February 19, 2020 | Today’s News

Study: Deep SSI Incidence Based on Wound Treatment for Trauma-related Lower Limb Fracture

A randomized clinical trial published online in JAMA did not observe significant differences in deep surgical site infection (SSI) incidence between operative patients with major trauma-related lower limb fractures treated with incisional negative pressure wound therapy versus standard wound dressing. The study spanned 24 trauma hospitals and encompassed 1,548 patients (mean age, 49.8 years; 38 percent were female) treated operatively for a lower limb fracture resulting from major trauma. Patients received either incisional negative pressure wound therapy (n = 785), in which a specialized dressing created negative pressure over the wound, or standard wound dressing (n = 763), in which negative pressure was not used. Data were available for 1,519 patients. Thirty-day deep SSI rates were 5.84 percent in the negative pressure group and 6.68 percent in the standard wound dressing group. At 90 days, deep SSI rates were 11.4 percent and 13.2 percent, respectively.

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Study Assesses Effect of ACA Medicaid Expansion on Orthopaedic Surgery Access in New York

A study published in the Feb. 15 issue of the Journal of the AAOS evaluated how Affordable Care Act (ACA)-associated Medicaid expansion impacted the utilization of elective orthopaedic surgery in New York state. The New York Statewide Planning and Research Cooperative System database was searched for patients who underwent one of 10 common elective orthopaedic surgeries between Jan. 1, 2012, and March 31, 2016. The New York Department of Health Medicaid Managed Care Enrollment Reports were queried for Medicaid monthly enrollment data. Of the 700,159 patients identified, 60,786 were Medicaid recipients; over the course of the study, a significant increase was observed in Medicaid enrollment and the proportion of Medicaid-reimbursed procedures.

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A study published online in Injury compared length of stay (LOS) and 30-day unplanned readmissions in patients with isolated humeral shaft fracture treated with open reduction internal fixation (ORIF) versus intramedullary nailing (IMN). Patients treated between 2015 and 2016 were identified using the national readmissions database. Final analysis included 406 ORIF patients and 406 IMN patients. Thirty-day readmission rates were 6.4 percent in the IMN group and 4.9 percent in the ORIF group. Both groups had a median LOS of three days. Independent risk factors for readmission included congestive heart failure (CHF), depression, and electrolyte abnormality. Risk factors for LOS exceeding three days included older age, CHF, electrolyte abnormality, obesity, Medicaid beneficiary, discharge to a facility, discharge with home services, and open fracture. Treatment technique did not predict 30-day readmission or LOS exceeding three days.

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According to a retrospective study published in the February issue of The Bone & Joint Journal, supine radiographs were predictive of in-brace correction and post-bracing curve magnitude in patients with adolescent idiopathic scoliosis (AIS) undergoing underarm bracing treatment. AIS patients prescribed an underarm brace between September 2008 and April 2013 were followed until age 18 or surgical intervention. The prebrace standing posteroanterior (PA) radiograph, supine whole spine radiograph, initial in-brace standing PA radiograph, and post-brace weaning standing PA radiograph were used to measure the major curve Cobb angle, curve type, and location. Final analysis included 586 patients (mean age, 12.6 years). Baseline Cobb angle did not largely differ between thoracic major curves (31.6 degrees) and lumbar major curves (30.3 degrees). The thoracic curves, compared to lumbar curves, had more curve progression (mean final Cobb angles, 40.5 degrees versus 31.8 degrees). Factors associated with curve progression included reduced age and Risser stage, thoracic curves, increased prebrace Cobb angle, and reduced correction and flexibility rates.

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According to news reports from the Desert Sun, orthopaedic surgeon David Duffner, MD, was shot and killed Friday, Feb. 14 at the Rancho Mirage Medical Plaza, located in Rancho Mirage, Calif. Walter Carter, 63, entered the office of Dr. Duffner, shot the physician multiple times, and then fatally shot himself. No one else was injured during the incident. It is unknown if Mr. Carter was a patient of Dr. Duffner. Police did not release information about the possible motive. Dr. Duffner was in practice for more than 30 years and most recently practiced at the Orthopedic & Physical Medicine Associates, an office he cofounded with two other medical professionals.

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AAOS Office of Government Relations Introduces 2020 Resident Advocacy Fellows

The AAOS Office of Government Relations is proud to introduce its 2020 Resident Advocacy Fellows: Carl L. Herndon, MD, and Kacy Peek, MD. Launched in early 2018, the one-year fellowship is designed to encourage orthopaedic residents to participate in the national health policy arena and ultimately become lifelong advocates of the profession.

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Personalize Your OVT Member Profile

Take five minutes to update your member profile on the newly expanded Orthopaedic Video Theater (OVT). Click on the person icon in the top right corner of the OVT landing page, select “My Profile,” and choose the specialty topics of most interest to you. You can also update your contact information and add an image and brief biography. By keeping your profile current, you get a much more personalized learning experience that addresses your needs, interests, and preferences.

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