Journal of surgical orthopaedic advances最新文献

The objective of this study was to determine if physicians are compensated equally for the treatment of femoral neck fractures based on fixation method in a propensity score matched cohort of patients. The American College of Surgeons' National Surgical Quality Improvement Project (ACS NSQIP) database was queried for patients undergoing open reduction internal fixation (ORIF), hemiarthroplasty (HA), and total hip arthroplasty (THA) for femoral neck fractures. Exact matching was used to account for differences in patient-specific variables and underlying medical comorbidities. Total relative value units (RVU), operative time, RVU/minute, and reimbursement/minute were compared between the three procedures after exact matching to assess relative valuation. Propensity score matching resulted in a total of 4,581 patients eligible for final data analysis (1,527 patients in each treatment group). The groups were very well matched for age, sex, BMI, comorbidities, and American Society of Anesthesiologists (ASA) class (p > 0.99 for all). When dividing compensation by case duration, ORIF generated the most RVUs per minute (0.31 ± 0.19 or $11.01 ± 7.02) followed by THA (0.27 ± 0.14 or $9.86 ± 5.15) and HA (0.25 ± 0.1 or $8.99 ± 3.75; p<0.001 for all). This study shows that orthopaedic surgeons are compensated the most for ORIF followed by THA and HA for fixation of femoral neck fractures. (Journal of Surgical Orthopaedic Advances 32(3):164-168, 2023).

Outcomes of the Surgical Implant Generation Network (SIGN) nail have been reported for femur and tibial fractures, but its use in tibiotalocalcaneal arthrodesis (TTCA) is not well studied. Radiographic and clinical outcomes of TTCA using the SIGN database in patients with > 6 months of radiographic follow up were analyzed. Rates of tibiotalar (TT) fusion and subtalar (ST) fusion at final follow up were assessed by two independent reviewers. Of the 62 patients identified, use of the SIGN nail for TCCA resulted in 53% rate of fusion in the TT joint and 20% in the ST joint. Thirty-seven patients (60%) demonstrated painless weight bearing at final follow up. There were no differences in incidence of painless weight bearing between consensus fused and not fused cohorts for TT and ST joints (p > 0.05). There were five implant failures, no cases of infection, and seven cases of reoperation. (Journal of Surgical Orthopaedic Advances 32(3):187-192, 2023).

To review the literature on iliac wing fractures to assess outcomes of operative and nonoperative treatment. A search of PubMed, MEDLINE, and Cochrane Database of Systematic Reviews was performed. Articles reporting on iliac wing fractures without pelvic ring destabilization or intraarticular extension were included. Study information and patient data were collected, and a Methodological Index for Non-randomized Studies (MINORS) score was assigned to each article. In total, 19,363 articles were identified with 32 qualifying for inclusion. The articles included 131 patients with 133 fractures. The mean age was 43.6, and mean follow-up time was 41.9 months. Forty-eight (36%) fractures were treated operatively, and 85 (64%) were treated nonoperatively. Associated injuries included bowel injuries, other pelvic fractures, gunshot wounds, and arterial injuries. There is an absence of comparative studies between operative and nonoperative management of iliac wing fractures. Indications for operative management appear to depend on comminution, open fractures, and associated injuries. (Journal of Surgical Orthopaedic Advances 32(3):139-147, 2023).

Outpatient shoulder arthroplasty presents potential clinical benefits but also risk without perioperative optimization. Length of stay depends largely on surgeon preferences, and a large single-surgeon cohort may provide insight into optimal strategies and costs for outpatient shoulder arthroplasty. A single-surgeon cohort of 472 anatomic and reverse shoulder arthroplasties performed between 2017 and 2020 was retrospectively reviewed. Cases were stratified by those who did or did not undergo same-day discharge. The 90-day readmission, discharge to post-acute care, cost, and 45 patient/case factors were examined. Two hundred fifty (53%) underwent same-day discharge, with the proportion of outpatient cases increasing over time to nearly 80%, with no significant difference in 90-day readmissions. Revision cases often underwent same-day discharge, whereas fractures were typically admitted. The cost was significantly higher for inpatients, with implants accounting for 52%. Surgeons may safely transition a substantial proportion of shoulder arthroplasties to same-day discharge with some reassurance regarding cost savings and 90-day readmissions. (Journal of Surgical Orthopaedic Advances 32(4):263-269, 2023).

Acute compartment syndrome (ACS) represents a surgical emergency requiring effective, complete fasciotomy. The purpose of this study is to evaluate cadaver-based training on the ability of practicing general surgeons to effectively perform upper extremity, thigh, and leg fasciotomies. One hundred seventeen general surgeons underwent a 2-day, cadaver-based course with formative and summative assessments based on validated scoring tools. Overall performance and critical item scores were recorded and compared utilizing analysis of variance with repeated measures and eta-squared values to evaluate effect size. For all three procedures, post-training scores were significantly improved when compared with pre-training scores (p < 0.001). Mean pre-training score for lower leg fasciotomy met the standard for competent performance of the procedure (total score > 80), whereas neither thigh nor upper extremity performance scores met this standard before training. This 2-day, cadaver-based course improves the ability of practicing general surgeons to effectively and independently perform upper extremity, thigh, and lower leg fasciotomies. (Journal of Surgical Orthopaedic Advances 32(4):238-241, 2023).

