Today’s Top Story
Study examines patterns among pediatric patients with gunshot injuries.
A study published in the January issue of the Journal of Pediatric Orthopaedics looks at fractures in pediatric gunshot victims. The research team reviewed records of 49 pediatric patients (58 fractures) treated for a gunshot-associated fracture at one of two level 1 pediatric trauma centers. They found that the tibia and femur were the most common sites of fracture (19 percent each), followed by the small bones of the foot (4 percent) and the fibula (4 percent). The research team noted that 71 percent of fractures were treated nonsurgically, while 35 percent of patients had fractures or complications requiring additional surgical procedures. Overall, 47 percent of patients had additional injuries, including abdominal or genitourinary injuries, neuropraxia or nerve injuries, and vascular injuries. Two patients developed infections (1 superficial and 1 deep) requiring multiple irrigation and debridement procedures, while three patients developed compartment syndrome, and four had vascular injuries that required repair. Read the abstract…

Other News

CDC releases draft guideline on prescribing opioids for chronic pain.
The U.S. Centers for Disease Control and Prevention (CDC) is accepting public comment on the draft “CDC Guideline for Prescribing Opioids for Chronic Pain.” Recommendations in the guideline include but are not limited to:

  • Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain. Providers should only consider adding opioid therapy if expected benefits for both pain and function are anticipated to outweigh risks to the patient.
  • Before starting and periodically during opioid therapy, providers should discuss with patients known risks and realistic benefits of opioid therapy and patient and provider responsibilities for managing therapy.
  • Providers should review the patient’s history of controlled substance prescriptions using state prescription drug monitoring program (PDMP) data to determine whether the patient is receiving high opioid dosages or dangerous combinations that put him or her at high risk for overdose.
  • When prescribing opioids for chronic pain, providers should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs.

CDC will accept written comments on the guideline until Jan. 13, 2016. Read the notice in the Federal Register…
Read the complete guideline…

Study: Open surgical management of pediatric patients with severely displaced radial neck fracture linked to less favorable outcomes.
According to a study published in the January issue of the Journal of Pediatric Orthopaedics, older children are more likely than younger children to have more severely displaced radial neck fractures that require open surgical management, placing them at greater risk of fair or poor outcomes. The authors evaluated data on 193 consecutive children with a radial neck fracture who were seen at a single level 1 trauma center and who had satisfactory initial treatment data and follow-up range-of-motion (ROM) data. Patients treated nonsurgically were of a younger average age than those in the surgical group. Overall, 13 percent of patients required surgical treatment (average age 9.1 years). Those who required open management were an average of 10 years old and had a significantly greater risk of a fair or poor ROM outcome than those treated with closed techniques. Patients treated surgically were more likely to experience complications, but the authors found that presence of a complication was not predictive of fair or poor outcomes in either the surgical or nonsurgical groups. Read the abstract…

Study: Family practice providers write greatest number of opioid prescriptions overall.
A study published online in the journal JAMA Internal Medicine examines opioid prescribing patterns by specialty and finds that family practice providers as a group write the greatest number of opioid prescriptions, although interventional pain management specialists write the most prescriptions per provider. The researchers reviewed individual prescriber data from the 2013 Medicare Part D claims data set. They found that orthopaedists as a group ranked fifth in overall opioid prescribing. Based on claims per prescriber type, orthopaedists wrote an average of 134.2 prescriptions, compared to 161.1 for family practice physicians and 1,124.9 for interventional pain management providers. Based on the data, “efforts to curtail national opioid overprescribing must address a broad swath of prescribers to be effective,” the researchers write. Read more…
Read the complete study…

Congress considering proposals to allow ASCs to qualify for EHR incentive programs.
Modern Healthcare reports that a pair of bills under consideration in the U.S. Congress would, if enacted, allow physicians who work in ambulatory surgery centers (ASCs) to participate in federal electronic health records (EHR) incentive payment programs. The writer notes that ASCs are currently excluded from qualification for EHR incentive payments, with the effect that many EHRs used in ASCs have not been tested and certified for use in the program. Read more…(registration may be required)
Read the House version of the bill…

Study: Industry funding of medical trials has increased as government funding has fallen off.
Data published in a research letter in the Dec. 14 issue of The Journal of the American Medical Association suggest a continuing decrease in newly registered trials funded by the National Institutes of Health (NIH) coupled with an increase in the number of trials funded by industry. The research team reviewed information from ClinicalTrials.gov and found that, based on “first received” date, the number of newly registered trials increased from 9,321 in 2006 to 18,400 in 2014. From 2006 to 2014, the number of industry-funded trials increased by 1,965 (43 percent) while the number of NIH-funded trials decreased by 328 (24 percent). During the same period, the research team states that funding from the “all others” category increased by 7,357 (227 percent). In a random sample of 500 trials in the “all others” category, 71 percent (n = 353) were funded from outside the United States. Read more…
Read the complete research letter…

Study: Lower vitamin D levels may increase risk of stress fracture.
Data published online in The Journal of Foot & Ankle Surgery suggest that reduced levels of vitamin D may be associated with an increased risk of stress fracture for active individuals. The researchers conducted a retrospective, cohort study of 53 patients who had vitamin D levels measured within 3 months of a confirmed diagnosis of stress fracture. They found that 83 percent (n = 44) had a serum 25-hydroxyvitamin D level of less than 40 ng/mL. Based on standards recommended by the Vitamin D Council, the researchers note that more than 80 percent of the patients would be classified as having insufficient or deficient vitamin D levels. Based on standards set by the Endocrine Society, more than 50 percent had insufficient levels. Read more…
Read the abstract…

Call for volunteers: Exhibits Committee.
Jan. 2, 2016 is the last day to submit your application for the position of chair designee on the Exhibits Committee. This committee plans and oversees technical and specialty exhibits for the AAOS Annual Meeting. Applicants for this position must be active fellows with an understanding of Academy priorities and standards, and challenges and opportunities related to the exhibits program. Learn more and submit your application…(member login required)