Faculty Bibliography

BACKGROUND: Despite the effectiveness of a two-stage exchange protocol for the treatment of deep periprosthetic infection, infection can persist after resection arthroplasty and treatment with antibiotics, leading to a failed second-stage reconstruction. Intraoperative analysis of frozen sections has been shown to have a high sensitivity and specificity for the identification of infection at the time of revision arthroplasty; however, the usefulness of this test at the time of reoperation after resection arthroplasty and treatment with antibiotics is, to our knowledge, unknown. METHODS: The medical records of sixty-four consecutive patients who had had a resection arthroplasty of either the knee (thirty-three patients) or the hip (thirty-one patients) and had had intraoperative analysis of frozen sections of periprosthetic tissue obtained at the time of a second-stage operation were reviewed. The mean interval between the resection arthroplasty and the attempted reimplantation was nineteen weeks. The results of the intraoperative analysis of the frozen sections were compared with those of analysis of permanent histological sections of the same tissues and with those of intraoperative cultures of specimens obtained from within the joint. The findings of the analyses of the frozen sections and the permanent histological sections were considered to be consistent with acute inflammation and infection if a mean of ten polymorphonuclear leukocytes or more per high-power field (forty times magnification) were seen in the five most cellular areas. RESULTS: The intraoperative frozen sections of the specimens from two patients (one of whom was considered to have a persistent infection) met the criteria for acute inflammation. Four patients were considered to have a persistent infection on the basis of positive intraoperative cultures or permanent histological sections. Overall, intraoperative analysis of frozen sections at the time of reimplantation after resection arthroplasty had a sensitivity of 25 percent (detection of one of four persistent infections), a specificity of 98 percent, a positive predictive value of 50 percent (one of two), a negative predictive value of 95 percent, and an accuracy of 94 percent. CONCLUSIONS: A negative finding on intraoperative analysis of frozen sections has a high predictive value with regard to ruling out the presence of infection; however, the sensitivity of the test for the detection of persistent infection is poor

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

Although most fractures of the proximal femur result from a fall and are related to direct loads to the hip, there is evidence that intrinsic factors, such as muscle contraction, can result in a hip fracture and subsequent fall. This paper reviews the current literature on the various mechanisms of femoral neck and intertrochanteric fractures

The purpose of this study was to investigate the effect of age, dominance, joint position, and lidocaine injection on proprioception of the normal shoulder. Position sense and the detection of passive shoulder motion were investigated in 40 young (20 to 30 years) and old (50 to 70 years) subjects. An additional 20 young subjects were tested before and after a glenohumeral (n = 10) or a subacromial (n = 10) lidocaine injection was performed. A significant decline occurred in proprioception between the young and old age groups. No difference was observed between dominant and nondominant sides. Position sense was consistently less accurate in the maximum range of motion tested when compared with the lesser ranges tested for flexion and abduction. No differences were identified in the ability to detect motion in flexion, abduction, and external rotation in the younger group, whereas in the older group a difference was observed in flexion. No learning effect was detected for any test trial. No significant changes occurred in proprioceptive ability after either glenohumeral or subacromial lidocaine injection was performed

Twenty-one elbow dislocations with an associated radial head fracture were treated with immediate joint reduction, stabilization, and early range-of-motion exercises. In all cases initial treatment involved closed reduction of the ulnohumeral joint. For those cases involving minimally displaced and a few moderately displaced radial head fractures, treatment consisted of benign neglect (4 of 21). Of the more severely displaced fractures (17 of 21), 9 were treated with open-reduction internal fixation and 8 with immediate silicone head replacement. Despite radial head treatment, 6 of these cases remained unstable, prompting primary repair of collateral ligaments; 3 eventually required application of a hinged fixator as a salvage option. Results confirmed that initial radial head displacement predicts functional outcome. Our study demonstrates that fracture dislocations of the elbow demand a broad consideration of treatment options and that reconstruction of elbow stability requires either primary repair of collateral ligaments or the possible use of a hinged fixator device

The American Shoulder and Elbow Surgeons have adopted a standardized form for assessment of the elbow. This form was developed by the Research Committee of the American Shoulder and Elbow Surgeons and subsequently adopted by the membership. The patient self-evaluation section contains visual analog scales for pain and a series of questions relating to function of the extremity. The responses to the questions are scored on a 4-point ordinal scale. The physician assessment section has 4 parts: motion, stability, strength, and physical findings. It is hoped that adoption of this method of data collection will stimulate multicenter studies and improve communication between professionals who assess and treat patients with elbow disorders

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