A Compatibility Guide for the Orthopaedic Surgeon Planning to Perform Hardware Removal Surgery.
CONCLUSIONS: Given the ubiquity of implanted orthopaedic implant, removal must be as safe, planned, and controlled as possible. The data in this article provide an inclusive, centralized resource for surgeons looking to confirm the compatibility of previously implanted screws and available removal equipment at their institution. PMID: 30212397 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 14, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Evaluation of US Orthopaedic Surgery Academic Centers Based on Measurements of Academic Achievement.
CONCLUSION: This algorithm may provide faculty with an assessment tool that can establish benchmarks to help focus efforts toward increasing the academic productivity of their respective programs. PMID: 30199475 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 11, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Symptomatic, Unstable Os Acromiale.
Authors: Hasan SA, Shiu B, Jauregui JJ Abstract Management of a persistently symptomatic, unstable os acromiale remains controversial. An unstable os acromiale is an easy diagnosis to miss and should be specifically evaluated for in patients with shoulder pain and a high degree of clinical suspicion. Surgical options include open or arthroscopic excision and open reduction and internal fixation. Open excision of large fragments has had poor results. Arthroscopic treatment is commonly used for small fragments (preacromion), and the technique has also been used in larger fragments (meso-os), but concerns persist over...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 11, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Treatment Patterns and Outcomes of Stable Hips in Infants With Ultrasonic Dysplasia.
This study assessed the treatment patterns for stable UD and determined the outcomes of Pavlik harness (PH) treatment or observation (OB). METHODS: This is a prospective study of 80 infants (107 hips) aged ≤12 weeks at presentation diagnosed with stable UD. RESULTS: Sixty-five hips were treated with PH, whereas 42 hips were observed. Patients who were older at the time of initial sonogram and those with lower head coverage were more likely to be treated with PH. The mean head coverage was lower in the PH group, indicating more severe UD. At a 2-year follow-up period, 93% of patients in the OB group and 87% in th...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 11, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Risk Factors for Prolonged Postoperative Opioid Use After Spine Surgery: A Review of Dispensation Trends From a State-run Prescription Monitoring Program.
Authors: Rosenthal BD, Suleiman LI, Kannan A, Edelstein AI, Hsu WK, Patel AA Abstract INTRODUCTION: Opioid abuse and dependence have a detrimental effect on elective orthopaedic surgeries, yet pain control is an important predictor of postoperative satisfaction. We aimed at better defining risk factors for prolonged postoperative opioid requirements and risk factors for patients requiring higher doses of opioids after spine surgery. METHODS: The Illinois Prescription Monitoring Program was queried to analyze opioid dispensation patterns at 3 and 6 months postoperatively for adult patients who had spine surgery ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 11, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Preoperative Narcotic Use and Inferior Outcomes After Anatomic Total Shoulder Arthroplasty: A Clinical and Radiographic Analysis.
Authors: Thompson KM, Hallock JD, Smith RA, Brolin TJ, Azar FM, Throckmorton TW Abstract INTRODUCTION: Our purpose was to determine whether the chronic use of preoperative narcotics adversely affected clinical and/or radiographic outcomes. METHODS: Seventy-three patients (79 shoulders) with primary total shoulder arthroplasty for osteoarthritis were evaluated clinically and radiographically at preoperative visits and postoperatively at a minimum follow-up of 2 years: 26 patients (28 shoulders) taking chronic narcotic pain medication for at least 3 months before surgery and 47 patients (51 shoulders) who were no...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 9, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Cost Comparison of Surgically Treated Ankle Fractures Managed in an Inpatient Versus Outpatient Setting.
CONCLUSION: Where medically/socially appropriate, this analysis suggests that ankle fracture surgery should be provided in an outpatient surgical facility to provide the greatest value to the patient and society. LEVEL OF EVIDENCE: Level III. PMID: 30192248 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 9, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Lipomatous Soft-tissue Tumors.
