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BackgroundModular knee arthrodesis (MKU) is a salvage treatment for recurrent periprosthetic joint infection (PJI) or PJI associated with notable bone loss. Reimplantation endoprosthetic reconstruction (REI) is an option in patients with MKU who have PJI clearance but are not satisfied with pain or functional outcomes with MKU. The purpose of this study was to evaluate the outcomes of MKU to REI conversion.MethodsThis was a single-center retrospective cohort study of 56 patients who underwent MKU to REI from 2010 to 2019. All patients were staged according to the McPherson staging system. An infecting organism was documented based on pre-MKU aspiration or intraoperative cultures at the time of MKU. Rate ratios were calculated for relevant patient factors. Rate ratios were calculated using Poisson regression with a log link.ResultsThe mean REI patient age was 67 years, most of the patients were McPherson B hosts (62.5%) with a type 2 (46.4%) or type 3 (51.8%) limb score, and all PJI were chronic. The most common infecting organisms at the time of MKU were Staphylococcus epidermidis (23.2%) and Staphylococcus aureus (23.2%, MSSA 14.3%, MRSA 8.9%). The mean time from MKU to REI was 220 days. An 8.9% REI index hospitalization complication rate and a 21.4% overall complication rate (excluding reinfection) were observed. Sixty-seven percent of the patients remained infection-free at an average follow-up of 37 months, among those there was 96.4% implant survivorship. No notable association was observed between index PJI organism or McPherson staging and REI failure secondary to PJI.DiscussionApproximately two thirds of patients who undergo conversion from MKU to REI have infection-free survival at the midterm follow-up. An index infecting organism and a McPherson host type do not seem to be markedly associated with reinfection risk. These findings help guide expectations of PJI MKU conversion to REI.

The rapid rollout of vaccinations in response to the COVID-19 pandemic has led to their widespread distribution and administration throughout the world. The benefit of these vaccinations in preventing the spread of the disease and diminishing symptoms in patients who contract COVID-19 has been fervently studied and reported. While vaccinations remain an effective and generally safe method of limiting disease transmission and virus-related mortality, vaccine administration is not completely without risk. Shoulder injuries related to vaccine administration (SIRVA) have been described with previously available vaccines but have yet to be widely reported in the COVID-19 vaccination population. We present a case report of a young, high-functioning patient who presented with acute subacromial bursitis after COVID-19 vaccine administration due to improper vaccination technique. The patient was treated with arthroscopic shoulder surgery and had near immediate relief of shoulder symptoms. [ABSTRACT FROM AUTHOR]

Background: There has been an increasing interest in lateral-based soft tissue reconstructive techniques as augments to anterior cruciate ligament reconstruction (ACLR). The objective of these procedures is to minimize anterolateral rotational instability of the knee after surgery. Despite the relatively rapid increase in surgical application of these techniques, many clinical questions remain. Purpose: To provide a comprehensive update on the current state of these lateral-based augmentation procedures by reviewing the origins of the surgical techniques, the biomechanical data to support their use, and the clinical results to date. Study Design: Systematic review. Methods: A systematic search of the literature was conducted via the Medline, EMBASE, Scopus, SportDiscus, and CINAHL databases. The search was designed to encompass the literature on lateral extra-articular tenodesis (LET) procedures and the anterolateral ligament (ALL) reconstruction. Titles and abstracts were reviewed for relevance and sorted into the following categories: anatomy, biomechanics, imaging/diagnostics, surgical techniques, and clinical outcomes. Results: The search identified 4016 articles. After review for relevance, 31, 53, 27, 35, 45, and 78 articles described the anatomy, biomechanics, imaging/diagnostics, surgical techniques, and clinical outcomes of either LET procedures or the ALL reconstruction, respectively. A multitude of investigations were available, revealing controversy in addition to consensus in several categories. The level of evidence obtained from this search was not adequate for systematic review or meta-analysis; thus, a current concepts review of the anatomy, biomechanics, imaging, surgical techniques, and clinical outcomes was performed. Conclusion: Histologically, the ALL appears to be a distinct structure that can be identified with advanced imaging techniques. Biomechanical evidence suggests that the anterolateral structures of the knee, including the ALL, contribute to minimizing anterolateral rotational instability. Cadaveric studies of combined ACLR-LET procedures demonstrated overconstraint of the knee; however, these findings have yet to be reproduced in the clinical literature. The current indications for LET augmentation in the setting of ACLR and the effect on knee kinematic and joint preservation should be the subject of future research. [ABSTRACT FROM AUTHOR]

