Pub Date : 2022-09-06DOI: 10.1097/BCO.0000000000001174
A. Yeganeh, M. Moghtadaei, H. Farahini, Shayan Amiri, M. Mahmoudi, Yasaman Hamidpour, Mikaiel Hajializade
Background: The conventional graft harvesting site in a Salter osteotomy might impair the cosmetic appearance of patients with developmental dysplasia of the hip (DDH). The authors evaluated if an alternative graft donor site on the iliac bone could eliminate this concern. Methods: In a prospective study, 23 patients who had DDH with an indication for Salter osteotomy were included. In 10 patients (study group), the vertical triangular graft was harvested from the one-third anterolateral section of the iliac wing. In the remaining 13 patients (control group), the graft was harvested from the conventional site. The radiographic measures, including acetabular index and center edge angle, Severin criteria, clinical outcomes (McKay criteria), and complication rates of the two groups were compared. Results: The clinical outcome, acetabular index, center-edge angle, and Severin criteria of the patients of the two groups were statistically comparable. Union of harvested sites was seen in all patients. The mean duration of surgery and blood loss were statistically comparable (P=0.49 and P=0.33, respectively). The rate of osteonecrosis was similar in the two groups. The only graft site morbidity was the anterior superior iliac spine (ASIS) asymmetry that was seen in all patients of the control group and no patients of the study group; a mean horizontal level difference of 2.2±0.5 cm was observed between the affected and unaffected ASIS of the control group. Conclusions: Vertical triangular graft harvest from the one-third anterolateral section of iliac wing in Salter osteotomy improves the cosmetic outcome through the reduction of pelvic deformity. Level of Evidence: Level III.
{"title":"Improving the cosmetic outcome of Salter osteotomy through the modification of iliac crest graft harvesting site: a pilot clinical study","authors":"A. Yeganeh, M. Moghtadaei, H. Farahini, Shayan Amiri, M. Mahmoudi, Yasaman Hamidpour, Mikaiel Hajializade","doi":"10.1097/BCO.0000000000001174","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001174","url":null,"abstract":"Background: The conventional graft harvesting site in a Salter osteotomy might impair the cosmetic appearance of patients with developmental dysplasia of the hip (DDH). The authors evaluated if an alternative graft donor site on the iliac bone could eliminate this concern. Methods: In a prospective study, 23 patients who had DDH with an indication for Salter osteotomy were included. In 10 patients (study group), the vertical triangular graft was harvested from the one-third anterolateral section of the iliac wing. In the remaining 13 patients (control group), the graft was harvested from the conventional site. The radiographic measures, including acetabular index and center edge angle, Severin criteria, clinical outcomes (McKay criteria), and complication rates of the two groups were compared. Results: The clinical outcome, acetabular index, center-edge angle, and Severin criteria of the patients of the two groups were statistically comparable. Union of harvested sites was seen in all patients. The mean duration of surgery and blood loss were statistically comparable (P=0.49 and P=0.33, respectively). The rate of osteonecrosis was similar in the two groups. The only graft site morbidity was the anterior superior iliac spine (ASIS) asymmetry that was seen in all patients of the control group and no patients of the study group; a mean horizontal level difference of 2.2±0.5 cm was observed between the affected and unaffected ASIS of the control group. Conclusions: Vertical triangular graft harvest from the one-third anterolateral section of iliac wing in Salter osteotomy improves the cosmetic outcome through the reduction of pelvic deformity. Level of Evidence: Level III.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 1","pages":"553 - 558"},"PeriodicalIF":0.3,"publicationDate":"2022-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44042330","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 : 2022-09-06DOI: 10.1097/BCO.0000000000001170
Alejandro Pando, Cristina DelPrete, Jennifer Su, F. Edobor-Osula
Background: Physician online reviews are a growing resource that patients use to choose healthcare providers. The authors investigated the factors involved in the recommendation of pediatric orthopaedic surgeons on a popular online physician-rating website. Methods: A cross-sectional study was conducted using the 2020-2021 Pediatric Orthopedic Society of North America directory to identify United States active board-certified pediatric orthopaedic surgeons. Healthgrades.com was used to gather data including geographic location, years of experience, type of ratings, age, sex, and likelihood to recommend score (LTRS). Quantitative analysis was conducted using descriptive statistics, Student t-test, Analysis of Variance (ANOVA), Pearson correlation, and multiple linear regression models. Results: Seven hundred and one POSNA members (566 men, 135 women) were identified. A higher likelihood to recommend score (LTRS) was associated with short waiting times (P<0.0001), reports of “appointment not being rushed” (P=0.001), and more total ratings (P=0.130). Male physicians were positively associated with LTRS (P=0.01). Surgeons with fewer years of experience had fewer negative reviews (P=0.02) and were more favorably rated (P<0.05). Patients gave more positive (mean=3.37) then negative (mean=0.73) reviews and selected more “what went well” factors (mean=72) rather than “what could be improved” factors (mean=13). The South had more total, positive, and 5-star ratings (P<0.01). Conclusions: Patients are more likely to rate pediatric orthopaedic surgeons on the two extremes when using online reviews. Physicians with the fewer years practicing received higher LTRS, suggesting satisfaction is not related to experience. Factors such as reducing waiting times and not rushing appointments may help improve the likelihood of physicians being recommended in the future. Level of Evidence: Level IV.
