Cannabidiol for Postoperative Pain Control After Arthroscopic Rotator Cuff Repair Demonstrates No Deficits in Patient-Reported Outcomes Versus Placebo: 1-Year Follow-up of a Randomized Controlled Trial.

Background: Cannabidiol (CBD) has been shown recently to positively affect patient pain and satisfaction immediately after arthroscopic rotator cuff repair (ARCR). However, it is unclear whether the addition of CBD to a perioperative regimen could affect postoperative outcomes. Purpose: To evaluate patient-reported outcomes among patients who underwent ARCR and received buccally absorbed CBD or an identical placebo for early postoperative pain management at 1-year follow-up. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Eligible patients had previously participated in a multicenter, placebo-controlled, randomized, double-blinded trial that evaluated the analgesic effects of CBD in the immediate postoperative period after ARCR. The experimental group received 25 mg of CBD 3 times/day if <80 kg and 50 mg of CBD 3 times/day if >80 kg for 14 days, with the control group receiving an identical placebo. The following outcomes were assessed at minimum 1-year follow-up: visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and patient satisfaction. The rates of achievement of the Patient Acceptable Symptom State (PASS) were compared based on ASES at latest follow-up. Continuous and categorical variables were compared with the Mann-Whitney U test and Fisher exact test, respectively. Results: Follow-up was obtained from 83 of 99 patients (83.8%) who completed the original trial. There were no significant differences between the CBD and control groups with respect to age, sex, body mass index, rate of concomitant procedures, or number of anchors used intraoperatively. At 1-year follow-up, there were no significant differences between the CBD and control groups in VAS pain (0.8 vs 1.2, P = .38), ASES (93.0 vs 91.1, P = .71), SANE (87.6 vs 90.1, P = .24), or satisfaction (97.4 vs 95.4, P = .41). A majority of patients achieved the PASS (81.0% [CBD] vs 77.5% [control]; P = .79). Conclusion: Perioperative use of CBD for pain control among patients undergoing ARCR did not result in any significant deficits in pain, satisfaction, or patient-reported outcomes at 1-year postoperatively compared with a placebo control group. These findings suggest that CBD can be considered in a postoperative multimodal pain management regimen without detrimental effects on outcome. Registration: NCT04672252 (ClinicalTrials.gov identifier).

Perceptions and Opinions on Cannabidiol in the Orthopaedic Sports Medicine Community.

Background: Cannabidiol (CBD) is a known pain modulator that is garnering increased attention in the orthopaedic world. There may be a considerable knowledge gap among orthopaedic sports medicine providers and their perception of its therapeutic value. Purpose: To (1) examine the knowledge and beliefs of sports medicine orthopaedic providers with respect to CBD, (2) deliver an educational component, and (3) elucidate potential barriers to its widespread application. Study Design: Cross-sectional study. Methods: A 3-component, 25-question online survey was distributed to members of the American Orthopaedic Society for Sports Medicine and the Arthroscopy Association of North America between July and October 2022. The first 20 questions assessed baseline knowledge and opinions regarding CBD, followed by an educational component, and then 5 questions assessing whether the respondents' opinions had changed after learning more about CBD. Responses were compared according to age, practice setting, and state's cannabinoid legalization status using the chi-square test, and changes in opinions from before to after the educational component were compared using the paired t test. Results: There were 101 survey responses, for a response rate of approximately 1%. Most respondents believed that there is a role for CBD in postoperative pain management (76%), acute pain and inflammation after an injury (62%), and chronic pain (94%). Most respondents admitted that they were not knowledgeable about the mechanism of action (89%) or their state's laws (66%) concerning CBD. A minority (25%) believed that CBD has psychoactive properties. While most respondents (76%) did not believe that they would be stigmatized if they were to suggest CBD to a patient, only 48% had ever suggested CBD. Notably, 94% of respondents had encountered patients who reported trying CBD to treat pain. After reading the fact sheet, 51% of respondents stated that their opinion on CBD had changed, and 63% felt inclined to investigate the topic further. Conclusion: Most survey respondents believed that CBD has a role in postoperative and chronic pain management. Although there was a relative familiarity with CBD, there was a knowledge gap, suggesting that increased attention, education, and research are necessary.

