ABSTRACT

Purpose: To evaluate the safety of hip arthroscopy combined with a periacetabular osteotomy (PAO) compared with PAO alone in treating concomitant intra-articular pathology in hip dysplasia.

Materials and methods: Forty-one patients (46 hips) with symptomatic hip dysplasia were retrospectively reviewed. Pre- and postoperative radiographic data and intraoperative data consisting of estimated blood loss, intraoperative and postoperative blood transfusions, operative time, and length of hospital stay were recorded. The complications occurring within the first 3 months after surgery including lateral femoral cutaneous and pudendal nerve neuropraxia, wound complications, and reoperations were recorded. Additionally, rates of deep venous thrombosis and other major adverse outcomes (myocardial infarction, pulmonary embolism, stroke, death) were examined.

Results: Twenty-one patients (24 hips) underwent PAO alone. Twenty patients (22 hips) underwent hip arthroscopy followed immediately by PAO. There were no significant differences in the 90-day complication rates between the two groups, comparing the rate of neuropraxia (p = 0.155) and wound complications (p = 0.6). Operative time for PAO alone was 179 minutes (standard deviation [SD] ± 37) compared with 251 minutes (SD ± 52) for combined hip arthroscopy and PAO (p < 0.001). No incidence of deep vein thrombosis or major adverse events was noted in either group. Preoperative lateral center edge angle (LCEA) and acetabular index (AI) were 14° and 20° respectively, in the PAO-alone group and 19° and 16° respectively, in the combined group. Postoperatively, LCEA was 29° in the PAOalone group and 30° in the combined group. Postoperative AI was 11° in the PAO-alone group and 5° in the combined group.

Conclusion: This study demonstrates that hip arthroscopy in combination with PAO to treat intra-articular pathology shows no difference in 90-day complication rates when compared with PAO alone.

Level of evidence: Level III, retrospective comparative study Keywords:

Neumann JA, Rickert KD, Bradley KE, Lewis BD, France MA, Olson SA. Concomitant Hip Arthroscopy and Periacetabular Osteotomy: Is there a Difference in Perioperative Complications compared with Periacetabular Osteotomy Alone? The Duke Orthop J 2017;7(1):51-57.

Source of support: Nil

Conflict of interest: None

ABSTRACT

The role of powder gloves in allergic reactions, infections, wound healing and granuloma formation has been known for many years. Despite a gradual shift away from powder gloves over the last several decades, many healthcare professionals and facilities continue to use powder gloves as the FDA has continued to refrain from issuing a comprehensive formal ban. However, recent advancements in glove technology and position statements by professional societies have continued the push for removal of powder gloves from all clinical and surgical settings and will hopefully entirely eradicate usage in the coming years.

Keywords: Glove, Infection, Operating room, Surgical glove.

Blizzard DJ, Agaba P, Morwood MP, Jerele JL, Zura RD. Risks and Benefits of the different Types of Gloves used in the Perioperative Setting. The Duke Orthop J 2017;7(1):3-10.

Source of support: Nil

Conflict of interest: None

ABSTRACT

Mesenchymal stem cells (MSCs) are multipotent cells with potential reparative properties for connective tissues, such as articular cartilage. The Lipogems adipose graft harvest system is a relatively novel technique for harvesting adiposederived MSCs and may be utilized in conjunction with various orthopaedic sports medicine procedures.

Keywords: Arthroscopy, Orthopaedic surgery, Stem cell.

Owusu-Akyaw KA, Godin J, Pecchia S, Oldweiler A, Moorman CT. Adipose-derived Mesenchymal Stem Cells and Arthroscopic Surgery. The Duke Orthop J 2017;7(1):34-38.

Source of support: Nil

Conflict of interest: None

ABSTRACT

Introduction: Amputations secondary to high-energy open fractures and blast, ballistic, and crush injuries to the lower extremity are common challenges faced by military and civilian orthopaedic surgeons. A lack of consensus on domains to be measured and quality of prosthetic rendering pose methodological challenges to researchers and clinicians alike. We conducted a systematic review of the literature to summarize which domains of health, prosthetic fit, and prosthetic alignment are used to describe outcomes for lower extremity amputees secondary to trauma.

Materials and methods: A search of PubMed, Cochrane, and Embase was conducted including the keywords: Amputation, traumatic, transtibial, survey, and metric. Articles were selected based on whether the study assessed clinical outcomes following transtibial amputation following trauma. Experimental and observational comparative studies and case series were included. Study characteristics and results were extracted using standardized data forms. The number of unique measures recorded, the frequency of measure use, and the number outcome measures were validated and were compiled.

