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Background: While initial reports of surgical repair are promising, literature detailing post-repair outcomes is lacking. This study explores the effectiveness of ulnar collateral ligament (UCL) repair in returning professional baseball players to their pre-injury level of play. Professional baseball players undergoing UCL repair will have successful outcomes and high return to sport rates after surgery. Methods: From 2016 to 2021, publicly available databases were utilized to search for professional baseball players who underwent UCL repair. Players were included if they underwent primary UCL repair with an internal brace. Players were excluded if they underwent revision UCL repair, UCL reconstruction, or were amateur baseball players. Results: Of the 11 pitchers that underwent UCL repair, MiLB pitchers returned to sport at an average of 17.5 months. MiLB pitchers had similar ERA, games played, innings pitched, and walks plus hits per inning pitched (WHIP) before and after surgery. Four MLB pitchers (80%) returned to sport at 9.55 months. MLB pitchers had fewer games played and innings pitched but similar ERA and WHIP in after versus before surgery. Pitch velocity and spin rates after surgery varied based on pitch type. The 7 positional players who underwent UCL repair showed no differences in batting or fielding performances before versus after surgery. Conclusions: UCL repair can successfully return both pitchers and positional players at both the MiLB and MLB level back to play at pre-injury levels. Repair can be considered as an option in the right type of injury for players hoping to maximize performance after surgery with minimal recovery time. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Background: Most healthcare providers utilize magnetic resonance imaging (MRI) to assist in diagnosing and treating osteochondritis dissecans (OCD) of the capitellum. However, consensus on imaging features that portend clinically relevant information in the care of these lesions has not been determined. Purpose: To conduct a survey on the MRI features of a capitellar OCD that are salient for clinical decision-making using a classic Delphi protocol. Study Design: A consensus statement. Methods: Invitations to participate were sent to 33 healthcare providers identified as capitellar OCD experts. A classic 3-round survey method was used to gather agreement and consensus on the level of importance for clinical decision-making on 33 MRI features. A concise list of features that guide decision-making on the stability of an OCD lesion and the ability of an OCD lesion to heal with nonoperative care was also identified. Agreement and consensus were determined a priori as ≥66%. Results: Of the 33 identified experts, 20 agreed to participate, and 17 (52%) completed all 3 rounds. Of the 33 MRI features evaluated, 17 reached agreement as important for clinical decision-making by the experts. Consensus was reached for a concise list of MRI features that were significant to decision-making (94%), suggestive of a stable lesion (100%), had the potential to heal with nonoperative treatment (94%), were suggestive of an unstable lesion (100%), and had low potential to heal with nonoperative treatment (88%). Conclusion: This 3-round Delphi process produced consensus on clinically relevant MRI features that contribute to clinical decision-making for capitellar OCD. The results of this study will be used as the basis for an interrater reliability assessment of the identified salient features, creating the foundation for developing a reliable MRI assessment tool rooted in clinical experiences. The development of a standardized assessment of capitellar OCD is intended to improve clinical practice and patient outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To compare bilateral standard glenohumeral range of motion, humeral torsion & humeral torsion-corrected glenohumeral range of motion within and between healthy adolescent baseball pitchers & adolescent baseball pitchers who have an injury to the throwing elbow. Secondarily, to analyze the relationship between humeral torsion angle and glenohumeral rotational motion in adolescent pitchers. Methods: Baseball pitchers aged 13-17 were prospectively enrolled into either a healthy group, if currently pitching in the community without complaint or injured group, if they presented to clinic for an elbow injury related to pitching. Bilateral standard glenohumeral internal & external rotation was measured in degrees using a bubble goniometer with the scapulothoracic joint manually stabilized. Bilateral humeral torsion angles were measured using an Ultrasound & bubble goniometer and were used to calculate humeral torsion-corrected glenohumeral range of motion. Parametric tests were used to compare values within and between groups for both the dominant and non-dominant extremities with significance defined as p<0.05. Pearson's correlation was used to evaluate the relationship between humeral torsion and standard glenohumeral motion in each group. Results: Twenty-nine healthy and twenty-five injured pitchers were enrolled with no difference in age or hand dominance between groups. The dominant shoulder of both the healthy (Table 2) and injured (Table 3) groups demonstrated a significant increase in humeral retrotorsion with increased standard glenohumeral external rotation & GIRD. However, no difference in humeral torsion-corrected range of motion was present within groups. Injured pitchers displayed less standard & humeral torsion-corrected external rotation of the dominant shoulder as well as less standard external rotation of the non-dominant shoulder compared to the healthy pitchers (Table 4). No difference in internal rotation measurements or humeral torsion was found between groups. A moderate correlation was found between ipsilateral humeral torsion angle and standard glenohumeral external (r=0.49) & internal rotation (r=-0.58) in the dominant shoulder of healthy pitchers (Figure 1) but no correlation (r< 0.3) was found between these measures in the dominant shoulder of injured pitchers. Conclusions: Both healthy & injured adolescent baseball pitchers displayed dominant shoulder GIRD, external rotation gain & retrotorsion of the humerus. In healthy pitchers, dominant glenohumeral motion was correlated to the humeral torsion angle suggesting that the osseous adaptation of humerus significantly contributed to these findings. However, this correlation was not found in the injured pitchers, suggesting that soft tissue factors played a larger role in the development of GIRD & external rotation gain in this group. Additionally, injured pitchers displayed less standard glenohumeral external rotation of both shoulders and less humeral torsion-corrected external rotation of the dominant shoulder compared to healthy pitchers. This suggests a baseline difference in the soft tissue and/or structure of the pitchers' shoulders between groups. Glenohumeral internal rotation and humeral retrotorsion were not associated with injury status in our study. Clinically, this study suggests that rehabilitation programs including modalities to improve external rotation may be of benefit for adolescent baseball pitchers with elbow injuries & further research on the structural variations of the adolescent pitching shoulder is needed. [ABSTRACT FROM AUTHOR]

