Publications by authors named "Oke A Anakwenze"

43 Publications

Characteristics and Risk Factors for 90-Day Readmission Following Shoulder Arthroplasty.

J Shoulder Elbow Surg 2021 Aug 25. Epub 2021 Aug 25.

Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, IL, USA. Electronic address:

Background: Anatomic and reverse total shoulder arthroplasty (aTSA, rTSA) are the standard of care for end-stage shoulder arthritis. Advancements in implant design, perioperative management, and patient selection have allowed shorter inpatient admissions. Unplanned readmissions remain a significant complication. Identification of risk factors for readmission is prudent as physicians and payers prepare for the adoption of bundled care reimbursement models. The purpose of the present study is to identify characteristics and risk factors associated with readmission following shoulder arthroplasty using a large, bi-institutional cohort.

Methods: 2,805 Anatomic and 2,605 reverse total shoulder arthroplasties drawn from two geographically diverse, tertiary health systems were examined for unplanned inpatient readmissions within 90 days following the index surgery (primary outcome). 40 preoperative patient sociodemographic and comorbidity factors were tested for their significance using both univariable and multivariable logistic regression, and backwards stepwise elimination selected for the most important associations for 90-day readmission. Readmissions were characterized as "medical" or "surgical" and subgroup analysis was performed. Short length of stay (discharge by postoperative day 1) and discharge to facility were also examined as secondary outcomes. Parameters associated with increased readmission risk were included in a predictive model.

Results: Within 90 days of surgery, 175 patients (3.2%) experienced an unanticipated readmission, with no significant difference between institutions (p=0.447). There were more readmissions for surgical complications than medical complications (62.9% vs. 37.1%, p<0.001). Patients discharged to SNF/rehab were significantly more likely to be readmitted (13.1 % vs 8.8 %, p=0.049), but short inpatient length of stay was not associated with an increased rate of 90-day readmission (42.9% vs 41.3%, p=0.684). Parameter selection based on predictive ability resulted in a multivariable logistic regression model composed of 16 preoperative patient factors, including reverse TSA, revision surgery, right-sided surgery and various comorbidities. The area under the Receiver Operator Characteristic curve for this multivariable logistic regression model is 0.716.

Conclusion: Risk factors for unplanned 90-day readmission following shoulder arthroplasty include reverse shoulder arthroplasty, surgery for revision and fracture, and right sided surgery. Additionally, there are several modifiable and non-modifiable risk factors which can be used to ascertain a patient's readmission probability. Shorter inpatient stays are not associated with increased risk of readmission, whereas discharge to post-acute care facilities does impose a greater risk of readmission. As scrutiny around health care cost increases, identifying and addressing risk factors for readmission following shoulder arthroplasty will become increasingly important.

Level Of Evidence: Level III; Retrospective Case-Control Design; Prognosis Study.
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http://dx.doi.org/10.1016/j.jse.2021.07.017DOI Listing
August 2021

Reverse total shoulder arthroplasty for oncologic reconstruction of the proximal humerus: a systematic review.

J Shoulder Elbow Surg 2021 Jul 15. Epub 2021 Jul 15.

Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.

Background: In recent years, there has been growing interest in the use of reverse total shoulder arthroplasty (rTSA) for reconstruction of the proximal humerus after oncologic resection. However, the indications and outcomes of oncologic rTSA remain unclear.

Methods: We conducted a systematic review to identify studies that reported outcomes of patients who underwent rTSA for oncologic reconstruction of the proximal humerus. Extracted data included demographic characteristics, indications, operative techniques, outcomes, and complications. Weighted means were calculated according to sample size.

Results: Twelve studies were included, containing 194 patients who underwent rTSA for oncologic reconstruction of the proximal humerus. The mean patient age was 48 years, and 52% of patients were male. Primary malignancies were present in 55% of patients; metastatic disease, 30%; and benign tumors, 9%. The mean humeral resection length was 12 cm. The mean postoperative Musculoskeletal Tumor Society score was 78%; Constant score, 60; and Toronto Extremity Salvage Score, 77%. The mean complication rate was 28%, with shoulder instability accounting for 63% of complications. Revisions were performed in 16% of patients, and the mean implant survival rate was 89% at a mean follow-up across studies of 53 months.

Conclusions: Although the existing literature is of poor study quality, with a high level of heterogeneity and risk of bias, rTSA appears to be a suitable option in appropriately selected patients undergoing oncologic resection and reconstruction of the proximal humerus. The most common complication is instability. Higher-quality evidence is needed to help guide decision making on appropriate implant utilization for patients undergoing oncologic resection of the proximal humerus.
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http://dx.doi.org/10.1016/j.jse.2021.06.004DOI Listing
July 2021

Short stay after shoulder arthroplasty does not increase 90-day readmissions in Medicare patients compared with privately insured patients.

J Shoulder Elbow Surg 2021 Jun 9. Epub 2021 Jun 9.

Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.

Background: As of January 1, 2021, total shoulder arthroplasty was removed from the Medicare inpatient-only list, reflecting a growing belief in the potential merits of same-day discharge regardless of insurance type. It is yet unknown whether Medicare populations, which frequently have more severe comorbidity burdens, would experience higher complication rates relative to privately insured patients, who are often younger with fewer comorbidities. Given the limited number of true outpatient cohorts available to study, discharge at least by postoperative day 1 may serve as a useful proxy for true same-day discharge, and we hypothesized that these Medicare patients would have increased 90-day readmission rates compared with their privately insured counterparts.

Methods: Data on 4723 total shoulder arthroplasties (anatomic in 2459 and reverse in 2264) from 2 large, geographically diverse health systems in patients having either Medicare or private insurance were collected. The unplanned 90-day readmission rate was the primary outcome, and patients were stratified into those who were discharged at least by postoperative day 1 (short inpatient stay) and those who were not. Patients with private insurance (n = 1845) were directly compared with those with Medicare (n = 2878), whereas cohorts of workers' compensation (n = 198) and Medicaid (n = 58) patients were analyzed separately. Forty preoperative variables were examined to compare overall health burden, with the χ and Wilcoxon rank sum tests used to test for statistical significance.

