Long-Term Results of Isolated Latissimus Dorsi to Rotator Cuff Transfer in Brachial Plexus Birth Injury.

Background Brachial plexus birth injury results in deficits in strength and motion, occasionally requiring surgery to restore power to the deficient external rotators of the shoulder in these patients. This is a retrospective analysis of the long-term results of an isolated latissimus dorsi transfer to the rotator cuff in patients with brachial plexus birth injury. Methods This is a retrospective review of prospectively collected data for patients undergoing isolated latissimus dorsi transfer into the infraspinatus in addition to release of the internal rotation contracture of the shoulder with greater than 5 years' follow-up. Preoperative and postoperative shoulder elevation and external rotation were documented. Failure of surgery was defined as a return of the internal rotation contracture and a clinically apparent clarion sign. Results A total of 22 patients satisfied the inclusion criteria: 9 global palsies and 13 upper trunk palsies. The average follow-up was 11 years, ranging from 7.5 to 15.9 years. There was a trend for improved external rotation in the global palsy cohort at final follow-up ( p = 0.084). All nine global palsies maintained adequate external rotation without a clarion sign. Five of the 13 upper trunk palsies failed the latissimus dorsi transfer and subsequently required either teres major transfer and/or rotational osteotomy. In these five failures, the period from initial transfer to failure averaged 6.6 years, ranging from 3.4 to 9.5 years. Conclusion The results of this study indicate that patients with global palsy have sustained long-term improved outcomes with isolated latissimus dorsi transfer while patients with upper trunk palsy have a high rate of failure. Based on these results, we recommend isolated latissimus dorsi transfer for global palsy patients who have isolated infraspinatus weakness. Level of Evidence: Case series - Level IV.

Representation of Female Speakers at the American Academy of Orthopaedic Surgeons Annual Meetings Over Time.

BACKGROUND: In the United States, women comprise 16% of orthopaedic surgery residents, 4% of fellows, and 6% of practicing orthopaedic surgeons. The underrepresentation of women in surgical subspecialties may be because of lack of early exposure to female mentors. Conference speaker roles are important for visibility. This study aims to evaluate the representation of women in speaker roles and responsibilities at the American Academy of Orthopaedic Surgeons (AAOS) meetings over time. METHODS: The names of speakers and session titles at the annual AAOS meetings were obtained from conference programs for the years 2009, 2014, and 2019. Each speaker was classified based on sex and role. Sessions discussing scientific or surgical topics were classified as technical and those that did not were classified as nontechnical. Descriptive statistics are provided, as well as individual-year odds ratios (ORs) and confidence intervals (CIs) examining sex versus technical session status and sex versus speaker role; combined results controlling for year are calculated using the Cochran-Mantel-Haenszel method. RESULTS: Overall, 3,980 speaking sessions were analyzed; 6.8% of speaking sessions were assigned to women. Women were more likely than men to participate in nontechnical speaking roles (OR 3.85; 95% CI, 2.79 to 4.78). Among talks given by women, the percentage that were nontechnical increased (25.5% in 2009, 24.3% in 2014, and 44.1% in 2019). Among moderator roles, the percentage assigned to women increased (4.5% in 2009, 6.0% in 2014, 14.5% in 2019). DISCUSSION: Our findings demonstrate an increase in female speakers at AAOS meetings from 2009 to 2019. The percentage of female moderators and nontechnical sessions given by women increased since 2009. A need for a shift in the distribution of speaker role exists, which promotes inclusivity and prevents professional marginalization. Representation of women as role models increases visibility and may address the leaky pipeline phenomenon and paucity of women in orthopaedics.

Cobertura de tejidos blandos en una lesión por aplastamiento de la mano en paciente con anemia de células falciformes

Se presenta el caso de una lesión por aplastamiento de la mano derecha en un paciente con historia clínica de anemia de células falciformes. Se realizó la reconstrucción con un colgajo de ingle, seguido de un colgajo de arteria interósea posterior y un colgajo anterolateral de muslo. El tratamiento de estas lesiones es complejo debido a la necesidad de tejidos blandos especializados, difíciles de reproducir para grandes defectos de la palma de la mano; además el grado de desarrollo de tejido cicatricial conduce a contracturas y dificultades en el uso funcional de la mano y los dedos. Este caso se agravó por el historial de anemia de células falciformes del paciente.

We report the case of a crush injury to the right hand in a patient with a clinical history of sickle cell anemia. Reconstruction was performed with a groin flap, followed by a posterior interosseous artery flap and an anterolateral thigh flap. The treatment of these injuries was complex due to the need for specialized soft tissues, which are difficult to reproduce for large defects in the palm of the hand. In addition, the degree of development of scar tissue leads to contractures and difficulties in the functional use of the hand and fingers. This case was aggravated by the patient's history of sickle cell anemia.

Neuropathic Arthropathy of the Glenohumeral Joint A Review of the Literature.

Neuropathic arthropathy, also known as Charcot arthropathy, is a degenerative disorder most commonly characterized by rapid destruction of the joint with extensive involvement of the bone and soft tissue. The underlying pathophysiology is thought to be due to loss of nociception (pain sensation), most frequently caused by diabetes mellitus, syphilitic myelopathy, or syringomyelia. A neuropathic shoulder is rare, with historic case series forming the bulk of the literature. The purpose of this review is to better understand the pathogenesis, clinical presentation, and management of neuropathic arthropathy of the glenohumeral joint. It should be stressed that the identification and management of the underlying etiology is paramount if the disease process is to be positively impacted. Although the mainstay of orthopedic management is non-surgical, little evidence exists to support the use of any specific therapeutic intervention. Recent literature suggests surgical reconstruction may be considered in very select patients.

Wrong-Site Surgery in Orthopaedics: Prevalence, Risk Factors, and Strategies for Prevention.

The incidence of wrong-site surgery in orthopaedics is unknown. This is due to a lack of data regarding the exact numbers of surgical procedures performed and a lack of a uniform mandatory error reporting infrastructure. Twenty-one percent of hand surgeons, 50% of spinal surgeons, and 8.3% of knee surgeons surveyed have reported performing at least one wrong-site surgery during their career. Every orthopaedic surgeon, no matter his or her orthopaedic subspecialty, is at risk for completing a wrong-site surgery during his or her career. Prevention of wrong-site surgery should remain a priority for the orthopaedic community. Surgeon leadership, commitment, and vigilance are critical to improve patient safety by ensuring that validated safety processes are used in all orthopaedic settings including effective surgical team communication, checklists, and routine collection and analysis of quality and safety data.