Faculty Bibliography

This study compares the results of arthroscopic and arthroscopically assisted mini-open rotator cuff repair in a series of 84 patients who underwent repair of small, medium, or large tears between March 1997 and September 2001 with at least 2 years of follow-up. There were 42 arthroscopic repairs and 42 mini-open repairs. Of the patients, 81 (96.4%) had good or excellent UCLA (University of California, Los Angeles) scores (40 arthroscopic repairs [95.2%] and 41 mini-open repairs [97.6%]); there were 2 fair results and 1 poor outcome. The ASES (American Shoulder and Elbow Surgeons) scores averaged 91.1 for the arthroscopic group and 90.2 for the mini-open group (P > .05). Six patients required further surgery (three from the arthroscopic group and three from the mini-open group). Of 84 patients, 83 (98.8%) reported being satisfied with the procedure. At greater than 2 years of follow-up, arthroscopic and mini-open rotator cuff repairs produced similar results for small, medium, and large rotator cuff tears with equivalent patient satisfaction rates

In a prospective, consecutive study conducted at a university teaching hospital, we evaluated the effects of Parkinson's disease (PD) on hip fracture outcomes. We followed 920 community-dwelling patients, aged 65 or older, who sustained a hip fracture that was operatively treated between July 1, 1987, and June 30, 1998. Presence or absence of PD had no bearing on type of surgery performed. Examined outcomes were postoperative complication rates; in-hospital mortality; length of hospital stay; discharge status (to home or to a skilled nursing facility); and mortality rate, place of residence, recovery of prefracture ambulatory ability, and return to prefracture activities of daily living (ADLs) 1 year after surgery Thirty-one patients (3.4%) had a history of PD before hip fracture. Patients with PD were more likely to be male, to live with another person, to have less ambulatory ability, and to be dependent in ADLs before hip fracture. Compared with patients without PD, they were hospitalized significantly longer and were more likely to be discharged to a skilled nursing facility. In addition, they declined more in level of independence in basic ADLs but not as much in instrumental ADLs at 1-year follow-up. Rates of postoperative complications, recovery of ambulatory ability within 1 year, and mortality within 1 year did not differ. These findings may guide orthopedic surgeons in counseling patients with PD and a hip fracture

The effect of glenohumeral arthritis and subsequent total shoulder arthroplasty (TSA) on shoulder proprioception has not been evaluated previously. A prospective analysis of 20 consecutive patients with unilateral advanced glenohumeral arthritis who underwent TSA was undertaken. Shoulder proprioception testing for passive position sense and detection of motion was performed 1 week before surgery and 6 months after TSA. The presence of glenohumeral arthritis had a significant effect on position sense for all 3 planes tested (flexion, abduction, and external rotation). There were significant differences (P < .05) compared with the uninvolved shoulder and with a group of 20 age- and gender-matched subjects without a history of shoulder problems. Six months after TSA, position sense was significantly improved (P < .05) and was not significantly different from that in the contralateral shoulder or the comparison group. Detection of motion was also significantly worse in the arthritic group compared with that in the uninvolved contralateral side (P < .05). Six months after TSA, the sensitivity to detection of motion improved (P < .01) and was not significantly different than that in the uninvolved contralateral shoulder. In addition, the postoperative values for the involved shoulder were not significantly different than those in the age- and gender-matched comparison group. This study demonstrates a significant decrease in proprioceptive function in patients with advanced glenohumeral arthritis. After TSA, there was a marked improvement in proprioception

The diagnosis and treatment of osseous deficiencies associated with anterior shoulder instability have been a challenge to physicians for centuries. Whereas historical goals centered on the stable reduction and prevention of recurrent dislocation, current standards of success are predicated on the restoration of motion and strength and the return to functional activities, including competitive athletics. Reestablishment of anterior shoulder stability thus requires the recognition of osseous defects of the humeral head and glenoid, as well as a thorough understanding of the available treatment options in the context of a disciplined treatment algorithm. Although many surgical procedures have been described for the management of osseous deficiencies in association with anterior shoulder instability, in the authors' experience, such procedures are seldom necessary. The purpose of this summary is to review treatment options as well as indications and techniques to address these bony deficiencies

