{"title":"New variant of terrible triad injury in a pediatric patient: a case report","authors":"Farid Najd Mazhar, Alireza Mirzaei, Hooman Shariatzadeh, Danial Hosseinzadeh","doi":"10.1097/bco.0000000000001222","DOIUrl":"https://doi.org/10.1097/bco.0000000000001222","url":null,"abstract":"","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42751734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-30DOI: 10.1097/bco.0000000000001221
Kyle Martin, Robert A. Magnussen, Nicholas Pappa, Alex C. DiBartola, Robert A. Duerr, Christopher C. Kaeding, David C. Flanigan
Background: There are few studies assessing the impact of age at time of surgery on meniscus repair failure risk and patient-reported outcome scores. We sought to determine whether age at time of meniscus repair surgery affects failure risk and patient-reported outcome scores. Methods: Patients who underwent meniscus repair during 2006-2013 were evaluated for meniscus repair failure and patient-reported outcome scores using the Knee Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score, and Marx Activity score at mean follow-up 6.5±2.0 yr post-operative. A multivariable linear regression analysis was used to assess the influence of patient age on patient-reported outcome scores following meniscus repair. Results: A total of 170 patients with mean age 27.8±10.1 yr (59% male) were identified, including 29 patients age 18 and younger and 141 patients over 18. Increasing patient age was associated with significantly lower IKDC (P=0.027), KOOS-ADL (P=0.003), and Marx activity scores (P<0.001). Repair failure occurred in 46 patients (27.1%) overall, including 7 failures (24.1%) in patients 18 and under and 39 failures (27.7%) in patients over 18. The logistic regression analysis demonstrated no association between age and meniscus repair failure risk when controlled for ACL reconstruction and BMI (P=0.69). Conclusion: Increased age is associated with poorer IKDC, KOOS-ADL, and Marx Activity scores following meniscus repair. However, there is no difference in failure of healing of meniscus repair between adolescent patients and adults. Level of Evidence: III
{"title":"Comparison of failure risk and outcome scores following meniscus repair among adolescent and adult patients","authors":"Kyle Martin, Robert A. Magnussen, Nicholas Pappa, Alex C. DiBartola, Robert A. Duerr, Christopher C. Kaeding, David C. Flanigan","doi":"10.1097/bco.0000000000001221","DOIUrl":"https://doi.org/10.1097/bco.0000000000001221","url":null,"abstract":"Background: There are few studies assessing the impact of age at time of surgery on meniscus repair failure risk and patient-reported outcome scores. We sought to determine whether age at time of meniscus repair surgery affects failure risk and patient-reported outcome scores. Methods: Patients who underwent meniscus repair during 2006-2013 were evaluated for meniscus repair failure and patient-reported outcome scores using the Knee Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score, and Marx Activity score at mean follow-up 6.5±2.0 yr post-operative. A multivariable linear regression analysis was used to assess the influence of patient age on patient-reported outcome scores following meniscus repair. Results: A total of 170 patients with mean age 27.8±10.1 yr (59% male) were identified, including 29 patients age 18 and younger and 141 patients over 18. Increasing patient age was associated with significantly lower IKDC (P=0.027), KOOS-ADL (P=0.003), and Marx activity scores (P<0.001). Repair failure occurred in 46 patients (27.1%) overall, including 7 failures (24.1%) in patients 18 and under and 39 failures (27.7%) in patients over 18. The logistic regression analysis demonstrated no association between age and meniscus repair failure risk when controlled for ACL reconstruction and BMI (P=0.69). Conclusion: Increased age is associated with poorer IKDC, KOOS-ADL, and Marx Activity scores following meniscus repair. However, there is no difference in failure of healing of meniscus repair between adolescent patients and adults. Level of Evidence: III","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135643178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-23DOI: 10.1097/BCO.0000000000001211
Mark F. Megerian, Gregory V. Schimizzi, Tyler J. Uppstrom, Karthik Nathan, C. Klinger, Dan Dziadosz, W. Ricci, S. Campbell
Background: Distal anterior cortical perforation is 1 complication of antegrade femoral nailing. The effect of greater trochanteric (GT) starting points on cortical perforation risk has not been described in human femoral models. This study assessed the influence of sagittal plane starting point on rate of anterior cortical perforation using 3D CT-reconstructions of human femora. Secondarily, patient age and nail radius of curvature (ROC) were assessed as risk factors. Methods: CT scans of 53 patients (18 non-geriatric (<65 yr), 35 geriatric (>65 yr)) with non-fractured femora were converted into dynamic 3D-reconstructed renderings. Medullary nails from two manufacturers that differed in ROC were digitally templated in each femur from an anterior, central, and posterior ⅓ GT starting point. The rate of anterior cortical perforation and distance from the inner anterior cortex to the nail tip were recorded. Results: Perforation rate increased significantly as starting point moved from anterior (6%), to central (43%), to posterior (79%) regardless of patient age or implant manufacturer (P<0.001). On average, an anterior starting point positioned the nail tip furthest from the inner anterior cortex (5. mm), safely within the canal (P<0.001). Perforation rate was significantly increased in the geriatric versus non-geriatric population (47% vs. 34%) (P=0.028), and when using the nail with the larger versus smaller ROC (50% vs. 36%) (P=0.03). Conclusion: Distal nail sagittal alignment is sensitive to both patient and treatment factors. A posterior starting point, increased age (>65 yr), and increased implant ROC significantly increase risk for anterior cortical perforation of the distal femur. Level of Evidence: III
{"title":"Influence of greater trochanteric starting point on distal anterior cortical perforation during antegrade femoral nailing","authors":"Mark F. Megerian, Gregory V. Schimizzi, Tyler J. Uppstrom, Karthik Nathan, C. Klinger, Dan Dziadosz, W. Ricci, S. Campbell","doi":"10.1097/BCO.0000000000001211","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001211","url":null,"abstract":"Background: Distal anterior cortical perforation is 1 complication of antegrade femoral nailing. The effect of greater trochanteric (GT) starting points on cortical perforation risk has not been described in human femoral models. This study assessed the influence of sagittal plane starting point on rate of anterior cortical perforation using 3D CT-reconstructions of human femora. Secondarily, patient age and nail radius of curvature (ROC) were assessed as risk factors. Methods: CT scans of 53 patients (18 non-geriatric (<65 yr), 35 geriatric (>65 yr)) with non-fractured femora were converted into dynamic 3D-reconstructed renderings. Medullary nails from two manufacturers that differed in ROC were digitally templated in each femur from an anterior, central, and posterior ⅓ GT starting point. The rate of anterior cortical perforation and distance from the inner anterior cortex to the nail tip were recorded. Results: Perforation rate increased significantly as starting point moved from anterior (6%), to central (43%), to posterior (79%) regardless of patient age or implant manufacturer (P<0.001). On average, an anterior starting point positioned the nail tip furthest from the inner anterior cortex (5. mm), safely within the canal (P<0.001). Perforation rate was significantly increased in the geriatric versus non-geriatric population (47% vs. 34%) (P=0.028), and when using the nail with the larger versus smaller ROC (50% vs. 36%) (P=0.03). Conclusion: Distal nail sagittal alignment is sensitive to both patient and treatment factors. A posterior starting point, increased age (>65 yr), and increased implant ROC significantly increase risk for anterior cortical perforation of the distal femur. Level of Evidence: III","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"194 - 200"},"PeriodicalIF":0.3,"publicationDate":"2023-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42256981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-16DOI: 10.1097/BCO.0000000000001206
Safoora Ebadi, Yousef Karimzad, Negar Aflakian, B. Forogh, K. Mansoori, A. Babaei-Ghazani
Background: Rotator cuff tendinopathy is the most common cause of painful shoulder. There is evidence supporting the use of extracorporeal shock wave therapy (ESWT) in the rotator cuff calcific tendinopathy, but evidence supporting its use in non-calcifying tendinopathy is lacking. The current study aimed to compare the clinical effectiveness of corticosteroid injections versus ESWT until 3 mo of follow-up for the management of painful non-calcific rotator cuff tendinopathies. Methods: A total of 33 patients affected by painful rotator cuff tendinopathy were randomly divided into 2 groups of 16 and 17 cases. The first group received corticosteroid injection under ultrasound guidance and the second group received three sessions of shockwave within 3 consecutive weeks consisted of 2000 pulse energy, 5 Hz frequency, and pressure of 4 bar using a radial shock wave device. Two outcome measures of VAS and Quick-DASH were obtained to evaluate patients before treatment, and 2 and 12 wk after treatment. Discussion: Regarding both VAS and the score of the Quick-DASH questionnaire, no statistically significant difference was observed between these 2 therapeutic interventions (ultrasound-guided corticosteroid injection and shockwave). Both interventions reduced the patient’s pain to the same extent (P-value=0.955 for VAS, and P-value=0.865 for Quick DASH questionnaire score). Moreover, within-group changes showed that both groups’ improvements were significant in the time intervals of 1 to 2 and 1 to 3. Conclusions: Corticosteroid injection and radial shockwave, both can be effective to the same extent in reducing pain and improving function in non-calcific shoulder tendinopathy. Level of Evidence: Level I.
