Predicting transfusion in shoulder arthroplasty.

BACKGROUND: This study was conducted to evaluate the incidence of transfusion in shoulder arthroplasty, determine clinical factors associated with increased risk for transfusion, and develop an algorithm to assist the surgeon in preoperative planning with regards to blood management. MATERIAL AND METHODS: The study had 2 phases: (1) development of a clinical prediction rule for transfusion using 280 procedures and (2) a validation study of the algorithm applied to 109 new patients. Phase 1 consisted of a retrospective record review of 280 consecutive shoulder arthroplasties to determine risk factors for transfusion. Phase 1 also identified a preoperative hemoglobin level of less than 12.5 g/dL as predictive of the need for blood transfusion. This cutoff was prospectively applied to 109 patients undergoing shoulder arthroplasty in phase 2. RESULTS: The transfusion rate for phase 1 was 19.6%. Preoperative hemoglobin level (P < .001), age (P= .003), and the number of comorbid conditions (P = .005) were statistically significant risk factors. Patients with a preoperative hemoglobin level of less than 12.5 g/dL have a 4-fold increased risk of requiring a blood transfusion. In phase 2, the cutoff of less than 12.5 g/dL yielded a sensitivity of 88%, specificity of 78%, and positive and negative likelihood ratios of 4.0 and 0.15, respectively. CONCLUSION: Preoperative hemoglobin level, age, and number of comorbid conditions are all predictive of transfusion in shoulder arthroplasty. Tailoring blood ordering based on a preoperative hemoglobin level of 12.5 g/dL is safe and effective. LEVEL OF EVIDENCE: Prognostic study, level 2.

Treatment of fragility ankle fractures using hindfoot nail, systemic review.

With an aging population, the prevalence of fragility ankle fractures is rising. The surgical management of these injuries is challenging and associated with high rates of complications. An extensive literature review (inception of data until September 2019) was undertaken to locate previous studies that have addressed the same topic. Seven studies met the inclusion criteria. The post-operative Olerud and Molander scores were comparable/slightly lower than pre-injury scores. Bony union was achieved in 90.3%-100% of cases. Hindfoot nails, when used to treat fragility ankle fractures, can facilitate early rehabilitation and restoration of function among elderly osteoporotic patients.

Simultaneous bilateral hip fractures in a level I trauma center.

BACKGROUND: Hip fractures are a common occurrence among the population today, especially in the elderly. However, the incidence of simultaneous bilateral hip fractures is very rare, and there is a paucity of data in the current literature documenting patients with these hip fractures. METHODS: A retrospective case review was performed on all patients treated for hip fractures during the past ten years at our Level I trauma center. RESULTS: From 1993 to 2002 there were eight patients who sustained simultaneous bilateral hip fractures. The mean age of the patients was 63 years (range, 34-88 years). The overall survival rate was 63%. In the patients of age group younger than 65, the survival rate was three out of four (75%). In the patients of age group 65 and older, the survival rate was two of four (50%). The length of hospital stay was shorter on average for the younger population, 19 days (range, 17-27 days). The average hospital duration for the older population was 29 days (range, 28-30). CONCLUSION: Bilateral hip fractures are usually the result of a high-energy trauma and are associated with other injuries. The morbidity and mortality of this injury are quite high. Patient age, associated injuries, and comorbid conditions should be examined closely because they may influence the patient's recovery.

Fatty infiltration does not progress after rotator cuff repair in a rabbit model.

PURPOSE: The purpose of this study is to evaluate the changes in fatty infiltration of the rotator cuff after it is repaired. METHODS: The supraspinatus muscle was unilaterally detached from the greater tuberosity in 15 New Zealand white rabbits. Six weeks after muscle detachment, 5 rabbits were killed to halt the process of fatty infiltration and 10 rabbits underwent primary repair of the rotator cuff. Six months after repair, the remaining 10 rabbits were killed, and the muscle specimens were examined microscopically to evaluate the muscle with respect to fatty infiltration. RESULTS: Fatty infiltration was evident 6 weeks after detachment of the supraspinatus tendon (P = .0012, analysis of variance). This infiltration was greatest at the musculotendinous junction (P = .0005) and decreased toward the muscle origin (P = .29). Six months after repair of the supraspinatus, there was no progression of fatty infiltration in the repaired muscle as compared with the controls (P = .3). CONCLUSIONS: Fatty infiltration of the rotator cuff in this animal model occurs as early as 6 weeks after a rotator cuff tear. After repair of the rotator cuff, the process of fatty infiltration does not progress any further. The changes that take place in this rabbit model in the first 6 weeks after a rotator cuff tear appear to be irreversible even with successful rotator cuff repair. CLINICAL RELEVANCE: The presence of fatty infiltration of a torn rotator cuff does not preclude a successful repair. The repair can prevent further progression and atrophy of the rotator cuff, but the changes that appear in the muscle as early as 6 weeks after a rotator cuff tear appear to be irreversible.

Fatty infiltration of the torn rotator cuff worsens over time in a rabbit model.

PURPOSE: The purpose of this investigation is to document quantitatively and qualitatively the changes that occur over time in the rotator cuff muscle after surgical detachment, simulating a chronic, unrepaired rotator cuff tear. METHODS: The supraspinatus muscle was unilaterally detached from the greater tuberosity in 20 New Zealand white rabbits. All tendons were tagged and retracted from the insertion on the greater tuberosity. Five rabbits were killed at each designated time interval of 6 weeks, 3 months, 6 months, or 1 year after surgery. All animals underwent whole-body perfusion at the time of death for tissue preservation. Gross and histologic evaluations were performed to quantify the progression of fatty infiltration over time. RESULTS: Loss of muscle and fatty infiltration were evident 6 weeks after detachment of the supraspinatus tendon. The fatty infiltration increased over time from 6 weeks to 1 year (P = .002, analysis of variance). The fatty infiltration was most pronounced near the supraspinatus insertion, and it progressed from the musculotendinous junction toward the muscle origin (Pearson correlation, r = -0.51; P < .0001). CONCLUSIONS: In this rabbit model of a surgically created rotator cuff tear, fatty infiltration is a progressive, infiltrative process that increases over time in the unrepaired rotator cuff. In addition, the muscle atrophy and fatty infiltration seen in rotator cuff tears progress from the musculotendinous junction toward the muscle origin. CLINICAL RELEVANCE: This animal model of a chronic rotator cuff tear shows that fatty infiltration of the supraspinatus muscle appears as early as 6 weeks and worsens over time in the unrepaired rotator cuff. This may have implications on both the timing and management of rotator cuff tears.

Effects of a cyclooxygenase 2 inhibitor on fracture healing in a rat model.

Since the advent of cyclooxygenase 2 (COX-2) inhibitors, little research has been done on the effects of these medications on fracture healing. In the study reported here, we sought to determine whether a COX-2 inhibitor, celecoxib, affects strength and amount of healing callus formed after a fracture. Forty-eight male Sprague-Dawley rats were evaluated for impairment of fracture healing with celecoxib use. Compared with controls, celecoxib-treated rats had a significant decrease in force required for refracture (P = .0199). We do not recommend routine use of celecoxib in postfracture pain control, particularly when fracture union is tenuous.