C5 nerve root palsy (without prior cervical decompression) case series: 9 patients with critical delay to presentation.

BACKGROUND: Distinguishing between cervical nerve root and intrinsic shoulder pathology can be a difficult task given the overlapping and often coexisting symptoms. OBJECTIVE: The objective of this study was to highlight the often-complicated presentation of these symptoms and the subsequent potential for delay in care regarding this subset of patients. METHODS: A total of 9 patients, managed by one of two different surgeons, were identified with a history of C5 nerve root palsy. A chart review was conducted, and the following information was recorded: presenting complaint, time from symptom onset to diagnosis, time from symptom onset to presentation to a spine surgeon, first specialist seen for symptoms, non-spinal advanced imaging and treatment conducted before diagnosis, preoperative and postoperative exam, time to recovery, and type of surgery. RESULTS: We observed an average time from onset of symptoms to presentation to a spine surgeon to be 31.6 weeks. These patients' time to full recovery after cervical decompression was 15 weeks. CONCLUSION: : We observed a critical delay to presentation in this series of patients with C5 nerve palsy. C5 nerve palsy should remain an elemental part of the differential diagnosis in the setting of any shoulder or neck pain presenting with weakness.

Collagenase Treatment for Dupuytren Contracture of the Metacarpophalangeal Joint After Arthrodesis of the Proximal Interphalangeal Joint.

Successful collagenase (Xiaflex) treatment of Dupuytren's contracture in the metacarpophalangeal joint is possible in the presence of previous arthrodesis of the proximal interphalangeal joint.

Cannabis Use Is Associated With Fewer Filled Opioid Prescriptions After Treatment of Proximal Humerus Fractures.

The purpose of this study was to use a large claims database to determine if there is a difference in opioid use after operative intervention for proximal humerus fractures in patients with known cannabis use compared with those who do not report cannabis use. The PearlDiver database was queried to find all patients who underwent proximal humerus open reduction and internal fixation. A group of patients with reported cannabis use or dependence was matched to a cohort without known cannabis use. Between the two groups, differences in the number of opioid prescriptions filled in the postoperative period (within 3 days), the morphine milligram equivalents (MMEs) prescribed in total and per day, and the number of opioid prescription refills were explored. There were 66,445 potential control patients compared with 1260 potential study patients. After conducting the propensity score match, a total of 1245 patients were included in each group. The patients in the cannabis group filled fewer opioid prescriptions (P=.045) and were prescribed fewer total MMEs (P=.044) in the first 3 days postoperatively. Results of this study indicate that patients who use cannabis products may use fewer opioids after proximal humerus open reduction and internal fixation. [Orthopedics. 202x;4x(x);xx-xx.].

Early Tibial Baseplate Fracture After Medial Unicondylar Knee Arthroplasty: A Report of 2 Cases.

CASE: Implant failure after unicondylar knee arthroplasty (UKA) is a rare but well-described complication in the arthroplasty literature. However, there is a paucity of literature regarding rapid catastrophic failure of modern implant designs. This is a case report of 2 patients with early catastrophic failure of the tibial baseplate after UKA with a Stryker Restoris MultiCompartmental Knee System implant using Mako robotic assistance, both requiring revision to total knee arthroplasty. CONCLUSION: Improved awareness and understanding of early UKA tibial baseplate failure may help identify both patient and surgical risk factors that could help prevent further instances in the future.

Cannabis use is associated with decreased opioid prescription fulfillment following single level anterior cervical discectomy and fusion (ACDF).

Background: Recently, there has been increasing legalization of marijuana within the United States, however data are mixed with respect to its efficacy in treating acute pain. Our goal was to identify a difference in opioid utilization in patients with known cannabis use before anterior cervical discectomy and fusion (ACDF) compared with those that report no cannabis use. Methods: This study was a retrospective case-control design using PearlDiver. Patients who underwent a single level ACDF between January 2010 and October 2020, were included. Patients were placed in the study group if they had a previous diagnosis of cannabis use, dependence, or abuse. Patients were excluded if they were under the age of 18 or if they had filled an opioid prescription within 3 months of their procedure. A control group was then created using a propensity score match on age, gender, and Charleston comorbidity index (CCI), and had no diagnosis of cannabis use. The primary outcome was the number of morphine milliequivalents (MME) dispensed per prescription following surgery. Results: A total of 1,339 patients were included in each group. The number of patients filling prescriptions was lower in the cannabis group than in the control group at 3 days postoperatively (p<.001). The average total MME per day as prescribed was lower in the cannabis group than the control group at 60 days post-op (48.5 vs. 59.4, respectively; p=.018). Conclusions: Patients who had a previous diagnosis of cannabis use, dependence or abuse filled fewer opioid prescriptions postoperatively (at 3 days postoperatively) and required lower doses (reduced average daily MME, at 60 days postoperatively) when compared with the control group.

The Effect of Lateral Opening Wedge Distal Femoral Varus Osteotomy on Tibiofemoral Contact Mechanics Through Knee Flexion.

BACKGROUND: Lateral opening wedge distal femoral osteotomy (DFO) unloads a diseased lateral compartment of the knee in patients with genu valgum. To the best of our knowledge, there are no biomechanical studies investigating the effect of knee flexion on contact pressure and area after DFO. HYPOTHESIS: As knee flexion angles increase, DFO will be less effective at unloading the lateral compartment of the knee. STUDY DESIGN: Controlled laboratory study. METHODS: Lateral opening wedge DFO was performed, correcting a mean of 7°, in 10 cadaveric knees using plate fixation. Tibiofemoral contact pressure was measured in 0°, 15°, 30°, 45°, 60°, and 75° of knee flexion before and after osteotomy using electronic sensors. Peak contact pressure (PCP), mean contact pressure (MCP), and contact area were measured for each condition. Anatomic dissection quantified the tibiofemoral contact position on the distal femur in all degrees of flexion. Mixed-effects regression analyses were used to compare the change in variables before and after osteotomy and between flexion angles. RESULTS: One sample had to be excluded because of tibiofemoral arthritis. MCP decreased in the lateral compartment after DFO throughout all degrees of flexion (all P < .05) but to the greatest extent in 0° of flexion. When examining the percentage of MCP in the lateral compartment, this decreased after DFO at 0° (70.4% to 40.0%; P < .001), 15° (65.1% to 52.1%; P < .001), 30° (60.7% to 52.0%; P = .003), 45° (55.8% to 49.7%; P = .033), and 60° (51.9% to 44.2%; P = .010) but not at 75° (50.2% to 45.3%; P = .112). PCP decreased in the lateral compartment after DFO at 0° (2.41 to 1.34 MPa; P < .001), 15° (2.50 to 1.81 MPa; P < .001), 30° (2.28 to 1.93 MPa; P = .039), 45° (2.21 to 1.73 MPa; P = .005), 60° (2.15 to 1.71 MPa; P = .009), and 75° (1.95 to 1.49 MPa; P = .012). The percentage of contact area decreased in the lateral compartment in full extension (68.7% to 48.1%; P = .007) but not at any other degree of flexion (all P > .05). CONCLUSION: DFO decreased lateral compartment pressure. However, it had the greatest effect in full knee extension. CLINICAL RELEVANCE: DFO decreased contact pressure in the lateral compartment but more effectively decreased contact pressure in the more anterior aspects of the femoral articular cartilage.