Orthopedics Commons^™

Revisiting The Faith Trial: A Secondary Analysis Yielding Novel Insights With The Win Ratio, Sofia Bzovsky, Nathan N. O'Hara, Gerard P. Slobogean, Sheila Sprague, Daniel E. Axelrod, Graeme Hoit, Kiara Pannozzo, Mohit Bhandari, Marc Swiontkowski, Emil Schemitsch, Rudolf W. Poolman, The Faith Investigators

Orthopaedic Surgery Faculty Publications

Background: Many orthopaedic trials use any unplanned reoperation as the primary outcome, but this overlooks how patients experience those outcomes. Using a high-quality hip fracture trial, we demonstrate how the relative importance of multiple patient-important outcomes can be effectively incorporated into data analysis, providing a more comprehensive understanding of treatment impact. Methods: This secondary analysis of the Fixation using Alternative Implants for the Treatment of Hip Fracture (FAITH) trial included 1,079 patients aged 50 years or older with a low-energy femoral neck fracture who were randomly assigned to treatment with a sliding hip screw or cancellous screws. The original trial …

Infection And Nonunion Rates In Open Fractures, Roman M. Natoli, Lucas S. Marchand, Sofia Bzovsky, Jennifer E. Hagen, Mark J. Gage, Christina A. Stennett, Nathan N. O’Hara, Kyle J. Jeray, Brad Petrisor, Sheila Sprague, Gerard P. Slobogean, Jeffrey Wells, Mohit Bhandari, Anthony D. Harris, C. Daniel Mullins, Lehana Thabane, Amber Wood, Gregory J. Della Rocca, Joan Hebden, Lyndsay M. O’Hara, Robert Zura, Christopher Lee, Joseph Patterson, Michael J. Gardner, Jenna Blasman, Jonah Davies, Stephen Liang, Monica Taljaard, The Flow Investigators, The Prep-It Investigators

Orthopaedic Surgery Faculty Publications

Background: Infection and nonunion are common sequelae of open fractures. Studies have shown infection and nonunion rates ranging from 2% to 52% and 12% to 17%, respectively. The present article describes the rates of surgical site infection (SSI) and delayed union/nonunion following open fractures in a large contemporary series of patients from prospective clinical trials with adjudicated outcomes. Methods: A descriptive analysis was performed with use of patient data from the FLOW, Aqueous-PREP, and PREPARE-Open studies. These studies, published within the past 10 years, included multiple international trauma centers and shared definitions for SSI and delayed union/nonunion. SSI and delayed …

Fascia Iliaca Compartment Block And Pericapsular Nerve Group Block Effect On Opioid Consumption In Hip Fracture Patients, David A. Brueggeman, Garrhett G. Via, Prachi Lele, Andrew W. Froehle, Michael J. Prayson, Scott J. Hadaway

Orthopaedic Surgery Faculty Publications

Background Effective pain control and reduced opioid consumption improve hip fracture outcomes. Fascia iliaca compartment blocks (FICB) effectively and safely manage acute hip fracture pain while reducing opioid consumption. Alternatively, pericapsular nerve group (PENG) blocks may provide similar analgesia while better-preserving motor function by targeting the highly innervated anterior hip capsule and sensory branches of the femoral, obturator, and accessory obturator nerves. Evidence for PENG's effectiveness is limited. The present retrospective study compared pain and MME in hip fracture patients receiving FICB (n = 1596) or PENG (n = 254), vs. a no-block (NB; n = 287) reference group. Methods …

Reimagining The Path Of An Unmatched Orthopaedic Residency Application, Stewart A. Bryant, Achraf H. Jardaly, Brent A. Ponce, S. Trent Guthrie, Harris Slone, Jeremy R. Bruce, Andrew W. Wilson, Charles Cody White, Afshin Razi, Amiethab Aiyer, Andrew Sobel, Anil B. Krishnamurthy, Ashley Rogerson, Benjamin Jackson, Brent M. Cone, Brian Scannell, Brock T. Wentz, Carl Paulino, Carol Lin, Charles J. Gatt, Charles Pasque, Craig Eberson, Daniel Wongworawat, Dawn Laporte, Gabriella Ode, George Dyer, Gregory A. Vrabec, Gregory Grabowski, Gregory Vrabec, Haleh Badkoobehi, James Purtill, Jayson Brooks

