J Benjamin Allis, Devon M Jeffcoat, Eric D Farrell
{"title":"How Feasible Are Digital Intraoperative Plain Radiographs in Orthopaedic Trauma Surgery?","authors":"J Benjamin Allis, Devon M Jeffcoat, Eric D Farrell","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The purpose of this study is to evaluate the feasibility and outcomes of obtaining routine intraoperative plain radiographs during orthopaedic trauma surgery. Seventy consecutive orthopaedic trauma patients in which intraoperative plain films were obtained in addition to fluoroscopy were reviewed. For each patient the time it took to obtain intraoperative plain radiographs was prospectively measured, in addition to the number of images taken, and quality of image. Then relative imaging times based on fracture locations were compared and the need for revision surgery based on mal-reduction or implant mal-positioning assessed. The average time required for intraoperative plain films to be obtained and reviewed by the surgeon was 3 minutes and 45 seconds. On average, 2.8 images were taken during each surgery. Proximal images took on average 44 seconds longer than distal images to obtain (p = 0.047). There was no significant difference in imaging times for upper versus lower extremities (p = 0.448). High quality images were obtained on all patients. There were no re-operations required in this series for mal-reduction of fracture, mal-positioning of implants or infection. In this study, there were no re-operations or perioperative complications when intraoperative plain films were obtained. Intraoperative plain films are a valuable tool for complex periarticular surgery or other cases where fracture reduction or implant location may be in question. (Journal of Surgical Orthopaedic Advances 32(3):160-163, 2023).</p>","PeriodicalId":516534,"journal":{"name":"Journal of surgical orthopaedic advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139522230","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}
Alexis Sandler, John Dunn, Adam Adler, Austin Fares, John Scanaliato
{"title":"Orthopaedic Injuries from All-Terrain Vehicles: An Epidemiological Account and Review of Legislation.","authors":"Alexis Sandler, John Dunn, Adam Adler, Austin Fares, John Scanaliato","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>All-terrain vehicles (ATVs) are an ongoing source of orthopaedic trauma in the United States. The National Electronic Injury Surveillance System (NEISS) database was queried for ATV-related extremity trauma from 2010 to 2019. An estimated 31,979 ATV-related injuries present to emergency departments annually without significant variability between years. Patients were predominantly white (63.5%), male (72.2%), and aged 18 - 44 (49.9%). Injury sites frequently included the shoulder (24%), wrist (12.8%), and ankle (11.2%). Fractures were most common followed by strains and sprains. Only 15.5% of injuries occurred on public land. Alcohol use was rarely implicated. Orthopaedic surgeons should be aware that rates of ATV-related musculoskeletal injuries have not changed significantly over the last ten years despite legislative efforts to improve ATV safety. Additionally, safety laws are inconsistent across the US, and many apply to the use of ATVs on public land when a minority of injuries occur on non-public land. (Journal of Surgical Orthopaedic Advances 32(4):225-231, 2023).</p>","PeriodicalId":516534,"journal":{"name":"Journal of surgical orthopaedic advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140320268","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}
Anokha A Padubidri, Anthony T Sorkin, Andrew Gudeman, Roman M Natoli, Greg E Gaski
{"title":"Outcomes Following Intramedullary Nailing of Select Periarticular Distal Tibia Fractures.","authors":"Anokha A Padubidri, Anthony T Sorkin, Andrew Gudeman, Roman M Natoli, Greg E Gaski","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Intramedullary nailing (IMN) of periarticular distal tibia fractures may offer advantages compared to plating. This study aims to report on the outcomes of select periarticular distal tibia fractures treated with IMN. Patients over 17 years of age that underwent IMN for extraarticular distal tibia fractures (Osteosynthesefragen/Orthopaedic Trauma Association [AO/OTA] 43-A), partial articular with associated segmental shaft component (43-B), and simple intraarticular (43-C1/2) at a Level I trauma center were included. The primary outcome was physical function (PF) and pain interference (PI) assessed via Patient-Reported Outcomes Measurement Information System (PROMIS). Secondary outcomes included reoperation, nonunion, infection, and malalignment. Eighty-four patients with > 12 months follow up were included. Mean PROMIS PI and PF scores were 55.5 and 45.0, respectively. The rate of nonunion and deep infection each were 8%. Eighty-four percent of patients achieved normal alignment. There were no differences detected in clinical outcomes between patients with intraarticular injuries compared with those with extraarticular fractures. Satisfactory clinical, radiographic, and patient-reported outcomes can be expected following treatment of extraarticular and simple intraarticular distal tibia fractures with IMN. (Journal of Surgical Orthopaedic Advances 32(4):246-251, 2023).</p>","PeriodicalId":516534,"journal":{"name":"Journal of surgical orthopaedic advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140320269","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}
Gregory J Booth, Jacob Cole, Phil Geiger, George C Balazs, Scott Hughey, Natalie Nepa, Ashton Goldman
