Pub Date : 2023-02-20DOI: 10.1097/BCO.0000000000001202
Christopher Cheng, A. Acuña, Joanne H. Wang, K. Malone
Background: Proximal row carpectomy (PRC) has been shown to be an effective treatment option for early stages of wrist arthritis. In the presence of midcarpal arthritis however, PRC has generally been contraindicated due to a high conversion rate to total wrist arthrodesis. Variations to PRC, including radio-capitate soft tissue interposition and capitate resurfacing, have been introduced to delay conversion and have demonstrated similar outcomes compared to standard PRC. Comparative outcomes between these technical variations have not been investigated however. Methods: Retrospective chart review was conducted for patients who underwent PRC with interposition or capitate resurfacing from 2009-2019. Patient demographics, pre- and post-operative range of motion, operative time, cost, and post-operative complications were collected. Descriptive statistics were expressed as means and standard deviations. Survivability was plotted on a Kaplan-Meier survival curve. Results: Final cohorts included ten patients who underwent PRC with interposition and six who underwent PRC with resurfacing. Resurfacing had longer average operative duration (51.3±18.3 vs. 79.0±16.5 min, P=0.009) and higher cost ($29,116±10,036 vs. $15,290±3,743, P=0.028). There was no significant difference in wrist ROM. Two of the six patients who underwent resurfacing experience complications requiring conversion to total wrist arthrodesis, however there was no significant difference in overall survivorship. Conclusions: In this observational comparative study, PRC with capitate resurfacing trended towards longer operative time, increased cost, and higher complication and conversion rate. Future larger and more standardized analyses are needed in order to evaluate the long-term outcomes of these procedures. Level of Evidence: Level IV – Case Series.
{"title":"Proximal row carpectomy of the wrist in the setting of midcarpal arthritis: Survivorship and associated complications in soft tissue interposition versus capitate resurfacing","authors":"Christopher Cheng, A. Acuña, Joanne H. Wang, K. Malone","doi":"10.1097/BCO.0000000000001202","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001202","url":null,"abstract":"Background: Proximal row carpectomy (PRC) has been shown to be an effective treatment option for early stages of wrist arthritis. In the presence of midcarpal arthritis however, PRC has generally been contraindicated due to a high conversion rate to total wrist arthrodesis. Variations to PRC, including radio-capitate soft tissue interposition and capitate resurfacing, have been introduced to delay conversion and have demonstrated similar outcomes compared to standard PRC. Comparative outcomes between these technical variations have not been investigated however. Methods: Retrospective chart review was conducted for patients who underwent PRC with interposition or capitate resurfacing from 2009-2019. Patient demographics, pre- and post-operative range of motion, operative time, cost, and post-operative complications were collected. Descriptive statistics were expressed as means and standard deviations. Survivability was plotted on a Kaplan-Meier survival curve. Results: Final cohorts included ten patients who underwent PRC with interposition and six who underwent PRC with resurfacing. Resurfacing had longer average operative duration (51.3±18.3 vs. 79.0±16.5 min, P=0.009) and higher cost ($29,116±10,036 vs. $15,290±3,743, P=0.028). There was no significant difference in wrist ROM. Two of the six patients who underwent resurfacing experience complications requiring conversion to total wrist arthrodesis, however there was no significant difference in overall survivorship. Conclusions: In this observational comparative study, PRC with capitate resurfacing trended towards longer operative time, increased cost, and higher complication and conversion rate. Future larger and more standardized analyses are needed in order to evaluate the long-term outcomes of these procedures. Level of Evidence: Level IV – Case Series.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"106 - 111"},"PeriodicalIF":0.3,"publicationDate":"2023-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42231636","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.0000000000001199
Evan Michaelson, B. Wiesel, Benjamin Siedlarz, A. Murthi, P. Sethi, D. Lutton, S. Nagda
