Spinopelvic Dissociation: A Retrospective Case Study and Review of Treatment Controversies.
We present a series of spinopelvic dissociation cases from a level I trauma center. METHODS: In this retrospective review of 18 consecutive cases treated surgically over a period of 4 years, we collected patient, injury, and surgical demographics and clinical and radiographic outcome measures. RESULTS: Twelve patients had associated injuries, five were intubated on arrival, and six had neurologic deficits at presentation. No patient had spinal decompression, and all patients underwent closed reduction and percutaneous fixation. There were no cases of iatrogenic nerve injury, despite the use of partially threaded sa...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 19, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Extremity War Injuries XII: Homeland Defense as a Translation of War Lessons Learned.
Authors: Stinner MDJ, Schmidt AH Abstract The 12th Extremity War Injuries Symposium focused on issues related to the transitions in medical care that are occurring as the focus of the war on terror changes. The symposium highlighted the results of Department of Defense-funded research in musculoskeletal injury, the evolution of combat casualty care, and the readiness of the fighting force. Presentations and discussions focused on force readiness of both troops and their medical support as well as the maintenance of the combat care expertise that has been developed during the previous decade of conflict. PMID: 2...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 16, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Reverse-reamed Intercalary Allograft: A Surgical Technique.
Authors: Wilke B, Cooper A, Gibbs CP, Spiguel A Abstract Allograft reconstruction of large segmental intercalary bone defects after tumor resection is a well-accepted surgical technique. Although results generally have been satisfactory, nonunion at the allograft-host bone junction site remains a notable concern. Various reports have described attempts to enhance junctional healing with a variety of complex osteotomies, often complicating an already complex procedure. The use of an innovative reverse reaming technique can decrease the level of intraoperative difficulty mating the allograft-host junction and theoret...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 15, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Analysis of Femoral Version in Patients Undergoing Periacetabular Osteotomy for Symptomatic Acetabular Dysplasia.
DISCUSSION: Despite concerns that transverse plane femoral anatomy influences the stability of the hip joint after skeletal maturity, we did not find a statistical association between femoral version and severity of dysplasia or presenting symptomatology. This finding suggests that femoral version is not a major influence on the clinical presentation of acetabular dysplasia. LEVEL OF EVIDENCE: Level IIIb. PMID: 29877918 [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 - June 8, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Concomitant Proximal and Distal Tibiofibular Joint Dislocation Associated With a Tibial Shaft Fracture.
Authors: Hwang JS, Sirkin MS, Gala Z, Adams M, Reilly MC Abstract An association exists between tibial shaft fractures and ankle injuries. In addition, although uncommon, an association between tibial shaft fractures and proximal tibiofibular dislocations has also been established. A review of the previous literature resulted in one case report of a complete proximal and distal tibiofibular joint dislocation without fracture of the tibia or fibula. Here, we discuss a case of a complete proximal and distal tibiofibular syndesmotic complex dislocation associated with a tibial shaft fracture. To the best of our knowle...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 8, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Comprehensive Review of Current Constraining Devices in Total Hip Arthroplasty.
Authors: Van der Merwe JM Abstract Hip instability after total joint arthroplasty is a devastating complication. Appropriate management of instability is a challenge. Three components that are commonly used in these challenging scenarios are constrained liners, constrained tripolar components, and nonconstrained tripolar components. The biomaterials and biomechanics of these devices vary. Surgeons must take into account the risks associated with each of these components and some surgical pearls for their use. A thorough review of the recent literature allows comparison of results addressing the short-, medium-, and...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 8, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

The Orthopaedic Surgery Residency Application Process: An Analysis of the Applicant Experience.
CONCLUSION: Applying to orthopaedic surgery residency is a complex, competitive, and costly experience for applicants. The application process may benefit from better expectation management of applicant candidacy and a more prohibitive communication policy between applicants and programs after the interview day. PMID: 29870416 [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 - June 6, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Venous Thromboembolism Prophylaxis in Spine Surgery.
