Outcomes of Pedicled Groin Flaps for Upper Extremity Injuries.

BACKGROUND: Free flap reconstruction has become the more common treatment over pedicled groin flaps for reconstruction of upper extremity injuries in recent years. Groin flaps are still used for a variety of reasons, though limited literature is available to guide surgeons and patients regarding outcomes. This study aimed to investigate the epidemiology and outcomes of pedicled groin flaps for upper extremity pathology. METHODS: The study was a single-institution retrospective case series at a level one trauma center including patients who underwent pedicled groin flaps for upper extremity soft tissue coverage between 1992 and 2022. The data collected included patient and injury characteristics, surgical management, and complication data. Ordinal logistic regression, univariate analysis, and bivariate analysis were performed to assess the relationship between the total number of groin flap surgeries and complications with patient and injury characteristics. RESULTS: The analysis included 88 pedicled groin flaps performed for upper extremity injuries, with a median follow-up of 1.14 years after injury. Patients had a median age of 35 (interquartile range [IQR]: 22-49) years and underwent a median of 4 (IQR: 3-5.25) surgeries with stiffness (90.6%), partial flap loss (38%), and infection (32%) as the most common complications. High-energy injuries increased the risk of requiring more surgeries based on ordinal logistic regression. Univariate and bivariate analysis revealed no significant difference in wound complications based on patient or injury characteristics. CONCLUSIONS: Patients undergoing pedicled groin flaps for upper extremity injuries can expect to undergo an average of 4 surgeries, and high-energy injuries predict the need for more surgeries.

Racial and Socioeconomic Disparities in Laminoplasty Versus Laminectomy With Fusion in Patients With Cervical Spondylosis.

STUDY DESIGN: A retrospective cohort study using prospectively collected data. OBJECTIVE: The aim of this study was to investigate preoperative differences in racial and socioeconomic factors in patients undergoing laminoplasty (LP) versus laminectomy and fusion (LF) for degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA: DCM is prevalent in the United States, requiring surgical intervention to prevent neurological degeneration. While LF is utilized more frequently, LP is an emerging alternative. Previous studies have demonstrated similar neurological outcomes for both procedures. However, treatment selection is primarily at the discretion of the surgeon and may be influenced by social determinants of health that impact surgical outcomes. MATERIALS AND METHODS: The Quality Outcome Database (QOD), a national spine registry, was queried for adult patients who underwent either LP or LF for the management of DCM. Covariates associated with socioeconomic status, pain and disability, and demographic and medical history were collected. Multivariate logistic regression was performed to assess patient factors associated with undergoing LP versus LF. RESULTS: Of 1673 DCM patients, 157 (9.4%) underwent LP and 1516 (90.6%) underwent LF. A significantly greater proportion of LP patients had private insurance (P<0.001), a greater than high school level education (P<0.001), were employed (P<0.001), and underwent primary surgery (P<0.001). LP patients reported significantly lower baseline neck/arm pain and Neck Disability Index (P<0.001). In the multivariate regression model, lower baseline neck pain [odds ratio (OR)=0.915, P=0.001], identifying as non-Caucasian (OR=2.082, P<0.032), being employed (OR=1.592, P=0.023), and having a greater than high school level education (OR=1.845, P<0.001) were associated with undergoing LP rather than LF. CONCLUSIONS: In DCM patients undergoing surgery, factors associated with patients undergoing LP versus LF included lower baseline neck pain, non-Caucasian race, higher education, and employment. While symptomatology may influence the decision to choose LP over LF, there may also be socioeconomic factors at play. The trend of more educated and employed patients undergoing LP warrants further investigation.

Crossing the Cervicothoracic Junction: A Review of the Current Literature.

