Suture Augmentation of Internal Fixation for Highly Comminuted Patella Fractures - Zachary Telgheder, MD; Gauray Mookerjee, MD; James Aglio, III, MD; and Matthew P. Sullivan, MD
| Treatment of comminuted patella fractures is challenging. Augmentation of internal fixation has been proposed to improve stability. The authors describe an effective technique to augment internal fixation consisting of locked sutures within the quadriceps and patellar tendons. This technique functions to off-load internal fixation and restore tension to the extensor mechanism. The locked suture augmentation technique was performed for 13 patients undergoing open treatment of patella fractures by the senior author from 2016 to 2019. Patients were followed for an average of 10.2 months. No patients suffered postoperative infection or wound complication requiring intervention. There were no cases of fracture displacement, implant failure, loss of fixation, postoperative infection, or wound complication requiring intervention. Mean range of motion was 0 – 134 degrees of extension, and no patients demonstrated an extensor lag. The authors conclude that locked suture augmentation of comminuted patella fractures represents a viable technique that demonstrates excellent early clinical results. (Journal of Surgical Orthopaedic Advances 33(4):201-205, 2024)
Key words: patella fracture, suture augmentation, locked suture, extensor mechanism injury, comminuted patella fracture, augmented internal fixation, locked suture augmentation technique
Antimicrobial Incise Drapes in Knee and Hip Arthroplasties: Meta-analysis of Randomized Controlled and Prospective Cohort Studies - Adam Pearl, MD; Mohamed E. Awad, MD, MBA; Ahmad I. Hasan, MD, MSc; and Khaled J. Saleh, MD, MSc, FRCS, MHCH, CPE
Traditional skin preparation and prophylactic antibiotics have not uniformly been successful in preventing surgical site infection (SSI) following total joint arthroplasties. Iodophor-impregnated adhesive dressings, such as Ioban, have shown promising effects in reducing the incidence of SSI. A systematic review and meta-analysis were conducted according to PRISMA checklist and the Cochrane Handbook for Systematic Reviews of Interventions. Non-stratified and stratified meta-analysis were conducted to test for confounding and biases. The methodological quality and risk of bias were analyzed and appraised. Five studies including 1,655 patients were eligible. In these studies, 51.6% of the included patients had antimicrobial incise drape in the setting of knee and hip arthroplasties. Both non-stratified and stratified analyses revealed that the antimicrobial incise drape significantly reduced the risk of contamination as compared with no drape (odds ratio = 0.54, p < 0.0001). Iodophor- impregnated incise drapes, such as Ioban, significantly reduce the risk of contamination in total joint arthroplasties. (Journal of Surgical Orthopaedic Advances 33(4):206-211, 2024)
Key words: antimicrobial incise drape, surgical site complications, Ioban, contamination, knee arthroplasty, hip arthroplasty
Rates and Risk Factors for Quadriceps and Patellar Tendon Repair Failure: A Single Institution Case Series - Madilyn Mandich, BS; Andrea H. Johnson, MSN, CRNP; Christina M. Morganti, MD; James J. York, MD; Benjamin M. Petre, MD; Justin J. Turcotte, PhD, MBA; and Daniel E. Redziniak, MD
Quadriceps and patellar tendon ruptures are rare but serious injuries that can severely disrupt function and quality of life. The aim of this study was to evaluate the rates and risk factors for failed quadriceps and patellar tendon repairs. A retrospective review of 78 patients undergoing surgical repair for quadriceps or patellar tendon rupture from March 2014 to December 2020 was performed. Univariate statistics were used to evaluate differences between groups. Approximately 10.3% of cases returned to the operating room, and 6.4% required revision repair for rerupture of the quadriceps or patellar tendon. Notable trends toward increased risk for rerupture included a history of prior knee surgery (odds ratio [OR] = 6.286, p = 0.065) and quadriceps tendon rupture (OR = 6.321, p = 0.055), although statistical significance was not achieved. Although not statistically significant, previous knee surgery and quadriceps tendon rupture appear to increase the risk of rerupture after primary tendon repair. (Journal of Surgical Orthopaedic Advances 33(4):212-215, 2024)
