Omarmccleary1094
Two patients required repeat I&D. A clinical determination of successful infection eradication was made in all cases.
The reported rate of deep infection after distal radius ORIF is less than 1%. There is no well-defined treatment algorithm for patients with deep infection after distal radius ORIF. However, removal of hardware and post-operative oral or intravenous antibiotic therapy appears effective, and is consistent with the standard practices of treating infection after other orthopaedic surgeries.
The reported rate of deep infection after distal radius ORIF is less than 1%. There is no well-defined treatment algorithm for patients with deep infection after distal radius ORIF. However, removal of hardware and post-operative oral or intravenous antibiotic therapy appears effective, and is consistent with the standard practices of treating infection after other orthopaedic surgeries.
A retrospective study was conducted to evaluate the role of distal radioulnar joint (DRUJ) effusion in aiding the diagnostic accuracy of central triangular fibrocartilage complex (TFCC) tears on non-contrast MRI.
89 consecutive patients who had undergone wrist arthroscopy for ulna sided wrist pain in our unit were identified and their preoperative imaging reviewed. Two consultant musculoskeletal Radiologists independently reported the presence or absence of a DRUJ effusion and or a TFCC tear. The inter-observer variability was calculated using weighted Kappa tests. Two by two tables were constructed to calculate the sensitivity and specificity of reported TFCC tear or DRUJ effusion on MRI in correctly diagnosing central TFCC tears identified at arthroscopy.
Sensitivity of MRI to report a TFCC tear was 0.56 and specificity was 0.79. Sensitivity increased to 0.89 if either a DRUJ effusion or TFCC tear were seen on MRI. When observed together, the presence of both a DRUJ effusion and a TFCC tear seen on tharable to rates demonstrated on MRA meta-analysis results (0.78). Furthermore, considering the absence of both a DRUJ effusion and TFCC tear seen on MRI is useful in excluding the presence of a TFCC tear at arthroscopy.
The objectives of this study were to (1) identify factors associated with skin tenting in displaced midshaft clavicle fractures and (2) analyze individual surgeon variation in this diagnosis.
A retrospective cohort study was performed at two Level I trauma centers of 396 patients with displaced midshaft clavicle fractures treated by 47 surgeons with open reduction internal fixation from January 2010 to March 2019. Our main outcome measure was skin tenting, as diagnosed by the treating surgeon and used as an indication for surgical treatment.
Skin tenting was diagnosed by the treating surgeon in 34 out of 396 patients (9%) with displaced midshaft clavicle fractures. Multivariable logistic regression analyses showed that lower BMI (
) and fracture shortening (
) were independently associated with skin tenting in displaced midshaft clavicle fractures. There was wide variation among surgeons in the rate of diagnosis of skin tenting, ranging from 0% to 41% prevalence of skin tenting depending on the treating surgeon (
).
Although lower BMI and greater fracture shortening were associated with skin tenting, the diagnosis is subjective. We found wide variation in the diagnosis of skin tenting, even among surgeons within a single metropolitan area.
Although lower BMI and greater fracture shortening were associated with skin tenting, the diagnosis is subjective. We found wide variation in the diagnosis of skin tenting, even among surgeons within a single metropolitan area.
The overall clinical picture surrounding native shoulder infections, and, in particular, the associated long-term functional outcomes of treatment are presently underreported. The purpose of this study is to examine the demographics, diagnostic and treatment strategies, and functional outcomes of isolated shoulder joint sepsis treated with surgical irrigation and debridement (I&D).
All patients treated with I&D for native shoulder sepsis between 2007 - 2017 were identified. Those without a minimum of one-year follow-up were excluded. Functional outcomes scores, reoperations, and predictors of poor outcome were evaluated.
Twenty-three patients were included in the final study population. Mean age-adjusted CCI score was 4.1 (SD = 3.4, Range = 0 - 10). Twelve patients (52.2%) were treated with open I&D, while 11 patients (47.8%) were treated arthroscopically. Nine patients (39.1%) required multiple I&Ds (mean total number of I&Ds = 1.7, SD = 1.0, Range 1 - 4). Five patients (21.7%) had at least one documented reinfection after their initial hospitalization, with the initial recurrence of infection occurring 2 - 15 months after the index procedure. Mean ASES score at final follow-up was 55.3 (SD = 26.7, Range 5.8 - 98.3) and mean SANE score was 53.3 (SD = 30.6, Range 0 - 100). Stepwise multiple linear regression modeling identified intravenous drug abuse as the most significant predictor for final ASES score [F(1,18) = 6.12, p = .024, adjusted R
= .254].
Following isolated shoulder joint sepsis, infection clearance and acceptable functional outcomes can be achieved using surgical I&D followed by a course of antibiotics, but outcomes are variable.
Following isolated shoulder joint sepsis, infection clearance and acceptable functional outcomes can be achieved using surgical I&D followed by a course of antibiotics, but outcomes are variable.
Relative value units (RVUs) are assigned to Current Procedural Technology (CPT) codes and give relative economic values to the services physicians provide. This study compared the RVU reimbursements for the surgical options of proximal humerus fractures in the elderly, which include arthroplasty (reverse [RSA] and total [TSA]), hemiarthroplasty (HA), and open reduction and internal fixation (ORIF).
