Accuracy and Interobserver and Intraobserver Reliability of Ultrasound in the Early Diagnosis of Occult Scaphoid Fractures: Diagnostic Criteria and a Way of Interpretation.
Authors: Malahias MA, Nikolaou VS, Chytas D, Kaseta MK, Babis GC Abstract The purpose of this study was to illustrate the usefulness of ultrasound in the early diagnosis of occult scaphoid fractures. Forty-eight patients with clinical symptoms of scaphoid fracture and negative initial X-rays were examined. All patients underwent ultrasonography in the emergency room (ER). After 14 days, a computed tomography (CT) scan was performed, which confirmed or not the initial suspicion of fracture. Twenty-two patients were found with subperiosteal hematoma, while six also had cortical discontinuity. The sensitivity of ultra...
Source: Journal of surgical orthopaedic advances - May 12, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Trends and Characteristics of Highly Cited Articles in Shoulder Arthroplasty.
This study sought to analyze highly cited shoulder arthroplasty articles and determine the best measure to assess their impact. Scopus identified the 50 most cited articles, and each was analyzed for citation number, authors, institution, country of origin, and journal of publication. SPSS 23 was used for descriptive statistics, and a Pearson correlation coefficient assessed the relationship between citation measures. The results revealed an average citation count of 259 ± 108 and a citation density (citation count/years since publication) of 18 ± 10 annually. Most articles originated in the United States (31...
Source: Journal of surgical orthopaedic advances - May 12, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Comparison of Scapular Mechanics After Activity With and Without a Targeted Compression Garment.
This study evaluated the ability of a compression shirt to maintain scapular alignment after fatiguing of periscapular musculature. Subjects' scapular movements were monitored before and after a periscapular muscle- fatiguing exercise program. In the anterior and posterior tilt and medial and lateral rotation dimensions, control and shirt subjects both exhibited differences between the prefatigue and postfatigue measurements throughout humeral elevation. In the retraction and protraction dimension, control subjects exhibited differences between prefatigue and postfatigue measurements for a large portion of elevation, while...
Source: Journal of surgical orthopaedic advances - May 12, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

High-Energy Midfoot Fracture-Dislocations: Staged Treatment With an External Fixator.
Authors: Arvesen JE, Burnett Z, Israel H, Watson JT, Cannada LK Abstract The purpose of this study was to analyze the clinical outcomes of patients treated for high-energy midfoot (Lisfranc) injuries with initial temporization of an external fixator before definitive fixation. A retrospective chart review at two level 1 trauma centers was completed. Clinical parameters including demographics and comorbidities were evaluated in addition to hospital and clinical data. Time to full weight bearing took an average of 4.4 months, and with the numbers available no significant difference (p
Source: Journal of surgical orthopaedic advances - May 12, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Survival of a Second-Generation Porous Plasma-Sprayed Acetabular Component at Minimum 15-Year Follow-up.
This study assessed the 15-year minimum outcomes of the RingLoc cup (Zimmer Biomet, Warsaw, Indiana), a second-generation cementless porous plasma-coated acetabular component. The study identified 2438 patients (2905 hips) who underwent total hip arthroplasty using the RingLoc acetabular component between 1992 and 2000. Fifteen-year minimum follow-up data were available on 431 consented patients (511 hips). Clinical outcomes included the Harris hip score. Follow-up radiographs, complications, and revisions were reviewed. Mean follow-up was 18.2 years (range, 15-24.7). Harris hip scores improved from 46.9 preoperatively to ...
Source: Journal of surgical orthopaedic advances - May 12, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Misdiagnosis and Radial Tunnel Syndrome: Considering the Distal Biceps Tendon.
This study is a 13-patient case series. The included patients presented with proximal forearm pain and positive provocative maneuvers for RTS. All included patients were found to have distal biceps pathology on MRI evaluation. At final follow-up (average 6.9 years), all patients had resolution of symptoms with therapy aimed specifically at addressing the distal biceps tendon. A diagnosis of insertional biceps tendonitis could explain both the typical success with conservative treatment and the poor results from surgical intervention for RTS. (Journal of Surgical Orthopaedic Advances 28(1):35-40, 2019). PMID: 31074735 [...
Source: Journal of surgical orthopaedic advances - May 12, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Shoulder Arthroplasty in Transplant Recipients: Complications and Mortality.
