Operative vs. Nonoperative Treatment of Isolated Humeral Shaft Fractures: A Prospective Cohort Study
J Surg Orthop Adv. 2021 Summer;30(2):67-72.ABSTRACTThe purpose was to compare plate and screw fixation (open reduction internal fixation [ORIF]) and functional bracing (FB) of isolated humeral shaft fractures with treatment and patient-based outcomes. We performed a prospective trial of ORIF v. FB at 12 centers. Surgeons counseled patients on treatment options and a patient centered decision was made. We enrolled 179 patients, of which 6-month data was analyzed for 102 (39 female; 63 male). Forty-five were treated with ORIF and 57 with FB. We found no difference in the disability of the arm, shoulder and hand (DASH) score,...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Lisa K Cannada Lauren Nelson Paul Tornetta Robert Hymes Clifford B Jones William Obremskey Eben Carroll Brian Mullis Michael Tucker David Teague Andrew Marcantonio Robert Ostrum Michael Del Core Heidi Israel Source Type: research

Is There a Critical Radiographic Angle That Portends Poor Functional Outcome Scores in Nonoperative Treatment of Isolated Humeral Shaft Fractures?
J Surg Orthop Adv. 2021 Summer;30(2):73-77.ABSTRACTOur purpose was to evaluate radiographic alignment of nonoperatively treated humerus fractures and determine if there is a critical angle associated with worse outcomes. All patients with humeral shaft fractures that were prospectively followed as part of a larger multicenter trial were reviewed. These patients were selected for nonoperative management based on shared decision making. There were 80 patients that healed with adequate data. The receiver operating characteristic (ROC) had best fit with a sagittal radiographic angle of 10° (AUC: 0.731) and coronal angle of...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Brian W Hill Lisa K Cannada Lauren Nelson Paul Tornetta Robert Hymes Clifford B Jones William Obremskey Eben Carroll Brian Mullis Michael Tucker David Teague Andrew Marcantonio Robert Ostrum Michael Del Core Heidi Israel Source Type: research

Anatomic Considerations Regarding the Placement of a Retrograde Intramedullary Fibular Screw
J Surg Orthop Adv. 2021 Summer;30(2):78-81.ABSTRACTThe purpose of this study was to identify the ideal start site for a retrograde intramedullary fibular cortical screw based on its relationship to the surrounding soft tissue structures and to assess for damage to the surrounding soft tissue structures caused during placement of the screw. Four fresh frozen cadavers underwent fluoroscopic placement of a 3.5 mm cortical screw utilizing a standardized protocol. No damage to the peroneal tendons were noted in any cadaver with the foot in an inverted and plantarflexed position. The closest structure to the center of the screw ...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Suman Medda Amy P Trammell Robert D Teasdall Source Type: research

No Increase in Instability with Obturator Externus Release in Direct Anterior Approach
J Surg Orthop Adv. 2021 Summer;30(2):82-84.ABSTRACTUse of the direct anterior approach in total hip arthroplasty is becoming increasingly common. Complications associated with this approach pertain to proximal femoral exposure. Selective capsular and tendinous releases improve exposure intraoperatively. Release of obturator externus has been avoided to prevent postoperative instability. A retrospective case-control review of consecutive patients who underwent direct anterior approach was performed. Demographic information, sequence of releases performed, dislocations that occurred postoperatively, and revision total hip ar...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Marc Hungerford Thomas Hendricks Philip Neubauer Ashlie Boner Source Type: research

Opioid Prescribing Patterns and Patient Satisfaction with Care
J Surg Orthop Adv. 2021 Summer;30(2):85-89.ABSTRACTWe sought to examine the relationship between opioid prescribing patterns and patient reported satisfaction with care. Opioid prescribing was characterized in terms of morphine equivalent daily dosing (MEDD), total morphine equivalent dosing (TMED), and total number of opioid prescriptions. A total of 1,666 opioid prescriptions were written for a TMED of 379,660 and a median MEDD of 204 (interquartile range [IQR] 195-269) from 2017-2019. Two hundred and forty-four patient satisfaction surveys were obtained for review and comparison. During the study period, 2,358 cases wer...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Maj Nathan S Lanham Cpt Kyle Bockelman Cpt Michael J Elsenbeck Ltc Brendan J McCriskin Maj P Scott H Robinson Maj James N Foster Maj Ret Jacob C L Rumley Source Type: research

The Impact of Certificate of Need Status on the Utilization and Reimbursement of Open and Endoscopic Carpal Tunnel Release
J Surg Orthop Adv. 2021 Summer;30(2):90-92.ABSTRACTA certificate of need (CON) permits a healthcare organization to build new facilities only if significant medical needs exist. Many states have implemented CON programs to prevent procedure overutilization and price inflation. We hypothesized that there are no differences in reimbursement or utilization for open and endoscopic carpal tunnel release (CTR) when comparing states with and without CON programs. We queried a private-payer database to identify open and endoscopic CTRs performed between 2007 and 2015. In total, 82,689 CTRs were identified: 70,160 open, 12,529 endo...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Sahitya K Denduluri Allison Roe Abiram Bala Nathaniel Fogel Chason Ziino Robin N Kamal Source Type: research

