November 12, 2018
Today’s Top Story

Study: Successful Occupational and Functional Outcomes Following Patellofemoral ACI

A study published online in The American Journal of Sports Medicine found that most patellofemoral autologous chondrocyte implantation (ACI) patients reported positive postoperative occupational outcomes and significantly decreased pain. Researchers assessed 72 military service members who under-went ACI for high-grade patellofemoral chondral defects between 2006 and 2014. Most procedures (85 percent) used a second-generation patellofemoral ACI with a type I/III collagen membrane, and more than half of defects (n = 40, 55 percent) occurred only in the patella. After treatment, 78 percent of service members (n = 56) returned to their occupational specialties. Three surgical failures (4.1 percent) occurred and required subsequent knee arthroplasty (n = 2) or a revision chondral procedure (n = 1). The only significant predictor of surgical and overall failures was the use of a periosteal patch. Age younger than 30 years, female sex, and regular tobacco use were all independently associated with overall failure.

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Other News

Study Finds Implant Position Has Minimal Effect on Reoperation Risk in Femoral Neck Fracture

According to a study published online in the Journal of Bone & Joint Surgery, risk factors for reoperation following osteosynthesis in patients treated for femoral neck fractures were insufficient fracture reduction, varus position of the implants, and femoral head perforation. Researchers used the Danish Fracture Database to identify 1,206 consecutive surgeries for a primary femoral neck fracture treated with parallel implants between December 2011 and November 2015. Pre- and postoperative radiographs measured fracture displacement, posterior tilt, the number of implants, posterior distance, calcar distance, tip-cartilage distance, and angulation of implants. In 997 cases, two implants were used, and in 209 cases, three implants were used. In 157 cases, the patient required reoperation within a year, and in 228 cases, the patient died within a year. Younger patients (< 70 years) were more likely than older patients to require revision surgery (18 percent versus 9.8 percent, respectively) but less likely to die (7.4 percent versus 26.3 percent, respectively). Posterior distance, calcar distance, tip-caput distance, and parallel implants had no impact on the need for reoperation.

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Study: Risk Factors for Hip Fracture in Older Spine Surgery Patients

Older patients may be at greater risk of hip fracture after lumbar spine surgery, according to a study published online in Osteoporosis International. Spinal surgery patients were identified from the National Health Insurance Research Database (NHIRD) (n = 3,345) and matched with 6,690 controls to compare hip fracture incidence. Data on 82,730 spinal surgery patients were also analyzed to compare different types of spinal surgeries. Spinal surgery patients experienced more hip fractures than the control group. Other risk factors included older age (60–79 years) and female sex. Long- and short-segment thoracolumbar spinal fusion patients were more likely to sustain a hip fracture than diskectomy patients. Researchers recommended fall prevention for geriatric spine surgery patients.

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Study: Post-discharge Urgent Care Visits More Frequent than Inpatient Readmissions in Ankle Fracture Surgery Patients

A retrospective analysis published online in Foot & Ankle International found that patients who underwent ankle open reduction and internal fixation (ORIF) have a higher rate of urgent care visits than inpatient readmissions 30 days after discharge. Researchers evaluated data on patients who underwent ankle ORIF at a single institution between July 1, 2016, and June 30, 2017. Within 30 days of discharge (mean, 11.8 days after surgery), 10.51 percent (n = 35) of patients went to urgent care. Reasons for visits included cast/splint-related issues (n = 16, 45.71 percent), pain (n = 7, 20 percent), and increased operative site drainage (n = 7, 20 percent). Patients with diabetes or underlying psychiatric disorders were more likely to make postoperative urgent care visits.

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Study: Cost Variations for Management of Pediatric Distal Radius Fractures

A retrospective review published online in the Journal of Pediatric Orthopaedics found that a bundled payment option may be cost effective for closed pediatric distal radius fracture patients treated without manipulation. Researchers assessed hospital and physician costs for 5,640 children treated by an orthopaedic surgeon for an isolated closed distal radius fracture between 2013 and 2015 at a single academic children’s hospital. Patients were classified by fracture management approach: closed treatment without manipulation (n = 4,602, 86.1 percent); closed reduction in the clinic, emergency department (ED), or radiology procedure suite (n = 922, 16.3 percent); or treatment in the operating room (OR) (n = 116, 2.1 percent). Closed treatment without manipulation was the most cost-effective treatment (mean cost, $1,390), followed by closed reduction ($4,263) and closed reduction and percutaneous pinning ($9,389) Fracture management approach and undergoing treatment in the OR had the most significant impacts on cost. Closed reduction in the clinic or ED and in the OR added $894 and $5,568, respectively, to total costs.

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New Survey Data Illustrate Developing Trends in Fellowship Choice

About 90 percent of orthopaedic surgery residents move on to a fellowship following residency to further their learning. Some residents “superspecialize,” or pursue multiple fellowships. AAOS Now reported on survey findings that indicate why residents pursue fellowships, what their interests are, and what they hope to gain from further training.

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Apply for the Patient Safety Committee Member-at-Large Position

The Patient Safety Committee has an open member-at-large position, a two-year term that runs from March 18, 2019, through March 12, 2021. The Patient Safety Committee tracks current patient safety and infectious disease trends in relation to orthopaedic surgery and uses this information to educate the fellowship. The Committee also interacts with regulatory agencies and other organizations to progress patient safety. The deadline to apply is Dec. 17.

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


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