Publications by authors named "Jason A Grassbaugh"

22 Publications

  • Page 1 of 1

Editorial Commentary: Radiographic Measurements of Knee Joint Space Are Inadequate for Demonstrating Chondral Restoration.

Arthroscopy 2021 02;37(2):669-671

Tacoma, Washington (E.D.A.).

Orthopaedic advancements into the 21st century will increasingly focus on chondral restoration to either halt or reverse degenerative processes. Researchers and clinicians will need tools beyond patient-reported outcomes to measure the effectiveness of these treatment efforts. The use of joint space width (JSW) as a surrogate for chondral restoration is inadequate. At a minimum, such observations must standardize load transmission across the joint to be useful. Simple, readily available, standardized, and clinically useful measures of knee chondral restoration would facilitate and accelerate advances in the field. For now, it may be that improvement in JSW after chondral restoration could be attributable to changes in mechanical alignment of the knee and not the chondral restoration. JSW is an inadequate surrogate for chondral restoration, and anyone doing a stress radiograph of a unicompartmental degenerative knee recognizes this point.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arthro.2020.11.012DOI Listing
February 2021

Ultrasound-Guided Biceps Tendon Sheath Injections Frequently Extravasate Into the Glenohumeral Joint.

Arthroscopy 2021 06 13;37(6):1711-1716. Epub 2021 Jan 13.

Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, U.S.A.

Purpose: To evaluate the frequency of glenohumeral joint extravasation of ultrasound (US)-guided biceps tendon sheath injections.

Methods: Fifty shoulders with a clinical diagnosis of bicipital tenosynovitis pain received a US-guided biceps sheath injection with anesthetic, steroid, and contrast (5.0 mL mixture) followed immediately by orthogonal radiographs to localize the anatomic distribution of the injection. Radiographic evaluation of contrast localization was determined and interobserver reliability calculated.

Results: All 50 postinjection radiographs (100%) demonstrated contrast within the biceps tendon sheath. In addition, 30 of 50 (60%) radiographs also revealed contrast in the glenohumeral joint. Interobserver reliability for determination of intraarticular contrast was good (kappa value 0.87).

Conclusions: US-guided bicipital sheath injections reproducibly result in intrasheath placement of injection fluid. Bicipital sheath injections performed with 5 mL of volume result in partial extravasation into the joint 60% of the time. These data may be useful for surgeons who use the results of diagnostic biceps injections for diagnosis and surgical decision-making.

Level Of Evidence: III, prospective cohort study, diagnosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arthro.2020.12.238DOI Listing
June 2021

Intraoperative Identification of Clavicle Fracture Patterns: Do Clavicles Fail in a Predictable Pattern?

J Orthop Trauma 2020 12;34(12):675-678

Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC.

Objectives: To characterize the fracture pattern and pattern of fragmentation for displaced, midshaft clavicle fractures undergoing operative management.

Design: Prospective observational study.

Setting: Two institutions. Level 1 and Level 2 Trauma Centers.

Patients/participants: Fifty-three patients who underwent operative repair of midshaft clavicle fracture.

Intervention: All clavicles were treated by operative open reduction internal fixation.

Main Outcome Measurements: All clavicles were categorized by the Robinson classification based on injury plain film bilateral upright clavicle radiographs. In addition, intraoperative fracture characteristics of fragment length and location were measured and recorded to evaluate the fracture pattern. All fractures were analyzed to determine the frequency of segmental comminution versus length-stable patterns, analyze characteristics of butterfly fragment size, number and location as well as the location of the cortical read for those length-stable fractures.

Results: Analysis revealed 55% were Robinson 2B2 based on preoperative radiographs. Length-stable, anatomic reduction was achievable in 83%. For those in which an anatomic cortical read was achievable, 97.7% had a read present in the posterior-superior aspect of the clavicle.

