Bilateral Lesser Tuberosity Fractures: Technique and a Case Report with Literature Review.

Isolated lesser tuberosity fractures are a rare subset of proximal humerus fractures and are often associated with seizures. Displaced fractures can lead to chronic pain, reduced shoulder function, and posterior instability. Operative treatment is frequently recommended with the displacement of more than 5 mm or angulation of more than 45 degrees. We report on a 31-year-old man with bilateral lesser tuberosity fractures who underwent operative fixation for 1 fracture and nonoperative fixation for the other.

Outcomes of gracilis free-flap muscle transfers and non-free-flap procedures for restoration of elbow flexion: A systematic review.

PURPOSE: Elbow flexion is one of the most important functions to restore following brachial plexus damage. The authors sought to systematically review available evidence to summarize outcomes of free gracilis and non-free muscle transfers in restoring elbow flexion. METHODS: MEDLINE, EMBASE, and Cochrane were searched to identify articles reporting on elbow flexion reanimation in terms of transfer failure rates, strengths, range of motion (ROM), and/or Disabilities of the Arm, Shoulder and Hand (DASH) scores. A systematic review was chosen to select studies and reported according to PRISMA guidelines. RESULTS: Forty-six studies met the inclusion criteria for this study. A total of 432 cases were gracilis free-flap muscle transfers (FFMT), and 982 cases were non-free muscle transfers. FFMT were shown to have higher Medical Research Council (MRC) strength scores than non-free muscle transfer groups. However, 42 studies, totaling 1,266 cases, were useful in evaluating graft failure, showing failure (MRC<3) in 77/419 (∼18.4%) of gracilis free-flap transfers and 215/847 (∼25.4%) of non-free muscle transfers. Sixteen articles, 285 cases, were useful to evaluate ROMs (total range: 0-140°), and eight articles, 215 cases, provided DASH scores (total range: 8-90.8). CONCLUSIONS: Of patients who underwent gracilis FFMT procedures, higher mean strength scores and lower failure rates were observed when compared with non-free muscle transfers. Articles reporting non-free muscle transfer procedures (pectoralis, pedicled, Steindler, vascularized ulnar nerve grafts, Oberlin, single/double nerve transfers) provided comprehensive insight into outcomes and indicated that they may result in pooerer poorer DASH scores and ROM.

Outcomes of Patients With Parkinson Disease Undergoing Cervical Spine Surgery for Radiculopathy and Myelopathy With Minimum 2-Year Follow-up.

STUDY DESIGN: This was a retrospective cohort analysis. OBJECTIVE: To identify the impact of Parkinson disease (PD) on 2-year postoperative outcomes following cervical spine surgery (CSS). SUMMARY OF BACKGROUND DATA: (PD) patients are prone to spine malalignment and surgical interventions, yet little is known regarding outcomes of CSS among PD patients. MATERIALS AND METHODS: All patients from the Statewide Planning and Research Cooperative System with cervical radiculopathy or myelopathy who underwent CSS were included; among these, those with PD were identified. PD and non-PD patients (n=64 each) were 1:1 propensity score-matched by age, sex, race, surgical approach, and Deyo-Charlson Comorbidity Index (DCCI). Demographics, hospital-related parameters, and adverse postoperative outcomes were compared between cohorts. Logistic regression identified predictive factors for outcomes. RESULTS: Overall, patient demographics were comparable between cohorts, except that DCCI was higher in PD patients (1.28 vs. 0.67, P=0.028). PD patients had lengthier mean hospital stays than non-PD patients (6.4 vs. 4.1 d, P=0.046). PD patients also incurred comparable total hospital expenses ($69,565 vs. $57,388, P=0.248). Individual medical complication rates were comparable between cohorts; though PD patients had higher rates of postoperative altered mental status (4.7% vs. 0%, P=0.08) and acute renal failure (10.9% vs. 3.1%, P=0.084), these differences were not significant. Yet, PD patients experienced higher rates of overall medical complications (35.9% vs. 18.8%, P=0.029). PD patients had comparable rates of individual and overall surgical complications. The PD cohort underwent higher reoperation rates (15.6% vs. 7.8%, P=0.169) compared with non-PD patients, though this difference was not significant. Of note, PD was not a significant predictor of overall 2-year complications (odds ratio=1.57, P=0.268) or reoperations (odds ratio=2.03, P=0.251). CONCLUSION: Overall medical complication rates were higher in patients with PD, while individual medical complications as well as surgical complication and reoperation rates after elective CSS were similar in patients with and without PD, though PD patients required longer hospital stays. Importantly, a baseline diagnosis of PD was not significantly associated with adverse two-year medical and surgical complications. This data may improve counseling and risk-stratification for PD patients before CSS. LEVEL OF EVIDENCE: Level III.

Evaluating success rate and comparing complications of operative techniques used to treat chronic syndesmosis injuries.

PURPOSE: To assess the success rate and complications of the surgical interventions used to manage chronic syndesmosis injuries. METHODS: Multiple online databases were queried to identify studies reporting operative intervention for chronic syndesmosis injuries. RESULTS: Modalities of operative fixation include suture-button fixation, arthroscopy and debridement, as well as arthrodesis. The use of operative treatment is effective; however, more direct comparison studies are necessary to evaluate the efficacy of each treatment. CONCLUSION: Various operative procedures have been used for the management of chronic syndesmotic injuries but further prospective studies are necessary to determine the type of treatment that should be indicated.

Prognosis of Significant Intraoperative Neurophysiologic Monitoring Events in Severe Spinal Deformity Surgery.

BACKGROUND: Intraoperative neurophysiologic monitoring has become a standard tool for mitigating neurologic injury during spinal deformity surgery. Significant monitoring changes during deformity correction are relatively uncommon. This study characterizes precipitating factors for neurologic injury and relates significant events and postoperative neurologic prognosis. METHODS: All spinal deformity surgeries at a West African hospital over a 12-month period were reviewed. Patients were included if complete operative reports, monitoring data, and postoperative neurologic examinations were available for review. Surgical and systemic triggers of monitoring events were recorded and neurologic status was followed for 6 weeks postoperatively. RESULTS: Eighty-eight patients met inclusion criteria. The average age was 14 years (3-28). The average kyphosis was 108° (54°-176°) and average scoliosis was 100° (48°-177°). There were 44 separate neurologic events in 34 patients (39%). The most common triggers were traction or positioning (16), posterior column osteotomies/vertebral column resections (9/1), and distraction, corrective maneuvers, or implant placement (12). On surgery completion, 100% (12/12) of events from non-osteotomy-related surgical procedures, 75% (12/16) of events from traction or positioning resolved; however, 0% (0/10) of events from osteotomies resolved completely. Eight percent (7/88) had new neurologic deficits postoperatively, all with intraoperative monitoring changes. In 6 of these 7 patients, the event was attributed to an osteotomy; in 1 patient the cause was not determined. At 6-week follow-up, all patients had some preserved motor function bilaterally with the ability to walk (ASIA D/E) or recovered completely. CONCLUSIONS: Intraoperative signal changes were most frequently from traction or positioning. However, the most common cause of persistent neurologic deterioration and the only cause of postoperative neurologic deficit was the performance of osteotomies. Unlike traction- or instrument-related correction, osteotomies produce irreversible changes, from canal intrusion or sudden localized deformity change. The incidence of postoperative neurologic deficit is very low when the inciting cause is reversed; however, osteotomy-related events are irreversible, with a high incidence of associated lasting neurologic injury.