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Global Volunteering in Orthopaedics: Availability and Implementation Considerations
Babu, Jacob M.; Cruz, Aristides; Patel, Shyam A.; Born, Christopher T.; Akelman, Edward
doi : 10.5435/JAAOS-D-20-00740
Journal of the American Academy of Orthopaedic Surgeons. 29(4):139-147, February 15, 2021.
The World Health Organization describes traumatic injuries as a “neglected epidemic” in developing countries, accounting for more deaths annually than HIV/AIDS, malaria, and tuberculosis combined. Low- and middle-income countries rely on volunteer assistance to address the growing surgical disease burden of traumatic injuries. Efforts to increase the availability of international electives for orthopaedic trainees can help with the short-term need for surgical personnel abroad and facilitate sustainability through capacity building, maximizing long-term benefits for all parties. The volunteer invariably benefits from this cross-cultural experience with many citing improved skills in communication, clinical diagnostics, appreciation of equality and diversity, and cost-consciousness. A consolidated discussion regarding barriers and implementation strategies can assist interested individuals and institutions plan for future volunteering endeavors.
Navicular Stress Fractures
Patel, Karan A.; Christopher, Zachary K.; Drakos, Mark C.; O'Malley, Martin J
doi : 10.5435/JAAOS-D-20-00869
Journal of the American Academy of Orthopaedic Surgeons. 29(4):148-157, February 15, 2021.
Navicular stress fractures are multifactorial injuries due to chronic overload on the navicular, particularly in young athletes. The navicular is subject to unique stresses and has a complex blood supply, making it susceptible to stress fractures and potentially delayed union or nonunion. Expeditious diagnosis is critical to prevent a delay in treatment and a poor outcome. Advanced imaging is essential in making the diagnosis and monitoring healing. Both nonsurgical and surgical treatments have demonstrated good results. Nonsurgical management consists of a period of immobilization and nonweight bearing, and surgical management typically involves open reduction and internal fixation. Patients need to be appropriately counseled regarding expectations for these challenging injuries.
Current Trends in the Evaluation and Management of Nondisplaced Femoral Neck Fractures in the Elderly
Okike, Kanu; Hasegawa, Ian G.
doi : 10.5435/JAAOS-D-20-00349
Journal of the American Academy of Orthopaedic Surgeons. 29(4):e154-e164, February 15, 2021.
Nondisplaced (Garden I and II) femoral neck (FN) fractures are commonly encountered by the practicing orthopaedic surgeon. Although these fractures are primarily classified based on the AP radiograph, the lateral radiograph should be closely scrutinized as well because posterior tilt has emerged as a consistent predictor of fixation failure. Internal fixation has for many years been the standard of care, with both cannulated screws and the sliding hip screw representing acceptable options. However, the outcomes after fixation of Garden I and II FN fractures have not been uniformly positive, with the rates of revision surgery ranging from 8% to 27%. Complications after fixation of nondisplaced FN fractures include nonunion, fixation failure, osteonecrosis, and femoral shortening causing inferior hip function. For these reasons, arthroplasty is increasingly considered a viable option in the treatment of these fractures, especially in the presence of factors that predispose to failure after fixation. Novel devices for FN fixation have recently been developed, although clinical data supporting their use are sparse at the present time.
Letter to the Editor: Technical Considerations and Fluoroscopy in Percutaneous Fixation of the Pelvis and Acetabulum
Lo, Yu Cheng
doi : 10.5435/JAAOS-D-20-00004
Journal of the American Academy of Orthopaedic Surgeons. 29(4):e165, February 15, 2021.
Letter to the Editor: Personality Assessment and Emotional Intelligence in Orthopaedic Surgery Residency Selection and Training
Guisse, Ndeye F.; Fakunle, Omolola P.
doi : 10.5435/JAAOS-D-20-00590
Journal of the American Academy of Orthopaedic Surgeons. 29(4):e166-e167, February 15, 2021.
Incidence and Risk Factors for the Development of Acute Colonic Pseudo-Obstruction (Ogilvie Syndrome) in Total Joint Arthroplasty Patients
Hsiue, Peter P.; Greig, Danielle; Chen, Clark J.; Patel, Bobby; Trikha, Rishi; Rowan, Fiachra E.; Khoshbin, Amir; Stavrakis, Alexandra I
doi : 10.5435/JAAOS-D-20-00096
Journal of the American Academy of Orthopaedic Surgeons. 29(4):159-166, February 15, 2021.