Authors: Strotman PK, Kothari A, Kuo P, Salazar DH, Garbis N Abstract Given the increase in the incidence and survivability of those with solid organ transplantations in the United States, the purpose of this study was to identify inpatient, 30-day, and 90-day outcomes following primary shoulder arthroplasty in transplant recipients. The Healthcare Cost and Utilization Project State Inpatient Databases identified patients who underwent shoulder arthroplasty after solid organ transplantation between January 2007 and December 2013. International Classification of Diseases, Ninth Revision, codes were used to define th...
Source: Journal of surgical orthopaedic advances - May 12, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Influence of Patient Activation, Pain Self-Efficacy, and Resilience on Pain Intensity and Magnitude of Limitations in Patients With Hip and Knee Arthritis.
This study prospectively enrolled 108 patients with hip or knee OA who were seeing an orthopedic surgeon before or after arthroplasty. Measures of coping strategies included the Patient Activation Measure (PAM), Pain Self-Efficacy Questionnaire (PSEQ-2), and the Brief Resilience Scale (BRS). The Hip Disability and Osteoarthritis Outcome Score, Junior (HOOS, JR), the Knee Injury and Osteoarthritis Outcome Score, Junior (KOOS, JR), and Numeric Rating Scale (NRS) were used to measure pain intensity. Pearson correlations measured the interrelationships of the outcome measures. The PSEQ-2 correlated significantly with the NRS, ...
Source: Journal of surgical orthopaedic advances - May 12, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Orthopaedic and Plastic Surgery Training Differences Manifested in the Analysis of Distal Radius Fracture Fixation.
Authors: Koehler LR, Kusnezov NA, Orr JD, Pallis M, Dunn JC Abstract All patients undergoing open reduction and internal fixation of a distal radius fracture (DRF) between the years 2010 and 2015 were isolated from the National Surgical Quality Improvement Program database. Patient demographics, respective surgical volume, outcome variables, and complications were extracted. The primary outcomes were surgical time, hospital length of stay, and unplanned reoperation. A total of 6691 patients were included in the study, the majority of whom were treated by orthopaedic surgeons. While there were no significant differe...
Source: Journal of surgical orthopaedic advances - May 12, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Multimodal Pain Management of Femoral Neck Fractures Treated With Hemiarthroplasty.
Authors: Hutchinson HL, Jaekel DJ, Lovald ST, Watson HN, Ong KL Abstract The purpose of this study was to evaluate a multimodal pain management program incorporating periarticular injections of liposomal bupivacaine after hemiarthroplasty treatment of femoral neck fractures. This retrospective study selected patients treated with periarticular injections of liposomal bupivacaine within the multimodal pain management program (LBUP) (n = 100) and a control group of patients treated without local infiltration (n = 78). Similar pain control was achieved between both groups from day 1 to day 4 postsurgery (min p = .392)...
Source: Journal of surgical orthopaedic advances - May 12, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Role of First Metacarpal Osteotomy in the Management of Basilar Thumb Arthritis.
This study reviews outcomes of patients undergoing Wilson extension osteotomy of the first metacarpal for treatment of carpometacarpal (CMC) joint pain and deformity. The study reviews varied indications for Wilson osteotomy outlining technique and functional outcomes. Twelve patients (11 female, 1 male) with an average age at surgery of 50 (range, 25-67) underwent osteotomy during the study period. Diagnoses included seven patients with early degenerative changes of the CMC joint with painful subluxation or instability. The remaining patients had symptomatic adduction contracture in either end-stage arthritis (three) or f...
Source: Journal of surgical orthopaedic advances - May 12, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

New Failure Mechanism of Acetabular Constrained Liner: A Case Report.
Authors: Wilkinson J, Edwards PK, Levine M, Barnes CL Abstract Implant dislocation following total hip arthroplasty, particularly revision arthroplasty, remains a common postoperative complication. Constrained acetabular liners provide surgeons with an implant option that provides resistance to dislocation forces. These added forces, however, are transmitted to the implant materials and to the bone\endash implant interface, resulting in unique failure mechanisms. This case report presents two cases highlighting a previously unreported mechanism of failure of the Depuy Pinnacle ES constrained liner encountered durin...
Source: Journal of surgical orthopaedic advances - May 12, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

A Modified "One-Stitch" Hamstring Tendon Suture Fixation Technique for Anterior Cruciate Ligament Graft Preparation.
