Low back pain is not typically thought to be a pediatric issue; however, this condition occurs in 33% of adolescents each year—a rate similar to that seen in adults. The most common identifiable cause of low back pain in the adolescent is spondylolysis, a defect in the pars interarticularis. How is this condition best diagnosed and treated? Do oblique radiographs help diagnose spondylolysis in adolescents? What kind of short- and long-term clinical outcomes can adolescents—and especially adolescent athletes—diagnosed with acute spondylolysis expect to have? What factors might predict long-term outcomes?
These important and clinically applicable questions will be addressed during a complimentary LIVE webinar, hosted jointly by the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) and The Journal of Bone & Joint Surgery (JBJS).
JBJS presenter, Peter Passias, MD, will discuss findings from a retrospective study of adolescents with and without L5 spondylolysis to address whether oblique radiographic views add value in the diagnosis of this cause of low back pain. This paper specifically addresses whether the diagnostic benefit of four-view studies outweighs the additional cost and radiation exposure, especially for young people.
JOSPT co-author Mitchell Selhorst, DPT, OCS, will share the results of a retrospective review of acute spondylolytic injuries in young athletes. This study reports long-term clinical outcomes for these patients and identifies significant predictors of these outcomes.
Moderated by JBJS Deputy Editor Andrew J. Schoenfeld, MD, who specializes in spondylolisthesis, spinal stenosis, and spinal surgery, the webinar will include additional insights from expert commentators, Chris Bono, MD,from Brigham and Women’s Hospital in Boston, and Michael Allen, PT, from Cincinnati Children’s Hospital Medical Center. The last 15 minutes will be devoted to a live Q&A session between the audience and panelists.
Space is limited, so Register Now.
OrthoBuzz occasionally receives posts from guest bloggers. This guest post comes from Jason Weisstein, MD, MPH, FACS.
I want to expand on my previous posts (Tips to Excel Under MIPS and Why EHR Data & Analytics Matter) and focus on another differentiating factor when it comes to electronic health record (EHR) systems and your success with Medicare’s Merit-based Incentive Payment System (MIPS).
The ability to interact with specialized health registries is another functionality your EHR system should have. Active engagement with a clinical data registry falls under the Advancing Care Information (ACI) component of MIPS. In general, having EHR-enabled access to such specialized health registries can make MIPS compliance easier and help you earn bonus points, which translates into increased practice income.
Some examples of orthopaedic-specific registries could include the following:
- Medial Meniscus Tear, Acute Registry
- Plantar Fasciitis Registry
- Low Back Pain
- Herniated Disc, Cervical Registry
In addition to having the ability to interact with orthopaedic-specific registries in order to participate in ACI and improve your MIPS score, registry engagement through your EHR system will help to improve population health by collecting and reporting on data about musculoskeletal treatment effectiveness and disease trends. Public health reporting can be very complicated and time-consuming, but having an EHR system that automatically and seamlessly collects and transmits the data to the registry, without manual intervention, is a robust advantage.
Finally, access to registry data will help your practice with the Improvement Activities component of MIPS, which, during the so-called transition year of 2017, is weighted at 15% of the total MIPS score.
Jason Weisstein, MD, MPH, FACS is the Medical Director of Orthopedics at Modernizing Medicine.
OrthoBuzz regularly brings you a current commentary on a “classic” article from The Journal of Bone & Joint Surgery. These articles have been selected by the Editor-in-Chief and Deputy Editors of The Journal because of their long-standing significance to the orthopaedic community and the many citations they receive in the literature. Our OrthoBuzz commentators highlight the impact that these JBJS articles have had on the practice of orthopaedics. Please feel free to join the conversation by clicking on the “Leave a Comment” button in the box to the left.
Charles Neer II , a true pioneer in shoulder surgery, coined the term “cuff-tear arthropathy” in 1977. In a landmark 1983 JBJS publication, Dr. Neer, with coauthors Craig and Fukuda (both of whom became internationally recognized experts in shoulder surgery), reported on the pathophysiology and treatment of this previously little-recognized condition that was associated with long-standing massive rotator cuff tears.
Neer’s early work with total shoulder arthroplasty, also reported in JBJS, included a small cohort of patients with cuff-tear arthropathy. In the 1983 article on cuff-tear arthropathy, Neer and his coauthors described the pathologic presentation and treatment with total shoulder arthroplasty, along with a proposed pathophysiologic mechanism. They noted that, although it was a difficult procedure, their preferred treatment was “total shoulder replacement with rotator cuff reconstruction and special rehabilitation.”