{"title":"Analysis of physician characteristics and factors influencing the online recommendation of pediatric orthopaedic surgeons: a cross-sectional study","authors":"Alejandro Pando, Cristina DelPrete, Jennifer Su, F. Edobor-Osula","doi":"10.1097/BCO.0000000000001170","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001170","url":null,"abstract":"Background: Physician online reviews are a growing resource that patients use to choose healthcare providers. The authors investigated the factors involved in the recommendation of pediatric orthopaedic surgeons on a popular online physician-rating website. Methods: A cross-sectional study was conducted using the 2020-2021 Pediatric Orthopedic Society of North America directory to identify United States active board-certified pediatric orthopaedic surgeons. Healthgrades.com was used to gather data including geographic location, years of experience, type of ratings, age, sex, and likelihood to recommend score (LTRS). Quantitative analysis was conducted using descriptive statistics, Student t-test, Analysis of Variance (ANOVA), Pearson correlation, and multiple linear regression models. Results: Seven hundred and one POSNA members (566 men, 135 women) were identified. A higher likelihood to recommend score (LTRS) was associated with short waiting times (P<0.0001), reports of “appointment not being rushed” (P=0.001), and more total ratings (P=0.130). Male physicians were positively associated with LTRS (P=0.01). Surgeons with fewer years of experience had fewer negative reviews (P=0.02) and were more favorably rated (P<0.05). Patients gave more positive (mean=3.37) then negative (mean=0.73) reviews and selected more “what went well” factors (mean=72) rather than “what could be improved” factors (mean=13). The South had more total, positive, and 5-star ratings (P<0.01). Conclusions: Patients are more likely to rate pediatric orthopaedic surgeons on the two extremes when using online reviews. Physicians with the fewer years practicing received higher LTRS, suggesting satisfaction is not related to experience. Factors such as reducing waiting times and not rushing appointments may help improve the likelihood of physicians being recommended in the future. Level of Evidence: Level IV.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 1","pages":"600 - 606"},"PeriodicalIF":0.3,"publicationDate":"2022-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44954727","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 : 2022-09-06DOI: 10.1097/BCO.0000000000001172
Nishant Bhatia, Yasim Khan, S. Garhia, L. Maini
INTRODUCTION Subluxation and dislocation of the hip occurring after proximal femoral fracture fixation are rare complications. Most have been reported to occur after trochanteric fracture fixation with a screw-plate combination. A subluxation or dislocation after internal fixation of femoral neck fractures is even more uncommon, and almost all reported cases involve basicervical fractures fixed with a screw-plate combination. To the best of the authors’ knowledge, hip subluxation or dislocation after fixation of a transcervical femoral neck fracture with a minimally invasive implant like a cannulated cancellous screw (CCS) has not been reported in the literature to date. Dislocation or subluxation after fixation can occur with (septic) or without (aseptic) infection. In the absence of infection, excessive valgus fixation, neck collapse, and capsular injury are the described mechanisms while septic subluxation or dislocation usually involves tense intraarticular collection or destruction of restraining structures caused by hip joint sepsis. The deep sepsis in such cases is usually a low-grade infection caused by Staphylococcus aureus or epidermidis presenting without any systemic signs. The outcome in both septic and aseptic dislocations is mostly poor, and often replacement surgery is needed. This report presents two patients with hip subluxation after minimally invasive fixation of displaced transcervical femoral neck fractures with CCS. Ethical approval was granted for the study by the Maulana Azad Medical College Ethical Clearance Board (MAM/LNH/120/2). Written, informed consent was obtained from all patients authorizing clinical examination, radiographic and photographic documentation, and surgical procedures.
