Excess Opioid Medication Video Summary
Postoperative pain management in orthopaedic surgery accounts for a substantial portion of opioid medications prescribed in the United States. https://goo.gl/rZaM3y #JBJS #JBJSVideoSummaries
Tags: opioid, Orthopaedic, Orthopedic, pain, prescription
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My TweetsAcute-onset posterior shoulder pain in the overhead throwing athlete? Consider first rib stress fracture!
In the May 15th issue of The Journal, Funakoshi et al. performed a retrospective chart review of 23 overhead throwing to investigate the characteristic clinical features, radiographic findings, and outcome of first rib stress fractures.
They reported the average patient age was 16.8 years and primarily affected the dominate side. Typical chief complaints included pain with swinging or pitching and posterior shoulder or thoracic back pain.
After an average of 7.5 months of conservative treatment, 19 (71%) of fractures had healed and 7 (29%) were diagnosed as nonunions. Of the 7 nonunions, only 3 were symptomatic and were treated with 1st rib resection.
To learn more, you can read this article in full on jbjs.org
#jbjs #orthopedics #orthopedicsurgery
#ortho #orthosurgery
#sportsmedicine #sports #medicine #surgery #baseball #evidencebasedmedicine #meded #medicalschool #medicaleducation #rib
Beware of the electrocautery during total joint arthroplasty!
Sonntag et al. present findings of two clinical case reviews and an in vitro study evaluating the effect of electrocautery damage on metallic femoral stems in the May 15th issue of The Journal.
In the clinical case reviews, two failed stems after revision arthroplasty were retrieved and analyzed for cause of failure. Superficial discoloration and melting marks were found on the stem including at the exact location of the initial crack which led to the failures.
In light of these findings, the authors performed an in vitro study in which titanium alloy femoral stems were exposed to electrocautery burns and then underwent cyclic loading to failure. Compared to undamaged controls, the electrocautry damaged stems showed a significantly reduced load to failure by up to 47%. Given these findings, the authors recommend using great caution to avoid contacting implants with electrocautery devices during revision arthroplasty surgery to avoid subsequent implant failure.
#jbjs #orthopedics #orthopedicsurgery #ortho #orthosurgery #surgery #medicine #arthroplasty #revisionarthroplasty #totaljointreplacement #hipreplacement #hiparthroplasty #totalhiparthroplasty #evidencebasedmedicine #orthopedicresidency #orthoresidency #medicalschool
May 2019 Article Exchange with JOSPT - “Cervical Muscle Endurance Performance in Women With and Without Migraine.” Learn more: https://bit.ly/2HKKdRN
The mysteries of the ulnar-sided wrist…
Need an update on ulnar-sided wrist pain? Check out the May 2019 issue of JBJS Reviews were Brogan et al. present a critical analysis review of ulnar-sided wrist pain. The author review the pertinent anatomy of the wrist, physical exam and provocative tests, imaging, differential diagnosis and pathophysiology.
They further review the evidence behind treatment modalities for the main 4 categories of ulnar-sided wrist pain: triangular fibrocartilage complex disorders, extensor carpi ulnaris instability, malunion of the sigmoid notch, and distal radioulnar joint arthritis.
You can find this article on jbjs.org under JBJS Reveiws.
#jbjs #orthopedics #orthopedicsurgery #ortho #orthosurgery #surgery #medicine #handsurgery #hand #wrist #evidencebasedmedicine #orthopedicresidency #orthoresidency #medicalschool
Selective fusion of a primary thoracic or lumbar curve in adolescent idiopathic scoliosis (AIS) can result in spontaneous correction of the secondary curve without instrumentation resulting in a balanced spine at 10 years post op.
In the May 1st issue of The Journal, Louer et al. report the updated 10-year follow-up results from a previous multicenter prospective study of selective fusion of primary thoracic and lumbar curves published in 2013. The original study was a prospective observational study in which AIS patients with Lenke “C” curves were treated with selective fusion in an effort to spare motion segments. Compensatory curves were left non-instrumented with the expectation that it would spontaneously correct.
10-year results demonstrate that the instrumented main thoracic and thoracolumbar/lumbar curves were corrected by an average of 51% and 60%, respectively. Furthermore, the uninstrumented, compensatory curves had gradual spontaneous correction that approached the magnitude of the fused curve at 5 years postop and this correction was maintained at 10 years.
Check out jbjs.org to read this article in full and many others!
#jbjs #orthopedicsurgery #orthopedics #ortho #orthosurgery #spinesurgery #spine #scoliosis #spinefusion #medicine #surgery #evidencebasedmedicine
Mechanical failure of intramedullary rods is a rare phenomenon and typically occurs in the setting of poor fracture reduction and/or non-union.
Lambers et al. report a novel pattern of nail breakage seen in the recently deployed TFNA Proximal Femoral Nailing System in the May 1st issue of The Journal. Their laboratory analyzed 16 cases of broken TFNA implants. Bone reduction quality was good in 10 cases, acceptable in 4, and poor in only 2 cases. The average time to implement failure was 5 months.
Interestingly, of 8 patients who were treated with a second TFNA after the first implant failed, 3 (38%) experienced repeat implant failures.
Evaluation of the nail specimens showed that all fractures began at the thinnest cross-sectional location on the lateral aspect of the nail. The novel pattern seen was a stepped propagation of fracturing whereby a crack arrested, turned 90 degrees, propagated, arrested, turned 90 degrees, and propagated again, continuing this process until failure.
Of note, this study cannot comment on the incidence or risk of the TFNA implant failure. It just serves as a descriptive study on its mode of fatigue failure. Further work will have to be performed to assess breakage rates and revision rates.
Visit jbjs.org to find this article and learn more. Also, it's open access!
#jbjs #fracture #orthopedicsurgery #orthopedics #hip #orthopedictrauma #orthosurgery #ortho #hipfracture #medicine #surgery #trauma #evidencebasedmedicine
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