{"title":"Extracorporeal shockwaves therapy versus corticosteroid injection for the treatment of non-calcific rotator cuff tendinopathies: a randomized trial","authors":"Safoora Ebadi, Yousef Karimzad, Negar Aflakian, B. Forogh, K. Mansoori, A. Babaei-Ghazani","doi":"10.1097/BCO.0000000000001206","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001206","url":null,"abstract":"Background: Rotator cuff tendinopathy is the most common cause of painful shoulder. There is evidence supporting the use of extracorporeal shock wave therapy (ESWT) in the rotator cuff calcific tendinopathy, but evidence supporting its use in non-calcifying tendinopathy is lacking. The current study aimed to compare the clinical effectiveness of corticosteroid injections versus ESWT until 3 mo of follow-up for the management of painful non-calcific rotator cuff tendinopathies. Methods: A total of 33 patients affected by painful rotator cuff tendinopathy were randomly divided into 2 groups of 16 and 17 cases. The first group received corticosteroid injection under ultrasound guidance and the second group received three sessions of shockwave within 3 consecutive weeks consisted of 2000 pulse energy, 5 Hz frequency, and pressure of 4 bar using a radial shock wave device. Two outcome measures of VAS and Quick-DASH were obtained to evaluate patients before treatment, and 2 and 12 wk after treatment. Discussion: Regarding both VAS and the score of the Quick-DASH questionnaire, no statistically significant difference was observed between these 2 therapeutic interventions (ultrasound-guided corticosteroid injection and shockwave). Both interventions reduced the patient’s pain to the same extent (P-value=0.955 for VAS, and P-value=0.865 for Quick DASH questionnaire score). Moreover, within-group changes showed that both groups’ improvements were significant in the time intervals of 1 to 2 and 1 to 3. Conclusions: Corticosteroid injection and radial shockwave, both can be effective to the same extent in reducing pain and improving function in non-calcific shoulder tendinopathy. Level of Evidence: Level I.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"185 - 190"},"PeriodicalIF":0.3,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42893366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-15DOI: 10.1097/BCO.0000000000001217
N. Wilson, A. Litsky, C. Iobst
Background: Guided growth using the eight-plate is the most common method to correct angular deformities in children. We compared the properties of four plate constructs (two-hole guided-growth plates, four-hole guided-growth plates, locking guided-growth plates, and one-third tubular plates) using a three-point bending model. Methods: A three-point bending model was constructed to test strength of four plates. An osteotomy was made in a Sawbones Cylinder. The plate was then fixed across the osteotomy site using the appropriate screws designed for the plate. A 5 N preload was applied, and a linearly applied force was applied under displacement control. Constructs were loaded to failure. Results: For an angular correction of 8.5 degrees, the four-hole guided-growth plates required the most force (40.9 N) followed by two-hole guided-growth plates (36.6 N). Locking plates and one-third tubular plates required less force to achieve the same correction (28.0 N and 23.0 N P<0.001), respectively. The four-hole plate was the stiffest construct (1.87 N/mm). Load to failure for the four-hole plates (46.0 N), two-hole plates (42.8 N). locking plates (32.1 N), and one-third tubular plates (25.5 P<0.001) followed similar trends as the force required for angular correction, with the four-hole plate requiring the most force. Conclusions: Despite the addition of two extra screws in the four-hole plate, this construct was only 10% stiffer than the two-hole plate. There is limited benefit to the use of a four-hole plate over a two-hole plate. The one-third tubular plate had the lowest load to failure of the four tested constructs. Level of Evidence: NA (biomechanical)
