Pub Date : 2022-11-21DOI: 10.1097/BCO.0000000000001193
Farid Najd Mazhar, Hooman Shariatzadeh, Dan Hosseinzadeh
Background: Diagnostic performance of the scratch collapse test for carpal tunnel syndrome (CTS) is not clear. This study evaluated its diagnostic capability for CTS diagnosis in comparison with other widely used clinical CTS tests, including the Tinel’s sign, Phalen’s test, and Durkan’s test. Methods: In a prospective case-control study, 78 CTS patients and 78 group-matched healthy control subjects were included. The electrodiagnostic testing was regarded as a reference standard CTS diagnostic method. The tests were conducted separately for the case and control groups; the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the tests were calculated. Results: The sensitivity, specificity, PPV, NPV, and accuracy of CTS diagnosis were 7.7%, 100%, 100%, 52% and 53.8% for the scratch collapse test; 91%, 97.4%, 97.3%, 91.6%, and 94.2% for the Tinel’s sign test; 84.6%, 100%,100%, 88.6%, and 93.6% for the Phalen’s test; and 87.2%, 100%, 100%, 88.6%, and 93.6% for the Durkan’s test, respectively. Conclusions: Scratch collapse test has a low sensitivity and accuracy for diagnosing CTS. These results do not support its routine use for the diagnosis of CTS. Level of Evidence: Level III
{"title":"Diagnostic capability of the scratch collapse test compared with other clinical diagnostic tests for diagnosis of carpal tunnel syndrome: a prospective case-control study","authors":"Farid Najd Mazhar, Hooman Shariatzadeh, Dan Hosseinzadeh","doi":"10.1097/BCO.0000000000001193","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001193","url":null,"abstract":"Background: Diagnostic performance of the scratch collapse test for carpal tunnel syndrome (CTS) is not clear. This study evaluated its diagnostic capability for CTS diagnosis in comparison with other widely used clinical CTS tests, including the Tinel’s sign, Phalen’s test, and Durkan’s test. Methods: In a prospective case-control study, 78 CTS patients and 78 group-matched healthy control subjects were included. The electrodiagnostic testing was regarded as a reference standard CTS diagnostic method. The tests were conducted separately for the case and control groups; the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the tests were calculated. Results: The sensitivity, specificity, PPV, NPV, and accuracy of CTS diagnosis were 7.7%, 100%, 100%, 52% and 53.8% for the scratch collapse test; 91%, 97.4%, 97.3%, 91.6%, and 94.2% for the Tinel’s sign test; 84.6%, 100%,100%, 88.6%, and 93.6% for the Phalen’s test; and 87.2%, 100%, 100%, 88.6%, and 93.6% for the Durkan’s test, respectively. Conclusions: Scratch collapse test has a low sensitivity and accuracy for diagnosing CTS. These results do not support its routine use for the diagnosis of CTS. Level of Evidence: Level III","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"5 - 8"},"PeriodicalIF":0.3,"publicationDate":"2022-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43421595","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 : 2022-11-18DOI: 10.1097/BCO.0000000000001180
Clayton Del Prince, Sonja Pavlesen, M. DiPaola
Background: Periprosthetic joint infection is a rare, but potentially devastating complication that can occur after prosthetic joint replacement. In 2016, the American Academy of Orthopaedic Surgeons (AAOS) revised its Appropriate Use Criteria (AUC) for the Management of Patients with Orthopaedic Implants Undergoing Dental Procedures. The objective of this study was to survey orthopaedic surgeons regarding their use of prophylactic antibiotics in arthroplasty patients undergoing dental procedures. Additionally, the authors inquired whether surgeons who have undergone arthroplasty procedures themselves practice the antibiotic prophylaxis when faced with decisions regarding their own joints. Methods: The authors surveyed currently practicing orthopaedic surgeons in the United States who perform joint arthroplasty procedures. The questions pertained to demographic data, training background, type of employment, arthroplasty type and volume, antibiotic prophylaxis practices, and awareness of the AAOS/American Dental Association (ADA) recommendations. Results: Two hundred, fourteen surveys were completed, though not all respondents answered every question. Most surgeons (149 of 200, 74.5%) routinely recommend prophylactic