Today’s Top Story
Study: Reducing opioid intake may not affect satisfaction or disability for ankle fracture patients treated with ORIF.
Findings published in the July issue of The Journal of the AAOS suggest that many ankle fracture patients may experience no significant loss in satisfaction if they are prescribed fewer opioids. The authors conducted a prospective study of 59 patients with ankle fracture treated with open reduction and internal fixation (ORIF). At suture removal and 5- to 8-month follow-up, they found no association between opioid intake and disability, satisfaction with treatment, or satisfaction with pain management. The authors note that the factors most consistently associated with disability, treatment satisfaction, satisfaction with pain management, pain at rest, and pain with activity at both time points were the psychologic measures of pain anxiety and catastrophic thinking. Read more…
Read the abstract…
     A report from the U.S. Centers for Disease Control and Prevention notes that opioid prescribing in the United States peaked in 2010 and then decreased each year through 2015, yet remains at high levels and varies from county to county. Read more…

Other News

Study: Delay of femoral shaft fracture fixation linked to longer hospital length of stay and increased risk of PE.
A study published online in the journal PLoS Medicine examines trends in the timing of femoral shaft fracture fixation following major trauma. The researchers conducted a retrospective, cohort study of 17,993 patients who underwent definitive fixation across 216 trauma centers. They found that the median time to fixation was 15 hours, with delayed fixation (≥24 hours) performed in 26 percent of patients. After adjustment, the researchers identified 57 hospitals (26 percent) as outliers, reflecting significant practice variation unexplained by patient case mix. Compared to hospitals in the lowest quartile of delayed fixation, patients treated at hospitals in the highest quartile experienced 2-fold higher rates of pulmonary embolism (PE) and required longer length of stay but saw no significant difference with respect to mortality. The researchers write that “trauma centers should strive to minimize delays in fixation, and quality improvement initiatives should emphasize this recommendation in best practice guidelines.” Read the abstract…

Study finds weak correlation between shoulder comfort and function and rotator cuff tear integrity.
According to a study published online in the Journal of Shoulder and Elbow Surgery, self-assessed shoulder comfort and function and active motion may not closely correlate to surgically documented rotator cuff tear integrity The research team reviewed data on 55 shoulders treated surgically for cuff-related symptoms, and compared preoperative Simple Shoulder Test score with objectively measured preoperative active shoulder motion and cuff integrity as observed at surgery. They found that surgically observed cuff integrity was not strongly associated with the shoulder comfort or function. The researchers believe that a better understanding of factors other than cuff integrity that may influence comfort and function for shoulders with cuff disease is needed to manage patients with rotator cuff disorders. Read the abstract…

Study: Socioeconomic deprivation and childhood obesity associated with increased likelihood of SCFE for younger patients.
Data from a study conducted in the United Kingdom and published online in the journal Archives of Disease in Childhood suggest that socioeconomic deprivation and childhood obesity may be associated with increased risk of slipped capital femoral epiphysis (SCFE) among pediatric individuals. The authors conducted a historic, cohort study of all patients younger than 16 years of age who had a diagnosis of SCFE and whose electronic medical record was held by one of 650 primary care practices in the U.K. between 1990 and 2013. They found that over the term of the study, SCFE incidence remained constant at 4.8 cases per 100,000 patients. They noted a strong association of SCFE with area-level socioeconomic deprivation and predisease obesity. Read more…
Read the complete study…

Endo Pharmaceuticals to stop marketing Opana ER pain medication.
Endo Pharmaceuticals has agreed to remove reformulated Opana ER (oxymorphone hydrochloride) from the market due to public health consequences of abuse. Opana ER was first approved in 2006 for management of moderate-to-severe pain when a continuous, around-the-clock opioid analgesic is needed for an extended period of time. In 2012, the manufacturer reformulated the drug to make it resistant to physical and chemical manipulation for abuse by snorting or injecting. After a review of postmarketing data, the U.S. Food and Drug Administration noted a significant shift in the route of abuse of Opana ER from nasal to injection following the product’s reformulation. Read more…
Read the original U.S. Food and Drug Administration announcement…

Wisconsin.
The Associated Press reports that a Wisconsin appeals court has overturned the state’s medical liability cap on the grounds that it is unconstitutional. The court concluded that the state’s cap on noneconomic medical liability damages negatively affected the most severely injured plaintiffs while allowing full damages to less severely injured patients, and therefore denied equal protection to all. Read more…
Read the decision (PDF)…

Call for volunteers: Tumor AUC voting panel.
The Musculoskeletal Tumor Society (MSTS) seeks AAOS and/or MSTS fellows to participate on the voting panel for the Surveillance of Local Recurrence and Distant Metastasis after Surgical Treatment of Bone and Soft Tissue Sarcomas Appropriate Use Criteria (AUC)—a project led by MSTS with the AAOS Evidence-based Medicine Unit. The voting panel will participate in two rounds of voting, during which they will rate the appropriateness of various imaging modalities for the given patient populations. Voting panel members will be required to complete the online AAOS conflict of interest enhanced disclosure form and attend a 1-day, in-person meeting in Rosemont, Ill. If you are interested in participating on the voting panel for this AUC topic, please email Mary DeMars by Monday, July 31 at: demars@aaos.org.

Call for volunteers: Education Assessments and Examinations Committee.
Aug. 1 is the last day to submit your application for a position on the Education Assessments and Examinations Committee (formerly the Central Evaluation Committee). Members of this committee write questions for the Orthopaedic In-Training Examination (OITE). The following positions are available, one opening each:

  • Pediatric Orthopaedics
  • Shoulder and Elbow
  • Sports Medicine

Applicants for these positions must have a practice emphasis in the relevant area. Learn more and submit your application…(member login required)