Low-velocity Gunshot Injuries to the Femur: What Is the Utility of Stabilizing Incomplete Fractures?
DISCUSSION: Only 6% of incomplete femur fractures treated at our hospital required later surgery for fracture displacement. Although incomplete fractures occur infrequently, nonsurgical management with limited weight bearing seems to be successful and cost-effective for most patients. We propose initial nonsurgical management of nondisplaced femoral fractures secondary to cortical penetration from low-energy gunshot wounds. PMID: 30531237 [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 - December 13, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

An Overview of Skin Antiseptics Used in Orthopaedic Surgery Procedures.
Authors: Letzelter J, Hill JB, Hacquebord J Abstract Surgical site infections (SSIs) in orthopaedics are a common complication, with more than half a million SSIs occurring in the United States each year. SSIs can carry a notable burden for patients and physicians alike. Skin antiseptic solution plays an important role in preventing SSI. Many studies have looked at different skin antiseptic solution in preventing SSIs. Different surgical preps can decrease bacterial loads at surgical sites in varying degrees. Yet, the amount of bacterial load does not always correlate with a lower risk of infection.Chlorhexidine, f...
Source: The Journal of the American Academy of Orthopaedic Surgeons - December 13, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Intra-articular Corticosteroid Injections for Symptomatic Knee Osteoarthritis: What the Orthopaedic Provider Needs to Know.
Authors: Martin CL, Browne JA Abstract Intra-articular corticosteroid injections have been used for decades in the management of symptomatic osteoarthritis of the knee and remain a common practice. The pain relief from a steroid injection is thought to work by reducing inflammation within the arthritic knee. Substantial variability remains among providers with regard to the technique used to perform the procedure, including the site of the injection, the medications injected, and the level of sterility. The success of steroid injections in relieving arthritic knee pain most often occurs in the short term. However, ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - December 13, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Cemented Femoral Component Use in Hip Arthroplasty.
Authors: Scanelli JA, Reiser GR, Sloboda JF, Moskal JT Abstract Elderly patients undergoing both elective and nonelective hip arthroplasty contribute markedly to health care spending, and the current aging population is likely to require even more resources. Several national joint replacement registries show a lower risk of revision surgery in patients older than 75 years who received cemented femoral components compared with cementless implants for primary total hip arthroplasty. Despite a higher incidence of early periprosthetic femoral fracture, noncemented femoral components are being used with increasing frequ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - December 13, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

All-epiphyseal Anterior Cruciate Ligament Reconstruction Does Not Increase the Risk of Complications Compared With Pediatric Transphyseal Reconstruction.
This study compares clinical outcomes and complications between all-epiphyseal and pediatric transphyseal ACLR. METHODS: We retrospectively reviewed 1,056 pediatric patients undergoing primary ACLR between 2000 and 2015. Of these, 51 were excluded (5 extra-articular and 46 partial transphyseal reconstructions). Demographic data, intraoperative findings and techniques, postoperative complications (including graft rupture, contralateral anterior cruciate ligament [ACL] tear, and meniscus injuries), clearance for sports, range of motion (ROM), and isokinetic strength testing were recorded. Univariate analysis was followed...
Source: The Journal of the American Academy of Orthopaedic Surgeons - December 13, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Cutibacterium acnes in Spine Pathology: Pathophysiology, Diagnosis, and Management.
Authors: Khalil JG, Gandhi SD, Park DK, Fischgrund JS Abstract Cutibacterium acnes, long thought to be skin flora of pathological insignificance, has seen a surge in interest for its role in spine pathology. C acnes has been identified as a pathogen in native spine infection and osteomyelitis, which has implications in the management compared with more commonly recognized pathogens. In addition, It has also been recognized as a pathogen in postoperative and implant-associated infections. Some evidence exists pointing to C acnes as an unrecognized source of otherwise aseptic pseudarthrosis. Recently, it is hypothesi...
