AAOS Approves First AUC

Mary Ann Porucznik

The AAOS Board of Directors approved the Academy’s first appropriate use criteria (AUC)—on the treatment of distal radius fractures—at their meeting on March 18, 2013. AUC, explained Kevin J. Bozic, MD, MBA, chair of the Council on Research and Quality, “are another step in ensuring that orthopaedic patients receive high quality, cost-effective, and appropriate musculoskeletal care.”

Obese Patients Present a Weighty Problem

Mary Ann Porucznik

Obesity is a big problem in the United States, where two thirds of the population is either overweight (body mass index [BMI] of 25 to 29.9) or obese (BMI of 30 or higher). That presents an issue—not only for orthopaedists and other medical specialists—but also for policymakers trying to find ways to cut healthcare costs.

Disk Regeneration: A Dream Within Reach?

Jay D. Lenn

The Catch 22 of managing back pain due to disk degeneration is that while surgical treatment usually eliminates pain, it often reduces flexibility of the spine. The precise biologic mechanisms that preserve disk integrity and thus ensure proper function are still a mystery. Among research studies to date, no consensus has been reached on treatment methods that will best alleviate pain and preserve flexibility.

Informed Consent—It’s Complicated

Thomas J. Moore, MD

Informed consent is a particularly thorny issue in medical ethics. In general, orthopaedists and orthopaedic residents are aware and compliant, although the lack of clear guidance on what, when, and how much to say is problematic. Several factors have been identified as optimal in obtaining informed consent, especially in the avoidance of litigation. For example, informed consent should be obtained in the clinic or office, rather than in the preoperative area.

Concentration: A Double-Edged Sword?

Joe B. Wilkinson, MD, FACS

Patient safety literature is filled with references to aviation accidents and safety. Probably the most often cited accident is the crash of United Airlines flight 173, which occurred in December 1978. As the plane began its approach into Portland, Ore., it appeared that one of the main landing gears had not deployed properly. It was not clear whether the problem was with the gear itself or with the gear indicator lights. The pilot became preoccupied with troubleshooting the gear problem.

The Challenge of Corrosion in Orthopaedic Implants

Kenneth L. Urish, MD, PhD; Paul A. Anderson, MD; William M. Mihalko, MD, PhD; the AAOS Biomedical Engineering Committee

Corrosion has been a persistent challenge in orthopaedics. Even Sir John Charnley noted the critical challenges of corrosion in the design of trauma and arthroplasty implants. The idea that different metals cannot be used in the same implant secondary to galvanic corrosion is a basic scientific concept in orthopaedic residency education. But in actual practice, multiple different metals are combined to improve overall implant design.

Kappa Delta Award Recognizes Research in Muscle Architecture

Terry Stanton

Considering how fundamental knowledge of muscle and its anatomy is to orthopaedics, Richard L. Lieber, PhD, found it “inconceivable” when he realized by looking at past textbooks that, prior to the 1990s, scant attention was paid to the basic architecture of muscle and its microscopic qualities. Richard L.