Dislocation of the Acromioclavicular Joint (JBJS 1987)

shoulder separation JBJS acromioclavicular AC separation
Taft, T. N., Wilson, F. C., & Oglesby, J. W. (1987). Dislocation of the acromioclavicular joint. An end-result study. The Journal of Bone & Joint Surgery, 69(7), 1045. https://doi.org/3654696

In this classic article from JBJS, Taft et al. retrospectively analyzed 127 patients who had been treated both operatively and nonoperatively for acute dislocation of the acromioclavicular joint. Average follow-up was approximately 10 years. Fifty-two of the patients were managed with surgery and 75 were management without surgery.

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Running Injury Risk Using Minimalist Shoes is Influenced by Training Distance and Body Mass

Fuller, J. T., Thewlis, D., Buckley, J. D., Brown, N. A. T., Hamill, J., & Tsiros, M. D. (2017). Body Mass and Weekly Training Distance Influence the Pain and Injuries Experienced by Runners Using Minimalist Shoes. The American Journal of Sports Medicine, 363546516682497. https://doi.org/10.1177/0363546516682497

This randomized clinical trial performed in Australia investigated running injury risk in 61 male runners with a mean age of 27 years old. All participants had a rearfoot strike at the beginning of the trial and met minimum training and performance requirements. Participants were randomized to a minimalist shoe or conventional shoe group for the remainder of the study. The minimalist shoe runners were then transitioned from their conventional shoes to minimalist shoes gradually over a 26 week period. Ultimately, 31 runners were allocated to the minimalist shoe group and 30 runners were allocated to the conventional shoe group. Runners completed a visual analog scale (VAS) weekly to assess their pain levels.
running injury running minimalist barefoot ajsm   running injury running minimalist barefoot ajsm

running injury running minimalist barefoot ajsm   running injury running minimalist barefoot ajsm   running injury running minimalist barefoot ajsm

Linear fixed-effects model predicted differences in weekly pain between minimalist and conventional shoes relative to weekly training distance.

Key findings of minimalist vs. conventional shoes include:
  • Knee, calf, shin, and ankle pain scores were significantly higher (more self-reported pain) in the minimalist shoe group than the conventional shoe group
  • There were no differences in foot, thigh, or lower back pain scores between groups
  • For runners using minimalist shoes, the risk of injury increased with increasing body mass and with increasing training distance
  • For runners using minimalist shoes, a body mass of 85kg or more correlated with a 68% chance of injury by the end of the 26 week training period
  • For runners using minimalist shoes, a weekly training distance of more than 21.7 miles resulted in a clinically significant increase in calf pain compared to conventional shoes
  • A weekly training distance of more than 24.9 miles resulted in clinically significant increases in shin and ankle pain compared to conventional shoes
  • Runners over 187 lbs were more than 3x as likely to sustain a running injury
  • The study authors concluded that heavier runners should avoid running in minimalist shoes
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Rotator Cuff Surgery is Most Common Upper Extremity Ambulatory Orthopaedic Procedure

shoulder specialist rotator cuff outpatient ambulatory surgery
Jain, N. B., Higgins, L. D., Losina, E., Collins, J., Blazar, P. E., & Katz, J. N. (2014). Epidemiology of musculoskeletal upper extremity ambulatory surgery in the United States. BMC Musculoskeletal Disorders, 15(1), 4. https://doi.org/10.1186/1471-2474-15-4

This study analyzed data from the 2006 National Survey of Ambulatory Surgery to assess which surgeries were most commonly performed in ambulatory surgery centers (outpatient) in the United States. They included only upper extremity surgeries.