The Use of Biologics in NFL Athletes: An Expert Consensus of NFL Team Physicians.

Background: There is a lack of published information outlining the use of biologics in National Football League (NFL) athletes and limited data to guide biologic treatment strategies. Purpose: To develop a consensus on the use of biologics among NFL team physicians. Study Design: Consensus statement. Methods: A working group of 6 experts convened a consensus process involving NFL team physicians using validated Delphi methodology. Physicians from 32 NFL teams as well as NFL London were invited to take part. This iterative process was used to define statements on the use of biologics in NFL athletes. A recent scoping review exploring biologics in professional athletes was used to inform the first of 3 rounds of surveys, with statements considered under 7 headings: biologics in general, challenges of treating NFL athletes, terminology/nomenclature, autologous blood products, cell-based therapies, guidance for NFL team physicians, and biologic research in the NFL. In addition to rating agreement, experts were encouraged to propose further items or modifications. Predefined criteria were used to refine item lists after each survey. For a consensus within the final round, defined a priori, items were included in the final information set if a minimum of 75% of respondents agreed and fewer than 10% disagreed. Results: Physicians from 26 NFL teams and NFL London responded to the initial invitation to participate in the Delphi process; 88.9% of participating team physicians completed the round 1 survey, with response rates of 87.5% in round 2 and 95.2% in round 3. After 3 rounds, 47 statements reached a consensus. A consensus was achieved that platelet-rich plasma has a positive impact on patellar tendinopathy and on symptoms in early osteoarthritis but not for other indications. NFL team physicians agreed that while cell therapies have the potential to improve symptoms, the misrepresentation of uncharacterized preparations as "stem cells" has contributed to the widespread use of unproven therapies. Conclusion: This study established an expert consensus on 47 statements relating to the use of biologics in NFL athletes. In addition to providing clinical guidance for the use of biologics in NFL athletes, this study identified key areas for future focus including the development of athlete education materials.

Buccally Absorbed Cannabidiol Shows Significantly Superior Pain Control and Improved Satisfaction Immediately After Arthroscopic Rotator Cuff Repair: A Placebo-Controlled, Double-Blinded, Randomized Trial.

BACKGROUND: Despite the widespread use and sales of cannabidiol (CBD) products in the United States, there is a paucity of literature to evaluate its effectiveness, safety, or ideal route of administration for postoperative pain. PURPOSE: To evaluate the potential analgesic effects of buccally absorbed CBD in patients who have undergone arthroscopic rotator cuff repair (ARCR). STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: This was a US Food and Drug Administration-sanctioned, multicenter, placebo-controlled, randomized, double-blinded trial conducted in patients undergoing ARCR. Patients aged from 18 to 75 years undergoing ARCR were prospectively enrolled and randomized to the control and experimental groups. The experimental group received an oral, buccally absorbed tablet containing 25 mg of CBD 3 times a day if <80 kg, or 50 mg of CBD 3 times a day if >80 kg, for 14 days postoperatively, while the control group received an identical placebo. Patients were followed up on days 1, 2, 7, and 14, and visual analog scale (VAS) for pain scores, opioid consumption, and satisfaction with pain control were recorded. Additionally, liver function tests were conducted on days 7 and 14 to assess safety, and nausea was monitored. P < .05 was considered to be statistically significant. RESULTS: Overall, 100 patients were recruited, with 1 patient being excluded, for a total of 99 patients. There were no significant differences in patient demographics between the 2 groups. On day 1, the VAS pain score was significantly lower in the CBD group than in the control group (4.4 ± 3.1 vs 5.7 ± 3.2, respectively; P = .04), although this difference was no longer present on day 2 (4.7 ± 2.8 vs 5.3 ± 2.6, respectively; P = .32). On both days 1 and 2, patient satisfaction with pain control was significantly higher in the CBD group than in the control group (day 1: 7.0 ± 3.0 vs 5.6 ± 3.7, respectively [P = .04]; day 2: 7.3 ± 2.5 vs 6.0 ± 3.3, respectively [P = .03]). The quantity of opioids consumed was low in both groups, and there were no statistically significant differences in opioid consumption (P > .05). On days 7 and 14, there were no statistically significant differences in VAS scores, opioid consumption, or patient satisfaction with pain control between the CBD and control groups (P > .05 for all). There were no significant differences in liver function test results postoperatively (P > .05). CONCLUSION: Buccally absorbed CBD demonstrated an acceptable safety profile and showed significant promise in the reduction of pain in the immediate perioperative period after ARCR compared with the control. Further studies are currently ongoing to confirm dosing and effectiveness in other orthopaedic conditions. REGISTRATION: NCT04672252 (ClinicalTrials.gov identifier).

