The phenomenon of work-family enrichment (WFE) is increasingly studied in medical professions, but has yet to be investigated in orthopaedic surgery. While much of the literature in this field has acknoweldged high levels of stress and burnout among orthopaedic surgeons, some studies have suggested that WFE may be an important factor in promoting positive outcomes in both personal and professional domains. Future research should aim to explore the benefits of WFE for orthopaedic surgeons, as well as the factors that contribute to job satisfaction and overall well-being. By supporting work-family enrichment, hospitals and healthcare centers may be able to create a more supportive work environment for orthopaedic surgeons, which could lead to higher levels of job satisfaction and better patient care.
{"title":"Work-Family Enrichment in Orthopaedic Surgery","authors":"Nicholas D. Thomas","doi":"10.60118/001c.77350","DOIUrl":"https://doi.org/10.60118/001c.77350","url":null,"abstract":"The phenomenon of work-family enrichment (WFE) is increasingly studied in medical professions, but has yet to be investigated in orthopaedic surgery. While much of the literature in this field has acknoweldged high levels of stress and burnout among orthopaedic surgeons, some studies have suggested that WFE may be an important factor in promoting positive outcomes in both personal and professional domains. Future research should aim to explore the benefits of WFE for orthopaedic surgeons, as well as the factors that contribute to job satisfaction and overall well-being. By supporting work-family enrichment, hospitals and healthcare centers may be able to create a more supportive work environment for orthopaedic surgeons, which could lead to higher levels of job satisfaction and better patient care.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134278151","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}
{"title":"Arthroscopic Full Thickness Rotator Cuff Repair with Biologic Augmentation","authors":"W. Ashraf","doi":"10.60118/001c.74411","DOIUrl":"https://doi.org/10.60118/001c.74411","url":null,"abstract":"","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115336979","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}
The thumb and its corresponding joints are important for daily life activities. Although rare, injuries to this apparatus would greatly affect any patient’s quality of life. We present in this article a case of a man who had a traumatic trapezium-thumb metacarpal base fracture-dislocation, a pattern described in the literature with no consenus on the treatment of choice, treated with closed reduction and percutaneous pinning with excellent functional and radiological results.
{"title":"Trapezium fracture and 1st CMC joint fracture-dislocation: a case report","authors":"Tarek Haj Shehadeh, Firas Kawtharani","doi":"10.60118/001c.74115","DOIUrl":"https://doi.org/10.60118/001c.74115","url":null,"abstract":"The thumb and its corresponding joints are important for daily life activities. Although rare, injuries to this apparatus would greatly affect any patient’s quality of life. We present in this article a case of a man who had a traumatic trapezium-thumb metacarpal base fracture-dislocation, a pattern described in the literature with no consenus on the treatment of choice, treated with closed reduction and percutaneous pinning with excellent functional and radiological results.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122783277","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}
S. Jenkins, A. Daji, Clyde K. Fomunung, Joel Grunhut, V. Sabesan
A 36-year-old male who suffered a left midshaft clavicle fracture, following a fall from a mountain bike, was treated unsuccessfully with two ORIF surgeries. Smoking cessation and management of hypovitaminosis was addressed preoperatively before final revision with a dual plate construct and tibial autologous bone graft. Follow-up radiographs taken at 12 months from the initial surgery showed intact hardware and full bone healing. Successful management of clavicle nonunions can be optimized through optimal plate selection, plate positioning, number of plates, construct biomechanics, biologic augmentation, and preoperative risk optimization. Efforts to minimize controllable risk factors for nonunion, such as smoking cessation or vitamin D supplementation, should be utilized both preoperatively and postoperatively.
