March 4, 2020 | Today’s News

Study: Relationship between Narcotic Use and Compartment Syndrome Treatment

A retrospective study published in the March issue of the Journal of Orthopaedic Trauma did not observe any correlation between preinjury opioid use and fasciotomy after lower-extremity trauma. Between 2011 and 2016, 245 consecutive patients were treated with fasciotomy for compartment syndrome of the lower extremity; 115 patients were excluded. A total of 390 age- and sex-matched controls with tibial fractures who did not require fasciotomy were also included. Chronic opioid use did not largely differ between patients who did and did not require fasciotomy. Average daily morphine milligram equivalents (MMEs) consumed did not largely differ, nor did active opioid use. Average MMEs per day did not differ among active narcotic users.

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Study Evaluates Lesser Tuberosity Osteotomy Outcomes in Total Shoulder Arthroplasty Patients

According to a retrospective study published in the February issue of the Journal of the AAOS: Global Research & Reviews ®, lesser tuberosity osteotomy (LTO) use in total shoulder arthroplasty (TSA) presents a risk of nonunion and displacement but is overall associated with high clinical and radiographic outcomes. Primary TSA patients who underwent LTO and had three-month postoperative radiographs were eligible for inclusion. Radiographs were reviewed to stratify LTO healing into one of three groups: healed, nondisplaced nonunion, or displaced nonunion. One-year postoperative outcomes included American Shoulder and Elbow Score (ASES), Single Assessment Numeric Evaluation (SANE) scores, and the Veterans Rand 12-Item (VR-12) mental and physical component scores. Final analysis included 142 shoulders (n = 130 patients). At a median one year postoperatively, 87 percent of patients had healed LTO, 8 percent had nondisplaced nonunions, and 5 percent had displaced nonunions. Median ASES outcomes were 89.2 in the healed LTO group and 96.7 in the LTO nondisplaced nonunion group; median VR-12 mental health component scores were 55.1 and 54.6, respectively; and median SANE scores were 85.0 and 75.1, respectively. Revision rates addressing subscapularis instability did not largely differ between the groups.

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A study published online in the Journal of Pediatric Orthopaedics detailed a technique for the management of neglected traumatic hip dislocation in children. Seven children presented at a single institution with posterior dislocations and no prior treatment; two cases also presented an associated marginal acetabular fracture. One patient with complete articular cartilage loss precluding open reduction was not included in the trial. Mean patient age was seven years, and the mean time to surgical intervention was 13.1 months. Preoperative skeletal traction was performed in all patients for 10 to 14 days; all cases received a posterolateral approach. Scar tissue was removed from the acetabulum; five cases necessitated a femoral shortening. Three cases presented minor erosion of the articular cartilage of the posterior aspect of the femoral head. Patients received a posterior capsulorrhaphy after reduction and were then immobilized for six to 12 weeks using a hip spica. At a mean follow-up of 44 months, 86 percent of patients were able to walk and run without a limp, could squat, and did not have pain. Mild pain and a limp were observed in one child. The mean Harris Hip Score was 98.9. No patients presented postoperative subluxed or dislocated hips. Per final follow-up radiographs, no evidence of growth disturbance was shown in 29 percent of cases, coxa magna in 57 percent, and partial femoral head collapse in one case.

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A retrospective study published online in JAMA Surgery analyzed the health and cost benefits of combination surgical jacket and bouffant use in the operating room and whether this practice reduces surgical site infection (SSI) risk. A total of 34,042 inpatient surgical encounters at a single academic tertiary care hospital were examined. Comparisons were made for three time periods between January 2017 and October 2018 following the implementation of surgical jackets and later of surgical jackets plus bouffant head covers. There were no significant differences among the three groups in the risk of SSI, mortality, postoperative sepsis, or wound dehiscence. The estimated annual cost of surgical jackets exceeded $300,000.

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Mallinckrodt reached a $1.6 billion settlement with attorneys general from 47 states and U.S. territories. The money from the settlement, if finalized, would be paid out over an eight-year period. According to California Attorney General Xavier Becerra, Mallinckrodt is the nation’s largest manufacturer of generic opioids.

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University of Pennsylvania Leads Collaboration to Create a Sustainable Solution for Orthopaedics in Sub-Saharan Africa

There has been growing interest from surgeons in wealthy nations to assist colleagues in low- and middle-income countries across all surgical subspecialties. Unfortunately, compared to other specialties, orthopaedic surgery is resource-intensive, requiring expensive implants, cumbersome equipment, and a great deal of instrumentation; most orthopaedic procedures cannot be performed effectively with just a scalpel and sutures. The University of Pennsylvania forged a relationship with the Department of Orthopaedics at Kilimanjaro Christian Medical Centre and proposed a solution to this problem.

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Personalize your OVT Member Profile

Take five minutes to update your member profile on the newly expanded Orthopaedic Video Theater (OVT). Click on the person icon in the top right corner of the OVT landing page, select “My Profile,” and choose the specialty topics of most interest to you. You can also update your contact information and add an image and brief biography. By keeping your profile current, you get a much more personalized learning experience that addresses your needs, interests, and preferences.

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