August 31, 2018 | Today’s News

Study measures probability of glove perforation during orthopaedic surgery maneuvers

Undetected microperforations in surgical gloves may occur during a variety of surgical maneuvers, according to findings from a study published in the September issue of the Journal of Orthopaedic Trauma. Four investigators performed six high-risk maneuvers in a simulated laboratory setting and assessed perforation rates. They detected 14.3 percent of perforations. Tear rates were highest while cleaning drill bit flutes by hand (85 percent). Catching a glove along the guide wire when passing a cannulated drill and around a rotating drill shaft had tear rates of 50 percent and 40 percent, respectively. Palpating the end of a flexible nail cut with a wire cutter versus a proprietary, nail-specific tool resulted in tear rates of 35 percent and 5 percent, respectively. The tear rate of blind digital fracture reduction was 20 percent Directly visualizing reduction and inserting screws while stabilizing the threads with one’s fingers each had a tear rate of 15 percent. Researchers recommend orthopaedic surgeons consider alternative techniques for certain maneuvers.

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Medical organizations support CMS initiative to decrease administrative burden

A total of 170 medical groups, including AAOS, wrote a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma in support of the agency’s Patients Over Paperwork initiative. The letter notes that excessive evaluation and management (E/M) documentation requirements take time away from patient care and make locating medical information in a patients’ records more difficult. However, the organizations raised concerns about a portion of the proposal that seeks to collapse payment rates for eight office visit services for new and established patients down to two each. The groups say this could have unintended consequences related to the coding policies.

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According to data published online in The Journal of Foot & Ankle Surgery, female sex and postoperative articular incongruity may be associated with inferior early clinical outcomes following ankle fracture surgery. The study included 88 patients who had their implants removed one year after surgery. American Orthopaedic Foot and Ankle Society scores were correlated with articular incongruity, and Foot and Ankle Outcome scores were linked to the AO classification and Lauge-Hansen classification. Involvement of the ankle joint fracture, as opposed to the lateral malleolus fracture height, impacted early clinical outcomes.

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Patients with liver disease may have an increased mortality rate following hip fracture (HF), according to a single-blind, cohort study published in the August issue of the journal Clinical Epidemiology. Researchers collected data from Danish registries on all HF patients between 1996 and 2013 (n = 152,180). Patients were divided into three groups: those with noncirrhotic liver disease (n = 2,552, 1.7 percent), liver cirrhosis (n = 1,866, 1.2 percent), and no liver disease (n = 147,762, 97.1 percent). Thirty-day mortality was 9.4 percent in patients with noncirrhotic liver disease, 12.6 percent in patients with liver cirrhosis, and 9.7 percent in those without liver disease. For individuals who survived the first 30 days after HF, 31–365-day mortality risks were 18.5 percent for those with noncirrhotic liver disease, 264 percent for patients with cirrhotic liver disease, and 19.4 percent for patients without liver disease.

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California may prohibit Medicaid work requirements

The California Senate passed a bill that would ban work requirements related to Medicaid, as well as waivers that impose waiting periods, time limits, and coverage lockouts if beneficiaries do not pay premiums. If Gov. Jerry Brown signs the bill, California would be the first state to ban employment obligations for Medicaid recipients.

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Sustainable solutions: Wide-awake hand surgery in Ghana

Donald Lalonde, MD, FRCSC, a hand surgeon in New Brunswick, Canada, began volunteering internationally in 1991, providing surgical care in resource-scarce settings through Operation Smile, Smile International, and Operation Rainbow Canada. During his time with these direct-service organizations, Dr. Lalonde witnessed many of the challenges low- and middle-income countries face in providing surgical care. His experience treating a young patient on an early trip to Peru crystalized his understanding of the need for sustainable solutions. Accomplishing this mission required support and buy-in from multiple partners, including local health institutions and health workers in resource-scarce countries.

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Last call: Apply for Orthopaedic Video Theater Committee member position

The Orthopaedic Video Theater Committee has an open foot and ankle member position, a two-year term that runs through March 21, 2021. The committee evaluates video and multimedia submissions and chooses the programs presented in the Orthopaedic Video Theater at the AAOS Annual Meeting. The last day to submit an application is Sept. 7.

Learn more and submit your application…(member login required)