Authors: Kepler CK, McKenzie J, Kreitz T, Vaccaro A Abstract Venous thromboembolism (VTE) is a source of morbidity and mortality in patients undergoing orthopaedic surgery. A substantial body of literature supports the use of VTE prophylactic agents in patients undergoing lower extremity surgery. Treatment options include early mobilization, mechanical prophylaxis via pneumatic compression devices, pharmacologic agents, and venous filters. No consensus has been established regarding utilization or timing of VTE prophylaxis measures after spine surgery. The risk of VTE in patients undergoing spine surgery is not wel...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 6, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Letter to the Editor: Factors Motivating Medical Students in Selecting a Career Specialty: Relevance for a Robust Orthopaedic Pipeline.
Authors: Broom R, Cadwallader C PMID: 29870418 [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 - June 6, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Managing Sports-related Concussions From Time of Injury Through Return to Play.
Authors: Shirley E, Hudspeth LJ, Maynard JR Abstract Sports-related concussions continue to generate widespread interest. A concussion is a complex pathophysiologic process, with or without loss of consciousness, that results in a disturbance of brain function. Risk factors include age
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 5, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Hip Instability in Patients With Down Syndrome.
Authors: Maranho D, Fuchs K, Kim YJ, Novais EN Abstract The incidence of hip instability in children with Down syndrome is 1% to 7%. The natural history is often progressive, with the typical onset of hypermobility of the hip evolving to habitual dislocation, persistent subluxation, and fixed dislocation, and eventually leading to the loss of independent mobility. Treatment focuses on stabilizing the hip joint and depends on the patient's age and the severity of the disease. Typically, surgical intervention is recommended for the treatment of patients with habitual dislocation, subluxation, and complete dislocation...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 2, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Teaching Professionalism in Orthopaedic Residency: Efficacy of the American Academy of Orthopaedic Surgeons Ethics Modules.
This study demonstrates that 11 of the 14 AAOS ethics scenarios, converted to online modules, teach ethical concepts to orthopaedic residents. Orthopaedic residency programs may find it valuable to engage their residents in the ethics scenarios created by the AAOS to complement their ethics curriculum. PMID: 29847419 [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 - June 1, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Sex-based Differences in Common Sports Injuries.
Authors: Carter CW, Ireland ML, Johnson AE, Levine WN, Martin S, Bedi A, Matzkin EG Abstract The patient's sex plays an important role in mediating the risk for, and experience of, disease. Injuries of the musculoskeletal system are no exception to this phenomenon. Increasing evidence shows that the incidence, clinical presentation, and treatment outcomes for male and female patients with common sports injuries may vary widely. Stress fracture, which is associated with the female athlete triad, is a sports injury with known sex-based differences. Other common sports-related injuries may also have distinct sex-based...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 1, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

The Role of Mentoring in the Development of Successful Orthopaedic Surgeons.
Authors: Mulcahey MK, Waterman BR, Hart R, Daniels AH Abstract Mentoring plays an integral role in orthopaedic surgeons' career development and personal growth. Effective mentors are committed to their roles, provide skilled instructional support, model continuous learning, and communicate optimism. Numerous obstacles impede productive mentoring relationships in medicine, including reluctance to ask for help, time constraints due to extensive work obligations, lack of institutional support, relational difficulties, and lack of mentoring skills. Effective partnerships require a concerted effort to establish behavior...
Source: The Journal of the American Academy of Orthopaedic Surgeons - June 1, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Lower Extremity Megaprostheses in Orthopaedic Oncology.
Authors: Lozano Calderón SA, Kuechle J, Raskin KA, Hornicek FJ Abstract The megaprosthesis is designed to reproduce the form and function of a removed or lost large segment of bone and accompanying soft tissues. Slow but substantial improvements in the design and surgical implementation of these devices have advanced the capacity to restore patients' functional abilities. The essential challenges include identifying the ideal materials, bonding these materials to bone and soft tissues, reproducing functional anatomy, and adapting to the growing skeleton. Failure of these devices can result from soft-tissue i...
