The American journal of orthopedics
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Review Case Reports
Tibialis Posterior Tendon Entrapment Within Posterior Malleolar Fracture Fragment.
Management of posterior malleolus fractures continues to be controversial, with respect to both need for fixation and fixation methods. Fixation methods include an open posterior approach to the ankle as well as percutaneous reduction and fixation with or without arthroscopy for visualization of the articular surface. ⋯ Tibialis posterior tendon entrapment within a posterior malleolus has not been previously reported. Ankle arthroscopy for posterior malleolus fractures provides an opportunity to identify soft-tissue or tendinous entrapment, articular surface reduction, and articular cartilage injuries unlikely to be identified with fluoroscopy alone and should be considered in reduction and fixation of posterior malleolus fractures.
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Arthroscopic shoulder surgery with the patient in the beach-chair position (BCP) has been associated with neurocognitive complications caused by cerebral ischemia. We reviewed the current literature for the incidence of postoperative neurocognitive deficits, number of reported neurocognitive complications, and incidence of intraoperative cerebral desaturation events in patients who underwent arthroscopic shoulder surgery in the BCP. Among 10 studies with a composite enrollment of 24,701 patients, there was only 1 case of a postoperative neurocognitive deficit (overall incidence, 0.004%). ⋯ Incidence of reported intraoperative cerebral desaturation events varied significantly (0%-100%; mean, 41.1%). Neurocognitive complications have been reported in patients who had arthroscopic shoulder surgery in the BCP. Intraoperative monitoring of cerebral perfusion, alternatives to general anesthesia, and prudent use of intraoperative blood pressure control may improve patient safety.
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Clinical outcomes of surgical management of full-thickness rotator cuff tears in professional baseball players have been uniformly poor. We conducted a study to investigate return-to-play data and functional performance using a novel arthroscopic repair technique. We hypothesized that arthroscopic rotator cuff repair would result in a high rate of return to professional pitching and favorable functional outcomes. ⋯ Overhead athletes require a delicate balance of shoulder mobility and stability to meet functional demands. Anatomical adaptations at the glenohumeral joint should be considered when performing rotator cuff repair in these patients in order to preserve peak functional performance. This novel repair technique affords a high rate of return to MLB play, though elite overhead throwers should be counseled that pitching productivity might decrease after surgery.