Background: Minimal data is available on the accuracy of diagnoses for orthopaedic shoulder complaints developed via telemedicine consultations. We hypothesize that evaluating surgeons can accurately diagnose and treat shoulder pathology via telemedicine evaluation. Methods: Patient evaluations for new shoulder complaints via telemedicine were retrospectively reviewed. Records were kept of all new patients seen via telemedicine, and all patients were advised to follow-up for in-person evaluation. All patients with in-person follow-up were included in final analysis. Changes in diagnosis or treatments were noted at time of in-person evaluation. Results: Eighty-two patients completed both telemedicine and in-person evaluation. 44 (53.6%) had no changes in diagnosis or treatment, and 22 (26.8%) had no change in diagnosis with advancement in treatment. Sixteen patients (19.5%) had a change in diagnosis or treatment. Of the 16 patients where changes were made, 9 patients were given additional diagnoses, and 7 patients had changes in their diagnosis at time of in-person follow-up. Two (2.4%) patients had a change in treatment resulting from the in-person visit. Fifty-seven patients (69.5%) had imaging (X-ray, MRI, or CT) available during the telemedicine visit. Conclusions: Telemedicine was an effective platform for evaluating patients with new shoulder complaints, with only 2.4% of treatments altered after in-person evaluation. There may be specific shoulder pathology that is more difficult to diagnose via telemedicine or without advanced imaging. Further research evaluating patient and surgeon satisfaction with telemedicine is underway. Level of Evidence: IV, Retrospective Cohort Study.
{"title":"Accuracy of telemedicine for the diagnosis and treatment of patients with shoulder complaints","authors":"Evan Michaelson, B. Wiesel, Benjamin Siedlarz, A. Murthi, P. Sethi, D. Lutton, S. Nagda","doi":"10.1097/BCO.0000000000001199","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001199","url":null,"abstract":"Background: Minimal data is available on the accuracy of diagnoses for orthopaedic shoulder complaints developed via telemedicine consultations. We hypothesize that evaluating surgeons can accurately diagnose and treat shoulder pathology via telemedicine evaluation. Methods: Patient evaluations for new shoulder complaints via telemedicine were retrospectively reviewed. Records were kept of all new patients seen via telemedicine, and all patients were advised to follow-up for in-person evaluation. All patients with in-person follow-up were included in final analysis. Changes in diagnosis or treatments were noted at time of in-person evaluation. Results: Eighty-two patients completed both telemedicine and in-person evaluation. 44 (53.6%) had no changes in diagnosis or treatment, and 22 (26.8%) had no change in diagnosis with advancement in treatment. Sixteen patients (19.5%) had a change in diagnosis or treatment. Of the 16 patients where changes were made, 9 patients were given additional diagnoses, and 7 patients had changes in their diagnosis at time of in-person follow-up. Two (2.4%) patients had a change in treatment resulting from the in-person visit. Fifty-seven patients (69.5%) had imaging (X-ray, MRI, or CT) available during the telemedicine visit. Conclusions: Telemedicine was an effective platform for evaluating patients with new shoulder complaints, with only 2.4% of treatments altered after in-person evaluation. There may be specific shoulder pathology that is more difficult to diagnose via telemedicine or without advanced imaging. Further research evaluating patient and surgeon satisfaction with telemedicine is underway. Level of Evidence: IV, Retrospective Cohort Study.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"112 - 116"},"PeriodicalIF":0.3,"publicationDate":"2023-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43915062","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.0000000000001200
Jonathan S. Yu, Jacob Zeitlin, H. Moore, A. Nocon, P. Sculco
Background: The 2018 Centers for Medicare & Medicaid Services (CMS) removal of total knee arthroplasty (TKA) from the Inpatient-Only (IPO) list was accompanied by confusion, lack of central guidance on patient selection criteria, payor misinterpretation of the updated policy, and altered payor incentives. The purpose of this study was to assess how the CMS policy change affected overall patient outcomes in the Medicare population after TKA. Methods: Using the ACS-NSQIP database, patients 65 years and older who underwent primary, elective, unilateral TKA without any significant medical comorbidity were included. Complication rates before (2014-2017) and after (2018-2019) CMS removal of TKA from the IPO list were compared using interrupted time series analysis to gauge the impact of the policy shift. Results: A total 185,294 TKA cases were included in the analysis. Following the CMS removal of TKA from the IPO list in 2018, there were significant decreases in rates of any adverse event (RR 0.90, 95% CI 0.83-0.98, P=0.02), any minor adverse event (RR 0.84, 95% CI 0.73-0.97, P=0.02), and thromboembolic events (RR 0.76, 95% CI 0.64-0.89, P<0.001) significantly decreased There were no significant changes in rates of readmission (RR 0.95, 95% CI 0.87-1.05, P=0.31), reoperation (RR 0.92, 95% CI 0.78-1.09, P=0.33), or any major adverse event (RR 0.92, 95% CI 0.83-1.01, P=0.07). Conclusions: Though the CMS removal of TKA from the IPO list in 2018 was accompanied by the emergence of key new issues, the policy change did not adversely affect 30-day postoperative outcomes in the Medicare TKA patient population. Level of Evidence: Level IV—retrospective cohort study.
