FEBRUARY 2010 VOLUME XXXIX NUMBER 2 pISSN:1078-4519 eISSN:1934-3418

E-PUBLISHING

11	Scapular Osteochondroma Treated With Arthroscopic Excision Using Prone Positioning Kristopher Aalderink, MD, and Brian Wolf, MD, MS Dr. Aalderink is Sports Fellow, Department of Orthopaedic Surgery, University of Iowa, Iowa City, Iowa. Osteochondromas, or exostoses, are common benign bone tumors. Most commonly, osteochondromas arise in the metaphyseal regions of long bones (femur, humerus, tibia). Seldom are osteochondromas found on the undersurface of the scapula; these osteochondromas invoke mechanical irritation that leads to bursa formation, snapping, and even winging of the scapula. Many authors have reported performing open surgical excision when these osteochondromas become symptomatic. In this report, we describe the case of a woman in her mid-20s with painful scapular snapping and winging from an osteochondroma treated with arthroscopic excision using prone positioning. Am J Orthop. 2010;39(2):E11-E14.
15	Advanced Shoulder Joint Tuberculosis Treated With Débridement and Closed Continuous Irrigation and Suction: A Report of Two Cases Kiyohisa Ogawa, MD, and Noriaki Nakamichi, MD Dr. Ogawa is Consultant, Sports Clinic, School of Medicine, Keio University, Shinjuku, Tokyo, Japan. Tuberculosis of the shoulder is rare and its diagnosis is likely to be delayed because its symptoms often resemble those of the primary frozen shoulder or rotator cuff syndrome. The standard treatment is principally antituberculous chemotherapy plus débridement, if necessary. In this report, we describe 2 patients with advanced shoulder joint tuberculosis that were treated by débridement and closed continuous irrigation and suction using normal saline followed by early range-of-motion exercise with satisfactory results. We emphasize that surgical débridement and closed continuous irrigation and suction, which is one of the standard treatment methods for severe or chronic musculoskeletal infection, should be considered in treating advanced shoulder joint tuberculosis. Am J Orthop. 2010;39(2):E15-E18.
19	Intraosseous Ganglion of the Glenoid Jeffrey E. Wong, BA, Steven A. Aviles, MD, and C. Benjamin Ma, MD Mr. Wong is Medical Student, School of Medicine, University of California, Irvine, California. Intraosseous ganglions in the glenoid are uncommon. This case report illustrates the management and outcome of this uncommon but symptomatic shoulder problem. Am J Orthop. 2010;39(2)):E19-E21

