Today’s Top Story
AAOS Board approves new AUC, adopts companion consensus statements to CPG on management of ACL injuries.
The AAOS Board of Directors has approved a new Appropriate Use Criteria (AUC) on the Management of Pediatric Supracondylar Humerus Fractures with Vascular Injury. The AUC is a supplemental document to the AUC for the Management of Pediatric Supracondylar Humerus Fractures published in 2014 that provides further detail on patients with suspected vascular injury. The Board also approved a reissue of the CPG on the Treatment of Pediatric Diaphyseal Femur Fractures, and adopted companion consensus statements to the CPG on the management of anterior cruciate ligament injuries. The companion consensus statements were developed by panels nominated by the National Athletic Trainer’s Association (NATA), the American Orthopaedic Society for Sports Medicine (AOSSM), and the American Physical Therapy Association (APTA); each of the statements have been approved by their respective developing organizations. The four statements cover the following treatment recommendations on topics initially proposed as part of the CPG, but for which no evidence could be found:

Statement #1: In the absence of reliable evidence, NATA recommends that people who sustain an acute traumatic knee joint injury with symptoms (e.g., feel or hear a pop, experience a giving way episode, pain, swelling or difficulty weight bearing) receive a physical examination by a qualified health care professional that assesses the structural integrity of the knee joint capsule, ligaments and menisci, and includes a neurovascular exam as soon as possible following injury. Immediate treatment with ice, compression, elevation, immobilization, and crutches is also indicated and patients should be referred for further musculoskeletal evaluation, unless signs and symptoms indicate that an emergent condition is present (e.g. neurovascular, gross deformity, uncontrollable pain).

Statement #2: In the absence of reliable evidence, NATA recommends that following an acute traumatic knee joint injury, patients with an abnormal neurovascular finding on physical exam, gross deformity, or severe and uncontrollable pain should receive emergent care to include immobilization and ongoing serial assessments of neurovascular function during transport to an emergency medical facility.

Statement #3: In the absence of reliable evidence, AOSSM recommends that physicians consider aspirating painful, tense effusions after knee injury.

Statement #4: In the absence of reliable evidence, it is the recommendation of APTA that a patient with an ACL tear who is not having ACL reconstruction undergo rehabilitation with goals of (1) full and pain-free knee joint ROM is restored (equal to that of the contralateral limb), (2) thigh muscle strength and single-hop test indices are at least 90 percent (ratio of involved to uninvolved limb performance), and (3) self-reported knee function on reliable, valid, and responsive questionnaires is at least 90 percent. Read the AUC…
View all AAOS CPGs and AUCs…

Other News

Study: Increased quality linked to decrease in medical liability claims.
Data published in the May/June issue of the American Journal of Medical Quality suggest that increased quality improvement measures may be associated with a decrease in frequency of medical liability claims. The research team compared two groups of hospitals within the same multihospital organization: one in Texas, which in 2003 implemented medical liability caps on noneconomic damages, and one in Louisiana, which did not undergo significant tort reform. They found that tort reform in Texas was linked to a significant reduction in the number of medical liability claims per quarter. However, in Louisiana, the researchers noted a significant correlation between increase in mean U.S. Centers for Medicare & Medicaid Services performance score and decrease in claim frequency. Read more…
Read the abstract…

Study: Ceramic bearing surfaces linked to reduced risk of dislocation after revision THA, compared to polyethylene.
According to a study published online in the journal Clinical Orthopaedics and Related Research, compared to polyethylene, ceramic bearing surfaces may be associated with reduced risk of dislocation after revision total hip arthroplasty (THA). The researchers retrospectively evaluated 240 patients (240 hips) who underwent THA revision surgery and who had normal contralateral hips. With the exception of bearing surface (80 ceramic-on-ceramic, 160 polyethylene), all patients had received the same implants for the primary arthroplasty. The researchers found that the use of polyethylene liners at the time of index arthroplasty was linked to significantly increased risk of dislocation after revision compared to ceramic liners. In addition, the researchers noted that, for ceramic-on-ceramic hips, no osteolysis was detected before revision, but 100 percent of polyethylene hips were observed to have osteolytic lesions on the acetabulum and femur. Read the abstract…

Study: Teenage boys who spend more time in front of the computer may be at risk for lower BMD.
Findings from a Norwegian study published online in the journal BMJ Open suggest teenage boys who spend time on screen-based sedentary activity may have reduced bone mineral density (BMD) compared to those who are more active. The authors reviewed data on 1,038 students aged 15 to 18 years who participated in the Tromsø Study. They found that increased screen time was positively related to body mass index (BMI) in boys, screen time was adversely associated with BMD at all sites (total hip, femoral neck, and total body), and the associations remained robust after adjustment for age, puberty, height, BMI, physical activity, vitamin D levels, smoking, alcohol, calcium, and carbonated drink consumption (p<0.05). In contrast, girls who spent increased time in front of the computer tended toward increased BMD.> Read more…
Read the complete study…

Report: Many hospitals fall short in hand washing practices.
A report from nonprofit The Leapfrog Group finds that as many as 23 percent of hospitals surveyed may fall short in encouraging proper hand hygiene. Findings from the report include the following:

  • The percentage of hospitals that met all 10 of Leapfrog’s hand-hygiene practices increased from 69 percent in 2013 to 77 percent in 2014.
  • Urban hospitals outperform rural hospitals, with about 20 percent more urban hospitals meeting Leapfrog’s standard and displaying increased year-over-year improvement in meeting the standard.
  • There is significant geographic variation in adoption of hand-hygiene safe practices: in five states, more than 90 percent of reporting hospitals met all practices, while in six states, only 60 percent or less of reporting hospitals met all practices.

Read more…
Read the complete report (PDF)…

Deadline approaching for grants under BOS Quality and Patient Safety Action Fund.
July 1 is the last day for applicants to apply for matching funds under the Board of Specialty Societies (BOS) Quality and Patient Safety Action Fund. Projects that meet prescribed criteria are eligible for AAOS matching funds up to $50,000. To be eligible for funds, projects must meet the following criteria:

  • Applicants must be BOS member organizations in good standing.
  • Proposed projects should be limited to quality and patient safety initiatives and related advocacy, such as performance measures, patient safety checklists, appropriate use criteria, clinical practice guidelines, and any derivatives.
  • Suggested projects must fit within AAOS quality and patient safety goals.
  • Applicants must provide matching funds to support the project.
  • If awarded financial support, the applicant must provide written progress reports, at least quarterly, and a final report upon conclusion of the project.

Read more…
     For additional information or to submit your application, please contact Paul Zemaitis, at 847-384-4315, or via email at

Reminder: Submit your OKU11 SAE answer file by June 30 to be included in the next quarterly scoring.
Submit your answers to AAOS for confidential scoring after completing the continuing medical education (CME) evaluation form. Your 20 scored and recorded CME credits will be posted to your transcript.

Call for volunteers: Central Evaluation Committee.
July 15 is the last day to submit your application for a position on the Central Evaluation Committee. Members of this committee write questions for the Orthopaedic In-Training Examination. Currently, two openings are available:

  • Hand (one member opening)
  • Spine (one member opening)

Applicants for these positions must be active or emeritus fellows with a practice emphasis in the relevant topic. Learn more and submit your application…(member login required)