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Diagnosis and Management of Acute Compartment Syndrome
Osborn, Patrick M.; Schmidt, Andrew H.
doi : 10.5435/JAAOS-D-19-00858
Journal of the American Academy of Orthopaedic Surgeons. 29(5):183-188, March 1, 2021.
The Major Extremity Trauma and Rehabilitation Consortium and the American Academy of Orthopaedic Surgeons have developed the Appropriate Use Criteria (AUC) for the Diagnosis and Management of Acute Compartment Syndrome (ACS). Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care, aid decision-making, and obtain the best possible outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The AUC for the Diagnosis and Management of ACS were derived by identifying clinical indications typical of patients suspected of an ACS in clinical practice. These indications were most often parameters observable by the clinician, including symptoms or results of diagnostic tests. The 135 patient scenarios and five treatments were developed by the writing panel, a group of clinicians who are specialists in this AUC topic. Next, a separate, multidisciplinary, voting panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a nine-point scale to designate a treatment as “appropriate” (median rating, seven to nine), “may be appropriate” (median rating, four to six), or “rarely appropriate” (median rating, one to three).
Anterior Approach to the Subaxial Cervical Spine: Pearls and Pitfalls
Razi, Afshin; Saleh, Hesham; DeLacure, Mark D.; Kim, Yong
doi : 10.5435/JAAOS-D-17-00891
Journal of the American Academy of Orthopaedic Surgeons. 29(5):183-188, March 1, 2021.
Since its introduction by Smith and Robinson, the anterior approach to the subaxial cervical spine has become one of the standard procedures for numerous cervical spine pathologies, including, but not limited to degenerative disease, trauma, tumor, deformity, and instability. Along with its increasing popularity and improvements in anterior instrumentation techniques, a comprehensive knowledge of the surgical anatomy during the anterior exposure is critical for trainees and experienced spine surgeons alike to minimize the infrequent but potentially devastating risks associated with this approach. Understanding the anatomy and techniques to minimize damage to relevant structures can reduce the risks of developing notable postoperative complications and morbidity.
Current Concepts in Pediatric Septic Arthritis
Erkilinc, Mehmet; Gilmore, Allison; Weber, Morgan; Mistovich, R. Justin
doi : 10.5435/JAAOS-D-20-00835
Journal of the American Academy of Orthopaedic Surgeons. 29(5):196-206, March 1, 2021.
Septic arthritis continues to present challenges regarding the clinical diagnosis, workup, and definitive management. Urgent management is essential, so treating surgeons must efficiently work through differential diagnoses, identify concomitant infections, and do a timely irrigation and débridement. The incidence of methicillin-resistant Staphylococcus aureus is increasing, typically resulting in a more rapid progression of symptoms with more severe clinical presentation. The diagnostic utility of MRI has resulted in improved detection of concomitant septic arthritis and osteomyelitis, although MRI must not substantially delay definitive management. Early diagnosis followed by urgent irrigation and débridement and antibiotic therapy are essential for satisfactory long-term outcomes. Antibiotics should not be administered until blood cultures and arthrocentesis fluid are obtained, except in rare cases of a septic or toxic patient. Once cultures are obtained, empiric antibiotic therapy should commence and provide coverage for the most likely pathogens, given the patient's age. Laboratory markers, especially C-reactive protein, should be followed until normalization and correlate with resolution of clinical symptoms. Definitive antibiotic selection should be shared with a pediatric infectious disease specialist, who can help guide the duration of treatment.
Direct Anterior Approach for Revision Total Hip Arthroplasty: Anatomy and Surgical Technique
Siddiqi, Ahmed; Alden, Kris J.; Yerasimides, Jonathan G.; Kamath, Atul F
doi : 10.5435/JAAOS-D-20-00334
Journal of the American Academy of Orthopaedic Surgeons. 29(5):e217-e231, March 1, 2021.
There has been increased interest and literature on the efficacy of direct anterior approach (DAA) for total hip arthroplasty (THA). Developments in surgical technique and instrumentation, along with exposure earlier in orthopaedic residency training, may augment the adoption of this approach among practicing orthopaedic surgeons. With the increasing number of primary THA performed through the DAA, understanding the indications and techniques associated with revision THA via the DAA has proved increasingly important. Patient positioning, understanding surgical anatomy and extensile maneuvers, and applying key reconstructive methods are essential for obtaining adequate exposure and fixation. Acetabular exposure can be facilitated through capsular and soft-tissue release, along with extensile approaches to the pelvis and acetabulum. Extensile distal extension can be performed for safe access to the femur, including extended femoral osteotomies. The purpose of this review is to describe indications, surgical anatomy, intraoperative tips, clinical outcomes, and complications after DAA for revision THA.
Cemented Femoral Fixation Using a Direct Anterior Approach: Background, Indications, and Surgical Technique
Hernandez, Nicholas M.; Gausden, Elizabeth B.; Taunton, Michael J.
doi : 10.5435/JAAOS-D-20-00800
Journal of the American Academy of Orthopaedic Surgeons. 29(5):207-212, March 1, 2021.
The use of the direct anterior approach (DAA) in total hip arthroplasty has increased dramatically over the past decade. Potential benefits of the DAA include earlier functional recovery and lower risk of periprosthetic dislocation, but issues with periprosthetic fracture and femoral loosening have been reported, particularly in elderly patients. Cemented femoral fixation may offer a means to decrease early femoral failure in elderly patients undergoing the DAA. Here, we will present a step-by-step technique for cementing the femoral implant through the DAA.
