No abstract

No abstract

A subset of patients do not have resolution of macular edema after treatment with intravitreal bevacizumab. Such patients may respond to treatment with an intravitreal dexamethasone implant.

Purpose: Multifragmentary fractures of the distal radius with articular and metaphyseal comminution (AO 23-C3) represent challenging injuries to manage. Distal fracture lines, articular comminution, and limited distal bone stock may preclude stable fixation with a volar locking plate. The use of a dorsal spanning plate (DSP) offers an alternative treatment option in this setting. We examined the radiographic outcomes of a consecutive series of patients with comminuted intra-articular distal radius fractures not amenable to volar locked plating, who were treated with a DSP. Methods: We reviewed all distal radius fractures treated with a dorsal spanning plate at our institution between October, 2014 and March, 2018. Patients with AO 23-C3 fractures treated with dorsal spanning plate fixation were included in this study. Demographic data, time from plate placement to removal, and postoperative radiographic outcomes were examined. Results: We identified 24 patients, mean age 41 years (range, 19e62 years). Mean follow-up was 19.5 weeks (range, 12e35 weeks) from the time of plate placement. Plates were removed at a mean of 87 days (range, 40e215 days) after surgery. All patients achieved radiographic union. Mean radial height at the time of union was 11.1 mm (SD, ±3.7 mm; range, 6e18 mm), radial inclination was 19.7 (SD, ±5.4 ; range, 9 to 30 ), ulnar variance was 1.0 mm (SD, ±2.4 mm; range, e3 to 6 mm), and volar tilt was 1.4 (SD, ±5.2 ; range, e10 to 14 ). Mean articular displacement was 1.7 mm (SD, ±1.7 mm; range, 0e6 mm). Malalignment of at least one of these radiographic parameters was identified in 16 of 24 patients at the time of union. Conclusions: Dorsal spanning plate fixation offers an alternative treatment option for comminuted intraarticular distal radius fractures (AO 23-C3). Although this technique presents a straightforward means for fixation of complex distal radius fractures, radiographic outcomes may be inferior relative to less complex fractures treated with standard volar plating techniques. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Treatment of intra-articular distal radius fractures centers on restoring length and alignment and obtaining congruency of the articular surface. A variety of techniques are available, from closed reduction to percutaneous, external, and internal fixation. Although comparative studies have not unequivocally demonstrated superiority of one of these techniques, volar locked plating has become a preferred means of internal fixation of intra-articular distal radius fractures. Despite the popularity of this technique, certain fractures may not be well-suited to volar locked plating alone, including dorsal shearing fractures 1 and complex articular fracture patterns. 2 Highly comminuted articular fractures provide a challenge in that standard volar plating options may not capture key articular fragments or provide sufficient stability to maintain alignment during healing. Higher complication rates with vo...

Background:Virtual reality arthroscopic simulators are an attractive option for resident training and are increasingly used across training programs. However, no study has analyzed the utility of simulators for trainees based on their level of training/postgraduate year (PGY).Purpose/Hypothesis:The primary aim of this study was to determine the utility of the ArthroS arthroscopic simulator for orthopaedic trainees based on their level of training. We hypothesized that residents at all levels would show similar improvements in performance after completion of the training modules.Study Design:Descriptive laboratory study.Methods:Eighteen orthopaedic surgery residents performed diagnostic knee and shoulder tasks on the ArthroS simulator. Participants completed a series of training modules and then repeated the diagnostic tasks. Correlation coefficients (r2) were calculated for improvements in the mean composite score (based on the Imperial Global Arthroscopy Rating Scale [IGARS]) as a function of PGY.Results:The mean improvement in the composite score for participants as a whole was 11.2 ± 10.0 points (P = .0003) for the knee simulator and 14.9 ± 10.9 points (P = .0352) for the shoulder simulator. When broken down by PGY, all groups showed improvement, with greater improvements seen for junior-level residents in the knee simulator and greater improvements seen for senior-level residents in the shoulder simulator. Analysis of variance for the score improvement variable among the different PGY groups yielded an f value of 1.640 (P = .2258) for the knee simulator data and an f value of 0.2292 (P = .917) for the shoulder simulator data. The correlation coefficient (r2) was –0.866 for the knee score improvement and 0.887 for the shoulder score improvement.Conclusion:Residents training on a virtual arthroscopic simulator made significant improvements in both knee and shoulder arthroscopic surgery skills.Clinical Relevance:The current study adds to mounting evidence supporting virtual arthroscopic simulator–based training for orthopaedic residents. Most significantly, this study also provides a baseline for evidence-based targeted use of arthroscopic simulators based on resident training level.