Journal of the American Academy of Orthopaedic Surgeons

Vertebral augmentation has been a well-studied adjunct percutaneous procedure in spine surgery. Cement augmentation has been used in the treatment of compression fractures through kyphoplasties or vertebroplasties. Historically, data have shown no difference between treating compression fractures conservatively versus with percutaneous cement augmentation procedures. Recent literature has shown improvement in patient outcomes and increase in mobility with percutaneous cement augmentation procedures. Cement augmentation has been used in treating patients with spinal column fractures in higher energy trauma...

INTRODUCTION: Acetabular fractures requiring an anterior approach have historically been delayed, allowing a stable clot to form before creating large surgical exposures. The purpose of this study was to determine whether immediate fixation of acetabular fractures within 24 hours using an anterior approach demonstrates notable difference in blood loss, length of stay (LOS), complications, or mortality compared with acetabular fractures treated after 24 hours. METHODS: Ninety-three patients were optimized for surgery within 24 hours of injury...

Considering the frequency of anterior cruciate ligament (ACL) tears, optimal management of these injuries was the subject of a 2022 clinical practice guideline update from The American Academy of Orthopaedic Surgeons (AAOS) with input from representatives from the American Orthopaedic Society for Sports Medicine, the Pediatric Orthopaedic Society of North America, the American Orthopaedic Society for Sports Medicine, the American Medical Society for Sports Medicine, the American Academy of Physical Medicine and Rehabilitation, and the American College of Emergency Physicians...

INTRODUCTION: The relationship between research productivity in training and future productivity as an attending spine surgeon is not well-established in the literature nor has the effect of geographic location of training institutions on future academic success been investigated. The aim of our study was to (1) summarize characteristics of academically productive spine surgeons, (2) assess predictors of long-term academic productivity, and (3) establish the effect of geographic location on long-term academic productivity...

INTRODUCTION: Bone anabolic agents can benefit orthopaedic patients perioperatively and improve outcomes after fragility fractures. However, preliminary animal data raised concern for the potential development of primary bony malignancies after treatment with these medications. METHODS: This investigation examined 44,728 patients older than 50 years who were prescribed teriparatide or abaloparatide and compared them with a matched control group to evaluate risk of primary bone cancer development...

Health literacy is a dynamic, multifaceted skill set that relies on patients, healthcare providers, and the healthcare system. In addition, health literacy assessment provides an avenue for evaluating patient understanding and offers insights into their health management capabilities. Inadequate health literacy results in poor patient outcomes and compromised care by considerably hindering successful communication and comprehension of relevant health information between the patient and the provider. In this narrative review, we explore why limited health literacy poses serious implications for orthopaedic patient health and safety, expectations, treatment outcomes, and healthcare costs...

BACKGROUND: Health inequities have been shown to have negative effects on patient care and the healthcare system. It is important for orthopaedic trauma surgeons and researchers to understand the extent to which patients are affected by these inequities. METHODS: We conducted a scoping review as outlined by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. We searched PubMed and Ovid Embase for articles relating to orthopaedic trauma surgery and health inequities...

Instability of the proximal tibiofibular joint is an uncommon and often unrecognized cause of lateral knee pain, mechanical symptoms, and instability. The condition results from one of three etiologies: acute traumatic dislocation, chronic or recurrent dislocations, and atraumatic subluxations. Generalized ligamentous laxity is a key predisposing factor for atraumatic subluxation. Instability of this joint may be in the anterolateral, posteromedial, or superior directions. Anterolateral instability is the most common type (80% to 85%) frequently occurring with hyperflexion of the knee with the ankle plantarflexed and inverted...

The number of spinal procedures and spinal fusions continues to grow. Although fusion procedures have a high success rate, they have inherent risks such as pseudarthrosis and adjacent segment disease. New innovations in spine techniques have sought to eliminate these complications by preserving motion in the spinal column. Several techniques and devices have been developed in the cervical and lumbar spine including cervical laminoplasty, cervical disk ADA, posterior lumbar motion preservation devices, and lumbar disk ADA...

Postoperative venous thromboembolism is a major adverse event associated with orthopaedic surgery. With the addition of perioperative anticoagulation and antiplatelet therapy, the rates of symptomatic venous thromboembolism have dropped to 1% to 3%, and as such, practicing orthopaedic surgeons must be familiar with these medications, including aspirin, heparin, or warfarin, and the use of direct oral anticoagulants (DOACs). DOACs are increasingly being prescribed due to their predictable pharmacokinetics and increased convenience, as they do not require routine monitoring, and 1% to 2% of the general population is currently anticoagulated...

