Pub Date : 2023-04-14DOI: 10.1097/BCO.0000000000001209
Harsh Wadhwa, L. H. Goodnough, Jigyasa Sharma, Clayton W. Maschhoff, Noelle L. Van Rysselberghe, J. Bishop, Michael J. Gardner
Background: Fixation of distal femur fractures with lateral locking plates has relatively high rates of clinical failure. Supplemental fixation has shown promising results, and may reduce rates of fixation failure or nonunion. This review aimed to assess the biomechanical and clinical evidence regarding the use of supplemental fixation of distal femur fractures. Methods: PubMed, Embase, and Cochrane databases were searched for English language studies up to December 4, 2020, identifying 1,829 studies. Biomechanical studies that assessed fracture displacement, load/cycles to failure, or construct stiffness and clinical studies that assessed fixation failure or nonunion after supplemental fixation of distal femur fractures were included. Studies with sample size ≤5, ORIF with non-locking plates, periprosthetic distal femoral fractures, nonunions or revision surgeries were excluded. Results: Seventeen studies were included, of which 8 were biomechanical and 9 clinical. Overall, biomechanical studies demonstrated increased construct stability and load to failure with various supplemental fixation strategies. Clinical studies demonstrated more mixed outcomes for nonunion and fixation failure rate among the various techniques. Conclusions: Biomechanical studies have demonstrated potential benefits of these strategies, but there remains a dearth of high-quality evidence evaluating their effect on clinical outcomes. Prospective RCTs are necessary to address these issues and confirm the results in the existing literature. Level of Evidence: IID
{"title":"Supplemental fixation of distal femur fractures: a review of biomechanical and clinical evidence","authors":"Harsh Wadhwa, L. H. Goodnough, Jigyasa Sharma, Clayton W. Maschhoff, Noelle L. Van Rysselberghe, J. Bishop, Michael J. Gardner","doi":"10.1097/BCO.0000000000001209","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001209","url":null,"abstract":"Background: Fixation of distal femur fractures with lateral locking plates has relatively high rates of clinical failure. Supplemental fixation has shown promising results, and may reduce rates of fixation failure or nonunion. This review aimed to assess the biomechanical and clinical evidence regarding the use of supplemental fixation of distal femur fractures. Methods: PubMed, Embase, and Cochrane databases were searched for English language studies up to December 4, 2020, identifying 1,829 studies. Biomechanical studies that assessed fracture displacement, load/cycles to failure, or construct stiffness and clinical studies that assessed fixation failure or nonunion after supplemental fixation of distal femur fractures were included. Studies with sample size ≤5, ORIF with non-locking plates, periprosthetic distal femoral fractures, nonunions or revision surgeries were excluded. Results: Seventeen studies were included, of which 8 were biomechanical and 9 clinical. Overall, biomechanical studies demonstrated increased construct stability and load to failure with various supplemental fixation strategies. Clinical studies demonstrated more mixed outcomes for nonunion and fixation failure rate among the various techniques. Conclusions: Biomechanical studies have demonstrated potential benefits of these strategies, but there remains a dearth of high-quality evidence evaluating their effect on clinical outcomes. Prospective RCTs are necessary to address these issues and confirm the results in the existing literature. Level of Evidence: IID","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"201 - 207"},"PeriodicalIF":0.3,"publicationDate":"2023-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44559746","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 : 2023-04-14DOI: 10.1097/BCO.0000000000001213
M. Safdari, Abdolshakur Rasuli Ostadi, Nahid Makhmalbaf, Mahshid Makhmalbaf, H. Makhmalbaf
Background: There is no consensus regarding the optimal timing of anterior cruciate ligament reconstruction (ACLR) and its clinical importance. Here, we compared the rate of the pre-reconstruction meniscus and cartilage injury, also the knee function, between the early ACLR (within six months of injury) and late ACLR (after six months of the injury). Methods: Retrospectively, 192 patients with an ACL tear who underwent ACLR within six months of injury (n=53) or after six months of injury (n=132) were included. Autograft bone patellar tendon bone was used as the graft choice. The rate of pre-reconstruction meniscal injury and chondral damage (Outerbridge classification) was compared between the two groups. The knee function, evaluated in the last follow-up using the Lysholm knee scale, was also compared. Results: The mean time from injury to surgery was 3.9±1.3 mo in the early group and 8.8±2.3 mo in the late group The pre-reconstruction meniscal injury was detected in 24 (45.3%) patients in the early ACLR group and 93 (66.9%) patients in the late ACLR group (P=0.006). Pre-reconstruction chondral damage was detected in six (11.3%) patients of the early ACLR group and 32 (23%) patients of the late ACLR group (P=0.049). The mean Lysholm knee scale was 86.7±6 (range 82-92) in the early ACLR group and 81.9±4.4 (range 80-84) in the late ACLR group (P<0.001). Conclusion: The higher rate of pre-reconstruction meniscal and chondral damage and lower functional score in the late ACLR group suggests avoiding ACLR delay more than six months after the injury. Level of Evidence: IV.