Conclusions: Midshaft clavicle fractures that meet conventional criteria for operative repair occur in a predictable manner with butterfly fragments generated from anterior-inferior compression and simple fracture line generated from tension along the posterior-superior aspect of the clavicle. Understanding this pattern can assist in the in surgical planning.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/BOT.0000000000001801DOI Listing
December 2020

Editorial Commentary: Anatomy of the Anterolateral Ligament of the Knee-The Science of Looking for Bigfoot.

Arthroscopy 2019 02;35(2):682-683

The anterolateral ligament of the knee continues to create a spirited debate within orthopaedics. This can be traced as far back as 1879, when Segond initially described a "pearly, resistant, fibrous band" of the anterolateral aspect of the knee. More recently, much orthopaedic research has been aimed at not only the clinical significance-but defining its very existence. At times, it seems akin to a modern-day search for Bigfoot-some see it, some do not. The authors of this commentary are becoming less skeptical of the anterolateral ligament's existence but remain in search of its surgical significance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arthro.2018.11.031DOI Listing
February 2019

Stress radiographs for evaluating acromioclavicular joint separations in an active-duty patient population: What have we learned?

J Orthop 2018 Mar 2;15(1):159-163. Epub 2018 Feb 2.

Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA; Medical University of South Carolina, Charleston, SC, USA; Fort Belvoir Community Hospital, Fort Belvoir, VA, USA; Madigan Army Medical Center, Fort Lewis, WA, United States.

Introduction: Acromioclavicular (AC) joint separation is a common entity in athletic patient populations. The surgical treatment of these injuries varies based upon extent of injury, with numerous imaging modalities recommended to differentiate injury severity and treatment options. The use of weighted stress radiographs is controversial in the diagnostic evaluation of AC separation with previous consensus recommending against their use. No study to date has investigated the clinical utilization of diagnostic studies in the evaluation of AC joint separations in a military surgeon population.

Methods: Thirty-eight shoulder or sports medicine sub-specialty certified orthopaedic surgeons on active service in the Army, Air Force, and Navy were surveyed on their evaluation and treatment protocols for AC joint injuries. Specifically analyzed were imaging choice including the use of weighted stress radiographs as well as treatment recommendations based upon Rockwood grade. Responses were recorded in addition to surgeon descriptive data. Responses were analyzed with descriptive statistics.

Results: Thirty-seven of the identified thirty eight surgeons responded to the survey, for a 97% response rate. Of the group, 70% of surgeons were within 10 years of completing fellowship with an estimated average of 15 AC joint separations treated annually. Plain radiographic examination was relied upon by 48% of surgeons for treatment of AC joint separation with 13% using weighted stress radiographs. Overall, 10% of surgeon stated that their treatment plan would vary based upon results from a weighted stress view. 51% of surgeons included magnetic resonance imaging in their diagnostic approach of these injuries. Treatment recommendation varied according to injury severity with 78% preferring nonoperative treatment for acute Grade III injuries with 86% waiting a minimum of 3 months before proceeding with operative treatment. For Grade V injuries, 81% of surgeon preferred operative treatment, with 59% incorporating a soft-tissue graft in their repair or reconstructive procedure.

Discussion: This study identified substantial practice variation amongst military surgeons treating a relatively homogenous population with AC joint separations, reflective of a lack of definitive evidence to guide diagnosis and treatment. Overall, nonoperative management is the preferred initial approach for Type III injuries and operative treatment is the preferred initial approach for Type V injuries. The diagnostic evaluation varied across the surgeon cohort, but 87% elected against the use of weighted stress radiographs for the evaluation of AC joint separations, with only 10% relying upon them to dictate their recommended treatment. Future research identifying optimal diagnosis and treatment of AC joint separations is needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jor.2018.01.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5895893PMC
March 2018

Editorial Commentary: Understanding Anterior Cruciate Ligament Failure: New Questions Emerge as Existing Ones Are Answered.

Arthroscopy 2018 03;34(3):704-705

Cartilage injuries are prevalent in patients undergoing knee anterior cruciate ligament revision surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arthro.2017.10.008DOI Listing
March 2018

Arthroscopic treatment of posterior shoulder instability in patients with and without glenoid dysplasia: a comparative outcomes analysis.