{"title":"Managing Recurrent Clavicle Nonunion and Construct Failure: A Case Report","authors":"S. Jenkins, A. Daji, Clyde K. Fomunung, Joel Grunhut, V. Sabesan","doi":"10.60118/001c.74034","DOIUrl":"https://doi.org/10.60118/001c.74034","url":null,"abstract":"A 36-year-old male who suffered a left midshaft clavicle fracture, following a fall from a mountain bike, was treated unsuccessfully with two ORIF surgeries. Smoking cessation and management of hypovitaminosis was addressed preoperatively before final revision with a dual plate construct and tibial autologous bone graft. Follow-up radiographs taken at 12 months from the initial surgery showed intact hardware and full bone healing. Successful management of clavicle nonunions can be optimized through optimal plate selection, plate positioning, number of plates, construct biomechanics, biologic augmentation, and preoperative risk optimization. Efforts to minimize controllable risk factors for nonunion, such as smoking cessation or vitamin D supplementation, should be utilized both preoperatively and postoperatively.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134375640","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}
Axillary nerve dysfunction has been a relative contraindication for reverse total shoulder arthroplasty (RTSA) as it implies deltoid dysfunction which is necessary for a successful outcome and to maintain stability. However, most axillary nerve injuries or brachial plexus injuries in the setting of acute fracture or fracture dislocation are temporary neuropraxias. Therefore, RTSA may be a feasible option in the acute setting in patients with associated axillary/brachial plexus injury. The objective of this study is to compare results of RTSA patients with preoperative nerve injuries to patients without nerve injuries at a minimum of 2 years. A retrospective case series of all proximal humerus fractures treated with rTSA from 2010 to 2018 by a single surgeon was performed. Inclusion criteria were patients with a diagnosis of fracture-dislocation of the proximal humerus. American Shoulder and Elbow Surgeon (ASES) scores, Simple Shoulder Test (SST) scores, range of motion (ROM) as well as complications were obtained at final follow up. A total 29 patients treated with RTSA for fracture-dislocation were identified. Five patients declined to participate in the study, 4 patients died prior to final follow-up, leaving 20 patients in the study group. Two patients were lost to follow-up leaving 18 of 20 patients (90%) with final follow up data. Seven (35%) patients presented with a brachial plexus/axillary nerve injury associated with their fracture. Average follow-up was 5.83 years (range 2-8 years). There were no differences between the two groups regarding age or body mass index (BMI). The American Society of Anesthesiologists (ASA) was higher in the group without nerve injury 2.92 +/- 0.28 vs 2.43 +/- 0.53 (P=0.0130). There was no difference in time to surgery after fracture between the 2 groups. At final follow-up, there was no difference between the 2 groups regarding shoulder ROM, ASES or SST scores. No patients experienced surgical complications, however, two patients were still reporting nerve related symptoms at final follow up. Reverse total shoulder arthroplasty for fracture-dislocation in the acute setting may be a feasible option in patients with concomitant brachial plexus injury.
{"title":"Reverse Total Shoulder Arthroplasty in Proximal Humerus Fractures with Concomitant Nerve Injury","authors":"Reza Katanbaf, R. M. Greiwe","doi":"10.60118/001c.74033","DOIUrl":"https://doi.org/10.60118/001c.74033","url":null,"abstract":"Axillary nerve dysfunction has been a relative contraindication for reverse total shoulder arthroplasty (RTSA) as it implies deltoid dysfunction which is necessary for a successful outcome and to maintain stability. However, most axillary nerve injuries or brachial plexus injuries in the setting of acute fracture or fracture dislocation are temporary neuropraxias. Therefore, RTSA may be a feasible option in the acute setting in patients with