JULY 2010 VOLUME XXXIX NUMBER 7 pISSN:1078-4519 eISSN:1934-3418

E-PUBLISHING

61	Proximal Humerus Fracture After Keyhole Biceps Tenodesis Stefanie N. Reiff, BA, Shane J. Nho, MD, MS, and Anthony A. Romeo, MD Ms. Reiff is a student and Research Coordinator, Department of Orthopedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois. A biceps tenodesis is a common surgical procedure that is often carried out in conjunction with other surgical shoulder repairs to relieve biceps tendonitis. This case presents a 50-year-old woman who suffered a humerus fracture following an open keyhole biceps tenodesis. The potential reasons for the fracture as well as a brief analysis of the technique itself are presented. To our knowledge, this is the first case report of a humerus fracture following keyhole biceps tenodesis in the English-language literature. Am J Orthop. 2010;39(7):E61-E63.
64	A Vascular Complication of Trochanteric-Entry Femoral Nailing on a Fracture Table John Kadzielski, MD, and Mark Vrahas, MD Dr. Kadzielski is Postgraduate Year 4 Resident, Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Boston, Massachusetts. In this case report, we describe a complication of occlusion of a low-flow artery related to traction and compression against the center post of a fracture table during trochanteric femoral nailing. The ischemic limb subsequently underwent urgent revascularization by the vascular surgery team. The patient was placed on anticoagulation and recovered. Radiographically visible vascular plaques should alert the surgeon to potential vascular complications of traction and center-post compression. Am J Orthop. 2010;39(7):E64-E66.
67	Heterotopic Ossification of the Deltoid Muscle After Arthroscopic Rotator Cuff Repair Brett S. Sanders, MD, Reg B. Wilcox III, PT, DPT, MS, OCS, and Laurence D. Higgins, MD Dr. Sanders is Team Physician, Center for Sports Medicine and Orthopedics, Chattanooga, Tennessee. Heterotopic ossification (HO), a well-known sequela of trauma, burns, head injury, and certain congenital or acquired metabolic conditions, has a predilection for the hip and the elbow. This disease has uncommonly been found after elective open shoulder surgery but extremely seldom after minimally invasive surgery. In our search of the peer-reviewed literature, we found no reports of HO after arthroscopic rotator cuff repair. The clinical importance of heterotopic bone after shoulder surgery remains unclear because of inconsistent definitions, varying correlations of symptom severity and radiographic findings, and lack of treatment efficacy data. Here we report a case of severely symptomatic HO after arthroscopic rotator cuff repair—successfully treated with excision of the heterotopic bone, interval release, and manipulation. Am J Orthop. 2010;39(7):E67-E71.

