Exercise-Induced Inguinal Hydrocele: An Unconventional Presentation of a Common Problem.

Inguinal hernias are very common. Well-established diagnostic criteria including examination and imaging are available. Ultrasound, herniography, CT, and MR imaging can provide additional diagnostic information when examination alone is not deemed sufficient. However, decision making should not be overly dependent on imaging but must factor in all relevant information. Described here is a case that would have been a missed diagnosis and an example of unconventional documentation that facilitated the patient getting their care.

The Cost of Oncology Drugs: A Pharmacy Perspective, Part 2.

Guidance documents, the Pharmacy Benefits Management Services, and the VA National Formulary help clinicians and pharmacists decide whether to administer high-cost cancer treatments.

The Cost of Oncology Drugs: A Pharmacy Perspective, Part I.

Even in the VA, the high cost of oncology medications are forcing health care providers to confront the economic impact of cancer care.

Acetabular reconstruction in revision total hip arthroplasty: maximizing function and outcomes in protrusio and cavitary defects.

Osteolysis in the periacetabular region is a common long-term complication of total hip arthroplasty that can lead to bone loss, implant loosening, and protrusio. Several systems have been developed for classifying osteolysis and guiding treatment. Options such as bone grafting or augmentation, with exchange of the bearing surface and, in some cases, revision of the acetabular component, can be used for treatment. Most cavitary and protrusio defects can be treated with a cementless revision cup using screw fixation and grafting with morcellized bone. However, structural augmentation, custom components, or cage reconstruction may occasionally be necessary for managing larger defects with severe loss of acetabular bone stock.

Is portable ultrasonography accurate in the evaluation of Schanz pin placement during extremity fracture fixation in austere environments?

OBJECTIVE: The purpose of this study was to investigate the efficacy of ultrasonography to confirm Schanz pin placement in a cadaveric model, and the interobserver repeatability of the ultrasound methodology. DESIGN: This investigation is a repeated measures cadaveric study with multiple examiners. PARTICIPANTS: Cadaveric preparation and observations were done by an orthopaedic traumatologist and resident, and two general surgery traumatologists. INTERVENTIONS: A total of 16 Schanz pins were equally placed in bilateral femora and tibiae. Four examiners took measurements of pin protrusion beyond the distal cortices using first ultrasonography and then by direct measurement after gross dissection. MAIN OUTCOME MEASURE(S): Distal Schanz pin protrusion length measurements from both ultrasonography and direct measurement post dissection. RESULTS: Schanz pin protrusion measurements are underestimated by ultrasonography (p < 0.01) by an average of 10 percent over the range of 5 to 18 mm, and they display a proportional bias that increases the under reporting as the magnitude of pin protrusion increases. Ultrasound data demonstrate good linear correlation and closely represent actual protrusion values in the 5 to 12 mm range. Interobserver repeatability analysis demonstrated that all examiners were not statistically different in their measurements despite minimal familiarity with the ultrasound methodology (p > 0.8). CONCLUSIONS: Despite the statistical imparity of pin protrusion measurement via ultrasound compared to that of gross dissection, a consideration of the clinical relevance of ultrasound measurement bias during an austere operating theatre leads to the conclusion that ultrasonography is an adequate methodology for Schanz pin protrusion measurement.

Highly crosslinked polyethylene is safe for use in total knee arthroplasty.

UNLABELLED: Highly cross-linked polyethylene (XLPE) has been used with good initial success in hip arthroplasty to reduce wear. However, the process of crosslinking reduces fracture toughness, raising concerns as to whether it can be safely used in total knee arthroplasty (TKA). We therefore asked whether XLPE can be used safely in TKA. We performed a retrospective review of 100 subjects receiving XLPE and compared them to 100 subjects who received standard polyethylene in the setting of TKA. The standard polyethylene group had a mean age of 70 with a minimum follow up of 82 months. The highly cross-linked polyethylene group had a mean age of 67 and a minimum follow up of 69 months (mean, 75 months; range, 69-82 months). On radiographic review, the standard group demonstrated 20 TKAs with radiolucencies; 4 of these had evidence of a loose tibial component. The standard group required three revisions related to loose tibial components. The XLPE group had 2 subjects that demonstrated radiolucencies on radiograph and no subjects with evidence of tibial loosening. There were no reoperations related to osteolysis. The data suggest XLPE in TKA can be used safely at least short- to midterm. Our study provides an impetus for further long-term investigation. LEVEL OF EVIDENCE: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.