Results: Medicare patients undergoing short-stay shoulder arthroplasty were not significantly more likely than those with private insurance to experience an unplanned 90-day readmission (3.6% vs. 2.5%, P = .14). This similarity existed despite a substantially worse comorbidity burden in the Medicare population (P < .05 for 26 of 40 factors). Furthermore, a short inpatient stay did not result in an increased 90-day readmission rate in either Medicare patients (3.6% vs. 3.4%, P = .77) or their privately insured counterparts (2.5% vs. 2.4%, P = .92). Notably, when the analysis was restricted to a single insurance type, readmission rates were significantly higher for reverse shoulder arthroplasty compared with total shoulder arthroplasty (P < .001 for both), but when the analysis was restricted to a single procedure (anatomic or reverse), readmission rates were similar between Medicare and privately insured patients, whether undergoing a short or extended length of stay.

Conclusions: Despite a substantially more severe comorbidity profile, Medicare patients undergoing short-stay shoulder arthroplasty did not experience a significantly higher rate of unplanned 90-day readmission relative to privately insured patients. A higher incidence of reverse shoulder arthroplasty in Medicare patients does increase their overall readmission rate, but a similar increase also appears in privately-insured patients undergoing a reverse indicating that Medicare populations may be similarly appropriate for accelerated-care pathways.
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http://dx.doi.org/10.1016/j.jse.2021.05.013DOI Listing
June 2021

Fracture location impacts opioid demand in upper extremity fracture surgery.

Injury 2021 Aug 20;52(8):2314-2321. Epub 2021 May 20.

Duke University Medical Center, Department of Orthopaedic Surgery, 200 Trent Drive, Durham, NC 27710. Electronic address:

Introduction: Opioid sparing protocols should be formulated with appropriate demand. Specific fracture location has been hypothesized as an important predictor of post-operative pain. The purpose of this study is to evaluate the impact of fracture location on perioperative opioid demand after surgery with the hypothesis that this factor would be significantly associated with perioperative opioid demand in upper extremity fracture surgery.

Methods: A national database was used to identify1-month pre-operative to 1-year postdischarge opioid demand in oxycodone 5-mg equivalents in 336,493 patients undergoing fracture fixation of the clavicle through distal radius between 2010 and 2020. Three timeframes were evaluated: 1-month pre-op to 90-days post-discharge, 3 months post-discharge to 1-year post-discharge, and 1-month pre-op to 1-year postdischarge. Multivariable main effects linear and logistic regression models were constructed to evaluate the changes in opioids filled, opioid prescriptions, and odds of two or more opioid prescriptions in these timeframes based on fracture location with adjustment for age, sex, obesity, pre-operative opioid usage, and polytrauma.

Results: Compared to distal radius fracture fixation, fixation of elbow, distal humerus, humeral shaft, and proximal humerus fractures were associated with large, significant increases in 1-month pre-op to 1-year post-discharge opioid filling (33.5 - 63.4 additional oxycodone 5-mg equivalents, all p<0.05) and number of filled prescriptions (0.33 - 0.92 additional prescriptions, all p<0.05) compared to patients with other operatively treated upper extremity injuries.

Discussion: Fracture location was a significant predictor of perioperative opioid demand. Elbow, distal humerus, humeral shaft, and proximal humerus fracture fixation was associated with the largest increases in opioid demand after upper extremity fracture fixation. Patients with these injuries may be at highest risk of extensive opioid consumption.

Level Of Evidence: Level III, retrospective, observational cohort study.
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http://dx.doi.org/10.1016/j.injury.2021.05.026DOI Listing
August 2021

Physician burnout and professional satisfaction in orthopedic surgeons during the COVID-19 Pandemic.

Work 2021 ;69(1):15-22

Background: Burnout and professional satisfaction is an often an overlooked component for healthcare outcomes; the COVID-19 pandemic represents an unprecedented stressor that could contribute to higher levels of burnout.

Objectives: Our primary objective was to evaluate the association of a battery of fulfillment, job satisfaction change, COVID-19 concerns, and coping measures. Our secondary objective was to determine whether the fulfillment and coping measures differed by gender and by experience levels among a battery of physician specialties.

Methods: The study was a purposive sample of convenience. Study participants included all trainees and attending orthopedic surgeons from our academic institution; all participants were invited to complete a survey built around a validated measure of professional fulfillment aimed at assessing response to acute change and stressors. We performed univariate statistics and a matrix correlational analysis to correlate different survey domains with variables of interest.

Results: The survey was sent electronically to 138 individuals; 63 surveys were completed (response rate = 45.7%). Twenty-seven (42.8%) individuals met the threshold criteria for fulfillment whereas 10 (15.9%) met the threshold for burnout. We found that surgeon perspectives on COVID-19 were not associated with burnout or professional fulfillment. Burnout was inversely associated with professional fulfillment (R = -0.35). Support seeking was noted to be correlated with professional fulfillment (R = 0.37).

Conclusions: Stressors related to COVID-19 pandemic were not correlated with physician burnout and fulfillment. This held true even when stratifying by gender and by attending vs. trainee. Continued efforts should be implemented to protect against physician burnout and ensure professional fulfillment for Orthopedic surgeons.
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http://dx.doi.org/10.3233/WOR-205288DOI Listing
June 2021

Malnutrition in elective shoulder arthroplasty: a multi-institutional retrospective study of preoperative albumin and adverse outcomes.

J Shoulder Elbow Surg 2021 Apr 2. Epub 2021 Apr 2.

Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA. Electronic address:

Background: Malnutrition is associated with poor postoperative outcomes after knee, hip, and spine surgery. However, whether albumin labs should be part of the routine preoperative workup for shoulder arthroplasty remains understudied. This study investigated the role of preoperative albumin levels in predicting common postoperative adverse outcomes in patients undergoing shoulder arthroplasty.

Methods: All shoulder arthroplasty cases performed at 2 tertiary referral centers between July 2013 and May 2019 (institution 1) and between June 2007 and Feb 2020 (institution 2) were reviewed. A total of 421 primary and 71 revision elective shoulder arthroplasty cases had preoperative albumin levels recorded. Common demographic variables and relevant Elixhauser comorbidities were pulled. Outcomes gathered included extended (>3 days) postoperative inpatient length of stay (eLOS), 90-day readmission, and discharge to rehab or skilled nursing facility (SNF).

