The Iowa orthopaedic journal最新文献

{"title":"No Difference in All Cause Revision Following Transition From Cemented to Cementless TKA.","authors":"Austin C Benson, Taylor J Den Hartog, Seth M Borchard, Daniel G Meeker, Luke A Nordstrom, Trevor J Allen, Timothy S Brown, Nicolas O Noiseux","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Cemented implants have long been considered the benchmark for total knee arthroplasty (TKA). With advances in highly porous metal technology, cementless TKA implants have shown promising short to medium term radiographic survivorship. While early data on cementless TKA is promising, many surgeons have concerns with transitioning a portion or majority of their patient population to cementless design. Our study aims to evaluate if there is an increase in revisions for surgeons in their first 100 cementless total knee arthroplasties.</p><p><strong>Methods: </strong>Retrospective review of the first 100 cementless total knee arthroplasties performed by two adult reconstruction surgeons, with minimum one year follow-up. Patient charts were reviewed for any evidence of complication or re-operation within one year from their surgical date. Patients were separated into 5 groups: operations 1 to 20, 21 to 40, 41 to 60, 61 to 80, and 81 to 100. All radiographs were reviewed for any signs of failure or loosening.</p><p><strong>Results: </strong>200 patients were reviewed in total, including the first 100 consecutive cementless total knee arthroplasties from each surgeon. There were no revisions at one year for patients in group 1. Group 2 had 1 revision. Group 3 had 1 revision followed by group 4 which had 4 revisions and group 5 in which 3 patients underwent revision TKA. There was no statistically significant difference between groups (p 0.16). There was no statistically significant difference in patient age (p 0.054) or BMI (p 0.114) for patients undergoing revision TKA. Kaplan-Meier did not show any difference between groups at one year follow-up.</p><p><strong>Conclusion: </strong>Transitioning from all cemented to cementless TKAs did not show an increase in complications leading to revision TKA, and there was no discernable 'learning curve' incorporating cementless TKAs into practice.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"46 1","pages":"49-54"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564357","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":"Resident Arthroscopy Simulation Curriculum Implementation and The Effect on Simulator Usage.","authors":"Alex M Meyer, Ryan Serbin, Eric Davis, Claude T Moorman, Gregg Nicandri, Alison P Toth","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Arthroscopy simulation has been shown to improve resident performance. Surgical simulation is desired by trainees and program directors; however, the simulator must be used regularly to receive maximal benefit. Unfortunately, in the absence of a formal recommended curriculum many trainees are not regularly utilizing these educational resources. The objective of this paper was to determine the change in arthroscopy simulator utilization following the implementation of an arthroscopy simulation curriculum for orthopedic surgery residents.</p><p><strong>Methods: </strong>This was a multi-center retrospective cohort study in which an arthroscopic simulation curriculum was developed and then implemented in October 2023 as recommended learning at two orthopedic surgery residency programs (80 residents) to be completed during their sports rotations during their PGY1, PGY2, and PGY4 years. A third program without a formal curriculum was used as a control (26 residents). Prior to implementation simulator was available for self-directed learning. Following implementation, the simulator was still available at any time, but certain modules were recommended to be completed while on sports rotations. The simulator usage before and after implementation of the curriculum was compared using two-tailed t-tests of pooled data comparing the months where a curriculum was and was not recommended. Pooled data for the two programs with a curriculum was compared from before and after curriculum was implemented.</p><p><strong>Results: </strong>For the two programs that implemented the curriculum, there was an increase from 0.05 hours (3 min) per resident per month to 0.24 hours (14.4 min) per resident per month for a 4.7-fold increase.Across all three residency programs, implementation of a formal curriculum demonstrated an increase from 0.10 hours (6.25 min) per resident per month to 0.24 hours (14.4 min) per resident per month (p-value 0.0022). Overall, curriculum implementation was associated with a 2.3-fold increase in simulator use.</p><p><strong>Conclusion: </strong>Having a formal curriculum that is recommended by orthopedic surgery residency programs increased simulator utilization by 2.34.7 times. Structured, recommended curricula may be necessary for residents to fully engage with simulation resources.