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Introduction: Ballistic fractures of the humerus secondary to gunshot wounds are increasingly common injuries that pose challenges for orthopedic surgeons. The primary purpose of this study was to examine the rates of neurovascular injury, compartment syndrome, and infection of ballistic humerus fractures relative to blunt, non-penetrating fractures. Methods: A consecutive cohort of 135 patients with ballistic humerus fractures and 167 patients with blunt humerus fractures treated at a level 1 trauma center were identified. A review of patient medical records and radiographic studies was performed to obtain demographic information, injury mechanism, fracture location, choice of treatment, and complications. Statistical analysis was performed using independent sample t -tests, chi-square tests, and odds ratios (p < 0.05 significance). Results: Compared with blunt fractures, patients in the ballistic fracture cohort were younger, male, African American, test positive for illicit drug use, and sustain proximal fractures. Ballistic fractures had significantly lower Injury Severity Scores and New Injury Severity Scores. Ballistic fractures were three times as likely to present with neurovascular injury than blunt fractures (OR: 2.927, p < 0.001). The overall rate of spontaneous recovery of significant motor function for ballistic fractures with neurologic injury was 55%. There were no statistically significant differences in rates of vascular injury, compartment syndrome, infection, non-union, or the need for soft tissue reconstruction. Conclusion: Compared with blunt humeral fractures, ballistic fractures appear to have a significantly higher rate of neurologic injury but no increased risk for compartment syndrome or infection. Surgical treatment of ballistic humeral injuries was not associated with increased neurological recovery compared to non-operatively managed fractures. [ABSTRACT FROM AUTHOR]

The stressors that National Football League (NFL) athletes face are well-described and documented with regard to multisystem afflictions and injury prevalence. However, the majority of literature discusses the short-term effects rather than long-term outcomes of playing professional football. The purpose of this study was to characterize the long-term musculoskeletal issues in the retired NFL population. Publications from CENTRAL, Scopus, Medline, PubMed, Embase, and Google Scholar were searched from database inception to February 2021. A total of 9 cohort studies evaluating lower extremity arthritis in retired NFL athletes were included for review. Two reviewers extracted data from the individual studies, including demographic information (age, body mass index, length of career, position), injury descriptions (location of injury, number of injuries, diagnoses), and procedure (total knee and or hip arthroplasty) frequency. Arthritis in retired NFL players was more than twice as prevalent than the general United States male population (95% CI: 2.1–2.3). Ankle osteoarthritis was directly correlated with the number of foot and ankle injuries. Players <50 years of age had a 16.1 and 13.8 times higher risk of undergoing TKA and THA, respectively, when compared to the general population. In older age groups, this trend held with retired NFL players being at least 4.3 and 4.6 times more likely than members of the general population to undergo TKA and THA, respectively. This review demonstrates that the effects of NFL-related lower extremity injuries extend beyond the players' careers and present a higher risk for early-onset osteoarthritis and overall frequency of undergoing total knee and hip arthroplasty. [ABSTRACT FROM AUTHOR]