Management of Sleep Disturbances Associated with Smith-Magenis Syndrome.

Smith-Magenis syndrome is a genetic disorder caused by a microdeletion involving the retinoic acid-induced 1 (RAI1) gene that maps on the short arm of chromosome 17p11.2 or a pathogenic mutation of RAI1. Smith-Magenis syndrome affects patients through numerous congenital anomalies, intellectual disabilities, behavioral challenges, and sleep disturbances. The sleep abnormalities associated with Smith-Magenis syndrome can include frequent nocturnal arousals, early morning awakenings, and sleep attacks during the day. The sleep problems associated with Smith-Magenis syndrome are attributed to haploinsufficiency of the RAI1 gene. One consequence of reduced function of RAI1, and characteristic of Smith-Magenis syndrome, is an inversion of melatonin secretion resulting in a diurnal rather than nocturnal pattern. Treatment of sleep problems in people with Smith-Magenis syndrome generally involves a combination of sleep hygiene techniques, supplemental melatonin, and/or other medications, such as melatonin receptor agonists, ß1-adrenergic antagonists, and stimulant medications, to improve sleep outcomes. Improvement in sleep has been shown to improve behavioral outcomes, which in turn improves the quality of life for both patients and their caregivers.

Objective measures of sleep disturbances in children with Potocki-Lupski syndrome.

Potocki-Lupski syndrome (PTLS; MIM 610883) is a neurodevelopmental disorder caused by a microduplication, a 3.7 Mb copy number variant, mapping within chromosome 17p11.2, encompassing the dosage-sensitive RAI1 gene. Whereas RAI1 triplosensitivity causes PTLS, haploinsufficiency of RAI1 due to 17p11.2 microdeletion causes the clinically distinct Smith-Magenis syndrome (SMS; MIM 182290). Most individuals with SMS have an inversion of the melatonin cycle. Subjects with PTLS have mild sleep disturbances such as sleep apnea with no melatonin abnormalities described. Sleep patterns and potential disturbances in subjects with PTLS have not been objectively characterized. We delineated sleep characteristics in 23 subjects with PTLS who underwent a polysomnogram at Texas Children's Hospital. Eleven of these subjects (58%) completed the Child's Sleep Habits Questionnaire (CSHQ). Urinary melatonin was measured in one patient and published previously. While the circadian rhythm of melatonin in PTLS appears not to be disrupted, we identified significant differences in sleep efficiency, percentage of rapid eye movement sleep, oxygen nadir, obstructive apnea hypopnea index, and periodic limb movements between prepubertal subjects with PTLS and previously published normative data. Data from the CSHQ indicate that 64% (7/11) of parents do not identify a sleep disturbance in their children. Our data indicate that younger individuals, <10 years, with PTLS have statistically significant abnormalities in five components of sleep despite lack of recognition of substantial sleep disturbances by parents. Our data support the contention that patients with PTLS should undergo clinical evaluations for sleep disordered breathing and periodic limb movement disorder, both of which are treatable conditions.

