Polydactyly of the Foot: A Review

Kelly, Derek M.; Mahmoud, Karim; Mauck, Benjamin M.

doi : 10.5435/JAAOS-D-20-00983

Journal of the American Academy of Orthopaedic Surgeons. 29(9):361-369, May 1, 2021.

Pediatric foot polydactyly presents in a wide variety of deformities from single extra digits attached only by a narrow soft-tissue connection to complex central foot duplications with tarsal bone duplication. The goal of surgical reconstruction is a stable, mobile, pain-free foot with five cosmetically appealing toes that allows for normal footwear and painless ambulation. This review covers the incidence, genetics and embryology, classification, presentation and natural history, physical examination, radiographic assessment, and surgical intervention for all types of foot polydactyly.

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Scoliosis Screening

Oetgen, Matthew E.; Heyer, Jessica H.; Kelly, Shannon M.

doi : 10.5435/JAAOS-D-20-00356

Journal of the American Academy of Orthopaedic Surgeons. 29(9):370-379, May 1, 2021.

The national recommendations for school screening programs for scoliosis in the United States have undergone a shift in perspective over the past two decades. In 2004, the United States Preventive Services Task Force recommended against screening programs but changed its recommendation to be inconclusive in 2018. Early diagnosis of scoliosis can allow for close monitoring of the deformity and early initiation of bracing treatment when appropriate, with the goal of preventing costly and invasive surgical intervention. Several different diagnostic tools are available, including Adam's forward bending test alone, Adam's forward bending test with scoliometry, the humpometer, and Moiré topography, each with varying degrees of sensitivity and specificity. Controversy prevails over the cost efficacy of screening programs and possible unnecessary exposure of adolescents to radiation for confirmatory radiographs after a positive screening test. However, the recent definitive evidence of bracing treatment efficacy in slowing the progression of scoliotic curves and preventing the need for surgery indicates that school screening programs may still have a role in allowing early diagnosis.

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Cast Saw Burn Prevention: An Evidence-Based Review

Larson, Jill E.; Nicolay, Richard W.

doi : 10.5435/JAAOS-D-20-00723

Journal of the American Academy of Orthopaedic Surgeons. 29(9):380-385, May 1, 2021.

Cast saw burns are an avoidable complication of cast removal and cast splitting. These iatrogenic injuries often lead to unacceptable clinical sequalae with significant financial and legal consequences. Therefore, a considerable body of research has been directed toward cast saw burn prevention. This review of currently published data provides clinicians with a summary of the literature to guide practice based on the best available evidence, with the goal of preventing iatrogenic cast saw burns. The PubMed database was queried for articles published from 1980 until present with the following key words: cast saw burns, cast saw blades, cast saws, orthopaedic education or surgical simulation. Relevant articles were reviewed and summarized. The prevention of cast saw burns involves awareness of clinical risk factors, maintenance of equipment, use of the proper technique, and the education of novice providers. By implementing evidence-based methods, orthopaedic surgeons and associated healthcare providers can aim to eliminate these preventable complications from their practice.

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The Spastic Upper Extremity in Children: Multilevel Surgical Decision-making

Chaudhry, Sonia; Bhardwaj, Praveen; Venkatramani, Hari; Sabapathy, S. Raja

doi : 10.5435/JAAOS-D-20-00719

Journal of the American Academy of Orthopaedic Surgeons. 29(9):e416-e426, May 1, 2021.

Multilevel surgery for upper extremity spasticity is the current surgical standard. While the literature details surgical techniques and outcomes, a comprehensive guide to surgical planning is lacking. Patients commonly present with posturing into shoulder internal rotation, elbow flexion, forearm pronation, wrist flexion with ulnar deviation, finger flexion, and thumb adduction, although variations exist. Multiple surgical options exist for each segment; therefore, repeated examinations for contracture, pathologic laxity, and out of phase activity are necessary to optimize the surgical plan. To avoid decreasing function, one must carefully balance the benefits of contracture release and tendon transfers with their weakening effects. In certain cases, stability from joint fusion outweighs the loss of motion. Failure to recognize dynamic posturing, grasp and release requirements, or hand intrinsic spasticity can worsen function and cause new deformities. Surgical indications are formulated for individual deformity patterns and severity along with personal/family goals. General comprehension, voluntary control, and sensation, although not modifiable, influence decision making and are prognostic indicators. Functional improvement is unlikely without preexisting voluntary control, but appearance and visual feedback may be improved by repositioning nonetheless. Appropriate interventions and management of expectations will optimize limb appearance and function while avoiding unexpected sequelae.

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Orthopaedic In-Training Examination: History, Perspective, and Tips for Residents

Le, Hai V.; Wick, Joseph B.; Haus, Brian M.; Dyer, George S. M

doi : 10.5435/JAAOS-D-20-01020

Journal of the American Academy of Orthopaedic Surgeons. 29(9):e427-e437, May 1, 2021.