Authors: Johnson CN, Ha AS, Chen E, Davidson D Abstract Lipomatous soft-tissue tumors are the most common neoplasms encountered by physicians. They range from benign lipomas to high-grade liposarcomas. Unplanned excisions of sarcomas are commonly due to the presumptive diagnosis of lipoma and can be avoided by understanding their diagnostic magnetic resonance imaging appearance. Magnetic resonance images should be obtained for all soft-tissue masses that are deep to fascia or those>5 cm in subcutaneous tissue. Atypical lipomatous tumors present as large deep fatty masses and have a propensity for local recurrenc...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 9, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Outcomes of Arthroscopic Posterior Medial Meniscus Root Repair: Association With Body Mass Index.
CONCLUSION: Although arthroscopic repair of posterior medial root tears has good clinical outcomes and a low rate of subsequent surgery, an elevated BMI level is associated with worse clinical outcomes and a higher rate of subsequent surgery. PMID: 30192250 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 9, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Perioperative Protocol for Elective Spine Surgery Is Associated With Reduced Length of Stay and Complications.
CONCLUSION: Length of stay and 90-day complications for elective spine surgery improved after implementation of an evidence-based perioperative protocol. Standardization efforts can improve quality and reduce costs, thereby improving the value of spine care. LEVEL OF EVIDENCE: Level III (retrospective review of prospectively collected data). PMID: 30192251 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 9, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Reporting the Influence of Sex in Research: Trends at AAOS Annual Meetings.
CONCLUSIONS: The reporting of sex-specific analyses has improved over time but accounts for 5.4% of research presented at annual meetings from 2006 to 2013. The inclusion of sex-specific analyses should be required for future research publications to better understand the influence of sex in musculoskeletal medicine. PMID: 30192252 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 9, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Disparities in Total Hip Arthroplasty Outcomes: Census Tract Data Show Interactions Between Race and Community Deprivation.
Authors: Goodman SM, Mehta B, Zhang M, Szymonifka J, Nguyen JT, Lee L, Figgie MP, Parks ML, Dey SA, Crego D, Russell LA, Mandl LA, Bass AR Abstract INTRODUCTION: Socioeconomic factors such as poverty may mediate racial disparities in health outcomes after total hip arthroplasty (THA) and confound analyses of differences between blacks and whites. METHODS: Using a large institutional THA registry, we built models incorporating individual and census tract data and analyzed interactions between race and percent of population with Medicaid coverage and its association with 2-year patient-reported outcomes. RESU...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 9, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Novel Surgical Approach to Segmental Bone Transport Using a Magnetic Intramedullary Limb Lengthening System.
Authors: Barinaga G, Beason AM, Gardner MP Abstract Posttraumatic bone defects (BDs) remain a difficult complication for orthopaedic surgeons. Surgical goals in these reconstructive cases are to create stable limb fixation, maintain limb length, and provide adequate soft-tissue coverage. Historically, surgical approaches in these cases have required the use of an external fixator, which is associated with several postoperative complications. A plate-assisted bone segment transport (PABST) technique using a magnetic limb lengthening system eliminates the need for an external fixator and is effective for these recons...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 9, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Specialty Focus: Trauma Issue.
Authors: Archdeacon MT PMID: 30192269 [PubMed - in process] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 9, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Advances in Wound Management.
Authors: Rosenbaum AJ, Banerjee S, Rezak KM, Uhl RL Abstract Wound management is a notable healthcare and financial burden, accounting for>$10 billion in annual healthcare spending in the United States. A multidisciplinary approach involving orthopaedic and plastic surgeons, wound care nursing, and medical and support staff is often necessary to improve outcomes. Orthopaedic surgeons must be familiar with the fundamental principles and evidenced-based concepts for the management of acute and chronic wounds. Knowledge of surgical dressings, negative pressure wound therapy, tissue expanders, dermal apposition, bio...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 6, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Increasing Rate of Surgical Fixation in Four- and Five-year-old Children With Femoral Shaft Fractures.
CONCLUSIONS: A clear and significant increase was noted in internal fixation for pediatric femoral shaft fractures in 4- and 5-year-old children, and the lower age limit for surgical management of these fractures is decreasing. LEVEL OF EVIDENCE: Level III. Retrospective comparative study. PMID: 30180090 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 6, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Biomechanical Analysis of Fixation Devices for Basicervical Femoral Neck Fractures.
