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The diagnosis and treatment of gunshot injuries requires an understanding of the trajectory of the bullet in each individual case. The majority of gunshot wounds present with easily understandable trajectories resulting in a concise, stream-lined work-up. Occasionally, the initial work-up may reveal a trajectory that is atypical. This can be due to internal bullet deflection, bullet embolism, or bullets that traverse multiple body cavities. Here we present the case of a gentleman who was shot in the left posterior chest, with the bullet ultimately lying-in profile with the patient's pituitary gland. The patient suffered injuries to his left lung, left internal jugular vein, and right optic nerve. On hospital day 1, he required neurosurgical operative intervention for increased somnolence and computed tomography findings which revealed tension pneumocephalus. On hospital day 15, he was discharged home after making a full recovery with the exception of continued blindness in the right eye. Gunshot wounds involving multiple body cavities can increase the complexity of a patient's injury pattern and require increased vigilance and complete history, physical examination, and imaging to ensure optimal outcomes.Blunt civilian perineal laceration with anorectal avulsion is rare and usually associated with severe pelvic trauma. The principles of management of these injuries consist of repair of the laceration (primarily or secondary), diversion of fecal stream, and presacral drainage of the wound. Unnecessary diversion of fecal stream may add complications and increases patient's morbidity. We report a case of severe blunt traumatic perineal laceration associated with partially avulsed anus which was managed without colostomy. The wound healed completely with preserved anal sphincter function. To our knowledge, no similar cases of anal avulsion were treated without diversion of the fecal stream in the English literature.Proximal humerus fractures are common and approximately 20% of displaced fractures may benefit from surgery. A lack of medial support is found to be a predictor of failure after surgical fixation of proximal humerus fractures. The optimal technique for restoring the medial hinge is unclear. We describe two cases of patients with a dislocated 4-part humerus fracture treated with a locking plate and an additional small intramedullary plate to support the medial hinge. This technique is simple and allows for an enhanced stability of the medial hinge during and after surgery.<br />Patient reported outcome measures are often used in medical research to evaluate symptoms and functional status in patients. The Boston Carpal Tunnel Questionnaire is specifically designed to evaluate functional status and symptom severity in patients with Carpal Tunnel Syndrome. The aim of this study was to validate and examine the measurement properties of the Functional Status Scale and Symptom Severity Scale from the Danish translated Boston Carpal Tunnel Questionnaire.<br />We analyzed 88 prospectively enrolled patients in the validity and responsiveness group and 31 prospectively enrolled patients in the reliability group. Patients in the validity and responsiveness group answered the Quick Disabilities of the Arm, Shoulder and Hand Questionnaire and the Danish translated Boston Carpal Tunnel Questionnaire preoperatively and after surgery. Patients in the responsiveness group answered the same questionnaire two times prior to surgery.<br />Responsiveness of the two subscales were high (Effect Size 0.99/1.76; Standardized Response Mean 0.86/1.50). Correlation to the Danish validated QuickDASH was high (rho 0.75/0.89). Test-retest reliability was high (ICC 0.94/0.90) and the internal consistency was high (Cronbach's alpha 0.93/0.92).<br />Our study shows satisfactory results of both subscales of the Danish translated Boston Carpal Tunnel Questionnaire. This makes it highly useful when conducting research on patients with Carpal Tunnel Syndrome.<br />The Danish Data Protection Agency jr. nr. 2007-58-0010.<br />The Danish Data Protection Agency jr. nr. 2007-58-0010.•Abrikossoff tumor is a rare tumor but not always benign.•Re-excission for positive margins in benign tumors may not be invariably necessary.•Cosmetic issues may play role in the treatment and follow-up in benign tumors.<br />The introduction of robotic technologies into the field of arthroplasty ushered in promises of increased precision and superior outcomes over conventional methods. However, the effect on outcomes in total hip arthroplasty (THA) remains debatable, particularly when considering the additional financial burden created by the addition of robotics. The purpose of this study is to examine total cost of care, length of stay (LOS), and postoperative complications in robotic-assisted vs conventional THA recipients.<br />A retrospective review of the Mariner database was performed within PearlDiver Technologies for patients undergoing THA from 2010 to 2018 (n= 714,859). Patients with robotic-assisted procedures were matched with patients undergoing conventional THA at a 11 ratio based on age, sex, Charlson Comorbidity Index, smoking, and obesity status (n= 4630). LOS, total cost of care, readmission rates, and medical and surgical outcomes were examined.<br />Robotic-assisted patients had shorter average LOS (3.4 vs 3.7 days,<br />= .001). The mean cost for robotic-assisted patients was $1684 and $1759 less at 90 days and 1 year, respectively (both<br />= .001). Readmission rates were higher for robotic-assisted patients at 1 year (7.8 vs 6.6%;<br />= .001), while surgical outcomes were not significantly different at all timepoints (all<br />&gt; .498). Robotic-assisted patients demonstrated significantly higher blood transfusion rates (4.4 vs 3.2%;<br />= .001).