Literature

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

This month’s Image Quiz from the JBJS Journal of Orthopaedics for Physician Assistants (JOPA) presents the case of a 7-year-old girl who sustained a wrist injury from a fall off of monkey bars. An initial lateral radiograph is shown here. Clinicians attempted a closed reduction and applied a long arm cast. At the 1-week follow-up visit, radiographs showed additional displacement and increased dorsal angulation. Select from among five possible choices for the greatest predictor of fracture displacement in the setting of distal radial metaphyseal fractures: increased fracture obliquity, a cast index ratio of less than or equal to 0.7, short arm casting, an intact ulna, or increased initial displacement of the radius.

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How best to treat clavicle fractures remains a controversial question in orthopaedics. A study by Huttunen et al. in the November 2, 2016 JBJS does not resolve that controversy, but it sheds a little light on it. The authors analyzed a validated Swedish hospital-discharge registry and determined that 44,609 clavicle fractures occurred in that country between 2001 and 2012. During that period, the incidence of clavicle fractures increased by 67%, from 35.6 to 59.3 per 100,000 person-years. During that same time, the rate of surgically treated clavicle fractures increased by 705%, from 2.5% of all clavicle fractures in 2001 to 12.1% in 2012.

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The November 2, 2016 issue of JBJS contains the second of a series of personal essays in which orthopaedic clinicians tell a story about a high-impact lesson they learned that has altered their worldview, enhanced them personally, and positively affected the care they provide as orthopaedic physicians. The second “What’s Important” piece comes from Dr. Augusto Sarmiento of the University of Miami School of Medicine. In his essay titled “Putting Patients First,” Dr. Sarmiento emphasizes that quality patient care must always outweigh orthopaedist self-interest. If you would like JBJS to consider your “What’s Important” story for publication, please submit a manuscript via Editorial Manager. When asked to select an article type, please choose Orthopaedic Forum and include “What’s Important:” at the beginning of the title.

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Ulnar shortening osteotomy is a widely accepted procedure for surgical treatment of ulnar impaction syndrome, but many techniques require special instrumentation to achieve accurate shortening, adequate fixation, and sufficient rotational control. In the November 2, 2016 issue of The Journal of Bone & Joint Surgery, Papatheodorou et al. report on outcomes in 164 patients who underwent so-called “step-cut” osteotomies for positive ulnar variances that ranged from +1 to +6 mm. The technique itself, which utilizes a standard neutralization plate and lag screw for fixation, is summarized and illustrated in the article. The authors emphasize that the step-cut approach does not require special jigs or instrumentation.

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OrthoBuzz occasionally receives posts from guest bloggers. In response to a recent JAMA study,the following two commentaries come from Chad Krueger, MD, and Shahriar Rahman, MS. “Hmmm…. Maybe I’m operating on too many ankle fractures.” That was my first thought as I read the abstract of the recent Willett et al. study in JAMA. They conducted a well-designed, randomized controlled trial that compared operative and nonoperative treatment of unstable ankle fractures, using the Olerud-Molander Ankle Score at 6 months postoperatively as the primary outcome measure. On the surface, it appeared as though patients who were treated nonoperatively with close contact casting did just as well as those who underwent operative intervention.

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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 November 2016:Comparative Survivorship of Different Tibial Designs in Primary Total Knee ArthroplastyAll-Polyethylene Versus Metal-Backed Tibial ComponentsRepair of Intraoperative Injury to the Medial Collateral Ligament During Primary Total Knee ArthroplastyRisk of Total Knee Arthroplasty After Operatively Treated Tibial Plateau FractureLong-Term Clinical Outcomes and Survivorship of Press-Fit Condylar Sigma Fixed-Bearing and Mobile-Bearing Total Knee Prostheses in the Same PatientsKnee studies offered on the JBJS Knee Spotlight will be updated monthly, so check the site often.

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The evolution of more rational educational programs and other societal changes point to a future where an increasing number of orthopaedic surgeons will be female. Thankfully, we have made gains in adjusting the medical community’s perspective on careers in orthopaedic surgery. No longer are we perceived to be “stronger than a mule and twice as smart” or merely “buckles and braces men.” Evolving interventional techniques that rarely require brute force have also helped change this view. At the same time, with the rapidly increasing need for musculoskeletal care as the population ages, we need every orthopaedic practitioner—male and female—to remain as healthy and active as possible.

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Despite the remarkable success of modern treatments for congenital clubfoot, including the Ponseti method, some kids still end up with a rigid residual deformity after walking age. In the October 19. 2016 edition of JBJS, Dragoni et al. investigated the Ponseti treatment in 44 patients (68 feet; mean age of 4.8 years) who had been previously treated with various surgical and conservative protocols but whose outcomes were fair or poor, according to International Clubfoot Study Group scores. The authors performed Ponseti manipulation and cast application with the patients under conscious sedation. Depending on the clinical situation, some patients also received percutaneous heel-cord surgery or percutaneous fasciotomy, and all those over 3 years old (88% of the feet) received tibialis anterior tendon transfer (TATT).

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OrthoBuzz regularly brings 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 highlight the impact that these JBJS articles have had on the practice of orthopaedics. Please feel free to join the conversation by clicking on the “Leave a Comment” button in the box to the left. The classic 1981 JBJS article by B.F.

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This month’s Image Quiz from the JBJS Journal of Orthopaedics for Physician Assistants(JOPA) presents the case of a teenage girl who dislocated her patella while playing volleyball. The quiz provides four postreduction images, two radiographs and two fat-suppressed MRI scans, and then readers are presented with two questions:What is the next best step in this patient’s treatment?Which concomitant condition does NOT cause an increased risk of patellar instability? Share this story: FacebookLinkedInTwitter Like this: LikeLoading... Related

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