Using magnetic resonance imaging to determine preoperative autograft sizes in anterior cruciate ligament reconstruction.

PURPOSE: Accurate prediction of autograft size for anterior cruciate ligament reconstruction can assist in preoperative planning and decision-making regarding graft choices. This study seeks to determine the accuracy of MRI measurements by comparing intraoperative measurements of the patella, semitendinosis, and gracilis tendons while correlating these measurements with patient anthropometric data such as gender, height, and weight. METHODS: A series of 20 consecutive patients were enrolled who underwent a magnetic resonance imaging study of the knee and proceeded with surgical reconstruction of the anterior cruciate ligament. Intraoperative measurements of the diameter of semitendinosis and gracilis tendons or width of patella tendon were compared to radiographic measurements obtained on the MRI. These measurements were analyzed using a paired t-test as well as regression analysis to evaluate strength of correlation between measurements and also to determine correlation with height, weight, and gender. RESULTS: There was no statistical difference between intraoperative and radiographic measurements (p > 0.05). There was strong correlation (Pearson r = 0.98, p = 0.00) found between intraoperative and radiographic measurements of the autograft tendons. Weaker correlation was seen with gender, height, and weight with intraoperative measurements. CONCLUSIONS: Measuring the diameter of the semitendinosis and gracilis tendons and patellar width on MRI can give an accurate prediction of actual intraoperative sizes of these anatomic structures. Height, weight, and gender were also correlated with tendon sizes implying that a patient of female gender or of smaller stature in height or weight may have smaller tendon sizes. Routine use of preoperative MRI measurements can guide surgeons with specific graft preferences to other surgical options if the graft is measured to be insufficient in size.

A profile of glenohumeral internal and external rotation motion in the uninjured high school baseball pitcher, part II: strength.

CONTEXT: A database describing the range of normal rotator cuff strength values in uninjured high school pitchers has not been established. Chronologic factors that contribute to adaptations in strength also have not been established. OBJECTIVES: To establish a normative profile of rotator cuff strength in uninjured high school baseball pitchers and to determine whether bilateral differences in rotator cuff strength are normal findings in this age group. DESIGN: Cohort study. SETTING: Baseball playing field. PATIENTS OR OTHER PARTICIPANTS: A total of 165 uninjured male high school baseball pitchers (age = 16 ± 1 years, height=1.8±0.1 m, mass=76.8±10.1 kg, pitching experience =7±2 years). MAIN OUTCOME MEASURE(S): Isometric rotator cuff strength was measured bilaterally with a handheld dynamometer. We calculated side-to-side differences in strength (external rotation [ER], internal rotation [IR], and the ratio of ER:IR at 90° of abduction), differences in strength by age, and the influence of chronologic factors (participant age, years of pitching experience) on limb strength. RESULTS: Side-to-side differences in strength were found for ER, IR, and ER:IR ratio at 90° of abduction. Age at the time of testing was a significant but weak predictor of both ER strength (R(2)=0.032, P = .02) and the ER:IR ratio (R(2)=0.051 , P = .004) at 90° of abduction. CONCLUSIONS: We established a normative profile of rotator cuff strength for the uninjured high school baseball pitcher that might be used to assist clinicians and researchers in the interpretation of muscle strength performance in this population. These data further suggested that dominant-limb adaptations in rotator cuff strength are a normal finding in this age group and did not demonstrate that these adaptations were a consequence of the age at the time of testing or the number of years of pitching experience.

A profile of glenohumeral internal and external rotation motion in the uninjured high school baseball pitcher, part I: motion.

