Gracilis Free Flap Technique for Elbow Flexion Reconstruction.

Background: Brachial plexus injuries (BPI) can be devastating for patients, often resulting in notable physical, psychological, and socioeconomic distress. Violent accidents that torque the head away from the shoulder frequently damage the upper brachial plexus roots, with varying severity of damage to the lower roots. Patients having pan-plexus injuries typically present with a flail extremity, loss of sensory function, and generalized atrophy.

Posterior Capsular Imbrication for Dynamic Genu Valgum.

Symptomatic genu recurvatum, defined as knee hyperextension beyond 5° with symptoms of pain or instability, is uncommon and presents a challenging treatment paradigm for orthopaedic surgeons. Treatment options focus on initial nonoperative management with bracing and physical therapy focused on correcting gait abnormalities and strengthening dynamic stabilizers, addressing soft-tissue laxity via posterior capsular tensioning/imbrication, and correcting osseous abnormalities with anterior opening-wedge proximal tibial osteotomies. In cases in which there are minimal bony abnormalities contributing to recurvatum, such as posterior tibial slope, posterior capsular imbrication is indicated.

Encoding of body state in whisker-related somatosensory cortex of freely moving mice.

Sensory systems have evolved to solve computational challenges that animals face during behavior in their natural environments. To illuminate how the sensory cortex operates under such conditions, we investigated the function of neurons in the whisker-related somatosensory cortex (wS1) of freely moving mice engaged in tactile exploratory behavior. By recording neural activity from wS1 while tracking the mouse's head/body in 3D, we found that wS1 neurons are substantially modulated by body state (configuration of the mouse's head and spine), even in the absence of whisker afferent input.

Multiligament Knee Injury With Common Peroneal Nerve Rupture: Single-Stage Reconstruction of the Anterior Cruciate Ligament, Posterolateral Corner, and Common Peroneal Nerve Graft.

Multiligament knee injuries (MLKIs) are rare injuries that can result in devastating outcomes and functional impairment, especially in the setting of concomitant peroneal nerve injuries. Incidence of common peroneal nerve (CPN) injuries in MLKIs or knee dislocations ranges from 10% to 40%, with significant morbidity associated, especially in the setting of complete rupture. Treatment for MLKI with associated CPN injury depends on the degree of ligamentous and nerve injury.

Surgical Technique, Tips, and Tricks: Medial Implantable Shock Absorber for Medial Compartment Knee Osteoarthritis.

Background: Isolated medial compartment knee osteoarthritis (OA) presents a challenging problem to treat for knee surgeons, with a multitude of options from conservative management, including injections and unloader braces, meniscal procedures, osteotomies, and unicompartmental knee arthroplasty (UKA). A new medial implantable shock absorber (MISHA) allows for offloading 142 N of the medial compartment during stance phase of gait.

Indications: US Food and Drug Administration approval was obtained on April 10, 2023, with the following indications: isolated medial knee OA (Kellgren-Lawrence grades I-IV) that failed 6 months of conservative management, ages 25 to 65 years, body mass index <35 or body weight <300 lbs, <15° of varus, no flexion contracture >10°, and no significant medial osteophytes or medial meniscal extrusion.

Trochleoplasty With Combined Soft Tissue Reconstruction for Patellar Instability.

Background: Patellofemoral instability is a relatively common condition and is multifactorial in its cause, with both soft tissue and bony components. Trochleoplasty is a newly described surgical procedure to help improve outcomes following patellar restabilization.

Indications: Trochleoplasty is an emerging surgical technique during patellar stabilization surgery in those patients with underlying trochlear dysplasia.

Basics of Ankle Arthroscopy Part 1: Patient Positioning and Preparation for Anterior Ankle Arthroscopy.

Anterior ankle arthroscopy is an important diagnostic and therapeutic tool in the treatment of pathologies of the ankle joint. In a series of 7 articles, the basics of ankle arthroscopy are reviewed. In this article (part 1), patient positioning, tourniquet placement, and draping for anterior ankle joint arthroscopy are reviewed.