Orthopaedic Surgery Faculty Publications

Background:. Few evidence-based suggestions are available to help applicants and mentors improve reapplication outcomes. We sought to provide program directors' (PDs) perspectives on actionable steps to improve reapplicants' chances for a match. Methods:. The PDs were asked to rank positions unmatched applicants can pursue, steps these applicants can take for the next application cycle, and reasons why reapplicants do not match. Results:. Responses from 66 of 123 PDs were received (53.6% response rate). Obtaining new recommendation letters and rotating with orthopaedics were the highest 20 ranked steps unmatched applicants can take. No curriculum vitae (CV) improvement, poor interview, and poor …

Analysis Of Vein Grafting Versus Arteriovenous Loop In Microvascular Head And Neck Reconstruction: Multicenter Series Of 36 Patients, Kaitlynne Y. Pak, Spencer R. Anderson, Tyler L. Langenfeld, Kenneth Tan, Allison Slijepcevic, Sunishka Wimalawansa, Yadranko Ducic, Mark K. Wax, Sameep P. Kadakia

Orthopaedic Surgery Faculty Publications

Background: The utilization of an arteriovenous loop is an underreported technique that affords the creation of reliable vascular options. Understanding the efficacy and impacting variables of microvascular reconstruction with an arteriovenous loop can be critical to its use.

Methods: Multi-institutional study of 36 patients who underwent vein grafting or AV loop with free tissue transfer.

Results: 58.3% of patients received prior radiation and 38.9% prior flap reconstruction. Flap success for vein grafting was 76% and AV loop was 100% (p = 0.16). Success for the radiated cohort was 90.5% and non-radiated 80% (p = 0.63). Flap success for the radiated, …

Effects Of Ohio Opioid Prescribing Policy On Postsurgical Prescriptions Following Sports Procedures, Joseph D. Henningsen, Scott Huff, Andrew D. Schneider, Fady Y. Hijji, Andrew W. Froehle, Anil Krishnamurthy

Orthopaedic Surgery Faculty Publications

Background: Prescribed opioid medication after orthopedic sports surgery has been shown to exceed patient requirements. In 2017, as a response to the opioid epidemic, Ohio passed Opioid Prescribing Guidelines (OPG) limiting narcotic prescriptions for acute pain. This study sought to evaluate the effects of the OPG on prescribing behavior of orthopedists following knee arthroscopy (KA), shoulder arthroscopy (SA), and anterior cruciate ligament reconstruction (ACLR).

Methods: An institutional database was queried to calculate morphine equivalent dose (MED) prescribed at discharge, acute follow-up (<90 days), and chronic follow-up (>90 days) and compare MED pre- and post-OPG. Cases were identified over a 2-year period starting 1 year …

Pragmatic Randomized Trial Evaluating Pre-Operative Aqueous Antiseptic Skin Solution In Open Fractures (Aqueous-Prep): The Feasibility Of A Cluster Randomized Crossover Study, Sheila Sprague, Paige Guyatt, Sofia Bzovsky, Uyen Nguyen, Mohit Bhandari, Lehana Thabane, Brad Petrisor, Herman S. Johal, Jordan Leonard, Shannon Dodds, Franca Mossuto, Robert V. O’Toole, Andrea Howe, Haley K. Demyanovich, Megan Camara, Nathan N. O’Hara, Gerard P. Slobogean, Jeffrey Wells, Jean Claude D’Alleyrand, Anthony D. Harris, Daniel C. Mullins, Amber Wood, Gregory J. Della Rocca, Joan Hebden, Lucas Marchand, Lyndsay M. O’Hara, Robert Zura, Michael J. Gardner, Jenna Blasman, Jonah Davies, Stephen Liang

Orthopaedic Surgery Faculty Publications

Background: Approximately 1 in 10 patients with a surgically treated open fracture will develop a surgical site infection. The Aqueous-PREP trial will investigate the effect of 10% povidone-iodine versus 4% chlorhexidine in aqueous antiseptic solutions in reducing infections after open fracture surgery. The study protocol was published in April 2020.