Results: The prevalence of malnutrition (albumin <3.5 g/dL) was higher in the revision group compared with the primary group (36.6% vs. 19.5%, P = .001). Reverse shoulder arthroplasty (P = .013) and increasing American Society of Anesthesiologists score (P = .016) were identified as independent risk factors for malnutrition in the primary group. In the revision group, liver disease was associated with malnutrition (P = .046). Malnourished primary shoulder arthroplasty patients had an increased incidence of eLOS (26.8% vs. 13.6%, P = .003) and discharge to rehab/SNF (18.3% vs. 10.3%, P = .045). On univariable analysis, low albumin had an odds ratio (OR) of 2.34 for eLOS (P = .004), which retained significance in a multivariable model including age, American Society of Anesthesiologists score, sex, and body mass index (OR 2.11, P = .03). On univariable analysis, low albumin had an OR of 1.94 for discharge to SNF/rehab (P = .048), but this did not reach significance in the multivariable model. Among revisions, malnourished patients had an increased incidence of eLOS (30.8% vs. 6.7%, P = .014) and discharge to rehab/SNF (26.9% vs. 4.4%, P = .010). In both the primary and revision groups, there was no difference in 90-day readmission rate between patients with low or normal albumin.

Conclusion: Malnutrition is more prevalent among revision shoulder arthroplasty patients compared with those undergoing a primary procedure. Primary shoulder arthroplasty patients with low preoperative albumin levels have an increased risk of eLOS and may have an increased need for postacute care. Low albumin was not associated with a risk of 90-day readmissions. Albumin level merits further investigation in large, prospective cohorts to clearly define its role in preoperative risk stratification.
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http://dx.doi.org/10.1016/j.jse.2021.03.143DOI Listing
April 2021

How Are Orthopaedic Sports Medicine Physicians Triaging Cases and Using Telehealth in Response to COVID-19? A Survey of AOSSM Membership.

Orthop J Sports Med 2021 Mar 3;9(3):2325967121990929. Epub 2021 Mar 3.

Duke Sport Science Institute; Department of Orthopaedics, Duke University Medical Center, Durham, North Carolina, USA.

Background: The COVID-19 pandemic has changed the practice of orthopaedic sports medicine. The threat of COVID-19 persists, and future restrictions to elective procedures are possible. It is important to understand how sports surgeons are prioritizing surgical cases during elective case restrictions and how telehealth is being incorporated into practice.

Purpose: To understand how orthopaedic sports surgeons have triaged surgical sports cases and how telehealth is being utilized in response to COVID-19.

Study Design: Cross-sectional study.

Methods: A survey was presented to participants of the American Orthopaedic Society for Sports Medicine (AOSSM) webinar "Handling Sports and COVID-19" and distributed through email to all members of the AOSSM. The survey consisted of 25 questions with 3 sections: demographics, clinical practice, and telehealth. Descriptive statistics were performed.

Results: Overall, 104 respondents participated. Respondents varied with respect to their location, type of clinical practice, and years in practice. The cases with the highest priority during triage included infections, fractures, and traumatic tendon ruptures (eg, quadriceps tendon). Before COVID-19, <14.0% of surgeons used telehealth, and 76.7% had never used telehealth. Now, however, 81.4% of respondents plan to use telehealth at least once a week in their practice. Respondents indicated postoperative visits and return patients as the most appropriate for telehealth. The majority felt that telehealth was not appropriate for new shoulder (65.9%) or knee (55.6%) evaluation. The leading barriers to telehealth use that were identified included, in decreasing order, concerns about clinical appropriateness, accuracy of physical examination, billing/reimbursement, and medicolegal concerns.

Conclusion: Telehealth has seen rapid adoption during the COVID-19 pandemic, and the majority of respondents plan to continue using it. It is being used more for established patients rather than new patient visits. For surgical cases, there was a clear triage priority of sports medicine cases, including infections, fractures, and traumatic tendon ruptures. Lower extremity cases had higher priority than upper extremity.
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http://dx.doi.org/10.1177/2325967121990929DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7934054PMC
March 2021

Use of a 5-item modified Fragility Index for risk stratification in patients undergoing surgical management of proximal humerus fractures.

JSES Int 2021 Mar 16;5(2):212-219. Epub 2020 Dec 16.

Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA.

Hypothesis: We hypothesized that the modified Fragility Index (mFI) would predict complications in patients older than 50 years who underwent operative intervention for a proximal humerus fracture.

Methods: We retrospectively reviewed the American College of Surgeons National Surgery Quality Improvement Program database, including patients older than 50 years who underwent open reduction and internal fixation of a proximal humerus fracture. A 5-item mFI score was then calculated for each patient. Postoperative complications, readmission and reoperation rates as well as length of stay (LOS) were recorded. Univariate as well as multivariable statistical analyses were performed, controlling for age, sex, body mass index, LOS, and operative time.

Results: We identified 2,004 patients (median age, 66 years; interquartile range: 59-74), of which 76.2% were female. As mFI increased from 0 to 2 or greater, 30-day readmission rate increased from 2.8% to 6.7% (-value = .005), rate of discharge to rehabilitation facility increased from 7.1% to 25.3% (-value < .001), and rates of any complication increased from 6.5% to 13.9% (-value < .001). Specifically, the rates of renal and hematologic complications increased significantly in patients with mFI of 2 or greater (-value = .042 and -value < .001, respectively). Compared with patients with mFI of 0, patients with mFI of 2 or greater were 2 times more likely to be readmitted within 30 days (odds ratio = 2.2, -value .026). In addition, patients with mFI of 2 or greater had an increased odds of discharge to a rehabilitation center (odds ratio = 2.3, -value < .001). However, increased fragility was not significantly associated with an increased odds of 30-day reoperation or any complication after controlling for demographic data, LOS, and operative time.

Conclusion: An increasing level of fragility is predictive of readmission and discharge to a rehabilitation center after open reduction and internal fixation of proximal humerus fractures. Our data suggest that a simple fragility evaluation can help inform surgical decision-making and counseling in patients older than 50 years with proximal humerus fractures.
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http://dx.doi.org/10.1016/j.jseint.2020.10.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910730PMC
March 2021

Malpractice trends in shoulder and elbow surgery.

J Shoulder Elbow Surg 2021 Sep 3;30(9):2007-2013. Epub 2021 Feb 3.

Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.

