High-intensity stretch treatment for severe postoperative adhesive capsulitis of the shoulder.

BACKGROUND: Some patients with postoperative adhesive capsulitis reach a plateau in their recovery with a standard protocol of physical therapy (PT), which puts them at risk for further surgical intervention. OBJECTIVES: We aimed to evaluate therapy for postoperative adhesive capsulitis of the shoulder in 2 groups of patients: (1) those who used a high-intensity stretch (HIS) device after reaching a plateau in their recovery with a standard protocol of traditional PT (PT+HIS) and (2) those who showed no plateau in their recovery with a standard protocol of traditional PT alone (PT only). METHODS: We retrospectively reviewed the records for 60 patients (51 males; mean age 46.7±12.6years) with postoperative adhesive capsulitis who received treatment between March 2007 and May 2010. Forward elevation and combined internal/external rotation at the initial postoperative visit and final visit were measured. The measurements from group 2 patients were used as an observational benchmark. RESULTS: The PT+HIS (n=42) and PT-only (n=18) patients did not differ in total follow-up time. Initial elevation was worse for PT+HIS than PT-only patients (22.1° lower, P=0.02), but the final elevation was equivalent. Initial rotation was worse for PT+HIS than PT-only patients (16.6° lower, P=0.04), but the final rotation was higher for PT+HIS patients (10.6° higher, P=0.04). Gains in elevation and rotation were greater for the PT+HIS than PT-only patients (P=0.04 and P=0.01). CONCLUSIONS: Patients with postoperative adhesive capsulitis of the shoulder who are unable to reach their PT treatment goals with a standard protocol of PT may benefit from the addition of HIS to their treatment regimen. HIS could be a valuable adjunct to PT for treating postoperative adhesive capsulitis in appropriate patients.

Late vascular injury following intertrochanteric fracture reduction with sliding hip screw.

A case involving late injuries to pelvic vessels caused by a sliding hip screw penetrating through the acetabulum has not been previously reported. We present the case of an 88-year-old man who presented with a retroperitoneal and extraperitoneal hematoma 4 months after open reduction and internal fixation of an intertrochanteric hip fracture. Surgical exploration showed a laceration of the left external iliac artery, which was repaired. However, the sliding hip screw was left in place. The patient's condition deteriorated, and he expired 2 days later. Postmortem examination revealed a laceration of the left internal iliac vein. Our calculations show that the compression screw utilized in the fixation may not have been properly engaged into the sliding screw.

Arthroscopic shaver-assisted total hip arthroplasty revision.

A case report of a 54-year-old man who underwent a revision arthroplasty 13 years after his original hip replacement is presented. The patient presented to the clinic with a 2-month history of hip pain. Severe pelvic osteolytic lesions were seen on radiographs. The revision procedure consisted of debridment of the osteolytic lesions and bone grafting. An arthroscopic shaver was used to remove the osteolytic lesions proximal to the acetabular cup. Excellent debridment was obtained. Cortical bone allograft was the used to fill the void areas behind the cup. The patient did well postoperatively with no recurrence of osteolysis as seen on radiographs obtained 7 months after surgery. This report presents a successful case of pelvic osteolytic debridment with the use of an arthroscopic shaver.

Bone and tissue allograft use by orthopaedic surgeons.

The purpose of our study was to determine the involvement of orthopaedic surgeons in the process of acquiring allografts they transplant. A questionnaire regarding allograft acquisition and use was directed to 340 hospitals. In approximately 85% of the institutions, nonorthopaedic personnel selected and acquired the allografts. In most, those responsible for providing surgeons with allografts had little or no knowledge of the practices of tissue banking and allograft transplantation biology. In about 15% of the hospitals, the surgeon was involved in the selection of the source of allografts. It is imperative that orthopaedic surgeons who transplant bone and tissue allografts become actively involved in determining the source and processing of tissue transplants they place in their patients.