Volume 28-1, Spring 2019

The purpose of this study was to illustrate the usefulness of ultrasound in the early diagnosis of occult scaphoid fractures. Forty-eight patients with clinical symptoms of scaphoid fracture and negative initial X-rays were examined. All patients underwent ultrasonography in the emergency room (ER). After 14 days, a computed tomography (CT) scan was performed, which confirmed or not the initial suspicion of fracture. Twenty-two patients were found with subperiosteal hematoma, while six also had cortical discontinuity. The sensitivity of ultrasound in the diagnosis of occult scaphoid fractures was 90% and the specificity was 85.7%. The positive prognostic value was 81.8%. The authors support the use of the scaphoid ultrasound only under strict circumstances. If subperiosteal hematoma or cortical discontinuity is present, there is a high likelihood of scaphoid fracture. On the contrary, if the ultrasound is negative and symptoms persist, the patient will require a CT scan or magnetic resonance imaging for definitive diagnosis. (Journal of Surgical Orthopaedic Advances 28(1):1–9, 2019) Key words: cost-effectiveness, diagnosis, occult fractures, scaphoid fractures, subperiostal hematoma, ultrasound

Citation calculations measure academic influence. This study sought to analyze highly cited shoulder arthroplasty articles and determine the best measure to assess their impact. Scopus identified the 50 most cited articles, and each was analyzed for citation number, authors, institution, country of origin, and journal of publication. SPSS 23 was used for descriptive statistics, and a Pearson correlation coefficient assessed the relationship between citation measures. The results revealed an average citation count of 259 ± 108 and a citation density (citation count /years since publication) of 18 ± 10 annually. Most articles originated in the United States (31) and France (9). Twelve surgeons were included on three or more articles. Forty-one studies were clinically based. Finally, correlation was demonstrated between citation count and citation density (r = 0.486, p ¡ .001). In conclusion, this study revealed the trends of highly cited shoulder arthroplasty articles and found citation count and citation density to be acceptable measures of academic influence. (Journal of Surgical Orthopaedic Advances 28(1):10–17, 2019) Key words: citation count, citation density, citation trends, shoulder arthroplasty, most cited, publication trends, Scopus

Muscle fatigue can result in scapular dyskinesis, which has been implicated in impingement, labral injury, and rotator cuff injury. This study evaluated the ability of a compression shirt to maintain scapular alignment after fatiguing of periscapular musculature. Subjects’ scapular movements were monitored before and after a periscapular muscle–fatiguing exercise program. In the anterior and posterior tilt and medial and lateral rotation dimensions, control and shirt subjects both exhibited differences between the prefatigue and postfatigue measurements throughout humeral elevation. In the retraction and protraction dimension, control subjects exhibited differences between prefatigue and postfatigue measurements for a large portion of elevation, while shirt subjects only had different measurements toward the extreme of shoulder flexion. Thus the shirt does not stabilize the scapula in the anterior and posterior tilt and medial and lateral rotation dimensions. In the retraction and protraction dimension, the shirt provides stability to the scapula and maintains prefatigue position. It is currently unclear if preserving one plane of scapular motion has clinical significance. (Journal of Surgical Orthopaedic Advances 28(1):18–23, 2019) Key words: biomechanics, injury prevention, scapular dyskinesis

The purpose of this study was to analyze the clinical outcomes of patients treated for high-energy midfoot (Lisfranc) injuries with initial temporization of an external fixator before definitive fixation. A retrospective chart review at two level 1 trauma centers was completed. Clinical parameters including demographics and comorbidities were evaluated in addition to hospital and clinical data. Time to full weight bearing took an average of 4.4 months, and with the numbers available no significant difference (p > .05) was found between the open reduction and internal fixation (ORIF) group and the arthrodesis group in regard to length of stay, days from initial reduction with an external fixator to definitive fixation, time to full weight bearing, or return to work. Staged treatment of high-energy Lisfranc injuries with external fixation demonstrated minimal soft tissue complications similar to other series reported in the literature. Definitive stabilization with either ORIF or arthrodesis produced similar results in staged treatment of these injuries. (Journal of Surgical Orthopaedic Advances 28(1):24–30, 2019) Key words: external fixation, Lisfranc fracture, midfoot fracture, tarsometatarsal fracture–dislocation

