Pub Date : 2022-08-17DOI: 10.2106/JBJS.JOPA.22.00012
H. Lebensohn, R. K. Dahlberg, W. Curtis, C.S. Pierce, D. Richter, C. Shultz
The workup of a patient with an orthopaedic injury frequently necessitates obtaining radiographs. Well-performed radiographs can give critical information on the health of joints, bone morphology, and other important aspects that can aid in accurate diagnosis. This review article aims to function as a technique guide for the radiographic assessment of the shoulder, hip, and knee in the evaluation of orthopaedic injuries while providing information on important anatomic landmarks and the diagnostic use unique to each radiographic view.
{"title":"A Technique Guide on Radiographic Imaging of the Shoulder, Hip, and Knee Joints","authors":"H. Lebensohn, R. K. Dahlberg, W. Curtis, C.S. Pierce, D. Richter, C. Shultz","doi":"10.2106/JBJS.JOPA.22.00012","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.22.00012","url":null,"abstract":"The workup of a patient with an orthopaedic injury frequently necessitates obtaining radiographs. Well-performed radiographs can give critical information on the health of joints, bone morphology, and other important aspects that can aid in accurate diagnosis. This review article aims to function as a technique guide for the radiographic assessment of the shoulder, hip, and knee in the evaluation of orthopaedic injuries while providing information on important anatomic landmarks and the diagnostic use unique to each radiographic view.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"10 1","pages":"e22.00012"},"PeriodicalIF":0.0,"publicationDate":"2022-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43260204","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 : 2022-08-12DOI: 10.2106/JBJS.JOPA.22.00007
Lori Fauquher, Mariah Barnes, Andrew N. Schmelz
Case: A 73-year-old female patient, who was an active, healthy retired elementary school teacher, presented to her primary care provider with complaints of anxiety and depression. She is currently being treated for hypertension and osteoarthritis. Her surgical history includes a hysterectomy at the age of 34 years and an internal fixation of the wrist at 69 years. Six months ago, she was treated for a fall after slipping on some ice on her way into the grocery store. She suffered a hip fracture and underwent successful surgical correction. After surgery, the patient spent months in rehab but never fully regained her mobility. The psychological strain of losing her independence was found to significantly contribute to her new diagnoses of anxiety and depression. She felt as though she was a burden to her working daughter, who must now assist with her daily activities. Should we have predicted this outcome for our patient sooner? If so, what could we have done to prevent this outcome?
{"title":"Management of Osteoporosis After Fragility Fracture","authors":"Lori Fauquher, Mariah Barnes, Andrew N. Schmelz","doi":"10.2106/JBJS.JOPA.22.00007","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.22.00007","url":null,"abstract":"Case: A 73-year-old female patient, who was an active, healthy retired elementary school teacher, presented to her primary care provider with complaints of anxiety and depression. She is currently being treated for hypertension and osteoarthritis. Her surgical history includes a hysterectomy at the age of 34 years and an internal fixation of the wrist at 69 years. Six months ago, she was treated for a fall after slipping on some ice on her way into the grocery store. She suffered a hip fracture and underwent successful surgical correction. After surgery, the patient spent months in rehab but never fully regained her mobility. The psychological strain of losing her independence was found to significantly contribute to her new diagnoses of anxiety and depression. She felt as though she was a burden to her working daughter, who must now assist with her daily activities. Should we have predicted this outcome for our patient sooner? If so, what could we have done to prevent this outcome?","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"10 1","pages":"e22.00007"},"PeriodicalIF":0.0,"publicationDate":"2022-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46588003","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 : 2022-07-13DOI: 10.2106/JBJS.JOPA.22.00008
L. Klein, Gary Sakryd
Arthrofibrosis after anterior cruciate ligament reconstruction is a known complication. Etiology, pathology, and treatment options for anterior interval scarring and cyclops lesions are discussed in detail. This case report describes both specific types of postsurgical scarring that occurred simultaneously in the same knee.
