Study: SSI Risk Factors in Tibial Plateau Fractures
A retrospective study published online in the Journal of Orthopaedic Trauma identified risk factors for surgical site infection (SSI) in patients with operatively treated tibial plateau fractures (TPFs). Of 2,106 patients with TPFs treated at seven level 1 trauma centers, 94 had deep SSIs; the average SSI rate was 4.5 percent. Type B and C injuries were observed in 57.5 percent and 42.5 percent of patients, respectively. Factors significantly associated with SSI risk were number of comorbidities (> 6 versus 0), diabetes, high BMI, AO fracture type C, and open fracture. More than half of the pathogens (55.1 percent) were resistant to perioperative antibiotic prophylaxis.
Study Identifies Foot and Ankle Insufficiency Fracture Risk Factors in Sedentary Women
A study published online in Foot & Ankle International evaluated factors that may increase the risk of foot and ankle insufficiency fractures in sedentary postmenopausal women. Data collection included fracture site, BMI, corticosteroid use, T scores of the femur and lumbar spine, and serum 25-hydroxyvitamin D level, as well as calcaneal pitch (CP), talar-first metatarsal, and metatarsus adductus (MA) angles. Fifty-five women with fractures and 51 controls were evaluated. Fractures occurred in the metatarsals in 89 percent of patients. The study group had lower bone mineral density (BMD). Risk factors for fracture development were the CP and MA angles and low lumbar BMD.
A study published in the November/December issue of the Journal of Pediatric Orthopaedics compared clinical outcomes in patients with triplane fractures by radiography alone versus radiography plus CT and nonoperative versus operative management. A systematic review yielded 11 articles encompassing 203 patients for inclusion. Male patients were older at the time of injury than female patients (14.2 years versus 12.6 years). Good/excellent Modified Weber Protocol scores did not largely differ between operative versus nonoperative patients, while patients who underwent radiography alone had significantly higher scores. Complication rates did not largely differ between operative versus nonoperative management (15 percent versus 16 percent).
Stark Law and Antikickback Statute Final Rules Released
Finalized changes to the Stark Law and the Antikickback Statute were released on Nov. 20. The modernized Stark Law rules work in conjunction with the Centers for Medicare & Medicaid Services’ (CMS) Patients Over Paperwork initiative, which seeks to relieve physicians of unnecessary physician burden, while still protecting patients from unnecessary services. The updated Antikickback Statute addresses concerns that the original rules prevent physicians from coordinating care with and for federal healthcare program beneficiaries.
Trump Administration Unveils ‘Most Favored Nation’ Innovation Drug Payment Model
The Trump Administration announced that the Most Favored Nation (MFN) drug payment model, which will reduce Medicare Part B payments for some drugs to the lowest price paid by other countries, will take effect in January 2021. The MFN model is estimated to save taxpayers and beneficiaries more than $85 billion over a seven-year period.
The Academy has launched the AAOS Leadership Institute (ALI), a new program available to all AAOS members that will provide training, mentoring, and networking opportunities to those seeking to acquire and refine the skills needed to progress and succeed as a volunteer leader at AAOS. ALI is offered in four successive tiers. Levels 1 and 2, available now, are offered to orient members into the Academy’s culture and resources and prepare them for AAOS committee service. ALI Levels 3 and 4 will be available later in 2021 through an application process for members who aspire to serve at higher levels of service.
AJRR Releases New Resource to Help Patients Better Understand Physician Recommendations
The American Joint Replacement Registry (AJRR), part of the AAOS Registry Program, has released the AJRR Patient-facing Interim Report, which takes clinical hip and knee arthroplasty data from the AJRR 2019 Annual Report and distills the information that is most relevant to patients and the public. The patient-centered report serves as a resource for the more than 1,600 participating sites to share with their patients. Additionally, those outside the profession can use the information within the report to learn more about hip and knee replacement procedures and how registry data can help to inform decisions and improve patient care.
