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Journal of Surgical Orthopaedic Advances

Justin D Orr, Kenneth A Heida
Posteriorly based osteochondral lesions of the talus (OCLTs) are relatively rare, and when they are symptomatic and not amenable to traditional arthroscopic treatment techniques, they may require osteochondral graft transfer procedures, such as the osteochondral autograft transfer system (OATS) procedure. Historically described osteotomies to gain perpendicular access to these OCLTs, while excellent techniques, present many possible postoperative morbidities. This technical tip describes the use of a prone position midline Achilles tendon-splitting approach, a well-described approach to the posterior ankle and hindfoot, to perform osteochondral autograft transfer without need for any malleolar osteotomies...
2017: Journal of Surgical Orthopaedic Advances
Hale Ersoy, Stephen J Pomeranz
Milwaukee shoulder syndrome (MSS) is a rare, rapidly destructive arthropathy associated with calcium hydroxyapatite crystal deposition. This condition is a combination of rotator cuff tear, osteoarthritic changes, noninflammatory joint effusion containing crystals, synovial hyperplasia, cartilage and subchondral bone destruction, and multiple osteochondral loose bodies. This article discusses pathophysiology, clinical presentation, differential considerations, and magnetic resonance imaging findings of MSS.
2017: Journal of Surgical Orthopaedic Advances
Vasanth Sathiyakumar, Rachel V Thakore, Cesar S Molina, William T Obremskey, Manish K Sethi
This study investigated whether current Medicare reimbursements for orthopaedic trauma procedures correlate with complications. A total of 18,510 patients representing 33 orthopaedic trauma procedures from 2005 to 2011 were studied. Adverse events and Medicare payments for each orthopaedic trauma procedure were collected. Linear regressions determined correlations between complications and Medicare payments for orthopaedic trauma procedures. A weak correlation between Medicare payments and complications was found for all procedures (r = ...
2017: Journal of Surgical Orthopaedic Advances
Joseph J King, Matthew R Patrick, Ryan E Schnetzer, Kevin W Farmer, Aimee M Struk, Cyndi Garvan, Thomas W Wright
A retrospective review was performed of all shoulder arthroplasties with patients grouped on the basis of transfusion protocol time period. Group 1 had transfusions if postoperative hematocrit was <30. Group 2 had transfusions based on symptomatic anemia. Bivariate analysis of transfusion factors and multivariate analysis of significant bivariate factors were performed. Protocol change decreased transfusion rates from 16% (group 1, 153 arthroplasties) to 8% (group 2, 149 arthroplasties). Reverse shoulder arthroplasty (RTSA) transfusion rate decreased dramatically (from 24% to 5%)...
2017: Journal of Surgical Orthopaedic Advances
Kevin M Kuhn, Lisa K Cannada, J Tracy Watson, Ashley Ali, John A Boudreau, Hassan R Mir, Jennifer M Bauer, Brian Mullis, Robert Hymes, Renee Genova, Michael Tucker, Daniel Schlatter
There are no data-supported recommendations on how proximal is too proximal for retrograde nailing (RGN). At six level 1 trauma centers, patients with femur fractures within the proximal one-third of the femur treated with RGN were included. This article describes a proximal segment capture ratio (PSCR) and nail segment capture ratio to evaluate RGN of proximal fractures. The study included 107 patients. The average follow-up was 44 weeks. There were two nonunions and three malunions. There was no significant difference between PSCR of 0...
2017: Journal of Surgical Orthopaedic Advances
Stephen Stacey, William Barfield, Luke Pietrykowski, John DesJardins, James Mooney
Cannulated screws are widely used for the treatment of slipped capital femoral epiphysis; however, the optimal choice and number of implants have not been clearly defined. Studies have shown that two screws are biomechanically superior to a single screw in load-to-failure testing, but the fatigue performance of different screw designs has not been investigated. This study compared the fatigue characteristics of fully and partially threaded cannulated screws. Partially and fully threaded 7.3-mm screws were subjected to cyclic loading on a custom testing fixture...