Background: Medical malpractice is a very common occurrence that many medical providers will have to face; approximately 17,000 medical malpractice cases are filed in the United States each year, and more than 99% of all surgeons are faced with at least 1 instance of malpractice litigation throughout their careers. Malpractice litigation also carries a major economic weight, with medical malpractice spending resulting in an aggregate expenditure of nearly $60 billion annually in the United States. Orthopedic surgery is one of the most common subspecialties involved in malpractice claims. Currently, there are no comprehensive studies examining malpractice lawsuits within shoulder and elbow surgery. Therefore, the purpose of this work is to examine trends in malpractice claims in shoulder and elbow surgery.

Methods: The Westlaw online legal database was queried in order to identify state and federal jury verdicts and settlements pertaining to shoulder and elbow surgery from 2010-2020. Only cases involving medical malpractice in which an orthopedic shoulder and elbow surgeon was a named defendant were included for analysis. All available details pertaining to the cases were collected. This included plaintiff demographic and geographic data. Details regarding the cases were also collected, such as anatomic location, pathology, complications, and case outcomes.

Results: Twenty-five malpractice lawsuits pertaining to orthopedic shoulder and elbow surgery were identified. Most plaintiffs in these cases were adult men, and the majority of cases were filed in the Southwest (28%) and Midwest (28%) regions of the United States. The most common anatomic region involved in claims was the rotator cuff (32%), followed by the glenohumeral joint (20%). The majority of these claims involved surgery (56%). Pain of mechanical nature was the most common complication seen in claims (56%). The jury ruled in favor of the defendant surgeon in most cases (80%).

Discussion: This is the first study that comprehensively examines the full scope of orthopedic shoulder and elbow malpractice claims across the United States. The most common complaint that plaintiffs reported at the time of litigation was residual pain after treatment due to a mechanical etiology, followed by complaints of nerve damage. A large portion of claims resulted after nonoperative treatment. A better understanding of the trends within malpractice claims is crucial to developing strategies for prevention.
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http://dx.doi.org/10.1016/j.jse.2020.12.018DOI Listing
September 2021

Rotator cuff to deltoid and pectoralis tendon to anatomic neck distances: methods for anatomic restoration of humeral height and tuberosity position in proximal humerus fractures for operative fixation and arthroplasty.

JSES Int 2020 Dec 26;4(4):869-874. Epub 2020 Aug 26.

Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.

Introduction: Proper anatomic tuberosity reduction and restoration of humeral height during surgical treatment of proximal humerus fractures leads to fewer complications and better outcomes. In the presence of significant displacement and comminution in proximal humerus fractures, the assessment of the correct tuberosity position and humeral height can be challenging. The goal of this cadaveric study was to provide new and useful measurements for intraoperative guidance of proper tuberosity position and humeral height when treating proximal humerus fractures with open reduction internal fixation, anatomic hemiarthroplasty, or reverse total shoulder arthroplasty.

Methods: A total of 28 cadaveric shoulders were dissected with a deltopectoral approach. The distance between the insertion of the supraspinatus tendon and the superior aspect of the deltoid tendon was measured (cuff to deltoid distance [CDD]). Secondly, the distance between the superior aspects of the pectoralis major tendon to the medial aspect of the anatomic neck (PND) was measured. Further, we sought to determine if these measurements would correlate to patient height and differ between gender.

Results: The average age of the donors was 65.3 years (64% male). The CDD and PND were 87.6 ± 10.6 and 16.6 ± 6.9 mm, respectively (mean ± standard deviation). There were no differences between females and males for the CDD (86.9 ± 9.4 vs. 87.2 ± 15.2 mm,  = .96) and PND (16.3 ± 9.1 vs. 17.1 ± 5.9 mm,  = .76). There was no correlation between the cadaver height and CDD (R2 = 0.1) and PND (R2 = 0.3).

Discussion: In this study, we describe 2 new measurement tools that can readily be applied intraoperatively during surgical treatment of proximal humerus fractures to aid in tuberosity reduction and humeral height assessment. These measurements were found to be independent of patient height and gender and can be used as a reference tool for most patients.
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http://dx.doi.org/10.1016/j.jseint.2020.07.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738573PMC
December 2020

Risk of suprascapular nerve injury during glenoid baseplate fixation for reverse total shoulder arthroplasty: a cadaveric study.

J Shoulder Elbow Surg 2021 Mar 21;30(3):532-537. Epub 2020 Jul 21.

Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.

Background: Reverse total shoulder arthroplasty (rTSA) is an effective treatment for patients with advanced rotator cuff arthropathy. During implantation of the glenoid baseplate, screws are inserted through the glenoid face into the scapular body to achieve adequate fixation. Placement of peripheral baseplate screws in the superior and posterior glenoid may increase the risk of injury to the suprascapular nerve (SSN). The purpose of this cadaveric study was to evaluate the risk of SSN injury with placement of baseplate screws in the superior and posterior direction.

Methods: Twelve cadaveric shoulders were implanted with glenoid baseplates. A bicortical 44-mm screw was placed in both the superior and posterior glenoid baseplate screw holes. Following implantation, the SSN was dissected and visualized through a posterior shoulder approach. The distance from the tip of the screws to the SSN and the distance from the screw's scapular exiting hole to the SSN was recorded. Average distances were calculated for each measurement.

Results: The superior screw contacted the SSN in 8 of the 12 specimens (66%). For the superior screw, the average distance from the exiting point in the scapula to the SSN was 9.2 ± 6.3 mm, with the shortest distance being 3.9 mm. The posterior screw contacted the SSN in 6 of 12 specimens (50%). For the posterior screw, the average distance from the exiting point to the SSN was 8.9 ± 3.8 mm, with the shortest distance to the nerve being 2.2 mm.

Conclusion: Placement of the superior and posterior screws in the glenoid baseplate during rTSA risks injury to the SSN. The safe zone for superior- and posterior-directed baseplate screw is <2 mm from its exiting point on the scapula. Therefore, precise measurements of screw lengths in this area is important in avoiding injury to the SSN.
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http://dx.doi.org/10.1016/j.jse.2020.07.008DOI Listing
March 2021

Trends in reimbursement for primary and revision total elbow arthroplasty.

J Shoulder Elbow Surg 2021 Jan 28;30(1):146-150. Epub 2020 Jun 28.

Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA.