antibiotics for all patients with total joint arthroplasties who undergo dental procedures. The majority of the surgeons (163 of 199, 81.9%) reported that they are aware of the current AAOS/ADA guidelines, but that did not have a substantial effect on whether they routinely recommend prophylactic antibiotics (P=0.74). Conclusions: Most orthopaedic surgeons surveyed said they understand the AAOS/ADA guidelines, but that they routinely prescribe prophylactic antibiotics for arthroplasty patients undergoing dental procedures. These prescribing practices have no significant relationship with their knowledge of the AAOS AUC, years of experience, volume, specialty, employment, or personal history of joint replacement. Level of Evidence: Level IV, cross-sectional survey
{"title":"Antibiotic prophylaxis for dental procedures after joint arthroplasty: a cross-sectional survey of orthopaedic surgeons about current practices","authors":"Clayton Del Prince, Sonja Pavlesen, M. DiPaola","doi":"10.1097/BCO.0000000000001180","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001180","url":null,"abstract":"Background: Periprosthetic joint infection is a rare, but potentially devastating complication that can occur after prosthetic joint replacement. In 2016, the American Academy of Orthopaedic Surgeons (AAOS) revised its Appropriate Use Criteria (AUC) for the Management of Patients with Orthopaedic Implants Undergoing Dental Procedures. The objective of this study was to survey orthopaedic surgeons regarding their use of prophylactic antibiotics in arthroplasty patients undergoing dental procedures. Additionally, the authors inquired whether surgeons who have undergone arthroplasty procedures themselves practice the antibiotic prophylaxis when faced with decisions regarding their own joints. Methods: The authors surveyed currently practicing orthopaedic surgeons in the United States who perform joint arthroplasty procedures. The questions pertained to demographic data, training background, type of employment, arthroplasty type and volume, antibiotic prophylaxis practices, and awareness of the AAOS/American Dental Association (ADA) recommendations. Results: Two hundred, fourteen surveys were completed, though not all respondents answered every question. Most surgeons (149 of 200, 74.5%) routinely recommend prophylactic antibiotics for all patients with total joint arthroplasties who undergo dental procedures. The majority of the surgeons (163 of 199, 81.9%) reported that they are aware of the current AAOS/ADA guidelines, but that did not have a substantial effect on whether they routinely recommend prophylactic antibiotics (P=0.74). Conclusions: Most orthopaedic surgeons surveyed said they understand the AAOS/ADA guidelines, but that they routinely prescribe prophylactic antibiotics for arthroplasty patients undergoing dental procedures. These prescribing practices have no significant relationship with their knowledge of the AAOS AUC, years of experience, volume, specialty, employment, or personal history of joint replacement. Level of Evidence: Level IV, cross-sectional survey","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"22 - 27"},"PeriodicalIF":0.3,"publicationDate":"2022-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44467767","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 : 2022-11-17DOI: 10.1097/BCO.0000000000001184
J. H. Dove, George J. Pasquarello, M. Dasilva
Distal biceps tendon injuries occur mostly in men aged 40 to 60 yr. The mechanism of failure is eccentric load of the biceps muscle while it is in a flexed position. The diagnosis of a distal biceps tendon rupture often can be made clinically with complete patient history and thorough physical examination. Patients may report a painful “pop” while the elbow is forcibly extended. They will describe pain in the antecubital fossa and weakness in the elbow. On examination, the clinical test described by O’Driscoll et al. known as the “hook test” can diagnose complete ruptures, especially when the findings are compared with the uninjured contralateral side. Of note, Devereaux et al. combined three clinical tests to identify a complete rupture. By using the hook test, passive forearm pronation, and the biceps crease interval in sequence, they found those tests resulted in 100% sensitivity and specificity when the outcomes of all three were in agreement. Despite the information that can be