CONTEXT: The magnitude of motion that is normal for the throwing shoulder in uninjured baseball pitchers has not been established. Chronologic factors contributing to adaptations in motion present in the thrower's shoulder also have not been established. OBJECTIVES: To develop a normative profile of glenohumeral rotation motion in uninjured high school baseball pitchers and to evaluate the effect of chronologic characteristics on the development of adaptations in shoulder rotation motion. DESIGN: Cohort study. SETTING: Baseball playing field. PATIENTS OR OTHER PARTICIPANTS: A total of 210 uninjured male high school baseball pitchers (age = 16 ± 1.1 years, height=1.8±0.1 m, mass=77.5±11.2 kg, pitching experience=6±2.3 years). INTERVENTION(S): Using standard goniometric techniques, we measured passive rotational glenohumeral range of motion bilaterally with participants in the supine position. MAIN OUTCOME MEASURE(S): Paired t tests were performed to identify differences in motion between limbs for the group. Analysis of variance and post hoc Tukey tests were conducted to identify differences in motion by age. Linear regressions were performed to determine the influence of chronologic factors on limb motion. RESULTS: Rotation motion characteristics for the population were established. We found no difference between sides for external rotation (ER) at 0° of abduction (t(209) = 0.658, P = .51), but we found side-to-side differences in ER (t(209) =-13.012,P < .001) and internal rotation (t(209) =15.304, P < .001) at 90° of abduction. Age at the time of testing was a significant negative predictor of ER motion for the dominant shoulder (R(2) = 0.019, P = .049) because less ER motion occurred at the dominant shoulder with advancing age. We found no differences in rotation motion in the dominant shoulder across ages (F(4,205) range, 0.451-1.730,P > .05). CONCLUSIONS: This range-of-motion profile might be used to assist with the interpretation of normal and atypical shoulder rotation motion in this population. Chronologic characteristics of athletes had no influence on range-of-motion adaptations in the thrower's shoulder.

Knotless rotator cuff repair in an external rotation model: the importance of medial-row horizontal mattress sutures.

PURPOSE: To evaluate the effect of the addition of 2 horizontal mattress knots to the medial row of a knotless rotator cuff construct on the biomechanical properties in terms of both cyclic and failure testing parameters in an external rotation model. METHODS: In 8 fresh-frozen human cadaveric shoulders, a knotless transosseous repair was performed, whereas in 8 contralateral matched-pair specimens, 2 horizontal mattress knots were added to the medial-row fixation. A custom jig was used that allowed external rotation (0° to 30°) with loading. A materials testing machine was used to cyclically load repairs from 0 to 180 N for 30 cycles and then to failure. Video digitizing software was used for analysis. Data from paired specimens were compared by use of paired Student t tests. RESULTS: Ultimate load to failure was significantly higher in the modified construct (549 N v 311 N, P = .01). Linear stiffness in the first cycle, at the 30th cycle, and at failure was significantly higher (P = .02, P = .02, and P = .04, respectively) in the modified construct as well. Energy absorbed by the repaired tissue was significantly less in the modified construct at the first cycle, at the 30th cycle, and at ultimate load to failure (P = .03, P = .02, and P = .04, respectively). Significantly greater anterior gap formation occurred with the knotless technique at the first cycle (4.55 v 1.35) and 30th cycle (7.67 mm v 1.77 mm) (P = .02). CONCLUSIONS: The modified construct shows improved biomechanical properties when allowing for external rotation during high-load testing. Using an additional horizontal mattress from separate sutures in the medial-row anchors helps to neutralize forces experienced by the repair. CLINICAL RELEVANCE: The addition of medial-row fixation to a knotless construct will enhance the stability of rotator cuff repairs with the goal of improved patient outcomes.

Comparison of shoulder range of motion, strength, and playing time in uninjured high school baseball pitchers who reside in warm- and cold-weather climates.

