Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews最新文献

{"title":"Predictive Factors for Failed Nonsurgical Management of Long Bone Metastasis and Myeloma.","authors":"Yixuan A Pei, Jaret M Karnuta, Joshua A Jones, Bradley Griffith, Lori Jia, Barzin Behzad, Kristy L Weber, Cara A Cipriano","doi":"10.5435/JAAOSGlobal-D-24-00362","DOIUrl":"10.5435/JAAOSGlobal-D-24-00362","url":null,"abstract":"<p><strong>Background: </strong>Understanding the risk factors for failing nonsurgical management of metastatic bone disease is necessary to determine those patients who will benefit from prophylactic stabilization; however, standard predictive models do not include several clinically relevant factors. The primary and secondary objectives of this study were to evaluate comprehensive patient- and disease-related factors as potential predictors of failure of radiation therapy alone for long bone lesions and overall survival in metastatic disease and myeloma.</p><p><strong>Methods: </strong>All patients who underwent radiation therapy for long bone metastases at our tertiary care institution from May 2011 to February 2020 were retrospectively reviewed. Of 475 lesions, we excluded those with prophylactic fixation or fracture before radiation therapy, and those <0.5 cm on plain radiographs. Outcomes of the 186 lesions were classified as no progression, progression requiring prophylactic fixation, or progression to pathologic fracture. Blinded radiograph review was done by two orthopaedic oncology surgeons and two musculoskeletal radiologists. Demographic, socioeconomic, lesion, cancer severity, and patient-specific risk factors were identified, and potential predictors were analyzed using backwards stepwise regression.</p><p><strong>Results: </strong>Following radiation therapy, 8.6% lesions underwent prophylactic fixation and 14.0% fractured. Prophylactic fixation was associated with Mirels' score (OR = 1.98, P = 0.025), lesion cortical involvement (OR = 16.96, P = 0.010), and younger patient age (OR = 0.93, P = 0.024). Fracture was associated with lesion cortical involvement (OR = 10.16, P = 0.003) and \"low risk\" histology (OR = 9.01, P = 0.057). Orthopaedic treatment (either prophylactic surgery or pathologic fracture management) was associated with Mirels' score (OR = 1.62, P = 0.015), lesion cortical involvement (OR = 8.94, P = 0.002), humerus location (OR = 4.19, P = 0.042), and Medicare (OR = 4.12, P = 0.062) or private insurance (OR = 5.69, P = 0.022) compared with Medicaid. ECOG score (OR = 1.28, P = 0.003) was found to be a risk factor for increased mortality after radiotherapy, while \"low risk\" histology (OR = 0.51, P = 0.029), mixed lesion type (OR = 0.34, P = 0.006), and increased body mass index (OR = 0.95, P = 0.001) were protective factors.</p><p><strong>Conclusions: </strong>Radiograph measurements of cortical involvement were the most clinically relevant for determination of metastatic lesion fracture risk; however, predictors of local failure not addressed in Mirels' score should be considered in clinical decisions about prophylactic fixation. Surgery may be underperformed for histologies commonly considered to be \"low risk\" for local progression after radiation therapy.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 2","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123857","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":"Disparity Between Perceived and Actual Opioid Prescriptions by Orthopaedic Surgeons After Total Joint Arthroplasty.","authors":"Tiffany N Bridges, Johnlevi S Lazaro, Dillon Clancy, Elizabeth Ford, Manuel Pontes, Sean McMillan","doi":"10.5435/JAAOSGlobal-D-24-00152","DOIUrl":"10.5435/JAAOSGlobal-D-24-00152","url":null,"abstract":"<p><strong>Introduction: </strong>Healthcare institutions have sought to standardize opioid prescribing after elective total joint arthroplasty. The purpose of this study was (1) to compare opioid prescriptions at discharge with perceived opioid prescribing patterns and (2) to determine the relationship between preoperative adjunctive treatments and opioids prescribed at discharge.</p><p><strong>Methods: </strong>All surgeons who performed total joint arthroplasty of the shoulder, hip, or knee from January 1, 2021, to October 4, 2023, at a single academic institution were included. Surgeons completed a survey assessing perceived opioid prescriptions at discharge and perioperative pain protocols. Actual prescriptions were captured using our institutional opioid database. All opioid prescriptions were converted to morphine milligram equivalents (MMEs).