Background: Relative value units (RVUs) are an essential component of reimbursement calculations from the Centers for Medicare & Medicaid Services. RVUs are calculated based on physician work, practice expense, and professional liability insurance. Procedures that are more complex, such as revision arthroplasty, require greater levels of physician work and should therefore be assigned a greater RVU. The purpose of this study is to compare RVUs assigned for primary and revision total elbow arthroplasty (TEA).

Methods: The National Surgical Quality Improvement Program database was used to collect all primary and revision total elbow arthroplasties performed between January 2015 and December 2017. Variables collected included age at time of surgery, RVUs assigned for the procedure, and operative time.

Results: A total of 359 cases (282 primary TEA, 77 revision TEA) were included in this study. Mean RVUs for primary TEA was 21.4 (2.0 standard deviation [SD]) vs. 24.4 (1.7 SD) for revision arthroplasty (P < .001). Mean operative time for primary TEA was 137.9 minutes (24.4 SD) vs. 185.5 minutes (99.7 SD) for revision TEA (P < .001). The RVU per minute for primary TEA was 0.16 and revision TEA was 0.13 (P < .001). This amounts to a yearly reimbursement difference of $71,024 in favor of primary TEA over revision TEA.

Conclusion: The current reimbursement model does not adequately account for increased operative time, technical demand, and pre- and postoperative care associated with revision elbow arthroplasty compared with primary TEA. This leads to a financial advantage on performing primary TEA.
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http://dx.doi.org/10.1016/j.jse.2020.06.004DOI Listing
January 2021

Strategies to decolonize the shoulder of Cutibacterium acnes: a review of the literature.

J Shoulder Elbow Surg 2020 Apr;29(4):660-666

Rothman Institute Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address:

Cutibacterium acnes is the most prevalent cause of joint infection after shoulder surgery. Current methods for decolonizing this bacterium from the shoulder region have proved ineffective owing to its unique niche within dermal sebaceous glands and hair follicles. When we are making decisions to decolonize the skin of C acnes, the risks associated with decolonization must be balanced by the potential benefits of reduced deep tissue inoculation. The purpose of this review was to describe currently available methods of decolonization and their efficacy.
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http://dx.doi.org/10.1016/j.jse.2019.11.037DOI Listing
April 2020

Medical Complications and Outcomes After Total Shoulder Arthroplasty: A Nationwide Analysis.

Am J Orthop (Belle Mead NJ) 2018 Oct;47(10)

Olympus Orthopedic Medical Group, 3750 Convoy Street, Suite 201, San Diego, CA 92111, USA. Email:

There is a paucity of evidence describing the types and rates of postoperative complications following total shoulder arthroplasty (TSA). We sought to analyze the complications following TSA and determine their effects on described outcome measures. Using discharge data from the weighted Nationwide Inpatient Sample from 2006 to 2010, patients who underwent primary TSA were identified. The prevalence of specific complications was identified using the , Clinical Modification (-CM) codes. The data from this database represent events occurring during admission, prior to discharge. The associations between patient characteristics, complications, and outcomes of TSA were evaluated. The specific outcomes analyzed in this study were mortality and length of stay (LOS). A total of 125,766 patients were identified. The rate of complication after TSA was 6.7% (8457 patients). The most frequent complications were respiratory, renal, and cardiac, occurring in 2.9%, 0.8%, and 0.8% of cases, respectively. Increasing age and total number of preoperative comorbidities significantly increased the likelihood of having a complication. The prevalence of postoperative shock and central nervous system, cardiac, vascular, and respiratory complications was significantly higher in patients who suffered postoperative mortality (88 patients; 0.07% mortality rate) than in those who survived surgery (P < 0.0001). In terms of LOS, shock and infectious and vascular complications most significantly increased the length of hospitalization. Postoperative complications following TSA are not uncommon and occur in >6% of patients. Older patients and certain comorbidities are associated with complications after surgery. These complications are associated with postoperative mortality and increased LOS.
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http://dx.doi.org/10.12788/ajo.2018.0086DOI Listing
October 2018

Effect of Age on Outcomes of Shoulder Arthroplasty.

Perm J 2017 ;21:16-056

Orthopedic Surgeon at the San Diego Medical Center in CA.

Context: Outcomes of total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA) as a function of age are not well known.

Objective: To understand the effects of age on revision rate, mortality, and hospital readmissions.

Design: A retrospective cohort study of prospectively collected data. Using an integrated health care system's shoulder arthroplasty registry, we identified patients who underwent TSA and RTSA between January 2007 and June 2012. Patients were grouped into older (> 75 years) and younger groups (≤ 75 years).

Main Outcome Measures: Differences in outcomes between both age groups.

Results: The TSA cohort had 2007 patients, and 538 (26.8%) were older than age 75 years. Older patients who underwent TSA had higher risks of 1-year mortality (2.0% vs 0.6%; odds ratio = 3.34, 95% confidence interval [CI] = 1.00-11.11, p = 0.049) and readmission within 90 days (7.6% vs 4.4%; odds ratio = 1.75, 95% CI = 1.17-2.63, p = 0.007). The RTSA cohort had 568 patients, and 295 (51.9%) of them were older than age 75 years. Older RTSA patients had a lower risk of revision (3.7% vs 8.1%; hazard ratio = 0.45, 95% CI = 0.24-0.89, p = 0.020).

Conclusion: Patient age is one of many important variables that surgeons should consider when performing shoulder arthroplasty. However, the impact of age in the TSA and RTSA populations is different. In the TSA cohort, older patients have higher risk of readmission and mortality. In the RTSA cohort, older patients have lower risk of revision.
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http://dx.doi.org/10.7812/TPP/16-056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5499606PMC
April 2018

Management of Acute Proximal Humeral Fractures.

J Am Acad Orthop Surg 2017 Jan;25(1):42-52

From the Department of Orthopaedic Surgery, St. Luke's University Health Network, Bethlehem, PA (Dr. Kancherla) and the Department of Orthopaedics, Kaiser Permanente, San Diego, CA (Dr. Singh and Dr. Anakwenze).

Proximal humeral fractures, which typically occur in elderly persons, are among the most common fractures. A myriad of nonsurgical and surgical treatment options exist for these injuries, including short-term immobilization and early physical therapy, percutaneous fixation, plate osteosynthesis, intramedullary nailing, hemiarthroplasty, and reverse shoulder arthroplasty. The choice of treatment depends on the fracture type and severity, surgeon expertise, patient age, and patient health status.
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http://dx.doi.org/10.5435/JAAOS-D-15-00240DOI Listing
January 2017

Lateral Ulnar Collateral Ligament Reconstruction: An Analysis of Ulnar Tunnel Locations.

