The Iowa orthopaedic journal最新文献

{"title":"Outcomes Following Primary Anterior Cruciate Ligament Reconstruction Using a Partial Transphyseal (Over-the-Top) Technique in Skeletally Immature Patients.","authors":"Alan G Shamrock,&nbsp;Kyle R Duchman,&nbsp;William T Cates,&nbsp;Robert A Cates,&nbsp;Zain M Khazi,&nbsp;Robert W Westermann,&nbsp;Matthew J Bollier,&nbsp;Brian R Wolf","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The incidence of anterior cruciate ligament (ACL) injuries in skeletally immature patients is increasing, with ACL reconstruction preferred in this population due to reported chondroprotective benefits. Due to concerns with growth disturbance following ACL reconstruction in skeletally immature patients, various physealsparing and partial transphyseal techniques have been developed. Currently, there is no consensus on the most effective ACL reconstruction technique in skeletally immature patients. The purpose of the current study was to report the outcomes of a partial-transphyseal over-the-top (OTT) ACL reconstruction in a cohort of skeletally immature patients.</p><p><strong>Methods: </strong>All patients with radiographic evidence of open tibial and femoral physes that underwent primary ACL reconstruction using a partial-transphyseal OTT technique between 2009-2018 at a single tertiary-care institution with at least twelve months of clinical follow-up were retrospectively reviewed. Patient demographics, physical examination findings, graft ruptures, return to sport, and Tegner activity levels were analyzed. Statistical significance was defined as p<0.05.</p><p><strong>Results: </strong>Overall, 11 males and 1 female (12 knees) with a mean age of 12.8±1.8 (range: 10-16) years were included in the study. The mean postoperative follow-up of the cohort was 2.3±1.2 (range: 1.1-5.2) years. All ACLs were reconstructed with hamstring autograft with allograft augmentation utilized in a single patient. There were two cases of ACL graft rupture (16.7%). All patients were able to return to the same or higher level of sporting activity at an average of 7.4+2.7 months. There were no cases of clinically significant longitudinal or angular growth disturbance.</p><p><strong>Conclusion: </strong>Partial transphyseal ACL reconstruction using a transphyseal tibial tunnel and an extra-articular OTT technique on the femur in skeletally immature patients affords minimal risk of growth disturbance with a graft rupture rate consistent with what has been reported in this high-risk population. All patients were able to return to sport at the same or higher level. <b>Level of Evidence: IV</b>.</p>","PeriodicalId":35582,"journal":{"name":"The Iowa orthopaedic journal","volume":" ","pages":"179-186"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210405/pdf/IOJ-42-01-179.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40597507","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":"Accelerated Return to Play in Professional Basketball Players With Surgically-Treated Metacarpal Shaft Fractures.","authors":"Harin B Parikh,&nbsp;Mojca C Herman,&nbsp;Steven S Shin","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Traditional rehabilitation protocols for surgically treated metacarpal shaft fracture allow for return to play at 6-8 weeks post-operative. This may be devastating for the elite athlete. We outline a protocol that may allow for professional basketball players to successfully return to sport within four weeks following surgery.</p><p><strong>Methods: </strong>Professional basketball players who sustained non-thumb metacarpal shaft fractures were included. All athletes underwent open reduction and internal fixation of the injured metacarpal. Patients were subsequently enrolled into an accelerated rehabilitation protocol.</p><p><strong>Results: </strong>The five athletes in our case series successfully passed return to sport testing within four weeks of surgery.</p><p><strong>Conclusion: </strong>A plate and screw construct can potentially allow for professional basketball players to return to play in half the time. Future research studies should include a larger pool of athletes to further investigate accelerated rehabilitation following surgical fixation of metacarpal fractures. <b>Level of Evidence: IV</b>.</p>","PeriodicalId":35582,"journal":{"name":"The Iowa orthopaedic journal","volume":" ","pages":"201-206"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210427/pdf/IOJ-42-01-201.