背景：八夹板引导生长是矫正儿童角畸形最常见的方法。我们使用三点弯曲模型比较了四种板结构（两孔导向生长板、四孔导向生长盘、锁定导向生长板和三分之一管状板）的性能。方法：建立三点弯曲模型，对四块钢板进行强度测试。在Sawbones圆柱体中进行了截骨术。然后使用为钢板设计的合适螺钉将钢板固定在截骨部位。施加5N的预载荷，并且在位移控制下施加线性施加的力。构造加载失败。结果：对于8.5度的角度校正，四个孔引导生长板需要最大的力（40.9N），其次是两个孔引导的生长板（36.6N）。锁定板和三分之一管状板需要较小的力来实现相同的校正（分别为28.0 N和23.0 N P<0.001）。四孔板是最硬的结构（1.87N/mm）。四孔板（46.0 N）、两孔板（42.8 N）的失效荷载。锁定板（32.1N）和三分之一管状板（25.5P＜0.001）遵循与角度校正所需力相似的趋势，其中四孔板需要最大的力。结论：尽管在四孔板中增加了两个额外的螺钉，但这种结构的刚度仅比两孔板高10%。与双孔板相比，使用四孔板的益处有限。在四种测试结构中，三分之一的管状板具有最低的失效载荷。证据级别：NA（生物力学）
{"title":"The biomechanics of four guided growth plates","authors":"N. Wilson, A. Litsky, C. Iobst","doi":"10.1097/BCO.0000000000001217","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001217","url":null,"abstract":"Background: Guided growth using the eight-plate is the most common method to correct angular deformities in children. We compared the properties of four plate constructs (two-hole guided-growth plates, four-hole guided-growth plates, locking guided-growth plates, and one-third tubular plates) using a three-point bending model. Methods: A three-point bending model was constructed to test strength of four plates. An osteotomy was made in a Sawbones Cylinder. The plate was then fixed across the osteotomy site using the appropriate screws designed for the plate. A 5 N preload was applied, and a linearly applied force was applied under displacement control. Constructs were loaded to failure. Results: For an angular correction of 8.5 degrees, the four-hole guided-growth plates required the most force (40.9 N) followed by two-hole guided-growth plates (36.6 N). Locking plates and one-third tubular plates required less force to achieve the same correction (28.0 N and 23.0 N P<0.001), respectively. The four-hole plate was the stiffest construct (1.87 N/mm). Load to failure for the four-hole plates (46.0 N), two-hole plates (42.8 N). locking plates (32.1 N), and one-third tubular plates (25.5 P<0.001) followed similar trends as the force required for angular correction, with the four-hole plate requiring the most force. Conclusions: Despite the addition of two extra screws in the four-hole plate, this construct was only 10% stiffer than the two-hole plate. There is limited benefit to the use of a four-hole plate over a two-hole plate. The one-third tubular plate had the lowest load to failure of the four tested constructs. Level of Evidence: NA (biomechanical)","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"236 - 239"},"PeriodicalIF":0.3,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44088411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-10DOI: 10.1097/BCO.0000000000001215
J. Eskew, Tyler Kelly, G. Ode
Effective pain management is essential in the treatment of musculoskeletal pathology. Corticosteroid injections have long been used both locally and systemically for their analgesic and anti-inflammatory properties in orthopedic conditions. Opioids have long been used in the perioperative setting to optimize pain control, however both corticosteroids and opioids are not without harm. Ketorolac, a nonsteroidal anti-inflammatory (NSAID) has shown to be effective as an anti-inflammatory and analgesic agent in and outside the perioperative setting with less risk of local and systemic side effects. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant publications were identified searching the PubMed database and EMBASE. The initial search totaled 3,978 articles. After thorough review, 21 full text manuscripts were included (Fig. 1 – PRISMA Chart). 21 full text manuscripts were reviewed assessing over 3,100 who received a local injection of Toradol. Overall, the studies reviewed universally demonstrated an excellent safety profile for ketorolac both systemically and locally. Clinical studies have shown that local application of ketorolac demonstrated decreased postoperative pain, decreased lengths of hospital stays, and decrease postoperative opioid use. This is the first ever study to assess the efficacy, safety profile, and postoperative outcomes with local use of ketorolac injections in musculoskeletal pathology. The local use of ketorolac in the intra-articular and peri-articular setting provides a safe and effective adjunct or alternative treatment in patients with musculoskeletal ailments.
