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Orthopedics

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https://www.readbyqxmd.com/read/28530768/perioperative-management-of-rheumatoid-medications-in-orthopedic-surgery
#1
Kunal Sindhu, Brian Cohen, Joseph A Gil
Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disorder known to cause progressive joint destruction. Over time, untreated RA can lead to pain and increasing disability, making orthopedic intervention necessary. The treatment of RA revolves around a variety of medications that blunt the overall immune response. However, this may increase the risk of infection and impair wound healing. Given the nature of this disease, orthopedists frequently encounter patients with RA in the operative setting. To optimize surgical outcomes, orthopedists must carefully manage and pay special attention to the adverse side effects of the complicated medication regimens of these patients perioperatively...
May 20, 2017: Orthopedics
https://www.readbyqxmd.com/read/28530767/diagnostic-evaluation-of-upper-extremity-masses-and-tumors
#2
Andrew R Tyser, Patrick A Holt, R Lor Randall
The appropriate evaluation of hand and upper extremity masses is an important aspect of the care of orthopedic patients. Although most of these masses are benign, the orthopedic surgeon must have a high index of suspicion when assessing them because early diagnosis and treatment of aggressive or malignant masses may have a great effect on patient outcomes. This article provides an overview of benign and malignant osseous and soft tissue masses that orthopedic surgeons may encounter and a detailed algorithm for evaluating these masses...
May 20, 2017: Orthopedics
https://www.readbyqxmd.com/read/28530766/right-ring-finger-volar-mass-in-a-14-year-old-boy
#3
Mary P Fox, Jack E McKay, Randall D Craver, Nicholas D Pappas
A trigger digit is relatively uncommon in adolescents and often has a different etiology in that age group vs adults. In the pediatric population, trigger digits frequently arise from a variety of underlying anatomic situations, including thickening of the flexor digitorum superficialis or flexor digitorum profundus tendons, an abnormal relationship between the flexor digitorum superficialis and flexor digitorum profundus tendons, a proximal flexor digitorum superficialis decussation, or constriction of the pulleys...
May 20, 2017: Orthopedics
https://www.readbyqxmd.com/read/28530765/perioperative-physiotherapy-in-total-knee-arthroplasty
#4
Melvin G Joice, Subhrojyoti Bhowmick, Derek F Amanatullah
Total knee arthroplasty has a high success rate. In the interest of enhancing patient outcomes, numerous perioperative interventions have been studied, including preoperative education, preoperative rehabilitation, postoperative inpatient rehabilitation, continuous passive motion, postoperative outpatient rehabilitation, unsupervised in-home exercises, telerehabilitation, and various combinations of these. This comprehensive review analyzes the existing body of evidence on these perioperative interventions and examines some burgeoning opportunities in rehabilitation after total knee arthroplasty in the interest of improving patient outcomes and ensuring sustainable health care utilization for the future of total knee arthroplasty...
May 20, 2017: Orthopedics
https://www.readbyqxmd.com/read/28504811/percutaneous-screw-fixation-for-scaphoid-fractures
#5
Mohamed E Al-Ashhab, Hossam El-Dein A Elbegawi
Treatment of nondisplaced scaphoid waist fractures has evolved from conventional cast immobilization to percutaneous screw insertion. This study assessed clinical and radiologic outcomes of volar percutaneous screw fixation for 15 type B2 scaphoid fractures (according to the Herbert and Fisher classification). All patients were followed for an average of 33 months (range, 6-50 months). All fractures achieved radiographic union at an average of 57 days (range, 35-70 days), requiring no additional procedures...
May 15, 2017: Orthopedics
https://www.readbyqxmd.com/read/28504810/using-a-structured-checklist-to-improve-the-orthopedic-ward-round-a-prospective-cohort-study
#6
Adrian J Talia, James Drummond, Cameron Muirhead, Phong Tran
Comprehensive and timely documentation on orthopedic ward rounds continues to be problematic, leading to delayed or inappropriate patient care and miscommunication between health care providers. The authors introduced a simple checklist to improve the documentation on orthopedic ward rounds in their institution. A prospective cohort study was performed. Standard care was provided for cohort A. During a 2-week period, the documentation of patient care by physicians following a ward round was assessed in terms of venous thromboembolism prophylaxis, fasting status, wound or dressing plan, weight-bearing status, and important surgical details...