Methods and design: The Aqueous-PREP trial is a pragmatic, multicenter, open-label, randomized multiple period cluster crossover trial. Each participating cluster is randomly assigned in a 1:1 ratio to provide 1 of the 2 study interventions on all eligible patients during a study period. The intervention periods are 2 months in …

Factors Associated With Surgeon Recommendation For Additional Cast Immobilization Of A Ct-Verified Nondisplaced Scaphoid Waist Fracture, Anne Eve J. Bulstra, Tom J. Crijns, Stein J. Janssen, Geert A. Buijze, David Ring, Ruurd L. Jaarsma, Gino M.M.J. Kerkhoffs, Miryam C. Obdeijn, Job N. Doornberg, A. Peters, A. B. Spoor, Abhay Shrivastava, Aakash Chauhan, Adam Shafritz, Asif M. Ilyas, Anne J.H. Vochteloo, Andrew John Powell, Alberto Pérez Castillo, Alexandre Leme Godoy-Santos, Amparo Gomez Gelvez, Andrea Bauer, Antonio Barquet, Anze Kristan, Ante Prkic, Axel Jubel, Boj Mirck, B. E. Kreis, H. Brent Bamberger, William Dias Belangero, Bernard F. Hearon, Bradley Palmer

Orthopaedic Surgery Faculty Publications

Introduction: Data from clinical trials suggest that CT-confirmed nondisplaced scaphoid waist fractures heal with less than the conventional 8-12 weeks of immobilization. Barriers to adopting shorter immobilization times in clinical practice may include a strong influence of fracture tenderness and radiographic appearance on decision-making. This study aimed to investigate (1) the degree to which surgeons use fracture tenderness and radiographic appearance of union, among other factors, to decide whether or not to recommend additional cast immobilization after 8 or 12 weeks of immobilization; (2) identify surgeon factors associated with the decision to continue cast immobilization after 8 or 12 weeks. …

Effect Of Change In Usmle Step 1 Grading On Orthopaedic Surgery Applicants: A Survey Of Orthopaedic Surgery Residency Program Directors., Alex Gu, Jacob Farrar, Safa C. Fassihi, Seth Stake, Pradip Ramamurti, Chapman Wei, Lauren E Wessel, Duretti T Fufa, Raj D. Rao

Orthopaedic Surgery Faculty Publications

No abstract provided.

Managing Work Flow In High Enrolling Trials: The Development And Implementation Of A Sampling Strategy In The Prepare Trial, David Pogorzelski, Uyen Nguyen, Paula Mckay, Lehana Thabane, Megan Camara, Lolita Ramsey, Rachel Seymour, J. Brett Goodman, Sheketha Mcgee, Joanne Fraifogl, Andrea Hudgins, Stephanie L. Tanner, Mohit Bhandari, Gerard P. Slobogean, Sheila Sprague, Jeffrey Wells, Prep-It Investigators Executive Committee

Orthopaedic Surgery Faculty Publications

Pragmatic trials in comparative effectiveness research assess the effects of different treatment, therapeutic, or healthcare options in clinical practice. They are characterized by broad eligibility criteria and large sample sizes, which can lead to an unmanageable number of participants, increasing the risk of bias and affecting the integrity of the trial. We describe the development of a sampling strategy tool and its use in the PREPARE trial to circumvent the challenge of unmanageable work flow. Given the broad eligibility criteria and high fracture volume at participating clinical sites in the PREPARE trial, a pragmatic sampling strategy was needed. Using data …

Risk Factors Associated With Infection In Open Fractures Of The Upper And Lower Extremities, Paul Tornetta, Gregory J. Della Rocca, Saam Morshed, Clifford Jones, Diane Heels-Ansdell, Sheila Sprague, Brad Petrisor, Kyle J. Jeray, Gina Del Fabbro, Sofia Bzovsky, Mohit Bhandari, Gordon H. Guyatt, Stephen D. Walter, Emil H. Schemitsch, Jeffrey Anglen, Michael Bosse, Susan Liew, Parag Sancheti, Paula Mckay, Kim Madden, Kerry Tai, Lisa Buckingham, Aravin Duraikannan, Stephanie L. Tanner, Rebecca G. Snider, Douglas Altman, Rajiv Gandhi, Markus Bischoff, Bill Ristevski, Krishan Rajaratnam, Dale Williams, Flow Investigators

