American journal of orthopedics (Belle Mead, N.J.)最新文献_第6页

Case Series Evaluating the Operative and Nonoperative Treatment of Scapular Fractures. 肩胛骨骨折手术与非手术治疗的病例分析。

American journal of orthopedics (Belle Mead, N.J.) Pub Date : 2018-08-01 DOI: 10.12788/ajo.2018.0067

Peter A Surace, Alysse J Boyd, Heather A Vallier

{"title":"Case Series Evaluating the Operative and Nonoperative Treatment of Scapular Fractures.","authors":"Peter A Surace, Alysse J Boyd, Heather A Vallier","doi":"10.12788/ajo.2018.0067","DOIUrl":"https://doi.org/10.12788/ajo.2018.0067","url":null,"abstract":"The injury parameters and patient characteristics that affect function after scapular fracture are poorly defined. We performed a retrospective review of 594 adult patients with a minimum 12-month follow-up after scapular fracture. Functional outcomes were prospectively assessed using the American Shoulder and Elbow Surgeons (ASES) survey in 153 patients after a mean of 62 months of follow-up. The population was 78% male, and 88% had injuries caused by a high-energy event. Only 4.6% had injuries isolated to the scapula. All fractures healed primarily and the mean ASES score was 79.3, indicating minimal functional impairment. However, 7 patients (4.6%) reported severe functional deficits. Fifteen patients (9.8%) underwent open reduction and internal fixation. These patients had a better mean ASES score than those who were treated nonoperatively (92.1 vs 77.9, P = .03). When fracture types were analyzed individually, there was an advantage to surgery in fractures involving the glenoid (96.0 vs 75.7, P < .05). Concomitant chest wall injury or the presence of adjacent fractures did not affect functional outcomes. Smokers had a worse mean score (73.3 vs 84.5, P = .01), as did patients with a history of alcohol abuse (70.3 vs 83.9, P < .05). In conclusion, mean ASES scores indicated good function overall. Patients with a history of tobacco use or alcohol abuse had worse outcome scores.","PeriodicalId":79316,"journal":{"name":"American journal of orthopedics (Belle Mead, N.J.)","volume":"47 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36458371","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}

引用次数: 4

Screw Fixation Without Bone Grafting for Delayed Unions and Nonunions of Minimally Displaced Scaphoids. 不植骨螺钉固定治疗轻度移位的舟骨延迟愈合和不愈合。

American journal of orthopedics (Belle Mead, N.J.) Pub Date : 2018-08-01 DOI: 10.12788/ajo.2018.0064

David Saper, Akash K Shah, Andrew B Stein, Andrew Jawa

引用次数: 1

Treatment of Grade III Acromioclavicular Separations in Professional Baseball Pitchers: A Survey of Major League Baseball Team Physicians. 职业棒球投手III级肩锁骨分离的治疗:美国职业棒球大联盟队医的调查。

American journal of orthopedics (Belle Mead, N.J.) Pub Date : 2018-07-01 DOI: 10.12788/ajo.2018.0051

Joseph N Liu, Grant H Garcia, K Durham Weeks, Jacob Joseph, Orr Limpisvasti, Edward G McFarland, Joshua S Dines

