Swing Type and Batting Grip Affect Peak Pressures on the Hook of Hamate in Collegiate Baseball Players.

BACKGROUND: Bat swing and grip type may contribute to hook of hamate fractures in baseball players. PURPOSE: To compare the effects of swing type and batting grip on the pressure and rate of pressure development over the hook of hamate in collegiate baseball players. STUDY DESIGN: Descriptive laboratory study. Level of evidence, 3. METHODS: This was an experimental quasi-randomized study of bat grip and swing differences in National Collegiate Athletic Association Division I baseball players (N = 14; age, 19.6 ± 1.1 years [mean ± SD]). All participants performed swings under 6 combinations: 3 grip types (all fingers on the bat shaft [AO], one finger off the bat shaft [OF], and choked up [CU]) and 2 swing types (full swing and check swing). Peak pressure and rate of pressure generation over the area of the hamate were assessed using a pressure sensor fitted to the palm of the bare hand over the area of the hamate. Wrist angular velocities and excursions of radial ulnar deviation were obtained using 3-dimensional motion analysis. RESULTS: The OF-check swing combination produced the highest peak pressure over the hamate (3.72 ± 2.64 kg/cm2) versus the AO-full swing (1.36 ± 0.73 kg/cm2), OF-full swing (1.68 ± 1.17 kg/cm2), and CU-full swing (1.18 ± 0.96 kg/cm2; P < .05 for all). There was a significant effect of condition on rate of pressure development across the 6 conditions (P = .023). Maximal wrist angular velocities were 44% lower in all check swing conditions than corresponding full swing conditions (P < .0001). The time to achieve the maximal wrist angular velocity was longest with the AO-full swing and shortest with the CU-check swing (100.1% vs 7.9% of swing cycle; P = .014). CONCLUSION: The OF-check swing condition produced the highest total pressure reading on the hook of hamate. Check swing conditions also had the steepest rate of pressure development as compared with the full swing conditions. CLINICAL RELEVANCE: Batters who frequently check their swings and use an OF or AO grip may benefit from bat modifications or grip adjustment to reduce stresses over the hamate. Athletic trainers and team physicians should be aware of these factors to counsel players in the context of previous or ongoing hand injury.

Outcome measures reported for the management of proximal humeral fractures: a systematic review.

BACKGROUND: The American Shoulder and Elbow Surgeons multicenter taskforce studying proximal humerus fractures reached no consensus on which outcome measures to include in future studies, and currently no gold standard exists. Knowledge of commonly used outcome measures will allow standardization, enabling more consistent proximal humerus fracture treatment comparison. This study identifies the most commonly reported outcome measures for proximal humerus fracture management in recent literature. METHODS: A systematic review identified all English-language articles assessing proximal humerus fractures from 2008 to 2018 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Review articles, meta-analyses, revision surgery, chronic injuries, studies with <15 patients, studies with <12 month follow-up, anatomic/biomechanical studies, and technique articles were excluded. Included studies were assessed for patient demographics and outcome scores, patient satisfaction, complications, range of motion, and strength. RESULTS: Of 655 articles, 74 met inclusion criteria. The number of proximal humerus fractures averaged 74.2 per study (mean patient age, 65.6 years). Mean follow-up was 30.7 months. Neer type 1, 2, 3, and 4 fractures were included in 8%, 51%, 81%, and 88% of studies, respectively. Twenty-two patient-reported outcome instruments were used including the Constant-Murley score (65%), Disabilities of the Arm, Shoulder, and Hand score (31%), visual analog scale pain (27%), and American Shoulder and Elbow Surgeons score (18%). An average of 2.2 measures per study were reported. CONCLUSION: Considerable variability exists in the use of outcome measures across the proximal humerus fracture literature, making treatment comparison challenging. We recommend that future literature on proximal humerus fractures use at least 3 outcomes measures and 1 general health score until the optimal scores are determined.

Is percent seminoma associated with intraoperative morbidity during post-chemotherapy RPLND?

INTRODUCTION: To evaluate whether varying degrees of seminomatous elements in the primary orchiectomy specimen would be predictive of patient morbidity during post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) since the desmoplastic reaction with seminoma is associated with increased intraoperative complexity. MATERIALS AND METHODS: We retrospectively identified 127 patients who underwent PC-RPLND for residual retroperitoneal masses. Clinicodemographic, intraoperative, and 30 day postoperative outcomes were compared for patients with pure seminoma (SEM), mixed germ cell tumors (GCT) containing seminoma elements (NS+SEM), and tumors with no seminoma elements (NS). Multivariate logistic regression was used to determine independent predictors of intraoperative and postoperative 30 day complications. RESULTS: We excluded 19 patients who received chemotherapy prior to orchiectomy, 2 patients with primary extragonadal GCT, and 3 patients who underwent re-do RPLND, leaving 103 patients for analysis. Fourteen patients (13.6%) had SEM, 18 (17.5%) had NS+SEM, and 71 (68.9%) had only NS elements. SEM patients were older (p = 0.03), had more intraoperative blood loss (p = 0.03), and were more likely to have residual seminomatous components in their post-chemotherapy lymph node (LN) histology (p = 0.01). Percent seminoma in the orchiectomy specimen was an independent predictor of estimated blood loss > 1.5 liters (odds ratio: 1.04, 95% confidence interval: 1.01-1.07; p = 0.013) after adjusting for age, stage, IGCCC risk category, preop chemotherapy, number and largest LN removed, need for vascular or adjacent organ resection (including nephrectomy), and LN histology. CONCLUSIONS: Higher percentage of seminoma in the orchiectomy specimen is associated with increased estimated blood loss during PC-RPLND. Percent seminoma, therefore, may be a useful prognostic tool for appropriate pre-surgical planning prior to PC-RPLND.

Sarcopenia as a predictor of complications in penile cancer patients undergoing inguinal lymph node dissection.

PURPOSE: Lymphadenectomy (LND) is part of the surgical management of penile cancer but causes significant perioperative morbidity. We determined whether sarcopenia, a novel marker of nutritional status, is a predictor of postoperative complications after LND. MATERIALS AND METHODS: Seventy-nine patients underwent LND for penile cancer from 1999 to 2014, and 43 had available preoperative abdominal imaging. Skeletal muscle index (SMI) was calculated on axial computed tomography images at the third lumbar vertebrae, and an SMI of 55 cm(2)/m(2) was used to classify patients as sarcopenic versus not. This classification was then correlated with postoperative complications and survival. RESULTS: Median lumbar SMI was 54.7 cm(2)/m(2) with 22 (51.2 %) patients categorized as sarcopenic versus 21 (48.8 %) who were not. Twenty-seven postoperative complications occurred in 20 patients within 30 days, of which 11 (40.7 %) were major (Clavien score ≥IIIa) and 16 (59.3 %) were minor. The most common complications were wound dehiscence (25.9 %), wound infection (18.5 %), lymphocele (18.5 %), and flap necrosis (14.8 %). On univariate analysis, the presence of sarcopenia, nodal disease, and lymphovascular invasion were predictors of postoperative complications. On multivariate analysis, only sarcopenia was an independent predictor of 30-day complications [p = 0.038; 95 % confidence interval (CI) 1.1-21.1]. Although sarcopenia was not statistically associated with worse overall survival (OS), there was a trend toward poorer outcomes in these patients. CONCLUSIONS: Sarcopenia can be a useful prognostic tool to predict the likelihood of postoperative complications after LND for penile cancer. Preoperative nutritional supplementation may help reduce complication rates in the future.