{"title":"More than six months delay in anterior cruciate ligament reconstruction is associated with a higher risk of pre-reconstruction meniscal and chondral damage","authors":"M. Safdari, Abdolshakur Rasuli Ostadi, Nahid Makhmalbaf, Mahshid Makhmalbaf, H. Makhmalbaf","doi":"10.1097/BCO.0000000000001213","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001213","url":null,"abstract":"Background: There is no consensus regarding the optimal timing of anterior cruciate ligament reconstruction (ACLR) and its clinical importance. Here, we compared the rate of the pre-reconstruction meniscus and cartilage injury, also the knee function, between the early ACLR (within six months of injury) and late ACLR (after six months of the injury). Methods: Retrospectively, 192 patients with an ACL tear who underwent ACLR within six months of injury (n=53) or after six months of injury (n=132) were included. Autograft bone patellar tendon bone was used as the graft choice. The rate of pre-reconstruction meniscal injury and chondral damage (Outerbridge classification) was compared between the two groups. The knee function, evaluated in the last follow-up using the Lysholm knee scale, was also compared. Results: The mean time from injury to surgery was 3.9±1.3 mo in the early group and 8.8±2.3 mo in the late group The pre-reconstruction meniscal injury was detected in 24 (45.3%) patients in the early ACLR group and 93 (66.9%) patients in the late ACLR group (P=0.006). Pre-reconstruction chondral damage was detected in six (11.3%) patients of the early ACLR group and 32 (23%) patients of the late ACLR group (P=0.049). The mean Lysholm knee scale was 86.7±6 (range 82-92) in the early ACLR group and 81.9±4.4 (range 80-84) in the late ACLR group (P<0.001). Conclusion: The higher rate of pre-reconstruction meniscal and chondral damage and lower functional score in the late ACLR group suggests avoiding ACLR delay more than six months after the injury. Level of Evidence: IV.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"176 - 179"},"PeriodicalIF":0.3,"publicationDate":"2023-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48085383","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 : 2023-04-12DOI: 10.1097/BCO.0000000000001210
Joshua Altman
INTRODUCTION S tress fractures are a relatively common and well documented injury among athletes and military recruits that typically result when repetitive mechanical stress on structurally normal bone exceeds intrinsic bone remodeling. This case report describes a rare presentation of a stress fracture of the distal femur in a competitive youth rower, in the absence of an obvious biomechanical mechanism given the lower impact nature of rowing. The injury was managed conservatively with rest, physical therapy, and gradual return to activity with the athlete making a full recovery. Prompt diagnosis and management is important to prevent further complication and reduce return to play time in stress fractures. Informed written consent for publication of this case report was provided by the patient and patient’s mother. Ethical approval was not required.