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"46 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564410","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":"Prognostic Role of Blood Inflammatory Composite Biomarkers in Dvt After Lower Extremity Fractures.","authors":"Sanam Mohammadzadeh, Farzad Fayedeh, Shokufe Khanzade, Philip Chen, Richard K Shields","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to comprehensively assess the most recent data on the prognostic effects of hematologic markers, including the neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), and systemic immune inflammation index (SII), on deep vein thrombosis (DVT) following lower limb fractures.</p><p><strong>Methods: </strong>We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This study was registered in PROSPERO (CRD420251006336). We performed a comprehensive search in the PubMed, EMBASE, Web of Science, and Scopus electronic databases. Date of publication and language were not restricted. Standardized mean difference (SMD) with 95% confidence interval (CI) was calculated and all statistical analyses were performed using Stata 18 software.</p><p><strong>Results: </strong>Ten studies, involving a total of 6183 patients with lower extremity fractures, of whom 896 developed DVT, were included in the final analysis. The results indicated that, compared to the non-DVT group, patients with DVT had higher levels of NLR (SMD = 0.48, 95% CI = 0.02-0.94, p = 0.04) and SII (SMD = 1.01, 95% CI = 0.121.89, p = 0.02). However, PLR and MLR level was not different between the two groups. Among the evaluated biomarkers, SII demonstrated the highest specificity (80%, PLR = 74%), while NLR had the highest sensitivity (68%).</p><p><strong>Conclusion: </strong>The literature supported that, compared to the non-DVT group, patients with DVT had higher levels of NLR and SII. Among these biomarkers, SII demonstrated the highest specificity, while NLR had the highest sensitivity. Composite inflammatory markers, particularly SII, may hold value in DVT risk stratification during post-fracture period.<b>Level of Evidence:</b> II.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"46 1","pages":"293-301"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857827","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":"Femoral Shaft Fragility Fractures: Peri-Implant Fracture Risk Mitigated by Femoral Neck Protection.","authors":"William D Lack, Micah Christenson, Michael Murphy, Zac Novaczyk, Nick Bostrom, Patrick Mark, Kaden Kunz, Hobie Summers, Joseph Cohen, Mai P Nguyen","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Despite their association with high morbidity and mortality rates, limited data is available regarding subsequent fracture after femoral shaft fragility fractures. Specifically, two clinically important questions remain unanswered: (1) What is the cumulative incidence of proximal peri-implant femur fractures following femoral shaft fragility fractures? (2) Is fixation protecting the proximal femur associated with a lower cumulative incidence of proximal peri-implant femur fracture compared to when the proximal femur is not protected?</p><p><strong>Methods: </strong>A multi-center retrospective cohort study was conducted at four level 1 trauma centers. Patients aged 50 years or older treated with reduction and fixation of a low energy femoral shaft fracture between 2005 to 2024 were included in this review.Cases were categorized by whether fixation protected the proximal femur. Descriptive statistics were reported, and Kaplan Meier survival analyses assessed associations of patient, injury and treatment characteristics with the main outcome of cumulative incidence of proximal peri-implant fracture. Statistical significance was considered for p < 0.05.</p><p><strong>Results: </strong>There were 245 patients with a median age of 75 years old and interquartile range (IQR) 65 to 83, 192 (78.4%) women, and median Charlson Comorbidity Index 4 (IQR 3 to 6). Assessment via the AO/OTA classification revealed 193 32A, 34 32B, and 18 32C fractures. The overall rate of subsequent proximal femur fracture was less with fixation that protected the proximal femur (0/119, 0%) than without (6/126, 4.8%), p = 0.030. Without fixation protecting the proximal femur, the cumulative incidence of proximal femur fracture climbed to 6.9% within 10 months of femoral shaft fracture and was significantly greater than a sustained 0% incidence when fixation protected the proximal femur, log-rank p = 0.015. Proximal femur fracture was not associated with age, sex, comorbidity burden or AO/OTA classification (p > 0.05 for all).</p><p><strong>Conclusion: </strong>Without fixation protecting the proximal femur, approximately 1 in 15 patients treated for a femoral shaft fracture sustained a proximal femur fracture within 10 months of fixation of their shaft fracture. Protecting the proximal femur reduces the cumulative incidence of proximal peri-implant femur fracture and should be considered when possible.