Reducing the use of complex words and reducing sentence length to < 15 words improves readability of patient education materials regarding sports medicine knee injuries

"Sports-related knee injuries such as anterior cruciate ligament (ACL) or meniscus tears are very common. Approximately 50% of internet users have reported using the internet to learn more information about a specific medical treatment or procedure. The internet’s usefulness is dependent not only on the content available to patients, but also the health literacy of the patient consuming the information. Poor health literacy is associated with poor outcomes. The NIH and AMA recommend that online patient resources be written at or below the sixth-grade reading level. Online PEMs in Orthopaedics have consistently been shown to be written above the NIH-recommended sixth-grade reading level to the detriment of patient health literacy. “A 2018 analysis of the readability of 39 AAOS Sports Med PEMs found that all PEMs were written above the 6th-grade reading level with 36% written above a 12th-grade reading level.” (PMID: 30480008) While many studies have suggested strategies to improve the readability of PEMs, literature describing the benefit of these proposed changes is scarce. The purpose of this study is to develop a standardized method to improve readability of Orthopaedic PEMs without diluting their critical content by reducing the use of complex words (> 3 syllables) and shortening sentence length to [less than] 15 words."--Introduction

A Unique Case of Unilateral Lower Extremity Sparing Systemic Peripheral Gangrene

We present here the case of a 70-year-old female who developed a systemic peripheral gangrene in both of her upper extremities (all fingers) and her right foot due to a severe septic shock requiring a systemic vasopressor therapy. Interestingly, the patient’s left foot remained spared from gangrenous changes possibly due to a chronic external iliac artery occlusion and thus the lower concentration of vasopressors in that extremity

Case Report A Unique Case of Unilateral Lower Extremity Sparing Systemic Peripheral Gangrene

We present here the case of a 70-year-old female who developed a systemic peripheral gangrene in both of her upper extremities (all fingers) and her right foot due to a severe septic shock requiring a systemic vasopressor therapy. Interestingly, the patient&apos;s left foot remained spared from gangrenous changes possibly due to a chronic external iliac artery occlusion and thus the lower concentration of vasopressors in that extremity

Arthroscopic Load-Shift Technique for Intraoperative Assessment of Shoulder Translation

Shoulder instability represents a spectrum of disease, ranging from subluxation to dislocation. It may present acutely after trauma or chronically as a result of multiple events. Physical examination is a key component in evaluating the degree of instability and laxity present; however, in-office guarding or apprehension may limit the examination. In addition, patient anatomy or operator technique may limit the accuracy and reproducibility of examination maneuvers such as the load-shift test. We propose an arthroscopic modification to the load-shift technique involving direct visualization to assess the direction and degree of shoulder instability. Our technique allows for the examination of a fully relaxed, anesthetized patient, eliminating guarding, and allows for intraoperative documentation of the patient's laxity both before and after surgical stabilization. In addition, this allows for custom titration of adjunctive capsulorrhaphy in arthroscopic stabilization cases

Elbow Arthroscopy for Posteromedial Impingement and Fixation of Olecranon Stress Fracture

Posteromedial elbow impingement due to valgus extension overload often develops as a result of excessive valgus and extension force during repetitive overhead throwing activities. Impingement classically occurs in throwing athletes such as baseball, tennis, softball, or lacrosse players. If isolated, arthroscopic removal of the posteromedial olecranon osteophytes shows excellent postoperative satisfaction, return to sport rates, and return to previous level of activity. This Technical Note describes treatment of posteromedial elbow impingement syndrome and associated olecranon stress fracture treated with arthroscopic removal of posteromedial osteophytes and arthroscopic-assisted screw fixation

Radiographic evaluation of common pediatric elbow injuries

Normal variations in anatomy in the skeletally immature patient may be mistaken for fracture or injury due to the presence of secondary centers of ossification. Variations in imaging exist from patient to patient based on sex, age, and may even vary from one extremity to the other on the same patient. Despite differences in the appearance of the bony anatomy of the elbow there are certain landmarks and relationships, which can help, distinguish normal from abnormal. We review common radiographic parameters and pitfalls associated in the evaluation of pediatric elbow imaging. We also review common clinical diagnoses in this population

Multiple Ankle Injuries Are Associated With an Increased Risk of Subsequent Concussion in National Football League Players

