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Expectations following sports medicine and arthroscopic procedures have been elevated because of captivating modern-day media coverage of high-profile athletic injuries, surgery, and rapid return to sports. Unfortunately, this general perception may be misleading, and orthopedic sports medicine physicians must be aware of the harsh reality of the trials and tribulations associated with the subspecialty. The purpose of this review article is to provide an updated brief overview of the complications and failure rates associated with common arthroscopic procedures including rotator cuff repair, biceps tenodesis, Bankart procedure, Latarjet procedure, anterior cruciate ligament reconstruction, anterior cruciate ligament repair, meniscal repair, tibial tubercle osteotomy, and medial patellofemoral ligament reconstruction. Highlighting the complications is the first step toward early recognition, enhancing preventative measures, and successful management.

Purpose Hyperkalemia more commonly affects patients with a glomerular filtration rate of less than 60 mL/min. Using intravenous (IV) insulin to shift potassium intracellularly may cause hypoglycemia, requiring additional treatment or longer hospitalization. Literature on insulin dosing in this context is limited, with one previous study indicating that 5 units of IV insulin might be as effective and result in less hypoglycemia than the standard dose of 10 units of IV insulin. The hyperkalemia treatment pathway at our institution was revised in May 2018 to include a reduced-dose option (5 units of insulin) for patients with end-stage renal disease. This study aimed to compare the prevalence of hypoglycemia between patients who received standard-dose vs reduced-dose IV insulin. Methods This single-center, retrospective, quasi-experimental study evaluated the impact of revision of the hyperkalemia treatment pathway by assessing rates of hypoglycemia during the 6 months before and after implementation of the revised pathway. The primary endpoint was prevalence of hypoglycemia, defined as a blood glucose level of less than or equal to 70 mg/dL. Results There was no statistically significant difference in the occurrence of hypoglycemia when comparing the pre- and postimplementation groups (36 [17.7%] patients vs 34 [18.7%] patients; P = 0.7924). The postimplementation group had a statistically significant lower reduction in potassium levels after treatment than the preimplementation group (mean [interquartile range], –0.9 [–1.3, –0.5] mEq/L vs –0.6 [–1.2, –0.2] mEq/L; P = 0.0095). Baseline potassium levels were similar between the groups. Conclusion Administration of reduced-dose IV insulin for treatment of hyperkalemia was significantly less effective in lowering serum potassium levels and did not decrease prevalence of hypoglycemia. When accounting for potential confounders, the only variable that was associated with hypoglycemia was pretreatment glucose level.

Cartilage defects of the humeral head in young, active patients provide a challenge to treating surgeons. The causes of humeral head osteochondral lesions are variable, but these lesions most commonly result from trauma and recurrent glenohumeral instability. Palliative and reparative techniques such as arthroscopic debridement and microfracture have traditionally been used as surgical treatment but have high failure rates. Similarly to surgical trends in the knee, cartilage restoration in the shoulder is becoming more prevalent in younger patients. Osteochondral allograft transplantation (OAT) has been used as a joint-preserving surgical option to restore hyaline cartilage in multiple joints for decades. Although OAT is more commonly used to re-establish the subchondral bony architecture in the treatment of recurrent shoulder instability, the procedure may also be indicated in young, active patients with focal humeral head chondral defects. OAT has been shown in early studies to provide improvement in functional outcome scores and good long-term graft survival with relatively low rates of complications. This report describes our straightforward, reproducible technique for the treatment of large, oblong chondral defects of the humeral head using OAT., Technique Video Video 1 Deltopectoral exposure of a right shoulder with a large, oblong chondral lesion. The lesion is measured, and a fresh humeral allograft is prepared for harvest. The corresponding area of the humeral allograft is measured and harvested using the elliptical cutting system instrumentation. The graft is soaked in autologous plasma while the recipient site is prepared using the elliptical cutting system instrumentation. The graft is implanted into the humeral head, and postoperative radiographs are viewed.

This list is part of an annotated bibliography of scholarly and critical work. The earlier parts were published in Bronte Studies, 32.2 (July 2007), 33.3 (November 2008), 34.3 (November 2009), 36.4...