CONCLUSIONS: Given our results and those of previous studies, we could not determine superiority of one implant and recommend that surgeons select fixation constructs based on the individual patient's anatomy and the surgeon's comfort with the implant. PMID: 30180091 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 6, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Incidence of Nerve Injury After Hip Arthroscopy.
CONCLUSIONS: The incidence of nerve injury after hip arthroscopy may be markedly higher than previously reported; however, resolution seems to occur as previously found in the literature. Patients should be educated regarding the risk of nerve injury during this procedure. LEVEL OF EVIDENCE: Level IV. PMID: 30180092 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 6, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Incidence of Posteromedial Meniscocapsular Separation and the Biomechanical Implications on the Anterior Cruciate Ligament.
Authors: Edgar C, Kumar N, Ware JK, Ziegler C, Reed DN, DiVenere J, Obopilwe E, Cote MP, Arciero RA Abstract PURPOSE: To report the incidence of posterior medial meniscocapsular junction (PMCJ) separation in patients with anterior cruciate ligament (ACL) injury and to evaluate its biomechanical effect on the ACL. METHODS: Three hundred thirty-seven consecutive patients undergoing isolated primary ACL reconstruction were retrospectively analyzed for PMCJ lesion. Forty-four patients were identified with PMCJ lesion and studied. Eight cadaver knees underwent biomechanical testing to determine anterior tibial displ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 6, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Current Concepts in Orthopaedic Care Disparities.
Authors: Pandya NK, Wustrack R, Metz L, Ward D Abstract Healthcare delivery is profoundly affected by race/ethnicity, sex, and socioeconomic status. The effect of these factors on patient health and the quality of care received is being studied in more detail. Orthopaedic surgery over the past several years has paid increasing attention to these disparities as well. Not only do these disparities exist with regard to accessing care but also with regard to the quality of care received and postoperative outcomes. Total joint arthroplasty, hip fractures, and spine surgery represent areas where the effect of these facto...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 6, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Management of Midshaft Clavicle Fractures in Adults.
Authors: Wiesel B, Nagda S, Mehta S, Churchill R Abstract Fractures of the clavicle are common injuries that occur across all age groups but are most frequently seen in the young, active patient population. Among the different types of clavicle fractures, those occurring in the middle third of the clavicular shaft are the most common. Historically, most of these fractures were treated by closed means even when notable displacement was present. Recently, there has been a renewed interest in assessing the best treatment option for these patients. Although nonsurgical treatment is a reliable method for treating many o...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 6, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Letter to the Editor: Sleep Quality in Patients With Rotator Cuff Disease.
Authors: Gorski J PMID: 30180096 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 6, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Reply to the Letter to the Editor: Sleep Quality in Patients With Rotator Cuff Disease.
Authors: Khazzam MS, Mulligan EP, Brunette-Christiansen M, Shirley Z PMID: 30180097 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 6, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Incidence and Risk Factors for Postoperative Hypothermia After Orthopaedic Surgery.
Authors: Kleimeyer JP, Harris AHS, Sanford J, Maloney WJ, Kadry B, Bishop JA Abstract INTRODUCTION: Postoperative hypothermia is a common complication of orthopaedic surgery associated with increased morbidity. We identified the incidence and risk factors for postoperative hypothermia across orthopaedic surgical procedures. METHODS: A total of 3,822 procedures were reviewed. Hypothermia was defined as temperature
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 1, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Recurrent Fragility Fractures: A Cross-sectional Analysis.
Authors: Dang DY, Zetumer S, Zhang AL Abstract INTRODUCTION: Despite growing rates of fragility fractures, there has been a lack of research investigating the risk and characteristics of recurrent fragility fractures. METHODS: The Medicare Standard Analytic Files database was used to identify patients from 2005 to 2009 who were older than 65 years, had a diagnosis of osteoporosis or osteopenia, and sustained a fragility fracture of the proximal humerus, distal radius, hip, ankle, or vertebral column. The incidence and type of recurrent fragility fracture were tracked over a 36-month period. RESULTS: A total...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 1, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Natural History of the Elbow Bony Architecture in Patients With Obstetric Brachial Plexus Injury and the Association With Flexion Contractures.
