Evaluation of deformation and fracture of three single-file NiTi rotary instruments: ProTaper F2, WaveOne Primary and OneShape in simulated curved canals

Purpose. The aim of the current study was to compare the incidence of deformation and fracture in three single-file NiTi instruments: ProTaper F2, WaveOne Primary and OneShape. Methods. Fifteen instruments were equally divided into three groups: ProTaper F2 in reciprocation, WaveOne Primary in reciprocation and OneShape in continuous rotation. Each instrument was used to prepare standardized simulated curved canals in resin blocks until fracture had occurred. Following each canal preparation, the instruments were examined for deformation both by naked eye inspection and stereomicroscopic examination. The average number of canals prepared until the first incidence of cracks and the average lifespan of the instruments were calculated. Data were analysed using one-way ANOVA and two-sample t-test. Results. There was no statistically significant difference between ProTaper and WaveOne instruments in both the incidence of cracks and the average lifespan (P > 0.05). OneShape instruments had a significantly delayed incidence of cracks and a longer lifespan than both ProTaper and WaveOne instruments (P < 0.05); however, OneShape instruments showed a noticeable early plastic deformation. Conclusion: PT F2 instrument was comparable to WO Primary instrument in terms of fracture resistance, while OS instrument had more fracture resistance than both PT F2 and WO Primary instruments

Extraosseous Ewing Sarcoma Presenting with Inferior ST-Elevation Myocardial Infarction and Systemic Emboli due to Tumor Thrombus and Invasion of the Left Atrium

Extraosseous Ewing sarcoma is an uncommon entity in the adult population. Cardiac metastases or local invasion of a tumor into the heart is a known but also infrequent occurrence for most malignancies. We present a case of a patient with a history of extraosseous Ewing sarcoma who presented to the emergency room with chest pain and was found to have an inferior ST-elevation myocardial infarction and systemic emboli and was found to have recurrence of sarcoma invading the left atrium

Human Botfly: A Case Report and Overview of Differential Diagnosis

Dermatobia hominis , commonly known as the human botfly, is native to Tropical America. As such, cutaneous infestation by its developing larvae, or myiasis, is quite common in this region. The distinct dermatological presentation of D hominis myiasis allows for its early recognition and noninvasive treatment by locals. However, it can prove quite perplexing for those unfamiliar with the lesion’s unique appearance. Common erroneous diagnoses include the following: folliculitis, benign dermatocyst, and embedded foreign body with localized infection. We present a patient who acquired D hominis while she was in Belize. In this report, we discuss the presentation, differential diagnosis, diagnostic tests, and therapeutic approaches of human botfly lesion to raise the awareness about human botfly

Predictors of return to work following primary arthroscopic rotator cuff repair: An analysis of 1502 cases

Background: It is undetermined which factors predict return to work after arthroscopic rotator cuff repair. Purpose: To identify which factors predicted return to work at any level and return to preinjury levels of work 6 months after arthroscopic rotator cuff repair. Study Design: Case-control study; Level of evidence, 3. Methods: Multiple logistic regression analysis of prospectively collected descriptive, preinjury, preoperative, and intraoperative data from 1502 consecutive primary arthroscopic rotator cuff repairs, performed by a single surgeon, was performed to identify independent predictors of return to work at 6 months postoperatively. Results: Six months after arthroscopic rotator cuff repair, 76% of patients had returned to work, and 40% had returned to preinjury levels of work. Return to work at 6 months was likely if patients were still working after their injuries but before surgery (Wald statistic [W] = 55, P <.0001), were stronger in internal rotation preoperatively (W = 8, P =.004), had full-thickness tears (W = 9, P =.002), and were female (W = 5, P =.030). Patients who continued working postinjury but presurgery were 1.6 times more likely to return to work at any level at 6 months compared to patients who were not working (P <.0001). Patients who had a less strenuous preinjury level of work (W = 173, P <.0001), worked at a mild to moderate level post injury but presurgery, had greater preoperative behind-the-back lift-off strength (W = 8, P =.004), and had less preoperative passive external rotation range of motion (W = 5, P =.034) were more likely to return to preinjury levels of work at 6 months postoperatively. Specifically, patients who worked at a mild to moderate level postinjury but presurgery were 2.5 times more likely to return to work than patients who were not working, or who were working strenuously postinjury but presurgery (p < 0.0001). Patients who nominated their preinjury level of work as “light” were 11 times more likely to return to preinjury levels of work at 6 months compared to those who nominated it as “strenuous” (P <.0001). Conclusion: Six months after rotator cuff repair, patients who continued to work after injury but presurgery were the most likely to return to work at any level, and patients who had less strenuous preinjury levels of work were the most likely to return to their preinjury levels of work. Greater preoperative subscapularis strength independently predicted return to work at any level and to preinjury levels

Revision rotator cuff repair with versus without an arthroscopically inserted onlay bioinductive implant in workers’ compensation patients

Background: The addition of onlay biological grafts to augment difficult rotator cuff repairs has shown encouraging results in a case series. Purpose/Hypothesis: The purpose of this study was to determine whether the addition of an onlay bioinductive implant would improve repair integrity, shear wave elastographic appearance of the repaired tendon and patch, and patient-rated and/or surgeon-measured shoulder function when used in workers' compensation patients undergoing revision arthroscopic rotator cuff repair. We hypothesized that the addition of the bioinductive implant would enhance repair integrity and clinical outcomes compared with standard repair. Study Design: Cohort study; Level of evidence, 3. Methods: A post hoc matched-cohort study was conducted on prospectively recruited workers’ compensation patients who received a bioinductive implant for revision rotator cuff repair (n = 19). The control group was selected from consecutive workers’ compensation revision rotator cuff repair patients before the introduction of bioinductive implants. Then, they were matched for age and tear size (n = 32). Kaplan-Meier curves were generated to compare the primary outcome of repair integrity between groups. The secondary outcomes were to evaluate the elastographic appearance of the tendon and patch in the bioinductive implant group and to compare patient-rated and surgeon-measured shoulder function between groups preoperatively and at 1 week, 6 weeks, 3 months, and 6 months postoperatively. Results: No major complications associated with the bioinductive implants were identified. Six months after the revision rotator cuff repair, the retear rate in the bioinductive implant group was 16% (3/19), compared with 19% (6/32) in the age- and tear size-matched control group (P =.458). At the final follow-up, the retear rate in the bioinductive implant group was 47% (9/19) at a mean of 14 months compared with 38% (12/32) at a mean of 29 months in the control group (P =.489). The shear wave elastographic stiffness of repaired tendons augmented with the bioinductive implant remained unchanged at 6 m/s from 1 week to 6 months postoperatively, which is lower than the stiffness of 10 m/s in healthy tendons. There were no significant differences in patient-rated or surgeon-measured outcomes between groups 6 months postoperatively. Conclusion: There were no differences in repair integrity or clinical outcomes between workers’ compensation patients who underwent revision arthroscopic rotator cuff repair with an onlay bioinductive implant compared to those who underwent standard revision rotator cuff repair