gained from the physical examination, some cases may remain equivocal, and clinicians will use imaging studies to confirm the diagnosis of distal biceps tendon injuries. Radiographs will often appear normal, but ultrasound (US) and MRI provide more information. MRI is considered the gold standard in diagnosing injuries of the distal biceps tendon; however, the expense must be considered when determining which study to obtain. If ultrasound provides similar information for surgeons, its cost-effectiveness makes it an attractive first option. Several studies have demonstrated the effective use of ultrasound to diagnose distal biceps tendon injuries; however, ultrasound is operator-dependent. Classically, four different approaches to evaluate the distal biceps tendon exist: anterior, medial, lateral, and posterior. There is no consensus regarding the best approach, but rather, combined use of all approaches help enhance the accuracy of the evaluation. Despite this idea, Miller et al. reviewed the four different approaches to evaluate the distal biceps tendon using ultrasound and found that readers and operators significantly preferred the medial approach (P<0.001) among the others. Conversely, while describing a new method of ultrasound evaluation of the distal biceps tendon using the crab position, Draghi et al. stated that the anterior approach with the forearm pronated was the most commonly used. Obviously, operator preference and experience influence the preferred approach. The crab position places the elbow in flexion and forearm in pronation and allows for coverage of 75% of the elbow in a single position. After the evaluation of the common extensor tendon in the long axis, the transducer is turned 90 degrees and moved distally, allowing a view of the distal biceps tendon in the transverse plane. Use of ultrasound to evaluate the distal biceps tendon can be challenging, but using consistent steps and approaches, accurate assessment can be obtained. This article pre
{"title":"Ultrasound assessment of distal biceps tendon injuries","authors":"J. H. Dove, George J. Pasquarello, M. Dasilva","doi":"10.1097/BCO.0000000000001184","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001184","url":null,"abstract":"Distal biceps tendon injuries occur mostly in men aged 40 to 60 yr. The mechanism of failure is eccentric load of the biceps muscle while it is in a flexed position. The diagnosis of a distal biceps tendon rupture often can be made clinically with complete patient history and thorough physical examination. Patients may report a painful “pop” while the elbow is forcibly extended. They will describe pain in the antecubital fossa and weakness in the elbow. On examination, the clinical test described by O’Driscoll et al. known as the “hook test” can diagnose complete ruptures, especially when the findings are compared with the uninjured contralateral side. Of note, Devereaux et al. combined three clinical tests to identify a complete rupture. By using the hook test, passive forearm pronation, and the biceps crease interval in sequence, they found those tests resulted in 100% sensitivity and specificity when the outcomes of all three were in agreement. Despite the information that can be gained from the physical examination, some cases may remain equivocal, and clinicians will use imaging studies to confirm the diagnosis of distal biceps tendon injuries. Radiographs will often appear normal, but ultrasound (US) and MRI provide more information. MRI is considered the gold standard in diagnosing injuries of the distal biceps tendon; however, the expense must be considered when determining which study to obtain. If ultrasound provides similar information for surgeons, its cost-effectiveness makes it an attractive first option. Several studies have demonstrated the effective use of ultrasound to diagnose distal biceps tendon injuries; however, ultrasound is operator-dependent. Classically, four different approaches to evaluate the distal biceps tendon exist: anterior, medial, lateral, and posterior. There is no consensus regarding the best approach, but rather, combined use of all approaches help enhance the accuracy of the evaluation. Despite this idea, Miller et al. reviewed the four different approaches to evaluate the distal biceps tendon using ultrasound and found that readers and operators significantly preferred the medial approach (P<0.001) among