No abstract

Level IV, case series.

This is the first systematic review looking at high-level evidence to compare open, percutaneous, and arthroscopic techniques for treating lateral epicondylitis. There are no clinically significant differences between the 3 surgical techniques (open, arthroscopic, and percutaneous) in terms of functional outcome (DASH), pain intensity (VAS), and patient satisfaction at 1-year follow-up.

Early return to play among athletes before Jones fracture union is associated with increased risk of failure. This study introduces a plantar-lateral plating construct that performed more favorably than intramedullary screw fixation when applied to simulated Jones fractures in cadaveric foot specimens. Further clinical comparative studies are needed to assess the clinical use of this construct.

Proximal fifth metatarsal fractures, zones II and III, are commonly treated surgically, especially in elite athletes. Intramedullary screw fixation remains the most used construct despite nonunion and refracture. High tensile forces on the plantar-lateral aspect of the fifth metatarsal are difficult to control, and intramedullary screw fixation depends on ideal screw position, length, and width. The authors present a plantar plating technique with cancellous bone autograft for zones II and III proximal fifth metatarsal fractures. Rotational instability and plantar-lateral gapping are resisted by applying a compression plate to the tension side of the fracture, eliminating causes for failure. [Orthopedics. 2017; 40(3):e563-e566.].

Background Total hip arthroplasty (THA) is the preferred treatment for displaced femoral neck fractures in select patients, although dislocation remains a concern. In some studies, the supercapsular percutaneously assisted (SuperPATH) approach has demonstrated early mobilization, short hospital stay, and low dislocation rates in primary THA, but there are little data on its use for fractures. This study describes the perioperative outcomes and early dislocation rate of SuperPATH THA for displaced femoral neck fragility fractures. Methods A retrospective review was performed of previous ambulatory patients with a displaced femoral neck fragility fracture treated with THA using the SuperPATH approach. Demographic data, time to ambulation, length of stay, and in-hospital complications during the hospital stay and follow-up period were recorded. Phone interviews were conducted to check for dislocations 1 year after surgery. Results Thirty-seven consecutive patients were included with an average age of 75.0 years. Hospital stay averaged 5.5 days, and patients were discharged on average postoperative day 3.6. About 83.8% of patients were ambulatory by postoperative day 1, and 94.6% ambulatory before discharge. Twenty-seven percent of patients were discharged home, 46% to inpatient rehabilitation, 24% to skilled nursing facility, and 1 patient to hospice. At follow-up, there was no symptomatic heterotopic ossification and no infections. Thirty-two patients were available for telephone interviews at 1 year, with no dislocations reported. Conclusions In this small cohort, the SuperPATH approach for THA appears to be safe and effective for use in femoral neck fragility fractures, resulting in early ambulation and a low dislocation rate.

We present a case of delayed, acute bilateral exertional compartment syndrome of the anterior thigh induced by callisthenic exercise. Symptoms consisted of pain out of proportion to examination findings, inability to ambulate, and severe pain with knee flexion. Treatment consisted of bilateral thigh fasciotomies and supportive therapy for concomitant rhabdomyolysis. Full strength, range of motion, and return to all military duties were achieved by 4 months postinjury.

Objectives:The purpose of this study was to determine: 1) normative data of multiple general health-, activity-, hip and groin-, and depression-specific patient-reported outcome (PRO) questionnaires; 2) if any PRO's were able to predict a positive anterior impingement test, in female professional soccer players. Methods: An IRB-approved cross-sectional investigation of adult female US professional soccer players was performed at the team pre-season physical examination day. Adult (>18 years of age) female players without prior hip surgery were eligible. Hip impingement physical examination was performed (anterior, subspine, lateral, posterior) and recorded. Multiple questionnaires were administered to each player, including Short-Form-12 (Mental Component and Physical Component Scores [MCS, PCS]), Tegner activity score, Non-Arthritic Hip Score (NAHS), Hip and Groin Outcome Score (HAGOS), international Hip Outcome Tool-12 (iHOT-12), and Zung Depression Index. Descriptive statistics were calculated. Kolmogorov-Smirnov analysis was performed for data normality and Pearson's (parametric) or Spearman's (non-parametric) to assess correlation of ROM and radiographs. Binary logistic regression was performed to ascertain the effects of each PRO questionnaire score and prediction of a positive anterior impingement test. Results: Twenty-four players (48 hips) were analyzed (25.4+/-3.0 years of age; 2.8+/-2.2 years professional experience). Scores were collected: Tegner 9.9+/-0.3; SF-12 PCS 52.9+/-7.4; SF-12 MCS 54.3+/-7.0; iHOT-12 96.6+/-5.4%; NAHS Total 97.9+/-4.9; HAGOS symptoms 90.5+/-10.5, pain 97.8+/-3.4, activities of daily living 99.4+/-2.2, sports 97.1+/-4.2, physical activity 97.9+/-7.1, and quality of life 95.8+/-8.7; Zung 27.6+/-5.9. The iHOT-12 was able to correctly predict 71% of cases of positive anterior impingement test for the left hip and the logistic regression model was statistically significant, (5.2)1, p=0.02. For the right hip, the iHOT-12 was able to correctly predict 79% of cases of positive anterior impingement and the logistic regression model was statistically significant, χ 2 (9.1)1, p=0.003. SF-12 MCS and PCS scores were able to correctly predict 83% of cases for the left hip and the logistic regression model was statistically significant, χ 2 (11)2, p=0.005. The Zung score was able to correctly predict 83% of cases for the left hip and the logistic regression model was statistically significant, χ 2 (4.1)1, p=0.04. Conclusion: Multiple general health-, activity-, hip and groin-, and depression-specific patient reported outcome scores were collected and normative data established in a US women's professional soccer club, showing that iHOT-12, SF-12 MCS and PCS, and Zung depression scores were able to correctly predict symptomatic impingement.