The Iowa orthopaedic journal最新文献

{"title":"Malnutrition is Common and Increases the Risk of Adverse Medical Events in Older Adults With Femoral Fragility Fractures.","authors":"Brady R Wilkinson,&nbsp;Qiang An,&nbsp;Natalie Glass,&nbsp;Aspen Miller,&nbsp;John Davison,&nbsp;Michael C Willey","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Femoral fragility fractures are one of the most common injuries managed by orthopedic surgeons. Malnutrition influences the poor outcomes observed in this population. Our purpose was to assess the annual trends of malnutrition diagnosis and determine risk factors for malnutrition and complications in patients 65 years and older presenting with femoral fragility fractures. We hypothesized that malnutrition would increase the risk of postoperative wound infection, wound dehiscence, non-union, and mortality.</p><p><strong>Methods: </strong>The PearlDiver database was reviewed from 2010 to 2020. Patients ≥ 65-years-old with femur fractures treated with operative fixation were identified by CPT code. A preoperative diagnosis of malnourished state was defined by ICD-9 and ICD-10 codes and patients were divided into malnourished and non-malnourished cohorts. Patients were tracked for one year following operative fixation of a femoral fragility fracture for the occurrence of infection, wound dehiscence, nonunion and mortality. The rates of these complications were compared between malnourished and nonmalnourished cohorts.</p><p><strong>Results: </strong>There were 178,283 total femoral fragility fractures identified in patients aged 65-years or older. The overall prevalence of malnutrition diagnosis in this geriatric population was 12.8%. Documented malnutrition in femoral fragility fractures increased from 1.6% to 32.9% from 2010-2020 (P<0.0001). Compared to patients without malnutrition, patients with malnutrition are at increased risk of mortality (OR 1.31, 95% CI 1.2558 - 1.3752, p < 0.0001), are more likely to develop a wound infection (OR 1.49; 95% CI 1.252 - 1.7626; p < 0.0001), more likely to have a wound dehiscence (OR 1.55; 95% CI 1.3416 - 1.7949; p < 0.0001), and more likely to develop non-union (1.89; 95% CI 1.6946 - 2.1095; p < 0.0001). Multiple demographic variables were associated with malnutrition diagnosis including higher age, higher Charlson Comorbidity Index, female sex, dementia, and institutionalization. Parkinson's disease, feeding difficulty and institutionalization demographic variables had the highest risk of malnutrition.</p><p><strong>Conclusion: </strong>The current study found that malnutrition diagnosis significantly increases the risk of adverse medical events in elderly adults with femoral fragility fractures. The rates of malnutrition increased steadily from 2010-2020. This trend is likely a result of increased awareness and testing for malnutrition, not reflecting an actual increased prevalence of malnutrition. Multiple expected demographic variables are associated with diagnosis of malnutrition. <b>Level of Evidence: III</b>.</p>","PeriodicalId":35582,"journal":{"name":"The Iowa orthopaedic journal","volume":" ","pages":"69-74"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210413/pdf/IOJ-42-01-069.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40587932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2022 IOJ Editors' Note.","authors":"Trevor Gulbrandsen,&nbsp;Malynda Wynn","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":35582,"journal":{"name":"The Iowa orthopaedic journal","volume":" ","pages":"iv"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210396/pdf/IOJ-42-01-iv.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40587937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician-Patient Communication in the Orthopedic Clinic: Surgeon-Identified Challenges.","authors":"Olivia C O'Reilly, Alan G Shamrock, Marcy Rosenbaum, Charles R Clark, Brendan M Patterson","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Effective communication between the physician and the patient is crucial to quality healthcare. The orthopedic surgery clinic setting provides an environment for cultivating the physician-patient relationship, eliciting diagnostic data, and developing treatment strategies. However, little is known about the orthopedic surgeon perspective on communicating with patients. The purpose of the study was to identify patient communication and care issues faced in the orthopedic surgery clinic setting that physicians categorize as challenging.</p><p><strong>Methods: </strong>All surgeons in the department of orthopedics in a large tertiary care center were invited to respond to an online survey on common communication challenges. Physicians were asked to rate 13 challenges identified by the literature and opinion leaders using a four-point Likert scale ranging from \"Not at all challenging\" to \"Extremely challenging\". In addition, the survey included open ended questions regarding common challenges in communicating with patients and types of encounters, and thematic analysis was applied. Mean scores were calculated.