Humeral Head Avascular Necrosis: Pathophysiology, Work-up, and Treatment Options.

» Avascular necrosis (AVN) of the humeral head is the result of ischemic injury to the epiphyseal bone leading to humeral head collapse and arthritis.» Common causes include trauma, chronic corticosteroid use, or systemic disease processes, such as sickle cell disease, systemic lupus erythematosus, or alcohol abuse.» Nonoperative treatment consists of risk factor management, physical therapy, anti-inflammatory medications, and activity modification.

Does Cervical Spondylolisthesis Influence Patient-Reported Outcomes After Anterior Cervical Discectomy and Fusion Surgery?

Background: No prior work has explored whether the presence of degenerative spondylolisthesis impacts patient-reported outcome measurements (PROMs) after an anterior cervical discectomy and fusion (ACDF); therefore, the goal of the current study was to determine whether the presence of a spondylolisthesis affects PROMs after an ACDF.

Methods: A retrospective cohort study was conducted on patients over the age of 18 who underwent a 1- or 2-level ACDF. All patients received preoperative standing lateral x-rays and were placed into 1 of 2 groups based on the presence of cervical spondylolisthesis from C2-T1: (1) no spondylolisthesis (NS) group or (2) spondylolisthesis (S) group.

Combined Depression and Anxiety Influence Patient-Reported Outcomes after Lumbar Fusion.

Background: Currently, no studies have assessed what effect the presence of both anxiety and depression may have on patient-reported outcome measurements (PROMs) compared to patients with a single or no mental health diagnosis.

Methods: Patients undergoing 1- to 3-level lumbar fusion at a single academic hospital were retrospectively queried. Anyone with depression and/or anxiety was identified using an existing clinical diagnosis in the medical chart.

Depression Identified on the Mental Component Score of the Short Form-12 Affects Health Related Quality of Life After Lumbar Decompression Surgery.

Study Design: This was a retrospective comparative study.

Objective: The goal of this study was to further elucidate the relationship between preoperative depression and patient-reported outcome measurements (PROMs) following lumbar decompression surgery.

Summary Of Background Data: The impact of preoperative depression on PROMs after lumbar decompression surgery is not well established.

The Outcomes of Patients With Neck Pain Following ACDF: A Comparison of Patients With Radiculopathy, Myelopathy, or Mixed Symptomatology.

Study Design: Retrospective cohort study.

Objective: The goal of the present study was to determine whether neck pain responds differently to anterior cervical discectomy and fusion (ACDF) between patients with cervical radiculopathy and/or cervical myelopathy.

Summary Of Background Data: Many patients who undergo ACDF because of radiculopathy/myelopathy also complain of neck pain.

BMI Does Not Affect Complications or Patient Reported Outcomes After Lumbar Decompression Surgery.

Study Design: This is a retrospective comparative review.

Objective: The objective of this study was to identify the influence of body mass index (BMI) on postsurgical complications and patient reported outcomes measures (PROMs) following lumbar decompression surgery.

Summary Of Background Data: Current literature does not accurately identify the impact of BMI on postsurgical complications or outcomes.

The Impact of Multiple Comorbid Mental Health Disorders on Health-related Quality of Life Following ACDF.

Study Design: Retrospective comparative study.

Objective: The goal was to determine whether comorbid depression and/or anxiety influence outcomes after anterior cervical discectomy and fusion (ACDF) for patients with degenerative cervical pathology.

Background Data: The role preoperative mental health has on patient reported outcomes after ACDF surgery is not well understood.

Preoperative Mental Health Component Scoring Is Related to Patient Reported Outcomes Following Lumbar Fusion.

Study Design: Retrospective cohort review.

Objective: The objective of this study was to identify depression using the Mental Component Score (MCS-12) of the Short Form-12 (SF-12) survey and to correlate with patient outcomes.

Summary Of Background Data: The impact of preexisting depressive symptoms on health-care related quality of life (HRQOL) outcomes following lumbar spine fusion is not well understood.

Proton Pump Inhibitor Use Affects Pseudarthrosis Rates and Influences Patient-Reported Outcomes.

Study Design: Retrospective cohort review.

Objectives: Cervical pseudarthrosis is a frequent cause of need for revision anterior cervical discectomy and fusion (ACDF) and may lead to worse patient-reported outcomes. The effect of proton pump inhibitors on cervical fusion rates are unknown.

Addition of 3% hydrogen peroxide to standard skin preparation reduces Cutibacterium acnes-positive culture rate in shoulder surgery: a prospective randomized controlled trial.

Background: Hydrogen peroxide is an inexpensive and effective antimicrobial agent that can be implemented in surgical skin preparations. The purpose of this study was to evaluate the decolonization effect of Cutibacterium acnes when adding hydrogen peroxide to a standard sterile preparation for shoulder surgery.

Methods: This was a single-institution, prospective, randomized controlled trial of male patients undergoing shoulder arthroscopy (April 2018 and May 2019).

What Tests Are Useful to Investigate a Possible Infection of Total Ankle Arthroplasty (TAA)? What Are Their Thresholds?

Recommendation: Overall, the approach to a potentially infected total ankle arthroplasty (TAA) does not change compared to other periprosthetic joint infections (PJIs). There are no novel or unique diagnostic procedures for TAA infection, specifically. Joint aspiration or intraoperative tissue/synovial biopsies with microbiological cultures are the most important diagnostic tests for suspected TAA infections.