Background: Tibial eminence fractures are bony avulsions of the anterior cruciate ligament from its insertion on the intercondylar eminence. Numerous anatomic factors have been associated with anterior cruciate ligament injuries, such as posterior tibial slope, but there are few studies evaluating the association with tibial eminence fracture. Purpose: To compare posterior tibial slope of pediatric patients with and without tibial eminence fractures. We hypothesized that a steeper posterior tibial slope would be associated with tibial eminence fracture. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent surgical treatment of tibial eminence fracture were retrospectively identified between January 2000 and July 2021. Adults aged >20 years and those without adequate imaging were excluded. Controls without gross ligamentous or osseous pathology were identified. Descriptive information and Meyers and McKeever classification were recorded. Posterior tibial slope measurements were obtained by 2 independent orthopaedic surgeons twice, with measurements separated by 3 weeks. Chi-square tests and independent-samples t tests were used to compare posterior tibial slope and patient characteristics. Inter- and intrareviewer variability was determined via the intraclass correlation coefficient. Results: A total of 51 patients with tibial eminence fractures and 57 controls were included. By sex, tibial eminence fractures occurred among 34 male and 17 female patients with a mean age of 10.9 years. The posterior tibial slope among those with tibial eminence fractures (9.7°) was not significantly greater than that of controls (8.8°; P =.07). Male patients with a tibial eminence fracture had significantly steeper slopes compared with controls (10.0° vs 8.4°; P =.006); this difference was not observed between female patients and female controls. Patients with a slope ≥1 SD above the mean (12.0°) had 3.8 times greater odds (95% CI, 1.3-11.6; P =.017) of having a tibial eminence fracture. Male patients with a posterior tibial slope >12° had 5.8 times greater odds (95% CI, 1.1-29.1; P =.034) of having a tibial eminence fracture compared with male controls. Conclusion: Male patients undergoing surgical fixation of a tibial eminence fracture had an increased posterior tibial slope as compared with case-controls. Increased posterior tibial slope may be a risk factor for sustaining a tibial eminence fracture, although the clinical significance of this deserves further investigation. [ABSTRACT FROM AUTHOR]

Ventriculomegaly (expansion of the brain's fluid-filled ventricles), a condition commonly found in the aging brain, results in areas of gliosis where the ependymal cells are replaced with dense astrocytic patches. Loss of ependymal cells would compromise trans-ependymal bulk flow mechanisms required for clearance of proteins and metabolites from the brain parenchyma. However, little is known about the interplay between age-related ventricle expansion, the decline in ependymal integrity, altered periventricular fluid homeostasis, abnormal protein accumulation and cognitive impairment. In collaboration with the Baltimore Longitudinal Study of Aging (BLSA) and Alzheimer's Disease Neuroimaging Initiative (ADNI), we analyzed longitudinal structural magnetic resonance imaging (MRI) and subject-matched fluid-attenuated inversion recovery (FLAIR) MRI and periventricular biospecimens to map spatiotemporally the progression of ventricle expansion and associated periventricular edema and loss of transependymal exchange functions in healthy aging individuals and those with varying degrees of cognitive impairment. We found that the trajectory of ventricle expansion and periventricular edema progression correlated with degree of cognitive impairment in both speed and severity, and confirmed that areas of expansion showed ventricle surface gliosis accompanied by edema and periventricular accumulation of protein aggregates, suggesting impaired clearance mechanisms in these regions. These findings reveal pathophysiological outcomes associated with normal brain aging and cognitive impairment, and indicate that a multifactorial analysis is best suited to predict and monitor cognitive decline. [ABSTRACT FROM AUTHOR]

We just had inchopped to the Fifth Fleet area of operations on Sept. 11, one year after the terrorist attacks against our country. It was our fifth day of flying [...]

Background: Considerable evidence supports corticosteroid injection as an effective treatment for trigger finger. One common side effect, the flare reaction, is a well-documented phenomenon of increased pain following steroid injections. Its incidence and intensity may be related to steroid composition. The purpose of this study was to determine whether betamethasone and methylprednisolone injections for trigger fingers have differing intensity of pain or incidence flare reaction., Methods: Patients with symptomatic trigger finger were recruited during their hand surgery visits. Patients were randomized into 2 treatment groups: betamethasone (40 mg) and methylprednisolone (6 mg) mixed with lidocaine 1%. Treatment group assignment was blinded to the patients and investigators. Visual analog scale pain measurements were taken prior to injection, 5 minutes postinjection, and daily thereafter for 7 days., Results: Sixty-four patients were randomized into the 2 treatment groups. Patients in the betamethasone group reported slightly higher baseline pain compared with the methylprednisolone group, but lower pain on day 1. None of the following days showed a statistically significant difference., Conclusions: The incidence of flare and severe flare reactions of betamethasone injections for trigger finger management was roughly double that of methylprednisolone, but this difference was not statistically significant. Further studies are required to evaluate the relative course of nonflare postinjection pain for different corticosteroid injections for trigger finger injections., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.