Anterior Cruciate Ligament Allograft Reconstruction Augmented With a Reinforced, Bioinductive Collagen Scaffold in the Setting of Multiligamentous Knee Injury.

The gold standard for surgical treatment of anterior cruciate ligament (ACL) injuries is reconstruction. There are a variety of graft options, from autograft to allograft, using bone-patellar tendon-bone (BTB), hamstrings, quadriceps, or Achilles, and, in the case of a multiligamentous knee injury (MLKI), allograft may be preferred to decrease operative time and graft harvest morbidity. The BioBrace (ConMed, New Haven, CT) is a bioinductive collagen scaffold designed to provide an environment for soft tissue remodeling with time zero biomechanical support and can be used to augment graft reconstructions in the case of concerns for allograft strength, healing, or width.

Cementing a Monoblock Dual-Mobility Implant into a Fully Porous Cup in Revision Total Hip Arthroplasty to Address Hip Instability: Surgical Technique.

Background: The use of a cemented monoblock dual-mobility implant into a fully porous cup is indicated for patients with acetabular bone loss who have a high risk of postoperative hip instability. Patients undergoing lumbar fusion for sagittal spinal deformities have an increased risk of hip dislocation (7.1%) and should be assessed on sitting and standing radiographs.

Closed Reduction of Developmental Dislocation of the Hip with Application of a Waterproof Cast.

Developmental dysplasia of the hip (DDH) is a common orthopaedic condition in infants with an incidence of 1 in 1000 infants. An ultrasound can be performed at 6 weeks if the infant exhibits any risk factors, either intrauterine or at birth. If an ultrasound is positive for DDH, treatment typically begins with a dynamic brace such as the Pavlik harness.

Development of text messages for primary prevention of cardiovascular disease in persons with HIV.

Objective: Persons with HIV (PWH) have increased risk for atherosclerotic cardiovascular disease (CVD). Despite this increased risk, perceived cardiovascular risk among PWH is low, and interventions that are known to be beneficial in the general population, such as statins, have low uptake in this population. We sought to develop a bank of text messages about (1) the association between HIV and CVD and (2) advice on reducing cardiovascular risk.

Cartilage Biopsy for Autologous Cell-Based Repair of the Knee in the Wide-Awake Setting Using Needle Arthroscopy.

Chondral and osteochondral lesions of the knee are a commonly occurring pathology that can pose challenges to the treating surgeon. For the appropriate cartilage injury, autologous cell-based articular cartilage repair techniques have shown promising results. However, these treatments traditionally require 2 separate surgical procedures.

Repair of a Femoral Head Fracture Dislocation With an Associated Posterior Wall Acetabular Fracture (Pipkin 4) via a Kocher-Langenbeck Approach.

A case of a 27-year-old man with a right-sided largely infra-foveal femoral head fracture dislocation with posterior wall acetabular fracture repaired via a Kocher-Langenbeck approach is presented. This is an atypical approach for fixation of the femoral head and acetabulum used because of the size and displacement of both the posterior wall fracture and the femoral head fracture. Indications for fixation of both the femoral head and the acetabulum include a displaced acetabular fracture with: (1) a fracture of the weight-bearing portion of the femoral head and/or (2) a fracture of the femoral head that engages the anterior or posterior wall.

Repair of the Galeazzi Fracture.

This is a case of a 36-year-old female patient presenting with left forearm and wrist pain after a ground-level fall onto her outstretched left hand. Clinical and radiographic evaluation is consistent with a left distal radial shaft fracture with disruption of the distal radioulnar joint, known as a Galeazzi fracture. The purpose of this video is to review the appropriate management of Galeazzi fractures and demonstrate our treatment with this surgical approach.

Operative Fixation of the Anteromedial Facet of the Coronoid Process.

Anteromedial coronoid facet fractures typically occur with varus, pronation, and axial forces applied to the elbow. Due in part to the high rate of concomitant lateral collateral ligament (LCL) injuries, untreated anteromedial facet fractures can result in varus and posteromedial rotatory elbow instability. Although small fractures that are not amenable to open reduction and internal fixation can be treated with isolated LCL repair, larger fragments are treated with buttress plating on the anteromedial surface of the coronoid with or without LCL repair.

