Today’s Top Story
Study: Suprapatellar IMN insertion may be linked with lower malalignment rate compared with infrapatellar technique.
According to a study published in the October issue of The Journal of Orthopaedic Trauma (JOT), use of the suprapatellar intramedullary nail (IMN) insertion technique may be linked to a lower rate of malalignment compared with the infrapatellar IMN technique. The researchers conducted a retrospective cohort study of 266 skeletally mature patients with distal tibia fracture who were seen at one of two centers; 132 patients were treated through a suprapatellar technique. Cohorts were matched with respect to age, gender, fracture grade, and presence of open fracture. The researchers found that primary angular malalignment of =5 degrees occurred in 26.1 percent of patients (n = 35) with infrapatellar IMN insertion and in 3.8 percent of patients (n = 5) who underwent suprapatellar IMN insertion. Read the abstract…

Other News

Study: Early application of vancomycin powder may help reduce infection in traumatic wounds.
Findings published in the October JOT suggests that early application of vancomycin powder may help prevent infection in traumatic wounds. The authors used an established segmental defect rat femur model contaminated with Staphylococcus aureus UAMS-1 followed by treatment at 6 or 24 hours postinfection. They evaluated three treatments: debridement and irrigation alone, and in combination with either vancomycin powder or vancomycin-impregnated poly (methyl methacrylate) beads. They found that locally applied vancomycin powder and impregnated beads significantly reduced bacteria within both the bone and implant when treatment was performed at 6 hours. However, delaying treatment to 24 hours significantly reduced the therapeutic efficacy of locally applied vancomycin in both groups. They note that at 14 days, vancomycin was detectable in the surrounding musculature of all animals and in serum of 20 percent of those treated with vancomycin powder. Read the abstract…

Study: Flattening of tibial slope may be associated with remaining PTT after PCL reconstruction.
Data published online in The American Journal of Sports Medicine suggest that flattening of the tibial slope (TS) may be associated with a significantly higher remaining posterior tibial translation (PTT) and lower reduction of PTT following posterior cruciate ligament (PCL) reconstruction. The researchers conducted a cohort study of 48 patients who underwent PCL reconstruction; 27 patients underwent an additional posterolateral corner reconstruction and 13 patients underwent a combined reconstruction of the PCL, anterior cruciate ligament, and posterolateral corner. At minimum 5-year follow-up, the researchers found a statistically significant correlation between TS and PTT. In addition, there was a significant correlation between TS and postoperative reduction of PTT. The researchers noted no significant association between number of operated ligaments and TS or mean reduction of PTT. Read the abstract…

Study: How common is HO following RSA?
A study published online in The Bone & Joint Journal examines the incidence of heterotopic ossification (HO) following reverse shoulder arthroplasty (RSA). The research team conducted a retrospective study of 132 consecutive patients (mean age, 69 years) who underwent Delta III or Delta Xtend RSA for the treatment of cuff tear arthropathy. They found that 31 patients had begun to develop HO by 3 months postoperative. Overall, 11 patients had grade 1a, 8 had grade 1b, 6 had grade 1c, and 14 had grade 2 HO, based on Hamada classification. The research team noted that HO evolved over a mean of 8.3 months (range, 3 to 21 months). Patients with HO had lower mean Constant-Murley scores at 3, 6, and 12 months postoperatively. The research team notes that HO was not associated with notching. Read the abstract…

Study: ACS NSQIP Pediatric Surgical Risk Calculator may offer excellent discrimination for mortality and other complications.
Findings published online in The Journal of the American College of Surgeons evaluate the use of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Pediatric Surgical Risk Calculator. The researchers used data on 181,353 pediatric cases from 67 hospitals to develop the calculator, which uses 18 preoperative variables to predict 9 postoperative outcomes. They found that the tool had excellent discrimination for mortality (c-statistic = 0.98), morbidity (c-statistic = 0.81), and 7 additional complications (c-statistics > 0.77). The researchers write that the Hosmer–Lemeshow statistic and graphical representations also showed excellent calibration. Read more…
Read the abstract…
Access the risk calculator…

Massachusetts.
The Massachusetts Medical Society (MMS) reports that the Massachusetts Executive Office of Health and Human Services is considering a revision to the Determination of Need process that would prohibit the establishment of ambulatory surgery centers (ASCs) not affiliated or partnered with an acute care hospital. A memorandum issued by the agency notes that the state Health Policy Commission has argued that “an unregulated approach […] would harm community hospitals and their financial solvency.” MMS responds that such a rule would preclude freestanding ASCs from providing higher quality and lower cost care compared to hospital-based surgical settings. Read more…
Read more about the proposed regulation…

Call for abstracts: 2017 EWI research symposium.
AAOS seeks abstracts for combat casualty and trauma-related research for poster presentations at the 2017 Extremity War Injuries (EWI) XII: Homeland Defense as a Translation of War Lessons Learned, to be held Jan. 30-Feb. 1, 2017, in Washington, D.C. Overall, 24 abstracts will be selected for poster presentations, and of those, 12 will be selected for podium presentations. Research should focus on one of the following themes:

  • Tactical medicine / intentional violence / disaster preparedness
  • Disaster preparedness and natural disasters
  • Disease and non-battle injury

The $600 EWI registration fee will be waived for poster presenters. Presenters are responsible for their own hotel and travel costs associated with attending the EWI symposium. Presenters will be responsible for hotel and travel costs associated with attending the EWI symposium. CME (up to 15.5 hours) will be available for EWI XII attendees and participants. Abstract submissions, along with current curriculum vitae, must be submitted by Oct. 10, 2016, to Erin Ransford, manager, research advocacy, at: ransford@aaos.org.
Learn more and obtain an abstract submission form…