AAOS Now, October 2018
Study Details How to Improve RTS Rates in Young Athletes with Shoulder Instability
Managing shoulder instability in athletes younger than 22 years of age can be challenging due to the high failure rates associated with nonoperative treatment and the high recurrence and low return-to-sport (RTS) rates following arthroscopic shoulder stabilization.
Meta-analysis Evaluates CDC’s Recommendation of a Single, Preoperative Dose of Antibiotics
Postoperative infections following orthopaedic procedures that involve placement of metallic implants can be devastating and may result in infected nonunion, removal of hardware and antibiotic spacer placement, prolonged use of antibiotics, or even amputation.
S. aureus Infects and Hides in Living Osteocytes in PJIs
Over the past three years, my colleagues and I have studied Staphylococcus aureus (S. aureus) bacteria and their ability to infect and reside inside human living osteocytes. This phenomenon may explain why periprosthetic joint infections (PJIs) are difficult to treat and clear, as well as why they can recur months or years after infection treatment or primary surgery.
Milestone: Academy Launches Shoulder and Elbow Registry
October is a milestone month for the Academy’s Registry Program, as it launches the Shoulder and Elbow Registry (SER). Building on the success of the American Joint Replacement Registry (AJRR)—the trailblazer data depository and resource for U.S. knee and hip arthroplasty that last year was reintegrated under the AAOS umbrella—SER will be previewed at the American Shoulder and Elbow Surgeons (ASES) meeting Oct. 11–14 and make its formal debut at the Academy’s Fall Meeting Oct. 25–27.
Joy in Practice Impacts Patient Safety
Loss of joy in practice—often referred to more pessimistically as “burnout”—is characterized by feelings of exhaustion, depersonalization or detachment, and perceived personal failure. Although orthopaedic surgeons have relatively high job satisfaction and reimbursement compared to other clinicians, trends suggest that—consistent with medicine in general—joy in orthopaedic practice is declining.
Patient Safety Committee Discusses Using Overutilization as a Quality Measure
When orthopaedic surgeons think of quality and safety, things like medication errors, wrong-site surgery, and hospital-acquired infection often come to mind. To be safe and improve quality, we adopt computerized order entry, utilize the World Health Organization checklist, and wash our hands going into and out of every patient’s room. And we measure our performance. When it comes so-called shared decision making, most of us think, “I do that well.” But do we really?
Communication Skills Are Critical to Improving Patient-centered Care and Shared Decision Making
This is part one of a two-part series on shared decision making. Part two, which will appear in the November issue of AAOS Now, will present an illustrative case where missing the basic tenets of shared decision making led to an unsatisfactory patient experience. Physicians cannot ignore the nontechnical, soft skills and still be successful In 1998, AAOS conducted an image perception survey, the results of which revealed that the public viewed orthopaedic surgeons as “high-tech and low-touch.”
Pediatric SHFs with Vascular Injuries Are Complex
Supracondylar humerus fractures (SHFs) are the most common fractures in children, and the annual rate of SHF presentation is estimated to be 177 per 100,000 children. More than 90 percent exhibit extension or posterior displacement of the distal fracture fragment. This fracture is associated with a high incidence of complications, including neurologic and vascular injury, as well as compartment syndrome. In children, SHF is associated with vascular complications in about 20 percent of cases.
Avoid Risks During Hip Fracture Management in a Medically Complex Patient
Care in the medically complex patient with a hip fracture can be difficult to organize, inefficient, and fraught with risks of complications. By creating a framework and a collaborative approach guided by the AAOS evidence-based Clinical Practice Guideline (CPG), providers can avoid pitfalls in the care of these challenging cases. A 65-year-old female was referred to her hematologist with profound anemia, hypercalcemia, and a protein gap on serum protein electrophoresis.
AOFAS Surveys the Field
The leaders of the American Orthopaedic Foot & Ankle Society (AOFAS) think they and their members are part of an exciting, satisfying, and multifaceted practice focus. They’d like to be sure the word gets out to aspiring orthopaedic surgeons.
A Personal Tale of Opioid Overprescribing
I awoke to a text message at 11 p.m. on a Monday night from one of the trainers. I thought it was about an athlete with a hand or elbow injury needing urgent surgical intervention. But, half asleep, I read: “Please call regarding patient that was assaulted over the weekend and attempted suicide today by taking a large amount of hydrocodone. She is in the intensive care unit (ICU).” I sat up, completely awake. After a quick phone conversation, there was no need to look up the patient.
An RCT of FAI Surgery Versus Physical Therapy: What Does It Really Teach Us?
The following letter is in response to a news brief included in the Feb. 21 issue of AAOS Headline News Now titled “Study: How does arthroscopy compare to PT for FAI?” Letters to the editor are encouraged; please send correspondence to email@example.com. Randomized, controlled trials (RCTs) represent the highest level of evidence and have a powerful ability to guide treatment recommendations. Although RCTs minimize selection bias, they are subject to other biases.