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40497221","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":"Surgical Hip Dislocation for a Diagnostic Dilemma: Differentiating Synovial Chondromatosis and Pigmented Villonodular Synovitis.","authors":"Aliya G Feroe,&nbsp;Mahad M Hassan,&nbsp;Mitchell S Fourman,&nbsp;Megan E Anderson,&nbsp;Young-Jo Kim","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Pigmented villonodular synovitis (PVNS) and synovial chondromatosis (SC) of the hip are rare synovial diseases that can induce joint destruction without early diagnosis and treatment. The extent of surgical excision is critical given the high rates of recurrence. In the presented case, a 19-year-old female was referred to our institution with progressive left hip pain and radiologic evidence of an intra-articular mass that was consistent with PVNS versus SC. Her medical history was notable for a prior excision of a fibrous lesion at an outside hospital at age 13 with persistent pain. The patient underwent a surgical hip dislocation approach to obtain near-complete visualization of the femoroacetabular joint, ensuring complete evaluation and excision. The tumor was intraoperatively diagnosed as SC and excised accordingly, during an uneventful operation. Pathology confirmed the diagnosis. The essential diagnostic and surgical steps for the management of this pelvic tumor diagnostic dilemma are described. <b>Level of Evidence: V</b>.</p>","PeriodicalId":35582,"journal":{"name":"The Iowa orthopaedic journal","volume":" ","pages":"263-265"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210434/pdf/IOJ-42-01-263.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40497224","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":"Department of Orthopedics and Rehabilitation Faculty 2021-2022.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":35582,"journal":{"name":"The Iowa orthopaedic journal","volume":" ","pages":"viii"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210392/pdf/IOJ-42-01-viii.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40497759","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 Graduating Fellows.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":35582,"journal":{"name":"The Iowa orthopaedic journal","volume":" ","pages":"xiv"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210411/pdf/IOJ-42-01-xiv.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40610387","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":"Does Aspirin Provide Adequate Chemoprophylaxis for Venous Thromboembolic Events in Operative Pelvic and Acetabular Fractures?","authors":"Kathryn B Metcalf,&nbsp;Jerry Y Du,&nbsp;George Ochenjele","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Several strategies exist to prevent venous thromboembolism (VTE) in operative pelvic and acetabular fractures, however literature lacks consensus on the optimal thromboprophylaxis. Even more debated, and perhaps controversial, is whether aspirin provides adequate thromboprophylaxis in the setting of these injuries. The primary objective was to evaluate the efficacy of aspirin in the prevention of venous thromboembolism (VTE) events, including deep vein thrombosis (DVT) and pulmonary embolism (PE) in operative pelvic and acetabular fractures compared to other anticoagulants.</p><p><strong>Methods: </strong>A retrospective chart review of pelvic and acetabular fractures that underwent operative fixation was completed. The incidence of VTE and hematoma formation was evaluated and compared between patients who received aspirin versus enoxaparin or heparin. Multivariate analysis was performed to control for confounding demographic, comorbidity, and injury-related variables. The outcome measurements included development of DVT and/or PE and hematoma formation.</p><p><strong>Results: </strong>Of patients with operative pelvic and acetabular fractures, 4.2% developed a DVT and 3.5% developed a PE, with 1.4% developing both. Of these patients 37.5% were treated with aspirin versus the 62.5% treated with heparin or enoxaparin. There was no significant difference in the incidence of DVT or PE between cohorts (p=0.498 and p=0.262). Aspirin trended toward significance as protective against post-operative hematoma (p=0.085).</p><p><strong>Conclusion: </strong>This study suggests that aspirin is an acceptable method of VTE thromboprophylaxis with no inferior results to other common anticoagulants used in operative pelvis and acetabular fractures. As a chemoprophylactic agent, aspirin is an efficacious option in these complex injuries that shows no increase in the incidence in symptomatic VTE events. <b>Level of Evidence: III</b>.</p>","PeriodicalId":35582,"journal":{"name":"The Iowa orthopaedic journal","volume":" ","pages":"83-88"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210404/pdf/IOJ-42-01-083.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40610392","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":"Clean or Dirty? A Systematic Review of Splash Basin Use and Its Infectious Potential in Orthopaedic Surgery.","authors":"Kevin Rezzadeh,&nbsp;Harin Parikh,&nbsp;Isabella Guanche,&nbsp;Eytan Debbi,&nbsp;Sean Rajaee,&nbsp;Ran Schwarzkopf,&nbsp;Guy Paiement","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Splash basins are used in orthopaedic surgery cases to wash and hold instrumentsintraoperatively. This systematic review aims to summarize information on contamination of splash basins intraoperatively.</p><p><strong>Methods: </strong>A systematic review was conducted using the following search terms: \"splash basin\" or \"splash bucket.