Published 11/1/2010

Second Look – Clinical News and Views

If you missed these Headline News Now items the first time around, AAOS Now gives you a second chance to review them. Headline News Now—the AAOS thrice-weekly, online update of news of interest to orthopaedic surgeons—brings you the latest on clinical, socioeconomic, and political issues, as well as important announcements from AAOS.

Task force offers recommendations on atypical fractures
A task force of the American Society for Bone and Mineral Research finds that the incidence of atypical femoral fractures associated with bisphosphonate therapy for osteoporosis appears to be very low compared to the number of vertebral, hip, and other fractures prevented by the drugs. But recent observations suggest that risk rises with increasing duration of exposure. The task force recommended the creation of specific diagnostic and procedural codes, the establishment of an international registry, and label changes to increase awareness among physicians and patients of the possibility of atypical femoral fractures.

Many orthopaedic surgery patients have low vitamin D
Patients undergoing orthopaedic surgery often have low serum levels of vitamin D—a factor that may negatively impact patient outcomes. A retrospective review of 723 patients scheduled for orthopaedic surgery at a single institution between January 2007 and March 2008 found that 43 percent of all patients had insufficient serum vitamin-D levels, and, of those, 40 percent had deficient levels. The prevalence of low vitamin-D levels was significantly higher in men (p=0.006) and among blacks and Hispanics, who were 5.5 times more likely to have low vitamin-D levels when compared to whites and Asians (p<0.001). the research appeared in the>Journal of Bone & Joint Surgery—American (JBJS-A) (Oct. 6).

Drug may reduce DVT clotting
A study in the New England Journal of Medicine (Sept. 23) suggests that fondaparinux may help patients with acute, symptomatic superficial-vein thrombosis of the legs avoid more serious clots. The randomized, double-blind, placebo-controlled trial of 3,002 patients who were assigned to receive either placebo (n=1,500) or 2.5 mg of fondaparinux (n=1,502) each day for 45 days found the rate of pulmonary embolism or deep-vein thrombosis (DVT) at 47 days was 85 percent lower in the fondaparinux group than in the placebo group (0.2 percent vs. 1.3 percent; p<0.001) and observed similar risk reductions at day 77. major bleeding occurred in one patient in each group. the incidence of serious adverse events was 0.7 percent with fondaparinux and 1.1 percent with placebo.>

ACDF outcomes less than expected
Data presented at the annual meeting of the North American Spine Society find that anterior cervical decompression and fusion (ACDF) results in a 10 percent reoperation rate and a 70 percent clinical success rate. The conclusions are based on a meta-analysis of five studies, covering a sample of 1,154 single-level ACDF patients—562 who had fusions with a stand-alone interbody cage, and 592 who had fusions with an interbody allograft along with a titanium cervical plate. The presenter stated that most doctors would probably estimate that ACDF produces a 95 percent success rate.

Complications frequent in early-onset scoliosis
A study in JBJS-A finds that, regardless of treatment modality, the management of early-onset scoliosis is prolonged and complications should be expected. Data from the multicenter Growing Spine Study Group database on 140 patients (mean age at initial surgery, 6 years) who received growing-rod treatment (total 897 procedures) found that at a mean 5-year follow-up, 81 patients (58 percent) had at least one complication. Of the 71 patients with a single rod, 19 (27 percent) had unplanned procedures due to complications; among the 69 patients with dual rods, 7 (10 percent) had complications (p=0.05). Thirteen of 51 patients (26 percent) with subcutaneous rod placement had wound complications compared to 9 of 88 patients (10 percent) with submuscular rod placement. Patients with subcutaneous dual rods had more wound complications, more prominent implants, and more unplanned surgical procedures than did those with submuscular dual rods (p=0.05). For each additional surgical procedure, complication risk increased by 24 percent.

Treating cancer patients whohave spinal fractures
According to data presented at the annual congress of the European Society for Medical Oncology, balloon kyphoplasty may be used to treat compression fractures of the spine for patients with multiple myeloma or metastatic cancer. The randomized trial of 134 patients assigned to either balloon kyphoplasty (n=70) or nonsurgical management (n=64) found that patients in the surgical group reported a significant improvement in back pain 1 week after surgery, while those who received nonsurgical management saw no improvement. All patients who underwent balloon kyphoplasty reported sustained improvements in quality of life for 1 year after treatment.