{"title":"Ketorolac as a Local Analgesic in Orthopaedic Conditions: A Systematic Review of Safety and Efficacy","authors":"J. Eskew, Tyler Kelly, G. Ode","doi":"10.1097/BCO.0000000000001215","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001215","url":null,"abstract":"Effective pain management is essential in the treatment of musculoskeletal pathology. Corticosteroid injections have long been used both locally and systemically for their analgesic and anti-inflammatory properties in orthopedic conditions. Opioids have long been used in the perioperative setting to optimize pain control, however both corticosteroids and opioids are not without harm. Ketorolac, a nonsteroidal anti-inflammatory (NSAID) has shown to be effective as an anti-inflammatory and analgesic agent in and outside the perioperative setting with less risk of local and systemic side effects. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant publications were identified searching the PubMed database and EMBASE. The initial search totaled 3,978 articles. After thorough review, 21 full text manuscripts were included (Fig. 1 – PRISMA Chart). 21 full text manuscripts were reviewed assessing over 3,100 who received a local injection of Toradol. Overall, the studies reviewed universally demonstrated an excellent safety profile for ketorolac both systemically and locally. Clinical studies have shown that local application of ketorolac demonstrated decreased postoperative pain, decreased lengths of hospital stays, and decrease postoperative opioid use. This is the first ever study to assess the efficacy, safety profile, and postoperative outcomes with local use of ketorolac injections in musculoskeletal pathology. The local use of ketorolac in the intra-articular and peri-articular setting provides a safe and effective adjunct or alternative treatment in patients with musculoskeletal ailments.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"142 - 159"},"PeriodicalIF":0.3,"publicationDate":"2023-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47292954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-04DOI: 10.1097/BCO.0000000000001216
Charles A. Johnson, Walker M. Heffron, W. N. Newton, Dane N Daley
Background: The purpose of this study is to 1) determine the effect of smoking status on the rate of acute postoperative complications and 2) evaluate smoking as an independent risk factor for complications following open reduction and internal fixation (ORIF) of distal upper extremity fractures. Methods: The National Surgical Quality Improvement Program (NSQIP) database was queried to identify adult patients (>18 yr old) who underwent open reduction and internal fixation (ORIF) of distal upper extremity fractures between 2005 and 2018. Closed fractures of the distal radius, distal ulna, carpals, metacarpals, and phalanx were included. Open fractures, closed reduction and percutaneous pinning (CRPP) procedures, and operations with concomitant procedure codes were excluded. Patients were classified as either current smokers or non-smokers. Univariate analysis and multivariate logistic regression were used to assess the risk of perioperative complications based on current smoking status. Results: A total of 22,002 patients met inclusion criteria. Smoking was independently associated with an increased risk of post-operative complications (OR 1.43, 1.15-1.78, P<0.001), specifically, superficial surgical site infections (OR 2.11, CI 1.23–3.60, P=0.007). Current smokers were additionally associated with an increased risk of unplanned reoperation (OR 1.65, CI 1.10–2.48, P=0.022), and unplanned readmission (OR 1.39, CI 1.02-1.90, P=0.037). Conclusions: Smoking independently increases the risk for overall complications including superficial infections, unplanned reoperation, and unplanned readmission following ORIF of distal upper extremity fractures. Level of Evidence: III.