{"title":"Treatment of Grade III Acromioclavicular Separations in Professional Baseball Pitchers: A Survey of Major League Baseball Team Physicians.","authors":"Joseph N Liu, Grant H Garcia, K Durham Weeks, Jacob Joseph, Orr Limpisvasti, Edward G McFarland, Joshua S Dines","doi":"10.12788/ajo.2018.0051","DOIUrl":"https://doi.org/10.12788/ajo.2018.0051","url":null,"abstract":"Despite advancements in surgical technique and understanding of throwing mechanics, controversy persists regarding the treatment of grade III acromioclavicular (AC) joint separations, particularly in throwing athletes. Twenty-eight major league baseball (MLB) orthopedic team physicians were surveyed to determine their definitive management of a grade III AC separation in the dominant arm of a professional baseball pitcher and their experience treating AC joint separations in starting pitchers and position players. Return-to-play outcomes were also evaluated. Twenty (71.4%) team physicians recommended nonoperative intervention compared to 8 (28.6%) who would have operated acutely. Eighteen (64.3%) team physicians had treated at least 1 professional pitcher with a grade III AC separation; 51 (77.3%) pitchers had been treated nonoperatively compared to 15 (22.7%) operatively. No difference was observed in the proportion of pitchers who returned to the same level of play (P = .54), had full, unrestricted range of motion (P = .23), or had full pain relief (P = .19) between the operatively and nonoperatively treated MLB pitchers. The majority (53.6%) of physicians would not include an injection if the injury was treated nonoperatively. Open coracoclavicular reconstruction (65.2%) was preferred for operative cases; 66.7% of surgeons would also include distal clavicle excision as an adjunct procedure. About 90% of physicians would return pitchers to throwing >12 weeks after surgery compared to after 4 to 6 weeks in nonoperatively treated cases. In conclusion, MLB team physicians preferred nonoperative management for an acute grade III AC joint separation in professional pitchers. If operative intervention is required, ligament reconstruction with adjunct distal clavicle excision were the most commonly performed procedures.","PeriodicalId":79316,"journal":{"name":"American journal of orthopedics (Belle Mead, N.J.)","volume":"47 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36367945","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}

引用次数: 2

Reasons for Readmission Following Primary Total Shoulder Arthroplasty. 初次全肩关节置换术后再入院的原因。

American journal of orthopedics (Belle Mead, N.J.) Pub Date : 2018-07-01 DOI: 10.12788/ajo.2018.0053

Gregory L Cvetanovich, Daniel D Bohl, Rachel M Frank, Nikhil N Verma, Brian J Cole, Gregory P Nicholson, Anthony A Romeo

{"title":"Reasons for Readmission Following Primary Total Shoulder Arthroplasty.","authors":"Gregory L Cvetanovich, Daniel D Bohl, Rachel M Frank, Nikhil N Verma, Brian J Cole, Gregory P Nicholson, Anthony A Romeo","doi":"10.12788/ajo.2018.0053","DOIUrl":"https://doi.org/10.12788/ajo.2018.0053","url":null,"abstract":"An increasing interest focuses on the rates and risk factors for hospital readmission. However, little is known regarding the readmission following total shoulder arthroplasty (TSA). This study aims to determine the rates, risk factors, and reasons for hospital readmission following primary TSA. Patients undergoing TSA (anatomic or reverse) as part of the American College of Surgeons National Surgical Quality Improvement Program in 2011 to 2013 were identified. The rate of unplanned readmission to the hospital within 30 postoperative days was characterized. Using multivariate regression, demographic and comorbidity factors were tested for independent association with readmission. Finally, the reasons for readmission were characterized. A total of 3627 patients were identified. Among the admitted patients, 93 (2.56%) were readmitted within 30 days of surgery. The independent risk factors for readmission included old age (for age 60-69 years, relative risk [RR] = 1.6; for age 70-79 years, RR = 2.3; for age ≥80 years, RR = 23.1; P = .042), male sex (RR = 1.6, P = .025), anemia (RR = 1.9, P = .005), and dependent functional status (RR = 2.8, P = .012). The reasons for readmission were available for 84 of the 93 readmitted patients. The most common reasons for readmission comprised pneumonia (14 cases, 16.7%), dislocation (7 cases, 8.3%), pulmonary embolism (7 cases, 8.3%), and surgical site infection (6 cases, 7.1%). Unplanned readmission occurs following about 1 in 40 cases of TSA. The most common causes of readmission include pneumonia, dislocation, pulmonary embolism, and surgical site infection. Patients with old age, male sex, anemia, and dependent functional status are at higher risk for readmission and should be counseled and monitored accordingly.","PeriodicalId":79316,"journal":{"name":"American journal of orthopedics (Belle Mead, N.J.)","volume":"47 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36367939","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}

