Literature

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

In the January 4, 2017 issue of The Journal, Swart et al. provide a well-done Markov decision analysis on the cost effectiveness of three treatment options for femoral neck fractures in patients between the age of 40 and 65: open reduction and internal fixation (ORIF), total hip arthroplasty (THA), and hemiarthroplasty. Plugging the best data available from the current orthopaedic literature into their model, the authors estimated the threshold age above which THA would be the superior strategy in this relatively young population.

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OrthoBuzz occasionally receives posts from guest bloggers. This guest post comes from Grigory Gershkovich, MD. Shoulder arthroplasty continues to grow in popularity, and as the number of shoulder arthroplasties rises, so will the number of revisions. Infection is one major reason for shoulder arthroplasty failure, and Propionibacterium has been increasingly recognized as a major culprit. However, Propionibacterium infection is difficult to diagnose. Despite improved detection techniques, diagnosis at the time of revision remains elusive because obvious signs of acute infection are often absent. The need to perform explantation in the setting of clinically apparent periprosthetic infection is obvious, but the appropriateness of single-stage revision with antibiotic treatment in shoulders with only apparent mechanical failures remains questionable.

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OrthoBuzz occasionally receives posts from guest bloggers. This guest post comes from Brett A. Freedman, MD. In the December 21, 2016 edition of the Journal of Bone & Joint Surgery, Bunta, et al. published an analysis of data from the Own the Bone quality improvement program collected between January 1, 2010 and March 31, 2015. Over this period of time, 125 sites prospectively collected detailed osteoporosis and bone health-related data points on men and women over the age of 50 who presented with a fragility fracture.

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The recently launched JBJS Knee Spotlight offers highly relevant and potentially practice-changing knee content from the most trusted source of orthopaedic information. Here are the five JBJS articles to which you will have full-text access through the Knee Spotlight during the month of January 2017: Differences in Short-Term Complications Between Unicompartmental and Total Knee Arthroplasty: A Propensity Score Matched Analysis Extensor Mechanism Allograft Reconstruction for Extensor Mechanism Failure Following Total Knee Arthroplasty What’s New in Adult Reconstructive Knee Surgery Bicruciate Substituting Design Does Not Improve Maximal Flexion in Total Knee Arthroplasty: A Randomized Controlled Trial

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As an end-of-year thank-you to the orthopaedic community, we’re offering limited-time full-text access to the five most-read JBJSReviews articles during 2016. The fact that several of these most-read articles were published prior to 2016 is testament to the durable utility of the orthopaedic information published in JBJS Reviews.Treatment of Proximal Humeral Fractures (2016)Arthroscopic Single-Row Versus Double-Row Repair for Full-Thickness Posterosuperior Rotator Cuff TearsTreatment of Proximal Humeral Fractures (2014)The Evaluation and Treatment of Pediatric Tarsal CoalitionsAcute Distal Radioulnar Joint Instability in Adults Share this story: FacebookLinkedInTwitter

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The exact mechanism by which osteochondritis dissecans (OCD) lesions develop is poorly understood. This month’s “Case Connections” spotlights 3 case reports of OCD in young baseball players, 2 of whom developed the condition in the shoulder. A fourth case report details 3 presentations of bilateral OCD of the femoral head that occurred in the same family over 3 generations. The springboard case report, from the December 28, 2016, edition of JBJS Case Connector, describes a 16-year-old Major League Baseball (MLB) pitching prospect in whom an OCD lesion of the shoulder healed radiographically and clinically after 8 months of non-throwing and physical therapy focused on improving range of motion and throwing mechanics.

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As an end-of-year thank-you to the orthopaedic community, we’re offering limited-time full-text access to the five most-read JBJS articles of 2016. The fact that several of these most-read articles were published prior to 2016 is testament to the durable utility of orthopaedic research published in The Journal of Bone & Joint Surgery.Bariatric Orthopaedics: Total Hip Arthroplasty in Super-Obese PatientsAntibiotic-Impregnated Cement Spacers for the Treatment of Infection Associated with Total Hip or Knee ArthroplastyThe Surgical Management of Chronic Tophaceous GoutRotator Cuff Tear Arthropathy: Evaluation, Diagnosis, and TreatmentAn Algorithmic Approach to the Management of Recurrent Lateral Patellar Dislocation

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The Ponseti method is a proven treatment for idiopathic clubfoot, yielding excellent outcomes with minimal pain or disability. However, as many as 40% of patients fail to respond to initial treatment or develop recurrent deformities. On Wednesday, January 25, 2017 at 8:00 PM EST, The Journal of Bone & Joint Surgery will host a complimentary webinar that delves into two recent JBJS studies investigating how to predict which patients are most likely to get subpar results from the Ponseti method, and how best to manage clubfoot relapses if they occur.

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In a retrospective case-cohort analysis of 364 shoulders that had primary repair of recurrent anterior instability, Zimmermann et al. conclude in the December 7, 2016 issue of JBJS that arthroscopic Bankart repairs were inferior to the open Latarjet procedure, at a mean follow-up of 10 years. Specific 10-year outcome comparisons included:Redislocations in 13% of the Bankart shoulders vs 1% of the Latarjet shouldersApprehension (fear of the shoulder dislocating with the arm in abduction and external rotation) in 29% of the Bankart patients vs 9% of the Latarjet patientsCumulative revision rate for recurrent instability of 21% in the Bankart group vs 1% in the Latarjet groupNot-satisfied rating from 13.2% of patients in the Bankart group vs 3.2% in the Latarjet groupOverall, there were few early and almost no late failures after the Latarjet procedure, while the arthroscopic Bankart repair was associated with an increasing failure rate over time.

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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, Nitin Jain, MD, MSPH, a co-author of the November 16, 2016 Specialty Update on Orthopaedic Rehabilitation, selected the five most clinically compelling findings from among the more than 40 studies summarized in the Specialty Update. Back Pain –A prospective cohort study1 evaluating the benefit of early imaging (within 6 weeks of index visit) for patients ≥65 years old with new-onset back pain found that those with early imaging had significantly higher resource utilization and expenditures compared with matched controls who did not undergo early imaging.

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