Orthopaedists Versus Radiologists: A Prospective Comparison of Radiographic Interpretation Between Orthopaedists and Radiologists at a Level I Trauma Center
J Surg Orthop Adv. 2021 Summer;30(2):93-95.ABSTRACTThe purpose of this investigation was to evaluate the difference in response time, accuracy of radiographic interpretation, and frequency of changes in clinical management necessary after inaccurate reads when comparing orthopaedic and radiology providers. Data including provider response time, accuracy of radiographic interpretation and the frequency of changes in clinical management necessary after imaging reads was collected over a continuous two-month period at a Level I Trauma center. A total of 188 orthopedic injuries involving imaging were included. Orthopedic provi...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Griffin Biedron Reuben Macias Isaac Fernandez Nicholas Kusnezov John C Dunn James H Nelson Source Type: research

Readability Level of English and Spanish Orthopaedic Patient Education Materials English and Spanish Patient Education
J Surg Orthop Adv. 2021 Summer;30(2):96-100.ABSTRACTThere are 16 million Hispanic people in the United States who rely on Spanish as their only effective method of communication. However, there is a scarcity of literature evaluating if patient education resources in Spanish meet the average American reading level or National Institute of Health (NIH) and American Medical Association (AMA) grade-level recommendations, especially in the field of orthopaedics. Representative orthopaedic search terms were input into Google and ten articles pertaining to patient education were selected. Videos, scientific journals, and surgical...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Michael J Patetta Kristina M Pond Elizabeth M Tennant Anshum Sood Mark H Gonzalez Source Type: research

Legislation Only Limiting Opioid Prescription Length Has Minimal Impact on Prescribing in Orthopaedic Trauma
This study evaluates the efficacy of North Carolina's Strengthen Opioid Misuse Prevention (STOP) Act in reducing the volume and rate of 90-day perioperative opioid prescribing to patients ages 18 and older after orthopaedic trauma surgery. Patients undergoing fracture surgery from January 2017 to June 2017 (pre-STOP) were compared with patients undergoing fracture surgery from January 2018 to June 2018 (post-STOP). Adjusted analyses demonstrated that patients undergoing surgery after the STOP Act (n = 730) were prescribed significantly lower volume of opioids in the discharge to 2-week time frame and at the first postopera...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Daniel J Cunningham Micaela L LaRose Isabel F DeLaura Gloria X Zhang Christopher S Klifto Mark J Gage Source Type: research

Visual Estimation of Length by Orthopaedic Surgeons: How Accurate Are Lengths Estimated in Digital Images Compared to In-Person Estimations?
J Surg Orthop Adv. 2021 Summer;30(2):108-111.ABSTRACTOrthopaedic surgeons are frequently required to make estimations, often without the use of measuring tools, including the lengths of wounds, incisions, bone fragments, and soft tissue defects. To evaluate the accuracy of these estimations, simulated wounds of randomized lengths were drawn on a healthy volunteer. Resident and attending physicians estimated the length of each wound via digital photograph and subsequently in person. Comparison of digital photograph versus in-person estimation was completed with paired t-test. The accuracy of estimation by experience level w...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: S Craig Morris Joshua N Speirs Christopher K Heinrich M Daniel Wongworawat Source Type: research

Bringing Physical Exam Skills Back from the Dead
J Surg Orthop Adv. 2021 Summer;30(2):112-115.ABSTRACTPhysical examination education begins early for medical learners. A hindrance to physical exam competency is lack of exposure to pathology in standardized patient settings. This research focuses on improving medical education through the utilization of cadavers that have undergone a soft-embalming technique: the Thiel method. Three scenarios were created in four Thiel cadavers: anterior cruciate ligament (ACL) tear, posterior cruciate ligament (PCL) tear, and sham incision. Students were asked to diagnose ACL tears using the Lachman exam. A total of 54 learners participa...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: James Ross Bailey David C Tapscott Norman Y Otsuka Kyle T Boden Robert M Becker Tom E Kwasigroch Brian D Johnston Source Type: research

Wartime Military Orthopaedics
J Surg Orthop Adv. 2021 Summer;30(2):116-119.ABSTRACTMilitary orthopaedic surgeons are faced with hardship and decreased morale. Surgeons have frequent deployments and practice inefficiencies resulting in poor retention rates. The purpose of this analysis is to report demographics and factors effecting military retention. A survey was sent to all members of the Society of Military Orthopedic Surgeons. The survey obtained demographic information, as well as factors affecting retention and termination of service. Data was compared between subset groups within the total respondent population. Of active-duty personnel, 38.5% p...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Michael D Eckhoff Richard L Purcell Justin D Orr Leon J Nesti Benjamin K Potter John C Dunn Source Type: research

Operative vs. Nonoperative Treatment of Isolated Humeral Shaft Fractures: A Prospective Cohort Study
J Surg Orthop Adv. 2021 Summer;30(2):67-72.ABSTRACTThe purpose was to compare plate and screw fixation (open reduction internal fixation [ORIF]) and functional bracing (FB) of isolated humeral shaft fractures with treatment and patient-based outcomes. We performed a prospective trial of ORIF v. FB at 12 centers. Surgeons counseled patients on treatment options and a patient centered decision was made. We enrolled 179 patients, of which 6-month data was analyzed for 102 (39 female; 63 male). Forty-five were treated with ORIF and 57 with FB. We found no difference in the disability of the arm, shoulder and hand (DASH) score,...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Lisa K Cannada Lauren Nelson Paul Tornetta Robert Hymes Clifford B Jones William Obremskey Eben Carroll Brian Mullis Michael Tucker David Teague Andrew Marcantonio Robert Ostrum Michael Del Core Heidi Israel Source Type: research