引用次数: 24

Volumetric Considerations for Valving Long-Arm Casts: The Utility of the Cast Spacer. 阀门长臂铸件的体积考虑:铸件垫片的实用性。

American journal of orthopedics (Belle Mead, N.J.) Pub Date : 2018-07-01 DOI: 10.12788/ajo.2018.0061

K Aaron Shaw, Colleen Moreland, Shawn E Boomsma, Justin M Hire, Richard Topolski, Craig D Cameron

{"title":"Volumetric Considerations for Valving Long-Arm Casts: The Utility of the Cast Spacer.","authors":"K Aaron Shaw, Colleen Moreland, Shawn E Boomsma, Justin M Hire, Richard Topolski, Craig D Cameron","doi":"10.12788/ajo.2018.0061","DOIUrl":"https://doi.org/10.12788/ajo.2018.0061","url":null,"abstract":"Fiberglass casts are frequently valved to accommodate swelling following injury or surgery. The use of cast spacers has been recommended to bridge this gap between pressure reduction and cast strength, but no studies have assessed their effect on cast pressure. We applied 30 long-arm fiberglass casts to adult volunteers, divided between a univalve group and a bivalve group. A pediatric blood pressure bladder was applied under the cast to simulate soft tissue swelling. Valved casts were secured using an elastic wrap, 10-mm cast spacer, or 15-mm cast spacer. Measurements of cast pressure and circumference were performed at each stage and compared on the basis of type of valve and securement. Our results indicated that cast univalving resulted in an approximately 60% reduction in cast pressures, with a 75% reduction seen in the bivalve group. The addition of cast spacers resulted in significant pressure reductions for both valving groups. The univalve group secured with a 10-mm cast spacer produced reductions in cast pressure similar to those of the elastic-wrapped bivalve cast, both with the cast padding intact and with it released. The use of cast spacers results in significant cast pressure reductions, regardless of valving technique. A univalved cast secured with a cast spacer can produce decreases in cast pressures similar to those seen with an elastic-wrapped bivalved cast, and it is a viable option for reducing cast pressure without compromising cast structural integrity with a bivalve technique.","PeriodicalId":79316,"journal":{"name":"American journal of orthopedics (Belle Mead, N.J.)","volume":"47 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36367946","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}

引用次数: 1

Total Joint Arthroplasty Quality Ratings: How Are They Similar and How Are They Different? 全关节置换术质量评分:它们的相似之处和不同之处?

American journal of orthopedics (Belle Mead, N.J.) Pub Date : 2018-07-01 DOI: 10.12788/ajo.2018.0060

David N Bernstein, Addisu Mesfin, Kevin J Bozic

{"title":"Total Joint Arthroplasty Quality Ratings: How Are They Similar and How Are They Different?","authors":"David N Bernstein, Addisu Mesfin, Kevin J Bozic","doi":"10.12788/ajo.2018.0060","DOIUrl":"https://doi.org/10.12788/ajo.2018.0060","url":null,"abstract":"A patient's perception of hospital or provider quality can have far-reaching effects, as it can impact reimbursement, patient selection of a surgeon, and healthcare competition. A variety of organizations offer quality designations for orthopedic surgery and its subspecialties. Our goal is to compare total joint arthroplasty (TJA) quality designation methodology across key quality rating organizations. One researcher conducted an initial Google search to determine organizations providing quality designations for hospitals and surgeons providing orthopedic procedures with a focus on TJA. Organizations that offer quality designation specific to TJA were determined. Organizations that provided general orthopedic surgery or only surgeon-specific quality designation were excluded from the analysis. The senior author confirmed the inclusion of the final organizations. Seven organizations fit our inclusion criteria. Only the private payers and The Joint Commission required hospital accreditation to meet quality designation criteria. Total arthroplasty volume was considered in 86% of the organizations' methodologies, and 57% of organizations utilized process measurements such as antibiotic prophylaxis and care pathways. In addition, 57% of organizations included patient experience in their methodologies. Only 29% of organizations included a cost element in their methodology. All organizations utilized outcome data and publicly reported all hospitals receiving their quality designation. Hospital quality designation methodologies are inconsistent in the context of TJA. All stakeholders (ie, providers, payers, and patients) should be involved in deciding the definition of quality.","PeriodicalId":79316,"journal":{"name":"American journal of orthopedics (Belle Mead, N.J.)","volume":"47 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36367944","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}

