Decision and communication aids used in orthopaedic practice had benefits for both patients and surgeons. These findings could be important in facilitating adoption of shared decision-making tools into routine orthopaedic practice.

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Background: Rupture of the distal biceps tendon remains an uncommon injury that is ideally treated by operative repair. Single-incision anterior approach with suture anchor repair is one such method. The purpose of this study was to describe the outcomes in patients who underwent repair of the distal biceps tendon with single anterior incision and suture anchor repair. Methods: One hundred and nineteen patients (120 repairs) with distal biceps tendon repairs between January 1, 2002 and December 31, 2012 were identified and their charts retrospectively reviewed. Twenty-five of these patients participated in additional collection of outcome data including range of motion, strength, pain, satisfaction, and clinical outcome. Results: In the retrospective analysis, the population was 93% male. Average age was 47.3 yr; however, females had a significantly higher mean age (62.5). Most of the patients (69.8%) returned to full or partial work. The additional data collection cohort reported high satisfaction, little-to-no pain on visual analog scale (VAS) and average Disability of the Arm Shoulder and Hand (DASH) scores. Patients with workers’ compensation claims reported significantly higher pain and worse DASH scores. There was small but significant loss of pronation, and a small loss of grip strength that approached significance. Conclusions: Single anterior incision with suture anchor repair may be utilized for repair of ruptures of the distal biceps tendon with good clinical and functional outcomes and minimal loss of range of motion and strength. Females tend to be older at presentation than males with this condition. As in other studies, workers’ compensation claims were associated with poorer clinical outcomes. Level of Evidence: Therapeutic, level IV, case series study.

Background: The conflict tactic of the Afghanistan theater of operations utilizes blast weapons while most patrols are on foot, leading to a pattern of injuries associated with lower extremity amputation termed “dismounted complex blast injury” (DCBI). The purpose of this study was to better define and describe the injuries occurring to the nonamputated extremities in patients injured as the result of DCBI. Methods: A retrospective review was conducted of data from the United States and United Kingdom Joint Theater Trauma Registries of injuries resulting from a dismounted improvised explosive device (IED) blast. CT and radiographs were used to characterize injuries. Fisher’s exact test was used to compare categorical data, and binomial logistic regression was used to compare proportions of types of injuries by traumatic amputation level observed. Results: Of the 295 patients with lower extremity injuries, 201 had traumatic lower extremity amputations (140 with bilateral lower extremity and 61 with single-leg amputations). All were male, with a mean age 23.38+/-3.77. Below-knee amputation was most common (55.7%), followed by through-knee (25%), and least frequently through-ankle amputation. Hindfoot-level amputation was associated with an 8.1% increase in the odds of the presence of a skeletal foot injury in the nonamputated lower extremity. An association of above-knee amputation with bilateral distal upper extremity injury was found. There was a 10.9% increase in odds for the ipsilateral hand/wrist fracture given an AKA. Conclusions: Proximal lower extremity amputation levels are significantly associated with distal upper extremity skeletal injury. Hindfoot-level amputation is significantly associated with contralateral foot fractures. Amputation levels proximal to the ankle often presented with associated genitourinary injuries.

Lateral ankle sprains are among the most common musculoskeletal injuries in athletes. While most patients recover from lateral ankle sprains, 40% will have residual symptoms. This case presentation reviews the literature and describes the surgical treatment of a 39-year-old female with a long history of bilateral ankle instability who was treated with the modified Broström-Gould procedure.