March 9, 2020 | Today’s News

Study Evaluates Combination Fascia Iliaca Compartment Block and Dexmedetomidine in Older THA Patients

A randomized, controlled trial (RCT) published online in the Journal of Orthopaedic Surgery and Research assessed the efficacy of fascia iliaca compartment block (FICB) combined with dexmedetomidine (DEX) for pain and inflammation control in total hip arthroplasty (THA) patients aged 60 years or older. Between March 2016 and December 2018, 119 patients underwent THA at a single institution. Patients were stratified into three groups: routine general anesthesia (control group); additional FICB postoperatively (FICB group); and preoperative DEX and postoperative FICB (combined group). Visual analog scale (VAS) scores were recorded at 12, 24, 48, and 72 hours postoperatively. Within 48 hours postoperatively, the patient-controlled intravenous analgesia (PCIA) pressing time was documented. Sleep quality was assessed using the Pittsburgh sleep quality index (PSQI) preoperatively and at one month postoperatively. The combined group, compared to the control and FICB groups, had significantly lower VAS scores at all measured time points. The FICB group, compared to controls, had significantly lower VAS scores at all time points. The combined group also had significantly lower PCIA pressing times and higher PSQI scores.

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Study Assesses Impact of IBD on Vertebral Fractures

According to a study published in the March 1 issue of the Journal of the AAOS ®, patients older than 60 years with inflammatory bowel disease (IBD) were not at a greater risk for vertebral fractures. CT scans for nonspinal conditions were examined for 55 IBD patients and 165 non-IBD controls to identify vertebral compression fractures (VCFs). Associations between age, sex, diagnosis of IBD, treatment, and time since diagnosis and VCFs were examined. Overall mean patient age was 72.5 years, and 75.0 percent were female. At least one VCF presented in 35 patients (16 percent): 16.4 percent in the IBD group and 15.8 percent in the control group. Fracture severity was similar between the groups. Older age was associated with VCFs.

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An RCT published in the February issue of the Journal of Bone and Joint Surgery compared subscapularis tenotomy versus peel in anatomic shoulder arthroplasty. A total of 100 patients were randomized to either subscapularis tenotomy (n = 47) or peel (n = 53). The primary outcome measure was internal rotation strength in the belly-press position at 24 months postoperatively. Other outcomes included Western Ontario Osteoarthritis of the Shoulder (WOOS) index score, American Shoulder and Elbow Surgeons (ASES) score, range of motion, radiographic lucencies, and adverse events. After 24 months, 81 percent of the cohort was available for follow-up. Both groups presented significant improvements in mean internal rotation strength, as well as in WOOS and ASES scores. No significant between-group differences were observed in internal rotation strength at 24 months.

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A retrospective study published online in The Journal of Hand Surgery assessed the risk of infection in trigger finger release surgery patients who received corticosteroid injection. Over a two-year period, 16 surgeons performed trigger release surgery in 2,480 fingers (n = 1,857 patients). Of the 1,343 fingers that received a corticosteroid injection before surgery, there were 11 deep (0.8 percent) and 24 superficial (1.8 percent) infections. Overall, 1,137 fingers did not receive corticosteroid injection; in this group, one deep (0.1 percent) and 17 superficial (1.5 percent) infections were observed. Fingers that developed a deep infection, compared to those with no infection, had a shorter median time from corticosteroid injection to trigger release surgery (63 days versus 183 days). Patients who underwent surgery within 90 days of an injection were more likely to sustain a deep infection than patients treated more than 90 days after an injection (eight infections in 395 fingers versus three infections in 948 fingers).

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A study published in the March/April issue of Current Orthopaedic Practice examined vitamin D insufficiency in pediatric orthopaedic patients versus typical children and adolescents to determine which patients are most at risk and should be screened. The study included 138 patients and 30 typical children aged two to 17 years; because no differences were observed on statistical analysis, the groups were analyzed together. The mean age was 11.9 years, and the mean vitamin D level was 26.5 ng/mL. Vitamin D deficiency was defined as < 20 ng/mL (n = 33), and insufficient was defined as 21–29 ng/mL (n = 84); 71 percent of patients were deficient or insufficient. Younger age was correlated with sufficient vitamin D levels. Factors negatively associated with vitamin D status were ethnic minority, higher body mass index, no insurance or Medicaid insurance, and less than 20 minutes a day of outside play time.

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Changing Our Paradigm to Fit the Ultimate Game

This first article in a two-part series on changing practice behaviors to benefit the good of the group discusses the book titled “Finite versus Infinite Game” and provides recommendations for leaders who wish to adopt an “infinite” mindset.

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Free Surgical Risk Reduction Toolkit

The best way to improve patient outcomes and help patients have a successful recovery from surgery is to avoid the complications that may lead to increased length of stay, hospital readmission, and multiple operations. Get equipped with quick reference strategies to mitigate preoperative, intraoperative, and postoperative risk factors that may contribute to surgical complications with the free Surgical Risk Reduction Toolkit.

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