Background There has been 25-year trend of decreasing value for orthopedic surgical work based on the Resource-Based Relative Value Scale (RBRVS) for Medicare reimbursement. This study was undertaken to estimate the time that Medicare payment rates for time spent in the office doing cognitive work will equal time dedicated in the operating room to performing procedural work based on long-term negative payment trends. Methods The RBRVS Update Committee database was accessed to extract the time elements for 2 procedures, total knee arthroplasty and total hip arthroplasty (27447 and 27130), on the day of surgery. The evaluation and management code mix for 2 mid-sized orthopedic practice was averaged to create an amalgamated rate for the reimbursement of office work on an hourly rate. A graph of the 25-year trend line in Medicare reimbursement for arthroplasty procedures was used to create a trend line. The trend line was then extrapolated to estimate the time in the future that the hourly rate for office work would equal the hourly rate for surgery. Results Time inputs and the Medicare conversion factor for 2021 were used in this analysis. Total procedural time for both 27447 and 27130 was 204 minutes (3.4 hours) on the day of surgery. An amalgamated hourly office rate of 7.9 relative value unit was calculated from the average of the 2 mid-sized private practices for an overall in office Medicare reimbursement of $318.89/h, with $1083.04 for the 3.4 hours allowed in the RBRVS Update Committee database for a joint replacement. When the trend line for reimbursement was extrapolated to the $1083.04 price point, the year corresponding to the point where hourly office reimbursement would equal hourly surgical work was 2024. Conclusion Policymakers in Washington and practicing orthopedic surgeons need to consider the looming economic parity of surgical and cognitive work for Medicare. Continued negative reimbursement rates are likely to decrease patient access to necessary surgical care and result in de facto rationing of arthroplasty services for Medicare patients. The deployment of the orthopedic workforce is likely to change to accommodate the decreases in the value of surgical work. This trend will have significant impact on the practice of musculoskeletal medicine and patient access to orthopedic services.

Clavicle fracture nonunion can lead to persistent pain and loss of shoulder function. Distal clavicle fractures have the greatest risk of nonunion and are often treated surgically. Bone grafting plays a vital role in the treatment of distal clavicle nonunion. Although multiple options for bone graft exist, the iliac crest has long been considered the gold standard for harvest. Despite its extensive use, multiple complications have been associated with iliac crest bone graft harvest. We advocate a surgical technique for arthroscopic bone graft harvest from the proximal humerus with open reduction and internal fixation of an ipsilateral distal clavicle nonunion.

This list is part of an annotated bibliography of scholarly and critical work. The earlier parts were published in Bronte Studies, 32.2 (July 2007), 33.3 (November 2008), 34.3 (November 2009), 36.4...

Charlotte Bronte, Embodiment and the Material World is thoroughly enjoyable to read, not something one can always say of an academically oriented collection of essays. From start to finish, the boo...

The 2016 bicentenary of Charlotte Bronte’s birth was marked by an unusually large number of publications on her life and work, including special journal issues of Victorian Review (42.2) and Victor...

Rotator cuff injuries in the skeletally immature population are uncommon, with most tears resulting from trauma or overuse in throwing athletes. Although the literature has referenced multiple repair methods in the pediatric population, an arthroscopic physeal-sparing technique has yet to be described. Given the proximity of the proximal humerus growth plate to the typical anchor placement during rotator cuff repair, we advocate a technique that avoids violation of the proximal humeral physis. Our technique shows an arthroscopic physeal-sparing repair using standard arthroscopic equipment and fluoroscopy.

