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Although many clinical studies about distal radius fracture (DRF) accompanied by volar lunate facet fragments (VLFF) have recently been reported, none focus on the direction of displacement of distal fragments. Many previous cases with difficulty in treating DRF with VLFF were volar-displaced fractures. Thus, the postoperative risk for re-displacement is different between volar- and dorsal-displaced fractures with VLFF. The aim of this study is to compare the outcome of dorsal-displaced fractures treated using proximal volar locking plates (PVLP) between those with VLFF and those without, in order to reconsider the indications of distal volar locking plates (DVLP) and investigate the possibility of treating dorsal-displaced DRF with VLFF using PVLP.

The subjects were 122 patients with dorsal-displaced DRFs treated using PVLP (42 males and 80 females, mean age 59.2 years old). The patients were divided into 13 patients with VLFF group and 109 patients without VLFF group, and the clinical outcomes at 12 months after surgery were compared.

No significant difference was noted on any evaluation between the groups. In addition, no postoperative re-displacement of VLFF was observed and bone union was confirmed. Furthermore, no osteoarthritic change was noted in all patients.

We confirmed that surgical treatment for dorsal-displaced DRF using PVLP is possible even in cases of DRF with VLFF. In addition, DVLP is an implant with a high complication risk; therefore, it may be necessary to reconsider the use of DVLP for dorsal-displaced DRF with VLFF treatable by PVLP.