Background: A primary challenge in the treatment of capitellar osteochondritis dissecans (OCD) is accurate imaging assessment. Radiographic classification consensus is not available in the current literature, and correlation of radiographs with lesion stability and resultant best treatment is lacking. Purpose: To determine the inter- and intrarater reliability of the presence or absence and common radiographic characteristics of capitellar OCD lesions. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: Anteroposterior, lateral, and oblique radiographs for 29 cases were reviewed by 7 orthopaedic surgeons. Images were assessed for elbow anthropometry and morphology, OCD presence, lesion characteristics, the presence of progeny bone and progeny features, and radial head abnormalities. Intra- and interrater reliability was assessed using Fleiss and Cohen kappa for nominal variables and intraclass correlation coefficients (ICCs) for continuous variables. Results: Surgeons demonstrated substantial to excellent inter- and intrarater reliability when assessing elbow characteristics: anthropometric (interrater ICC, 0.94-0.99; intrarater ICC, 0.82-0.96) and morphologic (Fleiss, 0.61-0.76; Cohen, 0.68). When the OCD lesion was assessed, fair to moderate interrater agreement was found for classifying the absence or presence of a lesion (Fleiss, 0.28-0.46) and the location of the OCD (Fleiss, 0.24-0.52), poor agreement for assessing the contour of the lesion (Fleiss, 0.00-0.09), and excellent agreement for measuring the size of the lesion (ICC, 0.82-0.94). Poor to fair interrater agreement was found for radial head abnormalities (Fleiss, 0.00-0.27). Progeny bone visualization and fragmentation demonstrated moderate interrater agreement (Fleiss, 0.43-0.47) where displacement of the bone demonstrated poor interrater agreement (Fleiss, 0.11-0.16). Intrarater agreement for OCD lesion characteristics, progeny bone visualization, and progeny bone features was moderate to excellent. Conclusion: Given only the fair to moderate agreement among raters for identifying OCD on radiographs, this imaging modality may not serve as a dependable screening tool in isolation. Additional imaging should be obtained if the clinical presentation suggests capitellar OCD and a definitive diagnosis is not possible with radiographs. However, clinicians can reliability measure the size of radiographically apparent OCD, suggesting that radiographs may serve as an appropriate imaging modality for follow-up care. [ABSTRACT FROM AUTHOR]

