Today’s Top Story
Study: Augmented repair may offer little advantage over simple repair for acute Achilles tendon rupture.
Findings from a study published in the Jan. 20 issue of The Journal of Bone & Joint Surgery (JBJS) suggest that augmented repair may offer little or no advantage over simple end-to-end repair of total Achilles tendon ruptures. The authors conducted a prospective, randomized trial of 55 patients with acute Achilles tendon rupture who received either simple end-to-end repair (n = 28) or fascial flap-augmented repair (n = 27). At mean 14-year follow-up, they found that the mean Leppilahti Achilles tendon score was 87.1 points for the nonaugmented repairs and 91.5 points for the augmented repairs. The authors state that surgical technique had no significant impact on strength parameters, and that strength did not significantly change between 12-month and 14-year follow-up examinations. Read the abstract…
Other News
Study: Higher BMI linked to increased risk of VTE among pediatric patients.
According to a study published in the January issue of the journal Hospital Pediatrics, increased body mass index (BMI) may be linked to increased risk of venous thromboembolism (VTE) in pediatric patients. The researchers conducted a retrospective chart review of 88 patients aged 2 to 18 years, along with two matched control subjects per case. They found a statistically significant association between incidence of VTE and increased BMI Z-score. In a multivariate analysis, BMI Z-score, bacteremia, stay in an intensive care unit, and use of oral contraceptives were significant predictors of VTE. Read more…
Read the abstract…
Study: Passive hip ROM may predict combined femoral torsion and central acetabular version.
Data published in the Jan. 20 JBJS suggest that passive hip range of motion (ROM) may predict combined femoral torsion and central acetabular version. The research team examined data on 221 patients (442 hips) who underwent hip arthroscopy. They found that hips with femoral antetorsion and acetabular anteversion exhibited the greatest internal rotation range of motion at a neutral hip position, while hips with femoral retrotorsion and acetabular retroversion demonstrated the least. The research team found increasing age and internal rotation range of motion at a neutral hip position to be the most significant predictors of an increased combined femoral torsion-acetabular version index. Overall, femoral torsion was significantly associated with female sex, BMI, and presence of pathology corresponding to cam-type femoroacetabular impingement (FAI); central acetabular version was significantly associated with age, female sex, and absence of mixed-type FAI pathology. Read the abstract…
Study: Surgeons often disagree on classification and management of subscapularis tendon tears.
Findings published in the February issue of the journal Arthroscopy suggest little agreement on the part of surgeons regarding the classification and management of subscapularis tendon tears based on arthroscopy and magnetic resonance imaging (MRI). The researchers asked 22 orthopaedic surgeons to review still arthroscopic and MRI images of the subscapularis tendon from patients with a random assortment of subscapularis morphology, classify the pathology based on two systems (Lafosse and Lyons), and choose whether they would repair the tendon and, if so, the method of repair. The survey was administered three times to each surgeon. The researchers noted that interobserver reliability on classification of tears was poor based on MRI (k = 0.18 to 0.19) and fair based on arthroscopy (k = 0.26 to 0.29). Interobserver agreement on whether surgical treatment was indicated was fair for both MRI (k = 0.28) and arthroscopy (k = 0.38), while the agreement for type of surgery was poor based on MRI (k = 0.18) and fair based on arthroscopy (k = 0.28). The researchers state that interobserver agreement did not improve even when MRI and arthroscopy were provided simultaneously. For all questions, arthroscopic images were associated with a higher level of agreement than MRI. Read the abstract…
Study: Emergency medicine drug shortages rose 435 percent over 7-year period.
A study published in the January issue of the journal Academic Emergency Medicine examines drug shortage trends in the United States from the perspective of emergency medicine (EM). The authors analyzed data from the University of Utah Drug Information Service between January 2001 and March 2014. They found that, of 1,798 drug shortages during the 159-month period, 610 shortages (33.9 percent) were classified as within the scope of EM practice. Of those, 321 (52.6 percent) were for drugs used as lifesaving interventions or for high-acuity conditions, and of those, 32 (10.0 percent) were for drugs with no available substitute. The prevalence of EM drug shortages fell from 2002 to 2007, then increased by 435 percent (from 23 to 123) between January 2008 and March 2014. During that timeframe, shortages in drugs used as a direct lifesaving intervention or for high-acuity conditions increased 393 percent (from 14 to 69), and shortages for drugs with no available substitute grew 125 percent (from four to nine). The authors note that infectious disease drugs were the most common EM drugs on shortage, with 148 drug shortages totaling 2,213 months during the study period. Read more…
Read the abstract…
CMS won’t recalculate alleged underpayments in 2004 case.
In a 2015 decision, a three-judge panel of the D.C. Circuit Court of Appeals ordered the U.S. Centers for Medicare & Medicaid Services (CMS) to explain payment calculations made in 2004. A lawsuit filed by 186 hospitals alleged that Medicare had underpaid them by more than $3 billion in outlier payments during 2004. Modern Healthcare reports that, on Friday, CMS complied with the court’s order by providing an explanation for its 2004 calculations, but the agency will not recalculate those payments. The judicial panel had already rejected hospitals’ arguments that the thresholds were “arbitrary and capricious,” and led to similar underpayments in 2005 and 2006. Read more…(registration may be required)
South Carolina.
An article in Modern Healthcare profiles a South Carolina initiative that requires participating hospitals to regularly use a pre-surgical safety checklist process. The writer notes that there is currently little data on the efficacy of surgical checklists, although project leaders have estimated that their use could save 500 patient lives per year. Read more…(registration may be required)
Call for volunteers: Musculoskeletal Tumor Society Systematic Review work group.
AAOS seeks participants for a work group to develop, in association with the Musculoskeletal Tumor Society, a Systematic Review on the Use of Imaging Prior to Referral to a Musculoskeletal Oncologist. Applicants must have a good understanding of evidence-based methods and no financial conflicts of interest relevant to this review topic. (All applicants will be required to complete the AAOS Orthopaedic Disclosure Program prior to starting any work.) To participate, or for more information, please contact Erica Linskey by Monday, Feb. 1, 2016, at: linskey@aaos.org