Pediatric patients with neuromuscular conditions often have nonorthopaedic implants that can pose a challenge for MRI acquisition and surgical planning. Treating physicians often find themselves in the position of navigating between seemingly overly risk-averse manufacturer's guidelines and an individual patient's benefits of an MRI or surgery. Most nonorthopaedic implants are compatible with MRI under specific conditions, though often require reprogramming or interrogation before and/or after the scan. For surgical procedures, the use of electrosurgical instrumentation poses a risk of electromagnetic interference and implants are thus often programmed or turned off for the procedures...

Despite the overall success of anatomic and reverse total shoulder arthroplasties (aTSA and rTSA), some patients continue to have or develop pain postoperatively. As the number of shoulder arthroplasties continues to increase in the United States, it is important that surgeons are able to recognize, diagnose, and treat the various pathologies. Some painful etiologies are specific to either aTSA or rTSA, and others can occur with both implant types. Infections, stiffness, neurologic syndromes, polyethylene wear, aseptic implant loosening, and metal allergies occur, regardless of implant choice...

Posterior glenohumeral instability is an underappreciated cause of disability that may necessitate surgical intervention to allow functional glenoid restoration. However, posterior glenoid bone abnormalities, when sufficiently severe, may contribute to persistent instability despite a well-performed capsulolabral repair. Recognition and understanding of these lesions is critical to both surgical decision making and execution of the surgical plan. Numerous procedures have been described to address posterior instability including recent developments in arthroscopic grafting techniques...

The selection of fusion levels in the treatment of adolescent idiopathic scoliosis remains complex. The goals of surgery are to minimize the risk of future progression and optimize spinal balance while fusing the least number of levels necessary. Several classifications, rules, and algorithms exist to guide decision making, although these have previously not been easily referenced in a study. This review aims to provide an evidence-based approach of selecting fusion levels that balances the expert opinion of the authors with the current literature...

INTRODUCTION: Previous studies demonstrated an increase in adverse outcomes for patients undergoing elective surgeries with poorly controlled diabetes mellitus. At a large, tertiary-care spine center with a notable population of patients with poorly controlled diabetes, an Endocrinology Fast-Track (EFT) program was developed to improve patient optimization before elective spine surgery. The purpose of this study was to report our early experience. METHODS: Seventy-five patients who were scheduled for elective spine surgery were noted to have Hgb A1c > 7 on preoperative evaluation...

Malnutrition is an increasingly prevalent problem in patients undergoing total joint arthroplasty (TJA). Increased risks associated with TJA in the setting of malnourishment have been well documented. Standardized scoring systems in addition to laboratory parameters such as albumin, prealbumin, transferrin, and total lymphocyte count have been developed to identify and evaluate malnourished patients. Despite an abundance of recent literature, there is no consensus on the best approach for screening TJA patients from a nutritional standpoint...

Management of soft-tissue injuries is a critical principle in the treatment of orthopaedic trauma. Understanding the options for soft-tissue reconstruction is vital for successful patient outcomes. Application of dermal regenerative templates (DRTs) in traumatic wounds has created a new rung in the reconstructive ladder bridging the gap between skin graft and flap coverage. There are multiple DRT products with specific clinical indications and mechanisms of action. This review outlines the up-to-date specifications and uses of DRT in commonly seen orthopaedic injuries...

INTRODUCTION: Orthobiologics are increasingly used to augment healing of tissues. Despite growing demand for orthobiologic products, many health systems do not enjoy substantial savings expected with high-volume purchases. The primary goal of this study was to evaluate an institutional program designed to (1) prioritize high-value orthobiologics and (2) incentivize vendor participation in value-driven contractual programs. METHODS: A three-step approach was used to reduce costs through optimization of orthobiologics supply chain...

INTRODUCTION: Lack of consideration for risk-based assessments that inform osteoporosis treatment decisions may contribute to disease burden. In this study, we examined the prevalence of patients at very high risk of fracture and evaluated real-world treatment practices for these patients. METHODS: This retrospective observational cohort study used real-world data linked to commercial and Medicare medical claims from Symphony Health PatientSource. Patients 50 years and older with osteoporosis (determined by the presence of a diagnosis code) and at very high risk of fracture according to the American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) (AACE/ACE) 2020 guidelines between January 1, 2018, and December 31, 2018, were included...

The Black pediatric population is one that has been historically underserved and continues to have unmet needs. Factors including lack of diversity in orthopaedic studies and in historical standards, such as bone age, may inadvertently lead to inferior care. There are certain conditions in this population for which the practicing orthopaedic surgeon should have a higher degree of suspicion, including slipped capital femoral epiphysis, Blount disease, and postaxial polydactyly. Systemic diseases with higher rates in this population have orthopaedic manifestations, including sickle cell disease, vitamin D deficiency, and obesity...