Introduced in 1963, the orthopaedic in-training examination (OITE) is a standardized, national test administered annually to orthopaedic residents by the American Academy of Orthopaedic Surgeons. The examination consists of 275 multiple-choice questions that cover 11 domains of orthopaedic knowledge, including basic science, foot and ankle, hand, hip and knee, oncology, pediatrics, shoulder and elbow, spine, sports medicine, trauma, and practice management. The OITE has been validated and is considered predictive of success in both orthopaedic surgery residency and on the American Board of Orthopaedic Surgery part I examination. This article provides a historical overview of the OITE, details its current structure and scoring system, and reviews currently available study materials. For examination preparation, the residents are encouraged to (1) start the examination preparation early, (2) practice on old OITE or self-assessment examination questions, (3) focus on the questions answered incorrectly, (4) focus on comprehension over memorization, and (5) recognize and avoid burnout. Finally, the residents should have a systemic way of approaching each multiple-choice question, both during practice and on the actual examination.

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Letters to the Editor: Current Concepts in the Treatment of Lateral Condyle Fractures in Children

Sinikumpu, Juha-Jaakko

doi : 10.5435/JAAOS-D-20-00411

Journal of the American Academy of Orthopaedic Surgeons. 29(9):e438-e439, May 1, 2021.

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Thermal Nerve Radiofrequency Ablation for the Nonsurgical Treatment of Knee Osteoarthritis: A Systematic Literature Review

Chen, Antonia F.; Mullen, Kyle; Casambre, Francisco; Visvabharathy, Vidya; Brown, Gregory A

doi : 10.5435/JAAOS-D-20-00522

Journal of the American Academy of Orthopaedic Surgeons. 29(9):387-396, May 1, 2021.

There are roughly 14 million adults in the United States presenting with symptomatic osteoarthritis (OA) of the knee. Nerve radiofrequency ablation (RFA) is a nonsurgical procedure for the management of knee OA symptoms, and no previous systematic review has been performed comparing geniculate nerve RFA to other nonsurgical treatments.

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Hospital Discharge Within a Day After Total Knee Arthroplasty Does Not Affect 1-Year Complications Compared With Rapid Discharge

Fassihi, Safa C.; Malahias, Michael-Alexander; Gu, Alex; Richardson, Shawn S.; Buller, Leonard T.; Stake, Seth; De Martino, Ivan; Pathak, Neil; Chen, Aaron Z.; Ast, Michael P.; Sculco, Peter K

doi : 10.5435/JAAOS-D-20-00187

Journal of the American Academy of Orthopaedic Surgeons. 29(9):397-405, May 1, 2021.

In patients undergoing total knee arthroplasty (TKA), it is unclear whether a difference in complication rates exists between patients discharged the day of surgery compared with subsequent postoperative days.

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Mechanical Evaluation of 2.7- Versus 3.5-mm Plating Constructs for Midshaft Clavicle Fractures

Alzahrani, Mohammad M.; Cota, Adam; Alkhelaifi, Khalid; Harvey, Edward J

doi : 10.5435/JAAOS-D-19-00495

Journal of the American Academy of Orthopaedic Surgeons. 29(9):e440-e446, May 1, 2021.

This study compares the mechanical performance of 2.7- and 3.5-mm plating constructs for the treatment of midshaft clavicle fractures.

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Does Surgeon Subspecialty Training Affect Outcomes in the Treatment of Displaced Supracondylar Humerus Fractures in Children?

Fisher, Brandon T.; Chong, Alexander C.M.; Flick, Travis; Forness, Mikayla; Sauer, Brian R.; Peterson, Jonathan B. Less

doi : 10.5435/JAAOS-D-20-00507

Journal of the American Academy of Orthopaedic Surgeons. 29(9):e447-e457, May 1, 2021.

The effect of the treating surgeon's subspecialty training on the outcomes of managing displaced supracondylar humerus fractures in the pediatric cohort remains under debate. The objective of this study was to examine patient outcomes and treatment variables for these injuries based on the surgeon subspecialty training.

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Use of Standardized Language for C-arm Fluoroscopy Improves Intraoperative Communication and Efficiency

Burke, John F.; Anciano, Victor; Novicoff, Wendy M.; Yarboro, Seth R. Less

doi : 10.5435/JAAOS-D-20-00314

Journal of the American Academy of Orthopaedic Surgeons. 29(9):e458-e464, May 1, 2021.

Intraoperative fluoroscopy is a ubiquitous tool in orthopaedic surgery. However, many orthopaedic surgeons and radiology technologists are not taught standard terminology to communicate with one another. Breakdown of communication leads to inefficiencies. Simulation studies have demonstrated that a common language for C-arm movements may reduce time to capture the desired images and number of radiographs required. Our objective was to investigate the effect of a standardized language protocol for intraoperative C-arm fluoroscopy on communication as perceived by the surgeon and radiology technologists.

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Development of Distal Femoral Metastasis is Rare in Cases of Isolated Proximal Femoral Metastases

Boden, Allison L.; Patel, Manan; Hoyt, Aaron; Subhawong, Ty; Conway, Sheila; Pretell-Mazzini, Juan

doi : 10.5435/JAAOS-D-20-00315

Journal of the American Academy of Orthopaedic Surgeons. 29(9):e465-e470, May 1, 2021.

In the setting of pathologic fractures or impending fractures of the femur, intramedullary nailing or hemiarthroplasty are the common surgical procedures indicated. Traditional teaching has stressed the importance of protecting the entire femur, and thus, it is common for these fractures to be treated with long nails or stems. Recent literature has begun to investigate whether this school of thought is valid and may challenge the perceived need for protection of the entire femur. The purpose of our study was to determine the incidence of ipsilateral distal femoral metastases after the treatment of proximal femoral metastases.

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