We confirmed that surgical treatment for dorsal-displaced DRF using PVLP is possible even in cases of DRF with VLFF. In addition, DVLP is an implant with a high complication risk; therefore, it may be necessary to reconsider the use of DVLP for dorsal-displaced DRF with VLFF treatable by PVLP.Avascular necrosis (AVN) of the talus remains a clinical challenge with suboptimal outcomes after treatment. In cases of extensive disease, the insufficient blood supply leads to a high rate of complications including non-union after surgical treatment. This, in conjunction with the development of premature adjacent arthritis represents a challenge for the treating surgeon. Nowadays, total ankle arthroplasty is a reasonable option for the treatment of end-stage ankle arthritis with improved short- and long-term outcomes. We present a technique for patients with end-stage ankle arthritis associated to extensive talar osteonecrosis, and patients with prior total ankle replacement and talar component collapse due to AVN. This technique provides a more anatomic treatment for patients with severely deficient bone stock due to talar necrosis with ankle arthritis or failed ankle replacement. Nonetheless, evaluation of the outcomes at long-term is needed. (Journal of Surgical Orthopaedic Advances 29(4)244-248, 2020).The purpose of our study was to determine the optimum number of opioid pills and morphine milligram equivalents (MME) required to treat postoperative pain following arthroscopic partial meniscectomy. A retrospective cohort study of 77 patients undergoing arthroscopic partial meniscectomy between January, 2017 and May, 2019 was conducted. Of patients, 19.48% took no opioids following surgery. Patients were prescribed 84.34 ± 49.54 MME on average and took 28.23 ± 40.99 MME. This equated to an average of 16.52 ± 8.85 narcotic pills prescribed and 4.90 ± 6.26 pills taken. Of 77 patients, 66 (85.7%) took less than 10 total pills, and 57 (74.0%) took 5 or fewer. Patients undergoing arthroscopic partial meniscectomy are commonly overprescribed opioids postoperatively. On average, patients consumed just under five narcotic pills, less than one-third of the number prescribed. A standard prescription of 5 opioid pills or 25 MME is recommended for patients undergoing arthroscopic partial meniscectomy. (Journal of Surgical Orthopaedic Advances 29(4)240-243, 2020).Femoral neck stress fractures (FNSF) are rare injuries and have shown poor results after displacement, including nonunion and osteonecrosis (ON). The goal of this study was to retrospectively evaluate a series of patients who underwent a valgus producing intertrochanteric osteotomy for FNSF nonunion and assess the degree of Pauwels' correction, ON rate, and return to duty. Current functional outcomes were prospectively obtained via a telephone script. Six patients underwent Pauwels' osteotomy for FNSF nonunion, and all went onto bony union. Three of the six patients progressed onto ON, with two patients requiring a total hip arthroplasty due to life-limiting symptoms. Pauwels' osteotomy is a reliable salvage procedure for FNSF nonunions. (Journal of Surgical Orthopaedic Advances 29(4)234-239, 2020).Our objective is to determine if radiographs are adequate for identification of retained microsurgical needles. Four microsurgical needles ranging from 3.8 mm to 6.5 mm in length and 50 μ to 130 μ in diameter were affixed to an anthropomorphic phantom limb. Portable radiograph images were then obtained and viewed by a group of 20 subjects comprised of attending radiologists, attending orthopaedic surgeons, orthopaedic surgery residents and operating room nurses. For all subjects, 3.35 out of 4 needles were identified in a mean 4.7 minutes. link= Selleckchem BTK inhibitor Radiologists identified all four needles and needed the least amount of time (mean 2.3 minutes). Orthopaedic surgery attendings identified a mean 3.5 of 4 needles while orthopaedic surgery residents and operating room nurses identified a mean 3 of 4 needles. Identification of microsurgical needles is possible using digital radiographs but requires 2-5 minutes of searching the image and adjusting the windows. (Journal of Surgical Orthopaedic Advances 29(4)230-233, 2020).While risk factors for postoperative urinary retention (POUR) after total joint arthroplasty (TJA) have been identified, its association with type of spinal anesthetic has not yet been thoroughly investigated. Patients undergoing primary TJA between 2013-2018 were reviewed. Selleckchem BTK inhibitor From August 2013 to March 2016 bupivacaine was primarily given and from March 2016 through August 2018, most, although not all, received mepivacaine. Selleckchem BTK inhibitor Patient demographics as well as intraoperative data were recorded. One-thousand and fifty-four patients were included. POUR rates were not significantly different between groups (5.5% vs 6.1%, p = 0.675). Those who received mepivacaine had a significantly shorter length of stay (LOS) (1 vs. 2 days, p less then 0.001). link2 However, spinal anesthetic type was not significantly associated with either POUR or LOS after controlling for between-group differences. Older age (odds ratio [OR] 1.024 [95% confidence interval CI1.000-1.049]; p = 0.049) and a history of benign prostatic hyperplasia or urinary incontinence/retention (OR 2.155 [95% CI1.114-4.168]; p = 0.023) were confirmed as independent risk factors for POUR. (Journal of Surgical Orthopaedic Advances 29(4)225-229, 2020).Current literature suggests that distal tibia Salter-Harris Type III and IV fractures with > 2 mm of displacement should be treated surgically to minimize growth arrest. The objective of the current study is to determine, in Salter-Harris Type III and IV distal tibia fractures, if gap displacements 2 mm post-surgery are associated with osteoarthritis, and to determine how often growth disturbances are observed in surgically-treated patients. A retrospective case series review of fourteen patients with displaced distal tibia Salter-Harris Type III and IV fractures was performed. The patients were evaluated using Kärrholm's method of clinical evaluation. The current study demonstrated that surgical reduction to less then 2 mm gap displacement results in fracture union in all cases, reduction to less then 2 mm does not result in osteoarthritis in any cases, and only 8% of patients demonstrated a growth disturbance with surgical intervention. (Journal of Surgical Orthopaedic Advances 29(4)219-224, 2020).Although the vast majority of arthroplasty surgeons allow patients to return to participation in golf following total knee arthroplasty (TKA) and total hip arthroplasty (THA), there is relatively little published data regarding how TKA or THA affects a patient's golfing ability. The purpose of this study was to determine how golfers' handicaps change following TKA and THA. We mailed a questionnaire to patients who had underwent primary TKA or THA at our institution and asked whether they played golf and for their golf handicap information network (GHIN) number. We then obtained handicap data for each patient that provided a GHIN number. Handicap increased 0.9 strokes 1 year following THA; however, this difference was not statistically significant (p = 0.20). Handicap increased 0.3 strokes 1 year following TKA; however, this difference was not statistically significant (p = 0.29). Our study demonstrates that despite improved implants, surgical techniques, and rehabilitation protocols that golf handicap does not change significantly following lower extremity total joint arthroplasty (TJA). (Journal of Surgical Orthopaedic Advances 29(4)216-218, 2020).The literature is scarce regarding the safety or efficacy of closed reduction attempts of acute glenohumeral fracture dislocations. The objective of this study was to assess the safety and success rate of attempted closed reduction of proximal humerus fracture dislocations. link3 A retrospective review was performed on all proximal humerus fracture dislocations seen at one institution from 2011-2015 in order to evaluate for clinical scenarios with greater failure rates of glenohumeral fracture dislocation joint reductions by closed manipulation. The results indicate that, in general, reduction attempts are safe, but that success rates are inversely proportional to fracture severity. link2 (Journal of Surgical Orthopaedic Advances 29(4)212-215, 2020).Cerclage fixation following intraoperative fracture of the proximal femur during total hip arthroplasty (THA) carries a risk of compromising the femoral blood supply. Thus, we sought to determine the minimum cerclage cable tension required to restore the stability of a cementless femoral stem. Cementless femoral prostheses were implanted in seven proximal femoral cadaver specimens, and a periprosthetic fracture was simulated in the medial cortex. link3 A single cerclage cable was placed just above the lesser trochanter and tensioned and tested at increasing intervals. The implant's torsional stability was determined in the intact bone, prior to fixation, and at each level of cable tension. We found that a single cerclage cable placed above the lesser trochanter can significantly improve, but not fully restore, torsional stability following intraoperative periprosthetic femur fracture during THA. The optimal position for a single cerclage cable appears to be above the lesser trochanter. (Journal of Surgical Orthopaedic Advances 29(4)209-211, 2020).Obesity is a modifiable risk factor that causes mechanical forces to be exerted within the joints, further contributing to the debilitating effects of osteoarthritis. Total Knee Arthroplasty (TKA) can have a profound impact on patients with osteoarthritis, providing them with increased quality of life, improved function, reduction of pain, while simultaneously preventing the development of additional comorbidities. Although there is inconclusive evidence that increased body mass index (BMI) is linked to increased perioperative complications among TKA patients, recent studies suggest this association exists. The aim of this study is to provide conclusive data on the effects of BMI on perioperative complications in TKA using the national risk-adjusted database, ACS-NSQIP. Our study demonstrated that there was a correlation between increased BMI and perioperative outcomes, particularly with surgical site infections, renal, and respiratory complications. (Journal of Surgical Orthopaedic Advances 29(4)205-208, 2020).