Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 472 | Issue 7 | Jul, 2014

Is Changing Hospitals for Revision Total Joint Arthroplasty Associated With More Complications?

Christopher J. Dy MD, MPH, Kevin J. Bozic MD, MBA, Douglas E. Padgett MD, Ting Jung Pan MPH, Robert G. Marx MD, Stephen Lyman PhD

Many patients change hospitals for revision total joint arthroplasty (TJA). The implications of changing hospitals must be better understood to inform appropriate utilization strategies.

Comparative Study of Simple and Complex Open Elbow Dislocations

Jorge G. Boretto MD, Mario Rodriguez Sammartino MD, Gerardo Gallucci MD, Pablo De Carli MD, David Ring MD, PhD

Open elbow dislocations are rare injuries. Most of the evidence related to these dislocations is found in case reports or in series with closed injuries. We reviewed the experiences of three centers in the treatment of open elbow dislocations.

Complications of Hinged External Fixation Compared With Cross-pinning of the Elbow for Acute and Subacute Instability

David Ring MD, PhD, Wendy E. Bruinsma MD, Jesse B. Jupiter MD

Elbows that are unstable after injury or reconstructive surgery often are stabilized using external fixation or cross-pinning of the joint supplemented by cast immobilization. The superiority of one approach or the other remains a matter of debate.

The Management of Elbow Instability Using an Internal Joint Stabilizer: Preliminary Results

Jorge L. Orbay MD, Michael R. Mijares MD

Nonsurgical and surgical treatments such as immobilization, transarticular pinning, and hinged or nonhinged external fixation have been used to treat unstable elbows. These methods all have drawbacks. We thought that a bent Steinmann pin introduced through the axis of ulnohumeral rotation and attached to the ulna could provide an improved method of treatment and that this could result in the development of a proper internal joint fixator that may have widespread application.

Revision Allograft Reconstruction of the Lateral Collateral Ligament Complex in Elbows With Previous Failed Reconstruction and Persistent Posterolateral Rotatory Instability

Yaser M. K. Baghdadi MD, Bernard F. Morrey MD, Shawn W. O’Driscoll MD, PhD, Scott P. Steinmann MD, Joaquin Sanchez-Sotelo MD, PhD

Primary reconstruction of the lateral collateral ligament complex (LCLC) using graft tissue restores elbow stability in many, but not all, elbows with acute or chronic posterolateral rotatory instability (PLRI). Revision reconstruction using a tendon allograft is occasionally considered for persistent PLRI, but the outcome of revision ligament reconstruction in this setting is largely unknown.

Transverse Coronoid Fracture: When Does It Have to Be Fixed?

Robert U. Hartzler MD, Manuel Llusa-Perez MD, Scott P. Steinmann MD, Bernard F. Morrey MD, Joaquin Sanchez-Sotelo MD, PhD

After elbow fracture-dislocation, surgeons confront numerous treatment options in pursuing a stable joint for early motion. The relative contributions of the radial head and coronoid, in combination, to elbow stability have not been defined fully.

Single-staged Treatment Using a Standardized Protocol Results in Functional Motion in the Majority of Patients With a Terrible Triad Elbow Injury

Akash Gupta MD, David Barei MD, Ansab Khwaja BA, Daphne Beingessner MD

Terrible triad injuries of the elbow, defined as elbow dislocation with associated fractures to the radial head and coronoid, are associated with stiffness, pain, and loss of motion. Studies to date have consisted of small sample sizes and used heterogeneous surgical techniques, which render comparisons difficult and unreliable.

Terrible Triad Injuries of the Elbow: Does the Coronoid Always Need to Be Fixed?

Loukia K. Papatheodorou MD, PhD, James H. Rubright MD, Kathryn A. Heim MD, Robert W. Weiser MPAs, PA-C, Dean G. Sotereanos MD

The “terrible triad” of the elbow is a complex injury that can lead to pain, stiffness, and posttraumatic arthritis if not appropriately treated. The primary goal of surgery for these injuries is to restore stability of the joint sufficient to permit early motion. Although most reports recommend repair and/or replacement of all coronoid and radial head fractures when possible, a recent cadaveric study demonstrated that type II coronoid fractures are stable unless the radial head is removed and not replaced.

Can We Treat Select Terrible Triad Injuries Nonoperatively?