{"title":"Machine Learning to Predict Discharge Destination After Total Knee Arthroplasty and Total Hip Arthroplasty.","authors":"Gregory J Booth, Jacob Cole, Phil Geiger, George C Balazs, Scott Hughey, Natalie Nepa, Ashton Goldman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Discharge destination impacts costs and perioperative planning for primary total knee (TKA) or hip arthroplasty (THA). The purpose of this study was to create a tool to predict discharge destination in contemporary patients. Models were developed using more than 400,000 patients from the National Surgical Quality Improvement Program database. Models were compared with a previously published model using area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA). AUC on patients with TKA was 0.729 (95% confidence interval [CI]: 0.719 to 0.738) and 0.688 (95% CI: 0.678 to 0.697) using the new and previous models, respectively. AUC on patients with THA was 0.768 (95% CI: 0.758 to 0.778) and 0.726 (95% CI: 0.714 to 0.737) using the new and previous models, respectively. DCA showed substantially improved net clinical benefit. The new models were integrated into a web-based application. This tool enhances clinical decision making for predicting discharge destination following primary TKA and THA. (Journal of Surgical Orthopaedic Advances 32(4):252-258, 2023).</p>","PeriodicalId":516534,"journal":{"name":"Journal of surgical orthopaedic advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140320265","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}
Matthew P Lunati, Jesse Seilern Und Aspang, J'Lynn L Baker, Jacob M Wilson, Thomas J Moore
{"title":"Radiographic Prediction of Soft Tissue Injury Associated with Tibial Plateau Fractures: The Direction of Articular Depression Matters.","authors":"Matthew P Lunati, Jesse Seilern Und Aspang, J'Lynn L Baker, Jacob M Wilson, Thomas J Moore","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This investigation aimed to evaluate the impact of coronal articular fragment displacement of Schatzker type II tibial plateau fractures on concomitant soft tissue knee injuries. One hundred consecutively treated patients were included. Depression depth and coronal articular fragment displacement were measured radiographically, and medial collateral ligament (MCL) and lateral meniscus (LM) injury, and pain and range of motion (ROM) on final follow up, were recorded. Multivariable regression was then performed. Coronal articular fragment displacement was medially and laterally hinged in 74% and 26% of patients, respectively. MCL injuries were significantly higher in the lateral hinge group (odds ratio [OR]: 3.25; confidence interval [CI]: 1.07 to 9.84; p = 0.03). No difference was found in LM injury incidence and amount of articular depression between groups. At final follow-up, average pain and ROM was similar between groups. Findings demonstrate a significant correlation between laterally hinged articular depression in Schatzker II tibial plateau fractures and concomitant MCL injury. (Journal of Surgical Orthopaedic Advances 32(4):270-275, 2023).</p>","PeriodicalId":516534,"journal":{"name":"Journal of surgical orthopaedic advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140320270","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}
Kamil Amer, Michael Metrione, Sirjanhar Singh, Jay Patel, Kathleen Beebea
{"title":"Characterization of Opioid Prescribing Tendencies Among Orthopaedic Surgeons: A National Perspective.","authors":"Kamil Amer, Michael Metrione, Sirjanhar Singh, Jay Patel, Kathleen Beebea","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>There has been increasing pressure on healthcare providers to exhibit restraint when prescribing opioids for pain control. However, data that characterizes the differences between orthopaedic providers and their accompanying prescription rates is not well developed. This study accessed Medicare Provider Utilization and Payment Data from 2015 to collect the number of prescriptions for opioid-based medications administered by orthopaedic surgeons across the country. A total of 19,410 orthopaedic providers were identified as opioid prescribers from the 2015 Medicare Part D Database. Providers averaged an opioid prescription every 10.9 days, with 94.7% of prescribers (18,387) having written more than 10 opioid prescriptions. Regionally, the Southern United States had the highest percentage of providers prescribing an opioid greater than 10 times at 96.4%. Female orthopaedic surgeons prescribed just over half the number of scripts that male surgeons did (79.4 vs. 154.2, p < 0.001). (Journal of Surgical Orthopaedic Advances 32(3):199-201, 2023).</p>","PeriodicalId":516534,"journal":{"name":"Journal of surgical orthopaedic advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139522133","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}
Kenneth F Taylor, M Daniel Hatch, Kavita T Vakharia, Randy M Hauck
{"title":"Minimally Invasive Cubital Tunnel Release Utilizing Lighted Retractors: A Study of Residents Novel to this Technique Utilizing a Cadaveric Model.","authors":"Kenneth F Taylor, M Daniel Hatch, Kavita T Vakharia, Randy M Hauck","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The purpose of this study was to evaluate whether a minimally-invasive cubital tunnel release using lighted retractors could be performed safely and completely by residents with no prior training in this technique. Ten residents participated in the study. Postoperative dissection of the specimens was performed utilizing a detailed checklist and global rating scale to evaluate the completeness of release as well as presence of neurologic injury. Performance of residents was compared. Rho correlation analysis was used to verify validity of the assessment tools. Training year most strongly correlated with Global Rating Scale assessment values. There was a trend correlating training year with faster surgical times, and Detailed Checklist scores. Validation measurements showed strong correlations between the pass/fail grade and the Detailed Checklist and the Global Rating Scale. Complete release of the ulnar nerve in situ utilizing lighted retractors can be performed with minimal training or experience. (Journal of Surgical Orthopaedic Advances 32(3):193-198, 2023).</p>","PeriodicalId":516534,"journal":{"name":"Journal of surgical orthopaedic advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139522342","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}