{"title":"Distal femur stress fracture: A unique case presentation in a youth rower","authors":"Joshua Altman","doi":"10.1097/BCO.0000000000001210","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001210","url":null,"abstract":"INTRODUCTION S tress fractures are a relatively common and well documented injury among athletes and military recruits that typically result when repetitive mechanical stress on structurally normal bone exceeds intrinsic bone remodeling. This case report describes a rare presentation of a stress fracture of the distal femur in a competitive youth rower, in the absence of an obvious biomechanical mechanism given the lower impact nature of rowing. The injury was managed conservatively with rest, physical therapy, and gradual return to activity with the athlete making a full recovery. Prompt diagnosis and management is important to prevent further complication and reduce return to play time in stress fractures. Informed written consent for publication of this case report was provided by the patient and patient’s mother. Ethical approval was not required.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"191 - 193"},"PeriodicalIF":0.3,"publicationDate":"2023-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42586675","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 : 2023-04-11DOI: 10.1097/BCO.0000000000001212
R. Samade, T. Scharschmidt
Background: The orthopaedic in-training examination (OITE) is an annual national assessment of knowledge in orthopaedic surgery residents. Our primary aim was to determine if intern performance in the OITE (measured by correct answers) differed before and after the adoption of a formal surgical skills month (SSM) in the residency curriculum. A secondary aim was to evaluate the relationship between intern OITE and post-graduate year two (PGY-2) scores. Methods: A single institution retrospective cohort study was performed, comparing orthopaedic surgery interns who took the OITE before (15 residents) and after (16 residents) the year 2013 (when an SSM was introduced). De-identified OITE raw and percentage correct scores were obtained from all resident records. Statistical testing included independent sample t test and linear regression, with a significance level of 0.05. Results: Comparison of OITE percentage of correct answers overall, between interns before and after 2013, showed a significant increase after initiating the SSM (44.8%±4.13% vs. 49.9%±8.44%, P=0.0414). In addition, regression analysis demonstrated a positive linear relationship between intern and PGY-2 OITE scores after the SSM was implemented (R 2=0.380, P=0.011, β=0.424, CI: 0.1135341 –1.190913). Conclusion: Implementation of an SSM led to increased intern OITE scores. Moreover, intern OITE scores were more predictive of PGY-2 scores after SSM implementation. Earlier education (such as a surgical skills month) for orthopaedic surgery interns can aid knowledge acquisition and career development at the beginning of their training. Level of Evidence: Level III.
{"title":"Effect of a surgical skills month on intern performance in the orthopaedic in-training examination","authors":"R. Samade, T. Scharschmidt","doi":"10.1097/BCO.0000000000001212","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001212","url":null,"abstract":"Background: The orthopaedic in-training examination (OITE) is an annual national assessment of knowledge in orthopaedic surgery residents. Our primary aim was to determine if intern performance in the OITE (measured by correct answers) differed before and after the adoption of a formal surgical skills month (SSM) in the residency curriculum. A secondary aim was to evaluate the relationship between intern OITE and post-graduate year two (PGY-2) scores. Methods: A single institution retrospective cohort study was performed, comparing orthopaedic surgery interns who took the OITE before (15 residents) and after (16 residents) the year 2013 (when an SSM was introduced). De-identified OITE raw and percentage correct scores were obtained from all resident records. Statistical testing included independent sample t test and linear regression, with a significance level of 0.05. Results: Comparison of OITE percentage of correct answers overall, between interns before and after 2013, showed a significant increase after initiating the SSM (44.8%±4.13% vs. 49.9%±8.44%, P=0.0414). In addition, regression analysis demonstrated a positive linear relationship between intern and PGY-2 OITE scores after the SSM was implemented (R 2=0.380, P=0.011, β=0.424, CI: 0.1135341 –1.190913). Conclusion: Implementation of an SSM led to increased intern OITE scores. Moreover, intern OITE scores were more predictive of PGY-2 scores after SSM implementation. Earlier education (such as a surgical skills month) for orthopaedic surgery interns can aid knowledge acquisition and career development at the beginning of their training. Level of Evidence: Level III.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"160 - 164"},"PeriodicalIF":0.3,"publicationDate":"2023-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47646679","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 : 2023-03-30DOI: 10.1097/BCO.0000000000001205
George W. Koutsouras, Michael Wade, S. Marawar
Background: Anterior cervical discectomy and fusion (ACDF) may alleviate cervical radiculopathy and myelopathy, with risks including dysphagia, cerebrospinal fluid leakage, neurological injury, and post operative pneumonia (POP). The incidence of POP among non-veteran patients who underwent ACDF surgery was 0.45%. Military veterans may have higher overall complication rates after undergoing ACDF. We aimed to describe the incidence and risk factors of POP among military veterans undergoing ACDF. Methods: This study was a retrospective analysis of the United States Veteran Affairs Surgical Quality Improvement Program database. We assessed the patients who underwent ACDF between January 2001 and December 2017. Bivariate and multivariate statistical analyses were performed to identify the rates of POP and the factors that may increase POP risk. Results: Among the 18,468 patients, 195 (1.06%) experienced POP. Independent risk factors included male sex, chronic steroid use, preoperative sepsis, diabetes, poor overall health, inpatient surgery, and emergency surgery. Multilevel ACDF was associated with a higher POP rate (P<0.001). In the multivariate analysis, patients with a history of severe chronic obstructive pulmonary disease (COPD) were more than twice as likely to experience POP than those without severe COPD (P<0.001). An additional hour in surgery was associated with 16% higher odds of POP (P<0.001). Conclusions: The incidence of POP following ACDF is greater than the nonveteran population, which may be contributed by several factors including COPD, inpatient surgery and length of surgery. The identification of veterans as a high-risk population can potentially help guide decision making when ACDF is considered. Level of Evidence: III.