Perioperative efficiency has become increasingly important with cost constraints and expanding indications for total hip arthroplasty (THA). We chose to analyze body mass index (BMI) and American Society of Anesthesiologists (ASA) score, in predicting perioperative efficiency. We retrospectively reviewed the institutional database for primary THAs from July 2015 to January 2018. Patient demographics and perioperative times lines were collected. A multivariable model was utilized to evaluate BMI (< 30, ≥ 30) and ASA (< 3, ≥ 3) for all outcomes. A total of 2,934 patients were included with mean age 62.0 (12.2) years, and 1,599 (54.5%) were female. A BMI ≥ 30 was associated with prolonged operative time (p < 0.001) while an ASA ≥ 3 was predictive of post-anesthesia care unit time (p < 0.001), physical therapy hours (p < 0.001), and length of stay (p < 0.001). Both BMI (p = 0.004) and ASA (p < 0.001) were associated with skilled nursing/rehabilitation dispositions. While BMI predicts prolonged operative time, ASA predicts perioperative delays for anesthesia, nursing, and physical therapy. (Journal of Surgical Orthopaedic Advances 32(3):169-172, 2023).

The purpose of this study was to evaluate the effectiveness of our novel chronic patellar tendon repair with allograft augmentation in an active-duty military population. From 2014 to 2018, five patients with chronic patellar tendon ruptures were treated with a primary repair of the patellar tendon augmented with Achilles tendon allograft. All patients were followed for 12 months, and their range of motion, Lysholm scores, and straight leg raise ability were assessed. Additionally, their return to active military duty was followed. All patients were managed with tendon reapproximation and Achilles allograft augmentation. Lysholm scores improved in all patients from an average of 35 to 87 postoperatively. No patients demonstrated postoperative extensor lag, and patients regained an average flexion of 130 degrees. All patients returned to active military duty. We presented a safe and effective technique to manage chronic patellar tendon ruptures that produced good outcomes. (Journal of Surgical Orthopaedic Advances 32(3):242-245, 2023).

The purpose of this study is to evaluate the feasibility and outcomes of obtaining routine intraoperative plain radiographs during orthopaedic trauma surgery. Seventy consecutive orthopaedic trauma patients in which intraoperative plain films were obtained in addition to fluoroscopy were reviewed. For each patient the time it took to obtain intraoperative plain radiographs was prospectively measured, in addition to the number of images taken, and quality of image. Then relative imaging times based on fracture locations were compared and the need for revision surgery based on mal-reduction or implant mal-positioning assessed. The average time required for intraoperative plain films to be obtained and reviewed by the surgeon was 3 minutes and 45 seconds. On average, 2.8 images were taken during each surgery. Proximal images took on average 44 seconds longer than distal images to obtain (p = 0.047). There was no significant difference in imaging times for upper versus lower extremities (p = 0.448). High quality images were obtained on all patients. There were no re-operations required in this series for mal-reduction of fracture, mal-positioning of implants or infection. In this study, there were no re-operations or perioperative complications when intraoperative plain films were obtained. Intraoperative plain films are a valuable tool for complex periarticular surgery or other cases where fracture reduction or implant location may be in question. (Journal of Surgical Orthopaedic Advances 32(3):160-163, 2023).

All-terrain vehicles (ATVs) are an ongoing source of orthopaedic trauma in the United States. The National Electronic Injury Surveillance System (NEISS) database was queried for ATV-related extremity trauma from 2010 to 2019. An estimated 31,979 ATV-related injuries present to emergency departments annually without significant variability between years. Patients were predominantly white (63.5%), male (72.2%), and aged 18 - 44 (49.9%). Injury sites frequently included the shoulder (24%), wrist (12.8%), and ankle (11.2%). Fractures were most common followed by strains and sprains. Only 15.5% of injuries occurred on public land. Alcohol use was rarely implicated. Orthopaedic surgeons should be aware that rates of ATV-related musculoskeletal injuries have not changed significantly over the last ten years despite legislative efforts to improve ATV safety. Additionally, safety laws are inconsistent across the US, and many apply to the use of ATVs on public land when a minority of injuries occur on non-public land. (Journal of Surgical Orthopaedic Advances 32(4):225-231, 2023).

Intramedullary nailing (IMN) of periarticular distal tibia fractures may offer advantages compared to plating. This study aims to report on the outcomes of select periarticular distal tibia fractures treated with IMN. Patients over 17 years of age that underwent IMN for extraarticular distal tibia fractures (Osteosynthesefragen/Orthopaedic Trauma Association [AO/OTA] 43-A), partial articular with associated segmental shaft component (43-B), and simple intraarticular (43-C1/2) at a Level I trauma center were included. The primary outcome was physical function (PF) and pain interference (PI) assessed via Patient-Reported Outcomes Measurement Information System (PROMIS). Secondary outcomes included reoperation, nonunion, infection, and malalignment. Eighty-four patients with > 12 months follow up were included. Mean PROMIS PI and PF scores were 55.5 and 45.0, respectively. The rate of nonunion and deep infection each were 8%. Eighty-four percent of patients achieved normal alignment. There were no differences detected in clinical outcomes between patients with intraarticular injuries compared with those with extraarticular fractures. Satisfactory clinical, radiographic, and patient-reported outcomes can be expected following treatment of extraarticular and simple intraarticular distal tibia fractures with IMN. (Journal of Surgical Orthopaedic Advances 32(4):246-251, 2023).