Orthopaedic Surgery Faculty Publications

Introduction: Open fractures are associated with a high risk of infection. The prevention of infection is the single most important goal, influencing perioperative care of patients with open fractures. Using data from 2,500 participants with open fracture wounds enrolled in the Fluid Lavage of Open Wounds trial, we conducted a multivariable analysis to determine the factors that are associated with infections 12 months postfracture. Methods: Eighteen predictor variables were identified for infection a priori from baseline data, fracture characteristics, and surgical data from the Fluid Lavage of Open Wounds trial. Twelve predictor variables were identified for deep infection, which included …

Inadvertent Radial Head Inversion During Closed Reduction Of A Pediatric Radial Neck Fracture, Zachary J. Sirois, Sarah Kreul, Craig F. Shank

Orthopaedic Surgery Faculty Publications

Management of displaced pediatric radial neck fractures can be fraught with challenges. This unique case presents an 11-year-old female with a Salter-Harris type II radial neck fracture and how her radial head overturned 180° with the articular surface facing the radial shaft rather than the capitellum during closed manipulation under anesthesia. The malreduction subsequently required open reduction and highlights the importance of a careful stepwise approach to managing markedly displaced radial neck fractures. After closed reduction, meticulous assessment of intraoperative imaging when determining proper alignment is of the utmost importance as a result of the transverse nature of Salter-Harris type …

Protocol For Serious Fall Injury Adjudication In The Strategies To Reduce Injuries And Develop Confidence In Elders (Stride) Study, David A. Ganz, Albert L. Siu, Jay Magaziner, Nancy K. Latham, Thomas G. Travison, Nancy P. Lorenze, Charles Lu, Rixin Wang, Erich J. Greene, Cynthia L. Stowe, Lea N. Harvin, Katy L.B. Araujo, Jerry H. Gurwitz, Yuri Agrawal, Rosaly Correa-De-Araujo, Peter Peduzzi, Thomas M. Gill, Shalender Bhasin, Thomas M. Gill, David B. Reuben, Siobhan Mcmahon, Nancy K. Latham, Shehzad Basaria, Brooke Brawley, Richard Eder, Amy Larson, Lori Goehring, Molly Lukas, Scott Margolis, Thomas W. Storer, Martha B. Carnie, Priscilla Gazarian

Orthopaedic Surgery Faculty Publications

Background: This paper describes a protocol for determining the incidence of serious fall injuries for Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE), a large, multicenter pragmatic clinical trial with limited resources for event adjudication. We describe how administrative data (from participating health systems and Medicare claims) can be used to confirm participant-reported events, with more time- and resource-intensive full-text medical record data used only on an "as-needed" basis. Methods: STRIDE is a pragmatic cluster-randomized controlled trial involving 5451 participants age ≥ 70 and at increased risk for falls, served by 86 primary care practices in 10 US …

A Value Analysis Of Microsurgical Lower Extremity Reconstruction Vs. Acellular Urinary Bladder Matrix (Ubm) For Radiation Wounds Of The Lower Extremity, Christopher J. Micallef, Jamie N. Johnson, R. Michael Johnson

Orthopaedic Surgery Faculty Publications

In the USA, external beam radiation is offered to patients as an alternative to surgery for non-melanoma skin cancers. While this technique may be useful in highly specific patient populations, recalcitrant chronic radiation wounds can result. These complex wounds ultimately may require major reconstructive surgery to achieve closure. Porcine urinary bladder matrix (UBM) may be effective in the treatment of radiation wounds and eliminating the need for vascularized tissue transfers. A case report of an elderly male with bilateral radiation wounds of the lower extremity, one extremity treated with free flap reconstruction and the other with porcine urinary bladder matrix, …

Enhancement Of Fracture Healing In The Rat, Modulated By Compounds That Stimulate Inducible Nitric Oxide Synthase: Acceleration Of Fracture Healing Via Inducible Nitric Oxide Synthase., R A Rajfer, A Kilic, Andrew S Neviaser, L M Schulte, S M Hlaing, J Landeros, M G Ferrini, E Ebramzadeh, S-H Park

Orthopaedic Surgery Faculty Publications

OBJECTIVES: We investigated the effects on fracture healing of two up-regulators of inducible nitric oxide synthase (iNOS) in a rat model of an open femoral osteotomy: tadalafil, a phosphodiesterase inhibitor, and the recently reported nutraceutical, COMB-4 (consisting of L-citrulline, Paullinia cupana, ginger and muira puama), given orally for either 14 or 42 days.