325	Guest Editorial—In This Issue Brian J. Cole, MD, MBA Dr. Cole, this journal’s Associate Editor for Shoulder and Elbow, is Professor, Department of Orthopedic Surgery and Anatomy and Cell Biology, and Director, Cartilage Restoration Center at Rush, Rush University Medical Center, Chicago, Illinois. Abstract not available. Am J Orthop. 2010;39(7):325.
326	Resurfacing of Isolated Articular Cartilage Defects in the Glenohumeral Joint With Microfracture: A Surgical Technique & Case Report Mark A. Slabaugh, MD, Rachel M. Frank, BS, and Brian J. Cole, MD, MBA MAJ Slabaugh, USAF, MC, is Assistant Professor of Surgery, Lackland Air Force Base, Texas. Isolated, full-thickness chondral lesions of the glenohumeral joint remain significant problems for athletes, workers, and the elderly. Microfracture has been established as an effective therapeutic solution for such cartilage defects of the knee, because of its low surgical morbidity and ease as a first-line treatment with good clinical outcomes. Although the indications for microfracture and the surgical techniques are similar for cartilage injuries of the shoulder and knee joints, the literature includes no reviews of the use of microfracture in the humeral head or glenoid surface. Overall, microfracture is a minimally invasive, technically simple surgical procedure that provides an excellent option for patients with isolated full-thickness chondral defects. In this article, we describe the subtleties of microfracture in the glenohumeral joint and outline the clinical course of a typical patient. Am J Orthop. 2010;39(7):326-332.
333	Incidence of Early Development of Radiolucent Lines in Keeled Polyethylene Glenoid Components After Total Shoulder Arthroplasty Shane J. Nho, MD, MS, Rachel M. Frank, BA, BS, Nikhil N. Verma, MD, and Anthony A. Romeo, MD Dr. Nho is Assistant Professor of Orthopedic Surgery, Department of Orthopedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois. Glenoid loosening after total shoulder arthroplasty (TSA) remains a major concern. The purpose of this study was to determine the incidence of radiolucent lines (RLLs) after TSA performed with modern glenoid bone preparation and cement techniques for keeled-back glenoid components. One hundred ten consecutive patients with osteoarthritis were included in this study. Patients had undergone primary TSA with a keeled-back glenoid component. Mean age was 64.0 years (SD, 10.6 years; range, 27-91 years). Two independent, blinded observers assessed the initial postoperative radiographs for RLLs using the Molé, Torchia, and Franklin classification systems. On 93 (84.5%) of the 110 radiographs, there was no evidence of RLLs; on the other 17 radiographs (15.5%), there was evidence of RLLs. Mean Torchia score was 0.02 (SD, 0.13) on the anteroposterior view and 0.14 (SD, 0.34) on the axillary lateral view. Mean Franklin score was 0.02 (SD, 0.13) on the anteroposterior view and 0.21 (SD, 0.62) on the axillary lateral view. Incidence of early RLLs in keeled-back glenoid components prepared with modern cement and bone compaction techniques was 15.5%, similar to what other investigators have reported for pegged-back glenoid components. Am J Orthop. 2010;39(7):333-337.
340	Effective Glenoid Version in Professional Baseball Players Mark C. Drakos, MD, Joseph U. Barker, MD, Daryl C. Osbahr, MD, Scott Lehto, MD, Jonas R. Ruzki, MD, Hollis Potter, MD, Struan H. Coleman, PhD, MD, Answorth A. Allen, MD, and David W. Altchek, MD Dr. Drakos is Foot and Ankle Fellow, Brown University, Providence, Rhode Island. The pathomechanics of the throwing shoulder have yet to be fully elucidated. The focus of this study reported here was to further characterize the morphology of the glenoid in a population of elite throwing athletes. We obtained magnetic resonance imaging scans of 38 professional baseball players (dominant shoulders) and of 35 age-matched nonthrowing control patients (17 dominant and 18 nondominant shoulders). Seven measurements were made by 3 blinded reviewers on 3 axial images per patient: version of superior glenoid, middle glenoid, inferior glenoid, superior capsulolabral junction, middle capsulolabral junction, inferior capsulolabral junction, and depth of concavity of glenoid in a middle slice. Mean age of the 38 players (24 pitchers, 14 fielders) was 26.8 years, and mean age of the 35 control patients was 27.6 years. Intraclass correlation coefficients ranged from .55 to .84 for the version measurements. There were no statistically significant differences between the pitchers and the fielders on any of the 7 measurements, but such differences were found between the throwers and the dominant-shoulder control patients on all 7 measurements. There were only 2 differences (version of superior glenoid, depth of concavity of glenoid in a middle slice) between dominant- and nondominant-shoulder control patients. There was significantly more retroversion in the osseous and soft tissues of the elite throwing athletes than in the nonthrowing control patients. This increased retroversion may play a role in development of internal impingement in the overhead athlete. Am J Orthop. 2010;39(7):340-344.
347	From Entrepreneur to Employee: Part 1. Ambiguity in Attitudes About Hospital Employment Karen A. Zupko, BSJ, and Cheryl L. Toth, MBA Ms. Zupko is President, KarenZupko & Associates, Inc., Chicago, Illinois. Abstract not available. Am J Orthop. 2010;39(7):347-349.
351	Arthroscopic Management of a Chronic Primary Anterior Shoulder Dislocation Gregory J. Galano, MD, Alexis A. Dieter, MD, Natan E. Moradi, and Christopher S. Ahmad, MD Dr. Galano is Resident, Orthopaedic Surgery, Columbia University Medical Center, New York, New York. Chronic anterior dislocation of the glenohumeral joint often leads to functional impairment and pain. Duration of dislocation is correlated with complications, and this injury is traditionally treated with an open procedure. A right-hand–dominant woman in her late 70s presented with traumatic chronic anterior dislocation of the glenohumeral joint. Her physical exam and imaging studies were consistent with anterior shoulder dislocation, a large Hill-Sachs deformity, and rotator cuff and anterior labral tears. A shoulder reduction under anesthesia was performed followed by an arthroscopic double-row rotator cuff repair. In addition, a labral repair was performed via percutaneously inserted suture anchors. Following this treatment, stability was restored to the glenohumeral joint. The patient progressed well with physical therapy and, at 1-year follow-up, the patient had returned to all routine activities pain-free. Arthroscopic repair of chronic primary traumatic anterior shoulder dislocations requiring surgical treatment is a valuable alternative to open procedures and should be considered in higher-functioning elderly patients. Percutaneous suture anchor placement minimizes trauma to an already pathologic rotator cuff and joint capsule. Am J Orthop. 2010;39(7):351-355.

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