Acute colonic pseudo-obstruction (Ogilvie syndrome [OS]) is a rare but devastating condition that can develop in orthopaedic patients postoperatively. The objective of this study was to identify the risk factors for developing OS after total hip arthroplasty (THA) or total knee arthroplasty (TKA) and to compare the outcomes between patients who did and did not develop OS postoperatively.
The Current State of Orthopaedic Educational Leadership
Bi, Andrew S.; Fisher, Nina D.; Singh, Sameer K.; Strauss, Eric J.; Zuckerman, Joseph D.; Egol, Kenneth A
doi : 10.5435/JAAOS-D-20-00279
Journal of the American Academy of Orthopaedic Surgeons. 29(4):167-175, February 15, 2021.
It is important to understand the current characteristics of orthopaedic surgery program leadership, especially in the current climate of modern medicine. The purpose of this report was to describe the demographic, academic, and geographic characteristics of current orthopaedic chairs and program directors (PDs).
Robotics and Navigation as Learning Tools for Fellows Training in Hip Arthroplasty
Shapira, Jacob; Diulus, Samantha C.; Rosinsky, Philip J.; Maldonado, David R.; Lall, Ajay C.; Domb, Benjamin G
doi : 10.5435/JAAOS-D-20-00357
Journal of the American Academy of Orthopaedic Surgeons. 29(4):176-181, February 15, 2021.
The association between implant malpositioning and complications has been repeatedly demonstrated. Recently, technological advancements have allowed for more consistent implant placement. Beyond this obvious application, these technologies may also serve as a learning tool. Thus, the aim of this study was to evaluate the accuracy of fellows' estimation of implant positioning using a robotic system.
Robotic Arm-assisted Total Hip Arthroplasty is More Cost-Effective Than Manual Total Hip Arthroplasty: A Markov Model Analysis
Maldonado, David R.; Go, Cammille C.; Kyin, Cynthia; Rosinsky, Philip J.; Shapira, Jacob; Lall, Ajay C.; Domb, Benjamin G. Less
doi : 10.5435/JAAOS-D-20-00498
Journal of the American Academy of Orthopaedic Surgeons. 29(4):e168-e177, February 15, 2021.
Total hip arthroplasty (THA) is the benchmark surgical treatment of advanced and symptomatic hip osteoarthritis. Preliminary evidence suggests that the robotic arm-assisted (RAA) technology yields more accurate and reproducible acetabular cup placement, which may improve survival rate and clinical results, but economic considerations are less well-defined. The purpose of this study was to compare the cost effectiveness of the RAA THA with manual THA (mTHA) modalities, considering direct medical costs and utilities from a payer's perspective.
Risk Factors for Elbow Joint Contracture After Surgical Repair of Traumatic Elbow Fracture
Carlock, Kurtis D.; Bianco, Isabella R.; Kugelman, David N.; Konda, Sanjit R.; Egol, Kenneth A
doi : 10.5435/JAAOS-D-18-00801
Journal of the American Academy of Orthopaedic Surgeons. 29(4):e178-e187, February 15, 2021.
The ability to predict contracture development after elbow fracture would benefit patients and physicians. This study aimed to identify factors associated with the development of posttraumatic elbow joint contracture.
State Medical Cannabis Laws Associated With Reduction in Opioid Prescriptions by Orthopaedic Surgeons in Medicare Part D Cohort
Lopez, Cesar D.; Boddapati, Venkat; Jobin, Charles M.; Hickernell, Thomas R
doi : 10.5435/JAAOS-D-19-00767
Journal of the American Academy of Orthopaedic Surgeons. 29(4):e188-e197, February 15, 2021.
Opioid prescriptions and abuse remain a significant national concern. Cannabinoids offer a potentially attractive nonopioid analgesic option for orthopaedic patients, and 32 US states have passed medical cannabis laws (MCLs), legalizing patient access to cannabinoids. We examine the association between implementation of state cannabis laws and prescribing patterns for opioids by orthopaedic surgeons in Medicare Part D patients between 2013 and 2017.
Spinopelvic Dissociation: A Systematic Review and Meta-analysis
B?cker, Henrik C.; Vosseller, J. Turner; Deml, Moritz C.; Perka, Carsten; Putzier, Michael
doi : 10.5435/JAAOS-D-19-00293
Journal of the American Academy of Orthopaedic Surgeons. 29(4):e198-e207, February 15, 2021.
Spinopelvic dissociation is a rare type of injury which occurs in approximately 2.9% of pelvic disruptions and correlates with high-energy trauma.