CAM-type femoroacetabular impingement continues to be an underrecognized cause of hip pain in elite athletes. Properties inherent to baseball such as throwing mechanics and hitting may enhance the risk of developing a cam deformity. Our goal is to gain an appreciation of the radiographic prevalence of cam deformities in elite baseball players. Prospective evaluation and radiographs of 80 elite baseball players were obtained during the 2016 preseason entrance examination. A sports medicine fellowship-trained orthopedic surgeon with experience treating hip disorders used standard radiographic measurements to assess for the radiographic presence of cam impingement. Radiographs with an alpha angle >55° on modified Dunn views were defined as cam positive. Of the 122 elite baseball players included in our analysis, 80 completed radiographic evaluation. Only 7.3% (9/122) of players reported hip pain and 1.6% (4/244) had a positive anterior impingement test. The prevalence of cam deformities in right and left hips were 54/80 (67.5%) and 40/80 (50.0%), respectively. The mean alpha angle for cam-positive right and left hips were 64.7 ± 6.9° and 64.9 ± 5.8°, respectively. Outfielders had the highest risk of right-sided cam morphology (Relative Risk (RR) = 1.6). Right hip cam deformities were significantly higher in right-handed pitchers compared with left-handed pitchers (P  = 0.02); however, there was no significant difference in left hip cam deformities between left- and right-handed pitchers (P  = 0.307). Our data suggest that elite baseball players have a significantly higher prevalence of radiographic cam impingement than the general population. [ABSTRACT FROM AUTHOR]

Background: Graft-tunnel mismatch is an avoidable complication in anterior cruciate ligament (ACL) reconstruction. Patient height and sex may be predictors of patellar tendon length (PTL) and intra-articular ACL length (IAL). Understanding these relationships may assist in reducing graft-tunnel mismatch during ACL reconstruction with bone–patellar tendon–bone (BTB) autograft. Purpose: To determine the association of patient height and sex with PTL and IAL. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Magnetic resonance imaging (MRI) studies were obtained on the healthy knees of 100 male and 100 female patients. Patients with prior surgery, open physes, significant degenerative changes, ACL rupture, or extensor mechanism injury were excluded. Three independent readers measured PTL, IAL, and Caton-Deschamps Index (CDI) on MRI. Bivariate and linear regression analysis was performed to detect the association of anthropometric data with anatomic parameters measured on MRI studies. Results: The mean age and body mass index were not significantly different between the male and female patients; however, male patients were significantly taller than female patients (1.75 vs 1.72 m, respectively; P <.001). There was a substantial agreement between the 3 readers for all parameters (κ > 0.75). Overall, female patients had significantly longer PTL (47.38 vs 43.92 mm), higher CDI (1.146 vs 1.071), and shorter IAL (33.05 vs 34.39 mm) (P <.001 for all). Results of the linear regression analysis demonstrated that both height and female sex were predictive of longer PTL. Further, height was independently predictive of IAL but sex was not. Conclusion: PTL was correlated more with patient sex than height. IAL was also correlated with patient sex. Longer BTB grafts are expected to be harvested in female patients compared with male patients of the same height despite shorter IAL. These associations should be considered during BTB ACL reconstruction to minimize graft-tunnel mismatch. [ABSTRACT FROM AUTHOR]