Key words: quadriceps tendon repair, patellar tendon repair, rerupture, risk factor, extensor mechanism
Handling of Sharps in the Operating Room: A Single Institution Review - Bryanna Vesely, DPM, MPH; Madeline Fram, BA; Matthew King, DPM; Lindsay LeSavage, DPM; Dekarlos Dial, DPM; and Ashleigh Medda, DPM
Operating room (OR) personnel are at a high risk for sharp injuries, which can cause serious side effects. The goals of this study are to analyze OR nurses and surgical technologists’ experiences and their current level of sharps education. An anonymous survey was sent to a single institution asking whether the participants have been stuck by a sharp, when they were stuck, and their perspective on sharp safety. Forty-two participants responded to the survey. The authors found 69% had sustained a sharp injury, 58.6% being stuck while handling sharps alone. The majority (90.5%) believed handing back sharps protected was the safest. Forty-five percent reported never attending continuing medication education (CME) regarding sharps. Only 59.4% of those who had CME found it helpful. This is the first study the authors know of that looked at OR personnel’s perspectives on sharps handling and CME. The authors recommend re-evaluation of current CME. (Journal of Surgical Orthopaedic Advances 33(4):216-218, 2024)
Key words: needle stick, occupational hazard, needlestick injury, operating room
Liposomal Bupivacaine Use During Adolescent Idiopathic Scoliosis Surgery Decreases Postoperative Narcotic Usage - Alexander H. Jinnah, MD, PhD; Rosser McCallie, MD; Alejandro Marquez-Lara, MD, PhD; Nicholas Tully, BS; Michael S. Hughes, MD; and John Frino, MD
Postoperative pain control in adolescent patients following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) requires a multimodal pain regimen involving a combination of opioids and adjuvant analgesic medications. The purpose of this study was to identify whether the use of the local anesthetic liposomal bupivacaine (LB) at time of closure following PSF reduced postoperative narcotic use in patients when compared with an alternative local anesthetic. Twenty-five patients who received LB at time of wound closure were matched with 25 AIS patients from the year prior to minimize changes in protocol and instrumentation. Charts were retrospectively reviewed, and significant difference was found in age, gender, body mass index, length of stay, visual analog scores for pain, or number of levels fused. However, the LB group had significantly less morphine equivalent totals. Based on the results, the authors would recommend the use of LB during closure of PSF for AIS. (Journal of Surgical Orthopaedic Advances 33(4):219-221, 2024)
Key words: pediatric spine, multimodal pain management, adolescent idiopathic scoliosis, posterior spinal fusion, liposomal bupivacaine
Infection Rates in Open Hand Fractures: Can Surgical Treatment Be Delayed? - Mark Adam Tait, MD; John White Bracey, MD; Paulvalery Roulette, MD; and Daniel Robert Lewis, MD
The authors hypothesized that the infection rates of open hand fractures treated in a delayed manner would not be higher than those treated immediately. The authors performed a retrospective chart review of patients treated between January 2008 and July 2014 at a Level 1 Trauma Center. Delayed (> 24 hours) versus early (< 24 hours) surgical treatment groups were identified for comparison to determined infection rates. One hundred twenty-nine patients with open hand fractures were compared. Fifty-eight received delayed treatment (> 24 hours), and 71 received immediate surgical treatment (< 24 hours). When adjusted for the severity of injury, there were no significant differences on the rate of infection and rate of reoperation between washout and antibiotics in the emergency department versus immediate surgical treatment. There were no differences in infection rates or reoperation for nonunions with respect to surgical intervention timing. (Journal of Surgical Orthopaedic Advances 33(4):222-224, 2024)