Between 1975 and 1983, they surgically treated only 26 patients. Others later recognized that total shoulder replacement was associated with early glenoid failure and recommended treatment with humeral hemiarthroplasty.1 With either approach, success was limited by rotator cuff deficiency and dysfunction. The results were variable, with a small proportion having good outcomes and others achieving some pain relief and limited functional improvement.
Although it was not the first attempt at a reverse shoulder arthroplasty (RSA), Grammont developed an innovative design with improved implant technology and biomechanics to treat massive rotator cuff tears.2 This solved the biomechanical problem that resulted from a deficient rotator cuff and forever revolutionized the care of cuff-deficient shoulders. The Delta 3 prosthesis became available in Europe in the early 1990s but was not widely available in the US until 2004, when it was approved by the FDA.
Initially developed, approved, and used exclusively for cuff-tear arthropathy, early clinical success led to utilization for other conditions with deficient or dysfunctional rotator cuffs, including pseudoparalysis, revision shoulder arthroplasty, acute proximal humerus fractures, fracture sequelae, and chronic glenohumeral dislocations. The results have been so good that the indications have expanded beyond the initial recommendations for use only in elderly low-demand patients. Initial concerns were mollified by the apparent longevity and reported survivorship. Subsequently, there has been such a huge increase in utilization that RSA is approaching 50 percent of the US market share and some of the international market. The implications of expanded indications and increased utilization are yet to be seen.
In 1983, Neer and coauthors reported on what was then a relatively uncommon degenerative condition of the shoulder. Today, rotator cuff-deficient shoulders are much more common and can be better treated due to advances in our understanding of the pathophysiology and biomechanics of the condition, as well as advances in shoulder arthroplasty technology.
Andrew Green, MD
JBJS Deputy Editor
1. Franklin JL, Barrett WP, Jackins SE, Matsen FA 3rd. Glenoid loosening in total shoulder
arthroplasty. Association with rotator cuff deficiency. J Arthroplasty. 1988;3(1):39-46.
2. Grammont PM, Baulot E. Delta shoulder prosthesis for rotator cuff rupture. Orthopedics. 1993 Jan;16(1):65-8
The debate continues as to whether midshaft clavicular fractures are optimally treated surgically or nonoperatively. More data about this clinical dilemma is delivered in the January 18, 2017 issue of JBJS, where Woltz et al. report findings from a multicenter controlled trial that randomized 160 clavicular-fracture patients to receive ORIF with a plate or nonoperative treatment with a sling and physical therapy.
The rate of radiographic nonunion was significantly higher in the nonoperatively treated group after 1 year, but no difference was found between the groups with respect to Constant and DASH scores at any time point—6 weeks, three months, and 1 year. Pain scores and general physical health were marginally better after operative treatment, but only at 6 weeks. However, the rate of second operations for adverse events in the ORIF group was considerable, and after 1 year, implant removal was performed in or scheduled for 16.7% of the operatively treated patients.
Based on these findings and other recent data, the authors “do not advocate routine operative treatment for displaced midshaft clavicular fractures,” although they say early plate fixation may offer advantages for patients who have high demands, high pain scores, or a strong preference for surgery. Based on the fact that “neither treatment option is clearly superior for all patients,” the authors conclude that “the clavicular fracture is preeminently suitable for shared treatment decision-making.”
The Ponseti method is a proven treatment for idiopathic clubfoot, yielding excellent outcomes with minimal pain or disability. However, as many as 40% of patients fail to respond to initial treatment or develop recurrent deformities.
On Wednesday, January 25, 2017 at 8:00 PM EST, The Journal of Bone & Joint Surgery hosted a webinar that delved into two recent JBJS studies investigating how to predict which patients are most likely to get subpar results from the Ponseti method, and how best to manage clubfoot relapses if they occur.
- Matthew Dobbs, MD, describes in detail various soft-tissue abnormalities present in patients with treatment-resistant clubfoot that are not present in treatment-responsive patients. These parameters could be used to predict which clubfoot patients are at greater risk of relapse.
- Jose Morcuende, MD, will spotlight findings from a study that followed treated clubfoot patients for 50 years to determine whether relapses managed with repeat casting and tibialis tendon transfer during early childhood prevented future relapses.
This webinar was moderated by James Kasser, MD, surgeon-in-chief at Boston Children’s hospital and a member of the JBJS Board of Trustees. The webinar offered additional perspectives on the authors’ presentations from two clubfoot-management experts—Steven Frick, MD and Gregory Mencio, MD. The last 15 minutes was devoted to a live Q&A session, during which the audience asked questions of all four panelists.
Register now to watch the webinar on-demand!