64	Editorial—Sarmiento’s Opportunity Peter D. McCann, MD Dr. McCann is Editor-in-Chief of this journal and Chair, Department of Orthopaedic Surgery at Beth Israel Medical Center, New York, New York. Abstract not available. Am J Orthop. 2010;39(2):64.
67	The Lull Before Reform: Taking Advantage of an Opportunity Augusto Sarmiento, MD Dr. Sarmiento is Professor and Chairman Emeritus, University of Miami, Miami, Florida. Abstract not available. Am J Orthop. 2010;39(2):67-68.
70	Impact of Reinfusion Drains on Hemoglobin Level in Total Knee Arthroplasty Palaniappan Lakshmanan, MS (Orth), FRCS (Orth), Balaji Purushothaman, MRCS, and Ajay Sharma, MS (Orth), MCh (Orth) Dr. Lakshmanan is Spinal Fellow, Centre for Spinal Studies and Surgery, Queen’s Medical Centre, Nottingham, United Kingdom. We conducted this study to determine the effect of reinfusion drains on the difference in hemoglobin (Hb) levels before and after total knee arthroplasty. Of the 158 patients who underwent total knee arthroplasty on one side, 74 had autologous blood transfusion through reinfusion drains (group 1); the other 84 did not have autologous blood transfusion, but ordinary suction drains were used to drain the wound during the immediate postoperative period (group 2). Mean preoperative Hb levels were 13.6 g/dL for group 1 (SD, 1.4 g/dL; range, 10.4-18.1 g/dL) and 13.6 g/dL for group 2 (SD, 1.3 g/dL; range, 10.0-16.7 g/dL). Mean postoperative Hb levels were 10.7 g/dL for group 1 (SD, 1.5 g/dL; range, 7.9-16.5 g/dL) and 10.7 g/dL for group 2 (SD, 1.6 g/dL; range, 5.4-13.6 g/dL). The difference in Hb levels between the groups before and after the surgery was analyzed with t test and found to be not significant (P = .76). The reinfusion drain cost £36.43 (?US$ 58.87) more than the suction drain. Autologous blood from reinfusion drains did not significantly improve postoperative Hb levels. Further use of reinfusion drain is not cost-beneficial. Am J Orthop. 2010;39(2):70-74.
76	Hemolysis and Survival of Autologous Red Blood Cells Salvaged After Cemented and Uncemented Total Hip Arthroplasty Branko Tripkovic, MD, PhD, Katarina Sakic, MD, PhD, Sanja Jakovina, MD, Šime Šakic, MD, PhD, and Zlatko Hrgovic, MD, PhD Dr. Tripkovic is Medical Doctor and Anesthesiologist, Orthopaedic Surgery Department, University Hospital Zagreb, Zagreb, Croatia. Autotransfusion is widely used after total hip arthroplasty (THA), but there are concerns about damage of red blood cells (RBCs) collected after surgery. In this study, we wanted to determine the damage and survival of RBCs salvaged after cemented THA and after uncemented THA and to compare the results. In this prospective study of 60 patients—30 who underwent cemented THA and 30 who underwent uncemented THA—postoperative autotransfusion systems (BIODREN; B.E.R.C.O., Modena, Italy) were used. Levels of potassium and free hemoglobin in the postoperative blood samples were analyzed. Before transfusion, salvaged RBCs were labeled with radioactive chromium-51, and their survival was measured. In blood salvaged after cemented THA, medium potassium level was 4.1 mmol/L (range, 3.2-5.6 mmol/L), and mean free hemoglobin level was 327 mg% (range, 120-410 mg%). In blood salvaged after uncemented THA, mean potassium level was 4.2 mmol/L (range, 3.1-5.5 mmol/L), and mean free hemoglobin level was 296 mg% (range, 130-402 mg%). In the cemented group, RBC survival was 73% at 48 hours after transfusion (range, 61%-79%), and mean time from 100% activity to 50% activity was 21 days (range, 14.2-28.2 days). In the uncemented group, RBC survival was 75% at 48 hours after transfusion (range, 68%-82%), and mean time from 100% to 50% activity of radio-labeled RBCs was 22 days (range, 16.2-29.4 days). There were no statistically significant differences in potassium levels, free hemoglobin levels, or RBC survival between the cemented and uncemented groups. Blood salvaged after surgery was not significantly damaged. Our study results confirmed that washing blood collected after surgery is not necessary. Not washing this blood is safe and decreases allogeneic transfusion in orthopedic procedures. Am J Orthop. 2010;39(2):76-79.
80	Admitting Service and Morbidity and Mortality in Elderly Patients After Hip Fracture: Finding a Threshold for Medical Versus Orthopedic Admission James M. Mok, MD, Salim K. Durrani, MS, Akira Yamamoto, MD, and Hubert T. Kim, MD, PhD Dr. Mok is Resident, Department of Orthopaedic Surgery, University of California, San Francisco, California. Outcomes by admitting service of 355 consecutive patients admitted for hip fracture at an academic medical center were retrospectively studied. An adverse event occurred in 53 patients (14.9%): 10 in-hospital deaths, 37 intensive care unit transfers, and 25 deaths within 30 days. No significant difference was found between percentages of patients with adverse events admitted to a medical service versus an orthopedic service (52.8% vs 47.2%; P = .8). Criteria that determine admitting service based on medical acuity do not adequately allocate patients at risk for serious morbidity and early mortality to a medical service. Addition of American Society of Anesthesiologists grade 4 and men 85 or older to existing criteria would increase the percentage of patients with adverse events admitted to a medical service (72% vs 28%; P<.005). Am J Orthop. 2010;39(2):80-87.
89	Anatomic Variations of the Palmaris Longus Muscle Min Jung Park, MD, MMSc, Surena Namdari, MD, MMSc, and Jeffrey Yao, MD Dr. Park is Resident, Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. The palmaris longus muscle exhibits significant anatomical variance compared with other muscles of the upper extremity. The most frequent variation is complete absence of the muscle, but a number of other variations exist. These variations include reversed, duplicated, bifid, or hypertrophied palmaris longus muscles. Many authors have reported the variations in case reports and described them using their own terms. In this case report and review of literature, we aim to consolidate the current knowledge regarding the anatomic variations of the palmaris longus muscle and its clinical relevance. Am J Orthop. 2010;39(2):89-94.
95	Muscle Herniation of the Extremity Scott E. Yochim, MD, Jean Jose, DO, and Paul D. Clifford, MD Dr. Yochim is Musculoskeletal Imaging Fellow, University of California San Diego, La Jolla, California. Abstract not available. Am J Orthop. 2010;39(2):95-96.

back to top