Published 9/1/2010

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.

Glucosamine no better than placebo for LBP
A Norwegian study in the Journal of the American Medical Association (JAMA) (July 7) finds that a 6-month course of oral glucosamine did not reduce pain in patients with chronic low back pain (LBP) and degenerative lumbar osteoarthritis (OA). The double-blind, randomized, placebo-controlled trial included 250 patients older than 25 years of age with chronic LBP (longer than 6 months) and degenerative lumbar OA. Patients were randomized to receive either 1,500 mg of oral glucosamine or placebo for 6 months. Using the Roland Morris Disability Questionnaire, researchers found no statistically significant difference in change between groups at either 6-month or 1-year follow-ups (p = 0.72).

Predicting pain reduction after rotator cuff repair
According to data in the American Journal of Sports Medicine (July), a preoperative modified impingement test might help patients understand the subjective level of pain reduction they may experience after rotator cuff repair. A visual analog scale (VAS) was used to measure preoperative pain in 153 patients (94 females) with a rotator cuff tear before and after injection of 8 mL of 1 percent lidocaine into the subacromial space. At 1-year follow-up, the amount of pain reduction after the modified impingement test was significantly related to improvement of postoperative pain (p < 0.001) on the VAS. The change in ASES score was also related to the amount of pain reduction after the modified impingement test (p = .001).

Treating ACL tears
A study in the New England Journal of Medicine (July 22) suggests that rehabilitation and early reconstruction of the anterior cruciate ligament (ACL) is not superior to a strategy of rehabilitation plus optional delayed ACL reconstruction for active, young adults with acute ACL tears. The randomized, controlled trial involved 121 active, young adults assigned to undergo rehabilitation plus early ACL reconstruction (n = 62) or structured rehabilitation with the option of later ACL reconstruction if needed (n = 59). One patient in the early reconstruction group did not have surgery, and 23 patients in the optional reconstruction group eventually had ACL reconstruction. The absolute change in the mean Knee Injury and Osteoarthritis Outcome Score from baseline to 2 years was 39.2 for patients in the early reconstruction group, and 39.4 for patients in the optional group (absolute between-group difference, 0.2; p = 0.96 after adjustment for the baseline score). The results were similar when the data were analyzed according to the treatment actually received.

HCA MRSA rates may be dropping
From 2005 through 2008, rates of invasive healthcare-associated (HCA) methicillin-resistant Staphylococcus aureus (MRSA) infections decreased across nine diverse metropolitan areas, according to data in JAMA (Aug. 11). Laboratory-identified episodes of invasive (from a normally sterile body site) MRSA infections (n = 21,503) were evaluated and classified based on the setting of the positive culture and the presence or absence of healthcare exposures. Of these, 17,508 were HCA; of HCA cases, 15,458 were MRSA bloodstream infections. The incidence rate of hospital-onset invasive MRSA infections was 1.02 per 10,000 population in 2005, and decreased 9.4 percent per year (p = 0.005). The incidence of healthcare-associated community-onset infections was 2.20 per 10,000 population in 2005 and decreased 5.7 percent per year (p = 0.01).

Fractures in high school athletes
A study in the Clinical Journal of Sport Medicine (July) finds that fractures have a high financial burden and can severely affect continued sports participation among high school athletes. An analysis of sports injury data from a nationally representative sample of 100 U.S. high schools from 2005 to 2009 found that fractures accounted for 10.1 percent of all injuries sustained by athletes. Football had the highest rate of fractures (4.61 per 10,000 athlete exposures).

The most frequently fractured body sites were the hand/finger (28.3 percent), wrist (10.4 percent), and lower leg (9.3 percent). In addition, 16.1 percent of fractures required surgical treatment, accounting for 26.9 percent of all injuries requiring surgery.

Sepsis and septic shock after surgery
A study in the Archives of Surgery (July) finds that sepsis and septic shock are more common after general surgery than pulmonary embolism (PE) or myocardial infarction (MI). The retrospective review of 363,897 general surgery patients from the 2005–2007 National Surgical Quality Improvement Program database found that 8,350 patients (2.3 percent) had sepsis, 5,977 (1.6 percent) had septic shock, 1,078 (0.3 percent) had PE, and 615 (0.2 percent) had MI. Sepsis and septic shock were more common after emergency surgery than after elective surgery (p < 0.001).

Dynamic fixators for unstable wrist fractures
Continuous dynamic traction with a dynamic external fixator may compare favorably to the use of static external fixators for the treatment of unstable distal radial fractures, according to data from a Norwegian study in the Journal of Bone & Joint Surgery—American (July 21). The prospective randomized study compared radiographic and clinical results of dynamic external fixation with those of static external fixation. Patients who underwent dynamic fixation had a significantly better restoration of radial length at 3-, 6-, and 12-month follow-up compared to patients who were treated with static fixation; regained wrist flexion, radial deviation, and pronation-supination significantly faster; and had significantly better wrist extension at all follow-ups. No significant differences in radial tilt or radial inclination were found between the two groups.

MRSA prevalence
Patients arriving at healthcare facilities via helicopter from community sites were just as likely to test positive for MRSA as patients who were being transferred from other healthcare facilities, according to data in Air Medical Journal (July/August). Of 827 patients flown by a single carrier and tested via nasal swab during an 8-month period in 2007, 51 were positive for MRSA—34 of 576 (5.9 percent) interfacility transports and 17 of 251 (6.8 percent) transported from other sites in the community, such as accident scenes.