May 15, 2017: Orthopedics
https://www.readbyqxmd.com/read/28504809/effect-of-lymphedema-treatment-for-management-of-acute-pilon-fractures
#7
John M Whatley, James A Lalonde, Craig C Greene, Kevin B Riche, Danielle M Tatum
Pilon fractures are high-energy injuries that often result in considerable edema and compromise of the soft tissue envelope of the ankle. These injuries are typically staged with an external fixator until the soft tissue is amenable for definitive fixation. This study was conducted to determine the effects of lymphedema treatment for the management of pilon fractures. Patients who underwent open reduction and internal fixation of pilon fractures between 2007 and 2014 at the authors' level II trauma center were identified by Current Procedural Terminology codes indicative of placement of an external fixator (20690) and open reduction and internal fixation of a pilon fracture (27826, 27827, or 27828)...
May 15, 2017: Orthopedics
https://www.readbyqxmd.com/read/28504808/outcome-of-reverse-shoulder-arthroplasty-for-patients-with-parkinson-s-disease-a-matched-cohort-study
#8
Michael C Cusick, Randall J Otto, Rachel E Clark, Mark A Frankle
Parkinson's disease (PD) is a progressive neurologic disorder that affects the musculoskeletal system. Currently, the use of reverse shoulder arthroplasty (RSA) for patients with PD has not been adequately studied. The authors sought to determine if RSA provided similar functional outcomes for patients with PD compared with a matched cohort of patients without PD. Between 2004 and 2011, 10 patients with PD (4 men, 6 women) underwent RSA. Patients with PD were matched to patients without PD at a 1:4 ratio based on age (average, 76 years; range, 63-85 years), sex (16 men, 24 women), preoperative diagnosis, and length of follow-up (average, 43 months; range, 24-128 months)...
May 15, 2017: Orthopedics
https://www.readbyqxmd.com/read/28481387/trapeziectomy-with-ligament-reconstruction-and-tendon-interposition-versus-a-trapeziometacarpal-prosthesis-for-the-treatment-of-thumb-basal-joint-osteoarthritis
#9
María José Robles-Molina, Francisco López-Caba, Rafael C Gómez-Sánchez, Encarnación Cárdenas-Grande, Miguel Pajares-López, Pedro Hernández-Cortés
Numerous surgical procedures have been described to treat trapeziometacarpal osteoarthritis, but no approach is currently considered superior. Good long-term outcomes have been reported with multiple procedures. No studies have been published comparing outcomes of the Arpe joint replacement (Biomet, Valence, France) with those of ligament reconstruction and tendon interposition (LRTI) using the Burton-Pellegrini technique. The study objective was to compare clinical outcomes between these techniques. Sixty-five patients with Eaton stage III osteoarthritis of the thumb were included in this retrospective follow-up study...
May 8, 2017: Orthopedics
https://www.readbyqxmd.com/read/28481386/early-versus-late-weight-bearing-protocols-for-surgically-managed-posterior-wall-acetabular-fractures
#10
Austin Heare, Nicholas Kramer, Christopher Salib, Cyril Mauffrey
Despite overall improved outcomes with open reduction and internal fixation of acetabular fractures, posterior wall fractures show disproportionately poor results. The effect of weight bearing on outcomes of fracture management has been investigated in many lower extremity fractures, but evidence-based recommendations in posterior wall acetabular fractures are lacking. The authors systematically reviewed the current literature to determine if a difference in outcome exists between early and late postoperative weight-bearing protocols for surgically managed posterior wall acetabular fractures...