associated axillary/brachial plexus injury. The objective of this study is to compare results of RTSA patients with preoperative nerve injuries to patients without nerve injuries at a minimum of 2 years. A retrospective case series of all proximal humerus fractures treated with rTSA from 2010 to 2018 by a single surgeon was performed. Inclusion criteria were patients with a diagnosis of fracture-dislocation of the proximal humerus. American Shoulder and Elbow Surgeon (ASES) scores, Simple Shoulder Test (SST) scores, range of motion (ROM) as well as complications were obtained at final follow up. A total 29 patients treated with RTSA for fracture-dislocation were identified. Five patients declined to participate in the study, 4 patients died prior to final follow-up, leaving 20 patients in the study group. Two patients were lost to follow-up leaving 18 of 20 patients (90%) with final follow up data. Seven (35%) patients presented with a brachial plexus/axillary nerve injury associated with their fracture. Average follow-up was 5.83 years (range 2-8 years). There were no differences between the two groups regarding age or body mass index (BMI). The American Society of Anesthesiologists (ASA) was higher in the group without nerve injury 2.92 +/- 0.28 vs 2.43 +/- 0.53 (P=0.0130). There was no difference in time to surgery after fracture between the 2 groups. At final follow-up, there was no difference between the 2 groups regarding shoulder ROM, ASES or SST scores. No patients experienced surgical complications, however, two patients were still reporting nerve related symptoms at final follow up. Reverse total shoulder arthroplasty for fracture-dislocation in the acute setting may be a feasible option in patients with concomitant brachial plexus injury.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126783536","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}
P. Jacob, T. E. Justice, Kristy Olivo, Kevin R. Glover
Periprosthetic joint infection (PJI) after total hip and total knee arthroplasty is a devastating complication that is known to be associated with costly, resource-intensive interventions that place a significant burden on the US healthcare system. Estimated average hospital costs to treat female patients with PJI after total knee arthroplasty (TKA) or total hip arthroplasty (THA) in 2018 was $27,307, and $32,956 respectively. While the average costs to treat male patients with PJI after TKA or THA was $27,097 and $33,090 respectively. One strategy aimed at preventing PJI after total joint arthroplasty is the use of an intra-operative wound irrigation with an antiseptic solution. This retrospective case review was conducted to assess the incidence of PJI after using a novel wound antiseptic irrigation solution in patients undergoing primary TKA and THA. The CDC defines surgical site infections, (SSI) as infections that occur after the surgery. The infections are further categorized as superficial involving the skin, or deep tissue. These infections are then divided into; superficial incisional SSI, deep incisional SSI, and organ-space SSI. In a study by Kannan et al., SSIs are more commonly seen in patients with more comorbidities. A consecutive series of 308 high-risk patients undergoing primary TKA or THA between January 4, 2021 and August 30, 2021, in whom Prontosan® Wound Irrigation Solution (B. Braun Medical Inc./ Innovice LLC), containing 0.1% Betaine, a surfactant, and 0.1% Polyhexanide (PHMB) was added to the intra-operative procedure, were evaluated for its impact on the incidence of PJI. The CDC’s Surgical Care Improvement Project, (SCIP) guidelines are standard of care and followed with each surgical procedure. The CDC recommends using antimicrobial prophylaxis at a time before skin incision such that the antibiotic concentration reaches the minimum bactericidal concentration at the time of skin incision, Berríos-Torres SI, et al. All data were prospectively submitted to the American Joint Replacement Registry (AJRR) was retrospectively analyzed to measure the incidence of postoperative infection. Primary TJA was