</p><p><strong>Results: </strong>Orthopaedic surgeons prescribed on average 594.2 MMEs more than they perceived as their postoperative protocol. They prescribed an additional 60.9 MMEs for every 10 MMEs that they perceived they were prescribing. Patients receiving liposomal bupivacaine were prescribed on average 597 fewer MMEs and had fewer opioid prescriptions (P < 0.001). Genicular nerve blocks and cryoneurolysis were associated with fewer prescribed MMEs (P < 0.001).</p><p><strong>Conclusion: </strong>Orthopaedic surgeons prescribe substantially more opioids than intended. This study underscores the need for standardized opioid prescribing practices and the potential of adjunctive treatments in reducing opioid prescribing.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 2","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11793258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123855","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":"Retrograde Femoral Lengthening Below a Total Hip Arthroplasty.","authors":"David Burns, Andrew G LoPolito, Jason Shih Hoellwarth, Taylor J Reif, Austin T Fragomen, S Robert Rozbruch","doi":"10.5435/JAAOSGlobal-D-24-00141","DOIUrl":"10.5435/JAAOSGlobal-D-24-00141","url":null,"abstract":"<p><strong>Background: </strong>Limb length discrepancy (LLD) after total hip arthroplasty (THA) is a common occurrence and can lead to back pain, disordered gait, and decreased functional outcomes. Femoral lengthening ipsilateral to a THA using a retrograde motorized intramedullary lengthening nail (MILN) is a hip-sparing option for limb equalization. There has been little published on the technique and results of this method.</p><p><strong>Methods: </strong>We retrospectively reviewed all patients at our institution who underwent unilateral femoral lengthening using a retrograde MILN ipsilateral and distal to a THA between April 2016 and June 2022. We describe the technique and considerations for this procedure in detail and report the patient demographic variables, etiology and magnitude of LLD, concomitant deformity, knee range of motion, time to union, and all adverse events and complications.</p><p><strong>Results: </strong>Eleven lengthening procedures were included in this cohort. Etiology for LLD included osteonecrosis (4); postinfection (3); and one each of post-trauma, congenital deficiency, hip dysplasia, and iatrogenic discrepancy secondary to the index THA procedure. The mean lengthening was 35.7 ± 14.7 mm (range 20 to 70 mm) with a lengthening index of 1.5 ± 1.2 months until union per cm of lengthening. Complications included two patients who required reamed exchange nailing to achieve union and one interprosthetic fracture treated with removal of the MILN and plate fixation. No adverse effects on THA function were documented.</p><p><strong>Conclusion: </strong>Femur lengthening using a retrograde MILN ipsilateral to a THA is a safe and reliable hip-sparing option for post-THA limb length equalization.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 2","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123858","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":"Effect of Antifibrotic Medications on Development of Postoperative Adhesive Capsulitis and Need for Manipulation Under Anesthesia Following Total Shoulder Arthroplasty.","authors":"Jordan Cook Serotte, Cody Lee, Sai Reddy, Lewis Shi, Nicholas H Maassen","doi":"10.5435/JAAOSGlobal-D-24-00374","DOIUrl":"10.5435/JAAOSGlobal-D-24-00374","url":null,"abstract":"<p><strong>Background: </strong>The local inflammatory response after total shoulder arthroplasty leads to increased scar formation and, potentially, adhesive capsulitis. Recent research has evaluated the use of antifibrotic medications to decrease rates of postoperative adhesive capsulitis (AC).</p><p><strong>Methods: </strong>PearlDiver database was used to analyze patients from 2010 to 2022 who underwent total shoulder arthroplasty, identified by Common Procedural Terminology codes. Medication usage was determined using National Drug Codes. Patients who developed ipsilateral AC within 6 months after surgery or underwent a manipulation under anesthesia (MUA) within 12 months of diagnosis of AC were identified. Logistic regression analysis was used to evaluate patient characteristics and drug class usage that increased odds for postoperative AC within 12 months and for MUA within 6 months of diagnosis of AC.</p><p><strong>Results: </strong>Overall, 1.3% (993/79,010) of patients developed postoperative AC within 6 months of surgery. Of those who developed AC, 7.2% (71/993) underwent MUA within 12 months of diagnosis. Medication use with any of the drug classes had no markedly decreased odds for the development of AC or subsequent MUA. Male sex, increasing age, and diagnosis of depression all markedly decreased the odds of developing AC ((odds ratio) OR = 0.42, P = 0.001; OR = 0.95, P < 0.001; OR = 0.59, P = 0.04, respectively) and subsequent need for MUA (OR = 0.68, P ≤ 0.001; OR = 0.96, P < 0.001; OR = 0.87, P = 0.04, respectively).