AAOS Now, July 2017
Trends in Early Onset Spinal Deformity
In considering treatment strategies for young patients with early onset scoliosis, orthopaedic spine surgeons must think "beyond the curve," said Suken A. Shah, MD, during the Scoliosis Research Society (SRS) session of the Federation of Spine Association's 2017 Specialty Day. The SRS has changed its definition of early onset scoliosis to include all the deformities diagnosed before age 10 years, said Dr.
The Impact of Changing ABOS Written Examinations
The American Board of Orthopaedic Surgery (ABOS) administers computer-based written examinations for both the initial board certification process and also as part of the recertification process. The recertification examination is taken at the end of a Diplomate's 10-year Maintenance of Certification (MOC) cycle.
Metacarpal Shaft Fractures a Challenge in Athletes
During a presentation at the American Society for Surgery of the Hand Specialty Day meeting, Julie E. Adams, MD, offered advice on the treatment of metacarpal shaft fractures in athletic patients and on return to play issues. Dr. Adams stated that there are multiple options for treatment, but the optimal approach is often driven by patient needs. "The stakes are very different for the weekend warrior and professional athletes," she noted.
New Habits Can Better Serve Patients
During a recent meeting of the Patient Safety Committee, Chair David Ring, MD, PhD, facilitated a discussion on how physicians can deal with the conflict between evidence and experience. Participating committee members Dwight Burney, MD; Michael Pinzur, MD; Alan Reznik, MD; Andrew Grose, MD; and Michael Marks, MD, shared strategies. Dr Ring: As physicians, we all have ways of dealing with the limits of modern medicine—habits we fall back on when we face difficult situations.
Patient-Reported Outcome Measures for Research, Reimbursement, and Point of Care
Patient-reported outcome measures (PROMs) have become more common over the past 30 years. Providers have been exposed to PROMs through the reporting of performance measures for the Physician Quality Reporting System and payment reform efforts such as the Merit-based Incentive Payment System track in the Quality Payment Program (QPP) under the Medicare Access and CHIP Reauthorization Act (MACRA).
Minority Representation Among Orthopaedic Surgery Residents
In terms of diversity in orthopaedic surgery, the primary focus has been on gender. Issues of gender diversity have recently been highlighted by the media, giving rise to social and professional outcries for more women in the field. But diversity encompasses more than gender and, although essential, the recent push for more women in the field falls short of addressing the limited racial and ethnic diversity of orthopaedic surgeons. Women account for 14.
Second Look – Clinical News and Views
These items originally appeared in AAOS Headline News Now, a thrice-weekly enewsletter that keeps AAOS members up to date on clinical, socioeconomic, and political issues, with links to more detailed information. Subscribe at www.aaos.org/news/news.
Abnormal Elbow Findings Identified in Little League Throwers
A study of Little League baseball players before and after a season of play found that arm pain and MRI abnormalities of the medial elbow were common even in players who complied with the Little League throwing guidelines, especially those who played year round. Study data also support the conclusion that pain and injury are more closely related to the cumulative number of throws and not necessarily the number of pitches in a given game.
Addressing the Opioid Epidemic
Although many patients may benefit from opioid medications, abuse of prescription opioids is a serious problem responsible for nearly 50 deaths a day and thousands of emergency department visits a year. For example, the number of emergencies related to nonmedical use of opioids increased 183 percent between 2004 and 2011. In response, state governments passed nearly 60 laws in 2015 aimed at curbing the opioid epidemic.
Staying out of Trouble Prescribing Controlled Substances
Physician and public awareness of issues related to opioid use has skyrocketed over the past several years. Prescription drug abusers outnumber those who use all other "street" drugs except marijuana, and twice as many deaths are caused by prescription opioids than heroin. Every state except Missouri now has a Prescription Drug Monitoring Program (PDMP) that tabulates and distributes data about federally controlled substances that are prescribed and dispensed.
The Arduous Trek to Follow the Evidence
For years, close margins at the time of breast cancer excision led to a return to the operating room to achieve a wider margin. Surgical oncologists were simply not sure of how wide a margin was "enough." Then, in 2014, a meta-analysis of available data showed that as long as the margin was clear, it did not need to be wide. Recently, the impact of this guidance on surgical rates was reported. In just 2 years, a sizable, 16 percent reduction in "take-back" surgery was reported.