JAAOS Global Research & Reviews最新文献

{"title":"Atraumatic Displaced Femoral Neck Fracture Postpartum: A Case Report and Review of the Literature","authors":"Samantha Tayne, David Fralinger, Arif Ali","doi":"10.5435/JAAOSGlobal-D-19-00037","DOIUrl":"https://doi.org/10.5435/JAAOSGlobal-D-19-00037","url":null,"abstract":"Hip pathology during pregnancy may include transient osteoporosis of the hip or osteonecrosis associated with pregnancy. Rarely, hip pathology during pregnancy may result in a fragility fracture or advanced collapse of the femoral head, necessitating surgical treatment. We present a case of a 32-year-old woman who postpartum was found to have a displaced right femoral neck fracture and an area of focal edema in the left femoral head with mild flattening of the articular surface. She was successfully treated with a total hip arthroplasty on the right, and a follow-up MRI of the left hip showed near-complete resolution of the edema in the femoral head. This case underlines the importance of maintaining a clinical suspicion for pathology of the hip during pregnancy and the subsequent consequences of a missed diagnosis.","PeriodicalId":145112,"journal":{"name":"JAAOS Global Research & Reviews","volume":"44 12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131132770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kyphectomy in Myelomeningocele for Severe Early-Onset Kyphosis Using Distal Intravertebral Fixation and Thoracic Growing Rods","authors":"K. S. Alshaalan, Jason J. Howard, Ahmed Khaled Alshangiti, Y. Alkhalife, S. Aleissa, S. A. Al Sayegh","doi":"10.5435/JAAOSGlobal-D-19-00006","DOIUrl":"https://doi.org/10.5435/JAAOSGlobal-D-19-00006","url":null,"abstract":"Background: Most kyphectomy techniques require distal dissection of the bifid posterior spinal elements for implants placement in the thoracolumbar/pelvic regions, traversing the scarred tissue associated with previous MMC closure, thereby theoretically increasing the risk of wound complications. The Halifax kyphectomy technique avoids the MMC scar but does not reliably facilitate thoracic growth for early-onset kyphosis. This study aims to report the technique and outcomes of a combined Halifax kyphectomy (resection of the apical vertebrae with distal anterior multilevel vertebral body fixation) and thoracic growing rod construct used to treat early-onset symptomatic gibbus in a patient with myelomeningocele (MMC). Methods: A 3-year-old girl with a thoracic MMC presented with symptomatic gibbus requiring surgical intervention. Correction by the Halifax kyphectomy technique combined with spine-based growing rods was performed. Results: After the correction, the skin was closed primarily without the need for any flap for coverage. No wound complications or infection occurred post-operatively. The intraoperative blood loss was 200 mL, and the surgical time was 419 minutes. No pulmonary complications occurred postoperatively. At the final follow-up at 3 years 11 months postoperatively, the child had no recurrence of the deformity. Conclusions: The combination of distal anterior multilevel vertebral body fixation with spine-based thoracic growing rods can successfully achieve kyphosis correction in MMC, with the potential to reduce complication rates and facilitate thoracic growth. Further investigation is necessary to prove whether the outcomes and the complication rates are superior to other established techniques.","PeriodicalId":145112,"journal":{"name":"JAAOS Global Research & Reviews","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129460621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Goal-directed Quality Improvement Initiative to Reduce Opioid Prescriptions After Orthopaedic Procedures","authors":"K. Choo, T. Grace, Krishn Khanna, J. Barry, Erik N. Hansen","doi":"10.5435/JAAOSGlobal-D-19-00109","DOIUrl":"https://doi.org/10.5435/JAAOSGlobal-D-19-00109","url":null,"abstract":"Introduction: Orthopaedic surgeons are increasingly aware of deleterious effects of the opioid epidemic and the association between overprescription and diversion toward nonmedical opioid use or substance abuse. Opiate prescriptions at the time of hospital discharge have been identified as target for intervention. This study describes the successful outcome of a goal-directed intervention aimed at decreasing opioid overprescription by providing routine feedback to providers regarding their prescribing patterns. Methods: The amount of opioid medications, quantified as oral morphine equivalents (OMEs), provided to opioid-naive adult patients on discharge after orthopaedic surgery was prospectively collected. As part of an institutional quality improvement