{"title":"Subtle hip joint subluxation after femoral neck fracture fixation: an ominous sign in a report of two cases","authors":"Nishant Bhatia, Yasim Khan, S. Garhia, L. Maini","doi":"10.1097/BCO.0000000000001172","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001172","url":null,"abstract":"INTRODUCTION Subluxation and dislocation of the hip occurring after proximal femoral fracture fixation are rare complications. Most have been reported to occur after trochanteric fracture fixation with a screw-plate combination. A subluxation or dislocation after internal fixation of femoral neck fractures is even more uncommon, and almost all reported cases involve basicervical fractures fixed with a screw-plate combination. To the best of the authors’ knowledge, hip subluxation or dislocation after fixation of a transcervical femoral neck fracture with a minimally invasive implant like a cannulated cancellous screw (CCS) has not been reported in the literature to date. Dislocation or subluxation after fixation can occur with (septic) or without (aseptic) infection. In the absence of infection, excessive valgus fixation, neck collapse, and capsular injury are the described mechanisms while septic subluxation or dislocation usually involves tense intraarticular collection or destruction of restraining structures caused by hip joint sepsis. The deep sepsis in such cases is usually a low-grade infection caused by Staphylococcus aureus or epidermidis presenting without any systemic signs. The outcome in both septic and aseptic dislocations is mostly poor, and often replacement surgery is needed. This report presents two patients with hip subluxation after minimally invasive fixation of displaced transcervical femoral neck fractures with CCS. Ethical approval was granted for the study by the Maulana Azad Medical College Ethical Clearance Board (MAM/LNH/120/2). Written, informed consent was obtained from all patients authorizing clinical examination, radiographic and photographic documentation, and surgical procedures.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 1","pages":"637 - 642"},"PeriodicalIF":0.3,"publicationDate":"2022-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41826790","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 : 2022-09-05DOI: 10.1097/BCO.0000000000001154
Farshad Nikouei, M. Shakeri, Hasan Ghandhari, M. Motalebi, E. Ameri
Background: Extracorporeal shock wave therapy (ESWT) has been used in the treatment of coccydynia. However, it has not yet been validated due to the dispersion of studies, the low number of patients, and the use of different measuring instruments. This meta-analysis was performed with the aim of collecting homogeneous studies to achieve a reliable result. Methods: The authors searched electronic databases including Google Scholar, Scopus, ScienceDirect, ISI Web of Science, Embase, and PubMed to find studies in which the effect of ESWT on coccydynia using visual analog scale (VAS) scores was evaluated starting in January 1990 through August 2021. All search procedures were performed by two authors. Results: The mean pain changes of 81 patients from four studies in 1 mo, 2 to 4 mo, and 6 to 12 mo after using ESWT were analyzed. Overall mean change of VAS score in 1 mo, 2 to 4 mo, and 6 to 12 mo after applying ESWT was -42.41 (I2=86.96%, 95% confidence interval [CI] of −56.88, −27.94, P=0.001), −41.01 (I2=0.0%, 95% CI of −46.98, −35.04, P=0.001) and −50.13 (I2=82.41%, 95% CI of −67.33; −32.94, P=0.001), respectively. Conclusions: The authors showed that ESWT lessened pain in patients with coccydynia. This effect did not diminish during a year; instead, it further reduced pain in patients. However, more research is needed to verify the results. Level of Evidence: Level I.
