Oakleyklausen4146

Decisional conflict scores were similar and low between the 2 groups 11.8 (usual care) and 11.4 (decision aid). There were no differences in secondary outcomes between usual care and the decision aid.

Our decision aid for the management of DDCF produces a similarly low decisional conflict score to consultation with an orthopaedic trauma surgeon. This decision aid could be a useful resource for surgeons who infrequently treat this injury or whose practices are shifting toward telemedicine visits. Providing a decision aid before consultation may help incorporate patient's values and preferences into the decision-making process between surgery and nonoperative management.

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Requests for opioid pain medication more than a few weeks after surgery are associated with greater symptoms of depression and cognitive biases regarding pain such as worst-case thinking and fear of painful movement. We sought factors associated with patient desire for more opioid medication and satisfaction with pain alleviation at suture removal after lower extremity surgery.

Cross sectional study.

Enrollment occurred at 1 of 4 orthopaedic offices in an urban setting.

At suture removal after lower extremity surgery, 134 patients completed questionnaires measuring catastrophic thinking, ability to reach goals and continue normal activities in spite of pain, symptoms of depression, and magnitude of physical limitations.

Psychological factors associated with questionnaire-reported patient desire for another opioid prescription, satisfaction with postoperative pain alleviation, and the self-reported number of pills remaining from original opioid prescription.

In logistic regression, smoking and greater catastrophic thinking were independently associated with desire for opioid refill (R2 = 0.20). Lower satisfaction with pain alleviation was associated with greater catastrophic thinking (R2 = 0.19). The size of surgery (large vs. medium/small procedure) was not associated with pain alleviation or satisfaction with pain alleviation.

The association between unhelpful cognitive bias regarding pain and request for more opioids reinforces the importance of diagnosing and addressing common misconceptions regarding pain in efforts to help people get comfortable.

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Access to fractures of the distal humeral capitellum, trochlea, and lateral condyle is difficult through traditional approaches due to limited anterior articular exposure for direct reduction and fixation. The purpose of this study is to evaluate the relative articular exposure of a surgical dislocation (SD) approach to the distal humerus compared with olecranon osteotomy (OO).

Eight paired elbows from 4 cadavers underwent either SD or OO approach. Methylene blue staining demarcated visualized articular surface before disarticulation of the elbows. The main outcome measures were average visualized total distal humeral articular surface and anterior and posterior surface, and capitellar surface relative to the total surfaces was compared for each surgical approach using unpaired parametric t-tests.

Intraclass correlation between raters was 0.995. The median exposed articular surface for SD and OO approaches was 90.0% and 62.8%, respectively. The overall exposure was significantly greater for the dislocation technique (P = 0.0003). With respect to specific regions of the distal humeral articular surface, SD allowed significantly greater visualization of the anterior surface (95.9% vs. 48.9%, P < 0.0001) and capitellum (100% vs. 40.4%, P < 0.0001).

The surgical elbow dislocation approach to the distal humerus permits near total exposure of the anterior articular surface and the entire capitellum. selleck inhibitor Our data support this approach for anterior articular fractures of the distal humerus, to include those fractures that extend to the medial surface of the trochlea.

The surgical elbow dislocation approach to the distal humerus permits near total exposure of the anterior articular surface and the entire capitellum. Our data support this approach for anterior articular fractures of the distal humerus, to include those fractures that extend to the medial surface of the trochlea.

To evaluate the diagnostic utility of leukocyte count (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) for distinguishing between septic and aseptic nonunions.

A single-gate (cohort) design was used, using 1 set of eligibility criteria applied to a consecutive sample of nonunions.

Private quaternary referral center.

Inclusion criteria were consecutive patients (≥18 years) with a nonunion requiring surgery that allowed for direct or medullary canal tissue sampling from the nonunion site. The cohort included 204 subjects with 211 nonunions.

Blood samples were drawn for laboratory analysis of WBC, ESR, and CRP before surgery.

The reference standard used to define infection was the fracture-related infection confirmatory criteria. Measures of diagnostic accuracy were calculated. To assess the additional diagnostic gain of each index lab test while simultaneously considering the others, logistic regression models were fit.

The prevalence of infection was 19% (40 of 211 nonunion sites). The positive likelihood ratios (95% confidence interval) for WBC, ESR, and CRP were 1.07 (0.38-3.02), 1.27 (0.88-1.82) and 1.57 (0.94-2.60), respectively. Multivariable modeling adjusted for the effect of preoperative antibiotics showed that WBC (P = 0.42), ESR (P = 0.48), and CRP (P = 0.23) were not significant predictors of infection.

In this consecutive sample of 211 nonunions in whom standard clinical practice would be to obtain index lab tests, our findings showed that WBC, ESR, and CRP were not significant predictors of infection.

Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.