Volume 18-4, Winter 2009

Over the last few years, locking plates have become increasingly popular for the treatment of a variety of periarticular fractures. Despite the popularity of these new implants, older implants have a long track record of success and are still appropriate for a variety of periarticular fractures. This article reviews some of the current literature on locking plates and compares results for general fracture types to conventional plate fixation. The question of whether a locking plate or conventional plate is best for the patient, easier for the surgeon to use, and cost-effective is discussed. (Journal of Surgical Orthopaedic Advances 18(4):163–169, 2009) Key words: blade plate, locking plate, periarticular fracture

Problems of the cervical spine and shoulder frequently have very similar presentations and can be difficult to differentiate. However, with a careful history, physical exam, imaging studies, and judicious use of diagnostic injections, the true source of a patient’s symptoms can be deciphered and treated. Cervical spondylosis not only causes pain in the neck and shoulder area, but can also cause radiating pain in the arm and forearm that can be confused with rotator cuff pathology, nerve compression in the shoulder area, or brachial neuritis. (Journal of Surgical Orthopaedic Advances 18(4):170–174, 2009) Key words: arm pain, cervical, radiculopathy, referred pain, rotator cuff, shoulder, spondylosis

This study compared the biomechanical performance of 4.5-mm limited contact dynamic compression plates (DCPs) and 3.5-mm locking compression plates (LCPs) for the fixation of unstable humeral shaft fractures. Composite humeri were divided into two groups: 3.5-mm LCPs and 4.5-mm DCPs. Osteotomy gaps of 5 mm, simulating diaphyseal comminution, were created. Stiffness tests were performed in anterior–posterior (AP) bending, medial–lateral (ML) bending, torsion, and axial compression. Results showed that while construct stiffnesses in ML bending and torsional loading are significantly higher for the 4.5 DCP group (p < .05), no statistically significant differences were observed in AP bending or axial compression. Fatigue characteristics under cyclic AP bending conditions were also evaluated, although no failures occurred. Data from the literature suggest that stiffness results for the LCP constructs perhaps afford sufficient fixation strength capable of supporting the physiologic loads most commonly applied during postoperative rehabilitation. However, results indicate that the DCP construct is mechanically advantageous for stabilizing diaphyseal comminuted fractures. (Journal of Surgical Orthopaedic Advances 18(4):175–181, 2009) Key words: biomechanics, fracture fixation, humerus, limited-contact dynamic compression plate, locking compression plate

This study compared compression generation between two headless compression screws: the Synthes 3.0-mm and the Acutrak standard. Twenty scaphoids were harvested from 10 pairs of fresh cadaveric forearms. A washer-shaped load cell was inserted between the halves of each scaphoid created by a simulated fracture via osteotomy. One scaphoid of each pair was tested with the Synthes and the other with the Acutrak. Parameters of interest were peak screw torque and fracture site compression. Differences in parameters of interest were checked for significance (p < .05) with paired t tests. No significant differences were shown in mean (š standard deviation) peak torque (57 š 28 Ncm vs. 55 š 32 Ncm; p < .84), compression immediately after insertion (119 š 54 N vs. 91 š 37 N; p < .15), or compression 5 min after insertion (32 š 30 N vs. 38 š 24 N; p < .61) between the Synthes and Acutrak screw fixations, respectively. The choice between these two screws to stabilize scaphoid waist fractures should be based on parameters other than compression generation, such as size, availability, cost, and ease of use of the implant. (Journal of Surgical Orthopaedic Advances 18(4):182–188, 2009) Key words: Acutrak standard screw, scaphoid fracture fixation, Synthes headless compression screw