{"title":"Did the centers for medicare & medicaid services’ 2018 policy change removing total knee arthroplasty from the inpatient-only list affect overall patient outcomes in the medicare population?","authors":"Jonathan S. Yu, Jacob Zeitlin, H. Moore, A. Nocon, P. Sculco","doi":"10.1097/BCO.0000000000001200","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001200","url":null,"abstract":"Background: The 2018 Centers for Medicare & Medicaid Services (CMS) removal of total knee arthroplasty (TKA) from the Inpatient-Only (IPO) list was accompanied by confusion, lack of central guidance on patient selection criteria, payor misinterpretation of the updated policy, and altered payor incentives. The purpose of this study was to assess how the CMS policy change affected overall patient outcomes in the Medicare population after TKA. Methods: Using the ACS-NSQIP database, patients 65 years and older who underwent primary, elective, unilateral TKA without any significant medical comorbidity were included. Complication rates before (2014-2017) and after (2018-2019) CMS removal of TKA from the IPO list were compared using interrupted time series analysis to gauge the impact of the policy shift. Results: A total 185,294 TKA cases were included in the analysis. Following the CMS removal of TKA from the IPO list in 2018, there were significant decreases in rates of any adverse event (RR 0.90, 95% CI 0.83-0.98, P=0.02), any minor adverse event (RR 0.84, 95% CI 0.73-0.97, P=0.02), and thromboembolic events (RR 0.76, 95% CI 0.64-0.89, P<0.001) significantly decreased There were no significant changes in rates of readmission (RR 0.95, 95% CI 0.87-1.05, P=0.31), reoperation (RR 0.92, 95% CI 0.78-1.09, P=0.33), or any major adverse event (RR 0.92, 95% CI 0.83-1.01, P=0.07). Conclusions: Though the CMS removal of TKA from the IPO list in 2018 was accompanied by the emergence of key new issues, the policy change did not adversely affect 30-day postoperative outcomes in the Medicare TKA patient population. Level of Evidence: Level IV—retrospective cohort study.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"97 - 102"},"PeriodicalIF":0.3,"publicationDate":"2023-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43013198","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 : 2023-01-23DOI: 10.1097/bco.0000000000001195
K. Mistretta, Melissa A. Wright, A. Murthi
{"title":"Acute operative stabilization of an elbow dislocation and associated brachial artery injury: A case report","authors":"K. Mistretta, Melissa A. Wright, A. Murthi","doi":"10.1097/bco.0000000000001195","DOIUrl":"https://doi.org/10.1097/bco.0000000000001195","url":null,"abstract":"","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43291467","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 : 2023-01-23DOI: 10.1097/BCO.0000000000001194
John Panzone, William F Lavelle, Richard A. Tallarico
INTRODUCTION Hypoglossal nerve palsy resulting from cervical spine surgery is exceedingly rare, with literature suggesting overall rates as low as 0.01% and institutional rates ranging from 0% to 1.28%. Still, the morbidity for patients is significant and can include symptoms such as dysphagia, dysarthria, and tongue weakness. Previous reports suggest patient positioning, retraction of the hypoglossal nerve or other anterior structures of the neck, or nerve compression from tracheal intubation may cause this complication. Klippel-Feil Syndrome (KFS) is a congenital disorder characterized by auto fusion of cervical vertebrae and has been associated with numerous orthopedic abnormalities including scoliosis and Sprengel deformity. KFS may also be associated with developmental abnormalities in other organ systems, which could lead to anatomical variations in structures such as nerves and blood vessels. We present a case of a 60-year-old male (Patient Z) with KFS who developed dysphagia, dysarthria, tongue deformation and flaccidity immediately following C3-C6 anterior cervical discectomy and fusion (ACDF) and was subsequently diagnosed with left-sided hypoglossal nerve palsy. The patient has given their informed consent for the clinical information and images presented. Institutional Review Board (IRB) ethical approval was not required for this case report. CASE REPORT