performed on 308 patients; of these 10 patients were bilateral TKA (205 TKA procedures and 113 THA procedures). The use of Prontosan® Wound Irrigation Solution was associated with zero (0%) incidence of postoperative infection in this population of patients during a 90-day episode of care, nor at any time postoperatively. CMS defines total joint arthroplasty codes as a major surgery, and encounters or procedures within 90 days of the initiating procedure are included in the 90-day episode of care. No patients were lost to follow-up. There was no incidence of PJI uncovered in this retrospective analysis. Adding Prontosan® Wound Irrigation Solution to the intra-operative protocol, contributed to the absence of PJI in this population and potentially avoided 1.74 female and 1.34 male TKA as well as .95 female and .75 THA resulting
全髋关节和全膝关节置换术后假体周围关节感染(PJI)是一种毁灭性的并发症，众所周知，它与昂贵的资源密集型干预措施有关，给美国医疗保健系统带来了重大负担。2018年，在全膝关节置换术(TKA)或全髋关节置换术(THA)后治疗女性PJI患者的平均医院费用估计分别为27,307美元和32,956美元。而TKA或THA后治疗男性PJI患者的平均费用分别为27,097美元和33,090美元。预防全关节置换术后PJI的一个策略是使用消毒溶液进行术中伤口冲洗。本回顾性病例回顾旨在评估原发性全膝关节置换术和全髋关节置换术患者使用新型伤口消毒冲洗液后PJI的发生率。美国疾病控制与预防中心将手术部位感染(SSI)定义为手术后发生的感染。感染进一步被分类为浅表感染，包括皮肤或深层组织。然后将这些感染分为;浅切口SSI，深切口SSI和器官间隙SSI。在Kannan等人的研究中，ssi更常见于合并症较多的患者。在2021年1月4日至2021年8月30日期间，对308例接受原发性TKA或THA的高危患者进行了连续的系列研究，在这些患者中，Prontosan®伤口冲洗液(B. Braun Medical Inc./ Innovice LLC)，含有0.1%甜菜碱、表面活性剂和0.1%聚己胺(PHMB)，被添加到术中，以评估其对PJI发生率的影响。疾病预防控制中心的外科护理改进项目(SCIP)指南是标准的护理，并遵循每一个手术程序。CDC建议在皮肤切口前使用抗菌药物预防，使抗生素浓度达到皮肤切口时的最低杀菌浓度，Berríos-Torres SI等。所有数据前瞻性地提交给美国关节置换登记处(AJRR)，回顾性分析以测量术后感染的发生率。308例患者行原发性TJA;10例患者为双侧全髋关节置换术(全髋关节置换术205例，全髋关节置换术113例)。Prontosan®伤口冲洗液的使用与该患者群体在90天护理期间的术后感染发生率为零(0%)相关，在术后任何时间也没有。CMS将全关节置换术代码定义为一项大手术，并且在开始手术后90天内的遭遇或手术包括在90天的护理中。无患者失访。本回顾性分析未发现PJI的发生率。在术中方案中加入Prontosan®伤口冲洗液，有助于消除该人群的PJI，并可能避免1.74例女性和1.34例男性TKA以及0.95例女性和0.75例THA，从而避免医院总费用83,824美元和56,126美元，分别总计139,950美元。
{"title":"Novel Intra- Operative Wound Irrigation Solution to Manage Infection Prevention in Patients Undergoing Primary Joint Arthroplasty: Retrospective Review of a Case Series of 308 Patients","authors":"P. Jacob, T. E. Justice, Kristy Olivo, Kevin R. Glover","doi":"10.60118/001c.72787","DOIUrl":"https://doi.org/10.60118/001c.72787","url":null,"abstract":"Periprosthetic joint infection (PJI) after total hip and total knee arthroplasty is a devastating complication that is known to be associated with costly, resource-intensive interventions that place a significant burden on the US healthcare system. Estimated average hospital costs to treat female patients with PJI after total knee arthroplasty (TKA) or total hip arthroplasty (THA) in 2018 was $27,307, and $32,956 respectively. While the average costs to treat male patients with PJI after TKA or THA was $27,097 and $33,090 respectively. One strategy aimed at preventing PJI after total joint arthroplasty is the use of an intra-operative wound irrigation with an antiseptic solution. This retrospective case review was conducted to assess the incidence of PJI after using a novel wound antiseptic irrigation solution in patients undergoing primary TKA and THA. The CDC defines surgical site infections, (SSI) as infections that occur after the surgery. The infections are further categorized as superficial involving the skin, or deep tissue. These infections are then divided into; superficial incisional SSI, deep incisional SSI, and organ-space SSI. In a study by Kannan et al., SSIs are more commonly seen in patients with more comorbidities. A consecutive series of 308 high-risk patients undergoing primary TKA or THA between January 4, 2021 and August 30, 2021, in whom Prontosan® Wound Irrigation Solution (B. Braun Medical Inc./ Innovice LLC), containing 0.1% Betaine, a surfactant, and 0.1% Polyhexanide (PHMB) was added to the intra-operative procedure, were evaluated for its impact on the incidence of PJI. The CDC’s Surgical Care Improvement Project, (SCIP) guidelines are standard of care and followed with each surgical procedure. The CDC recommends using antimicrobial prophylaxis at a time before skin incision such that the antibiotic concentration reaches the minimum