Pelvic Incidence Changes Between Flexion and Extension.

STUDY DESIGN: Retrospective single-center. OBJECTIVES: To investigate changes in pelvic incidence from flexion to extension. To assess interobserver error in the measurement of pelvic incidence. BACKGROUND: Pelvic incidence (PI) has been considered a static parameter since it was originally described. But recent studies have shown that PI can change with age and after spinal procedures. Changes in PI based on position have not been investigated. METHODS: Seventy-two patients who had obtained flexion and extension radiographs of the lumbar spine were identified using strict inclusion and exclusion criteria. PI along with pelvic tilt (PT), sacral slope (SS), and lumbar lordosis were measured in both flexion and extension by two independent measurers. Variations in all parameters and interobserver measurement reliability were analyzed for the entire group. RESULTS: PI changed significantly from flexion to extension with a general tendency to decrease: mean (-0.94°), p <.044. However, these changes might have had opposite vectors, and exceeded | 6°| (measurement error) in 20% of cases, with a maximum of 12°. Inconsistencies in changes of SS, as opposed to PT from flexion to extension, were found to be the major factor determining changes in PI (p >.001). Obesity significantly contributed to differences in PI between flexion and extension (p = .003). CONCLUSIONS: PI is a dynamic parameter that changes between flexion and extension. Changes in SS are the main factor involved in these changes, implicating movement through the sacroiliac joints as the cause. Obese patients have greater changes in PI from flexion to extension. LEVEL OF EVIDENCE: Level II.

Utility of Postoperative Antibiotics After Percutaneous Pinning of Pediatric Supracondylar Humerus Fractures.

BACKGROUND: Pediatric supracondylar humerus fractures are common injuries that are often treated surgically with closed reduction and percutaneous pinning. Although surgical-site infections are rare, postoperative antibiotics are frequently administered without evidence or guidelines for their use. With the increasing prevalence of antibiotic-resistant organisms and heightened focus on health care costs, appropriate and evidence-based use of antibiotics is needed. We hypothesized that postoperative antibiotic administration would not decrease the rate of surgical-site infection. METHODS: A billing query identified 951 patients with operatively treated supracondylar humerus fractures at our institution over a 15-year period. Records were reviewed for demographic data, perioperative antibiotic use, and the presence of surgical-site infection. Exclusion criteria were open fractures, open reduction, pathologic fractures, metabolic bone disease, the presence of other injuries that required operative treatment, and follow-up <2 weeks after pin removal. χ and Fisher exact test were used to compare antibiotic use to the incidence of surgical-site infection. RESULTS: Six hundred eighteen patients met our inclusion criteria. Two hundred thirty-eight patients (38.5%) received postoperative antibiotics. Eleven surgical-site infections were identified for an overall rate of 1.8%. The use of postoperative antibiotics was not associated with a lower rate of surgical-site infection (P=0.883). Patients with a type III fracture (P<0.001), diminished preoperative vascular (P=0.001) and neurological status (P=0.019), and postoperative hospital admission (P<0.001) were significantly more likely to receive postoperative antibiotics. CONCLUSIONS: Administration of postoperative antibiotics after closed reduction and percutaneous pinning of pediatric supracondylar humerus fractures does not decrease the rate of surgical-site infection. LEVEL OF EVIDENCE: Level III-therapeutic.

Comparison of manipulation and arthroscopic capsular release for adhesive capsulitis: a systematic review.

BACKGROUND: It is currently unclear as to whether there is a difference in the clinical effectiveness of an arthroscopic capsular release compared to a manipulation under anaesthesia (MUA) in patients with recalcitrant idiopathic adhesive capsulitis. METHODS: A systematic review was performed using computerized keyword searches of MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews. Two reviewers independently performed searches and article reduction. Studies that reported outcomes data following either a manipulation under regional or general anaesthesia or an arthroscopic capsular release in patients with idiopathic adhesive capsulitis were included. Data on clinical measures of shoulder range of motion and subjective outcome measures were extracted and summarized. RESULTS: Twenty-two studies (21 studies provided level IV evidence) including 989 patients were included resulting in a comparison of 9 MUA and 17 capsular release groups. Patients were 60% female with a median age of 52 years old (range, 24-91 years). Median duration of symptoms and follow-up were 9 months (range, 3-50) and 35 months (range, 3-189), respectively. There were minimal differences in the median changes in abduction, flexion, and external rotation range of motion (ROM), and final Constant score between the MUA and capsular release groups. CONCLUSION: The quality of evidence available is low and the data available demonstrate little benefit for a capsular release instead of, or in addition to, an MUA. A high quality study is required to definitively evaluate the relative benefits of these procedures.

Osteosarcoma Phenotype Is Inhibited by 3,4-Methylenedioxy-ß-nitrostyrene.

ß-nitrostyrene compounds, such as 3,4-methylenedioxy-ß-nitrostyrene (MNS), inhibit growth and induce apoptosis in tumor cells, but no reports have investigated their role in osteosarcoma. In this study, human osteosarcoma cell families with cell lines of varying tumorigenic and metastatic potential were utilized. Scrape motility assays, colony formation assays, and colony survival assays were performed with osteosarcoma cell lines, both in the presence and absence of MNS. Effects of MNS on human osteoblasts and airway epithelial cells were assessed in monolayer cultures. MNS decreased metastatic cell line motility by 72-76% and colony formation by 95-100%. MNS consistently disrupted preformed colonies in a time-dependent and dose-dependent manner. MNS had similar effects on human osteoblasts but little effect on airway epithelial cells. An inactive analog of MNS had no detectable effects, demonstrating specificity. MNS decreases motility and colony formation of osteosarcoma cells and disrupts preformed cell colonies, while producing little effect on pulmonary epithelial cells.