{"title":"Hypoglossal nerve palsy following spine surgery in Klippel-Feil syndrome patient","authors":"John Panzone, William F Lavelle, Richard A. Tallarico","doi":"10.1097/BCO.0000000000001194","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001194","url":null,"abstract":"INTRODUCTION Hypoglossal nerve palsy resulting from cervical spine surgery is exceedingly rare, with literature suggesting overall rates as low as 0.01% and institutional rates ranging from 0% to 1.28%. Still, the morbidity for patients is significant and can include symptoms such as dysphagia, dysarthria, and tongue weakness. Previous reports suggest patient positioning, retraction of the hypoglossal nerve or other anterior structures of the neck, or nerve compression from tracheal intubation may cause this complication. Klippel-Feil Syndrome (KFS) is a congenital disorder characterized by auto fusion of cervical vertebrae and has been associated with numerous orthopedic abnormalities including scoliosis and Sprengel deformity. KFS may also be associated with developmental abnormalities in other organ systems, which could lead to anatomical variations in structures such as nerves and blood vessels. We present a case of a 60-year-old male (Patient Z) with KFS who developed dysphagia, dysarthria, tongue deformation and flaccidity immediately following C3-C6 anterior cervical discectomy and fusion (ACDF) and was subsequently diagnosed with left-sided hypoglossal nerve palsy. The patient has given their informed consent for the clinical information and images presented. Institutional Review Board (IRB) ethical approval was not required for this case report. CASE REPORT","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"89 - 93"},"PeriodicalIF":0.3,"publicationDate":"2023-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41577591","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 : 2022-11-28DOI: 10.1097/BCO.0000000000001189
David A. Brueggeman, G. Via, Joseph G. Lyons, A. Froehle, A. Krishnamurthy
Background: Interviews are considered fundamental to the residency application. Universal implementation of virtual interviews (VIs) caused substantial modifications to the 2020/2021 residency application cycle. Previous work elucidated the expectations and perceptions of candidates and program directors (PDs) prior to the match. The authors aimed to assess whether the match results affected perceptions of VIs. Methods: An online survey was distributed to candidates and PDs of the 2020/2021 orthopaedic surgery residency application cycle. Questions assessed match results, the perceived impact of VIs, and interview format preferences for upcoming application cycles. Results: Responses included 39 PDs (20% response rate) and 71 candidates (14% response rate). PDs in the sample reported filling all positions. Of the 71 candidates, 19 went unmatched. Candidates had significantly higher prematch expectations of the impact of VIs than PDs (P=0.039). PDs reported significantly different changes in perception of VIs after the match compared with candidates, with more positive views of VIs reported (P=0.009). Compared with matched candidates, unmatched candidates expressed significantly greater dissatisfaction with the match result (P<0.001). Conclusions: PDs reported higher satisfaction with VIs than expected after the match compared with prematch expectations. Candidates’ opinions of VIs postmatch were polarized. Unmatched candidates expressed a high level of dissatisfaction with the match and overwhelmingly felt VIs negatively affected their chances of matching. A large majority of PDs and matched candidates were satisfied with the outcomes of the match and VIs; nevertheless, this did not confer broad support for continuing VIs in the future. Level of Evidence: Level IV