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NCAA Football Injuries – Most Surgeries are Arthroscopic

2459519 TSUTWFM8 items 1 default ASC http://www.orthoconsult.com/wp-content/plugins/zotpress/ Epidemiologic study of NCAA (collegiate) football injuries across 60 teams over 5 seasons. Most common orthopaedic injuries were lower extremity. This 2016 study utilized information from the NCAA injury surveillance system over 5 seasons. Key findings include: Over 18,000 football injuries 39% were in competition, 56% were in regular practices The highest injury…

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Long-Term Outcomes of Isolated Stable Radial Head Fractures (JBJS 2014)

Background Concern for long term results of non-op Mason type I and II fx’s, good short and mid-term results but no good long term data Design Inclusion: Skeletally mature, >15yo, isolated Mason I or II radial head fx, non-op management Exclusion: Mason type III, concomitant ipsilateral elbow fx, elbow fx/dislocation, associated elbow/forearm instability, lost to f/u Same tx protocol Immobilization…

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A Prospective Randomized Multicenter Trial Comparing Clinical Outcomes of Patients Treated Surgically with a Static or Dynamic Implant for Acute Ankle Syndesmosis Rupture (JOT 2015)

Study hypothesis Dynamic fixation would provide better clinical and radiographic outcomes Design 70 pts total between 5 centers (ended with 32 in screw and 33 in tightrope) no differences b/w pts surgery < 8 days after injury prospective, randomized, double blinded study exclusion criteria: polytrauma, neuro impairment, BMI >40, poor medical condition that limited rehab or participation in study’s tests…

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Current failure mechanisms after knee arthroplasty have changed: polyethylene wear is less common in revision surgery (JBJS 2015)

Background/Purpose -Previous studies from 1986-2000 showed polyethylene wear reason for revision in 25% -This study to clarify more up-to-date reasons for failure/revision of TKA correlated with time and to see if polyethylene wear still major reason for revision Methods -Retrospective including 1st revisions b/w 2005-2010 @ 2 high volume joint centers (university academic + nonuniversity academic) -Failure times from index…

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Effectiveness of Surgery for Lumbar Stenosis and Degenerative Spondy in the Octogenarian Population: Analysis of SPORT data (JBJS 2015)

Background: People are living longer, older population numbers are increasing and both stenosis and spondy are common it people over 60 yrs old. Can be treated with both operative and non-op means. Purpose: Determine whether surgery is an effective option for the tx of stenosis of the lumbar spine and degenerative spondy in octogenarian population. Materials/Methods: Patients in the SPORTS database –…

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Risk Factors for Failure of a Single Surgical Debridement in Adults with Acute Septic Arthritis (JBJS 2015)

Background - Acute septic arthritis urgent condition, usually able to be treated with single debridement / irrigation. - Risk factors for development of septic arthritis known - DM, RA, IVDA, immunosuppression, socioeconomic status - No published data regarding risk of failure of single surgical debridement   Methods - retrospective review of septic arthritis cases from 2000-2011 identified from billing database…

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Distal radius fractures in children: Risk factors for redisplacement following closed reduction

Background 21-39% of pediatric distal radius fractures are reported to re-displace after closed reduction Few prospective studies have examined risk factors for redisplacement Purpose of study: Determine rate of redisplacement and identify those risk factors Methods Prospective study from 2/2011-10/2012. Inclusion criteria- CR of displaced distal radius fx under sedation. Exclusion criteria- previous fx at same site or pathologic fx.…

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Long-Term Outcomes Following a Single Corticosteroid Injection for Trigger Finger (JBJS 2015) Wojahn et al.

Wojahn RD, Foeger NC, Gelberman RH, Calfee RP. Long-term outcomes following a single corticosteroid injection for trigger finger. J Bone Joint Surg Am. 2014 Nov 19;96(22):1849-54. doi: 10.2106/JBJS.N.00004. PubMed PMID: 25410501; PubMed Central PMCID: PMC4238395. Background:  Corticosteroid injection (CSI) mainstay of nonoperative treatment of trigger finger. 61%-84% success in short term followup. One prior study demonstrated linear failure in the…

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A Prospective Evaluation of Survivorship of Asymptomatic Degenerative Rotator Cuff Tears