CONCLUSIONS: In the absence of a radial head dislocation, most elbow joints do not seem to undergo abnormal anatomic bony changes in patients with OBPI and flexion contractures. LEVEL OF EVIDENCE: Level IV (retrospective case series). PMID: 30169445 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 1, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Patient and Practice Trends in Total Ankle Replacement and Tibiotalar Arthrodesis in the United States From 2007 to 2013.
Authors: Vakhshori V, Sabour AF, Alluri RK, Hatch GF, Tan EW Abstract INTRODUCTION: Both total ankle replacement (TAR) and tibiotalar arthrodesis (TTA) are used in the surgical management of ankle arthritis. Over the past decade, TAR instrumentation, techniques, and implants have improved, making the procedure more reliable and reproducible, thus making TAR more common. METHODS: The Nationwide Inpatient Sample database from 2007 to 2013 was used to obtain data on patients elder than 50 years who underwent either TAR or TTA. Differences in temporal, demographic, and diagnosis trends between TAR and TTA were anal...
Source: The Journal of the American Academy of Orthopaedic Surgeons - September 1, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Chronic Achilles Ruptures: Reconstructive Options.
Authors: Schweitzer KM, Dekker TJ, Adams SB Abstract Achilles tendon ruptures, if neglected or identified late, lead to impairments in function and gait. Surgical reconstruction is typically required to restore the resting length and tension to the gastrocnemius-soleus complex. A variety of reconstructive options have been described, depending on several factors, including chronicity, residual gap size, remaining tissue quality and vascularity, location of tendon rupture or deficiency, and patient-specific factors. Despite the many surgical options described from local soft-tissue rearrangements and tendon transfer...
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 31, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

American Academy of Orthopaedic Surgeons Appropriate Use Criteria: Management of Osteoarthritis of the Hip.
Authors: Piuzzi NS, Manner P, Levine B PMID: 30157057 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 31, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Comparative Utilization of Reverse and Anatomic Total Shoulder Arthroplasty: A Comprehensive Analysis of a High-volume Center.
DISCUSSION: Over the past decade, RTSA has become the most common primary shoulder arthroplasty, reflecting the clinical success of the procedure. This increase is due to both an increase in the number of RTSAs performed for rotator cuff tear arthropathy as well as expanding surgical indications for RTSA. LEVEL OF EVIDENCE: Retrospective, level IV. PMID: 30161057 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 31, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Antibiotic-laden Bone Cement in Primary and Revision Hip and Knee Arthroplasty.
Authors: Gandhi R, Backstein D, Zywiel MG Abstract Antibiotic-laden bone cement (ALBC) has a number of different uses in primary and revision total joint arthroplasty. However, considerable controversy remains regarding how and when it is best used. The prophylactic use of low-dose ALBC in primary cemented total hip arthroplasty is well supported by the literature, conferring both clinical and economic benefits. In contrast, conclusive evidence on the clinical efficacy or economic benefit of the routine use of ALBC in primary total knee arthroplasty remains elusive. Given the currently available evidence, we cannot...
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 31, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Trends in Deep Vein Thrombosis Prophylaxis and Deep Vein Thrombosis Rates After Total Hip and Knee Arthroplasty.
CONCLUSION: After THA and TKA, warfarin is the most commonly prescribed prophylaxis. Patients with hypercoagulability diagnoses are at a higher risk of postoperative DVT. The likelihood of DVT within 6 months of THA and TKA was markedly higher in patients treated with warfarin and lovenox and markedly lower in those treated with aspirin, fondaparinux, and rivaroxaban. LEVEL OF EVIDENCE: Level III. PMID: 30153117 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 30, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Association of the Graft Size and Arthrofibrosis in Young Patients After Primary Anterior Cruciate Ligament Reconstruction.
CONCLUSION: For young patients, the decision on the graft size must consider the possibility of arthrofibrosis with a larger graft versus reinjury with a smaller graft. PMID: 30148751 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 28, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Hip Instability in Patients With Down Syndrome: Erratum.
Authors: PMID: 30138246 [PubMed - in process] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 25, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Evaluation and Management of Failed Hemiarthroplasty.
