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Background: Many procedures have been proposed for the correction of anterior shoulder instability. Some of these procedures address the problem anatomically, such as the Bankart procedure, and some prevent instability nonanatomically, such as the Bristow-Latarjet procedure. A modified Bristow procedure was the procedure of choice for anterior shoulder instability among midshipmen at the United States Naval Academy from 1975 to 1979., Hypothesis: The modified Bristow procedure for anterior shoulder instability provides good shoulder function and stability in the long term., Study Design: Case series; Level of evidence, 4., Methods: There were 52 shoulders in 49 patients reviewed at a mean follow-up of 26.4 years. The Rowe score, Single Assessment Numeric Evaluation, and Western Ontario Shoulder Instability Index were used to assess outcomes., Results: The mean Rowe score was 81.8 (range, 5-100), and the mean Single Assessment Numeric Evaluation score was 82.9 (range, 30-100), with an overall Single Assessment Numeric Evaluation of 71.2% (37 of 52 shoulders) rated as good and excellent. The mean Western Ontario Shoulder Instability Index was 376 of 2100 (range, 0-1560). Overall, recurrent instability occurred in 8 of 52 shoulders (15.4%), with recurrent dislocation in 5 shoulders (9.6%) and recurrent subluxation in 3 shoulders (5.8%). The mean time to recurrent dislocation was 7.0 years., Conclusion: This study represents the longest follow-up in the literature of the modified Bristow procedure. The authors have shown nearly 70% good and excellent results and recurrent instability comparable with other long-term follow-up studies of open instability procedures.

This study sought to ascertain the differences between what is found on an orthopedic preoperative examination of a glass injury to the hand and the actual intraoperative deficiencies noted in the operating room. The cases of 34 patients who presented to our institution for a shattered glass laceration to the hand, forearm, or wrist between 1998 and 2001 were reviewed. The preoperative examination significantly underestimated the amount of damage to tendons, arteries and nerves. The most frequent injury pattern was the flexor digitorum superficialis (34/103 = 33%), the radial artery (7/18 = 39%), and the superficial branch of the radial nerve (7/32 = 22%). A glass injury to the hand can be a deceivingly debilitating and significant injury. The preoperative examination, even when specifically evaluating for deficiencies, significantly underestimates the extent of damage. If glass is implicated as a causative agent, careful orthopedic evaluation and surgical management should be considered even in light of a normal preoperative examination.

Background: Posterior shoulder instability is a relatively rare condition and a surgical challenge. Arthroscopic techniques have allowed for a potential improvement as well as diagnosis and management of this condition., Purpose: To evaluate the outcomes of arthroscopic posterior shoulder stabilization and to evaluate preoperative and intraoperative variables as predictors of success., Study Design: Case series; Level of evidence, 4., Methods: Thirty-three consecutive patients with a mean age of 25 years (range, 19-34 years) who underwent posterior arthroscopic shoulder stabilization with suture anchors (mean, 3 anchors) or suture capsulolabral plication (mean, 5.3 stitches) or both were reviewed at a mean follow-up of 39.1 months (range, 22-60 months). Shoulder outcomes rating scores were determined using the American Shoulder and Elbow Surgeons Rating Scale, the Western Ontario Shoulder Instability Index, the Subjective Patient Shoulder Evaluation, and the Single Assessment Numeric Evaluation., Results: There were 7 failures: 4 for recurrent instability and 3 for symptoms of pain. Overall, outcomes scores demonstrated mean values of the American Shoulder and Elbow Surgeons Rating Scale of 94.6, Subjective Patient Shoulder Evaluation of 20.0, Western Ontario Shoulder Instability Index of 389.4 (81.5% of normal), and Single Assessment Numeric Evaluation of 87.5. Patients with voluntary instability demonstrated worse outcomes (P = .025), and those with prior surgery of the shoulder also did worse (P = .02)., Conclusion: Arthroscopic treatment of posterior shoulder instability is an effective means to improve symptoms associated with recurrent posterior subluxation of the shoulder. It can provide predictable success in the setting of unidirectional, nonvoluntary posterior instability without prior surgery.

Purpose: A snapping hip (coxa saltans) secondary to a tight iliotibial band rarely needs surgical intervention. The purpose of this study is to present the surgical results of refractory external-type snapping hip by Z-plasty of the iliotibial band., Materials and Methods: Nine symptomatic snapping hips in 8 consecutive patients (1 bilateral) from August 1997 through March 2002 who underwent an iliotibial band Z-plasty were reviewed., Results: Eight of the 9 hips were in active-duty military and 1 was a civilian, with an average age of 25.6 years (range, 21 to 38 years). Mean duration of symptoms prior to surgical intervention was 25.2 months (range, 16 to 39 months) with an average follow-up of 22.9 months (range, 7 to 38 months). All patients had complete resolution of the snapping hip, and all but 1 returned to full unrestricted activities. The 1 failure had persistent groin pain but no residual snapping., Conclusions: Patients with snapping hip of the iliotibial band refractory to conservative treatment are rare. The surgical results of Z-plasty are excellent and predictable. Careful screening is necessary to preclude other confounding diagnoses. Z-plasty is recommended as an effective surgical treatment of the refractory snapping hip secondary to iliotibial band tightness.

The risk of litigation in the emergency room is not directly proportional to the severity of injury. In fact, the risk of initiation of legal action is greater in cases of relatively modest permanent and partial disability. In these cases, failure to obtain and document informed consent, failure to effectively communicate with the patient and family, and failure to assure followup and prompt assessment of complications are the factors that have most frequently led to litigation. Orthopaedic surgery ranks fifth among medical specialties in the total number of claims filed and also fifth in the cumulative amount of financial payments. Approximately 30% of filed cases ultimately result in some form of financial payment. The driving force behind litigation is financial gain for plaintiff's attorneys and compensation for plaintiffs. The motive is not the improvement of medical delivery systems or individual behavior. Access to useful data of a legal nature is extremely difficult. Only a small number of cases go on to a jury-based decision of public record. It is difficult to get accurate and complete information on the total number of cases filed, cases withdrawn, terms of settlements, and arbitrations because of the confidential nature of the settlement process.

Subchondral cysts in the knee may occur in the progression of osteoarthrosis. We report on bilateral subchondral cysts located in the lateral femoral condyle in an active 39-year-old man presenting with knee pain at rest. Relief was achieved with arthroscopic decompression. Current research and increasing knowledge may help explain this uncommon presentation. Selected cases of this type can benefit from arthroscopic decompression.

The first modern textbook on spinal biomechanics was written by Giovanni Alfonso Borelli in 1680. A mathematician, astronomer, and physicist by trade, Borelli became consumed in the physical laws of nature and the human body. His work served as a monumental contribution to ascertain, in depth and with undiminished accuracy, the basic biomechanical principles of the human body.