AAOS Approves Updated Evidence-based CPG for the Management of Hip Fractures in Older Adults
The AAOS Board of Directors approved the update to the 2014 Management of Hip Fractures in the Elderly Clinical Practice Guideline (CPG). This CPG provided updates to more than 80 percent of the prior guideline’s recommendations, with four recommendations being upgraded from moderate to strong strength of evidence. Most notably, the recommendation on surgical timing was changed to favor surgery within 24 to 48 hours of admissions.
Study Measures Indicators of Strain in Surgeons via a Wearable Fitness Device
In a study, 21 orthopaedic surgeons (faculty, n = 9; residents, n = 12) wore wearable fitness devices and completed daily questionnaires over a 12-week period to assess strain and burnout. The Maslach Burnout Inventory questionnaire was performed at baseline. Residents demonstrated greater physiological strain (negatively trending heart rate variability) compared to faculty (33.3 percent versus 11.1 percent). Compared with baseline, heart rate variability tended to improve in the day following time in the OR and the day after greater device-reported sleep. This study was published in the Dec. 15 issue of the Journal of the AAOS ®.
Study Reports >90 Percent Survivorship at 10 Years after Arthroscopy for FAI
A study of 119 patients, published online in American Journal of Sports Medicine, reported a 91% survivorship rate and 90% patient satisfaction rate at 10-year follow-up in patients who underwent arthroscopic correction of symptomatic femoroacetabular impingement (FAI). Patients achieved significant improvements in modified Harris Hip Scores, the 36-Item Short Form Health Survey, and Western Ontario and McMaster Universities Osteoarthritis Index scores at long-term follow-up. No significant changes were reported in UCLA Activity Scale scores.
Study: Bleeding Disorders Are Associated with Complications in Ankle Fracture Surgery
Bleeding disorders may be a risk factor for complications after ORIF (open reduction and internal fixation) for ankle fractures, according to a retrospective study published online in Foot & Ankle International. The National Surgical Quality Improvement Program database (2006–2018) was queried and 10,306 patients undergoing ankle fracture surgery were identified, including 3.9 percent (n = 397) with a bleeding disorder. The investigators found a significant association between presence of a bleeding disorder and increased risk of postoperative complications, postoperative blood transfusion, and length of stay >5 days.
Study: Concomitant Injuries Associated with Traumatic Spinal Fractures
A retrospective study published online in Injury identified concomitant injuries associated with spine level fractures in patients with polytrauma. The American College of Surgeons registry was reviewed and 3,399 spine fracture patients were assessed. Concomitant injuries associated with cervical spine fractures were head trauma/bleeding, facial/skull fractures, cervical cord injuries, and falls of ≤6 meters. Thoracic spine fractures were associated with rib fractures, and lumbar fractures were linked to rib and pelvis/lower extremity fractures, thoracic/retroperitoneal visceral injuries, and falls of >6 meters.
Advocacy 101: The U.S. Supreme Court Can Influence the Healthcare System
In the latest part of this yearlong series dedicated to introducing advocacy and explaining key concepts to AAOS members, Douglas W. Lundy, MD, MBA, FAAOS, describes five Supreme Court cases that have impacted how physicians practice medicine. With a few exceptions, “many of us cannot name a judicial case where the Supreme Court had any significant impact on the practice of medicine,” writes Dr. Lundy. However, decisions made at the highest court may impact how orthopaedic surgeons practice.
AAOS is seeking volunteers to review their Clinical Practice Guideline on the Management of Anterior Cruciate Ligament Injuries. Applications will be reviewed and approved on a first come, first served basis.