the others. Conversely, while describing a new method of ultrasound evaluation of the distal biceps tendon using the crab position, Draghi et al. stated that the anterior approach with the forearm pronated was the most commonly used. Obviously, operator preference and experience influence the preferred approach. The crab position places the elbow in flexion and forearm in pronation and allows for coverage of 75% of the elbow in a single position. After the evaluation of the common extensor tendon in the long axis, the transducer is turned 90 degrees and moved distally, allowing a view of the distal biceps tendon in the transverse plane. Use of ultrasound to evaluate the distal biceps tendon can be challenging, but using consistent steps and approaches, accurate assessment can be obtained. This article pre","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"79 - 81"},"PeriodicalIF":0.3,"publicationDate":"2022-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"62061391","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 : 2022-11-17DOI: 10.1097/BCO.0000000000001186
R. Samade, M. Kogan, Scott E. Porter, Joshua C. Patt, J. Samora
Background: Standardized letters of recommendation (SLORs) were introduced to facilitate the comparison of applicants for orthopaedic surgery residency positions, but concerns have arisen regarding the prevalence of their use and potential limitations. Methods: An 11-question electronic survey was sent to all letter of recommendation (LOR) authors and program coordinators who were identified as having completed or prepared a SLOR during the 2020 orthopaedic surgery residency match cycle. A total of 740 LOR authors and 218 program coordinators were invited via initial and reminder electronic mail messages. Results: The survey response rate was 18.1% for LOR authors and 25.2% for program coordinators. The proportion of LORs written that were SLORs significantly increased from prior to the 2020 match cycle to the 2020 match cycle (72.7% to 90.2%, ratio =1.240, P<0.001). There was not a significant increase in the proportion of LORs that were SLORs prepared by program coordinators (83.7% to 77.6%, ratio =0.927, P=0.375). A majority of LOR authors and program coordinators were aware of electronic (82.1% and 76.5%, respectively) and paper SLORs (91.0% and 88.2%, respectively). Conclusions: This study found that SLOR usage increased among LOR authors. However, a parallel increase in SLOR preparation was not reported by program coordinators. Level of Evidence: Level III
{"title":"Use of standardized letters of recommendation for orthopaedic surgery residency: a national survey study","authors":"R. Samade, M. Kogan, Scott E. Porter, Joshua C. Patt, J. Samora","doi":"10.1097/BCO.0000000000001186","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001186","url":null,"abstract":"Background: Standardized letters of recommendation (SLORs) were introduced to facilitate the comparison of applicants for orthopaedic surgery residency positions, but concerns have arisen regarding the prevalence of their use and potential limitations. Methods: An 11-question electronic survey was sent to all letter of recommendation (LOR) authors and program coordinators who were identified as having completed or prepared a SLOR during the 2020 orthopaedic surgery residency match cycle. A total of 740 LOR authors and 218 program coordinators were invited via initial and reminder electronic mail messages. Results: The survey response rate was 18.1% for LOR authors and 25.2% for program coordinators. The proportion of LORs written that were SLORs significantly increased from prior to the 2020 match cycle to the 2020 match cycle (72.7% to 90.2%, ratio =1.240, P<0.001). There was not a significant increase in the proportion of LORs that were SLORs prepared by program coordinators (83.7% to 77.6%, ratio =0.927, P=0.375). A majority of LOR authors and program coordinators were aware of electronic (82.1% and 76.5%, respectively) and paper SLORs (91.0% and 88.2%, respectively). Conclusions: This study found that SLOR usage increased among LOR authors. However, a parallel increase in SLOR preparation was not reported by program coordinators. Level of Evidence: Level III","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"39 - 45"},"PeriodicalIF":0.3,"publicationDate":"2022-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46328996","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 : 2022-11-17DOI: 10.1097/BCO.0000000000001179