{"title":"Case Report: Arthrofibrosis of the Knee After Anterior Cruciate Ligament Reconstruction: Anterior Interval Scarring and Cyclops Lesion","authors":"L. Klein, Gary Sakryd","doi":"10.2106/JBJS.JOPA.22.00008","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.22.00008","url":null,"abstract":"Arthrofibrosis after anterior cruciate ligament reconstruction is a known complication. Etiology, pathology, and treatment options for anterior interval scarring and cyclops lesions are discussed in detail. This case report describes both specific types of postsurgical scarring that occurred simultaneously in the same knee.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"10 1","pages":"e22.00008"},"PeriodicalIF":0.0,"publicationDate":"2022-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49556651","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 : 2022-06-02DOI: 10.2106/JBJS.JOPA.21.00036
Annie Y. Wong
Osteoarthritis is a degenerative joint disease that affects millions of adults in the United States and is a significant healthcare burden for medical costs and loss of productivity. Although osteoarthritis may inhibit different joints in the body, the knee joint is most commonly affected, leading to knee pain, swelling, and stiffness. This issue is encountered by healthcare providers in orthopaedics, emergency medicine, and primary care daily, and the biomedical model taught in medical education often emphasizes a one-size-fits-all treatment approach. This literature review examines whether the biopsychosocial model could be used to manage chronic knee osteoarthritis instead. This report introduces the biopsychosocial model as a holistic approach that considers a patient's psychological and social factors in addition to the biology of disease. This report concludes that although the effectiveness of the biopsychosocial model and management of cancer-related pain have been studied, additional research is needed to examine the utilization of the biopsychosocial model with chronic knee osteoarthritis.
{"title":"Knee Deep in Pain","authors":"Annie Y. Wong","doi":"10.2106/JBJS.JOPA.21.00036","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.21.00036","url":null,"abstract":"Osteoarthritis is a degenerative joint disease that affects millions of adults in the United States and is a significant healthcare burden for medical costs and loss of productivity. Although osteoarthritis may inhibit different joints in the body, the knee joint is most commonly affected, leading to knee pain, swelling, and stiffness. This issue is encountered by healthcare providers in orthopaedics, emergency medicine, and primary care daily, and the biomedical model taught in medical education often emphasizes a one-size-fits-all treatment approach. This literature review examines whether the biopsychosocial model could be used to manage chronic knee osteoarthritis instead. This report introduces the biopsychosocial model as a holistic approach that considers a patient's psychological and social factors in addition to the biology of disease. This report concludes that although the effectiveness of the biopsychosocial model and management of cancer-related pain have been studied, additional research is needed to examine the utilization of the biopsychosocial model with chronic knee osteoarthritis.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"10 1","pages":"e21.00036"},"PeriodicalIF":0.0,"publicationDate":"2022-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45785492","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 : 2022-05-25DOI: 10.2106/jbjs.jopa.22.00003
Joshua K. Radi, K. S. Min
The following article addresses a case study regarding a 15-year-old adolescent boy who presented with right shoulder pain after a hockey injury and was diagnosed and treated for a distal clavicle physeal fracture. Topics include anatomy, mechanism of injury, prevalence, workup and diagnosis, treatment (operative vs. nonoperative), and return-to-sports guidance. This is a rare injury in the pediatric population, but with proper diagnosis and management, the prognosis is a full recovery after 3 months.
{"title":"Distal Clavicle Physeal Fracture in a 15-Year-Old Adolescent Boy","authors":"Joshua K. Radi, K. S. Min","doi":"10.2106/jbjs.jopa.22.00003","DOIUrl":"https://doi.org/10.2106/jbjs.jopa.22.00003","url":null,"abstract":"The following article addresses a case study regarding a 15-year-old adolescent boy who presented with right shoulder pain after a hockey injury and was diagnosed and treated for a distal clavicle physeal fracture. Topics include anatomy, mechanism of injury, prevalence, workup and diagnosis, treatment (operative vs. nonoperative), and return-to-sports guidance. This is a rare injury in the pediatric population, but with proper diagnosis and management, the prognosis is a full recovery after 3 months.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47860219","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 : 2022-05-04DOI: 10.2106/JBJS.JOPA.21.00037
Carmine J. Spadaccini
This review aims to determine the elements a hospital-based knee arthroplasty program should consider when developing a rapid recovery protocol. It will examine the perioperative pathway and how a program can break down each phase for success. Secondary objectives of this review include how and why the culture surrounding knee arthroplasty has changed and why it is in a hospital's best interest to adopt a rapid recovery pathway in light of this new landscape. An extensive search was performed through databases which included Still OneSearch, EBSCOhost, and PubMed. Sources aligned with the review's objectives. Inclusion criteria involved primary sources, secondary sources, and peer-reviewed articles less than 5 years old. On finding primary and secondary sources, reference sections provided additional materials to ensure high-quality research. Outpatient knee arthroplasty has gained interest in the past 10 years, and rapid recovery protocols have helped promote this likely development. The rapidly changing landscape surrounding knee arthroplasty was triggered by insurance companies and pushed even further because of the COVID-19 pandemic. Developing a rapid recovery protocol in the hospital setting involves a change in overall culture, interprofessional participation, and patient and family cooperation. Although not an easy task, adopting a rapid recovery protocol for knee arthroplasty has been shown to improve overall patient outcomes by decreasing length of stay, decreasing complications, and increasing discharge home rates. Along with improved outcomes, we have improvements in patient satisfaction and overall cost savings.