Authors: Sheth NP, Dattilo JR, Schwarzkopf R Abstract Hemiarthroplasty is a common procedure for treatment of displaced femoral neck fractures in low-demand patients. As hip fracture incidence continues to increase, the need for revision hemiarthroplasty is also expected to increase. Multiple etiologies can result in a failed hemiarthroplasty, including persistent pain, infection, instability, leg-length discrepancy, and trauma. Preoperative clinical, radiographic, and laboratory assessments are critical in determining the etiology of the painful hemiarthroplasty. The standard of care for surgical management of fai...
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 25, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Construct Validation of a Novel Hip Fracture Fixation Surgical Simulator.
The objective of this study was to determine whether the simulation platform can distinguish between novice and experienced practitioners of percutaneous pinning of hip fractures. METHODS: Medical students, orthopaedic residents, orthopaedic trauma fellows, and attending surgeons completed in situ hip-pinning simulation that recorded performance measures related to surgical accuracy, time, and use of fluoroscopy. Linear regression models were used to compare the association between performance and practitioner experience. RESULTS: Notable associations were shown between performance and practitioner experience in 10...
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 25, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Challenges in Treating Acromioclavicular Separations: Current Concepts.
Authors: Cook JB, Krul KP Abstract Injuries to the acromioclavicular joint constitute approximately 3.2% of shoulder injuries. Although the overall goal of treatment continues to be return to activity with a pain-free shoulder, the treatment of acromioclavicular joint separations has been fraught with conflict since the earliest reports in both ancient and modern literature. Accurate diagnosis and classification are important to determine the optimal treatment. Nonsurgical therapy remains the mainstay for treatment of low- and most mid-grade injuries, although recent biomechanical and biokinetic data might suggest ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 25, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Peroneal Tendon Tears: We Should Consider Looking at the Muscle Instead.
DISCUSSION: Patients with PB tendon tear demonstrate markedly higher grades of fatty degeneration compared with patients without peroneal pathology. The Goutallier classification may become a valuable instrument for assessing the severity of a PB tear. LEVEL OF EVIDENCE: Level III-diagnostic study. PMID: 30138295 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 25, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Trampoline-Related Injuries: A Comparison of Injuries Sustained at Commercial Jump Parks Versus Domestic Home Trampolines.
DISCUSSION: Trampoline-related injury distribution included a higher percentage of fractures/dislocations, lower extremity fractures, fractures in adults, and surgical interventions associated with jump parks versus home trampolines. LEVEL OF EVIDENCE: Level III. PMID: 30138296 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 25, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Alignment and Balance Methods in Total Knee Arthroplasty.
Authors: Jaffe WL, Dundon JM, Camus T Abstract Total knee arthroplasty is one of the most commonly performed orthopaedic surgical procedures in the United States. Primary concepts in the surgical technique include restoring limb alignment and soft-tissue balance about the knee. Currently, traditional mechanical alignment concepts that focus on restoring neutral limb alignment have been challenged by the principle of kinematic alignment. In addition to these recent philosophical challenges, new technologies have been introduced to help the surgeon more accurately achieve optimal limb alignment and soft-tissue balanc...
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 24, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Utility of Routine Postoperative Radiographs After Fixation of Lower Extremity Fractures.
CONCLUSION: Routine radiographs in isolation contribute to changes in management (1) in the immediate postoperative period in select cases and (2) during the period when advancement to full weight bearing is being considered up until clinical fracture union. LEVEL OF EVIDENCE: Level III. PMID: 30134306 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 24, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Pilon Fracture: Preventing Complications.
Authors: Kottmeier SA, Madison RD, Divaris N Abstract Fractures of the distal tibial plafond (ie, pilon) comprise a broad range of injury mechanisms, patient demographics, and soft-tissue and osseous lesions. Patients often present with considerably comminuted fracture patterns and notable soft-tissue compromise. Surgical intervention must be performed with respect for the exceedingly vulnerable soft-tissue envelope and with a properly executed technique. Even with proper timing, favorable host factors, and expert surgical technique, restoration of function and avoidance of complications are not always achievable. ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 24, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Surgical Management of Patellofemoral Instability in the Skeletally Immature Patient.