Noureldin Mohamed AbdelKawi, Y. Abed, A. El-Negery, Samir Kotb
Background: Although considered as a benign tumor, giant cell tumor of bone (GCTB) has an aggressive biological behavior with high tendency for local recurrence (LR). The most commonly used method of treatment of GCTB is intralesional curettage augmented by various types of local adjuvants. The aim of this study was to evaluate the rate of recurrence of GCTB after surgical treatment to detect the risk factors that may influence the rate of LR. Methods: Fifty-two cases of GCTB that had been treated in a university hospital musculoskeletal oncology unit, between 2012 and 2017 were retrospectively reviewed after minimal follow-up of 4 yr and risk factors of LR were determined. Results: All LRs occurred within the first 3 yr (4 to 31 mo). Curettage was used to manage 34 patient cases, from which 11 patients (32.4%) showed LR. Only one patient (5.6%) of the 18 wide local excision patients developed recurrence. The highest recurrence rate was found among the lesions of the proximal femur. Neither the tumor volume nor the pathological grade had a significant impact on the rate of LR. The presence of soft-tissue invasion, occurrence of pathological fracture at presentation and using curettage as a method of treatment were associated with significantly higher rate of LR. Conclusions: Lesions in the proximal femur, occurrence of pathological fracture at presentation, soft-tissue invasion, and curettage as management option were found to be associated with an increased risk of LR of GCTB. Level of Evidence: Level III
{"title":"Risk factors for local recurrence of giant cell tumor of bone of the extremities: a retrospective study","authors":"Noureldin Mohamed AbdelKawi, Y. Abed, A. El-Negery, Samir Kotb","doi":"10.1097/BCO.0000000000001179","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001179","url":null,"abstract":"Background: Although considered as a benign tumor, giant cell tumor of bone (GCTB) has an aggressive biological behavior with high tendency for local recurrence (LR). The most commonly used method of treatment of GCTB is intralesional curettage augmented by various types of local adjuvants. The aim of this study was to evaluate the rate of recurrence of GCTB after surgical treatment to detect the risk factors that may influence the rate of LR. Methods: Fifty-two cases of GCTB that had been treated in a university hospital musculoskeletal oncology unit, between 2012 and 2017 were retrospectively reviewed after minimal follow-up of 4 yr and risk factors of LR were determined. Results: All LRs occurred within the first 3 yr (4 to 31 mo). Curettage was used to manage 34 patient cases, from which 11 patients (32.4%) showed LR. Only one patient (5.6%) of the 18 wide local excision patients developed recurrence. The highest recurrence rate was found among the lesions of the proximal femur. Neither the tumor volume nor the pathological grade had a significant impact on the rate of LR. The presence of soft-tissue invasion, occurrence of pathological fracture at presentation and using curettage as a method of treatment were associated with significantly higher rate of LR. Conclusions: Lesions in the proximal femur, occurrence of pathological fracture at presentation, soft-tissue invasion, and curettage as management option were found to be associated with an increased risk of LR of GCTB. Level of Evidence: Level III","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"16 - 21"},"PeriodicalIF":0.3,"publicationDate":"2022-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44896931","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 : 2022-11-17DOI: 10.1097/BCO.0000000000001187
Peter Y. W. Chan, M. Huo
Osteoarthritis is a chronic and debilitating condition, and the hip joint is commonly affected. Total hip arthroplasty is an effective treatment for end-stage osteoarthritis. Intraarticular injections may be used to treat pain relief before total hip arthroplasty. There are controversies on whether intraarticular injections prior to total hip arthroplasty are safe because of concerns that they may increase the risk of infection after surgery. This study reviewed the most current published evidence from the past 20 yr regarding the risks of infection from intraarticular injections before total hip arthroplasty.