May 8, 2017: Orthopedics
https://www.readbyqxmd.com/read/28481385/an-assessment-of-the-safety-of-an-orthopedic-specialty-hospital-a-5-year-experience
#11
Eric M Padegimas, Matthew L Ramsey, Matthew Austin, Javad Parvizi, Gerald R Williams, Kelly Doyle, Michael E West, Richard H Rothman, Alexander R Vaccaro, Surena Namdari
One of the goals of orthopedic specialty hospitals is to provide safe and efficient care to medically optimized patients. The authors' orthopedic specialty hospital is a physician-owned, 24-bed facility that accommodates a multispecialty orthopedic practice in the areas of spine, hip and knee arthroplasty, shoulder and elbow, sports, foot and ankle, and hand surgery. The purpose of this study was to examine the first 5 years of an institutional experience with an orthopedic specialty hospital and to determine if any procedures were at increased risk of postoperative transfer...
May 8, 2017: Orthopedics
https://www.readbyqxmd.com/read/28481384/the-use-of-intraoperative-sensors-significantly-increases-the-patient-reported-rate-of-improvement-in-primary-total-knee-arthroplasty
#12
James C Chow, Leigh Breslauer
Albeit multifactorial, patient satisfaction is predominantly driven by postoperative pain and function. Unfortunately, approximately 20% of total knee arthroplasty (TKA) recipients are dissatisfied with the outcome of their surgery. Objective balancing of the soft tissue envelope may contribute to significant decrease in pain and increase in function when compared with traditional subjective methods. In an effort to confirm this, a cohort of manual TKA patient outcomes was compared with sensor-assisted TKA outcomes...
May 8, 2017: Orthopedics
https://www.readbyqxmd.com/read/28481383/amount-of-minutes-played-does-not-contribute-to-anterior-cruciate-ligament-injury-in-national-basketball-association-athletes
#13
Kelechi R Okoroha, Kojo Marfo, Fabien Meta, Robert Matar, Ramsy Shehab, Terry Thompson, Vasilios Moutzouros, Eric C Makhni
There is limited information on the potential risk factors for sustaining an anterior cruciate ligament (ACL) tear in National Basketball Association (NBA) athletes. This study evaluated 83 NBA players who sustained an ACL injury between 1984 and 2015 to determine the influence of minutes played on injury risk. Minutes played in the injury game, during the season, and over their career were assessed, along with the ability to return to play, player efficiency rating, and playing time after return. Athletes in the NBA played significantly fewer minutes before sustaining an ACL injury (17...
May 8, 2017: Orthopedics
https://www.readbyqxmd.com/read/28437550/use-of-magnetic-resonance-imaging-to-predict-quadrupled-semitendinosus-graft-diameter-in-all-inside-anterior-cruciate-ligament-reconstruction
#14
Joseph Serino, Ryan Murray, Evan H Argintar
This study was conducted to evaluate whether preoperative magnetic resonance imaging (MRI) measurements of the cross-sectional area and length of the semitendinosus tendon correlated with graft diameter. The goal of the study was to identify tendons at risk for requiring graft augmentation. The records of 140 consecutive patients undergoing anterior cruciate ligament (ACL) reconstruction between 2013 and 2016 were examined retrospectively. The study included 39 patients who underwent all-inside ACL reconstruction with a semitendinosus autograft...
April 24, 2017: Orthopedics
https://www.readbyqxmd.com/read/28437549/poor-utility-of-gonadal-shielding-for-pediatric-pelvic-radiographs
#15
Mark C Lee, Jessica Lloyd, Matthew J Solomito
Plain pelvic radiographs are commonly used for a variety of pediatric orthopedic disorders. Lead shielding is typically placed over the gonads to minimize radiation exposure to these sensitive tissues. However, misplaced shielding can sabotage efforts to protect patients from excessive radiation exposure either by not covering radiosensitive tissues or by obscuring anatomic areas of interest, prompting repeat radiographic examinations. The goal of this study was to determine the incidence of misplaced shielding for pelvic radiographs obtained for pediatric orthopedic evaluation...