initiative, medical providers received reports every 2 months detailing median discharge OMEs prescribed, trended over time. After 6 months, a retrospective comparison was done between preintervention and intervention patient cohorts. Results: There were 401 patients in the preintervention cohort and 429 patients in the intervention cohort. Both groups were similar in regard to age, sex, rates of depression, surgical time, length of stay, orthopaedic subspecialty, and inpatient opioid requirement before discharge. Patients in the intervention cohort were prescribed markedly fewer opioid medications by 25%, equivalent to 20 tablets of 5-mg oxycodone IR (450 versus 600 OMEs, P < 0.001). Despite these opioid medications, opioid refill rates during the first 90 days after discharge did not markedly change between groups. Discussion: It is critical to judiciously treat postoperative pain while avoiding opioid overprescription. This study demonstrated the outcome of a goal-directed initiative to decrease overprescription of opioid medications. The initiative reduced discharge opioid prescriptions yet did not increase the risk of requiring a prescription refill in the postoperative period. This indicates that such an approach can result in opioid reduction, while still providing appropriate care and pain control for patients.","PeriodicalId":145112,"journal":{"name":"JAAOS Global Research & Reviews","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116738508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sciatic Nerve Palsy After Distal Femoral Traction for Vertically Unstable Pelvic Fracture in a Neurologically Intact Patient","authors":"Brenton G. Albracht, Mark Jenkins","doi":"10.5435/jaaosglobal-d-19-00045","DOIUrl":"https://doi.org/10.5435/jaaosglobal-d-19-00045","url":null,"abstract":"Vertically unstable fractures of the pelvis require a notable amount of energy to cause disruption of the posterior elements of the pelvic ring. Superior migration of the hemipelvis demonstrates the inherent instability of this fracture pattern. Surgical fixation is required in most cases, but while resuscitation efforts are underway, placing the patient in skeletal traction to reduce the hemipelvis is often recommended. Although skeletal traction has been described in many sources, no consensus exists on the amount of weight that should be used. This has led to anecdotal recommendations that vary between institutions. Without clear guidelines for treatment, a vertically translated hemipelvis was overreduced and subsequently sustained a sciatic nerve palsy in a patient who was neurologically intact on presentation. We aim to describe a rare complication of skeletal traction and propose a treatment algorithm to reduce the incidence of future complications.","PeriodicalId":145112,"journal":{"name":"JAAOS Global Research & Reviews","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123633376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Youth Kicker's Knee: Lateral Distal Femoral Hemiphyseal Arrest Secondary to Chronic Repetitive Microtrauma","authors":"Michael Dempewolf, Kevin Kwan, Benjamin Sherman, J. Schlechter","doi":"10.5435/JAAOSGlobal-D-19-00079","DOIUrl":"https://doi.org/10.5435/JAAOSGlobal-D-19-00079","url":null,"abstract":"Year-round competitive sports place the youth athlete at risk for injury from chronic repetitive stress. Stress injuries to the distal femoral physis in adolescents are rare. This report highlights three male youth soccer players who presented with a lateral distal femoral hemiphyseal arrest and a subsequent unilateral genu valgum deformity in their dominant “kicking leg” due to repetitive microtrauma, a phenomenon we refer to as youth kicker’s knee. Mean age was 14.2 years, and all participated in year-round soccer and American football. Imaging demonstrated aberration of the distal lateral femoral physis. All patients were surgically treated. Our series illustrates a unique presentation of a chronic overuse injury in hyper sporting adolescents resulting in an ipsilateral genu valgum deformity. Understanding adolescent growth and developmental characteristics is paramount to appropriate care, prevention, and treatment of physeal injuries that may occur from repetitive overuse and avoid surgery in these young athletes when possible.","PeriodicalId":145112,"journal":{"name":"JAAOS Global Research & Reviews","volume":"358 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115945028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Haitian Orthopaedic Residency Exchange Program","authors":"Robert E. Belding, G. Grabowski, Kevin A. Williams, K. Mobley, C. Bray, S. Woolf, Patrick Jumelle, David