Variation of the Arthroscopic Mumford Procedure for Resecting the Distal Clavicle--Paul D. Lesko
Fifty-seven patients had arthroscopic Mumford procedures for acromioclavicular (AC) pain unresponsive to conservative treatment. Thirty-nine of these patients had concomitant rotator cuff repairs. All had significant improvement of distal clavicular pain. Neither the amount nor the completeness of the distal clavicle resection affected the results. One patient with a significant retained lateral clavicular spike required additional surgery for excision. Arthroscopic distal clavicle resection is a safe and effective method of alleviating AC pain.
Cemented Total Hip Arthroplasty With Boneloc Bone Cement--David C. Markel, Daniel B. Hoard, and Charles A. Porretta
Boneloc cement (WK-345, Biomet Inc, Warsaw, Ind) attempted to improve cement characteristics by reducing exotherm during polymerization, lowering residual monomer and solubility, raising molecular weight, and lowering airborne monomer and aromatic amines. To study the effi-cacy of this cement, a selected group of 20 patients were prospectively enrolled and followed up after hip arthroplasty. All components were cemented. During the enrollment period, approximately 70 other hip arthroplasties were performed. Clinical evaluation was based on the Harris hip score. Radiographic evaluation was based on assessment of position of the components, subsidence, and/or presence of radiolucencies. Patients had follow-up for an average of 42 months (11 to 58 months); 1 was lost to follow-up. Of these, 7 (35%) had failure at last follow-up. Despite its initial promise, Boneloc cement had an unacceptably high failure rate over a relatively short follow-up period and is not recommended for use. Despite the longevity and odor toxicity problems with conv
Group B Streptococcal Prosthetic Joint Infections--Joan M. Duggan, Gregory Georgiadis, Cornel VanGorp, and James Kleshinski
We report 6 cases of group B streptococcal prosthetic joint infections seen in our institution and review 8 previously reported cases. These 14 patients (6 men and 8 women) had an average age of 69. Seven hip joints and 7 knee joints were affected. Only 4 patients had risk factors for prosthetic joint infection (diabetes mellitus in 2, cancer in 1, and myelodysplasia in 1). The average time from surgery to onset of symptoms was approximately 4 years (range, 5 months to 10 years). Pain in the affected joint was the chief complaint. Six patients had bacteremia. Seven patients had known or suspected foci of infection, which were genitourinary tract (1), skin and soft tissue trauma sites (1), gastrointestinal tract (1), and oropharynx (1). Nine patients required prosthesis removal in addition to antibiotic therapy. Two patients had apparent cure of the infection with retention of the prosthesis. Group B streptococcal prosthetic joint infections appear to be a late complication of prosthetic joint replacement surgery.
Surgical Treatment Results in Scaphoid Nonunion--Mustafa Basbozkurt, MD, Ethem Gur, MD
Fracture of the scaphoid is the most common fracture in the wrist. We retrospectively reviewed 42 cases of established nonunion of the scaphoid that had been treated by four methods: with two Kirschner wires (K wires) and pronator quadratus pedicled bone graft in 5 patients; AO cannulated screw and graft in 8 patients; Herbert screw and graft in 19 patients; and two K wires and graft in 10 patients. Follow-up ranged from 1 to 5 years (between January 1995 and January 2000). Radiographs and computed tomography (CT) scans were analyzed for confirmation of osseous union. The average period of clinical and radiologic union was 13.2 weeks (range, 10 to 33 weeks). There was a significant improvement in the grasping power, radiologic healing, clinical satisfaction, and pain relief in the patients who had operation.
Prevalence of Orthopaedic Maladies in People Who Flyfish: An Internet-Based Survey--Keith Robert Berend, MD
In this study, we define the prevalence of back and joint pains in people who flyfish. We use the Internet as a source of data. Requests for participation were posted on flyfishing Web sites. Eighty-nine people were surveyed (E-mail group). A control group of 42 flyfishing club members participated (Club group). Epidemiologic information, flyfishing data, and location of pain were collected. Low back pain in the 131 participants was 59%. No differences between the two groups in location or prevalence were noted. Saltwater fishermen had the highest rates of shoulder and elbow pain (31%). Trout fishermen had the highest rate of wrist pain (31%). Warmwater anglers had the least leg (12%), elbow (12%), and shoulder pain (18%). These afflictions mirror reports for other recreational activities. Low back pain was the most prevalent complaint, followed by wrist/hand and shoulder. Flyfishing subtypes have different rates and locations of pain, explained by equipment and technique. This report defines use of the Internet as a data source for research.
Langerhans Cell Granulomatosis Manifested as Pigmented Villonodular Synovitis--Cooley G. Pantazis, MD, Kimberly Templeton, MD, Ossama W. Tawfik, MD, PhD, Raul Braylan, MD
We report an unusual case of Langerhans cell granulomatosis (LCG) manifested as a villous synovial proliferation in a 38-year-old female jogger. One year after the onset of joint symptoms, she had a classical LCG presentation with skin and visceral lymph node involvement. Review of the literature revealed only one case of synovial shoulder joint tenosynovitis associated with LCG in a middle-aged woman. Ours is the first reported case presenting clinically in the synovium of the hip joint as pigmented villonodular synovitis. Histiocytic/dendritic proliferations involving the synovial tissues are not uncommon. These lesions as well as the rare multicentric reticulohistiocytosis (MRH), a systemic monocytoid/ histiocytic disorder with multinucleated giant cells, polyarthritis, and papulonodular skin lesions, should be considered in the differential diagnosis. Clinical and pathologic features will distinguish LCG from MRH.
Iatrogenic Snapping of the Medial Head of the Triceps After Ulnar Nerve Transposition--Robert J. Spinner, MD, Gerard T. Gabel, MD
We postulate an iatrogenic cause for snapping of the medial head of the triceps. A patient whose ulnar nerve and triceps did not dislocate over the medial epicondyle preoperatively had snapping of a portion of the medial triceps after submuscular transposition of the ulnar nerve. We believe that release of the brachial fascia and excision of the medial intermuscular septum removed the restraint to anterior translation of the medial aspect of the triceps, permitting dislocation of a portion of the medial head of the triceps with elbow flexion in this case. Previous reports of snapping of the triceps resulting after ulnar nerve transposition occurred in patients whose ulnar nerve dislocated preoperatively; in these cases, the triceps was thought to have dislocated preoperatively (along with the ulnar nerve) but was not recognized. Careful intraoperative assessment of the triceps after ulnar nerve transposition should prevent medial triceps instability as a postoperative concern.