Templating for Total Hip Arthroplasty in the Modern Age
Vigdorchik, Jonathan M.; Sharma, Abhinav K.; Jerabek, Seth A.; Mayman, David J.; Sculco, Peter K
doi : 10.5435/JAAOS-D-20-00693
Journal of the American Academy of Orthopaedic Surgeons. 29(5):e208-e216, March 1, 2021.
Preoperative templating provides several benefits to the patient, surgeon, and hospital. Appropriate implant selection and sizing optimizes surgical workflow and leads to efficient care-delivery systems. Accurate templating establishes intraoperative targets for component position and reduces complications such as leg length inequality, impingement, wear, dislocation, and fracture, all of which lead to decreased patient satisfaction. Recent technological advances in preoperative imaging include a better understanding of patient-specific pelvic motion allowing the surgeon to preoperatively address the risk of lumbar pathology with adjustments in component placement and bearing choice. The introduction of two-dimensional to three-dimensional (3D) radiographs, biplanar low-dose radiographs, and computed tomography scans with 3D reconstructions have all allowed for a more comprehensive preoperative planning in 3D. This article will review the fundamentals of templating before total hip arthroplasty with an emphasis on how to incorporate and implement patient-specific pelvic motion and 3D templating into practice.
Walking Greater Than 5 Feet After Hip Fracture Surgery Is Associated With Fewer Complications, Including Death
VanTienderen, Richard J.; Fernandez, Isaac; Reich, Michael S.; Nguyen, Mai P
doi : 10.5435/JAAOS-D-19-00320
Journal of the American Academy of Orthopaedic Surgeons. 29(5):213-218, March 1, 2021.
Hip fractures in the elderly are associated with notable morbidity. The influence of postoperative ambulation on outcomes is not well described. We hypothesized that patients who mobilize faster after surgical intervention would demonstrate fewer postoperative complications.
Notable Variability in Opioid-prescribing Practices After Common Orthopaedic Procedures
Traven, Sophia A.; Brinton, Daniel L.; Woolf, Shane K.; Leddy, Lee R.; Gottschalk, Michael B.; Slone, Harris S
doi : 10.5435/JAAOS-D-19-00798
Journal of the American Academy of Orthopaedic Surgeons. 29(5):219-226, March 1, 2021.
The purpose of this study was to evaluate nationwide trends and regional variability in opioid prescriptions after common orthopaedic procedures.
Opioid Prescriptions by Orthopaedic Surgeons in a Medicare Population: Recent Trends, Potential Complications, and Characteristics of High Prescribers
Boddapati, Venkat; Padaki, Ajay S.; Lehman, Ronald A.; Lenke, Lawrence G.; Levine, William N.; Riew, K. Daniel
doi : 10.5435/JAAOS-D-20-00612
Journal of the American Academy of Orthopaedic Surgeons. 29(5):e232-e237, March 1, 2021.
Orthopaedic surgeons prescribe an estimated 7.7% of all US opioid prescriptions, and understanding prescribing patterns is important to curtail the inappropriate dispensing of these drugs. The purpose of this study was to characterize recent trends in opioid prescribing patterns by orthopaedic surgeons within a Medicare population and to identify demographical characteristics associated with the highest prescribers.
Early Ambulation After Hip Fracture Surgery Is Associated With Decreased 30-Day Mortality
Heiden, Jace J.; Goodin, Stephen R.; Mormino, Matthew A.; Siebler, Justin C.; Putnam, Sara M.; Lyden, Elizabeth R.; Tao, Matthew A
doi : 10.5435/JAAOS-D-20-00554
Journal of the American Academy of Orthopaedic Surgeons. 29(5):e238-e242, March 1, 2021.
Hip fractures frequently present in complicated patients and are fraught with high morbidity and mortality rates. Postoperatively, delayed ambulation has been identified as a factor associated with increased mortality, although its magnitude has yet to be quantified. Therefore, this article aims to evaluate mortality after hip fracture surgery because it relates to early postoperative ambulation, taking into account preexisting comorbidity burden.
Does a Career in Orthopaedic Surgery Affect a Woman's Fertility?
Poon, Selina; Luong, Marilan; Hargett, Damayea; Lorimer, Shannon; Nguyen, Cynthia; Payares, Monica; Friedman, Samara
doi : 10.5435/JAAOS-D-20-00198
Journal of the American Academy of Orthopaedic Surgeons. 29(5):e243-e250, March 1, 2021.
Orthopaedic surgery lags behind other specialties in the recruitment of women. Concerns about fertility, pregnancy, and childbearing may be a deterrent to women when considering orthopaedic surgery as a specialty.
An Isolated Transosseous Flexible Suture Frame in the Treatment of Patellar Tendon Rupture Provides Adequate Mechanical Resistance
Besa, Pablo; Telias, Alberto; Orrego, Francisca; Guzm?n-Venegas, Rodrigo; Cariola, Mart?n; Amen?bar, Diego; Palma, Felipe H.; Irarr?zaval, Sebasti?n; Orrego, Mario
doi : 10.5435/JAAOS-D-19-00509
Journal of the American Academy of Orthopaedic Surgeons. 29(5):e251-e257, March 1, 2021.
Acute patellar tendon ruptures are frequently observed in patients with metabolic comorbidities, and the benchmark treatment is surgical repair. It is desirable not to harm an already fragile biologic environment with sutures and hardware. We aimed to compare the mechanical requirements of an isolated, flexible, high-strength nonabsorbable transosseous suture frame with that of the Krackow suture technique.
