Comparison of Sports Medicine Questions on the Orthopaedic In-Training Examination Between 2009 and 2012 and 2017 and 2020 Reveals an Increasing Number of References

Purpose To provide an updated analysis of the sports medicine section of the Orthopedic In-Training Examination (OITE). Methods A cross-sectional review of OITE sports medicine questions from 2009 to 2012 and 2017-2020 was performed. Subtopics, taxonomy, references, and use of imaging modalities were recorded and changes between the time periods were analyzed. Results The most tested sports medicine subtopics included ACL (12.6%), rotator cuff (10.5%), and throwing injuries to the shoulder (7.4%) in the early subset, while ACL (10%), rotator cuff (6.25%), shoulder instability (6.25%), and throwing injuries to the elbow (6.25%) were the most common in the later subset. The American Journal of Sports Medicine (28.3%) was the most cited journal referenced from 2009 to 2012, while The Journal of the American Academy of Orthopaedic Surgeons (17.5%) was most referenced in questions from 2017 to 2020. The number of references per question increased from the early to the late subset (P \u3c .001). There was a trend toward an increased taxonomy type one questions (P = .114), while type 2 questions had a decreased trend (P = .263) when comparing the new subset to the early group. Conclusion When comparing sports medicine OITE questions from 2009 to 2012 and 2017 to 2020, there was an increase in the number of references per question. Subtopics, taxonomy, lag time, and use of imaging modalities did not show statistically significant changes. Clinical Relevance This study provides a detailed analysis of the sports medicine section of the OITE, which can be used by residents and program directors to direct their preparation for the annual examination. The results of this study may help examining boards align their examinations and provide a benchmark for future studies

A review of chronic pectoralis major tears: what options are available?

Rupture of the pectoralis major muscle typically occurs in the young, active male. Acute management of these injuries is recommended; however, what if the patient presents with a chronic tear of the pectoralis major? Physical exams and magnetic resonance imaging can help identify the injury and guide the physician with a plan for management. Nonoperative management is feasible, but is recommended for elderly, low-demand patients whose functional goals are minimal. Repair of chronic tears should be reserved for younger, healthier patients with high functional demands. Although operative management provides better functional outcomes, operative treatment of chronic pectoralis tears can be challenging. Tendon retraction, poor tendinous substance and quality of tissue, muscle atrophy, scar formation, and altered anatomy make direct repairs complicated, often necessitating auto- or allograft use. We review the various graft options and fixation methods that can be used when treating patients with chronic pectoralis major tears

Iatrogenic Obturator Hip Dislocation with Intrapelvic Migration

Obturator hip dislocations are rare, typically resulting from high-energy trauma in native hips. These types of dislocations are treated with closed reduction under sedation. Open reduction and internal fixation may be performed in the presence of associated fractures. Still rarer are obturator hip dislocations that penetrate through the obturator foramen itself. These types of dislocations have only been reported three other times in the literature, all within native hips. To date, there have been no reports of foraminal obturator dislocations after total hip arthroplasty. We report of the first periprosthetic foraminal obturator hip dislocation, which was caused iatrogenically during attempts at closed reduction of a posterior hip dislocation in the setting of a chronic greater trochanter fracture. Altered joint biomechanics stemming from a weak hip abductor mechanism rendered the patient vulnerable to this specific dislocation subtype, which ultimately required open surgical intervention. An early assessment and identification of this dislocation prevented excessive closed reduction maneuvers, which otherwise could have had detrimental consequences including damage to vital intrapelvic structures. This case report raises awareness to this very rare, yet potential complication after total hip arthroplasty

Predictive Factors Influencing Internal Rotation Following Reverse Total Shoulder Arthroplasty

Introduction Reverse total shoulder arthroplasty (RSA) is increasingly utilized as a treatment modality for various pathologies. The purpose of this review is to identify preoperative risk factors associated with loss of IR following RSA. Methods A systematic review was conducted using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Ovid MEDLINE, OVID Embase and Scopus were queried. The inclusion criteria were: English language, minimum one-year follow-up postoperatively, study published after 2012, minimum of ten patients in a series, surgery was RSA for any indication, IR is explicitly reported. The exclusion criteria were: full text was unavailable, unable to be translated to English, follow-up < one year, case reports or series of less than ten cases, review articles, tendon transfers were performed at the time of surgery, the procedure performed was not RSA, and the range of motion in IR was not reported. Results The search yielded 3,792 titles, and 1,497 duplicate records were removed before screening. Ultimately, 16 studies met inclusion criteria with a total of 5124 patients that underwent RSA. Three studies found that poor preoperative functional IR served as a significant risk factor for poor postoperative IR. Eight studies addressed the impact of subscapularis with four reporting no difference in IR based on subscapularis repair, and four reporting significant improvements with subscapularis repair. Additionally, two studies reported that BMI negatively affected IR, while two showed it had no impact. Preoperative opioid use was found to negatively affect IR. Other studies showed that glenoid retroversion, component lateralization and individualized component positioning affected postoperative IR. Discussion/Conclusion: This study found that preoperative IR, individualized implant version, preoperative opioid use, increased glenoid lateralization were all found to have a significant impact on IR following RSA. Studies that analyzed the impact of subscapularis repair and BMI reported conflicting results