the femur is a frequent sequela after an episode of acute patellofemoral instability. ¼: Patients commonly present with anterior knee pain after direct trauma to the patella or a noncontact twisting injury. ¼: Radiographs and magnetic resonance imaging (MRI) are the most common imaging modalities that are used to diagnose OCFs. ¼: Arthroscopy may be indicated in cases of displaced OCFs, and the decision regarding osteochondral fragment fixation or loose body removal depends on fragment size, location, and extent of injury. ¼: Most of the current literature suggests worse outcomes for patients with OCFs who undergo nonoperative treatment, no significant differences in outcomes for patients sustaining an acute patellar dislocation with or without an OCF, and inconclusive results concerning outcomes for patients treated with loose body removal compared with fixation. ¼: Current outcome data are limited by studies with low levels of evidence; therefore, well-designed randomized controlled trials are needed.

Humeral Avulsion of the Glenohumeral Ligament: Diagnosis and Management.

¼: The most common type of humeral avulsion of the glenohumeral ligament (HAGL) is a purely ligamentous avulsion involving the anterior inferior glenohumeral ligament (IGHL), but other variants are seen, including posterior lesions and those with an osseous avulsion. ¼: A central lesion between the intact anterior and posterior bands of the IGHL is gaining recognition as a distinct clinical entity. ¼: HAGL lesions are most commonly seen in patients with anterior instability without a Bankart tear or in those with persistent symptoms despite having undergone a Bankart repair. ¼: Magnetic resonance imaging is the most sensitive imaging modality. An arthrogram is helpful with subacute and chronic lesions when the joint is not distended. Arthroscopy is the gold standard for diagnosis. ¼: While some have reported success with nonoperative management, surgical repair with either arthroscopic or open techniques has provided a high rate of successful outcomes; however, the literature is limited to mostly Level-IV and V evidence.

Comparing patient reported outcomes in depuy sigma curved versus curved plus polyethylene inserts in cruciate retaining total knee arthroplasty.

Total knee designs have evolved to allow more motion with compromising stability. The purpose of this study is to compare standard congruency and anterior lipped liners' effects on patient reported outcomes after TKA. 68 patients were retrospectively reviewed, and their SF-12 and KOOS scores were assessed preoperatively and one year post-operatively. Two-sample t-tests were used to compare differences between groups. The CVD design had a statistically significant greater improvement in KOOS-Pain compared to CVD+. No statistical difference was observed in the outcomes. The results may suggest that higher congruency designs lead to less physiological joint kinematics and pain.

Gorham Disease Limited to the Left Upper Extremity Without Hand Involvement.

In this case report, we present a young female patient with a history of Gorham disease, who sustained pathologic fractures of the left radius and ulna after a low-impact fall. Massive osteolysis of the left forearm and wrist was noted on plain radiographs. The patient had had 8 previous left upper-extremity fractures without evidence of disease in any other area of the body.

Periprosthetic Infections of the Shoulder: Diagnosis and Management.

The use of shoulder arthroplasty is continuing to expand. Periprosthetic joint infection of the shoulder is a devastating complication occurring in approximately 1% of cases. The most common organisms responsible for the infection are Cutibacterium acnes (formerly Propionibacterium acnes) (∼39%) and coagulase-negative Staphylococcus (∼29%). Evaluation of patients includes history and physical examination, serologic testing, imaging, possible joint aspiration, and tissue culture. Diagnosing infections caused by lower virulence organisms (eg, C acnes) poses a challenge to the surgeon because traditional diagnostic tests (erythrocyte sedimentation rate, C-reactive protein, and joint aspiration) have a low sensitivity due to the lack of an inflammatory response. Periprosthetic joint infections of the shoulder due to Staphylococcus aureus and other highly virulent organisms are often easy to diagnose and are usually treated with two-stage revisions. However, for infections with C acnes and coagulase-negative Staphylococcus, single- and two-stage revision surgeries have shown similar ability to clear the infection. Unexpected positive cultures for C acnes during revision surgery are not uncommon; the proper management is still under investigation and remains a challenge.

Iliac vein compression syndrome from anterior perforation of a pedicle screw.

May-Thurner syndrome is an anatomic variant where the right common iliac artery compresses the left common iliac vein. The variant exists in a significant portion of the population, but is usually asymptomatic; however, clinically significant stenosis can occur by iatrogenic means. In this report, we describe a patient who presents with left lower extremity pain and swelling. Initial workup for deep vein thrombosis was negative. After being referred to our venous clinic, a magnetic resonance angiography revealed narrowing of the left common iliac vein with a tortuous right common iliac artery crossing over the constriction. During left iliac vein stent placement, a pedicle screw from a prior L2-S1 spinal fusion was noted to be perforated through L5 vertebral body impinging the posterior aspect of the vein. This case demonstrates that increased scrutiny must be applied when dealing with pathology in close proximity to any implanted medical device.