Background: An anatomic double-tunnel (DT) reconstruction technique has been widely adopted to reconstruct the ruptured coracoclavicular (CC) ligaments seen with high-grade acromioclavicular (AC) joint injuries. However, the anatomic DT reconstruction has been associated with the risk of clavicle fractures, which may be problematic, particularly for contact athletes. Purpose/Hypothesis: The purpose was to compare a single-tunnel (ST) CC ligament reconstruction for AC joint injuries with the native state as well as with the more established anatomic DT CC ligament reconstruction. The hypothesis was that ST CC ligament reconstruction would demonstrate biomechanical properties similar to those of the native state and the DT CC ligament reconstruction. Study Design: Controlled laboratory study. Methods: Eighteen fresh-frozen human cadaveric shoulders (9 matched pairs) with mean ± SD age of 55.5 ± 8.5 years underwent biomechanical testing. One specimen of each matched pair underwent a ST CC ligament reconstruction and the second, a DT CC ligament reconstruction. The ST and DT CC ligament reconstruction techniques involved a 5-mm distal clavicle excision, avoided coracoid drilling, and utilized a 3.0-mm suture anchor to fix the excess lateral limb to reconstruct the superior AC joint capsule. The ST CC ligament reconstruction technique additionally included a 1.3-mm suture tape to help avoid a sawing effect, as well as a dog-bone button over the clavicular tunnel to increase stability of the construct. All specimens were tested to 70 N in 3 directions (superior, anterior, and posterior) in the intact and reconstructed states. The ultimate load, yield load, stiffness, and mode of failure of the reconstructed specimens were tested. Results: There were no significant differences in translation at 70 N in the superior (P = .31), anterior (P = .56), and posterior (P = .35) directions between the ST CC ligament reconstruction and the intact state. The ultimate load to failure, yield load, and stiffness in the ST and DT groups were also not significantly different. There were no distal clavicle fractures in load-to-failure testing in the ST or DT group. Conclusion: In this biomechanical study, ST CC ligament reconstruction demonstrates biomechanical properties comparable to the intact state. Additionally, use of the ST CC ligament reconstruction shows biomechanical properties similar to the DT CC ligament reconstruction technique while theoretically posing less risk of clavicle fracture. Clinical Relevance: This study suggests that the ST CC ligament reconstruction has biomechanical properties equivalent to the DT CC ligament reconstruction with less theoretical risk of clavicle fracture. [ABSTRACT FROM AUTHOR]

Objectives: Abnormal patellar femoral morphology is a central risk factor for patellar instability. While this relationship has been well studied in the adult population, less is known about the relationship during skeletal development. Prior studies have demonstrated that the morphology of the knee changes as a child develops. We predict that a significant difference in the morphological development of children with instability compared to children without instability. Our objective is to compare the progression of morphological parameters in patients with patellar instability to patients without patellar instability. Methods: An IRB approved retrospective chart review was performed measuring TT-TG, trochlear depth, and patellar height (Caton Deschamps Index) in skeletally immature patients between the ages of 5 and 16 who underwent an MRI of their knee. Patients with patellar instability were MRI age matched in a 1 to 2 ratio to patients without patellar instability. Exclusion criteria included osteoarthritis, prior knee surgery, and unreadable MRIs. Morphological measurements were then compared between the two group. Statistical analysis was performed using paired sample t-tests with p< 0.05 considered significant. Morphological measurements were then plotted overtime at each age group to determine changes in morphology as a patient develops. Results: A total of 180 patients were included in our analysis. Sixty patients with patellar instability were compared to 120 patients without patellar instability. There was a significant difference in all measurements between the patients with patellar instability and patients without (TT-TG 10.50mm versus 15.72mm, p<0.01; trochlear depth 5.55 mm versus 3.77mm, p<0.01; Caton Deschamps Index 1.07 versus 1.19, p<0.01). TT-TG for patients with prior instability was greater at all ages when compared patients without patellar instability. As patients aged, trochlear depth increased in patients without patellar instability, while it remained relatively stable in patients with patellar instability. Caton Deschamps Index was greater in patients with patellar instability compared to patients without patellar instability at most ages, however they were mostly within normal limit (0.6-1.3). Conclusions: Our data demonstrates that trochlear depth continues to increase in skeletally immature patients without patellar instability as they aged, while patients with patellar instability remained relatively stable. Future studies can be aimed at determining if intervening at a younger age and reducing the patella in these unstable patients can result in increased trochlear depth as they develop. [ABSTRACT FROM AUTHOR]