Am J Orthop (Belle Mead NJ) 2016 Feb;45(2):53-7

Olympus Orthopedics, San Diego, CA.

We conducted a study to determine precise ulnar tunnel location during lateral ulnar collateral ligament reconstruction to maximize bony bridge and graft construct perpendicularity. Three-dimensional computer models of 15 adult elbows were constructed. These elbow models were manipulated for simulated 4-mm tunnel drilling. The proximal ulna tunnels were placed at the radial head-neck junction and sequentially 0, 5, and 10 mm posterior to the supinator crest. The bony bridges created by these tunnels were measured. Location of the humeral isometric point was determined and marked as the humeral tunnel location. Graft configuration was simulated. Using all the simulated ulna tunnels, we measured the proximal and distal limbs of the graft. In addition, we measured the degree of perpendicularity of the graft limbs. The ulnar tunnel bony bridge was significantly longer with more posterior placement of the proximal tunnel relative to the supinator crest. An increase in degree of perpendicularity of graft to ulnar tunnels was noted with posterior shifts in proximal tunnel location. Posterior placement of the proximal ulna tunnel allows for a larger bony bridge and a more geometrically favorable reconstruction.
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February 2016

Coracoid fracture after reverse total shoulder arthroplasty: a report of 2 cases.

Am J Orthop (Belle Mead NJ) 2015 Nov;44(11):E469-72

Department of Orthopaedic Surgery, St. Luke's University Health Network, Bethlehem, PA.

Although reverse total shoulder arthroplasty is largely successful, there are still complications that require appropriate diagnostic workup and treatment. These 2 cases of patients with a coracoid fracture were encountered at 3 months and 15 months after reverse total shoulder arthroplasty. One patient presented with new-onset pain in the coracoid region without significant functional deficit, and the other presented with functional deficit and complaint of a strange noise at the anterior aspect of the operative shoulder. While standard radiographs did not detect the fracture, computed tomography imaging was sufficient to establish the diagnosis. Ultimately, nonoperative management led to resolution of these symptoms.
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November 2015

Reverse shoulder arthroplasty for the management of proximal humerus fractures.

J Am Acad Orthop Surg 2015 Mar 28;23(3):190-201. Epub 2015 Jan 28.

The use of reverse shoulder arthroplasty is becoming increasingly popular for the treatment of complex three- and four-part proximal humerus fractures in the elderly compared with the often unpredictable and poor outcomes provided by open reduction and internal fixation and by hemiarthroplasty. Inferior results with plate osteosynthesis are often a result of complications of humeral head osteonecrosis, loss of fixation, and screw penetration through the humeral head, whereas major concerns with hemiarthroplasty are tuberosity resorption, malunion, and nonunion resulting in pseudoparalysis. Comparative studies support the use of reverse shoulder arthroplasty in elderly patients with complex proximal humerus fractures because the functional outcomes and relief of pain are reliably improved. Repair and union of the greater tuberosity fragment during reverse shoulder arthroplasty demonstrates improved external rotation, clinical outcomes, and patient satisfaction compared with outcomes after tuberosity resection, nonunion, or resorption. Satisfactory results can be obtained with careful preoperative planning and attention to technical details.
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http://dx.doi.org/10.5435/JAAOS-D-13-00190DOI Listing
March 2015

Clavicle stress fracture after reverse shoulder arthroplasty.

J Shoulder Elbow Surg 2014 Jul;23(7):e170-2

Department of Orthopaedic Surgery, Kaiser Permanente, San Diego, CA, USA.

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http://dx.doi.org/10.1016/j.jse.2014.03.015DOI Listing
July 2014

Treatment of Medial Collateral Ligament Injuries of the Elbow with Use of the "Tommy John" Operation: Indications and Results.

JBJS Rev 2014 Jun;2(6)

Center for Shoulder, Elbow, and Sports Medicine, Department of Orthopaedic Surgery, Columbia University, 622 West 168th Street, PH-11, New York, NY 10032.

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http://dx.doi.org/10.2106/JBJS.RVW.M.00057DOI Listing
June 2014

Surgical treatment of posterolateral rotatory instability of the elbow.

Arthroscopy 2014 Jul 14;30(7):866-71. Epub 2014 Apr 14.

Department of Orthopaedic Surgery, Center for Shoulder, Elbow, and Sports Medicine, Columbia University, New York, New York, U.S.A.

Purpose: The purpose of this systematic review was to critically examine the outcomes of lateral ulnar collateral ligament reconstruction for posterolateral rotatory instability (PLRI) of the elbow.

Methods: A systematic review of the literature was performed. Two reviewers assessed and confirmed the methodologic and patient data from the included studies. Frequency-weighted means were calculated for outcomes that were present in multiple studies.

Results: Eight studies fulfilled our criteria, and they included 130 patients. The mean age was 38.1 years, and the mean follow-up period was 44.5 months. Traumatic dislocation was the most common cause of PLRI. Of the studies that reported the Mayo Elbow Performance Score, 91% of patients had good or excellent results, with a frequency-weighted mean of 91. Improvement in elbow range of motion was noted (133° to 138° of flexion [P < .0001] and 6.6° to 3.9° of extension [P = .005]). A complication rate of 11% was noted, with recurrent instability noted to occur in 8% of patients.

Conclusions: PLRI of the elbow remains to be fully understood. Treatment strategies vary and should be performed based on surgeon experience and evidence available. Most patients will have good or excellent results after surgery; however, up to 11% of patients may have complications.

Level Of Evidence: Level IV, systematic review of Level II through IV studies.
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http://dx.doi.org/10.1016/j.arthro.2014.02.029DOI Listing
July 2014

Arthroscopic Hill-Sachs remplissage: a systematic review.

