The Journal of the American Academy of Orthopaedic Surgeons
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J Am Acad Orthop Surg · Jun 2019
ReviewBiplane Double-supported Screw Fixation of Femoral Neck Fractures: Surgical Technique and Surgical Notes.
Osteosynthesis of femoral neck fractures is still associated with high complication rates. The novel method of biplane double-supported screw fixation offers better osteosynthesis stability by buttressing two of three medially diverging cannulated screws on the inferior neck cortex. Biomechanically, the most effective component of this fixation is the third, inferior obtuse screw, supported along considerable distance on both the inferior and posterior cortices of the femoral neck following its spiral anterior curve. ⋯ Although the method has been recently communicated, some important surgical aspects still remain to be discussed. This report aims at describing a detailed and modified surgical technique and providing criteria and recommendations for its successful application according to the clinical experience over more than 9 years. LEVEL OF EVIDENCE:: Level V, expert evidence.
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J Am Acad Orthop Surg · May 2019
ReviewThe Use of Spinal Cord Stimulation/Neuromodulation in the Management of Chronic Pain.
Chronic pain causes a tremendous burden on the society in terms of economic factors and social costs. Rates of spinal surgery, especially spinal fusion, have increased exponentially over the past decade. The opioid epidemic in the United States has been one response to the management of pain, but it has been fraught with numerous catastrophic-related adverse effects. ⋯ Ablations can be associated with burning discomfort, lack of efficacy, recurrent symptoms, and infection. High-frequency stimulation, burst stimulation, tonic stimulation with broader paddles, and new stimulation targets such as the dorsal root ganglion hold promise for improved pain management via neuromodulation moving forward. Although a significant rate of complications with SCS technology are well described, this can be a useful tool in the management of chronic spine-related pain.
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J Am Acad Orthop Surg · May 2019
Comparative StudyComparing Standard Versus Extended Culture Duration in Acute Hip and Knee Periprosthetic Joint Infection.
Periprosthetic joint infection (PJI) is a devastating complication of hip and knee arthroplasties. Surgical cultures are essential for the diagnosis and treatment of PJI. Yet, the ideal culture duration remains unclear. This study compares culture yield, organism profile, and treatment success between standard (5 days) and extended (14 days) cultures in acute hip and knee PJI. ⋯ Extended culture duration in acute hip and knee PJIs did not change the rate of culture-negative PJI, identify more patients with polymicrobial PJI, or improve the success of surgical treatment. The only difference was a higher incidence of P acnes growth, but contaminants or indolent chronic PJI cannot be excluded. Although extended culture growth may be indicated in acute shoulder arthroplasty PJI, its utility in hip or knee arthroplasty may be limited. Higher-level studies will be needed to address this in the future.
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J Am Acad Orthop Surg · Mar 2019
ReviewEvaluation and Treatment of Patients With Acetabular Osteolysis After Total Hip Arthroplasty.
As the demand for total hip arthroplasty (THA) continues to increase, the burden of revision THA is also expected to increase. Although the quality of polyethylene has improved markedly, osteolysis continues to be a risk for older designs and younger, active patients. Although progressive but typically asymptomatic in early stages, osteolysis can result in component failure and complicate revision surgery. ⋯ Well-fixed, noncemented modular acetabular components may be treated with curettage and bone grafting, as well as having to bear liner exchange with retention of the acetabular shell. However, in the setting of osteolysis, it is controversial whether bone grafting and component retention is superior to cup revision. This review explores the pathophysiology of osteolysis after THA and provides a comprehensive analysis of the evaluation and treatment of patients with osteolysis.
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J Am Acad Orthop Surg · Mar 2019
ReviewUpdates on and Controversies Related to Management of Radial Nerve Injuries.
Radial nerve injuries are among the most common major traumatic peripheral nerve injuries. Recent literature has updated our knowledge of aspects ranging from radial nerve anatomy to treatment options. Observation and tendon transfers were, and still are, the mainstays of management. ⋯ Nerve repair techniques using conduits, wraps, autograft, and allograft allow tension-free coaptations to improve success. Nerve transfers have evolved to allow a more anatomic recovery of function if used in a timely manner. This review offers an update on radial nerve injuries that reflects recent advances.