背景：体外冲击波治疗（ESWT）已被用于治疗球虫。然而，由于研究的分散性、患者数量少以及使用不同的测量仪器，它尚未得到验证。进行这项荟萃分析的目的是收集同质研究，以获得可靠的结果。方法：作者搜索了包括Google Scholar、Scopus、ScienceDirect、ISI Web of Science、Embase和PubMed在内的电子数据库，以寻找从1990年1月到2021年8月使用视觉模拟量表（VAS）评分评估ESWT对球虫影响的研究。所有搜索程序均由两名作者执行。结果：分析了四项研究中81名患者在使用ESWT后1个月、2至4个月和6至12个月的平均疼痛变化。应用ESWT后1个月、2个月至4个月和6个月至12个月VAS评分的总体平均变化分别为-42.41（I2=86.96%，95%置信区间[CI]为−56.88、−27.94，P=0.001）、−41.01（I2=0.0%，95%可信区间为−46.98、−35.04，P=0.000）和−50.13（I2=82.41%，95%CI为−67.33；−32.94，P=0.01）。结论：作者表明ESWT减轻了球虫患者的疼痛。这种影响在一年中没有减弱；相反，它进一步减轻了患者的疼痛。然而，还需要更多的研究来验证结果。证据级别：一级。
{"title":"The effect of extracorporeal shock wave therapy in coccydynia: a systematic review and meta-analysis","authors":"Farshad Nikouei, M. Shakeri, Hasan Ghandhari, M. Motalebi, E. Ameri","doi":"10.1097/BCO.0000000000001154","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001154","url":null,"abstract":"Background: Extracorporeal shock wave therapy (ESWT) has been used in the treatment of coccydynia. However, it has not yet been validated due to the dispersion of studies, the low number of patients, and the use of different measuring instruments. This meta-analysis was performed with the aim of collecting homogeneous studies to achieve a reliable result. Methods: The authors searched electronic databases including Google Scholar, Scopus, ScienceDirect, ISI Web of Science, Embase, and PubMed to find studies in which the effect of ESWT on coccydynia using visual analog scale (VAS) scores was evaluated starting in January 1990 through August 2021. All search procedures were performed by two authors. Results: The mean pain changes of 81 patients from four studies in 1 mo, 2 to 4 mo, and 6 to 12 mo after using ESWT were analyzed. Overall mean change of VAS score in 1 mo, 2 to 4 mo, and 6 to 12 mo after applying ESWT was -42.41 (I2=86.96%, 95% confidence interval [CI] of −56.88, −27.94, P=0.001), −41.01 (I2=0.0%, 95% CI of −46.98, −35.04, P=0.001) and −50.13 (I2=82.41%, 95% CI of −67.33; −32.94, P=0.001), respectively. Conclusions: The authors showed that ESWT lessened pain in patients with coccydynia. This effect did not diminish during a year; instead, it further reduced pain in patients. However, more research is needed to verify the results. Level of Evidence: Level I.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 1","pages":"613 - 618"},"PeriodicalIF":0.3,"publicationDate":"2022-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41958460","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 : 2022-09-02DOI: 10.1097/BCO.0000000000001156
Haitham K. Haroun
Background: Double bundle reconstruction of superficial medial collateral (sMCL) and posterior oblique (POL) ligaments with a single femoral tunnel using distally based semitendinosus is a traditional procedure for management of medial knee ligament complex injuries. However, the transferred tendon was always routed in nonanatomical configuration. The author reports the clinical outcomes and complications in a reconstruction technique with anatomical graft routing method. Methods: Fourteen patients with International Knee Documentation Committee (IKDC) grade 3 or 4 valgus instability and anteromedial rotatory instability underwent reconstruction of sMCL and POL by anatomically routed semitendinosus tendon transfer. The average age of the patients was 36.6 yr. Medial-sided knee ligament injury was isolated in two patients and part of multiligament knee injury in 12 patients. The average duration between injury and surgery was 7 wk (range 2 to 25). Patients were evaluated preoperatively and at final follow-up. Results: After a median follow-up of 29.5 mo (range, 24 to 36), the mean Lysholm and IKDC subjective scores improved from 27 (2.95) and 46.8 (8.26) preoperatively to 87.6 (3.44) and 71.7 (3.68) at latest follow-up (P<0.05), respectively. Nine patients (64.3%) returned at a preinjury Tegner score level at final follow-up. Both medial and posteromedial laxity were significantly improved on physical examination (P<0.01). No patients had recurrent laxity of medial knee reconstruction or any concurrent cruciate ligament reconstructions. Conclusions: Reconstruction of sMCL and POL using anatomically routed semitendinosus transfer showed favorable clinical outcomes without recurrence of medial or anteromedial instability after midterm follow-up. Level of Evidence: Level IV.
