The Iowa orthopaedic journal最新文献

{"title":"Is Perioperative Radiotherapy Effective in Preventing Local Recurrence in Myxofibrosarcoma?","authors":"Shah Fahad, Abigai Grothe, Qiang An, Benjamin J Miller","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Myxofibrosarcoma (MFS) is a rare type of soft tissue sarcoma that is locally aggressive and has a high risk of recurrence. The effectiveness of perioperative radiotherapy (RT) in preventing local recurrence (LR) of MFS remains uncertain. This retrospective study aimed to evaluate the impact of perioperative radiotherapy on local recurrence in patients with MFS.</p><p><strong>Methods: </strong>A total of 75 patients diagnosed with MFS and treated at a single institution were included in the study. Patient data, including demographics, tumor characteristics, and treatment variables, were collected from electronic medical records. The primary endpoint was the occurrence of local recurrence.</p><p><strong>Results: </strong>Among the patients, 25/75 (33.3%) received radiation therapy, while 50/75 (66.7%) did not. Local recurrence in the radiated group was 28% (7/25) compared to 36% (18/50) in the non-irradiated group (p = 0.20). The LR rate trended higher in patients who received RT postoperatively (adjuvant) (6/12, 50%) than preoperatively (neoadjuvant) (1/13, 7.6%) (p = 0.124). Of the 54 patients with negative margins, the local recurrence rate was lower in the radiated group (1/12, 8.33) than the non-irradiated group (9/36, 25%) (p = 0.034). A subgroup analysis based on tumor grade did not reveal any significant differences in recurrence rates between the radiated and non-irradiated groups. Furthermore, there was no significant difference in recurrence rates between the irradiated and non-irradiated groups at the one-year (p = 0.32), two-year (p = 0.24), and five-year (p = 0.32) follow-up marks.</p><p><strong>Conclusion: </strong>Although radiotherapy demonstrated a trend toward reduction in recurrence rates in patients with MFS in this study, the observed difference did not reach statistical significance. Neoadjuvant radiation appears to be more effective than adjuvant radiation. However, there was a significant reduction in recurrence in patients with negative margins who received radiation demonstrating that effective surgical resection continues to be the most important intervention in patients with myxofibrosarcoma. <b>Level of Evidence: III</b>.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"44 1","pages":"85-92"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11195901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452607","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":"2024 Graduating Orthopedic Residents.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"44 1","pages":"xi-xiii"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11195899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452591","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":"Iowa Orthopedic Journal Editors Emeriti.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"44 1","pages":"iii"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11195878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452606","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":"New Orthopedic Faculty.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"44 1","pages":"xvi"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11195907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452610","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":"Peri-Operative Management of Periacetabular Osteotomy: A Report of Current Practices from the Anchor Group, Supporting Literature, and Areas for Future Investigation.","authors":"Michael Willey, Andrea M Spiker, Matthew R Schmitz, Etienne L Belzile, Rafael J Sierra, John Clohisy, Michael Stover","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Periacetabular osteotomy (PAO) is a well-established surgical treatment for hip dysplasia, but very few studies report the impact of peri-operative management strategies on early pain and function. The purpose of this study is to describe peri-operative management variability among a group of experienced surgeons and review the literature supporting these practice patterns.</p><p><strong>Methods: </strong>We surveyed 16 surgeons that perform PAO to document various aspects of peri-operative management at four stages: pre-operative, intra-operative, post-operative in the hospital, and at discharge. Our goal was to report current surgical pain management strategies, adjunct medications, type of anesthesia, deep venous thrombosis and heterotopic ossification prophylaxis strategies, initiation of physical therapy, and use of continuous passive motion (CPM). We reviewed current literature to identify studies supporting these perioperative strategies and identify knowledge gaps that would benefit from further investigation.</p><p><strong>Results: </strong>Of the 16 surgeons surveyed, 75% had been in practice greater than 10 years and most had not altered their post-operative protocol for more than 3 years. 15/16 surgeons felt that length of stay could be reduced at their institution with improved peri-operative pain management. 6/16 were considering or had already implemented outpatient PAO as a part of their practice. We found significant variability in the pain medications provided at all peri-operative stages. 14/16 utilized general anesthesia, and many utilized epidural or peripheral nerve blocks. 6/16 surgeons utilized surgical field block (also referred to as periarticular block). These surgeons advocated that surgical field block was an effective intervention with no/minimal complication risk. There is very little literature critically evaluating efficacy of these perioperative management strategies for PAO.</p><p><strong>Conclusion: </strong>There is significant practice variability in peri-operative management of PAO surgery. We report various strategies utilized by a group of experienced surgeons and review supporting literature. There are significant knowledge gaps in best surgical pain management strategies, adjunct medications, surgical field blocks, and use of CPM that need further investigation. <b>Level of Evidence: IV</b>.