Results: Literature search ultimately resulted in 273 articles being included. A conceptual model was constructed to capture and organize the causal and temporal relationships between fit, alignment, and outcome. Of the 68 articles that used questionnaires to assess prosthetic fit, 37 used a questionnaire designed specifically for the study as opposed to a published or validated tool. Four validated tools were commonly used to capture patient satisfaction with a prosthesis: The OPUS, PEQ, TAPES, and the Socket Comfort Fit Score. Prosthetic alignment was assessed in 19 of 273 articles. One article validated the use of an alignment jig for quantification and prescription of prostheses. Totally, 8 of 19 articles assessing alignment used gait analysis and ground reaction forces to capture differences due to alterations in alignment.

Discussion: Choice of an appropriate outcome measure is critical in generating evidence to support treatment decisions for patients undergoing transtibial amputation after trauma. We found a large number of different tools being used across studies, making results difficult to compare. Prosthetic fit and comfort of the residual limb in the socket and the alignment of the socket and the shank of the prosthesis make up the foundation for the proposed conceptual model. In order to distinguish effects attributable to an intervention of interest vs the impact of the quality of the socket fitting, validation of a clinically objective scoring system to assess socket fit is necessary.

Conclusion: A large number of different tools are currently being used across studies to assess outcomes for transtibial amputees resulting from trauma, and there is a need for development and validation of a clinically objective scoring system to assess socket fit.

Keywords: Assessment tool, Transtibial amputation, Traumatic.

Baumgartner R, Morshed S. Assessment Measures for Evaluation of Outcomes in Transtibial Amputees resulting from Trauma: A Systematic Review. The Duke Orthop J 2017;7(1):23-29.

Source of support: Nil

Conflict of interest: None

ABSTRACT

The purpose of this study was to assess the inter- and intraobserver reliability through visual perception of a previously described classification system of proximal femoral morphology. The interobserver reliability ranged from slight to moderate across testing. Experience appears to play a role as the intratester reliability did not differ with fellowship trained attending physicians, but differences were seen with junior- and senior-level residents. The diversity of the proximal femoral morphology likely represents a continuum rather than three distinct shapes. This may imply that for many proximal femoral canals, characterization of a single type may not be possible. Further research is warranted to determine the clinical significance of these findings.

Keywords: Bone quality, Proximal femoral morphology, Total hip arthroplasty.

How to cite this article:Jennings JM, Thiele RAR, Krynetskiy E, Wellman SS, Attarian DE, Bolognesi MP. Independent Analysis of the Dorr Classification of Proximal Femoral Morphology: A Reliability Study. The Duke Orthop J 2016;6(1):12-16.

Source of support: Nil

Conflict of interest: None

ABSTRACT

Multiligament Knee Injuries (MLKI) are rare but devastating injuries that require both acute and chronic management. These injuries necessitate operative management with individual patient factors dictating management in an acute (<6weeks) versus chronic (>6 weeks) time frame. Anterior cruciate ligament, posterior cruciate ligament and posterolateral corner reconstruction remains the gold standard for operative management while most medial collateral ligament injuries can be managed non-operatively. Graft fixation sequence is essential in re-tensioning the soft tissues to allow for a functional and balanced knee post-operatively- the PCL is first fixed in flexion, followed by the ACL in extension, and then lastly, the PLC and MCL are addressed as needed. This review paper highlights technical considerations demonstrated in two case reports to include timing of surgery, graft selection and sequence of graft fixation.

Keywords: Graft fixation sequence, Graft selection, Multligament knee injury, Technical considerations.

How to cite this article:Dekker TJ, Kildow BJ, Guerrero EM, Moorman CT III. Technical Aspects of Addressing Multiligament Knee Instability. The Duke Orthop J 2016;6(1):47-53.

Source of support: Nil

Conflict of interest: None

ABSTRACT

Background: Ultrasonography is an increasingly valuable tool for the diagnosis and treatment of musculoskeletal disorders. In the past, ultrasound has been used for diagnostic purposes, with increasing use of image guidance for joint injections.

Hypothesis: Ultrasound-guided intraarticular native nontraumatic hip injections are equally as accurate with less cost as other diagnostic imaging modalities including fluoroscopicguided injections.

Design: This analysis was based on a meta-analysis of the accuracy of the different imaging modalities. Initially a search was performed for intraarticular hip injections in PubMed, Embase, and ClinicalTrials.gov. Injection accuracy rates between groups were analyzed via proportional meta-analysis. For the economic analysis, compensation data were determined from estimated charges from Duke University Medical Center.

Results: Compared with gold standards of accurate injections (such as fluoroscopic and computed tomography-guided injections), ultrasound is 97% as accurate (confidence interval 93%, 99%). Based on 2014 reimbursement data, reimbursement for large-joint intraarticular injection averages $61.99 (37.38£, 47.18€) ($49.20-$76.31). Fluoroscopic global reimbursement averages $105.32 (63.51£, 80.13€) ($76.75-$134.72). Ultrasound guidance global reimbursement averages $75.99 (45.86£, 57.83€) ($57.95-$93.15).

Conclusion: Ultrasound-guided hip injections are an accurate technique for alleviating hip pain at less cost. In an era of increasing concern for health care expenditures, finding an accurate, effective, and cost-friendly alternative has the potential for widespread adaptation and practice.

