Today’s Top Story

Postoperative Bracing May Not Be Effective After Spinal Surgery

According to a literature review published in the September issue of The Spine Journal, bracing after neck or back surgery may not improve outcomes. Researchers conducted a systematic search of MEDLINE, Embase, and the Cochrane Collaboration Library from 1970 to May 2017 and manually searched the reference list of relevant studies and previously published reviews. They selected literature that compared disability, quality of life, functional impairment, radiographic outcomes, cost-effectiveness, or complications between patients treated postoperatively with bracing or without. Based on low to moderate evidence, researchers found no significant difference in most measures of disability, pain, quality of life, functional impairment, radiographic outcomes, and safety between the groups. In isolated studies, significant and inconsistent differences were observed for Neck Disability Index six weeks postoperation or Short Form-36 Physical Component Score 1.5, three, six, and 12 months following surgery.

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Other News

Study: Angiographic Embolization before Operative Treatment for Pelvic/Acetabular Fractures Could Increase Complications

A retrospective case series published in the September issue of the Journal of Orthopaedic Trauma found that open reduction internal fixation (ORIF) of pelvic/acetabular fractures with pelvic angiography embolization (PAE) may increase patients’ risk of complications. Researchers studied 50 patients who underwent ORIF of pelvic/acetabular fractures with PAE and a control group of 61 patients with no PAE. The PAE group had a significantly higher rate of complications than those who did not have PAE (20 percent versus 4.9 percent). Internal iliac artery embolization and posterior surgical approaches had the highest complication rates. The authors suggested that the trauma surgeon, interventional radiologist, and orthopaedic surgeon discuss the potential PAE ahead of ORIF surgery to avoid non-selective embolization and decrease complication risk.

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Study Finds Possible Predictive Value of Preoperative NLR for Relapse in PVNS of the Knee

Preoperative neutrophil-lymphocyte ratio (NLR) may be an easy, cost-effective way to predict relapse in pigmented villonodular synovitis (PVNS) of the knee joint following arthroscopic synovectomy followed by local radiotherapy. The study, published online in BMC Musculoskeletal Disorders, included 60 pathological-proven PVNS knee joint cases from April 2006 to March 2017. At a mean follow-up of 528 months, the recurrence rate was about 23.3 percent (n = 14). Researchers observed a correlation between NLR and postoperative recurrence. The receiver operating characteristic (ROC) curves indicated that a NLC over 2.42 was strongly predictive of recurrence (sensitivity, 71.4 percent; specificity, 78.3 percent).

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Similar Complications Seen with CAAPs Versus No CAAPs in Operative Ankle Fracture

Ankle fracture fixation with concurrent ankle arthroscopic procedures (CAAPs) may not be more effective in reducing the postoperation risk for reoperation than fixation without CAAPs, according to a study published online in The Journal of Foot and Ankle Surgery. Researchers used the PearlDiver database to identify 32,307 patients who underwent ankle fracture fixation from January 2007 to December 2011, 248 of whom received CAAP and 32,059 did not. There was no significant difference in reoperation rates between the CAAP group and non-CAAP group (7.7 percent versus 8.6 percent). Of the 19 CAAP patients who underwent reoperation, 13 had arthroscopic débridement and six had either ankle refixation or osteochondral autograft transfer. In the 3,021 non-CAAP reoperation patients, 83.2 percent were ankle refixation, 14.3 percent were arthroscopic procedures, and 2.5 percent were ankle arthrodesis. No complications were reported in CAAP group, while the non-CAAP group complications included wound dehiscence (2.4 percent), deep vein thrombosis (0.8 percent), and pulmonary embolism (0.4 percent).

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Synovial Fluid Gram Stain May Not Be Reliable to Detect Pediatric SA

When screening for pediatric septic arthritis (SA), the Gram stain may not be an efficient method, according to a study published in the October issue of the Journal of Pediatric Orthopaedics. Researchers identified 302 patients who underwent incision and drainage for suspected SA between January 2007 and October 2016. They evaluated results of the synovial fluid Gram stain, as well as synovial cell count/differential and serum markers. Thirty-four percent of patients (n = 102) had positive synovial fluid cultures, and Gram stain detected a microorganism in 16 percent of patients (n = 47) Gram stain sensitivity was 0.40, and specificity for SA detection was 0.97. The Gram stain misdiagnosed one out of every five patients. The authors concluded that the Gram stain result is a poor screening tool for the detection of SA and is particularly ineffective for the detection of gram-negative organisms.

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October AAOS Now Is Now Available Online

AAOS members will soon receive the print edition of the October issue of AAOS Now, but the electronic edition is already available on the AAOS Now website and on iOS and Android devices through the AAOS Access app. This month’s issue includes information on sports medicine, recurrent disk herniations, and answers to five common coding questions.

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Last Call: Apply for the AMA Guides to the Evaluation of Permanent Impairment Fly-In Liaison Position

The AAOS seeks to nominate one member to serve as the AAOS representative during an open discussion about the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). The liaison will participate in a full-day meeting on Nov. 2, 2018, in Rosemont, Ill. The deadline to apply is Oct. 8.

Learn more and submit your application…(member login required)