November 22, 2019
Today’s Top Story

Study Evaluates Efficacy of Arthroscopic Treatment in Acute Septic Hip Arthritis in Pediatric Patients

A retrospective case series study published online in Arthroscopy observed favorable outcomes among patients aged 10 years or younger with acute septic arthritis of the hip who received arthroscopic treatment. Patients who underwent arthroscopic treatment (anterolateral and medial subadductor two-portal approach) between January 2014 and January 2017 and had at least two years of follow-up were included in the study. The Waldvogel criteria were implemented to diagnose septic arthritis. Final analysis included 15 hips in 15 patients (mean age, 5.2 years; nine patients were male). Mean hospital length of stay was 4.2 days; patients used antibiotics for a mean 34 days. All patients had excellent Bennett scores, and the mean Harris Hip Score was 96.3 after at least 24 months of follow-up. No surgical interventions were required, and no degenerative changes or avascular necrosis presented.

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In Other News

Study: Mortality Rates Among Older Patients Treated with Reverse Shoulder Arthroplasty for Displaced Proximal Humerus Fractures

A retrospective study published online in Orthopaedics & Traumatology: Surgery & Research observed high mortality rates among older patients who underwent reverse shoulder arthroplasty (RSA) to treat displaced proximal humerus fractures. Between 1995 and 2016, 898 displaced proximal humeral fracture patients were treated with RSA at 14 public and private French hospitals. Most patients (87 percent) had a three- or four-fragment fracture, and mean age at fracture and surgery was 79 years (range, 46–98 years). Most patients (80 percent) were female, and 60 percent had an American Society of Anesthesiologists (ASA) grade of one or two; the most prevalent comorbidities were cardiovascular and neurological. One- and five-year postoperative survival rates were 94 percent and 73 percent, respectively. At 19-year follow-up, 42 percent of patients were still alive. Risk factors for early mortality included the presence of comorbidities (ASA score greater than three or four) and cognitive disorders. Time to surgery, fracture type, associated fractures, and discharge disposition did not affect postoperative mortality.

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Study: Can PROMIS Values Predict Bunion Surgery Outcomes?

A study published online in Foot & Ankle International measured the predictive value of the Patient-reported Outcomes Measurement Information System (PROMIS) to determine which patients would benefit from bunion surgery. The researchers prospectively collected PROMIS physical function (PF), pain interference (PI), and depression assessments for 42 patients. Minimally clinically important difference (MCID), receiver operating characteristic curves, and area under the curve (AUC) analyses were conducted comparing preoperative and final follow-up visit scores. AUCs for PROMIS PI and depression were not significant, but PF presented a significant AUC and likelihood ratio. The PF threshold to achieve MCID was 49.6, and the likelihood ratio was 0.14.

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Study Measures Incidence of Cerebrospinal Fluid Leakage in Patients Treated with Intrathecal Baclofen Pump

A retrospective study published online in the Journal of Pediatric Orthopaedics identified incidence and risk factors for cerebrospinal fluid (CSF) leakage among cerebral palsy (CP) patients who receive an intrathecal baclofen (ITB) pump. Over a 15-year period, 720 ITB procedures were performed in 341 CP patients. Factors evaluated included patient demographics, medical comorbidities, muscle tone patterns, feeding tube status, seizure history, inpatient events, ITB-related CSF leak, and headache complaints and their management. About a quarter of patients (n = 85, 24.9 percent) experienced 90 CSF leak episodes; of these patients, 61 reported 72 headache episodes. Risk factors for CSF leak included epilepsy/seizure history, feeding tube, mixed type CP, and dystonic type CP. The risk of CSF leak was greater after secondary ITB procedures due to complications (24.2 percent) compared to primary ITB administration (5.8 percent).

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Lawmakers Request Information from Google and Ascension on Healthcare Data Initiative

Leaders on the House Committee of Energy and Commerce (E&C) wrote letters to the CEOs of Google and Ascension asking for additional information regarding their deal, code-named “Project Nightingale.” The collaboration will reportedly provide the tech giant with medical data on millions of patients that includes diagnoses, lab results, and hospitalization records.

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Read the E&C press release…


Ballistic Trauma Basics for Orthopaedic Surgeons

Like blunt force trauma, ballistic trauma is seen in rural and urban settings alike, and injury severity presents on a spectrum from minor to mortal. Ballistic kinetics must be considered in the assessment and treatment of gunshot wounds (GSWs), as well as the projectile’s course through the body, in addition to the presence and location of residual wadding or bullet fragments. This article reviews firearm ballistics, GSW evaluation and treatment, and demographics of nonfatal GSWs in the United States.

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AAOS Makes Strategic Investment in Biologics Research and Development

AAOS announced a strategic investment in the field of biologics this week. Over the next five years, AAOS will prioritize research and development for a biologics-focused competency within the Academy’s existing business. The focus of this effort will be to create evidence-based, unbiased information, thought-leadership, position statements, and educational content to help shape and guide orthopaedic surgeons and their patients within this space.

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