INTRODUCTION The direct anterior approach (DAA) and anterolateral approach (ALA) may be used for hip hemiarthroplasty (HHA) as a treatment for femoral neck fractures. The DAA often utilizes intraoperative fluoroscopy to determine leg length and offset, while the ALA traditionally utilizes an intraoperative clinical exam to determine offset and leg length. This study will evaluate two techniques: the “grid fluoroscopy [GF] technique” and the “intraoperative exam [IE] technique,” each performed by one of two separate surgeons, and compare each technique’s accuracy to restore leg length and femoral offset in a patient population that underwent HHA. METHODS Two investigators retrospectively reviewed charts of 208 randomly selected patients who had an HHA from either a DAA or ALA performed by two different surgeons for the treatment of femoral neck fractures. Postoperative AP pelvis radiographs were measured to determine offset and leg length compared with the non-operative extremity. Non-normal continuous variables were provided by median and interquartile range. Data were analyzed with the Mann-Whitney U test and Student’s t-test. RESULTS After inclusion and exclusion criteria, data were reviewed on 173 hemiarthroplasties. The mean age was 80.3 years (± 11.2 years). Of the surgical patients, 65.9% were female, and 70.9% identified their ethnicity as white. The DAA was used in 93 patients and ALA in 80 patients. Analysis comparing the two techniques demonstrated no statistically significant differences in median leg length between GF technique (1.02 IQR -0.1, 2.0 mm) and IE technique (1.25 IQR -2.4, 1.3 mm,) (p=0.67). There was also no statistically significant difference in offset between GF technique (1.3 IQR 0.2, 2.1 mm) and IE technique (0.6 IQR -2.7 mm, 3.2 mm) (p=0.13). However, a difference was found in mean length of surgery that was statistically significant. We found that the mean length of surgery for the IE technique was 74.8 ± 24.7 minutes versus the GF technique, which was 95.1 ± 23.0 minutes, (p<0.0001). DISCUSSION There was no significant difference between leg length and offset with the use of intraoperative fluoroscopy with DAA compared to no intraoperative imaging with ALA. Our study suggests that DAA and ALA are equally effective approaches for re-establishing symmetric leg length and offset in HHA for femoral neck fractures. In this study, the ALA had a shorter surgical time compared to DAA, potentially due to the utilization of intraoperative fluoroscopy for this particular technique during the DAA.
Objective: To examine the effects of implementing a dedicated orthopaedic trauma room (DOTR) on elective arthroplasty volume. Design: Retrospective cohort study. Setting: Level I academic trauma center. Intervention: A retrospective analysis was performed for two 3-year intervals before and after DOTR introduction on January 20, 2013, at a Level I trauma center. Surgeons were included if they performed elective primary total hip arthroplasty (THA), total knee arthroplasty (TKA), total shoulder arthroplasty (TSA), or reverse total shoulder arthroplasty (RTSA) regularly from 2010 to 2015. Main Outcome Measures: Change in elective arthroplasty volume after the implementation of a DOTR. Results: A total of 2339 cases were performed by surgeons A-E, with an average of 303.3 cases per year pre-DOTR and an average of 476.3 cases per year post-DOTR. On average, within our institution, there were 75.79 per 10,000 cases/year in Michigan pre-DOTR and 104.2 per 10,000 cases/year in Michigan post-DOTR. Surgeons A-E averaged 173.0 more cases per year and increased their average proportion of elective arthroplasty case volume in Michigan. There was a statistically significant market share increase of 9.8 per 10,000 cases/year in Michigan, at our hospital in the post-DOTR periods (P = 0.039) (CI [0.5442, 19.21], SE = 4.523). This market share increase of 9.8 cases/10,000 cases was the yearly increase in market share that our average surgeons saw after the DOTR implementation, this took into account the observed annual increase in arthroplasty volume statewide during those years. Conclusion: Implementation of a DOTR was associated with increases in the total number, annual mean, and annual proportion of elective arthroplasty cases performed in Michigan for both elective surgeons and the institution as a whole. These findings reveal a benefit of DOTR implementation to elective arthroplasty surgeons and health systems on a larger scale, in the form of increased arthroplasty case volume.
Introduction: Acute compartment syndrome is a surgical emergency that is mainly diagnosed clinically. Acute exertional compartment syndrome of the medial compartment of the foot is a rare condition most often result from strenuous exercise. Early diagnosis is most often a clinical examination, however, laboratory and magnetic resonance imaging (MRI) can assist in the diagnosis if clinician uncertainty persists. We present a case report of acute exertional compartment syndrome of the medial compartment of the foot after physical activity. Case Report: A 28-year-old male presents to the emergency department the day after playing basketball, with severe atraumatic medial foot pain. Clinical examination demonstrated tenderness and swelling over the medial arch of the foot. Creatine phosphokinase (CPK) results at 9500 international units. MRI demonstrated fusiform edema of the abductor hallucis. Subsequent fasciotomy revealed protruding muscle during fascial incision and relieved the patient of their pain. Return to surgery 48 h after initial fasciotomy revealed gray discoloration and lack of contractility of the muscle tissue. The patient was recovering well at the first post-operative visit, however, was lost to follow-up thereafter. Conclusion: Acute exertional compartment syndrome of the medial compartment of the foot is a rarely reported diagnosis, likely due to a combination of missed diagnosis and underreporting. Laboratory tests for CPK may be elevated, and MRI may be helpful in the diagnosis of this condition. Fasciotomy of the medial compartment of the foot relieved the patient’s symptoms, and to our knowledge had a good outcome. Keywords: Compartment syndrome, foot, medial compartment, abductor halluces.
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