{"title":"Postmatch perceptions of virtual interviews among orthopaedic surgery program directors and candidates: results of an online survey","authors":"David A. Brueggeman, G. Via, Joseph G. Lyons, A. Froehle, A. Krishnamurthy","doi":"10.1097/BCO.0000000000001189","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001189","url":null,"abstract":"Background: Interviews are considered fundamental to the residency application. Universal implementation of virtual interviews (VIs) caused substantial modifications to the 2020/2021 residency application cycle. Previous work elucidated the expectations and perceptions of candidates and program directors (PDs) prior to the match. The authors aimed to assess whether the match results affected perceptions of VIs. Methods: An online survey was distributed to candidates and PDs of the 2020/2021 orthopaedic surgery residency application cycle. Questions assessed match results, the perceived impact of VIs, and interview format preferences for upcoming application cycles. Results: Responses included 39 PDs (20% response rate) and 71 candidates (14% response rate). PDs in the sample reported filling all positions. Of the 71 candidates, 19 went unmatched. Candidates had significantly higher prematch expectations of the impact of VIs than PDs (P=0.039). PDs reported significantly different changes in perception of VIs after the match compared with candidates, with more positive views of VIs reported (P=0.009). Compared with matched candidates, unmatched candidates expressed significantly greater dissatisfaction with the match result (P<0.001). Conclusions: PDs reported higher satisfaction with VIs than expected after the match compared with prematch expectations. Candidates’ opinions of VIs postmatch were polarized. Unmatched candidates expressed a high level of dissatisfaction with the match and overwhelmingly felt VIs negatively affected their chances of matching. A large majority of PDs and matched candidates were satisfied with the outcomes of the match and VIs; nevertheless, this did not confer broad support for continuing VIs in the future. Level of Evidence: Level IV","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"46 - 52"},"PeriodicalIF":0.3,"publicationDate":"2022-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44696735","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 : 2022-11-21DOI: 10.1097/BCO.0000000000001191
Hooman Shariatzadeh, Farid Najd Mazhar, Dan Hosseinzadeh
Background: Perilunate dislocations (PLD) and perilunate fracture-dislocations (PLFD) are rare, but serious wrist injuries. This study reports the radiographic and clinical outcomes of PLD/PLFD in a series of 30 patients. Methods: Thirty patients with PLD (n=4) or PLFD (n=26) and a mean follow-up of 17.2 mo (range 12 to 21) were included in this retrospective study. Radiographic outcomes included the scapholunate angle, scapholunate interval, and carpal height ratio. Clinical outcomes included the wrist range of motion (ROM), pinch, and grip strength. Wrist function was assessed by a modified Mayo wrist score. Results: At the final follow-up, the scapholunate angle and interval were above the normal value in 10 and three patients, respectively. The carpal height ratio was normal in all patients. The mean wrist flexion was 44.2±15.8 degrees. The mean wrist extension was 28.3±15.4 degrees. The mean radial deviation was 14.3±4.3 degrees. The mean ulnar deviation was 18.4±6.3 degrees. The mean grip strength was 50.4±11.6 lb. in the involved wrist and 54.6±13.3 lb. in the noninvolved wrist (P=0.27). The mean pinch strength was 9.1±2.1 lb. in the involved wrist and 9.5±1.8 lb. in the noninvolved wrist (P=0.15). The mean modified Mayo score of the patients was 65.5±10. Postoperative stiffness, pain, and carpal instability were observed in six, five, and nine patients, respectively. Conclusions: Surgical treatment of PLD/PLFD provides satisfactory radiographic outcomes. Clinical outcomes seem to be less satisfactory, even after prompt diagnosis and treatment. Level of Evidence: Level IV
