Nonoperative Treatment of Periprosthetic Humeral Shaft Fractures After Reverse Total Shoulder Arthroplasty.

Few studies report on periprosthetic humeral shaft fractures after reverse total shoulder arthroplasty (RTSA). The authors evaluated outcomes of 5 patients with this complication who were initially treated nonoperatively. Of 152 patients who underwent RTSA at the authors' institution from 2012 to 2017, 4 experienced periprosthetic humeral shaft fractures. One patient was referred to the authors for fracture treatment. All 5 patients were initially treated nonoperatively. The mean duration of follow-up was 11.5 months (range, 1.5-26 months). The authors analyzed time to fracture union, Single Assessment Numeric Evaluation (SANE) score, visual analog scale (VAS) score for pain, and active shoulder range of motion. Fracture union occurred in 4 patients treated nonoperatively at a mean of 4.4 months. Mean SANE score was 55 of 100 (range, 20-85). Mean VAS score was 3.4 of 10 (range, 0-8). Mean forward elevation was 83° (range, 45°-110°); mean abduction was 65° (range, 45°-80°); and mean external rotation with the arm at the side was 15° (range, 0°-30°). Many factors must be considered when customizing treatment for patients with periprosthetic fracture after RTSA. This case series indicates that nonoperative treatment of postoperative periprosthetic humeral shaft fractures can be successful. [Orthopedics. 2020;43(6):e553-e560.].

Effectiveness of Surgical Safety Checklists in Improving Patient Safety.

Wrong-site surgery is all too common. Despite more than a decade of campaigns by major organizations to prevent these events, there are still reports of such mistakes. This article reviews the recent literature on surgical safety checklists and other tools designed to prevent wrong-site surgery and improve patient safety in the operating room. Emphasis is placed on how well institutions comply with these guidelines, the perceptions and attitudes of those who are asked to implement them, and their effectiveness. The literature shows that the implementation of such protocols has improved patient safety. In general, these efforts are viewed favorably by operating room personnel. However, the role of these checklists and other tools in reducing wrong-sided surgeries has not been proven. The goal of the health care profession should be to continue to improve on the advances that have been made in implementing surgical checklists and preventing wrong-site surgery. Practitioners at the authors' institution are continuously searching for ways to improve on the current protocols to prevent wrong-site surgeries. The authors recently employed a protocol in which surgical instruments are kept in the back of the room, away from the patient, until completion of the surgical time-out. This practice helps to ensure that team members are not distracted or preoccupied with setting up equipment during the time-out. This approach also helps to mitigate the hierarchal style in the operating room.

The role of the elastic fiber system in the pathogenesis of osteoarthritis and knee joint laxity.

Osteoarthritis (OA) is a disease of synovial joints in which all articular structures are affected. Evidence suggests that a decreased density in the elastic fiber concentration of the knee capsule is associated with joint hypermobility, a condition associated with OA. However, there is no study that shows a direct relationship between the elastic fiber system and knee OA. The purpose of this study is to determine if there is a correlation between the elastic fiber density in medial (MCL) and lateral (LCL) collateral ligaments and the severity of OA. The elastic fiber concentration in MCL and LCL were examined in cadaver knees (n = 10; 4 M, 6 F). The elastic fiber density, measured as the concentration of elastic fibers per unit area, was correlated with the severity of OA, which was graded on a 0-16 scale using histologic and macroscopic markers. Among all subjects, elastic fiber concentrations between MCL (mean 15.49% ± 2.49) and LCL (mean 13.93 ± 3.63) showed a significant difference (P = 0.023). There were no inter-gender differences between the elastic fiber concentration in either MCL or LCL. Among all subjects, the severity of OA was found to be correlated negatively with the elastic fiber concentration in both MCL (r = -0.693, P ≤ 0.05) and LCL (r = -0.718, P ≤ 0.05). This is the first study to show a correlation between the elastic fiber system and knee OA.