This article introduces a new technique involving a modified "one-stitch" hamstring tendon suture fixation technique. (Journal of Surgical Orthopaedic Advances 28(1):74-76, 2019). PMID: 31074742 [PubMed - in process] (Source: Journal of surgical orthopaedic advances)
Source: Journal of surgical orthopaedic advances - May 12, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Posterior Fibula of Pes Cavus: Real or Artifact? Answer Based on Cross-Sectional Imaging.
This study shows that the cavus fibula is truly more posterior in patients with high arches. (Journal of Surgical Orthopaedic Advances 27(4):255-260, 2018). PMID: 30777822 [PubMed - in process] (Source: Journal of surgical orthopaedic advances)
Source: Journal of surgical orthopaedic advances - February 21, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Ascorbic Acid and Its Clinical Role in Orthopaedic Surgery.
Authors: Luo TD, Marois AJ, Smith TL, Willey JS, Emory CL Abstract Ascorbic acid (vitamin C) is an essential micronutrient with evidence supporting its role in bone formation, tissue repair, and collagen production. Its clinical importance to the field of orthopaedic surgery has yet to be fully defined. Several observational studies have shown improved bone density and reduced hip fracture risk with supplementation. Its effect on bone fracture and soft tissue injury has been promising in animal models, but is not adequately studied in human trials. Results have been mixed concerning its role in chondroprotection an...
Source: Journal of surgical orthopaedic advances - February 21, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Opioid Prescribing in the Pediatric Orthopaedic Trauma Population.
Authors: Simril RT, Scannell BP, Wally MK, LeFlore MH, Seymour RB, Hsu JR, Beuhler M, Bosse MJ, Gerkin E, Gibbs M, Griggs C, Jarrett S, Leas D, Runyon M, Saha A, Schiro S, Watling B, Wyatt S Abstract The purpose of this article is to describe opioid prescribing patterns for children with orthopaedic injuries. A retrospective chart review was conducted on pediatric orthopaedic trauma patients (n = 124) who were discharged from the hospital or emergency department or had a clinic visit during a 1-month period. Patient demographics, prescription specifics, injury details, and fracture fixation information were collect...
Source: Journal of surgical orthopaedic advances - February 21, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Comparison of Hand Drills for the Insertion of Skeletal Traction Pins.
Authors: Roth CA, Turkula S, Fuller DA, Graf KW Abstract Skeletal traction pins are inserted as part of emergent stabilization of lower extremity fractures. The purpose of this study is to compare two drill options: a reusable store-bought drill and a single-use, sterilely packaged drill. The reusable drill and disposable drill were compared by having volunteers insert traction pins within a foam bone, fully encased, knee joint model using both systems. The two drill types were evaluated on three measures: user satisfaction, time required for insertion of the pins, and cost. The disposable drill received a statisti...
Source: Journal of surgical orthopaedic advances - February 21, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Impact of Fluoroscopically Guided Bone Biopsy on Antibiotic Management of Osteomyelitis in the Lower Extremity.
This study evaluated the impact of fluoroscopically guided percutaneous bone biopsy on altering antibiotic regimens in lower extremity osteomyelitis. Eighty-eight patients who received fluoroscopically guided bone biopsies were identified. There was bacterial growth in 28% of bone biopsies overall. The rate of positive culture was decreased in patients started on empiric antibiotics before biopsy (23%) compare with patients without empiric antibiotics (44%). Antibiotic regimens were changed in 24% of patients overall in response to culture data. The majority of positive biopsy cultures (76%) but minority of negative biopsy...
Source: Journal of surgical orthopaedic advances - February 21, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Comparison of Microbial Count on Various Surfaces in Operating Rooms at Different Times of the Day.
Authors: Petersen-Fitts G, Gambone A, Sherwood A, Whaley J, Katz DL, Lima DJL, Sabesan V Abstract The purpose of this study was to determine the degree of microbial contamination of surfaces in the operating room (OR) and to understand the relationship between time and location of contamination. Five OR surfaces were sampled at two time points on three consecutive Mondays and Thursdays. Each sample was cultured on a blood agar plate and introduced to a liquid nutrient broth. The most sterile surface was the OR lights with only one positive growth sample at each time. At both times, the most commonly contaminated su...
Source: Journal of surgical orthopaedic advances - February 21, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Excess Readmission-Based Penalty: Is Arthroplasty Different From the Other Outcomes?
