Low mental health scores are associated with worse patient-reported outcomes and difficulty with return to work and sport after distal biceps repair.

BACKGROUND: Most patients have successful outcomes with minimal limitations after distal biceps repair, but a minority continues experiencing functional constraints. We hypothesize that low scores on a validated mental health measure correlate with worse patient-reported outcomes and increased difficulty with return to work and sport. METHODS: We conducted a retrospective review of a consecutive series of patients who underwent distal biceps repair with a single-incision cortical button technique and immediate mobilization. Patient-reported outcome data were available at 1 year or later for 33 (85%) patients. The primary outcomes were American Shoulder and Elbow Surgeons-Elbow (ASES-E) score, Single Assessment Numeric Evaluation score, Visual Analog Scale for pain, Disabilities of the Arm, Shoulder and Hand Score (QuickDASH), and Veterans RAND 12 (VR-12) quality-of-life assessment. RESULTS: All patients were male, with a median age of 49 years (range, 28-65). None had reruptures, and 1 (3%) had superficial wound dehiscence that healed without further surgery. Eleven (33%) had postoperative neuropraxia, 6 of which resolved completely. At latest follow-up, the median Visual Analog Scale was 0 (range, 0-5; mean, 1), and median ASES-E functional score was 36 (range, 24-36; mean, 34). Median Single Assessment Numeric Evaluation score was 92 (range, 41-100). The median QuickDASH was 5 (range, 0-50; mean, 11). More than half of the patients with VR-12 mental component score (MCS) < 50 (5 of 9, 56%) reported difficulty with work activities, compared with 4% (1 of 24) of patients with an MCS ≥ 50 (P = .001). Most patients (8 of 9, 89%) with an MCS < 50 also reported difficulty with return to sporting activities, compared with only 8% (2 of 24) of patients with MCS ≥ 50 (P < .0001). Patients with an MCS < 50 (n = 9) had significantly worse ASES-E functional scores (median, 34; range, 27-36) and QuickDASH scores (median 23, range 0-43), compared with those with an MCS ≥ 50 (ASES-E: median, 36; range, 24-36; P = .033; QuickDASH: median, 2; range, 0-50; P = .026). Most patients (17 of 24, 71%) with MCS ≥ 50 had a perfect score of 36 on the ASES-E functional outcome score, compared with only 22% (2 of 9) among patients with MCS < 50. CONCLUSION: Patients who undergo distal biceps repair show excellent functional patient-reported outcomes at 1-year and later follow-up. Lower scores on the VR-12 MCS are associated with worse patient-reported outcome scores and difficulty with return to work and sporting activities.

Ultrasound for Infants at Risk for Developmental Dysplasia of the Hip.

The best screening method for developmental dysplasia of the hip is controversial. Ultrasonography is sensitive, but cost-effectiveness may limit its use. This study assessed whether ultrasound screening would increase in effectiveness if targeted toward infants with established risk factors for developmental dysplasia of the hip and normal findings on physical examination. All ultrasound scans performed at the authors' institution from January 2007 through January 2011 to screen for developmental dysplasia of the hip were reviewed. Infants with risk factors for developmental dysplasia of the hip and normal findings on physical examination by orthopedic faculty or a pediatrician were selected. Of the 530 cases that were reviewed, 217 had risk factors for developmental dysplasia of the hip and normal findings on physical examination. Mean age of the 217 selected patients was 6.9 weeks. Of the patients, 83% were female, 77% had breech presentation, 30% were firstborn children, 13% had intrauterine packaging abnormalities, and 3% had a family history of developmental dysplasia of the hip. Of the 217 infants, 44 had 1 risk factor, 121 had 2 risk factors, 46 had 3 risk factors, and 6 had 4 risk factors. Dynamic ultrasound evaluation showed instability in 17 patients, for a 7.8% incidence of developmental dysplasia of the hip. All 17 patients were treated with a Pavlik harness. The results suggested that selective ultrasound screening may be effective in infants with risk factors and normal findings on physical examination. Selective ultrasound screening changed treatment management in almost 8% of patients and clinical follow-up in 6.5%. Analysis of the cost-effectiveness of screening is needed.

Accuracy of fluoroscopy versus computer-assisted navigation for the placement of anterior cervical pedicle screws.

STUDY DESIGN: Randomized laboratory cadaver study. OBJECTIVE: The objective of this study was to determine the accuracy of anterior transpedicular screw placement in the cervical spine using conventional fluoroscopy versus computer-assisted navigation. SUMMARY OF BACKGROUND DATA: Traditionally, global cervical instability has required anterior and posterior fixation due to the superior biomechanical stability of circumferential constructs. Anterior transpedicular screws (ATPS) have recently been advocated as a single surgical approach. Current clinical publications report using fluoroscopic guidance for screw placement. Computer-assisted navigation (CAN) systems have demonstrated enhanced accuracy of pedicle screw placement at all spine levels but have not been assessed for ATPS. METHODS: The anterior vertebrae of 9 fresh frozen cadaver cervical spines were exposed, preserving the lateral and posterior soft tissue envelope. Nine practicing spine surgeons placed 2.0-mm titanium anterior transpecidular Kirschner wires into the C3-T1 pedicles bilaterally using fluoroscopy or CAN guidance. Specimens were imaged by computed tomography and virtual screws were overlaid on the K-wires. Targeting accuracy was compared between the 2 techniques in all planes using a 5-level grading scale. RESULTS: The percentage of acceptable screw placements for fluoroscopy and CAN was 42.6% and 66.7%, respectively (P = 0.012). Catastrophic screw placement (grade 3 or 4) was 33.3% for fluoroscopy and 16.7% for CAN. In the multivariable model, the accuracy rate was 67% lower for fluoroscopy than for CAN after controlling for other factors (odds ratio: 0.33, 95% confidence interval: 0.14-0.79). CONCLUSION: The accuracy of CAN-guided placement of K-wires for ATPS was superior to placement under fluoroscopic guidance, demonstrating statistically more acceptable screw placements and significantly less catastrophic virtual screws. However, malposition was still high, with potential for vertebral artery and neurological injury in a clinical setting. Further advancement in current ATPS techniques is warranted prior to widespread implementation in a patient setting. LEVEL OF EVIDENCE: N/A.