Journal of Orthopaedic Experience & Innovation最新文献

{"title":"Risk Factors for Unexpected Hospital Admission Following Achilles Tendon Repair: A National Database Study","authors":"John M. Tarazi, Matthew J. Partan, Areil Aminov, Alain E. Sherman, A. Bitterman, Randy M. Cohn","doi":"10.60118/001c.68116","DOIUrl":"https://doi.org/10.60118/001c.68116","url":null,"abstract":"Achilles tendon rupture (ATR) repair is one of the most common orthopaedic surgeries performed in the United States, however there is a paucity of literature on predisposing risk factors for hospital readmissions. The purpose of this study is to identify risk factors for 30-day readmission in patients undergoing ATR repair with emphasis on procedures performed in the outpatient setting. Specifically, we examine: 1) 30-day post-operative hospital readmission rates; 2) the medical comorbidities and patient characteristics that predisposed this cohort to post-operative complications; and 3) the complications leading to readmission.  The ACS-NSQIP was queried for patients who underwent ATR from 2015 to 2019 using CPT code 27650 in all fields yielding a sample size of 3,887 cases. The following demographic, lifestyle, and comorbidity variables were recorded: age, sex, race, BMI, morbid obesity (BMI ≥ 40.00 kg/m2), bleeding disorders, chronic obstructive pulmonary disease (COPD), diabetes mellitus, hypertension, tobacco use, and chronic steroid use. The primary outcome of 30-day readmission was defined as unplanned hospital readmission likely related to the principal procedure. Independent samples Student’s t-tests, chi-squared, and, where appropriate, Fisher’s exact tests were used in univariate analyses to identify demographic, lifestyle, and peri-operative variables related to 30-day readmission following ATR. Multivariate logistic regression modeling was subsequently performed. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated and reported. Of the 3,887 patients included in our sample, 28 were readmitted within the 30-day post-operative period, corresponding to a readmission rate of 0.73%. Significant relationships with univariate analyses between readmission status and the following patient variables included: mean patient age (p = 0.02); hypertension (p < 0.001); BMI (p = 0.01); morbid obesity (p = 0.002); ASA Classification (p = 0.006); and bleeding disorders (p = 0.03). Multivariate logistic regression modeling confirmed that the following patient variables were associated with statistically significantly increased odds of readmission: age, p = 0.02), OR = 1.03, 95% CI [1.01, 1.06]; hypertension, p < 0.001, OR = 3.82, 95% CI [1.81, 8.06]; BMI, p = 0.01, OR = 1.06, 95% CI [1.01, 1.11]; morbid obesity, p = 0.004, OR = 3.53, 95% CI [1.49, 8.36]. Our study indicated that only 0.73% of patients were readmitted after their outpatient procedure. Patients who: 1) have BMIs greater than 40; 2) are older in age 3) have hypertension; and 4) a higher ASA Classification were at increased risk for readmission.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience &amp; Innovation","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115165147","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":"Factors Influencing the Decision to Pursue Multiple Fellowships Following Graduation from Orthopaedic Surgery Residency","authors":"Andrew W Antes, Victoria K. Ierulli, Lisa K. Cannada, M. Mulcahey","doi":"10.60118/001c.68316","DOIUrl":"https://doi.org/10.60118/001c.68316","url":null,"abstract":"Among practicing orthopaedic surgeons, the population that self-identify as generalists has been declining for the past three decades, while sub-specialization has become more prevalent. As more residents are pursuing fellowship training, some elect to complete multiple fellowships, but due to a lack of research, there is a lack of insight into the reasons behind these decisions. The purpose of this study was to determine factors influencing the decision of orthopaedic surgery residents to pursue more than one fellowship following graduation from residency. An anonymous survey was distributed via email to all PGY-4 and PGY-5 orthopaedic surgery residents who had matched into one or more fellowships in the spring of 2021 and 2022. Responses were analyzed to determine the prevalence of different specialties, reasons for pursuing fellowship, and among those pursuing more than one fellowship, the reasons they chose to do so. 259 responses were collected from residents entering a fellowship, with 74 (28.6%) entering fellowships in the Midwest, 54 (20.8%) in the Southwest, 51 (19.7%) in the Northeast, 42 (16.2%) in the Southwest, and 32 (12.4%) in the West. 19 (7.3%) respondents reported matching into two or more fellowships. Among the