Using the National Surgical Quality Improvement Program, a total of 1,437 patients of at least 65 years of age with proximal humerus fractures between 2008 and 2016 were identified. Of those, 259 underwent RSA/TSA (CPT code 23472), 418 underwent HA (CPT codes 23470 and 23616), and 760 underwent ORIF (CPT code 23615). Univariate analysis compared RVU per minute, reimbursement rate, and the average annual revenue across cohorts based on respective operative times.
RSA/TSA generated a mean RVU per minute of 0.197 (SD 0.078; 95%CI [0.188, 0.207]), which was significantly greater than the mean RVU per minute for 23470 HA (0.156; SD 0.057; 95%CI [0.148, 0.163]), 23616 HA (0.166; SD 0.065; 95%CI [0.005, 0.156]), and ORIF (0.135; SD 0.048; 95%CI [0.132, 0.138];
). This converted to respective reimbursement rates of $6.97/min (SD 2.78; 95%CI [6.63, 7.31]), $5.48/min (SD 2.05; 95%CI [5.22, 5.74]), $5.83/min (SD 2.28; 95%CI [5.49, 6.16]) and $4.74/min (SD 1.69; 95%CI [4.62, 4.87]). After extrapolation, respective average annual revenues were $580,386, $456,633, $475,077, and $395,608.
RSA/TSA provides significantly greater reimbursement rates compared to HA and ORIF. Orthopaedic surgeons can use this information to optimize daily procedural cost-effectiveness in their practices.
RSA/TSA provides significantly greater reimbursement rates compared to HA and ORIF. Orthopaedic surgeons can use this information to optimize daily procedural cost-effectiveness in their practices.
Shoulder arthroplasty improves shoulder range of motion (ROM), strength and function in patients with advanced shoulder disease. However, clinical outcomes vary and are not always predictable among patients. Pre-operative factors and patients' characteristics may influence improvement after surgery. This study examined the impact of the pre-operative objective measures range of motion (ROM) and strength, age, sex, and comorbidities on shoulder ROM, strength status and the amount of improvement one year following shoulder arthroplasty.
140 patients were assessed pre-operatively and one year after shoulder arthroplasty in this prospective cohort study. Pearson's correlations and multiple regression analyses were performed to test the impact of potential predictors on abduction, flexion, internal rotation and external rotation ROM as well as on shoulder abductors, flexors, internal rotators and external rotators strength at one year.
Pre-operative ROM significantly predicted 10% - 37% of the improvement inare significant predictors of the improvement in the shoulder ROM and strength one year after shoulder arthroplasty. The improvement in these measures is expected to decline with age and men are expected to gain more strength than women following this surgical intervention.
High re-tear rates after repairing large-sized posterosuperior rotator cuff tears remain a significant concern which may affect the clinical outcome. Chidamide nmr The most optimal type of repair (single versus double-row suture bridge) suited for large size tear remains debatable.
In a retrospective cohort study with a minimum of five years follow up, the structural and functional outcome of 103 patients with large size cuff tear repaired with single row (SR) or double row suture bridge (DRSB) were evaluated. The structural outcome was assessed with ultrasonography whereas functional outcome was evaluated with Constant Murley (CM) and American shoulder elbow score (ASES).
There were 55 patients in the SR group and 48 patients in the DRSB group with a mean follow-up of 74.2 months (range, 60-96 months). While comparing the structural integrity in two groups, we found significantly lower re-tear rates in the DRSB group as compared to the SR group (10.4% vs. 32.7%;
). Also, there were more focal defects in the SR group (25.4%) than the DRSB group (8.3%). Overall, there was no significant difference in CM and ASES scores when the SR group was compared to DRSB. However, subgroup analysis between those with intact and retorn tendon revealed significant difference (
) in the clinical scores.
At a minimum of five years follow-up, the DRSB repair of large posterosuperior cuff tear resulted in superior structural healing over SR repair. Nevertheless, overall there was no significant functional difference between both the techniques. However, the functional outcome of the healed tendon subgroup was superior to retear tendon subgroup.
At a minimum of five years follow-up, the DRSB repair of large posterosuperior cuff tear resulted in superior structural healing over SR repair. Nevertheless, overall there was no significant functional difference between both the techniques. However, the functional outcome of the healed tendon subgroup was superior to retear tendon subgroup.
The recurrence of ganglion cysts after surgical excision has a reported rate of 4% to 40%. Recurrence rate after revision surgical excision is unknown. The purpose of this study was to define the incidence of recurrent ganglion cysts in patients who underwent a secondary excision procedure.
With Institutional Review Board approval, we retrospectively identified by CPT code and reviewed charts of patients who had recurrent ganglion cyst excision performed over a five-year period (2010 - 2014). Recurrence was defined as reappearance of a cyst in the same area as it was previously. Demographic information including recurrences and revision surgeries was collected in addition to outcome variables such as patient satisfaction, pain levels, and functional limitations.
Out of the 42 revision cases identified 20 patients were reached. Mean time to recurrence of the cyst after the first ganglion cyst excision was 2.5 years (range 1 month - 12 years). After the second ganglion cyst excision, three patients (15%) had a recurrence, each occurring within one year (mean 11 months; range 9-12).
