Luis Grau

Osteochondritis Dissecans of the Glenoid in a Major League Baseball Prospect: A Case Report

Case:A 16-year-old Major League Baseball prospect presented with persistent shoulder pain associated with throwing. Magnetic resonance imaging (MRI) demonstrated a large osteochondritis dissecans lesion in the posterosuperior aspect of the glenoid. The patient was restricted from throwing and underwent therapy to improve range of motion and throwing mechanics. Eight months after initiating nonoperative treatment, an MRI arthrogram demonstrated a healed lesion. At follow-up 2 years after treatment, full relief of symptoms had persisted. Conclusion:Osteochondritis dissecans lesions of the glenoid are extremely rare, but have the potential to heal in overhead-throwing athletes. To our knowledge, this is the only case reported in the literature that demonstrates a healed osteochondritis dissecans lesion of the glenoid following nonoperative treatment.

Operative Trends in the Treatment of Hip Fractures and the Role of Arthroplasty

Introduction: There is a projected exponential increase in the number of hip fractures in the United States. Trends in patient demographics and the role of total hip arthroplasty (THA) and its associated outcomes following hip fractures surgery have not been well studied. Methods: Patients with proximal femur fractures between 1990 and 2007 were identified in the National Hospital Discharge Survey database. Demographics, comorbidities, perioperative complications, and discharge status for patients undergoing THA, hemiarthroplasty, or internal fixation were examined. Multivariable regression was performed to determine independent risk factors for perioperative complications. Results: Between 1990 and 2007, there was a statistically significant increase in patient age, adverse events, medical comorbidities, surgical complications, medical complications, and nonroutine discharge across all surgical treatment modalities. In the same time period, the utilization of THA for all fracture types decreased significantly. Discussion: Total hip arthroplasty was found to be an independent risk factor for perioperative complications. Orthopedic surgeons should be aware that the hip fracture population continues to get older, with more medical comorbidities and are at higher risk for perioperative complications. Conclusion: Total hip arthroplasty is associated with a higher rate of perioperative complications in the hip fracture population.

Novel technique for a symptomatic subscapularis herniation through a scapu-lar defect

Fractures of the scapula are rare and have been reported to account for only 1% of all fractures and 3%-5% of upper extremity fractures. Several studies have reported successful outcomes with non-operative treatment of scapula fractures. Although non-operative treatments are successful in a very high percentage of patients, very few cases of non-union of scapular body fractures have been reported. In our review of the literature, we found two case reports of scapular body fractures developed into non-unions. In both of these cases, open reduction and internal fixation with reconstruction plates and bone graft was successful at eliminating pain and restoring function. This is a case report of a patient with a symptomatic, extra-articular scapular body defect from a non-union that was treated successfully with an acellular dermal extracellular matrix and bone graft using a novel technique

Biomechanics of the Acute Boutonniere Deformity

PURPOSE To demonstrate which structures of the extensor mechanism create a boutonniere deformity, when damaged, in a cadaver model. An analysis of how damage to these anatomical structures affects the biomechanical performance of the extensor mechanism was also performed. METHODS We secured 18 fresh cadaveric hands onto an apparatus consisting of a computer-controlled motor and tensiometer attached in series to the extensor communis tendon of the ring and middle digits. The central slip, transverse, and oblique fibers of the interosseous hood and the triangular ligament were sequentially divided. After each structure was divided, the motors were activated to provide a constant tendon displacement force. The angular displacement at the proximal interphalangeal (PIP) and distal interphalangeal joints was recorded. RESULTS In all digits, detachment of the central slip from the middle phalanx produced a decrease in extension of the PIP joint. When the transverse and oblique fibers of the interosseous hood were also divided, extension at the PIP joint was further decreased. A boutonniere deformity occurred only when all 3 structures were damaged. CONCLUSIONS The boutonniere deformity requires subluxation of the lateral bands volar to the axis of rotation of the PIP joint. This study demonstrates that damage to the central slip alone does not cause the deformity. Combined injury of the central slip, triangular ligament, and transverse and oblique fibers of the interosseous hood causes a boutonniere deformity. CLINICAL RELEVANCE Division of the central slip leads to loss of extension at the PIP joint. A more substantial loss of extension after injury or development of a boutonniere deformity should alert clinicians that other structures of the extensor mechanism are also damaged.