Background:Previous studies investigating the windmill softball pitch have focused primarily on shoulder musculature and function, collecting limited data on elbow and forearm musculature. Little information is available in the literature regarding the forearm. This study documents forearm muscle electromyographic (EMG) activity that has not been previously published.Purpose:Elbow and upper extremity overuse injuries are on the rise in fast-pitch softball pitchers. This study attempts to describe forearm muscle activity in softball pitchers during the windmill softball pitch. Overuse injuries can be prevented if a better understanding of mechanics is defined.Study Design:Descriptive laboratory study.Methods:Surface EMG and high-speed videography was used to study forearm muscle activation patterns during the windmill softball pitch on 10 female collegiate-level pitchers. Maximum voluntary isometric contraction of each muscle was used as a normalizing value. Each subject was tested during a single laboratory session per pitcher. Data included peak muscle activation, average muscle activation, and time to peak activation for 6 pitch types: fastball, changeup, riseball, curveball, screwball, and dropball.Results:During the first 4 phases, muscle activity (seen as signal strength on the EMG recordings) was limited and static in nature. The greatest activation occurred in phases 5 and 6, with increased signal strength, evidence of stretch-shortening cycle, and different muscle characteristics with each pitch style. These 2 phases of the windmill pitch are where the arm is placed in the 6 o’clock position and then at release of the ball. The flexor carpi ulnaris signal strength was significantly greater than the other forearm flexors. Timing of phases 1 through 5 was successively shorter for each pitch. There was a secondary pattern of activation in the flexor carpi ulnaris in phase 4 for all pitches except the fastball and riseball.Conclusion:During the 6 pitches, the greatest muscular activity was in phases 5 and 6. Flexor carpi ulnaris activity was greatest among the muscles tested. The riseball had the highest peak activity, but the curveball and dropball had the highest average signal strength. This muscle activity correlates with increasing distraction in the elbow, suggesting that flexor muscles act to counterdistract the elbow as they do for the baseball pitch.Clinical Relevance:Windmill pitchers are unique among overhead athletes as they throw, on average, more pitches per overhead athlete. Understanding the mechanics and physiology of the elbow in windmill pitchers is crucial to prevention and treatment of these increasingly common elbow injuries. This study establishes baseline data that will be useful to further prevent windmill pitch elbow injury.

BackgroundThe goal of this study was to evaluate a new second generation of computer-assisted fluoroscopic navigation software for fracture reduction (SGFR) of long-bone fractures. The new software allows simultaneous tracking of two moving bone fragments. 2005--2007, patients with isolated, extra-articular longbone fracture of either the femur or tibia were considered for computer-assisted fluoroscopic fracture reduction surgery. The operative tasks were: (1) fracture reduction; (2) determination of the entry point, and; (3) Poller screw insertion, when needed. Fracture reduction was achieved by one of two methods: (1) fracture edges or (2) medullary canal recognition. Fracture reduction was considered successful if the guide wire was introduced through the fracture without further radiation. Methods Between ResultsWe treated 38 patients (27 men and 11 women); with 15 femoral and 23 tibial fractures, with intramedullary nail fixation. In all patients, the point of entry was navigated successfully. In four patients, the insertion of the blocking screw was planned and executed without further radiation. All fractures were successfully reduced using the SGFR system. In nine patients, we used method 1, in 22 patients method 2, and in six a combination of both. The number of fluoroscopic images was dramatically reduced to four to six images. ConclusionsFracture reduction was reliably achievable in all patients using the SGFR. A key conclusion is that only a small number of fluoroscopic images are required. Although timing was not an objective of this study, we believe that there was a noticeable reduction of intraoperative time.

Bilateral tibiofemoral knee dislocations are a relatively rare injury, and there is a scarcity of literature on its appropriate evaluation and treatment. Even less knee dislocations with concomitant popliteal artery injury have been described. Postoperative graft occlusion accounts for approximately half of the overall complication rate, occurring in up to 18% of the patients undergoing femoropopliteal bypass grafting. Furthermore, anticoagulation and antiplatelet therapy after graft placement is a point of contention. Here, we describe a case of a knee dislocation with associated popliteal artery transection treated initially with successful knee-spanning external fixation and arterial grafting, respectively. At 6 weeks after injury, the patient underwent external fixation removal and closed manipulation of the knee for arthrofibrosis. After manipulation, yet still under anesthesia, distal pulses were acutely diminished and subsequent CTA demonstrated femoropopliteal graft thrombosis. This case demonstrates successful recognition, thrombectomy, and restoration of arterial blood flow, which has since been maintained. Written consent by the patient involved in this case report was obtained.T ibiofemoral knee dislocations (KDs) are rare, so recognition and treatment of associated arterial injury can be difficult. [1][2][3][4] In addition, no gold standard for treating these concomitant orthopaedic and arterial injuries has been defined. 5 KDs are reported as less than 0.02% of all orthopaedic injuries. 6 Although there have been reported cases of bilateral KDs, there have been even fewer KDs with a concomitant popliteal artery injury. [1][2][3][4] In 2018, Moura et al 6 described a case of bilateral KDs with associated bilateral popliteal artery injuries, which was the first reported case at the time. A case series of two patients who required popliteal artery grafts after unilateral KDs reported limb survival; in their literature review, they found both a lower proportion of concomitant vascular injury with KDs and an even lower proportion that undergo surgical treatment than previously reported. 7 Zachary W. Fulton, DO