Interposition Arthroplasty of the Elbow After Proximal Ulna Reconstruction With the Masquelet Technique: A Case Report.

INTRODUCTION: Periarticular bone loss in the upper extremity poses challenges for a functional reconstruction. CASE: A 32-year-old man sustained an open elbow fracture-dislocation from a high-velocity gunshot resulting in significant bone and soft-tissue loss about the proximal ulna. He underwent bony reconstruction with the Masquelet technique and delayed interposition arthroplasty in an attempt to preserve function. CONCLUSIONS: The Masquelet technique, coupled with interposition arthroplasty, may be used to address significant articular bony defects about the proximal ulna, allowing patients to maintain function and limit pain.

Corrigendum to "Bilateral Proximal Tibia Stress Fractures through Persistent Physes".

[This corrects the article DOI: 10.1155/2018/8181547.].

Treatment of a Subacute Locked Thumb Metacarpophalangeal Joint with Sesamoid Entrapment.

INTRODUCTION: Locked thumb metacarpophalangeal (MCP) joints due to entrapped radial sesamoids are rare injuries that commonly require open reduction, especially when the injury is delayed in presentation. CASE PRESENTATION: We present a case of a 24-year-old female with a subacute thumb MCP joint subluxation due to an incarcerated radial sesamoid. She underwent successful closed reduction but had persistent pain and difficulty gripping large objects necessitating eventual open volar plate repair despite therapy. She was able to achieve full motion, with little pain and disability, after undergoing delayed volar plate repair. DISCUSSION: Delayed volar plate repair may be considered for those patients who fail to improve with conservative management and occupational therapy after a successful closed reduction for thumb MCP joint subluxation due to an incarcerated radial sesamoid.

Patient Safety: Driving After Foot and Ankle Surgery.

This article provides a review of the existing literature regarding driving limitations following lower extremity orthopedic surgery. Medicolegal requirements and insurance recommendations are often vague and subject to interpretation. Several studies have examined the impact of surgery and immobilization on brake reaction time. This study summarizes the findings of these studies. Additionally, the authors consider the impact of lower extremity amputations and peripheral vascular disease on driving. Literature regarding opioid use, obesity, sleep apnea, increasing age, and distraction is also reviewed. An improved understanding of these topics will enhance the orthopedic surgeon's ability to counsel patients and optimize their safety.

Bilateral Proximal Tibia Stress Fractures through Persistent Physes.

INTRODUCTION: Fatigue fractures are stress fractures resulting from repetitive trauma in areas of stress concentration. Prior case reports and studies have described stress fractures through persistent physes about the olecranon and distal fibula, as evidenced by hyaline cartilage on histologic analysis. However, there have been no documented proximal tibia stress fractures through persistent physes. CASE PRESENTATION: A 29-year-old military male basic trainee with varus alignment about his knees suffered bilateral medial tibial plateau stress fractures several weeks into military basic training. He underwent radiographic and laboratory evaluation of his stress fractures and eventual operative fixation of his bilateral tibial plateau fractures. Intraoperative specimens obtained from the fracture sites distal to the articular surface demonstrated abnormal fibrous appearing tissue. Histology demonstrated the presence of hyaline cartilage. DISCUSSION: A 29-year-old military male basic trainee had bilateral proximal tibia stress fractures through persistent physes confirmed with biopsies demonstrating hyaline cartilage. Our belief is that the patient's persistent physes placed him at a greater risk for stress fractures and these may benefit from fixation in soldiers and athletes.

A Comparison of Outcomes of Particulated Juvenile Articular Cartilage and Bone Marrow Aspirate Concentrate for Articular Cartilage Lesions of the Talus.

BACKGROUND: Articular cartilage lesions of the talus remain a challenging clinical problem because of the lack of natural regeneration and limited treatment options. Microfracture is often the first-line therapy, however lesions larger than 1.5 cm2 have been shown to not do as well with this treatment method. METHODS: The objective of this retrospective study was to evaluate the outcomes of iliac crest bone marrow aspirate concentrate/collagen scaffold (ICBMA) and particulated juvenile articular cartilage (PJAC) for larger articular cartilage lesions of the talus. Fifteen patients undergoing ICBMA or PJAC for articular cartilage lesions of the talus from 2010 to 2013 were reviewed. Twelve patients, 6 from each treatment option, were included in the study. American Orthopaedic Foot and Ankle Surgeons (AOFAS), Foot and Ankle Ability Measure (FAAM), and Short Form-12 (SF-12) outcome scores were collected for each patient. RESULTS: The mean age was 34.7 ± 14.8 years for ICBMA and 31.5 ± 7.4 years for PJAC. Lesion size was 2.0 ± 1.1 cm2 for ICBMA and 1.9 ± 0.9 cm2 for PJAC. At a mean follow-up of 25.7 months (range, 12-42 months), the mean AOFAS score was 71.33 for ICBMA and 95.83 for PJAC ( P = .019). The FAAM activities of daily living subscale mean was 77.77 for ICBMA and 97.02 for PJAC ( P = .027). The mean FAAM sports subscale was 45.14 for ICBMA and 86.31 for PJAC ( P = .054). The SF-12 physical health mean was 47.58 for ICBMA and 53.98 for PJAC ( P = .315). The SF-12 mental health mean was 53.25 for ICBMA and 57.8 for PJAC ( P = .315). One patient in treated initially with ICBMA underwent revision fixation for nonunion of their medial malleolar osteotomy, which ultimately resulted in removal of hardware and tibiotalar arthrodesis at 2 years from the index procedure. CONCLUSION: In the present analysis, PJAC yields better clinical outcomes at 2 years when compared with ICBMA for articular cartilage lesions of the talus that were on average greater than 1.5cm2. LEVELS OF EVIDENCE: Therapeutic, Level IV: Retrospective, Case series.

