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  • Ovid Technologies (Wolters Kluwer Health)  (71)
  • 1
    Online Resource
    Online Resource
    Is Lateral Femoral Nailing Associated With Increased Intensive Care Unit Days? A Propensity-Matched Analysis of 848 Cases
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Journal of Orthopaedic Trauma Vol. 32, No. 1 ( 2018-01), p. 39-42
    Details
    In: Journal of Orthopaedic Trauma, Ovid Technologies (Wolters Kluwer Health), Vol. 32, No. 1 ( 2018-01), p. 39-42
    Abstract: The purpose of this study is to determine if lateral patient position during femoral nailing is associated with increases in intensive care unit (ICU) length of stay (LOS) or ventilator days when compared with femoral nailing in a supine position. Design: Retrospective cohort study. Setting: Level 1 trauma center. Patients/Participants: Patients with femoral shaft fractures treated with intramedullary fixation were identified. Propensity matching was performed to minimize selection bias using factors thought to be associated with surgeon selection of supine nailing at our institution (Injury Severity Score, Abbreviated Injury Score brain, and bilateral fractures). After matching, 848 patients were included in the analysis. Intervention: Femoral nailing in the lateral position compared with the supine position. Main Outcome Measurements: Our primary outcome measure was ICU LOS. Ventilator days were the secondary outcome. Results: Treating patients with femoral nailing in the lateral position was associated with a 1.88 days (95% confidence interval, 0.73–3.02; P = 0.001) reduction in ICU LOS in our adjusted model. Intramedullary nailing in the lateral position was associated with a 1.29 days (95% confidence interval, −0.12 to 2.69) decrease in postoperative time on a ventilator. However, this finding was not statistically significant ( P = 0.07). Conclusion: Lateral femoral nailing was associated with decreased ICU LOS ( P = 0.001) even after accounting for selection bias using propensity score matching. Our data indicate that lateral femoral nailing is likely not associated with the increased risk of pulmonary complication. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
    Type of Medium: Online Resource
    ISSN: 0890-5339
    URL: Article
    DOI: 10.1097/BOT.0000000000000999
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2041334-8
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  • 2
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    Prevalence of Depression and Posttraumatic Stress Disorder After Acute Orthopaedic Trauma: A Systematic Review and Meta-Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Journal of Orthopaedic Trauma Vol. 31, No. 1 ( 2017-01), p. 47-55
    Details
    In: Journal of Orthopaedic Trauma, Ovid Technologies (Wolters Kluwer Health), Vol. 31, No. 1 ( 2017-01), p. 47-55
    Abstract: This study aims to systematically assess the existing literature and to derive a pooled estimate of the prevalence of depression and posttraumatic stress disorder (PTSD) in adult patients after acute orthopaedic trauma. Data Sources: A comprehensive search of databases, including MEDLINE, Embase, PsycINFO, and Cochrane Central Register of Controlled Trials databases was conducted through June 2015. Study Selection: We included studies that assessed the prevalence of depression or PTSD in patients who experienced acute orthopaedic trauma to the appendicular skeleton or pelvis. Studies with a sample size of ≤10 were excluded. Data Extraction: Two authors independently extracted data from the selected studies and the data collected were compared with verify agreement. Data Synthesis: Twenty-seven studies and 7109 subjects were included in the analysis. Using a random-effects model, the weighted pooled prevalence of depression was 32.6% (95% CI, 25.0%–41.2%) and the weighted pooled prevalence of PTSD was 26.6% (95% CI, 19.0%–35.9%). Six studies evaluated the prevalence of both depression and PTSD in patients with acute orthopaedic injuries. The weighted pooled prevalence of both depression and PTSD for those patients was 16.8% (95% CI, 9.0%–29.4%). Conclusions: Nearly one-third of patients suffer from depression and more than one-quarter of patients suffer from PTSD after an acute orthopaedic injury suggesting that strategies to address both the mental and physical rehabilitation after an orthopaedic injury should be considered to optimize patient recovery. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
    Type of Medium: Online Resource
    ISSN: 0890-5339
    URL: Article
    DOI: 10.1097/BOT.0000000000000664
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
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  • 3
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    Does an Implant Usage Report Card Impact Orthopaedic Trauma Implant Stewardship?
