Study: ORIF offers early advantage over nonsurgical treatment of displaced midshaft clavicle fracture
According to a study published online in the Journal of Orthopaedic Trauma, open reduction and internal fixation (ORIF) may offer improved early outcomes compared to nonsurgical treatment of displaced midshaft clavicle fracture, although longer-term outcomes are similar. The researchers conducted a meta-analysis of randomized controlled trials that reported nonunion, shoulder functional outcomes, and subsequent surgery rates or pain scores. They found that the risk ratio of nonunion was 0.15 for ORIF compared with that of nonsurgical treatment. In addition, Constant and disabilities of the arm, shoulder and hand (DASH) scores were significantly better with ORIF at up to six-month follow-up. At 12 months, the mean difference in DASH scores was statistically insignificant across both treatments, although Constant scores remained significant in ORIF. The researchers state that subsequent surgeries and pain scores were similar for both treatments.
Study: Cementless femoral stem fixation linked to increased risk of early revision among older patients
Data from a study conducted in Australia and published online in the journal Clinical Orthopaedics and Related Research suggest that cementless femoral stem fixation may be associated with a higher early rate of revision compared to cemented fixation in patients aged 75 years or older. The authors reviewed data from the Australian Orthopaedic Association National Joint Replacement Registry to identify the three cemented and the three cementless femoral stems with the lowest 10-year revision rates. They found that early revision was 9.14 times more common among the three cementless stems compared to the three cemented stems. After three months postoperative, they found no significant difference in revision rates across cohorts.
Study: Greater tuberosity angle may serve as marker for rotator cuff tear
A study published online in the Journal of Shoulder and Elbow Surgery suggests that greater tuberosity angle (GTA) may be a reliable radiographic marker for rotator cuff tear. The researchers conducted a prospective study of 71 patients, 33 of whom had a degenerative rotator cuff tear involving at least the supraspinatus, and a control cohort of 38 individuals with no rotator cuff pathology. They found that the mean GTA value was 72.5° in the patient group and 65.2° in the control cohort. The researchers state that a value above 70° resulted in 93-fold higher odds of detecting a rotator cuff tear, with high interobserver and intraobserver reliability.
CMS issues proposed rules to update certain payment systems and improve transparency
The U.S. Centers for Medicare & Medicaid Services (CMS) has issued several proposed rules to alter payment systems for services furnished by a range of medical facilities. Among other things, the “Fiscal Year 2019 Medicare Inpatient Rehabilitation Facility [IFR] Prospective Payment System Proposed Rule” would:
Allow the post-admission physician evaluation to count as one of the face-to-face physician visits.
Allow the rehabilitation physician to lead the interdisciplinary team meeting remotely without any additional documentation requirements.
Remove the admission order documentation requirement in an effort to reduce duplicative documentation requirements.
The agency also released proposed rules that address skilled nursing facility payments, hospice care, and inpatient psychiatric facilities.
Study: Denosumab may help reduce risk of fracture for patients on glucocorticoids
A study published online in the journal The Lancet—Diabetes & Endocrinology suggests that denosumab may help reduce risk of fracture for certain patients who have been prescribed glucocorticoids. Members of the research team conducted an international, double-blind, active-controlled, double-dummy, noninferiority study of 795 adult patients, 505 of whom were glucocorticoid continuing and 290 of whom were glucocorticoid initiating, and who were randomly assigned to receive either denosumab (n = 398) or risedronate (n = 397). At 12 months, they found that denosumab was both noninferior and superior to risedronate for effect on bone mineral density at the lumbar spine in both glucocorticoid-continuing and glucocorticoid-initiating cohorts. Overall incidence of adverse events, serious adverse events, and fractures was similar across treatment groups.
Study: Concussion linked to increased risk of lower extremity injury among young athletes
Young athletes who have experienced a concussion may be at increased risk of lower extremity injury, according to research presented at the annual meeting of the American Medical Society for Sports Medicine. The researchers conducted a one-year, prospective study of male and female high school soccer players from 52 different high schools. They found that athletes who reported any prior concussion were 85 percent more likely than those with no reported concussions to experience a leg injury during the athletic season. The researchers suggest that adolescent athletes with a concussion history may have ongoing neuromuscular and neurocognitive issues that may increase risk of injury, and note that such factors are not currently identified through clinical postconcussion testing.
AAOS members will soon receive the print edition of the May issue of AAOS Now, but the electronic edition is already available on the AAOS Now website and on iOS and Android devices through the AAOS Access app. This month’s issue includes an article on sexual harassment and bullying in the medical profession, a profile of an osteoporosis program implemented at a multispecialty musculoskeletal practice, continuing coverage of the AAOS 2018 Annual Meeting, and much more.