{"title":"The safety of intraarticular injection prior to total hip arthroplasty: a review","authors":"Peter Y. W. Chan, M. Huo","doi":"10.1097/BCO.0000000000001187","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001187","url":null,"abstract":"Osteoarthritis is a chronic and debilitating condition, and the hip joint is commonly affected. Total hip arthroplasty is an effective treatment for end-stage osteoarthritis. Intraarticular injections may be used to treat pain relief before total hip arthroplasty. There are controversies on whether intraarticular injections prior to total hip arthroplasty are safe because of concerns that they may increase the risk of infection after surgery. This study reviewed the most current published evidence from the past 20 yr regarding the risks of infection from intraarticular injections before total hip arthroplasty.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"66 - 72"},"PeriodicalIF":0.3,"publicationDate":"2022-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44574081","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 : 2022-11-17DOI: 10.1097/BCO.0000000000001185
Lauren E. Massey, Lasun O. Oladeji, E. Esposito, J. Cook, G. D. Della Rocca, B. Crist
Background: Pilon fractures are associated with a high incidence of complications, yet there continues to be uncertainty regarding variables associated with adverse outcomes after pilon open reduction and internal fixation (ORIF). This study sought to characterize the rate of arthrodesis and identify risk factors that increase the likelihood of ankle arthrodesis in patients with ORIF pilon fractures. Methods: After institutional review board approval, a retrospective review was conducted to identify patients who underwent ORIF of pilon fractures at an ACS Level I trauma center from 2005 to 2014. Medical records and radiographs were reviewed retrospectively for patient demographics, comorbidities, fracture characteristics, associated injuries, mechanism of injury, and functional activity. Logistic regression analyses were performed to identify risk factors associated with arthrodesis. Results: 282 pilon fractures (279 patients) met inclusion criteria. There were 182 men and 97 women with an average age of 43.8±15.2 yr. Overall, 15 pilon fractures (5.3%) in six male patients and nine female patients were treated with an ankle arthrodesis an average of 1.73±5.15 yr after their initial injury. Following multivariable logistic regression analysis, age greater than 40 yr, tobacco use, and nonunion were identified as independent predictors of arthrodesis. Conclusions: This study found a number of patient-related factors associated with an increased risk of arthrodesis after a pilon fracture was sustained. Multivariable logistical analysis identified age greater than 40 yr, tobacco use, and nonunion as independent predictors of arthrodesis following pilon fracture ORIF. Level of Evidence: Level III
{"title":"Incidence and risk factors of ankle fusion after pilon fracture: a retrospective review","authors":"Lauren E. Massey, Lasun O. Oladeji, E. Esposito, J. Cook, G. D. Della Rocca, B. Crist","doi":"10.1097/BCO.0000000000001185","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001185","url":null,"abstract":"Background: Pilon fractures are associated with a high incidence of complications, yet there continues to be uncertainty regarding variables associated with adverse outcomes after pilon open reduction and internal fixation (ORIF). This study sought to characterize the rate of arthrodesis and identify risk factors that increase the likelihood of ankle arthrodesis in patients with ORIF pilon fractures. Methods: After institutional review board approval, a retrospective review was conducted to identify patients who underwent ORIF of pilon fractures at an ACS Level I trauma center from 2005 to 2014. Medical records and radiographs were reviewed retrospectively for patient demographics, comorbidities, fracture characteristics, associated injuries, mechanism of injury, and functional activity. Logistic regression analyses were performed to identify risk factors associated with arthrodesis. Results: 282 pilon fractures (279 patients) met inclusion criteria. There were 182 men and 97 women with an average age of 43.8±15.2 yr. Overall, 15 pilon fractures (5.3%) in six male patients and nine female patients were treated with an ankle arthrodesis an average of 1.73±5.15 yr after their initial injury. Following multivariable logistic regression analysis, age greater than 40 yr, tobacco use, and nonunion were identified as independent predictors of arthrodesis. Conclusions: This study found a number of patient-related factors associated with an increased risk of arthrodesis after a pilon fracture was sustained. Multivariable logistical analysis identified age greater than 40 yr, tobacco use, and nonunion as independent predictors of arthrodesis following pilon fracture ORIF. Level of Evidence: Level III","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"34 - 38"},"PeriodicalIF":0.3,"publicationDate":"2022-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45920511","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 : 2022-11-16DOI: 10.1097/BCO.0000000000001183