</p><p><strong>Conclusion: </strong>Patients on an antifibrotic medication had no difference in the odds of being diagnosed with AC within 6 months of surgery and for MUA within 12 months of diagnosis of AC. Male sex, increasing age, and presence of depression markedly decreased the odds.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 2","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123856","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 Influence of Multiple Modifiable Risk Factors on 30-day Readmissions and 90-day Major Complications After a Total Hip and Knee Arthroplasty: An Analysis of a Large Claims Database.","authors":"Lucas M Luong, Regina O Kostyun, Daniel K Witmer, John C Grady-Benson","doi":"10.5435/JAAOSGlobal-D-24-00151","DOIUrl":"10.5435/JAAOSGlobal-D-24-00151","url":null,"abstract":"<p><strong>Background: </strong>Preoperative optimization of modifiable risk factors (MRFs) for arthroplasty patients is a critical aspect of predicting and improving postoperative outcomes. This study evaluates the correlation between seven MRFs and postoperative adverse outcomes after total hip arthroplasty (THA) and total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>A retrospective review of primary TKA and THA were identified from a large medical claims database. Patients were categorized based on the number of MRF diagnoses present before surgery (anemia, malnutrition, obesity, opioid abuse/dependence, mental illness, type 2 diabetes mellitus, and tobacco use), from zero to seven. Adverse outcomes evaluated were surgical site infections (SSIs), venous thromboembolic events (VTEs), and readmissions.</p><p><strong>Results: </strong>Of the patient records queried (THA = 303,857; TKA = 692,157), two or more MRFs were identified in 41% of THA patients and 47% of TKA patients. Patients with two or more MRFs were at an increased odds of developing an SSI, and patients with three or more MRFs had increase odds of having a 30-day hospital readmission.</p><p><strong>Conclusions: </strong>This study adds to the compendium of literature, which promotes preoperative optimization of MRFs in arthroplasty patients to decrease the risks of 90-day postoperative complications.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 2","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123859","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":"Clinical and Radiographic Outcomes of Small Caliber Intramedullary Nails for Tibial Shaft Fractures.","authors":"Shannon Tse, Aziz Saade, Samuel K Simister, Lydia J McKeithan, Micaela White, Rebeka Dejenie, Branden Brooks, Rahul Bhale, Sean T Campbell, Ellen Fitzpatrick, Gillian L Soles, Mark A Lee, Augustine M Saiz","doi":"10.5435/JAAOSGlobal-D-24-00389","DOIUrl":"10.5435/JAAOSGlobal-D-24-00389","url":null,"abstract":"<p><strong>Introduction: </strong>Tibial shaft fractures, frequently treated with intramedullary nailing (IMN), are high-risk fractures of nonunion. The effect of intramedullary nail diameter on fracture union reduction remains an area of investigation, with many surgeons anecdotally preferring to place at least a 10-mm tibial nail. We hypothesized that small-caliber nails (SCNs) (diameter ≤9 mm) are safe to use and have no difference in complication rates compared with large-caliber nails (LCNs) (≥10 mm).</p><p><strong>Methods: </strong>A retrospective study was conducted on patients with tibial shaft fractures undergoing reamed IMN at a level 1 trauma center between 2018 and 2022. Patient and injury characteristics, intramedullary nail diameter, surgical details, and postoperative complication rates were recorded. Nail and intramedullary canal width at the isthmus on coronal radiographs determined the nail-canal ratio. Radiographic coronal and sagittal displacement, angulations between fracture segments, and coronal plane tibial mechanical axis were evaluated on latest radiographs.</p><p><strong>Results: </strong>Among 113 patients, 68 received SCN while 45 received LCN. No difference was observed in the nail-canal ratio between the SCN and LCN groups, indicating that smaller nails were used for smaller canals. No significant demographic differences were noted between groups. LCNs were more prevalent in (AO Foundation/Orthopaedic Trauma Association classification) AO/OTA 42C (P = 0.03) and Gustilo-Anderson type III fractures (P = 0.05). The LCN group had higher rates of revision surgery (20% vs. 5.9%, P = 0.03) and wound dehiscence (8.9% vs. 0%, P = 0.02). Gustilo-Anderson IIIA fractures were independently associated with poorer outcomes overall. Radiographic parameters were comparable between groups.