Background: Internal bracing of anterior cruciate ligament (ACL) surgery is a newer concept gaining popularity. Purpose/Hypothesis: To assess the biomechanical performance of soft tissue ACL reconstruction allografts reinforced with suture tape. It was hypothesized that load to failure would increase and cyclic displacement would decrease at time zero in the constructs reinforced with internal brace suture tape compared with those without suture tape augmentation. Study Design: Controlled laboratory study. Methods: We performed ACL reconstruction on porcine knees using bovine extensor tendon soft tissue allografts: 10 knees without (control) and 10 knees with (reinforced) suture tape reinforcement. An all-inside reconstruction technique was utilized with retrograde tunnel creation. An adjustable-loop device was used for femoral and tibial fixation of all grafts. The suture tape was placed through the tension loop in the femoral fixation construct and independently fixed in the tibia with an interference screw anchor. For each specimen, the authors recorded ultimate load, yield load, stiffness, cyclic displacement, and mode of failure. Outcomes between groups were compared using the Student t test. Results: There was a 33% decrease in mean cyclic displacement in the specimens with reinforced grafts (reinforced vs control: 3.9 ± 0.7 vs 5.8 ± 1.5 mm; P = .001). The reinforced grafts also had a 22% higher mean ultimate load (921 ± 180 vs 717 ± 122 N; P = .008) and a 25% higher mean yield load (808 ± 201 vs 602 ± 155 N; P = .020). There was no significant difference in stiffness between the reinforced versus nonreinforced grafts (136 ± 16 vs 132 ± 18 N/mm; P = .617). Three of the 10 control specimens failed at the graft, compared with 1 of 10 reinforced grafts. All other constructs in both groups failed at the tibial fixation site. Conclusion: Suture tape reinforcement of soft tissue grafts significantly decreased cyclic displacement while significantly increasing ultimate and yield loads without increasing graft construct stiffness during biomechanical testing at time zero in a porcine animal model. Clinical Relevance: The improved biomechanical performance of suture tape–reinforced graft constructs could allow patients to participate in earlier advancement of aggressive rehabilitation and potentially reduce failure rates as graft remodeling progresses.
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Purpose: This study introduces a modified use of a fibular strut allograft as an adjunct to lateral locked plating in the treatment of osteoporotic two-part fractures of the proximal humerus. Methods: A prospective series of 13 consecutive patients (mean age 68; range, 60 to 88) with displaced two-part fractures of the proximal humerus were included. The main outcome measures included radiographic healing, clinical and radiographic findings of complications, assessment of shoulder function measured with the Shoulder Function Index, and ultrasonography assessment of rotator cuff disruption. Results: At postoperative month four, every fracture healed as evidenced on radiographic assessment. Clinically, patients achieved an average shoulder forward flexion of 141.5°, external rotation of 37°, and abduction of 98°. The mean Shoulder Function Index score was 73.2 (range, 64 to 77). No patients were included who required a major or a minor revision surgery. The average follow-up was 13.2 months (range, 12 to 15). Ultrasonography demonstrated no tears of the rotator cuff. Discussion: In a series of 13 patients, our technique facilitated fracture reduction while avoiding additional soft-tissue dissection at the fracture site and enabled supplementary stabilization after application of a lateral locking plate. Using this technique, we had minimal complications, a high rate of osseous healing, and achieved favorable clinical outcomes in a challenging patient population.
This case report presents a unique clinical dilemma in the treatment of a large full-thickness dorsal hand wound in a 64-year-old Caucasian woman with recently diagnosed acquired hemophilia A. The wound was instigated by nominal blunt force trauma to the dorsal hand and progressed to a large desquamating bulla. Treatment was initiated by careful evacuation of the bulla and daily dressing changes. The resulting necrosis of the skin produced a loose eschar. Subsequent removal of the eschar left the extensor tendons with minimal hypodermis covering the paratenon. The potential for life-threatening hemorrhage limited treatment options. The wound was treated with Integra Dermal Regeneration Template and planned for delayed definitive coverage. Continued concern for hemorrhage and comorbid conditions delayed skin grafting. Wound surveillance demonstrated notable interval healing ultimately resulting in complete regeneration of the skin, providing full coverage of the wound and no functional deficits without surgical intervention or skin grafting. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Full-thickness hand wounds present a challenge for the managing clinician to provide long-term adequate functional results. Larger and deep wounds usually require skin grafting to provide suitable coverage and healing. The use of Integra Dermal Regeneration Template (Plainsboro, NJ) has been implemented in the treatment of wounds related to burns, tumor resection, degloving injuries, traumatic wounds to the extremities, and pedicle donor flaps. 1e5 Integra provides an acellular bilaminate dermal-substitute membrane of collagen and chondroitin-6-sulfate to facilitate the migration of fibroblasts, macrophages, and lymphocytes and stimulation of capillary bed development.Acquired hemophilia is a potentially life-threatening autoimmune bleeding disorder caused by the development of autoantibodies against coagulation factors. Acquired hemophilia A (AHA) is the most common manifestation of this disease produced by autoantibodies against Factor VIII. 6,7 Only about half of AHA cases can be attributed to underlying conditions such as malignancy, other autoimmune disorders, or pregnancy. The rest are idiopathic, but all present with spontaneous hemorrhage into the soft tissues, muscles, and mucosa without a history of abnormal bleeding. 8 This case report presents the challenges of managing a patient with AHA after minimal hand trauma evolved into a full-thickness dorsal hand wound with other limiting comorbid conditions during the treatment course.We followed Strengthening the Reporting of Observational Studies in Epidemiology and Case Report for this case. Case ReportA 64-year-old Caucasian woman presented with an evolving hemorrhage on the dorsum of the left hand. The initial trauma was the result of striking the hand on a table while reaching for a piece of paper. This caused a small abrasion with progression of swelling, extensive ecchymosis, and pain of the hand and f...
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