Peter S. Rose, MD, FAAOS Selected as 2022 JAAOS Editor-in-Chief

Levine, William N. MD, FAAOS; Editor-in-Chief

doi : 10.5435/JAAOS-D-21-00343

Journal of the American Academy of Orthopaedic Surgeons: June 1, 2021 - Volume 29 - Issue 11 - p 453-454

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Under Disclosure of Conflicts of Interest Is Less Frequent in Senior Authors: A Cross-sectional Review of All Authors Submitting to JAAOS Between 2014 and 2018

Tisherman, Robert T. MD; Murray, Ryan S. MD; Musahl, Volker MD; Lesniak, Bryson MD

doi : 10.5435/JAAOS-D-20-01270

Journal of the American Academy of Orthopaedic Surgeons: June 1, 2021 - Volume 29 - Issue 11 - p 455-461

The interactions between physicians and industry are necessary for advancement of clinical practice and improvement in medical devices. Physician-industry relationships also introduces financial conflicts of interest into research publications. Payments to physicians do not inherently introduce bias in research, but failure to disclose potential conflicts of interest can negatively impact the perceived integrity of authors, editors, and journals. The conflict of interest disclosure statement in all articles published in the Journal of the American Academy of Orthopaedic Surgery between 2014 and 2018 were compared to the financial payments indexed in the Center for Open Payments Database. Payment type, magnitude, and payer were obtained for each payment meeting inclusion criteria. Statistical comparisons were made using Mann-Whitney comparisons due to non-normal distribution of payment amounts.

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Current Concepts in the Management of Dupuytren Disease of the Hand

Gil, Joseph A. MD; Akelman, Matthew R. MD; Hresko, Andrew M. MD; Akelman, Edward MD

doi : 10.5435/JAAOS-D-20-00190

Journal of the American Academy of Orthopaedic Surgeons: June 1, 2021 - Volume 29 - Issue 11 - p 462-469

Dupuytren disease is a fibroproliferative disorder of the palmar fascia of the hand. Little agreement and remarkable variability exists in treatment algorithms between surgeons. Because the cellular and molecular etiology of Dupuytren has been elucidated, ongoing efforts have been made to identify potential chemotherapeutic targets that could modulate the phenotypic expression of the disease. Although these efforts may dramatically alter the approach to treating this disease in the future, these approaches are largely experimental at this point. Over the past decade, the mainstay nonsurgical options have continued to be percutaneous needle aponeurotomy and collagenase Clostridium hystoliticum, and the most common surgical option is limited fasciectomy.

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Treatment of Valgus-Impacted and Nondisplaced Femoral Neck Fragility Fractures in the Elderly

Kamara, Eli MD; Zvi, Yoav Shimon MD; Vail, Thomas Parker MD

doi : 10.5435/JAAOS-D-19-00866

Journal of the American Academy of Orthopaedic Surgeons: June 1, 2021 - Volume 29 - Issue 11 - p 470-477

As the life expectancy of the worldwide population increases, the number of hip fractures in the elderly cohort is expected to grow. It is important for surgeons to critically analyze available treatment options for these injuries, with the goal of optimizing outcomes and minimizing complications. Femoral neck fractures make up approximately half of all hip fractures. Nonoperative treatment of valgus-impacted and nondisplaced (Garden I and II) femoral neck fractures has high rates of secondary displacement, osteonecrosis, and nonunion; only patients with notable risk for perioperative complications are treated nonoperatively. Surgical intervention is the standard of care, with options including internal fixation (IF) with multiple cancellous screws or a sliding hip screw, hemiarthroplasty, or total hip arthroplasty. Patients with a posterior tilt of greater than 20° have a high rate of revision surgery when treated with IF and may benefit from primary arthroplasty. Furthermore, primary arthroplasty has demonstrated lower revision surgery rates and equivalent postoperative mortality when compared with IF. Surgeons should be aware of the functional outcomes, complications, revision surgery rates, and mortality rates associated with each treatment modality to make a patient-specific decision regarding their care.

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Principles of Locking Plate Fixation of Proximal Humerus Fractures

Omid, Reza MD; Trasolini, Nicholas A. MD; Stone, Michael A. MD; Namdari, Surena MD

doi : 10.5435/JAAOS-D-20-00558

Journal of the American Academy of Orthopaedic Surgeons: June 1, 2021 - Volume 29 - Issue 11 - p e523-e535

Proximal humerus fractures are common, particularly in elderly patients and those with osteopenia or osteoporosis. Although nonsurgical management results in satisfactory outcomes for most patients, surgical treatment is indicated in select cases. Despite an increasing trend toward arthroplasty, open reduction and internal fixation of proximal humerus fractures can still provide excellent clinical outcomes. Proper technique for internal fixation of the proximal humerus requires an understanding of osseous and neurovascular anatomy. In particular, understanding reliable regions of biomechanically superior bone can help prevent failure of fixation. Biomechanical studies have shown that locked plating of proximal humerus fractures provides stable fixation. Cadaveric and finite element models underscore the importance of screw placement in the posteromedial metaphysis. When medial column support is challenging to obtain, or when bone quality is poor, augmentation with bone autograft, allograft, and/or synthetic composites can improve the biomechanics of internal fixation constructs. The purpose of this review is to outline the anatomic, biologic, and biomechanical principles of plate fixation for proximal humerus fractures to provide evidence-based recommendations for optimizing fixation and preventing fixation failure.