The 2016 bicentenary of Charlotte Bronte’s birth and was marked by an unusually large number of publications on her life and work, including special journal issues of Victorian Review (42.2) and Victorians: A Journal of Culture and Literature (130). In order to accommodate all of this work, we have decided to review the year in two sections: the present list, which covers Charlotte Bronte alone, and a subsequent list which will cover Emily and Anne Bronte.This list is part of an annotated bibliography of scholarly and critical work. The earlier parts were published in Bronte Studies, 32.2 (July 2007), 33.3 (November 2008), 34.3 (November 2009), 36.4 (November 2011), 37.3 (September 2012), 39.1 (January 2014), 41.3 (September 2016), 42.4 (November 2017), and 43.4 (October 2018). The present part covers work published in 2016.Bibliographical details are followed where possible by summaries and assessments. Essays published in Bronte Studies are as a rule excluded, as are books reviewed in Bronte Studies; re...

Robert Gamble’s Mrs. Gaskell’s Personal Pantheon accomplishes far more than ‘illuminating Mrs. Gaskell’s inner circle’: Gamble takes on the task of unravelling the ‘bewilderingly complex network of...

Meniscal tears are among the most common knee injuries encountered by an orthopaedic surgeon. Once treated with total meniscectomy, meniscal preservation is now the standard of care. Not all meniscal tears are repairable, and meniscal allograft transplantation has become an integral part of the preservation algorithm. This procedure is often recommended in a young active patient with healthy articular cartilage who has undergone a previous subtotal or total meniscectomy. There are many surgical methods for meniscal allograft transplantation, and the bone bridge technique has shown good improvement in outcome scores and good long-term survival. We describe our preferred technique for preparation of the dovetail bone bridge meniscal allograft for lateral meniscal allograft transplantation., Technique Video Video 1 Preparation of a lateral meniscus allograft using the dovetail bone bridge technique.

Patellar tendon ruptures are rare injuries in young athletes, resulting in disruption of the extensor mechanism, and require surgery for functional recovery. Several techniques have been reported, including end-to-end repair and single-row suture anchor constructs. The strength of these repairs has been questioned, and they are commonly augmented. We endorse a double-row repair technique that provides an anatomic restoration of the footprint, has high fixation strength, eliminates the need for graft augmentation, and allows early motion.

BACKGROUND/AIM Limited research has been available to support the use of the Kettle Test in a subacute rehabilitation setting with patients diagnosed with a variety of medical conditions. The Kettle Test is an occupation based performance measure designed to detect cognitive processes and function. The aim of this research was to measure the correlation between three cognitive tests, the Mini-Mental State Examination (MMSE), Cognitive Functional Independence Measure (Cognitive FIM) and the Kettle Test. Secondly, to assess the efficacy of these tests in predicting functional outcomes via the motor subscale of the Functional Independence Measure (mFIM). METHODS A prospective single-centre cohort study in a subacute rehabilitation setting of 97 patients. RESULTS Correlation coefficients between the tests were statistically significant and moderately strong, with values ranging from 0.593 to -0.589. Significant positive correlations were seen between admission MMSE, Cognitive FIM and the mFIM and significant negative correlations between Kettle Test scores and the mFIM. The Kettle Test score had a stronger relationship with mFIM (r = -0.40; P

This list is part of an annotated bibliography of scholarly and critical work. The earlier parts were published in Bronte Studies, 32.2 (July 2007), 33.3 (November 2008), 34.3 (November 2009), 36.4...

Peter Cook’s The Romantic Legacy of Charles Dickens immediately establishes that there is a significant gap in current Dickens scholarship when it comes to considering the influence of Romanticism ...

This list is part of an annotated bibliography of scholarly and critical work. The earlier parts were published in Bronte Studies, 32.2 (July 2007), 33.3 (November 2008), 34.3 (November 2009), 36.4 (November 2011), 37.3 (September 2012), 39.1 (January 2014) and 41.3 (September 2016). The present part covers work published in 2014.

M. Joan Chard’s Victorian Pilgrimage offers a clearly written, enjoyable exposition of the motif of the spiritual journey in the works of three female Victorian novelists: Charlotte Bronte, Elizabe...