Keywords: Accuracy, Cost analysis, Guided injections, Musculoskeletal ultrasound.

How to cite this article:Porras L, Boggess B. Economic Analysis of Accuracy and Cost of Ultrasound-guided Intraarticular Hip Injections. The Duke Orthop J 2016;6(1):35-40.

Source of support: The Duke University Internal Medicine Research Grant funded this study.

Conflict of interest: Dr Boggess maintains industry relationships with GE, SonoSite, Bioventus, and Arthrex although none provided funding. For the remaining authors none were declared.

ABSTRACT

The Bernese periacetabular osteotomy (PAO) is a powerful technique for correcting acetabular coverage in patients with developmental dysplasia of the hip. However, there is increasing recognition of additional intraarticular pathologies that may contribute to ongoing pain. For this reason, for the last 3 years, we have combined hip arthroscopy with PAO to treat intraarticular pathology along with improving acetabular coverage. Our technique is reviewed below.

Keywords: Arthroscopy, Dysplasia, Hip, Osteotomy.

How to cite this article:Lewis BD, Olson SA. Technique for Combined Hip Arthroscopy and Periacetabular Osteotomy for the Patient with Hip Dysplasia and Intraarticular Pathology. The Duke Orthop J 2016;6(1):41-46.

Source of support: Nil

Conflict of interest: None

ABSTRACT

Introduction: Health care delivery is contingent on efficient communication among providers. We hypothesized that using smart-device two-way communication would result in faster provider responses when compared with alphanumeric paging among resident physicians in an academic medical center.

Methods: Resident physicians were given an Apple iPad Mini smart device with a Health Insurance Portability and Accountability Act-compliant smart-device two-way communication application. Patient care messages were randomized for transmission via smart-device two-way texting or standard one-way paging. Physician response time was recorded as the primary outcome measure.

Results: The study was halted after participation of the first 24 residents due to safety concerns. A technical glitch was identified in which the smart devices automatically powered off to conserve battery life. The first 72 smart devices to first 37 pager communication response times were similar (8 vs 6 minutes, p = 0.43). In analysis of responses within 5 minutes of c ommunication ( the t ime s mart d evices p owered o ff), smart-device responses occurred significantly faster (1 vs 2 minutes, p < 0.05) but the response frequency was less in the smart-device group (33 vs 62%, p < 0.05), and thus the study was ended early due to safety concerns.

Discussion: Based on our initial findings, smart devices have potential to improve communication but technical issues must be addressed prior to usage as the sole means of communication.

Keywords: Academic, Communication, Device, Hospital, iPad, Pager, Trial, Smart.

How to cite this article:Hamid KS, Nwachukwu BU, Hsu E, Dutta S, Babcock SN, Baker BW, Wohler AD, D’Agostino RB Jr, Lang JE. A Clinical Trial Evaluation of Pager vs S mart-device E fficacy i n a n Academic Hospital Setting. The Duke Orthop J 2016;6(1):1-6.

Source of support: This study was funded by an intramural IRSC grant at Wake Forest Baptist Medical Center.

Conflict of interest: None

ABSTRACT

Background: While there have been multiple studies published that have stressed the importance of restoring various different radiographic parameters to improve functional outcome scores, there is no consensus on the parameter that correlates most with patients’ functional outcomes. We hypothesize that obtaining near anatomical reduction of the palmar lunate facet is critical to improving functional outcome scores. The purpose of this study is to determine the effects of reduction and stabilization of the palmar lunate facet on functional outcomes in patients with intra-articular distal radius fracture.

Materials and methods: We prospectively collected clinical examination data, radiographic measurements, and functional outcome scores on 157 patients who were treated operatively for multifragmentary intra-articular fractures of the distal radius (AO Type C3) between 1996 and 2006. Prospective data were acquired at 3, 6 months, and 1 year postsurgical intervention in clinical follow-up. Based on radiographic measurements, patients were designated into a nondisplaced palmar lunate facet group and a displaced palmar lunate facet group. Clinical and functional outcomes were then compared between the groups.

Results: Patients without displacement had a significantly higher value of wrist extension and forearm supination when compared with the patients with displacement. In addition, the Gartland and Werley score was significantly higher in patients with displacement of the palmar lunate facet.

Conclusion: This study demonstrates that patients with near anatomical reduction of the palmar lunate facet after surgical treatment of an intra-articular distal radius fracture had improved range of motion and better functional outcome scores compared with patients with residual displacement of the palmar lunate facet.

keywords: Distal radius fracture, Lunate facet, Outcomes.

How to cite this article:Richard MJ, Lampley AJ, Patel PD, Nomides REK, Mithani SK, Leversedge FJ, Ruch DS. The Importance of the Palmar Lunate Facet in the Treatment of Distal Radius Fractures. The Duke Orthop J 2016;6(1):56-60.

Source of support: Nil

Conflict of interest: None