Campbell Foundation

Abstract Background: Tibial plateau fractures are traumatic injuries with severities ranging from nondisplaced to complicated fractures. This study describes the epidemiological characteristics of patients with tibial plateau fractures treated in five trauma clinics.Methods: This retrospective, cross-sectional study included 1,165 patients with tibial plateau fractures treated between December 2015 and May 2017. Subjects were selected from the medical records of five institutions based on the inclusion and exclusion criteria. Age, sex, laterality, fracture type, trauma mechanism, vehicle type, classification, and associated injuries were assessed via univariate and bivariate analyses. Results: In total, 23.3% of patients with tibial fractures treated during the study period had tibial plateau fractures. Of those affected, 73% were men and 50% were younger than 40 years. Furthermore, 95.7% of fractures were caused by traffic accidents, 82.6% of which involved motorcycles. Fractures were closed in 93.1% of cases, and 78% of subjects had associated injuries. The most common fractures, according to Schatzker classification, were type VI (23%) and V (19.1%) fractures.Conclusions: Tibial plateau fractures are frequent injuries in our setting and mostly occur in men in their 30s and 40s. These fractures are typically caused by motorcycle traffic accidents. Level of Evidence: IV

Migration of total knee arthroplasty (TKA) procedures from the inpatient setting to outpatient venues, especially freestanding ambulatory surgery centers (ASCs), requires the use of reliable patient selection algorithms and standardized perioperative pathways to facilitate favorable outcomes for patients. This retrospective chart review included consecutive TKA procedures performed over a 5-year period between January 2014 and January 2019 at 2 freestanding ASCs. The patient selection algorithm was developed on the basis of patient comorbidities to minimize the potential for adverse events. All procedures were performed by one of eight orthopedic surgeons who were identified a priori as adhering to similar multimodal pain management regimens, including the use of spinal anesthesia, general or monitored-care anesthesia, adductor canal blocks, pericapsular injection of liposomal bupivacaine, nonsteroidal anti-inflammatory drugs, gabapentin, tramadol, acetaminophen, and oxycodone on an as-needed basis. Outcomes, including surgical complications, healthcare resource utilization (HCRU), and patient satisfaction, were measured before discharge and at a 90-day follow-up visit. Four hundred thirty-nine TKA procedures in 386 patients were identified for inclusion. Of these patients, 115 (29.8%) were performed in patients with the American Society of Anesthesiologists physical status IIIa. Mean (standard deviation) length of stay at the ASC was 500 (107) minutes, including 136 (47) minutes of surgery and 201 (78) minutes to ambulation. The overall rates of surgical complications and 90-day hospital admissions were low (1.4% and 0.7%, respectively), as was the need for additional HCRU, including additional surgical procedures related to index surgery, emergency department visits, and unplanned clinic visits or calls. At the 90-day follow-up visit, 96% of patients reported being pleased with their outcomes. With careful patient selection, standardized perioperative pathways, and multimodal analgesia protocols, TKA procedures can be performed in the ASC setting with low complication rates, minimal postdischarge HCRU, and high rates of patient satisfaction. III.

University of Tennessee/Campbell Foundation, Memphis, TN The author receives royalties from Wolters Kluwer and Elsevier. Financial Disclosure: The author reports no conflicts of interest. Correspondence to Andrew H. Crenshaw, Jr., MD, Editor-in-Chief, University of Tennessee/Campbell Foundation, Memphis, TN, Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN 38104 Tel: +901 759 3277; Fax: +901 759 3278; e-mail. [email protected]

Recurrent dislocation of the elbow is extremely rare in children. Surgical correction must be aimed at the specific pathology present in each case. Transfer of the biceps tendon and a central slip of the triceps were successful in an 8-year-old boy who had sustained six dislocations in 2 years.

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The effect of prolonged daily electrical stimulation (ES) on quadriceps strength in 22 patients during the 6 weeks following anterior cruciate reconstruction was investigated. Patients were randomly assigned to receive either a combination of ES and exercise or exercise alone. Isometric quadriceps strength was measured at the 7th, 8th, and 9th postoperative weeks. No significant difference in strength existed between the groups as a result of ES. A significant difference in strength did exist between competitive and recreational athletes regardless of treatment. Further research is needed to determine if the addition of ES to isometric exercise during immobilization can significantly retard strength loss after anterior cruciate reconstructive surgery.

A method of repair following rupture of the distal tendon of the biceps brachii is described. This method has two advantages. First, it restores the tendon to its anatomical insertion and the biceps to its function as a supinator as well as a flexor of the forearm. Second, the use of two approaches obviates the difficulties and dangers of exposing the radial tuberosity through the anterior approach.

Fifty arthroplasties of the hip in forty-three patients with use of the Crawford Adams cup are reported. See Images in the PDF file. In general, the results have been satisfactory. Severe pain, the primary indication for operation, was relieved in forty-five of the fifty hips. The majority of excellent results occurred in hips with arthritis secondary to trauma. Necrosis of the head beneath the cup, recognized as a possibility at the beginning of this series, materialized in three patients. One of these represents the only case of infection in the series, and this was probably present at the time of arthroplasty. Two cups broke because of mechanical faults. The method of manufacture has been changed so that the cup is now constructed of one piece of metal.