BACKGROUND: There is an assumption that baseball athletes who reside in warm-weather climates experience larger magnitude adaptations in throwing shoulder motion and strength compared with their peers who reside in cold-weather climates. HYPOTHESES: (1) The warm-weather climate (WWC) group would exhibit more pronounced shoulder motion and strength adaptations than the cold-weather climate (CWC) group, and (2) the WWC group would participate in pitching activities for a greater proportion of the year than the CWC group, with the time spent pitching predicting throwing shoulder motion and strength in both groups. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: One hundred uninjured high school pitchers (50 each WWC, CWC) were recruited. Rotational shoulder motion and isometric strength were measured and participants reported the number of months per year they pitched. To identify differences between groups, t tests were performed; linear regression was used to determine the influence of pitching volume on shoulder motion and strength. RESULTS: The WWC group pitched more months per year than athletes from the CWC group, with the number of months spent pitching negatively related to internal rotation motion and external rotation strength. The WWC group exhibited greater shoulder range of motion in all planes compared with the CWC group, as well as significantly lower external rotation strength and external/internal rotation strength ratios. There was no difference in internal rotation strength between groups, nor a difference in the magnitude of side-to-side differences for strength or motion measures. CONCLUSION: Athletes who reside in cold- and warm-weather climates exhibit differences in throwing shoulder motion and strength, related in part to the number of months spent participating in pitching activities. The amount of time spent participating in pitching activities and the magnitude of range of motion and strength adaptations in athletes who reside in warm-weather climates may make these athletes more susceptible to throwing-related injuries.

A unique failure mechanism of a distal radius fracture fixed with volar plating--a case report.

Various treatment options exist for distal radius fractures, and the complications associated with operative and nonoperative management are well documented in the literature. While surgical management with the use of various buttress and locked plating constructs has gained popularity, the long-term outcomes of these plating techniques have not yet significantly demonstrated improved outcomes, as compared to adequately reduced nonoperative measures. Furthermore, this operative technique can be associated with failures and complications. We present a case report of one volar-plate construct requiring revision, secondary to loss of fracture reduction, with no evidence of implant loosening or failure. A literature review on the complications associated with these plate constructs is also presented.

Femoroacetabular impingement--diagnosis and treatment.

Femoroacetabular impingement results from an abnormal contact between the femur and the pelvis. This abnormal contact leads to developmental changes in the femoral neck, labrum, and acetabulum. Secondary to the altered hip joint mechanics, chondral damage occurs and initiates the degenerative process, eventually leading to osteoarthritis. Numerous etiologies have been implicated in femoroacetabular impingement, and a variety of treatment algorithms have been established, with no definitive gold standard. However, the treatment of this disorder with joint preserving techniques offers a viable option between the extremes of nonoperative treatment and total joint arthroplasty.

Assessment of arthroscopic training in U.S. orthopedic surgery residency programs--a resident self-assessment.

BACKGROUND: There has been an increasing number of arthroscopic surgeries performed in general orthopedic surgery practice, as well as a rapid evolution of arthroscopic techniques. The objective of this investigation was to assess the adequacy of arthroscopic training in U.S. orthopedic residency programs from a resident and program director perspective. MATERIALS AND METHODS: The study was performed with a mail-in survey to orthopaedic surgery residents and program directors. Out of 151 programs contacted, we received responses from 24 program directors (15.9%) and 272 residents (11.1% of 2447 possible residents in years 2 through 5 in 2006). Program demographics and resident and program director assessments of arthroscopic surgical training was obtained from the questionnaire. Assessment of open surgical techniques was used as a control. The responses from fifth-year residents (83 of a possible 612 in 2006 (13.6%)) and program directors were used for detailed analysis. RESULTS: Only 32% (27/83) of fifth-year residents felt there was adequate time dedicated to arthroscopic training, compared to 66% (16/24) of program directors (p < 0.01). Thirty-four percent (28/83) of fifth-year residents felt as prepared in arthroscopy as open techniques, in contrast to 58% (14/24) of program directors, who felt fifth-year residents were appropriately prepared in arthroscopic techniques (p = 0.03). The amount of surgery that residents are allowed to perform correlated significantly (p < 0.01) with confidence levels. CONCLUSIONS: Fifth-year residents who were surveyed felt less prepared in arthroscopic training, compared to open surgical procedures. Program directors surveyed over estimated confidence levels in fifth-year residents performing arthroscopic procedures. To ensure that graduating residents are appropriately prepared for the current demands of a clinical setting, it may be necessary to reexamine residency requirements to ensure adequate practice in developing arthroscopic surgical skills.