J Shoulder Elbow Surg 2017 Dec 19;26(12):2103-2109. Epub 2017 Jul 19.

Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA. Electronic address:

Background: The purpose of this study was to evaluate the influence of glenoid dysplasia on outcomes after isolated arthroscopic posterior labral repair in a young military population.

Methods: Thirty-seven male patients who underwent arthroscopic posterior labral repair for symptomatic posterior shoulder instability were evaluated at a mean duration of 3.1 years. A comparative analysis was performed for those with glenoid dysplasia and without dysplasia. Additional factors analyzed included military occupational specialty (MOS), preoperative mental health clinical encounters and mental health medication use, and radiographic characteristics (version, posterior humeral head subluxation, and posterior capsular area) on a preoperative standard shoulder magnetic resonance arthrogram. The groups were analyzed with regard to shoulder outcome scores (subjective shoulder value [SSV], American Shoulder and Elbow Surgeons [ASES] rating scale, Western Ontario Shoulder Instability Index [WOSI]), need for revision surgery, and medical separation from the military.

Results: Of 37 patients, 3 (8.1%) underwent revision surgery and 6 (16%) underwent medical separation. Overall outcome assessment demonstrated a mean SSV of 67.9 (range, 25-100) ± 22.1, mean ASES of 65.6 (range, 15-100) ±  22, and mean WOSI of 822.6 (range, 5-1854) ± 538. There were no significant differences in clinical outcome scores between the glenoid dysplasia and no dysplasia groups (SSV, P = .55; ASES, P = .57; WOSI, P = .56). MOS (P = .02) and a history of mental health encounters (P = .04) were significantly associated with diminished outcomes.

Conclusions: The presence or absence of glenoid dysplasia did not influence the outcome after arthroscopic posterior labral repair in a young military population. However, a history of mental health clinical encounters and an infantry MOS were significantly associated with poorer clinical outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jse.2017.05.033DOI Listing
December 2017

Refuting the lipstick sign.

J Shoulder Elbow Surg 2017 Aug 27;26(8):1416-1422. Epub 2017 Mar 27.

Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA. Electronic address:

Background: Arthroscopic examination of the tendon has been described as the "gold standard" for diagnosis of tendinitis of the long head of the biceps (LHB). An arthroscopic finding of an inflamed and hyperemic LHB within the bicipital groove has been described as the "lipstick sign." Studies evaluating direct visualization in diagnosis of LHB tendinitis are lacking.

Methods: During a 1-year period, 363 arthroscopic shoulder procedures were performed, with 16 and 39 patients prospectively selected as positive cases and negative controls, respectively. All positive controls had groove tenderness, positive Speed maneuver, and diagnostic ultrasound-guided bicipital injection. Negative controls had none of these findings. Six surgeons reviewed randomized deidentified arthroscopic pictures of enrolled patients The surgeons were asked whether the images demonstrated LHB tendinitis and if the lipstick sign was present.

Results: Overall sensitivity and specificity were 49% and 66%, respectively, for detecting LHB tendinitis and 64% and 31%, respectively, for erythema. The nonweighted κ score for interobserver reliability ranged from 0.042 to 0.419 (mean, 0.215 ± 0.116) for tendinitis and from 0.486 to 0.835 (mean, 0.680 ± 0.102) for erythema. The nonweighted κ score for intraobserver reliability ranged from 0.264 to 0.854 (mean, 0.615) for tendinitis and from 0.641 to 0.951 (mean, 0.783) for erythema.

Conclusions: The presence of the lipstick sign performed only moderately well in a rigorously designed level III study to evaluate its sensitivity and specificity. There is only fair agreement among participating surgeons in diagnosing LHB tendinitis arthroscopically. Consequently, LHB tendinitis requiring tenodesis remains a clinical diagnosis that should be made before arthroscopic examination.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jse.2017.01.009DOI Listing
August 2017

Accuracy of Ultrasound-Guided Intra-articular Hip Injections Performed in the Orthopedic Clinic.

