Ultrasound Examination Techniques for Elbow Injuries in Overhead Athletes

Hultman, Kristi L.; Goldman, Brian H.; Nazarian, Levon N.; Ciccotti, Michael G

doi : 10.5435/JAAOS-D-20-00935

Journal of the American Academy of Orthopaedic Surgeons. 29(6):227-234, March 15, 2021.

Elbow pain is a frequent complaint among overhead athletes. Standard evaluation of the elbow uses history and physical examination, with radiographic imaging and MRI aiding in the confirmation of diagnosis. Musculoskeletal ultrasonography (US) provides dynamic, functional assessment of tendons and ligaments in the elbow, allowing the visualization of structures under stress and motion. Stress US offers the ability to detect injuries to the ulnar collateral ligament by measuring changes in joint space under stress. The freedom of dynamic imaging means results are dependent on the skill of the US operator to obtain the most accurate and complete evaluation. US is cost efficient and portable, allowing for quick examination at the point of care. This article provides a technique guide for sports medicine specialists performing US examination of the elbow.

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The Application of All-arthroscopic Technique to Deep Osteochondral Lesions in the Talus With Scaffold and Autograft Bone Taken From the Tibial Plafond

Akmese, Ramazan; Ertan, Mehmet Batu; ?zyildiran, Mustafa

doi : 10.5435/JAAOS-D-20-00636

Journal of the American Academy of Orthopaedic Surgeons. 29(6):e258-e266, March 15, 2021.

Osteochondral lesions in the talus are frequently seen disorders that can cause chronic ankle pain. Surgical treatment is determined by the size and location of the lesion. The microfracture procedure and additional application of scaffold technique have gained popularity for the treatment of small osteochondral defects. However, these techniques may be insufficient and have poor outcomes in deep lesions. Therefore, several different invasive surgical techniques that require the malleolar osteotomy have been described. Problems associated with the invasive surgical intervention may be seen such as reduction loss in the osteotomy site, delayed union or nonunion, permanent pain, and/or swelling. We describe a new all-arthroscopic technique for the treatment of deep talus osteochondral lesions using an autologous bone graft taken from the tibial plafond region together with a chitosan-based noncellular scaffold.

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Artificial Intelligence for the Orthopaedic Surgeon: An Overview of Potential Benefits, Limitations, and Clinical Applications

Makhni, Eric C.; Makhni, Sonya; Ramkumar, Prem N.

doi : 10.5435/JAAOS-D-20-00846

Journal of the American Academy of Orthopaedic Surgeons. 29(6):235-243, March 15, 2021.

Artificial intelligence (AI), along with its subset technology machine learning, has transformed numerous industries through newfound efficiencies and supportive decision-making. These technologies have similarly begun to find application within United States healthcare, particularly orthopaedics. Although these modalities have the potential to similarly transform health care, there exist limitations that must also be recognized and understood. Unfortunately, most clinicians do not have an understanding of the fundamentals of AI and therefore may have challenges in contextualizing its impact in modern healthcare. The purpose of this review was to provide an overview of the key concepts of AI and machine learning with the orthopaedic surgeon in mind. The review further highlights the potential benefits and limitations of AI, along with an overview of its applications, in orthopaedics.

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Patella Fractures: Approach to Treatment

Hargett, Damayea I.; Sanderson, Brent R.; Little, Milton T.M.

doi : 10.5435/JAAOS-D-20-00591

Journal of the American Academy of Orthopaedic Surgeons. 29(6):244-253, March 15, 2021.

Patellar fracture morphology varies based on the mechanism of injury. Most fractures are either a result of direct impact or through an indirect eccentric extensor contraction injury. Each fracture pattern requires appropriate preoperative planning and individualization of the fixation method. Displaced fractures affect the extension apparatus, and often require surgical fixation. Surgical treatment is recommended in fractures with any of the following features: articular step-off > 2 mm, > 3 mm of fracture displacement, open fractures, and displaced fractures affecting the extensor mechanism. Meticulous handling of the soft-tissue envelope is of the utmost importance, given the patella's tenuous blood supply and limited soft-tissue envelope. Incongruent articular surface can result in detrimental long-term effects; therefore, surgical treatment is directed toward anatomic reduction and fixation. The evolution of patellar fracture fixation continues to maximize options to balance rigid fixation with low-profile fixation constructs. Improving functional outcomes, minimizing soft-tissue irritation, and limiting postoperative complications are possible by using the therapeutic principles of rigid anatomical fixation and meticulous soft-tissue handling.

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Avascular Necrosis of the Talus

Parekh, Selene G.; Kadakia, Rishin J.

doi : 10.5435/JAAOS-D-20-00418

Journal of the American Academy of Orthopaedic Surgeons. 29(6):e267-e278, March 15, 2021.