Is There a Critical Radiographic Angle That Portends Poor Functional Outcome Scores in Nonoperative Treatment of Isolated Humeral Shaft Fractures?
J Surg Orthop Adv. 2021 Summer;30(2):73-77.ABSTRACTOur purpose was to evaluate radiographic alignment of nonoperatively treated humerus fractures and determine if there is a critical angle associated with worse outcomes. All patients with humeral shaft fractures that were prospectively followed as part of a larger multicenter trial were reviewed. These patients were selected for nonoperative management based on shared decision making. There were 80 patients that healed with adequate data. The receiver operating characteristic (ROC) had best fit with a sagittal radiographic angle of 10° (AUC: 0.731) and coronal angle of...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Brian W Hill Lisa K Cannada Lauren Nelson Paul Tornetta Robert Hymes Clifford B Jones William Obremskey Eben Carroll Brian Mullis Michael Tucker David Teague Andrew Marcantonio Robert Ostrum Michael Del Core Heidi Israel Source Type: research

Anatomic Considerations Regarding the Placement of a Retrograde Intramedullary Fibular Screw
J Surg Orthop Adv. 2021 Summer;30(2):78-81.ABSTRACTThe purpose of this study was to identify the ideal start site for a retrograde intramedullary fibular cortical screw based on its relationship to the surrounding soft tissue structures and to assess for damage to the surrounding soft tissue structures caused during placement of the screw. Four fresh frozen cadavers underwent fluoroscopic placement of a 3.5 mm cortical screw utilizing a standardized protocol. No damage to the peroneal tendons were noted in any cadaver with the foot in an inverted and plantarflexed position. The closest structure to the center of the screw ...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Suman Medda Amy P Trammell Robert D Teasdall Source Type: research

No Increase in Instability with Obturator Externus Release in Direct Anterior Approach
J Surg Orthop Adv. 2021 Summer;30(2):82-84.ABSTRACTUse of the direct anterior approach in total hip arthroplasty is becoming increasingly common. Complications associated with this approach pertain to proximal femoral exposure. Selective capsular and tendinous releases improve exposure intraoperatively. Release of obturator externus has been avoided to prevent postoperative instability. A retrospective case-control review of consecutive patients who underwent direct anterior approach was performed. Demographic information, sequence of releases performed, dislocations that occurred postoperatively, and revision total hip ar...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Marc Hungerford Thomas Hendricks Philip Neubauer Ashlie Boner Source Type: research

Opioid Prescribing Patterns and Patient Satisfaction with Care
J Surg Orthop Adv. 2021 Summer;30(2):85-89.ABSTRACTWe sought to examine the relationship between opioid prescribing patterns and patient reported satisfaction with care. Opioid prescribing was characterized in terms of morphine equivalent daily dosing (MEDD), total morphine equivalent dosing (TMED), and total number of opioid prescriptions. A total of 1,666 opioid prescriptions were written for a TMED of 379,660 and a median MEDD of 204 (interquartile range [IQR] 195-269) from 2017-2019. Two hundred and forty-four patient satisfaction surveys were obtained for review and comparison. During the study period, 2,358 cases wer...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Maj Nathan S Lanham Cpt Kyle Bockelman Cpt Michael J Elsenbeck Ltc Brendan J McCriskin Maj P Scott H Robinson Maj James N Foster Maj Ret Jacob C L Rumley Source Type: research

The Impact of Certificate of Need Status on the Utilization and Reimbursement of Open and Endoscopic Carpal Tunnel Release
J Surg Orthop Adv. 2021 Summer;30(2):90-92.ABSTRACTA certificate of need (CON) permits a healthcare organization to build new facilities only if significant medical needs exist. Many states have implemented CON programs to prevent procedure overutilization and price inflation. We hypothesized that there are no differences in reimbursement or utilization for open and endoscopic carpal tunnel release (CTR) when comparing states with and without CON programs. We queried a private-payer database to identify open and endoscopic CTRs performed between 2007 and 2015. In total, 82,689 CTRs were identified: 70,160 open, 12,529 endo...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Sahitya K Denduluri Allison Roe Abiram Bala Nathaniel Fogel Chason Ziino Robin N Kamal Source Type: research

Orthopaedists Versus Radiologists: A Prospective Comparison of Radiographic Interpretation Between Orthopaedists and Radiologists at a Level I Trauma Center
J Surg Orthop Adv. 2021 Summer;30(2):93-95.ABSTRACTThe purpose of this investigation was to evaluate the difference in response time, accuracy of radiographic interpretation, and frequency of changes in clinical management necessary after inaccurate reads when comparing orthopaedic and radiology providers. Data including provider response time, accuracy of radiographic interpretation and the frequency of changes in clinical management necessary after imaging reads was collected over a continuous two-month period at a Level I Trauma center. A total of 188 orthopedic injuries involving imaging were included. Orthopedic provi...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Griffin Biedron Reuben Macias Isaac Fernandez Nicholas Kusnezov John C Dunn James H Nelson Source Type: research

