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Hip fractures in older patients are projected to increase in frequency as the US population continues to age. A thorough history and physical examination is essential. The initial workup should include radiographic imaging. Operative stabilization is the treatment of choice for most femoral neck or intertrochanteric hip fractures. The goals should be to achieve a stable reduction to allow for early patient mobilization, restore the patient's preinjury level of function, and minimize the risk of medical complications. Postoperative complications are associated with mortality and diminished return of function. All patients with hip fractures should receive perioperative deep venous thrombosis chemoprophylaxis, unless it is contraindicated. A multidisciplinary approach to postoperative rehabilitation can short-en the inpatient stay and decrease the mortality rate. [ABSTRACT FROM AUTHOR]

Purpose: To determine when patients recover the ability to safely operate the brakes of an automobile after a right-knee anterior cruciate ligament reconstruction (ACLR)., Methods: A computerized driving simulator was used to determine braking ability after an isolated right-knee ACLR. Thirty healthy volunteers were tested at 1 visit to determine normal mean values, and 27 treatment subjects were tested at 1 week, 3 weeks, and 6 weeks after ACLR. Nine study subjects were treated with a patella tendon (BPTB) autograft, 9 were treated with a hamstring (HS) autograft, and 9 were treated with a tibialis anterior (TA) allograft. The driving simulator collected data on brake reaction time (BRT), brake travel time (BTT), and total brake time (TBT) at each visit., Results: The control group generated a BRT of 725 milliseconds, BTT of 2.87 seconds, and TBT of 3.59 seconds. At week 1, all treatment patients had significant differences compared with controls for BRT, BTT, and TBT, except the BTT of the HS group. At week 3, all measures for the allograft group and the BRT for both autograft groups were no longer significantly different compared with controls, but significant differences were found for TBT in the HS and BPTB groups (P = .03, P = .01). At week 6, BRT, BTT, and TBT were no longer significantly different for either the HS group or BPTB group., Conclusions: Patients who underwent a right-knee ACLR with a TA allograft regained normal braking times by week 3 postoperatively. In contrast, those treated with a BPTB or HS autograft demonstrated significantly delayed braking times at 3 weeks but returned to normal braking ability by week 6. Those treated with an autograft had an earlier return of normalized BRT than BTT., Level of Evidence: Level III, case-control series., (Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: Injection to the acromioclavicular (AC) joint can be both diagnostic and therapeutic., Purpose: The purpose of this study was to evaluate the accuracy of in vivo AC joint injections., Study Design: Case series; Level of evidence, 4., Methods: Thirty patients with pain localized to the AC joint were injected with 1 mL of 1% lidocaine and 0.5 mL of radiographic contrast material (Isovue). Radiographs of the AC joint were taken after the injection. Each radiograph was reviewed by a musculoskeletal radiologist and graded as intra-articular, extra-articular, or partially intra-articular., Results: Of the 30 injections performed, 13 (43.3%) were intra-articular, 7 (23.3%) were partially articular, and 10 (33.3%) were extra-articular. When the intra-articular and the partially articular groups were combined, 20 patients (66.7%) had some contrast dye in the AC joint., Conclusion: This study demonstrates that despite the relatively superficial location of the AC joint, the clinical accuracy of AC joint injections remains relatively low.

Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder affecting multiple organ systems, joints, ligaments, and bones and commonly involves the cervical spine. Chronic synovitis may result in bony erosion and ligamentous laxity that result in instability and subluxation. Anterior atlantoaxial subluxation (AAS) is the most frequently occurring deformity, due to laxity of the primary and secondary ligamentous restraints. Additional manifestations of RA include cranial settling, subaxial subluxation, or a combination of these. Although clinical findings can be confounded by the severity of multifocal joint and systemic involvement, a careful history is critical to identify symptoms of cervical disease; serial physical examination is the best noninvasive diagnostic tool. Thorough physical and neurologic examinations should be performed in all patients and serial functional assessments charted. Radiographs of the cervical spine with lateral flexion-extension dynamic views should be obtained periodically and used to "clear" the cervical spine before elective surgery requiring general anesthesia. Advanced imaging, such as magnetic resonance imaging (MRI) or myelography and computed tomography (CT), may be necessary to evaluate the neuraxis. Early initiation of pharmacotherapy may slow progression of rheumatoid cervical disease. Operative intervention before the onset of advanced myelopathy results in improved outcomes compared to the surgical stabilization of patients whose conditions are more advanced. A multidisciplinary approach involving rheumatology, surgery, and rehabilitation is beneficial to optimize outcomes.

Currently, there are several femoral stem designs available for use, but few have an extended track record. We have previously reported on 10- and 15-year outcome studies of total hip arthroplasty (THA) using a cemented normalized and proportionalized femoral stem from a single surgeon series. This is a follow-up study reporting the minimum 20-year outcome of this femoral stem design. The study began with THA performed in a consecutive series of 184 patients; stem fixation was achieved using first-generation cementing techniques. The overall early complication rate was 10%. There were 23 patients (31 hips) who had been followed-up for a minimum 20-year period (average 21.3 years). Mean d'Aubigne and Postel scores improved from 5.9 to 11.3; mean Harris hip scores improved from 43.8 to 92.8. Kaplan-Meier survivorship was 93% at 20 years (95% confidence interval); there were no stem failures. The use of a cemented normalized and proportionalized femoral stem in primary THA provides satisfactory long-term clinical and radiological outcomes in patients.