2017: Journal of Surgical Orthopaedic Advances
Ben M Albert, Anna Lee, Taylor W McLendon, Randolph S Devereaux, Craig C Odum, Guy D Foulkes
Ambulatory surgery centers are the preferred setting for many procedures formerly performed in a hospital setting. This study sought to determine whether outpatient total elbow arthroplasty (TEA) is as safe as inpatient TEA. A retrospective analysis was performed of inpatient (IP) versus outpatient (OP) TEA by a single surgeon over a period of 18 years. Demographic, social, and comorbidity measures as well as complication rates were analyzed and stratified by IP or OP status. Bivariate comparison showed increased prevalence of coronary artery disease in the OP group (32% vs...
2017: Journal of Surgical Orthopaedic Advances
Gregory K Faucher, Jimmy H Daruwalla, John G Seiler
A systematic review of the literature was performed to compare complications of endoscopic and open carpal tunnel release. Techniques were further subdivided into traditional open, limited open, single-portal endoscopic, and two-portal endoscopic. This study also compared incidence of complications in each group based on chronological periods of data collection. The study found that endoscopic release has a higher incidence of transient nerve injury. There was also an increased incidence of superficial palmar arch injuries in the endoscopic group in the 1960-1990 time period as compared with the 1991-2000 and 2001-2012 periods...
2017: Journal of Surgical Orthopaedic Advances
Mark S Anderson, Mark Ghamsary, Phillip T Guillen, Montri D Wongworawat
Multiple methods for surgical fixation of distal radius fractures exist, including percutaneous pinning with Kirschner wires and open reduction volar plating. Despite increased costs, the hypothesis of this study was that open reduction and volar plating does not provide improved outcomes over wire fixation. Following Transparent Reporting of Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a meta-analysis of randomized controlled trials was conducted comparing these two methods with regard to clinical outcomes, radiographic parameters, and complications...
2017: Journal of Surgical Orthopaedic Advances
Brian A Kelly, Dustin S Hambright, Edward K Rodriguez
The objective of this study was to examine the risk to the sciatic nerve and femoral artery during open passage of cerclage wires and to evaluate the safest techniques. After a standard lateral approach, cerclage passes along the femur were made in cadaveric specimens. Distance to the sciatic nerve and femoral artery was recorded. Careful technique resulted in an increase in distance to the sciatic nerve and femoral artery. There was an increase in the distance to the femoral artery with passes in an anterior to posterior direction...
2017: Journal of Surgical Orthopaedic Advances
Hale Ersoy, R Nicholas Trane, Stephen J Pomeranz
Femoroacetabular impingement (FAI) has gained considerable attention for the past 20 years and has been accepted as a predisposing factor for early osteoarthritis in young patients, particularly in the population participating in sports. Patients with FAI typically present with deep, intermittent groin discomfort during or after activities involving repetitive or persistent hip flexion. Symptomatic improvement can be achieved from arthroscopic debridement of unstable cartilage flaps, shaving of cartilage irregularities, and surgical correction of deformity of the femoral head\endash neck junction...
2016: Journal of Surgical Orthopaedic Advances
James R Kee, Richard G Smith, C Lowry Barnes
Orthopaedic surgeons often treat patients with chronic musculoskeletal pain. This musculoskeletal pain is increasingly being treated with opioid medications, contributing to the growing opioid epidemic in the United States. Opioid use and abuse before orthopaedic surgery are associated with worse clinical outcomes. This article reviews the risk factors for opioid use, misuse, and other behaviors in chronic pain patients, discusses the screening tools for opioid misuse in chronic pain patients, and provides recommendations for the orthopaedic surgeon's role in managing these complicated patients...
