August 29, 2018 | Today’s News

Study: Methylprednisolone use for pain management after TKA

A meta-analysis published in the September issue of the International Journal of Surgery found that methylprednisolone may be safe and effective in relieving postoperative pain following total knee arthroplasty (TKA). Researchers conducted a literature review and identified four randomized, controlled trials that included 248 patients. Participants received methylprednisolone or placebo following surgery. Those who received methylprednisolone reported significantly lower postoperative pain scores at six (weighted mean difference [WMD] = –0.661), 12 (WMD = –0.555), and 24 (WMD = –0.648) hours. Researchers also reported decreased narcotic consumption and opioid-related adverse events in the intervention group.

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Study links frailty to mortality and complications following traumatic orthopaedic injury

Frailty may be a risk factor for mortality and other complications in younger patients who sustain traumatic orthopaedic injuries, according to a study published online in the journal Injury. Researchers assessed the American College of Surgeons National Surgical Quality Improvement Program database to identify 56,241 patients who underwent surgery for pelvis, acetabulum, and lower extremity trauma between 2005 and 2014. They used a modified frailty index (mFI) to predict mortality following surgery. Both mFI score and Clavien-Dindo grade IV complications were strong indicators of 30-day mortality in patients aged younger than 60 years (28 percent). The mFI scores could be used in younger patients for perioperative counseling and to improve postoperative outcomes, according to the researchers.

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A controlled, crossover study published online in BMC Musculoskeletal Disorders found that use of kinesiotape (KT) after rotator cuff surgery offered no clinical benefits related to range of motion (ROM), strength, or pain, but that it positively affected muscular activity. Researchers studied 39 patients without tape, with KT, and with a sham tape (ST) at six and 12 weeks following rotator cuff surgery. At six weeks, KT and ST increased flexion ROM, and KT appeared to decrease recruitment of the upper shoulder trapezius.

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Surgery within one day of hospital admission was associated with the lowest mortality rates among hip fracture patients in a study published in the August issue of CMAJ. Researchers used discharge abstracts from the Canadian Institute for Health Information between 2004 and 2012 for 139,119 medically stable hip fracture patients aged 65 years and older. Among the patients, 23.1 percent underwent surgery the same day they were admitted (n = 32,120), 43.5 percent on inpatient day two (n = 60,505), 21 percent on day three (n = 29,236), and 12.4 percent after day three (n = 17,258). For patients who had surgery on admission day, the 30-day in-hospital mortality rate was 4.9 percent compared to 6.9 percent for those who had the operation after day three. Researchers estimated that an additional 10.9 deaths per 1,000 surgeries would have occurred if all patients had surgery after the third day. They recommend hospitals expedite operating room access for patients whose surgeries have not been delayed for medical reasons.

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A retrospective case review published online in the journal Injury found that percutaneous screw fixation may be a safe technique to treat painful lateral malleolus nonunion. Researchers reviewed 12 cases of percutaneous lateral malleolus nonunion stabilization procedures between 2011 and 2017; all 12 fractures united. In one case, a superficial wound infection occurred and was treated with antibiotics. In another, a drill-piece fracture required conversion to an open procedure using plate stabilization. Based on their analysis, the researchers concluded that percutaneous stabilization is a safe and effective technique for treating nonunion of lateral malleolus fractures.

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Academy approves guidelines for SSIs and imaging before referral to an oncologist

The Academy’s Board of Directors has approved two systematic literature reviews (SLRs): Management of Surgical Site Infections (SSIs) and Use of Imaging Prior to Referral to a Musculoskeletal Oncologist. The latter SLR was a product of the Musculoskeletal Tumor Society and was developed through the Academy’s Clinical Practice Guideline (CPG) process by the AAOS Evidence-Based Quality and Value Unit, with funding provided by both organizations. AAOS endorsement allows the SLR to be listed on the OrthoGuidelines web platform and mobile app. An SLR is equivalent in format to a CPG but with a narrower focus and a smaller set of questions deliberated by the work group.

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Final call: Apply for Resident Bowl Question Workgroup member position

The Resident Bowl Question Workgroup has an open member position, a five-month term that runs from Oct. 1 to March 8, 2019. Members of this work group will develop questions and answers for the Resident Bowl, an event that enables residents to compete against one another in a quiz-bowl setting for a chance to win grand and runner-up prizes. The last day to submit an application is Sept. 15.

Learn more and submit your application…(member login required)