Today’s Top Story

Study: ACD may improve outcomes for certain lumbar microdiskectomy patients

Findings from a study published online in The Spine Journal suggest that annular closure with a bone-anchored annular closure device (ACD) may reduce the risk of symptomatic recurrence and reoperation for patients who are at high risk of herniation recurrence following lumbar microdiskectomy. The authors conducted a multicenter, randomized, superiority study of 554 participants, 276 of whom underwent lumbar microdiskectomy with additional bone-anchored ACD and 278 of whom underwent lumbar microdiskectomy only. At two-year follow-up, they found that 12 percent of patients in the ACD cohort experienced symptomatic reherniation, compared to 25 percent of patients in the control cohort. There were 29 reoperations in 24 patients in the annular closure device group and 61 reoperations in 45 control patients. The authors note that scores for back pain, leg pain, Oswestry Disability Index, and health-related quality of life at regular visits were comparable between groups over the study period.

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Other News

Study: Many patients treated with Ponseti method do not adhere to bracing protocol

Data from a study published in the May 2 issue of The Journal of Bone & Joint Surgery suggest suggest that patients with clubfoot experience satisfactory mid-term outcomes when treated with the Ponseti method, although some challenges remain. The researchers reviewed data on 101 pediatric patients who met inclusion criteria. At mean 811-month follow-up, they found that based on Dallas outcome criteria, 62 percent of patients had outcomes rated as good, 38 percent had outcomes rated as fair, and no patient had an outcome rated as poor. However, only 37 percent of families reported adherence to the bracing protocol, 68 percent of patients had one or more relapses, and 38 percent of patients had undergone a tendon transfer.

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Study: What are the trends in firearm-associated fractures?

A study published online in the Journal of Pediatric Orthopaedics examines trends in firearm-associated fractures in pediatric patients. Members of the research team reviewed data from the Kids’ Inpatient Database from 2003 to 2012 and found that over the study period, the incidence of firearm-associated fractures among patients aged 20 years and younger increased from 73 cases per 100,000 admissions to 96 cases per 100,000 admissions. Overall, the group consisting of patients four years old and younger experienced the largest increase in injury frequency, with a four-fold increase in the rate of unintentional injury. The most common age group affected by firearm-associated fractures was 15 to 20 year olds, with minority and male individuals disproportionately affected. Assault and unintentional causes were the most common reasons for such injuries.

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Study: Opioid use increased over time across demographics

Information published online in the American Journal of Public Health suggests a narrowing divide in opioid prescribing by race in the United States. The authors reviewed data from the Medical Expenditure Panel Survey to conduct a nationally representative, serial cross-sectional study of noninstitutionalized adults who received prescription pain medication for noncancer pain from 2000 to 2015. They found that the age- and gender-adjusted rate of prescription opioid use increased across all groups. By 2015, approximately 23 percent of non-Hispanic black adults and non-Hispanic white adults had used opioids.

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AMA report examines healthcare spending trends

A report from the American Medical Association (AMA) looks at trends in national healthcare spending. The report states that the United States spent $3.3 trillion on healthcare in 2016, or $10,348 per capita—a 4.3 percent increase from 2015, but a lower growth rate than 5.8 percent in 2015 and 5.1 percent in 2014. Segments of personal health spending in 2016 included:

  • hospital care: $1.08 trillion
  • physician services: $521.7 billion
  • prescription drugs: $328.6 billion
  • services received in nursing care facilities: $162.7 billion
  • clinical services: $143.2 billion

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FDA chief calls for reexamination of drug rebates

Reuters reports that the head of the U.S. Food and Drug Administration (FDA) has criticized the practice of drug rebates and called for a review of current safe harbor rules under the Anti-Kickback Statute. The statute makes it illegal to pay an incentive for drugs or services that Medicare, Medicaid, or other federal healthcare programs cover. However, pharmaceutical companies commonly set a high “list price” for a drug, then lower the cost for health plans via rebates in exchange for the broad access to patients. President Donald J. Trump is expected to soon unveil new proposals to curb rising drug costs, and some observers believe that the statements from FDA commissioner Scott Gottlieb, MD, may telegraph government intentions.

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Manuscript submission open for 2019 Kappa Delta and OREF Clinical Research Awards

AAOS is currently accepting manuscripts for the 2019 Kappa Delta Awards and the Orthopaedic Research and Education Foundation (OREF) Clinical Research Award. Up to two $20,000 Kappa Delta awards (Elizabeth Winston Lanier Award and Ann Doner Vaughan Award), one $20,000 Kappa Delta Young Investigator award, and one $20,000 OREF award will be bestowed, provided manuscripts of requisite quality are submitted. Manuscripts, which are due no later than 11:59 p.m. CT on July 1, must be submitted by members (or candidate members) of the AAOS, Orthopaedic Research Society, Canadian Orthopaedic Association, or Canadian Orthopaedic Research Society.

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