A study published in the Sept. 15 issue of the Journal of the AAOS ® questioned whether the ideal entry point of the intramedullary nail (IMN) during tibia fracture fixation is maintained after insertion. The study evaluated 50 consecutive tibia fractures that underwent IMN fixation sized 9 mm to 13 mm and 50 treated with the suprapatellar approach. Per intraoperative fluoroscopy, the average deviation from the ideal entry point averaged 4.6 mm medially, 2.9 mm anteriorly, and 27 mm distally. The final IMN position was different from the entry point by more than one standard deviation in the coronal or sagittal plane in 30 percent of cases.
Study Evaluates Closed Reduction Procedure for Developmental Dysplasia of the Hip by Age
A retrospective study published online in BMC Musculoskeletal Disorders compared midterm outcomes for closed reduction in cases of developmental dysplasia of the hip by different age groups. A total of 107 patients (156 hips) with a median age at initial reduction of 13 years were stratified into three groups: age younger than 12 months, age 12 to 18 months, or age older than 18 months. Mean follow-up was 6.7 years. Avascular necrosis was observed in 15.4 percent of hips, residual acetabular dysplasia (RAD) in 17.3 percent, and redislocation in 14.7 percent. Age older than 18 months was a risk factor for RAD.
Study Reviews Bone Cysts and Osteolysis in Ankle Replacement
A study published online in Foot & Ankle International evaluated the prevalence of preoperative bone cysts in end-stage ankle arthritis patients undergoing total ankle replacement (TAR) and assessed available data on bone cysts and osteolysis associated with TAR. A total of 120 consecutive patients (mean age, 63.4 years) were assessed: 17 had no bone cysts, and 10 had cysts that would be completely removed by surgery, so 93 patients were analyzed. Plain radiographs did not show the cysts in 60 percent of cases. A third of patients had cysts larger than 5 mm. The most common locations for cysts were the medial (36 percent) and lateral malleoli (33 percent).
Study Analyzes Hospital Reimbursement and Surgeon Payments in Arthroscopic RCR Costs
According to a study published in the September issue of Arthroscopy, despite significant increases in outpatient rotator cuff repair (RCR) charges for hospitals, surgeons, and anesthesiologists, hospital reimbursements have substantially increased compared to those of surgeons and anesthesiologists. A total of 12,617 Medicare patients from 2005 to 2014 were assessed. Over the study period, hospital charges for RCR significantly increased by 136 percent, and surgeon charges increased by 33 percent. Reimbursements for hospitals increased by 123 percent but were largely unchanged for surgeons (3 percent). No significant changes were observed in Charlson Comorbidity Index over the study period.
Study Determines Safety, Efficacy of Percutaneous Vertebroplasty in Endplate Fracture Around Schmorl’s Node
A study published online in the Journal of Orthopaedic Surgery and Research observed acceptable safety and efficacy outcomes in percutaneous vertebroplasty to treat endplate fractures around the Schmorl’s node. Final analysis included 65 patients. Visual analog scale and Oswestry Disability Index scores significantly improved one year postoperatively. Five patients (7.7 percent) experienced cement leakage into the disk space, and two patients (3.1 percent) sustained adjacent segment refractures; no other surgical complications were observed.
Clinical Photography in the Orthopaedic Electronic Medical Record
The use of medical photography dates back to 1845, when Gordon Buck, MD, published preoperative photos. Clinical photos augment the documentation of wounds, soft tissues, alignment, and range of motion. Currently, there are no orthopaedic-specific standards for clinical photography, and less than 50 percent of orthopaedic publications adhere to plastic surgery criteria. This article focuses on app-based clinical photo capture for providers even with no professional photographic experience.