Orthopedics 2017 Mar 20;40(2):96-100. Epub 2016 Dec 20.

Intra-articular hip injections have proven clinical value for both diagnostic and therapeutic purposes. Historically, these injections have been performed by radiologists using fluoroscopic guidance. This necessitates a radiology referral, delays the injection, and represents lost productivity for the orthopedist. Ultrasound-guided intra-articular hip injections have been described in the radiology literature with excellent accuracy. These injections were performed by radiologists. The purpose of this study was to determine the accuracy of ultrasound-guided hip injections performed in the orthopedic clinic by orthopedic surgeons and orthopedic physician assistants. Fifty ultrasound-guided hip injections were performed using a standard technique. Contrast was included, and an anteroposterior pelvis radiograph was obtained immediately following injection. Diagnosis, body mass index, procedure time, and visual analog scale scores were recorded. Radiographs were reviewed independently by a musculoskeletal radiologist and an orthopedic surgeon to determine intra-articular placement of the injection. A total of 50 hips were injected. There was no identifiable contrast in 2 patients, leaving 48 hips for analysis. Of these, contrast was injected intra-articularly in 46 hips for an accuracy of 96%. Average procedural time was 2.6 minutes, and the average visual analog scale score was 1.9 during the procedure. Revenue value units ranged from 1.72-2.55 for ultrasound-guided hip injections. These findings indicate ultrasound-guided intra-articular hip injections performed in the orthopedic clinic by surgeons or physician assistants are accurate, efficient, and patient-friendly. Additionally, they preserve patient continuity and maintain productivity within the orthopedic clinic. [Orthopedics. 2017; 40(2):96-100.].
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3928/01477447-20161213-03DOI Listing
March 2017

Return to Duty Rates Following Meniscal Repair Surgery in an Active Duty Military Population.

Mil Med 2016 11;181(11):e1661-e1665

Orthopaedic Surgery Service, Madigan Army Medical Center, 9040 Jackson Avenue, Tacoma, WA, 98431.

Meniscal injury is a common knee injury in a young athletic population. Maintaining the integrity of the meniscus is critical to reducing contact pressures on the tibiofemoral articulation. The purpose of this study is to analyze the outcomes of meniscal repair in a young military population. We conducted a retrospective review of all meniscal repairs performed on active duty Army personnel at a Military Medical Center from January 2002 to December 2012. One hundred seventy-eight active duty patients, mean age 28 (19-48) years underwent 178 meniscal repairs. Postoperatively, 33 (18.5%) patients were medically separated from the military at an average time of 29 months. Fifty (28%) patients required a permanent duty restricting profile. Ninety-five (53.5%) patients required no profile after meniscal repair at an average follow-up of 5 (1.5-12.3) years. Meniscal repair in this young military population allowed 81.5% of patients to return to duty; however, 34% of those required a permanent duty restricting profile. Approximately 20% of patients required medical separation from the military after meniscal repair. Older age was significantly associated with the ability to remain on active duty (p = 0.01).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7205/MILMED-D-15-00589DOI Listing
November 2016

Glenoid Dysplasia: Pathophysiology, Diagnosis, and Management.