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"44 1","pages":"159-166"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11195894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452552","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 Patient Provider Educational Interactions and Associated Preoperative Variables on Outcomes in the Hip Dysplasia Population.","authors":"Alisa Drapeaux, Michael Willey, John Davison","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Patient provider interactions influence patient treatment adherence, clinical outcomes, patient satisfaction, and an overall patient's engagement in healthcare decisions. The purpose of this study was to examine the effectiveness of patient provider educational interactions and associated variables on patient reported outcomes in the hip dysplasia population.</p><p><strong>Methods: </strong>A secondary data analysis was completed with 6-month postoperative survey data from participants, who had undergone periacetabular osteotomy. Data analysis including demographic variables, patient reported outcome results, and pre-operative knowledge retention.</p><p><strong>Results: </strong>A significant difference was found between participants' expectations of crutch use and physical therapy care with actual performance (p<0.001 and p=0.01) and with engagement in pre-operative support based on mental health history (p=0.02).</p><p><strong>Conclusion: </strong>Pre-operative interactions with a provider team and prior patients (pre-operative support) can influence a patient's educational experience. Providers should review educational interventions and offer pre-operative support to patients. <b>Level of Evidence: VI</b>.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"44 2","pages":"13-26"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985634","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":"Health Literacy in Shoulder Arthroscopy: A Quantitative Assessment of the Understandability and Readability of Online Patient Education Material.","authors":"Olivia C O'Reilly, Mary K Skalitzky, Kyle K Kesler, Alan G Shamrock, Burke Gao, Trevor R Gulbrandsen, Matthew J Bollier","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The National Institutes of Health (NIH) and American Medical Association (AMA) recommend that online health information be written at a maximum 6th grade reading level. The aim was to evaluate online resources regarding shoulder arthroscopy utilizing measures of readability, understandability, and actionability, using syntax reading grade level and the Patient Education Materials Assessment Tool (PEMAT-P).</p><p><strong>Methods: </strong>An online Google™ search utilizing \"shoulder arthroscopy\" was performed. From the top 50 results, websites directed at educating patients were included. News and scientific articles, audiovisual materials, industry websites, and unrelated materials were excluded. Readability was calculated using objective algorithms: Flesch-Kincaid Grade-Level (FKGL), Simple Measure of Gobbledygook (SMOG) grade, Coleman-Liau Index (CLI), and Gunning-Fog Index (GFI). The PEMAT-P was used to assess understandability and actionability, with a 70% score threshold. Scores were compared across academic institutions, private practices, and commercial health publishers. The correlation between search rank and readability, understandability, and actionability was calculated.</p><p><strong>Results: </strong>Two independent searches yielded 53 websites, with 44 (83.02%) meeting inclusion criteria. No mean readability score performed below a 10th grade reading level. Only one website scored at or below 6th grade reading level. Mean understandability and actionability scores were 63.02%±12.09 and 29.77%±20.63, neither of which met the PEMAT threshold. Twelve (27.27%) websites met the understandability threshold, while none met the actionability threshold. Institution categories scored similarly in understandability (61.71%, 62.68%, 63.67%) among academic, private practice, and commercial health publishers respectively (p=0.9536). No readability or PEMAT score correlated with search rank.</p><p><strong>Conclusion: </strong>Online shoulder arthroscopy patient education materials score poorly in readability, understandability, and actionability. One website scored at the NIH and AMA recommended reading level, and 27.27% of websites scored above the 70% PEMAT score for understandability. None met the actionability threshold. Future efforts should improve online resources to optimize patient education and facilitate informed decision-making. <b>Level of Evidence: IV</b>.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"44 1","pages":"151-158"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11195902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452602","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 Impact of Additional Fractures and Polytrauma on Complications in Patients Undergoing Femoral Neck Fracture Fixation.","authors":"Ayobami S Ogunsola, Seth M Borchard, Michael C Marinier, Aly Fayed, Matthew D Karam, Jacob M Elkins","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>While there have been significant advancements in recent years, complications following fixation for femoral neck fractures remain a concern. This retrospective cohort study aimed to investigate the influence of polytrauma and additional fractures on the occurrence of complications in patients who underwent surgical fixation for femoral neck fractures. The study focused on analyzing patient demographics, comorbidities, fracture classifications, fixation methods, and the likelihood of experiencing post-operative complications, with a specific emphasis on the impact of polytrauma and additional fractures.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed data from medical records and radiographs of patients who underwent surgical fixation for femoral neck fractures at a tertiary care center between 2007 and 2020. A total of 58 patients met inclusion criteria and were assessed based on their medical history, comorbidities, fracture classification, fixation method, and the occurrence of complications such as osteonecrosis, non-union, limb length discrepancy, and conversion to Total Hip Arthroplasty (THA). Among the patients, 36 received Cancellous Screw (CS) fixation, 12 underwent Sliding Hip Screw (SHS) fixation, while the remaining 10 patients who underwent different fixation methods were excluded from the analysis due to the heterogeneity of the group.