{"title":"Hospital-Based Rapid Recovery Protocol in Knee Arthroplasty","authors":"Carmine J. Spadaccini","doi":"10.2106/JBJS.JOPA.21.00037","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.21.00037","url":null,"abstract":"This review aims to determine the elements a hospital-based knee arthroplasty program should consider when developing a rapid recovery protocol. It will examine the perioperative pathway and how a program can break down each phase for success. Secondary objectives of this review include how and why the culture surrounding knee arthroplasty has changed and why it is in a hospital's best interest to adopt a rapid recovery pathway in light of this new landscape. An extensive search was performed through databases which included Still OneSearch, EBSCOhost, and PubMed. Sources aligned with the review's objectives. Inclusion criteria involved primary sources, secondary sources, and peer-reviewed articles less than 5 years old. On finding primary and secondary sources, reference sections provided additional materials to ensure high-quality research. Outpatient knee arthroplasty has gained interest in the past 10 years, and rapid recovery protocols have helped promote this likely development. The rapidly changing landscape surrounding knee arthroplasty was triggered by insurance companies and pushed even further because of the COVID-19 pandemic. Developing a rapid recovery protocol in the hospital setting involves a change in overall culture, interprofessional participation, and patient and family cooperation. Although not an easy task, adopting a rapid recovery protocol for knee arthroplasty has been shown to improve overall patient outcomes by decreasing length of stay, decreasing complications, and increasing discharge home rates. Along with improved outcomes, we have improvements in patient satisfaction and overall cost savings.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44878483","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 : 2022-04-22DOI: 10.2106/JBJS.JOPA.21.00035
Jamie Goldstone Adler
Lumbar fusions can be performed under general anesthesia or as an awake procedure under spinal anesthesia. There is no consensus on the benefits of awake lumbar fusion. Improved patient satisfaction, less blood loss, stable hemodynamics, less postoperative pain, less postoperative nausea and vomiting, and less postoperative delirium are all possible benefits of awake lumbar fusion. Early, limited research confirms these benefits.
{"title":"Awake Lumbar Fusion","authors":"Jamie Goldstone Adler","doi":"10.2106/JBJS.JOPA.21.00035","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.21.00035","url":null,"abstract":"Lumbar fusions can be performed under general anesthesia or as an awake procedure under spinal anesthesia. There is no consensus on the benefits of awake lumbar fusion. Improved patient satisfaction, less blood loss, stable hemodynamics, less postoperative pain, less postoperative nausea and vomiting, and less postoperative delirium are all possible benefits of awake lumbar fusion. Early, limited research confirms these benefits.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"10 1","pages":"e21.00035"},"PeriodicalIF":0.0,"publicationDate":"2022-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43132489","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 : 2022-04-13DOI: 10.2106/JBJS.JOPA.22.00002
G. Foremny, D. Quintero, C. Emerson, L. Baker, T. Subhawong, J. Pretell-Mazzini, J. Jose
Juxtacortical lesions appear as neoplastic formations on the outer cortical surface of bone. They can arise from nonneoplastic and neoplastic origin, the latter of which might be malignant. Juxtacortical lesions of neoplastic origin can be categorized into bone-forming lesions, cartilaginous lesions, fibrous lesions, lesions of local vascular or neurogenic origin, or metastatic lesions. Forming a differential diagnosis can be challenging for any physician assistant. We selected a series of cases from our tertiary care clinic that have been subject to discussion for their similarity but vastly different prognosis. Our aim is to provide a rubric to compare juxtacortical lesions with guide orthopaedic and sport medicine providers in determining the immediacy of referral and follow-up.