fellowships pursued, sports medicine was most popular with 10 (52.6%) respondents; followed by shoulder/elbow (5; 26.3%). Out of all 259 respondents, 252 (97.3%) indicated their fellowship choices were based on interest, and 192 (74.1%) were also affected by marketability. Mentorship played a role for 173 (66.8%) and training in an area of deficiency was important for 149 (57.5%). Among those pursuing multiple fellowships, many combinations seem to have been made to decrease the time to breaking even on the financial investment involved in pursuing fellowships after residency. Most orthopaedic surgery residents elect to pursue fellowship training due to personal interest in the field, as well as to increase their marketability, and shorten the time to breaking even in comparison to the loss of compensation required for pursuing fellowship. Our results indicate that residents pursuing multiple fellowships are those interested in less marketable specialties, who then pursue a second fellowship with higher returns on investment, such as completing fellowships in pediatrics and sports medicine.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience &amp; Innovation","volume":"140 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123332911","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":"Stemless Shoulder Arthroplasty for Glenohumeral Arthritis with Underlying Varus Malunion of the Proximal Humerus - A Case Report with Mid-Term Follow Up","authors":"K. Setter, Salvatore M Cavallaro, D. Jann, N. Setter","doi":"10.60118/001c.55784","DOIUrl":"https://doi.org/10.60118/001c.55784","url":null,"abstract":"We present a 65 year old right hand dominant female with a varus malunion of her right proximal humerus who went on to develop post-traumatic arthritis of her right glenohumeral joint refractory to years of conservative management. Due to inability to pass a stemmed humeral implant as well as concerns associated with a proximal humerus osteotomy, we performed a total shoulder arthroplasty using a stemless humeral implant. We present mid-term follow up at six years showing excellent range of motion, excellent functional scores, and radiographs. This is one of the only US based studies to our knowledge to report mid-term data on clinical and radiographic outcomes for the use of a stemless humeral implant during a total shoulder arthroplasty in the setting of a proximal humerus deformity","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience &amp; Innovation","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127494067","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":"Robotic Assisted Total Knee Arthroplasty in Arthrofibrosis or the Preoperatively Stiff Knee: A Case Report","authors":"Brandon Passano, Jacob Becker, J. Koenig","doi":"10.60118/001c.70174","DOIUrl":"https://doi.org/10.60118/001c.70174","url":null,"abstract":"Total knee arthroplasty (TKA) for arthrofibrosis or preoperatively stiff knees can present a set of difficult problems that challenge both the patient and surgeon. Patients with limited preoperative range of motion (ROM) are inherently at risk for worse outcomes. Prior literature has demonstrated the utility of robotic-assisted TKA (raTKA) regarding gap balancing and coronal deformity, however it has not been previously described in context of the preoperatively stiff knee. Here, we report a case of a patient undergoing primary TKA for severe osteoarthritis with significant preoperative stiffness resulting in severely limited ROM of only 5 degrees. This was performed with the use of a navigated raTKA system in conjunction with dynamic predictive balancing technology. With this method, the knee was balanced through bony cuts without the need for extensive soft tissue releases. This patient had excellent improvement in ROM and KOOS Scores at 3-month follow up. This patient’s early post-operative results demonstrate the potential benefits of utilizing raTKA for preoperative stiff knees and may lay groundwork for future literature.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience &amp; Innovation","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121384410","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":"New reconstructive option in chronic distal biceps ruptures. A case report.","authors":"Miguel Tovar-Bazaga, María Pérez-Cuesta Llaneras, A. Badia","doi":"10.60118/001c.72645","DOIUrl":"https://doi.org/10.60118/001c.72645","url":null,"abstract":"Distal biceps ruptures usually present as an acute injury. Difficulties in treatment happen when the presentation is delayed, becoming a real challenge. We present a case report of a young bodybuilder who suffered a distal biceps rupture with 35 days of treatment’s delay. A surgical distal biceps reconstruction was performed. Due to prolonged chronology, a surgical repair was not possible. An acellular dermal matrix was used as a graft in order to reconstruct the retracted and frayed tendon. Intraoperative and one year follow-up clinical photos are presented showing full range of motion. Chronic distal biceps rupture is a challenging issue. A sterile acellular dermal matrix, used with a meticulous surgical technique, has shown a strong reconstruction with promising functional outcomes.