{"title":"Anterior cervical discectomy and fusion and pneumonia: use of the VASQIP database","authors":"George W. Koutsouras, Michael Wade, S. Marawar","doi":"10.1097/BCO.0000000000001205","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001205","url":null,"abstract":"Background: Anterior cervical discectomy and fusion (ACDF) may alleviate cervical radiculopathy and myelopathy, with risks including dysphagia, cerebrospinal fluid leakage, neurological injury, and post operative pneumonia (POP). The incidence of POP among non-veteran patients who underwent ACDF surgery was 0.45%. Military veterans may have higher overall complication rates after undergoing ACDF. We aimed to describe the incidence and risk factors of POP among military veterans undergoing ACDF. Methods: This study was a retrospective analysis of the United States Veteran Affairs Surgical Quality Improvement Program database. We assessed the patients who underwent ACDF between January 2001 and December 2017. Bivariate and multivariate statistical analyses were performed to identify the rates of POP and the factors that may increase POP risk. Results: Among the 18,468 patients, 195 (1.06%) experienced POP. Independent risk factors included male sex, chronic steroid use, preoperative sepsis, diabetes, poor overall health, inpatient surgery, and emergency surgery. Multilevel ACDF was associated with a higher POP rate (P<0.001). In the multivariate analysis, patients with a history of severe chronic obstructive pulmonary disease (COPD) were more than twice as likely to experience POP than those without severe COPD (P<0.001). An additional hour in surgery was associated with 16% higher odds of POP (P<0.001). Conclusions: The incidence of POP following ACDF is greater than the nonveteran population, which may be contributed by several factors including COPD, inpatient surgery and length of surgery. The identification of veterans as a high-risk population can potentially help guide decision making when ACDF is considered. Level of Evidence: III.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"180 - 184"},"PeriodicalIF":0.3,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45909064","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 : 2023-03-29DOI: 10.1097/BCO.0000000000001207
Paul M. Alvarez, C. Curatolo, M. N. Desai, A. Malik, Logan J Roebke, Matthew Pigott
Background: An increasing number of patients with a history of solid organ transplantation (SOT) are presenting for total joint arthroplasty (TJA). The primary aim of this study is to evaluate clinical outcomes after primary total joint arthroplasty in patients with a history of SOT compared to matched controls. Methods: We performed a review of prospectively collected data on consecutive adult patients with a history of SOT undergoing TJA from January 2014 to January 2021. Pearson-Chi square tests were used to compare differences in baseline demographics and clinical characteristics between SOT and matched controls. Multi-variate logistic regression analyses were used to assess whether patients who had a prior SOT were at higher risk of experiencing post-operative complications, readmissions, reoperations, longer length of stay and non-home discharges after primary TJA. Results: A total of 81 operations met inclusion criteria which were compared to 82 age matched controls without a history of SOT. Patients with a history of SOT were more likely to require a hospitalization greater than 2 days compared to the control group (n=63, 77.8% vs. n=16, 19.5%; P=0.011), had an increased risk of hyperkalemia (n=15, 18.5% vs. n=1, 1.2%; P=0.049), and any post-operative complication (n=55, 67.9% vs. n=21, 25.6%; P=0.025). Conclusions: Despite the increased risk of acute post-operative complications and longer hospital stays, primary TJA has been shown to be a safe and effective option for treatment of DJD or AVN in patients with a history of SOT when completed via a multi-disciplinary approach. Level of Evidence: Retrospective Analysis, Level IV.