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"46 1","pages":"261-266"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564355","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":"Decision-Making and Management of Acute Isolated Syndesmosis Injuries in Athletes.","authors":"Richard VanTienderen, Matthew Bollier, Brian Wolf, Ned Amendola, Kyle Duchman","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The ankle joint is one of the most frequently injured joints in the athletic population. Some articles estimate that it accounts for approximately 40% of all sports injuries, with lateral ankle sprains accounting for approximately 85% of injuries whereas medial ankle and syndesmosis injuries account for approximately 4-5% and 1-11%, respectively.^1-4 Incidence of ankle sprains has been reported to be as high as 7 per 1,000 exposures for court sports and 1 per 1,000 exposures for field sports with lateral ankle sprains being more common than medial or syndesmotic ankle inju-ries.⁵ While high ankle sprain, or syndesmosis injury, is less prevalent than lateral ankle sprain, it still accounts for a high injury burden. Among athletes from the National Collegiate Athletic Association (NCAA), the incidence of syndesmosis injury was found to be 1.00 per 10,000 athleteexposures, with men's football, wrestling and ice hockey having the highest rates of injury.³ Optimizing treatment of syndesmosis injury is important as they typically require a longer recovery period and have a high recurrence rate.^3,6,7 The purpose of this article is to review the pertinent anatomy and diagnostic features of syndesmosis injury, discuss the indications and goals of operative and non-operative management, and discuss return to play recommendations following these injuries.</p><p><strong>Level of evidence: </strong>V.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"46 1","pages":"189-202"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564185","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":"Outcomes of Glucagon-Like-Peptide-1 Receptor Agonists (GLP-1A) and Patients Undergoing Total Hip Arthroplasty (THA): A Systematic Review and Meta-Analysis.","authors":"Troy B Puga, Tanner Haechten, Vincent Dieu, McKenna W Box, Kyle P O'Connor, John T Riehl","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Glucagon-Like-Peptide-1 Receptor Agonists (GLP-1a) medications have rapidly grown in popularity, however, their effects on the outcomes of Total Hip Arthroplasty (THA) remain largely unclear. The objective of this systematic review and meta-analysis is to evaluate the outcomes of patients undergoing THA and using a GLP-1a medication.</p><p><strong>Methods: </strong>A search was conducted across six databases. The search used a combination of keywords and Medical Subject Heading (MeSH) terms. Titles and abstracts were screened for eligibility for inclusion criteria. Full texts were screened and included if they met eligibility criteria. Demographics and results of the studies were extracted from included articles. Meta-analysis was conducted.</p><p><strong>Results: </strong>In this systematic review and metaanalysis, 10 studies met final inclusion criteria, and nine studies met inclusion for meta-analysis. Patients using GLP-1a medications in the setting of THA to those not using GLP-1a medications found a statistically significant decrease in the odds of readmission (OR: 0.81 (95% CI: 0.70-0.93); P<0.001), and no significant difference in the odds of surgical site infections (OR: 0.85 (95% CI: 0.601.20); P=0.36). At 90 days, there was no significant difference in prosthetic joint infections (OR: 1.19 (95% CI: 0.92-1.54); P=0.18), periprosthetic fractures (OR: 1.17 (95% CI: 0.82-1.68); P=0.40), and surgical or medical complications (OR: 0.84 (95% CI: 0.68-1.03); P=0.10) (Figures 4-6). At 2 years, there was no significant difference in periprosthetic fractures (OR: 0.99 (95% CI: 0.531.84); P=0.97) or prosthetic joint infections (OR: 0.98 (95% CI: 0.67-1.44); P=0.93).</p><p><strong>Conclusion: </strong>The findings of this study suggest that patients using GLP-1a medications while undergoing THA had reduced 90 day readmission rates, with equivalent rates of SSI, medical and surgical complications, PJI at 90 days and 2 years, and periprosthetic fracture 90 days and 2 years when compared with those not using GLP-1a medications. GLP-1a medications may be safely used in patients undergoing THA.