bactericidal concentration at the time of skin incision, Berríos-Torres SI, et al. All data were prospectively submitted to the American Joint Replacement Registry (AJRR) was retrospectively analyzed to measure the incidence of postoperative infection. Primary TJA was performed on 308 patients; of these 10 patients were bilateral TKA (205 TKA procedures and 113 THA procedures). The use of Prontosan® Wound Irrigation Solution was associated with zero (0%) incidence of postoperative infection in this population of patients during a 90-day episode of care, nor at any time postoperatively. CMS defines total joint arthroplasty codes as a major surgery, and encounters or procedures within 90 days of the initiating procedure are included in the 90-day episode of care. No patients were lost to follow-up. There was no incidence of PJI uncovered in this retrospective analysis. Adding Prontosan® Wound Irrigation Solution to the intra-operative protocol, contributed to the absence of PJI in this population and potentially avoided 1.74 female and 1.34 male TKA as well as .95 female and .75 THA resulting","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114148311","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}
Lacee K. Collins, Sione A. Ofa, Cadence Miskimin, M. Mulcahey
In the U.S., approximately 1.6 to 3.8 million concussions occur yearly as a result of sports. Athletes are especially at risk of sustaining cognitive deficits as a result of a concussion. These can manifest as impairments of attention, verbal and visual memory, visual perception, and executive function. The purpose of this study was to examine cognitive deficits following sport-related concussions in the acute, intermediate, and long-term time period after initial head trauma. A systematic review of the literature was performed according to PRISMA guidelines using the PubMed, Psychinfo, and Web of Science databases. Search terms included sports-related concussion, traumatic brain injury (TBI), and cognitive impairments. Studies were excluded if they measured non-cognitive deficits or had subjective results. Participant characteristics such as average age, gender, and athletic status were also included from all articles. Systematic Review. Level 4. Studies were included if they met the following criteria: explicit time points following injury, focus on cognitive deficits, and injuries were not self-diagnosed. Twenty-six studies, with a total of 4,534 patients, were included. Ten of twenty-six (38.4%) studies were separated into control groups versus concussed groups, while nine of twenty-six (34.6%) compared baseline scores to post-injury scores. In the included studies, cognitive deficits were seen across all of the domains in all three time periods following an initial concussion. A sports related concussion could result in cognitive deficits in the domains of visual memory, verbal memory, processing speed, executive function, and reaction time. Additionally, athletes typically experience cognitive deficits for only days to weeks following a sports related concussion, but symptoms can continue for months or years following the injury, depending on severity. These conclusions should be taken into consideration when determining inidivudalized return-to-play protocol for each athlete.
在美国，每年大约有160万到380万脑震荡是由运动引起的。运动员尤其容易因脑震荡而出现认知缺陷。这些可以表现为注意力、语言和视觉记忆、视觉感知和执行功能的损害。本研究的目的是检查头部创伤后急性、中期和长期运动相关脑震荡后的认知缺陷。根据PRISMA指南，使用PubMed、Psychinfo和Web of Science数据库对文献进行系统综述。搜索词包括与运动有关的脑震荡、创伤性脑损伤(TBI)和认知障碍。如果研究测量了非认知缺陷或有主观结果，则排除在外。参与者的特征，如平均年龄、性别和运动状态也包括在所有文章中。系统的回顾。4级。符合以下标准的研究被纳入:损伤后明确的时间点，关注认知缺陷，损伤不是自我诊断的。纳入26项研究，共4534例患者。26项研究中有10项(38.4%)被分为对照组和脑震荡组，而26项研究中有9项(34.6%)将基线评分与损伤后评分进行比较。在纳入的研究中，在最初脑震荡后的三个时间段内，所有领域都出现了认知缺陷。与运动相关的脑震荡可能导致视觉记忆、言语记忆、处理速度、执行功能和反应时间等领域的认知缺陷。此外，运动员在运动相关的脑震荡后通常只会经历几天到几周的认知缺陷，但根据严重程度，损伤后症状可能会持续数月或数年。在为每位运动员确定个性化的恢复比赛方案时，应考虑到这些结论。