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience &amp; Innovation","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131132524","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 Use of Virtual Reality Training in Preparation for Reverse Total Shoulder Arthroplasty – A Case Report","authors":"Brianne Handal, Samuel Shine, Madison M. Messmer, Adam Dann","doi":"10.60118/001c.68117","DOIUrl":"https://doi.org/10.60118/001c.68117","url":null,"abstract":"","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience &amp; Innovation","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121917386","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":"Treatment of a comminuted patella fracture with a patella rim plate- a case report.","authors":"Olusegun Onibonoje, M. Ayzenberg","doi":"10.60118/001c.71398","DOIUrl":"https://doi.org/10.60118/001c.71398","url":null,"abstract":"Patella fractures with comminution present a difficult challenge to the orthopedic surgeon. The use of a rim plate technique as a novel low profile method for the surgical management of comminuted patellar fractures provides the ability to minimize soft tissue irritation, hardware prominence, stable construct, and preservation of the patella in cases of comminution while achieving post operative goals of attainment of knee range of motion and ambulatory function.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience &amp; Innovation","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116184379","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 Effect of Community Type on Access to Orthopedic Services for Medicaid-Insured Patients","authors":"Feyikemi Ogunfuwa, Matthew Zinner, A. Lavin, Austin W. Hansen, Payton Yerke-Hansen, Devin Q. John, Carlos A. Fernandez, Clyde K. Fomunung, V. Sabesan","doi":"10.60118/001c.67848","DOIUrl":"https://doi.org/10.60118/001c.67848","url":null,"abstract":"Medicaid-insured patients have less access to specialty care compared to those who are privately insured. Limited and delayed access to orthopaedic services can affect patient outcomes, especially for patients living in rural areas. The purpose of this study was to evaluate the effect of community setting in access to orthopaedic care for Medicaid-insured patients. The study population included board-certified orthopaedic specialists obtained from the American Academy of Orthopaedic Surgeons (AAOS) within five Florida counties, representing urban and rural communities. Investigators used the Secret Shopper methodology to schedule an appointment for a rotator cuff repair. Medicaid acceptance rate, wait time, and average distance to clinics accepting Medicaid were calculated and compared between urban and rural counties. Of the 108 clinics identified, 76.9% performed arthroscopic rotator cuff repair. The appointment rate across all counties was 100% (n=83) for privately insured patients and 9.6% (n=8) for Medicaid patients. There was no significant difference in access when comparing access to care with Medicaid in urban and rural counties (p=0.984). Medicaid patients had significantly shorter wait times in rural counties compared to urban counties (p=0.021). Rural counties encountered a significantly greater average travel distance to clinics accepting Medicaid compared to urban counties (p=0.042). Medicaid-insured patients have limited access to orthopaedic care, regardless of community setting. Medicaid-insured patients in rural counties were more likely to have shorter wait times to the appointment and travel longer distances to clinics.