Radiologic anatomic study of the humeral medullary canal.

Hypothesis/Background: Patient-specific implants have become an increasingly researched area to improve surgical outcomes. Patient-specific implants have been suggested to provide advantages for better implant alignment and thus improve surgical outcomes. One such area for application is in the use of intramedullary nails for humeral fracture stabilization. However, the anatomy of the canal is not well defined, especially in a larger scale demographic study. Methods: In this observational cross-sectional study, axial computed tomography scans of 150 humeri were used to measure the cortical thickness and canal width in both coronal and sagittal orientations. Measurements were made at 7 evenly spaced levels along the humerus from the surgical neck to the point immediately superior to the supracondylar ridge. X-rays were used to measure the valgus, recurvatum, and procurvatum angles, along with their associated locations. Demographic data recorded included age, gender, body mass index (BMI), race, and ethnicity. Results: The mean coronal canal widths decreased inferiorly from the surgical neck to midshaft before increasing to the supracondylar fossa. Mean sagittal widths decreased along the complete course of the canal. The ratio of coronal to sagittal canal widths decreased from 1.09 at level 1 to 0.83 at level 5 before increasing to 1.30 at level 7. Females had significantly smaller canal widths and cortex thicknesses in both the sagittal and coronal planes throughout the course of the canal. There were no significant differences in canal widths among ethnicities. Age was positively correlated with the canal width in the coronal and sagittal orientations but was negatively correlated with cortical thickness in all 7 levels. BMI was not significantly correlated with canal width. Conclusion/Discussion: The data included in this study may be used to determine standard widths and measurements of the humerus. However, there are notable patterns or differences in the shape of the medullary canal of the humerus between subgroups. This study is the first to conduct a larger scale demographic investigation comparing the humeral canal characteristics among sex, ethnicity, age, and BMI. These data may serve as a platform to further investigate the course of the medullary canal.

Increased patient resilience scores are related to positive postoperative outcomes in rotator cuff repairs.

HYPOTHESIS: We sought to determine whether patients' preoperative resilience scores predict postoperative outcomes in arthroscopic rotator cuff repair surgery. METHODS: Patients were prospectively enrolled and underwent data collection preoperatively and at 3, 6, 12, and 24 months postoperatively. Data collected included demographic characteristics and the Brief Resilience Scale (BRS) score, visual analog scale score, Veterans RAND 12-Item Health Survey scores (mental component [VR-12M] and physical component [VR-12P]), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, Single Assessment Numeric Evaluation score, and Simple Shoulder Test (SST) score. RESULTS: In total, 131 patients had complete 1- or 2-year postoperative outcome measures. Female patients comprised 56.5% of our sample, and the average age was 57.6 years. Between the low, normal, and high resilience groups, there were significant differences in the VR-12M scores at 0, 12, and 24 months postoperatively (P < .01 for all). The VR-12P scores at 12 months were 44.2, 47.4, and 49.8 in the low, normal, and high resilience groups, respectively, showing a trend upward, but this failed to reach the level of significance (P = .08). The SST scores of the low, normal, and high resilience groups at 12 months were 69.1, 79.9, and 85.1, respectively, again showing a trend upward, but this failed to reach the level of significance (P = .07). The SST scores at 0 and 24 months did not differ between groups. There were no significant differences in American Shoulder and Elbow Surgeons, visual analog scale, and Single Assessment Numeric Evaluation scores at 0, 12, or 24 months postoperatively. We found a significant positive correlation between the BRS score and SST score at 12 months (R = 0.18), VR-12M score at 12 months (R = 0.38), VR-12M score at 24 months (R = 0.31), and VR-12P score at 12 months (R = 0.21). CONCLUSIONS: Our study provides evidence that BRS scores in patients undergoing arthroscopic rotator cuff repair are related to postoperative outcomes, measured through the VR-12M and SST scores at 2-year follow-up.

Sleep disturbances and depression are bidirectionally associated among college student athletes across COVID-19 pandemic exposure classes.

College athletes may be vulnerable to sleep disturbances and depression during the COVID-19 pandemic as a result of large shifts in social and athletic obligations. In a national sample of college athletes, we examined the associations between sleep disturbances and depression across two timepoints, using COVID-19 exposure as a moderator. Data were collected from 2098 NCAA Division I, II, and III college athletes during two timepoints, from April 10 to May 23, and from August 4 to September 15, 2020. First, a latent class analysis was conducted with five indicators of levels of COVID-19 exposure to determine different exposure profiles. Second, to examine the directionality of associations between sleep disturbance and depression, a cross-lagged panel model was added to the latent class membership structural equation model; this allowed for testing of moderation by COVID exposure class membership. Four highly homogeneous, well-separated classes of COVID-19 exposure were enumerated: Low Exposure (57%); Quarantine Only (21%); High Other, Low Self Exposure (14%); and High Exposure (8%). COVID-19 exposure class membership did not significantly moderate associations between sleep disturbances and depression. However, student athletes significantly differed in T2 depression by their COVID-19 exposure class membership. Depression and sleep disturbances were positively correlated at both timepoints (r T1 = 0.39; r T2 = 0.30). Additionally, cross-lagged associations were found such that T2 depression was associated with T1 sleep disturbances (ß = 0.14) and vice versa (ß = 0.11). These cross-lagged associations were not significantly affected by athletes' level of COVID-19 exposure during the beginning of the pandemic.

Gender Differences in Seeking Health Care and Postintervention Pain Outcomes in Foot and Ankle Orthopedic Patients.

Background: A significant portion of the adults suffer from foot and ankle pain. The sex differences that exist throughout health care, pain management, and orthopedics may further complicate treatment strategies. The purpose of this study was to determine if there were any differences in women and men in health care seeking behavior and symptom chronicity in a West Texas orthopedic population with foot and ankle conditions. Materials and Methods: Data from 137 patients were collected in a retrospective chart review. Data were analyzed to determine if there were sex differences in time to primary care provider (PCP) after ankle injury, referral time from PCP to orthopedic surgeon consult, time from orthopedic consult to surgical intervention (if applicable), and chronicity of symptoms. Results: Women had a significantly higher percentage of chronic injuries than men (30.7% vs. 10.9%), but there were no sex differences in time to PCP from the time of injury, time from PCP visit to orthopedic consult, and time from orthopedic consult to surgical intervention. There were also no differences in those same time frames when compared by chronicity of symptoms (acute injury vs. chronic injury). Finally, we did not find any differences in pain scores between sexes or chronicity of symptoms. Conclusions: This study suggests that conventional health seeking sex differences may not apply to the foot and ankle patient population in West Texas and surrounding rural areas. Continuing to examine patterns in sex differences may lead to the development of more efficient and tailored treatment approaches and better outcomes.