February 28, 2020 | Today’s News

A retrospective study published online in the Journal of Shoulder and Elbow Surgery differentiated soft-tissue injury patterns of dislocation between posteromedial rotatory instability (PMRI) and simple posteromedial (PM) dislocation of the elbow joint. Patients with PMRI dislocation (n = 13) and simple PM dislocation (n = 10) underwent three-dimensional CT and MRI. Simple radiographs were used to stratify the dislocation direction into the pure-posterior or PM type. The following characteristics were identified: ulnar collateral ligament, lateral collateral ligament complex (LCLC), overlying extensor muscle, and locus of bone contusion. Both groups had completely ruptured LCLC. A greater proportion of patients in the simple PM dislocation group had a completely torn ulnar collateral ligament compared to the PMRI dislocation group (90 percent versus 23 percent). When assessing injury patterns of the LCLC and overlying extensor muscle, in the PMRI dislocation group, 10 patients (77 percent) presented the distraction type, and three patients (23 percent) presented the stripping type; in the simple PM dislocation group, all patients had the distraction type. In the PMRI dislocation group, two patients (15 percent) presented bone contusion at the posterolateral olecranon. In the PMRI dislocation group, bone contusion was observed at the PM olecranon in four patients (40 percent). In the simple PM dislocation group, bone contusion was observed at the PM olecranon in four patients (40 percent) and one patient each at the posterolateral olecranon, posterior olecranon, and PM-posterolateral olecranon. Seven patients in the PMRI dislocation group had the PM type, and six had the pure-posterior type.

According to a study published in the February issue of The Journal of Arthroplasty, zip codes may not be an acceptable proxy for socioeconomic status within a single surgeon’s practice. The researchers used public zip code and Geographic Information Systems (GIS) tax map data to compare real estate holdings for 244 total joint arthroplasty patients. GIS data were compared against the average home value in a specific zip code. The mean home value determined through GIS data was $335,993 but using zip code data was $243,663. Home value would have been mischaracterized in 15 percent of patients if only zip code data were used.

A study published online in The Spine Journal compared trabecular bone mineral density (BMD) variations in the cervical spine and first thoracic vertebra in anterior cervical diskectomy and fusion (ACDF) patients. Researchers retrospectively reviewed ACDF patients treated at a single institution between 2015 and 2018 and who had available preoperative CT scans. Patients underwent asynchronous quantitative CT (QCT) measurements of the lateral masses of C1 and the C2-T1 vertebral bodies. A total of 194 eligible patients (mean age, 55.9 years; 62.9 percent were male) were included. The interclass correlation coefficients of cervical QCT measurements was 0.92. The mid-cervical spine (C4) presented the highest trabecular BMD, which decreased in the caudal direction. BMD was significantly lower in C7 and T1 compared to all other levels. BMD was significantly correlated with all measured levels.

A systematic review and meta-analysis published online in JAMA Internal Medicine compared the effectiveness of aspirin versus other anticoagulants in preventing postoperative venous thromboembolism (VTE) prophylaxis in total hip replacement (THR) and total knee replacement (TKR) patients. Randomized, controlled trials (RCTs) were identified through searches of the MEDLINE, Embase, Web of Science, and Cochrane Library databases, as well as bibliographic searches. Search terms were related to the population, drug intervention, and outcome. Final analysis included 13 RCTs encompassing 6,060 total patients (mean age, 63.0 years; 57.2 percent were female). The relative risk (RR) of postoperative VTE for aspirin, compared to other anticoagulants, was 1.12; results were similar for deep vein thrombosis (DVT) (RR = 1.04) and pulmonary embolism (PE) (RR = 1.01). The use of aspirin versus other anticoagulants did not largely impact adverse event risk. Separate analyses of THRs and TKRs did not yield significant differences in VTE, DVT, and PE risks between aspirin versus other anticoagulants. Evidence ranged from low to high quality. The study authors concluded that the effectiveness of aspirin was comparable to that of other anticoagulants and recommended that future studies include a noninferiority analysis of aspirin compared to alternative anticoagulants and cost-effectiveness. [This is an update to a previous summary included in Headline News Now. Thank you to David C. Ring, MD, PhD, for his feedback.]

According to a report from Coverys, 17 percent of surgery-related malpractice claims involve orthopaedic surgery—coming in just behind general surgery at 22 percent. In claims related to orthopaedic surgery, 85 percent allege issues with surgeon performance compared to an average of 78 percent across all surgical specialties.

The question, “Are you allergic to any medications?” is a critical component of triage and history of an orthopaedic surgery patient. Self-reported potential allergens and reactions are incorporated into decision-making for each patient’s care and treatment. For orthopaedic surgeons, potentially inaccurate listings can affect the quality and safety of patient care.

Consider applying for the following positions:

• Liaison Activities member position (Agency for Healthcare Research and Quality U.S. Preventative Service Task Force)—applications are accepted until March 2
• Social Media Ambassador Program chair position—applications are accepted until March 3
• Education Assessments and Examinations Committee member position (spine)—applications are accepted until April 15
• Education Assessments and Examinations Committee member position (sports medicine)—applications are accepted until April 15