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Purpose Implant loosening represents one of the major factors of total hip arthroplasty (THA) failure. The purpose of this study was to identify specific markers indicative of septic and aseptic loosening in patients that underwent THA. Methods Flow cytometry was performed in blood samples of 20 patients with loosening (10 septic/10 aseptic). Additional ten healthy individuals served as a control group. The expression of surface receptors and cytoplasmic molecules in patients that underwent THA was quantified. CD62L, CD18, CD11a, CD11b and CD11c expressions were evaluated and correlated with the presence of loosening. Also, a comparison between septic and aseptic THA loosening characteristics was performed. Results The mean fluorescence intensity (MFI) for CD18 was significantly decreased on all leukocytes subsets in both septic and aseptic loosening compared to control group (p\0.005 in all occasions). Patients with aseptic loosening showed increased MFI for CD11b in granulocytes and for CD11c in monocytes and granulocytes compared to the control and aseptic group (p = 0.02 and p = 0.005, respectively). In patients with septic loosening, an increase in MFI for CD11c was observed in monocytes only compared to control group (p = 0.03). The comparison between aseptic and septic loosening showed significantly lower CD18 MFI value in granulocytes for aseptic loosening (p = 0.008). Conclusions CD11 and CD18 MFI values appear to be indicative of loosening in THAs. Flow cytometry markers can be used to identify THA loosening, as well as to differentiate between septic and aseptic cases.

Purpose: This study compared endoscopic carpal tunnel release with the conventional open technique with respect to short- and long-term improvements in functional and clinical outcomes. Methods: We assessed 72 outpatients diagnosed with carpal tunnel syndrome. Of these patients, 37 underwent the endoscopic method according to Chow and 35 were assigned to the open method. Improvement in symptoms, severity, and functionality were evaluated at 2 days, 1 week, 2 weeks, and 1 year postoperatively. Changes in clinical outcomes were evaluated at 1 year postoperatively. Complications were also assessed. Results: Both groups showed similar improvement in all but 1 outcome 1 year after the release; increase in grip strength was significantly higher in the endoscopic group. However, the endoscopic method showed a greater improvement in symptoms and functional status compared with the open method at 2 days, 1 week, and 2 weeks postoperatively. Separate analysis of the questions referring to pain showed that the delay in improvement in the open group was because of the persistence of pain for a longer period. Paresthesias and numbness decrease immediately after the operation with comparable rates for both groups. Conclusions: Endoscopic carpal tunnel release provides a faster recovery to operated patients for the first 2 weeks, with faster relief of pain and faster improvement in functional abilities. Paresthesia and numbness subside in an identical manner with the 2 techniques. At 1 year postoperatively, both open and endoscopic techniques seem to be equivalently efficient. Level of Evidence: Level II, prospective comparative study.

Although acute vascular injury is a common complication in children with severely displaced supracondylar humeral fractures, the management of patients with a pink pulseless hand still remains controversial. Between 1994 and 2006, 66 children with displaced supracondylar fractures of the humerus were treated. Five patients had an absence of the radial pulse with an otherwise well perfused hand. In one patient, radial pulse returned after closed reduction of the fracture. In four patients, open reduction and vascular exploration was required. Three patients had brachial artery occlusion because of thrombus formation. Thrombectomy was performed, which led to the restoration of a palpable radial pulse. In one patient with open fracture, brachial artery contusion and spasm were found, and treated by removal of adventitia. Surgical exploration for the restoration of brachial artery patency should be performed, even in the presence of viable pink hand after an attempt at closed reduction.

Background:The posterior cruciate ligament (PCL) index quantifies the curvature of the PCL seen on magnetic resonance imaging (MRI) that is caused by a change in tibiofemoral alignment in the anterior cruciate ligament (ACL)–deficient knee. It has been proposed that the PCL index may be useful in assessing the success of ACL reconstruction (ACLR).Hypothesis/Purpose:The purpose of this study was to test if the PCL index is predictive of in vivo rotational kinematics and joint laxity measures in knees of patients after single-bundle ACLR. The hypothesis was that the PCL index is predictive of rotational knee kinematics and objective laxity scores.Study Design:Controlled laboratory study.Methods:At a mean of 18.1 months postoperatively, the PCL index was defined on MRI in 16 patients prospectively followed up after anatomic single-bundle ACLR and in 16 matched controls. The patients were evaluated with 3-dimensional motion analysis during (1) descending and pivoting as well as (2) landing and pivoting tasks. The side-to-side difference in tibial rotation range of motion between the reconstructed knee and the contralateral intact knee was calculated. The side-to-side difference in anterior tibial translation was measured with a KT-1000 arthrometer. Linear regression models were used with the PCL index as a predictor of the side-to-side difference in tibial rotation for each task and the side-to-side difference in anterior tibial translation.Results:The PCL index of the reconstructed knees was significantly lower compared with that of the control knees ( P < .001). The index was predictive of the side-to-side difference in tibial rotation during both tasks ( R2= 0.472 and 0.477, P = .003), with a lower index being indicative of increased rotational laxity. It was not predictive of anterior tibial translation (at 134 N: R2= 0.13, P = .17; at maximum force: R2= 0.009, P = .726).Conclusion:The PCL index after anatomic single-bundle ACLR using a bone–patellar tendon–bone graft is predictive of rotational kinematics during in vivo dynamic pivoting activities. The results show that the PCL index is correlated with the postoperative ability to control rotational kinematics of the knee joint.Clinical Relevance:This study provides evidence regarding the interplay between restoration of the native ACL’s anatomy and the PCL’s appearance and suggests that the effective restoration of tibiofemoral alignment after ACLR that is reflected in the PCL index translates into better functional outcomes as measured by tibial rotation during pivoting activities.