{"title":"Image Findings of Juxtacortical Lesions","authors":"G. Foremny, D. Quintero, C. Emerson, L. Baker, T. Subhawong, J. Pretell-Mazzini, J. Jose","doi":"10.2106/JBJS.JOPA.22.00002","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.22.00002","url":null,"abstract":"Juxtacortical lesions appear as neoplastic formations on the outer cortical surface of bone. They can arise from nonneoplastic and neoplastic origin, the latter of which might be malignant. Juxtacortical lesions of neoplastic origin can be categorized into bone-forming lesions, cartilaginous lesions, fibrous lesions, lesions of local vascular or neurogenic origin, or metastatic lesions. Forming a differential diagnosis can be challenging for any physician assistant. We selected a series of cases from our tertiary care clinic that have been subject to discussion for their similarity but vastly different prognosis. Our aim is to provide a rubric to compare juxtacortical lesions with guide orthopaedic and sport medicine providers in determining the immediacy of referral and follow-up.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":"10 1","pages":"e22.00002"},"PeriodicalIF":0.0,"publicationDate":"2022-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45964783","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 : 2022-04-06DOI: 10.2106/JBJS.JOPA.21.00038
W. Curtis, River Fine, Addi N. Moya, R. Blackstone, Richard M Wardell, Gehron P. Treme, D. Richter
Introduction: Many patients within the orthopaedic population experience 1 or more psychosocial issues that may profoundly affect their postoperative outcomes after orthopaedic surgery. Despite the common nature of these factors, there is a paucity of literature describing their effect on orthopaedic outcomes. The purpose of this review was to describe the anecdotal 10 most-encountered psychosocial factors in our patient population, their described influence on orthopaedic outcomes, and how they may be addressed. These factors include expectations, fear of reinjury, socioeconomic status, social support, allergies, addiction, depression and anxiety, resilience, self-efficacy, and other mental health disorders. Methods: A thorough review of the PubMed-indexed literature was conducted using each one of our psychosocial factors described here combined with the key words “orthopaedic outcome.” Study Design: This was a clinical review paper. Level of Evidence: Not applicable. Results: These 10 psychosocial influences have dramatic effects on the recovery and outcomes after orthopaedic procedures. Patients benefit from early recognition and management of these issues before and after surgery. Conclusions: Each of the psychosocial factors reviewed in this paper has a significant influence on outcomes after orthopaedic surgery. A strong understanding of these factors and how to address them will aid orthopaedic surgeons in maximizing postoperative outcomes for their patients. Further research is necessary to improve our treatment strategies for this complex patient population.
{"title":"The “Top 10” Psychosocial Factors Affecting Orthopaedic Outcomes","authors":"W. Curtis, River Fine, Addi N. Moya, R. Blackstone, Richard M Wardell, Gehron P. Treme, D. Richter","doi":"10.2106/JBJS.JOPA.21.00038","DOIUrl":"https://doi.org/10.2106/JBJS.JOPA.21.00038","url":null,"abstract":"Introduction: Many patients within the orthopaedic population experience 1 or more psychosocial issues that may profoundly affect their postoperative outcomes after orthopaedic surgery. Despite the common nature of these factors, there is a paucity of literature describing their effect on orthopaedic outcomes. The purpose of this review was to describe the anecdotal 10 most-encountered psychosocial factors in our patient population, their described influence on orthopaedic outcomes, and how they may be addressed. These factors include expectations, fear of reinjury, socioeconomic status, social support, allergies, addiction, depression and anxiety, resilience, self-efficacy, and other mental health disorders. Methods: A thorough review of the PubMed-indexed literature was conducted using each one of our psychosocial factors described here combined with the key words “orthopaedic outcome.” Study Design: This was a clinical review paper. Level of Evidence: Not applicable. Results: These 10 psychosocial influences have dramatic effects on the recovery and outcomes after orthopaedic procedures. Patients benefit from early recognition and management of these issues before and after surgery. Conclusions: Each of the psychosocial factors reviewed in this paper has a significant influence on outcomes after orthopaedic surgery. A strong understanding of these factors and how to address them will aid orthopaedic surgeons in maximizing postoperative outcomes for their patients. Further research is necessary to improve our treatment strategies for this complex patient population.","PeriodicalId":93583,"journal":{"name":"Journal of orthopedics for physician assistants","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44375486","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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