This study aimed to evaluate the potential effects of poverty, race, and hospital volume on excess readmissions, with>3000 hospitals participating in "Hospital Compare." Correlations between excess readmission ratios for five eligible outcomes (including hip and knee arthroplasty) were assessed with the three area and hospital-level factors: poverty, race (percent of black population), and hospital volume (number of discharges). Correlation coefficients of the ratios with race were approximately r = 0.2, consistently larger than those with poverty (r = 0-0.1), and those with volume were r = 0 to -0.5. Hip and ...
Source: Journal of surgical orthopaedic advances - February 21, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Insulin-Dependent Diabetes Is an Independent Risk Factor for Complications and Readmissions After Total Joint Replacements.
This study examined the risk for postoperative complications, reoperations, and readmissions for patients with insulin-dependent diabetes mellitus (IDDM), patients with non-insulin-dependent diabetes mellitus (NIDDM), and patients without diabetes undergoing total joint replacements (TJRs). The American College of Surgeons National Surgical Quality Improvement Program database was queried for all primary TJRs in 2015. The study identified 78,744 TJRs (84.1% nondiabetic patients, 12.0% NIDDM, and 3.9% IDDM). Multiple logistic regression models identified IDDM as an independent risk factor for increased blood loss, myocardia...
Source: Journal of surgical orthopaedic advances - February 21, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Treatment of Pediatric Osteoid Osteomas Not Amenable to Radiofrequency Ablation: A Retrospective Review of Surgical Outcomes.
Authors: Sanders T, Wenger DE, Ashraf A, McIntosh AL, Stans AA, Shaughnessy WJ, van Wijnen AJ, Larson AN Abstract The purpose of this study is to describe the surgical treatment of osteoid osteomas in a pediatric cohort of patients who were found not to be candidates for percutaneous ablative therapies. Medical records for 29 pediatric patients who were treated surgically for osteoid osteomas were reviewed. Reasons for surgical management included diagnostic uncertainty or lesions that were in close proximity to an articular surface or neurovascular structure. Twenty-eight patients experienced complete symptom reso...
Source: Journal of surgical orthopaedic advances - February 21, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Does Traction Decrease the Need for Open Reduction in Femoral Shaft Fractures Treated Within 24 Hours?
This study evaluates whether preoperative skeletal traction reduces the need for open reduction in femoral shaft fractures treated with intramedullary nailing (IMN) within 24 hours. A retrospective review was conducted of femoral shaft fractures undergoing IMN within 1 day of admission. Primary outcome was an open reduction at the time of IMN. Secondary outcomes were blood loss and transfusion requirements. One hundred eighty-four patients were analyzed, 106 in the knee immobilizer group and 78 in the skeletal traction group. Skeletal traction did not reduce the need for an open reduction. The knee immobilizer group requir...
Source: Journal of surgical orthopaedic advances - February 21, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

What Factors Influence Compliance With Sequential Compression Devices in an Orthopaedic Unit: A Quality Assurance Observational Study.
Authors: Baldwin AL, McMahon SJ, Mesfin A Abstract The purpose of this study was to determine the compliance rate with sequential suppression devices (SCDs) of patients admitted to an orthopaedic unit of a level I trauma center. A quality assurance observational study was conducted over a 4-week period (June/July 2015). Three observations were performed per 24-hour period (0700, 1300, 1900 hours). ``Full SCD compliance'' was defined as the SCD ordered, on and functioning properly at the time of observation. Of the 1356 observations in 109 patients, 434 (32%) were fully compliant with SCD prophylaxis. SCD compliance...
Source: Journal of surgical orthopaedic advances - February 21, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Return to Duty in Military Members Following Surgical Treatment of Incomplete Femoral Neck Fractures.
Authors: Griffis CE, Rocchi V, Cochran G, Kuhn KM Abstract The purpose of this study was to determine whether active duty military members treated surgically for incomplete femoral neck stress fractures (FNSFs) return to duty. A retrospective review of 53 patients was evaluated to determine the rate of return to duty (RTD) related to sex, branch of service, side of fracture, and signs of femoroacetabular impingement (FAI). Signs of FAI were measured and compared to RTD. Sixty-seven percent of the sample population did not return to duty. Eighty-three percent of Marine Corps members did not return to duty and 18% of...
