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Upcoming Own the Bone Events

ownbone_logo-r.pngSpring and Summer 2017 are busy seasons for Own the Bone, the American Orthopaedic Association’s national post-fracture, systems-based, multidisciplinary fragility fracture prevention initiative:

Webinar: Components of a Secondary Fracture Prevention Program – May 4

On Thursday, May 4, at 5:00pm CDT (6:00pm EDT) Paul A. Anderson, MD, FAOA, from the University of Wisconsin, and Karen Cummings, PA-C, from the University of Michigan, will discuss the components of a successful secondary fracture prevention program.

Own the Bone Charlotte SymposiumJune 23: Fragility Fracture Care Coordination and Secondary Fracture Prevention

Join the National Association of Orthopaedic Nurses (NAON) and The American Orthopaedic Association for this full-day event on Friday, June 23. Attendees will receive a Fragility Fracture Symposium Certificate of Completion and continuing education credit.

Fragility Fracture Workshop at PAOS Annual Conference – August 21, Baltimore, MD

Join Physician Assistants in Orthopaedic Surgery (PAOS) and Own the Bone for a full-day fragility fracture and bone health workshop on the first day of the PAOS Annual Conference, Monday, August 21, in Baltimore.

JBJS/JSES Webinar–Rotator Cuff Tears: On Whom Should We Operate?

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The prevalence of rotator-cuff tears is reported to be as high as 30% in people over the age of 60 years. Yet there is still no clear consensus on the indications for surgical treatment of these tears.

On Wednesday, May 24, 2017 at 7:00 PM EDT, The Journal of Bone & Joint Surgery (JBJS) and the Journal of Shoulder and Elbow Surgery (JSES) will host a complimentary* webinar that presents findings from two recently published Level I studies of rotator-cuff tears.

  • John Kuhn, MD, discusses findings from a prospective multicenter cohort study in JSES that identifies the characteristics with the greatest influence over whether patients choose surgery for a chronic, symptomatic, full-thickness rotator cuff tear.
  • Stefan Moosmayer, MD, reports results from a randomized controlled trial in JBJS that found interesting clinical-outcome differences between physiotherapy alone and tendon repair in patients with tears ≤3 cm.

This webinar is co-moderated by Andrew Green, MD, JBJS deputy editor and chief of the Division of Shoulder and Elbow Surgery at the Warren Alpert Medical School of Brown University and Bill Mallon, MD, past-president of the American Shoulder and Elbow Surgeons (ASES) and editor-in-chief of the Journal of Shoulder and Elbow Surgery (JSES). The webinar will offer additional perspectives on the authors’ presentations from two rotator-cuff experts—Lawrence Higgins, MD and Leesa Galatz, MD. The last 15 minutes will be devoted to a live Q&A session, during which the audience can ask questions of all four panelists.

Seats are limited, so register now!

*This webinar is complimentary for those who attend the event live.

Follow Preop Heart-Testing Guidelines with Elderly Hip Fracture Patients

Heart Ultrasound.jpgFrom the perspective of a geriatric patient with a hip fracture, having a preoperative echocardiogram may not seem like a big deal, especially since it’s a noninvasive test. However, as Adair et al. reveal in an April 19, 2017 JBJS study, following clinical guidelines established by the American College of Cardiology (ACC) and the American Heart Association (AHA) could have prevented “cardiac echoes” from being done in 34% of 100 elderly hip fracture patients without missing any disease. Such unnecessary testing not only adds cost to the health care system, but can also delay surgical treatment for an operation that evidence suggests is best performed within 24 to 48 hours.

A single reviewer blinded to the later results of the tests assessed whether the ACC/AHA guidelines were followed in each case of an ordered echo; when ≥1 of the criteria were met, the echo was considered ordered in accordance with the guidelines. The rate of adherence to the guidelines was 66% over the 3.5-year study period. No important heart disease was found in any of the 34 patients who underwent an echocardiogram that had not been indicated by the guideline criteria, and 14 of the 66 patients (21%) for whom an echo was indicated by the criteria were found to have heart conditions serious enough to modify anesthesia or medical management.

