Acute idiopathic sudden sensorineural hearing loss (ISSNHL) following lumbar spinal surgery is an exceedingly rare phenomenon. This paper presents a case of ISSNHL presenting acutely after lumbar spine decompression and fusion treated with transtympanic steroids and hyperbaric oxygen (HBO2) therapy. It also presents the ironic case of SSNHL secondary to presumed viral pathology sustained by the patient’s operative surgeon who was treated with transtympanic steroids and HBO2 as well. Proposed etiologies of the patient’s ISSNHL include: hypo- tension, prone operative position, malfitted/malpositioned headrest, microemboli from a cell-saver, and nitrous oxide anesthesia. The role of systemic hypotension as an etiology of ISSNHL is discussed given the fact that there are no reported cases of ISSNHL in orthopedic procedures performed with permissive hypotension. The initiation of steroids and HBO2 therapy has been shown to be an effective treatment for ISSNHL when started within 14 days of symptom onset. HBO2 and transtympanic steroids were initiated 10 days earlier in the operative surgeon, which showed to be a better treatment modality compared to the postoperative patient. ISSNHL in the acute postoperative period of lumbar spinal fusion surgery presents a unique treatment dilemma because systemic steroids are routinely avoided over concerns of pseudarthrosis. Of the seven documented cases of ISSNHL following lumbar spine surgery, none underwent HBO2 as a treatment modality.

A partial triceps tendon tear is an uncommon injury. Even rarer is a bilateral partial triceps tendon tear in which there has been one documented case. This case report illustrates a 37-yr-old African-American male who sustained non-simultaneous bilateral partial triceps tendon avulsions. He sustained a traumatic right partial triceps tendon avulsion after a fall onto an outstretched right arm that required operative repair after failure of conservative treatment. Five months later, he sustained a similar injury after falling on an outstretched left arm that was repaired 9 d later. His post-operative courses were uncomplicated. He returned to full duty at his 6 mo and remained symptom free at 12 mo. The case demonstrates that operative treatment of partial triceps tendon avulsions using bone tunnels yields good outcomes in high-demand patients who have failed conservative treatment and who have had an operative repair of the contralateral extremity.

Introduction The purpose of this study to analyze the financial impact of choosing a civilian or military orthopedic surgery career. It will examine the most common scenarios to become an orthopedic surgeon in the Navy Health Professions Scholarship Program to include becoming a flight surgeon. To the authors’ knowledge, there is no peer-reviewed literature that financially analyzes the most common scenarios for a Navy Health Professions Scholarship Program scholarship recipient to become an orthopedic surgeon. Materials and Methods Salaries for Navy orthopedic surgeons, residents, and flight surgeons were recorded using the 2020 Defense Finance and Accounting Service pay tables and Navy Fiscal Year 2019 Medical Corps Special Pay Guidance. The median income of civilian orthopedic surgeons was recorded using Salary.com. The present value (PV) and future value (FV) were calculated using the Consumer Price Index-U and average Department of Defense pay increases over the past 20 years. Six common scenarios were utilized to calculate the PV and FV of civilian compared to Navy orthopedic surgeons. Results The two highest earning net FVs among all Navy scenarios were those surgeons who kept their Navy tour to 5 years or less (flight surgeon tour/separate or civilian deferment/separate). The civilian throughout scenario had the highest net FV of $19,974,673 after retiring at the age of 65. Flight surgeon tour/separate and civilian deferment/separate scenarios only made $843,751 and $1,401,630 less respectively than a pure civilian career due to the tax shelter afforded by the military pay. All Navy retirement scenarios to include Navy throughout, civilian deferment/Navy throughout, flight surgeon tour/Navy throughout resulted in a net FV less than $17,700,000. Civilian residency/deferment and retiring in the Navy had the worst net FV among all scenarios. Conclusions It was found that the shorter tours in the Navy had a higher net FV than those who made the Navy a career in orthopedic surgery. Flight surgery is a rewarding operational experience with among the highest net FV among Navy scenarios and is only slightly less than the net FV of a pure civilian career. However, it can be more difficult to apply for civilian orthopedic surgery after serving a flight surgeon tour. Lastly, the net FV was very similar between a civilian orthopedic surgeon career and the shorter tours served in the Navy. Factors such as higher civilian income with associated loan repayment/signing bonuses makes the civilian orthopedic surgery route the best financial option. This study will help those medical students considering a military versus a civilian career in orthopedic surgery and aid in Department of Defense recruitment/retention.

Background: Ulnar collateral ligament (UCL) tears in the throwing elbow are classified according to grade and location using magnetic resonance arthrography (MRA). However, the frequency of each tear type and the association to age, competition level, and radiographic findings in adolescent baseball pitchers are unknown. Purposes: The primary purpose of this study was to use MRA to characterize the severity, location, and UCL tear type in adolescent pitchers. The second aim was to describe the relationship between the UCL tear type and age, competition level, and plain radiographic findings. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Records of adolescent pitchers with a UCL tear treated by the senior author between 2007 and 2016 were retrospectively reviewed. MRA scans were reviewed and tears were classified according to the Joyner-Andrews classification. Low-grade partial tears are classified as type I, high-grade partial tears as type II, complete full-thickness tears as type III, and tear pathology in >1 region in the UCL as type IV. Each type of tear also has a location designated at the midsubstance, ulna (U), or humerus (H). Patient characteristics, competition level, and associated plain radiographic abnormalities were recorded. Univariate analyses were performed to examine the relationships between tear types and age, competition level, and plain radiographic findings. Results: A total of 200 adolescent pitchers (mean ± SD age, 17.2 ± 1.5 years) with MRA scans were reviewed. Type II-H (n = 62), type II-U (n = 51), and type III-U (n = 28) were the most common tear types observed. Type II tears comprised 64.5% of adolescent UCL tears, with type II-H being the most common. Plain radiographs were abnormal in 32% of patients, with calcifications (10.5%) and olecranon osteophytes (12.5%) being the most common findings. There were no significant relationships between tear type and age ( P = .25), competition level ( P = .23), or radiographic abnormalities ( P = .75). Conclusion: Humeral-sided high-grade partial tears were the most common tear type in adolescent pitchers. There was no relationship between UCL tear type and age competition level, and plain radiographic abnormalities.