Outcomes of shoulder replacement in humeral head avascular necrosis.

BACKGROUND: This retrospective review evaluated 25 patients with 29 shoulders treated with arthroplasty for humeral head avascular necrosis (HHAVN) between 2004 and 2015. We hypothesized that regardless of implant, radiographic stage, or etiology, patients would appreciate significant improvement in pain, range of motion, and shoulder functionality after surgical intervention. METHODS: Data were obtained by record review on all patients meeting inclusion criteria. Outcomes were evaluated using Simple Shoulder Test, Modified Constant Score, University of California Los Angeles Shoulder Rating Scale, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form. The data were assessed by all patients and subcategories (treatment, avascular necrosis stage, and underlying cause). RESULTS: At a mean follow-up of 3.9 years (range, 1-8.5 years), all patients who underwent operative intervention for HHAVN showed statistically significant improvement in functionality measurements (P < .01). Patients who underwent total shoulder arthroplasty (TSA) noted higher median outcome scores and greater improvement in all scoring methods compared with their hemiarthroplasty counterparts. The high-stage disease shoulders showed similar trends over low-stage counterparts. The shoulders in the trauma causal group had the highest scores in 3 of 4 outcome measures and favorable change in all scoring methods. These differences were not statistically significant (P > .05). No revision arthroplasties were required. Minor complications (suture abscess and intraoperative calcar fracture requiring cabling) occurred in 2 TSA patients. CONCLUSIONS: Our outcomes demonstrate that in the short- to midterm follow-up, TSA or hemiarthroplasty is a safe and equally effective treatment for patients diagnosed with HHAVN regardless of etiology and radiographic staging.

Effect of post-operative NSAID use on rotator cuff repair outcomes.

Background: The impact of non-steroidal anti-inflammatory drugs (NSAIDs) on rotator cuff repair is an ongoing area of study within orthopedics, with conflicting results in current literature. Despite concerns over the deleterious effects of NSAIDs on rotator cuff healing, they are becoming an integral part of a multimodal post-operative pain control regiment. The purpose of this study was to compare post-operative patient-reported outcomes (PROs), complications rates, and retear rates of arthroscopic rotator cuff repairs in patients using ibuprofen post-operatively to those who abstained from NSAIDs for six weeks after surgery. It was hypothesized that a short course of ibuprofen post-operatively would not lead to inferior PRO scores, increased retear rates, nor increased complication rates after arthroscopic rotator cuff repair. Methods: Patients of the primary surgeon who underwent arthroscopic rotator cuff repair between 2012 and 2022 were evaluated by retrospective chart review. In May 2017 the primary surgeon changed his protocol from avoiding NSAIDs for six weeks after surgery to routinely prescribing two weeks of Ibuprofen 800 mg TID post-operatively. Patients who avoided NSAIDs for six weeks were compared to patients who were prescribed NSAIDs post-operatively. Patient demographic data, pre-operative MRI results, pre-operative and post-operative PROs were collected from the EMR. Additionally, post-operative complications and repair failures requiring reoperation within one year were evaluated. Results: 125 patients met inclusion criteria for this study with 36 patients in the NSAID group and 89 in the no NSAID group. When comparing improvement in PROs, the NSAID group reached MCID at one year in 83.8 % of patients and the no NSAID group reached MCID at one year in 73.9 % of patients. There was no significant difference between the groups in reaching MCID improvement at one year (p = 0.471). Five post-operative complications were reported in the no NSAID group and two in the NSAID group (5.7 % vs 5.4 %, respectively, p = 0.827). Finally, there was no significant difference in the percentage of post-operative rotator cuff repair failures requiring revision in the first year between the groups (2.3 % vs 2.7 %, p = 1.000). Conclusion: There was no difference in percent of patients improving their PRO by the MCID between the groups that used ibuprofen and the group that did not. There was also no difference in post-operative complication rates and rates of symptomatic retear requiring reoperation between the groups. This supports that a short course of NSAIDs post-operatively, specifically ibuprofen, after rotator cuff repair does not increase reoperation rates nor lead to a clinically significant decrease in PROs at one year.

Marking Pen Bacterial Contamination During Shoulder Surgery.