{"title":"Smoking is associated with surgical site infection, unplanned reoperation, and unplanned 30-day readmission with distal upper extremity fractures","authors":"Charles A. Johnson, Walker M. Heffron, W. N. Newton, Dane N Daley","doi":"10.1097/BCO.0000000000001216","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001216","url":null,"abstract":"Background: The purpose of this study is to 1) determine the effect of smoking status on the rate of acute postoperative complications and 2) evaluate smoking as an independent risk factor for complications following open reduction and internal fixation (ORIF) of distal upper extremity fractures. Methods: The National Surgical Quality Improvement Program (NSQIP) database was queried to identify adult patients (>18 yr old) who underwent open reduction and internal fixation (ORIF) of distal upper extremity fractures between 2005 and 2018. Closed fractures of the distal radius, distal ulna, carpals, metacarpals, and phalanx were included. Open fractures, closed reduction and percutaneous pinning (CRPP) procedures, and operations with concomitant procedure codes were excluded. Patients were classified as either current smokers or non-smokers. Univariate analysis and multivariate logistic regression were used to assess the risk of perioperative complications based on current smoking status. Results: A total of 22,002 patients met inclusion criteria. Smoking was independently associated with an increased risk of post-operative complications (OR 1.43, 1.15-1.78, P<0.001), specifically, superficial surgical site infections (OR 2.11, CI 1.23–3.60, P=0.007). Current smokers were additionally associated with an increased risk of unplanned reoperation (OR 1.65, CI 1.10–2.48, P=0.022), and unplanned readmission (OR 1.39, CI 1.02-1.90, P=0.037). Conclusions: Smoking independently increases the risk for overall complications including superficial infections, unplanned reoperation, and unplanned readmission following ORIF of distal upper extremity fractures. Level of Evidence: III.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"165 - 169"},"PeriodicalIF":0.3,"publicationDate":"2023-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45097267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-28DOI: 10.1097/BCO.0000000000001214
K. Mistretta, Pooyan Abbasi, Melissa A. Wright, A. Murthi
Background: Nitinol staples have been used effectively for stabilization and compression at fracture sites. This study compared yield load, fracture displacement, and load to failure between nitinol staples and superior plating for midshaft clavicle fractures. Methods: Ten pairs of cadaveric clavicles underwent midshaft osteotomy. Each specimen in each pair was randomly assigned to fixation with superiorly placed nitinol staples or with superior plating. Specimens were loaded cyclically with increasing loads to a maximum of 1200 cycles and 60 N. Fracture displacement and construct stiffness were compared at each load. Load to failure was performed at the conclusion of testing. Results: The staple group demonstrated lower yield load and higher median fracture displacement at all levels of force compared to the plate group. Median displacement at physiologic load was 15.3 (IQR 12.8-16.5) mm for the staple construct and 2.9 (IQR 2.5-3.6) mm for plated constructs (P=2.04E-07). Median stiffness of plated constructs was significantly higher than staple constructs at all levels (P<0.05). Median cycles to failure for staple constructs was significantly lower compared to plated constructs (P=0.004). Median load to failure was significantly higher for plated constructs compared to staple constructs (P=2.8E-06). Conclusions: Nitinol staple fixation of midshaft clavicle fractures demonstrated lower yield load, stiffness, increased displacement, and lower load to failure compared to superior plate fixation. However, staple constructs provided adequate stability to maintain reduction of the fracture at physiologic levels of repetitive stress, indicating a potential role for nitinol staples in clavicle fracture fixation.
