Painful Entrapment of the Lateral Antebrachial Cutaneous Nerve After Distal Biceps Repair: A Case Report.

CASE: A 46-year-old man presented with continued pain after distal biceps repair. On revision surgery, he was found to have entrapment of the lateral antebrachial cutaneous nerve (LABCN). After nerve transection, relocation to its native course, and subsequent repair, the patient experienced complete resolution of his preoperative symptomatology. CONCLUSION: To the author's knowledge, the current study is the first to describe symptomatic entrapment of the LABCN after distal biceps repair with a satisfying outcome after nerve transection, relocation, and repair.

Impact of Obesity, Smoking, and Age on 30-Day Postoperative Outcomes of Patients Undergoing Arthroscopic Meniscus Surgery.

BACKGROUND: The purpose of this study was to evaluate the impact that obesity, smoking, and older age have on 30-day postoperative complications, reoperations, and readmissions of patients undergoing arthroscopic meniscectomy or meniscus repair. MATERIALS AND METHODS: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried to identify meniscus surgeries and operative outcomes between 2008 and 2016. Controlled regression analysis was then performed to evaluate for an association between obesity, age, and smoking and these outcomes. RESULTS: While obesity showed no influence on adverse postoperative complications or reoperations, class I obesity was associated with a lower rate of readmission. Older age, smoking, and comorbidity burden were significant predictors of postoperative complications, reoperations, and/or readmissions. Age 80 years or older was particularly predictive of 30-day complications (odds ratio, 3.5; P<.001) and readmissions (odds ratio, 2.5; P=.004). CONCLUSION: Obesity is not a major risk factor for complications when undergoing meniscus surgery, while age older than 70 years predicts negative short-term postoperative outcomes. [Orthopedics. 20XX;4X(X):XXX-XXX.].

Prediction of primary admission total charges following cervical disc arthroplasty utilizing machine learning.

BACKGROUND CONTEXT: Cervical disc arthroplasty (CDA) has become an increasingly popular alternative to anterior cervical discectomy and fusion, offering benefits such as motion preservation and reduced risk of adjacent segment disease. Despite its advantages, understanding the economic implications associated with varying patient and hospital factors remains critical. PURPOSE: To evaluate how hospital size, geographic region, and patient-specific variables influence charges associated with the primary admission period following CDA. STUDY DESIGN: A retrospective analysis using machine learning models to predict and analyze charge factors associated with CDA. PATIENT SAMPLE: Data from the National Inpatient Sample (NIS) database from 2016 to 2020 was used, focusing on patients undergoing CDA. OUTCOME MEASURES: The primary outcome was total charge associated with the primary admission for CDA, analyzed against patient demographics, hospital characteristics, and regional economic conditions. METHODS: Multivariate linear regression and machine learning algorithms including logistic regression, random forest, and gradient boosting trees were employed to assess their predictive power on charge outcomes. Statistical significance was set at the 0.003 level after applying a Bonferroni correction. RESULTS: The analysis included 3,772 eligible CDA cases. Major predictors of charge identified were hospital size and ownership type, with large and privately owned hospitals associated with higher charges (p<.001). The Western region of the U.S. also showed significantly higher charges compared to the Northeast (p<.001). The gradient boosting trees model showed the highest accuracy (AUC=85.6%). Length of stay and wage index were significant charge drivers, with each additional inpatient day increasing charges significantly (p<.001) and higher wage index regions correlating with increased charges (p<.001). CONCLUSIONS: Hospital size, geographic region, and specific patient demographics significantly influence the charges of CDA. Machine learning models proved effective in predicting these charges, suggesting that they could be instrumental in guiding economic decision-making in spine surgery. Future efforts should aim to incorporate these models into broader clinical practice to optimize healthcare spending and enhance patient care outcomes.

Cannabis Use Is Associated With Fewer Filled Opioid Prescriptions After Treatment of Proximal Humerus Fractures.

The purpose of this study was to use a large claims database to determine if there is a difference in opioid use after operative intervention for proximal humerus fractures in patients with known cannabis use compared with those who do not report cannabis use. The PearlDiver database was queried to find all patients who underwent proximal humerus open reduction and internal fixation. A group of patients with reported cannabis use or dependence was matched to a cohort without known cannabis use. Between the two groups, differences in the number of opioid prescriptions filled in the postoperative period (within 3 days), the morphine milligram equivalents (MMEs) prescribed in total and per day, and the number of opioid prescription refills were explored. There were 66,445 potential control patients compared with 1260 potential study patients. After conducting the propensity score match, a total of 1245 patients were included in each group. The patients in the cannabis group filled fewer opioid prescriptions (P=.045) and were prescribed fewer total MMEs (P=.044) in the first 3 days postoperatively. Results of this study indicate that patients who use cannabis products may use fewer opioids after proximal humerus open reduction and internal fixation. [Orthopedics. 202x;4x(x);xx-xx.].

Plate vs. intramedullary screw fixation of chevron olecranon osteotomies: a biomechanical study.

Background: Intra-articular distal humerus fractures frequently require olecranon osteotomies for adequate exposure, but fixation of olecranon osteotomies is associated with high rates of hardware-related complications requiring subsequent reoperation for removal. Intramedullary screw fixation is an attractive option to attempt to minimize hardware prominence. The purpose of this biomechanical study is to directly compare intramedullary screw fixation (IMSF) with plate fixation (PF) of chevron olecranon osteotomies. It was hypothesized that PF would be biomechanically superior to IMSF. Methods: Chevron olecranon osteotomies of 12 matched pairs of fresh-frozen human cadaveric elbows were repaired with either precontoured proximal ulna locking plates or cannulated screws with a washer. Displacement and amplitude of displacement at the dorsal and medial aspects of the osteotomies under cyclic loading conditions were measured. Finally, the specimens were loaded to failure. Results: The IMSF group had significantly greater medial displacement (P = .034) and dorsal amplitude (P = .029) than the PF group. Medial displacement was negatively correlated with bone mineral density in the IMSF group (r = -0.66, P = .035) but not in the PF group (r = .160, P = .64). Mean load to failure between groups, however, was not statistically significant (P = .183). Conclusions: While there was no statistically significant difference in the load to failure between the two groups, IMSF repair resulted in significantly greater displacement of the medial osteotomy site during cyclic loading and greater amplitude of displacement dorsally with loading force. Decreased bone mineral density was associated with an increased displacement of the medial repair site. These results suggest that IMSF of olecranon osteotomies may result in increased fracture site displacement when compared to PF; this displacement may be greater in patients with poor bone quality.