{"title":"Outcomes of primary total joint arthroplasty in patients with a history of solid organ transplantation, a single institution analysis","authors":"Paul M. Alvarez, C. Curatolo, M. N. Desai, A. Malik, Logan J Roebke, Matthew Pigott","doi":"10.1097/BCO.0000000000001207","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001207","url":null,"abstract":"Background: An increasing number of patients with a history of solid organ transplantation (SOT) are presenting for total joint arthroplasty (TJA). The primary aim of this study is to evaluate clinical outcomes after primary total joint arthroplasty in patients with a history of SOT compared to matched controls. Methods: We performed a review of prospectively collected data on consecutive adult patients with a history of SOT undergoing TJA from January 2014 to January 2021. Pearson-Chi square tests were used to compare differences in baseline demographics and clinical characteristics between SOT and matched controls. Multi-variate logistic regression analyses were used to assess whether patients who had a prior SOT were at higher risk of experiencing post-operative complications, readmissions, reoperations, longer length of stay and non-home discharges after primary TJA. Results: A total of 81 operations met inclusion criteria which were compared to 82 age matched controls without a history of SOT. Patients with a history of SOT were more likely to require a hospitalization greater than 2 days compared to the control group (n=63, 77.8% vs. n=16, 19.5%; P=0.011), had an increased risk of hyperkalemia (n=15, 18.5% vs. n=1, 1.2%; P=0.049), and any post-operative complication (n=55, 67.9% vs. n=21, 25.6%; P=0.025). Conclusions: Despite the increased risk of acute post-operative complications and longer hospital stays, primary TJA has been shown to be a safe and effective option for treatment of DJD or AVN in patients with a history of SOT when completed via a multi-disciplinary approach. Level of Evidence: Retrospective Analysis, Level IV.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"170 - 175"},"PeriodicalIF":0.3,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48785915","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 : 2023-03-03DOI: 10.1097/BCO.0000000000001201
Christine Wassef, A. Frangenberg, Haeun Lee, Nwamaka Iloani, Christopher Bates, Amanda C. Pientka, William F. Pientka
Background: In 2014, the United States Drug Enforcement Agency rescheduled hydrocodone from schedule III to II to mitigate the opiate crisis in America. Hydrocodone has long served as common pain medication after outpatient orthopaedic surgical procedures in the United States. We hypothesize rescheduling of hydrocodone would correlate with an increase in postoperative emergency department visits for pain. Methods: We performed a retrospective review of all outpatient orthopaedic procedures and identified all patients who subsequently presented to our emergency department for postoperative pain for the one calendar year prior to and after the rescheduling of hydrocodone. Results: We identified 2984 orthopaedic procedures and 3193 emergency department visits for postoperative pain across all surgical specialties. 875 orthopaedic procedures occurred prior to hydrocodone rescheduling with 48 postoperative ED visits for pain (5.4%). 2109 procedures occurred after the rescheduling of hydrocodone with 123 ED visits for pain postoperatively (5.8%). 199 patients presented to the ED for postoperative pain, for a total of 345 visits. The median postoperative time to emergency room visit for the pre-rescheduling group was 6.5 days versus 4.0 days post-rescheduling. Conclusions: We identified statistically significant differences in postoperative medication and prescribed amounts. We identified no difference in the proportion of patients that went to the emergency room by timeframe relative to hydrocodone rescheduling, nor did we identify a difference between samples in terms of gender, race, insurance status, and comorbid conditions. Increased restriction on hydrocodone prescribing did not increase emergency department visits for pain after outpatient orthopaedic surgery. Level of Evidence: Therapeutic III.