Authors: Redler LH, Wright ML Abstract Compared with skeletally mature patients, skeletally immature patients are at a higher risk of acute traumatic patellar dislocation. Surgical treatment is the standard of care for patients with recurrent instability and requires important and technically challenging physeal considerations. Physeal-sparing medial patellofemoral ligament reconstruction is the treatment of choice for these patients, replacing older nonanatomic extensor mechanism realignment techniques. Implant-mediated guided growth is an important adjunct to correct genu valgum angular deformities that contribut...
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 24, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Management of Osteoarthritis of the Hip.
Authors: Quinn RH, Murray J, Pezold R, Hall Q Abstract The American Academy of Orthopaedic Surgeons has developed the Appropriate Use Criteria (AUC) for the Management of Osteoarthritis of the Hip. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The Management of Osteoarthritis of the Hip AUC clinical patient scenarios were derived from indications typical of patients presenting with osteoarthritis of the hip...
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 24, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Does Joint Injury Make Young Joints Old?
Authors: Diekman BO, Collins JA, Loeser RF PMID: 30134310 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 24, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Predicting Adverse Outcomes After Total Hip Arthroplasty: A Comparison of Demographics, the American Society of Anesthesiologists class, the Modified Charlson Comorbidity Index, and the Modified Frailty Index.
CONCLUSION: For THA, easily obtained patient ASA and age are more predictive of perioperative adverse outcomes than the more complex and numerically tabulated modified Charlson Comorbidity Index and modified Frailty Index. PMID: 30130353 [PubMed - as supplied by publisher] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 22, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Management of Bunionette Deformity.
Authors: Shi GG, Humayun A, Whalen JL, Kitaoka HB Abstract Bunionette deformity, historically known as tailor's bunion, is a forefoot protuberance laterally, dorsolaterally, or plantarlaterally along the fifth metatarsal head. Although bunionette deformity has been compared to hallux valgus deformity, it is likely due to a multifactorial, anatomic interplay between fifth metatarsal bony morphology and forefoot soft-tissue imbalance. Friction generated between the bony prominence, soft tissue, and associated constrictive footwear can result in keratosis, inflammation, pain, and ulceration. Symptomatic bunionettes ar...
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 22, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Diagnosis and Management of Ipsilateral Femoral Neck and Shaft Fractures.
Authors: Jones CB, Walker JB Abstract Ipsilateral femoral neck and shaft fractures typically occur as a result of high-energy trauma in young adults. Up to 9% of femoral shaft fractures will have an associated femoral neck fracture. Awareness of this association and the use of a protocolized approach to diagnosis and management can help prevent missed injuries and the associated complications of displacement, nonunion, and osteonecrosis. The femoral neck fracture is often vertically oriented and either nondisplaced or minimally displaced, and thus, these fractures are frequently missed in the initial evaluation. Fi...
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 22, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Intramedullary Nailing of Periarticular Fractures.
Authors: Virkus WW, Kempton LB, Sorkin AT, Gaski GE Abstract Plate fixation has historically been the preferred surgical treatment method for periarticular fractures of the lower extremity. This trend has stemmed from difficulties with fracture reduction and concerns of inadequate fixation with intramedullary implants. However, the body of literature on management of periarticular fractures of the lower extremities has expanded in recent years, indicating that intramedullary nailing of distal femur, proximal tibia, and distal tibia fractures may be the preferred method of treatment in some cases. Intramedullary nai...
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 18, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Management of the Failed Medial Unicompartmental Knee Arthroplasty.
Authors: Crawford DA, Berend KR, Lombardi AV Abstract With recent design modifications, proper patient selection, and sound surgical technique, medial unicompartmental knee arthroplasty has demonstrated long-term success in the management of degenerative joint disease. Nevertheless, complications do occur, most often aseptic loosening, tibial fracture, polyethylene wear, bearing dislocation, disease progression, infection, and unexplained pain. Some failures can be managed with retention of the implant, whereas others require revision to total knee arthroplasty (TKA), possibly including augments and stems. Although...
Source: The Journal of the American Academy of Orthopaedic Surgeons - August 18, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research