Journal of surgical orthopaedic advances最新文献

Following low-energy distal radius fractures (DRF) patients rarely receive a bone health evaluation. The purpose of this survey was to investigate the attitudes and practices of American Society for Surgery of the Hand (ASSH) members regarding osteoporosis and low-energy DRF. An electronic survey was sent to 4,125 members of the ASSH. Physicians were asked about referral patterns, comfort level with labs and imaging related to bone health, and barriers. There were 475 responses (response rate 11.5%). Most respondents always (33.1%) or often (32.8%) talk about osteoporosis risk after low-energy DRF. Most respondents (87.6%) do not routinely order metabolic labs. Less than half knew of an available Fracture Liaison Service. Barriers to discussion included not enough time (32.6%), not comfortable with the topic (12.6%), and not within practice scope (33.3%). Respondents reported variable comfort levels discussing and implementing osteoporosis care in the setting of low-energy DRF. (Journal of Surgical Orthopaedic Advances 31(3):155-160, 2022).

The Certificate of Need (CON) program was established to respond to increasing healthcare costs; however, its impact on spine surgery trends is not well understood. The purpose of this study was to evaluate the impact of CON status on utilization of single-level lumbar discectomy. A combined Medicare and private payer database was used to identify single level lumbar discectomies performed from 2007 to 2015. Utilization and reimbursement trends were compared using the compound annual growth rate (CAGR) with reimbursement adjusted by the consumer price index. For this study, 30,617 lumbar discectomies were analyzed. Procedure utilization increased across all settings. CAGR was highest in the outpatient CON group (19.7%) and lowest in the inpatient non-CON group (0.5%). Reimbursement increased in the outpatient setting (CAGR: 1.2% CON, 1.0% non-CON), but decreased in the inpatient setting (CAGR: -6.1% CON, -5.5% non-CON). These trends are important to consider in a value-based healthcare environment. (Journal of Surgical Orthopaedic Advances 31(4):218-221, 2022).

This study aimed to characterize postoperative infection rate among patients undergoing definitive fixation of both open and closed fractures during the same surgery. Outcomes between patients with open fractures (OF) treated first were compared to those with closed fractures (CF) treated first. We identified 303 adult patients with multiple (≥ 2) pelvis and extremity fractures who presented to our Level 1 Trauma hospital in 2017. Forty patients with at least one open and one closed fracture treated with operative fixation during the same surgery were included in analysis. Eight surgical site infections (SSI) developed in seven patients. There was no significant difference between treatment order groups (OF = 4 patients (5 fractures), CF = 3 patients (3 fractures); p > 0.99). This is the first study comparing different chronologies of operative fixation in coexisting open and closed fractures. Our study shows that the choice of treatment order does not influence SSI risk. (Journal of Surgical Orthopaedic Advances 31(3):181-186, 2022).

This study assessed the effect of preoperative planning using a 3D-printed periarticular fracture model on operative performance. A complex pilon fracture was 3D-printed, and a preoperative plan was developed. Orthopaedic surgery residents (n = 20) were randomized into two groups. Group 1 performed routine preoperative planning, while Group 2 was also practiced using a 3D-printed construct before performing fixation of the 3D-printed model. Resident performance was assessed using a video motion capture system and evaluated by blinded reviewers. Three residents (3D group) completed fixation within the allotted 45 minutes. The 3D group had less hand distance traveled for step 1 (89 m vs. 162 m, p = 0.04). The 3D group had better performance on three of the four components and more acceptable reductions (6 vs. 0, p = 0.009). Average global rating scale was higher in the 3D group (3.0 vs. 1.7, p = 0.0095). Use of 3D-printed models for preoperative planning improved resident performance. (Journal of Surgical Orthopaedic Advances 31(3):187-192, 2022).

The objective of this study is to measure the prevalence and demographic predictors of depressive symptoms in a diverse group of adolescent athletes. Retrospective chart review of demographic and Patient Health Questionnaire-Adolescent (PHQ-A) data obtained during a mass pre-participation physical exam (PPE) was examined. Independent variables included race and sex. A total of 16.9% (n = 115) of students had clinically meaningful depressive symptoms, while 2.5% (n = 23) reported having thoughts that they would be better off dead or of hurting themselves. Of those who had moderate to severe levels of depressive symptoms, 25.8% (n = 31) were Black females, significantly more than any other race-sex group. A majority of our sample did not have depressive symptoms but a plan for those in severe mental distress must be in place. Prevalence of adolescent depressive symptoms, mental health emergency preparedness and culturally sensitive interventions deserve further investigation. (Journal of Surgical Orthopaedic Advances 31(3):193-198, 2022).

We reviewed pediatric open fractures treated at a large Level 1 children's trauma center to determine the rate of infection after open fractures, potential risk factors for infection, and the rate of infection caused by antibiotic-resistant organisms. A retrospective review identified 288 open fractures in children 1 to 17 years of age. Post-traumatic infections developed in 24 (8.3%) open fractures. There was no significant association between the development of infection and mechanism of injury (p = 0.33), time to surgical debridement (p = 0.93), or type of empiric antibiotic given (p = 0.66). Infection occurred more frequently in overweight and obese patients (odds ratio = 2.22; 95% confidence interval: 0.93, 5.46, p = 0.07). There was one infection (4.2%) caused by methicillin-resistant staphylococcus aureus (MRSA). The most commonly identified organisms on culture were methicillin-sensitive staphylococcus aureus (n = 3) and pseudomonas (n = 3). Obesity is a significant risk factor for the development of infection after an open fracture in the pediatric population. (Journal of Surgical Orthopaedic Advances 31(2):073-075, 2022).