{"title":"Reconstruction of medial collateral ligament and posterior oblique ligament of the knee using anatomically routed semitendinosus transfer: a retrospective case series","authors":"Haitham K. Haroun","doi":"10.1097/BCO.0000000000001156","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001156","url":null,"abstract":"Background: Double bundle reconstruction of superficial medial collateral (sMCL) and posterior oblique (POL) ligaments with a single femoral tunnel using distally based semitendinosus is a traditional procedure for management of medial knee ligament complex injuries. However, the transferred tendon was always routed in nonanatomical configuration. The author reports the clinical outcomes and complications in a reconstruction technique with anatomical graft routing method. Methods: Fourteen patients with International Knee Documentation Committee (IKDC) grade 3 or 4 valgus instability and anteromedial rotatory instability underwent reconstruction of sMCL and POL by anatomically routed semitendinosus tendon transfer. The average age of the patients was 36.6 yr. Medial-sided knee ligament injury was isolated in two patients and part of multiligament knee injury in 12 patients. The average duration between injury and surgery was 7 wk (range 2 to 25). Patients were evaluated preoperatively and at final follow-up. Results: After a median follow-up of 29.5 mo (range, 24 to 36), the mean Lysholm and IKDC subjective scores improved from 27 (2.95) and 46.8 (8.26) preoperatively to 87.6 (3.44) and 71.7 (3.68) at latest follow-up (P<0.05), respectively. Nine patients (64.3%) returned at a preinjury Tegner score level at final follow-up. Both medial and posteromedial laxity were significantly improved on physical examination (P<0.01). No patients had recurrent laxity of medial knee reconstruction or any concurrent cruciate ligament reconstructions. Conclusions: Reconstruction of sMCL and POL using anatomically routed semitendinosus transfer showed favorable clinical outcomes without recurrence of medial or anteromedial instability after midterm follow-up. Level of Evidence: Level IV.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 1","pages":"571 - 579"},"PeriodicalIF":0.3,"publicationDate":"2022-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48637526","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 : 2022-09-02DOI: 10.1097/BCO.0000000000001159
David Martin, Corey Bindner, John Dawson, Scott J Mitchell, Christopher H. Perkins, Omar H. Atassi
Background: The purpose of this study was to assess the impact of social distancing orders on ambulatory orthopaedic fracture care at a level 1 trauma center during the Coronavirus Disease 2019 (COVID-19) pandemic. Methods: All ambulatory orthopaedic fractures that presented to the author’s Level 1 trauma center were analyzed retrospectively between December 2019 and June 2020. Patients were divided into prepandemic (n=377) and pandemic (n=224) groups based on the date of presentation. Primary outcomes included new ambulatory fracture volume, and time to presentation and surgery. Secondary outcomes included fracture type and clinic no-show rates. Results: In the first 8 wk after the pandemic began, there was a 60.8% decrease in new patients with ambulatory fractures (24.6/week pre-pandemic, 9.63/week during the first 8 wk, P=0.001). The presentation rate of patients with new ambulatory fractures returned to the prepandemic baseline after the first 8 wk of the pandemic. No significant difference in time to presentation or surgery was noted between groups. There was no statistically significant difference in the presentation rate of the most commonly treated fracture types (ankle, distal radius, hand, or foot) between groups. There was a statistically significant increase in overall clinic no-show rate during the pandemic period. Conclusions: An initial decrease in ambulatory fracture volume was seen during the first 8 wk of the COVID-19 pandemic. No delay in time to presentation or time to surgery was seen between groups. After the first 8 wk of the pandemic, a return to normal ambulatory fracture volume was seen. Level of Evidence: Level III.
{"title":"No delay in care of ambulatory orthopaedic fractures observed during the early Coronavirus-2019 pandemic: a retrospective cohort study","authors":"David Martin, Corey Bindner, John Dawson, Scott J Mitchell, Christopher H. Perkins, Omar H. Atassi","doi":"10.1097/BCO.0000000000001159","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001159","url":null,"abstract":"Background: The purpose of this study was to assess the impact of social distancing orders on ambulatory orthopaedic fracture care at a level 1 trauma center during the Coronavirus Disease 2019 (COVID-19) pandemic. Methods: All ambulatory orthopaedic fractures that presented to the author’s Level 1 trauma center were analyzed retrospectively between December 2019 and June 2020. Patients were divided into prepandemic (n=377) and pandemic (n=224) groups based on the date of presentation. Primary outcomes included new ambulatory fracture volume, and time to presentation and surgery. Secondary outcomes included fracture type and clinic no-show rates. Results: In the first 8 wk after the pandemic began, there was a 60.8% decrease in new patients with ambulatory fractures (24.6/week pre-pandemic, 9.63/week during the first 8 wk, P=0.001). The presentation rate of patients with new ambulatory fractures returned to the prepandemic baseline after the first 8 wk of the pandemic. No significant difference in time to presentation or surgery was noted between groups. There was no statistically significant difference in the presentation rate of the most commonly treated fracture types (ankle, distal radius, hand, or foot) between groups. There was a statistically significant increase in overall clinic no-show rate during the pandemic period. Conclusions: An initial decrease in ambulatory fracture volume was seen during the first 8 wk of the COVID-19 pandemic. No delay in time to presentation or time to surgery was seen between groups. After the first 8 wk of the pandemic, a return to normal ambulatory fracture volume was seen. Level of Evidence: Level III.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 1","pages":"514 - 518"},"PeriodicalIF":0.3,"publicationDate":"2022-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49045217","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 : 2022-08-31DOI: 10.1097/BCO.0000000000001158