ABSTRACT: The cervicothoracic junction (CTJ) is the site of transition in biomechanical, osseous, and alignment properties of the spine. The interface between the highly mobile, lordotic cervical spine and the rigid, kyphotic thoracic spine results increased the biomechanical stress experienced at this junction. The concentration of stress at this level has led to high rates of failure when instrumenting near or across the CTJ. The changes in osseous anatomy from the cervical spine to the thoracic spine present additional challenges in construct planning. For these reasons, a thorough understanding of the complexity of the cervicothoracic junction is necessary when operating near or across the CTJ. There are multiple options for cervical fixation, including lateral mass screws, pedicle screws, and laminar screws, each with its own advantages and risks. Instrumentation at C7 is controversial, and there is data supporting both its inclusion in constructs and no risk when this level is skipped. Thoracic pedicle screws are the preferred method of fixation in this region of the spine; however, the connection between cervical and thoracic screws can be challenging due to differences in alignment. Transitional rods and rod connectors mitigate some of the difficulties with this transition and have shown to be effective options. Recently, more investigation has looked into the failure of posterior cervical constructs which end at or near the CTJ. The trend in data has favored fixation to T1 or T2 rather than ending a construct at C7 due to the decreased rates of distal junction kyphosis. Although data on patient-reported outcomes with a length of constructs and the lowest instrumented vertebra is scarce, preliminary reports show no difference at this time. As posterior cervical instrumentation continues to increase in frequency, the CTJ will continue to be an area of difficulty in navigation and instrumentation. A thorough understanding of this region is necessary and continued research is needed to improve outcomes. LEVEL OF EVIDENCE: Level V.

Cruciate Substituting Implants in Primary Total Knee Arthroplasty.

The use of cruciate substituting (CS) total knee replacement has been increasing in popularity. There are numerous factors that have likely contributed to this expansion. The CS philosophy incorporates the ease of use commonly cited by advocates of the posterior stabilized (PS) total knee design with the bone preservation associated with a cruciate retaining (CR) design. The ultra-congruent highly cross-linked polyethylene liner increases stability without an appreciable change in wear. Furthermore, balancing the flexion and extension gaps does not require "titrating" the posterior cruciate ligament, improving the user-friendliness. This paper reviews the nuances of this implant design compared to PS and CR designs as well as provides surgical technique recommendations/considerations.

Performance and Return to Sport After Hip Arthroscopy for Femoroacetabular Impingement in Professional Athletes Differs Between Sports.

PURPOSE: To determine (1) return-to-sport rates for National Football League, Major League Baseball, National Basketball Association, and National Hockey League (NHL) athletes after hip arthroscopy for femoroacetabular impingement syndrome, (2) postoperative return-to-sport rate differences between sports, (3) differences in postoperative career length and games per season, (4) differences in preoperative and postoperative performance, and (5) postoperative performance compared with that of matched control players. METHODS: Professional athletes who underwent hip arthroscopy for femoroacetabular impingement syndrome were identified. Matched control players were identified by position, age, experience, and performance. Return to sport was defined as playing in at least 1 game after surgery. Continuous variables for each group were compared by using a 2-tailed paired-samples Student t test or χ2 test. A Bonferroni correction was used to control for multiple comparisons with statistical significance defined by a P value < .002. RESULTS: One hundred seventy-two players (86.4%) (mean age, 28.8 ± 5.2 years) were able to return to sport at an average of 7.1 ± 4.1 months. Athletes played 3.5 ± 2.4 years after surgery without significant differences between sports (P > .002). NHL players who underwent surgery played significantly fewer years (4.4 vs 3.3 years) (P < .001) and fewer games per season (4 fewer games) (P <.001) after surgery compared with control players. NHL players also had a significant decrease in performance after surgery compared with their performance before surgery (P < .001). In National Football League, Major League Baseball, and National Basketball Association athletes, no significant differences were found in games per season, career length, or preoperative performance compared with postoperative performance and performance of matched control players (P > .002). CONCLUSION: The RTS rate for professional athletes after surgery for femoroacetabular impingement syndrome is high. Only NHL athletes had significantly shorter careers and played significantly fewer games per season compared with matched control players, with no difference between sports. NHL athletes had significantly worse postoperative performance compared with preoperative performance, with all other sports demonstrating a career-related decline similar to that of matched control players.