Introduction: The frequency of anterior cruciate ligament (ACL) injuries is increasing in pediatric and adolescent patients. Currently, there is no standardized skeletal maturity determination for pediatric and adolescent patients that present with an ACL tear. Hypothesis/Purpose: This study aims to evaluate physicians' preferences for obtaining bone age studies for pediatric and adolescent patients with an ACL injury. Methods: A survey link was sent to the members of Pediatric Research in Sports Medicine (PRiSM). Participation in the survey was voluntary. Consent was obtained by the participants taking part in the survey. Results: Forty-five physician responses were included in this analysis. Seven were female, thirty-six male, and one preferred not to answer. Twenty physicians had completed a pediatric orthopaedic fellowship, six had completed a sports medicine fellowship, and nineteen had completed both. Thirty-five respondents reported that greater than 75% of their patients were 18 years old or younger. When asked about the number of ACL reconstructions performed each year on skeletally immature patients, 15.6% (n=7) report less than 5, 11.1% (n=5) said 5-9, 44.4% (n=20) said 10-34, 20.0% (n=9) report 35-49, and 8.9% (n=4) said they perform 50 or more. A majority of the participants (n=32) said that they routinely obtain a skeletal age study. Of the participants that routinely order a skeletal age study, 100% (n=32) get a bone age for patients 11 and 12 years old. Seventeen (n=17) obtain a bone age study for patients 8-14 years of age. When asked about bone age determination method, 100% (n=45) said one method they use is hand bone age and twenty-four (n=24) only use hand bone age. Thirty-four (n=34) report they sometimes see a significant difference (2 or more years) between bone age radiographs and chronological age while eleven (n=11) report they almost never see a significant difference. Thirty-one report that a patient's skeletal age sometimes changes their technique or graft preference. Conclusion: Results of this survey suggest that bone age studies are used to treat pediatric and adolescent patients with ACL injuries. Hand bone age, in particular the Greulich-Pyle method, is the most widely used among the respondents. Obtaining bone age radiographs can help physicians to formulate a proper treatment plan for their patients. Further research is needed to identify the true impact of bone age studies on the treatment of ACL injuries in pediatric and adolescent patients. Table 1: Preferences for Obtaining Bone Age Studies for Pediatric and Adolescent Patients with ACL Injuries [ABSTRACT FROM AUTHOR]

Introduction: The frequency of anterior cruciate ligament (ACL) injuries is increasing in pediatric and adolescent patients. Most surgeons elect to reconstruct the ACL in young, active patients to facilitate the resumption of sports and restore stability to the knee. Surgical technique and graft type preferences depend on the surgeon and skeletal maturity of the patient, but there is no clear standard based on age. Hypothesis/Purpose: This study aims to evaluate physicians' preferences for choosing a surgical plan for pediatric and adolescent patients with an ACL injury. Methods: A voluntary survey link was sent to members of Pediatric Research in Sports Medicine (PRiSM). Consent was obtained by the participants taking part in the survey. Results: Forty-five (n=45) physician responses were included in this analysis. Seven were female, thirty-six male, and one preferred not to answer. Twenty completed pediatric orthopaedic fellowships, six completed sports medicine fellowships, and nineteen completed both pediatric orthopaedic and sports medicine fellowships. Thirty-five respondents reported that greater than 75% of their patients were 18 years old or younger. The majority prefer the over the top technique for 8 to 10-year-old males over the all epiphyseal, partial transphyseal, and transphyseal techniques. The technique preference is split for 11, 12, and 13-year-old males. Twenty-five respondents prefer the partial transphyseal technique for 14-year-old male patients. A majority (n=42, n=43) prefer the transphyseal technique for 16 year old males and skeletally mature males. The technique preferences for female patients 9 years or less is the over the top technique. The technique preference is split for 10, 11, 12, and 13-year-old females. The majority (n=37, n=44, n=44) prefer the transphyseal technique for 14-year-old, 16-year-old, and skeletally mature female patients. The graft preference for males 11 years old or younger is the iliotibial band (ITB). The graft preference for males 12-year-old and older was split among the hamstring, ITB, bone-tendon-bone (BTB) and quadriceps grafts. When looking at the preferred graft for female patients, a majority prefer ITB for patients 10-years-old and younger. The participants' graft preferences for female patients 11-years-old and older is split. Conclusion: Results of this survey suggest that graft type and surgical technique preferences for pediatric and adolescent patients with ACL tears change based on the patient's age, with more agreement among surgeons at the extremes of patient ages. Further research is needed to track the impact of each surgical technique and graft choice on pediatric and adolescent patients. Table 1. Surgical Technique and Graft Preferences for Pediatric and Adolescent Patients with ACL Injuries [ABSTRACT FROM AUTHOR]