Readability Level of English and Spanish Orthopaedic Patient Education Materials English and Spanish Patient Education
J Surg Orthop Adv. 2021 Summer;30(2):96-100.ABSTRACTThere are 16 million Hispanic people in the United States who rely on Spanish as their only effective method of communication. However, there is a scarcity of literature evaluating if patient education resources in Spanish meet the average American reading level or National Institute of Health (NIH) and American Medical Association (AMA) grade-level recommendations, especially in the field of orthopaedics. Representative orthopaedic search terms were input into Google and ten articles pertaining to patient education were selected. Videos, scientific journals, and surgical...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Michael J Patetta Kristina M Pond Elizabeth M Tennant Anshum Sood Mark H Gonzalez Source Type: research

Legislation Only Limiting Opioid Prescription Length Has Minimal Impact on Prescribing in Orthopaedic Trauma
This study evaluates the efficacy of North Carolina's Strengthen Opioid Misuse Prevention (STOP) Act in reducing the volume and rate of 90-day perioperative opioid prescribing to patients ages 18 and older after orthopaedic trauma surgery. Patients undergoing fracture surgery from January 2017 to June 2017 (pre-STOP) were compared with patients undergoing fracture surgery from January 2018 to June 2018 (post-STOP). Adjusted analyses demonstrated that patients undergoing surgery after the STOP Act (n = 730) were prescribed significantly lower volume of opioids in the discharge to 2-week time frame and at the first postopera...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Daniel J Cunningham Micaela L LaRose Isabel F DeLaura Gloria X Zhang Christopher S Klifto Mark J Gage Source Type: research

Visual Estimation of Length by Orthopaedic Surgeons: How Accurate Are Lengths Estimated in Digital Images Compared to In-Person Estimations?
J Surg Orthop Adv. 2021 Summer;30(2):108-111.ABSTRACTOrthopaedic surgeons are frequently required to make estimations, often without the use of measuring tools, including the lengths of wounds, incisions, bone fragments, and soft tissue defects. To evaluate the accuracy of these estimations, simulated wounds of randomized lengths were drawn on a healthy volunteer. Resident and attending physicians estimated the length of each wound via digital photograph and subsequently in person. Comparison of digital photograph versus in-person estimation was completed with paired t-test. The accuracy of estimation by experience level w...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: S Craig Morris Joshua N Speirs Christopher K Heinrich M Daniel Wongworawat Source Type: research

Bringing Physical Exam Skills Back from the Dead
J Surg Orthop Adv. 2021 Summer;30(2):112-115.ABSTRACTPhysical examination education begins early for medical learners. A hindrance to physical exam competency is lack of exposure to pathology in standardized patient settings. This research focuses on improving medical education through the utilization of cadavers that have undergone a soft-embalming technique: the Thiel method. Three scenarios were created in four Thiel cadavers: anterior cruciate ligament (ACL) tear, posterior cruciate ligament (PCL) tear, and sham incision. Students were asked to diagnose ACL tears using the Lachman exam. A total of 54 learners participa...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: James Ross Bailey David C Tapscott Norman Y Otsuka Kyle T Boden Robert M Becker Tom E Kwasigroch Brian D Johnston Source Type: research

Wartime Military Orthopaedics
J Surg Orthop Adv. 2021 Summer;30(2):116-119.ABSTRACTMilitary orthopaedic surgeons are faced with hardship and decreased morale. Surgeons have frequent deployments and practice inefficiencies resulting in poor retention rates. The purpose of this analysis is to report demographics and factors effecting military retention. A survey was sent to all members of the Society of Military Orthopedic Surgeons. The survey obtained demographic information, as well as factors affecting retention and termination of service. Data was compared between subset groups within the total respondent population. Of active-duty personnel, 38.5% p...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Michael D Eckhoff Richard L Purcell Justin D Orr Leon J Nesti Benjamin K Potter John C Dunn Source Type: research

Operative vs. Nonoperative Treatment of Isolated Humeral Shaft Fractures: A Prospective Cohort Study
J Surg Orthop Adv. 2021 Summer;30(2):67-72.ABSTRACTThe purpose was to compare plate and screw fixation (open reduction internal fixation [ORIF]) and functional bracing (FB) of isolated humeral shaft fractures with treatment and patient-based outcomes. We performed a prospective trial of ORIF v. FB at 12 centers. Surgeons counseled patients on treatment options and a patient centered decision was made. We enrolled 179 patients, of which 6-month data was analyzed for 102 (39 female; 63 male). Forty-five were treated with ORIF and 57 with FB. We found no difference in the disability of the arm, shoulder and hand (DASH) score,...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Lisa K Cannada Lauren Nelson Paul Tornetta Robert Hymes Clifford B Jones William Obremskey Eben Carroll Brian Mullis Michael Tucker David Teague Andrew Marcantonio Robert Ostrum Michael Del Core Heidi Israel Source Type: research

