Outcomes of distal biceps tendon repair using a dual incision, cortical button technique: a single surgeon study.

BACKGROUND: The purpose of this study was to evaluate patient-reported outcomes, function, complication rates, and radiographs in a series of patients with distal biceps tendon repair using the dual incision cortical button technique by a single surgeon. By having a single surgeon perform the surgery, the technique is standardized to all patients. Twenty-two patients consented to participate in the study. The average time from surgery to review was 2.2 years. Patient satisfaction was assessed using the DASH, Oxford, and Mayo Elbow Performance Scores. METHODS: Range of movement was assessed and compared to the unaffected limb using a goniometer. Isometric flexion and supination strength was tested using a standardized dynamometer-both measurements taken by a single physiotherapist. Radiographs were discussed at the time of the review by 2 orthopedic surgeons to check for heterotopic ossification. RESULTS: The mean DASH score was 6.3 postsurgery at the time of follow-up. There was no significant difference in active range of movement between the repaired and nonrepaired arm in flexion, extension, supination, or pronation. Four radiographs showed evidence of heterotopic ossification (HTO)-none showed synostosis. For patients with HTO, there was evidence that supination was inhibited compared to those patients who did not have HTO. CONCLUSION: Our study found that at an average of 2 years of follow-up these patients had good outcomes clinically with no major complications. HTO was present in only 4 patients, and there was a significant difference in supination compared to those who did not have HTO. These patients had an average DASH of 14 compared to a score of 4.5 in those who did not have an HTO. The study showed that the dual incision cortical button repair remains a procedure with excellent patient outcomes at the risk of HTO.

Keeping the Traction on in Orthopaedics.

The trauma and orthopaedic speciality continues to advance as surgery becomes more accessible and safe. However, the bygone days of treatment with traction still has its merits and should remain a part of practitioner's repertoire. This will allow the practitioners to be resourceful in times of unexpected scenarios. We aim to write this article to describe indications, applications of various forms of traction, and their relevant complications.

The Role of Reverse Shoulder Arthroplasty in Elderly Trauma: A Systematic Review.

OBJECTIVES: The primary objective of this systematic review was to evaluate pain relief and shoulder functional outcome following reverse shoulder arthroplasty for three- and four-part proximal humerus fractures in patients over the age of 60 years. The secondary objective was to assess the clinical end radiological complications following this procedure for this indication. METHODS: Studies were identified using a MEDLINE search for relevant articles on 20th May 2019. The key terms 'reverse shoulder arthroplasty' and 'proximal humerus fracture' were used. RESULTS: Five retrospective case-series fully met the eligibility criteria. No randomized controlled trials or meta-analyses were found. All of the studies agreed that reverse shoulder arthroplasty was able to offer good pain relief, function end range of forward flexion (FF), and abduction (Abd.). Restrictions in shoulder rotation have to be fully addressed. The rate of major complications, reduction in functional outcome, and development of scapular notching with time was a concern. CONCLUSIONS: Reverse shoulder arthroplasty for comminuted proximal humerus fractures has increased over the past several years, yet the published data evaluating the surgical outcome is limited. Large well-designed prospective randomized controlled trials are needed for comparing the various treatment options, in order to ensure that these patients receive the best treatment available.

Patient and Radiographic Factors Help to Predict Metal-on-Metal Hip Resurfacings with Evidence of a Pseudotumor.

BACKGROUND: The role of radiographs in the follow-up of patients with metal-on-metal hip resurfacing (MoMHR) implants is unclear. We investigated whether a combination of patient and radiographic factors predicted MoMHRs with evidence of a pseudotumor. METHODS: We performed a retrospective single-center case-control study of 384 MoMHRs. The pseudotumor group of 130 hips all had evidence of a symptomatic pseudotumor on cross-sectional imaging, with the diagnosis confirmed at revision. The nonpseudotumor group of 254 hips (a subgroup of these hips were previously reported on) all had normal findings on cross-sectional imaging. Radiographs taken immediately prior to revision were assessed in the pseudotumor group and were compared with radiographs taken at the time of normal cross-sectional imaging in the nonpseudotumor group. Two blinded independent observers analyzed the radiographs for signs of failure, with excellent interobserver agreement. Logistic regression modeling identified the patient and radiographic predictors of revision for pseudotumor. RESULTS: Hips with a pseudotumor more commonly had abnormal findings on radiographs compared to hips without a pseudotumor (80.0% compared with 63.4%; p = 0.001). Patient and radiographic factors predictive of revision for pseudotumor in the multivariable model were female sex (odds ratio [OR], 3.14; 95% confidence interval [CI], 1.85 to 5.35; p < 0.001), high inclination (OR, 1.04 per degree; 95% CI, 1.01 to 1.07 per degree; p = 0.006), acetabular osteolysis (OR, 5.06; 95% CI, 2.14 to 12.0; p < 0.001), femoral osteolysis (OR, 17.8; 95% CI, 5.09 to 62.2; p < 0.001), and acetabular loosening (OR, 3.35; 95% CI, 1.34 to 8.35; p = 0.009). Factors predictive of not having a pseudotumor were anteversion of ≥5° (5° to <10°: OR, 0.31; 95% CI, 0.12 to 0.77; p = 0.012; and ≥10°: OR, 0.32; 95% CI, 0.15 to 0.70; p = 0.004) and heterotopic ossification (OR, 0.19; 95% CI, 0.05 to 0.72; p = 0.015). The final multivariable model was well calibrated (p = 0.589), with good discriminatory ability (area under the curve = 0.801; sensitivity = 74.4%; specificity = 71.7%). CONCLUSIONS: A combination of patient and radiographic factors provided useful information for distinguishing between MoMHRs with and without evidence of a pseudotumor. Surgeons may wish to consider these specific patient and radiographic factors before proceeding with cross-sectional imaging. Radiographs are important when assessing patients with MoMHR implants and should be included in all follow-up protocols. LEVEL OF EVIDENCE: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Varicella zoster virus infection is an unusual cause of splenic rupture.

A 22-year-old man presented with a 1-day history of severe abdominal pain. He developed a generalised vesicular rash 12 h prior to admission. On examination, he was maximally tender with peritonism in the lower abdomen. Working diagnosis was perforated appendix and a decision to investigate with CT was made, which showed intra-abdominal haemorrhage likely arising from a ruptured spleen. After a period of observation, he subsequently underwent laparotomy and emergency splenectomy. Viral PCR from vesicular fluid was positive for varicella zoster virus. Viral serology was otherwise negative.