\" Two authors independently reviewed the literature. Studies were included if they reported on intraoperative splash basin contamination rates. Studies were excluded if they were not relevant to orthopaedic surgery, non-English articles, or repeat studies yielded by different online databases.</p><p><strong>Results: </strong>There were seven studies included in this review. The median contamination rate of sterile water or physiologic saline splash basins was 23.9% [range: 2%-74%]. The addition of surgical antiseptics to sterile water splash basins was associated with 0% contamination rates in two studies. The most frequent splash basin contaminants identified in bacterial culture were coagulase negative staphylococcus (50%) and staphylococcus aureus (10%).</p><p><strong>Conclusion: </strong>The splash basin appears to be a frequent source of contamination in the operating room. Many studies suggest abandoning splash basin use altogether, although the efficacy of alternative methods such as cleaning instruments with lap pads in avoiding contamination of the sterile field has not been studied. Further investigation into surgical teams' use of the splash basin and the contents of the splash basin as they relate to contamination rates may help advance our understanding of optimal use of this surgical tool. Shorter case durations and dilute surgical antiseptics in splash basins appear associated with lower splash basin contamination risk. <b>Level of Evidence: V</b>.</p>","PeriodicalId":35582,"journal":{"name":"The Iowa orthopaedic journal","volume":"42 2","pages":"82-89"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9769359/pdf/IOJ-2022-082.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9486907","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":"Patient Reported Outcomes After Conversion vs. Primary Total Hip Arthroplasty: A Propensity Matched Analysis.","authors":"Jason S Lipof,&nbsp;Brittany E Haws,&nbsp;David A Quinzi,&nbsp;Benjamin F Ricciardi,&nbsp;Kyle T Judd","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Conversion total hip arthroplasty (cTHA) is increasingly utilized as a salvage procedure for complications associated with fracture fixation around the hip and acetabulum and for failed hip preservation surgery. While primary THA (pTHA) has a high success rate, little is known about outcomes following conversion THA. The purpose of this study is to evaluate patient reported outcomes (PROs) and complication rates following conversion THA compared to primary THA.</p><p><strong>Methods: </strong>Patients that underwent cTHA or pTHA from 2015-2020 at a large tertiary referral academic center were retrospectively identified. THA patients were propensity matched in a 1:1 fashion by age, body mass index (BMI), and sex. Pain scores and PROMIS physical function (PF), pain interference (PI), and depression (DA) scores were compared at preoperative and final postoperative follow up timepoints using independent t-tests. Differences in complication and reoperation rates between cohorts were assessed using chi square analysis.</p><p><strong>Results: </strong>A total of 118 THAs (59 cTHA, 59 pTHA) were included in this analysis with an average follow up of 21.3 months. cTHAs were most commonly performed following hip fracture fixation (50.8%). The conversion cohort had significantly longer lengths of stay (3.6 days vs 1.9 days, p<0.01) and greater use of revision-type implants (39.0% vs 0.0%, p<0.01) compared to pTHA. There was no significant difference in complication rates (cTHA = 15.3%, pTHA = 8.5%; p=0.26), with intraoperative fracture being the most common for both. Primary and conversion THA groups also experienced similar reoperation rates (cTHA = 5.1%, pTHA = 6.8%; p=0.70). No significant differences in PROs at final follow up were identified between groups.</p><p><strong>Conclusion: </strong>Patients undergoing cTHA required increased utilization of revision hip implants and had longer lengths of stay, but had comparable complication and reoperation rates, and ultimately demonstrated similar improvements in PROMIS scores compared to a matched cohort of pTHA patients. <b>Level of Evidence: III</b>.</p>","PeriodicalId":35582,"journal":{"name":"The Iowa orthopaedic journal","volume":"42 2","pages":"47-52"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9769348/pdf/IOJ-2022-047.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9471041","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":"Delayed Onset Post-Operative Neurologic Deficit in a Patient With Mucopolysaccharidosis type VI: A Case Report.","authors":"Christopher Lindsay,&nbsp;Joshua Holt,&nbsp;Stuart Weinstein","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Mucopolysaccharidoses (MPS) are lysosomal storage disorders characterized by abnormal deposition of glycosaminoglycans (GAGs) in tissues. In type VI MPS, otherwise known as Maroteaux-Lamy syndrome, the defect is in the enzyme N-acetylgalactosamine-4-sulfatase. Thoracolumbar kyphosis results from GAG deposition, leading to incompetence of posterior ligamentous structures as well as poor trunk control. Though neurologic symptoms from canal compression due to deformity and hypertrophy of tissues have been described, occasionally requiring surgical decompression, there has not been a prior report of late onset of symptoms in a previously neurologically intact patient following surgery to correct spine deformity.