Is There a Critical Radiographic Angle That Portends Poor Functional Outcome Scores in Nonoperative Treatment of Isolated Humeral Shaft Fractures?
J Surg Orthop Adv. 2021 Summer;30(2):73-77.ABSTRACTOur purpose was to evaluate radiographic alignment of nonoperatively treated humerus fractures and determine if there is a critical angle associated with worse outcomes. All patients with humeral shaft fractures that were prospectively followed as part of a larger multicenter trial were reviewed. These patients were selected for nonoperative management based on shared decision making. There were 80 patients that healed with adequate data. The receiver operating characteristic (ROC) had best fit with a sagittal radiographic angle of 10° (AUC: 0.731) and coronal angle of...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Brian W Hill Lisa K Cannada Lauren Nelson Paul Tornetta Robert Hymes Clifford B Jones William Obremskey Eben Carroll Brian Mullis Michael Tucker David Teague Andrew Marcantonio Robert Ostrum Michael Del Core Heidi Israel Source Type: research

Anatomic Considerations Regarding the Placement of a Retrograde Intramedullary Fibular Screw
J Surg Orthop Adv. 2021 Summer;30(2):78-81.ABSTRACTThe purpose of this study was to identify the ideal start site for a retrograde intramedullary fibular cortical screw based on its relationship to the surrounding soft tissue structures and to assess for damage to the surrounding soft tissue structures caused during placement of the screw. Four fresh frozen cadavers underwent fluoroscopic placement of a 3.5 mm cortical screw utilizing a standardized protocol. No damage to the peroneal tendons were noted in any cadaver with the foot in an inverted and plantarflexed position. The closest structure to the center of the screw ...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Suman Medda Amy P Trammell Robert D Teasdall Source Type: research

No Increase in Instability with Obturator Externus Release in Direct Anterior Approach
J Surg Orthop Adv. 2021 Summer;30(2):82-84.ABSTRACTUse of the direct anterior approach in total hip arthroplasty is becoming increasingly common. Complications associated with this approach pertain to proximal femoral exposure. Selective capsular and tendinous releases improve exposure intraoperatively. Release of obturator externus has been avoided to prevent postoperative instability. A retrospective case-control review of consecutive patients who underwent direct anterior approach was performed. Demographic information, sequence of releases performed, dislocations that occurred postoperatively, and revision total hip ar...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Marc Hungerford Thomas Hendricks Philip Neubauer Ashlie Boner Source Type: research

Opioid Prescribing Patterns and Patient Satisfaction with Care
J Surg Orthop Adv. 2021 Summer;30(2):85-89.ABSTRACTWe sought to examine the relationship between opioid prescribing patterns and patient reported satisfaction with care. Opioid prescribing was characterized in terms of morphine equivalent daily dosing (MEDD), total morphine equivalent dosing (TMED), and total number of opioid prescriptions. A total of 1,666 opioid prescriptions were written for a TMED of 379,660 and a median MEDD of 204 (interquartile range [IQR] 195-269) from 2017-2019. Two hundred and forty-four patient satisfaction surveys were obtained for review and comparison. During the study period, 2,358 cases wer...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Maj Nathan S Lanham Cpt Kyle Bockelman Cpt Michael J Elsenbeck Ltc Brendan J McCriskin Maj P Scott H Robinson Maj James N Foster Maj Ret Jacob C L Rumley Source Type: research

The Impact of Certificate of Need Status on the Utilization and Reimbursement of Open and Endoscopic Carpal Tunnel Release
J Surg Orthop Adv. 2021 Summer;30(2):90-92.ABSTRACTA certificate of need (CON) permits a healthcare organization to build new facilities only if significant medical needs exist. Many states have implemented CON programs to prevent procedure overutilization and price inflation. We hypothesized that there are no differences in reimbursement or utilization for open and endoscopic carpal tunnel release (CTR) when comparing states with and without CON programs. We queried a private-payer database to identify open and endoscopic CTRs performed between 2007 and 2015. In total, 82,689 CTRs were identified: 70,160 open, 12,529 endo...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Sahitya K Denduluri Allison Roe Abiram Bala Nathaniel Fogel Chason Ziino Robin N Kamal Source Type: research

Orthopaedists Versus Radiologists: A Prospective Comparison of Radiographic Interpretation Between Orthopaedists and Radiologists at a Level I Trauma Center
J Surg Orthop Adv. 2021 Summer;30(2):93-95.ABSTRACTThe purpose of this investigation was to evaluate the difference in response time, accuracy of radiographic interpretation, and frequency of changes in clinical management necessary after inaccurate reads when comparing orthopaedic and radiology providers. Data including provider response time, accuracy of radiographic interpretation and the frequency of changes in clinical management necessary after imaging reads was collected over a continuous two-month period at a Level I Trauma center. A total of 188 orthopedic injuries involving imaging were included. Orthopedic provi...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Griffin Biedron Reuben Macias Isaac Fernandez Nicholas Kusnezov John C Dunn James H Nelson Source Type: research

