The impact of COVID-19 on the spatial distribution of shooting violence in Buffalo, NY.

OBJECTIVES: This paper examines the extent to which hotspots of shooting violence changed following the emergence of COVID-19. METHODS: This analysis uses Andresen's Spatial Point Pattern test on 1500 by 1500 foot grid cells, correcting for multiple comparisons, on a 10-year sample of geocoded shooting data from Buffalo New York. RESULTS: This work finds zero micro-grid cells are not statistically different from pre to post COVID stay at home orders and instead that the observed rise in shootings in the sample appears to be a consistent proportional increase across the city. CONCLUSIONS: These findings provide law enforcement with useful information about how to respond to the recent rise in shooting violence, but additional work is needed to better understand what, among a number of competing theories, is driving the increase. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11292-021-09497-4.

Ultrasound evaluation of arthroscopic full-thickness supraspinatus rotator cuff repair: single-row versus double-row suture bridge (transosseous equivalent) fixation. Results of a prospective, randomized study.

BACKGROUND: The purpose of this study was to compare the structural outcomes of a single-row rotator cuff repair and double-row suture bridge fixation after arthroscopic repair of a full-thickness supraspinatus rotator cuff tear. MATERIAL AND METHODS: We evaluated with diagnostic ultrasound a consecutive series of ninety shoulders in ninety patients with full-thickness supraspinatus tears at an average of 10 months (range, 6-12) after operation. A single surgeon at a single hospital performed the repairs. Inclusion criteria were full-thickness supraspinatus tears less than 25 mm in their anterior to posterior dimension. Exclusion criteria were prior operations on the shoulder, partial thickness tears, subscapularis tears, infraspinatus tears, combined supraspinatus and infraspinatus repairs and irreparable supraspinatus tears. Forty-three shoulders were repaired with single-row technique and 47 shoulders with double-row suture bridge technique. Postoperative rehabilitation was identical for both groups. Ultrasound criteria for healed repair included visualization of a tendon with normal thickness and length, and a negative compression test. RESULTS: Eighty-three patients were available for ultrasound examination (40 single-row and 43 suture-bridge). Thirty of 40 patients (75%) with single-row repair demonstrated a healed rotator cuff repair compared to 40/43 (93%) patients with suture-bridge repair (P = .024). CONCLUSION: Arthroscopic double-row suture bridge repair (transosseous equivalent) of an isolated supraspinatus rotator cuff tear resulted in a significantly higher tendon healing rate (as determined by ultrasound examination) when compared to arthroscopic single-row repair.

Influence of arm lengthening in reverse shoulder arthroplasty.

BACKGROUND: Reverse shoulder arthroplasty (RSA) can improve anterior active elevation (AAE) by lengthening of the deltoid and hence increasing its lever arm. However, evaluations of functional outcomes of RSA have shown variable improvements in the range of motion. The aim of our study was to correlate humeral and arm lengthening to postoperative AAE. METHODS: We reviewed 183 RSAs with a minimum follow-up of 1 year. Lengthening of the humerus and the arm was evaluated in relation to the contralateral side. RESULTS: We observed mean humeral lengthening of 0.2 ± 1.4 cm (range, -4.7 to +5.2 cm) and mean arm lengthening of 1.6 ± 1.9 cm (range, -5.1 to +5.4 cm). Postoperative AAE was 140° ± 27° (range, 30° to 180°). We found no significant correlation between lengthening or shortening of the humerus and AAE (P = .169). Shortening of the arm led to a mean AAE value of 122°; lengthening of 0 and 1 cm, mean AAE of 140°; lengthening of greater than 1 cm to 2.5 cm, mean AAE of 144°; and lengthening of greater than 2.5 cm, mean AAE of 147°. When we compared patients with lengthening of the arm and those with shortening, the postoperative AAE was significantly greater after arm lengthening, 145° versus 122°, with a mean difference of 23° (95% confidence interval, 13° to 33°) (P < .001). CONCLUSION: This study shows that shortening of the arm reduced AAE. With respect to arm lengthening, a lengthening threshold was not found. An objective assessment of deltoid lengthening is possible preoperatively, intraoperatively, and postoperatively, and this measure seems to correlate with the functional outcome.

Indications for reverse total shoulder arthroplasty in rotator cuff disease.

BACKGROUND: Reverse total shoulder arthroplasty (RTSA) was introduced to treat rotator cuff tear arthropathy but is now used to treat a variety of problems. Although its use has expanded substantially since the FDA's approval in 2004, the appropriateness in patients with rotator cuff disease is unclear. QUESTIONS/PURPOSES: We review the use of RTSA in patients with rotator cuff disease to (1) describe classification of rotator cuff tear reparability and the concept of a balanced shoulder; (2) explore the theory behind RTSA design relative to rotator cuff arthropathy; (3) discuss the indications and contraindications for RTSA; and (4) review published outcomes of RTSA for rotator cuff arthropathy. METHODS: We performed a selective review of the literature on the use of RTSA in the treatment of rotator cuff disease. RESULTS: Modern RTSA designs restore deltoid tension and a functional fulcrum to the rotator cuff deficient shoulder, which allows recovery of active shoulder elevation and effectively restores function in short- and medium-term followup studies. CONCLUSIONS: In short-term followup the RTSA relieves symptoms and restores function for patients with cuff tear arthropathy and irreparable rotator cuff tears with pseudoparalysis (preserved deltoid contraction but loss of active elevation). Severely impaired deltoid function, an isolated supraspinatus tear, and the presence of full active shoulder elevation with a massive rotator cuff tear and arthritis are contraindications to RTSA. CLINICAL RELEVANCE: For properly selected patients who have symptomatic and disabling rotator cuff deficiency, RTSA can result in life-changing improvements in pain, motion, function, and patient satisfaction. LEVEL OF EVIDENCE: Level V therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Synthesis of bis-Isoxazole-bis-Methylene Dinitrate: A Potential Nitrate Plasticizer and Melt-Castable Energetic Material.

