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AAOS 2019 Annual Meeting Paper Presentation: Three Factors Can Predict Complications in Lower Extremity Fractures

A study that will be presented today at the AAOS 2019 Annual Meeting identified three risk factors associated with wound complications for lower extremity fracture surgery. Heel-pad edema index ≥ 1.4, body mass index > 25 kg/m 2, and tobacco use significantly increased the complication risk A total of 93 patients completed the study, and the overall wound complication rate was 18.3 percent. Among the 71 patients with ankle fractures, the complication rate was 14.1 percent. Time to surgery and soft tissue swelling were not associated with complications. Patients with none of the identified predictive factors had a 3 percent probability of sustaining a wound complication. Patients with one of three, two of three, or all three of the predictive factors had a 12 percent to 36 percent, 60 percent to 86 percent, and 96 percent probability of sustaining a wound complication, respectively.

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Other News

Study Compares TKA Mobilization Outcomes for Analgesic Methods

A randomized, controlled trial (RCT) published in the April issue of the European Journal of Anaesthesiology compared local infiltration anesthesia (LIA) to sciatic nerve and adductor canal block to determine the effect on mobility, postoperative pain, and patient satisfaction after total knee arthroplasty (TKA). One cohort (n = 20) received a single-shot sciatic nerve block with 20 mL of ropivacaine 0.75 percent combined with an adductor canal block with a catheter placed for less than four days with an infusion of ropivacaine 0.2 percent at a rate of 6 mL h−1 (nerve block patients). The other cohort (n = 20) received LIA of the knee capsule at the end of surgery with 150 mL of ropivacaine 0.2 percent (LIA patients). Both LIA and nerve block patients were mobilized to walk after TKA at similar times (24 hours versus 27.1 hours, respectively). LIA patients reported a higher mean maximum postoperative pain score on exertion, as well as higher intraoperative opioid requirements. Both groups had similar patient satisfaction, postoperative oral morphine equivalents, and resting pain levels LIA patients had lower anesthesia induction time.

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AAOS 2019 Annual Meeting Paper Presentation: Regional Anesthesia in THA May Reduce Complications

Researchers compared outcomes for total hip arthroplasty (THA) patients who received regional anesthesia versus those who underwent general anesthesia in a study that will be presented today at the AAOS 2019 Annual Meeting. The researchers found that epidural and spinal anesthesia could result in shorter hospital length of stay (LOS) and decreased risk for 30-day complications. Data were collected from the American College of Surgeons National Surgical Quality Improvement Program database on 132,919 THA patients (mean age, 65 years) who underwent surgery between 2005 and 2016. More than half of patients (n = 73,794, 55.5 percent) underwent general anesthesia; 43.7 percent (n = 58,087) underwent spinal anesthesia, and the remaining 0.83 percent (n = 1,101) underwent epidural anesthesia. The general anesthesia group had a longer unadjusted LOS (3.1 days) compared to both spinal (2.8 days) and epidural (2.8 days) patients. The general anesthesia group had higher unadjusted rates of 30-day major and minor complications (4.39 percent) compared to the epidural (3.54 percent) and spinal (3.18 percent) groups.

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Study Compares Early Mobilization to Standard Rehabilitation after Rotator Cuff Repair

Early mobilization may not be advantageous compared to standard rehabilitation for arthroscopic rotator cuff repair, according to an RCT published in the March issue of Arthroscopy. After preoperative assessment, 206 full-thickness rotator cuff tear patients receiving arthroscopic repair were randomized to early mobilization (self-weaned from sling and performed pain-free active range of motion [ROM] during the first six weeks) (n = 103) or standard rehabilitation (wore a sling for six weeks with no active ROM) (n = 103). Shoulder ROM, pain, strength, and health-related quality of life (HRQoL) were assessed preoperatively. Shoulder ROM, pain, and HRQoL were assessed postoperatively at six weeks and at three, six, 12, and 24 months. Strength was evaluated at 12 and 24 months. Most patients (n = 171, 83 percent) were followed for 24 months. After six weeks, the only between-group difference was significantly improved forward flexion and abduction in early mobilization patients. Pain, strength, and HRQoL did not differ at any time. At 12-month postoperative ultrasound testing, 52 patients (30 percent early mobilization, 33 percent standard rehabilitation) presented with a full-thickness tear.

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Study Reviews Incidence and Clinical Features of Postoperative Spinal Epidural Hematoma

A retrospective study published in the March 15 issue of Spine evaluated the prevalence and clinical characteristics associated with symptomatic postoperative spinal epidural hematoma (PSEH). Among 3,371 patients treated at a single institution, 14 developed symptomatic PSEH. Symptoms were observed between zero and seven days and occurred during the delayed phase in 43 percent of cases. Of the six cervical and thoracic surgery patients, the predominant symptom was paralysis. In lumbar procedures, most patients experienced severe pain. Early and delayed groups had similar outcomes. Most cases (n = 10) had good neurological outcomes, while two had partial and two had poor neurological outcomes.

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AAOS Now

Prevention, Early Treatment Is Critical When Treating Frostbite Injuries

Frostbite results in a wide range of injuries and can be devastating in extreme forms. Injury severity depends on exposure duration, not absolute temperature. As frostbite becomes more common in the civilian population, particularly affecting those with a history of mental illness or homelessness, recognizing and understanding the early stages of the injury are critical to initial treatment and limb preservation.

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Your AAOS

NEW! Guided Exhibit Hall Tours at the AAOS 2019 Annual Meeting

AAOS is offering free guided tours of the Exhibit Hall for attendees of the AAOS 2019 Annual Meeting. These tours will provide insight into products for specific orthopaedic specialty areas. Each tour will focus on one specialty area, including biologics, hip and knee, shoulder and elbow, sports medicine, and trauma. Tours will take place tomorrow and Thursday from 8 a.m. to 9 a.m.

Register for the guided Exhibit Hall tours…

 

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