Joseph Kitchen, B. Hartley, D. Seligson
Background: Heterotopic ossification (HO) is a known complication of acetabular fracture repair. After surgery, standard methods for HO prevention involve observation, radiation therapy, or a course of nonsteroidal antiinflammatories (indomethacin). Methods: A retrospective chart review was performed to analyze the effectiveness of radiation and indomethacin as HO prophylaxis after acetabular fracture surgical repair. Data were analyzed from 117 patients who underwent stabilization of the acetabulum utilizing a posterior approach from 2016 to 2020. Patients were classified into three groups based on the postoperative therapy received: radiation therapy, indomethacin therapy, or no prophylaxis. Grade of HO for each patient was determined by examining pelvic radiographs using the Brooker classification system at the most recent follow-up. Incidence of total and severe HO was recorded for each group and compared. Demographics, follow-up time, injury severity, and other trauma characteristics also were reported. Statistics were calculated using a combination of analysis of the variance (ANOVA), chi square, and Kruskal-Wallis testing. Results: The indomethacin group was younger than the other two groups with a shorter average follow-up time. The radiation group demonstrated a lower incidence of severe and total HO compared to the control group. The indomethacin group had significantly less total HO than the control group. Conclusions: With a decreased incidence of severe HO in the radiation group compared to no prophylaxis, this study supports the utility of radiation therapy as HO prophylaxis following acetabular fracture repair using a posterior approach. It shows a trend indicating that indomethacin also may be useful. Level of Evidence: Level III.
{"title":"Heterotopic ossification prophylaxis after acetabular fracture fixation using a posterior approach: a retrospective study at a level 1 trauma center","authors":"Joseph Kitchen, B. Hartley, D. Seligson","doi":"10.1097/BCO.0000000000001158","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001158","url":null,"abstract":"Background: Heterotopic ossification (HO) is a known complication of acetabular fracture repair. After surgery, standard methods for HO prevention involve observation, radiation therapy, or a course of nonsteroidal antiinflammatories (indomethacin). Methods: A retrospective chart review was performed to analyze the effectiveness of radiation and indomethacin as HO prophylaxis after acetabular fracture surgical repair. Data were analyzed from 117 patients who underwent stabilization of the acetabulum utilizing a posterior approach from 2016 to 2020. Patients were classified into three groups based on the postoperative therapy received: radiation therapy, indomethacin therapy, or no prophylaxis. Grade of HO for each patient was determined by examining pelvic radiographs using the Brooker classification system at the most recent follow-up. Incidence of total and severe HO was recorded for each group and compared. Demographics, follow-up time, injury severity, and other trauma characteristics also were reported. Statistics were calculated using a combination of analysis of the variance (ANOVA), chi square, and Kruskal-Wallis testing. Results: The indomethacin group was younger than the other two groups with a shorter average follow-up time. The radiation group demonstrated a lower incidence of severe and total HO compared to the control group. The indomethacin group had significantly less total HO than the control group. Conclusions: With a decreased incidence of severe HO in the radiation group compared to no prophylaxis, this study supports the utility of radiation therapy as HO prophylaxis following acetabular fracture repair using a posterior approach. It shows a trend indicating that indomethacin also may be useful. Level of Evidence: Level III.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 1","pages":"508 - 513"},"PeriodicalIF":0.3,"publicationDate":"2022-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41552091","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 : 2022-08-30DOI: 10.1097/BCO.0000000000001155
Syed Mohd Esmat Hussaini, Saturveithan Chandirasegaran, M. F. Yusof, A. M. Abdul Wahid
INTRODUCTION Congenital knee dislocation (CKD) is a condition characterized by knee hyperextension with anterior displacement of the tibia in relation to the femur. It covers a wide spectrum of severity ranging from subluxation to dislocation. This is a rare condition with an incidence of one in 100,000 livebirths with higher frequency reported in the female population. It may occur in isolation but occurs more commonly in combination with other musculoskeletal anomalies such as developmental dysplasia of hip (DDH) and congenital talipes equinovarus (CTEV). Further investigation is always advocated because of possible association with conditions like arthrogryposis multiplex congenita, myelomeningocele, Marfan, Ehler-Danlos, and Larsen syndromes. The authors report a case of a dysmorphic newborn with bilateral CKD who was successfully treated with early manipulation and serial casting. The mother provided written informed consent for the use of data related to this case prior to publication. Institutional review board approval was not required for this case report.
