Journal of surgical orthopaedic advances最新文献

Prophylactic radiotherapy (XRT) is a commonly used treatment to decrease heterotopic ossification (HO) in patients with traumatic hip injuries. We conducted a retrospective review of patients at risk for HO who underwent XRT. Of the patients reviewed, 27.3% developed radiographic HO, 11.2% developed symptoms, and 2.0% required resection surgery. Patients were divided into primary (n = 71) and secondary prophylaxis (n = 27) cohorts. In the primary group, 25.0% developed radiographic HO, 5.6% developed symptoms, and 0 required surgery. In the secondary cohort, 33.3% of patients developed new radiographic HO, and 25.9% were symptomatic: four had a Brooker score of 3, and three had a score of 4 (p = 0.03), and 7.4% required surgical resection. (Journal of Surgical Orthopaedic Advances 31(2):113-118, 2022).

Proximal humerus fractures represent one of the most common fractures in the elderly, and are increasingly treated with surgical fixation. Suture augmentation attaching the rotator cuff to the plate has been advocated to combat varus collapse and other associated complications. The objective of this study was to evaluate the contribution of rotator cuff augmentation to stability of proximal humerus fracture fixation. Twelve shoulder specimens from six cadavers underwent simulated two-part and three-part proximal humerus fractures. Matched specimens from the same cadaver were randomized to suture augmentation with locking plate fixation vs. locking plate fixation alone. Greater tuberosity fragment displacement was recorded during cyclic rotational strain of the glenohumeral joint. Greater tuberosity displacement in the two-part fracture model trended towards greater motion without suture augmentation, but did not reach statistical significance (0.032 + 0.012 mm vs. 0.213 + 0.109 mm, p = 0.130). In the three-part fracture model, there was a statistically significant decrease in fracture displacement in the presence of suture augmentation (0.068 + 0.025 mm vs. 2.392 + 0.373 mm, p < 0.001). No specimens demonstrated premature failure during cyclic loading. Suture augmentation of locking plate fixation of three-part proximal humerus fractures results in decreased fracture displacement than locked plating alone, during rotational stresses simulating in vivo rotator cuff deformation forces. (Journal of Surgical Orthopaedic Advances 31(2):119-122, 2022).

Pectoralis major tendon injuries are an uncommon injury. They can be treated with primary repair, however, when the tendon becomes retracted it necessitates tendon reconstruction. We performed a systematic review to evaluate patient characteristics, surgical techniques, and outcomes associated with pectoralis major reconstruction. A review was performed for studies published between 1990 and 2019. Peer-reviewed studies with a minimum 1-year follow-up were included. Return to activity, range of motion, complications, and functional outcome scores were primary outcomes. Fourteen primary studies with 88 total patients met inclusion criteria. All patients were male with the average age of 34.6 years-old. Hamstring autograft represented the most frequently used graft type (35). Functional outcomes demonstrated good to excellent results in the majority of patients. Pectoralis major tendon reconstruction is a viable option for tears not amenable to primary repair. We found good to excellent outcomes, and 94.2% return to sport for patients undergoing reconstruction. (Journal of Surgical Orthopaedic Advances 31(2):123-126, 2022).

Pitching kinematic and kinetic assessments require normative values to make valuable comparisons to athletic peers. The purpose of this research note was to report normative values of pitching kinematics and kinetics and to compare kinetics by competition level. A retrospective review was performed on three-dimensional baseball pitching biomechanical evaluations. Kinematics and kinetics were calculated. Pitchers were portioned into competition level groups. Kinetic group differences were assessed through analyses of variance with significance level p < 0.05. One-hundred and twenty pitchers were included. Elbow varus torque was greater in higher competition levels. Shoulder distraction force was greater in higher competition levels. All levels demonstrated similar maximum vertical push off ground reaction force (p = 0.960) and maximum vertical landing ground reaction force (p = 0.135). Higher competition level pitchers demonstrated improved pitching kinematic efficiency compared to lower-level pitchers. However, college and professional pitchers exhibited greater arm stress, which may be attributed to increased pitching velocity. These pitching biomechanical data can be used as normative comparisons when examining pitching mechanics at multiple competition levels throughout an athlete's baseball career. (Journal of Surgical Orthopaedic Advances 31(3):177-180, 2022).

The purpose of this study was to quantify the impact of low-fidelity simulation on resident surgical skills education. Fourteen orthopaedic surgery residents (PGY-1 through PGY-5) were separated into two, training-level-matched cohorts - an untrained control cohort (UCC) and a low-fidelity Sawbones training cohort (SAW). Together, both cohorts received didactic instruction on the soft-tissue approach, intra-operative reduction, internal-fixation, and surgical wound closure of Schatzker II tibial plateau fractures. The SAW cohort first rehearsed open-reduction, internal-fixation on radiopaque Sawbones models (Pacific Research Laboratories Inc. Vashon, WA). Both cohorts were then evaluated while performing the same procedure on high-fidelity cadaveric models (Rimasys GmbH Cologne, Germany). Surgical skill and knowledge were assessed using the objective structured assessment of technical skills (OSATS) tool, a written exam, and an after-action survey. There were no significant differences in OSATS scores or written exam scores between the two cohorts. A near-linear positive relationship (R2 = 0.9737) existed between training year and average overall OSATS score. All residents expressed a preference for surgical skills training with high-fidelity cadaveric models. The results of this study fail to demonstrate a training advantage of low-fidelity Sawbones models when surgical skill is measured on high-fidelity cadaveric models. Despite this, residents across both cohorts qualitatively felt the high-fidelity models offered a better educational opportunity for surgical practice than did the low-fidelity Sawbones models. (Journal of Surgical Orthopaedic Advances 31(2):109-112, 2022).