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Journal of Orthopaedic Trauma Vol. 33, No. 11 ( 2019-11), p. e427-e432
    Details
    In: Journal of Orthopaedic Trauma, Ovid Technologies (Wolters Kluwer Health), Vol. 33, No. 11 ( 2019-11), p. e427-e432
    Abstract: As hospitals seek to control variable expenses, orthopaedic surgeons have come under scrutiny because of relatively high implant costs. We aimed to determine whether feedback to surgeons regarding implant costs results in changes in implant selection. Methods: This study was undertaken at a statewide trauma referral center and included 6 fellowship-trained orthopaedic trauma surgeons. A previously implemented implant stewardship program at our institution using a “red-yellow-green” (RYG) implant selection tool classifies 7 commonly used trauma implant constructs based on cost and categorizes each implant as red (used for patient-specific requirements, most expensive), yellow (midrange), and green (preferred vendor, least expensive). The constructs included were femoral intramedullary nail, tibial intramedullary nail, long and short cephalomedullary nails, distal femoral plate, proximal tibial plate, and lower-limb external fixator. Baseline implant usage from the previous year was obtained and provided to each surgeon. Each surgeon received a monthly feedback report containing individual implant utilization and overall ranking. Results: The overall RYG score increased from 68.7 to 79.1 of 100 ( P 〈 0.001). Three of the 7 implants (tibial and femoral nails and lower-limb external fixation) had significant increases in their RYG scores; implant selections for the other 4 implants were not significantly altered. A decrease of 1.8% (95% confidence interval, 0.4–3.2, P = 0.01) was noted in overall implant costs over the study period. Conclusion: Our intervention resulted in changes in surgeons' implant selections and cost savings. However, surgeons were unwilling to change certain implants despite their being more expensive.
    Type of Medium: Online Resource
    ISSN: 0890-5339
    URL: Article
    DOI: 10.1097/BOT.0000000000001557
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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  • 4
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    Online Resource
    The Capacity to Manage Orthopaedic Trauma
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Journal of Orthopaedic Trauma Vol. 29, No. Supplement 10 ( 2015-10), p. S1-
    Details
    In: Journal of Orthopaedic Trauma, Ovid Technologies (Wolters Kluwer Health), Vol. 29, No. Supplement 10 ( 2015-10), p. S1-
    Type of Medium: Online Resource
    ISSN: 0890-5339
    URL: Article
    DOI: 10.1097/BOT.0000000000000414
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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  • 5
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    Quantitative Evaluation of Embolic Load in Femoral and Tibial Shaft Fractures Treated With Reamed Intramedullary Fixation
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Journal of Orthopaedic Trauma Vol. 35, No. 8 ( 2021-08), p. e283-e288
    Details
    In: Journal of Orthopaedic Trauma, Ovid Technologies (Wolters Kluwer Health), Vol. 35, No. 8 ( 2021-08), p. e283-e288
    Abstract: To compare the volume of embolic load during intramedullary fixation of femoral and tibial shaft fractures. Our hypothesis was that tibial intramedullary nails (IMNs) would be associated with less volume of intravasation of marrow than IM nailing of femur fractures. Design: Prospective observational study. Setting: Urban Level I trauma center. Patients/Participants: Twenty-three patients consented for the study: 14 with femoral shaft fractures and 9 with tibial shaft fractures. Intervention: All patients underwent continuous transesophageal echocardiography, and volume of embolic load was evaluated during 5 distinct stages: postinduction, initial guide wire, reaming (REAM), nail insertion, and postoperative. Main Outcome Measurements: Volume of embolic load was measured based on previously described luminosity scores. The embolic load based on fracture location and procedure stage was evaluated using a mixed effects model. Results: The IMN procedure increased the embolic load by 215% (−12% to 442%, P = 0.07) in femur patients relative to tibia patients after adjusting for baseline levels. Of the 5 steps measured, REAM was associated with the greatest increase in embolic load relative to the guide wire placement and controlling for fracture location (421%, 95% confidence interval: 169%–673%, P 〈 0.01). Conclusions: Femoral shaft IMN fixation was associated with a 215% increase in embolic load in comparison with tibial shaft IMN fixation, with the greatest quantitative load during the REAM stage; however, both procedures produce embolic load. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
    Type of Medium: Online Resource
    ISSN: 0890-5339
    URL: Article
    DOI: 10.1097/BOT.0000000000002025
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2041334-8
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  • 6
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    Quantitative Lesser Trochanter Profile Versus Cortical Step Sign in Assessing Femoral Malrotation After Femoral Nailing
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Journal of Orthopaedic Trauma Vol. 34, No. 7 ( 2020-07), p. e256-e260
    Details
    In: Journal of Orthopaedic Trauma, Ovid Technologies (Wolters Kluwer Health), Vol. 34, No. 7 ( 2020-07), p. e256-e260
    Abstract: We describe the novel quantitative lesser trochanter profile (QLTP) technique to determine the magnitude and direction of femoral malrotation and to compare its performance with the cortical step sign technique. For this assessment, 9 orthopaedic surgeons estimated the magnitude and direction of femoral malrotation with each technique in 198 anteroposterior view images of the proximal cadaveric femur and osteotomy sites. Based on the results, the main benefit of the QLTP technique over the cortical step sign technique is the ability to determine the direction of femoral malrotation. The QLTP technique was also more accurate in measuring malrotation and had less error. However, the QLTP technique requires additional imaging, and the mean difference in error between the 2 techniques might not be clinically meaningful.