</p><p><strong>Results: </strong>Nineteen orthopedic surgeons completed the survey and were included in the analysis. Orthopedic surgeons identified misaligned expectations for surgical intervention for a nonsurgical diagnosis as the most challenging encounter in the clinic (16/19). Managing postoperative patient expectations (14/19) and communicating with patients who were dissatisfied with their surgical outcome (13/19) were also commonly rated as particularly challenging. Open ended responses echoed these ratings and additional difficulty facilitating patient understanding of complex information as common communication challenges.</p><p><strong>Conclusion: </strong>Common challenges in the orthopedic clinic often surround managing patient expectations and providing effective explanations, particularly where physicians perceive a surgical intervention as inappropriate for addressing the patient complaint. Identifying these issues can guide training efforts to help orthopedic physicians in managing these and improving communication. These findings can also provide basis for collecting information about communication challenges from orthopedic surgeons across institutions. <b>Level of Evidence: IV</b>.</p>","PeriodicalId":35582,"journal":{"name":"The Iowa orthopaedic journal","volume":" ","pages":"275-281"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210441/pdf/IOJ-42-01-275.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40497223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Do We Do About US News?","authors":"Benjamin J Miller","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":35582,"journal":{"name":"The Iowa orthopaedic journal","volume":" ","pages":"15-17"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210415/pdf/IOJ-42-01-015.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40587938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Orthopaedic Surgical Training on Body Composition.","authors":"Michael C Marinier,&nbsp;Trevor R Gulbrandsen,&nbsp;Jacob M Elkins","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Residency is known to consist of rigorous training that has contributed to increased rates of resident burn out, depression, and suicide. There have been recent efforts to attempt to combat and solve the rising levels of mental health concerns amongst physicians and physicians in training. While studies have examined the adverse effects of medical training on mental health, few have examined the associated changes in physical health. This study aimed to identify and compare baseline body composition and hand grip strength of orthopaedic surgery residents. The second aim was to identify and compare changes that may occur over the course of the training program.</p><p><strong>Methods: </strong>First year orthopaedic surgery residents (\"interns\") were recruited to undergo body composition measurements via bioimpedance analysis (BIA) during their first, third, and twelfth month of post-graduate training. At each interval, three hand-grip-strength measurements per hand were captured. Additionally, orthopaedic surgery residents who had already completed their first year (\"non-interns\") were recruited to undergo baseline and 12-month BIA for comparison.</p><p><strong>Results: </strong>Six interns and six non-interns were recruited. The interns lost 2.88 ± 4.26 kg (-3.31% ± 4.75%) of their initial body mass with most of the loss being body fat mass (1.97 ± 2.62 kg) by three months. Interns recovered a fair amount of mass loss by 12 months with a net change of -0.78 ± 3.14 kg (-1.09% ± 3.90%). Non-interns experienced an overall net weight gain (1.20 ± 3.64 kg; 1.68% ± 5.55%) over the same period. Intern HGS changed by -1.92 ± 2.49 kg and 3.39 ± 2.34 kg at 3- (n=6) and 12-months (n=3), respectively.</p><p><strong>Conclusion: </strong>This study demonstrates that there is an appreciable decrease in overall body mass, lean tissue mass, and body fat throughout the orthopaedic resident's intern year. The results demonstrate an initial fall in each body metric and strength by 3-months followed by partial recovery by 12-months. This pattern contrasts the average gain of body mass in each measured metric by non-interns. This study is limited by population sizes and by incompleteness of HGS data. <b>Level of Evidence: II</b>.</p>","PeriodicalId":35582,"journal":{"name":"The Iowa orthopaedic journal","volume":" ","pages":"31-34"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210408/pdf/IOJ-42-01-031.