J Bone Joint Surg Am 2016 Jun;98(11):958-68

Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts

➤Subtle forms of glenoid dysplasia may be more common than previously thought and likely predispose some patients to symptomatic posterior shoulder instability. Severe glenoid dysplasia is a rare condition with characteristic radiographic findings involving the posteroinferior aspect of the glenoid that often remains asymptomatic.➤Instability symptoms related to glenoid dysplasia may develop over time with increased activities or trauma. Physical therapy focusing on rotator cuff strengthening and proprioceptive control should be the initial management.➤Magnetic resonance imaging and computed tomographic arthrograms are useful for detecting subtle glenoid dysplasia by revealing the presence of an abnormally thickened or hypertrophic posterior part of the labrum, increased capsular volume, glenoid retroversion, and posteroinferior glenoid deficiency.➤Open and arthroscopic labral repair and capsulorrhaphy procedures have been described for symptomatic posterior shoulder instability. Glenoid retroversion of >10° may be a risk factor for failure following soft-tissue-only procedures for symptomatic glenoid dysplasia.➤Osseous procedures are categorized as either glenoid reorientation (osteotomy) or glenoid augmentation (bone graft), and no predictable results have been demonstrated for any surgical strategy. Glenoid osteotomies have been described for increased retroversion, with successful results, although others have noted substantial complications and poor outcomes.➤In severe glenoid dysplasia, the combination of bone deficiency and retroversion makes glenoid osteotomy extremely challenging. Bone grafts placed in a lateralized position to create a blocking effect may increase the risk of the development of arthritis, while newer techniques that place the graft in a congruent position may decrease this risk.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2106/JBJS.15.00916DOI Listing
June 2016

Intramedullary Fixation of Clavicle Fractures: Anatomy, Indications, Advantages, and Disadvantages.

J Am Acad Orthop Surg 2016 Jul;24(7):455-64

From the Orthopaedic Surgery Service, Madigan Army Medical Center, Tacoma, WA.

Historically, management of displaced midshaft clavicle fractures has consisted of nonsurgical treatment. However, recent literature has supported surgical repair of displaced and shortened clavicle fractures. Several options exist for surgical fixation, including plate and intramedullary (IM) fixation. IM fixation has the potential advantages of a smaller incision and decreased dissection and soft-tissue exposure. For the last two decades, the use of Rockwood and Hagie pins represented the most popular form of IM fixation, but concerns exist regarding stability and complications. The use of alternative IM implants, such as Kirschner wires, titanium elastic nails, and cannulated screws, also has been described in limited case series. However, concerns persist regarding the complications associated with the use of these implants, including implant failure, migration, skin complications, and construct stability. Second-generation IM implants have been developed to reduce the limitations of earlier IM devices. Although anatomic and clinical studies have supported IM fixation of midshaft clavicle fractures, further research is necessary to determine the optimal fixation method.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5435/JAAOS-D-14-00336DOI Listing
July 2016

Infection Rate of Intramedullary Nailing in Closed Fractures of the Femoral Diaphysis After Temporizing External Fixation in an Austere Environment.

J Orthop Trauma 2015 Sep;29(9):e316-20

*Orthopaedic Surgery Service, Department of Surgery, Madigan Army Medical Center, Tacoma, WA; †Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, San Antonio, TX; and ‡G&T Orthopedics and Sports Medicine, Elmhurst, IL.

Objectives: To determine the infection rate of intramedullary (IM) nailing of closed diaphyseal femur fractures after temporary stabilization with external fixation in an austere combat environment.

Design: Retrospective case series.

Setting: Iraq and Afghanistan Theater and Military Medical Treatment Centers in the United States and Landstuhl, Germany.

Patients: Military personnel who underwent temporizing external fixation of a closed diaphyseal femur fracture (OTA 32) with later conversion to an IM nail between 2003 and 2012.

Intervention: Patients were identified from the Joint Theater Trauma Registry and Department of Defense electronic medical record, and a retrospective review was performed.

Main Outcome Measurements: Variables measured included age, gender, mechanism of injury, Injury Severity Score, associated injuries (to include thoracic and abdominal injuries), base deficit, history of massive transfusion, date of injury, date and place of external and IM fixations, time to conversion procedure, report of superficial or deep infection, report of fracture union, and date of last follow-up.

Results: One hundred twenty-two patients, mean age 25 (18-43) years, sustained 125 closed femoral diaphyseal fractures from May 2003 to July 2012. External fixation was performed at a mean of 0.2 days (median of the day of injury) and a range of 0-3 days. Mean time to IM nail conversion procedure was 6.9 (1-20) days. Infection rate was 2.5%, with a P of 0.188. Average follow-up was 41.4 (12-119) months.