Allison R Mitchell, Kingsley A Oladeji, John C Bonano, Abiram Bala, Derek F Amanatullah
{"title":"Pes Planovalgus Is Associated with Increased Comorbidities and Poor Outcomes After Total Knee Arthroplasty.","authors":"Allison R Mitchell, Kingsley A Oladeji, John C Bonano, Abiram Bala, Derek F Amanatullah","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Pes planovalgus affects knee biomechanics but there are no studies describing its impact on total knee arthroplasty (TKA). We aim to characterize the demographics, medical, and surgical complications of patients with pes planovalgus undergoing TKA. A Medicare database was queried using ICD-9 codes to identify 5,750 patients with and 23,000 patients without pes planovalgus who underwent TKA from 2005 to 2014. Standard descriptive statistics were used to compare medical and surgical complications at 90 days and 2 years, with alpha < 0.003 after a Bonferroni Correction. Patients with pes planovalgus had an elevated incidence of hypertension (80%, p < 0.001), pulmonary disease (31%, p < 0.001), hypothyroidism (28%, p < 0.001), diabetes (30%, p < 0.001), vascular disease (20%, p < 0.001), obesity (26%, p < 0.001), and depression (23%, p < 0.001). They also had increased odds of deep vein thrombosis (DVT) (odds ratio [OR] 1.3, p < 0.001), stiffness (OR 1.3, p < 0.003) and revision (OR 1.59, p < 0.003) at 90 days. At 2 years, odds of stiffness had increased (OR 1.34, p < 0.001) with similar rates of revision and medical complications. Pes planovaglus is associated with increased medical comorbidities and this patient population may be at an increased risk for postoperative stiffness, early revisions, and DVT after TKA. Arthroplasty surgeons should be conscious of these risks when considering TKA in a patient with pes planovalgus and counsel them appropriately. (Journal of Surgical Orthopaedic Advances 32(3):202-206, 2023).</p>","PeriodicalId":516534,"journal":{"name":"Journal of surgical orthopaedic advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139522348","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}
Nicholas C Danford, Christina E Freibott, Seth C Shoap, Hans Polzer, J Turner Vosseller
{"title":"Revision Surgery and Wound Complications with Minimally Invasive Compared to Open Achilles Tendon Repair: A Retrospective Comparative Study of 116 Patients.","authors":"Nicholas C Danford, Christina E Freibott, Seth C Shoap, Hans Polzer, J Turner Vosseller","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The current study analyzed revision surgery rate and wound complications of patients with Achilles tendon ruptures that received either minimally invasive repair or open standard repair. A retrospective chart review of patients that had Achilles tendon repair performed using either an open or minimally invasive technique was conducted. Primary outcomes were revision surgery rate and wound complication rate. Twenty-nine (25.0%) patients had the minimally invasive approach, while 87 (75.0%) had the open approach. On average there were 0.16 additional surgeries per patient in the open group versus none in the minimally invasive group (p = 0.003). There were 13 wound-related complications, all of which were in the open group (p = 0.06). Revision surgery rates are significantly higher for patients treated with open Achilles repair versus those treated with a minimally invasive technique. Patients may benefit from a minimally invasive as opposed to open technique. (Journal of Surgical Orthopaedic Advances 32(3):173-176, 2023).</p>","PeriodicalId":516534,"journal":{"name":"Journal of surgical orthopaedic advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139522351","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":"Modified Saha Procedure for Chronic Paralytic Shoulder after Reverse Shoulder Arthroplasty Complicated with Brachial Plexus Injury.","authors":"Rachel Bordelon, Amy Trammell, Zhongyu Li","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Nerve injuries after reverse total shoulder arthroplasty (rTSA) are rare, and fortunately, most patients recover without long-term sequelae. However, irreversible deltoid paralysis due to brachial plexus or axillary nerve injury is devastating, as the deltoid is the main force of movement of the humerus after rTSA. Denervation of the deltoid results in weakness in abduction, forward flexion, and elevation, as well as varying degrees of chronic pain and shoulder instability. Treatment options for chronic deltoid denervation after axillary nerve or brachial plexus injuries are limited, since nerve repair, graft, or transfer procedures are ineffective. Trapezius tendon transfers, including the Saha technique, have been used to treat chronic deltoid weakness in native shoulders. Here, the authors present a modified Saha technique to improve shoulder motion and stability in patients with chronic deltoid paralysis following rTSA. (Journal of Surgical Orthopaedic Advances 32(4):276-280, 2023).</p>","PeriodicalId":516534,"journal":{"name":"Journal of surgical orthopaedic advances","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140320266","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}