Posterior shoulder dislocation is an unusual injury often associated with electrical shock or seizure. As with anterior instability, patients frequently present with an impaction injury to the anterior aspect of the humeral head known as a “reverse Hill-Sachs lesion.” The treatment of this bony defect is controversial, and multiple surgical procedures to fill the defect in an effort to decrease recurrence have been described. Most of the reports have focused on an open approach using variations of lesser tuberosity and subscapularis transfers, bone allograft, and even arthroplasty to assist with persistent instability. We advocate an arthroscopic technique that involves a suture anchor–based distal tenodesis of the subscapularis tendon or a reverse remplissage procedure.

Distal triceps ruptures are uncommon injuries resulting in loss of elbow extension strength and necessitating surgical repair to ensure optimal functional outcome. Traditional fixation techniques using running, locking sutures through the tendon secured through bone tunnels have been shown to poorly restore the anatomic footprint and are mechanically inferior to anatomic repairs. We endorse restoring the anatomic footprint of the distal triceps, similar to the well-researched rotator cuff repair model.

This edition of ‘The Pirate’ provides a rich and rewarding experience for all readers, whether or not they have been previously acquainted with Branwell Bronte’s youthful writings. The pleasure beg...

Of her four novels, Charlotte Bronte's Shirley (1849) is the one most concerned with the 'condition of England' question. Despite the novel's portrayal of two important aspects of the 'condition of England' - the need for improved industrial relations between mill-owners and workers, and improved gender relations between men and women - Shirley's most persistent and pervasive call for reform centres on the Church of England. 1 Shirley depicts the danger of the Established Church's becoming overly Catholic, overly Protestant, or overly disconnected from society. In the world of the novel, a healthy Church is portrayed as essential to England's social well-being. By critiquing the High and Low Church parties in Shirley, Charlotte Bronte suggests that the Church should not be distracted by excessive debate over forms and rituals (High Church) or by an undue emotionalism that encourages revolutionary tendencies (Low Church).

Background and purpose Case based learning is a commonly used pedagogy to facilitate active learning and development of problem-solving skills, however its utility may be limited in a large lecture environment. Fishbowl activities have been utilized in higher education to encourage discussion and postformal thinking and may be useful in engaging large class sizes in collective problem-solving activities. Educational activity and setting The fishbowl activity took place in a second-year six-credit hour infectious disease course delivered in the spring of 2017, consisting 95 students. A pre-post survey was administered via Google® forms and consisted of demographic items (age, race, gender), students’ self-reported level of preparation, perceived benefits of the activity, strengths and weakness of the fishbowl activity, and postformal thought using the Complex Postformal Thought (PFT) questionnaire. Findings Aggregate mean postformal thinking score was 51.98 in the pre-survey and 56.26 in the post-survey (p Discussion Overall, this activity was generally well received by the students and may have positively impacted their postformal thinking. It appears that the fishbowl activity concept may transfer easily to pharmacy education and be an additional active learning tool for pharmacy educators based on these limited pilot results. Summary Fishbowl activities may be a valuable educational tool for the development of postformal thinking skills in pharmacy students. Further studies are needed to evaluate the effectiveness and applicability of using this active learning approach in pharmacy education.

Osteochondritis dissecans (OCD) of the capitellum is a common disorder that causes pain and functional limitation in the adolescent elbow. Although conservative management is the first line of treatment, surgical intervention is usually recommended for patients with persistent mechanical symptoms, loose bodies, or unstable lesions. Elbow arthroscopy has become the gold standard to evaluate and treat symptomatic OCD lesions. Arthroscopic debridement and bone marrow stimulation have been shown to yield good short-term results. Unfortunately, long-term follow-up has shown less favorable outcomes, with degenerative changes frequently documented. Current marrow stimulation techniques promote the formation of fibrocartilage, which is known to be less durable than hyaline cartilage. We describe an arthroscopic technique of debridement and drilling supplemented with a micronized allogeneic cartilage scaffold to address OCD lesions of the capitellum in an effort to promote hyaline cartilage formation.

Surgical and conservative management of partial tears of the rotator cuff has long been a controversial topic for many generations of shoulder surgeons. These tears frequently occur on both the articular and bursal surfaces and within the intrasubstance of the rotator cuff. The term “PASTA lesion” describes the partial articular supraspinatus tendon avulsion–type injury. A less common variant of this injury is the bony PASTA lesion or partial articular bony avulsion of the supraspinatus tendon (PABAST).

