August 15, 2023 | Today’s News

Study Compares Complications Associated with Fixation Methods in Lower Extremity Intercalary Allograft Reconstruction

Fixation with an intramedullary nail (IMN) for intercalary allograft reconstruction in the lower extremity resulted in a longer median fracture-free allograft survival versus fixation with an extramedullary plate (EMP; 7.9 years versus 3.2 years, respectively), according to a retrospective chart review in the Journal of the AAOS^®. The rate of complications was compared in 51 patients. The incidence of nonunion at all allograft-to-native bone junction sites was 21 percent in the IMN group and 25 percent in EMP group. The overall need for revision surgery was 59 percent and 71 percent in the IMN and EMP groups, respectively.

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Does a Minimally Invasive Side Plate Fixation Reduce Perioperative Bleeding during Trochanteric Fracture Fixation?

Orthopaedics & Traumatology: Surgery & Research published a randomized controlled trial investigating whether minimally invasive side plate fixation resulted in reduced perioperative bleeding compared with conventional fixation during trochanteric fracture fixation. In total, 108 patients were randomized to receive either conventional or minimally invasive side plate fixation. Perioperative bleeding (243 mL versus 334 mL), operating time (65 minutes versus 79 minutes), and scar length after 45 days (7 cm versus 14 cm) were significantly reduced in the minimally invasive group; however, there were no significant differences between groups in terms of postoperative complications and revision surgery.

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A systematic review in the Bone & Joint Journal found that female orthopaedic surgeons had high rates of obstetric complications and infertility. To examine the data of pregnancy, parenthood, and fertility among orthopaedic surgeons, 19 studies met the inclusion criteria for analysis. According to the review, orthopaedic surgeons experienced higher reported rates of obstetric complications, congenital abnormalities, and infertility when compared with the general population. Children were noted to be conceived at a later age, with childbearing voluntarily delayed.

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Arthroscopy published a retrospective study assessing patient-reported outcomes and rates of revision and complications of patients undergoing arthroscopic bone marrow stimulation for osteochondral lesions of the tibial plafond (OLTP). The patient-reported outcomes examined included the Numeric Rating Scale (NRS) and Foot and Ankle Outcome Score. Fifty-one patients comprised the study population. The mean NRS during walking was 1.9 at the two-year follow-up, and anterior-posterior OLTP size was significantly associated with a higher NRS pain score during walking. Overall, 6 percent of patients required revision surgery, and 12 percent of patients experienced minor complications.

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The Journal of Pediatric Orthopaedics published a study that investigated the efficacy of liposomal bupivacaine injectable suspension admixture administered as a single-shot adductor canal peripheral nerve block (SPNB+BL) in decreasing the use of at-home opioid analgesics after ACL reconstruction (ACLR) compared with single-shot peripheral nerve block with bupivacaine (SPNB+B). The SPNB+BL and SPNB+B cohorts consisted of 32 and 26 patients, respectively. There were no significant differences in visual analog scale or pain treatment satisfaction scores between groups. Significantly fewer SPNB+BL patients required opioids than SPNB+B patients (7.7 percent versus 28.1 percent).

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Killing Hope: A Resident’s Difficult but Necessary Reflection on How to Navigate Patient Expectations

In this edition of the Final Cut, Janice Bonsu, MD, MPH, orthopaedic surgery resident at Emory University and member of the AAOS Now Editorial Board, discusses how she approaches having difficult conversations with patients, particularly when giving bad news. As she writes, “How can I deliver bad news in a way that leaves the patient feeling empowered and not defeated?” Dr. Bonsu shares lessons learned from her attendings on how to successfully navigate these conversations and support patients as they process grief and other difficult emotions

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ROCK Calendar Enhancements Make Scheduling a Breeze

The AAOS Resident Orthopaedic Core Knowledge (ROCK) digital learning platform has been updated with new features that provide program directors with more flexibility when scheduling assignments for their residents. They can now set study schedules in blocks of weeks, making it easy to create a schedule that covers a specific topic or period of time. Programs that have different learning goals or need to track residents’ progress differently will benefit from using multiple calendars and assigning study plans to specific individuals or an entire cohort. For a limited time, U.S.-based residency programs that subscribe to ResStudy will have free access through June 30, 2024.

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OrthoInfo, the Academy’s patient education website, is here to provide your patients with in-depth information—all written, reviewed, and regularly updated by orthopaedic experts. This includes a full range of articles to help ensure a safe return to school and club sports for kids of all ages, helping parents keep their young athletes healthy. Visit orthoinfo.org to discover a wealth of musculoskeletal health content that you can share with patients any time: You can print it, send it electronically, or link to it from your practice site. Or add this QR code to your business cards, email signature, patient handouts, etc., to give patients direct access to the website.

Read “A Guide to Safety for Young Athletes”…

Read “High School Sports Injuries”…

Read “Overuse Injuries in Children”…

Read “Sports Concussion”…

Read “Skin Infections in Athletes”…