What Is the Optimal Protocol for Performing Debridement, Antibiotics and Implant Retention (DAIR) in an Infected Total Ankle Arthroplasty (TAA) (Type and Volume of Irrigation Solution, and so on)?

Recommendation: Debridement, antibiotics, and implant retention (DAIR) in acute total ankle arthroplasty (TAA) infections may be an acceptable treatment option. If performed, DAIR should be done meticulously, ensuring that all necrotic or infected tissues are removed and modular parts of the prosthesis, if any, exchanged. The infected joint should also be irrigated with antiseptic solutions.

Robotic Guidance in Minimally Invasive Spine Surgery: a Review of Recent Literature and Commentary on a Developing Technology.

Purpose Of Review: Minimally invasive spine surgery (MIS) and robotic technology are growing in popularity and are increasing utilized in combination. The purpose of this review is to identify the current successes, potential drawbacks, and future directions of robotic guidance for MIS compared to traditional techniques.

Recent Findings: Recent literature highlights successful incorporation of robotic guidance in MIS as a consistently accurate method for pedicle screw placement.

Case Report of an Isolated Proximal Tibiofibular Joint Dislocation in a Professional Ice Hockey Player.

Introduction: Dislocations of the proximal tibiofibular joint are an uncommon injury but have been reported in a variety of different athletes. Treatment and rehabilitation ofthese cases have ranged significantly across the reported cases.

Case Report: The present case describes a 23-year-old male professional hockey player who suffered an isolated anterior dislocation of the proximal tibiofibular joint.

Correlation of MRI to Arthroscopy in the Elbow: Thrower's Elbow and Ulnar Collateral Ligament Injury.

One cannot overstate the importance of a thorough history and physical examination, supplemented with directed imaging, to help pinpoint the exact cause of the athlete's elbow pain. Although plain radiographs should not be overlooked, advanced imaging plays a critical role in diagnosis and management of pathology in the thrower's elbow, including computed tomography, magnetic resonance imaging, and stress ultrasound. By judiciously combining these elements, the clinician can appropriately manage these injuries in order to successfully return the athlete to their preinjury level of play.

Economic Burden of Inpatient Admission of Ankle Fractures.

Background: Ankle fractures are among the most prevalent traumatic orthopaedic injuries. A large proportion of patients sustaining operative ankle fractures are admitted directly from the emergency department prior to operative management. In the authors' experience, however, many closed ankle injuries may be safely and effectively managed on an outpatient basis.

Single Incision Distal Biceps Repair With Hemi-Krackow Suture Technique: Surgical Technique and Early Outcomes.

Background: Many surgical methods exist for distal biceps repair. We present the technique and early outcomes of a series of distal biceps repairs completed with a novel suturing technique utilizing a hemi-Krackow locking stitch at the tendon-bone interface.

Methods: A retrospective review was performed of patients who underwent primary distal biceps repair using a single anterior incision with 2 suture anchors utilizing a hemi-Krackow stitch.

Concomitant Total Wrist and Total Elbow Arthroplasty in a Rheumatoid Patient.

Background Concomitant arthroplasty has been described to have several benefits over multistage procedures. Ipsilateral total elbow and total shoulder arthroplasty has been reported with good outcomes in upper extremity concomitant arthroplasty. Case Description A 65-year-old woman presented with ipsilateral left-sided wrist and elbow joint degeneration as a result of longstanding rheumatoid arthritis.

Management of a Dermocutaneous Black Mold Abscess of the Finger with Flexor Sheath Involvement.

Case: We present the case of a 76-year-old man with a black mold infection of the index finger. This granulomatous abscess uncharacteristically invaded the flexor sheath compartment, threatening proximal spread. Treatment consisted of excision of the abscess and drainage of the flexor sheath.

Cam lesion femoral osteoplasty: in vitro biomechanical evaluation of iatrogenic femoral cortical notching and risk of neck fracture.

Purpose: To investigate the effect of femoral cortical notching at different depths on the peak compressive load and energy required to cause a femoral neck fracture in composite femurs.

Methods: Thirty fourth-generation composite femurs were divided into 5 groups: (1) intact with an inherent alpha angle of 61°, (2) resection of inherent cam lesion by reducing the alpha angle from 61° to 45°, (3) cam resection and cortical notching of a 5.5-mm spherical diameter by 2.

Recruitment and activity of the pectineus and piriformis muscles during hip rehabilitation exercises: an electromyography study.

Background: The pectineus muscle has been reported to function primarily as a hip flexor and secondarily as a hip internal rotator; the piriformis muscle has been reported to function as an abductor and external rotator of the hip. The recruitment and activations of these muscles during hip rehabilitation exercises have not been detailed.

Hypothesis: The authors hypothesized that they would measure the highest pectineus activation during exercises involving hip flexion, with moderate pectineus activation during exercises with hip internal rotation.

"At-risk" positioning and hip biomechanics of the Peewee ice hockey sprint start.

Background: Femoroacetabular impingement (FAI) is becoming a prevalent overuse injury diagnosis among hockey players. In the adult ice hockey stride, the "at-risk" hip position, defined by internal rotation during flexion and external rotation during abduction, reportedly increases hip vulnerability to labral injury as a result of FAI.

Hypothesis: Peewee youth ice hockey players display the kinematics for both described at-risk hip positions (internal rotation during flexion and external rotation during abduction) in the ice hockey sprint start.