Source: The Journal of the American Academy of Orthopaedic Surgeons - May 23, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Staging of Bone and Soft-tissue Sarcomas.
Authors: Steffner RJ, Jang ES Abstract The purpose of staging in orthopaedic oncology is to provide a framework for classifying tumors based on their risk of local recurrence and distant metastasis to guide treatment decisions. Two separate systems are commonly used to categorize bone and soft-tissue sarcomas. The Musculoskeletal Tumor Society system for bone sarcomas and the Enneking system for soft-tissue sarcomas are the original staging systems developed by orthopaedic surgeons. The American Joint Committee on Cancer staging systems for bone and soft-tissue sarcomas are periodically updated based on new data, a...
Source: The Journal of the American Academy of Orthopaedic Surgeons - May 23, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Management of Pediatric Femoral Neck Fracture.
Authors: Patterson JT, Tangtiphaiboontana J, Pandya NK Abstract In the pediatric population, femoral neck fracture is a relatively uncommon injury with a high complication rate, despite appropriate diagnosis and management. The anatomy and blood supply of the proximal femur in the skeletally immature patient differs from that in the adult patient. Generally, these fractures result from high-energy trauma and are categorized using the Delbet classification system. This system both guides management and aids the clinician in determining the risk of osteonecrosis after these fractures. Other complications include phys...
Source: The Journal of the American Academy of Orthopaedic Surgeons - May 23, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Basic Science and Clinical Application of Reamed Sources for Autogenous Bone Graft Harvest.
Authors: Higgins TF, Marchand LS Abstract Autologous bone graft remains the only clinically available source of graft material with osteogenic, osteoinductive, and osteoconductive properties. Although iliac crest autologous bone graft has long served as the benchmark, reamed autogenous bone graft offers several advantages. Reamed autograft has a biochemical and cellular profile that is at least equivalent, and perhaps superior, to that of iliac crest autograft. In addition, larger volumes of reamed autograft can be obtained via less-invasive techniques, giving surgeons an accessible source of mesenchymal stem cells...
Source: The Journal of the American Academy of Orthopaedic Surgeons - May 23, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Letter to the Editor: The Weight-Bearing Shoulder.
Authors: King JJ, Wright TW PMID: 29781822 [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 - May 23, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Reply to the Letter to the Editor: The Weight-Bearing Shoulder.
Authors: Patel RM, Gelber JD, Schickendantz MS PMID: 29781823 [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 - May 23, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Lateral Patellar Instability in the Skeletally Mature Patient: Evaluation and Surgical Management.
Authors: Diduch DR, Kandil A, Burrus MT Abstract Lateral patellar instability is a common disease process that affects all types of patients. Depending on the patient's anatomy and the results of preoperative imaging, surgical management options include medial patellofemoral ligament reconstruction, tibial tubercle osteotomy, and sulcus-deepening trochleoplasty. Medial patellofemoral ligament reconstruction or repair is useful for almost all patients, whereas tibial tubercle osteotomy is helpful to correct a lateralized tibial tubercle and the associated elevated lateral pull of the extensor mechanism. For a select...
Source: The Journal of the American Academy of Orthopaedic Surgeons - May 23, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Costs and Radiographic Outcomes of Rotational Ankle Fractures Treated by Orthopaedic Surgeons With or Without Trauma Fellowship Training.
Authors: Virkus WW, Wetzel RJ, McKinley TO, Sorkin AT, Cheesman JS, Hill LC, Kempton LB Abstract INTRODUCTION: We evaluated the radiographic outcomes and surgical costs of surgically treated rotational ankle fractures in our health system between providers who had completed a trauma fellowship and those who had not. METHODS: We grouped patients into those treated by trauma-trained orthopaedic surgeons (TTOS) and non-trauma-trained orthopaedic surgeons (NTTOS). We graded the quality of fracture reductions and calculated implant-related costs of treatment. RESULTS: A total of 208 fractures met the inclusion c...