Source: Journal of surgical orthopaedic advances - February 21, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Patient Attitudes Toward Local Anesthesia With or Without Sedation for Minor Hand Procedures.
Authors: Bowman SH, Horst TA, Kokko KP, Barfield W, Angermeier E Abstract The purpose of this study was to assess patient preferences in this population with respect to anesthesia for minor hand procedures. This prospective cohort study assessed 183 patients undergoing minor hand surgery to determine their preferences for local-only anesthesia with or without sedation and the reasons for their choices. Fifty-six percent of patients preferred local anesthesia with sedation, 43% preferred local-only anesthesia, and 2% had no preference. Caucasian patients were 2.7 times more likely to choose local-only anesthesia. Ot...
Source: Journal of surgical orthopaedic advances - February 21, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Effect of Facility on Operative Costs of Total Ankle Arthroplasties.
This study supports the use of ASC facilities to achieve efficient resource use in the operative treatment of~total ankle arthroplasties (Journal of Surgical Orthopaedic Advances 27(4):321-324, 2018). PMID: 30777835 [PubMed - in process] (Source: Journal of surgical orthopaedic advances)
Source: Journal of surgical orthopaedic advances - February 21, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Location of the Popliteal Artery in Knee Extension on Magnetic Resonance Imaging.
Authors: Simons M, Schraut N, Moretti V, Klazura G, Chuang D, Parekh A, Gonzalez M Abstract The goal of this study was to define the course of the popliteal artery (PA) and determine any variability among different patient demographics; by identifying risk factors for injury, surgeons can decrease patient morbidity and mortality. Ninety-four adult magnetic resonance imaging studies of the knee were reviewed. In extension, the artery is at most 7.87 mm posterior and 4.83 mm lateral to the midline below the tibial plateau. Proximally, the artery is more anterior and midline. With increasing body mass indexes, the art...
Source: Journal of surgical orthopaedic advances - February 21, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Distal Femoral Flexion Closing Wedge Osteotomy for Treatment of Failed Chronic Distal Femoral Extension Osteotomy in a Patient With Poliomyelitis.
This report describes the successful use of a posterior closing wedge flexion osteotomy with plate fixation to correct a hyperextension deformity caused by a failed or overcorrected extension osteotomy in a 40-year-old man. In this patient, this flexion osteotomy led to complete deformity correction, resolution of symptoms, functional improvement, and return to work without restrictions. (Journal of Surgical Orthopaedic Advances 27(4):329-334, 2018). PMID: 30777837 [PubMed - in process] (Source: Journal of surgical orthopaedic advances)
Source: Journal of surgical orthopaedic advances - February 21, 2019 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Evaluation of Biofilms on Explanted Shoulder Prostheses Using Functional Biofilm Assay and Scanning Electron Microscopy.
This study evaluates shoulder prostheses for infection using sonication and a functional biofilm assay. Nineteen patients undergoing revision shoulder arthroplasty were followed prospectively. Periprosthetic tissue and prosthetic components were obtained during the revision and evaluated with a functional biofilm assay. Results were compared with conventional cultures and laboratory results. Hardware samples were analyzed with scanning electron microscopy. Six of the 19 cases demonstrated growth on the biofilm assay. Three of these had positive conventional culture results and met Musculoskeletal Infection Society (MSIS) c...
Source: Journal of surgical orthopaedic advances - November 30, 2018 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Beyond Mirels: Factors Influencing Surgical Outcome of Metastasis to the Extremities in the Modern Era.
This study sought to identify additional variables associated with surgical failure, radiographic disease progression, and patient survival. A retrospective review was performed of patients from January 2004 to 2014 who underwent surgical treatment of skeletal metastases of the extremities, were>18 years of age, and had adequate radiographic surveillance. Eighty-nine metastatic bone lesions in 77 patients were included. Mirels score>8 (p = .015) and tumor origin (p = .008) were associated with surgical failure, which was 16.8%. Male gender (p
Source: Journal of surgical orthopaedic advances - November 30, 2018 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Player Performance After Returning From a Concussion in the National Football League: A Pilot Study.
This study aimed to determine if gameplay performance in the National Football League (NFL) is adversely affected after returning to play from a sport-related concussion (SRC). Players who sustained a SRC between the 2007-2008 and 2013-2014 seasons were identified. Concussed players were matched to nonconcussed control players in a 2:1 (control-case) fashion by position, season, experience, age, body mass index, and time missed. Gameplay statistics were recorded for the three games before and after returning from SRC. When compared with the control group, the majority of NFL players did not demonstrate any performance-base...