Kevin Chan MD, MSc, Joy C. MacDermid BScPT, MSc, PhD, Kenneth J. Faber MD, MHPE, FRCSC, Graham J. W. King MD, MSc, FRCSC, George S. Athwal MD

While the majority of terrible triad elbow injuries (ulnohumeral dislocation with radial head and coronoid fractures) are managed surgically, nonoperative treatment may be appropriate in selected patients, but results with this approach have been limited by very small studies.

Injury Patterns and Outcomes of Open Fractures of the Proximal Ulna Do Not Differ From Closed Fractures

Paul H. Yi BA, Alexander A. Weening MD, Sangmin R. Shin MD, Khalil I. Hussein BA, Paul Tornetta MD, Andrew Jawa MD

The incidence and injury patterns of open fractures of the proximal ulna are poorly elucidated and little evidence exists to guide management.

Is ORIF Superior to Nonoperative Treatment in Isolated Displaced Partial Articular Fractures of the Radial Head?

Albert Yoon MBChB, Graham J. W. King MD, MSc, Ruby Grewal MD, MSc

While good results have been reported with both nonoperative and operative treatment of isolated displaced partial radial head fractures, there remains considerable disagreement about the role of surgery in the management of these injuries.

Radiographic Loss of Contact Between Radial Head Fracture Fragments Is Moderately Reliable

Wendy E. Bruinsma MD, Thierry Guitton MD, PhD, David Ring MD, PhD

Loss of contact between radial head fracture fragments is strongly associated with other elbow or forearm injuries. If this finding has adequate interobserver reliability, it could help examiners identify and treat associated ligament injuries and fractures (eg, forearm interosseous ligament injury or elbow dislocation).

Open Reduction and Internal Fixation of Radial Head Fractures: Do Outcomes Differ Between Simple and Complex Injuries?

Jeffrey M. Pike MD, MPH, Ruby Grewal MD, MSc, George S. Athwal MD, Kenneth J. Faber MD, MHPE, Graham J. W. King MD, MSc

Radial head fractures can occur in isolation or in association with elbow and forearm injuries. Treatment options include nonoperative management, fragment or whole-head excision, open reduction and internal fixation (ORIF), and radial head arthroplasty. However, the evidence supporting ORIF for repairable radial head fractures is inconclusive.

Fixation Versus Replacement of Radial Head in Terrible Triad: Is There a Difference in Elbow Stability and Prognosis?

Tyler Steven Watters MD, Grant E. Garrigues MD, David Ring MD, PhD, David S. Ruch MD

Surgical treatment for terrible triad injuries of the elbow (defined as elbow dislocations with concomitant fractures of the radial head and coronoid) remains a challenging clinical problem. Specifically, the question of whether to repair or replace the radial head remains controversial.

Radial Head Replacement for Acute Complex Fractures: What Are the Rate and Risks Factors for Revision or Removal?

Andrew D. Duckworth MSc, MRCSEd, Neil R. Wickramasinghe MBChB, Nicholas D. Clement MRCSEd, Charles M. Court-Brown MD, FRCSEd(Orth), Margaret M. McQueen MD, FRCSEd(Orth)

When treating complex radial head fractures, important goals include prevention of elbow or forearm instability, with restoration of radiocapitellar contact essential. When open reduction and internal fixation cannot achieve this, radial head replacement is routinely employed, but the frequency of and risk factors for prosthesis revision or removal are not well defined.

Radial Head Reconstruction in Elbow Fracture-Dislocation: Monopolar or Bipolar Prosthesis?

Robert U. Hartzler MD, MS, Bernard F. Morrey MD, Scott P. Steinmann MD, Manuel Llusa-Perez MD, Joaquin Sanchez-Sotelo MD, PhD

Monopolar and bipolar radial head prosthetic arthroplasties have been used successfully to treat elbow fracture-dislocation with unsalvageable radial head fractures. The relative stability of these two designs in different clinical situations is a topic of ongoing investigation.

Anconeus Interposition Arthroplasty: Mid- to Long-term Results

Yaser M. K. Baghdadi MD, Bernard F. Morrey MD, Joaquin Sanchez-Sotelo MD, PhD

Radiocapitellar arthritis and/or proximal radioulnar impingement can be difficult to treat. Interposition of the anconeus muscle has been described in the past as an alternative option in managing arthritis, but there are little published data about relief of pain and restoration of function over the long term in patients treated with this approach.