J Bone Joint Surg Am 2014 Apr;96(7):549-55

Department of Orthopaedic Surgery, New York-Presbyterian Hospital/Columbia University Medical Center, 622 West 168th Street, PH-11, New York, NY 10032. E-mail address for J.J. Iyengar:

Background: Failure to address humeral osseous defects during arthroscopic stabilization surgery for glenohumeral instability leads to an increased rate of recurrence. Arthroscopic remplissage has been proposed as a treatment option for substantial Hill-Sachs lesions. The aim of this systematic review was to examine the outcomes of the remplissage procedure for the treatment of anterior glenohumeral instability of the shoulder with a humeral head defect.

Methods: A systematic literature review was performed to evaluate the outcomes of arthroscopic Hill-Sachs remplissage. Studies that reported on patients who underwent arthroscopic infraspinatus tenodesis concomitant with a standard Bankart repair were included if they had relevant clinical outcomes and associated complications. The frequency-weighted mean was calculated for outcome measures that were similar across several studies.

Results: Six studies fulfilled the inclusion criteria and were included in the review. The studies included 167 patients (mean age, 27.5 years) with a mean follow-up of 26.8 months (range, twelve to forty-three months). Patients had a frequency-weighted mean adjusted Rowe score of 36.1 preoperatively compared with 87.6 postoperatively (p < 0.001). In the studies with motion measurements, shoulder motion was not affected postoperatively (p > 0.05); mean forward elevation changed from 165.7° preoperatively to 170.3° postoperatively, and mean external rotation changed from 57.2° to 54.6°. Nine of 167 shoulders experienced an episode of recurrent glenohumeral instability (overall recurrence rate, 5.4%).

Conclusions: Postoperative clinical outcome scores were generally good to excellent following arthroscopic remplissage. No studies indicated a significant loss of shoulder motion following the procedure. The failure rate following Hill-Sachs remplissage compared favorably with previously published rates for patients without clinically important Hill-Sachs lesions who underwent arthroscopic Bankart repair alone. The overall complication rate across the studies was low, further supporting the use of this technique along with Bankart repair in the treatment of glenohumeral instability with a concurrent osseous defect of the humeral head.
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http://dx.doi.org/10.2106/JBJS.L.01760DOI Listing
April 2014

Characterization of the Supinator Tubercle for Lateral Ulnar Collateral Ligament Reconstruction.

Orthop J Sports Med 2014 Apr 23;2(4):2325967114530969. Epub 2014 Apr 23.

Columbia University Medical Center, New York, New York, USA.

Background: Lateral ulnar collateral ligament (LUCL) reconstruction requires proper understanding and identification of anatomic structures about the lateral elbow. The insertion site of the LUCL is based on the supinator tubercle.

Purpose: To characterize the supinator tubercle relative to other surrounding anatomic landmarks.

Study Design: Descriptive laboratory study.

Methods: Computed tomography (CT) scans of 10 adult elbows were retrospectively reviewed. These CT scans were converted into patient-specific 3-dimensional computer models. Using a user-defined coordinate system, an ulnar Cartesian coordinate system was defined with anatomic landmarks as reference points to standardize the position of each model. The length of the supinator crest was measured. Following this, the crest was examined for a distinct raised bony tuberosity that would be consistent with the supinator tubercle. If no distinctly raised tubercle was noted, the most prominent appearing location of the crest distal to the radial notch was considered the tubercle. The distance from the proximal radial head junction to the supinator tubercle was recorded. Finally, the distance from the supinator crest at the radial head junction to the posterior cortex in the sagittal plane was measured.

Results: The supinator tubercle was found to be prominent in 5 of 10 ulnar models. The supinator crest was 43.59 ± 13.28 mm long, and the supinator tubercle lateral extrusion was 5.60 ± 0.90 mm. The distance between the radial head junction and the supinator tubercle was found to be 15 ± 2.37 mm, and the distance from the supinator crest at the radial head junction to the posterior cortex was 10.25 ± 2.07 mm.

Conclusion: The supinator tubercle is frequently not prominent or easily recognizable. Its relationship to other structures is of value. The proximal border of the radial head, residing 15 mm proximal to the most predictable location of the supinator tubercle, is a useful landmark when drilling tunnels during LUCL reconstructions.

Clinical Relevance: Results of this study may aid proper anatomic LUCL reconstruction.
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http://dx.doi.org/10.1177/2325967114530969DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555592PMC
April 2014

Reverse shoulder arthroplasty for acute proximal humerus fractures: a systematic review.

J Shoulder Elbow Surg 2014 Apr 7;23(4):e73-80. Epub 2014 Jan 7.

Department of Orthopaedic Surgery, Center for Shoulder, Elbow, and Sports Medicine, Columbia University, New York, NY, USA. Electronic address:

Background: Proximal humerus fractures are one of the most common fractures among elderly patients. We performed a systematic review to detail the demographics, outcomes, and complications of patients who undergo reverse shoulder arthroplasty for complex proximal humerus fractures.

Methods: A systematic review of the literature was performed. Two reviewers assessed and confirmed the methodical quality of each study. Studies that met our criteria were assessed for pertinent data, and when available, similar outcomes were combined to generate frequency-weighted means.

Results: Nine studies met the inclusion and exclusion criteria for this review. The frequency weighted mean age was 77.5 years and the mean follow up was 43.2 months. Females comprised 90.4% of the patient population. Four-part fractures were most commonly encountered. The frequency weighted mean constant's score was 55.9. Frequency weighted mean active forward flexion, abduction, and external rotation at neutral were 122°, 97°, and 18°, respectively. Tuberosity repair was associated with significantly higher external rotation compared to no repair (24° vs 15°; P = .0003). The most common complication was scapular notching (32%) while the impact of this finding remains unknown.

Conclusion: Pooled data and frequency weighted mean outcomes showed that RSA patients tend to be elderly women and still have postoperative dysfunction despite well-controlled pain. Repair of the greater tuberosity allows greater range of motion in patients.
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http://dx.doi.org/10.1016/j.jse.2013.09.012DOI Listing
April 2014

Medial Epicondyle Morphology in Elite Overhead Athletes: A Closer Look Using 3-Dimensional Computer Simulation.

Orthop J Sports Med 2014 Jan 7;2(1):2325967113517211. Epub 2014 Jan 7.

Department of Orthopaedic Surgery, Columbia Presbyterian Medical Center, New York, New York, USA.

Background: Prior studies have attempted to determine morphological characteristics of the medial epicondyle in overhead athletes, but no study has reported on precise quantitative differences between elite overhead athletes and control patients.