Conclusions: Acceptable low infection rates can be achieved after IM nailing of closed diaphyseal femur fractures treated with initial external fixation in an austere combat environment.

Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/BOT.0000000000000327DOI Listing
September 2015

Pseudarthrosis of the clavicle.

Orthopedics 2014 May;37(5):295, 349-50

A 21-year-old active duty soldier presented with right shoulder pain and prominence over his right clavicle, with no history of trauma. He recalled that the deformity had been present for a long time, but only recently became painful. The onset of shoulder pain coincided with the beginning of his military service and the requirement to wear over-the-shoulder equipment such as back packs and load-bearing equipment. Physical examination revealed a prominence over the right midshaft clavicle with tenderness to palpation, full active range of motion of the shoulder, and that he was neurovascularly intact.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3928/01477447-20140430-01DOI Listing
May 2014

A simple surgical technique for subpectoral biceps tenodesis using a double-loaded suture anchor.

Arthrosc Tech 2013 May 23;2(2):e191-6. Epub 2013 May 23.

Department of Orthopedics, Madigan Army Medical Center, Tacoma, Washington, U.S.A.

Multiple different surgical techniques have previously been described to address long head of the biceps tendinopathy. Subpectoral biceps tenodesis has proven to be an effective procedure to relieve pain and maintain function. We describe a surgical technique for subpectoral biceps tenodesis using a single double-loaded suture anchor implant. Advantages of this procedure include the ease of implant placement and the freedom this technique affords to perform the anchor placement without direct visualization of the docking site.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.eats.2013.02.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3716235PMC
May 2013

Surgical technique affects outcomes in acromioclavicular reconstruction.

J Surg Orthop Adv 2013 ;22(1):71-6

Department of Orthopedics, Womack Army Medical Center, Fort Bragg, NC, USA.

Optimal treatment for acromioclavicular (AC) dislocation is unknown. Numerous surgical procedures for AC injuries have been described with little comparison. This study sought to compare the clinical and radiographic results of various surgical techniques in order to identify the optimal surgical technique. Ninety patients met inclusion criteria of AC reconstruction at this institution. A retrospective review of outcomes was performed using the electronic records system. Radiographs were measured for pre- and postoperative grade and percent elevation versus the contralateral side. Overall revision rate was 9%. Suture button fixation had a revision rate of 0% compared to 14% (p = .01). Reconstruction procedures performed with distal clavicle excision showed a higher revision rate, 17% compared to 0% (p = .003). There were no statistically significant clinical differences. AC reconstructions performed with suture button construct were superior to other surgical techniques. Procedures performed with distal clavicle excision were inferior to those without.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3113/jsoa.2013.0071DOI Listing
April 2013

Triple arthrodesis with lateral column lengthening for the treatment of planovalgus deformity.

J Pediatr Orthop 2011 Oct-Nov;31(7):773-82

Madigan Army Medical Center, Tacoma, WA 99204-2901, USA.

Background: The rigid planovalgus foot has historically been difficult to correct and maintain in a corrected position with triple arthrodesis (TA). The lateral column lengthening (LCL) is a procedure that corrects the position of the planovalgus foot. Combining the TA with LCL at the calcaneocuboid joint may improve ultimate position after fusion for patients with rigid planovalgus foot deformities.

Methods: A retrospective review of all patients who underwent TA with LCL through the calcaneocuboid joint for rigid planovalgus foot deformity was performed. Preoperative and postoperative radiographs were compared for foot alignment by measuring the talo-first metatarsal angle in the anterior-posterior and lateral planes, calcaneal pitch, talo-horizontal angle, metatarsal stacking angle, and medial/lateral column ratio. Clinical outcomes were evaluated for correlation with preoperative and postoperative deformity and surgical indications.

Results: were evaluated using radiographic and clinic outcome measures developed for TA and LCL.