Talar osteonecrosis results from trauma to the fragile blood supply to the talus. Many etiologies exist that can cause talar osteonecrosis, with the most common being talar neck fractures. Patients with talar osteonecrosis frequently present with progressive ankle pain and limited range of motion. Treatment strategy depends primarily on the stage of disease. Conservative care in the form of medications and bracing treatment can be beneficial for patients with low functional status and early disease stages. Surgical options also exist for early disease without talar collapse that can potentially preserve the tibiotalar joint. Once talar collapse develops, surgical treatment is move invasive and typically involves an arthrodesis or talus arthroplasty. Although some treatment guidelines exist based on the disease stage, talar osteonecrosis is a complex problem, and treatment strategy should always be determined on a case-by-case basis carefully examining all clinical aspects.

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Incidental Durotomy in Lumbar Spine Surgery; Risk Factors, Complications, and Perioperative Management

Hassanzadeh, Hamid; Bell, Joshua; Bhatia, Manminder; Puvanesarajah, Varun 

doi : 10.5435/JAAOS-D-20-00210

Journal of the American Academy of Orthopaedic Surgeons. 29(6):e279-e286, March 15, 2021.

Incidental durotomy (ID) can occur in up to 14% of all lumbar spine surgeries. The risk of this complication is markedly higher among elderly patients with advanced spinal pathology. In addition, revision cases and other more invasive procedures increase the risk of ID. When unrepaired, IDs can increase the risk of developing meningitis and can lead to the formation of cerebrospinal fluid fistulas and pseudomeningoceles. Intraoperative recognition and repair are essential to ID management, although repair techniques vary considerably. Although primary suture repair is considered the “benchmark,” indirect repair alone has shown comparable outcomes. Given the concern for infection after ID, many have indicated for prolonged prophylactic antibiotic regimens. However, there is little clinical evidence that this is necessary after adequate repair. The addition of subfascial drains have been shown to promote wound healing and early ambulation, whereas no consensus on duration of indwelling drains exists and such management is largely case dependent. Early ambulation after surgery has not shown to be associated with increased risk of further ID complications and decreases rehabilitation time, length of stay, and risk of venous thromboembolism. However, there remains a role for conservation mobilization protocols in more severe cases where notable symptoms are observed.

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The Impact of Unguided Trauma Simulation Practice on Novice Performance: A Randomized Controlled Trial

Wang, Kevin C.; Bernardoni, Eamon D.; Cotter, Eric J.; Levine, Brett R.; Frank, Rachel M

doi : 10.5435/JAAOS-D-19-00225

Journal of the American Academy of Orthopaedic Surgeons. 29(6):255-262, March 15, 2021.

The purpose of this investigation was to determine the impact of simulator practice on task completion time, radiation use, success rate, and overall quality in a simulation of placing a distal locking screw.

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The Impact of Subspecialty Fellows on Orthopaedic Resident Surgical Experience: A Multicenter Study of 51,111 Cases

Jiang, Sam Y.; Carlock, Kurtis D.; Campbell, Sean T.; Vorhies, John S.; Gardner, Michael J.; Leucht, Philipp; Bishop, Julius A

doi : 10.5435/JAAOS-D-20-00233

Journal of the American Academy of Orthopaedic Surgeons. 29(6):263-270, March 15, 2021.

Meaningful participation in surgery is important for orthopaedic resident education. This study aimed to quantify the effect of fellows on resident surgical experience. We hypothesized that as fellowship programs expanded, resident caseload would decrease, whereas “double-scrubbed” cases would increase.

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The Influence of Exposure in Training to the Open Bankart on the Declining Current Use of the Procedure

Neviaser, Robert J.; Parker, Rachel L.; Neviaser, Andrew S.

doi : 10.5435/JAAOS-D-20-00368

Journal of the American Academy of Orthopaedic Surgeons. 29(6):e287-e296, March 15, 2021.

The purpose of this study was to assess the influence of exposure to the open Bankart during residency and fellowship on the trend toward obsolescence of the procedure. Our hypothesis was that the open Bankart would be used with decreasing frequency and that this would be related to lack of exposure to the procedure during training.

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Soft-tissue Sarcoma of the Hand: Patient Characteristics, Treatment, and Oncologic Outcomes

Lans, Jonathan; Yue, Kai-Lou C.; Castelein, René M.; Suster, David I.; Nielsen, G. Petur; Chen, Neal C.; Calderon, Santiago A. Lozano

doi : 10.5435/JAAOS-D-20-00434

Journal of the American Academy of Orthopaedic Surgeons. 29(6):e297-e307, March 15, 2021.

The aim of this study was to describe patient characteristics, treatment, and oncologic outcomes of soft-tissue sarcomas (STSs) of the hand.

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Letters to the Editor: Effects of Diabetes Mellitus on Functional Outcomes and Complications After Torsional Ankle Fracture

Jahansooz, Julia R.

doi : 10.5435/JAAOS-D-20-00217

Journal of the American Academy of Orthopaedic Surgeons. 29(6):e308-e309, March 15, 2021.

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Reply to Letter to the Editor: Effects of Diabetes Mellitus on Functional Outcomes and Complications After Torsional Ankle Fracture

Vallier, Heather A.; Benedick, Alex

doi : 10.5435/JAAOS-D-20-00566

Journal of the American Academy of Orthopaedic Surgeons. 29(6):e310-e311, March 15, 2021.

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