Revision Anterior Cruciate Ligament Reconstruction: Results of a Single-stage Approach Using Allograft Dowel Bone Grafting for Femoral Defects.

INTRODUCTION: The purpose of this study was to present results of single-stage revision anterior cruciate ligament (ACL) reconstruction using an allograft bone dowel for isolated femoral bony deficiency. METHODS: Sixteen patients underwent single-stage revision ACL reconstruction using an allograft bone dowel for isolated femoral bony deficiency between 2007 and 2012. Twelve patients (75%) completed study visits, which included CT scans as well as completion of validated outcomes measures. RESULTS: The average KT-1000 side-to-side difference was 1.0 mm ± 2.9 mm. The average International Knee Documentation Committee score was 70.2 ± 17.8, the Tegner score was 4.8 ± 2.8, and the visual analog scale pain score was 2.8 ± 2.4. An analysis of CT scans showed that all 12 dowels had excellent (>75%) incorporation. CONCLUSIONS: A single-stage approach for revision ACL reconstruction using allograft dowels for isolated femoral bony deficiency yields objective and subjective outcomes comparable to those reported in the literature for two-stage and other single-stage techniques, with good incorporation of the dowels. LEVEL OF EVIDENCE: Retrospective case series, level IV.

Identification of T-cell factor-4 isoforms that contribute to the malignant phenotype of hepatocellular carcinoma cells.

The Wnt/ß-catenin signaling pathway is frequently activated in hepatocellular carcinoma (HCC). Downstream signaling events involving the Wnt/ß-catenin cascade occur through T-cell factor (TCF) proteins. The human TCF-4 gene is composed of 17 exons with multiple alternative splicing sites. However, the role of different TCF-4 isoforms in the pathogenesis of HCC is unknown. The purpose of this study was to identify and characterize TCF-4 isoforms in HCC. We identified 14 novel TCF-4 isoforms from four HCC cell lines. Functional analysis following transfection and expression in HCC cells revealed distinct effects on the phenotype. The TCF-4J isoform expression produced striking features of malignant transformation characterized by high cell proliferation rate, migration and colony formation even though its transcriptional activity was low. In contrast, the TCF-4K isoform displayed low TCF transcriptional activity; cell proliferation rate and colony formation were reduced as well. Interestingly, TCF-4J and TCF-4K differed by only five amino acids (the SxxSS motif). Thus, these studies suggest that conserved splicing motifs may have a major influence on the transcriptional activity and functional properties of TCF-4 isoforms and alter the characteristics of the malignant phenotype.

Aircraft measurements of nitrogen and phosphorus in and around the Lake Tahoe Basin: implications for possible sources of atmospheric pollutants to Lake Tahoe.

Atmospheric deposition of nitrogen (N) and phosphorus (P) into Lake Tahoe appears to have been a major factor responsible for the shifting of the lake's nutrient response from N-limited to P-limited. To characterize atmospheric N and P in and around the Lake Tahoe Basin during summer, samples were collected using an instrumented aircraft flown over three locations: the Sierra Nevada foothills east of Sacramento ("low-Sierra"), further east and higher in the Sierra ("mid-Sierra"), and in the Tahoe Basin. Measurements were also made within the smoke plume downwind of an intense forest fire just outside the Tahoe Basin. Samples were collected using a denuder-filter pack sampling system (DFP) and analyzed for gaseous and water-soluble particle components including HNO3/ NO3-, NH3 /NH4+, organic N (ON), total N, SRP (soluble reactive phosphate) and total P. The average total gaseous and particulate N concentrations (+/- 1sigma) measured over the low- and mid-Sierra were 660 (+/- 270) and 630 (+/- 350) nmol N/m3-air, respectively. Total airborne N concentrations in the Tahoe samples were one-half to one-fifth of these values. The forest fire plume had the highest concentration of atmospheric N (860 nmol N/m3-air) and a greater contribution of organic N (ON) to the total N compared to nonsmoky conditions. Airborne P was rarely observed over the low- and mid-Sierra but was present at low concentrations over Lake Tahoe, with average +/- 1sigma) concentrations of 2.3 +/- 2.9 and 2.8 +/- 0.8 nmol P/m3-air under typical clear air and slightly smoky air conditions, respectively. Phosphorus in the forestfire plume was present at concentrations approximately 10 times greater than over the Tahoe Basin. P in these samples included both fine and coarse particulate phosphate as well as unidentified, possibly organic, gaseous P species. Overall, our results suggest that out-of-basin emissions could be significant sources of nitrogen to Lake Tahoe during the summer and that forest fires could be important sources of both N and P.