The most common documented reasons for ordering an echo outside the guideline criteria were dementia that prevented evaluation of preoperative cardiac condition and generic “evaluation of cardiac function,” even though those patients had no history, physical exam findings, or work-ups that suggested heart disease.

Adair et al. conclude that these findings “suggest that integration of [clinical practice guidelines] into a perioperative protocol has the potential to improve the efficiency of preoperative evaluation, reduce resource utilization, and reduce the time to surgery without sacrificing patient safety.”

April 2017 Article Exchange with JOSPT

JOSPT_Article_Exchange_Logo.pngIn 2015, JBJS launched an“article exchange” collaboration with the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) to support multidisciplinary integration, continuity of care, and excellent patient outcomes in orthopaedics and sports medicine.

During the month of April 2017, JBJS and OrthoBuzz readers will have access to the JOSPT article titled “Dry Needling Versus Cortisone Injection in the Treatment of Greater Trochanteric Pain Syndrome: A Noninferiority Randomized Clinical Trial.”

In that randomized clinical trial of 43 patients (50 hips), dry needling was found to be a non-inferior treatment alternative to cortisone injections.

JBJS EST 2016 Editor’s Choice Awards

JBJS Essential Surgical Techniques (EST) is pleased to congratulate the winners of its two Editor’s Choice Awards for 2016:

The award for best technique article went to Austin T. Fragomen, MD and S. Robert Rozbruch, MD for Lengthening of the Femur with a Remote-Controlled Magnetic Intramedullary Nail.

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The recipients of the best Key Procedures video award were Jesse D. Chlebeck, MD; Christopher E. Birch, MD; and Jennifer W. Lisle, MD for Percutaneous in Situ Fixation of Slipped Capital Femoral Epiphysis.

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Click here to learn about the 2017 EST Editor’s Choice competition.

Are You Paying Your PAs Market Wages?

JOPA_Salary_Survey_Cover.pngGet the answer to that question and many more in the 2016 Salary and Call Survey, compiled by JOPA, the JBJS Journal of Orthopaedics for Physician Assistants.

In addition to a US regional breakdown of average base salaries among PAs working in orthopaedics, the 2016 survey contains accurate, trending information from PAs about:

  • Hospital versus Private-Practice Salaries
  • Trends in Bonuses, Benefits, and Perks
  • Workload and Autonomy
  • Call Structures and Schedules
  • Job Satisfaction

The survey was conducted by email during November and December 2016. JBJS Journal of Orthopaedics for Physician Assistants (JOPA) sent an online survey to 3,056 JOPA subscribers. Three-hundred twenty (320) physician assistants in orthopaedics responded, representing a response rate of 10%. At a 95% confidence level, results are projected at a ±5.5% margin of error.

Reverse TSA Components Are Durable, But Patient Outcomes Decline Over a Decade

Reverse TSA for O'Buzz.jpegReverse total shoulder arthroplasty (RTSA) has yielded promising medium-term outcomes, but what about longer-term results? In the March 15, 2017 edition of The Journal, Bacle et al. look at patient outcomes, prosthetic survival, and complications after a mean follow up of 12.5 years.

The good-news finding from this study was that the overall prosthetic survival rate (using revision as the end point) was 93%, confirming the reliability of the Grammont-style prosthesis. Time, however, took its toll on other outcomes. For example, both mean and absolute Constant scores among the cohort decreased significantly compared with the scores at the medium-term follow up (a minimum of 2 years). The cumulative long-term complication rate was 29%, with 10 of the 47 complications occurring at a mean of 8.3 years. Seven of those 10 delayed complications were attributed to mechanical loosening.