{"title":"Cognitive Deficits Following Concussion: A Systematic Review","authors":"Lacee K. Collins, Sione A. Ofa, Cadence Miskimin, M. Mulcahey","doi":"10.60118/001c.68393","DOIUrl":"https://doi.org/10.60118/001c.68393","url":null,"abstract":"In the U.S., approximately 1.6 to 3.8 million concussions occur yearly as a result of sports. Athletes are especially at risk of sustaining cognitive deficits as a result of a concussion. These can manifest as impairments of attention, verbal and visual memory, visual perception, and executive function. The purpose of this study was to examine cognitive deficits following sport-related concussions in the acute, intermediate, and long-term time period after initial head trauma. A systematic review of the literature was performed according to PRISMA guidelines using the PubMed, Psychinfo, and Web of Science databases. Search terms included sports-related concussion, traumatic brain injury (TBI), and cognitive impairments. Studies were excluded if they measured non-cognitive deficits or had subjective results. Participant characteristics such as average age, gender, and athletic status were also included from all articles. Systematic Review. Level 4. Studies were included if they met the following criteria: explicit time points following injury, focus on cognitive deficits, and injuries were not self-diagnosed. Twenty-six studies, with a total of 4,534 patients, were included. Ten of twenty-six (38.4%) studies were separated into control groups versus concussed groups, while nine of twenty-six (34.6%) compared baseline scores to post-injury scores. In the included studies, cognitive deficits were seen across all of the domains in all three time periods following an initial concussion. A sports related concussion could result in cognitive deficits in the domains of visual memory, verbal memory, processing speed, executive function, and reaction time. Additionally, athletes typically experience cognitive deficits for only days to weeks following a sports related concussion, but symptoms can continue for months or years following the injury, depending on severity. These conclusions should be taken into consideration when determining inidivudalized return-to-play protocol for each athlete.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121865177","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}
Proximal tibiofibular joint (PTFJ) dislocation is a rare acute injury of the knee that is often misdiagnosed or overlooked. The diagnosis should be considered as part of the differential in any patient presenting with acute-onset lateral knee pain after an aggressive torsion trauma to a flexed knee. This case report detailing surgical fixation of a PTFJ dislocation is unique in that surgical lateral collateral ligament (LCL) repair was necessary and performed, and PTFJ fixation occurred following recent open reduction internal fixation (ORIF) of the tibia. This paper details specific technique and orientation of fixation to best return the PTFJ to anatomic alignment, as failure to do so can lead to instances of chronic morbidity. This case report describes surgical fixation of a traumatic posteromedial (Type III) PTFJ dislocation. During ORIF of the ipsilateral tibia, significant PTFJ laxity and displacement was noted intraoperatively. This necessitated a return to the operating room for definitive PTFJ surgical fixation with two TightRope syndesmotic suture button fixation devices with simultaneous intraoperative LCL repair with #2 Fiberwire. While few case reports have documented the use of TightRope syndesmotic fixation of the PTFJ, these authors present a novel method of orienting the fixation from the posterolateral fibula to the anteromedial tibia with simultaneous caudal to cranial direction in order to create orthogonal fixation of the PTFJ. This creates an orientation of fixation perpendicular to the anatomic alignment of the native PTFJ.We believe that this orientation of syndesmotic PTFJ fixation most physiologically replicates that of the native PTFJ, and will lead to effective surgical results and improved patient outcomes. We also believe that publications on this topic will help bring awareness to an underrecognized and underdiagnosed joint pathology, with the hopes that future patients will benefit and receive more thorough and efficient care.