Source: The Journal of the American Academy of Orthopaedic Surgeons - December 7, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Septic Arthritis of the Hip-Risk Factors Associated With Secondary Surgery.
DISCUSSION: Forty-one percent of children in this multicenter cohort underwent at least one repeat surgical procedure after the index arthrotomy for management of presumed SAH. Risk factors for return to the operating room include elevated initial erythrocyte sedimentation rate and C-reactive protein, infection with MRSA, and presence of osteomyelitis. LEVEL OF EVIDENCE: Level 3, case-cohort series. Type of evidence, therapeutic. PMID: 30520802 [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 - December 7, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Obstructive Sleep Apnea and Arthroscopic Rotator Cuff Repair-Are Complication Rates Really Increased?
Authors: Cancienne JM, Brockmeier SF, Deasey MJ, Werner BC Abstract BACKGROUND: A few investigations exist which evaluate the influence of obstructive sleep apnea (OSA) on complications after arthroscopic rotator cuff repair. METHODS: A database was queried for patients undergoing rotator cuff repair with and without OSA and further subdivided into those with and without a billing code for a continuous positive airway pressure (CPAP) device. Thirty-day and 6-month adverse events were assessed. RESULTS: After regression analysis, patients with OSA had markedly increased emergency department visits and hospital admission (P
Source: The Journal of the American Academy of Orthopaedic Surgeons - December 7, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Diagnosis and Management of Fungal Periprosthetic Joint Infections.
Authors: Nace J, Siddiqi A, Talmo CT, Chen AF Abstract Fungal periprosthetic joint infection (PJI) is a devastating complication because it can be difficult to diagnose, manage, and eradicate. Fungal PJI treatment requires a systematic approach. Increased awareness is essential when patients with painful arthroplasties present with immunosuppression, significant comorbidities, multiple surgeries, and history of drug use. Every suspected fungal PJI should be promptly diagnosed using readily available serum and synovial fluid markers. Surgical management involves débridement, antibiotics, and implant retention...
Source: The Journal of the American Academy of Orthopaedic Surgeons - December 7, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Perioperative Management of the Orthopaedic Patient and Alcohol Use, Abuse, and Withdrawal.
Authors: Zamorano DP, Lim PK, Haghverdian BA, Gupta R Abstract Alcohol is one of most commonly abused substances in the United States, and it has contributed to a growing epidemic of medical ailments, including cirrhosis, neurologic and psychosocial disorders, impairment to fertility, and cancer. Moreover, acute and chronic alcohol use represent a significant risk factor for orthopaedic injury and postoperative complications. Yet, relatively little is known about the clinical implications of alcohol abuse in common orthopaedic procedures. Acute withdrawal from alcohol is potentially fatal, particularly in the ortho...
Source: The Journal of the American Academy of Orthopaedic Surgeons - December 2, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

The Perception of Pregnancy and Parenthood Among Female Orthopaedic Surgery Residents.
CONCLUSION: This study demonstrates that most female orthopaedic trainees do not have children during residency. Most respondents experienced bias from co-residents about women having children during residency, and nearly half experienced such bias from orthopaedic attendings. Combating bias about pregnancy during residency may help encourage more women to pursue a career in orthopaedics. PMID: 30499893 [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 - December 2, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Predictors of Length of Stay and Discharge Disposition After Shoulder Arthroplasty: A Systematic Review.
DISCUSSION: Patient factors affecting LOS and likelihood of discharge to a facility include age>65 years, female sex, diabetes, obesity, and reverse shoulder arthroplasty. These factors can be used to develop studies to preoperatively predict outcomes after shoulder arthroplasty and to help identify patients who may be at risk of prolonged postoperative admission. LEVEL OF EVIDENCE: Prognostic level IV. PMID: 30499894 [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 - December 2, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Stem Cells and Platelet-rich Plasma for Knee Osteoarthritis: Prevalence and Cost in South Florida.