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience &amp; Innovation","volume":"97 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131688657","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":"Number of Stairs at Home is Associated with Discharge to Post-Acute Care Facility Following Total Knee Arthroplasty","authors":"Jaques Williams, M. Held, Mouhanad M. El Othmani, Alexander L. Neuwirth, J. Geller, H. Cooper, R. Shah","doi":"10.60118/001c.67847","DOIUrl":"https://doi.org/10.60118/001c.67847","url":null,"abstract":"Discharge to post-acute care facility (PACF) carries significant cost and quality burdens to patients undergoing total knee arthroplasty (TKA). In a recent study of pre-bundled payment model patients, the number of stairs (NOS) at home did not influence discharge to PACF for total hip arthroplasty. However, no study has yet examined NOS as it relates to discharge destination after TKA. In a large metropolitan market, it is not uncommon to have several flights of stairs leading to a home. We hypothesize that the number of unavoidable stairs to enter a home is a significant risk factor for discharge to PACF. We reviewed 557 patients who underwent elective TKA at a single urban academic medical center between November 2011 and October 2014. Demographic data as well as NOS, ASA score, RAPT score, LOS, operative time, and tranexamic acid use were collected. T-tests, ANOVA, and Kruskal-Wallis analysis were conducted followed by a logistic regression to compare associations of factors to discharge to PACF. Of the 540 patients included in analysis, 193 (35.7%) were discharged home and 347 (64.3%) were discharged to a PACF. NOS (OR=1.457, p<0.001) and increased age (OR=1.057, p<0.001) were found to be significant risk factors for discharge to PACF while female sex (OR=0.57, p=0.013) and higher RAPT scores (OR=0.83, p=0.004) were protective against discharge to PACF. With the conclusion of recent bundled payment programs, financial carrots may disappear, though it is likely that sticks will remain. Therefore, all risk factors must be identified and addressed. We found, in a pre-bundled payments era, that stairs is a risk factor for non-home discharge in a metropolitan population, and we confirmed other known risk factors of older age, higher ASA score, and lower RAPT score.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience &amp; Innovation","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123729116","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 Majority of Orthopaedic Surgery Residency Faculty in the United States are Allopathic Males","authors":"Rachel A. Ranson, T. Peabody, Christopher Saker, A. Lucido, Jiateng Lin, Arianna L. Gianakos, M. Stamm, M. Mulcahey","doi":"10.60118/001c.57673","DOIUrl":"https://doi.org/10.60118/001c.57673","url":null,"abstract":"There is a paucity of information regarding the demographic characteristics of faculty at Accreditation Council for Graduate Medical Education (ACGME) orthopaedic surgery residency programs. The purpose of this study was to determine the demographics and education training of all current orthopaedic surgery residency program faculty members. We hypothesized that there would be a sex discrepancy among orthopaedic surgery faculty, and that there would be fewer DO (Doctor of Osteopathic Medicine) than MD (Medical Doctor) orthopaedic surgeons in academic medicine. The Fellowship and Residency Electronic Interactive Database was used to identify all orthopaedic surgery residency programs in the United States. The following information was collected from each program website: faculty sex, degree, academic role, administrative title, and subspecialty. Faculty roles, titles, and subspecialties were compared across type of institution, degree earned, and sex using Chi squared and Analysis of Variance (ANOVA). Of the 4,325 faculty members identified, 3,893 were male (90%) and 4,033 were MDs (93%). The most common subspecialty was sports medicine (789, 18%). While traditional ACGME programs still had more MD faculty (3,728, 97.5%) (p<0.001), the majority of faculty at traditional American Osteopathic Association (AOA) programs were also MDs (305, 61%). There were more male DOs than male MDs (95.6% vs. 89.3%, p<0.001). More DOs practiced general orthopaedics (14.8% vs. 4.1%), whereas more MDs practiced upper extremity and orthopaedic oncology (p<0.001). More male faculty practiced adult reconstruction (616, 15.8%), trauma (489, 12.6%), spine (471, 12.1%), and sports medicine (719, 18.5%), whereas more female faculty practiced pediatrics (135, 31.3%), upper extremity (100, 23.1%), and oncology (33, 7.6%). More male faculty held titles as chair of orthopaedic surgery (145, 3.7%) and fellowship director (111, 2.9%) than females (5, 1.2% and 5, 1.2%). Males were also listed as assistant professor (1057, 27.2% vs 188, 43.5%), associate professor (636, 16.3% vs 86, 19.9%), and professor (618, 15.9% vs 41, 9.5%) more commonly than females. The current faculty of orthopaedic surgery residency programs is heavily male dominated, holding higher academic roles and administrative titles than women. There is also a high prevalence of MDs with higher academic roles and administrative titles than DOs.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience &amp; Innovation","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125133441","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}