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Orthopedic Clinics of North America

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https://www.readbyqxmd.com/read/29499829/evidence-based-medicine
#1
EDITORIAL
Frederick M Azar
No abstract text is available yet for this article.
April 2018: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/29499828/patient-reported-outcomes-in-foot-and-ankle-surgery
#2
REVIEW
Kenneth J Hunt, Eric Lakey
Patient-reported outcomes (PROs) are a measure of health care quality that empower patients to share their health care perceptions with their providers. In orthopedic foot and ankle surgery, these measures can range from global assessments of pain or satisfaction to complex questionnaires designed to assess the function of specific anatomic regions or the recovery from specific procedures. This article seeks to characterize the use of PROs in foot and ankle surgery, describe some of the most commonly used measures, discuss implementation in everyday clinical practice, and explore the future of PROs in foot and ankle orthopedics...
April 2018: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/29499827/venous-thromboembolism-disease-prophylaxis-in-foot-and-ankle-surgery
#3
REVIEW
Bonnie Y Chien, Tonya Dixon, Daniel Guss, Christopher DiGiovanni
There are limited data to guide the use of venous thromboembolism disease (VTED) prophylaxis after foot and ankle surgery. Although there is general consensus that the overall risk is lower than after hip or knee replacement, subpopulations of patients may be at relatively heightened risk. Furthermore, existing data are often conflicting regarding the efficacy of prophylaxis, with little acknowledgment of the tradeoffs between VTED prophylaxis and potential complications associated with the use of such medications...
April 2018: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/29499826/venous-thromboembolism-prophylaxis-in-shoulder-surgery
#4
REVIEW
William R Aibinder, Joaquin Sanchez-Sotelo
The incidence of venous thromboembolic events (VTEs) complicating shoulder surgery is difficult to estimate. Case reports, retrospective studies, prospective studies, and systematic reviews vary in terms of separating symptomatic versus asymptomatic VTEs, those occurring in the upper versus lower extremities, and those leading to pulmonary embolism. Reported rates vary between 0.02% and 13%. Arthroplasty is associated with a higher incidence than arthroscopy. Surgery for fracture presents increased risk. Mechanical prophylaxis using compression devices could be considered given its favorable risk-benefit profile...
April 2018: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/29499825/antibiotic-prophylaxis-and-prevention-of-surgical-site-infection-in-shoulder-and-elbow-surgery
#5
REVIEW
K Keely Boyle, Thomas R Duquin
Infection after orthopedic procedures is a devastating and serious complication associated with significant clinical and financial challenges to the health care system and unfortunate patient. The time and resource-intensive nature of treating infection after orthopedic procedures has turned attention toward enhancing prevention and establishing quality improvement measures. Prevention strategies throughout the perioperative period include host optimization, risk mitigation, reducing bacterial burden and proper wound management...
April 2018: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/29499824/injection-therapies-for-rotator-cuff-disease
#6
REVIEW
Kenneth M Lin, Dean Wang, Joshua S Dines
Rotator cuff disease affects a large proportion of the overall population and encompasses a wide spectrum of pathologies, including subacromial impingement, rotator cuff tendinopathy or tear, and calcific tendinitis. Various injection therapies have been used for the treatment of rotator cuff disease, including corticosteroid, prolotherapy, platelet-rich plasma, stem cells, and ultrasound-guided barbotage for calcific tendinitis. However, the existing evidence for these therapies remains controversial or sparse...
April 2018: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/29499823/carpal-tunnel-syndrome-making-evidence-based-treatment-decisions
#7
REVIEW
James H Calandruccio, Norfleet B Thompson
Carpal tunnel syndrome (CTS) is one of the most common musculoskeletal disorders of the upper extremity. Comorbidities associated with the development of CTS include diabetes and obesity. Although a high rate of repetitive hand/wrist motions is a risk factor, there is insufficient evidence to implicate computer use in the development of CTS. Initial treatment generally is nonoperative, with the strongest evidence supporting bracing/splinting. Strong evidence supports operative treatment, regardless of technique, as superior to nonoperative treatment...