</p><p><strong>Conclusions: </strong>Small-diameter and large-diameter reamed intramedullary nails can be effective in treating tibial shaft fractures. Nail-canal ratios and alignment were similar between the two groups, suggesting that surgeons should not feel obligated to ream to a 10-mm nail in a smaller patient with a well-reduced fracture.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 2","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123843","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":"Predictors of Venous Thromboembolism Following Geriatric Distal Femur Fracture Fixation: Are These Patients at Higher Risk Compared With Hip Fracture Patients?","authors":"Anthony E Seddio, Rajiv S Vasudevan, Michael J Gouzoulis, Sahir S Jabbouri, Jonathan N Grauer, Brianna R Fram","doi":"10.5435/JAAOSGlobal-D-24-00246","DOIUrl":"10.5435/JAAOSGlobal-D-24-00246","url":null,"abstract":"<p><strong>Introduction: </strong>Venous thromboembolism (VTE) following injury and subsequent fixation of a distal femur fracture (DFFx) is associated with considerable morbidity. However, the incidence of VTE, associated factors, and the relative risk compared with hip fracture (HFx) fixation remains poorly characterized.</p><p><strong>Methods: </strong>Retrospective cohort study using the PearlDiver M165 database to identify geriatric patients who underwent DFFx and HFx fixation. Clinical risk factors of VTE within 90 days of DFFx and the risk modification associated with enoxaparin (Lovenox) and direct oral anticoagulants (DOACs) relative to aspirin/nonprescription agents were characterized. To determine the odds of VTE following fixation of DFFx relative to HFx, a matched comparison based on age, sex, and Elixhauser Comorbidity Index was done.</p><p><strong>Results: </strong>Of 24,358 DFFx patients, 1684 (6.9%) developed VTE. Independent risk factors included a prior VTE (odds ratio [OR] 28.76), displaced DFFx morphologies (condylar [OR 5.44], and supracondylar without intracondylar extension [OR 3.96] and with extension [OR 3.75]), active cancer (OR 2.11), coagulopathy disorder (OR 1.15), and younger age (OR 1.03) (P < 0.05 for all). Lovenox and DOAC were both associated with reduced odds of VTE (OR 0.40 and OR 0.61, respectively) (P < 0.05 for both). Relative to HFx patients, DFFx patients demonstrated heightened odds of VTE (OR 1.25) (P < 0.001).</p><p><strong>Discussion: </strong>This study identified a relatively high rate of VTE, 6.9% within 90 days, following surgical management of DFFx and heightened odds of VTE relative to HFx patients. Various factors demonstrated a notable association with increased odds of VTE, although both Lovenox and DOACs may be effective therapeutic options for risk mitigation.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013566","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":"Gender and Racial Disparities in Pediatric Orthopaedic Surgery Fellows: A Decade-Long Analysis.","authors":"Imran Bitar, Mazen Zamzam, Sazid Hasan, Ehab Saleh","doi":"10.5435/JAAOSGlobal-D-24-00309","DOIUrl":"https://doi.org/10.5435/JAAOSGlobal-D-24-00309","url":null,"abstract":"<p><strong>Background: </strong>Despite increasing diversity among medical students, pediatric orthopaedic surgery remains underrepresented regarding gender and ethnic diversity. Previous studies highlight notable underrepresentation of women and minorities in orthopaedic subspecialty fellowships.</p><p><strong>Methods: </strong>This study analyzed data from 2013 to 2023 on pediatric orthopaedic surgery fellows, collected through the Accreditation Council for Graduate Medical Education and Graduate Medical Education Consensus. Self-identified race and gender data were used to assess trends over the decade.</p><p><strong>Results: </strong>The analysis included 380 fellows, of whom 62.4% were male and 37.1% were female. Racial distribution showed 62.9% White, 9.2% Asian, 4.5% Hispanic/Latino/Spanish, 4.5% Black/African American, 0% American Indian/Alaskan Native, 0% Native Hawaiian/Pacific Islander, 0.53% multiple race/ethnicity, and 8.4% other. Notably, 37.1% of fellows were non-White.</p><p><strong>Conclusion: </strong>The study reveals persistent gender and racial disparities in pediatric orthopaedic surgery fellowships. Targeted recruitment and support for underrepresented groups, along with systemic changes to address barriers, are crucial for fostering a diverse and inclusive workforce. Enhanced diversity is essential for providing culturally competent care to the diverse patient population.