Background: There is a gap in the literature regarding musculoskeletal risk factors for concussion within the National Football League (NFL), which is an avenue that must be explored to promote player safety given the high incidence of both injury types. This study aims to observe if ankle injuries are associated with an increased risk of subsequent concussion in NFL players. Methods: The public online database ProFootballReference.com was used to identify ankle injuries and concussions in NFL players from the 2009-2010 to 2019-2020 seasons. Multivariable logistic regression for subsequent concussion and ankle injury was performed, adjusting for body mass index (BMI), age, and player position. For descriptive statistics, unpaired t tests with unequal variance were performed for continuous variables, including BMI and age. χ 2 testing was performed for categorical variables, including player position, and whether the position was offensive, defensive, or on special teams. Results: Of the 5538 NFL players included in the study, 941 had an ankle injury, 633 had a concussion, and 240 had both an ankle injury and a subsequent concussion. The adjusted odds ratio (aOR) for concussion following a single ankle injury was 0.90 (95% CI 0.72-1.14, P  = .387); however, the aOR for concussion following multiple ankle injuries was 2.87 (95% CI 1.23-6.75, P  = .015). Special teams players had the lowest risk for concussion (aOR 0.17, 95% CI 0.069-0.36, P  < .001) following ankle injury, and there was no significant difference in risk between offense and defense (aOR 0.91, 95% CI 0.77-1.08, P  = .295). Conclusion: Multiple ankle injuries were associated with an increased risk of a subsequent concussion after adjusting for BMI; player position; and offense, defense, or special teams designation. These findings can inform injury prevention practices in the National Football League. Level of Evidence: Level III, retrospective comparative study

Multiple Ankle Injuries are Associated with an Increased Risk of Subsequent Concussion in National Football League Players

Category: Sports; Ankle Introduction/Purpose: Ankle injuries are among the most common musculoskeletal injuries in National Football League (NFL) players. Concussions are also concerningly frequent, especially given increasing post-mortem observations of chronic traumatic encephalopathy (CTE) in former NFL players. There is a gap in the literature regarding musculoskeletal risk factors for concussion, which is an avenue that must be explored to promote player safety. The purpose of this study is to observe if ankle injuries, especially multiple ankle injuries, are associated with an increased risk of subsequent concussion in NFL players. Methods: The public online database ProFootballReference.com was utilized to identify ankle injuries and concussions in NFL players, as well as demographic variables such as BMI and age. Multivariable logistic regression for subsequent concussion and ankle injury was performed, adjusting for BMI and player position. For descriptive statistics, unpaired T-tests with unequal variance were performed for continuous variables, including BMI and age. Chi-squared testing was performed for categorical variables, including player position, and whether the position was offensive (quarterback, running back, tight end, wide receiver, offensive line), defensive (defensive back, defensive line, linebacker), or on special teams (kicker, punter, long snapper). Results: 5,538 NFL players from the 2009-2010 to 2019-2020 seasons were included in the study. The mean BMI and age of the cohort was 31.06 (SD 4.55) and 24.41 (SD 3.63), respectively. Of these players, 941 had an ankle injury, 633 had a concussion, and 240 had both an ankle injury and a subsequent concussion. The adjusted odds ratio (aOR) for concussion following a single ankle injury was 0.90 (95% CI 0.72 – 1.14, p = 0.387), however, the aOR for concussion following multiple ankle injuries was 2.88 (95% CI 1.28 – 6.74, p = 0.015). The kicker position was determined to have the lowest risk for concussion following ankle injury, and the positions with comparatively greater risk are outlined in Table 1. Conclusion: Multiple ankle injuries were associated with an increased risk of a subsequent concussion by 188% after adjusting for BMI, player position, and offense/defense/special teams designation. Special teams as a group and by position (kicker, long snapper, punter) had the lowest risk of concussion following ankle injury, likely owing to the lower-impact nature of these positions. These findings can inform injury prevention practices in the National Football League

Tibial Eminence Fracture Repair With Double Hewson Suture Passer Technique

Displaced tibial eminence fractures are commonly encountered in pediatric patients and are often considered to be functionally equivalent to an anterior cruciate ligament (ACL) rupture. While a variety of techniques are available for fixation of this injury, we describe an anchorless technique relying on suture fixation tied over a bone bridge. This technique also relies on two intra-articular Hewson suture passers to quickly and effectively pass and shuttle sutures through the ACL and tibial bone tunnels in order to reduce and fix the fracture fragment. We also briefly review various types of fixation used for tibial eminence fractures