Leiomyosarcoma of the somatic soft tissues.

Leiomyosarcomas of the somatic soft tissues are tumors of smooth muscle origin that occur in the extremities. These lesions are commonly high-grade tumors that carry a poor prognosis. Recommended treatment often includes wide excision and chemotherapy or radiation therapy. Sixty-five patients were followed for a mean of 4.1 years. The mean maximum tumor diameter was 7 cm, and approximately 70% of all patients had tumors deep to fascia. Including all stages of disease, the overall 1-, 2-, and 5-year survival rates were 91%, 87%, and 68%, respectively. Mitotic rate and tumor depth were significant predictors of development of recurrent disease and metastatic disease. Tumor size was another predictor of recurrent disease. The mitotic rate and AJCC stage were also important predictors of overall survival. Patients with deep lesions, histologic grade 3 disease/higher mitotic rates, and advanced stage of disease had a poorer prognosis and thus were more likely to undergo adjuvant chemotherapy. Future clinical studies may help determine if knowledge of these predictors can help guide treatment and improve clinical outcomes.

Arthroscopic capsulolabral repair for posterior shoulder instability in throwing athletes compared with nonthrowing athletes.

BACKGROUND: There are limited studies evaluating arthroscopic treatment of unidirectional posterior shoulder instability in overhead-throwing athletes. HYPOTHESIS: Arthroscopic capsulolabral repair for unidirectional posterior shoulder instability will yield equivalent stability and functional outcomes in the overhead-throwing athlete and nonthrowers. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Ninety-eight athletes (107 shoulders) with unidirectional posterior shoulder instability were treated with arthroscopic posterior capsulolabral reconstruction or, rarely, capsular plication alone, as determined by their specific intra-articular lesions. Patients were evaluated prospectively with the American Shoulder and Elbow Surgeons scoring system. Stability, range of motion, strength, pain, and function were assessed preoperatively and postoperatively with standardized subjective scales. Results for 27 dominant shoulders in throwing athletes (25%) were compared with those for 80 shoulders in nonthrowing athletes (75%). RESULTS: At a mean follow-up of 27 months postoperatively, there were no differences in the American Shoulder and Elbow Surgeons score or scores for stability, range of motion, strength, pain, and function between the throwers and nonthrowers, with both groups showing a significant improvement in all categories (P < .0001). Excellent or good results were achieved in 89% of the throwers and 93% of the nonthrowers. Throwing athletes were less likely to return to their preinjury levels of sport (55%) compared with nonthrowing athletes (71%). CONCLUSION: Arthroscopic posterior capsulolabral repair effectively improves stability, range of motion, strength, pain, and function in throwing athletes with unidirectional posterior shoulder instability. Despite similar outcome measures to nonthrowers, throwing athletes are less likely to return to their preinjury levels of sport.

Cryotherapy temperature differences after total knee arthroplasty: a prospective randomized trial.

In spite of its widespread use after orthopaedic procedures, the literature evaluating the clinical efficacy of cryotherapy is controversial. The purpose of this prospective randomized trial was to compare two different temperatures for administering cryotherapy after total knee arthroplasty with regards to short-term postoperative outcomes. Sixty-four subjects were assigned either the 45 degrees F group or the 75 degrees F group. Subjects in the 45 degrees group were as likely to report a lower pain score at the time of follow-up compared to the 75 degrees group. Our results demonstrate no additional analgesic effect associated with the lower temperature of cryotherapy. Postoperative narcotic consumption, postoperative drainage, self-reported knee function, and range of motion were not affected by the different cryotherapy temperatures. No adverse effects were reported with the cryotherapy treatment.

Intramedullary fixation of fibular fractures with flexible titanium elastic nails: surgical technique and a case report.

Intramedullary fixation of fibular fractures has been reported in the literature. Its advantages include ease of fixation as well as minimal soft tissue disruption. Various implants have been described, including the Inyo nail and Rush rods. Several studies have examined their use in older people with osteoporotic bone as well as in instances where soft tissue preservation is of concern. To our knowledge, no technique has been described using flexible titanium elastic nails (TENS) (Synthes; Paoli, PA). We illustrate such a technique as well as a case report that demonstrates our experience. Insertion of flexible titanium elastic nails requires attention to detail with preservation of the peroneal tendons and their sheath. While such a construct cannot control rotation, it can preserve length as well as prevent varus and valgus displacement. Future endeavors could focus on the biomechanical principles of intramedullary fibular fixation with TENS nails.

Manufacturing imperfection of a locking plate screw hole: a case report.

Plate and screw fixation devices are essential in the orthopaedic surgical management of various fractures. Production of these devices has been nearly perfected, with few manufacturing defects reported. Assuming that all implants have been machined properly may cause a surgeon to overlook a manufacturing defect and may potentially result in a poor patient outcome. We report a case of the imperfect manufacturing of a less invasive stabilization system (LISS) plate screw hole. This resulted in a loss of fixation of a single locking screw to the plate in the treatment of a distal femoral fracture. Prompt recognition of the defect helped avoid a potential adverse outcome for the patient. When these issues arise, open dialogue with industry is crucial to promptly identify a solution and enhance patient care. This case highlights the manufacturing company's outstanding quality control and prompt solution of such an occurrence. It is the purpose of this report to raise surgeons' awareness of potential manufacturing problems with implants and prevent negative consequences as a result.

An anatomic study of the cephalic vein in the deltopectoral shoulder approach.

There has been debate regarding medial or lateral retraction of the cephalic vein in the deltopectoral approach to the shoulder. Those who recommend lateral retraction of the vein cite multiple feeder vessels from the deltoid muscle; however, there is little evidence to support this in the orthopaedic literature. The purpose of our study was to determine if there are more lateral branches than medial branches to the cephalic vein in the deltopectoral groove. Forty fresh frozen cadaveric shoulders underwent retrograde latex injection of the cephalic vein. A deltopectoral incision was used, and the numbers of medial and lateral branches were recorded. In the deltopectoral groove there were more lateral than medial feeder vessels to the cephalic vein. There also were more branches to the vein in the proximal (1/2) of the incision compared with the distal (1/2). Most of the specimens dissected had more lateral branches to the cephalic vein than medial branches. Based on the number of feeder vessels to the cephalic vein, results of our study support lateral retraction of the cephalic vein in a majority of shoulders during the deltopectoral approach to the shoulder.

Arthroscopic-assisted revision of telescopic rods in osteogenesis imperfecta.

Bailey-Dubow extensible nails are intramedullary stabilization devices designed to prevent deformities and recurrent long bone fractures in patients with osteogenesis imperfecta. The rods consist of a hollow outer sleeve and a solid inner obturator, allowing for telescoping of the rods and expansion of the device with longitudinal growth of the bone. Migration of the nail into the joint is a known complication of this procedure, which can lead to pain and loss of motion. This is a case report of the use of an arthroscopic approach to manipulate femoral and tibial Bailey-Dubow rods that migrated into the knee joint.