Archive | November 2017

Nov. 15 Webinar—Treating Clavicle Fractures

Capture_Clavicle FX for OBuzzOn November 15, 2017 at 7 PM EDTJBJS will join with JSES (Journal of Shoulder and Elbow Surgery) to present a webinar looking at the current paradigm for treating  clavicle fractures. Co-moderated by Drs. William Mallon, editor-in-chief of JSES, and Andrew Green, deputy editor of JBJS, the webinar will focus on two recent clavicle-fracture papers:

  • Dr. Philip Ahrens will discuss his recent JBJS paper, “The Clavicle Trial: A Multicenter Randomized Controlled Trial Comparing Operative with Nonoperative Treatment of Displaced Midshaft Clavicle Fractures.”
  • Dr. Brian Feeley will discuss his 2016 JSES paper, “Plate Fixation of Midshaft Clavicular Fractures: Patient-Reported Outcomes and Hardware-Related Complications.”

After each author presentation, expert commentary will be provided. Discussing Dr. Ahrens’ paper will be Dr. Michael McKee, recently named chairman of orthopaedics at the University of Arizona. Dr. Gus Mazzocca, chairman of orthopaedics at the University of Connecticut, will comment on Dr. Feeley’s paper. The webinar will then be open to addressing viewer-submitted questions for the authors and the commentators.

Seats are limited, so register now!

JBJS Unveils Reimagined Website

Hub_Homepage-2An authoritative source for clinically useful orthopaedic information for more than 125 years, The Journal of Bone & Joint Surgery (JBJS) has launched an entirely reengineered website—jbjs.org. This superior online orthopaedic experience—fully optimized for mobile devices—speeds users to targeted content across all six JBJS journals. With a more robust search engine and subspecialty collections, the new jbjs.org delivers practice-specific research results for journal articles, videos, images, webinars, podcasts, and CME activities—all with a single click.

Complimentary access to the new jbjs.org is available until December 31, 2017.

The new website also enhances the capacity of “My JBJS,” where users can store and organize content they have bookmarked. In addition, the site offers clearly organized direct links to JBJS CME material that is related to the user’s search query.

The new jbjs.org also features Clinical Summaries, 300- to 400-word “mini-reviews” of the latest clinical findings pertaining to 100 of the most common orthopaedic conditions. Each Clinical Summary is accompanied by direct links to the most relevant, highly cited articles in JBJS and other peer-reviewed orthopaedic and general-medicine journals. “We believe that Clinical Summaries represent a uniquely useful and evidence-based contribution to orthopaedic practice and the review process in orthopaedic surgery—and that they will improve patient care and enhance professional satisfaction,” said JBJS Editor-in-Chief Marc Swiontkowski, MD.

“The new jbjs.org gives us a unique publishing platform that allows the physician to control the experience,” said Paul Sandford, Chief Executive Officer at JBJS. “All digital content resources—including articles, videos, images, and more—can now be easily located and utilized through a proprietary search feature, subspecialty collections, and Clinical Summaries. This application will open the door for new developments and expand our presence and impact with orthopaedists both in the US and globally.”

For more information about the entirely new jbjs.org, click here.

Anatomic and Reverse Shoulder Replacement: Comparing Improvements Over Time

ATSA vs RTSA for OBuzz
Although the indications for anatomic and reverse total shoulder arthroplasty (TSA) are different, better understanding of the rate of improvement with each type of surgery could help establish more realistic patient expectations for recovery—and help surgeons and physical therapists design different strategies for postoperative care. With those goals in mind, Simovitch et al. use prospectively collected data to compare, at a minimum 2-year follow-up, clinical and range-of-motion (ROM) outcomes among 505 anatomic TSA patients and 678 reverse TSA patients. The findings appear in in the November 1, 2017 issue of JBJS.

The authors tracked five clinical outcome scores (SST, UCLA Shoulder, ASES, Constant, and SPADI), along with 4 relevant ROM measures. In both groups, >95% of patients reported clinical improvement in all 5 clinical metrics by 6 months, and full improvement was noted by 24 months. Not surprisingly, the mean age of patients who underwent reverse TSA was >5 years older and their shoulder-function scores and ROM were generally worse than those of the anatomic TSA patients.

At the time of the latest follow-up, patients who underwent anatomic TSA fared significantly better than patients who underwent reverse TSA in 3 of the 5 clinical outcome metrics and in all 4 ROM measurements. On the other hand, those who had reverse TSAs had significantly larger improvements in the Constant score (which emphasizes strength more than the other 4 clinical metrics) and active forward flexion.

ROM-wise, at approximately 6 years after surgery, the authors noted a progressive decrease in the magnitude of improvement for abduction and forward flexion in both groups. According to Simovitch et al., the observed discrepancies between clinical and ROM outcomes at longer-term follow-up suggest that “subjective (e.g., patient-reported) assessments of outcome and function likely continue to be stable or improve despite range-of-motion worsening and, as such, may imply that patient expectations change with follow-up time.”

Pulsatile Lavage Harms Muscle in Rat Model of Blast Injury

Rat Limb for OBuzzBasic science investigations into clinically relevant orthopaedic conditions are very common—and often very fruitful. What’s not very common is seeing results from large, multicenter randomized trials published in the same time frame as high-quality in vivo basic-science research on the same clinical topic.

But the uncommon has occurred. In the November 1, 2017 issue of The Journal, Chiaramonti et al. present research on the effects of 20-psi pulsatile lavage versus 1-psi bulb-syringe irrigation on soft tissue in a rat model of blast injuries. With support from the US Department of Defense, Chiaramonti et al. developed an elegant animal study that found radiological and histological evidence that lavage under pressure—previously thought to be critical to removing contamination in high-energy open fractures—results in muscle necrosis and wound complications.

Although none of the rats developed heterotopic ossification during the 6-month study period, the authors plausibly suggest that the muscle injury and dystrophic calcification they revealed “may potentiate the formation of heterotopic ossification by creating a favorable local environment.” Heterotopic ossification is an unfortunately common sequela in patients who suffer blast-related limb amputations.

The aforementioned rare alignment between basic-research findings and clinical findings in people relates to a large multicenter randomized clinical trial recently published in The New England Journal of Medicine. That study found that one-year reoperation rates among nearly 2,500 patients treated surgically for open-fracture wounds were similar whether high, low, or very low irrigation pressures were used. This is a case where the clinical advice from basic-study authors Chiaramonti et al. to keep “delivery device irrigation pressure below the 15 to 20-psi range” when managing open fractures is based on very solid ground.

Marc Swiontkowski, MD
JBJS Editor-in-Chief