Source: The Journal of the American Academy of Orthopaedic Surgeons - May 23, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Letter to the Editor: Blood-loss Management in Spine Surgery.
Authors: Bednar DA PMID: 29757864 [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 - May 16, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Reply to the Letter to the Editor: Blood-loss Management in Spine Surgery.
Authors: Bible JE PMID: 29757865 [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 - May 16, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Orthopaedic Resident Surgical Case Log Disparities Observed in the Next Accreditation System.
CONCLUSIONS: The decrease in logged procedures with the NAS may be related to new guidance, resident logging habits, an actual decrease in surgical experience, or unknown causes, or combinations of these factors. A new baseline of case data may be emerging post-NAS. To ensure the highest quality education, NAS case logs warrant continued study to determine how the data should be used in residency education and accreditation decisions. PMID: 29762189 [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 - May 16, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Revision Ulnar Collateral Ligament Reconstruction.
Authors: Bruce JR, ElAttrache NS, Andrews JR Abstract Ulnar collateral ligament injuries continue to occur despite efforts to educate pitchers, coaches, and families at the amateur and professional levels about pitch counts, mechanics, and injury prevention. Although the data on the incidence of ulnar collateral ligament reconstructions are inconclusive, an increase in these reconstructions may mean a corresponding increase in the number of reconstruction failures and revision reconstruction surgeries. Less is known about the outcomes of revision ulnar collateral ligament reconstruction; not unexpectedly, early res...
Source: The Journal of the American Academy of Orthopaedic Surgeons - May 16, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Functional Outcomes and Complications After Oncologic Reconstruction of the Proximal Humerus.
DISCUSSION: All three articular oncologic shoulder reconstructions were comparable in terms of function. This large series confirms a higher fracture rate in OAs, which explains the observed higher revision rate and apparent lower survival rate in this subgroup. PMID: 29762195 [PubMed - in process] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - May 16, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Primary and Secondary Total Knee Arthroplasty for Tibial Plateau Fractures.
Authors: Stevenson I, McMillan TE, Baliga S, Schemitsch EH Abstract The surgical management of tibial plateau fractures can be technically demanding. In younger patients, the mainstay is fixation with cartilage preservation. In older patients with osteoporotic bone, this method has higher rates of fixation failure; in addition, it requires prolonged bed rest or protected weight bearing, which are major challenges in this group. In contrast, total knee arthroplasty performed acutely for primary treatment of tibial plateau fractures has potential advantages for elderly patients, such as immediate stability, early mob...
Source: The Journal of the American Academy of Orthopaedic Surgeons - May 8, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Spinopelvic Fixation.
Authors: Esmende SM, Shah KN, Daniels AH Abstract Fixation at the lumbosacral junction continues to be a challenge for spine surgeons despite advances in spinal instrumentation techniques. The poor bone quality of the sacrum, the complex regional anatomy, and the tremendous biomechanical forces at the lumbosacral junction contribute to the high rates of instrumentation-related complications. Although many spinopelvic fixation techniques have been reported, only a few are still widely used because of the high complication rates associated with previous techniques. Spinopelvic fixation has numerous indications. Long-...
Source: The Journal of the American Academy of Orthopaedic Surgeons - May 8, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Management of Articular Cartilage Defects in the Glenohumeral Joint.
Authors: Seidl AJ, Kraeutler MJ Abstract Articular cartilage defects are not often encountered in the glenohumeral joint. These lesions are typically found in patients with shoulder trauma, recurrent instability, or previous surgical treatment. Diagnosis can be difficult; these defects are often found incidentally during arthroscopic or open surgical management of other pathology. Initial management of isolated glenohumeral chondral defects is nonsurgical and includes physical therapy and/or corticosteroid injections. If nonsurgical treatment is unsuccessful, patients may undergo surgery. Because these lesions occu...