Hemiarthroplasty is a common form of treatment for rotator cuff tear arthropathy. Clinical outcomes of the bone-sparing Copeland Extended Articular Surface (EAS) hemi-resurfacing arthroplasty for rotator cuff tear arthropathy have not been reported in the literature. This article presents the authors’ preliminary results in this study. Six patients treated with this prosthesis were retrospectively reviewed and the preoperative and postoperative scores for range of motion and outcomes as assessed by the disabilities of the arm, shoulder, and hand (DASH) questionnaire and visual analog scale for pain were compared. Significant improvements were found in function, with DASH scores decreasing from an average of 55 to 22, pain improving from 8.83 to 4.5, and external rotation improving from 49° to 67°. Five of the six patients were satisfied with the outcome of the procedure. This level IV therapeutic study concluded that the bone-sparing Copeland EAS hemi-resurfacing arthroplasty is a viable alternative to stemmed hemiarthroplasty for the treatment of rotator cuff tear arthropathy in younger, more active patients in whom future revision is a likely possibility. (Journal of Surgical Orthopaedic Advances 18(4):189–194, 2009) Key words: arthritis, arthroplasty, cuff tear arthropathy, resurfacing, shoulder

To determine the impact of the new Joint Academy on volume and length of stay (LOS), the authors undertook a retrospective record review for January–March of 2006 and 2007. A total of 413 primary and revision total joint replacements performed by two surgeons were reviewed, with 10.7% more procedures in 2007 than in 2006. The weighted average LOS in 2006 was 3.44 days; in 2007 it was 3.36 days. Significantly, the authors also compared volumes and LOS by weekday of admission and found no statistical variance in average length of stay (ALOS) by weekday of admission. Revisions negatively affected ALOS but added volume. It was concluded that the Joint Academy had a positive impact on volume and LOS, with most patients successfully discharged on postoperative day 3 due to the program’s standardized order sets and appropriate resource allocation. (Journal of Surgical Orthopaedic Advances 18(4):195–199, 2009) Key words: length of stay, total hip replacement, total joint replacement, total knee replacement, volume

A retrospective review was performed to analyze the radiographic and functional outcomes of two different surgeries to repair a pseudarthrosis following a transforaminal lumbar interbody fusion (TLIF) procedure. Although there are several published reports on the results of the TLIF procedure, there are no reports on how to salvage a failed TLIF. A total of 38 consecutive patients with failed TLIF procedures (at 50 levels) were repaired by either a direct anterior approach only (21 patients) or by a combined direct anterior approach coupled with a posterior exploration and pseudarthrosis repair (17 patients). The minimum follow-up after revision was 24 months. Clinical outcome was measured by Oswestry Disability Index, Roland Morris Questionnaire, SF-36, and the authors’ own centers’ satisfaction questionnaire in 17 of the 38 patients. The fusion rate for the anterior-alone group was 81% (17/21) and 88% (15/17) for the anterior-posterior group, not a statistically significant difference. The Oswestry scores averaged 56.4 for the anterior lumbar interbody fusion (ALIF) group and 51.4 for the anterior-posterior fusion (APF) group. The Roland-Morris scores averaged 18.9 for the ALIF group and 20.0 for the APF group. The SF-36 showed similar outcomes in both groups. The authors’ center’s satisfaction questionnaire also showed similar results. The outcomes, both radiologic and functional, were equal in both groups. There was very little improvement in functional outcomes comparing prerepair to postrepair based on the authors’ questionnaire. (Journal of Surgical Orthopaedic Advances 18(4):200–204, 2009) Key words: ALIF vs. APF surgery, pseudarthrosis repair, revision TLIF, salvage procedures

Osteochondroma is the most frequent bone tumor and can rarely cause vascular complications. False aneurysms of the popliteal artery due to an osteochondroma are not common in the pediatric population. The case of an 11-year-old boy who presented with a painful mass on the posterior aspect of his distal thigh is described. Radiologic studies revealed an osteochondroma of the distal femur and a pseudoaneurysm of the popliteal fossa. A combined orthopaedic and vascular surgery was undertaken. The exostosis was excised and the popliteal artery was repaired by performing a venous patch angioplasty technique. A review of the literature regarding this vascular complication in young patients is also reported. (Journal of Surgical Orthopaedic Advances 18(4):205–210, 2009) Key words: children, osteochondroma, popliteal artery, pseudoaneurysm

This article describes a technique for the operating table setup for application of circular external fixation devices. This technique uses Universal Split Leg Accessories for the operating room table, which facilitates intraoperative fluoroscopy and makes the application of circular external fixation devices less cumbersome and more efficient. (Journal of Surgical Orthopaedic Advances 18(4):211–213, 2009) Key words: circular external fixator, intraoperative fluoroscopy, positioning