Faculty Bibliography

A case of an isolated popliteus tendon rupture occurring during sport in a skeletally immature athlete is presented. Treatment is not always clearly defined, as both nonoperative and operative have been successful. Because the outcome of rest from sports activity and failed trials of physical therapy allowed continued discomfort in the posterolateral aspect of the knee in this patient, repeat imaging and arthroscopy were performed. Part of the popliteus tendon was demonstrated to have ossified and was openly debrided. The remaining tendon was repaired to the lateral capsule. The patient went on to a full recovery and return to sport.

Twenty uninjured male volunteers were studied to characterize normal elbow proprioception and to investigate the effect of applying an elastic bandage to the extremity and injection of an intraarticular anesthetic. A modified Biodex dynamometer was used to study position sense and detection of motion. In part 1 of the study position sense was tested by flexing the elbow to a predetermined angle, returning to the starting position, and then asking the subject to identify that angle. In part 2 detection of motion was tested by asking the subject to disengage the apparatus by pressing a stop button when movement was detected. The testing conditions in part 1 and part 2 were repeated after the elbow was wrapped with an elastic bandage and again after an intraarticular injection of 3 cc 1% lidocaine with the bandage removed. Ten additional subjects underwent testing of both elbows to examine the effect of arm dominance. Mean position sense was within 3.3 degrees+/-1.3 degrees of the actual angle in trials without an elastic bandage or an anesthetic. A significant improvement in position sense was observed (2.2 degrees+/-1.2 degrees) after an elastic bandage was applied (P < .004). No significant difference was seen in position sense after lidocaine was injected. The mean threshold for detection of motion in trials without an elastic bandage or an anesthetic was 4.21 degrees+/-1.56 degrees. No significant differences were seen in detection of motion observed with the elastic bandage or intraarticular anesthetic. No significant differences were seen between dominant and nondominant extremities for both position sense and detection of motion. The application of an elastic bandage improved position sense, suggesting that tactile cues from cutaneous or other extraarticular receptors may play a role in elbow proprioception. Intraarticular anesthesia, however, had little effect, suggesting that intracapsular receptors play a lesser role in elbow proprioception. The determination of proprioceptive qualities for the normal elbow can aid in the understanding of elbow function and provide a basis for defining its role in elbow dysfunction

OBJECTIVE: To present a consecutive series of older patients with pubic rami fractures and evaluate their long term functional outcome. STUDY DESIGN: Retrospective. METHODS: Sixty-three consecutive community-dwelling, ambulatory patients who sustained a public rami fracture and were treated at one hospital were reviewed. Fifty-two of sixty-three patients (83%) had radiographic evidence of pubic rami fracture at initial presentation; in the remaining eleven patients, the diagnosis of pubic rami fracture was made after additional imaging studies. Sixty patients (95%) required hospitalization for pain control and progressive mobilization. RESULTS: The hospital length of stay for the sixty admitted patients averaged fourteen days; patients who had three or more associated medical comorbidities or required use of a cane or walker for ambulation prior to fracture were more likely to have been hospitalized greater than two weeks. Thirty-eight patients were available for one year minimum follow-up; thirty-five of thirty-eight patients (92%) were living at home, 84% had no or mild complaints of hip/groin pain, 92% had returned to their prefracture ambulatory status, and 95% had returned to their performance function in activities of daily living. CONCLUSIONS: 1) Elderly patients with pubic rami fractures utilize substantial healthcare resources based upon length of stay and need for home care services; and 2) those patients who survive have a good prognosis with regard to long term pain relief and functional outcome

STUDY DESIGN: A prospective study was performed. OBJECTIVES: The goals of the study were to determine the incidence of deep vein thrombosis after major adult spinal surgery and the optimal mode of prophylaxis in this surgical population. SUMMARY OF BACKGROUND DATA: Few studies have evaluated deep vein thrombosis incidence and prophylaxis after major adult spinal surgery. Incidence rates have ranged from 0.9-14%. METHODS: Three hundred twenty-nine patients were evaluated. One hundred ten patients were randomized to 3 different deep vein thrombosis prophylaxis groups. These patients had duplex doppler scans between the fifth and seventh postoperative days. The remaining 219 patients formed a nonrandomized group and received either thrombosis embolic deterrent stockings alone or thrombosis embolic deterrent stockings and pneumatic compression boots for deep vein thrombosis prophylaxis. The type of deep vein thrombosis prophylaxis in this group was based on surgeon preference. All 329 patients were followed for clinical signs and symptoms of thromboembolic disease. Patients were followed clinically for a minimum of 1 year. RESULTS: All 110 prophylaxis study group patients were clinically asymptomatic and 109 duplex scans were normal. One scan was indeterminate and a follow-up venogram was negative. Two patients in the coumadin group (5.7%) experienced excessive blood loss. One of the 219 patients from the nonrandomized group developed a clinically detectable proximal deep vein thrombosis which was confirmed by duplex ultra-sonography. The overall clinical incidence of deep vein thrombosis was 0.3% (1 in 329 patients). CONCLUSIONS: This low 0.3% rate is in agreement with recent studies that focus on thromboembolic disease. Given the low incidence, routine screening for asymptomatic thrombi appears unwarranted. In addition, mechanical prophylaxis with graduated compression stockings and pneumatic compression boots is preferable to anticoagulation therapy.