Literature

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

Reporting in the September 2, 2015 issue of The Journal of Bone and Joint Surgery, European researchers Moroder et al. found that 7 of 45 patients (17.5%) without substantial glenoid bone loss who underwent open Bankart repairs had a recurrence of instability during an average 22 years of follow-up. This high failure rate is in line with findings from previous studies, but the authors include data indicating that, compared to patients who did not experience recurrent instability, “the recurrence of instability did not appear to significantly affect the subjective and objective outcome scores or the degree of work and sports impairment.

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“Health-related quality of life” is easier to say than to measure. In the September 2, 2015 edition of The Journal, Schottel et al. document the impact of a diaphyseal nonunion on health-related quality of life using the well-accepted methodology of time trade-off. In this approach, patients are asked what percentage of their remaining life they would be willing to trade for perfect health, free from the disability in question. Among the 832 long-bone nonunions studied, Schottel et al. found patients were willing to trade an average of 32% of their remaining lifespan for perfect health. Patients with nonunions of the forearm were willing to trade the greatest percentage of their lives (46%) to be rid of their disability.

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Doximity’s 2015-2016 Residency Navigator is designed to help medical students make informed choices about residency programs by analyzing more than 94,000 ratings and hand-written reviews from Doximity members who are currently in or recently graduated from US residency programs. From that data, Doximity’s VP of Product Management Shari Buck turned up two interesting findings about orthopaedists in training: –Among the specialties with the highest ratings for work hours (tolerability of shift and call schedules) and schedule flexibility (real-life accommodations for events such as weddings and pregnancy), orthopaedic surgery came in fourth, behind physiatry, dermatology, and radiation oncology—and just ahead of emergency medicine.

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The hip-arthroplasty community currently feels that the advantages gained from head-neck modularity outweigh the risks, but JBJS Case Connector raises that risk-benefit question in an August 26, 2015 “Watch” article. Modular head-neck failures of total-hip prostheses are indeed rare complications, but the potentially catastrophic consequences and a seemingly increased incidence are raising concern among orthopaedists. Prompted by a case report by Swann et al. in the August 26, 2015 JBJS Case Connector and a report by Arvinte et al. in the April 22, 2015 JBJSCase Connector, the Watch describes three patients who experienced a complete head-neck dissociation seven to fourteen years after primary arthroplasty with modular components.

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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. Here is a summary of selected findings from Level I and II studies cited in the July 15, 2015 Specialty Update on orthopaedic trauma: Clavicular Fractures –Among 46 patients with acute clavicular fractures, upright radiographs were better than supine radiographs at demonstrating clavicular displacement. Proximal Humeral Fractures –A prospective randomized study of 120 patients undergoing open reduction and internal fixation (ORIF) of proximal humeral fractures showed that the deltoid-split and deltopectoral approaches resulted in similar patient outcomes. Femoral Shaft Fractures

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Every clinician treating musculoskeletal injury or disease knows that pain perception among patients is highly subjective and variable. Given the same objective magnitude of a pain stimulus, one person will grade it a 2 on the visual analog scale (VAS), while another will rate it an 8.  I am sure that every dentist experiences similar patient variability! What is behind this, and what can we do with our decision making related to pain management to ensure compassionate and effective orthopaedic care? We know that cultural and social factors play a role in pain perception, as do smoking and opiate-abuse history.

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For over 125 years, the Journal of Bone & Joint Surgery (JBJS) has been the premier journal for orthopaedic surgeons. Today, our publication portfolio has grown to 4 peer-reviewed, evidence-based journals. Two of these journals offer continuing medication education (CME) for orthopaedic generalists, specialists and allied health personnel. The development of the CME activities is overseen by a committee consisting of editors from The Journal and JBJS Reviews. The JBJS CME program is designed to enhance the knowledge, competence and performance of orthopaedic surgeons worldwide, and to improve musculoskeletal health for their patients. Our CME program addresses a range of clinical topics including: adult hip and knee reconstruction, foot and ankle surgery, spine surgery, shoulder and elbow surgery, pain management, sports medicine, pediatrics, and trauma.

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Each month during the coming year, OrthoBuzz will bring you a current commentary on a “classic” article from The Journal of Bone & Joint Surgery. These articles have been selected by the Editor-in-Chief and Deputy Editors of The Journal because of their long-standing significance to the orthopaedic community and the many citations they receive in the literature. Our OrthoBuzz commentators will highlight the impact that these JBJS articles have had on the practice of orthopaedics. Please feel free to join the conversation about these classics by clicking on the “Leave a Comment” button in the box to the left. For a good long while, the 1972 JBJS article titled “Anterior Acromioplasty for the Chronic Impingement Syndrome in the Shoulder” by Charles S.

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Along with the sharply rising number of total hip and knee arthroplasties performed in the US comes an increasingly compelling need to prevent periprosthetic joint infections (PJIs). If a PJI occurs, guidelines recommend a two- to six-week post-revision course of pathogen-specific intravenous antibiotic therapy. However, the benefit of chronic suppression with oral antibiotics beyond that is unproven. In the August 5 edition of The Journal of Bone & Joint Surgery, Siqueira et al. compared the infection-free prosthetic survivorship in 92 patients who underwent chronic oral antibiotic suppression for a minimum of six months with prosthetic survivorship in a matched cohort who did not receive extended antibiotic treatment.

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Meniscal transplantation is often recommended after total meniscectomy for patients younger than 50  who remain symptomatic and show articular cartilage deterioration. But for how long are these transplants effective? That’s what Noyes et al. attempt to answer in a survivorship analysis in the August 5, 2015 Journal of Bone & Joint Surgery. Extending the follow-up from a JBJS study they published in 2005, the authors tracked 40 cryopreserved menisci implanted into 38 patients for an average of 11 years. They measured transplant survival in two distinct ways:In terms of symptom-driven endpoints, including transplant removal, revision, or tibiofemoral compartment painIn terms of additional asymptomatic “worst-case” endpoints, including grade-3 signal intensity, extrusion (>50% of meniscal width), evident meniscal tear (per MRI or physical examination), or radiographic loss of joint space.

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