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11741215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013270","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":"Identifying Risk Factors of Children Who Suffered Physical Abuse: A Systematic Review.","authors":"Alexandra Flaherty, Samir Ghandour, Karina Mirochnik, Andreea Lucaciu, Nour Nassour, John Y Kwon, Mitchel B Harris, Soheil Ashkani-Esfahani","doi":"10.5435/JAAOSGlobal-D-24-00163","DOIUrl":"10.5435/JAAOSGlobal-D-24-00163","url":null,"abstract":"<p><strong>Background: </strong>Approximately 25% of children in the United States experience child abuse or neglect, 18% of whom are physically abused. Physicians are often in a position to differentiate accidental trauma from physical child abuse. Therefore, the aim of this study was to review recent literature for risk factors associated with physical child abuse.</p><p><strong>Methods: </strong>In this systematic review, three electronic databases were searched for articles published in the past 10 years, using the terms \"abuse,\" \"risk factors,\" and \"children,\" with associated variations. A total of 1,568 articles were identified. A sequential screening process was conducted by two independent reviewers in each phase, and 63 articles were included in the final analysis. Data extraction was conducted, and a narrative synthesis was conducted.</p><p><strong>Results: </strong>Sociodemographic risk factors of physical child abuse were younger age, male sex, African American or Hispanic race, nonprivate insurance, lower income, and lower maternal education. Other risk factors reported were previous reports of child abuse, birth defects, and developmental, musculoskeletal, intellectual, or mood disorders. Clinical and radiographic signs possibly indicative of child abuse included subdural hematoma, traumatic brain injury, retinal injury, bruising, superficial skin injury, lung injury, and fracture in skull, femur, clavicle, humerus, and foot.</p><p><strong>Conclusion: </strong>The results of this systematic review provide insights into the potential risk factors that should be considered when assessing a child for physical abuse in the health care setting.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11741222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013615","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":"Emergency Department Visits After Total Joint Arthroplasty in a Closed Urban Setting: A Report of 1,000 Consecutive Cases.","authors":"Julia Fisher, Lily Khabie, Ira H Kirschenbaum","doi":"10.5435/JAAOSGlobal-D-24-00252","DOIUrl":"10.5435/JAAOSGlobal-D-24-00252","url":null,"abstract":"<p><strong>Background: </strong>Rates of emergency department (ED) visits and readmissions after total joint arthroplasty (TJA) have been cited as indicators of TJA quality. Understanding the incidence and nature of these events is critical for prevention. The purpose of this study was to analyze readmission rates 30 and 90 days after TJA at a safety-net hospital in an urban setting and to compare this readmission rate with that for non-safety-net hospitals found in the current literature. In addition, we aimed to quantify the readmissions in our safety-net hospital that led to future complications. This would help us identify if there is a high incidence of preventable readmission rates in this unique socioeconomic environment.</p><p><strong>Methods: </strong>Using our institutional electronic medical record system, we retrospectively studied 1000 consecutive TJA encounters between 2014 and 2019 to determine the rates of treat-and-release ED visits within 30 and 90 days after surgery. The ED charts were reviewed, and patients who returned to the operating room (OR) for a TJA complication within 1 year of surgery were identified. We compared the OR return rates of people who had ED visits with those in the control group.</p><p><strong>Results: </strong>A total of 110 (11%) and 191 (19.1%) patients visited the ED within 30 and 90 days of surgery, respectively. Fisher exact test confirmed that having an ED visit within 90 days of TJA because of lower extremity pain and/or swelling or a social issue was associated with returning to the OR within a year of TJA. Having an ED visit within 30 or 90 days of total hip replacement was associated with returning to the OR for total hip replacement complications.</p><p><strong>Conclusion: </strong>ED visits after TJA at an urban safety-net hospital were markedly higher than those reported in the literature for nonurban safety-net hospitals. In addition, postoperative ED visits for specific diagnoses may predict complications. This indication may have implications for a risk adjustment in programs such as bundled payments. Our results also indicate overutilization of the ED by avoidable ED visits. This represents a call for alternatives to the ED for patients after TJA in environments served by safety-net hospitals.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11737489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013336","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}