DISCUSSION: Biological injectables as treatment of knee OA have potential use in the nonsurgical management of this disease. Data on the effectiveness are lacking and are conflicting. Data should continue to be investigational. LEVEL OF EVIDENCE: Level IV. PMID: 30499895 [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 - December 2, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Approaching Unusual Pediatric Distal Humerus Fracture Patterns.
We describe our treatment philosophy for pediatric elbow fractures and how these principles were applied to some unusual fractures that presented to our institution. PMID: 30480586 [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 - November 29, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Predicting Discharge Disposition After Shoulder Arthroplasty in the United States.
DISCUSSION: Discharge disposition can be predicted using a nomogram with commonly identified preoperative and intraoperative variables. LEVEL OF EVIDENCE: Level III, retrospective cohort design, observational study. PMID: 30480587 [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 - November 29, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Venous Thromboembolism After Shoulder Arthoplasty and Arthroscopy.
Authors: Rapp CM, Shields EJ, Wiater BP, Wiater JM Abstract Venous thromboembolism (VTE) in the orthopaedic literature largely focuses on lower extremity trauma and arthroplasty, with relatively few investigations of VTE after shoulder surgery. Because the rate of shoulder surgery, especially arthroplasty, continues to expand, it is important for practicing surgeons to understand the magnitude of risk, potential consequences, and prevention methods with regard to VTE. VTE after shoulder surgery has been a topic of increasing interest over the past decade, and the purpose of this review is to examine the recent lite...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 29, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Challenges to Orthopaedic Resident Education.
Authors: LaPorte DM, Tornetta P, Marsh JL Abstract Orthopaedic resident educators confront many important issues. This may be the most challenging time yet for orthopaedic education. A survey of program directors and chairs aimed to identify the major challenges in orthopaedic education. Many issues were identified, and the following four major themes emerged: (1) loss of professionalism, (2) too much emphasis on procedures, (3) lack of clinical experience, and (4) challenges with external oversight. Professionalism in taking care of patients may be compromised by work-hour limitations and affected by generational ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 29, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Microinstability of the Hip-Gaining Acceptance.
Authors: Safran MR Abstract The hip has generally been considered an inherently stable joint. However, the femoral head moves relative to the acetabulum. Although the bones are primarily important in hip stability, the importance of the soft tissues has recently been demonstrated. Symptomatic microinstability of the hip is defined as extraphysiologic hip motion that causes pain with or without symptoms of hip joint unsteadiness and may be the result of bony deficiency and/or soft-tissue damage or loss. Recent work has helped improve the ability to identify microinstability patients preoperatively. Initial managemen...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 27, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Preoperative Opioid Use Among Patients Undergoing Shoulder Arthroplasty Predicts Prolonged Postoperative Opioid Use.
This study determines the incidence of opioid use before shoulder arthroplasty and analyzes its influence on postoperative use. METHODS: A retrospective analysis of patients undergoing shoulder arthroplasty with at least 2-year follow-up was performed. Then, at pre- and postoperative appointments, the patients were asked "Do you take narcotic pain medication (codeine or stronger)?" RESULTS: Among 490 patients included in the study, 35.5% reported preoperative opioid use. These patients had higher incidence of opioid use at 1-year follow-up (29.1% versus 4.9%; odds ratio, 8.320; P
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 27, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Deltoid Ligament Rupture in Ankle Fracture: Diagnosis and Management.
Authors: Lee S, Lin J, Hamid KS, Bohl DD Abstract The last stage of a supination-external rotation ankle fracture involves either transverse fracture of the medial malleolus or rupture of the deltoid ligament. When the deltoid ligament ruptures, a "bimalleolar equivalent" ankle fracture occurs, and the surgeon is presented with several diagnostic and therapeutic challenges. In the native ankle, the deltoid ligament provides restraint to eversion and external rotation of the talus on the tibia. In bimalleolar equivalent ankle fractures, there is often gross medial instability even after fibular reduction. ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 27, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Etiology, Evaluation, and Management Options for the Stiff Digit.