Achilles tendon pathology is common and affects athletes and nonathletes alike. The cause is multifactorial and controversial, involving biological, anatomical, and mechanical factors. A variety of conditions characterized by Achilles tendon inflammation and/or degeneration can be clinically and histologically differentiated. These include insertional Achilles tendinopathy, retrocalcaneal bursitis, Achilles paratenonitis, Achilles tendinosis, and Achilles paratenonitis with tendinosis. The mainstay of treatment for all of these diagnoses is nonoperative. There is a large body of evidence addressing treatment of acute and chronic Achilles tendon ruptures; however, controversy remains. [ABSTRACT FROM AUTHOR]

Achilles tendon pathology is common and affects athletes and nonathletes alike. The cause is multifactorial and controversial, involving biological, anatomical, and mechanical factors. A variety of conditions characterized by Achilles tendon inflammation and/or degeneration can be clinically and histologically differentiated. These include insertional Achilles tendinopathy, retrocalcaneal bursitis, Achilles paratenonitis, Achilles tendinosis, and Achilles paratenonitis with tendinosis. The mainstay of treatment for all of these diagnoses is nonoperative. There is a large body of evidence addressing treatment of acute and chronic Achilles tendon ruptures; however, controversy remains. [ABSTRACT FROM AUTHOR]

ABSTRACT The purpose of this study was to determine if a horizontal cleavage lesion (HCL) of the posterior horn of the medial meniscus would result in changes to tibiofemoral contact mechanics, as measured by peak contact pressure and contact area, which can lead to cartilage degeneration. To study this, 10 cadaveric knees were tested in a rig where forces were applied (500 N Compression, 100 N shear, 2.5 Nm Torque) and the knee dynamically flexed from −5° to 135°, as peak contact pressure and contact area were recorded. After testing of the intact knee, a horizontal cleavage lesion was created arthroscopically and testing repeated. The Wilcoxon signed-rank test was used to determine if there were differences in peak contact pressure and contact area between the intact knee and that with the HCL. A statistically significant increase in peak contact pressure of 13%, on average, and a decrease in contact area of 6%, on average, was noted following the HCL. This suggests that a horizontal cleavage lesion will result in small but statistically significant changes in tibiofemoral contact mechanics which may lead to cartilage degeneration. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:584-590, 2015. [ABSTRACT FROM AUTHOR]

Varus or valgus malalignment of the lower extremity can alter the load distribution across the knee and hasten the development of focal osteoarthritis. Although knee arthroplasty remains an effective option for end-stage arthritis, it is not typically recommended in the young, active patient. In the setting of painful unicompartmental cartilage injury in a mechanically malaligned limb, alignment correction by osteotomy has been shown to slow the progression of osteoarthritis and lessen pain. In this review, we will discuss the different options, indications, and techniques for osteotomies about the knee. [ABSTRACT FROM AUTHOR]

The article discusses a case study of a 51-year-old man who was presented with right hip pain and femoroacetabular impingement (FAI) symptoms. Mentioned are results of the magnetic resonance imaging (MRI) depicting a right acetabular labral tear. Tackled is the calcium hydroxyapatite deposition of the man's hip.