Injury Complexity Factors Predict Heterotopic Ossification Restricting Motion After Elbow Trauma

Jimme K. Wiggers MD, Gijs T. T. Helmerhorst MD, Kim M. Brouwer MD, PhD, Maarten C. Niekel MD, Fiesky Nunez MD, David Ring MD, PhD

Heterotopic ossification (HO) is a common extrinsic cause of elbow stiffness after trauma. However, factors associated with the development of HO are incompletely understood.

High Satisfaction Yet Decreased Activity 4 Years After Transphyseal ACL Reconstruction

Gregory A. Schmale MD, Christopher Kweon MD, Roger V. Larson MD, Viviana Bompadre PhD

ACL injuries in preteens and teens are common occurrences. Reconstruction is believed to be optimum treatment for those wishing to return to running, cutting, and jumping sports. Rates of reoperation, satisfaction, and long-term return to and maintenance of preinjury activity after ACL reconstruction in young athletes are important information for physicians, patients, and parents.

Does Intraarticular Inflammation Predict Biomechanical Cartilage Properties?

Wenzel Waldstein MD, Giorgio Perino MD, Shari T. Jawetz MD, Susannah L. Gilbert MS, Friedrich Boettner MD

Intact cartilage in the lateral compartment is an important requirement for medial unicompartmental knee arthroplasty (UKA). Progression of cartilage degeneration in the lateral compartment is a common failure mode of medial UKA. Little is known about factors that influence the mechanical properties of lateral compartment cartilage.

Rotating-platform TKA No Different from Fixed-bearing TKA Regarding Survivorship or Performance: A Meta-analysis

Joseph T. Moskal MD, Susan G. Capps PhD

Mobile bearings have been compared with fixed bearings used in TKA. However, rotating platforms, a specific type of mobile bearing, have not been compared with fixed-bearings using meta-analysis.

Current Modes of Failure in TKA: Infection, Instability, and Stiffness Predominate

David H. Le MD, Stuart B. Goodman MD, PhD, William J. Maloney MD, James I. Huddleston MD

Historically, polyethylene wear and its sequelae (osteolysis, late instability, aseptic loosening) were common causes for revision total knee arthroplasty (TKA). Recently, polyethylene manufacturing has become more consistent; furthermore, a clearer understanding of the importance of oxidation on polyethylene performance led to packaging of the polyethylene bearings in an inert environment. This improved the quality and consistency of polyethylene used in TKA, raising the question of whether different failure modes now predominate after TKA.

Two-stage Approach to Primary TKA in Infected Arthritic Knees Using Intraoperatively Molded Articulating Cement Spacers

Aseem Arif Shaikh MS, Chul-Won Ha MD, Yong-Geun Park MD, Yong-Beom Park MD

The treatment of knee arthritis with coexistent bone or joint sepsis is challenging. Despite the condition causing considerable morbidity, there is no generally agreed-upon approach to its treatment.

Sonication of Antibiotic Spacers Predicts Failure during Two-stage Revision for Prosthetic Knee and Hip Infections

Charles L. Nelson MD, Robert B. Jones MD, Nathaniel C. Wingert MD, Michael Foltzer MD, Thomas R. Bowen MD

Periprosthetic joint infection is a leading cause of failure after two-stage reimplantation. One cause of relapse may be persistent subclinical infection. Difficulty exists in detecting biofilm-forming infections. Sonication disrupts biofilm and has led to higher rates of positive intraoperative cultures.

Hip Resurfacing versus Total Hip Arthroplasty: A Systematic Review Comparing Standardized Outcomes

Deborah A. Marshall PhD, Karen Pykerman MPH, Jason Werle MD, Diane Lorenzetti MLS, Tracy Wasylak CHE, MSc, BN, Tom Noseworthy MD, MSc, MPH, Donald A. Dick MD, Greg O’Connor MD, Aish Sundaram BMSc, Sanne Heintzbergen MSc, Cy Frank MD

Metal-on-metal hip resurfacing was developed for younger, active patients as an alternative to THA, but it remains controversial. Study heterogeneity, inconsistent outcome definitions, and unstandardized outcome measures challenge our ability to compare arthroplasty outcomes studies.

Loosely Implanted Cementless Stems May Become Rotationally Stable After Loading

Arun Kannan MD, John R. Owen MS, Jennifer S. Wayne PhD, William A. Jiranek MD

Experimental studies have suggested that initial micromotion of cementless components may lead to failure of osteointegration. Roentgen stereophotogrammetric analyses have shown durable implant fixation can be achieved long-term even when initial instability exists, as evidenced by subsidence. However improved implant stability as a result of subsidence, before osteointegration, has not been shown biomechanically.

