Faculty Bibliography

The extreme range of motion at the shoulder, the high angular velocities and torques, and the repetitious nature of the pitching motion combine to make the shoulder vulnerable to injury during the baseball pitch. An understanding of the biomechanics that contribute to shoulder injuries during each phase of the pitching motion can facilitate the athlete's diagnosis, treatment, and rehabilitation. Common injuries that occur during the late cocking and acceleration phases of the pitch include anterior instability and impingement, bicipital tendinitis, and subacromial impingement. Nonoperative treatment consisting of an initial period of rest and NSAIDS, followed by physical therapy and a gradual return to activity, is usually successful. When this approach fails, surgical intervention, either arthroscopic or open, may be necessary. Physical therapy and rehabilitation are directed toward restoring the integrity and strength of the dynamic and static stabilizers of the shoulder joint, yet preserving the range of motion necessary for performance. Through rehabilitation, the dedicated athlete can often return to the pitching mound at his previous level of performance

The lack of literature on residency selection criteria used by orthopaedic program directors has left medical students in the position of relying on rumor and anecdotal information as to what program directors value most highly when sorting through large candidate pools. The purpose of this study was to compare the perspectives on resident selection criteria solicited from orthopaedic program directors and residency applicants. A power analysis was done to determine adequate sample size. A 26-item questionnaire was mailed to 98 residency applicants who interviewed at our program and 156 orthopaedic program directors. The program directors were also asked to elaborate on those factors that were most important in their selection process. A two-tailed Student's t-test was employed to compare the two groups. Significance was set at p < 0.05. Statistically significant differences between applicant and program director ratings were found in 12 of the 26 questionnaire items. Applicants (n = 91) ranked the following criteria as most important: a letter of recommendation from an orthopaedic surgeon (8.6 on a scale of 1 to 10, 10 being most important), USMLE I score (7.7), and rank in medical school (7.6). The most important criteria for the directors (n = 109) were: the applicant performed a rotation at the director's program (7.9), USMLE I score (7.8), and rank in medical school (7.8). This study provides the most comprehensive empirical data to date as to the factors which orthopaedic program directors consider most important during the residency selection process. To our knowledge, this is the first study in the orthopaedic literature that compares the program directors 'and residency applicants' views on resident selection criteria. Significant differences were found between applicant and program director views on resident selection criteria

A retrospective study was performed to compare nonoperative and operative treatments of Type II distal clavicle fractures. From a total of 30 diagnosed patients, 16 were identified as receiving nonoperative treatment and 14 open reduction and coracoclavicular stabilization. The average follow-up was 53.5 months for the nonoperative group and 59.8 months for the operative group. All patients were evaluated postoperatively for pain, range of motion, function, and fracture healing as well as for isokinetic strength. Fractures treated surgically achieved union within six to ten weeks. Nonoperative treatment resulted in seven nonunions. There were no significant differences between the two groups in the mean UCLA, Constant, and ASES scores. Nonunion had no significant effect on functional outcome or strength. This study suggests that Type II distal clavicle fractures can be successfully managed nonoperatively. The high incidence of nonunion does not impede a clinical outcome comparable to that achieved by surgical treatment

The indications for glenohumeral arthroplasty are severe pain and restricted range of motion associated with radiographic evidence of advanced glenohumeral arthritis. Nonsurgical management consisting of rest, physical therapy, and antiinflammatory medication should be tried before considering surgical management. It is important that each patient be evaluated on the basis of the clinical disease and radiographic characteristics of the underlying diagnosis. Preoperative considerations should include a careful assessment of bone quality and quantity and associated deformity. Evaluation of the soft tissues, particularly the rotator cuff and deltoid muscles, is essential because the success of total shoulder arthroplasty depends greatly on the integrity of these structures. Associated upper and lower extremity degenerative arthritis should be evaluated and carefully considered, particularly with respect to the timing of surgical management. Careful consideration of these factors is invaluable in obtaining successful outcomes of total shoulder arthroplasty

Background. More than 20 studies have investigated the relation between meat and dairy consumption and breast cancer risk with conflicting results. Our objective was evaluate the risk of assess whether non-dietary risk factors modify the relation. studies from North America and Western Europe with at least 200 intakes, and a validation study of dietary assessment instrument. diagnosed with invasive breast cancer during to 15 year of intakes of total meat, red me white meat, total dairy fluids, or total dairy solids and breast cancer risk. Categor analyses suggested a J-shaped association for egg consumption where, comp to women who did not eat eggs, breast cancer risk was slightly decreased am women who consumed <2 eggs per week but slightly increased among women who consumed >=1 egg per day. Conclusions. We produ and risk of breast cancer. An inconsistent relation between egg consumption risk of breast cancer merits further investigation

The midterm results of primary posterior cruciate ligament-retaining, minimally conforming, cemented modular total knee arthroplasties using the Genesis I prosthesis in 110 knees in 72 patients were reviewed. Patients were evaluated at a mean follow-up of 7.3 years by Knee Society pain and functional scores, radiographic and survivorship analysis, and Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) health status questionnaire. Range of motion increased from an average of 96.3 degrees to 112.5 degrees. Knee Society pain and functional scores increased from preoperative averages of 55 and 44 to 92 and 88, respectively. There were 91 excellent, 16 good, 1 fair, and 2 poor results. WOMAC scores were increased significantly in each subcategory examined (pain, stiffness, and physical function). Kaplan-Meier survivorship was 97% at 10 years. An increase in loosening as a result of eccentric stress concentration secondary to the nonconforming design of this prosthesis, theoretically a matter of some clinical concern, was not shown in this investigation

The reliability of combined indium-111 leukocyte/technetium-99m sulfur colloid scans, with and without the addition of blood pooling and blood flow studies, in the diagnosis of infected total joint arthroplasty was investigated. Both scans were performed on 58 patients before reoperation of total hip or knee arthroplasty in the period 1996-1999. Results for imaging alone included 100% specificity, 46% sensitivity, 100% positive predictive value, 84% negative predictive value, and 88% accuracy. Inclusion of blood pooling and flow phase data improved results to 66% sensitivity, 89% negative predictive value, and 90% accuracy, with reductions in specificity (98%) and positive predictive value (91%). Routine use of these radionuclide scans is not supported by these data