|Thomas Thornhill, MD
Moderator: Thomas S. Thornhill, MD
|Lauren Adey, MD
||Philip Blazar, MD
Elbow Capsulectomy for Post-Traumatic Elbow Stiffness
Lauren Adey, MD
Advisor: David Ring, MD
Discussor: Philip Blazar, MD
Previous trauma remains the most common cause of elbow stiffness. Dr.
Adey evaluated the results of 46 patients who had undergone elbow capsulectomy
in order to examine if there were any factors predictive of outcome.
These patients were followed for an average of 48 months after capsular excision.
The average improvement in ulno-humeral motion was 58 degrees
and the average flexion arc was 103 degrees at final follow-up. Twenty-nine
percent of patients required a second capsular excision. Dr. Adey found that
pain and ulnar nerve dysfunction were more important determinants than
range of motion in overall function, as measured by the DASH and MEPI
Dr. Blazar commended Dr. Adey on addressing factors that may limit the
restoration of function and mobility after elbow capsulectomy. Dr. Blazar
highlighted the finding that thirty percent of patients required revision surgery.
He also noted that in these patients, symptoms related to ulnar nerve
dysfunction will improved over time. Overall, elbow capsulectomy is useful
to restore functional mobility in stiff elbows with limited arthrosis, although
more than one procedure may be needed.
|Brent Ponce, MD
||James Kasser, MD
Relationship Between Complications and Timing of Follow-up
After Closed Reduction and Percutaneous Pinning of Supracondylar Fractures
Brent Ponce, MD
Discussor: James Kasser, MD
Advisor: Peter Waters, MD
Up to 75% of pediatric fractures occur in the upper extremity, with supracondylar
fractures being the most common injury pattern. Over the past
several decades, there has been a shift from non-operative to surgical treatment
of displaced supracondylar fractures. Dr. Ponce retrospectively reviewed
complications from a consecutive case series of 104 displaced supracondylar
humerus fractures treated with closed reduction and percutaneous pinning
at Children’s Hospital, Boston. The purpose of Dr. Ponce’s study was to evaluate
the necessity of clinical and radiographic evaluation within 10 days of
closed reduction and percutaneous pinning. Group 1(52 patients) had initial
follow-up radiographs with 10 days and Group 2 (52 patients) had follow-up
radiographs after 10 days or at time of pin removal. The overall complication
rate was 7.7%. No association between late follow-up and complications was
identified. It was concluded that clinical and radiographic evaluation of displaced
supracondylar fractures requiring closed reduction and percutaneous
pinning can be safely delayed until time of pin removal.
Dr. Kasser commended Dr. Ponce for investigating the relationship
between follow-up and complications in an injury for which Children’s
Hospital manages approximately 250 cases per year. Dr. Kasser questioned
what 10-day follow-up may offer, when the primary decision point is the 3
week pin removal. In this investigation, no benefit or decrease in complications
was shown by clinical and radiological evaluation at 10 days.
|Eric Giza, MD
||Tammy Martin, MD
Part I: An Analysis of Injuries in the Women’s United Soccer Association
Part II: Implementation of a Prospective National Injury Registry for Professional Soccer
Eric Giza, MD
Discussor: Tammy Martin, MD
Advisor: Thomas Gill, MD
In Part I, Dr. Giza discussed his analysis of soccer injuries in the first two
years of the Women’s United Soccer Association (WUSA). In this preliminary
study, information on injuries was obtained from an insurance company
database and subsequently confirmed by team trainers. The overall injury
incidence rate was 1.93 injuries per 1000 player hours. The most common
location was the knee (31.8%), followed by the head (10.4%), ankle (9.3%),
and foot (9.3%). Of the head injuries, fractures of nasal and facial bones were
the most common, followed by concussions. More injuries occurred in the
latter portion of the season which may be related to deconditioning and
increased intensity during the playoffs.
In Part II, Dr. Giza reported on his work on implementing an injury
database for professional soccer, in an effort to prospectively study injuries
and improve the safety and health of professional athletes. The goals of this
database include improving the standard of medical record keeping for professional
soccer players, evaluating the effectiveness of current treatment
methods, and providing a large sample of epidemiological data.
Dr. Martin commended Dr. Giza on this preliminary study of injuries in
professional female soccer players. She raised the notion of under-reporting
of injuries by players and questioned whether the true incidence of injury can
be accurately obtained in order to institute an injury prevention program.
Interestingly, Dr. Martin noted that despite a lower injury rate compared
to the men’s MLS league, WUSA players still had a higher ACL injury rate.
Therefore, even with higher levels of training, the ACL injury rate in female
athletes remains higher than in males. Dr. Martin also expressed her concern
over the number of head injuries and encouraged efforts to monitor their
effects over time.
|James O'Holleran, MD
||Tom Gill, MD
Outcomes Assesment in the Shoulder
James O'Holleran, MD
Discussor: Tom Gill, MD
Advisor: Mininder Kocher, MD
Historically, outcomes after shoulder surgery have largely relied upon
physician-based assessments. Over the past decade, however, the importance
of patients' subjective evaluations of outcome has been recognized. In
Dr. O’Holleran's three-part study, he examined the determinants of patient
satisfaction after rotator cuff surgery and anterior instability surgery. He also
examined the reliability and validity of the American Shoulder and Elbow
Surgeons (ASES) shoulder score. Dr. O'Holleran found that the most robust
associations with patient satisfaction after rotator cuff repair and anterior
instability surgery and outcomes were related to subjective variables of symptoms
and function. Overall, most patients would have the surgery again and
most would recommend it to another. In the third part of Dr. O'Holleran’s
study, the ASES shoulder score demonstrated an acceptable psychometric
performance for outcomes assessment in patients with rotator cuff disease,
instability, and arthritis.
Dr. Gill commended Dr. O'Holleran on a timely and elegant study which
will contribute to the ongoing debate on outcome assessments. Historically,
patient satisfaction had rarely been addressed, but Dr. O'Holleran’s study
emphasizes the importance of patient-derived subjective assessments in
evaluating the outcomes of shoulder surgery.