{"title":"Fixation of transverse midshaft clavicle fractures with nitinol staples vs. superior locked plating: a biomechanical study","authors":"K. Mistretta, Pooyan Abbasi, Melissa A. Wright, A. Murthi","doi":"10.1097/BCO.0000000000001214","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001214","url":null,"abstract":"Background: Nitinol staples have been used effectively for stabilization and compression at fracture sites. This study compared yield load, fracture displacement, and load to failure between nitinol staples and superior plating for midshaft clavicle fractures. Methods: Ten pairs of cadaveric clavicles underwent midshaft osteotomy. Each specimen in each pair was randomly assigned to fixation with superiorly placed nitinol staples or with superior plating. Specimens were loaded cyclically with increasing loads to a maximum of 1200 cycles and 60 N. Fracture displacement and construct stiffness were compared at each load. Load to failure was performed at the conclusion of testing. Results: The staple group demonstrated lower yield load and higher median fracture displacement at all levels of force compared to the plate group. Median displacement at physiologic load was 15.3 (IQR 12.8-16.5) mm for the staple construct and 2.9 (IQR 2.5-3.6) mm for plated constructs (P=2.04E-07). Median stiffness of plated constructs was significantly higher than staple constructs at all levels (P<0.05). Median cycles to failure for staple constructs was significantly lower compared to plated constructs (P=0.004). Median load to failure was significantly higher for plated constructs compared to staple constructs (P=2.8E-06). Conclusions: Nitinol staple fixation of midshaft clavicle fractures demonstrated lower yield load, stiffness, increased displacement, and lower load to failure compared to superior plate fixation. However, staple constructs provided adequate stability to maintain reduction of the fracture at physiologic levels of repetitive stress, indicating a potential role for nitinol staples in clavicle fracture fixation.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"137 - 141"},"PeriodicalIF":0.3,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48298954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-26DOI: 10.1097/bco.0000000000001198
{"title":"Does a medial mini-incision decrease the risk of iatrogenic ulnar nerve injury in pediatric supracondylar humeral fractures treated with closed reduction and percutaneous pinning?: A retrospective cohort study: Erratum","authors":"","doi":"10.1097/bco.0000000000001198","DOIUrl":"https://doi.org/10.1097/bco.0000000000001198","url":null,"abstract":"","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42869196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-21DOI: 10.1097/BCO.0000000000001208
Taeko Fukuda, S. Imai, K. Maruo, H. Horiguchi
Background: If functional decline after hip surgery can be predicted without special assessment, the effects of new treatments and rehabilitation practices can be easily compared with previous cases or those in other countries. The purpose of this study was to develop and examine a formula for such prediction. Methods: Data of 3,120 patients older than 65 yr with hip fracture were analyzed. The Barthel Index was used for evaluating activities of daily living (ADL). Low ADL was defined as patients with a lower score at discharge than the score at admission and patients with complete dependence at admission that did not change until discharge. Three models were developed in a training sample: Basic, Comorbidity, and Laboratory & Vital Signs models were created by inputting basic patient data, the basic data plus comorbidities, the basic data and comorbidities plus 8 laboratory test results and 5 vital signs, respectively. All potential variables with statistical significance < 0.2 on univariate analyses and some variables that may be clinically meaningful were included in multivariable models. The final model was developed by stepwise logistic regression. Results: The c-statistic of the Laboratory & Vital Signs formula was 0.701 and the predictive value was 76.9%. The c-statistics of the Basic and Comorbidity formulas were 0.643 and 0.664, respectively. Applying the Laboratory & Vital Signs formula to the validation sample, the c-statistic was 0.663. Conclusions: The formula developed from the medical data collected routinely before surgery could predict low ADL following hip fracture surgery in elderly patients. Level of Evidence: IVb
{"title":"A formula for predicting postoperative functional decline using routine medical data in elderly patients after hip fracture surgery","authors":"Taeko Fukuda, S. Imai, K. Maruo, H. Horiguchi","doi":"10.1097/BCO.0000000000001208","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001208","url":null,"abstract":"Background: If functional decline after hip surgery can be predicted without special assessment, the effects of new treatments and rehabilitation practices can be easily compared with previous cases or those in other countries. The purpose of this study was to develop and examine a formula for such prediction. Methods: Data of 3,120 patients older than 65 yr with hip fracture were analyzed. The Barthel Index was used for evaluating activities of daily living (ADL). Low ADL was defined as patients with a lower score at discharge than the score at admission and patients with complete dependence at admission that did not change until discharge. Three models were developed in a training sample: Basic, Comorbidity, and Laboratory & Vital Signs models were created by inputting basic patient data, the basic data plus comorbidities, the basic data and comorbidities plus 8 laboratory test results and 5 vital signs, respectively. All potential variables with statistical significance < 0.2 on univariate analyses and some variables that may be clinically meaningful were included in multivariable models. The final model was developed by stepwise logistic regression. Results: The c-statistic of the Laboratory & Vital Signs formula was 0.701 and the predictive value was 76.9%. The c-statistics of the Basic and Comorbidity formulas were 0.643 and 0.664, respectively. Applying the Laboratory & Vital Signs formula to the validation sample, the c-statistic was 0.663. Conclusions: The formula developed from the medical data collected routinely before surgery could predict low ADL following hip fracture surgery in elderly patients. Level of Evidence: IVb","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"208 - 214"},"PeriodicalIF":0.3,"publicationDate":"2023-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44674205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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