Authors: Catalano LW, Barron OA, Glickel SZ, Minhas SV Abstract The stiff digit may be a consequence of trauma or surgery to the hand and fingers and can markedly affect a patient's level of function and quality of life. Stiffness and contractures may be caused by one or a combination of factors including joint, intrinsic, extensor, and flexor tendon pathology, and the patient's individual biology. A thorough understanding of the anatomy, function, and relationship of these structures on finger joint range of motion is crucial for interpreting physical examination findings and preoperative planning. For most cases,...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 27, 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: Erratum.
Authors: PMID: 30461467 [PubMed - in process] (Source: The Journal of the American Academy of Orthopaedic Surgeons)
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 23, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Three Different Databases, Three Different Complication Rates for Knee and Hip Arthroplasty: Comparing the National Inpatient Sample, National Hospital Discharge Survey, and National Surgical Quality Improvement Program, 2006 to 2010.
CONCLUSION: The estimated complication rates from THA and TKA depend on which data source is used because of differences in data collection and sampling methodology. Similar differences may exist in other publications that use such secondary data sources. PMID: 30461517 [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 - November 23, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Effect of Obesity on the Development, Management, and Outcomes of Spinal Disorders.
Authors: Jain D, Berven S Abstract Obesity is a major public health issue in the United States, and rates of obesity continue to increase across the population. The association of obesity with degenerative spinal pathology underlies the observation that a substantial number of patients undergoing spine surgery are either overweight or obese. Obesity is a notable independent risk factor for both surgical and medical complications in the perioperative period and an important consideration in preoperative planning, intraoperative strategies, and postoperative management. Despite these increased risks, surgery in obese...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 23, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Mortality After Periprosthetic Femur Fractures During and After Primary and Revision Total Hip Arthroplasty.
CONCLUSION: Periprosthetic femur fractures are not associated with excess mortality among primary osteoarthritis patients. LEVEL OF EVIDENCE: Level III. PMID: 30461519 [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 - November 23, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Musculoskeletal-based Patient-reported Outcome Performance Measures, Where Have We Been-Where Are We Going.
This article reviews the current state of PROs and discusses future directions. Specifically, this article will review the current history and background of PROs; it will highlight the perspective of the National Quality Forum and review the efforts of the musculoskeletal community related to PROs. Goals, positive aspects, limitations, and barriers related to PROs will be discussed. Additionally, development considerations and strategies will be highlighted. Finally, development recommendations from the American Academy of Orthopaedic Surgery position statement "principles for musculoskeletal based PRO performance mea...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 23, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Biologic Adjuvants for the Management of Osteochondral Lesions of the Talus.
Authors: Hogan MV, Hicks JJ, Chambers MC, Kennedy JG Abstract Surgical techniques for the management of recalcitrant osteochondral lesions of the talus have improved; however, the poor healing potential of cartilage may impede long-term outcomes. Repair (microfracture) or replacement (osteochondral transplants) is the standard of care. Reparative strategies lead to production of fibrocartilage, which, compared with the native type II articular cartilage, has decreased mechanical and wear properties. The success of osteochondral transplants may be hindered by poor integration between grafts and host that results in ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 16, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Surgical Management of Neuromas of the Hand and Wrist.
Authors: Regal S, Tang P Abstract Neuromas of the hand and wrist are common causes of peripheral nerve pain. Neuromas are formed after the nerve sustains an injury, and they can be debilitating and painful. The diagnosis is made by a thorough history and physical examination. The treatment options are quite varied, but conservative measures tailored to the patient should be initiated first. No surgical treatment has been proven superior to others or to nonsurgical treatment. PMID: 30431503 [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 - November 16, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Necrotizing Soft-tissue Infections: An Orthopaedic Emergency.