Source: Journal of surgical orthopaedic advances - November 30, 2018 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Are Cardiac Complications Associated With Other Adverse Events? A Look at 56,000 Orthopaedic Trauma Patients.
Authors: Yarlagadda M, Shen M, Abraham A, Mousavi I, Sethi MK Abstract The purpose of this study was to identify those complications for which patients with adverse cardiac events are at risk within the 30-day postoperative period following treatment oforthopaedic trauma cases. This was a retrospective cohort study of orthopaedic trauma patients in the United States between 2006 and 2013. A total of 56,336 patients meeting any one of 89 CPT codes in the American College of Surgeons National Surgical Quality Improvement Program database were used. The main outcome measure was myocardial infarction or cardiac arrest ...
Source: Journal of surgical orthopaedic advances - November 30, 2018 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Management of Femoral Defects Greater Than 5 cm Following Open Femur Fractures: A 12-Year Retrospective Review.
This study sought to evaluate the outcomes of patients with osseous defects exceeding 5 cm following open femur fractures. Size of the osseous defect, method of internal fixation (plate vs. intramedullary nail), patient demographics, medical comorbidities, and surgical complications were collected. Twenty-seven of the 832 open femur fracture patients had osseous defects exceeding 5 cm. Mean osseous defect size was 8 cm, and each patient had an average of four operations including initial debridement. Average time from injury to bone grafting was 123.7 days. The overall complication rate was 48.1% (n = 13). The most common ...
Source: Journal of surgical orthopaedic advances - November 30, 2018 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Multilevel Lumbar Fusion Is a Risk Factor for Lower Return to Work Rates Among Workers' Compensation Subjects With Degenerative Disc Disease.
This study sought to determine the impact of fused levels on return to work (RTW) status in a workers' compensation (WC) setting. Nine hundred thirty-seven subjects were selected for study. The primary outcome was the ability to RTW within 2 years following fusion and to sustain this level for greater than 6 months. Many secondary outcomes were collected. A multivariate logistic regression model was used to determine the impact of multilevel fusion on RTW status. Of the multilevel fusion group, 21.7% met the RTW criteria versus 28.1% of the single-level fusion group (p
Source: Journal of surgical orthopaedic advances - November 30, 2018 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Influence of Level 1 Evidence on Management of Clavicle and Distal Humerus Fractures: A Nationwide Comparative Study of Records From 2005 to 2014.
Authors: Kurowicki J, Triplet JJ, Rosas S, Yee Law T, Niedzielak T, Momoh E, Levy JC Abstract The purpose of this study was to examine alterations in national trends managing midshaft clavicle fractures (MCF) and intra-articular distal humerus fractures (DHF) surrounding recent level 1 publications. A retrospective review of the PearlDiver supercomputer for DHF and MCF was performed. Using age limits defined in the original level 1 studies, total use and annual use rates were examined. Nonoperative management and open reduction and internal fixation (ORIF) were reviewed for MCF. ORIF and total elbow arthroplasty (T...
Source: Journal of surgical orthopaedic advances - November 30, 2018 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Early-Stage Chronic Kidney Disease and Hip Fracture Mortality.
This study followed overall patient mortality at 90 days and at 1 year postoperatively. Patients with CKD had higher mortality at both 90 days and 1 year compared with those without CKD (hazard ratio 1.69 and 1.84, respectively). In a subgroup analysis to determine the effect of CKD stage, only stage 3 CKD was associated with increased mortality. The orthopaedic surgeon can play a key role in identifying at-risk patients and help to facilitate additional management. (Journal of Surgical Orthopaedic Advances 27(3):226-230, 2018). PMID: 30489248 [PubMed - in process] (Source: Journal of surgical orthopaedic advances)
Source: Journal of surgical orthopaedic advances - November 30, 2018 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Opioid Prescriptions After Total Joint Arthroplasty.
This study retrospectively reviewed a consecutive series of 1000 TJAs from April 2014 through September 2015. Postoperative opioid prescriptions were quantified using standardized morphine milligram equivalents (MME). Eighty-four percent of total knee arthroplasty (TKA) and 77% of total hip arthroplasty (THA) patients were opioid naïve. The median opioid volume of the first prescription for those undergoing TKA was greater than for those undergoing THA (600 vs. 450 MME), as was the proportion of individuals requiring one or more refills (48% vs. 32%). The total volume of opioids after TKA was also higher than for tota...
