While critical bone loss has yet to be defined for arthroscopic Bankart reconstruction, our data indicate that "critical" bone loss should be lower than the 20% to 25% threshold often cited. In our population with a high level of mandatory activity, bone loss above 13.5% led to a clinically significant decrease in WOSI scores consistent with an unacceptable outcome, even in patients who did not sustain a recurrence of their instability.

No abstract

Level IV, prognostic case series.

Psychiatric comorbidities are an important risk factor in active-duty military personnel undergoing surgery for femoroacetabular impingement. Mental health medication use is associated with poorer outcome scores and can significantly lower the possibility of returning to active-duty status.

Patient reported outcome measures (PROMs) are key tools when performing clinical research and PROM data are increasingly used to inform clinical decision-making, patient-centered care, health policy and more recently, reimbursement decisions. PROMs must possess particular properties before they are used. Thus purpose of this paper is to give an overview of PROMs, their definition, how their evidence can be assessed, how they should be reported in clinical research, how to choose PROMs, the types of PROMs available in orthopaedics, where these measures can be found, PROMs in orthopaedic clinical practice and what are some key next steps in this field. If PROMs are used in accordance with the guidance in this article, I believe we will gain considerable insight into PROMs in orthopaedics and will advance this field in a way that can contribute to science, improve patient care and save considerable resources. Why Patient Reported Outcome Measures? The development, testing and implementation of tools to aid in the measurement of phenomena in medicine are central to clinical practice and clinical research. Measurements in clinical practice form the basis of diagnosis, prognosis, evaluation and follow-up. Measurements in clinical research allow for the collection of data that afford us the information needed to test specific hypotheses [1]. The field of measurement in medicine includes both psychometrics and clinimetrics [2-4]. But, it has been argued thatthere is little distinction between these two areas [3]. Throughout this paper the term psychometrics will be used and more generally the term measurement to refer to these fields.

Flexor tendon entrapment after a pediatric forearm fracture is a rarely reported complication that is often diagnosed late. Flexor tendon entrapment is more frequently reported after distal forearm fractures, and possible etiologies include fibrosis secondary to hemorrhage at the fracture site and simple entrapment of the muscle belly.This article describes a case of ring finger flexor digitorum profundus entrapment in a 12-year-old boy with a closed both-bone forearm fracture that was treated with closed reduction and intramedullary nail fixation. Preoperatively, the patient had full flexion and extension of all fingers. The entrapment was noted at the first postoperative follow-up when the patient could fully extend the ring finger proximal interphalangeal joint but was unable to concomitantly extend the metacarpal phalangeal joint. Magnetic resonance imaging and ultrasound were obtained to identify the entrapment site. Intraoperatively, a portion of the flexor digitorum profundus musculotendinous junction was entrapped in the fracture site. After release of the entrapment, the patient gained immediate passive range of motion. Subsequently, the hardware was removed, and the patient healed and regained full ring finger function. To the authors' knowledge, this is the only report of isolated ring finger flexor digitorum profundus entrapment after closed reduction and intramedullary fixation of a pediatric forearm fracture. The authors recommend vigilant physical examination of passive and active range of motion of all digital joints with the wrist in flexion and extension before and after bony manipulation.

Level II-prospective, comparative study.

Objectives:Resilience, which is a psychometric property related to “hardiness” or the ability to respond to challenging situations, is a recognized predictor in many outcomes’ domains. This has been studied extensively in stressful situations such as military returning from deployment, serious disease, and traumatic injury. To date however, no study has assessed the role of patient resiliency with respect to surgical outcome. The purpose of this study was to assess the role of preoperative resiliency as calculated by the Brief Resiliency Score (BRS) on relevant surgical outcomes, including the time required to return to full unrestricted activity following an arthroscopic Bankart repair. In addition the correlation between pre-operative BRS with post-operative BRS, post-operative Western Ontario Instability Index (WOSI), American Shoulder and Elbow (ASES) and Single Assessment Numeric Evaluation (SANE) scores was also assessed.Methods:This is a retrospective review of prospectively gathered data on 25 consecutive active duty military patients undergoing an arthroscopic Bankart repair for instability. The mean follow-up was 24.3 months (range, 23-27) as the primary outcome was return to unrestricted duty which occurs within the first year post-intervention. There were 24 males and 1 female. All patients were on unrestricted active military duty prior to injuring the operative shoulder. All patients completed BRS, WOSI, ASES, and SANE questionnaires prior to operative intervention. They then completed the same questionnaires at the most recent follow-up as well as an additional questionnaire on military duty status (unrestricted duty, limited duty, medical separation from the military). Patients were divided into low resiliency and high resiliency groups based on a score of <4.0 for low and ≥4.0 for high in the BRS, and their outcomes were compared.Results:All patients had been cleared for return to full-duty or were undergoing a medical separation at final follow-up. There were no differences between groups in demographics, glenoid bone loss, or glenoid track status. Pre-operative BRS was significantly correlated with time to return to full duty, need for medical separation from the military, post-operative WOSI, SANE and ASES scores and change between pre- and post-operative WOSI, ASES and SANE scores. Those patients with high resiliency returned to full duty significantly faster than the low resiliency group (4.4 v 6.7 months, p<0.01), had better post-operative WOSI (86.4% v 48.9%, p<0.01), SANE (92 v 72, p=0.03), ASES scores (91.5 v 67.6, p=0.03) and were 5 times less likely to be medically separated from the military (7.7% v 38.5%, p<0.01). Also, patients with high resiliency had significantly greater improvement comparing pre-operative to post-operative WOSI (44.8% v 20.3%, p=0.04), ASES (22.0 v 7.5, p=0.04) and SANE scores (2.5 v 1.3, p=0.01). There were no patients with a change between pre- and post-operative resiliency classification.Conclusion:Preoperative resiliency was highly predictive of the time req...