Authors: Lee A, May A, Obremskey WT Abstract Necrotizing soft-tissue infections are caused by a variety of bacterial pathogens that may affect patients at any age or health status. This orthopaedic emergency initially presents with nonspecific signs such as erythema and edema. As the disease progresses, classic signs such as bullae, cutaneous anesthesia, ecchymosis, tense edema, and gas can be seen. A high level of suspicion is needed to properly identify and treat in a timely manner. Pain out of proportion to presentation and rapid progression even with appropriate antibiotic treatment should heighten suspicion of...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 16, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Comparing Standard Versus Extended Culture Duration in Acute Hip and Knee Periprosthetic Joint Infection.
CONCLUSION: Extended culture duration in acute hip and knee PJIs did not change the rate of culture-negative PJI, identify more patients with polymicrobial PJI, or improve the success of surgical treatment. The only difference was a higher incidence of P acnes growth, but contaminants or indolent chronic PJI cannot be excluded. Although extended culture growth may be indicated in acute shoulder arthroplasty PJI, its utility in hip or knee arthroplasty may be limited. Higher-level studies will be needed to address this in the future. PMID: 30431505 [PubMed - as supplied by publisher] (Source: The Journal of the American...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 16, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Interventions for Distal Radius Fractures: A Network Meta-analysis of Randomized Trials.
CONCLUSIONS: A network meta-analysis of randomized trials revealed that open reduction and internal fixation with a plate offers the best results for adult patients with a distal radius fracture, in terms of early and sustained functional recovery and a reduction in fracture healing complications. Determining whether one approach to PF or plate design is superior requires further study. PMID: 30431506 [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 - November 16, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Upper Extremity Immobilization and Driving: Limitations and Liability.
Authors: Chong PY, Golinvaux NS, Lee DH Abstract Orthopaedic injuries of the upper extremity remain common, often requiring prolonged immobilization after surgical or nonsurgical management. Upper extremity immobilization often has a profound effect on a patient's daily life, including one's ability to safely operate a motor vehicle. Current literature on the safety of driving while immobilized is varied, although above-elbow immobilization of the upper extremity is generally thought to present a particular hazard to safe driving. Unfortunately, as common as this situation is, currently little to no guidance exists...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 16, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Ten- and 20-year Survivorship of the Hip After Periacetabular Osteotomy for Acetabular Dysplasia.
Authors: Ziran N, Varcadipane J, Kadri O, Ussef N, Kanim L, Foster A, Matta J Abstract INTRODUCTION: Acetabular dysplasia is a multifactorial condition characterized by a shallow hip socket with predisposition to osteoarthritis of the hip. The Bernese periacetabular osteotomy (PAO), developed by Reinhold Ganz in 1984, reorients the dysplastic hip joint to provide more uniform coverage of the femoral head and to extend the longevity of the native hip. Since 1987, the senior author performed the Bernese PAO on more than 430 patients. We performed a cross-sectional retrospective study on this cohort of patients to det...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 16, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Congenital Tibial Deficiency.
Authors: Litrenta J, Young M, Birch JG, Oetgen ME Abstract Congenital tibial deficiency is a rare condition characterized by partial to complete absence of the tibia, an intact but frequently overgrown fibula, variable degrees of knee deformity and function, and an abnormal equinovarus foot. It can occur in isolation but also presents concurrently with other orthopaedic anomalies and syndromic conditions. Among these, congenital abnormalities of the hand and femur are most commonly observed. Many theories exist regarding its etiology and some genetic mutations have been identified; however, the underlying mechanism...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 13, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Insurance Status Affects Complication Rates After Total Hip Arthroplasty.