Source: Journal of surgical orthopaedic advances - November 30, 2018 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Remodeling of the Calcaneocuboid Joint in the Acquired Flatfoot.
Authors: Manoli A Abstract There has been debate recently as to whether the lateral column is actually short in the acquired flatfoot. Doubters argue that it is not possible for the lateral column to change in length and actually shorten, especially in the acquired type. In this series of 21 consecutive patients operated on for an acquired flatfoot, the calcaneocuboid joint (CC) had remodeled in all, resulting in the calcaneal side being short, facing laterally and dorsally. These findings give evidence to the rationale for performing a lateral column lengthening (LCL) proximal to the CC joint to treat the acquired...
Source: Journal of surgical orthopaedic advances - November 30, 2018 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

The "Well-Cap" Technique: Screw Insertion for Pelvic Nutrient Foramen Hemostasis.
The "Well-Cap" Technique: Screw Insertion for Pelvic Nutrient Foramen Hemostasis. J Surg Orthop Adv. 2018;27(3):246-250 Authors: Southam BR, Avilucea FR, Schroeder AJ, Finnan RP, Archdeacon MT Abstract Several approaches to the pelvis and acetabulum involve subperiosteal dissection of the iliacus from the internal iliac fossa.Typically bleeding is encountered from the nutrient foramen located near the sacroiliac joint. Bone wax and electrocautery have traditionally been used to achieve hemostasis from this foramen but produce inconsistent results.The authors of this technical tip describe a n...
Source: Journal of surgical orthopaedic advances - November 30, 2018 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Use of 360 ° Feedback to Develop Physician Leaders in Orthopaedic Surgery.
Use of 360° Feedback to Develop Physician Leaders in Orthopaedic Surgery. J Surg Orthop Adv. 2018;27(2):85-91 Authors: Gregory PJ, Ring D, Rubash H, Harmon L Abstract Twelve service chiefs participated in 360° feedback surveys and coaching as part of a departmental leadership development activity. Changes in the means of both composite survey scores and individual behavioral item scores over time were evaluated with paired t tests. Agreement between self-rating and rating of others was evaluated with unpaired t tests. There was a nonsignificant change in overall behavioral performance (composit...
Source: Journal of surgical orthopaedic advances - August 8, 2018 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Analysis of References Used in Orthopaedic Self-Assessment Exams.
This study aims to identify the most impactful resources for preparation for and maintenance of board certification. Questions included in the Orthopaedic Self-Assessment Exams (SAEs) from 2009 to 2014 were examined with the type and age of reference materials cited for each question. There were 4479 total citations. There were 289 journals and 95 textbooks identified. The Journal of Bone and Joint Surgery (15% of citations), Journal of the American Academy of Orthopaedic Surgeons (11%), and Clinical Orthopaedic and Related Research (6%) were the most frequently cited journals. The average age of cited articles was 8.2 yea...
Source: Journal of surgical orthopaedic advances - August 8, 2018 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Interest in Orthopedic Surgery Residency: A Google Trends Analysis.
Authors: Ikpeze TC, Mesfin A Abstract Google Trends, a powerful online search tool, was used to evaluate the association between the United States applicant pool for orthopedic surgery residency and Internet queries for orthopedic residency and orthopedic salary. From 2006 to 2015, searches for orthopedic salary and orthopedic residency were conducted by Google Trends. Data from the National Residency Match Program (NRMP) in the same time period was plotted and subsequently compared to the Google Trends results. From 2006 to 2015, Google Trends demonstrated an increase in orthopedic residency queries with the large...
Source: Journal of surgical orthopaedic advances - August 8, 2018 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Marginal Skin Flap Advancement: A Technique to Optimize the Skin Graft Interface Following Tumor Resections.
Authors: Chen WA, Ward WG Abstract Split-thickness skin graft (STSG) for soft tissue defects is often required following tumor resections. There is often a step-off with subcutaneous adipose tissue along the defect margins. This review of 20 years of experience was performed to determine the success of marginal skin flap advancement, a simple surgical technique addressing this issue. Seventy-one cases were identified that underwent sarcoma resection and this technique. Marginal skin flap advancement decreased the defect size from 217 š 162 cm2 to 128 š 101 cm2 (p
Source: Journal of surgical orthopaedic advances - August 8, 2018 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

How Often Are Protocols Followed at Level I Trauma Centers?