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Modern Principles in the Acute Surgical Management of Open Distal Tibial Fractures

Shafiq, Babar MD; Hacquebord, Jacques MD; Wright, David J. MD; Gupta, Ranjan MD

doi : 10.5435/JAAOS-D-20-00502

Journal of the American Academy of Orthopaedic Surgeons: June 1, 2021 - Volume 29 - Issue 11 - p e536-e547

Over the past two decades, management of open distal tibial fractures has evolved such that a staged approach, with external fixation and débridement during the index procedure, followed by definitive fixation and wound closure at a later date, is often considered the standard of care. Although definitive treatment of these complex injuries is often done by a multidisciplinary team of surgeons well versed in periarticular fracture repair and soft-tissue coverage in the distal extremity, the on-call orthopaedic surgeon doing the index procedure must understand the principles and rationale of the staged treatment algorithm to avoid compromising definitive treatment options and ensure the best possible patient outcome. The mechanism of injury, neurovascular status, size and location of soft-tissue injury, fracture pattern, and concomitant injuries in the polytraumatized patient should direct the treatment plan and anticipated outcomes. This review focuses on evaluation and management of these complex injuries with an emphasis on early aggressive débridement, principles of initial fracture fixation, and modern options for soft-tissue coverage, including local and free tissue transfer.

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HIV-Positive Patients Are at Increased Risk of Venous Thromboembolism After Total Joint Replacement

Olson, Jeffrey J. MD; Schwab, Pierre-Emmanuel MD; Jackson, Jonathan MD; Lange, Jeffrey K. MD; Bedair, Hany S. MD; Abdeen, Ayesha MD, FRCS(C)

doi : 10.5435/JAAOS-D-20-00737

Journal of the American Academy of Orthopaedic Surgeons: June 1, 2021 - Volume 29 - Issue 11 - p 479-485

Antiretroviral therapy has improved the life expectancy of HIV patients, leading to an increase in total joint replacement for age-related osteoarthritis. HIV patients are inherently hypercoagulable at baseline. The goal of our study was to compare the incidence of venous thromboembolism (VTE) in HIV patients with HIV-negative controls after total joint replacement.

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Opioid Prescription After Carpal Tunnel Release Is Declining Independent of State Laws

Cunningham, Daniel J. MD, MHSc; Saltzman, Eliana B. MD; Lorenzana, Daniel J. MD; Klifto, Christopher S. MD; Richard, Marc J. MD; Pidgeon, Tyler S. MD

doi : 10.5435/JAAOS-D-20-00955

Journal of the American Academy of Orthopaedic Surgeons: June 1, 2021 - Volume 29 - Issue 11 - p 486-497

The opioid misuse crisis focused attention on opioid overprescribing prompting legislation, limiting prescribing. The purpose of this study was to evaluate of opioid filling surrounding carpal tunnel release (CTR) with the hypothesis that filling has decreased in response to state legislation.

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The Readability of Online Educational Materials for Femoroacetabular Impingement Syndrome

Kiapour, Ata M. PhD, MMSc; Otoukesh, Babak MD; Hosseinzadeh, Shayan MD

doi : 10.5435/JAAOS-D-20-00834

Journal of the American Academy of Orthopaedic Surgeons: June 1, 2021 - Volume 29 - Issue 11 - p e548-e554

Although the readability of online materials has been thoroughly studied across different orthopaedic surgery disorders, inadequacy in information exists regarding the readability of the websites pertaining to femoroacetabular impingement (FAI). Given its high prevalence and the importance of providing appropriate online education materials in its prognosis, the primary aim of this study was to assess the readability of web-based patient education materials regarding this disease. “Femoroacetabular impingement,” “FAI,” and “hip impingement” were used as search queries in this study. Readability was evaluated based on five established algorithms, and the readability of contents was compared by website type and also search query. In this study of 59 unique websites on FAI, using five different validated readability formulas, we demonstrated that none of the top 30 webpages were written at the recommended reading level. They were found through three different search queries on the three most used search engines. Current FAI online education materials accessible to patients are written above the recommended levels, and it seems that to improve equity and accessibility in healthcare, universities, hospitals, and healthcare professional societies have a responsibility to ensure that the online materials are provided at more appropriate levels. Early detection and treatment of FAI play a key role in preventing the progression to hip osteoarthritis. Thus, providing appropriate online education materials is of great importance in this prevention by increasing patients' understanding of the disease and the advantages and disadvantages of the treatment options.

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One Dose Versus Two Doses of Intravenous Tranexamic Acid in Total Joint Arthroplasty

Golz, Andrew G. MD; Yee, Heather K. MA; Davis, Benjamin J. MD; Adams, William H. PhD; Brown, Nicholas M. MD

doi : 10.5435/JAAOS-D-20-00658

Journal of the American Academy of Orthopaedic Surgeons: June 1, 2021 - Volume 29 - Issue 11 - p e555-e562

Despite its widespread use, a single formulation or dosing regimen of tranexamic acid (TXA) has not been universally agreed on for total joint arthroplasty. The purpose of this study is to compare previously uninvestigated single-dose and two-dose regimens in postoperative hemoglobin level and secondary outcomes within 30 days of surgery.

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Trends in Spinal Surgery Performed by American Board of Orthopaedic Surgery Part II Candidates (2008 to 2017)

Yeung, Caleb M. MD; Schoenfeld, Andrew J. MD, MSc; Lightsey, Harry M. IV MD; Kang, James D. MD; Makhni, Melvin C. MD, MBA

doi : 10.5435/JAAOS-D-20-00437

Journal of the American Academy of Orthopaedic Surgeons: June 1, 2021 - Volume 29 - Issue 11 - p e563-e575

The American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination is typically taken two calendar years after fellowship completion. Despite previous studies using ABOS Part II Oral Examination data in other subspecialties, types of cases performed by spine surgeons in initial independent practice have not been well-studied. Such data may help trainees anticipate case composition observed in early practice and allow spine fellowship programs to understand emerging trends.

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