Source: The Journal of the American Academy of Orthopaedic Surgeons - April 28, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Heterotopic Ossification of the Inferior Pubic Ramus.
Authors: Cheng CW, Kim SP, Francis JJ, Wetzel RJ Abstract The hip is a common location for heterotopic ossification after surgical trauma, blunt trauma, or muscle injury. However, the region around the pubic rami is an unusual location for heterotopic bone formation. Here, we present a case of a young, active man in the Armed Forces Reserve with a large heterotopic bone involving the left inferior pubic ramus who underwent surgical excision through an unusual approach via the perineum. The patient had notable pain relief postoperatively and returned to his active duties 1 month after surgery without discomfort or f...
Source: The Journal of the American Academy of Orthopaedic Surgeons - April 28, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Surgical Management of Osteoarthritis of the Knee.
Authors: Quinn RH, Murray JN, Pezold R, Sevarino KS Abstract The American Academy of Orthopaedic Surgeons has developed Appropriate Use Criteria (AUC) for Surgical Management of Osteoarthritis of the Knee. 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 Surgical Management of Osteoarthritis of the Knee AUC clinical patient scenarios were derived from indications of patients under consideration for surgica...
Source: The Journal of the American Academy of Orthopaedic Surgeons - April 26, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Mixed Treatment Comparisons for Nonsurgical Treatment of Knee Osteoarthritis: A Network Meta-analysis.
DISCUSSION: Naproxen ranked most effective among conservative treatments of KOA and should be considered when treating pain and function because of its relative safety and low cost. The best available evidence was analyzed, but there were instances of inconsistency in the design and duration among articles, potentially affecting uniform data inclusion. PMID: 29688920 [PubMed - in process] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - April 26, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Association of Perioperative Glycemic Control With Deep Postoperative Infection After Shoulder Arthroplasty in Patients With Diabetes.
CONCLUSIONS: The risk of wound complications and deep postoperative infection in patients with DM increases as the perioperative HbA1c level increases. An HbA1c level>8.0 mg/dL could serve as a threshold for a markedly increased risk of infection. LEVEL OF EVIDENCE: Therapeutic level III, case-control study, treatment study. PMID: 29688958 [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 - April 26, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Arthroscopic Management of Tibial Spine Avulsion Fractures: Principles and Techniques.
Authors: Strauss EJ, Kaplan DJ, Weinberg ME, Egol J, Jazrawi LM Abstract Tibial spine fractures are uncommon injuries affecting the insertion of the anterior cruciate ligament on the tibia. They typically occur in skeletally immature patients aged 8 to 14 years and result from hyperextension of the knee with a valgus or rotational force. Diagnosis is based on history, physical examination, and standard radiographs. The use of MRI can identify entrapped soft tissue that may prevent reduction. Open or arthroscopic repair is indicated in patients with partially displaced fractures (>5 mm) with one third to one half...
Source: The Journal of the American Academy of Orthopaedic Surgeons - April 26, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Design Rationale for Total Ankle Arthroplasty Systems: An Update.
Authors: Gross CE, Palanca AA, DeOrio JK Abstract The design of total ankle arthroplasty systems is evolving as a result of findings from longer-term studies. Our understanding of modes of failure has increased, and surgical techniques have become more refined. Currently, five total ankle arthroplasty systems are used in the United States. The landscape has changed considerably in the decade since the latest article reviewing total ankle design was published. Some implants with acceptable intermediate results had much poorer outcomes at 7- to 10-year follow-up. As more research showing mid- to long-term outcomes is...
Source: The Journal of the American Academy of Orthopaedic Surgeons - April 26, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Does Total Intravenous Anesthesia With Short-acting Spinal Anesthetics in Primary Hip and Knee Arthroplasty Facilitate Early Hospital Discharge?