This study analyzes adherence to an evidence-based protocol established at two level I trauma centers to determine its effect on clinical decision making. The centers' trauma databases were retrospectively studied and 51 patients with long bone fractures were identified who required revascularization and orthopaedic intervention and survived long enough to receive an index intervention. An arterial shunt was the protocol's first step; the preprotocol rate of shunting was 9.5%, while the postprotocol rate of shunting was 3.3%. The protocol's next step was external fixation; among the cases managed without a shunt, external ...
Source: Journal of surgical orthopaedic advances - August 8, 2018 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Predictors of Acute Complications Following Traumatic Upper Extremity Amputation.
This study sought to identify acute complications following major UEAs by the 2009-2012 National Trauma Databank to extract demographics, comorbidities, concomitant injuries, and surgical characteristics for major traumatic UEA patients. Multivariate analyses identified significant predictors of mortality and major systemic complications. Major traumatic upper extremity amputations were identified in 1190 patients. Major systemic complications occurred in 13% of patients and most often involved pulmonary (7.4%) or renal (4.7%) systems. Overall in-hospital mortality rate was 11%. Male sex, prehospital systolic blood pressur...
Source: Journal of surgical orthopaedic advances - August 8, 2018 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Hip and Knee Arthroplasty Outcomes After Abdominal Organ Transplantation.
Authors: Duplantier NL, Rivere AE, Cohen AJ, Chimento GF Abstract This case control study retrospectively compares patients who underwent solid organ transplantation and total joint replacement with a control group that only underwent joint replacement. The study compares 42 transplant patients who underwent liver or kidney transplantation and total hip arthroplasty (THA) or total knee arthroplasty (TKA) to a matched group of 42 nontransplant patients who underwent only THA or TKA. The transplant cohort had significantly more complications (18) than the nontransplant cohort (7) (p D .022). Renal transplant patients...
Source: Journal of surgical orthopaedic advances - August 8, 2018 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Functional Outcomes of Isolated Gastrocnemius Recession.
Authors: Messerschmidt C, Netto A, Barfield WR, Gross C, McKibbin W Abstract The effects of gastrocnemius recession on strength and function are underreported. This prospective study reports strength and functional effects after isolated gastrocnemius recession. Patients (n D 20) underwent an isolated gastrocnemius recession for foot and ankle conditions with associated gastrocnemius or gastrocnemius-soleus contracture. Eight patients prospectively underwent range of motion (ROM) and Biodex testing preoperatively and at 3 and 6 months postoperatively. Foot Function Index (FFI) assessed functional outcomes. Repeated...
Source: Journal of surgical orthopaedic advances - August 8, 2018 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Self-Citation Does Not Appear to Artificially Inflate Orthopaedic Journal Ranking.
This study analyzed the top 30 orthopaedic journals to determine which journals had higher self-citation rates and if those rates had any correlation with their impact factors and SCImago Journal Ranks. The study verified that self-citing was more common in specialty journals compared with general orthopaedic journals (p D .002). The results demonstrate a more positive correlation between self-citation and SCImago Journal Rank than impact factor. This finding suggests that the impact factor's inclusion of self-citations should not be thought to artificially inflate the impact factor of the subspecialty journals that most c...
Source: Journal of surgical orthopaedic advances - August 8, 2018 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research

Effectiveness of Thrombin-Collagen and Autologous Platelet-Rich Plasma in Total Hip Arthroplasty Hemostasis: A Prospective, Randomized, Controlled Trial.
Authors: Bowman EN, McCabe MP, Cleveland KB Abstract Bovine derived thrombin-collagen combined with autologous platelet-rich plasma (PRP) has shown promise as a topical, surgical hemostatic agent. The purpose of this study was to determine the effect of thrombin-collagen-PRP on perioperative blood loss in total hip arthroplasty (THA). A prospective, single-blinded, randomized, controlled study comparing thrombin-collagen-PRP use to standard treatment was performed. All patients undergoing elective primary THA for osteoarthritis by a single physician at a single institution were included. Thirty-nine patients were e...
Source: Journal of surgical orthopaedic advances - August 8, 2018 Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research