Hospital Costs of Total Hip Arthroplasty for Developmental Dysplasia of the Hip

Ali Ashraf MD, A. Noelle Larson MD, Hilal Maradit-Kremers MD, MSc, Walter K. Kremers PhD, David G. Lewallen MD

Developmental dysplasia of the hip (DDH) is a leading cause of total hip arthroplasty (THA) in younger patients. It is unknown how the hospital costs of THA in patients with DDH compare with patients with degenerative arthritis.

Outcome After Reconstruction of the Proximal Humerus for Tumor Resection: A Systematic Review

Teun Teunis MD, Sjoerd P. F. T. Nota MD, Francis J. Hornicek MD, PhD, Joseph H. Schwab MD, MS, Santiago A. Lozano-Calderón MD, PhD

Tumors of the appendicular skeleton commonly affect the proximal humerus, but there is no consensus regarding the best reconstructive technique after proximal humerus resection for tumors of the shoulder.

Undiagnosed Vertebral Fractures Influence Quality of Life in Postmenopausal Women With Reduced Ultrasound Parameters

Ranuccio Nuti MD, Carla Caffarelli MD, PhD, Giuseppe Guglielmi MD, Luigi Gennari MD, PhD, Stefano Gonnelli MD

Osteoporosis, a multifactorial systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to increased bone fragility, is a worldwide public health problem. Vertebral fractures affect approximately 20% of postmenopausal women and are a hallmark of osteoporosis, but they may pass unnoticed, although they may lead to long-term immobility and disability.

Effectiveness of Sustained Stretching of the Inferior Capsule in the Management of a Frozen Shoulder

Antony Paul MPT, Joshua Samuel Rajkumar MPT, Smita Peter MPT, Litson Lambert BPT

Physiotherapy treatment of frozen shoulder is varied, but most lack specific focus on the underlying disorder, which is the adhered shoulder capsule. Although positive effects were found after physiotherapy, the recurrence and prolonged disability of a frozen shoulder are major factors to focus on to provide the appropriate treatment.

Heterotopic Ossification of the Elbow Treated With Surgical Resection: Risk Factors, Bony Ankylosis, and Complications

Dane Salazar MD, Andrew Golz BS, Heidi Israel PhD, Guido Marra MD

Heterotopic ossification is the most common extrinsic cause of elbow contracture and may lead to clinically important stiffness, and rarely, complete bony ankylosis. Surgery sometimes is performed to treat this problem, and published reports differ regarding the factors that are associated with success or failure after this operation and whether the procedure is effective for patients with elbow ankylosis.

Are There Risk Factors for Complications of Perforator-based Propeller Flaps for Lower-extremity Reconstruction?

Marco Innocenti MD, Giulio Menichini MD, Carla Baldrighi MD, Luca Delcroix MD, Livia Vignini MS, Pierluigi Tos MD

Conventional pedicled flaps for soft tissue reconstruction of lower extremities have shortcomings, including donor-site morbidity, restricted arc of rotation, and poor cosmetic results. Propeller flaps offer several potential advantages, including no need for microvascular anastomosis and low impact on donor sites, but their drawbacks have not been fully characterized.

The Effect of Resident Participation on Short-term Outcomes After Orthopaedic Surgery

Andrew J. Pugely MD, Yubo Gao PhD, Christopher T. Martin MD, John J. Callaghan MD, Stuart L. Weinstein MD, J. Lawrence Marsh MD

The influence of resident involvement on short-term outcomes after orthopaedic surgery is mostly unknown.

Reply to the Letter to the Editor

Dong Hoon Lee MD, PhD, Keun Jung Ryu MD, Jin Woo Kim MD, Kyung Chung Kang MD, PhD, Young Rak Choi MD

Erratum to: Does Intraoperative Navigation Assistance Improve Bone Tumor Resection and Allograft Reconstruction Results?

Luis Aponte-Tinao MD, Lucas E. Ritacco MD, Miguel A. Ayerza MD, D. Luis Muscolo MD, Jose I. Albergo MD, Germán L. Farfalli MD

Erratum to: High Methodologic Quality But Poor Applicability: Assessment of the AAOS Guidelines Using The AGREE II Instrument

Sanjeeve Sabharwal MBBS, MRCS, MSc, Nirav K. Patel MBBS, MRCS, MSc, Salman Gauher MBBS, BSc, Ian Holloway MBBS, FRCS (Orth), Thanos Athanasiou MD, PhD, FRCS, FETCS
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