A. Bhaskarwar, Narinder Kumar
Background: Venous thromboembolism (VTE) is a frequent and serious complication in orthopaedic surgeries of the lower limbs. Subsequent pulmonary embolism (PE) makes it the most common cause of death after joint replacement surgeries of the lower limbs. In this study, a multimodal approach for thromboprophylaxis was adopted in patients undergoing total hip replacement (THR) and hemiarthroplasty (HA), including pharmaceutical and mechanical agents recommended by the American Academy of Orthopaedic Surgeons (AAOS) as per risk stratified approach, and the effectiveness of the same was measured by clinical and radiographic assessment. Methods: This was a prospective observational longitudinal study with evaluation at multiple points of time carried out at a tertiary care orthopaedic center. The study included 66 consecutive patients who underwent hip replacement arthroplasty (45 THR, 21 HA). Mechanical and pharmacological (soluble aspirin) prophylaxis modalities for deep venous thrombosis (DVT) were administered to all patients after risk stratification. Patients were assessed for evidence of DVT at 2,6, and 12 wk postoperatively by clinical tests and color Doppler flow imaging (CDFI). Results: This study confirmed efficacy of AAOS recommended risk stratified approach of thromboprophylaxis by combined use of soluble aspirin and various other mechanical measures in patients having standard risk for PE and bleeding undergoing THR or HA because none of the patients developed DVT per clinical assessment and confirmed by CDFI carried out at follow-up. Conclusions: Prevention of DVT as recommended by AAOS has proven to be effective as well as cheaper in moderate-risk patients undergoing hip replacement surgery. Though there were no major differences in complication rates in respect to other prophylaxis except prevalence of major bleeding was very low. Level of Evidence: Level II
{"title":"Assessment of risk-stratified approach to thromboprophylaxis in hip arthroplasty patients: a prospective cohort study","authors":"A. Bhaskarwar, Narinder Kumar","doi":"10.1097/BCO.0000000000001183","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001183","url":null,"abstract":"Background: Venous thromboembolism (VTE) is a frequent and serious complication in orthopaedic surgeries of the lower limbs. Subsequent pulmonary embolism (PE) makes it the most common cause of death after joint replacement surgeries of the lower limbs. In this study, a multimodal approach for thromboprophylaxis was adopted in patients undergoing total hip replacement (THR) and hemiarthroplasty (HA), including pharmaceutical and mechanical agents recommended by the American Academy of Orthopaedic Surgeons (AAOS) as per risk stratified approach, and the effectiveness of the same was measured by clinical and radiographic assessment. Methods: This was a prospective observational longitudinal study with evaluation at multiple points of time carried out at a tertiary care orthopaedic center. The study included 66 consecutive patients who underwent hip replacement arthroplasty (45 THR, 21 HA). Mechanical and pharmacological (soluble aspirin) prophylaxis modalities for deep venous thrombosis (DVT) were administered to all patients after risk stratification. Patients were assessed for evidence of DVT at 2,6, and 12 wk postoperatively by clinical tests and color Doppler flow imaging (CDFI). Results: This study confirmed efficacy of AAOS recommended risk stratified approach of thromboprophylaxis by combined use of soluble aspirin and various other mechanical measures in patients having standard risk for PE and bleeding undergoing THR or HA because none of the patients developed DVT per clinical assessment and confirmed by CDFI carried out at follow-up. Conclusions: Prevention of DVT as recommended by AAOS has proven to be effective as well as cheaper in moderate-risk patients undergoing hip replacement surgery. Though there were no major differences in complication rates in respect to other prophylaxis except prevalence of major bleeding was very low. Level of Evidence: Level II","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"1 - 4"},"PeriodicalIF":0.3,"publicationDate":"2022-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46017415","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 : 2022-11-15DOI: 10.1097/BCO.0000000000001190
Chase M. Romere, R. Shah