Readability Level of English and Spanish Orthopaedic Patient Education Materials English and Spanish Patient Education
J Surg Orthop Adv. 2021 Summer;30(2):96-100.ABSTRACTThere are 16 million Hispanic people in the United States who rely on Spanish as their only effective method of communication. However, there is a scarcity of literature evaluating if patient education resources in Spanish meet the average American reading level or National Institute of Health (NIH) and American Medical Association (AMA) grade-level recommendations, especially in the field of orthopaedics. Representative orthopaedic search terms were input into Google and ten articles pertaining to patient education were selected. Videos, scientific journals, and surgical...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Michael J Patetta Kristina M Pond Elizabeth M Tennant Anshum Sood Mark H Gonzalez Source Type: research

Legislation Only Limiting Opioid Prescription Length Has Minimal Impact on Prescribing in Orthopaedic Trauma
This study evaluates the efficacy of North Carolina's Strengthen Opioid Misuse Prevention (STOP) Act in reducing the volume and rate of 90-day perioperative opioid prescribing to patients ages 18 and older after orthopaedic trauma surgery. Patients undergoing fracture surgery from January 2017 to June 2017 (pre-STOP) were compared with patients undergoing fracture surgery from January 2018 to June 2018 (post-STOP). Adjusted analyses demonstrated that patients undergoing surgery after the STOP Act (n = 730) were prescribed significantly lower volume of opioids in the discharge to 2-week time frame and at the first postopera...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Daniel J Cunningham Micaela L LaRose Isabel F DeLaura Gloria X Zhang Christopher S Klifto Mark J Gage Source Type: research

Visual Estimation of Length by Orthopaedic Surgeons: How Accurate Are Lengths Estimated in Digital Images Compared to In-Person Estimations?
J Surg Orthop Adv. 2021 Summer;30(2):108-111.ABSTRACTOrthopaedic surgeons are frequently required to make estimations, often without the use of measuring tools, including the lengths of wounds, incisions, bone fragments, and soft tissue defects. To evaluate the accuracy of these estimations, simulated wounds of randomized lengths were drawn on a healthy volunteer. Resident and attending physicians estimated the length of each wound via digital photograph and subsequently in person. Comparison of digital photograph versus in-person estimation was completed with paired t-test. The accuracy of estimation by experience level w...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: S Craig Morris Joshua N Speirs Christopher K Heinrich M Daniel Wongworawat Source Type: research

Bringing Physical Exam Skills Back from the Dead
J Surg Orthop Adv. 2021 Summer;30(2):112-115.ABSTRACTPhysical examination education begins early for medical learners. A hindrance to physical exam competency is lack of exposure to pathology in standardized patient settings. This research focuses on improving medical education through the utilization of cadavers that have undergone a soft-embalming technique: the Thiel method. Three scenarios were created in four Thiel cadavers: anterior cruciate ligament (ACL) tear, posterior cruciate ligament (PCL) tear, and sham incision. Students were asked to diagnose ACL tears using the Lachman exam. A total of 54 learners participa...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: James Ross Bailey David C Tapscott Norman Y Otsuka Kyle T Boden Robert M Becker Tom E Kwasigroch Brian D Johnston Source Type: research

Wartime Military Orthopaedics
J Surg Orthop Adv. 2021 Summer;30(2):116-119.ABSTRACTMilitary orthopaedic surgeons are faced with hardship and decreased morale. Surgeons have frequent deployments and practice inefficiencies resulting in poor retention rates. The purpose of this analysis is to report demographics and factors effecting military retention. A survey was sent to all members of the Society of Military Orthopedic Surgeons. The survey obtained demographic information, as well as factors affecting retention and termination of service. Data was compared between subset groups within the total respondent population. Of active-duty personnel, 38.5% p...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Michael D Eckhoff Richard L Purcell Justin D Orr Leon J Nesti Benjamin K Potter John C Dunn Source Type: research

Operative vs. Nonoperative Treatment of Isolated Humeral Shaft Fractures: A Prospective Cohort Study
J Surg Orthop Adv. 2021 Summer;30(2):67-72.ABSTRACTThe purpose was to compare plate and screw fixation (open reduction internal fixation [ORIF]) and functional bracing (FB) of isolated humeral shaft fractures with treatment and patient-based outcomes. We performed a prospective trial of ORIF v. FB at 12 centers. Surgeons counseled patients on treatment options and a patient centered decision was made. We enrolled 179 patients, of which 6-month data was analyzed for 102 (39 female; 63 male). Forty-five were treated with ORIF and 57 with FB. We found no difference in the disability of the arm, shoulder and hand (DASH) score,...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Lisa K Cannada Lauren Nelson Paul Tornetta Robert Hymes Clifford B Jones William Obremskey Eben Carroll Brian Mullis Michael Tucker David Teague Andrew Marcantonio Robert Ostrum Michael Del Core Heidi Israel Source Type: research

Is There a Critical Radiographic Angle That Portends Poor Functional Outcome Scores in Nonoperative Treatment of Isolated Humeral Shaft Fractures?
J Surg Orthop Adv. 2021 Summer;30(2):73-77.ABSTRACTOur purpose was to evaluate radiographic alignment of nonoperatively treated humerus fractures and determine if there is a critical angle associated with worse outcomes. All patients with humeral shaft fractures that were prospectively followed as part of a larger multicenter trial were reviewed. These patients were selected for nonoperative management based on shared decision making. There were 80 patients that healed with adequate data. The receiver operating characteristic (ROC) had best fit with a sagittal radiographic angle of 10° (AUC: 0.731) and coronal angle of...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Brian W Hill Lisa K Cannada Lauren Nelson Paul Tornetta Robert Hymes Clifford B Jones William Obremskey Eben Carroll Brian Mullis Michael Tucker David Teague Andrew Marcantonio Robert Ostrum Michael Del Core Heidi Israel Source Type: research