FOR A POET WHOSE STYLE JOHN KEATS FAMOUSLY AND JUSTIFIABLY dubbed "the egotistical sublime," (1) William Wordsworth's autobiographical narrative in the fourth paragraph of "Lines Written a Few Miles above Tintern Abbey" is remarkably (and deliberately) obscure. (2) Writing in 1798 and recalling his visit to the Wye Valley five years previously in 1793, Wordsworth declares his hope that he will find "life and food / For future years" (65-66) in the present moment, Though changed, no doubt, from what I was, when first I came among these hills; when like a roe I bounded o'er the mountains, by the sides Of the deep rivers, and the lonely streams, Wherever nature led; more like a man Flying from something that he dreads, than one Who sought the thing he loved. For nature then (The coarser pleasures of my boyish days, And their glad animal movements all gone by,) To me was all in all.... (67-7 6) (3) It is a critical commonplace that "Tintern Abbey" is riddled with elisions, absences, and incomplete comparisons--after all, the poem surprisingly negleets to mention Tintern Abbey at all. (4) Wordsworth's comparatives in lines 67-76 of the poem have been particularly troublesome, provoking questions that remain unsatisfactorily answered: How is the speaker "like a roe"? How is he "like a man"? What is the "something" that he dreads? What is the "thing" that he might have loved? How can one interpret the poet's confusing movement through time, from his "boyish days" (74), to "what [he] was" (67) five years earlier, to who he is now? Wordsworth seems deliberately to obscure the personal allusions to his life five years earlier. Most of these mysteries can be cleared up, however, if one recognizes in these lines Wordsworth's allusions to the Song of Songs, the Bible's erotic love poem. I have located over fifty critical responses to lines 67-76 in "Tintern Abbey": none of them convincingly answers the questions posed above. (5) The notes in Michael Mason's excellent edition of Lyrical Ballads exemplify the challenges confronting a skilled literary critic attempting to explicate these lines for a perplexed reader: 68-73. a me ... he loved: the ambiguous and interacting similes in these lines leave the question of the balance between frightened flight and loving quest, in the Wordsworth of 1793, intriguingly uncertain. If the 'like' of 'more like a man' has the sense which the 'like' of 'like a roe' at first seems to have--the sense of 'with the appearance of'-- then we have a purely exterior picture of Wordsworth's state in 1793. But the second 'like' is perhaps better read as meaning 'in the condition of,' and however we take it the image of a fleeing man modifies the bounding roe image significantly through the suggestion of a deer hunt. In 'Hart-leap Well' ... Wordsworth tells the story of a hunted stag which is in flight and seeking to return to a beloved spot. (6) One can sense the tentative nature of Mason's speculations as he attempts to clarify what seems "ambiguous" and "intriguingly uncertain." He rightly dismisses the first interpretive option--for a male poet to compare his external appearance to a man's seems strangely obvious and unimaginative. Mason's second suggestion is more plausible--that the force of Wordsworth's comparison falls not on the word "man" at all, but on the action of "flying" rather than seeking. However, this interpretation still raises the question as to what the man is fleeing and what he might instead have been seeking. The image of the hunt that Mason suggests, while possible, does not seem to fit well with the language Wordsworth uses here. The image of a deer flying from "dread" seems too psychological to work in this context--besides, at this point the speaker is no longer like a deer, but like a man. The connection between the roe and the man remains ambiguous--why would Wordsworth have chosen to compare himself to a roe? …

In Emily Bronte and the Religious Imagination, Simon Marsden seeks to move beyond critical readings that narrowly define religion ‘as a relatively static body of received truths’. When critics meas...

This is part of an annotated bibliography of scholarly and critical essays. The earlier parts were published in Bronte Studies, 32.2 (July 2007), 33.3 (November 2008), 34.3 (November 2009), 36.4 (November 2011), and 37.3 (September 2012). The present part covers mainly work published in 2010–11.