Objective To describe the management of Radiation Therapy Oncology Group ( RTOG) grade 4 urinary adverse events ( UAEs) after radiotherapy ( RT) for prostate cancer ( PCa). Methods We conducted a single-centre retrospective review, over a 6-year period (2010-2015), to identify men with RTOG grade 4 UAEs after RT for PCa. RT was classified as combined therapy (radical prostatectomy [ RP] followed by external beam radiotherapy [ EBRT], EBRT + low-dose-rate [ LDR] brachytherapy, EBRT + high-dose-rate [ HDR] brachytherapy or other combinations of RT) or monotherapy RT. UAEs were classified as outlet (urethral stricture, bladder neck contracture, prostate necrosis, or recto-urethral fistula) or bladder (contraction, necrosis, fistula, ureteric stricture or haemorrhage) UAEs. Results We identified 73 men with a mean age of 73 years. Of these, 44 (60%) received combined therapy, consisting of RP + EBRT ( n = 19), HDR brachytherapy + EBRT ( n = 19), LDR brachytherapy + EBRT ( n = 5), and other combined RT ( n = 1). Twenty-nine (40%) patients had monotherapy consisting of EBRT ( n = 4), HDR brachytherapy ( n = 11), LDR brachytherapy ( n = 12), or proton beam therapy ( n = 2). UAEs were isolated to the bladder in six men (8%), the outlet in 52 men (71%), and to both in 15 men (21%). UAE management included: conservative in 21 (29%), indwelling catheters in 12 (16%), reconstructive in 19 (26%), and urinary diversion ( UD) in 23 men (32%). Reconstruction included: ureteric ( n = 4), recto-urethral fistula repair ( n = 2), and posterior urethroplasty ( n =13), of which 14/16 surgeries (88%) with follow-up >90 days were successful. Conclusions Although the incidence of RTOG grade 4 UAEs after PCa radiation treatment is not well defined, their associated morbidity is significant, and approximately one third of patients with these high-grade complications require UD. Conversely, only about a quarter of patients can be managed with conservative strategies or local surgeries. Reconstruction is successful in selected patients. [ABSTRACT FROM AUTHOR]

Introduction: Distal femur fractures are complex injuries that often present with multiple fragments, posing notable challenges to fixation. This study aimed to (1) use preoperative CT scans to graphically display fracture lines in intra-articular distal femur fractures and (2) identify common fracture patterns in these injuries., Methods: All skeletally mature patients that underwent surgical fixation of Orthopaedic Trauma Association type 33C distal femur fractures between 2012 and 2022 were identified across two level 1 trauma centers (n = 63). Preoperative axial, sagittal, and coronal computed tomography scans were obtained. Fracture lines in each plane were traced out and superimposed on standardized distal femur cross-sections, generating a fracture map for each plane. Injury and fracture characteristics were summarized and compared between fracture patterns., Results: On axial scans, 59 of 63 fractures contained a central intercondylar split from the intercondylar notch to the trochlea. On coronal scans, fracture lines originated at the notch and exited laterally and medially in the supracondylar region, creating a Y-shape. One-third of all fractures contained coronal fracture lines, with most involving the lateral condyle. Based on fracture line orientation and location, fractures were divided into four main fracture pattern types. Type 4 fractures (central split and medial coronal fracture line) were associated with lower average medial fracture height and a lower rate of medial metaphyseal comminution., Discussion: We found that C-type distal femur fractures can present with four main fracture patterns. Most fractures contain a central sagittal intercondylar split, and a high proportion of fractures contain either medial or lateral coronal fracture lines. Fracture pattern was associated with mechanism of injury, presence of medial comminution, and medial fracture line height. Future studies should focus on clinical outcomes and surgical management of these distinct fracture patterns., Level of Evidence: IV., (Copyright © 2024 by the American Academy of Orthopaedic Surgeons.)

Background: Modular knee arthrodesis (MKU) is a salvage treatment for recurrent periprosthetic joint infection (PJI) or PJI associated with notable bone loss. Reimplantation endoprosthetic reconstruction (REI) is an option in patients with MKU who have PJI clearance but are not satisfied with pain or functional outcomes with MKU. The purpose of this study was to evaluate the outcomes of MKU to REI conversion., Methods: This was a single-center retrospective cohort study of 56 patients who underwent MKU to REI from 2010 to 2019. All patients were staged according to the McPherson staging system. An infecting organism was documented based on pre-MKU aspiration or intraoperative cultures at the time of MKU. Rate ratios were calculated for relevant patient factors. Rate ratios were calculated using Poisson regression with a log link., Results: The mean REI patient age was 67 years, most of the patients were McPherson B hosts (62.5%) with a type 2 (46.4%) or type 3 (51.8%) limb score, and all PJI were chronic. The most common infecting organisms at the time of MKU were Staphylococcus epidermidis (23.2%) and Staphylococcus aureus (23.2%, MSSA 14.3%, MRSA 8.9%). The mean time from MKU to REI was 220 days. An 8.9% REI index hospitalization complication rate and a 21.4% overall complication rate (excluding reinfection) were observed. Sixty-seven percent of the patients remained infection-free at an average follow-up of 37 months, among those there was 96.4% implant survivorship. No notable association was observed between index PJI organism or McPherson staging and REI failure secondary to PJI., Discussion: Approximately two thirds of patients who undergo conversion from MKU to REI have infection-free survival at the midterm follow-up. An index infecting organism and a McPherson host type do not seem to be markedly associated with reinfection risk. These findings help guide expectations of PJI MKU conversion to REI., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Repetitive overhead throwing generates tremendous demands on the shoulder joint of the overhead athlete. Clinicians, therapists, and medical staff are charged with optimizing a throwing athlete's shoulder mobility and stability to maximize performance and prevent injury. Modifiable risk factors such as strength asymmetry, glenohumeral range of motion deficits, and scapulothoracic joint abnormalities contribute to the overhead athlete's predisposition to shoulder injury. Most shoulder injuries in the overhead thrower can be successfully treated nonoperatively to allow in-season return to sport. The optimal rehabilitation program must be based on an accurate evaluation of historical and physical information as well as diagnostic imaging. Return to play decisions should be individualized and should weigh subjective assessments along with objective measurements of range of motion, strength, and function. The purpose of this clinical commentary is to summarize the current literature regarding the nonoperative treatment options for these common injuries, and to present a treatment plan to safely return these athletes to the field of play., Level of Evidence: 5.