Key words: phalanx, finger fracture, metacarpal, open fracture, infection
Return to Shooting Sports After Shoulder Surgery: An Expert Survey - Robert R. Williams, MD; and Jeremy S. Somerson, MD
The authors sent a 13-question web-based survey to all American Shoulder and Elbow Surgeons members regarding a timeline of return to shooting sports after shoulder surgery and received 107 responses from all 50 states and eight from outside the United States. Of the respondents, 74.8% considered their rehabilitation protocol “conservative.” Surgeons who considered their rehabilitation protocol to be “aggressive” were more likely to return patients to shooting earlier after rotator cuff repair (p = 0.008), anatomic total shoulder arthroplasty (p = 0.015), and reverse total shoulder arthroplasty (p = 0.003). Most surgeons released their patients after 12 weeks. The majority (95.3%) of respondents were asked by patients about shooting after shoulder surgery. Longer duration of practice correlated significantly with the likelihood of being asked about shooting (p = 0.015). Most surgeons would release their patients to return to shooting sports 12 weeks after surgery. It is unknown how shooting affects implant fixation in vivo. (Journal of Surgical Orthopaedic Advances 33(4):225-227, 2024)
Key words: firearms, rehabilitation, return to sport, rotator cuff injuries, shoulder replacement arthroplasty
Public Knowledge and Perception of Outpatient Shoulder Arthroplasty - Jay M. Levin, MD, MBA; Aman Chopra, BA; Daniel E. Goltz, MD, MBA; John Wickman, MD, MBA; Thorsten Seyler, MD, PhD; Tally Lassiter, MD, MHA; Oke Anakwenze, MD, MBA; and Christopher S. Klifto, MD
There is a growing trend in performing outpatient total shoulder arthroplasty (TSA). The purpose of this study was to analyze the public perception of outpatient TSA by querying a validated online market research platform regarding the public’s knowledge, expectations, and beliefs on outpatient TSA. One thousand eighty respondents completed the survey in 2021. Simple and multivariable logistic regressions were performed to determine factors that were associated with an expected prolonged (2+ days) length of stay (LOS) after TSA. The mean expected LOS was 1.7 ± 1.5 days, with 48% of respondents expecting a prolonged LOS. Increasing age (p = 0.005) and unfamiliarity with outpatient TSA (p = 0.004) were signifi cant predictors for expecting a prolonged LOS following TSA. The highest perceived risk of outpatient TSA was experiencing an avoidable complication (23%), whereas perceived benefi ts included reduced cost (38%) and quicker recovery (27%). Although outpatient TSA is becoming increasingly popular, a gap in public knowledge and expectations is evident. ( Journal of Surgical Orthopaedic Advances 33(4):228-232, 2024)
Key words: shoulder arthroplasty, total shoulder, outpatient, public perception, survey, length of stay
Biomechanical Implications of Asymmetric Gardner-Wells Tong Placement During Cervical Spine Traction - Hossein Tabrizi, MD; Evan Kohler, MD; Sarah Adams, BS; David Fernandez, MD; and Patrick Atkinson, PhD
In cases of cervical facet dislocations, traction is typically delivered in the acute se! ing with tongs a! ached to the skull via two pins. Although the pins are recommended to be inserted symmetrically in a neutral loading position, erroneous asymmetric pin placement has been documented in case reports, but its biomechanical implications are unknown. The current study utilized a human surrogate to evaluate the infl uence of asymmetrically placed pins in the axial or frontal planes. In addition, asymmetry of the cable that delivers the traction force to the tongs was also investigated. In the majority of the pin confi guration experiments, pin asymmetry did not signifi cantly aff ect cervical spine loading. One exception was if one pin was placed 1 cm anterior to neutral and the contralateral was in the neutral position. This confi guration resulted in a signifi cant increase in the cervical extension moment, which should typically be avoided because it can hinder reduction. (Journal of Surgical Orthopaedic Advances 33(4):233-239, 2024)
Key words: Gardner-Wells tongs, cervical facet dislocation, cervical traction, asymmetric pin placement