{"title":"Recalcitrant congenital knee dislocation: a case report of successful serial casting in a dysmorphic infant","authors":"Syed Mohd Esmat Hussaini, Saturveithan Chandirasegaran, M. F. Yusof, A. M. Abdul Wahid","doi":"10.1097/BCO.0000000000001155","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001155","url":null,"abstract":"INTRODUCTION Congenital knee dislocation (CKD) is a condition characterized by knee hyperextension with anterior displacement of the tibia in relation to the femur. It covers a wide spectrum of severity ranging from subluxation to dislocation. This is a rare condition with an incidence of one in 100,000 livebirths with higher frequency reported in the female population. It may occur in isolation but occurs more commonly in combination with other musculoskeletal anomalies such as developmental dysplasia of hip (DDH) and congenital talipes equinovarus (CTEV). Further investigation is always advocated because of possible association with conditions like arthrogryposis multiplex congenita, myelomeningocele, Marfan, Ehler-Danlos, and Larsen syndromes. The authors report a case of a dysmorphic newborn with bilateral CKD who was successfully treated with early manipulation and serial casting. The mother provided written informed consent for the use of data related to this case prior to publication. Institutional review board approval was not required for this case report.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 1","pages":"623 - 625"},"PeriodicalIF":0.3,"publicationDate":"2022-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43300562","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 : 2022-08-30DOI: 10.1097/BCO.0000000000001168
Sherif Adel Lotfy, Tarek El Nor, Mohamed Romeih
Background: Unstable intertrochanteric fractures represent about 60% of all trochanteric fractures. Dynamic hip screw alone in an unstable fracture pattern has a high failure rate of about 50%. Proximal femoral nail is technically a difficult surgery and has complications including nail failure, femoral shaft fracture, malreduction, screw cut-out, and nonunion. Putting a buttress like a trochanteric-stabilization plate acts as a support to the dynamic hip screw and gives good lateral wall buttress, which prevents excessive shaft medialization. Methods: Twenty-one patients with closed unstable trochanteric fractures were treated by dynamic hip screw with trochanteric stabilization plate. Results: According to the modified Harris Hip Scoring system, 11 patients had excellent results, five patients had good results, four patients had fair results, and one patient had a poor result. Conclusions: The dynamic hip screw with trochanteric stabilization plate provides a stable construct for unstable intertrochanteric fractures as it gives a good lateral wall buttress which prevents excessive fracture collapse, femoral shaft medialization, and consecutive limb shortening. It effectively supports the unstable greater trochanteric fragment and can maintain the lever arm with adequate abductor strength. Level of Evidence: Level IV.
