Literature

Evidence based literature that is truly important to your orthopaedic clinical practice.

The estimated annual cost of surgical treatment for anterior cruciate ligament (ACL) ruptures in the US is $2 billion. Are ACL surgery patients—and the health care system—getting significant value for all that money spent? In the May 3, 2017 issue of The Journal of Bone & Joint Surgery, Nwachukwu et al. set out to answer that question by retrospectively analyzing rates of return to play and satisfaction among 231 ACL-surgery patients (mean age of 27 years) who were followed for a mean of 3.7 years.

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In 2015, JBJS launched an“article exchange” collaboration with the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) to support multidisciplinary integration, continuity of care, and excellent patient outcomes in orthopaedics and sports medicine. During the month of May 2017, JBJS and OrthoBuzz readers will have open access to the JOSPT article titled “Risk of Recurrence of Low Back Pain (LBP): A Systematic Review.” In that systematic review, the authors found low quality and heterogeneity among studies of this topic. They concluded that “the available research does not provide robust estimates of the risk of LBP recurrence and provides little information about factors that predict recurrence in people recently recovered from an episode of LBP.

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Shoulder surgery for complex conditions such as irreparably large rotator cuff tears has been revolutionized by the concept of reverse total shoulder arthroplasty (rTSA). Improved design of rTSA implants by multiple manufacturers has resulted in excellent functional outcomes from these procedures. I have been educated by my shoulder colleagues to the fact that primary rTSA is actually technically less demanding than primary anatomic TSA because of greater exposure of the scapula/ glenoid anatomy. When anatomic TSA clinically and/or radiographically fails, conversion to rTSA is an alternate to revision anatomic TSA.

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Spring and Summer 2017 are busy seasons for Own the Bone, the American Orthopaedic Association’s national post-fracture, systems-based, multidisciplinary fragility fracture prevention initiative: Webinar: Components of a Secondary Fracture Prevention Program – May 4 On Thursday, May 4, at 5:00pm CDT (6:00pm EDT) Paul A. Anderson, MD, FAOA, from the University of Wisconsin, and Karen Cummings, PA-C, from the University of Michigan, will discuss the components of a successful secondary fracture prevention program. Own the Bone Charlotte Symposium – June 23: Fragility Fracture Care Coordination and Secondary Fracture Prevention Join the National Association of Orthopaedic Nurses (NAON) and The American Orthopaedic Association for this full-day event on Friday, June 23.

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An estimated 40% of total costs from a total hip arthroplasty (THA) episode are accrued from post-discharge services.  With that in mind, Austin et al. embarked on a randomized controlled trial comparing outcomes among two groups of primary THA patients: those who followed a 10-week self-directed home exercise regimen (n=54) and those who received a combination of in-home and outpatient physical therapy (PT) for 10 weeks (n=54). The results were published in the April 19, 2017 edition of The Journal of Bone & Joint Surgery. At 1 month and 6 to 12 months after surgery, patients in both groups showed significant preoperative-to-postoperative improvements in function as measured by all administered instruments (Harris Hip Score, WOMAC Index, and SF-36 Physical Health Survey).

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Every month, JBJS publishes a Specialty Update—a review of the most pertinent and impactful studies published in the orthopaedic literature during the previous year in 13 subspecialties. Click here for a collection of all OrthoBuzz Specialty Update summaries. This month, Derek Kelly, MD, co-author of the February 15, 2017 Specialty Update on Pediatric Orthopaedics, selected the five most clinically compelling findings from among the 60 studies summarized in the Specialty Update. Upper-Extremity Trauma —A systematic review of eight randomized studies comparing splinting with casting for distal radial buckle fractures confirmed that splinting was superior in function, cost, and convenience, without an increased complication rate.1 Lower-Extremity Trauma —A review of the treatment of 361 pediatric diaphyseal femoral fractures before and after the 2009 publication of AAOS clinical guidelines for treating such fractures revealed that the guidance had little impact on the treatment algorithm in one pediatric hospital.

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Anterior cruciate ligament (ACL) reconstruction is a common and predominantly successful surgical intervention.  But are there any specific preoperative patient characteristics or intraoperative surgical decisions that lead to better or worse outcomes? And can understanding brain function changes of patients after ACL reconstruction reveal how to improve postsurgical rehabilitation to further enhance outcomes? These intriguing and clinically applicable questions will be addressed on Tuesday, April 4, 2017 at 8:00 PM EDT during a complimentary* LIVE webinar, hosted jointly by The Journal of Bone & Joint Surgery (JBJS) and the Journal of Orthopaedic & Sports Physical Therapy (JOSPT).

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This monumental volume, of which K. Mohan lyer is the editor, was written by several authors. It contains more than 500 pages and provides comprehensive cover of the hip joint in 15 broad chapters. After a rather brief embryological and anatomical description, the author studies the biomechanics defining the forces applied to the femoral head in particular. Each chapter ends with a rich reference list.  

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JBJS, Inc., is pleased to announce the development ofJBJS Clinical Classroom on NEJM Knowledge+. Using research-proven, state-of-the-art adaptive learning technology developed by Area9 and employed by NEJM Knowledge+, JBJS Clinical Classroom will provide orthopaedic surgeons with a personalized learning experience at any stage in their career. Users will learn by answering case-based, short-form, and fill-in-the-blank questions based on JBJS gold-standard content, enhanced  by technology that continuously adapts to learners’ goals, pace, and knowledge gaps. JBJS Clinical Classroom on NEJM Knowledge+ will be available before the end of 2017. Share this story: FacebookLinkedInTwitter

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In the March 1, 2017 edition of The Journal, Eliezer et al. report on their experience managing femoral fractures in a major treatment center in Dar es Salaam, Tanzania, one of many low-resource locations around the world. The authors tracked one-year outcomes for 331 femoral fractures in 329 patients. The vast majority of those fractures were treated with intramedullary nails, with open reduction and without intraoperative imaging. The actual reoperation rate for nails was 3.4%, with infection being the most common reason for reoperation. Eliezer et al.

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