April 2018: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/29499822/evidence-based-review-of-distal-radius-fractures
#8
REVIEW
Benjamin M Mauck, Colin W Swigler
Distal radius fractures are one of the most commonly treated fractures in the United States. The highest rates are seen among the elderly, second only to hip fractures. With the increasing aging population these numbers are projected to continue to increase. Distal radius fractures include a spectrum of injury patterns encountered by general practitioners and orthopedists alike. This evidence-based review of distal radius fractures incorporates current and available literature on the diagnosis, management, and treatment of fractures of the distal radius...
April 2018: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/29499821/pediatric-orthopedic-trauma-an-evidence-based-approach
#9
REVIEW
Elizabeth W Hubbard, Anthony I Riccio
The management of pediatric fractures has evolved over the past several decades, and many injuries that were previously being managed nonoperatively are now being treated surgically. The American Academy of Orthopaedic Surgeons has developed clinical guidelines to help guide decision making and streamline patient care for certain injuries, but many topics remain controversial. This article analyzes the evidence regarding management of 5 of the most common and controversial injuries in pediatric orthopedics today...
April 2018: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/29499820/current-use-of-evidence-based-medicine-in-pediatric-spine-surgery
#10
REVIEW
Matthew E Oetgen
Evidence-based medicine (EBM) is a process of decision-making aimed at making the best clinical decisions as they relate to patients' health. The current use of EBM in pediatric spine surgery is varied, based mainly on the availability of high-quality data. The use of EBM is limited in idiopathic scoliosis, whereas EBM has been used to investigate the treatment of pediatric spondylolysis. Studies on early onset scoliosis are of low quality, making EBM difficult in this condition. Future focus and commitment to study quality in pediatric spinal surgery will likely increase the role of EBM in these conditions...
April 2018: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/29499819/hip-surveillance-in-children-with-cerebral-palsy
#11
REVIEW
Aaron Huser, Michelle Mo, Pooya Hosseinzadeh
The hip is the second most common involved joint in cerebral palsy. Hip displacement occurs in more than 33% of children with cerebral palsy, with a higher prevalence in nonambulatory children. Hip displacement in this population is typically progressive. Hip dislocation can result in pain and difficulty with sitting and perineal care. Since early stage of hip displacement can be silent, and hip surveillance programs are recommended. Most programs use the degree of hip dysplasia and Growth Motor Function Classification System level for screening recommendations...
April 2018: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/29499818/articular-incongruity-in-the-lower-extremity-how-much-is-too-much
#12
REVIEW
Tim R Beals, Robert Harris, Darryl A Auston
Intraarticular fractures carry a significant risk for posttraumatic osteoarthritis, and this risk varies across different joint surfaces of the lower extremity. These differences are likely due to the anatomic and biomechanical specifics of each joint surface. High-quality human studies are lacking to delineate the threshold articular incongruity that significantly increases risk for posttraumatic osteoarthritis and diminished clinical outcomes for many joint surfaces. Even with anatomic reduction of the articular surface, close attention must be paid to mechanical axis and joint stability to optimize outcomes...
April 2018: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/29499817/use-of-tourniquets-in-limb-trauma-surgery
#13
REVIEW
Yelena Bogdan, David L Helfet
Although tourniquets are commonly used in patients with limb trauma patients, both in the acute and elective settings, no set protocols exist for their indications, contraindications, or proper use. This article addresses the current literature on optimal pressure, timing, cuff design, and complications of tourniquets in trauma patients. General issues are discussed, followed by those specific to upper and lower extremities. Lastly, serious complications, such as pulmonary embolism, are described.