{"title":"Postoperative emergency department visits for pain after outpatient orthopaedic surgery: did rescheduling hydrocodone make a difference?","authors":"Christine Wassef, A. Frangenberg, Haeun Lee, Nwamaka Iloani, Christopher Bates, Amanda C. Pientka, William F. Pientka","doi":"10.1097/BCO.0000000000001201","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001201","url":null,"abstract":"Background: In 2014, the United States Drug Enforcement Agency rescheduled hydrocodone from schedule III to II to mitigate the opiate crisis in America. Hydrocodone has long served as common pain medication after outpatient orthopaedic surgical procedures in the United States. We hypothesize rescheduling of hydrocodone would correlate with an increase in postoperative emergency department visits for pain. Methods: We performed a retrospective review of all outpatient orthopaedic procedures and identified all patients who subsequently presented to our emergency department for postoperative pain for the one calendar year prior to and after the rescheduling of hydrocodone. Results: We identified 2984 orthopaedic procedures and 3193 emergency department visits for postoperative pain across all surgical specialties. 875 orthopaedic procedures occurred prior to hydrocodone rescheduling with 48 postoperative ED visits for pain (5.4%). 2109 procedures occurred after the rescheduling of hydrocodone with 123 ED visits for pain postoperatively (5.8%). 199 patients presented to the ED for postoperative pain, for a total of 345 visits. The median postoperative time to emergency room visit for the pre-rescheduling group was 6.5 days versus 4.0 days post-rescheduling. Conclusions: We identified statistically significant differences in postoperative medication and prescribed amounts. We identified no difference in the proportion of patients that went to the emergency room by timeframe relative to hydrocodone rescheduling, nor did we identify a difference between samples in terms of gender, race, insurance status, and comorbid conditions. Increased restriction on hydrocodone prescribing did not increase emergency department visits for pain after outpatient orthopaedic surgery. Level of Evidence: Therapeutic III.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"123 - 127"},"PeriodicalIF":0.3,"publicationDate":"2023-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47159592","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 : 2023-02-27DOI: 10.1097/BCO.0000000000001204
Caryn Lindsey, G. Dornan, Karma McKelvey
Background: In the United States, the COVID-19 pandemic resulted in a widespread mental health crisis. Overarchingly, medical clinics have been slow to adopt an interdisciplinary approach to patient care, though depression has been shown to negatively affect many clinical outcomes. With an ongoing, worsening mental health crisis in conjunction with a dramatic increase in demand for Total Joint Replacement anticipated by 2030, more routine depression screening and adequate mental health support is imperative. Our clinic implemented a Collaborative Care Model (CCM) in March of 2020 with a Licensed Clinical Social Worker (LCSW). Methods: Using data collected at our outpatient clinic between September 1, 2018 and August 31, 2021, we compared changes in Patient-Reported Outcome Measurements Information System (PROMIS) depression scores from the group of patients seen before CCM adoption (“pre-CCM”) with scores from the group after (“post-CCM”). Results: We found no between-group differences in PROMIS depression score changes. Increased pain interference was positively associated with increased depression in the pre-CCM group, but not in the post-CCM group. Conclusions: Our CCM was successful in mitigating for our patients the mental health crisis reflected among the general population during the lockdowns and uncertainty of the COVID-19 pandemic. The CCM also diminished further exacerbation of depression secondary to increased pain interference and the overall impact the pandemic had on healthcare operations. A CCM inclusive of an LCSW may also further support community resource linkage, complex care coordination, and assessment of other mental health conditions related to orthopaedic conditions or injury, such as anxiety and post-traumatic stress disorder.