The efficient and scalable synthesis of 3,3'-bis-isoxazole-5,5'-bis-methylene dinitrate and its energetic properties are described. The material has favorable sensitivity properties; energetic properties point toward its potential as both a melt-castable secondary explosive and as a propellant plasticizer.

Unicompartmental knee arthroplasty in patients sixty years of age or younger.

BACKGROUND: Unicompartmental knee arthroplasty has been used to treat elderly, low-demand patients, but the literature is sparse regarding the use of this procedure for younger, active patients. The purpose of the present retrospective study was to evaluate the results of unicompartmental knee arthroplasty in younger, more active patients. METHODS: Forty-one patients underwent forty-six consecutive unicompartmental knee arthroplasties with use of the Miller-Galante system between 1988 and 1996. All of the patients were sixty years of age or younger and all were physically active. The Hospital for Special Surgery knee score and the University of California at Los Angeles activity assessment were used to rate the function and to determine the activity level of each patient, respectively. Serial radiographs were used to evaluate the status of prosthetic fixation, femorotibial alignment, and the progression of arthrosis in the unreplaced compartment. Long-term survivorship was calculated with use of Kaplan-Meier analysis. RESULTS: The mean duration of follow-up was eleven years. Of the forty-five knees that were available for follow-up, three had been revised. The Hospital for Special Surgery score was excellent for thirty-nine (93%) of the remaining forty-two knees and good for three. The University of California at Los Angeles activity assessment score was 6.6 +/- 1.4 for the knees in which the original prosthesis had been retained and 7.3 +/- 1.5 for those in which it had been revised. Two asymptomatic patients had revision of a modular tibial component because of substantial radiographic evidence of polyethylene wear; one of these patients had exchange of the polyethylene insert and the tibial tray, and the other had exchange of the polyethylene insert only. A third patient underwent revision total knee arthroplasty because of continuing knee pain and a progressive tibial radiolucent line that was >2 mm in width. The average postoperative femorotibial alignment was 5 degrees of valgus. Nine knees had progression of arthritis in the unresurfaced compartment; none of these knees were revised, and none of the patients had deterioration in the Hospital for Special Surgery score. Kaplan-Meier analysis demonstrated an eleven-year survivorship of 92%. CONCLUSIONS: At an average duration of follow-up of eleven years, unicompartmental knee arthroplasty was associated with pain relief and excellent function in a cohort of patients who had been sixty years of age or younger and active at the time of surgery.

Retrospective comparison of freehand and ultrasound-guided shoulder steroid injections.

The objective of this study was to assess the clinical benefits and financial feasibility of using ultrasound for steroid injections of the shoulder. A retrospective chart review and telephone survey of patients in a clinical shoulder practice were performed. ICD-9 codes and CPT codes identified patients who received shoulder injections without (2006) and with (2007) ultrasound guidance during 2 consecutive years. Results were assessed by patient assessment of relief and duration of that relief via telephone survey or from chart review. Financial data was assessed by reviewing the patients' accounts. One hundred fifty-seven injections were given in 2006 and 159 in 2007. In 2006, 126 unique patients were injected compared to 99 unique patients in 2007 (P<.001). Clinical data was collected on 272 patients (86.1%). Ultrasound had no significant effect on the amount of pain relief following injection (P=.468). One hundred thirty-six patients (50.0%) reported significant pain relief, 72 (26.5%) reported moderate, 39 (14.3%) reported mild, and 25 (9.2%) reported no pain relief following injection. During both years, 92.4% of patients had subacromial injections with no significant difference in injection sites (subacromial vs glenohumeral) between the 2 years (P=.252). Neither the injection site (subacromial or glenohumeral, P=.152) nor diagnosis (P=.540) had a significant effect on pain relief. Financial collections from injections increased as expected due to the use of ultrasound.Ultrasound guidance did not change the efficacy of steroid injections, the number of injections, or the type of injections. Steroid injections are useful for managing pain in several shoulder conditions and ultrasound guidance may not be necessary.

Lateral unicompartmental knee arthroplasty: survivorship and technical considerations at an average follow-up of 12.4 years.

Successful medial unicompartmental knee arthroplasty is becoming standard; however, the "screw-home" mechanism, internal femoral rotation on a fixed tibia as the knee is fully extended, should be taken into account with lateral compartment arthroplasty. Twenty-nine consecutive lateral unicompartmental arthroplasties were performed with our unique tibial component positioning in 10 degrees to 15 degrees of internal rotation to compensate for the "screw-home" mechanism. The Hospital for Special Surgery knee score and serial radiographs were used in the evaluation of each patient. The mean duration of follow-up was 12.4 years with no revisions. The HSS score was excellent or good in all knees. The average postoperative femoral-tibial alignment was 5 degrees of valgus, and the average posterior tibial slope was 6 degrees . Lateral unicompartmental arthroplasty can provide excellent long-term results with modified positioning of the tibial component.