Reliability of early postoperative radiographic assessment of tunnel placement after anterior cruciate ligament reconstruction.

PURPOSE: To evaluate the interobserver and intraobserver reliability of radiographic assessment of tunnel placement in anterior cruciate ligament reconstruction. METHODS: Seven sports fellowship-trained orthopaedic surgeons in the Multicenter Orthopaedic Outcomes Network (MOON) group participated in the study. We prospectively enrolled 54 consecutive patients after primary anterior cruciate ligament reconstruction. Postoperative plain radiographs were obtained including a full-extension anteroposterior view of the knee, a lateral view of the knee in full extension, and a notch view at 45° of flexion (Rosenberg view). Three blinded reviewers performed 8 different radiographic measurements including those of Harner and Aglietti/Jonsson. Intraclass correlation coefficients were used to determine reliability of the measurements. Intrarater reliability was assessed by repeated measurements of a subset of 20 patient images from 1 institution, and inter-rater reliability was assessed by use of all 54 sets of films from a total of 4 institutions. RESULTS: Intraobserver reliability for femoral measures ranged from none to substantial, with notch height having the worst results. Intraobserver reliability was moderate to almost perfect for tibial measures. Interobserver reliability ranged from slight to moderate for femoral measures. The Harner method for determining tunnel depth was more reliable than the Aglietti/Jonsson method. Interobserver reliability for tibial measures ranged from fair to substantial. The presence of metal interference screws did not improve reliability of measurements. CONCLUSIONS: Postoperative radiographs are easily obtained, but our results show that radiographic measurements are of quite variable reliability, with most of the results falling into the fair to moderate categories.

Intrapelvic migration of a gamma nail lag screw: review of the possible mechanisms.

This article presents a case of intrapelvic migration of a Gamma nail lag screw (Stryker, Mahwah, New Jersey) in an 82-year-old woman 7 months after fixation of an unstable pertrochanteric fracture. Two of the most common complications associated with the use of the Gamma nail and other sliding intramedullary devices, as well as lag screw and side plate devices, relate to the lag screw: cut out and medial migration in the femoral head. As compared to lag screw migration in the femoral head, intrapelvic migration of the Gamma lag screw is a rare complication. To our knowledge, intra-pelvic migration after disengagement of the lag screw from the Gamma nail has been reported in the literature only 3 times. Several risk factors can be associated with Gamma nail failure, most importantly damage to femoral head leading to lag screw migration, plate/lag or nail/lag screw interface dysfunction, technical mistakes, and additional subsequent trauma. This article reviews the literature and the theories for such device failures.

Closed reduction of a dislocated constrained total hip arthroplasty using a novel technique with a PEG board.

This article describes a case of closed reduction of a dislocated total hip arthroplasty (THA) out of a constrained acetabular liner using a novel technique with a peg board secured to the operating table.A 79-year-old woman sustained multiple dislocations after a primary THA. She was converted to a constrained liner and sustained no further dislocations for 5 years. She presented after dislocating her hip while getting out of a chair. The patient was taken to the operating room, placed under general anesthesia, and laid supine on the operating table, to which a peg board had been previously securely attached. A padded perineal post was placed in the patient's groin into the peg board. Under fluoroscopy, in-line traction was applied to the right leg until the femoral head was perched on the acetabular liner. With internal rotation and pressure over the trochanter, the femoral head was reduced.This technique requires less set-up time than using a fracture table. It also securely stabilizes the patient without skilled assistants during longitudinal traction. Moreover, if closed reduction fails, the patient can be rapidly placed in the lateral decubitus position for open reduction or revision arthroplasty. Successful closed reduction of a dislocated constrained liner turns an emergent case into an elective case if revision arthroplasty is indicated. This technique can also be easily used for the more common reductions of dislocated nonconstrained THAs.

Mentoring in otolaryngology training programs.

OBJECTIVE: The Accreditation Council for Graduate Medical Education's focus on outcome-based training has made the mentoring process critical for resident education. It is unknown how otolaryngology training programs mentor residents. Our objective was to determine the current state of mentoring in otolaryngology training programs and describe resident perceptions of mentoring. STUDY DESIGN: Cross-sectional survey. SETTING: Accredited U.S. otolaryngology training programs. SUBJECTS AND METHODS: All U.S. otolaryngology residents and program directors were contacted via e-mail with a link to an online survey. RESULTS: Of the 1411 residents contacted, 27.7 percent responded, representing 71 of the 103 accredited otolaryngology programs. Of the 103 program directors contacted, 37.9 percent responded. Of these programs, 26 had formal mentoring programs, 45 did not have formal mentoring programs, and 12 programs were listed in both categories. Fifty-one percent of male residents and 49 percent of female residents had mentors. The most important mentor characteristics were personality match, good clinical role model, and similar subspecialty interests. Least important characteristics were race, gender, and age. Twenty-six percent of residents felt that mentoring was critical to their training, while 63 percent of residents listed mentoring as important but not critical. Programs with fewer faculty and residents were less likely to offer formal mentoring (P = 0.007 and 0.054, respectively). Of residents who did not have mentors, 80 percent lacked a mentor because their residency had no formal mentoring program. CONCLUSION: Residents perceive mentoring as important, and formal mentoring programs should be incorporated into otolaryngology training programs.

Case report and literature review anterior shoulder dislocation with three-part proximal humerus fracture and humeral shaft fracture.

Dislocation of the shoulder and proximal humerus fracture with coexistent humeral shaft fracture is a rare injury reported in literature. There have been a total of 20 cases reported in the literature since 19401-13 (see Table 1). These injuries often occur as a result of high velocity trauma and most have been treated, at least partially, with invasive or operative management. We present the case of a woman with an anterior dislocation, three-part proximal humerus fracture and concomitant humerus shaft fracture and discuss her non-invasive treatment.

The value of mentorship in orthopaedic surgery resident education: the residents' perspective.

BACKGROUND: The concept of mentoring is believed to be influential in an effective medical and surgical educational environment. Several authors have discussed the issue of mentorship and its challenges, yet no one has studied the prevalence of mentoring among orthopaedic residency programs and its perceived value from the orthopaedic residents' perspective. METHODS: Between January 1, 2008, and February 1, 2008, a survey created by the American Academy of Orthopaedic Surgeons was distributed by mail and e-mail to 3655 orthopaedic residents to obtain their opinion of the value of and their experience with mentorship. RESULTS: Five hundred and six (14%) of the surveyed residents responded. Nearly half of the responding residents either had a mentor or were involved in a mentoring program. Nearly all ranked the value of mentorship as very high and anticipated substantial help from their mentor in their career, research, and education. Only 44% were satisfied with their mentoring environment, and only 17% were highly satisfied. The residents were most satisfied with mentoring when there was a formal program in place. Ninety-six percent of the respondents thought that mentors were either critical or beneficial to their training. Residents who had selected their own mentor were more satisfied with their mentor than were those who had their mentor assigned. CONCLUSIONS: Residents with mentors, residents in mentoring programs, and residents who selected their own mentors had higher satisfaction with their mentoring environment than did those with no formal mentoring program. Residency programs should consider establishing formal mentorship programs and encourage residents to select their own mentors.