DECEMBER 2008 VOLUME XXXVII NUMBER 12 pISSN:1078-4519 eISSN:1934-3418

E-PUBLISHING

196	Compartment Syndrome: Remain Vigilant Joseph Borrelli, Jr., MD Dr. Borrelli is Professor and Chairman, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas. Abstract not available. Am J Orthop. 2008;37(12):E196-E197.
198	Compartment Syndrome of the Leg After Intraosseous Infusion: Guidelines for Prevention, Early Detection, and Treatment Alfred Atanda, Jr., MD, and Mindy B. Statter, MD Dr. Atanda is Chief Resident, Division of Orthopaedic Surgery, University of Chicago Hospital, Chicago, Illinois. Abstract not available. Introduction provided instead. Obtaining adequate vascular access in the multiply injured or critically ill pediatric patient can be very difficult. Options for gaining access to the venous circulation include peripheral percutaneous cannulation, intraosseous (IO) infusion, percutaneous central venous access, and peripheral venous cutdown. If percutaneous access is not achieved after 2 attempts, consideration should be given to IO infusion or peripheral venous cutdown. Percutaneous central venous cannulation is not routinely used for primary access for resuscitation in adult trauma patients and should not be used as such in pediatric trauma patients. IO infusion is an expedient, safe, and reliable method of administering fluids and medications during resuscitation.1-3 However, potential complications associated with IO infusion include osteomyelitis, cellulitis, fracture at IO-line site, compartment syndrome, and fat embolism.4-10 Although compartment syndrome is a rare complication of IO-line placement, this case report illustrates that it can occur. This report also emphasizes that, with proper technique, attention to detail, and serial monitoring of the involved limb, compartment syndrome and other potential complications can be avoided. We have obtained the patient’s guardian’s informed, written consent to publish the case report. Am J Orthop. 2008;37(12):E198-E200.
201	Delayed Presentation of Compartment Syndrome of the Proximal Lower Extremity After Low-Energy Trauma in Patients Taking Warfarin Robert J. Gaines, MD, Craig J. Randall, MD, Kerri L. Browne, PAC, Donald R. Carr, MD, and Jerome G. Enad, MD Dr. Gaines is Lieutenant Commander, Medical Corps, US Navy, and Resident in Orthopaedic Surgery, Bone and Joint/Sports Medicine Institute, Naval Medical Center, Portsmouth, Virginia. Abstract not available. Introduction provided instead. Compartment syndrome is a well-known phenomenon that occurs after injuries to the lower extremities. Clinicians are easily alerted to its presence in the leg after tibial fracture when the patient presents with firm muscular compartments and significant pain that increases with passive stretching of the ankle or the digits of the foot. However, making the diagnosis without a clear history of significant trauma and an easily reproducible physical examination is difficult. Confounding variables (eg, patient comorbidities, medication profiles) become especially important in the elderly population. These patients usually have multiple medical problems being treated with medications. Anticoagulants, warfarin in particular, dramatically impair elderly patients’ ability to recover from minor trauma. As demonstrated in this report, continued intramuscular bleeding can progress to compartment syndrome in patients with very limited physiologic reserve. We describe the cases of 3 patients who developed compartment syndrome after sustaining very low-energy trauma while anticoagulated with warfarin for chronic cardiac conditions. Am J Orthop. 2008;37(12):E201-E204.
205	The Roles of Funding Source, Clinical Trial Outcome, and Quality of Reporting in Orthopedic Surgery Literature Safdar N. Khan, MD, Matthew J. Mermer, MD, Elizabeth Myers, PhD, and Harvinder S. Sandhu, MD Dr. Khan is Resident, Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, California. Compared with nonfunded or peer-reviewed funded projects, industry-sponsored clinical trials have traditionally been associated with more positive results. This relationship has been extensively studied in the nonsurgical literature. Although a few authors have addressed specialties, little has been reported on orthopedic clinical trials and their association with funding, study outcome, and efforts to reduce bias after randomization across journals of multiple subspecialties. For the study reported here, we selected 5 major orthopedic subspecialty journals: Journal of Bone and Joint Surgery (American Volume), Spine, Journal of Arthroplasty, Journal of Orthopaedic Trauma, and American Journal of Sports Medicine. We chose a 2-year limit for investigation (2002– 2004); included all original randomized clinical trials reported in these 5 journals; and examined these trials for their study design, funding source, outcome, bias potential, and conclusion reached. Support for the 100 eligible orthopedic clinical trials was stated as coming from industry (26 trials, 26%), nonprofit sources (19 trials, 19%), and mixed sources (5 trials, 5%); no support was stated in 46 trials (46%), and support was not reported in 4 trials (4%). Of the 26 trials reporting industry support, 22 (85%) were graded as indicating an outcome favorable to the new treatment. The association between industry funding and favorable outcome was strong and significant (P<.001). In almost half of the studies reported in Journal of Bone and Joint Surgery and Spine, measures taken to reduce bias were not documented. Our results indicate that there is a significant positive association between reported clinical trial outcome and funding source in the orthopedic surgery literature across subspecialties. There appears to be poor recording of how to reduce bias in the selected journals. Am J Orthop. 2008;37(12):E205-E212.
213	Spontaneous Tibialis Anterior Tendon Rupture: Delayed Repair With Free-Sliding Tibialis Anterior Tendon Graft George S. Sapkas, MD, PhD, Apostolos Tzoutzopoulos, MD, Fotis C. Tsoukas, MD, and Ioannis K. Triantafillopoulos, MD, PhD, FEBOT Dr. Sapkas is Associate Professor of Orthopaedics, Orthopaedic Department, Metropolitan Hospital, Neo Faliro, Greece. Abstract not available. Introduction provided instead. Rupture of the tibialis anterior (TA) tendon is rare.1,2 A spontaneous rupture is even rarer.3 The rarity of the condition and the subtle physical signs4 make the diagnosis difficult. A high level of suspicion and meticulous clinical evaluation are required. We report on a case of spontaneous TA rupture in a man in his early 50s with diabetes. The tendon defect was 8 cm long, and reconstruction was performed with a free-sliding TA tendon ipsilateral autograft. Am J Orthop. 2008;37(12):E213-E216.