Anatomic Considerations Regarding the Placement of a Retrograde Intramedullary Fibular Screw
J Surg Orthop Adv. 2021 Summer;30(2):78-81.ABSTRACTThe purpose of this study was to identify the ideal start site for a retrograde intramedullary fibular cortical screw based on its relationship to the surrounding soft tissue structures and to assess for damage to the surrounding soft tissue structures caused during placement of the screw. Four fresh frozen cadavers underwent fluoroscopic placement of a 3.5 mm cortical screw utilizing a standardized protocol. No damage to the peroneal tendons were noted in any cadaver with the foot in an inverted and plantarflexed position. The closest structure to the center of the screw ...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Suman Medda Amy P Trammell Robert D Teasdall Source Type: research

No Increase in Instability with Obturator Externus Release in Direct Anterior Approach
J Surg Orthop Adv. 2021 Summer;30(2):82-84.ABSTRACTUse of the direct anterior approach in total hip arthroplasty is becoming increasingly common. Complications associated with this approach pertain to proximal femoral exposure. Selective capsular and tendinous releases improve exposure intraoperatively. Release of obturator externus has been avoided to prevent postoperative instability. A retrospective case-control review of consecutive patients who underwent direct anterior approach was performed. Demographic information, sequence of releases performed, dislocations that occurred postoperatively, and revision total hip ar...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Marc Hungerford Thomas Hendricks Philip Neubauer Ashlie Boner Source Type: research

Opioid Prescribing Patterns and Patient Satisfaction with Care
J Surg Orthop Adv. 2021 Summer;30(2):85-89.ABSTRACTWe sought to examine the relationship between opioid prescribing patterns and patient reported satisfaction with care. Opioid prescribing was characterized in terms of morphine equivalent daily dosing (MEDD), total morphine equivalent dosing (TMED), and total number of opioid prescriptions. A total of 1,666 opioid prescriptions were written for a TMED of 379,660 and a median MEDD of 204 (interquartile range [IQR] 195-269) from 2017-2019. Two hundred and forty-four patient satisfaction surveys were obtained for review and comparison. During the study period, 2,358 cases wer...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Maj Nathan S Lanham Cpt Kyle Bockelman Cpt Michael J Elsenbeck Ltc Brendan J McCriskin Maj P Scott H Robinson Maj James N Foster Maj Ret Jacob C L Rumley Source Type: research

The Impact of Certificate of Need Status on the Utilization and Reimbursement of Open and Endoscopic Carpal Tunnel Release
J Surg Orthop Adv. 2021 Summer;30(2):90-92.ABSTRACTA certificate of need (CON) permits a healthcare organization to build new facilities only if significant medical needs exist. Many states have implemented CON programs to prevent procedure overutilization and price inflation. We hypothesized that there are no differences in reimbursement or utilization for open and endoscopic carpal tunnel release (CTR) when comparing states with and without CON programs. We queried a private-payer database to identify open and endoscopic CTRs performed between 2007 and 2015. In total, 82,689 CTRs were identified: 70,160 open, 12,529 endo...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Sahitya K Denduluri Allison Roe Abiram Bala Nathaniel Fogel Chason Ziino Robin N Kamal Source Type: research

Orthopaedists Versus Radiologists: A Prospective Comparison of Radiographic Interpretation Between Orthopaedists and Radiologists at a Level I Trauma Center
J Surg Orthop Adv. 2021 Summer;30(2):93-95.ABSTRACTThe purpose of this investigation was to evaluate the difference in response time, accuracy of radiographic interpretation, and frequency of changes in clinical management necessary after inaccurate reads when comparing orthopaedic and radiology providers. Data including provider response time, accuracy of radiographic interpretation and the frequency of changes in clinical management necessary after imaging reads was collected over a continuous two-month period at a Level I Trauma center. A total of 188 orthopedic injuries involving imaging were included. Orthopedic provi...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Griffin Biedron Reuben Macias Isaac Fernandez Nicholas Kusnezov John C Dunn James H Nelson Source Type: research

Readability Level of English and Spanish Orthopaedic Patient Education Materials English and Spanish Patient Education
J Surg Orthop Adv. 2021 Summer;30(2):96-100.ABSTRACTThere are 16 million Hispanic people in the United States who rely on Spanish as their only effective method of communication. However, there is a scarcity of literature evaluating if patient education resources in Spanish meet the average American reading level or National Institute of Health (NIH) and American Medical Association (AMA) grade-level recommendations, especially in the field of orthopaedics. Representative orthopaedic search terms were input into Google and ten articles pertaining to patient education were selected. Videos, scientific journals, and surgical...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Michael J Patetta Kristina M Pond Elizabeth M Tennant Anshum Sood Mark H Gonzalez Source Type: research