    Type of Medium: Online Resource
    ISSN: 0890-5339
    URL: Article
    DOI: 10.1097/BOT.0000000000001722
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2041334-8
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  • 7
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    Difference in Resident Versus Attending Perspective of Competency and Autonomy During Arthroscopic Rotator Cuff Repairs
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  JBJS Open Access Vol. 6, No. 1 ( 2021-2-24)
    Details
    In: JBJS Open Access, Ovid Technologies (Wolters Kluwer Health), Vol. 6, No. 1 ( 2021-2-24)
    Abstract: A noted deficiency in orthopaedic resident education is a lack of intraoperative autonomy; however, no studies exist evaluating this issue. The purpose of this study was to determine whether there is a difference between resident and attending perception of resident competency and autonomy during arthroscopic rotator cuff repairs and whether increased perceived competency leads to more autonomy. Methods: This study included 21 orthopaedic residents and 7 attendings from a single residency program. A survey was developed that included the previously validated Ottawa Surgical Competency Operating Room Evaluation (O-SCORE) and implemented novel arthroscopic rotator cuff repair questions concerning 5 key procedural steps determined by attendings. The survey assessed resident and attending perception of percent opportunity given and percent completed of each step and whether the resident could complete the surgery independently. Paired comparisons were conducted using the Wilcoxon signed-rank test. Agreement between residents and attendings was calculated using a linear-weighted Gwet's AC 2 . A secondary analysis investigated resident perception of autonomy stratified by attending perception of competency using Kruskal-Wallis tests. Results: One hundred forty-two surveys were completed over one academic year. Residents reported a 4-point higher median O-SCORE (34) than attendings (30; p 〈 0.01; agreement = 0.63). Residents perceived less opportunity compared with attendings, with a median opportunity to complete each step of 54% vs. 70% (p 〈 0.01; agreement = 0.39). Residents also perceived lower percent completed of the key steps compared with attendings, with medians of 52% vs. 61% (p 〈 0.01; agreement = 0.37). Resident perceived opportunity increased with higher attending reported O-SCOREs (p 〈 0.01) and percent completion of the key steps (p 〈 0.01). No statistically significant increase in perceived opportunity was observed the with post-graduate year (PGY) level (p = 0.35). Discussion: This study demonstrated a significant difference in perception between residents and attendings regarding resident competency and autonomy during arthroscopic rotator cuff repairs. It also demonstrated that with increasing attending perception of competency, there was an increasing resident perception of autonomy, but there was no statistically significant difference of perceived autonomy based on the PGY-level.