{"title":"Dynamic hip screw with stabilization plate in unstable intertrochanteric fractures: a case series","authors":"Sherif Adel Lotfy, Tarek El Nor, Mohamed Romeih","doi":"10.1097/BCO.0000000000001168","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001168","url":null,"abstract":"Background: Unstable intertrochanteric fractures represent about 60% of all trochanteric fractures. Dynamic hip screw alone in an unstable fracture pattern has a high failure rate of about 50%. Proximal femoral nail is technically a difficult surgery and has complications including nail failure, femoral shaft fracture, malreduction, screw cut-out, and nonunion. Putting a buttress like a trochanteric-stabilization plate acts as a support to the dynamic hip screw and gives good lateral wall buttress, which prevents excessive shaft medialization. Methods: Twenty-one patients with closed unstable trochanteric fractures were treated by dynamic hip screw with trochanteric stabilization plate. Results: According to the modified Harris Hip Scoring system, 11 patients had excellent results, five patients had good results, four patients had fair results, and one patient had a poor result. Conclusions: The dynamic hip screw with trochanteric stabilization plate provides a stable construct for unstable intertrochanteric fractures as it gives a good lateral wall buttress which prevents excessive fracture collapse, femoral shaft medialization, and consecutive limb shortening. It effectively supports the unstable greater trochanteric fragment and can maintain the lever arm with adequate abductor strength. Level of Evidence: Level IV.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 1","pages":"530 - 537"},"PeriodicalIF":0.3,"publicationDate":"2022-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45033662","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 : 2022-08-30DOI: 10.1097/BCO.0000000000001160
A. Bagherifard, Sajad Fakoor, Peyman Hashemi, M. Mohammadpour
INTRODUCTION Osteoid osteoma is a relatively frequent benign boneforming tumor that accounts for about 5% of all bone tumors and 11% of benign bone tumors. It mostly involves the long bones of the appendicular skeleton and is characterized by episodes of night pain. Although nonsteroidal antiinflammatory drugs (NSAIDs) generally reduce the pain, such treatment requires long-term (3 to 4 yr) consumption of those medications. Surgical excision is indicated for patients with severe pain that is nonresponsive to medications. CT scanning is the modality of choice for the diagnosis of osteoid osteoma to show the characteristic nidus. The diagnosis is not generally difficult if the typical clinical and radiographic features are present. However, in a considerable number of patients, the lesion is not presented with typical characteristics, making the diagnosis difficult. For that reason, misdiagnosis of osteoid osteoma occurs frequently. In one study, 44.8% of patients with osteoid osteoma were misdiagnosed with other lesions such as intraarticular infection, synovitis, Perthes disease, osteomyelitis, and joint tuberculosis. Intraarticular localization of osteoid osteoma accounts for about 10% of those lesions and is associated with nonspecific pain and symptoms that generally are misdiagnosed with more common joint pathologies, such as inflammatory joint diseases or osteochondritis dissecans (OCD). For that reason, its diagnosis has been made with a significant delay compared to extraarticular lesions (26.6 mo vs. 8.5 mo). Since misdiagnosis could lead to overtreatment of the patient as well as long-term patient suffering, awareness of conditions that may complicate the diagnosis of osteoid osteoma is critical. This study reports a complicated diagnosis of intraarticular osteoid osteoma in an adult female who presented with persistent knee pain. Informed consent was obtained from the patient to use her medical data for publication. Case reports do not require ethical approval according to the guidelines of the authors’ university. CASE REPORT
{"title":"Intraarticular osteoid osteoma of the knee misdiagnosed as meniscal tear: a case report","authors":"A. Bagherifard, Sajad Fakoor, Peyman Hashemi, M. Mohammadpour","doi":"10.1097/BCO.0000000000001160","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001160","url":null,"abstract":"INTRODUCTION Osteoid osteoma is a relatively frequent benign boneforming tumor that accounts for about 5% of all bone tumors and 11% of benign bone tumors. It mostly involves the long bones of the appendicular skeleton and is characterized by episodes of night pain. Although nonsteroidal antiinflammatory drugs (NSAIDs) generally reduce the pain, such treatment requires long-term (3 to 4 yr) consumption of those medications. Surgical excision is indicated for patients with severe pain that is nonresponsive to medications. CT scanning is the modality of choice for the diagnosis of osteoid osteoma to show the characteristic nidus. The diagnosis is not generally difficult if the typical clinical and radiographic features are present. However, in a considerable number of patients, the lesion is not presented with typical characteristics, making the diagnosis difficult. For that reason, misdiagnosis of osteoid osteoma occurs frequently. In one study, 44.8% of patients with osteoid osteoma were misdiagnosed with other lesions such as intraarticular infection, synovitis, Perthes disease, osteomyelitis, and joint tuberculosis. Intraarticular localization of osteoid osteoma accounts for about 10% of those lesions and is associated with nonspecific pain and symptoms that generally are misdiagnosed with more common joint pathologies, such as inflammatory joint diseases or osteochondritis dissecans (OCD). For that reason, its diagnosis has been made with a significant delay compared to extraarticular lesions (26.6 mo vs. 8.5 mo). Since misdiagnosis could lead to overtreatment of the patient as well as long-term patient suffering, awareness of conditions that may complicate the diagnosis of osteoid osteoma is critical. This study reports a complicated diagnosis of intraarticular osteoid osteoma in an adult female who presented with persistent knee pain. Informed consent was obtained from the patient to use her medical data for publication. Case reports do not require ethical approval according to the guidelines of the authors’ university. CASE REPORT","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 1","pages":"619 - 622"},"PeriodicalIF":0.3,"publicationDate":"2022-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48476867","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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