The authors suggest that the deterioration of RTSA outcomes seen in this study “is probably related to patient aging coupled with bone erosion and/or deltoid impairment over time.” They conclude that long-term RTSA outcomes “may be impacted by both the etiology of the shoulder dysfunction and the time since implantation.”

For more peer-reviewed content related to RTSA from JBJS Essential Surgical Techniques, click on the following links:

 

Both Subjective and Objective Measures Tell the Shoulder Story

Shoulder ROM Image for OBuzz.jpegWhen surgeons and patients discuss what treatment will work best for a particular musculoskeletal ailment, they often rely on both “subjective” and “objective” outcome data from previously published assessments. Reviewing both types of data is a good idea, because a study among more than 100 patients with shoulder osteoarthritis by Matsen et al. in the March 1, 2017 issue of The Journal of Bone & Joint Surgery found poor correlation between objective measures of active abduction and subjective patient self-assessments using the Simple Shoulder Test (SST).

The authors used a statistical method called “coefficient of determination”
to confirm “a highly variable relationship” between the patient-reported SST (subjective) and motor-sensor range-of-motion (objective) measurements. In less statistical language, many of the shoulders had good motion and poor self-assessed function, while others had poor motion and good self-assessed function.

The findings led the authors to conclude that “studies of treatment outcomes should include separate assessments of these 2 complementary aspects of shoulder function.”  That conclusion was seconded and expanded upon in a commentary by Jeffrey S. Abrams, MD, who wrote that “either [subjective or objective] assessment used independently may lead to the wrong impression.”

JBJS Case Connections—Spinal Epidural Hematoma: Rare, But Potentially Devastating

CCX O'Buzz Image.gifSpinal epidural hematoma is a rare condition. Because the etiology is often unclear and the medical history is frequently innocuous, a high index of suspicion is required in order to maximize the chances of a successful outcome.

This month’s “Case Connections” spotlights 4 cases of spinal epidural hematoma involving 2 elderly women, a male Olympic-caliber swimmer, and a preadolescent boy.

In the springboard case, from the March 22, 2017, edition of JBJS Case Connector, Yamaguchi et al. report on a 90-year-old woman with a history of transient ischemic attacks (TIAs) and combined aspirin-dipyridamole therapy in whom a large spontaneous spinal epidural hematoma (SSEH) developed rapidly after she shifted her position in bed. The authors concluded that their case emphasized that “early diagnosis of an SSEH and prompt surgical intervention can avoid catastrophic and permanent neurological deterioration and compromise.”

Three additional JBJS Case Connector case reports summarized in the article focus on:

Among the take-home points from this “Case Connections” article: MRI is the gold standard for the diagnosis of spinal epidural hematomas, and treatment typically involves operative decompression consisting of laminectomies and evacuation of the hematoma.

Thank You, JBJS Reviewers

During the 2017 AAOS Annual Meeting in San Diego next week, JBJS will formally recognize its 30 Elite Reviewers.

In the days leading up to the Annual Meeting, we would like to profile and thank some of our additional outstanding reviewers. Today, let’s meet Peter Stern and Kevin Garvin:

Stern

 

 

Peter Stern, MD
University of Cincinnati

 


What do you like best about reviewing for JBJS?
Expands my knowledge base and permits me to participate in a activity which I believe is paramount to broadening the orthopedic peer reviewed knowledge base.

How do you find time to review for JBJS?
I make the time on the weekend. Get up early.

What do you see as JBJS’ role in shaping the future of orthopaedics?
It’s the #1 peer-reviewed journal and provides accurate msk information in
many domains such as JBJS, JBJS Reviews, the virtual recertification course, Case Connector, etc.

 

 

Garvin

Kevin L. Garvin, MD
Nebraska Medical Center

What do you like best about reviewing for JBJS?
The opportunity to review cutting edge research and hopefully
help improve the clarity of the research.

How do you find time to review for JBJS?
I just make time for doing the reviews.

What do you see as JBJS’ role in shaping the future of orthopaedics?
One of the leading media for communicating new research.