Combined Anterior Opening-Wedge High Tibial Osteotomy and Tibial Tubercle Osteotomy with Posterior Cruciate Ligament Reconstruction.

Despite multiple advances in techniques for posterior cruciate ligament reconstruction (PCL-R), residual posterior laxity continues to be a commonly reported complication. Multiple studies demonstrated a decreased or flat posterior tibial slope, increases posterior laxity, and forces placed across the native and reconstructed PCL. Anterior opening wedge high tibial osteotomies (aOW-HTO) can be used to increase posterior tibial slope, thereby reducing tibial sag and posterior laxity.

Use of an mHealth Ketogenic Diet App Intervention and User Behaviors Associated With Weight Loss in Adults With Overweight or Obesity: Secondary Analysis of a Randomized Clinical Trial.

Background: Low-carbohydrate ketogenic diets are a viable method to lose weight that have regained popularity in recent years. Technology in the form of mobile health (mHealth) apps allows for scalable and remote delivery of such dietary interventions and are increasingly being used by the general population without direct medical supervision. However, it is currently unknown which factors related to app use and user behavior are associated with successful weight loss.

Arthroscopic Technique for Reduction and Fixation of an Acetabular Rim Fracture.

Acetabular rim fractures can accompany patients with femoroacetabular impingement. Frequently, the acetabular rim fracture is excised. However, if the osseous fragment of the acetabular rim fracture is large enough to result in instability, then the acetabular rim fracture should be reduced and secured with internal fixation.

Staged Reconstruction of a Moore Type 4 Fracture Dislocation, Parts 1 and 2.

High-energy tibial plateau fractures are associated with knee fracture dislocations and concomitant ligamentous injury. Both bony and ligamentous injuries can require surgical fixation, often requiring a multidisciplinary team and staged treatment. This article and accompanying video describe the workup and treatment of a Moore type 4 tibial plateau rim compression fracture with posterolateral corner and anterior cruciate ligament rupture that underwent open reduction internal fixation of the tibial plateau with posterolateral corner reconstruction and then staged anterior cruciate ligament reconstruction with quad tendon autograft.

Acute Distal Triceps Tendon Rupture Repair: Case Presentation and Surgical Technique.

This case presentation and surgical technique demonstrates a complete distal triceps tendon rupture repair with single-row suture anchor fixation through a posterior midline approach to the elbow in a 17-year-old male rugby player. Key procedure points include complete triceps mobilization for adequate excursion to facilitate repair, identification of the ulnar nerve, isolation and sharp debridement of torn tissue to healthy tendon, thorough debridement of the olecranon reattachment site, suture construct, and order of fixation to optimize tendon-bone apposition.

Treatment of a Chronic Elbow Dislocation With an Internal Fixator.

There are a variety of ways to treat chronic elbow dislocations, including repeat closed reduction and immobilization, transarticular pinning, temporary bridge plating, hinged or rigid external fixation, and internal fixator application. Although each have distinct advantages and disadvantages, avoiding recurrent instability is critical. The internal-fixator is a relatively new option to maintain a stable, concentric reduction and facilitate early range of motion.

Sternoclavicular Joint Reconstruction for Medial Clavicle Fracture Nonunion.

Operative management of sternoclavicular fracture-dislocations is recommended in the setting of symptomatic nonunion. Treatment options include open reduction internal fixation, fragment excision, and ligamentous reconstruction. We present a 29-year-old man with a medial clavicle fracture nonunion that previously failed open reduction internal fixation and was treated with sternoclavicular joint reconstruction using tendon allograft.

Repair of Humeral Shaft Nonunion With Plate and Screw Fixation and Iliac Crest Bone Graft.

A 58-year-old woman with a proximal 1/3 humeral shaft nonunion presented 2 years after initial injury. We present a technique for nonunion repair, including nonunion site preparation, direct compression of the fracture site using plate osteosynthesis, and iliac crest bone graft harvest and utilization. The purpose of this video is to review humeral shaft nonunion literature and describe our management technique.