{"title":"Integration of collaborative care model ameliorates population level COVID-19 Pandemic-related depressive symptoms among orthopaedic clinic patient population in US major metropolitan area","authors":"Caryn Lindsey, G. Dornan, Karma McKelvey","doi":"10.1097/BCO.0000000000001204","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001204","url":null,"abstract":"Background: In the United States, the COVID-19 pandemic resulted in a widespread mental health crisis. Overarchingly, medical clinics have been slow to adopt an interdisciplinary approach to patient care, though depression has been shown to negatively affect many clinical outcomes. With an ongoing, worsening mental health crisis in conjunction with a dramatic increase in demand for Total Joint Replacement anticipated by 2030, more routine depression screening and adequate mental health support is imperative. Our clinic implemented a Collaborative Care Model (CCM) in March of 2020 with a Licensed Clinical Social Worker (LCSW). Methods: Using data collected at our outpatient clinic between September 1, 2018 and August 31, 2021, we compared changes in Patient-Reported Outcome Measurements Information System (PROMIS) depression scores from the group of patients seen before CCM adoption (“pre-CCM”) with scores from the group after (“post-CCM”). Results: We found no between-group differences in PROMIS depression score changes. Increased pain interference was positively associated with increased depression in the pre-CCM group, but not in the post-CCM group. Conclusions: Our CCM was successful in mitigating for our patients the mental health crisis reflected among the general population during the lockdowns and uncertainty of the COVID-19 pandemic. The CCM also diminished further exacerbation of depression secondary to increased pain interference and the overall impact the pandemic had on healthcare operations. A CCM inclusive of an LCSW may also further support community resource linkage, complex care coordination, and assessment of other mental health conditions related to orthopaedic conditions or injury, such as anxiety and post-traumatic stress disorder.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"128 - 134"},"PeriodicalIF":0.3,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41764552","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 : 2023-02-20DOI: 10.1097/BCO.0000000000001197
Cole J. Ohnoutka, Lasun O. Oladeji, N. Cherian, Daniel Hogan, B. Crist
Background: Social media is a robust outreach tool that allows programs to outreach with prospective applicants while maintaining social distancing policies. The purpose of this study was to evaluate how the COVID-19 pandemic influenced the social media practices of ACGME accredited orthopaedic surgery residency programs. Methods: An analysis of orthopaedic surgery residency social media accounts was performed to identify changes in practices from July 2019 to December 2020. Social media participation was analyzed with respect to program type, location, size, geographical location, and Doximity ranking. Results: A total of 194 residency programs were included in this study. Twitter accounts increased from 56 (28.9%) in December 2019 to 87 (44.8%) in January 2021 while Instagram accounts increased from 16 (8.2%) to 107 (55.2%). Allopathic programs, programs with a higher Doximity Reputation Ranking, and those with more than 35 residents were significantly more likely to have an Instagram or Twitter account (P<0.05). There was a significant increase in the average number of Instagram posts per month in July and September 2020 (P<0.05) 2020 as compared to the same period in 2019. Conclusions: There was an increase in the prevalence of orthopaedic residency social media accounts during the Covid pandemic. Allopathic programs, programs with a higher Doximity Reputation Ranking, and larger programs were more likely to utilize social media. Social media offers another avenue for programs to communicate with applicants and an increasing number of programs are harnessing this tool to connect with the next generation of orthopaedic surgeons. Level of Evidence: Level IV.
{"title":"The impact of COVID-19 on the social media practices of orthopaedic surgery residency programs","authors":"Cole J. Ohnoutka, Lasun O. Oladeji, N. Cherian, Daniel Hogan, B. Crist","doi":"10.1097/BCO.0000000000001197","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001197","url":null,"abstract":"Background: Social media is a robust outreach tool that allows programs to outreach with prospective applicants while maintaining social distancing policies. The purpose of this study was to evaluate how the COVID-19 pandemic influenced the social media practices of ACGME accredited orthopaedic surgery residency programs. Methods: An analysis of orthopaedic surgery residency social media accounts was performed to identify changes in practices from July 2019 to December 2020. Social media participation was analyzed with respect to program type, location, size, geographical location, and Doximity ranking. Results: A total of 194 residency programs were included in this study. Twitter accounts increased from 56 (28.9%) in December 2019 to 87 (44.8%) in January 2021 while Instagram accounts increased from 16 (8.2%) to 107 (55.2%). Allopathic