{"title":"Operative Treatment of Acute Traumatic Dislocation of the Proximal Tibiofibular Joint with TightRope Fixation and Primary LCL Repair Following Tibial Intramedullary Nailing","authors":"W. Faerber, Dallyn Udal, Kayleigh Corrado","doi":"10.60118/001c.68315","DOIUrl":"https://doi.org/10.60118/001c.68315","url":null,"abstract":"Proximal tibiofibular joint (PTFJ) dislocation is a rare acute injury of the knee that is often misdiagnosed or overlooked. The diagnosis should be considered as part of the differential in any patient presenting with acute-onset lateral knee pain after an aggressive torsion trauma to a flexed knee. This case report detailing surgical fixation of a PTFJ dislocation is unique in that surgical lateral collateral ligament (LCL) repair was necessary and performed, and PTFJ fixation occurred following recent open reduction internal fixation (ORIF) of the tibia. This paper details specific technique and orientation of fixation to best return the PTFJ to anatomic alignment, as failure to do so can lead to instances of chronic morbidity. This case report describes surgical fixation of a traumatic posteromedial (Type III) PTFJ dislocation. During ORIF of the ipsilateral tibia, significant PTFJ laxity and displacement was noted intraoperatively. This necessitated a return to the operating room for definitive PTFJ surgical fixation with two TightRope syndesmotic suture button fixation devices with simultaneous intraoperative LCL repair with #2 Fiberwire. While few case reports have documented the use of TightRope syndesmotic fixation of the PTFJ, these authors present a novel method of orienting the fixation from the posterolateral fibula to the anteromedial tibia with simultaneous caudal to cranial direction in order to create orthogonal fixation of the PTFJ. This creates an orientation of fixation perpendicular to the anatomic alignment of the native PTFJ.We believe that this orientation of syndesmotic PTFJ fixation most physiologically replicates that of the native PTFJ, and will lead to effective surgical results and improved patient outcomes. We also believe that publications on this topic will help bring awareness to an underrecognized and underdiagnosed joint pathology, with the hopes that future patients will benefit and receive more thorough and efficient care.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128661651","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}
Bradley T. Hammoor, Austin C. Kaidi, T. Hickernell, H. Cooper
Total hip (THA) and knee arthroplasties (TKA) are common elective procedures, and dedicated arthroplasty teams perform multiple procedures per day. Little is documented about how time-of-day scheduling affects the intraoperative efficiency of total joint arthroplasties (TJA). In this study, we analyzed the effects of surgical start time on TJA operative lengths. A retrospective study was performed for primary TJA patients done within a four-year period at a single academic medical center. Surgical start time, operative duration, and patient demographics were collected. Based on a 12-hour operative day, surgical start times were categorized as early (7AM to 11AM), mid-day (11AM to 3PM), or late (after 3PM). A chi-squared test was performed to examine for associations between patient demographics and surgical start time. A multivariate linear regression (MLR) was performed to determine the effect of surgical start time on operative duration. P-values less than 0.05 were considered significant. This study identified 1663 TJAs – 869 total knee (TKA) and 791 total hip arthroplasties (THA) who met inclusion criteria. Among TKAs, we identified 319 (36.7%) early, 437 (50.3%) mid-day, and 113 (13.0%) late operations. Among THAs, we identified 407 (51.4%) early, 297 (37.5%) mid-day, and 87 (11.0%) late operations. MLR demonstrated that for TKA there was a 4.9 (p =0.018) and 7.3 (p=0.013) minute increase for mid-day and late cases, respectively. For THAs, a non-early start time was associated with an increased operative duration of 9.1 to 12 minutes (p<0.001). Surgical start time has a statistically significant, but minimal, effect on operative length for TJAs, with later cases being slightly longer than first-start cases.
{"title":"Total Joint Arthroplasty Time-of-Day Start Time Has Minimal Effect on Intraoperative Efficiency","authors":"Bradley T. Hammoor, Austin C. Kaidi, T. Hickernell, H. Cooper","doi":"10.60118/001c.72786","DOIUrl":"https://doi.org/10.60118/001c.72786","url":null,"abstract":"Total hip (THA) and knee arthroplasties (TKA) are common elective procedures, and dedicated arthroplasty teams perform multiple procedures per day. Little is documented about how time-of-day scheduling affects the intraoperative efficiency of total joint arthroplasties (TJA). In this study, we analyzed the effects of surgical start time on TJA operative lengths. A retrospective study was performed for primary TJA patients done within a four-year period at a single academic medical center. Surgical start time, operative duration, and patient demographics were collected. Based on a 12-hour operative day, surgical start times were categorized as early (7AM to 11AM), mid-day (11AM to 3PM), or late (after 3PM). A chi-squared test was performed to examine for associations between patient demographics and surgical start time. A multivariate linear regression (MLR) was performed to determine the effect of surgical start time on operative duration. P-values less than 0.05 were considered significant. This study identified 1663 TJAs – 869 total knee (TKA) and 791 total hip arthroplasties (THA) who met inclusion criteria. Among TKAs, we identified 319 (36.7%) early, 437 (50.3%) mid-day, and 113 (13.0%) late operations. Among THAs, we identified 407 (51.4%) early, 297 (37.5%) mid-day, and 87 (11.0%) late operations. MLR demonstrated that for TKA there was a 4.9 (p =0.018) and 7.3 (p=0.013) minute increase for mid-day and late cases, respectively. For THAs, a non-early start time was associated with an increased operative duration of 9.1 to 12 minutes (p<0.001). Surgical start time has a statistically significant, but minimal, effect on operative length for TJAs, with later cases being slightly longer than first-start cases.