April 2018: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/29499816/bundle-payment-for-musculoskeletal-care-current-evidence-part-2
#14
REVIEW
Meghan A Piccinin, Zain Sayeed, Ryan Kozlowski, Vamsy Bobba, David Knesek, Todd Frush
In an effort to rein in expenditures and improve quality of care, the Centers for Medicare and Medicaid Services (CMS) has initiated bundled reimbursement programs for total joint arthroplasty (TJA) procedures. The success of CMS's bundled payment models has prompted some private insurers to collaborate with provider organizations to institute similar bundled contracts for TJA. The authors review the experiences of orthopedic groups in the implementation of bundled payments for primary and revision TJA through both public and private payers...
April 2018: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/29499815/bundle-payment-for-musculoskeletal-care-current-evidence-part-1
#15
REVIEW
Meghan A Piccinin, Zain Sayeed, Ryan Kozlowski, Vamsy Bobba, David Knesek, Todd Frush
In the face of escalating costs and variations in quality of care, bundled payment models for total joint arthroplasty procedures are becoming increasingly common, both through the Centers for Medicare & Medicaid Services and private payer organizations. The effective implementation of these payment models requires cooperation between multiple service providers to ensure economic viability without deterioration in care quality. This article introduces a stepwise model for the financial analysis of bundled contracts for use in negotiations between hospitals and private payer organizations...
April 2018: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/29499814/respiratory-synchronized-versus-intermittent-pneumatic-compression-in-prevention-of-venous-thromboembolism-after-total-joint-arthroplasty-a-systematic-review-and-meta-analysis
#16
REVIEW
Ameer M Elbuluk, Kelvin Y Kim, Kevin K Chen, Afshin A Anoushiravani, Ran Schwarzkopf, Richard Iorio
The objective of this study was to evaluate the efficacy of respiratory synchronized compression devices (RSCDs) versus nonsynchronized intermittent pneumatic compression devices (NSIPCDs) in preventing venous thromboembolism (VTE) after total joint arthroplasty. A systematic literature review was conducted. Data regarding surgical procedure, deep vein thrombosis, pulmonary embolism, mortality, and adverse events were abstracted. Compared with control groups, the risk ratio of deep vein thrombosis development was 0...
April 2018: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/29145991/outpatient-surgery
#17
EDITORIAL
Frederick M Azar
No abstract text is available yet for this article.
January 2018: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/29145990/the-role-of-superior-capsule-reconstruction-in-rotator-cuff-tears
#18
REVIEW
Paul Sethi, Wm Grant Franco
Massive, irreparable rotator cuff disease is a challenging problem to treat, especially in the younger active patient. This condition allows the deltoid to generate anterosuperior translation and shoulder dysfunction. Ideally, this dysfunction may be improved with rotator cuff repair. However, in the setting of irreparable rotator cuff disease, normal function is challenging to restore. Superior capsule reconstruction theoretically improves function by recentering the humeral head and improving glenohumeral kinematics...
January 2018: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/29145989/pain-management-strategies-in-shoulder-arthroplasty
#19
REVIEW
Jason L Codding, Charles L Getz
Pain control in total shoulder arthroplasty demands a multidisciplinary approach with collaboration between patients, surgeon, and anesthetist. A multimodal approach with preemptive medication, regional blockade, local anesthetics, and a combination of acetaminophen, nonsteroidal antiinflammatory drugs, tramadol, and gabapentinoids postoperatively leads to pain control and patient satisfaction. Assessment of patients' expectations constitutes a vital aspect of the preoperative patient evaluation. Educating and psychologically preparing patients reduces postoperative pain...
January 2018: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/29145988/outpatient-shoulder-arthroplasty
#20
REVIEW
Tyler J Brolin, Thomas W Throckmorton
Health care policy makers have placed increased attention on the cost of health care making outpatient joint arthroplasty an attractive alternative to routine hospital admission. Recent studies have shown outpatient shoulder arthroplasty is a safe and cost-effective alternative to inpatient shoulder arthroplasty. Proper patient selection, patient education, effective pain management strategies, and attention to intraoperative blood loss are keys in the success of outpatient shoulder arthroplasty.
January 2018: Orthopedic Clinics of North America
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