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40497225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Accuracy of Wrist Intra-articular Needle Placement Via Ulnocarpal Approach by Training Level: A Cadaveric Study.","authors":"Sierra Phillips, Megan Lameka, Christopher Beaumont, Nileshkumar Chaudhari, Jared Halstrom, James Rush Jones, Nicholas A Andrews, Ashish Shah","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Intra-articular injections are a standard therapy and diagnostic tool for a variety of wrist conditions. Accurate needle placement is crucial for proper therapeutic benefit and prevention of complications. While some studies claim accurate needle placement requires imaging, others conclude that anatomical guidance is sufficient. This study aimed to evaluate the accuracy of intra-articular wrist needle placement with the ulnocarpal approach across differing levels of training using clinical anatomy alone.</p><p><strong>Methods: </strong>Fourteen fresh-frozen, above-elbow cadaveric specimens were used. Intra-articular needle placement into the wrist via an ulnocarpal approach was attempted by nine study participants: two interns, two junior-level residents, two senior-level residents, two hand fellows, and one attending hand surgeon. Each injection was performed based on clinical examination and landmarks alone. The number of attempts and total time taken for each injection was recorded.</p><p><strong>Results: </strong>Overall success rate was 71%, (89 of 126 attempts) and did not vary significantly across levels of training. Average time for needle placement among all participants was 10.9 ± 6.5 seconds. Timing of successful intra-articular needle placement (10.4 ± 5.2 seconds) significantly differed between levels. However, timing did not trend in any direction with more or less training. No significant difference was noted in total attempts or attempts with successful outcomes when comparing level of training.</p><p><strong>Conclusion: </strong>The ulnocarpal approach is a viable option for injection or aspiration of the wrist without image guidance. We were unable to show any relevant trends with timing or number of attempts in comparison to level of training. <b>Level of Evidence: V</b>.</p>","PeriodicalId":35582,"journal":{"name":"The Iowa orthopaedic journal","volume":" ","pages":"207-211"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210423/pdf/IOJ-42-01-207.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40587936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Large Number of Reviews on Physician Rating Websites May Reflect Reputation Management.","authors":"Shyam Ramachandran, David Ring, David Langerhuizen, Gregg Vagner","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Physicians with a large number of reviews and a high rating may be employing reputation management strategies. Specialists may be more likely than non-specialists to employ such strategies. This should be apparent in a study of online physician reviews on physician rating websites (PRW).</p><p><strong>Methods: </strong>Using one physician rating website, we gathered orthopedic surgeon and family physician reviews. We measured Spearman correlations between the number of reviews and average numerical rating and used chi-squared to test threshold relationships.</p><p><strong>Results: </strong>There were very small negative Spear-man correlations between the number of online reviews and the average numerical rating for orthopedic surgeons (p= -0.097, p-value=<0.001) family medicine physicians (p= -0.170, p-value=<0.001; Figure 2). Physicians with more than 100 reviews had a greater average numerical rating than physicians with fewer than 50 reviews. Orthopedic surgeons are more likely than family medicine physicians to have a large number of reviews and average numerical rating greater than 3.</p><p><strong>Conclusion: </strong>The small fraction of physician with a high number of reviews may be utilizing reputation management strategies, and this seems relatively specific to specialists rather than non-specialists. <b>Level of Evidence: III</b>.</p>","PeriodicalId":35582,"journal":{"name":"The Iowa orthopaedic journal","volume":" ","pages":"283-286"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210437/pdf/IOJ-42-01-283.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40610389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Face Masks on the Doctor-Patient Relationship in Orthopaedics.","authors":"Shivani Pandya,&nbsp;Anil B Sedani,&nbsp;Alina Syros,&nbsp;Ramakanth R Yakkanti,&nbsp;Seth D Dodds,&nbsp;Amiethab A Aiyer","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Since the onset of the COVID-19 pandemic, the widespread use of face masks has grown exponentially. There is limited data highlighting the patient perception of face mask use during this pandemic, specifically in orthopaedic clinics. The purpose of this study was to determine the patient's perception of the implementation of face masks in the orthopaedic clinic during a period of mask mandates and if this change impacted the success of their interactions with physicians. The secondary aim includes measures of patient satisfaction such as the ability to understand conversation and communicate effectively with the physician.