April 24, 2017: Orthopedics
https://www.readbyqxmd.com/read/28437548/arthroscopic-treatment-of-a-displaced-nonunion-of-the-anterior-inferior-iliac-spine-causing-extra-articular-impingement
#16
Motoi Shibahara, Yasuo Ohnishi, Eisaburo Honda, Dean K Matsuda, Soshi Uchida
This report describes a case of nonunion of an anterior inferior iliac spine (AIIS) apophyseal avulsion fracture with resultant subspine impingement combined with symptomatic femoroacetabular impingement (FAI). A 16-year-old male soccer player presented with a 6-month history of right groin pain exacerbated by kicking and running. The patient was diagnosed with a displaced nonunion of the AIIS apophysis avulsion fracture causing secondary extra-articular impingement beyond cam-type FAI by physical examination and radiological findings...
April 24, 2017: Orthopedics
https://www.readbyqxmd.com/read/28437547/concordance-of-patient-and-physician-perceptions-of-care-in-an-orthopedic-clinic
#17
Kelly Zhang, Charles Day, Matthew L Iorio
It is essential to study whether physicians' perceptions align with their patients' views, as understanding patient perception leads to superior satisfaction and health outcomes. Previous studies have established differences in physician-patient perceptions, but no studies have been conducted in orthopedic clinics. The authors' primary goal was to evaluate differences in physician and patient perceptions of an orthopedic clinic visit. Their secondary objective was to determine the influence of visit length, demographics, and depression risk-level on patient satisfaction...
April 24, 2017: Orthopedics
https://www.readbyqxmd.com/read/28437546/root-cause-analysis-and-actions-for-the-prevention-of-medical-errors-quality-improvement-and-resident-education
#18
Ryan Charles, Brandon Hood, Joseph M DeRosier, John W Gosbee, James P Bagian, Ying Li, Michelle S Caird, J Sybil Biermann, Mark E Hake
The quality of care delivered by orthopedic surgeons continues to grow in importance. Multiple orthopedic programs, organizations, and committees have been created to measure the quality of surgical care and reduce the incidence of medical adverse events. Structured root cause analysis and actions (RCA2) has become an area of interest. If performed thoroughly, RCA2 has been shown to reduce surgical errors across many subspecialties. The Accreditation Council for Graduate Medical Education has a new mandate for programs to involve residents in quality improvement processes...
April 24, 2017: Orthopedics
https://www.readbyqxmd.com/read/28437545/union-knee-alignment-and-clinical-outcomes-of-patients-treated-with-autologous-bone-grafting-for-medial-tibial-defects-in-primary-total-knee-arthroplasty
#19
Kunihiro Hosaka, Shu Saito, Teruyasu Oyama, Hirohisa Fujimaki, Eiji Cho, Kanki Ishigaki, Yasuaki Tokuhashi
Autologous bone grafting is an established method to overcome bone deficiencies in primary total knee arthroplasty (TKA). However, recently, metal augments have been used by many surgeons. Although autologous bone grafting is a common technique, few large studies have described its success in achieving bone union in primary TKA. The goal of this study was to evaluate primary TKA with autologous bone grafting for tibial defects. A total of 68 knees that had undergone arthroplasty with autologous bone grafting with more than 1 year of follow-up were evaluated...
April 24, 2017: Orthopedics
https://www.readbyqxmd.com/read/28418577/prospective-assessment-of-sleep-quality-before-and-after-primary-total-joint-replacement
#20
Blaine T Manning, Sean M Kearns, Daniel D Bohl, Tori Edmiston, Scott M Sporer, Brett R Levine
Sleep disruption is a common, yet rarely addressed, complaint among patients who have undergone total joint arthroplasty (TJA). This study assessed sleep quality before and after primary TJA. A total of 105 patients who underwent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) prospectively completed questionnaires during the preoperative, early postoperative, and late postoperative periods. The survey included the Epworth Sleepiness Scale, current sleeping habits, and patient perspectives of sleep quality and duration...
April 18, 2017: Orthopedics
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