Faculty Bibliography

Salter-Harris type III fractures of the proximal humerus are rare injuries. We report a Salter-Harris type III anterior fracture-dislocation of the proximal humerus in a 10-year-old boy that was open reduced and internally stabilized. A bone scan performed during the initial hospitalization and at 2-year follow-up revealed devascularization and subsequent revascularization of the humeral head. At 2-year follow-up, the patient had full motion of the shoulder, no pain, and arm strength equal to that of the contralateral side. Four cases of Salter-Harris type III fractures of the proximal humerus have been previously reported; good early clinical outcomes were obtained in all. Despite devascularization of the epiphyseal fragment, excellent clinical outcomes may result

The strength of active flexion/extension and supination/pronation was measured isokinetically in 60 right-hand-dominant nonathletic men. They were equally divided into a younger group (20 to 30 years) and an older group (50 to 60 years) with moderate occupational and spare-time activity levels. Peak torque, work, power, and the angle of peak torque production were measured bilaterally at a slow (90 degrees/sec) and a fast (180 degrees/sec) speed of movement. Although highly significant differences were found between the young and older groups in flexion and extension, no age-related differences were found in supination and pronation. The dominant side had significantly higher levels of peak torque, work, and power in flexion; however, no significant differences were detected in peak torque for extension, supination, and pronation. Isokinetic peak torque and work were greater at the slower speed as opposed to power, which was significantly greater at the faster speed with the exception of pronation movement. With regard to the angle where peak torque was achieved, significant differences were detected between groups, which suggests that age appears to affect where in the range of motion peak torque is produced

OBJECTIVE: To determine whether allogeneic red blood cell transfusion is a predictor for developing an in-hospital postoperative urinary tract, respiratory, or wound infection. STUDY DESIGN: Prospective, consecutive. METHODS: Six hundred eighty-seven community-dwelling, ambulatory, geriatric hip fracture patients were prospectively followed; all patients had operative fracture treatment and received perioperative antibiotics. RESULTS: Sixty-eight patients had a culture-positive infection before operative treatment. One hundred thirty-four of the remaining 619 patients (21.6%) developed a postoperative infection, primarily a urinary tract infection. The infection rate was 26.8% in transfused patients compared with 14.9% in nontransfused patients (p = 0.001). When stratifying by the type of infection, only the risk of urinary tract infection was statistically significant (p = 0.001). After controlling for the effect of patient age, sex, number of preinjury medical comorbidities, American Society of Anesthesiologists (ASA) rating of operative risk, fracture type, surgical delay, type of surgery, type of anesthesia, operative time, and blood loss, the relationship between allogeneic red blood cell transfusion and postoperative urinal tract infection remained statistically significant. CONCLUSIONS: Geriatric hip fracture patients who receive allogeneic red blood cell transfusions are at higher risk for developing a postoperative urinary tract infection than are those patients who are not transfused

One hundred ten acromial anatomic specimens were classified by three shoulder surgeons with the classification system described by Bigliani et al. to determine the interobserver reliability. These results demonstrated a fair to poor level of interobserver reliability. Given this relatively low level of agreement, the diagnosis of impingement and rotator cuff tears should be based on clinical findings supplemented, when indicated, by rotatory cuff imaging with less diagnostic reliance placed on the assessment of acromial morphology

OBJECTIVE: To determine the one year mortality following hip fracture in an ambulatory, community dwelling, cognitively intact elderly population and to examine the role of specific type, number, and severity of associated medical comorbidities. DESIGN: Prospective, consecutive. METHODS: Six hundred twelve elderly who sustained a non-pathologic hip fracture were followed. RESULTS: Twenty-four patients (4%) died during hospitalization; seventy-eight (12.7%) died within one year of fracture. The factors that were predictive of mortality, based on multivariate analysis, were patient age > 85 years, preinjury dependency in basic activities of daily living, a history of malignancy other than skin cancer, American Society of Anesthesiologists rating of operative risk 3 or 4, and the development of one or more in-hospital postoperative complications; all factors other than the development of an in-hospital complication were independent of treatment. CONCLUSION: These results indicate that efforts at reducing one year mortality after hip fracture should be directed at the prevention of postoperative complications

One hundred and four patients who had a minimally displaced fracture of the proximal part of the humerus (a so-called one-part fracture) were managed with a standardized therapy regimen and followed for more than one year. The clinical outcome was assessed on the basis of pain, function, and the range of motion of the shoulder. The duration of follow-up averaged forty-one months (range, twelve to 117 months). All fractures united without additional displacement. Eighty patients (77 per cent) had a good or excellent result, fourteen (13 per cent) had a fair result, and ten (10 per cent) had a poor result. Ninety four patients (90 per cent) had either no or mild pain in the shoulder, eight (8 per cent) had moderate pain, and two (2 per cent) had severe pain. Functional recovery averaged 94 per cent; forty-eight patients (46 per cent) had 100 per cent functional recovery. At the time of the most recent follow-up, forward elevation of the injured shoulder averaged 89 per cent; external rotation, 87 per cent; and internal rotation, 88 per cent that of the uninjured shoulder. The percentage of good and excellent results was significantly greater (p < 0.01) and external rotation was significantly better (p < 0.01) at the time of the latest follow-up for the patients who had started supervised physical therapy less than fourteen days after the injury than for the patients who had started such therapy at fourteen days or later