Authors: Klavas DM, Karim A, Lambert BS, Ferris MS, Delgado D, Incavo SJ Abstract INTRODUCTION: Our study assessed the effect of total intravenous anesthesia (TIVA) with short-acting spinal anesthesia and aggressive day-of-surgery postoperative day 0 physical therapy (POD#0 PT) on hospital length of stay (LOS) in patients who underwent primary total joint arthroplasty. METHODS: A retrospective chart review compared the hospital LOS of 116 patients who underwent primary total hip arthroplasty and total knee arthroplasty with TIVA and short-acting spinal blockade ("Updated protocol group") with that of ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - April 26, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Radiographic Resource Utilization in the Initial Referral and Evaluation of Patients With Adolescent Idiopathic Scoliosis.
DISCUSSION: We found a large number of missing or inadequate radiographs, leading to repeat radiation exposure in this cohort. Improvements in the utilization of radiographs before orthopaedic referral could decrease unnecessary patient radiation exposure. PMID: 29683814 [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 - April 25, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Osteoimmunology: Effects of Standard Orthopaedic Interventions on Inflammatory Response and Early Fracture Healing.
Authors: Schneider PS, Sandman E, Martineau PA Abstract Achieving fracture union is highly dependent on the initial inflammatory phase of fracture healing, which is influenced by both the local and systemic inflammatory environments. The rapidly emerging field of osteoimmunology involves the study of the interactions between the immune system and the skeletal system. Recent research has advanced the current state of knowledge regarding the effects of the surrounding soft-tissue injury, fracture hematoma, and the method of fracture fixation on the inflammatory phase of fracture healing. Acute systemic inflammation, ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - April 18, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Bony Reconstruction of the Anterior Glenoid Rim.
Authors: Willemot LB, Elhassan BT, Verborgt O Abstract Recurrent anterior shoulder instability is associated with glenohumeral bone loss. Glenoid deficiency compromises the concavity-compression mechanism. Medial Hill-Sachs lesions can result in an off-track humeral position. Anterior glenoid reconstruction or augmentation prevents recurrence by addressing the pathomechanics. In Bristow and Latarjet procedures, the coracoid process is harvested for conjoint tendon transfer, capsular reinforcement, and glenoid rim restoration. Complications and the nonanatomic nature of the procedure have spurred research on graft s...
Source: The Journal of the American Academy of Orthopaedic Surgeons - April 18, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Early Recurrence of a Solid Variant of Aneurysmal Bone Cyst in a Young Child After Resection: Technique and Literature Review and Two-year Follow-up After Corpectomy.
We report the case of an Enneking stage 3 S-ABC in a 5-year-old boy at C7 that showed rapid local recurrence after primary excision from posterior and dorsal stabilization requiring ventral corpectomy and posterior excision of the right lateral mass and right posterolateral fusion. Histologic examination disclosed an S-ABC. To our knowledge, this is the first case of S-ABC described in the literature that used both anterior and posterior approaches and complete corpectomy. Over a 2-year period, the patient showed no radiologic or clinical signs of local recurrence with excellent neurologic function. Solid-variant aneurysma...
Source: The Journal of the American Academy of Orthopaedic Surgeons - April 13, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Distal Femoral Varus Osteotomy for the Management of Valgus Deformity of the Knee.
Authors: Sherman SL, Thompson SF, Clohisy JCF Abstract Distal femoral varus osteotomy is a well-described treatment option for patients with valgus malalignment associated with a variety of underlying conditions. This procedure may be the definitive treatment option in active patients with isolated lateral compartment osteoarthritis or posttraumatic arthritis. It may be a useful concomitant procedure in young patients with lateral meniscus deficiency, focal chondral defects, chronic medial collateral ligament insufficiency, and/or patellofemoral instability. Distal femoral varus osteotomy can be performed with medi...
Source: The Journal of the American Academy of Orthopaedic Surgeons - April 10, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Patient-reported Outcome Measurement for Patients With Total Knee Arthroplasty.