<br />Robotic-assisted THA was associated with minimal decreases in LOS and costs as compared to conventional methods. However, robotics was associated with slightly higher readmissions and blood transfusions.<br />Robotic-assisted THA was associated with minimal decreases in LOS and costs as compared to conventional methods. However, robotics was associated with slightly higher readmissions and blood transfusions.Recent advancements in computer-assisted surgery have led to a renewed interest in robotic-assisted hip arthroplasty. This technology assists with component position which is especially useful in prior trauma or dysplasia cases. We present a case of a surgical hip fusion conversion to total hip arthroplasty with the use of robotic-assisted technology. Enhanced preoperative planning with the ability to manipulate implant position before execution can be invaluable during complex procedures. Further research is warranted before revision cases using computerized navigation systems becomes more prevalent.<br />Limb salvage procedures have become more prevalent in orthopedic oncology. Endoprostheses have been used successfully to reconstruct large skeletal deficits. The aim was to review intermediate to long-term follow-up of distal femoral replacements in the setting of neoplastic disease about the knee.<br />This was a single-center retrospective cohort study from 1997 to 2018 in a national referral center for oncology. The secondary objectives were to describe morbidity and mortality in this cohort. We recorded the modes of failure using Henderson classification system, complications, revisions, and all further operations.<br />Seventy-two distal femoral replacements were performed. Osteosarcoma was the most common indication (55 patients). Other indications included chondrosarcoma (7 patients), giant cell tumor (5 patients), Ewing's sarcoma (2 patients), metastatic spread (2 patients), and leiomyosarcoma (1 patient). One-year mortality was 1.38% with an overall mortality of 13.8%, at the end of the study period. The 1-year revision rate was 4.2%, 30.5% for 10 years, and 38.8% for more than 15 years. The overall implant survival rate was 63.8%. The most common reasons for failure included aseptic loosening (16.6%), infection (16.6%), and local recurrence (9.7%) with an amputation rate of 6.9% in the cohort.<br />Neoplastic disease of the lower limb is associated with significant morbidity. Aseptic loosening (16.6%) and infection (16.6%) were the most common reasons for failure in this cohort.<br />Neoplastic disease of the lower limb is associated with significant morbidity. Aseptic loosening (16.6%) and infection (16.6%) were the most common reasons for failure in this cohort.<br />Optimal pain management is key to successful recovery in revision total hip arthroplasty. Lumbar plexus blocks (LPBs) have traditionally been used for postoperative pain management. Recently, the lumbar erector spinae plane block (LESPB) has emerged as a promising regional anesthesia technique and is relatively simple to perform. Our study aimed to evaluate whether continuous LESPB provided better analgesia and clinical outcomes than continuous LPB in revision hip arthroplasty.<br />We compared 25 LPBs with 25 LESPBs performed from October 2017 to November 2018 for revision hip arthroplasty. The primary outcome of this study was difference in opioid consumption between the groups at 24 hours postoperatively. [https://www.selleckchem.com/products/Perifosine.html learn more] Secondary outcomes include pain scores, hospital lengths of stay, pain adjunct consumption, and incidence of postoperative nausea and vomiting.<br />There was no significant difference in average opioid consumption between the LPB and LESPB groups during the first 24 hours postoperatively (73.8 ± 68.1 mg vs 85.1 ± 69.7 mg, respectively,<br />= .57). Similarly, there was no significant difference in average pain scores (3.3 ± 2.1 vs 3.7 ± 1.8, respectively,<br />= .42).<br />There was no significant difference in opioid consumption and pain scores in patients with continuous LESPB compared with those with continuous LPB. While our study did not show a difference in these outcomes, the LESPB is a straightforward regional block that avoids many of the risks of LPBs and may be as effective for pain control.<br />There was no significant difference in opioid consumption and pain scores in patients with continuous LESPB compared with those with continuous LPB. While our study did not show a difference in these outcomes, the LESPB is a straightforward regional block that avoids many of the risks of LPBs and may be as effective for pain control.<br />This study compares postoperative pain scores and functional outcomes between liposomal bupivacaine peri-articular injection (LB-PAI) vs a single-shot adductor canal block (ACB) using bupivacaine HCl in patients undergoing primary total knee arthroplasty (TKA).<br />This is a randomized controlled trial of 56 patients who were treated with TKA for arthritis. Patients were randomized to receive an intraoperative LB-PAI (n= 27) or preoperative ACB using bupivacaine HCl (n= 29). Both groups were otherwise given our institutional standard multimodal pain protocol. Data on Visual Analog Scale (VAS) pain scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, knee range of motion, postoperative ambulation distance, hospital length of stay, and opioid use were collected. The total cost of each intervention was compared at the conclusion of the study.<br />Age, gender, or body mass index was similar between groups. Compared to the ACB group, the LB-PAI group trended to lower average VAS pain scores on postoperative days 0, 1, and 2 (average difference [95% confidence interval]=-0.