Unstable C1 Fracture Managed with Internal Fixation Using Lateral Mass Screws: A Case Report.

CASE: A 47-year-old woman presented with an unstable C1 fracture after falling down several stairs. She was found to have a sagittal split fracture of the right C1 lateral mass extending into the posterior arch. The fracture was treated with a direct posterior osteosynthesis of C1 using lateral mass screws. CONCLUSION: Surgical management of unstable C1 fractures has traditionally involved posterior fusion of C1 to C2 or fusion from the occiput to C2. These fusion procedures can be quite functionally limiting. Recently, direct osteosynthesis of C1 has been shown to be an effective, motion-preserving alternative.

Arthroscopic Treatment of Traumatic Hip Dislocations in Children and Adolescents: A Preliminary Study.

INTRODUCTION: Traumatic hip dislocations in children and adolescents require prompt concentric reduction. Incomplete reduction with or without retained osteochondral fragments has traditionally been addressed with open reduction. We report on the use of arthroscopy to remove loose bodies and reduce enfolded soft tissues to obtain concentric reduction in the pediatric and adolescent population. Specific note is made of underlying pathology and arthroscopic intervention. METHODS: After obtaining Institutional Review Board approval, we performed a retrospective review of patients under the age of 19 who were treated with hip arthroscopy following hip dislocation reduction at a single children's hospital from 2006 to 2013. Clinic notes, operative reports, radiographic images, and arthroscopic photographs were reviewed. RESULTS: Seven patients were identified (aged 8 to 17) who underwent hip arthroscopy after a posterior hip dislocation. Intra-articular bone fragments were found in 6 of 7 patients and 5 of 7 patients had an incongruent hip joint identified by imaging before surgery. The predominant pathology was avulsion of a small bony fragment attached to the posterior capsular labral soft-tissue complex, which became enfolded and blocked reduction (5 of 7 patients). In all cases, the enfolded soft tissue was reduced without soft tissue or bone repair. Additional loose osteochondral fragments were removed, and in 2 cases an avulsed ligamentum teres was debrided. Average follow-up was 10 months. No avascular necrosis or recurrent instability was identified in any case. CONCLUSIONS: When incongruent hip joints were arthroscopically evaluated after traumatic dislocation, a consistent pattern of interposition of avulsed posterior bone fragment with attached capsule and labrum was found. Reduction of the capsulolabral complex without repair provided satisfactory short-term outcomes. Arthroscopic treatment of such cases was effective and well tolerated and could lead to considerably less postoperative pain and surgical morbidity than open surgical treatment. LEVEL OF EVIDENCE: Level IV-case series.

Analysis of Predictors and Outcomes of Allogenic Blood Transfusion After Shoulder Arthroplasty.

In shoulder arthroplasty, patients often receive postoperative blood transfusions. Studies of predictors of allogeneic blood transfusion (ABT) in these patients have been limited by sample size. We conducted a study to identify predictors of ABT in patients undergoing shoulder arthroplasty and to evaluate the effect of ABT on postoperative outcomes, including inpatient mortality, adverse events, prolonged hospital stay, and nonroutine discharge. Using the Nationwide Inpatient Sample, we stratified an estimated 422,371 patients who presented for shoulder arthroplasty between January 1, 2002, and December 31, 2011, into total shoulder arthroplasty (59.3%) and hemiarthroplasty (40.7%) cohorts, and then subdivided these cohorts into patients who received blood transfusions and those who did not. Patients who received ABTs were older, female, and nonwhite and had Medicare or Medicaid insurance. Many had a primary diagnosis of proximal humerus fracture. Those who received ABT were more likely to experience adverse events or a prolonged hospital stay and were more often discharged to a nursing home or an extended-care facility. The 5 most significant predictors of ABT in a population of 422,371 patients who underwent shoulder arthroplasty were fracture, fracture nonunion, deficiency anemia, coagulopathy, and avascular necrosis. Given these findings, it is important to identify at-risk patients before surgery in order to provide education and minimize risk.

How Useful are Orthopedic Surgery Residency Web Pages?

OBJECTIVE: Medical students interested in orthopedic surgery residency positions frequently use the Internet as a modality to gather information about individual residency programs. Students often invest a painstaking amount of time and effort in determining programs that they are interested in, and the Internet is central to this process. Numerous studies have concluded that program websites are a valuable resource for residency and fellowship applicants. The purpose of the present study was to provide an update on the web pages of academic orthopedic surgery departments in the United States and to rate their utility in providing information on quality of education, faculty and resident information, environment, and applicant information. DESIGN: We reviewed existing websites for the 156 departments or divisions of orthopedic surgery that are currently accredited for resident education by the Accreditation Council for Graduate Medical Education. Each website was assessed for quality of information regarding quality of education, faculty and resident information, environment, and applicant information. RESULTS: We noted that 152 of the 156 departments (97%) had functioning websites that could be accessed. There was high variability regarding the comprehensiveness of orthopedic residency websites. Most of the orthopedic websites provided information on conference, didactics, and resident rotations. Less than 50% of programs provided information on resident call schedules, resident or faculty research and publications, resident hometowns, or resident salary. CONCLUSIONS: There is a lack of consistency regarding the content presented on orthopedic residency websites. As the competition for orthopedic websites continues to increase, applicants flock to the Internet to learn more about orthopedic websites in greater number. A well-constructed website has the potential to increase the caliber of students applying to a said program.