Results: : Twenty-nine surgeries were identified with solid fusions occurring in 27 patients by 12 weeks postoperatively. Two patients with cerebral palsy had persistent hindfoot valgus. At an average follow-up of 32 months after surgical intervention, correction of the talo-first metatarsal angle in the AP and lateral planes, calcaneal pitch, and talo-horizontal angles were statistically significant. There were 25 good clinical results with minimal or no pain with activity (86.2%) and 4 poor or fair results with moderate or severe pain (13.8%). There were 26 radiographic successes (89.7%) and 3 radiographic failures (10.3%). Cerebral palsy was associated with a higher rate of radiographic failures (P=0.01). There were 15 total complications in 11 feet (37.9%). These included 4 related to hardware, 3 involving neurological symptoms, 2 related to soft tissues, development of a symptomatic bony prominence in 2 patients, 1 forefoot deformity, 2 nonunions, and 1 case of Achilles tendonitis.

Conclusion: Good correction can be obtained and maintained with LCL and TA for rigid planovalgus foot deformity. The procedure is associated with good short-term clinical and radiographic outcomes and improves the position of the foot with diminished risk of recurrent or continued deformity as compared with historical controls.

Level Of Evidence: Level IV (case series).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/BPO.0b013e31822d3882DOI Listing
January 2012

Instrumentation-specific infection after anterior cruciate ligament reconstruction.

Sports Health 2009 Nov;1(6):481-5

Madigan Army Medical Center, Tacoma, Washington.

Background: Anterior cruciate ligament (ACL) reconstruction is uncommonly complicated by postoperative infections, the causes of which are rarely identified.

Hypothesis/purpose: The goal of this study was to characterize the relationship between methodological sterilization failure and ACL reconstruction infection at an army medical center.

Study Design: Case series.

Methods: Demographic, clinical, and laboratory data were collected on 5 postoperative infections during a 14-week period in 2003. All ACL reconstructions completed within the past 6 years at the institution were reviewed to establish a baseline infection rate.

Results: There was a 14-week period in which 5 cases of infection occurred postoperatively, an infection rate of 12.2%. Previous and subsequent to the identified period, the established rate of infection after ACL reconstruction was 0.3%. There were no violations of sterile technique noted in any of the identified cases. All cases utilized hamstring autograft. All cases also used the DePuy Mitek Intrafix system for tibial fixation of the graft. Two of these cases had positive cultures.

Conclusions: An isolated series of increased infection rate led to an investigation into the sterile technique. This revealed gross biomaterial remaining inside instrumentation common to all the cases, the DePuy Mitek Intrafix system. The modular cannulated hex driver, made to fit over a small caliber wire, had no wire brushes of a small-enough diameter for the cleaning and sterilization procedure. After recognition of infection, all patients were treated with surgical irrigation and debridement of the affected knee, as well as individualized antibiotic therapy. Patients were followed postoperatively and no patients required revision ACL reconstruction or radical debridement of the graft.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1941738109347975DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445146PMC
November 2009

Pectoralis major tendon repairs in the active-duty population.

Am J Orthop (Belle Mead NJ) 2009 Jan;38(1):26-30

Department of Orthopaedic Surgery, Madigan Army Medical Center, Fort Lewis, Washington, USA.

Rupture of the pectoralis major tendon is an uncommon injury that typically occurs in young, active people. Of this injury population, active-duty military personnel represent a unique, athletic subset that is commonly treated with operative repair. For the retrospective case series reported here, we hypothesized that active-duty soldiers with acute and chronic pectoralis major tendon ruptures treated with operative repair would have high levels of patient satisfaction, quick return to work and sports, and few long-term complications. We retrospectively reviewed all pectoralis major tendon rupture repairs performed at our institution between 2000 and 2007. Charts were thoroughly reviewed, and patients were asked to complete DASH (Disabilities of the Arm, Shoulder, and Hand) and supplemental questionnaires. Paired Student's t test was performed, and Ps were calculated to analyze statistical differences between immediate- and delayed-treatment groups. Fourteen patients were identified. The most common mechanism of injury was bench-pressing weights. Overall DASH, Work Module, and Sports Module scores were good to excellent. There was a statistically significant difference between outcomes for the immediate- and delayed- treatment groups, with the immediate-treatment group having better overall DASH and Work Module scores. Patients had a 30% to 40% objective loss of strength after surgery. Active-duty soldiers reported acceptable overall outcomes after both immediate and delayed treatment for pectoralis major tendon ruptures, but a statistically significant difference was found in overall DASH and Work Module scores between the treatment groups.
View Article and Find Full Text PDF

Download full-text PDF

Source
January 2009

Congenital ingrown toenail of the hallux.