Koon","doi":"10.5435/JAAOSGlobal-D-19-00027","DOIUrl":"https://doi.org/10.5435/JAAOSGlobal-D-19-00027","url":null,"abstract":"Background: After a devastating earthquake in Haiti in 2010, multiple South Carolinian orthopaedic teams, funded by the South Carolina Orthopedic Association (SCOA), developed an exchange program for Haitian residents. Methods: SCOA teams have sequentially logged their patient experiences since 2015 for a total of six updates per year. These logs were reviewed in detail to evaluate clinical results in terms of case volumes, cases performed, follow-up obtained, and complications. Results: Twenty-one orthopaedic attendings, 19 South Carolina orthopaedic residents, 22 Haitian orthopaedic residents, and 22 ancillary staff have rotated through Hospital Lumiere. The teams have seen over 2000 patients in the orthopaedic clinic and performed 554 surgeries, including 207 fractures (half of which being open), 24 nonunion and 7 malunion repairs, 15 lower extremity amputations, 27 hemiarthroplasties for femoral neck fractures, and 34 cases of chronic osteomyelitis. Discussion: The SCOA Foundation has developed a coordinated service for the musculoskeletal needs of the Haitian people while collaboratively elevating the standard of orthopaedic training in Haiti. We report a collaborative model that other US residency programs can use to impart beneficial changes not only in their home program, but also in training programs abroad.","PeriodicalId":145112,"journal":{"name":"JAAOS Global Research & Reviews","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125684059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plate-assisted Bone Segment Transport With Motorized Lengthening Nails and Locking Plates: A Technique to Treat Femoral and Tibial Bone Defects","authors":"U. Olesen, T. Nygaard, Daniel E. Prince, Matthew P. Gardner, Upender M. Singh, M. McNally, C. Green, J. Herzenberg","doi":"10.5435/JAAOSGlobal-D-19-00064","DOIUrl":"https://doi.org/10.5435/JAAOSGlobal-D-19-00064","url":null,"abstract":"Background: This article describes a new bone transport technique for femoral and tibial bone defects using lengthening nails combined with locking plates. We term it plate-assisted bone segment transport (PABST). Methods: Nine patients with five femoral and four tibial bone defects from open fractures or malignancies were treated between 2016 and 2018. Mean femoral defect length was 9.3 cm (range 7 to 11.5). Mean tibial defect was 8.9 cm (range 4.8 to 15). The patients were evaluated for time to weight bearing, consolidation index, mechanical axis deviation, and limb length discrepancy. Results: Seven of nine patients have fully consolidated. The mean consolidation time was 6.6 months. The consolidation index was 0.9 (femur) and 1.26 (tibia) mo/cm. Two patients required supplementary lengthening. One patient had mild varus, one mild valgus; the remainder had a normal mechanical axis. Limb length discrepancy remained acceptable in all patients. The main complications were heterotopic ossification, delayed healing, and reduced knee motion. Conclusion: Bone transport with lengthening nails and locking plates is an effective and patient-friendly way of treating bone defects, eliminating the adverse effects of external fixation and reducing treatment time. The plate provides stability during transport and docking; it can address concomitant fractures and facilitates acute shortenings.","PeriodicalId":145112,"journal":{"name":"JAAOS Global Research & Reviews","volume":"306 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123124081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Sleep Position for Possible Nightly Aggravation and Delay of Healing in Tennis Elbow","authors":"J. Gorski","doi":"10.5435/JAAOSGlobal-D-19-00082","DOIUrl":"https://doi.org/10.5435/JAAOSGlobal-D-19-00082","url":null,"abstract":"Introduction: Tennis elbow symptoms are reportedly most severe in the morning, which prompted a search for a pathological process while asleep. A “pathological sleep position” was hypothesized that repetitively aggravates an elbow lesion if the arm is overhead and pressure is on the lateral elbow. This hypothesis was tested by using a restraint to keep the arm down while asleep. Methods: This study was a retrospective review. All patients were advised to use a restraint to keep the arm down at night. The presence of the restraint in the morning was correlated with the subjective report. The control group consisted of the noncompliant patients. Results: Compliance and subjective improvement was documented in 33 of 39 patients (85%). Subjective improvement was reported by 66% of the compliant patients