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The Mental Side of the Injured Athlete
Daley, Mary M. MD; Griffith, Kelsey MS; Milewski, Matthew D. MD; Christino, Melissa A. MD
doi : 10.5435/JAAOS-D-20-00974
Journal of the American Academy of Orthopaedic Surgeons: June 15, 2021 - Volume 29 - Issue 12 - p 499-506
The psychosocial benefits of participating in sports have long been appreciated. However, athletes are often faced with circumstances that make them susceptible to psychological challenges unique to the athletic population. One such circumstance is injury in sport, which can be a source of notable distress and may precipitate the emergence of new or exacerbation of underlying psychological disorders. In athletes who are injured, particularly those undergoing surgical intervention, psychological factors play a substantial role in the recovery process. A more comprehensive understanding of the complex interplay between psychological and physical health in the setting of an injury is essential to optimize patient care. The aim of this review was to highlight the impact of psychological factors on measurable outcomes after orthopaedic surgical interventions and to explore interventions that can be implemented to improve surgical outcomes and the overall care of injured athletes.
Stress Fractures of the Fifth Metatarsal in Athletes
Patel, Karan A. MD; Christopher, Zachary K. MD; Hubbard, Christopher E. MD; O'Malley, Martin J. MD
doi : 10.5435/JAAOS-D-20-01060
Journal of the American Academy of Orthopaedic Surgeons: June 15, 2021 - Volume 29 - Issue 12 - p 507-517
Stress fractures of the fifth metatarsal (zones 2 and 3) remain a challenging clinical problem. It has been well established that nonsurgical treatment has unacceptably high nonunion and refracture rates. Surgical fixation remains the treatment of choice in the athletic cohort, and intramedullary screw fixation with a solid screw has been established as the most predictable means of achieving a successful outcome. Recently, the use of a plantar plate has also been advocated as has been shown in some studies to be more biomechanically advantageous. The use of bone grafting at the primary surgery and morphology and screw type are also important decisions to be made when treating these patients. This review will discuss our management of both primary fractures and refractures of the fifth metatarsal in athletes.
Open and Arthroscopic Triangular Fibrocartilage Complex (TFCC) Repair
Srinivasan, Ramesh C. MD; Shrouder-Henry, Jason J. MD, MBA, FRCS(C); Richard, Marc J. MD; Ruch, David S. MD
doi : 10.5435/JAAOS-D-20-00998
Journal of the American Academy of Orthopaedic Surgeons: June 15, 2021 - Volume 29 - Issue 12 - p 518-525
Triangular fibrocartilage complex (TFCC) tears, whether acute or chronic, can result in persistent ulnar-sided wrist pain. Although diagnosis and nonsurgical management of TFCC tears is well described, there remains ongoing discussion about the optimal surgical technique, specifically open or arthroscopic. This article reviews the most up-to-date literature regarding TFCC injury including demographics, risk factors for TFCC injury, classification of acute and chronic TFCC tears, history and physical examination, appropriate diagnostic imaging, surgical indications, pertinent surgical anatomy, open and arthroscopic TFCC repair, fixation biomechanics and techniques, postoperative rehabilitation, and clinical outcomes.
The Use of Tranexamic Acid in Hip and Pelvic Fracture Surgeries
Adams, John D. Jr MD, FAAOS; Marshall, William A. MD
doi : 10.5435/JAAOS-D-20-00750
Journal of the American Academy of Orthopaedic Surgeons: June 15, 2021 - Volume 29 - Issue 12 - p e576-e583
Tranexamic acid (TXA) use has expanded across many surgical specialties. It has been shown to reduce blood loss, decrease transfusion rates, and, in some cases, improve mortality. Within orthopaedic surgery, its popularity has primarily grown within arthroplasty and spinal surgery. It has only recently gained traction within the field of orthopaedic trauma and fracture care. At this time, most literature focuses on hip fracture and pelvic trauma surgery. For hip fractures, the results are encouraging and generally support the claim that TXA may lower overall blood loss and decrease transfusions. Conversely, less support exists for TXA use in fractures of the acetabulum or pelvic ring. Based on the current fracture-related studies, TXA does not seem to carry an increased risk of thromboembolism or other complications. In addition, few studies have been noted discussing the route of administration, timing, or dosage. This article reviews the most current literature regarding TXA use in fracture care and expands on the need for further research to evaluate the role of TXA in orthopaedic trauma populations who carry a high risk for transfusion.
Patient Engagement Technologies in Orthopaedics: What They Are, What They Offer, and Impact
Kavolus, Joseph J. MD, MSCR; Moverman, Michael A. MD; Karas, Vasili MD; Iorio, Richard MD
doi : 10.5435/JAAOS-D-20-00585
Journal of the American Academy of Orthopaedic Surgeons: June 15, 2021 - Volume 29 - Issue 12 - p e584-e592
The modern era is an increasingly digital and connected world. Most of the Americans now use a smartphone irrespective of age or income level. As smartphone technologies become ubiquitous, there is tremendous interest and growth in mobile health applications. One segment of these new technologies are the so-called patient engagement platforms. These technologies present a host of features that may improve care. This article provides an introduction to this growing technology sector, offers insight into what they may offer patients and surgeons, and discusses how to evaluate various platforms.