引用次数: 4

Preventative Care in Orthopedics: Treating Injuries Before They Happen. 骨科的预防护理:在伤害发生之前进行治疗。

American journal of orthopedics (Belle Mead, N.J.) Pub Date : 2018-07-01 DOI: 10.12788/ajo.2018.0059

Andrea Halim

引用次数: 0

Inadvertent Perioperative Hypothermia During Orthopedic Surgery. 骨科手术围手术期的意外低温。

American journal of orthopedics (Belle Mead, N.J.) Pub Date : 2018-07-01 DOI: 10.12788/ajo.2018.0056

Chandrakanth Boddu, Joseph Cushner, Giles R Scuderi

引用次数: 8

Snapping Biceps Femoris Tendon. 拉伸股二头肌肌腱。

American journal of orthopedics (Belle Mead, N.J.) Pub Date : 2018-07-01 DOI: 10.12788/ajo.2018.0055

Justin J Ernat, Joseph W Galvin

引用次数: 2

Real-World Evidence for Safety and Effectiveness of Repeated Courses of Hyaluronic Acid Injections on the Time to Knee Replacement Surgery. 反复注射透明质酸对膝关节置换术时间的安全性和有效性的真实证据。

American journal of orthopedics (Belle Mead, N.J.) Pub Date : 2018-07-01 DOI: 10.12788/ajo.2018.0058

Vinod Dasa, Sooyeol Lim, Peter Heeckt

{"title":"Real-World Evidence for Safety and Effectiveness of Repeated Courses of Hyaluronic Acid Injections on the Time to Knee Replacement Surgery.","authors":"Vinod Dasa, Sooyeol Lim, Peter Heeckt","doi":"10.12788/ajo.2018.0058","DOIUrl":"https://doi.org/10.12788/ajo.2018.0058","url":null,"abstract":"Osteoarthritis (OA) of the knee is a top cause of disability among the elderly. Total knee replacement (TKR) has been available as an effective and definite surgical method to treat severe OA of the knee. However, TKR is a significant procedure with potential risk for serious complications and high costs. Alternative lower risk therapies that can delay or obviate TKR are valuable to those who are poor candidates for surgery or wish to avoid TKR as long as possible. Given the chondroprotective effects of hyaluronic acid (HA) injections, they are a safe and effective treatment to improve pain, function, and longevity of the knee. Thus, HA features the potential to delay or obviate TKR. We aim to study the safety and effectiveness of repeated courses of HA on the time to TKR over a 3-year period using data from a large US health plan administrative claims database. Retrospective analyses were conducted by identifying knee OA patients during the selection period (2007-2010). The follow-up period was 36 months, post-index date of initial HA injection. Procedural outcomes and adverse events of interest were tabulated and analyzed. A Cox proportional hazards model was used to model the risk of TKR. A total of 50,389 patients who received HA for treatment of knee OA and met the study inclusion criteria were analyzed. Successive courses of HA showed a good safety profile and led to high proportions of patients without TKR 3 years after treatment initiation. Multivariate statistical modeling showed that multiple courses of HA injections significantly decreased the rates of TKR (95.0% without TKR for ≥5 courses vs 71.6% without TKR for 1 course; hazard ratio, 0.138; P < .0001). Repeated courses of treatment with HA are safe and are associated with the delay of TKR for up to 3 years. Additional research is needed to evaluate the effect of repeated HA courses on delaying TKR beyond a 3-year time horizon.","PeriodicalId":79316,"journal":{"name":"American journal of orthopedics (Belle Mead, N.J.)","volume":"47 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36369453","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}

引用次数: 26