Surgical management of hip fractures: an evidence-based review of the literature. II: intertrochanteric fractures.

Treatment of intertrochanteric hip fracture is based on patient medical condition, preexisting degenerative arthritis, bone quality, and the biomechanics of the fracture configuration. A critical review of the evidence-based literature demonstrates a preference for surgical fixation in patients who are medically stable. Stable fractures can be successfully treated with plate-and-screw implants and with intramedullary devices. Although unstable fractures may theoretically benefit from load-sharing intramedullary implants, this result has not been demonstrated in the current evidence-based literature.

Surgical management of hip fractures: an evidence-based review of the literature. I: femoral neck fractures.

During the past 10 years, there has been a worldwide effort in all medical fields to base clinical health care decisions on available evidence as described by thorough reviews of the literature. Hip fractures pose a significant health care problem worldwide, with an annual incidence of approximately 1.7 million. Globally, the mean age of the population is increasing, and the number of hip fractures is expected to triple in the next 50 years. One-year mortality rates currently range from 14% to 36%, and care for these patients represents a major global economic burden. Surgical options for the management of femoral neck fractures are closely linked to individual patient factors and to the location and degree of fracture displacement. Nonsurgical management of intracapsular hip fractures is limited. Based on a critical, evidence-based review of the current literature, we have found minimal differences between implants used for internal fixation of displaced fractures. Cemented, unipolar hemiarthroplasty remains a good option with reasonable results. In the appropriate patient population, outcomes following total hip arthroplasty are favorable and appear to be superior to those of internal fixation.

Peroneal nerve compression secondary to an anomalous biceps femoris muscle in an adolescent athlete.

Common peroneal nerve compression is a well-recognized entity that can cause severe debilitating clinical manifestations. The current literature describes numerous locations and mechanisms of compression, including both structural and systemic causes. Anatomical variants should be considered part of the differential diagnosis in peroneal nerve impingement. We present the case of a 14-year-old basketball player with footdrop secondary to compression of the common peroneal nerve from an accessory biceps femoris muscle, which was treated by neurolysis. In addition, we review the systematic workup of patients with nerve compression.

Rugby injuries: a review of concepts and current literature.

Rugby football continues to grow in popularity internation- ally and within the United States. In 1995, rugby union, one form of rugby, turned from amateur to professional through- out Europe, increasing the potential for monetary reward, which, in turn, secondary to higher levels of play, increased the risk of injury. With this increased higher interest and the increasing number of inexperienced and professional players in the U.S., there is a need for a comprehensive analysis of professional rugby union injury in the American literature and increased awareness of rugby injuries, in general, for all levels of players. This paper provides an in-depth analysis of professional rugby union injuries that will assist ortho- paedic surgeons treating these injuries in the U.S. The data described highlights the potential impact of rugby injury in the U.S. and provides an overview of the international data to serve as the basis for future American studies. An additional goal of this review is to stimulate discussion regarding the necessity of implementing additional safety precautions for this high-risk sport. Finally, this analysis highlights the in- consistencies and discrepancies of the literature with respect to rugby union injury and the variability and weak interstudy reproducibility of current rugby injury data.

Bilateral humerus and corner fractures in an 18-month-old infant: a case report and review of child abuse from the resident perspective.

Child abuse continues to be a serious problem that is likely to be encountered in all medical specialties, with orthopaedic surgeons commonly evaluating children having sustained musculoskeletal injuries. In busy emergency departments and clinics, junior residents shoulder much of the responsibility in identifying cases of abuse. We report the case of an otherwise healthy 18-month-old child, who presented to the emergency room with bilateral humeral shaft and corner fractures. These injuries were originally presented to the orthopaedic resident as having occurred from an accidental fall from a crib. The appropriate evaluation for a patient suspected of sustaining an injury from child abuse is reviewed.