Risk Factors for Increased Consumption of Narcotics After Hip Arthroscopy: A Prospective, Randomized Control Trial
Selley, Ryan S. MD; Hartwell, Matthew J. MD; Alvandi, Bejan A. MD; Terry, Michael A. MD; Tjong, Vehniah K. MD
doi : 10.5435/JAAOS-D-20-00122
Journal of the American Academy of Orthopaedic Surgeons: June 15, 2021 - Volume 29 - Issue 12 - p 527-536
No accepted standard exists regarding the number of opioids to prescribe after many surgical procedures, and previous literature has indicated that the number of opioids prescribed influences the total number of pills consumed. The goal of this study was to investigate whether prescribing less opioids after hip arthroscopy results in less total postoperative utilization without compromising analgesia and identify risk factors for increased use.
Comorbidity Burden Contributing to Racial Disparities in Outpatient Versus Inpatient Total Knee Arthroplasty
Wu, Mark MD; Belay, Elshaday MD; Cochrane, Niall MD; O'Donnell, Jeffrey MD; Seyler, Thorsten MD, PhD
doi : 10.5435/JAAOS-D-20-01038
Journal of the American Academy of Orthopaedic Surgeons: June 15, 2021 - Volume 29 - Issue 12 - p 537-543
Outpatient total knee arthroplasty (TKA) is increasingly common in the setting of early-recovery protocols, value-based care, and removal from the inpatient-only list by the Centers for Medicare & Medicaid Services. Given the established racial disparities that exist in different aspects of total joint arthroplasty, we aimed to investigate whether racial and ethnic disparities exist in outpatient compared with inpatient TKA.
A Matched Control Analysis on the Effects of Alcohol Use Disorder After Primary Total Knee Arthroplasty in Medicare Patients
Luo, T. David MD; Vakharia, Rushabh M. MD; Gwam, Chukwuweike U. MD, MBA; Zuskov, Andrey MD; Plate, Johannes F. MD, PhD; Roche, Martin W. MD
doi : 10.5435/JAAOS-D-20-00466
Journal of the American Academy of Orthopaedic Surgeons: June 15, 2021 - Volume 29 - Issue 12 - p e593-e600
Several studies have found the negative impact of alcohol use disorder (AUD), most notably coagulation derangements. We sought to investigate the effects of AUD after primary total knee arthroplasty (TKA) for (1) postoperative complications, (2) lengths of stay, and (3) costs of care.
Major Orthopaedic Conference Abstract Publication: An Analysis of Abstracts Accepted for the AAOS Annual Meetings Between 2014 and 2017
Le, Ryan BA; Anderson, Amanda BS; Chalmers, Christen E. BS; Scolaro, John A. MD; Lee, Yu-Po MD; Bhatia, Nitin MD
doi : 10.5435/JAAOS-D-20-00501
Journal of the American Academy of Orthopaedic Surgeons: June 15, 2021 - Volume 29 - Issue 12 - p e601-e608
The American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting provides an opportunity for clinicians to attain the most recent advancements in the orthopaedic field. However, the most recent study analyzing publication rates from the 2001 Annual Meeting determined that only 49% of the podium and poster abstracts were eventually published. The purpose of this study was to determine the publication rate, likelihood of publication based on the presentation format, and time to publication for abstracts presented at the 2014 to 2017 AAOS Annual Meetings.
A Tensionable Suture-based Cerclage Is an Alternative to Stainless Steel Cerclage Fixation for Stabilization of a Humeral Osteotomy During Shoulder Arthroplasty
Denard, Patrick J. MD; Nolte, Philip-C. MD, MA; Millett, Peter J. MD, MSc; Adams, Christopher R. MD; Liebler, Stephenie A.H. PhD; Rego, George MPH, PA-C; Higgins, Laurence D. MD, MBA
doi : 10.5435/JAAOS-D-20-00047
Journal of the American Academy of Orthopaedic Surgeons: June 15, 2021 - Volume 29 - Issue 12 - p e609-e617
Fixation of periprosthetic humeral fractures is most commonly obtained with steel-based wires or cables; however, disadvantages with these constructs are numerous. Suture-based cerclages offer the advantage of easy handling, less radiographic interference, and risk of metallosis, as well as decreased risk of cutting into the soft humeral bone. Therefore, the purpose of this study was to compare a suture-based cerclage to a stainless steel wire cerclage (SSWC) for stabilization of the humerus during shoulder arthroplasty.
Dual-Mobility Articulations in Femoral Neck Fractures: A Systematic Review of the Literature and Meta-analysis of the Outcomes
Albanese, Kevin M. MD; Deshmane, Prashant MD; Patil, Nilesh MD; Larsen, David A. PhD; Ordway, Nathaniel R. MS
doi : 10.5435/JAAOS-D-20-00407
Journal of the American Academy of Orthopaedic Surgeons: June 15, 2021 - Volume 29 - Issue 12 - p e618-e627
Femoral neck fractures have been traditionally managed with hemiarthroplasty (HA) or conventional total hip arthroplasty (CTHA). There has been recent interest in using dual-mobility components (DMC) in total hip arthroplasty for patients with femoral neck fractures to provide increased stability and decrease the need for future revision.