</p><p><strong>Methods: </strong>Participants were recruited on the day of their appointment at our institution's orthopaedic clinic and provided with instructions via email. The online, anonymous survey included the CARE questionnaire - a tool to examine patient satisfaction by assessing perception of empathy and was conducted using Qualtrics.</p><p><strong>Results: </strong>Does patient preference to have their physician wear a face mask impact the success of their interactions with physicians? Overall, the use of face masks by physicians did not negatively impact patient encounters. CARE scores for patients who preferred masks (37.2) were similar to those who preferred their physician did not wear a mask (37.5). Is patient satisfaction affected by the use of face masks in the orthopaedic clinic? Patients who preferred that their doctor wear a face mask stated that it had no negative impact on the effect of communication or conversation with the physician. Other factors such as how well the patients knew the physician and patient gender had a greater impact on the CARE score than masks did.</p><p><strong>Conclusion: </strong>Our study determined that the preference of face masks by patients does not impact the success of their interactions with physicians using the CARE score. The findings of this study are valuable in informing orthopaedic physicians about patient attitudes towards mask use and could influence decision making for not only the COVID-19 pandemic, but also future infectious outbreaks that may arise. <b>Level of Evidence: III</b>.</p>","PeriodicalId":35582,"journal":{"name":"The Iowa orthopaedic journal","volume":" ","pages":"267-273"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210425/pdf/IOJ-42-01-267.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40584877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Local Recurrence of Soft Tissue Sarcoma Revisited: Is there a Role for \"Selective\" Radiation?","authors":"Nathan E Saxby,&nbsp;Qiang An,&nbsp;Benjamin J Miller","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Radiation therapy (RT) is often utilized in cases of high-grade soft tissue sarcoma (STS), but there remain situations where treatment is with surgical excision alone. Our goals were to determine (1) the local recurrence (LR) rate with and without perioperative RT and (2) associations between local recurrence, patient, tumor, and treatment variables.</p><p><strong>Methods: </strong>We performed a retrospective review of 165 consecutive STS patients. A Cox proportional hazards model was used to investigate variables associated with local recurrence.</p><p><strong>Results: </strong>LR occurred in 15/78 (19%) without RT, 4/29 (14%) with postoperative RT, and 0/58 with preoperative RT (p=0.002). We found increased rates of local recurrence at 24 months for myxofibrosarcoma (p=0.001) and no-RT (p=0.003). Myxofibrosarcoma accounted for 33 (20%) of the study patients and 12 (63%) of the local recurrences.</p><p><strong>Conclusion: </strong>The LR rate in patients treated with surgery alone was disproportionately attributable to myxofibrosarcoma (11/23 cases, 48%). Other subtypes demonstrated a lower rate of LR in the absence of RT (4/55 cases, 7%), and no LR occurred when final margins were >2 mm. In certain circumstances treatment with a negative margin surgical resection followed by close observation is justifiable. RT is effective and should continue to be considered routinely in myxofibrosarcoma or when surgical margins are inadequate. <b>Level of Evidence: III</b>.</p>","PeriodicalId":35582,"journal":{"name":"The Iowa orthopaedic journal","volume":" ","pages":"239-248"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210402/pdf/IOJ-42-01-239.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40584878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2022 Dedication of the Iowa Orthopedic Journal: Professor Jose A. Morcuende.","authors":"Joseph A Buckwalter,&nbsp;J Lawrence Marsh,&nbsp;Malynda Wynn,&nbsp;Kari Nickols","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":35582,"journal":{"name":"The Iowa orthopaedic journal","volume":" ","pages":"v"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210400/pdf/IOJ-42-01-v.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40584880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}