Effect of Surgical Start Time on Length of Stay, Morbidity Rate, and Surgical Risk in Elective Total Hip Arthroplasty - Michael J. Patetta, MD; Justin T. DesLaurier, MD; Elan Volchenko, MD; Jessica A. Hossa, BS; Matthew A. Siegel, MD; Abhishek Deshpande, MD; Lucas Paladino, MD; Asher E. Lichtig, MD; Mark D. Orland, MD; Hristo I. Piponov, MD; and Mark H. Gonzalez, MD, PhD
There is conflicting literature regarding the effect of surgical start time for total hip arthroplasty (THA) on morbidity. This study examined outcomes between start time groups in elective THA. A retrospective review identified patients undergoing elective cementless primary THA between 2009 and 2019. Patients were divided into morning or evening start time groups. Chi-squared analysis and independent sample t-tests were run to detect differences between groups in matched and unmatched analysis. Five hundred fifteen patients were identified based on selection criteria. Chi-squared analysis and independent sample t-tests identified no significant differences in duration of surgery, estimated blood loss, length of stay, or other complications between start time groups. This study provided clinical data over a 10-year period supporting that surgical start time in elective THA does not have a significant impact on outcomes. (Journal of Surgical Orthopaedic Advances 33(4):240-243, 2024)
Key words: total hip arthroplasty, total hip replacement, total joint replacement, surgical start time, outcomes, Propensity Score Matched Analysis
The Association of Biological Sex on Outcomes Following Primary Total Shoulder Arthroplasty for the Glenohumeral Osteoarthritis - Nicole Ackerman, BS; Alejandra Moncayo, MPH; Lucas C. Voyvodic, BS; Ariel N. Rodriguez, MD; Miriam D. Weisberg, MD; Afshin E. Razi, MD; and Jack Choueka, MD
There are limited data demonstrating the association of sex with diff erent risks for complications following upper and lower total joint arthroplasty. Therefore, this study set out to determine whether biological sex is associated with diff erent outcomes following primary total shoulder arthroplasty. The Mariner claims database was used to identify patients who underwent primary total joint arthroplasty (TSA) for the treatment of glenohumeral osteoarthritis (OA) between 2005 and 2017. Primary endpoints of the study were to compare frequency of 90-day medical complications between male and female cohorts. This study demonstrates that, within 90 days, TSA males and females do experience signifi cantly diff erent medical complications, specifi cally, the rate of transfusion of blood products and urinary tract infections (UTIs). This study can be used to evaluate sex-specific risk of medical complications following TSAs. (Journal of Surgical Orthopaedic Advances 33(4):244-246, 2024)
Key words: total shoulder arthroplasty, glenohumeral osteoarthritis, biological sex, complications, PearlDiver
Factors Influencing Professional Well-being in Orthopaedic Surgeons - Zachery Hong, MPHS and Anna N. Miller, MD
Diminished physician well-being is a serious occupational hazard in orthopaedic surgery that results from burnout and low professional fulfillment. The authors surveyed 331 members of the American Orthopaedic Association and used the Professional Fulfillment Index (PFI) to determine presence of burnout and low professional fulfillment. Thirty-three percent (110/331) of respondents were burned out. Predictors of burnout included early career stage, work hours, and specialization in arthroplasty. Forty-four percent (185/331) of respondents were not professionally fulfilled. Predictors of low professional fulfillment included early career stage, work hours, specialization in foot/ankle, female gender, and not having children. No significant relationship between PFI well-being and self-reported medical errors was found. An orthopaedic surgeon’s well-being is influenced by personal and career-related factors that may be used to guide interventions that minimize burnout and maximize professional fulfillment. (Journal of Surgical Orthopaedic Advances 33(4):247-253, 2024)
Key words: well-being, burnout, professional fulfillment, orthopaedic surgery, medical errors