</p><p><strong>Methods: </strong>The case reviewed is a 14 year old girl with mucopolysaccharidosis type VI underwent anterior release and posterior instrumentation for correction of severe progressive lumbar kyphosis. Postoperatively she developed delayed onset of profound lower extremity weakness and underwent urgent wide laminectomies and resection of thickened ligamentum flavum. At 1 year follow-up, she had near complete neurologic recovery.</p><p><strong>Conclusion: </strong>Patients with mucopolysacchari-doses are at significant risk for neurologic compromise both as part of the natural history of the disease, and as a risk of deformity correction. The surgeon must consider the pathologic thickening of tissues surrounding the spinal cord when planning surgery. <b>Level of Evidence: IV</b>.</p>","PeriodicalId":35582,"journal":{"name":"The Iowa orthopaedic journal","volume":"42 2","pages":"122-127"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9769351/pdf/IOJ-2022-122.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9471042","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":"Total Knee Arthroplasty: A Quantitative Assessment of Online Patient Education Resources.","authors":"Trevor R Gulbrandsen,&nbsp;Mary Kate Skalitzky,&nbsp;Sarah E Ryan,&nbsp;Burke Gao,&nbsp;Alan G Shamrock,&nbsp;Timothy S Brown,&nbsp;Jacob M Elkins","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Patients often turn to the online resources to learn about orthopedic procedures. As the rate of joint arthroplasty is projected to increase, the corresponding interest in relevant online education material will increase as well. The American Medical Association (AMA) and National Institutes of Health (NIH) recommend that publicly available online health information be written at the 6th grade or lower reading level to be fully understood by the average adult in the United States. Additionally, educational resources should be written such that readers can process key information (understandability) or identify available actions to take (actionability). The purpose of this study was to quantify the readability, understandability, and actionability of online patient educational materials regarding total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>The most common Google™ search term utilized by the American public was determined to be \"knee replacement\". Subsequently two independent online searches (Google.com) were performed. From the top 50 search results, websites were included if directed at educating patients regarding TKA. Non-text websites (audiovisual), articles (news/research/industry), and unrelated resources were excluded. Readability was quantified using the following valid objective algorithms: Flesch-Kincaid Grade-Level (FKGL), Simple Measure of Gobbledygook (SMOG) grade, Coleman-Liau Index (CLI), and Gunning-Fog Index (GFI). PEMAT was utilized to assess understandability and actionability (0-100%; score ≥70% indicates acceptable scoring). The relationship between search rank with FKGL and PEMAT scores was quantified.</p><p><strong>Results: </strong>A total of 34 (68%) unique websites met inclusion criteria. The mean FKGL, SMOG, CLI, and GFI was 11.8±1.6, 11.1±1.2, 11.9±1.4, and 14.7±1.6, respectively. None of the websites scored within the acceptable NIH/AMA recommended reading levels. Mean understandability and actionability scores were 54.9±12.1 and 30.3±22.0. Only 5.9% (n=2) and 9.2% (n=1) of websites met the ≥70% threshold for understandability and actionability. Only 29.4% (n=10) sources used common language and only 26.9% (n=9) properly defined complicated medical terms. Based on website type, the mean understandability scores for academic institution, private practice, and health information publisher websites were 57.2±8.8%, 52.6±11.1%, and 54.3±15.3% (p=0.67). Readability (rho: -0.07; p=0.69), understandability (rho: -0.02; p=0.93), and actionability (rho: -0.22; p=0.23) scores were not associated with Google™ search rank.</p><p><strong>Conclusion: </strong>TKA materials scored poorly with respect to readability, understandability, and actionability. None of the resources scored within the recommended AMA/NIH reading levels. Only 5.9% scored adequately on understandability measures. Substantial efforts are needed to improve online resources to optimize patient comprehension and fac","PeriodicalId":35582,"journal":{"name":"The Iowa orthopaedic journal","volume":"42 2","pages":"98-106"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9769358/pdf/IOJ-2022-098.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9486909","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}