{"title":"Short-term outcomes of perilunate dislocations and perilunate fracture-dislocations: a single-center retrospective study","authors":"Hooman Shariatzadeh, Farid Najd Mazhar, Dan Hosseinzadeh","doi":"10.1097/BCO.0000000000001191","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001191","url":null,"abstract":"Background: Perilunate dislocations (PLD) and perilunate fracture-dislocations (PLFD) are rare, but serious wrist injuries. This study reports the radiographic and clinical outcomes of PLD/PLFD in a series of 30 patients. Methods: Thirty patients with PLD (n=4) or PLFD (n=26) and a mean follow-up of 17.2 mo (range 12 to 21) were included in this retrospective study. Radiographic outcomes included the scapholunate angle, scapholunate interval, and carpal height ratio. Clinical outcomes included the wrist range of motion (ROM), pinch, and grip strength. Wrist function was assessed by a modified Mayo wrist score. Results: At the final follow-up, the scapholunate angle and interval were above the normal value in 10 and three patients, respectively. The carpal height ratio was normal in all patients. The mean wrist flexion was 44.2±15.8 degrees. The mean wrist extension was 28.3±15.4 degrees. The mean radial deviation was 14.3±4.3 degrees. The mean ulnar deviation was 18.4±6.3 degrees. The mean grip strength was 50.4±11.6 lb. in the involved wrist and 54.6±13.3 lb. in the noninvolved wrist (P=0.27). The mean pinch strength was 9.1±2.1 lb. in the involved wrist and 9.5±1.8 lb. in the noninvolved wrist (P=0.15). The mean modified Mayo score of the patients was 65.5±10. Postoperative stiffness, pain, and carpal instability were observed in six, five, and nine patients, respectively. Conclusions: Surgical treatment of PLD/PLFD provides satisfactory radiographic outcomes. Clinical outcomes seem to be less satisfactory, even after prompt diagnosis and treatment. Level of Evidence: Level IV","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"56 - 59"},"PeriodicalIF":0.3,"publicationDate":"2022-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42546143","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 : 2022-11-21DOI: 10.1097/BCO.0000000000001192
M. Chehrassan, M. Shakeri, Farshad Nikouei, Mahtab Toulany, Mitra Faraji, A. Habibollahzadeh, Hasan Ghandhari
Background: The flexibility of the thoracic curve is important for the preoperative planning for patients with Scheuermann kyphosis (SK), and a lateral bolster hyperextension radiograph (HE) is the standard available method for this purpose. In this study, the authors aimed to evaluate how the flexibility of the thoracic curve in classic SK patients correlates between supine MRI and HE radiography. Methods: In a retrospective cross-sectional study, 38 SK patients who underwent surgical correction were included. Cobb angles were measured on three different images: lateral standing radiographs (EOS), lateral supine bolster HE radiography, and T2-weighted sagittal MRI. The mean differences between the Cobb angles measured on standing radiographs (EOS) and supine modalities (HE and MRI) was considered as the flexibility of the thoracic curve. Measurements were done two times by two orthopaedic spine surgeons, and acceptable intraobserver and interobserver reliability was observed using an intraclass correlation coefficient test. Results: The study population included 23 (60.5%) male patients and 15 (39.5%) female patients with a mean age of 23.4±8.8 yr (range 13 to 48). The mean flexibility of the thoracic curve was 31±10.9 degrees (40.5%) on supine MRIs and 36.1±11.5 degrees (47.25%) on bolster HE radiographs. A significant correlation was observed between the mean flexibility of the thoracic curve on MRI and HE radiographs (r=0.601, P<0.001). Conclusions: Supine MRI can be regarded as a promising alternative to bolster HE radiography in determining the flexibility of thoracic curves in patients with classic SK. Level of Evidence: Level III