BACKGROUND: Equipment used to guide surgical incisions has been shown to be a source of bacterial contamination during surgery. PURPOSE/HYPOTHESIS: To compare the culture-positive rates of sterile marking pens used before and after skin preparation for shoulder surgery. It was hypothesized that there will be no difference in culture-positive rates from marking pens used after skin preparation compared with before skin preparation. STUDY DESIGN: Controlled laboratory study. METHODS: Overall, 43 consecutive patients undergoing elective shoulder surgery were enrolled prospectively into this study. Each patient provided 2 samples: study pens (from marking the surgical site incision after skin preparation) and positive control pens (from marking the surgical site incision before skin preparation). In addition, there were 43 negative control pens evaluated (straight from the packaging without any patient contact). Cultures were evaluated at 4 and 21 days, and all positive cultures were further evaluated for speciation, if able. Standard descriptive summaries and Fisher exact tests were used to compare the study samples. RESULTS: The average age of the 43 patients was 54 years (range, 18-76 years). There were 29 (67%) female patients, and 30 (70%) procedures were on the right shoulder. Of the 43 procedures performed, 29 (67.4%) were arthroscopic, 12 (27.9%) were open, and 2 (4.7%) were closed. Of the 43 study pens, 1 culture was positive for Propionibacterium acnes (2.3%). Of the 43 positive control pens, 2 cultures were positive for bacterial growth (4.7%): P. acnes and Gram-positive bacilli (no speciation could be obtained). Of the 43 negative control pens, none of the cultures were positive for bacterial growth (0%). There was no statistical difference in the culture-positive rate between the study pens and the positive or negative control pens (P ≥ .999). CONCLUSION: Study results indicated that sterile surgical marking pens used to plan incisions and to outline anatomic landmarks did not have a higher culture-positive rate compared with pens used on unprepared skin or pens straight from the packaging. CLINICAL RELEVANCE: As a precaution, sterile surgical marking pens should be discarded after use on the skin surface and not placed on the sterile field.

Factors influencing side air curtain deployment in rollover motor vehicle accidents.

Objective: Recent changes in FMVSS have led to the utilization of side air curtains to provide occupant retention during rollover events. However, the safety advantage provided by the air curtains relies on the vehicle system's ability to detect the rollover event and deploy the curtains. The purpose of this study is to identify crash and vehicle characteristics in motor vehicle rollovers that influence side air curtain deployment and occupant outcomes. The current study aims to improve the understanding of rollover events and inspire more robust air curtain deployment strategies.Methods: Study data were extracted from rollover cases documented in the NASS-CDS data set from 2011 to 2015. Vehicle model years of 2011 or later with side air curtains installed were examined. The presence of a rollover sensor in each vehicle was determined from vehicle content data available on the Insurance Institute for Highway Safety's crash rating website. The resulting data set contained 14,003 weighted cases of rollover accidents in which the side air curtain did not deploy (40 raw count) and 23,178 cases of deployment (80 raw count).Results: Several crash event and vehicle characteristics were similar for the nondeployed and deployed groups, including number of quarter turns, primary location of damage, initiating event for the rollover, and vehicle model year. However, the nondeployed group included significantly more passenger vehicle body types (vs. SUV or truck) and had a significantly lower rate of rollover sensor presence. Presence of a rollover sensor increased the odds air curtain deployment by a factor of 36.5 (95% confidence interval [CI], 5.06-265). Cases in which both side air curtains deployed resulted in a higher frequency of injured occupants (Maximum Abbreviated Injury Scale [MAIS] ≥ 3). However, rollover events resulting in these injuries were also associated with higher rates of impact with another object or vehicle and damage to the roof of the vehicle, suggesting a higher energy event.Conclusions: Nondeployment of the side curtain airbags in rollovers occurred more frequently in vehicles without dedicated rollover sensors, which were most frequently passenger vehicles.

Pre-bending a dynamic compression plate significantly alters strain distribution near the fracture plane in the mid-shaft femur.

This study evaluated the effect of pre-bending dynamic compression plates on fracture site compression. Recommendations of 1 to 2 mm of pre-bend have been proposed, but there does not appear to be experimental data to confirm the optimal pre-bend magnitude. Dynamic compression plating was performed on the lateral convex surface of 18 femoral analogs to fixate a simulated mid-shaft fracture. Plates with 0 mm (flat plate), 1 mm, and 2 mm of pre-bend were evaluated for their production of compression by determining the strain magnitudes for 10 equal-sized zones across the anterior cortex at the osteotomy site using digital imaging correlation. The 0 and 1 mm plates produced significantly more compression at the near cortex (p = 0.001 and p = 0.003, respectively) than the 2 mm plate. However, the 0 and 1 mm plates also created visible diastasis at the far cortex, while the 2 mm plate exhibited compression across all zones. The strain magnitudes for the 0 mm (R2 = 0.62) and 1 mm (R2 = 0.86) plates linearly and significantly decreased from the region adjacent to the plate until a region 50%-60% across the analog diameter. In contrast, the 2 mm plate exhibited uniform strains across the osteotomy site. This study demonstrates that pre-bending a dynamic compression plate 2 mm prior to fixation on a convex lateral femur provides the most compression at the far cortex. It also produces more uniform compression across the fracture when compared to 0 and 1 mm of pre-bend.