Hypothesis: The medial epicondyle in overhead athletes is larger in volume than those of control patients.

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: Computer simulation modeling from advanced (computed tomography/magnetic resonance imaging) imaging of the elbow of 37 patients (22 elite overhead athletes, 15 control patients) was performed to provide detailed assessment of the morphological characteristics of the medial epicondyle. Several quantitative metrics regarding the medial epicondyle were measured and compared across both cohorts, including that of epicondyle width (medial-lateral), height (superior-inferior), thickness (anterior-posterior), volume, percentage cortical volume, and morphology of the inferior slope of the epicondyle.

Results: The medial epicondyle in overhead athletes was significantly larger than that found in nonathlete controls (4976 vs 3682 mm(3); P = .001). There was no significance between the 2 cohorts in medial-lateral width (16.8 vs 16.6 mm; P = .68), but there was a difference in anterior-posterior thickness (16.96 vs 14.40 mm; P = .001) and superior-inferior height (39.55 vs 35.86 mm; P = .09) in athletes versus controls. The epicondyle volume was 97.9% cortical bone in athletes compared with 82.3% in control patients (P < .001). There were no differences in the morphology of the inferior epicondyle slope between the 2 groups.

Conclusion: The medial epicondyle in overhead athletes is larger in volume and anterior-posterior thickness than those of control patients. Additionally, the medial epicondyle is comprised nearly entirely of cortical bone in overhead athletes.

Clinical Relevance: These quantitative findings support the theory of adaptive remodeling in skeletally immature overhead athletes.
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http://dx.doi.org/10.1177/2325967113517211DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555523PMC
January 2014

Posterolateral rotatory instability of the elbow.

Am J Sports Med 2014 Feb 11;42(2):485-91. Epub 2013 Jul 11.

William N. Levine, Department of Orthopaedic Surgery, Center for Shoulder, Elbow, and Sports Medicine, Columbia University, New York, New York.

Symptomatic posterolateral rotatory instability (PLRI) results from a lateral collateral ligament complex injury and presents with pain, clicking, and subluxation within the flexion and extension arcs of elbow motion. Often, symptoms and examination characteristics are subtle and can be easily misdiagnosed. Therefore, a thorough history and provocative physical examination maneuvers are important to correctly establish the diagnosis. Patients frequently have a history of elbow trauma such as an episode(s) of elbow dislocation, prior surgery, or previous cortisone injections. Radiographs and advanced imaging can aid in the diagnosis, and examination under anesthesia, manipulation with arthroscopic visualization, and/or stress radiographs can be confirmatory. Symptomatic cases of PLRI can be effectively treated with a repair or isometric ligament reconstruction.
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http://dx.doi.org/10.1177/0363546513494579DOI Listing
February 2014

Isolated sciatic nerve entrapment by ectopic bone after femoral head fracture-dislocation.

Am J Orthop (Belle Mead NJ) 2013 Jun;42(6):275-8

Department of Orthopaedic Surgery, University of Pennsylvania, PA 19104, USA.

Although posttraumatic pelvic heterotopic ossification (HO) after hip fracture dislocation is well established, and nerve encasement by HO may occur, the development of neurologic deficit is rare. A thorough history and adequate clinical suspicion are imperative in the workup of affected patients. Computed tomography and magnetic resonance imaging provide good visualization and assist in surgical planning. If symptoms persist and are recalcitrant to conservative management, surgical intervention with HO excision and nerve neurolysis can be performed with success.
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June 2013

Distal biceps tendon repair: an analysis of timing of surgery on outcomes.

J Athl Train 2013 Jan-Feb;48(1):9-11

Department of Orthopaedic Surgery, University of Pennsylvania, USA.

Context: Surgical repair of the ruptured distal biceps brachaii tendon is an effective treatment in injured patients. Timing of surgery is considered an important factor when managing these patients.

Objective: To compare our outcomes after distal biceps tendon acute (at 4 weeks or less) or chronic (greater than 4 weeks) repair.

Design: Cohort study.

Setting: Clinical practice.

Patients Or Other Participants: Of 18 patients in a tertiary practice who underwent distal biceps repair, 12 and 6 underwent acute or chronic repair, respectively. The average durations from injury to surgery were 15.3 (range, 9 to 25) and 50.1 (range, 29 to 75) days for the acute and chronic groups, respectively.

Intervention(s): Distal biceps tendon repair.

Main Outcome Measure(s): Disabilities of the Arm, Shoulder and Hand (DASH) scoring, range of motion, and clinical and radiographic complications.

Results: No differences were noted between the groups in DASH scoring or range of motion. No complications occurred, and radiographic outcomes were satisfactory, without evidence of heterotopic ossification in any patients.

Conclusions: Secure repair of a distal biceps tendon injury may yield similar results, whether it is performed in the acute or chronic setting.
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http://dx.doi.org/10.4085/1062-6050-48.1.10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3554038PMC
October 2013

Arthroscopic rotator cuff repair: impact of diabetes mellitus on patient outcomes.

Phys Sportsmed 2013 Feb;41(1):22-9

Sound Shore Medical Center, New Rochelle, NY, USA.

Introduction: Arthroscopic repair of rotator cuff tears has been associated with satisfactory improvement in pain and function. The goal of this study was to compare the results of patients with diabetes and patients without diabetes after the 2 cohorts underwent arthroscopic rotator cuff repair (RCR).

Methods: We performed a retrospective review of 56 patients with type 1 diabetes mellitus or type 2 diabetes mellitus and 67 patients without diabetes, all of whom underwent arthroscopic RCR with 1 year of follow-up. Changes in range of motion (ROM), American Shoulder and Elbow Surgeons (ASES) score, and Penn Shoulder Score (PSS) were compared between both groups at 1 year postoperatively.

Results: There was a statistically significant improvement in ROM for both groups. However, patients without diabetes had greater forward flexion (P = 0.02), abduction (P = 0.04), and external rotation (P = 0.004). Both groups noted significant improvement in their respective ASES score and PSS. However, patients with diabetes had a lower ASES score (P < 0.01) and PSS (P < 0.01). There were no differences in recurrent tears or complications.

Conclusion: Arthroscopic RCR in patients with diabetes resulted in improved postoperative ROM and function.
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http://dx.doi.org/10.3810/psm.2013.02.1995DOI Listing
February 2013
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