Background: Patients use online physician ratings to select an orthopaedic surgeon. The objectives of this paper were to investigate whether ratings are concordant among online review sites rating orthopaedic surgeons and examine physician practice characteristics associated with higher physician ratings. Methods: Orthopaedic surgeons in Illinois who accepted Medicare patients in 2015 were included in this study. Physician practice characteristics, demographics, and information regarding their Medicare volume were obtained for each surgeon. Information regarding each surgeon’s average and number of ratings was collected from Yelp, Healthgrades, Google, and Vitals.com. The authors examined concordance between sites by investigating how many physicians were given high ratings on one site (>4/5), but low ratings on another site (<2 .5/5). Finally, a multivariable regression model was developed to investigate the association between physician characteristics and online ratings. Results: Two hundred ninety-five orthopaedic surgeons were included in the study sample. The number of reviews per physician varied greatly, with some surgeons having as high as 300 and many having no reviews. Of the physicians reviewed as low-performing on one site, 65.9% were rated as high-performing on another site. Physicians were more likely to have better ratings if they graduated after 1995 (P<0.05) or performed a higher volume of Medicare services (P<0.05). Total number of reviews had a statistically significant positive correlation with average rating (r=0.26, P<0.001). Conclusions: The discordance among review sites for orthopaedic surgeons suggests that patients should exercise caution when using online reviews. As their use increases, the healthcare community should take a closer look at standardizing reviews. Level of Evidence: Level III
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Pub Date : 2022-11-15DOI: 10.1097/BCO.0000000000001182
J. Pritchett
All busy surgeons will eventually face a severe intraoperative hemorrhage and about one-third will have an intraoperative death. Situational awareness is the key to good operating room leadership and clinical performance. Technical, emotional, and professional skills are equally necessary. When hemorrhage occurs, some surgeons are affected by a “startle” response and freeze. An immediate surgical plan to stop the hemorrhage by pressure or direct vascular control is required. A stable patient presents other options such as waiting for additional surgical or interventional help; an unstable patient does not. The operating room team and family look to the surgeon as the threat-and-error manager. The surgeon must fill this role with a skilled, open, and compassionate approach rather than a hesitant, protective, or defensive approach. The urgent needs of the patient can require a surgeon to perform an unfamiliar or unpracticed exposure when there is no safe alternative. The emotional and professional cost of a fatal intraoperative hemorrhage is significant. With preparation, a better path for the surgeon, operating room staff and patient is possible. This review presents six actual scenarios of managing hemorrhage in orthopaedic surgery.
{"title":"Unexpected operative death from hemorrhage: a review of six cases and recommendations","authors":"J. Pritchett","doi":"10.1097/BCO.0000000000001182","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001182","url":null,"abstract":"All busy surgeons will eventually face a severe intraoperative hemorrhage and about one-third will have an intraoperative death. Situational awareness is the key to good operating room leadership and clinical performance. Technical, emotional, and professional skills are equally necessary. When hemorrhage occurs, some surgeons are affected by a “startle” response and freeze. An immediate surgical plan to stop the hemorrhage by pressure or direct vascular control is required. A stable patient presents other options such as waiting for additional surgical or interventional help; an unstable patient does not. The operating room team and family look to the surgeon as the threat-and-error manager. The surgeon must fill this role with a skilled, open, and compassionate approach rather than a hesitant, protective, or defensive approach. The urgent needs of the patient can require a surgeon to perform an unfamiliar or unpracticed exposure when there is no safe alternative. The emotional and professional cost of a fatal intraoperative hemorrhage is significant. With preparation, a better path for the surgeon, operating room staff and patient is possible. This review presents six actual scenarios of managing hemorrhage in orthopaedic surgery.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"73 - 78"},"PeriodicalIF":0.3,"publicationDate":"2022-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48715545","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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