Faculty Bibliography

The effects of the anterior and posterior sternoclavicular joint (SCJ) soft tissue structures on joint dislocation strength by sequential sectioning the ligaments and capsule of twenty-eight SCJs were evaluated. The medial clavicle of each specimen was initially loaded in the anterior and posterior directions to provide control values for joint laxity. The anterior or posterior ligaments and capsular structures of the SCJs were then selectively cut and the specimens retested for laxity and then loaded to failure simulating either anterior or posterior dislocation. Testing of intact specimens showed that the posterior ligaments were stiffer than other structures in that it was significantly more difficult to posteriorly displace the SCJ than in any other direction and that the capsule was the important anterior structure affecting joint laxity. Load-to-failure testing showed that it required 50% more force to create a failure by posterior dislocation than by anterior dislocation. The results of this study explain the clinical rarity of posterior sternoclavicular joint dislocations

Recent studies have suggested that patients with a history of diabetes undergoing hip fracture stabilization have higher rates of morbidity and mortality as well as poorer functional results than control groups of non-diabetics. This study was performed to evaluate the effect of diabetes on patient outcome after hip fracture. Between July 1987 and December 1996, 849 community dwelling elderly who sustained an operatively treated hip fracture were prospectively followed to determine the effect of diabetes on patient outcome. The predictor variable was the presence or absence of diabetes mellitus. Ninety-three patients (11%) had a history of diabetes. Diabetic patients were more dependent in activities of daily living and ambulation prior to hip fracture. The presence of diabetes mellitus also increased the likelihood of a patient dying during hospitalization, but had no effect on recovery of ambulatory ability or activities of daily living. Although diabetic patients have increased in-hospital mortality when compared to non-diabetic patients, patients with diabetes are just as likely to recover pre-fracture functional status as non-diabetic patients

Variations in the shape and orientation of the anterior acromion have been implicated as predisposing factors for the development of rotator cuff problems. We determined and analyzed by computer digitization the anterior and posterior acromial slopes for 141 cadaver shoulders (whose rotator cuff status had been previously assessed). No significant differences in either the anterior or posterior angle were found between the intact and rotator cuff tear groups. Frequency histograms of both angles demonstrated continuous, normal distributions. The individual acromions were consistently asymmetric in that the anterior slope was larger than the posterior slope. However, the anterior slope distribution did not reveal groupings indicative of the specific acromial types previously reported. These results suggest that acromial classification into flat, curved, and hooked types does not accurately describe the actual anatomical findings

The incidence of hip fracture worldwide varies significantly from region to region. Numerous factors such as age, sex, race, site of residence, medical comorbidities, osseous anatomy, nutrition, smoking, and climate can affect the risk of hip fracture. Although no consensus exists for the role of all of these variables in hip fracture incidence, analysis of theses factors may result in a better understanding of hip fracture etiology and development of preventive measures

BACKGROUND: There have been conflicting reports regarding the effect of the size of a tear of the rotator cuff on the ultimate functional outcome after repair of the rotator cuff. While some authors have reported that the size of the tear does not adversely affect the overall result of repair, others have reported that the outcome is less predictable after repair of a large tear than after repair of a small tear. The purpose of the present study was to examine the long-term functional outcome and the recovery of strength in thirty consecutive patients who had had repair of a large or massive tear of the rotator cuff. METHODS: Thirty consecutive patients who had operative repair of a large or massive chronic tear of the rotator cuff had a comprehensive isokinetic assessment of the strength of the shoulder preoperatively, twelve months postoperatively, and a mean of sixty-five months (range, forty-six to ninety-three months) postoperatively. The functional outcome was assessed with the University of California at Los Angeles shoulder score. RESULTS: All patients reported that they were satisfied with the result and had increased strength compared with preoperatively. There was a significant decrease in pain (p < 0.01) and significant improvements in function (p < 0.01) and the range of motion (p < 0.01). The mean University of California at Los Angeles shoulder score increased significantly from 12.3 points preoperatively to 31.0 points at the most recent follow-up examination (p < 0.01). The mean peak torque in flexion, abduction, and external rotation increased significantly to 80 percent (p < 0.01), 73 percent (p < 0.01), and 91 percent (p < 0.01), respectively, of that of the uninvolved shoulder by the time of the most recent follow-up examination. CONCLUSIONS: Repair of a large or massive tear of the rotator cuff can have a satisfactory long-term outcome. The results of the present study suggest that more than one year is needed for complete restoration of strength. The strength of the affected shoulders still did not equal that of the unaffected, contralateral shoulders by the time of the long-term follow-up

Hip fractures, a significant cause of morbidity and mortality in the elderly, are expected to exponentially increase in frequency over the next 50 years as a result of increased life expectancy and population growth. The economic impact of the cost of hip fractures may be enormous. The overall cost of hip fractures includes not only death and illness, but also the costs of medical and custodial care, functional limitations, reduced quality of life, loss of independence, and inability to work, as well as other factors that are difficult to assess--most notably, the indirect effect of the hip fracture on the spouse or family members responsible for care. This review will evaluate the cost of geriatric hip fractures in the hopes of defining the enormous socioeconomic burden of such fractures