We describe temporal and regional variation in hip fracture rates for people aged 65 or older in New York state (NYS) from 1985 to 1996. Our descriptive study was of all hip fracture cases admitted to NYS hospitals during that period. Case data were obtained from the Statewide Planning and Research Cooperative System (SPARCS) of the NYS Department of Health. US Census Bureau population estimates were obtained for each year from 1985 to 1996 to compute the annual hip fracture rate for each NYS county. These rates were adjusted for differences in age, gender, and race and were compared using logistic regression. Approximately 14,000 hip fractures occurred annually from 1985 to 1996. The annual rate (number of hip fractures per 1000 population) decreased from 6.4 in 1985 to 5.3 in 1996. White women aged 85 or older had the highest rate (26/1000); nonwhite men aged 65 to 69 had the lowest rate (<1/1000). Statewide annual rates decreased slightly over time, but this change was not reflected in all age, gender, and race subgroups. There was important, consistent variation in county rates after adjustment for age, gender, and race. Other researchers have identified geographic variation in national rates, but the postulated environmental and weather-related factors (eg, water fluoridation use; rainfall and sunshine amounts) have explained only a small proportion of this variation. Identification of risk factors that can better explain regional rate variation may lead to development of intervention strategies that could significantly reduce the risk for hip fracture among people 65 or older

BACKGROUND: The impact of strict enforcement of Section 405 of the New York State Public Health Code to restrict resident work to eighty hours per week and the adoption of a similar policy by the Accreditation Council on Graduate Medical Education in 2002 for orthopaedic residency training have not been evaluated. Adoption of these rules has created accreditation as well as staffing problems and has generated controversy in the surgical training community. The purposes of this study were (1) to evaluate the attitudes of orthopaedic residents and attending surgeons toward the Code 405 work-hour regulations and the effect of those regulations on the perceived quality of residency training, quality of life, and patient care and (2) to quantify the effect of the work-hour restrictions on the actual number of hours worked. METHODS: We administered a thirty-four-question Likert-style questionnaire to forty-eight orthopaedic surgery residents (postgraduate years [PGY]-2 through 5) and a similar twenty-nine-question Likert-style questionnaire to thirty-nine orthopaedic attending surgeons. All questionnaires were collected anonymously and analyzed. Additionally, resident work hours before and after strict enforcement of the Code 405 regulations were obtained from resident time sheets. RESULTS: The average weekly work hours decreased from 89.25 to 74.25 hours for PGY-2 residents and from 86.5 to 73.25 hours for PGY-3 residents, and they increased from 61.5 to 68.5 hours for PGY-4 residents. Residents at all levels felt that they had increased time available for reading. There was general agreement between attending and resident surgeons that their operating experience had been negatively impacted. Senior residents thought that their education had been negatively affected, while junior residents thought that their operating experience in general had been negatively affected. Senior residents and attending surgeons felt that continuity of care had been negatively impacted. All agreed that quality of life for the residents had improved and that residents were more rested. CONCLUSIONS: On the basis of the survey data, the implementation of the new work-hour restrictions was found to result in a decrease in the number of hours worked per week for PGY-2 and PGY-3 residents and in an increase in work hours for PGY-4 residents. This could explain the definite difference between the attitudes expressed by the senior residents and those of the junior residents. Senior residents felt that their education was negatively impacted by the work rules, while junior residents expressed a more neutral view. However, senior residents did not believe that their operative experience was as negatively impacted as did junior residents. Although junior and senior residents and attending surgeons agreed that resident quality of life had improved, we were not able to determine whether this offset the perceived negative impact on education, continuity of care, and operative experience

This study examined the effect of weather and seasonality on hipfracture incidence in older adults residing in New York City. A total off 66,346 patients aged > or = 65 years who sustained a fracture of the femoralneck or intertrochanteric region from 1985 to 1996 comprised the study population. Hip fractures were more likely to occur in the winter than in any of the other seasons (P<.001). Factors significantly correlated with hip fractureincluded minimum daily temperature (r=.167, P<.001), daily wind speed (r=.166, P<.001), maximum daily temperature (r=.155, P<.001), minutes of sunshine (r=.067, P<.01), and average relative humidity (r=.033, P=.03). A greater number of hip fractures occurred in colder months, withambient temperature rather than any adverse circumstances related to rainor snowfall associated most closely to injury. As most fractures occurredindoors, precipitation is less likely to play a part in hip fracture occurrence in this population

Hip fractures have been among the most studied injury patterns in adults. The number of hip fractures is increasing exponentially, and their treatment costs place great economic strain on society. Recently developed hip fracture treatments, emphasizing cost containment, deformity prevention, and evidence-based medicine, are attempts to optimize patient outcomes. In this article, we outline some of these developments with respect to femoral neck and intertrochanteric fractures