Abstract Background Anterior instability has consistently been shown to be the most common type of glenohumeral instability. Recent studies have demonstrated a higher percentage posterior and combined (anterior posterior) than had previously reported; however, this work not replicated recently in particularly young military population, which may representative an especially athletic or high-demand group. Question/purpose What proportion arthroscopic shoulder stabilization procedures are...

Quantifying bone mineral density (BMD) on CT using commercial software demonstrates good-to-excellent correlations with dual-energy x-ray absorptiometry (DEXA) results. However, previous techniques to measure Hounsfield units (HUs) within the proximal femur demonstrate less successful correlation DEXA An effective method of measuring HUs from colonoscopy might allow for opportunistic osteoporosis screening.(1) Do HU measurements correlate results? (2) How is our single measurement technique...

Abstract Background Flap-based limb salvage surgery balances the morbidity and complexity of soft tissue transfer against potential benefit preserving a functional when faced with traumatized extremity composite injury. These injuries are well suited for multidisciplinary management between orthopaedic plastic surgeons. Thus, it makes intuitive sense that collaborative, orthoplastic approach to flap-based can result in improved outcomes decreased risk flap failure other complications,...

Retrospective database review.The incidence and risk factors for surgical delay of multilevel spine fusion adult spinal deformity (ASD), the complications corresponding therewith, remain unknown. The objectives this study are to assess unexpected elective fusions on date surgery as well postoperative associated with these delays.We conducted a retrospective review ACS-NSQIP patients undergoing instrumentation greater than 7 levels ASD between years 2005 2015. Preoperative were compared...

Abstract Introduction Peripheral nerve injuries are a leading cause of disability within the Military Health System (MHS) patient population. Many peripheral (PNIs) amenable to therapeutic intervention but require timely diagnosis and prompt referral specialty center capable intervention, as functional outcomes directly related duration between injury intervention. Even when appropriately identified, PNI management in MHS is often challenged by lack an established pathway for care...

Objective: To demonstrate the role of advanced orthoplastic techniques in harnessing full potential elective amputation as a functionally restorative procedure. Summary Background Data: Once considered unfortunate consequence failed reconstructive efforts, recent outcomes studies have prompted re-evaluation management complex extremity trauma. However, even is appropriately afforded greater consideration part algorithm, that are commonly utilized pursuit limb salvage rarely applied to...

This case demonstrates the successful attempt at a combined distal tibial turn-up plasty and intercalary calcaneal osteocutaneous fillet flap to increase functional limb length in order salvage transtibial amputation following high-energy blast injury.A is preferred over more proximal levels of because decreased energy expenditure that required for ambulation. In cases where there not enough viable tibia allow level amputation, combining with can be utilized optimize residual amputation.

Large soft tissue defects associated with major limb amputation pose a challenge to the reconstructive surgeon due 3-dimensional contour of residual and need withstand unnatural shear forces imparted by prosthetic sockets. Fasciocutaneous flaps based on circumflex scapular system have proven useful for coverage durability provided, absence functional morbidity, ease reelevation. A modified, bilobed flap design that incorporates large Burrow triangles into each serves leverage perforasome...

Mombell, Kyle MD; Perry, Nicholas Wade, Sean M. Fredericks, Donald Glassman, David Morrissey, Patrick MD Author Information

Objectives: In biomechanical studies, suture tapes have demonstrated improved load to failure and tissue tear-through for labral repair compared suture, suggesting that a tape construct in may reduce rates. However, clinical especially comparative, are lacking. The purpose of this study was 1) determine the rate recurrent instability at minimum 2-year follow-up shoulders with isolated anterior, posterior, or combined anterior posterior 2) compare survivability risk factors persistently...

Nonunions are a vexing problem for the orthopedic surgeon. Herein, we describe an adjunct to standard exchange nailing procedure adapted from established limb lengthening technique in which cortical vents drilled adjacent nonunion site. These transcortical drill tunnels facilitate local dispersion of osteogenic intramedullary reamings around site during nailing, whereby extruded serve as autograft nonunion. This simple adjunctive can increase likelihood achieving union when performed with...

Free functional gracilis transfer is a well-established technique for restoring active elbow flexion in brachial plexus injuries following delayed presentation or failed nerve reconstruction procedures. In cases of upper trunk injuries, the lower intraplexal median and ulnar nerves are spared, thereby making them available to reinnervate transferred gracilis. Therefore, we have inverted conventional free orientation so as orient flap's recipient closer proximity donor fascicles enable short,...

As the combat operational tempo of military conflicts in Iraq and Afghanistan has declined over last decade, there been a decrease number patients requiring acute limb salvage. In their place, growing population with persistent functional deficits, pain, inadequate soft tissue coverage stemming from prior salvage strategies have returned to our institution seeking revision surgery. Herein, we examine institution's evolving surgical approach extremity reconstruction 2011 through 2019,...

Abstract Introduction Prior to being largely abandoned due unacceptably high failure rates and the adverse physiologic reactions metal ions, metal-on-metal (MoM) total hip arthroplasty (THA) resurfacing (HR) were in widespread use throughout USA, potential benefit of decreased volumetric wear made it particular interest those who serve a young active population, such as military surgeons. The aim our study was determine revision rate on implants performed at institution obtain current...

Fredericks, Donald R. Jr MD*; Wade, Sean M. Pisano, Alfred J. Bharmal, Husain MD† Author Information

Wade, Sean M. MD; Clark, DesRaj Fredericks, Donald R. Jr Wagner, Scott C. MD Author Information

Primary closure of large flap donor sites is a well-recognized challenge for reconstructive surgeons. At our institution, we have implemented novel site strategy that enables single stage primary fasciocutaneous flaps while minimizing the morbidity, pain, and inconvenience associated with previously established techniques. This utilizes continuous external tissue expansion (CETE) device to offload tension from taut by generating progressive laxity in surrounding soft tissues over course...

A 30-year-old semiprofessional football player presented with chronic bilateral quadriceps tendon ruptures. Both ruptures were unsuitable for isolated primary repair because of retraction and immobility. novel reconstruction technique using semitendinosus gracilis autografts was performed to restore both lower extremities' disrupted extensor mechanisms. At the final follow-up, patient regained excellent motion knees returned high-intensity activity.Chronic present challenges related quality...

Wade, Sean M. MD; Fredericks, Donald R. Jr Slaven, E. Dingle, Marvin Wagner, Scott C. MD Author Information