programs, programs with a higher Doximity Reputation Ranking, and those with more than 35 residents were significantly more likely to have an Instagram or Twitter account (P<0.05). There was a significant increase in the average number of Instagram posts per month in July and September 2020 (P<0.05) 2020 as compared to the same period in 2019. Conclusions: There was an increase in the prevalence of orthopaedic residency social media accounts during the Covid pandemic. Allopathic programs, programs with a higher Doximity Reputation Ranking, and larger programs were more likely to utilize social media. Social media offers another avenue for programs to communicate with applicants and an increasing number of programs are harnessing this tool to connect with the next generation of orthopaedic surgeons. Level of Evidence: Level IV.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"117 - 122"},"PeriodicalIF":0.3,"publicationDate":"2023-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43718916","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 : 2023-02-20DOI: 10.1097/BCO.0000000000001203
Stephen A. Stearns, Clay B. Beagles, Katherine Hegermiller, C. Harper
Background: The COVID-19 pandemic significantly impacted elective surgical volume across the country; however, its effect on urgent transfers is unclear. This study sought to understand the impact of COVID-19 on transfers for hand surgery evaluation at a single quaternary referral center during the initial 3 mo of state mandated restrictions. Methods: A retrospective analysis was performed comparing the rate and character of transfers for hand surgery evaluation from March to June of 2020 to a temporally matched cohort averaged across 2018 and 2019. The primary outcome of this study was transfer frequency, with secondary outcomes of treatment rendered and type of disposition. Results: The rate of transfer between emergency departments for hand surgery evaluation was not statistically different from before to during COVID (ED-to-ED transfer rate: 4.3% and 5.1% respectively, P=0.68). Patient demographics were similar, with no difference in age (pre-COVID-19 mean 48.6 yr vs. intra-COVID-19 mean 53.2 yr, P=0.31) or type of insurance (P=0.99). Regarding reason for transfer, both cohorts were similar in the number of transfers for trauma versus infection (pre-COVID-19 infection: 11 trauma: 20.5 vs. intra-COVID-19 infection: 4 trauma: 17 P=0.99). We observed similar rates of transfers requiring procedural intervention (pre-COVID-19 69.8% vs. intra-COVID-19 57.1% P=0.19). Lastly, there was no difference in admission patterns, with pre-COVID-19 rates (71.4%) similar to those during COVID-19 (52%) P=0.15. Conclusions: Despite the many changes to healthcare in the US during the COVID-19 pandemic, the practice of transferring for evaluation to a Level 1 hand surgery center was similar to pre-pandemic years. Level VI Evidence: Presenting a single descriptive study.
{"title":"Impact of COVID-19 on hand surgery transfers at a level-1 trauma center","authors":"Stephen A. Stearns, Clay B. Beagles, Katherine Hegermiller, C. Harper","doi":"10.1097/BCO.0000000000001203","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001203","url":null,"abstract":"Background: The COVID-19 pandemic significantly impacted elective surgical volume across the country; however, its effect on urgent transfers is unclear. This study sought to understand the impact of COVID-19 on transfers for hand surgery evaluation at a single quaternary referral center during the initial 3 mo of state mandated restrictions. Methods: A retrospective analysis was performed comparing the rate and character of transfers for hand surgery evaluation from March to June of 2020 to a temporally matched cohort averaged across 2018 and 2019. The primary outcome of this study was transfer frequency, with secondary outcomes of treatment rendered and type of disposition. Results: The rate of transfer between emergency departments for hand surgery evaluation was not statistically different from before to during COVID (ED-to-ED transfer rate: 4.3% and 5.1% respectively, P=0.68). Patient demographics were similar, with no difference in age (pre-COVID-19 mean 48.6 yr vs. intra-COVID-19 mean 53.2 yr, P=0.31) or type of insurance (P=0.99). Regarding reason for transfer, both cohorts were similar in the number of transfers for trauma versus infection (pre-COVID-19 infection: 11 trauma: 20.5 vs. intra-COVID-19 infection: 4 trauma: 17 P=0.99). We observed similar rates of transfers requiring procedural intervention (pre-COVID-19 69.8% vs. intra-COVID-19 57.1% P=0.19). Lastly, there was no difference in admission patterns, with pre-COVID-19 rates (71.4%) similar to those during COVID-19 (52%) P=0.15. Conclusions: Despite the many changes to healthcare in the US during the COVID-19 pandemic, the practice of transferring for evaluation to a Level 1 hand surgery center was similar to pre-pandemic years. Level VI Evidence: Presenting a single descriptive study.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"103 - 105"},"PeriodicalIF":0.3,"publicationDate":"2023-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46454897","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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