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"46 1","pages":"55-64"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564316","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":"Predicting Non-Home Discharge Following Primary Total Hip Arthroplasty Using an Artificial Neural Network to Identify the Most Important Variables.","authors":"Campbell Dopke, Theodore Quan, Taylor Raffa, Joseph E Manzi, Philip M Parel, Sean Tabaie, Savyasachi C Thakkar","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Total hip arthroplasty (THA) has continued to increase in incidence. With expanding focus on value-based care and adoption of bundled payments at some facilities, cost containment measures, including discharging patients to home as soon as possible postoperatively, have gained attention. Therefore, it is important to determine patient characteristics associated with discharge disposition. The purpose of this study was to develop and utilize an artificial neural network (ANN) model to determine the most important non-modifiable and modifiable factors that can predispose patients to be discharged to a non-home destination following primary THA..</p><p><strong>Methods: </strong>The National Surgical Quality Improvement Program database was used to identify patients who underwent primary THA from 20162019. Demographic, comorbidity, preoperative, and intraoperative variables were analyzed in this study. Statistically significant variables, with a p-value < 0.05, were inputted into the ANN model.</p><p><strong>Results: </strong>In total, 124,691 patients were analyzed in the study, of which 19,275 (15.5%) were discharged to a non-home destination. The ANN reached a Receiver Operating Characteristic (ROC) Area-Under-the-Curve (AUC) of 0.793. The five most important variables which helped to predict non-home discharge following primary THA were age, operative time, preoperative hematocrit, functional status, and preoperative international normalized ratio (INR).</p><p><strong>Conclusion: </strong>The present study used an ANN model and identified several significant factors which can help predict patients being discharged to a non-home location following primary THA.</p><p><strong>Clinical relevance: </strong>Clinicians should be aware of these variables and explore reductions to nonhome discharges through preoperative patient optimization, where possible.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"46 1","pages":"65-72"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Contemporary Analysis of Corticosteroid Injections in Patients with Mild, Moderate, and Severe Hip Osteoarthritis: High Risk, Low Reward.","authors":"Alan D Lam, Nihir Parikh, Priya Sivalingam, Jennifer Bido, Yale A Fillingham, Chad A Krueger","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Hip osteoarthritis (HOA) represents a leading cause of disability in the United States. Consequently, intraarticular corticosteroid injections (lACSIs) are routinely recommended and utilized for non-surgical management of symptomatic HOA. While they are shown to decrease pain intensity, few studies have reported on the potential risk of rapidly progressive osteoarthritis (RPOA). This study aimed to assess the rate of HOA progression following IACSI in patients with mild, moderate, and severe HOA.</p><p><strong>Methods: </strong>This single-institution study retrospectively reviewed patients who underwent image-guided IACSI for HOA between January 1, 2022 and January 1, 2023, with a minimum follow-up of two years. Pre-injection and post-injection radiographs were reviewed to assign HOA grades (0-4) using the Kellgren-Lawrence (KL) classification system. Patients with mild, moderate, and severe (KL 2-4) HOA on pre-injection radiographs were included. Primary outcomes included changes in post-injection KL grades and time-to-total hip arthroplasty (THA).</p><p><strong>Results: </strong>There were 560 patients included, with an average age of 66.7 years, a mean BMI of 30.1, and 59.5% women. For patients with pre-injection KL grade < 4 (i.e., mild and moderate HOA or KL grades 2 and 3), there was HOA progression of one level in 185 (45.7%) patients. In the 147 (26.3%) patients with a pre-injection KL grade < 3 (i.e., mild HOA or KL grade 2), 32 (21.8%) increased by two levels. From the total cohort, 491 (87.6%) patients ultimately underwent THA. The average time-to-THA was 206 ± 95.6 days. There were no significant differences between pre-injection and post-injection patient-reported outcomes (PROs).</p><p><strong>Conclusion: </strong>Radiographic comparisons before and after IACSI revealed concerning HOA progression in over half the patients without severe HOA. Combined with a minimal change in PROs and most patients electing to undergo THA within the following months, the safety and utility of IACSI in this population must be reconsidered.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"46 1","pages":"15-20"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564246","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":"Biomechanical Evaluation of Suture Tape Versus Metallic Wire With Cannulated Screws Tension Band Fixation For Transverse Patella Fractures: A Biomechanical Study.","authors":"Michael C LaRoque, Alexander C M Chong, Bruce E Piatt","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Transverse patella fractures requiring surgical fixation are typically treated with a tension band construct using metal wire. This technique is associated with high rates of complications and reoperation. Alternative fixation technique utilizing non-absorbable suture materials have been introduced. This biomechanical study aims to compare the stability of two tension band constructs, both utilizing headed cannulated lag screws, with either suture tape or traditional metal wire under cyclic load conditions, simulating repetitive physiological stress.