This study assessed the National Surgical Quality Improvement Program (NSQIP), which provides data on 30-day post-operative complications from 500+ institutions, to identify risk factors for wound complications in patients undergoing primary total hip arthroplasty (THA). Patients undergoing primary THA between 2010-2017 were retrospectively reviewed. Patients experiencing post-operative wound complications were stratified based on pre-operative characteristics. Multivariate regression model was used to assess these characteristics as independent risk factors for post-operative complications. Of 119,096 patients undergoing primary THA, 1,264 (1.06%), 280 (0.2%), 622 (0.52%) and 139 (0.12%) experienced wound complications, deep surgical site infection, superficial surgical site infection, and wound dehiscence, respectively. Pre-operative transfusion (p < 0.0001), steroid use (p = 0.01), and obesity (p < 0.0001) were risk factors for wound dehiscence. Pre-operative transfusion (p < 0.0001), cardiac comorbidities (p = 0.02), and steroid use (p = 0.01) were risk factors for superficial surgical site infection. Assessment of the NSQIP identified modifiable risk factors for wound complications following primary THA, including pre-operative transfusion, steroid use, and obesity. (Journal of Surgical Orthopaedic Advances 31(4):242-247, 2022).

The objective of this study was to determine if the implementation of an opioid stewardship initiative involving early conversion to oral opioids improves outcomes in postoperative orthopaedic patients. This single-center retrospective chart review compared adult patients undergoing lower extremity orthopaedic procedures during a specified six-month time period. The primary outcome was total opioid utilization in morphine milligram equivalence (MME) at 48-hours post-surgery. Four hundred ninety-five patients were included in the study, 233 in the intervention group and 262 in the pre-intervention group. The average pain scores at 12, 24 and 48 hours postoperatively were similar among the two groups. After a multivariate linear regression was performed, a 22.9 MME reduction was estimated in the post-implementation group compared to the pre-implementation group (p = 0.003). Based on these results, it appears that converting from intravenous to oral narcotics 24-hours post-orthopaedic surgery reduces total mean MMEs while providing similar pain control. (Journal of Surgical Orthopaedic Advances 31(2):086-089, 2022).

Conservative treatment of adhesive capsulitis fails in up to 30% of patients. Manipulation under anesthesia (MUA) has been shown to be safe and effective, although complications (iatrogenic fracture, glenohumeral dislocation, rotator cuff tears, nerve injuries) have been reported. This study details a novel technique, FEAR (Forward elevation, Extension, Adduction/abduction, and internal and external Rotation), and its results. Medical records review identified 100 patients with a diagnosis of adhesive capsulitis who had at least 6 weeks of physical therapy, with or without corticosteroid injection, with persistence of pain and loss of motion loss. An Institutional Review Board approved phone survey obtained Single Assessment Numeric Evaluation (SANE) scores, visual analog scale (VAS) scores, functional scores, and range of motion, with 43 available for survey. At average 5-year follow-up, 81% had excellent (≥ 90) scores and 77% were pain-free. Patients with diabetes and male patients had significantly lower SANE scores at follow-up. (Journal of Surgical Orthopaedic Advances 31(2):096-099, 2022).

Proximal humerus fractures (PHF) are common in elderly and osteoporotic patients, and these fractures are often described using the Neer classification. As reverse shoulder arthroplasty (RSA) for PHF becomes more common, it is helpful to identify the utility of Neer classification in predicting postoperative outcomes for patients undergoing RSA. The medical records of patients undergoing primary RSA for PHF at a single academic institution from 2013-2019 were identified using medical billing codes. A multivariable logistic regression analysis identified independent factors associated with all cause 90-day readmissions, reoperation, and length of stay (LOS) greater than three days. Fifty-five patients (average age of 72.3 ± 8.6 years) were included. No statistically significant differences among two-, three-, and four-part fractures with regard to LOS, discharge location, 90-day readmission, revision surgery, postoperative dislocation, or deep infection were detected. These findings suggest that Neer classification for PHF is not predictive of short-term complications after RSA. (Journal of Surgical Orthopaedic Advances 31(2):104-108, 2022).

The current medical schools and orthopaedic residency programs in the state of North Carolina have evolved based upon geopolitical, economic events, historical reports and regulations. The American Medical Association Committee on Medical Education, the Flexner Report and the Sherman Antitrust Act and their recommendations were codified by state regulatory agencies and state law. These important pressures created the programs as they are known today. The result was the forced closure of most early medical institutions in the state of North Carolina in the early 1900s. Industrial resource consolidation by monopolies was the motivation for the Sherman antitrust act. Enforced by Theodore Roosevelt, this legislation disbanded major monopolies and encouraged philanthropy. This manuscript details the evolution of modern medical education and highlights the impact of historical social, economic and political events on the development of Duke, Wake Forest, University of North Carolina and Charlotte/ Atrium Health orthopedic programs in North Carolina. (Journal of Surgical Orthopaedic Advances 31(3):139-143, 2022).