This study assessed the 15-year minimum outcomes of the RingLoc cup (Zimmer Biomet, Warsaw, Indiana), a second-generation cementless porous plasma-coated acetabular component. The study identified 2438 patients (2905 hips) who underwent total hip arthroplasty using the RingLoc acetabular component between 1992 and 2000. Fifteen-year minimum follow-up data were available on 431 consented patients (511 hips). Clinical outcomes included the Harris hip score. Follow-up radiographs, complications, and revisions were reviewed. Mean follow-up was 18.2 years (range, 15–24.7). Harris hip scores improved from 46.9 preoperatively to 79.3 postoperatively (p ¡ .001). Reoperation for any reason was performed in 141 hips (27.6%). Isolated liner exchange was performed in 96 hips (18.8%) and acetabular revisions were performed in 44 hips (8.6%). Acetabular survivorship at 15 years was 93.5% for all causes and 94.3% for aseptic revision. This study demonstrated excellent acetabular survivorship of the porous plasma-sprayed RingLoc cup at a minimum 15-year follow-up. (Journal of Surgical Orthopaedic Advances 28(1):31–34, 2019) Key words: acetabulum, cementless, porous, survivorship

Radial tunnel syndrome (RTS) has long been a difficult therapeutic and diagnostic entity for upper extremity surgeons. The presentation is vague and the diagnosis is typically one of exclusion. Multiple clinicalentitiesareknowntomimicRTS,butlittleattentionhasbeenpaidtothedistalbiceps.Experience suggests that insertional biceps tendonitis is a potential confounding diagnosis in suspected RTS and that magnetic resonance imaging (MRI) may be of diagnostic benefit in chronic cases before surgical intervention is undertaken. This study is a 13-patient case series. The included patients presented with proximal forearm pain and positive provocative maneuvers for RTS. All included patients were found to have distal biceps pathology on MRI evaluation. At final follow-up (average 6.9 years), all patients had resolution of symptoms with therapy aimed specifically at addressing the distal biceps tendon. A diagnosis of insertional biceps tendonitis could explain both the typical success with conservative treatment and the poor results from surgical intervention for RTS. (Journal of Surgical Orthopaedic Advances 28(1):35–40, 2019) Key words: conservative management, distal biceps, misdiagnosis, radial tunnel syndrome, tendonitis, therapy

Given the increase in the incidence and survivability of those with solid organ transplantations in the UnitedStates,thepurposeofthisstudywastoidentifyinpatient,30-day,and90-dayoutcomesfollowing primary shoulder arthroplasty in transplant recipients. The Healthcare Cost and Utilization Project State Inpatient Databases identified patients who underwent shoulder arthroplasty after solid organ transplantation between January 2007 and December 2013. International Classification of Diseases, Ninth Revision, codes were used to define the primary composite outcome of death or postoperative complication. Logistic models with frequency weights were used to compare propensity-matched groups. Patients undergoing primary shoulder arthroplasty following solid organ transplant are at elevated risk of inpatient and 30-day and 90-day postoperative complications (respiratory, hemorrhage) and have longer length of stays compared with nontransplant patients. Transplant patients did not have an increased risk of surgical site infection or mortality at any time point (Journal of Surgical Orthopaedic Advances 28(1):41–47, 2019) Key words: complication, immunosuppression, infection, outcomes, shoulder arthroplasty, solid organ transplan

Studying the relative impact of various measures of coping strategies can help determine which ones are most useful for patients with osteoarthritis (OA).This study prospectively enrolled 108 patients with hip or knee OA who were seeing an orthopedic surgeon before or after arthroplasty. Measures of coping strategies included the Patient Activation Measure (PAM), Pain Self-Efficacy Questionnaire (PSEQ-2), and the Brief Resilience Scale (BRS). The Hip Disability and Osteoarthritis Outcome Score, Junior (HOOS, JR), the Knee Injury and Osteoarthritis Outcome Score, Junior (KOOS, JR), and Numeric Rating Scale (NRS) were used to measure pain intensity. Pearson correlations measured the interrelationships of the outcome measures. The PSEQ-2 correlated significantly with the NRS, but the confidence intervals for the three instruments overlapped. The PAM and the PSEQ-2 correlated with the KOOS, JR. Only the PSEQ-2 was associated with variation in the NRS. The PAM, PSEQ-2, and BRS correlated with one another. While measures of self-efficacy, active involvement in care, and general resilience were correlated, the measure of pain self-efficacy had the strongest association with patient-reported outcomes. (Journal of Surgical Orthopaedic Advances 28(1):48–52, 2019) Key words: osteoarthritis, patient activation, patient-reported outcomes, resilience, self-efficacy

