Orthopedics Commons^™

Optimizing The Management Of Anterior Monteggia Fractures: A Biomechanical Evaluation Of Treatment Options, Kirk D. Vannitamby

Electronic Thesis and Dissertation Repository

Anterior Monteggia injuries are frequently complicated by persistent radial head instability and suboptimal outcomes. Using a cadaveric elbow motion simulator, we quantified the contributions of ligaments of the proximal radius on maintaining radial head stability, evaluated the effectiveness of ulnar overcorrection to create an apex dorsal angulation in stabilizing the radiocapitellar joint, and finally compared the stabilizing effect of annular ligament repair to three different reconstruction techniques. Our results showed increased anterior radial head translation with progressive soft tissue sectioning with the annular ligament as the primary stabilizer. Ulnar overcorrection and forearm pronation were shown to decrease anterior translation of …

Systematic Review Of Prevalence, Risk Factors, And Management Of Instability Following Reverse Shoulder Arthroplasty, Jeffrey J. Olson, Michael D. Galetta, Rachel E. Keller, Luke S. Oh, Evan A. O'Donnell

Orthopedic Surgery Resident Research

Background

Since its approval for use, reverse shoulder arthroplasty (RSA) has become the primary treatment for cuff tear arthropathy, with indications expanding more recently to include revision fracture, osteoarthritis with significant glenoid bone loss, tumor, and chronic instability. Instability is a well-described postoperative complication, occurring in 1to 31% of relatively small cohorts and case series. Given the relative infrequency of instability, there remains a need for a comprehensive review of instability with a focus on risk factors and management. Our goal of this systematic review is to describe the prevalence, risk factors, and management strategies for instability …

The Vulcan Sign: A Radiographic And Clinical Indicator Of Plantar Plate And Collatoeral Ligament Injury, Katherine Gavin

Western Journal of Orthopaedics

Introduction: There is no consensus on terminology used to describe the radiographic and clinical findings commonly encountered in second metatarsophalangeal (MTP) instability. We propose the use of a consensus term, the Vulcan sign, to describe the deformity commonly seen in second MTP instability and verify its utility as an adjunct in the diagnosis and treatment of plantar plate and collateral ligament pathology. Methods: We retrospectively evaluated preoperative anteroposterior weight-bearing x-rays of 156 feet of patients who underwent operative intervention for second MTP instability and the presence of a Vulcan sign at the second webspace, defined as more than 50% medial …

Performance Of The Promis After Operative Interventions For Shoulder Instability, Christina J. Hajewski, Natalie A. Glass, Robert W. Westermann, Matthew Bollier, Brian R. Wolf, Carolyn Hettrich

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to capture patient-reported outcomes (PROs) in an efficient manner. Few studies have assessed this instrument postoperatively.

Purpose: To compare the PROMIS Physical Function computer adaptive test (PROMIS PF CAT) and Upper Extremity (PROMIS UE) item bank to other previously validated PRO instruments and to evaluate ceiling and floor effects and construct validity responsiveness in patients who underwent operative interventions for shoulder instability.

Study Design: Cohort study (diagnosis); Level of evidence, 2.

Methods: A total of 72 patients who underwent operative interventions for shoulder instability completed the American Shoulder and Elbow …

Radial Head Stability In Anterior Monteggia Injuries: An In Vitro Biomechanical Study, Armin Badre

Electronic Thesis and Dissertation Repository

Anterior Monteggia fracture-dislocations are frequently complicated by persistent radial head instability leading to suboptimal outcomes. In this biomechanical investigation using a cadaveric elbow motion simulator, we examined the effects of ulnar extension angulation, soft tissue disruption, biceps loading and elbow motion on radial head translation. Our results showed significant anterior radial head translation with progressive ulnar extension angulation, with greater soft tissue injuries and increased biceps loading (P=.000). There was no significant difference in radial head translation between simulated active and passive elbow flexion (P=.251). These findings support the importance of an anatomic reduction of the ulnar fracture. However, in …

Understanding Preferences For Treatment After Hypothetical First-Time Anterior Shoulder Dislocation: Surveying An Online Panel Utilizing A Novel Shared Decision-Making Tool, Ben Streufert, Shelby D. Reed, Lori A. Orlando, Dean C. Taylor, Joel C. Huber, Richard C. Mather Iii

Orthopaedics and Sports Medicine Faculty Publications

Background: Although surgical management of a first-time anterior shoulder dislocation (FTASD) can reduce the risk of recurrent dislocation, other treatment characteristics, costs, and outcomes are important to patients considering treatment options. While patient preferences, such as those elicited by conjoint analysis, have been shown to be important in medical decision-making, the magnitudes or effects of patient preferences in treating an FTASD are unknown.

Purpose: To test a novel shared decision-making tool after sustained FTASD. Specifically measured were the following: (1) importance of aspects of operative versus nonoperative treatment, (2) respondents’ agreement with results generated by the tool, (3) willingness to …

Causes, Evaluation, And Treatment Of Instability Of The Patellofemoral Joint Of The Knee: A Review, Michael J. Hopson

UNM Orthopaedic Research Journal

Instability of the patellofemoral (PF) joint of the knee is typically caused by chronic atraumatic injuries and inciting traumatic events. Anatomically, bony and softtissue structures surrounding the PF joint and extensor mechanism contribute to overall stability of the area, which results in efficient kinematic function at the PF articulation. Furthermore, physiological, genetic, anatomical, and demographical factors may affect the development and progression of PF joint instability. Treatment techniques have varied owing to individual factors that may have influence on pathological features of the injury. Nonoperative treatment has predominantly focused on strengthening of the quadriceps and vastus medialis by coordinated, closed …

The Effects Of A Semi-Rigid Ankle Brace On A Simulated Isolated Subtalar Joint Instability, Julie Choisne, Matthew C. Hoch, Sebastian Bawab, Ian Alexander, Stacie I. Ringleb

Mechanical & Aerospace Engineering Faculty Publications

Subtalar joint instability is hypothesized to occur after injuries to the calcaneofibular ligament (CFL) in isolation or in combination with the cervical and the talocalcaneal interosseous ligaments. A common treatment for hindfoot instability is the application of an ankle brace. However, the ability of an ankle brace to promote subtalar joint stability is not well established. We assessed the kinematics of the subtalar joint, ankle, and hindfoot in the presence of isolated subtalar instability, investigated the effect of bracing in a CFL deficient foot and with a total rupture of the intrinsic ligaments, and evaluated how maximum inversion range of …

Effects Of Lateral Ligament Sectioning On The Stability Of The Ankle And Subtalar Joint, Stacie I. Ringleb, Ajaya Dhakal, Claude D. Anderson, Sebastian Bawab, Rajesh Paranjape

Mechanical & Aerospace Engineering Faculty Publications

Patients with subtalar joint instability are often diagnosed with ankle instability. Only after a prolonged period of time in which a patient does not improve after treatment for ankle instability is subtalar joint instability considered. To develop a clinically relevant method to diagnose subtalar joint instability, the kinematics of the simulated unstable subtalar joint were examined. A 6 degree-of-freedom positioning and loading device was developed. Plantarflexion/dorsiflexion, inversion/eversion, and internal/external rotation were applied individually or as coupled motions along with an anterior/posterior drawer. Kinematic data were collected from sensors attached to the calcaneus, talus, and tibia by keeping all the ligaments …