Osteolysis of the distal clavicle was originally described as a sequela of acute trauma to the shoulder by Dupas et al. in 1936.~ It can been seen after a contusion to the shoulder, a clavicle fracture, or an acromioclavicular joint dislocation. The condition can also result from participation in contact sports such as football,6 rugby,4 hockey,' and judo,9 but it most commonly follows a fall or motor vehicle accident. In 1959, Ehricht3 first reported the occurrence of osteolysis without an acute traumatic event. He attributed the osteolysis of the distal clavicle in an air hammer operator to repetitive microtrauma. Since then about 100 cases of &dquo;stress&dquo;-induced osteolysis of the distal clavicle have been reported. Most of these patients have been weight lifters. Cahilll reported the largest series in 1982. He described 46 male patients with osteolysis of the distal clavicle, 45 of whom were weight lifters. To our knowledge, there has not been a report in the orthopaedic literature of a female weight lifter with osteolysis of the distal clavicle. We will describe the first such case. CASE REPORTA 27-year-old healthy policewoman who was a competitive body builder presented to us complaining of 4 to 6 weeks of pain and swelling localized to her right acromioclavicular joint. She claimed that the pain was exacerbated by weight lifting, particularly bench presses. She denied pain in any other bone or joint, or a history of any systemic illness.Her physical examination revealed her to be a robust, well-developed woman with tenderness and swelling over the right acromioclavicular joint. She had full painless range of motion of the right shoulder and no evidence of rotator cuff lesions or shoulder instability. Radiographs on initial presentation showed mild resorption of the distal right clavicle and widening of the acromioclavicular joint (Fig. 1). She was initially treated with ice, antiinflammatory medications, and cessation of weight lifting.She returned for followup 1 month later, claiming that her symptoms had improved but that once she stopped taking the medication, her symptoms recurred. On this visit she was given an injection of steroid and xylocaine into the right acromioclavicular joint. The patient experienced relief of her pain from the injection and resumed weight lifting and body building. Three months later the pain and swelling in her right acromioclavicular joint returned. Bone scintigraphy at this time showed asymmetric increased uptake in the right acromioclavicular joint, consistent with osteolysis of the distal clavicle (Fig. 2). Serum electrolytes, including calcium and phosphate, were within normal limits. The patient was advised that her symptoms would likely improve if she stopped weight lifting, but that if she desired to continue training, the treatment of choice would be excision of her right distal clavicle. She wished to continue body building and weight lifting and therefore underwent resection arthroplasty of her right distal clavicle.Microscopic examination of the surgical sp...

Venous thromboembolism (VTE) is a serious and predictable complication following arthroplasty. It has been recognized that a strategy utilizing individualized anticoagulation choices based on patient risk stratification results in improved patient outcomes. A 2013 version of the Caprini Risk Score has previously been validated for use in total joint arthroplasty. A Caprini score of 10 or greater assesses the patient as “high risk” while 9 or less is considered “low risk.” Patients scored as “low risk” for postoperative VTE receive enteric coated aspirin 81 mg twice a day for 6 weeks. Patients scored as “high risk” for VTE are prescribed apixaban. This retrospective cohort study was conducted to assess the safety and efficacy of the thromboprophylaxis treatment prescribed based on a standardized risk assessment protocol for the calendar year 2020. Patients having total hip arthroplasty, total knee arthroplasty, revision total hip arthroplasty, revision total knee arthroplasty, or bilateral arthroplasties by 13 surgeons (N = 873) were reviewed. Patients were risk assessed using the Caprini Risk Score and thromboprophylaxis was prescribed based on the score obtained. The annual rate of VTE was 0.2%. The Caprini Risk Score is an effective approach to individualize thromboprophylaxis choices after total joint arthroplasty.

Two of the more common potential complications after arthroplasty are venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolus (PE), and excess bleeding. Appropriate chemoprophylaxis choices are essential to prevent some of these adverse events and from exacerbating others. Risk stratification to prescribe safe and effective medications in the prevention of postoperative VTE has shown benefit in this regard. The Department of Orthopaedic Surgery at Syosset Hospital/Northwell Health, which performs over 1200 arthroplasties annually, has validated and is using the 2013 version of the Caprini Risk Assessment Model (RAM) to stratify each patient for risk of postoperative VTE. This tool results in a culling of information, past and present, personal and familial, that provides a truly thorough evaluation of the patient’s risk for postoperative VTE. The Caprini score then guides the medication choices for thromboprophylaxis. The Caprini score is only valuable if the data is properly collected, and we have learned numerous lessons after applying it for 18 months. Risk stratification requires practice and experience to achieve expertise in perioperative patient evaluation. Having access to pertinent patient information, while gaining proficiency in completing the Caprini RAM, is vital to its efficacy. Ongoing, real time analyses of patient outcomes, with subsequent change in process, is key to improving patient care.