Volume 21-2, Summer 2012

We describe an oblique step-cut osteotomy technique for ulnar shortening. The technique requires no special instrumentation. It requires only an eight-hole 3.5-mm low-contact dynamic compression plate for fixation. Sixteen patients with posttraumatic ulnar impaction syndrome were treated. The average patient age was 40 years. The mean followup duration was 8 (range, 3 to 28) months. No nonunions occurred. Two patients required hardware removal for symptomatic hardware. Fourteen of the 16 patients reported persistence of occasional pain with some activities, but only 10 had any pain elicited at the time of examination. One patient required revision of the ulnar shortening procedure for persistence of symptoms. Functional outcomes were comparable with ulnar shortening performed by other methods. However, this technique might offer improved union rates compared with those described in the literature and is applicable to treat ulnar impaction syndrome arising from other causes. Key words: improved union, oblique step-cut osteotomy, posttraumatic ulnar impaction syndrome, ulnar shortening

The anterior approach to total hip arthroplasty has the advantages of using intermuscular and internervous planes, but it is technically demanding. We evaluated the learning curve for this approach with regard to operative parameters and immediate outcomes. From November 2005 through May 2007, 73 patients underwent 81 consecutive primary anterior-approach total hip arthroplasties. We grouped the hips into three consecutive groups of 20 and one of 21, and surgical and fluoroscopy times, estimated blood loss, intraoperative and postoperative complications, patient comorbidities, component position, and leg-length discrepancy were compared (statistical significance, p < 0.05). Comparing Groups 1 and 4, there were only two significant differences: operative time, 124 to 98 minutes, respectively, and estimated blood loss, 596 to 347 mL, respectively. Proficiency improved after Group 2 (40 cases) and was more marked after Group 3 (60 cases), with no major complications. Surgeons considering this approach should expect a substantial learning period. Key words: total hip arthroplasty, anterior approach, learning curve

To determine if ethyl chloride is an effective disinfectant alone or combined with povidone iodine in a clinical setting, 35 volunteers had different portions of their knees swabbed with sterile cotton-tip applicators after an area of skin was prepared with either ethyl chloride alone, povidone iodine alone, or povidone iodine followed by ethyl chloride. An area with no preparation at all served as the control. Specimens were then cultured on agar plates and bacterial growth assessed. When the data was categorized as colony forming units (CFUs) or no CFUs, both ethyl chloride and povidone iodine used alone had significantly fewer specimens with CFUs (p D 0.001) than controls, but were not significantly different from each other (p D 0.18). Additionally, the combination of povidone iodine followed by ethyl chloride spray had significantly fewer samples with CFUs than either product used alone (p D 0.001). In addition to its local anesthetic properties, ethyl chloride may be an effective disinfectant alone and may improve skin disinfection when used with povidone iodine compared to povidone iodine alone. Key words: ethyl chloride, povidone iodine, disinfectant, office procedures

Previous studies have reported publication rates of abstracts presented at orthopaedic meetings from 22 to 68 percent. The objective of this study was to determine the publication rate of papers presented at the Society of Military Orthopaedic Surgeons (SOMOS) meetings from 1999 to 2003. A database was created including all abstracts presented at SOMOS meetings from 1999 to 2003 as listed in official program books. To assess whether each abstract resulted in publication in a peer-reviewed journal, a computerized PubMed search of the presenting author and appropriate keywords from the title was conducted. Overall, 191 of the 435 abstracts presented at SOMOS from 1999 to 2003 were published in a peer-reviewed journal, giving a publication rate of 44%. The publication rate of abstract presentations at annual SOMOS meetings compares favorably with the rates for other orthopaedic meetings. However, less than 50% result in peer-reviewed publication. Key words: publication, abstracts, military, orthopaedics

Our objective is to assess the utility of the radial torsion angle (RTA) as described by Bindra et al. in the clinical setting among patients with previous distal radial fractures compared to normal controls. We hypothesize that the side-to-side RTA difference will be increased in subjects with previous forearm fracture as compared to normal subjects. Nineteen patients with a history of distal radial fractures and five normal subjects underwent bilateral upper extremity computerized tomography (CT) scans between 1999 and 2006. The radial torsion angle and the side-to-side difference were calculated by two radiologists. Correlation was made between the RTA and the patient’s forearm range of motion (ROM). Mean patient age was 37.8 +- 14.2 years. Mean radial torsion angle was 49.3 +- 22.4 degrees in the affected side and 36.7 +- 13.8 degrees in the unaffected side (p D 0.005). Mean side-to-side RTA was 18.4 +- 10 degrees in the cases versus 3.0 +- 1.41 degrees in normal subjects (p < 0.0001). Kappa coefficient for the side-to-side RTA differences was 0.62 (good agreement). Eighteen out of the 19 patients underwent surgery, ten of which were osteotomies. There was a statistically significant increase in side-to-side difference in the RTA among patients compared to controls. Key words: radial torsion angle, computed tomography, CT

Leiomyosarcomas of the somatic soft tissues are tumors of smooth muscle origin that occur in the extremities. These lesions are commonly high-grade tumors that carry a poor prognosis. Recommended treatment often includes wide excision and chemotherapy or radiation therapy. Sixty-five patients were followed for a mean of 4.1 years. The mean maximum tumor diameter was 7 cm, and approximately 70% of all patients had tumors deep to fascia. Including all stages of disease, the overall 1-, 2-, and 5-year survival rates were 91%, 87%, and 68%, respectively. Mitotic rate and tumor depth were significant predictors of development of recurrent disease and metastatic disease. Tumor size was another predictor of recurrent disease. The mitotic rate and AJCC stage were also important predictors of overall survival. Patients with deep lesions, histologic grade 3 disease/higher mitotic rates, and advanced stage of disease had a poorer prognosis and thus were more likely to undergo adjuvant chemotherapy. Future clinical studies may help determine if knowledge of these predictors can help guide treatment and improve clinical outcomes. Key words: leiomyosarcoma, soft tissue tumor

The purpose of this case report is to describe a novel use of computer assistance in identifying and restoring the mechanical axis in the treatment of a periprosthetic distal femur fracture in a 76-year-old female patient with a total knee arthroplasty.

We present a woman with chondroblastic osteosarcoma of the left ilium extending to the L4 epidural space and invading the inferior vena cava and right atrium, misdiagnosed as deep venous thrombosis. After neoadjuvant chemotherapy, two stage resection was planned. During the anterior approach, a mass in the left common iliac vein and inferior vena cava was found and tumor thromboembolism was diagnosed. Frozen sections showed chondroblastic osteosarcoma. The patient denied further surgery and had palliative intensity modulated radiation therapy. Key words: osteosarcoma, inferior vena cava; tumor thromboembolism