MATERIALS AND METHODS: Unilateral femoral osteotomies were created in 58 male rats and fixed with an intramedullary compression nail. Rats were treated daily either with vehicle, tadalafil or COMB-4. Biomechanical testing of the healed fracture was performed on day 42. The volume, mineral content and bone density …

Spontaneous Hemarthrosis Of The Knee - Late Complication Of Flexible Femur Nailing: A Case Report., Indranil V Kushare, Matthew E. Oetgen, Suzanne J Walters

Orthopaedic Surgery Faculty Publications

We present a case report of acute spontaneous knee hemarthosis due to erosion of the nail through the knee joint capsule in a boy, seven months following retrograde flexible nailing for fractured femur. Careful positioning of the location of the insertion site of flexible nails and proper nail tip management are important to avoid this rare late complication.

Complications And Predictors Of Need For Return To The Operating Room In The Treatment Of Supracondylar Humerus Fractures In Children, Matthew E. Oetgen, Gudrun E. Mirick, Lara Atwater, John F. Lovejoy

Orthopaedic Surgery Faculty Publications

Supracondylar humerus fractures are common pediatric injuries. Little is known about the risk factors for repeat operative procedures. A retrospective chart review of 709 patients treated for a displaced supracondylar humerus fracture was performed to identify risk factors for return to the operating room during the initial post-operative period. Deviations of routine fracture care were recorded and complication rates were compared between Gartland type 2 and 3 fractures using logistic regression. Type 3 fractures were found to have a higher complication rate, and, specifically, more peri-operative nerve palsies, more likely to need to return to the operating room for hardware …

Initial Report Of The Osteogenesis Imperfecta Adult Natural History Initiative., Laura L. Tosi, Matthew E. Oetgen, Marianne K Floor, Mary Beth Huber, Ann M Kennelly, Robert J. Mccarter, +5 Additional Authors

Orthopaedic Surgery Faculty Publications

BACKGROUND: A better understanding of the natural history of osteogenesis imperfecta (OI) in adulthood should improve health care for patients with this rare condition.

METHODS: The Osteogenesis Imperfecta Foundation established the Adult Natural History Initiative (ANHI) in 2010 to give voice to the health concerns of the adult OI community and to begin to address existing knowledge gaps for this condition. Using a web-based platform, 959 adults with self-reported OI, representing a wide range of self-reported disease severity, reported symptoms and health conditions, estimated the impact of these concerns on present and future health-related quality of life (QoL) and completed …

Multiple Epidural Steroid Injections And Body Mass Index Linked With Occurrence Of Epidural Lipomatosis: A Case Series., Rafael Jaimes, Angelo G. Rocco

Orthopaedic Surgery Faculty Publications

BACKGROUND:

Epidural lipomatosis (EL) is an increase of adipose tissue, normally occurring in the epidural space, sufficient to distort the thecal sac and compress neural elements. There is a lack of knowledge of risk factors, impact on patient's symptoms, and its possible association with epidural steroid injections.

METHODS:

History, physical examination, patient chart, and MRI were analyzed from 856 outpatients referred for epidural steroid injections. Seventy patients with signs of EL on MRI comprised the study group. Thirty-four randomly selected patients comprised the control group. The severity of EL was determined by the MRI assessment. The impact of EL was …

Mechanical Contributors To Sex Differences In Idiopathic Knee Osteoarthritis, Daniel P. Nicolella, Mary I. O'Connor, Roger M. Enoka, Barbara D. Boyan, David A. Hart, Eileen Resnick, Karen J. Berkeley, Kathleen A. Sluka, C. Kent Kwoh, Laura L. Tosi, Richard D. Coutts, Wendy M. Kohrt

Orthopaedic Surgery Faculty Publications

The occurrence of knee osteoarthritis (OA) increases with age and is more common in women compared with men, especially after the age of 50 years. Recent work suggests that contact stress in the knee cartilage is a significant predictor of the risk for developing knee OA. Significant gaps in knowledge remain, however, as to how changes in musculoskeletal traits disturb the normal mechanical environment of the knee and contribute to sex differences in the initiation and progression of idiopathic knee OA. To illustrate this knowledge deficit, we summarize what is known about the influence of limb alignment, muscle function, and …