Purpose To compare the effectiveness of buddy strapping and aluminum orthosis for treatment of proximal interphalangeal (PIP) joint hyperextension injuries. We also evaluated the effect of age on the outcome by comparing our results in adults and children. Methods One hundred twenty-one consecutive patients with a PIP joint hyperextension injury of the index, middle, ring, or little finger and without fracture were evaluated. Patients were randomly assigned into 2 groups. In the first group, treatment included buddy strapping of the injured finger to its neighbor noninjured finger for a week. In the second group, immobilization was secured with an aluminum extension blocking orthosis for a week in 15° flexion. Assessment of motion, edema, pain, and strength were performed weekly for the first month and then at 3, 6, and 12 months after injury. Results The patients treated with buddy strapping exhibited similar outcomes compared with those treated with aluminum orthoses. In patients with full recovery, buddy strapping allowed earlier recovery of motion and resolution of edema and pain compared with aluminum orthosis immobilization. Furthermore, PIP injuries appear to have better outcomes in children than in adults. Conclusions Buddy strapping is easy and effective treatment for PIP joint hyperextension injuries. Type of study/level of evidence Therapeutic I.

We compared 2 different protocols of early mobilization with a protocol of delayed mobilization in patients with simple radial head fractures (B2.1 type of Orthopaedic Trauma Association Classification). An attempt to correlate certain characteristics of the radial head fractures with outcome was made.Prospective randomized comparative study.Level 1 trauma center.One hundred eighty consecutive patients were randomly allocated into 3 different protocols.In the first group, immediate mobilization of the elbow joint was applied. In the second, a sling was used for 2 days and then active mobilization was introduced. The third protocol represented the control group where immobilization in a cast for 7 days before the mobilization was applied.Broberg and Morrey score, The American Shoulder and Elbow Surgeons-Elbow score, visual analogue scale, and grip and pinch strength were evaluated.The 2 protocols introducing early mobilization resulted in better outcome compared with immobilization. The first protocol resulted in worse pain in the first 3 days. Range of motion, strength, and functional outcome was better in patients allocated to the second protocol. These differences were more evident in displaced fractures. A fragment displacement of more than 4 mm and an angulation of more than 30 degrees proved to impair outcome.Early mobilization of simple radial head fractures seemed to be a safe and an effective treatment option. It seems that a delay of 48 hours before early mobilization could be advantageous. Individualization of treatment in accordance to the characteristics of fracture could be a decisive factor for outcome.Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Hypothesis The optimal surgical treatment for cubital tunnel syndrome remains unclear. We aim to evaluate the long-term outcome of surgical treatment by comparing the results of the different methods proposed. Materials and methods We retrospectively reviewed 113 patients in whom 3 different surgical methods were used for cubital tunnel syndrome treatment. In situ decompression, partial epicondylectomy, and anterior subcutaneous transposition were performed from 1997 to 2007. Results Results were graded as excellent in 51 patients (45%), good in 34 (30%), fair in 8 (7%), and poor in 20 (18%). When we compared the results among the different surgical procedures, good and excellent results were achieved in 26 of 31 patients (84%) treated with in situ decompression, 36 of 45 (80%) treated with release and partial medial epicondylectomy, and 23 of 37 (62%) treated with release and anterior subcutaneous transposition of the nerve. Conclusions Our results indicate that in situ decompression and partial epicondylectomy both represent efficient and safe methods for cubital tunnel syndrome management. In patients in whom anterior subcutaneous transposition was performed, although they had a significant improvement of their clinical signs and symptoms, they had an inferior outcome when compared with patients treated with the other 2 methods.