607	GUEST EDITORIAL—Another New Frontier: Hip Arthroscopy James P. Tasto, MD Dr. Tasto, this journal’s Department Editor for Socioeconomics and Practice Management, is Clinical Professor, Department of Orthopaedic Surgery, University of California, San Diego. Abstract not available. Am J Orthop. 2008;37(12):607.
608	5 Points on Arthroscopic Treatment of Femoroacetabular Impingement Thomas G. Sampson, MD Dr. Sampson is Director of Hip Arthroscopy, Post Street Surgery Center, and Medical Director, Total Joint Center, Saint Francis Memorial Hospital, San Francisco, California. Abstract not available. Am J Orthop. 2008;37(12):608-612.
614	Wrist Arthroscopy Using a Shoulder Traction Boom Jeffrey E. Budoff, MD, and Leonard Gordon, MD Dr. Budoff is Associate Clinical Professor, Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, Texas. Overhead boom traction is commonly used in shoulder arthroscopy. In this article, we describe using overhead boom traction in wrist arthroscopy. The advantages are circumferential fluoroscopic access; lack of central post interference with instrumentation; and continuous, uninterrupted traction without need for frequent “dialing up” of traction tower height. Am J Orthop. 2008;37(12):614-615.
618	Arthroscopic Removal of EndoButton After Anterior Cruciate Ligament Reconstruction: Case Report and Surgical Technique Charles Petit, MD, and Peter J. Millett, MD, MSc Dr. Petit is a Sports Medicine Fellow, Steadman Hawkins Research Foundation, Vail, Colorado. Multiple methods of anterior cruciate ligament reconstruction are in use, and femoral fixation has been much discussed. The EndoButton Continuous Loop (Smith & Nephew Endoscopy, Andover, Mass) fixation device has been shown to be efficacious and is in widespread use, but few complications have been reported. In this article, we describe the case of a properly positioned EndoButton that caused symptomatic extensor mechanism irritation necessitating arthroscopic removal. Am J Orthop. 2008;37(12):618-620.
621	Management of Persistent Postpartum Pelvic Pain Yoram A. Weil, MD, Christian Hierholzer, MD, Domenico Sama, MD, Christopher Wright, BS, Markku T. Nousiainen, MD, FRCS(C), Peter Kloen, MD, and David L. Helfet, MD Dr. Weil is Attending Orthopedic Surgeon, Hadassah Hebrew University Hospital, Jerusalem, Israel. Persistent postpartum pelvic pain is an uncommon but disabling disorder. Although symptoms resolve spontaneously in the majority of cases, some carefully selected women with this chronic condition might benefit from surgical stabilization of the pelvic ring. We retrospectively studied 19 patients whose persistent postpartum pelvic pain was treated at our center. Although most patients were successfully treated nonoperatively, 6 (31.5%) underwent surgery because of symptoms persisting more than 1 year. Imaging studies, including magnetic resonance imaging, were used to assess the extent and the nature of the lesion before surgery. Eleven patients had degenerative changes in the anterior pelvic ring; the other 8 patients had degenerative sacroiliac joint changes. Surgical procedures included resection of the diseased fragment, anterior symphyseal plating, and bone grafting with and without posterior ring stabilization. For all patients, mean Majeed outcome score was 85 (range, 46-100). No significant difference in outcomes was found between the surgically treated patients and the nonoperatively treated patients. Am J Orthop. 2008;37(12):621-626.
627	Isolated Avulsion Fracture of the Lesser Tuberosity of the Humerus in an Adult: Case Report and Literature Review Aman Dhawan, MD, Kevin Kirk, DO, Thomas Dowd, MD, and William Doukas, MD MAJ Dhawan, MC, USA, is Assistant Professor of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland. Abstract not available. Am J Orthop. 2008;37(12):627-630.
632	Disaster Preparedness—Don’t Get Caught Without a Plan Steve Gillies, BA, and Karen Zupko, BSJ Mr. Gillies is Research Analyst, KarenZupko & Associates, Inc., Chicago, Illinois. Abstract not available. Am J Orthop. 2008;37(12):632-635.
636	Acetabular Labral Tears Brian J. Parker, MD, and Paul D. Clifford, MD Dr. Parker is Musculoskeletal Imaging Fellow, Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida. Abstract not available. Am J Orthop. 2008;37(12):636-637.

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