</p><p><strong>Methods: </strong>Six matched pairs of fresh frozen cadaveric knees were obtained for testing. A standardized transverse patellar osteotomy (AO/OTA 34C1.1) was created in each to simulate a simple transverse patella fracture. Each pair was repaired using a tension band construct with headed cannulated screws, randomized to fixation with either suture tape or metal wire. All specimens underwent cyclic loading from 0 to 90 knee flexion at a frequency of 0.2 Hz for up to 1000 cycles. Two displacement transducers were used to measure real-time fracture gap displacement during testing from the start of testing and until clinical fixation failure. Clinical failure is defined as fracture gap displacement > 3 mm.</p><p><strong>Results: </strong>Clinical failure occurred in 5 of 6 specimens (83%) in the suture tape group, with a mean of 296±433 cycles. In the metal wire group, 4 of 6 specimens (67%) experienced clinical failure, with a mean of 421±461 cycles. There was no statistically significant difference in cycles to failure between the two groups (p=0.29). Kaplan-Meier survival analysis demonstrated a 500-cycle survival rate of 33% (95% CI: 0%-71%) for both groups.</p><p><strong>Conclusion: </strong>Both constructs may be considered viable options for the surgical treatment of simple transverse patella fractures.</p><p><strong>Level of evidence: </strong>V.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"46 1","pages":"223-230"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564124","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":"Assessing Pain Control and Satisfaction in Spine Surgery Amidst COVID-19 Staff Shortages: A Retrospective Study on Patient-Controlled Analgesia.","authors":"Emma Bechler, Kristina Rossmiller, Reagan Grieser-Yoder, Jill Corlette, Krit Petrachaianan, Natalie Glass, Catherine Olinger","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Effective pain management is critical for recovery after spine surgery, as inadequate control can delay mobilization, prolong hospitalization, and raise opioid consumption.^1-4 Among the strategies available, patient-controlled analgesia (PCA) enables patients to self-administer intravenous opioids within preset safety limits. Inconsistencies in opioid use, pain scores, and length of stay suggest that the effectiveness of PCA may be shaped by contextual and institutional variables. One example being the significant strain the COVID-19 pandemic placed on hospital staffing and perioperative workflows, potentially undermining the effectiveness of provider-administered analge-sia.^9-10 Although postoperative pain management has been previously studied, few investigations have examined how pandemic-related staffing shortages may have impacted the comparative effectiveness of PCA versus non-PCA strategies.</p><p><strong>Methods: </strong>This retrospective cohort study included 5,528 adult patients who underwent one of four spine procedures between January 2018 and December 2023. Patients were stratified by analgesia type (PCA vs. non-PCA) and time period (pre-COVID vs. post-COVID). Primary outcomes included total opioid consumption (measured in morphine milliequivalents, MME) and average Visual Analog Scale (VAS) pain scores in the first 24 hours postoperatively. Multivariable regression adjusted for demographics including age, sex, obesity, and smoking.</p><p><strong>Results: </strong>PCA use was associated with a 52.1% reduction in opioid consumption compared to non-PCA (p < 0.001). This effect was most pronounced post-COVID (74.2% reduction), though not statistically significant. Despite reduced opioid use, PCA patients reported slightly higher VAS scores (+0.814, p = 0.0013). Subgroup analyses revealed higher opioid use and pain scores among smokers and obese patients, while male sex predicted lower pain scores. PCA was particularly beneficial in more invasive procedures, and its expanded use in less complex surgeries post-COVID did not increase pain scores.</p><p><strong>Conclusion: </strong>PCA significantly reduced opioid use following spine surgery, though pain scores were modestly higher. During staffing shortages, PCA may offer operational and clinical advantages. Patient-specific risk factors should guide individualized pain protocols.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"46 1","pages":"143-150"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563669","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}