</p><p><strong>Results: </strong>Demographic characteristics and comorbidities were similar between the CS and SHS fixation groups. The overall complication rate for CS fixation was 16.7% (6/36 patients), while the rate for SHS fixation was 33.3% (4/12 patients). However, when considering the presence of polytrauma and additional fractures, a significant association with increased complication rates was observed. Cox proportional regression analysis revealed that the absence of polytrauma/additional fractures significantly reduced the complication rates by more than 90% (Hazard ratio (HRpolytrauma)=0.01, P value = 0.01). This highlights the substantial impact of polytrauma and additional fractures on complications in femoral neck fracture fixation surgeries.</p><p><strong>Conclusion: </strong>This study emphasizes the need for thorough evaluation and tailored management strategies for patients with femoral neck fractures associated with polytrauma or additional fractures to minimize the complications of femoral neck fracture surgery. Further research is warranted to explore potential preventive measures and optimized treatment approaches for this high-risk patient subset of the femoral neck fracture population. <b>Level of Evidence: III</b>.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"44 2","pages":"157-163"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985562","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":"Standardized Multimodal Pain Protocol Minimizes Inpatient Opioid Administration in Pediatric Orthopedic Surgery Population.","authors":"Dalibel Bravo, Ryan Roach, James Feng, Noah Llaneras, David Godfried, Mara Karamitopoulos","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Optimal management of post-operative pain is a critical component of orthopedic surgical care. There is a heightened awareness of narcotic prescribing habits given the current \"opioid epidemic.\" The lack of standardized protocols has led to increased errors, delayed access to prescribed medications, and excessive narcotic prescribing.The purpose of this study is to assess the current trends in opioid use and document the prescribing patterns in the pediatric population before and after the implementation of a standardized protocol at our Institution.</p><p><strong>Methods: </strong>A multimodal postoperative pain pathway was developed and implemented throughout a large, academic, pediatric orthopedic division. The pathway utilized opioid and non-opioid pain medications and educational handouts with descriptions of the different classes of pain medication and specific dosing regimens.A query of electronic medical records was completed to identify all patients under the age of 18 that underwent inpatient orthopedic surgery from January 2016 to June 2018. Based on surgical dissection and anticipated postoperative pain, procedures were grouped into low complexity and high complexity. The average amount of opioids administered to the patients during their stay in the hospital was converted to morphine milligram equivalents (MME). The average MME was plotted, and the trends were analyzed.</p><p><strong>Results: </strong>455 inpatients met the inclusion criteria. Opioid pain medication administration was significantly higher in the high-complexity group compared to the low-complexity group. Implementing the multimodal pain pathway significantly reduces opioid administration in both groups without an increase in length of stay.</p><p><strong>Conclusion: </strong>Implementation of a standardized, post-operative, multimodal pain regimen lead to a significant decrease in the amount of administered narcotics following inpatient orthopedic surgery without an increase in length of stay. <b>Level of Evidence: IV</b>.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"44 2","pages":"139-144"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985927","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":"Orthopedic Surgery <50 Days Following Covid-19 Infection Is Not Associated With Increased Postoperative Complications.","authors":"Katelyn T Koschmeder, J Adam Driscoll, Taylor Den Hartog, Christopher Halbur, Ryan Bailey, Ethan Kuperman, Brendan M Patterson, Catherine Olinger, Nicolas O Noiseux","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Recent literature indicates that COVID-19 infection is a negative predictor of good outcomes following elective orthopedic surgery. However, the ideal timing of surgery after infection is unclear. The purpose of this study was to compare the rates of post-operative complications between those who underwent elective orthopedic surgery <50 days and >50 days after COVID-19 infection.</p><p><strong>Methods: </strong>This is a pilot study utilizing retrospective review of 28 adult subjects who underwent orthopedic surgery including 17 total-knee arthroplasties, seven total-hip arthroplasties, three posterior spinal fusions, and one common peroneal decompression. These subjects were indicated for an orthopedic surgery that was canceled due to positive pre-operative COVID-19 testing. The subjects were rescheduled for surgery between March 2020-December 2022.There were two cohorts: those who underwent surgery <50 days after COVID-19 infection (n=14) and subjects who underwent surgery >50 days after COVID-19 infection (n=14). Demographics, preoperative comorbid conditions, and post-operative complications were recorded and compared.</p><p><strong>Results: </strong>There were no significant demographic differences between the two cohorts with respect to age, body mass index, weight, and American Society of Anesthesiologists (ASA) grade. The two cohorts had no significant difference in pre-existing comorbid conditions with hypertension and peripheral vascular disease being the most common comorbidities overall. There were six postoperative complications involving four subjects within 90 days of surgery. One subject developed a postoperative pulmonary embolism (PE), and another subject developed a surgical-site infection, sepsis, and renal failure; both in the >50 days cohort. One patient in each cohort required reoperation. There was no difference in postoperative complications such as deep vein thrombosis (DVT), PE, sepsis, renal failure, and intensive care unit (ICU) admission between the two cohorts.</p><p><strong>Conclusion: </strong>This pilot cohort study demonstrates that COVID-19 infection within 50 days of orthopedic surgery does not significantly increase the risk of postoperative complications such as DVT, PE, surgical site infection, renal failure, ICU admission, reoperation, or death. Further evaluation of the effects of COVID-19 on surgical outcomes in larger cohorts is warranted. <b>Level of Evidence: III</b>.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"44 2","pages":"133-138"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985912","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}