Today’s Top Story
Study: Is close contact casting preferable to surgery for unstable ankle fracture?
Data from a study conducted in the United Kingdom and published in the Oct. 11 issue of The Journal of the American Medical Association suggest that close contact casting or surgical fixation may offer similar short-term functional outcomes for older adults with unstable ankle fracture. The authors conducted a randomized trial with blinded outcome assessment of 620 patients treated with either a molded below-knee cast with minimal padding or surgical fixation, 593 of whom completed the study. Overall 579 of 620 patients received the allocated treatment, with 52 of 275 (19 percent) who initially received casting later converting to surgery. At 6-month follow-up, the authors found no significant difference in Olerud-Molander Ankle Score between casting and surgical cohorts, nor any significant difference in secondary outcomes such as quality of life, pain, ankle motion, mobility, and patient satisfaction. They noted that infection and wound breakdown, as well as additional surgical procedures, were more common in the surgical group. However, radiologic malunion was more common in the casting group. In addition, casting required less operating room time compared with surgery.
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Other News

Study: Altered knee joint mechanics may affect likelihood of OA following ACL reconstruction.
A study published in a special issue of the Journal of Orthopaedic Research attempts to identify risk factors for development of post-traumatic osteoarthritis (OA) following anterior cruciate ligament (ACL) reconstruction. The researchers note that altered mechanical loading of the knee may be associated with development of post-traumatic OA. They conducted a gait analysis of 30 athletes 6 months after ACL reconstruction, and used an electromyographic-driven musculoskeletal model to estimate joint contact forces. They found that external knee adduction moment was a significant predictor of medial compartment contact forces in both limbs, while vertical ground reaction force and co-contraction contributed significantly only in the contralateral limb.
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Study: OAT linked to greater activity and lower risk of failure compared with MFX in patients with larger knee cartilage lesions.
Findings published in the October issue of the journal Arthroscopy suggest that osteochondral autograft transfer (OAT) may be linked with higher activity levels and lower risk of failure compared with microfracture (MFX) for patients with knee cartilage lesions greater than 3 cm2. The authors conducted a meta-analysis of six studies covering 249 patients with a mean follow-up of 67.2 months. They found that Tegner scores were superior in patients treated with OAT compared with MFX, while failure rates of MFX were higher than OAT. In addition, at 3-year follow-up, OAT was superior to MFX based on subjective outcome scores. The authors state that for OAT lesions larger than 3 cm2, OAT was superior to MFX with respect to activity level. They noted no significant difference between OAT and MFX for lesions less than 3 cm2 at midterm.
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Study: Early-career trauma surgeons seeing fewer acetabular fractures over time.
According to a study published in the October issue of The Journal of Orthopaedic Trauma, a reduced case volume of acetabular fractures treated by early-career orthopaedic surgeons may have implications for training and experience. The researchers reviewed case log data for 468 candidates who examined as trauma subspecialists over a 13-year period. They evaluated case volume over time for pelvis, acetabulum, and periarticular fracture surgeries and found that surgeon case volume was stable over time. However, the number of acetabulum fracture surgeries performed decreased significantly from a mean of 10.1 cases in 2003 to 5.2 cases in 2015. The researchers found no significant change in the number of pelvic fracture surgeries, but noted a trend toward fewer periarticular fracture surgeries.
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Study: Few rural trauma patients initially transported to major trauma centers.
A study published online in JAMA Surgery compares treatment for trauma patients in urban and rural settings. The research team analyzed prospectively gathered data on 53,487 injured patients transported by emergency medical services agencies to 28 hospitals in 2 rural and 5 urban counties in Oregon and Washington. An institution was considered rural based on 60 minutes or more driving proximity to the nearest level I or II trauma center and/or rural designation in the U.S. Centers for Medicare & Medicaid Services ambulance fee schedule by zip code. They found that rural vs. urban sensitivity of field triage for identifying patients requiring early critical resources was 65.2 percent vs. 80.5 percent, with only 29.4 percent of rural patients who needed critical resources initially transported to major trauma centers, compared to 88.7 percent of urban patients. After accounting for transfers, 39.8 percent of rural patients requiring critical resources were cared for in major trauma centers, compared to 88.7 percent of urban patients. The research team noted that mortality did not differ significantly between rural and urban regions; however, 89.6 percent of rural deaths occurred within 24 hours, compared with 64 percent of urban deaths. In addition, rural regions had higher transfer rates and longer transfer distances.
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USBJI grant mentoring and career development program accepting applications from young investigators.
Jan. 15, 2017 is the deadline for young investigators to apply to take part in the United States Bone and Joint Initiative (USBJI) and Bone and Joint Canada grant mentoring program. The program is open to promising junior faculty, senior fellows, or postdoctoral researchers who have been nominated by their department or division chairs. It is also open to senior fellows or residents who are doing research and have a faculty appointment in place or confirmed. Basic and clinical investigators, without or with training awards (including K awards) are invited to apply. Investigators selected to take part in the program attend two workshops, 12-18 months apart, and work with faculty between workshops to develop their grant applications. Attendees are given the opportunity to maintain a relationship with a mentor until their application is funded. The next workshop will take place April 7-9, 2017, in Rosemont, Ill.
Learn more and submit your application…

Call for volunteers: Alliance for Patient Access Pain Therapy Access Physicians Working Group.
AAOS seeks to nominate one member to the Alliance for Patient Access Pain Therapy Access Physicians Working Group. The working group brings together healthcare providers with an interest in public policy with the goal of enabling patient access to appropriate pain management. Applicants for this position must be active fellows, candidate members, candidate members osteopathic, candidate member applicants for fellowship, or candidate member applicants for fellowship osteopathic. In addition, all applicants must provide the following: an online AAOS CAP application, a current curriculum vitae, and a 100-word biosketch. All supporting materials must be submitted by Oct. 20, 2016 at 11:59 p.m. CT, to Kyle Shah at