A Hematoma Block in the Wrist for a Displaced Distal Radius Fracture Induces Systemic Neurological Symptoms: A Case Report.

Hematoma blocks are considered a relatively simple, safe, and effective technique in the acute setting to provide sufficient anesthesia and allow for closed reduction of displaced distal radius fractures. Complications associated with the utilization of local anesthetics in this setting are rare. We present the case of a patient who had a hematoma block in the wrist and developed short-term systemic neurologic complications likely secondary to systemic absorption of 20 mL of 1% lidocaine without epinephrine via the cancellous bone channels.

Midterm Follow-up of Divergent Peg Glenoid Components in Total Shoulder Arthroplasty.

Glenoid component aseptic loosening is the most common source of total shoulder arthroplasty (TSA) revision. Divergent pegged glenoids may improve fixation. Thirty-four patients underwent divergent peg TSA. Data were reviewed for component loosening. Failure was defined as the need for revision after loosening. The last postoperative radiographs were graded on a Lazarus glenoid lucency scale. Mean follow-up was 5.6 years ± 2.44 (range, 2-10 years). Radiolucency around one or fewer pegs was noted in 14/20 patients. Six glenoids had complete radiolucency around two pegs; one shoulder had gross loosening. No secondary surgery was performed. Improvements were seen in active elevation and internal rotation. The mean Shoulder Pain and Disability Index (SPADI) score decreased by 48.1 points (p = .039). Shoulder elevation, internal rotation, and SPADI scores significantly improved at final follow-up. No patients underwent revision for glenoid loosening. There were, however, a significant number of patients with radiolucency around two pegs. (Journal of Surgical Orthopaedic Advances 27(1):6-9, 2018).

Comparison of cannulated screws with FiberWire or stainless steel wire for patella fracture fixation: A pilot study.

PURPOSE: This pilot study tested whether FiberWire provides similar protection to steel wire against repair displacement in patella fractures. METHODS: Thirteen cadaver knees were cyclically loaded with 10 cycles (0-90° flexion) and fracture displacement was recorded. Fixation methods were also tested in load to failure (>3 mm displacement). RESULTS: There was no difference between wire types in fracture displacement (1.4 mm ± 0.33 mm vs 1.2 mm ± 0.34 mm, respectively; p = 0.418) or in the load to failure (714.7 N ± 110.9 N vs 744.5 N ± 92.8 N, respectively; p = 0.360). CONCLUSION: FiberWire provides similar protection to steel wire against repair displacement after fixation of patellar fractures.

The functional impact of bilateral reverse total shoulder arthroplasty.

BACKGROUND: The use of reverse total shoulder arthroplasty (RTSA) has been increasing. However, many recommend against bilateral RTSA because of concerns over lack of internal rotation (IR) and the resultant difficulties with activities of daily living (ADLs). METHODS: Data on 15 consecutive patients who underwent staged bilateral primary RTSA for cuff tear arthropathy (CTA) were retrospectively reviewed. All operations were performed by a single surgeon. The mean follow-up was 33.4 months from the second RTSA. The mean age of the patients at the time of the first operation was 72.9 years. The mean duration between arthroplasties was 21.6 months. Patients were evaluated preoperatively and postoperatively at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and yearly with standardized clinical examinations and outcome measures questionnaires. RESULTS: On both operative sides, elevation showed significant improvement from preoperative values; however, external rotation, abduction, and IR did not show significant improvement at an average follow-up of 33.4 months. Functional outcome scores of both RTSA shoulders showed significant improvement from preoperative values; however, the 12-Item Short-Form Health Survey scores on either shoulder did not show significant improvement. Evaluation of the outcome measures questionnaire revealed that all patients were able to perform perineal hygiene after their RTSAs. CONCLUSION: Bilateral RTSA results in marked improvement in forward elevation, pain, and functional outcomes, and carries a high rate of satisfaction in subjective patient assessment. Common ADLs that require significant IR, such as perineal care, were not problematic in the cohort.