Background: Defining the epidemiology of adverse events after THA will aid in the development of strategies to enhance perioperative care.Questions/purposes: We identified (1) risk factors for adverse events in Medicare beneficiaries while hospitalized after THA and (2) trends in the rates of adverse events.Patients and Methods: Data were abstracted from medical records of 1809 Medicare beneficiaries who underwent THA from 2002 to 2007. We used the hierarchical generalized linear modeling approach to assess the odds of change in adverse events over time, the association of adverse events with outcomes, and the relationship of adverse events with patient characteristics by modeling the log-odds of adverse events as a function of demographic and clinical variables adjusted for year variable.Results: The overall rate of adverse events was 5.8%; the 30-day mortality rate was 1.00%. Increased age, obesity, and year of procedure were risk factors for experiencing any adverse event. Annual rates of adverse events from 2002 to 2007 were 9.1%, 8.2%, 4.9%, 4.1%, 3.5%, and 3.0%, respectively. Experiencing any adverse event was associated with an increased length of stay and an increased chance of readmission but not with an increased chance of mortality. The annual rate of all adverse events decreased from 2002-2004 to 2005-2007 (odds ratio = 0.83; 95% confidence interval, 0.74-0.92).Conclusions: Older and obese patients should be counseled regarding their increased risk for the development of adverse events after THA. The cause of the decline in the rate of adverse events between two time periods is unclear and warrants further investigation to confirm and identify the cause. [ABSTRACT FROM AUTHOR]

Background: Defining the epidemiology of adverse events after THA will aid in the development of strategies to enhance perioperative care. Questions/purposes: We identified (1) risk factors for adverse events in Medicare beneficiaries while hospitalized after THA and (2) trends in the rates of adverse events. Patients and Methods: Data were abstracted from medical records of 1809 Medicare beneficiaries who underwent THA from 2002 to 2007. We used the hierarchical generalized linear modeling approach to assess the odds of change in adverse events over time, the association of adverse events with outcomes, and the relationship of adverse events with patient characteristics by modeling the log-odds of adverse events as a function of demographic and clinical variables adjusted for year variable. Results: The overall rate of adverse events was 5.8%; the 30-day mortality rate was 1.00%. Increased age, obesity, and year of procedure were risk factors for experiencing any adverse event. Annual rates of adverse events from 2002 to 2007 were 9.1%, 8.2%, 4.9%, 4.1%, 3.5%, and 3.0%, respectively. Experiencing any adverse event was associated with an increased length of stay and an increased chance of readmission but not with an increased chance of mortality. The annual rate of all adverse events decreased from 2002-2004 to 2005-2007 (odds ratio = 0.83; 95% confidence interval, 0.74-0.92). Conclusions: Older and obese patients should be counseled regarding their increased risk for the development of adverse events after THA. The cause of the decline in the rate of adverse events between two time periods is unclear and warrants further investigation to confirm and identify the cause. [ABSTRACT FROM AUTHOR]

The radial head plays a critical role in the stability of the elbow joint and its range of motion. Injuries may occur across a spectrum of severity, ranging from low energy non-displaced fractures to high energy comminuted fractures. Multiple classification systems exist to help characterize radial head fractures and their associated injuries, as well as to guide treatment strategies. Depending on the type of fracture, non-operative management may be possible if early range of motion is initiated. Other options include open reduction and internal fixation or excision followed by arthroplasty. A lateral approach is typically used for adequate surgical exposure. Controversy still remains regarding operative management of more severe fractures, but studies have shown good outcomes after radial head replacement for these fractures. We will review the current treatments available for radial head fractures, highlighting gaps in knowledge, as well as providing recommendations for the care of these injuries.Level of evidence: Level V. [ABSTRACT FROM AUTHOR]