Legislation Only Limiting Opioid Prescription Length Has Minimal Impact on Prescribing in Orthopaedic Trauma
This study evaluates the efficacy of North Carolina's Strengthen Opioid Misuse Prevention (STOP) Act in reducing the volume and rate of 90-day perioperative opioid prescribing to patients ages 18 and older after orthopaedic trauma surgery. Patients undergoing fracture surgery from January 2017 to June 2017 (pre-STOP) were compared with patients undergoing fracture surgery from January 2018 to June 2018 (post-STOP). Adjusted analyses demonstrated that patients undergoing surgery after the STOP Act (n = 730) were prescribed significantly lower volume of opioids in the discharge to 2-week time frame and at the first postopera...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Daniel J Cunningham Micaela L LaRose Isabel F DeLaura Gloria X Zhang Christopher S Klifto Mark J Gage Source Type: research

Visual Estimation of Length by Orthopaedic Surgeons: How Accurate Are Lengths Estimated in Digital Images Compared to In-Person Estimations?
J Surg Orthop Adv. 2021 Summer;30(2):108-111.ABSTRACTOrthopaedic surgeons are frequently required to make estimations, often without the use of measuring tools, including the lengths of wounds, incisions, bone fragments, and soft tissue defects. To evaluate the accuracy of these estimations, simulated wounds of randomized lengths were drawn on a healthy volunteer. Resident and attending physicians estimated the length of each wound via digital photograph and subsequently in person. Comparison of digital photograph versus in-person estimation was completed with paired t-test. The accuracy of estimation by experience level w...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: S Craig Morris Joshua N Speirs Christopher K Heinrich M Daniel Wongworawat Source Type: research

Bringing Physical Exam Skills Back from the Dead
J Surg Orthop Adv. 2021 Summer;30(2):112-115.ABSTRACTPhysical examination education begins early for medical learners. A hindrance to physical exam competency is lack of exposure to pathology in standardized patient settings. This research focuses on improving medical education through the utilization of cadavers that have undergone a soft-embalming technique: the Thiel method. Three scenarios were created in four Thiel cadavers: anterior cruciate ligament (ACL) tear, posterior cruciate ligament (PCL) tear, and sham incision. Students were asked to diagnose ACL tears using the Lachman exam. A total of 54 learners participa...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: James Ross Bailey David C Tapscott Norman Y Otsuka Kyle T Boden Robert M Becker Tom E Kwasigroch Brian D Johnston Source Type: research

Wartime Military Orthopaedics
J Surg Orthop Adv. 2021 Summer;30(2):116-119.ABSTRACTMilitary orthopaedic surgeons are faced with hardship and decreased morale. Surgeons have frequent deployments and practice inefficiencies resulting in poor retention rates. The purpose of this analysis is to report demographics and factors effecting military retention. A survey was sent to all members of the Society of Military Orthopedic Surgeons. The survey obtained demographic information, as well as factors affecting retention and termination of service. Data was compared between subset groups within the total respondent population. Of active-duty personnel, 38.5% p...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Michael D Eckhoff Richard L Purcell Justin D Orr Leon J Nesti Benjamin K Potter John C Dunn Source Type: research

Operative vs. Nonoperative Treatment of Isolated Humeral Shaft Fractures: A Prospective Cohort Study
J Surg Orthop Adv. 2021 Summer;30(2):67-72.ABSTRACTThe purpose was to compare plate and screw fixation (open reduction internal fixation [ORIF]) and functional bracing (FB) of isolated humeral shaft fractures with treatment and patient-based outcomes. We performed a prospective trial of ORIF v. FB at 12 centers. Surgeons counseled patients on treatment options and a patient centered decision was made. We enrolled 179 patients, of which 6-month data was analyzed for 102 (39 female; 63 male). Forty-five were treated with ORIF and 57 with FB. We found no difference in the disability of the arm, shoulder and hand (DASH) score,...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Lisa K Cannada Lauren Nelson Paul Tornetta Robert Hymes Clifford B Jones William Obremskey Eben Carroll Brian Mullis Michael Tucker David Teague Andrew Marcantonio Robert Ostrum Michael Del Core Heidi Israel Source Type: research

Is There a Critical Radiographic Angle That Portends Poor Functional Outcome Scores in Nonoperative Treatment of Isolated Humeral Shaft Fractures?
J Surg Orthop Adv. 2021 Summer;30(2):73-77.ABSTRACTOur purpose was to evaluate radiographic alignment of nonoperatively treated humerus fractures and determine if there is a critical angle associated with worse outcomes. All patients with humeral shaft fractures that were prospectively followed as part of a larger multicenter trial were reviewed. These patients were selected for nonoperative management based on shared decision making. There were 80 patients that healed with adequate data. The receiver operating characteristic (ROC) had best fit with a sagittal radiographic angle of 10° (AUC: 0.731) and coronal angle of...
Source: Journal of surgical orthopaedic advances - June 28, 2021 Category: Orthopaedics Authors: Brian W Hill Lisa K Cannada Lauren Nelson Paul Tornetta Robert Hymes Clifford B Jones William Obremskey Eben Carroll Brian Mullis Michael Tucker David Teague Andrew Marcantonio Robert Ostrum Michael Del Core Heidi Israel Source Type: research