after 1 month. Pain continued after the first 3 months only in 6 of 39 noncompliant patients (15%). Discussion: In this pilot study, patients who kept the arm down at night improved, whereas patients who were noncompliant continued to be symptomatic. Sleep position should be considered as a possible aggravating factor that delays healing of an acute injury and results in chronic pain. If validated, keeping the arm down at night can be recommended for tennis elbow.","PeriodicalId":145112,"journal":{"name":"JAAOS Global Research & Reviews","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129674004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstracts Accepted for Presentation at Orthopaedic Trauma or Arthroplasty Conferences: Which Conference Is the Best Indicator of Future Publication?","authors":"Eric Potter, Isaac Fernandez, Meghan Fillinger, D. Potter, M. Nguyen, Michael S Reich","doi":"10.5435/JAAOSGlobal-D-19-00020","DOIUrl":"https://doi.org/10.5435/JAAOSGlobal-D-19-00020","url":null,"abstract":"Introduction: Time and financial resources pose limitations to orthopaedic surgeons wishing to advance their orthopaedic knowledge, and surgeons frequently must choose one meeting to attend. We sought to determine whether abstracts presented at the American Academy of Orthopaedic Surgeons (AAOS) annual meeting or the trauma (Orthopaedic Trauma Association [OTA]) or arthroplasty (American Association of Hip and Knee Surgeons [AAHKS]) subspecialty meetings, respectively, were higher yield with respect to material ultimately being published. We hypothesized that papers accepted by AAOS would demonstrate higher conversion to publication compared with OTA and AAHKS but expected abstract publication rates from OTA and AAHKS to be similar. Methods: All clinical and preclinical abstracts from the trauma and total joint arthroplasty subspecialties presented at the AAOS, OTA, and AAHKS annual meetings in 2015 were evaluated. Data collected included the current status of the publication, journal and publication date, time to publication, and country of origin (United States or international). Results: There were 516 (N = 213, AAOS; N = 303, OTA) trauma and 711 (N = 470, AAOS; N = 241 AAHKS) arthroplasty poster and podium presentations. When comparing publication rates in trauma, no significant difference was observed in overall publication rates between AAOS and OTA at 57.2% (N = 122 published) and 60.4% (N = 183 published), respectively (P = 0.54). In addition, no significant difference was observed in overall publication rates in arthroplasty between AAOS and AAHKS, with publication rates of 65.3% (N = 307 published) and 59.8% (N = 144 published), respectively (P = 0.17). Of abstracts that were published, AAHKS arthroplasty abstracts were more likely to be published in The Journal of Arthroplasty (JOA, 69.4%) compared with OTA trauma abstracts published in the Journal of Orthopaedic Trauma (JOT, 33.3%), P < 0.001. Conclusion: The overall publication rates, along with publication rates to premiere subspecialty journals, is indicative of forefront research being presented at the three annual meetings. Given the comparable research quality of OTA and AAHKS abstracts, the AAOS meeting appears to provide the highest yield for surgeons with more generalized practices or practices spanning multiple subspecialties.","PeriodicalId":145112,"journal":{"name":"JAAOS Global Research & Reviews","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128380589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paradoxical Embolization of the Bilateral Subclavian Arteries After High Tibial Osteotomy","authors":"Takahito Miyake, O. Obayashi, A. Kanda, Hideshi Okada, S. Ogura, K. Kaneko","doi":"10.5435/JAAOSGlobal-D-19-00044","DOIUrl":"https://doi.org/10.5435/JAAOSGlobal-D-19-00044","url":null,"abstract":"A patent foramen ovale provides a portal through which a thrombus might pass from the right side of the circulation to the left. A 65-year-old man underwent high tibial osteotomy after the diagnosis of the right knee osteoarthritis. On postoperative day 12, he developed bilateral arm paresthesia. Enhanced CT revealed emboli in the bilateral pulmonary and subclavian arteries and deep vein thrombosis in the left lower limb. Transesophageal echocardiography after treatment revealed a patent foramen ovale during the Valsalva maneuver. It was thought that bilateral arm paresthesias were caused by the arterial emboli in the bilateral subclavian arteries.","PeriodicalId":145112,"journal":{"name":"JAAOS Global Research & Reviews","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130201584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}