High-Grade Partial and Retracted (<2 cm) Proximal Hamstring Ruptures: Nonsurgical Treatment Revisited.

BACKGROUND: High-grade partial proximal hamstring tears and complete tears with retraction less than 2 cm are a subset of proximal hamstring injuries where, historically, treatment has been nonoperative. It is unknown how nonoperative treatment compares with operative treatment. HYPOTHESIS: The clinical and functional outcomes of nonoperative and operative treatment of partial/complete proximal hamstring tears were compared. We hypothesize that operative treatment of these tears leads to better clinical and functional results. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A retrospective review identified patients with a high-grade partial or complete proximal hamstring rupture with retraction less than 2 cm treated either operatively or nonoperatively from 2007 to 2015. All patients had an initial period of nonoperative treatment. Surgery was offered if patients had continued pain and/or limited function refractory to nonoperative treatment with physical therapy. Outcome measures were each patient's strength perception, ability to return to activity, Lower Extremity Functional Scale (LEFS) score, Short Form-12 (SF-12) physical and mental component outcome scores, distance traversed by a single-leg hop, and Biodex hamstring strength testing. RESULTS: A total of 25 patients were enrolled in the study. The 15 patients who were treated nonoperatively sustained injuries at a mean age of 55.73 ± 14.83 years and were evaluated 35.47 ± 30.35 months after injury. The 10 patients who elected to have surgery sustained injuries at 50.40 ± 6.31 years of age (P = .23) and were evaluated 30.11 ± 19.43 months after surgery. LEFS scores were significantly greater for the operative group compared with the nonoperative group (77/80 vs 64.3/80; P = .01). SF-12 physical component scores for the operative group were also significantly greater (P = .03). Objectively, operative and nonoperative treatment modalities showed no significant difference in terms of single-leg hop distance compared with each patient's noninjured leg (P = .26) and torque deficit at isokinetic speeds of 60 and 180 deg/s (P = .46 and .70, respectively). CONCLUSION: Patients who undergo operative and nonoperative treatment of high-grade partial and/or complete proximal hamstring tears with <2 cm retraction demonstrate good clinical and functional outcomes. In our series, 40% of patients treated nonoperatively with physical therapy went on to have surgery. For those patients with persistent pain and/or loss of function despite conservative treatment, surgical repair is a viable treatment option that is met with good results.

Musculoskeletal ultrasound education: orthopaedic resident ability following a multimedia tutorial.

Musculoskeletal ultrasound (MSK-US) is a quick and effective imaging tool that can be utilized by orthopaedic surgeons to identify common musculoskeletal pathology such as ankle tendinopathy. This study evaluated the ability of 15 orthopaedic surgery residents to identify and measure ankle tendons after attending a multimedia tutorial on MSK-US. Afterwards, proficiency of usage was assessed by identification and quantification of three ankle tendons (Achilles, tibialis posterior, and flexor hallucis longus) in a cadaver limb. Resident comfort level and plan for future use were also assessed. After completing the tutorial, accuracy measuring the Achilles, tibialis posterior, and flexor hallucis longus tendons was 94.8%, 90.2%, and 90.1%, respectively. Resident comfort level improved from a level of 2.3 before the tutorial to 6.8 afterwards. Seventy-one percent of residents plan to use ultrasound in clinical practice. These results show that orthopaedic surgery residents can identify and assess tendon size via MSK-US with sufficient accuracy after a multimedia tutorial.

The golf ball sign: arthroscopic localization of an osteochondritis dissecans lesion of the knee.

We report on the arthroscopic treatment of a 12-year-old boy diagnosed with an osteochondral defect of the medial femoral condyle. He underwent arthroscopic fixation of the defect, and during the surgery, a blunt trocar was used to localize the lesion. The trocar created a transient dimpling effect on the cartilage overlying the osteochondral defect that resembled the surface of a golf ball. This "golf ball sign" then served as a visual guide during placement of a chondral dart. When present, it is believed that this sign can benefit arthroscopists by helping to improve intraoperative localization of an osteochondral defect.

Race may not affect [correct] outcomes in operatively treated tibia fractures.

BACKGROUND: A recent review of the literature found worse outcomes and longer length of stay for minorities undergoing TKAs and THAs when compared with whites. It is unclear if this association exists for the operative treatment of tibia fractures. QUESTIONS/PURPOSES: The purpose of this study is to determine if there is a difference in etiology or the rate of complications for operative treatment of tibia fractures as a function of racial heritage. Secondary objectives include definition of etiology, mechanism, and fracture location as a function of race in the urban setting, and an attempt to determine if differences in etiology or complications depend on race and fracture location for tibial plateau or shaft fractures. METHODS: A retrospective chart review was conducted at our Level 1 urban trauma center from January 1, 2005 to December 31, 2009 using ICD-9 code 823 to identify patients with tibia fractures. Charts were reviewed to confirm operative intervention, location of fracture, mechanism, demographic data, length of stay, and complications (infection, reoperation, compartment syndrome, deep venous thrombosis, pulmonary embolism, death). RESULTS: There was no difference in the rate of infection within 90 days with respect to race. There also was no difference in the rate of reoperation, deep venous thrombosis, pulmonary embolism, mortality, and length of stay between white patients and minority patients. Subgroup analysis showed no difference in the rate of infection for plateau or shaft fractures. Compartment syndrome was more frequent in white patients, specifically white patients with tibia shaft fractures. Minority patients were more likely to have a gunshot wound as a mechanism of injury. CONCLUSION: With the possible exception of an increased risk of compartment syndrome in white patients, there is no difference in outcomes with respect to race for operatively treated tibia fractures, regardless of fracture location. Gunshot wounds have become an increasingly prevalent mechanism of injury in minority patients. LEVEL OF EVIDENCE: Level IV, prognostic study. See the Guidelines for Authors for a description of levels of evidence.