This study evaluates the effect of patient insurance status on complications after primary elective THA using the Nationwide Inpatient Sample. METHODS: All patients undergoing primary elective THA from 1998 to 2011 were included. Patient demographics, comorbidities, and complications were collected and compared based on insurance type. Multivariable logistic regression and a matched cohort analysis were performed. RESULTS: About 515,037 patients (53.7% Medicare, 40.1% private insurance, 3.9% Medicaid/uninsured, and 2.2% other) were included, who underwent elective THA. Privately insured patients had fewer medical c...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 13, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

AAOS Appropriate Use Criteria: The Management of Developmental Dysplasia of the Hip in Infants up to Six Months of Age: Intended for Use by Orthopaedic Specialists.
Authors: Schaeffer E, Lubicky J, Mulpuri K PMID: 30418271 [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 - November 13, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

AAOS Appropriate Use Criteria: The Management of Developmental Dysplasia of the Hip in Infants up to 6 Months of Age: Intended for Use by General Pediatricians and Referring Physicians.
Authors: Schaeffer E, Lubicky J, Mulpuri K PMID: 30418272 [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 - November 13, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Economic and Outcomes Analysis of Recalcitrant Cervical Radiculopathy: Is Nonsurgical Management or Surgery More Cost-Effective?
This study directly compares the economical and clinical effectiveness of the use of cervical epidural injections and continued physical therapy versus surgical management in cases of cervical radiculopathy that have failed 6 weeks of conservative management. METHODS: A theoretical cohort of patients with cervical radiculopathy resistant to 6 weeks of noninvasive conservative management were simulated to treatment with either anterior cervical diskectomy and fusion (ACDF) or cervical epidural injections and continued physical therapy and analyzed with Markov chain decision tree Monte Carlo simulation. RESULTS: The ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 10, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Thromboelastography for the Orthopaedic Surgeon.
Authors: Hagedorn JC, Bardes JM, Paris CL, Lindsey RW Abstract Evaluation of coagulation is vital in the care of the orthopaedic patients, particularly in the subspecialties of trauma, spine, arthroplasty, and revision surgery resulting from blood loss and coagulopathies. Although conventional tests (prothrombin time/international normalized ratio, activated partial thromboplastin time, platelet count, and fibrinogen) are most commonly used, others like thromboelastography (TEG) are also available to the orthopaedic surgeons. TEG is a blood test developed in the 1950s, which provides a snapshot of a patient's coagu...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 10, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Medial Unicompartmental Arthroplasty of the Knee.
Authors: Jennings JM, Kleeman-Forsthuber LT, Bolognesi MP Abstract Indications for medial unicompartmental knee arthroplasty (UKA) have expanded over the past two decades. Proposed advantages include faster recovery, improved kinematics, and better functional outcomes compared with total knee arthroplasty (TKA) in age-matched control subjects. A focused preoperative examination and imaging is essential to identify appropriate surgical candidates. No difference has been demonstrated between fixed- and mobile-bearing implants for implant survivorship or patient-reported outcomes. The most common reasons for conversio...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 10, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Course of the Femoral Artery in the Mid- and Distal Thigh and Implications for Medial Approaches to the Distal Femur: A CT Angiography Study.
DISCUSSION: A wide safe zone exists in the medial distal femur. The artery crosses the midsagittal axis of the medial femur an average of 18.8 cm proximal to the adductor tubercle. PMID: 30407980 [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 - November 10, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Scheuermann's Kyphosis: Diagnosis, Management, and Selecting Fusion Levels.
Authors: Sardar ZM, Ames RJ, Lenke L Abstract Scheuermann's kyphosis (SK) is a rigid structural deformity of the thoracic spine defined radiographically as three or more contiguous vertebrae with at least 5° of wedging anteriorly. Prevalence of the disease is thought to be between 0.4% and 10%. The true cause of SK remains unclear; however, various theories include growth irregularities, mechanical factors, genetic factors, and/or poor bone quality as the causes. Patients with mild disease (less than 70°) generally have a favorable prognosis with good clinical outcomes. Most patients with SK are successfull...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 10, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Biplane Double-supported Screw Fixation of Femoral Neck Fractures: Surgical Technique and Surgical Notes.