2016: Journal of Surgical Orthopaedic Advances
Kristie B Hadden, Latrina Y Prince, C Lowry Barnes
Opioid misuse has been linked to patient health literacy. This study aimed to estimate the prevalence of low health literacy in a sample of orthopaedic patients on opioids. Data were extracted from an electronic medical record database using queries that included an 8-month time frame, active status in an orthopaedic clinic, ICD-10 codes for opioids, and health literacy screening results. In the study sample of 8963 orthopaedic patients, 7103 had opioids in their current chart. Of those patients with opioids in their chart, 1547 had inadequate health literacy as measured by a validated health literacy screening question...
2016: Journal of Surgical Orthopaedic Advances
Robert M O'Neal, Kipp A Cryer, Paul K Edwards, C Lowry Barnes, Simon C Mears
The use of opioids in the United States has become an epidemic. Opioids have become frequently prescribed for arthritic pain in the hip and knee. The use of opioidsas first-round therapy for pain has been driven by several factors, including the health care providers' lack of understanding that anti-inflammatory medications are at least as effective as opioids, a patient's expectation of complete pain relief on presentation to the emergency room or doctor's office, and increasing importance placed on patient satisfaction...
2016: Journal of Surgical Orthopaedic Advances
Zachary C Lum, Adolph V Lombardi, Jason Hurst, Michael Morris, Keith Berend
The purpose of this study was to determine if periarticular injection (PAI) with liposomal bupivacaine cocktail has a synergistic effect on pain relief with a single-injection adductor canal block in knee arthroplasty. Three hundred thirty-three knee arthroplasties were divided into three groups. Group 1 received general anesthesia (GA) and liposomal bupivacaine PAI. Group 2 received GA, peripheral nerve block (PNB), and liposomal bupivacaine PAI. Group 3 received GA, PNB, and ``plain'' ropivacaine PAI. Remaining perioperative multimodal medications and therapies were identical...
2016: Journal of Surgical Orthopaedic Advances
Jeff Gonzales, Scott T Lovald, Edmund C Lau, Kevin L Ong
Opioids are frequently used as part of multimodal pain management protocols for knee arthroscopy; however, their use may be associated with opioid-related adverse events. The purpose of this study was to evaluate the risk of potential analgesic-related complications after knee arthroscopy using a nationally representative database. Using 2010\endash 2012 Medicare claims data, patients undergoing knee arthroscopy procedures (including ligament repair, meniscectomy, and chondroplasty) were identified. The risk of complications related to typical modalities of analgesia, including opioids, within 90 days following surgery was assessed using multivariate Cox regression...
2016: Journal of Surgical Orthopaedic Advances
Alexander H Jinnah, Beth P Smith, Brett C Perricelli
Postoperative pain control following total joint arthroplasty results in improved patient mobilization, participation in physical therapy, and potentially reduced hospital costs. It was hypothesized that using a multimodal pain protocol focusing on periarticular injections including liposomal bupivacaine would have improved results when compared with a parenteral opioid-based regimen. The results showed a decrease in length of stay and rate of discharge to skilled nursing facilities with the implementation of a novel multimodal pain protocol...
2016: Journal of Surgical Orthopaedic Advances
Girish P Joshi, Richard J Hawkins, Mark A Frankle, Jeffrey S Abrams
Postsurgical pain, like that associated with major upper extremity surgery, can be significant and usually require the use of opioid analgesics. However, opioids are associated with significant adverse effects, including respiratory depression, which often drive the use of multimodal therapy with nonopioid analgesics, including local and regional analgesia techniques. However, use of older local anesthetics provides a limited duration of analgesia. An innovative formulation of liposomal bupivacaine (Exparel), which is approved for surgical site infiltration, can provide a longer duration of analgesia...
2016: Journal of Surgical Orthopaedic Advances
L Andrew Koman
No abstract text is available yet for this article.
2016: Journal of Surgical Orthopaedic Advances
Anil Agarwal, Abbas Shaharyar, Anubrat Kumar, Mohd Shafi Bhat
Ponseti casts for congenital clubfoot are generally removed in the clinics by soaking and unwrapping them. It is often difficult to find the plaster bandage edge for unwrapping it. The use of flags at cast ends can ease this problem.
2016: Journal of Surgical Orthopaedic Advances
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