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The scarf osteotomy provides a predictable and effective correction of moderate to severe hallux valgus deformities.

Over the past 20 to 30 years, arthroscopic shoulder techniques have become increasingly popular. Although these techniques have several advantages over open surgery, surgical complications are no less prevalent or devastating than those associated with open techniques. Some of the complications associated with arthroscopic shoulder surgery include recurrent instability, soft-tissue injury, and neurapraxia. These complications can be minimized with thoughtful consideration of the surgical indications, careful patient selection and positioning, and a thorough knowledge of the shoulder anatomy. Deep infection following arthroscopic shoulder surgery is rare; however, the shoulder is particularly susceptible to Propionibacterium acnes infection, which is mildly virulent and has a benign presentation. The surgeon must maintain a high index of suspicion for this infection. Thromboemoblic complications associated with arthroscopic shoulder techniques are also rare, and studies have shown that pharmacologic prophylaxis has minimal efficacy in preventing these complications. Because high-quality studies on the subject are lacking, minimal evidence is available to suggest strategies for prevention.

Elbow injury is encountered less frequently than are other joint conditions. The bony architecture, muscle, ligament, and nerve anatomy are complex, and the forces leading to injury in the athlete's elbow are unique. Appreciating the pathomechanics leading to injury and a detailed knowledge of elbow anatomy are the foundation for conducting a directed history and physical examination that achieves an accurate diagnosis. Recent advances in physical examination have improved our ability to accurately diagnose and treat athletic elbow disorders. This article reviews general and focused physical examination maneuvers of the elbow in a systematic anatomic fashion.

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Background Aseptic osteolysis has been the single most important factor limiting the longevity of a THA. A great deal of attention has been focused on the development of implants and materials that minimize the development of osteolysis. The monoblock porous tantalum acetabular cup was designed to minimize osteolysis, but whether it does so is unclear. Questions/purposes We evaluated the incidence of osteolytic lesions after THA using a monoblock porous tantalum acetabular component. Methods We retrospectively reviewed 51 patients who had a THA using a monoblock porous tantalum acetabular cup. At a minimum of 9.6 years postoperatively (average, 10.3 years; SD, 0.2 years; range, 9.6-10.8 years), a helical CT scan of the pelvis using a metal suppression protocol was obtained. This scan was evaluated for the presence of osteolysis.

Displaced isolated greater tuberosity fractures are rare injuries that require operative treatment to optimize rotator cuff function and prevent painful subacromial impingement. A lack of consensus exists regarding ideal management of these injuries because of the paucity of literature on the subject.The outcomes of 17 patients treated with open (n=15) or arthroscopic (n=2) fixation at the authors' institution between 2001 and 2009 were retrospectively reviewed. Postoperative range of motion, American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) score, and overall patient satisfaction were recorded at final follow-up. At a mean of 5.2 years (range 1.5-9.7 years), average postoperative active forward elevation was 150.3° (range, 60°-180°), ASES score was 82.9 (range, 46.7-100), and VAS score was 1.4 (range, 0-5). According to Neer's criteria, the overall outcome was excellent in 11 (65%) patients, satisfactory in 5 (29%) patients, and unsatisfactory in 1 (6%) patient. Final postoperative radiographs were available for 15 patients at a mean of 6.64 months. Radiographic union with near-anatomic position of the greater tuberosity was achieved in 13 (87%) of 15 patients. The presence of rotator cuff and rotator interval tears requiring repair, history of dislocation, age 60 years or older, and delayed time to surgery ≥ 10 days did not significantly (P>.05) influence the patients' final active forward elevation and ASES scores.Favorable patient outcomes can be achieved when fractures with >5 mm of displacement are treated with anatomic reduction and secure fixation. For a specific injury, the ideal surgical approach and method of fixation is dictated by patient characteristics and fracture pattern.

Background After arthroscopic shoulder stabilization, the loss of motion or delayed recovery of motion remains a clinical problem and may lead to poor patient satisfaction. There remains no consensus regarding the optimal position for postoperative immobilization and it is not known whether the position for shoulder immobilization has an effect on motion and functional recovery. Questions/purposes We asked: (1) Do patients treated with external rotation (ER) bracing after arthroscopic anterior shoulder stabilization reliably regain ROM and shoulder function? And (2) what is the frequency of recurrent instability and brace-related complications associated with the use of ER bracing? Methods Forty consecutive patients with a primary diagnosis of anterior shoulder instability underwent arthroscopic stabilization and received postoperative ER bracing; 33 patients (83%; mean age, 23 years; range, 13-44 years) were followed for at least 1 year postoperatively and seven patients were lost to followup. Shoulder ROM and functional scores were recorded preoperatively and at 2 weeks, 12 weeks, 6 months, and greater than 1 year (mean, 16 months) after surgery. Results All patients recovered their preoperative ROM and most patients achieved normal ROM by 3 months after surgery. Significant improvements in American Shoulder and Elbow Surgeons (ASES) and Western Ontario Shoulder Instability (WOSI) scores were observed at each postoperative time point. The mean (± SD) final scores were 95 ± 9 for the ASES and 87%