This report aims at describing a detailed and modified surgical technique and providing criteria and recommendations for its successful application according to the clinical experience over more than 9 years. LEVEL OF EVIDENCE:: Level V, expert evidenceThis is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. PMID: 30399029 [PubMed - as supplied by ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 8, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Inappropriate Questions Asked of Female Orthopaedic Surgery Applicants From 1971 to 2015: A Cross-sectional Study.
DISCUSSION: The present study suggests that over half of female applicants have been asked inappropriate questions at orthopaedic surgery residency interviews, and that there has been no improvement in that percentage over nearly five decades. It is the responsibility those interviewing to be aware of this issue and to be in compliance with national guidelines. LEVEL OF EVIDENCE: Level IV. PMID: 30399030 [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 - November 8, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Contemporary Management of Appendicular Skeletal Metastasis by Primary Tumor Type.
Authors: Johnson CN, Gurich RW, Pavey GJ, Thompson MJ Abstract Skeletal metastases exert a profound effect on patients and society, and will be encountered by most orthopedic surgeons. Once a primary malignancy is diagnosed, multidisciplinary management should focus on maximizing the quality of life while minimizing disease- and treatment-related morbidity. This may be best achieved with discerning attention to the unique characteristics of primary cancer types, including pathologic fracture healing rates, longevity, and efficacy of adjuvant therapies. Some lesions may respond well to nonsurgical measures, whereas ...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 6, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

External Fixation in the Emergency Department for Pilon and Unstable Ankle Fractures.
CONCLUSION: No statistically significant differences were found in postsurgical complications (surgical or infectious) or ex-fix revision rates for the ED ex-fix group and the OR ex-fix group. Results indicate that uniplanar ex-fix may be safely applied in the ED. LEVEL OF EVIDENCE: Level III, therapeutic. PMID: 30394911 [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 - November 6, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

A Comprehensive Review of Physical Examination Tests of the Cervical Spine, Scapula, and Rotator Cuff.
Authors: Hippensteel KJ, Brophy R, Smith MV, Wright RW Abstract A thorough physical examination of the shoulder and cervical spine is critical in establishing a focused differential diagnosis of the pathology in and around the shoulder joint. Numerous tests have been described in the literature to help improve the diagnostic accuracy of specific shoulder or cervical spine pathology. A comprehensive approach for the physical examination of the cervical spine, scapula, and rotator cuff is presented and descriptions on how the tests are performed and the evidence behind why specific tests are used in enabling improved...
Source: The Journal of the American Academy of Orthopaedic Surgeons - November 3, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

Comprehensive Review of Provocative and Instability Physical Examination Tests of the Shoulder.
This article assesses provocative and instability examination tests of the shoulder. Descriptions on how the tests are performed and their diagnostic accuracy are presented. PMID: 30383578 [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 - November 3, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

The Application of Medicare Data for Musculoskeletal Research in the United States: A Systematic Review.
DISCUSSION: Medicare claims data provide a unique way for researchers to study a nationally representative patient population longitudinally. A significant limitation of using claims data has been a lack of granularity on defining severity of a condition. LEVEL OF EVIDENCE: Therapeutic level III. PMID: 30379756 [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 - November 2, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research

The Effect of Length of Stay and Discharge Disposition on Hospital Consumer Assessment of Healthcare Providers and Systems Scores in Orthopaedic Patients.
DISCUSSION: Shorter LOS and discharge to home after orthopaedic surgery are associated with better HCAHPS scores. Earlier discharge leads to an improved patient-reported experience and can increase reimbursements. Expedient, appropriate discharge of hospitalized orthopaedic patients should be a treatment goal after orthopaedic surgery. PMID: 30379757 [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 - November 2, 2018 Category: Orthopaedics Tags: J Am Acad Orthop Surg Source Type: research