Today’s Top Story

Study: Maternal Smoking Increases One-year Fracture Risk in Offspring

Women who smoke during pregnancy may increase the chance of fracture incidence during the first year of their offspring’s life, according to a study published online in The BMJ. The study included 1,680,307 patients born to mothers who did (n = 377,367, 22.5 percent) or did not (n = 1,302,940) smoke in early pregnancy. Median follow-up was 21.1 years, during which time 377,970 fractures were recorded. The correlation between prenatal smoking and fracture risk in offspring varied by attained age. Overall, women who smoked during pregnancy were more likely to have offspring who sustained fracture before age one. An increase in the number of daily cigarettes smoked correlated with an increase in fracture risk during the first year of life. Throughout the whole cohort, smoking was associated with an increased incidence of fracture from ages five to 32 years, but the trend of increased number of cigarettes smoked and increased fracture risk was not observed.

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In Other News

Study Measures Effect of ACL Reconstruction History on MLB Draft

According to a cohort study published online in The American Journal of Sports Medicine, prospective Major League Baseball (MLB) draftees with a history of anterior cruciate ligament (ACL) reconstruction are not less likely to be drafted from the minor leagues to the major leagues. MLB predraft medical records spanning 2004 through 2008 were obtained to identify players with a documented ACL injury who underwent reconstruction prior to the draft. Each ACL reconstruction patient was matched to three control players. Data from the time of the draft through the 2015 season were assessed. Outcomes included highest professional level of advancement, disabled list (DL) time, and batting and pitching performance Among the 40 ACL reconstruction draftees, 22 were pitchers and 18 were position players; draftees were matched to 120 controls (66 pitchers, 54 position players). The groups did not largely differ in highest level of professional advancement or mean total number of times and days on the DL, although the ACL reconstruction group had a significantly greater mean number of times and days on the DL because of a knee injury. Pitchers’ performances and position players’ batting performances did not significantly differ between the groups.

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Study: X-ray versus CT Scan to Diagnose Wrist Injury

A study published online in Injury compared the diagnostic accuracy of X-ray versus CT scan in patients presenting to the emergency department (ED) with wrist injuries. Between Jan. 1, 2017, and Jan. 1, 2018, 274 patients with trauma-related wrist injuries were admitted to the ED and underwent X-ray and CT scan. An orthopaedics and traumatology specialist evaluated the X-ray images. Calculations were performed to determine the sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and Kappa (κ) coefficient of X-ray according to CT. The use of X-ray identified fractures in 180 patients (66 percent) compared to 196 patients (72 percent) with CT scan. The following X-ray values, compared to CT, were calculated: Sn, 89 percent; Sp, 92 percent; PPV, 97 percent; NPV, 77 percent; and κ coefficient, 0.764. X-ray sensitivity compared to CT was highest in detecting radius (Sn, 95 percent; κ coefficient, 0.896) and fifth metacarpal (Sn, 77 percent; κ coefficient, 0.859) fractures; X-ray sensitivity was lowest in detecting scaphoid, capitate, pisiform, trapezium hamate, and triquetrum fractures.

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Study Examines Use of Hoffer Technique for Brachial Plexus Birth Palsy

According to a retrospective study published in the February issue of The Bone & Joint Journal, the Hoffer procedure significantly improved functional outcomes in brachial plexus birth palsy (BPBP) patients. Outcomes including active shoulder range of movement (ROM), aggregate modified Mallet classification scores, Hospital for Sick Children Active Movement Scale (AMS) scores, and/or Toronto Test Scores were evaluated in BPBP patients who received the Hoffer technique and had at least two years of follow-up. The whole cohort presented significantly improved functional outcomes and active shoulder abduction and external rotation ROM. Patients aged younger than 2.5 years, compared to older patients, had higher postoperative AMS, abduction ROM and strength scores, and aggregate postoperative Toronto Test Scores. Humeral derotational osteotomy was subsequently performed in 17 patients (16 percent); risk factors included lower preoperative AMS external rotation scores and external rotation ROM.

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House Committee Releases New Surprise Medical Billing Legislation

Late last week, the House Ways & Means Committee issued bipartisan legislation tackling surprise medical billing. The proposal, which is scheduled for markup on Feb. 12, would eliminate balance billing for emergent procedures. Conflicts would be resolved with an independent mediation process. AAOS is reviewing the proposal and continues to advocate for a fair, accessible Independent Dispute Resolution process for resolving payment disputes.

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How Does Your Revenue Cycle Stack Up Against Your Peers?

Each year, KarenZupko & Associates, Inc., (KZA) sends a precourse survey to those who have registered for the KZA/AAOS coding and reimbursement workshops. The results provide insights on a variety of coding, documentation, and revenue-cycle processes and trends. In 2019, KZA received 178 completed surveys. This article summarizes three revenue cycle data points from the 2019 survey results and provides commentary and guidance from two revenue-cycle experts.

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AAOS Practice Management Resources

The Academy’s numerous free practice management resources provide knowledge, education, clinical tools, and professional support that help you meet the challenges of your chosen specialty and build mastery throughout your career. Access white papers, the Practice Management Advice Center, webinar recordings, and learn about topics such as Medicare Access and CHIP Reauthorization Act delivery reform and the Quality Payment Program.

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