{"title":"Comparison of MRI and bolster hyperextension radiography in determining the flexibility of thoracic curves in Scheuermann kyphosis: a retrospective cross-sectional study","authors":"M. Chehrassan, M. Shakeri, Farshad Nikouei, Mahtab Toulany, Mitra Faraji, A. Habibollahzadeh, Hasan Ghandhari","doi":"10.1097/BCO.0000000000001192","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001192","url":null,"abstract":"Background: The flexibility of the thoracic curve is important for the preoperative planning for patients with Scheuermann kyphosis (SK), and a lateral bolster hyperextension radiograph (HE) is the standard available method for this purpose. In this study, the authors aimed to evaluate how the flexibility of the thoracic curve in classic SK patients correlates between supine MRI and HE radiography. Methods: In a retrospective cross-sectional study, 38 SK patients who underwent surgical correction were included. Cobb angles were measured on three different images: lateral standing radiographs (EOS), lateral supine bolster HE radiography, and T2-weighted sagittal MRI. The mean differences between the Cobb angles measured on standing radiographs (EOS) and supine modalities (HE and MRI) was considered as the flexibility of the thoracic curve. Measurements were done two times by two orthopaedic spine surgeons, and acceptable intraobserver and interobserver reliability was observed using an intraclass correlation coefficient test. Results: The study population included 23 (60.5%) male patients and 15 (39.5%) female patients with a mean age of 23.4±8.8 yr (range 13 to 48). The mean flexibility of the thoracic curve was 31±10.9 degrees (40.5%) on supine MRIs and 36.1±11.5 degrees (47.25%) on bolster HE radiographs. A significant correlation was observed between the mean flexibility of the thoracic curve on MRI and HE radiographs (r=0.601, P<0.001). Conclusions: Supine MRI can be regarded as a promising alternative to bolster HE radiography in determining the flexibility of thoracic curves in patients with classic SK. Level of Evidence: Level III","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"60 - 65"},"PeriodicalIF":0.3,"publicationDate":"2022-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42069659","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 : 2022-11-21DOI: 10.1097/BCO.0000000000001188
Dhiraj Patel, Matthew Lippel, David J. Lunardini, R. Monsey, Chason Ziino
Background: This study investigated the role of preoperative supplementation of 25(OH)D, a precursor of the active form of vitamin D, as a cost-effective strategy to decrease pseudarthrosis rates and overall healthcare burden after posterolateral fusion (PLF). Previous literature has emphasized the importance of vitamin D in bone health maintenance, spinal health, and outcomes in spinal fusion. Inadequate preoperative 25(OH)D levels may increase pseudarthrosis rates after PLF. Thus, a cost-estimation model was developed to determine the cost-effectiveness of both selective and nonselective 25(OH)D supplementation in PLF. Methods: Prevalence and cost data were obtained from published literature through systematic reviews. Cost of serum 25(OH)D assay and supplementation were obtained from public-use data. Mean, lower, and upper bounds of 1-year cost-savings were calculated for both supplementation scenarios. Results: Preoperative 25(OH)D screening and subsequent selective 25(OH)D supplementation was calculated to result in a mean cost-savings of $10,978,440 ($9,969,394 to $11,987,485) per 10,000 PLF cases. Nonselective 25(OH)D supplementation of all PLF patients was calculated to result in a mean cost-savings of $11,213,318 ($10,204,272 to $12,222,363) per 10,000 cases. Univariate adjustment projects that selective supplementation is a cost-effective strategy in clinical contexts where revision PLF costs exceed $781.89 and prevalence of 25(OH)D deficiency ≥0.612%. Nonselective supplementation is cost-effective in clinical scenarios where revision PLF cost ≥$198.09 and prevalence of 25(OH)D deficiency ≥0.1645%. Conclusions: This cost-predictive model promotes the role of preoperative 25(OH)D supplementation as a cost-effective mechanism to reduce overall healthcare burden after PLF. Nonselective supplementation appears to be more cost-effective than selective supplementation, likely due to the relatively lower cost of 25(OH)D supplementation compared with serum assays. Level of Evidence: Level III
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