Oral Contraceptive Pills Are Not a Risk Factor for Deep Vein Thrombosis or Pulmonary Embolism After Arthroscopic Shoulder Surgery

Background: Worldwide, more than 100 million women between the ages of 15 and 49 years take oral contraceptive pills (OCPs). OCP use increases the risk of venous thromboembolism (VTE) through its primary drug, ethinylestradiol, which slows liver metabolism, promotes tissue retention, and ultimately favors fibrinolysis inhibition and thrombosis. Purpose: To evaluate the effects of OCP use on VTE after arthroscopic shoulder surgery. Study Design: Cohort study; Level of evidence, 3. Methods: A large national payer database (PearlDiver) was queried for patients undergoing arthroscopic shoulder surgery. The incidence of VTE was evaluated in female patients taking OCPs and those not taking OCPs. A matched group was subsequently created to evaluate the incidence of VTE in similar patients with and without OCP use. Results: A total of 57,727 patients underwent arthroscopic shoulder surgery from 2007 to 2016, and 26,365 patients (45.7%) were female. At the time of surgery, 924 female patients (3.5%) were taking OCPs. The incidence of vascular thrombosis was 0.57% (n = 328) after arthroscopic shoulder surgery, and there was no significant difference in the rate of vascular thrombosis in male or female patients (0.57% vs 0.57%, respectively; P \u3e .99). The incidence of VTE in female patients taking and not taking OCPs was 0.22% and 0.57%, respectively (P = .2). In a matched-group analysis, no significant difference existed in VTE incidence between patients with versus without OCP use (0.22% vs 0.56%, respectively; P = .2). On multivariate analysis, hypertension (odds ratio [OR], 2.00; P \u3c .001) and obesity (OR, 1.43; P = .002) were risk factors for VTE. Conclusion: OCP use at the time of arthroscopic shoulder surgery is not associated with an increased risk of VTE. Obesity and hypertension are associated with a greater risk for thrombolic events, although the risk remains very low. Our findings suggest that patients taking OCPs should be managed according to the surgeon’s standard prophylaxis protocol for arthroscopic shoulder surgery

Reference Point Indentation Improves DeXA-Derived BMD Prediction of Femoral Neck Strength Independently of Loca Tissue Mineral Density and Periostea Micro-Porosity

Mentor: Simon Y. Tang From the Washington University Undergraduate Research Digest: WUURD, Volume 9, Issue 1, Fall 2013. Published by the Office of Undergraduate Research. Joy Zalis Kiefer Director of Undergraduate Research and Assistant Dean in the College of Arts & Sciences

Fabella Syndrome and Common Peroneal Neuropathy following Total Knee Arthroplasty

Case. A 62-year-old man presented with persistent lateral knee pain 15 months following an uncomplicated total knee arthroplasty. There was a tendinous snapping structure over the lateral aspect of the knee in deep flexion with positive Tinel’s sign over the fibular head. The patient underwent an uncomplicated flabella excision. The patient was cleared to return to work and full duty at two months postoperatively. Conclusion. Flabella syndrome is a rare but increasingly common mechanism of persistent lateral knee pain following total knee arthroplasty. Surgeons should be aware of this etiology of persistent lateral knee pain and offer treatment modalities to address this pathology

Patellar Tendon Excision and Repair for Residual Patella Alta after Prior Failed Patellar Tendon Repair: Surgical Decision Making and Outcome

Presented in this report is a complex revision case of a patellar tendon repair preceded by excess tendon excision to correct for recurrent patella alta deformity, in a workers’ compensation patient. The goal of this procedure was to alleviate this patient’s pain, to preserve his ability to function in his activities of daily living, and to allow him to return to work at some capacity. On postoperative radiographs, the revision procedure appeared to have successfully corrected this patient’s patella alta deformity. After an extended rehabilitation process, this patient had reached maximal medical improvement at 1-year follow-up. He displayed modest improvements in all PROs, including a clinically significant improvement in his short-form mental component score. Despite his functional capacity being still somewhat limited, this patient reported subjective satisfaction after this complicated salvage procedure

Botulinum Toxin as an Adjunctive Therapy for Immobilization of a Distal Humerus Fracture in Parkinson\u27s Disease-Associated Psychosis: A Case Report

BACKGROUND Attainment of extremity immobilization in orthopedic trauma patients experiencing psychosis is often uniquely challenging. Many fractures, including those of the distal humerus, require a period of immobilization postoperatively to optimize fracture healing. Patients with Parkinson\u27s disease have also been shown to have lower rates of union after fracture compared to the general population. The combination of Parkinson\u27s disease and associated psychosis requires heightened attention to those parameters that may hinder fracture healing, such as inadequate immobilization of the fracture. Botulinum toxin has previously been described as a potential adjunctive therapy for fracture immobilization but has not yet been described in the setting of distal humerus fractures. CASE REPORT A 75-year-old woman with Parkinson\u27s disease-associated psychosis presented 2 weeks after open reduction and internal fixation of a distal third humeral shaft fracture due to failure of fixation and episodes of violent hallucinations. The patient underwent irrigation and debridement, and revision open reduction and internal fixation. Given her uncontrolled hallucinations, intramuscular botulinum toxin injections were given to the right triceps, biceps, and brachialis muscles to aid in the immobilization of the right extremity and protect the surgical site during the perioperative period. The patient subsequently followed up at the clinic 3 months postoperatively with ongoing fracture healing, evidenced by bridging callous and bone formation on radiographs, as well as a return of motion to the extremity. CONCLUSIONS Botulinum toxin may be a safe and effective adjunct for fracture immobilization in patients who are difficult to immobilize and have high fixation failure risk

Tibial Tubercle Avulsion Fracture with Multiple Concomitant Injuries in an Adolescent Male Athlete

Tibial tubercle avulsion fractures are an uncommon injury occurring due to strong contraction of the quadriceps femoris muscle during leg extension, ultimately causing failure of the physis at the patellar tendon insertion. This injury has been previously reported with various concomitant injuries, such as compartment syndrome from bleeding into the anterior compartment, vascular injury, patellar tendon avulsion, and meniscal injury—exhibited only with fracture types that extend intra-articularly. We report the case of a 14-year-old healthy adolescent male basketball player who sustained this injury as a result of a collision with another player. He initially reported to the emergency department and then presented to our practice, where he was diagnosed with a tibial tubercle avulsion fracture with patellar tendon rupture. During the operative management of these injuries, it was noted that fascial tissue avulsed through the injury site causing subacute extensive bleeding within the anterolateral compartments. Due to concerns of compartment syndrome, a fascial release was performed along the anterolateral compartments. By five months postoperatively, the patient demonstrated near-normal function, no evidence of extensor lag, and nearly full range of motion. Unlike previously reported cases, this is the first report of a patient who suffered such an injury with multiple concomitant injuries to the neighboring structures. Due to the severity of compartment syndrome and the variability in its temporal presentation from the initial injury, it is paramount that careful evaluation of vascular integrity and a low threshold for fasciotomy be in place to prevent vascular compromise