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BACKGROUND: Distracted driving has become alarmingly widespread, and its prevalence continues to increase despite efforts by government and nongovernment organizations to educate the public about this pervasive problem. Every year, 1.35 million people die, and nearly 80 million people get injured in road traffic incidents. Motor vehicle crashes are the leading cause of death among young people, and distracted driving plays a huge role in road traffic fatalities and injuries. Considering that most people now use the internet as an information source and Google is the most visited website and number one online search engine in the world, we performed a qualitative analysis of information available through Google on distracted driving and its outcomes. OBJECTIVE: The goal of this study was to analyze the quality and accuracy of the information on distracted driving and its consequences available to the general public when using Google as a search engine for distracted driving. METHODS: In November 2018, a nonregional Google search on distracted driving was conducted. The first two pages of the Google search results were selected for analysis. Data were collected on the type of website, type of distraction, consequences of distracted driving described, presence and referencing of statistics, and orthopedic and nonorthopedic injuries described, with their acute and chronic sequelae. RESULTS: In total, we analyzed 25 websites: 12 websites (48%) were from government bodies, which were the most common type of websites; 19 (76%) of the sites provided statistics; and 15 (60%) referenced the source of the statistic. Mobile phones were the most frequently cited type of distraction, with 17 (68%) sites discussing it, while death was the most commonly mentioned consequence of distracted driving, quoted in 15 (60%) of the websites. Additionally, 52% of the sites provided tips on how to avoid distracted driving. Only one website mentioned orthopedic injuries. CONCLUSIONS: The prevalence of distracted driving is increasing, and so are the consequences associated with it. Nevertheless, the information available online does not accurately describe the current circumstances regarding this issue. The National Highway Traffic Safety Administration attributed 391,000 injuries and 3477 deaths to distracted driving in 2015, which are 5000 more injuries and almost 150 more fatalities compared to 2011. However, despite these figures, most of the websites discussed death as a consequence of distracted driving and often overlooked injuries, even though injuries are over 100 times more likely to occur in distraction-affected crashes. The websites also largely fail to address other forms of driving distractions, like daydreaming or talking to a passenger, and mostly focus on mobile phone-related activities as distractions. More specific information on the dangers of distracted driving and nonlethal trauma may support an overall cultural shift to curb this behavior.
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BACKGROUND: Anatomic glenoid reconstruction involves the use of distal tibial allograft for bony augmentation of the glenoid surface. An all-arthroscopic approach was recently described to avoid damage to the subscapularis tendon and preserve the capsule and labrum. PURPOSE: To explore and compare change in surgical time between 2 proposed methods used for the treatment of anterior shoulder instability-arthroscopic anatomic glenoid reconstruction (AAGR) and arthroscopic Latarjet (AL)-over successive procedures. We also compared graft positioning on the anterior glenoid surface between the 2 methods. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: This was a single-surgeon retrospective review of 54 cases of surgically treated recurrent anterior shoulder instability: 27 had AAGR with distal tibial allograft, while the other 27 had AL. AAGR with the distal tibial allograft was the primary choice for the treatment of anterior shoulder instability; however, AL was performed when tibial allograft was not available from the bone bank. Thus, there was an overlapping period for those 2 procedures. Procedure start and end times were recorded, and duration was calculated. Postoperative 3-dimensional computed tomography scans were reviewed, and graft position was judged to be in the lower third (desired position), middle third, or upper third of the anterior glenoid surface. To assess learning, these data were organized in chronological order of surgery, and each surgical cohort was divided into 3 chronological clusters of 9 patients each. Learning was assessed through change in operative time over successive clusters, change in variability of operative time among clusters, and change in graft positioning among clusters. Statistical analysis comprised a 2-tailed independent-sample t test and the Levene test for equality of variance. RESULTS: Our study found that AAGR was significantly faster to perform than AL in the early (P = .001), middle (P = .001), and late (P = .05) clusters of each cohort. Duration of surgery did not significantly improve across clusters within each cohort (P = .15-.79). There were no significant changes in the variability of surgical time in the AAGR group (P = .09) or the AL group (P = .13). Desired positioning of the bone graft on the anterior glenoid surface (lower third) was identified more commonly in the AAGR cohort. CONCLUSION: AAGR is faster to learn and perform than AL for the treatment of recurrent anterior shoulder instability with significant glenoid bone loss. The current study found higher rates of desired graft positioning for AAGR clusters.
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BACKGROUND: An arthroscopic technique for anatomic glenoid reconstruction has been proposed for the treatment of glenohumeral bone loss in patients with recurrent shoulder instability. This technique is proposed as an alternative to open techniques as well as to the technically challenging arthroscopic Latarjet procedure. In arthroscopic anatomic glenoid reconstruction, a distal tibial allograft is inserted through a novel far medial portal, superior to the subscapularis tendon and lateral to the conjoint tendon. PURPOSE: To evaluate the safety of the far medial arthroscopic portal for anatomic glenoid reconstruction in a cadaveric study. STUDY DESIGN: Descriptive laboratory study. METHODS: Ten cadaveric shoulder specimens were dissected after inside-out medial arthroscopic portal insertion in the lateral decubitus position for arthroscopic anatomic glenoid reconstruction. A single observer performed 3 measurements on each specimen with a digital caliper (to the nearest 0.1 mm) from the medial portal to neurovascular structures, and the mean (±SD) and the range were calculated. The anthropometric data of the cadaveric specimens were also collected. RESULTS: The mean distances between the far medial arthroscopic portal and sensitive anatomic structures were as follows: 50.79 ± 13.69 mm from the musculocutaneous nerve, 46.28 ± 9.64 mm from the axillary nerve, 6.71 ± 8.52 mm from the cephalic vein, and 48.52 ± 7.22 mm from the subclavian artery and vein. The mean size of the medial arthroscopic portal was 25.60 mm. In all cases, the subscapularis muscle was intact. CONCLUSION: The far medial arthroscopic portal for anatomic glenoid reconstruction without a subscapularis split presents a minimal risk to most neurovascular structures during bony reconstruction of the glenoid surface in patients with anterior shoulder instability. The only anatomic structure at risk is the cephalic vein, while the axillary and musculocutaneous nerves are at a safe distance away from the portal, based on previous shoulder arthroscopic portal safety studies in the literature. CLINICAL RELEVANCE: Arthroscopic anatomic glenoid reconstruction using a distal tibial allograft is increasing in popularity for the treatment of anterior shoulder instability with significant bone loss. Being a relatively new technique, the safety of it has yet to be established. This study aimed to demonstrate the safety of a new portal used for arthroscopic anatomic glenoid reconstruction.