Authors: Perruccio AV, Davis AM PMID: 29629917 [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 - April 10, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Form Follows Function: Partnering for Success.
Authors: Halsey DA PMID: 29629918 [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 - April 10, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

The Use of Closed Incision Negative-Pressure Wound Therapy in Orthopaedic Surgery.
Authors: Nam D, Sershon RA, Levine BR, Della Valle CJ Abstract Wound complications and surgical site infections after orthopaedic procedures result in substantial morbidity and costs. Traditional postoperative wound care consists of applying sterile, dry gauze and abdominal pads to the surgical site, with more frequent dressing changes performed in cases in which wound drainage is excessive. Persistent incisional drainage is of particular concern because it increases the risk of deep infection. The use of closed incision negative-pressure wound therapy (ciNPWT) to manage delayed wound healing was first reported a d...
Source: The Journal of the American Academy of Orthopaedic Surgeons - April 6, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Clinical Applications of Ultrasonography in the Shoulder and Elbow.
Authors: Lin A, Gasbarro G, Sakr M Abstract In the past 30 years, the use of ultrasonography in the field of orthopaedics has evolved. As ultrasonography has been refined, smaller machines with higher fidelity and better transducers have become available at a lower cost. Diagnostic and therapeutic applications of ultrasonography in the shoulder and elbow have expanded imaging options and provided alternatives to surgical management. Ultrasonography is a dynamic tool that affords immediate diagnostic assessment for clinical correlation and can be used for serial examinations and image guidance during therapeutic pro...
Source: The Journal of the American Academy of Orthopaedic Surgeons - April 6, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

AAOS Appropriate Use Criteria: Surgical Management of Osteoarthritis of the Knee.
Authors: Manner PA, Tubb CC, Levine BR PMID: 29621052 [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 - April 6, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Radiation Exposure and Health Risks for Orthopaedic Surgeons.
Authors: Hayda RA, Hsu RY, DePasse JM, Gil JA Abstract Orthopaedic surgeons are routinely exposed to intraoperative radiation and, therefore, follow the principle of "as low as reasonably achievable" with regard to occupational safety. However, standardized education on the long-term health effects of radiation and the basis for current radiation exposure limits is limited in the field of orthopaedics. Much of orthopaedic surgeons' understanding of radiation exposure limits is extrapolated from studies of survivors of the atomic bombings in Hiroshima and Nagasaki, Japan. Epidemiologic studies on cancer ri...
Source: The Journal of the American Academy of Orthopaedic Surgeons - March 24, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Routine Plain Radiographs in the Setting of Atraumatic Shoulder Pain: Are They Useful?
Authors: Feder OI, Levy BJ, Gruson KI Abstract INTRODUCTION: Plain radiographs of the shoulder are routinely obtained for patients presenting with atraumatic shoulder pain. The diagnostic utility of these radiographs is debatable. METHODS: Patients presenting for the first time to a shoulder clinic with atraumatic shoulder pain received a plain radiographic series. After considering their medical history and physical examination, we made a preliminary diagnosis and formulated a tentative treatment plan. We then reviewed the radiographs and determined whether the addition of these radiographs altered the diagnos...
Source: The Journal of the American Academy of Orthopaedic Surgeons - March 24, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Effects of Vitamin D on Skeletal Muscle and Athletic Performance.
Authors: Abrams GD, Feldman D, Safran MR Abstract Vitamin D is known to be important for calcium homeostasis and bone metabolism. It also has important direct effects on skeletal muscle. Unlike authentic vitamins, which cannot be synthesized in the body, vitamin D is produced in the skin using sunlight. Through its nuclear receptor (ie, vitamin D receptor) located throughout the body, including skeletal muscle, vitamin D initiates genomic and nongenomic pathways regulating multiple actions, including myocyte proliferation and growth. In some studies, vitamin D supplementation has been shown to increase muscle stren...
Source: The Journal of the American Academy of Orthopaedic Surgeons - March 23, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research