Selective Iliotibial Band Release for Iliotibial Band Traction Syndrome After Second-Generation Motion-Guided Bicruciate Stabilizing Total Knee Arthroplasty and Its Rationale: A Case Report With Review of Literature.

Iliotibial band traction syndrome (ITBTS) after total knee arthroplasty (TKA) has been well documented following first-generation guided motion bicruciate substituting (BCS) TKA. The incidence of ITBTS following second-generation BCS has been found to be rare, and surgical release of the IT band has not been reported. A 64-year old male was diagnosed with ITBTS following second-generation guided motion BCS TKA. After a three-month trial of non-surgical treatment, he underwent selective open release of the iliotibial band (ITB), which successfully relieved his symptoms. Orthopedic surgeons should keep ITBTS as a possible differential diagnosis when evaluating the lateral-sided knee pain following guided motion BCS TKA.

Epidemiology of NCAA Bone Stress Injuries: A Comparison of Athletes in Divisions I, II, and III.

BACKGROUND: Bone stress injuries (BSIs) are a major source of functional impairment in athletes of all sports, with many risk factors, including athlete characteristics and type of sport. In National Collegiate Athletic Association (NCAA) athletics, the stratification of programs into divisions with different characteristics and makeup has been identified as increasing the risk for certain kinds of injuries, but there have been no studies on the difference of BSI rates and characteristics between athletes in Division I (DI) and those in Divisions II and III (DII and DIII). PURPOSE/HYPOTHESIS: To characterize the BSI rates in each division and compare the incidence and characteristics of BSIs within divisions. Our hypothesis was that BSI rates would be higher in DII and DIII athletes as compared with DI athletes. STUDY DESIGN: Descriptive epidemiology study. METHODS: Five years of recorded BSI data in collegiate athletes via the NCAA Injury Surveillance Program were examined for the academic years 2009-2010 to 2013-2014. BSI rates per 100,000 athlete-exposures (AEs) were compared for DI versus DII and DIII athletes using risk ratios and 95% CIs. Time lost to injury, time of season of injury, and class composition of injured athletes were also compared between divisions. RESULTS: Over the 5 years studied, DII and DIII programs reported 252 BSIs more than 1,793,777 AEs (14.05 per 100,000 AEs), and DI programs reported 235 BSIs over 2,022,592 AEs (11.62 per 100,000 AEs). The risk ratio was significant for D1 versus DII and DIII (1.21; 95% CI, 1.01-1.44). There was a significant difference in time lost to injury in DI versus DII and DIII, χ2(5, n = 449) = 16.54; P = .006. When data were stratified by individual sport, there were no significant divisional differences in high-risk sports. CONCLUSION: In the current study, NCAA DII and DIII athletes had higher rates of BSI than their DI counterparts. As compared with DII and DIII athletes, the DI athletes had a significantly greater proportion of BSIs that did not result in absence from participation in sport.

YouTube as a Source of Patient Information for Prenatal Repair of Myelomeningocele.

OBJECTIVE: With the increasing interest in fetal repair of myelomeningoceles (MMCs) over the last decade, it is reasonable to anticipate the need for high quality and accessible educational materials for patients. Patients often look to the internet for details regarding medical topics and specifically to YouTube for informative health-related videos. This study aims to analyze the content and shortcomings of currently available videos on YouTube regarding prenatal repair of MMCs. STUDY DESIGN: A YouTube search was performed on December 15, 2018, using the terms "fetoscopic surgery for neural tube defect" and "fetal surgery for neural tube defect." The first 50 videos from each search were sorted by relevance and evaluated for video source (i.e., professional, personal, or other), target audience (medical professionals or general public), general descriptive statistics (i.e., video length, number of views, number of comments), and for five areas of content determined by the authors to constitute basic patient information regarding a surgical procedure: (1) procedure details, (2) eligibility criteria, (3) alternatives to surgery, (4) surgical risks, and (5) success rate. Accuracy of videos was not assessed. RESULTS: Of the 16 videos that met inclusion criteria, only 1 discussed fetoscopic surgery. The majority (62.5%) of videos were produced by a professional source and 81.3% were targeted toward the general public rather than medical professionals. Of the 16 videos, 10 (62.5%) included details regarding the surgery, 3 (18.8%) discussed eligibility criteria, and 8 (50.0%) mentioned alternatives to surgery. Additionally, seven videos (43.8%) discussed risks of the procedure and six (37.5%) included surgical success rate. CONCLUSION: Only 2 of the 16 videos included all five areas of content that were evaluated, and both were in regard to open fetal repair. This study not only calls attention to the initial shortcomings of YouTube videos regarding fetal surgery for neural tube defects but also demonstrates the need for further investigation and more comprehensive analysis.

Predicting dysphagia in children undergoing surgery for posterior fossa tumors.

PURPOSE: Posterior fossa tumors (PFTs) are the most common type of brain tumor in children. Dysphagia is a known complication of PFT resection in children, but data regarding risk factors and clinical course are sparse. METHODS: The records of all children who underwent resection of posterior fossa tumor between April 2007 and May 2017 at our institution were analyzed. Clinical, radiographic, histologic data were gathered. Swallowing function was assessed immediately postoperatively and at 1-year follow-up. RESULTS: A total of 197 patients were included. Forty-three (21.8%) patients developed dysphagia after surgery. Patients who developed dysphagia were younger (4.5 vs. 7.2 years, p < 0.01), were more likely to have brainstem compression (74.4% vs. 57.8%, p < 0.03) or invasion (14.0 vs. 9.7%, p < 0.03), and were more likely to have ependymoma (27.9% vs. 13.6%, p < 0.01) or ATRT (atypical teratoid/rhabdoid tumor) (9.3% vs. 3.9%, p < 0.01). Patients with postoperative dysphagia also had a longer length of stay (33.7 vs. 12.7 days, p < 0.01) and were more likely to be discharged to inpatient rehabilitation (25.6% vs. 9.1%, p < 0.01). Ten patients (5.1%) were PEG-dependent by 1-year follow-up. These patients were younger (2.7 vs. 5.6 years, p < 0.01), had a longer length of stay (55.5 vs. 27.4 days, p < 0.01), and were more likely to have ATRT (30.0% vs. 0.0%, p < 0.01). Recovery was not associated with tumor grade or extent of resection. CONCLUSIONS: Dysphagia after PFT resection is associated with younger age, aggressive tumor histology, and increased healthcare utilization. While most patients recover, a small percentage are still dependent on enteral feeding at 1-year follow-up. Further research is needed to identify factors associated with persistent deficits.

An Infected Urachal Cyst in a 4-Year-Old Girl Presenting with Recurrent Abdominal Pain.

BACKGROUND: Urachal cysts are remnants of urachal ducts and usually present when they get infected or undergo malignant transformation. CASE REPORT: A 4-year-old girl presented to the Emergency Department (ED) with intermittent abdominal pain, fever, dysuria, and umbilical swelling. She was diagnosed with an abscess related to an infected urachal cyst by ultrasound. The patient was treated with antibiotics, and the abscess was drained by Interventional Radiology with ultrasound guidance. She recovered uneventfully and was discharged home. The urachal cyst was excised a month later. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Though urachal cysts are rare, it is important to consider this entity in the differential diagnosis of acute abdomen and recurrent abdominal pain in the ED setting.