Low back pain is an extremely common presenting complaint that occurs in upward of 80% of persons. Treatment of an acute episode of back pain includes relative rest, activity modification, nonsteroidal anti-inflammatories, and physical therapy. Patient education is also imperative, as these patients are at risk for further future episodes of back pain. Chronic back pain (>6 months' duration) develops in a small percentage of patients. Clinicians' ability to diagnose the exact pathologic source of these symptoms is severely limited, making a cure unlikely. Treatment of these patients should be supportive, the goal being to improve pain and function.

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Anterior cruciate ligament (ACL) reconstructions are complex orthopedic procedures in which a proficient team is of vital importance. Outpatient surgical centers (OSCs) often provide orthopedic-specific teams; however, hospital operating rooms (ORs) commonly rotate staff. The purpose of this study was to compare the efficiency of pediatric ACL reconstructions between a surgical center and a hospital OR owned and directed by a single institution. Cases examined involved pediatric patients, aged 12 to 18 years (mean age, 15.9±1.5 years), who underwent ACL reconstructions by a single orthopedic surgeon from 2009 to 2014. Procedural efficiency was defined as shorter total OR time, less total staff, and fewer support staff changes. Total OR time was also broken into 3 distinct time periods: in-room to incision time, total procedure time, and stop time to out-of-room time. A total of 49 ACL reconstructions were performed in healthy athletes, with 28 surgeries at the OSC (mean age, 15.7±1.3 years) and 21 surgeries in the hospital OR (mean age, 16.1±1.8 years). Overall efficiency was higher at the OSC, with total OR time improved by 30 minutes on average (P=.0001) with less total staff (P=.0002). Surgical technician and nursing changes occurred 6 and 2.5 times more often in the hospital OR, respectively. Procedural efficiency was greater at the OSC. The provision of consistent and experienced orthopedicspecific teams allows for improvement in OR efficiency, cost, and value. [Orthopedics. 2017; 40(5):297-302.].

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Nerve laceration accompanying traumatic fracture is rare. We review the reported cases of nerve laceration and present two cases treated at our institution. Though uncommon, nerve laceration should be considered in the setting of traumatic fracture with neurological injury, particularly open fractures.

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For patients with DIP ganglion cysts, this newly described technique of volar, transtendon, intra-articular injection of corticosteroid provides a safe and effective treatment. This technique allows for ease and consistency of needle placement for intra-articular corticosteroid delivery while minimizing the potential soft tissue and infection concerns described with other techniques.