January 22, 2020 | Today’s News

Study: Does Fascia Iliaca Compartment Block Reduce Postoperative Pain after Hip Surgery?

According to a randomized, prospective trial published in the January issue of the Journal of Orthopaedic Trauma, preoperative fascia iliaca compartment block in hip fracture patients significantly reduced postoperative opioid consumption and improved patient satisfaction. Patients were randomized to receive an ultrasound-guided fascia iliaca compartment block just prior to anesthesia initiation or a control group. Acetaminophen consumption for mild pain, tramadol consumption for moderate pain, and functional recovery did not largely differ between the groups. The fascia iliaca compartment block group consumed significantly less morphine than the control group (0.4 mg versus 19.4 mg) and reported higher satisfaction.

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Study: Predictors of Complications in Solid Organ Transplant Patients Who Undergo Upper-extremity Surgery

A study published online in The Journal of Hand Surgery analyzed the prevalence of and factors associated with complications of upper-extremity surgery in solid organ transplant patients. Patients who underwent an upper-extremity procedure at a single institution by one of six surgeons between 2006 and 2018 were identified. Data collected included demographics, transplant date and type, upper-extremity surgery procedure and date, antirejection medications, American Society of Anesthesiologists (ASA) Physical Status Classification System score, and complications (defined as any surgical complication within one year and any medical complications within 30 days of surgery). Final analysis included 51 procedures (32 patients), of which 21 sustained complications. The most common surgical complication was infection, which was equally as likely to present before and after 30 days. Most complications were grade 2, and no grade 4/5 complications were recorded. There were no significant differences in age, ASA score, type or number of solid organ transplants, and immunosuppressive regimens between procedures that did and did not result in complications. Male patients were more likely than female patients to sustain complications.

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A study published in the January issue of the Journal of Shoulder and Elbow Surgery found that major league baseball (MLB) teams incur significant financial losses due to salaries paid to players undergoing ulnar collateral ligament reconstruction (UCLR). MLB pitchers who underwent UCLR between Jan. 1, 2004, and Dec. 31, 2014, were identified. Economic loss was determined by contract terms and time away from competition. Final analysis included 194 pitchers; an average of 180.2 days of the MLB regular season were missed. The cost of recovery (COR) was $3950 million, for an average $1.9 million per player. The largest total COR was for starting pitchers ($239.6 million), and closers made up the largest economic loss per player ($3.9 million/player). Just about three-quarters of pitchers (77 percent) returned to MLB play.

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A study published online in BMC Musculoskeletal Disorders observed good outcomes for physically active patients who received distal tibial osteotomy with joint distraction to treat ankle osteoarthritis (OA). Arthroscopic synovectomy and a microfracture procedure and then angled osteotomy and distal tibia correction were conducted in 21 patients. The ankle joint was stabilized upon improvement. All patients received an external fixator and joint distraction of about 5.8 mm. Patients were allowed full weight-bearing walking immediately postoperatively. Upon ankle stress radiography, significant improvements were observed in the anteroposterior and lateral mortise angle during weight-bearing, talar tilt angle, and anterior translation of the talus. Improvements were also observed on MRI. Significant improvements were observed in visual analog scale and American Orthopedic Foot & Ankle Society scores. No severe complications presented.

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Patients presenting with new musculoskeletal pain at their first physician visit are prescribed opioids more often than physical therapy, counseling, and other nonpharmacologic treatments, despite differing clinical recommendations, according to a study published online in The Journal of Pain. Lead author Richard Nahin, PhD, MPH, senior epidemiologist at the National Center for Complementary and Integrative Health, said, “This study serves as a benchmark for clinicians to assess how much progress we’re making toward integrating guidelines, including the [Centers for Disease Control and Prevention] Guideline for Prescribing Opioids for Chronic Pain, into clinical practice and offers insight on where to focus efforts to close gaps in care during that critical first patient visit.”

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Opinions on Operative Treatment of Clavicle Fractures from Sports and Trauma Experts

Over the years, treatment of midshaft clavicle fractures has evolved. Since 2010, more than 100 articles have been published per year. With any new level 1 evidence, some practitioners jump on the bandwagon. But the question remains: Is open reduction and internal fixation of midshaft clavicle fractures the better treatment option? In this article, trauma and sports medicine physicians comment on the recent meta-analysis by Guerra et al., which concluded that operative treatment was superior.

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Help Puerto Rico after Devastating Earthquake

A 5.9 magnitude earthquake rocked Puerto Rico on Jan. 11, and the region is in need of support. AAOS received some on-the-ground intel from its own Puerto Rico Board of Councilors representative, Pablo Marrero, MD, noting that chronic conditions are not being treated adequately due to lack of electrical power and water. If you have questions or would like to speak with an orthopaedic surgeon on the ground in Puerto Rico, contact Dr. Marrero directly at bonedocboricua@gmail.com.

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