Keener JD, Galatz LM, Teefey SA, Middleton WD, Steger-May K, Stobbs-Cucchi G, Patton R, Yamaguchi K. A prospective evaluation of survivorship of asymptomatic degenerative rotator cuff tears. J Bone Joint Surg Am. 2015 Jan 21;97(2):89-98. doi: 10.2106/JBJS.N.00099. PubMed PMID: 25609434; PubMed Central PMCID: PMC4296477. Location: Shoulder and Elbow Service, Dept. Orthopaedic Surgery, Washington University, St. Louis, Missouri Goals: To better…

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Journal Club: JBJS 2015 – Operative compared with non-operative treatment of a thoracolumbar burst fracture without neurologic deficit

Wood KB, Buttermann GR, Phukan R, Harrod CC, Mehbod A, Shannon B, Bono CM,Harris MB. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit: a prospective randomized study with follow-up at sixteen to twenty-two years. J Bone Joint Surg Am. 2015 Jan7;97(1):3-9. doi: 10.2106/JBJS.N.00226. PubMed PMID: 25568388. Background: Is some controversy over optimal management of neurologically…

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Journal Club: Long term results of tibialis anterior transfer for relapsed idiopathic clubfoot treated with the ponseti method

Holt JB, Oji DE, Yack HJ, Morcuende JA. Long-term results of tibialis anterior tendon transfer for relapsed idiopathic clubfoot treated with the Ponseti method: a follow-up of thirty-seven to fifty-five years. J Bone Joint Surg Am. 2015 Jan 7;97(1):47-55. doi: 10.2106/JBJS.N.00525. PubMed PMID: 25568394. Methods: Retrospective study with mean follow up of 43 years. 35 patients (60 clubfeet) were included.…

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Journal Club: Post-traumatic avascular necrosis in talar neck fractures with extension into the talar body

AAOS 2015 Presentation; Kevin Murr MD, Zack Unger MD, Jeremy Burnham MD, Raymond Wright MD, Eric Moghadamian MD Background: AVN is a well known complication of talar neck fractures and can be correlated with the Hawkins classification. Talar neck and body fractures do not commonly occur together Purpose of study: (1) Determine effect on AVN rates of proximal extension of…

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Spine Journal Club: Lumbar Disc Herniation

Led by Carter Cassidy, MD Papers: Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE. Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the maine lumbar spine study. Spine (Phila Pa 1976). 2005 Apr 15;30(8):927-35. PubMed PMID: 15834338. Weber H. Lumbar disc herniation. A controlled, prospective study with…

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Assessment of Instability Factors in Adult Distal Radius Fractures – Nesbitt et al (J Hand Surg 2004)

PMID 15576227 Lafontaine factors of instability initial dorsal angulation of greater than 20 degrees dorsal comminution radiocarpal intraarticular involvement associated ulna fractures age greater than 60 This study looked at 50 patients with radiographs at 1 week, 2 weeks, and 4 weeks after reduction Age was found to be a statistically significant predictor of secondary displacement Age was the only…

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Prediction of Instability in Distal Radius Fractures – Mackenney et al (JBJS 2006)

http://www.ncbi.nlm.nih.gov/pubmed/16951109 Prospective collection of data on 4000 distal radial fractures collected at the Edinburgh Orthopaedic Trauma Unit Outcome measures included radiographic measurements at 1 week and 6 weeks Results: Predictors of early and late instability were patient age, metaphyseal comminution, and ulnar variance. Minimally displaced fractures only had a 10% chance of later instability Displaced fractures had 43% chance of…

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Functional Outcomes for Unstable Distal Radial Fractures Treated with Open Reduction and Internal Fixation or Closed Reduction and Percutaneous Fixation – Rozental et al (JBJS 2009)

PubMed extraarticular or simple split intraarticular distal radius fractures ORIF (open reduction and internal fixation) has better functional (DASH) outcomes at 6, 9, and 12 weeks. outcomes were the same at a year  

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