April 27, 2020 | Today’s News

A Message from the AAOS President

In his latest message, AAOS President Joseph A. Bosco III, MD, FAAOS, highlighted the latest COVID-19 relief package passed by Congress and signed by President Donald J. Trump last week, which adds an additional $75 billion in reimbursement to hospitals and healthcare providers for healthcare-related expenses or lost revenues attributable to COVID-19. He also addressed the proposed amendments to the AAOS bylaws. Dr. Bosco said, “The purpose of the proposed changes is to streamline our bylaws and allow us to nimbly evolve our organization to face the challenges of a rapidly evolving healthcare ecosystem. That is why I along with our Board of Directors, Board of Councilors, and Board of Specialty Societies strongly support them. We urge you to approve and support them as well.”

Read Dr. Bosco’s message…

The Centers for Medicare & Medicaid Services (CMS) is reevaluating the amounts its Accelerated Payment Program will pay out. Also, effective immediately, CMS suspended its Advance Payment Program to Part B suppliers. The news comes following the $175 billion allocated to healthcare provider relief payments and the more than $100 billion paid to healthcare providers and suppliers through these programs.

Read the CMS press release…

Read the fact sheet…

With the outbreak of novel coronavirus (COVID-19), many outpatient clinics and facilities find themselves unprepared for telehealth visits. The care team’s clinical decision-making must first determine which patients are at higher risk for COVID-19 morbidity and then decide which of them still need evaluation. This process will dramatically increase patient phone calls and portal messaging in the coming weeks. This article provides virtual video visit guidelines for established patients.

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Study Measures Effect of Acetaminophen on Delirium in Older Hip Fracture Patients

According to a study published in the April 15 issue of the Journal of the AAOS ®, intravenous (IV) acetaminophen was correlated with fewer episodes of delirium in hip fracture patients aged older than 60 years. A total of 123 hip fragility fracture patients were retrospectively reviewed. A validated chart-based review tool was used to establish delirium. Analysis included rate of delirium, length of stay (LOS), pain scores, opioid administration, need for one-to-one supervision, and readmissions. About half of patients (n = 65, 52.8 percent) received IV acetaminophen, of whom 10 experienced delirium compared to 19 of 58 patients who did not receive IV acetaminophen (15.4 percent versus 32.8 percent). The IV acetaminophen group had lower IV opioid doses on postoperative day one, were less likely to need one-to-one supervision, and had shorter LOS. No significant between-group differences were observed for readmission rate and discharge disposition.

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A study published in the April issue of The Journal of Hand Surgery assessed outcomes of intra-articular distal radius fractures with displaced dorsal lunate facet fragments treated with combination volar plating and dorsal screw that integrates into the plate. Patient charts were retrospectively reviewed to evaluate clinical and radiographic outcomes. Final analysis included 12 patients (mean age, 55.2 years; eight patients were female) who were followed for a mean 11.5 months. Three-quarters of patients were injured due to a fall from standing. At final follow-up, preinjury function levels were achieved by all patients, as was bony union. At final follow-up, the average radiographic parameters were: radial inclination, 24.2 degrees; volar tilt, 1.3 degrees; and ulnar variance, 0.9 degrees. Four patients presented transient median nerve paresthesias; spontaneous resolution occurred in three patients. There were no incidences of loss of articular reduction.

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A study published in the May issue of the Journal of Shoulder and Elbow Surgery compared reverse shoulder arthroplasty (RSA) with versus without latissimus dorsi and teres major tendon transfer in patients with rotator cuff tear arthropathy and combined loss of elevation and external rotation (CLEER). Eligible patients undergoing RSA with rotator cuff tear arthropathy and CLEER were randomized to receive RSA either with or without tendon transfer. The main outcome measure was the Activities of Daily Living and External Rotation (ADLER) score two years postoperatively. Additional outcomes included the Disabilities of the Arm, Shoulder, and Hand (DASH); American Shoulder and Elbow Surgeons (ASES); and Simple Shoulder Test (SST) scores. At final follow-up, there were no significant between-group differences in ADLER, DASH, ASES, or SST scores. Postoperative resolution of the Hornblower sign presented in 58.3 percent of the control group and 73.3 percent of the treatment group.

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A study published in the April issue of Foot & Ankle International assessed the rate of displacement and patient-reported outcome measures (PROMs) after conservative management of minimally displaced Lisfranc injury. Patient demographics, injury mechanism, and radiological outcomes for 26 minimally displaced Lisfranc injury patients who presented at a single institution were retrospectively collected. PROMs collected at least one year postoperatively included the American Orthopaedic Foot & Ankle Society (AOFAS) midfoot score and Manchester Oxford Foot Questionnaire (MOXFQ). Just over half of patients (n = 14) experienced displacement after a median 14 days. After 12 weeks of conservative treatment, the other 12 patients remained minimally displaced. Initial weight-bearing status did not appear to influence subsequent displacement risk. Mean follow-up was 54 months, at which time PROMs were not significantly different between patients whose injury remained minimally displaced versus those who required operative treatment (AOFAS, 78.0 versus 75.9; MOXFQ, 24.8 versus 26.3).

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