J Pediatr Orthop 2007 Dec;27(8):886-9

Madigan Army Medical Center, Tacoma, WA, USA.

Background: Ingrown toenail in the infant is a rare entity that has only occasionally been discussed in the medical literature. At birth, or soon thereafter, children present with bilateral ingrown hallux toenails notable for pain, tenderness, erythema, purulence, and hypertrophy of the skin and fat of the distal end of the great toes extending over the dorsum of the nail plates. Inflammatory and infectious granulation tissue develops with time.

Methods: We present a case series of 4 patients with bilateral congenitally ingrown hallux toenails. Conservative and surgical treatment modalities were used, with 3 of 4 patients undergoing wedge resection of the hypertrophic soft tissues at the distal end of the toes.

Results: There were excellent results in both feet of all patients with resolution of the condition and no recurrences in any patient. Clinical photos are provided for all patients.

Conclusions: Ingrown toenail in the infant is a rare entity that occasionally requires surgical treatment. Excellent results are expected with wedge resection of the hypertrophic soft tissues.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/bpo.0b013e3181594d09DOI Listing
December 2007

Blinded comparison of preoperative duplex ultrasound scanning and contrast arteriography for planning revascularization at the level of the tibia.

J Vasc Surg 2003 Jun;37(6):1186-90

Department of Surgery, Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756, USA.

Purpose: We examined whether preoperative duplex ultrasound scanning (DU) could replace contrast material-enhanced arteriography (CA) in selecting the recipient artery of tibial or peroneal artery bypass grafts.

Methods: In patients who underwent tibial or peroneal artery bypass grafting because of critical ischemia, images were obtained of the lower extremity arterial circulation with both DU and CA. Vascular surgeons, blinded to the operation performed, reviewed either DU or CA images for arterial visualization and patency. The tibial or peroneal artery best suited to receive the bypass graft was selected by surgeons using only data from either DU or CA images. This selection was compared with the artery actually used at bypass surgery.

Results: Preoperative DU and CA data for 40 lower extremities in 38 patients undergoing bypass grafting at the level of the tibia provided 110 arteries: 38 anterior tibial arteries, 32 peroneal arteries, and 40 posterior tibial arteries. Ten arteries (8 peroneal, 2 anterior tibial) were not identified with DU, and 1 artery (anterior tibial) was not identified with CA. DU enabled prediction of the artery actually used in 88% of patients (35 of 40), whereas CA enabled prediction of the artery actually used in 93% of patients (37 of 40; P =.59). Duplicate findings at DU and CA enabled selection of 85% of arteries actually used (95% confidence interval, 71%-93%). Arteries used for bypass grafting had significantly higher peak systolic velocity (35 cm/s vs 25 cm/s; P =.04), higher end-diastolic velocity (15 cm/s vs 9 cm/s; P =.005), and greater diameter (2.4 mm vs 1.7 mm; P =.003) compared with arteries not selected for bypass grafting.

Conclusion: Findings at DU and CA typically agree when used to select tibial or peroneal arteries for bypass grafting. With DU there is occasional difficulty in identification of the peroneal artery, but selection of the actual artery used is accurate. Peak systolic velocity, end-diastolic velocity, and diameter characteristics correlate with arteriographic criteria for tibial bypass target artery selection. If DU enables adequate identification of a target artery for bypass grafting, and especially if the peroneal artery is seen, findings at CA are not likely to alter bypass execution.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/s0741-5214(03)00328-8DOI Listing
June 2003
-->