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"243 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114579441","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}
R. Mobbs, Tajrian Amin, S. Stulberg, Jeffery M Kerina, Victor Hernandez, R. Bolander
As wearable devices become more sophisticated, their application in monitoring the post-surgical recovery curve following Total Knee Arthroplasty (TKA) may be used to assist with rehabilitation and general care. While there is growing interest in this area, much of the research involves studies with small samples, non-pragmatic designs, and short monitoring periods. This study aims to characterize the progress and recovery kinetics of remote monitoring in the early post-TKA period, using many patients and across multiple surgeons and institutions. Between June 2018 and June 2021, adult patients undergoing primary unilateral partial or total Knee Arthroplasty for end-stage knee osteoarthritis were preoperatively recruited to wear a remote monitoring system to track their recovery. Patients were provided with device education and knee specific surface sensors. The data collected by the sensors were transmitted to a smartphone application. Patients wore the surface sensors for a period as defined by their surgeon (2-, 4-, or 6-weeks duration). Primary measures were maximal daily flexion, minimal daily extension, and Total Daily Steps (TDS). Secondary outcomes were patient-reported pain scores. A total of 435 patients were recruited into the study. The primary outcomes of flexion and extension did not significantly differ from baseline, and TDS improved significantly from preoperative baseline to 6 weeks postoperative follow up. All metrics improved relative to surgical intervention relative to 6 weeks postoperative. This study demonstrates that remote monitoring using knee specific surface sensors can capture the expected recovery kinetics following knee replacement surgery. The data provided, range of motion and total daily step counts can be used by providers to set expectations for recovery following intervention. Further work is required to compare surface sensor monitoring against standard post-surgical outcome measures to evaluate whether superior results may result from remote monitoring.
{"title":"Remote Monitoring using Wearable Technology after Knee Arthroplasty Using a Joint-Specific Wearable Device: A Prospective Cohort Study of 435 patients with 6 week follow up.","authors":"R. Mobbs, Tajrian Amin, S. Stulberg, Jeffery M Kerina, Victor Hernandez, R. Bolander","doi":"10.60118/001c.72644","DOIUrl":"https://doi.org/10.60118/001c.72644","url":null,"abstract":"As wearable devices become more sophisticated, their application in monitoring the post-surgical recovery curve following Total Knee Arthroplasty (TKA) may be used to assist with rehabilitation and general care. While there is growing interest in this area, much of the research involves studies with small samples, non-pragmatic designs, and short monitoring periods. This study aims to characterize the progress and recovery kinetics of remote monitoring in the early post-TKA period, using many patients and across multiple surgeons and institutions. Between June 2018 and June 2021, adult patients undergoing primary unilateral partial or total Knee Arthroplasty for end-stage knee osteoarthritis were preoperatively recruited to wear a remote monitoring system to track their recovery. Patients were provided with device education and knee specific surface sensors. The data collected by the sensors were transmitted to a smartphone application. Patients wore the surface sensors for a period as defined by their surgeon (2-, 4-, or 6-weeks duration). Primary measures were maximal daily flexion, minimal daily extension, and Total Daily Steps (TDS). Secondary outcomes were patient-reported pain scores. A total of 435 patients were recruited into the study. The primary outcomes of flexion and extension did not significantly differ from baseline, and TDS improved significantly from preoperative baseline to 6 weeks postoperative follow up. All metrics improved relative to surgical intervention relative to 6 weeks postoperative. This study demonstrates that remote monitoring using knee specific surface sensors can capture the expected recovery kinetics following knee replacement surgery. The data provided, range of motion and total daily step counts can be used by providers to set expectations for recovery following intervention. Further work is required to compare surface sensor monitoring against standard post-surgical outcome measures to evaluate whether superior results may result from remote monitoring.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124177564","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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