The use of bioabsorbable implants has become commonplace in the treatment of shoulder rotator cuff and labral injuries. These absorbable implants were specifically designed to allow sufficient time for healing to occur before their gradual resorption. First-generation implants were composed of polyglycolic acid (PGA) and found to rapidly absorb and cause significant foreign body reactions. 2 The next generation of implants was made of the homopolymer poly-L-lactic acid (PLLA) and was designed to degrade at a much slower rate. 4,9 Various researchers have observed small areas of osteolysis after repair of shoulder abnormalities with absorbable anchors. Both biological and mechanical theories exist to account for the lytic changes. 4,7-10 We present a case of poly(L-lactide-co-D, Llactide) (PLDLA) suture anchor fixation of both a rotator cuff tear and a superior labral anterior posterior (SLAP) lesion with the development of extensive osteolysis in the humeral head. We propose that the mechanism for the lysis was a mechanical one because no lysis appeared in the glenoid around the other PLDLA implant. CASE REPORTA 20-year-old National Collegiate Athletic Association Division I defensive back complained of pain in his right shoulder for several months after a fall on an outstretched arm. He noted pain in the anterolateral aspect of the shoulder exacerbated with lifting weights and abduction of the shoulder. On examination, he had full range of motion with slight decrease in strength of the supraspinatus muscle. No atrophy of the rotator cuff or surrounding musculature was noted. There was no evidence of instability on examination. In addition, he had a negative active compression test result and positive impingement signs. Treatment with rotator cuff rehabilitation and antiinflammatory drugs was initiated.He continued to play with improved, periodic symptoms. However, he reinjured the shoulder during a game when he fell directly on it and noted a sensation of the shoulder shifting in and out of place. Radiographs were obtained ( Figure 1), and an MRI showed a rotator cuff tear and superior labral abnormality. Based on his ongoing symptoms for nearly 1 year with recent exacerbation and the MRI findings, plans were made to proceed with arthroscopic evaluation and treatment of rotator cuff and labral abnormality.A type II SLAP lesion was arthroscopically repaired with a single Arthrex Bio-Fastack (Naples, Fla) absorbable suture anchor. A small full-thickness tear of the supraspinatus was repaired with a mini-open technique using an Arthrex Bio-Corkscrew suture anchor. Both anchors are molded from PLDLA with an insert-molded eyelet of nonabsorbable polyester suture. The PLDLA implants were placed in standard fashion, using a tap to create the insertion site for the anchor.Postoperatively, he progressed well, and he resumed playing college football the next season. On examination at 8 months after surgery, he had full active and passive range of motion. His shoulder was stable with no evidence of instability. The O'Brie...

Open fractures are often classified according to a system described by Gustilo and Anderson. However, this system was applied to open long bone factures, which may not predict the incidence of infection in open metaphyseal fractures of the upper extremity. Other studies have found that wound contamination and systemic illness were the best predictors of infections in open hand fractures. Our study assessed infection in open distal radius fractures and identifies factors that are associated with these infections. We hypothesize that contamination, rather than absolute wound size, is the best predictor of infection associated with open distal radius fractures. A review by CPT code yielded 42 patients with open distal radius fractures between 1997 and 2002 treated at a level one trauma center. Medical records and radiographic follow-up were reviewed to assess the time to irrigation and debridement, the number of debridements in initial treatment period, the method of operative stabilization, the Gustilo and Anderson type of fracture, the Swanson type of fracture, and description of wound contamination. Forty-two patients were followed up for an average of 15 months (range 4 to 68 months). Twentyfour fractures were classified as Gustilo and Anderson type I, ten were type II, and eight were type III, 30 were Swanson type I, and 12 were Swanson type II. Five of the 42 fractures were considered contaminated. Two were exposed to fecal contamination. The others were contaminated with tar, dirt/ grass, and gravel, respectively. Three of 42 (7%) fractures developed infections. All three infected cases received a single irrigation and debridement. Two of five contaminated fractures (40%) developed a polymicrobial infection. Both were exposed to fecal contamination and, therefore, considered Swanson type II fractures. They were classified as Gustilo and Anderson type II and IIIB based solely upon the size of the wound. Both required multiple debridements and eventually wrist fusions. The third infection occurred in a Gustilo and Anderson type II and Swanson type I open fracture treated with one debridement and plate fixation. Hardware removal, debridement, and antibiotics resolved the infection. Three contaminated fractures that healed uneventfully received two debridements. Statistical analysis revealed a correlation with infection and contamination (p=0.0331). The number of initial debridements played a role in infection, but was not statistically significant. No relationship between infection and time to initial irrigation and debridement, method of fixation, Gustilo and Anderson type, or Swanson type was found. We propose that open distal radius fractures behave differently than open long bone fractures. Infection developed in 7% of the distal radius fractures in our study and was significantly associated with wound contamination. We recommend that contamination be included as factor for prognosis in open distal radius fractures. Contaminated fractures should be treated with multiple debridements as part of the ...

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Posterior pelvic ring injuries with dissociation of the sacroiliac joint can be a therapeutic challenge. Open procedures for reduction have a significant risk for wound complications although inadequate reductions using percutaneous methods can have poor long-term outcomes. Several indirect reduction methods have been previously described for closed reduction of the sacroiliac joint. We present our technique for the intraoperative use of the pelvic c-clamp as a reduction aid for the posterior pelvis in conjunction with percutaneous iliosacral screw fixation. This technique has been used routinely in our patients who sustain injuries to the sacroiliac joint and are candidates for closed reduction and percutaneous fixation. Our objective is to provide orthopedic surgeons an additional means by which to reduce sacroiliac disruptions by percutaneous means.