Acromial and scapular spine fractures after reverse total shoulder arthroplasty occur predominantly as a result of bony insufficiency secondary to patient and intra-operative technical factors. The spectrum of the pathology can range from a stress reaction to an undisplaced or displaced fracture. Prompt diagnosis of these fractures requires a high suspicion in the postoperative patient with a clinical presentation of acute onset of pain along the acromion or scapular spine and/or deterioration of shoulder function. Conventional shoulder radiographs are frequently unreliable in identifying these fractures, especially if they are undisplaced. Computed tomography (CT) and/or single photon emission computed tomography/CT scans are useful imaging modalities for obtaining a definitive diagnosis. Early diagnosis and non-operative treatment of a stress reaction or undisplaced fracture is essential for preventing further displacement and potential disability. The management of displaced fractures is challenging for the orthopaedic surgeon as a result of high rates of mal-union or non-union, decreased functional outcomes, and variable results after open reduction and internal fixation. Strategies for preventing these fractures include optimizing the patient's bone health, correct glenoid baseplate screw length and position, and avoiding excessive deltoid tension. Further research is required to identify the specific patient and fracture characteristics that will benefit from conservative versus operative management.

We developed an educational model that simulates a distal radial fracture requiring closed reduction and cast application. We demonstrated construct validity, as the GRS and OSATS tools were able to differentiate senior from junior residents. We were unable to differentiate trainees using radiographic assessment, as all residents restored anatomical alignment and had comparable three-point index scores.

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Background: Conventional radiographs are routinely used to evaluate acetabular bone loss as part of the follow-up in patients who undergo total hip arthroplasty (THA). The objective of this study was to examine the accuracy and specificity of conventional radiographs reviewed by arthroplasty surgeons in detecting acetabular bone loss in patients with prior THA. Methods:Using a cadaveric pelvic model, a defined percentage of bone was incrementally removed from the posterior acetabular column, followed by implantation of uncemented cups into both acetabula. Ten orthopedic arthroplasty surgeons, blinded to the defect sizes, assessed the percentage of bone defect using standard anteroposterior, Judet and oblique conventional radiographs. Results:Observers were unable to accurately grade bone defects using conventional radiographs. For defects less than 50%, observers reported on average a defect of 11%. Although observer estimates of defects 50% or more increased, these treatmentaltering bone deficiencies remained grossly underestimated, with a sensitivity and specificity of 36.6% and 97.6%, respectively. Conclusion:Conventional radiographs reviewed by experienced arthroplasty surgeons do not reliably detect small bone lesions (< 50%). Although more successful in detecting larger bone lesions, surgeons tend to underestimate actual bone loss. Computed tomography scanning may be indicated if accurate estimation of acetabular bone loss is required in patients who have undergone previous THA.Contexte : On utilise habituellement les radiographies ordinaires pour évaluer la perte osseuse au niveau de l'acétabulum lors du suivi des patients qui subissent une chirurgie pour prothèse totale de la hanche (PTH). L'objectif de la présente étude était de vérifier la précision et la spécificité des radiographies ordinaires examinées par des chirurgiens spécialistes de l'arthroplastie pour le dépistage de la perte osseuse acétabulaire chez des patients ayant déjà subi une PTH.Méthodes : Sur un modèle de bassin de cadavre, nous avons graduellement retiré un pourcentage prédéfini de tissu osseux de la colonne acétabulaire postérieure, après quoi nous avons implanté des cotyles prothétiques non cimentés dans les 2 acétabu-lums. Dix chirurgiens orthopédistes spécialistes de l'arthroplastie qui ne connaissaient pas la taille des anomalies ont évalué le pourcentage de perte osseuse à l'aide de radiographies ordinaires antéropostérieurs, de Judet et obliques. Résultats :Les observateurs se sont révélés incapables d'évaluer avec précision les pertes osseuses à l'aide des radiographies ordinaires. Pour les anomalies inférieures à 50 %, les observateurs ont signalé en moyenne des anomalies de 11 %. Même si les estimations des anomalies de 50 % ou plus par les observateurs étaient plus élevées, ces déficits osseux qui modifient le traitement sont restés largement sous-estimés, avec une sensibilité et une spécificité de 36,6 % et 97,6 %, respectivement. Conclusion :Les radiographies ordinaires examinées par des spécialistes de l'arthroplastie...

Recovery room radiographs (RRR) are routinely performed after total knee arthroplasty (TKA). This study investigates the utility of these radiographs. Twenty four arthroplasty surgeons were surveyed to rank the value of RRRs. Since RRRs were primarily valued for educational purposes, we examined the ability of 49 orthopaedic trainees to determine the coronal alignment of TKA performed in cadaveric specimens based on these radiographs in neutral, 10°internal and external rotations. Surgeons rated the quality of the RRRs to be significantly lower than the radiographs taken in the radiology suite (5.5±2.5 versus 8.9±0.9, p< 0.0001). Of an estimated 65,910 TKAs performed by these surgeons, only eight cases (0.01%) required same day revision based on the RRR. Neutral alignment was significantly more accurately (p<0.0001) interpreted than valgus or varus (69.4% versus 42.9% and 16.3%, respectively). Surprisingly, internal rotation of the limb significantly improved interpretation of both varus (from 16.3% to 40.8%, p=0.014) and valgus (from 42.9% to 63.3%, p= 0.048). Increased level of orthopaedic training did not significantly affect the accuracy of interpretation (p=0.46).Interpretation of RRRs for coronal malalignment is inaccurate and has a limited educational value.

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