October 11, 2019
Today’s Top Story

Study Compares Outcomes for Operative versus Nonoperative Type B Fibula Fracture Management

A retrospective cohort study published online in Injury observed similar long-term outcomes between operative and nonoperative treatment for patients with isolated type B fibula fracture. Consecutive patients aged 18 to 75 years treated for a distal fibula fracture at the level of the syndesmosis without an additional medial or posterior fracture and with a medial clear space ≤ 6 mm between January 2008 and December 2015 were included. Patients completed a questionnaire that included the Olerud-Molander Ankle Score (OMAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, EuroQol-5D (EQ-5D) for quality of life, and visual analog scale (VAS) score for pain sensation. Final analysis included 229 patients with a mean follow-up of 5.3 years. Nonoperatively and operatively treated patients did not have significantly different mean EQ-5D score (0.8 versus 0.9), VAS score (0.8 versus 1.3), OMAS (84 versus 84), or AOFAS (93 versus 90). A third of operative patients had persistent pain and underwent revision surgery for implant removal. Wound infection requiring intravenous antibiotic treatment presented in 3 percent of the operative group. There was one case of deep venous thrombosis in the fractured leg in the nonoperative cohort.

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In Other News

Study: Drain Use Declining in TKA

According to a retrospective study published in the Oct. 15 issue of the Journal of the AAOS, data do not support the use of drains in total knee arthroplasty (TKA), which may be leading to a decline in this practice. Using the national claims-based Premier Healthcare Database, 1,130,124 TKAs performed between 2006 and 2016 were compared by patients who did and did not receive a drain. Outcome measures included the association between drain use and blood transfusions, postoperative infections, 30-day readmission, and length and cost of hospitalization. The use of drains significantly declined from 2006 (33.0 percent, n = 22,901/69,370) to 2016 (15.6 percent, n = 19,418/124,440). Drain use was more common in large (> 500 beds, 27.1 percent) and nonteaching (26.9 percent) hospitals. Compared to no drain, TKA with a drain was significantly associated with blood transfusion risk, but effects on the other outcomes were minimal.

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Study: Influential Factors in Nonoperative Sagittal Band Injury Treatment Outcomes

A study published in the October issue of The Journal of Hand Surgery identified factors that may affect the prognosis for patients with sagittal band injuries managed nonoperatively. The study included 94 patients with traumatic sagittal band injuries who underwent initial seven-week metacarpophalangeal joint extension orthosis wear treatment: five weeks of full-time and two weeks of part-time wear. Treatment response was assessed after 24 weeks, including finger range of motion (ROM); extensor tendon instability; grip strength; and functional outcome measured as Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score. Influence of age, sex, occupation, hand dominance, type of injury, injury severity, time to treatment, and the duration of orthosis wear were considered. At 24-week follow-up, 67 (71 percent) patients achieved resolution of symptomatic translocation. Compared to the unaffected hand, grip strength was 83 percent, and ROM was 90 percent. Mean QuickDASH score was 15. Of the 27 patients who had persistent symptomatic tendon subluxation, 18 required surgical repair. The failure group had a significantly higher percentage of manual laborers than the success group. Patients with treatment failure were older in age, had longer symptom durations, and had a greater likelihood for grade III injuries. In multivariable analysis, factors associated with treatment failure included manual labor, longer symptom duration, and grade III injury.

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Study Compares Outcomes for Primary versus Secondary Proximal Humerus Fracture Treatment

According to a study published in the October issue of The Bone & Joint Journal, the rate of reoperation is significantly higher among patients who undergo arthroplasty for failed open reduction and internal fixation (ORIF) of proximal humerus fracture (PHF) compared to primary arthroplasty for PHF. Between 2004 and 2015, 1,624 patients underwent initial arthroplasty for PHF, and 98 underwent secondary arthroplasty following failed ORIF. Reoperation rates were 4.4 percent (n = 72) in the primary arthroplasty group and 19.4 percent (n = 19) in the revision arthroplasty group. The difference remained significant when adjusting for covariables.

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New Proposed Rules Address Stark, Anti-kickback Laws

The Centers for Medicare & Medicaid Services and the Department of Health and Human Services Office of Inspector General proposed two new rules to reform anti-kickback and Stark self-referral laws. The current rules, structured to address fraud issues, hinder data sharing and care coordination. The changes being proposed would allow specialty physician practices to share patient data with primary care physicians to more efficiently manage care, as well as allow hospitals to team up to combat cybersecurity issues.

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High Prevalence of Depression Found in Shoulder Surgery Patients

In a study of patients who underwent surgical stabilization for glenohumeral instability, 51 percent demonstrated preoperative symptoms consistent with clinical depression (CD), and 24 percent demonstrated symptoms consistent with CD one year after surgery. Furthermore, patients with worse CD symptomatology demonstrated worse pre- and postoperative shoulder function. The researchers defined CD with a previously validated questionnaire used for depression screening.

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Tune in to the Orthopaedic Video Theater Practice Management Channel

The AAOS Orthopaedic Video Theater (OVT) is a valuable resource for orthopaedic surgeons around the globe and at all career levels—from residency through retirement. In 2018, the AAOS Board of Directors identified a need for additional practice management education. In response, a new OVT channel was created to assist members in running efficient, profitable, and compliant orthopaedic practices. New practice management content will be added to the channel on a quarterly basis to continually update and enhance the library. The first 15 videos have already been added.

View the practice management channel…(member login required)


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