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Background: Glenoid component positioning is an important and challenging aspect of total shoulder arthroplasty. The use of freehand technique with standard instrumentation or preoperative planning based on 2-dimensional computed tomography (CT) scans provides an opportunity for improvement in terms of component accuracy, precision, and deformity correction. These techniques have produced varying outcomes. Methods: Preoperative planning software (PPS), patient specific instrumentation (PSI), and intraoperative navigation (NAV) have been developed to improve the accuracy of implant placement and deformity correction with the ultimate goals of improved patient outcomes and implant longevity. Literature search was conducted on published and available studies comparing the accuracy of glenoid component placement and improvements in surgical and patient outcomes amongst the aforementioned techniques. Results: PPS, PSI, and NAV have demonstrated improved accuracy over freehand techniques with standard instrumentation. However, data demonstrating the clinical benefit and cost effectiveness of these new technologies are lacking. Discussion: In this paper, we reviewed the evidence available to answer the question of whether or not advanced shoulder arthroplasty technologies have been beneficial and reviewed future technologies in development such as virtual/mixed-reality and robotic assisted shoulder surgery. Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Surgical release of elbow contracture is associated with injury to structures traversing the elbow. To date, only one other case report has been published describing anterior interosseous nerve (AIN) palsy that developed immediately after open elbow contracture release and debridement. Here we describe the unique case of a patient that developed AIN palsy 1 week after operation, including magnetic resonance imaging and electrodiagnostic studies, to shed some light on the etiology of this rare complication. [ABSTRACT FROM AUTHOR]

Background: Historically, failed conservative treatment for irreparably damaged distal radioulnar joints (DRUJs) is treated via distal ulnar resection or DRUJ fusion; complications include disabling painful convergence of the radius and ulnar stump during lifting Various treatments for radioulnar impingement include distal radioulnar Achilles tendon allograft interpositional arthroplasty. This technique does not adequately prevent radioulnar impingement and we explore an alternative treatment. Methods: We report 7 adult patients who failed Achilles tendon interposition, subsequently treated with Aptis total DRUJ prostheses (mean follow-up, 26 months; range, 7-40). Results: Revision to Aptis prosthesis produced clinically stable DRUJ, improved grip strength and painless lifting capabilities, high patient satisfaction, and no major complications. All returned to daily activities and even recreational sports. Conclusions: Tendon lacks biomechanical features key to the shock-absorbing function of cartilage--features it cannot deliver when used to prevent radioulnar convergence. We report Aptis DRUJ prosthesis as an alternative to the tendon allograft technique. [ABSTRACT FROM AUTHOR]

An 83-year-old male, status one year post-primary right reverse shoulder arthroplasty, presented with clinical and radiographic signs of shoulder instability. The patient subsequently underwent revision reverse shoulder arthroplasty with postoperative cultures growing Cryptococcus neoformans in all five tissue samples. He was placed on temporary fluconazole since he demanded to leave the hospital during a holiday weekend with plans to get readmitted later. IV amphotericin B was used as induction treatment for two weeks followed by PO voriconazole, which was taken by the patient until eight months postoperatively. He was followed up in the orthopedic clinic status post revision procedure at one and two months and was found to be progressing well. The patient presented to the emergency department eight months after the revision procedure for an unrelated concern that was inconsequential. There were no signs of infection as vital signs and laboratory markers were normal. At 18 months postoperatively, he presented to an outside facility with a left distal femur periprosthetic fracture around a total knee implant, for which open reduction and internal fixation (ORIF) was performed. During this hospital stay, an orthopedic team, known to the authors, evaluated the patient. The right shoulder was stable and without pain, with vitals signs and laboratory markers showing no signs of infection. The patient reported that he continued to be employed as a maintenance worker at a motel. He was discharged soon and is living with current revision shoulder arthroplasty implants., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Gabriel et al.)

Introduction Limited research exists on the association between coronavirus 2019 (COVID-19) infection and outcomes following surgical fixation for humerus fractures. The objective of this study was to evaluate the effects of COVID-19 on the clinical outcomes of patients undergoing humerus fracture surgery. Methods Approval to utilize insurance claim data from the Change Healthcare dataset was obtained from the Datavant COVID-19 Research Database. Patients older than 55 years old who underwent humerus fracture surgery from April 1, 2020, to March 1, 2022, were included in the analysis. COVID-19 status, comorbidities, and adverse events were identified using the International Classification of Diseases, 10th Revision (ICD-10) diagnostic codes. Propensity score matching with age, sex, and comorbidities was completed to create a 1:10 matched COVID-19-negative cohort. Univariate and multivariate logistic regressions were performed to assess the association of COVID-19 positivity with perioperative adverse events. Results A total of 18,365 patients underwent humerus fracture surgery in this study, of which 132 (0.72%) tested positive for COVID-19. Univariate analysis found that COVID-19-positive patients were at higher risk for myocardial infarction (5.30% vs. 1.74%, p = 0.015) and acute kidney injury (28.79% vs. 12.50%, p < 0.001) when compared to the 1:10 matched COVID-19-negative cohort. In addition, multivariate logistic regression found that COVID-19-positive patients had higher odds of experiencing any adverse event (2.57; 95% CI: 1.69-3.91; p < 0.001) or a minor adverse event (2.44; 95% CI: 1.57-3.79; p < 0.001). Conclusion COVID-19-positive patients have increased odds of experiencing adverse events after undergoing humerus fracture surgery in comparison to a matched COVID-19-negative control. Findings from this study stress the importance of using COVID-19 status as a factor in predicting outcomes following orthopedic surgery in this patient population., Competing Interests: The authors have declared financial relationships, which are detailed in the next section., (Copyright © 2024, Scigliano et al.)

The use of tranexamic acid (TXA) in total knee arthroplasty (TKA) has become common practice. Recent literature has demonstrated a reduction in postoperative knee swelling and drain output while using TXA. Our purpose is to analyze the range of motion (ROM) following TKA in patients who received TXA compared with a control group. We hypothesize that patients treated with TXA will have improved early postoperative ROM when compared with controls. A retrospective chart review was performed for patients who underwent TKA from 2010 to 2012 performed by a single orthopaedic surgeon. Patients were stratified into three cohorts by route of TXA administration including intravenous (IV), topical, and a control group. Dependent variables analyzed included extension, flexion, and total arc ROM on each postoperative day (POD), average ROM across all three postoperative days, as well as pre-to-postoperative differences in ROM. Demographic data were recorded for each patient. A total of 174 patients were included for analysis, 75 controls and 99 receiving TXA. A significant difference was found between the treatment groups and the control for all variables (for each, p  ≤ 0.002). There were no significant differences in ROM between the IV and topical TXA treatment groups (for each, p  ≥ 0.558). A multivariate analysis demonstrated no significant difference between the groups in complication rate or demographic variables. The use of TXA may improve early postoperative ROM following TKA., Competing Interests: None., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)