The quality of reduction of distal radius fractures is assessed mainly by degree of restoration of radial angle and palmar tilt. This cadaver study investigates the effects of forearm rotation of these measurements. A 5 degree rotational change produces a 1.6 degree change in palmar tilt on the conventional lateral view and a 1.0 degree change on the 15 degree lateral view. Lateral radiographs could be rotated 15 degrees-30 degrees and still be considered acceptable. Therefore, rotation may produce up to a 4.0 degree (15 degrees lateral view) or 6.4 degree (conventional lateral view) change in measured palmar tilt. To provide clearer measuring landmarks and minimize error due to rotation, we recommend obtaining the 15 degree lateral view routinely in fractures with significant dorsal angulation. We also studied the interobserver variability of different surgeons assessing radial angle and palmar tilt. The mean standard deviation between surgeons was 3.2 degrees for radial angle, 3.6 degrees for conventional lateral palmar tilt, and 2.1 degrees for 15 degrees lateral palmar tilt.
Recent biomechanical and clinical studies have brought attention to improved surgical techniques and clinical outcomes of PCL reconstruction. In contrast to anterior cruciate ligament (ACL) injuries, isolated posterior cruciate ligament (PCL) injuries occur much less frequently and have traditionally been treated non-operatively. Even when a PCL injury meets operative indications, outcomes of PCL reconstruction historically do not match the success rates of ACL reconstruction procedures. As such, there remains controversy regarding appropriate indications and techniques for surgical repair leading to a paucity of conclusive data regarding surgical outcomes. Recently, however, there has been an increase in focus on the role of the PCL in proper knee biomechanics and negative long-term sequelae of chronic PCL insufficiency. This improved understanding has led to advancements in surgical technique and graft options for PCL reconstruction.
Distal radius repair is a common orthopedic surgery often performed at outpatient surgical centers. To date, little is known regarding optimal pain control in this setting. In this study, the authors evaluated patients who underwent distal radius open reduction and internal fixation (ORIF) in an outpatient surgery center setting. Comparisons between 2 surgical groups, peripheral nerve block without general anesthesia vs general anesthesia only, were recorded in terms of postoperative length of stay (LOS) in phase I, total LOS, and patient-reported pain level at discharge. The authors identified 80 patients undergoing distal radius ORIF from March to August 2016. A total of 37 (46.3%) patients received general anesthesia only and 43 (53.8%) patients received peripheral nerve block without general anesthesia. Overall, patients in the nerve block only group showed a statistically significant decrease in pain at discharge, as well as decreased phase I and total LOS. Although the power of the data is low relative to the number of distal radius procedures performed every year, there is a trend of better pain control and decreased LOS when using nerve blocks instead of general anesthesia. [
Orthopedics
. 2020;43(6):e549–e552.]
Introduction. This is a case report of an isolated vastus lateralis rupture identified by MRI and treated successfully with surgical repair. Case Presentation. A 50-year-old male recreational weightlifter who sustained an isolated vastus lateralis rupture while dead lifting and underwent surgical repair using a suture anchor fixation. Conclusion. An isolated vastus lateralis rupture is a rare injury that may be successfully treated with surgical repair allowing return to preinjury activities.
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