All patients undergoing open reduction and internal fixation of a distal radius fracture (DRF) between the years 2010 and 2015 were isolated from the National Surgical Quality Improvement Program database. Patient demographics, respective surgical volume, outcome variables, and complications were extracted. The primary outcomes were surgical time, hospital length of stay, and unplanned reoperation. A total of 6691 patients were included in the study, the majority of whom were treated by orthopaedicsurgeons.Whiletherewerenosignificantdifferencesinbaselinedemographicsbetweenthe patients treated by orthopaedic and plastic surgeons, the overall operative time was significantly less for DRFsfixedbyorthopaedicsurgeons.Whiletherewasasignificantdifferenceforextra-articularfractures, this difference increased significantly for complex intra-articular fractures. Additionally, hospital length of stay was significantly shorter for patients treated by orthopaedic surgeons. To produce well-rounded, technically skilled surgeons, plastic surgery programs should incorporate fixation principles into their training programs. (Journal of Surgical Orthopaedic Advances 28(1):53–57, 2019) Key words: distal radius fracture, orthopaedic surgery, plastic surgery, residency training

The purpose of this study was to evaluate a multimodal pain management program incorporating periarticular injections of liposomal bupivacaine after hemiarthroplasty treatment of femoral neck fractures. This retrospective study selected patients treated with periarticular injections of liposomal bupivacaine within the multimodal pain management program (LBUP) (n=100) and a control group of patients treated without local infiltration (n=78). Similar pain control was achieved between both groups from day 1 to day 4 postsurgery (min p= .392). Length of stay was significantly lower for LBUP patients (4.8 days vs. 5.7 days, p= .013), and LBUP patients were significantly more likely to be ambulatory at discharge (82% vs. 69%, p= .013). LBUP patients were also less likely to need the intensive care unit (4% vs. 14%, p= .027). The percentage of patients with at least one opioid-related adverse event was lower in the LBUP group (3% vs. 8%, p= .156) as was the 90-day mortality rate (2% vs. 8%, p= .069), but the differences were not statistically significant. (Journal of Surgical Orthopaedic Advances 28(1):58–62, 2019) Key words: hemiarthroplasty, hip fracture, liposomal bupivacaine, multimodal pain management

This study reviews outcomes of patients undergoing Wilson extension osteotomy of the first metacarpal fortreatmentofcarpometacarpal(CMC)jointpainanddeformity.Thestudyreviewsvariedindicationsfor Wilsonosteotomyoutliningtechniqueandfunctionaloutcomes.Twelvepatients(11female,1male)with anaverageageatsurgeryof50(range,25–67)underwentosteotomyduringthestudyperiod.Diagnoses included seven patients with early degenerative changes of the CMC joint with painful subluxation or instability. The remaining patients had symptomatic adduction contracture in either end-stage arthritis (three) or following prior trapeziectomy (two). Average motion improved modestly among all groups with considerable improvement of metacarpophalangeal hyperextension in late deformity patients. Wilson osteotomy is a motion-preserving alternative procedure that may be indicated for patients with early CMC arthrosis and instability as well as for patients with adduction contractures in end-stage arthritis or posttrapeziectomy (Journal of Surgical Orthopaedic Advances 28(1):63–67, 2019) Key words: basilar thumb arthritis, corrective osteotomy, first metacarpal osteotomy, metacarpal osteotomy, Wilson extension osteotomy

Implant dislocation following total hip arthroplasty, particularly revision arthroplasty, remains a common postoperative complication. Constrained acetabular liners provide surgeons with an implant option that provides resistance to dislocation forces. These added forces, however, are transmitted to the implant materials and to the bone–implant interface, resulting in unique failure mechanisms. This case report presents two cases highlighting a previously unreported mechanism of failure of the Depuy Pinnacle ES constrained liner encountered during intraoperative implantation of the components (Journal of Surgical Orthopaedic Advances 28(1):68–73, 2019) Key words: constrained liner, cross-linked polyethylene, Depuy Pinnacle ES, failure, hip arthroplasty, polyethylene fracture

Hamstring tendon autografts are very often used for anterior cruciate ligament (ACL) reconstruction. After harvesting of the tendons, each end is most commonly fixed with a running whipstitch suture technique, which permits adequate handling and tensioning of the graft. This conventional technique, which uses multiple locking stitches running up and down the ends of both tendons, is time consuming and carries a risk for tendon damage and needle stick injuries. As a result of the conventional whipstitch technique, suture material is left behind within the tendon inside the tibial canal, which may lead to a local inflammatory response during resorption of the sutures. This article introduces a new technique involving a modified ‘‘one-stitch’’ hamstring tendon suture fixation technique. (Journal of Surgical Orthopaedic Advances 28(1):74–76, 2019) Key words: ACL graft, anterior cruciate ligament graft, hamstring tendon suture fixation technique, one-stitch hamstring tendon suture fixation technique, orthopedic surgery, surgical technique