    Type of Medium: Online Resource
    ISSN: 2472-7245
    URL: Article
    DOI: 10.2106/JBJS.OA.20.00014
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2873843-3
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  • 8
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    Technical Factors Contributing to Nonunion in Supracondylar Distal Femur Fractures Treated With Lateral Locked Plating: A Risk-Stratified Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2024
    In:  Journal of Orthopaedic Trauma Vol. 38, No. 1 ( 2024-01), p. 49-55
    Details
    In: Journal of Orthopaedic Trauma, Ovid Technologies (Wolters Kluwer Health), Vol. 38, No. 1 ( 2024-01), p. 49-55
    Abstract: To identify technical factors associated with nonunion after operative treatment with lateral locked plating. METHODS: Design: Retrospective cohort study. Setting: Ten Level I trauma centers. Patient Selection Criteria: Adult patients with supracondylar distal femur fractures (OTA/AO type 33A or C) treated with lateral locked plating from 2010 through 2019. Outcome Measures and Comparisons: Surgery for nonunion stratified by risk for nonunion. RESULTS: The cohort included 615 patients with supracondylar distal femur fractures. The median patient age was 61 years old (interquartile range: 46 -72years) and 375 (61%) were female. Observed were nonunion rates of 2% in a low risk of nonunion group (n = 129), 4% in a medium-risk group (n = 333), and 14% in a high-risk group (n = 153). Varus malreduction with an anatomic lateral distal femoral angle greater than 84 degrees, was associated with double the odds of nonunion compared to those without such varus [odds ratio, 2.1; 95% confidence interval (CI), 1.1–4.2; P = 0.03]. Malreduction by medial translation of the articular block increased the odds of nonunion, with 30% increased odds per 4 mm of medial translation (95% CI, 1.0–1.6; P = 0.03). Working length increased the odds of nonunion in the medium risk group, with an 18% increase in nonunion per 10-mm increase in working length (95% CI, 1.0–1.4; P = 0.01). Increased proximal screw density was protective against nonunion (odds ratio, 0.71; 95% CI, 0.53–0.92; P = 0.02) but yielded lower mRUST scores with each 0.1 increase in screw density associated with a 0.4-point lower mRUST (95% CI, -0.55 to -0.15; P 〈 0.001). Lateral plate length and type of plate material were not associated with nonunion. ( P 〉 0.05). CONCLUSIONS: Malreduction is a surgeon-controlled variable associated with nonunion after lateral locked plating of supracondylar distal femur fractures. Longer working lengths were associated with nonunion, suggesting that bridge plating may be less likely to succeed for longer fractures. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
    Type of Medium: Online Resource
    ISSN: 0890-5339
    URL: Article
    DOI: 10.1097/BOT.0000000000002680
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2024
    detail.hit.zdb_id: 2041334-8
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  • 9
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    Telemedicine and Socioeconomics in Orthopaedic Trauma Patients: A Quasi-Experimental Study During the COVID-19 Pandemic
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Journal of the American Academy of Orthopaedic Surgeons Vol. 30, No. 18 ( 2022-09-15), p. 910-916
    Details
    In: Journal of the American Academy of Orthopaedic Surgeons, Ovid Technologies (Wolters Kluwer Health), Vol. 30, No. 18 ( 2022-09-15), p. 910-916
    Abstract: Socioeconomic factors may introduce barriers to telemedicine care access. This study examines changes in clinic absenteeism for orthopaedic trauma patients after the introduction of a telemedicine postoperative follow-up option during the COVID-19 pandemic with attention to patient socioeconomic status (SES). Methods: Patients (n = 1,060) undergoing surgical treatment of pelvic and extremity trauma were retrospectively assigned to preintervention and postintervention cohorts using a quasi-experimental design. The intervention is the April 2020 introduction of a telemedicine follow-up option for postoperative trauma care. The primary outcome was the missed visit rate (MVR) for postoperative appointments. We used Poisson regression models to estimate the relative change in MVR adjusting for patient age and sex. SES-based subgroup analysis was based on the Area Deprivation Index (ADI) according to home address. Results: The pre-telemedicine group included 635 patients; the post-telemedicine group included 425 patients. The median MVR in the pre-telemedicine group was 28% (95% confidence interval [CI], 10% to 45%) and 24% (95% CI, 6% to 43%) in the post-telemedicine group. Low SES was associated with a 40% relative increase in MVR (95% CI, 17% to 67%, P 〈 0.001) compared with patients with high SES. Relative MVR changes between pre-telemedicine and post-telemedicine groups did not reach statistical significance in any socioeconomic strata (low ADI, −6%; 95% CI, −25% to 17%; P = 0.56; medium ADI, −18%; 95% CI, −35% to 2%; P = 0.07; high ADI, −12%; 95% CI, −28% to 7%; P = 0.20). Conclusions: Low SES was associated with a higher MVR both before and after the introduction of a telemedicine option. However, no evidence in this cohort demonstrated a change in absenteeism based on SES after the introduction of the telemedicine option. Clinicians should be reassured that there is no evidence that telemedicine introduces additional socioeconomic bias in postoperative orthopaedic trauma care. Level of Evidence: III
    Type of Medium: Online Resource
    ISSN: 1067-151X , 1940-5480
    URL: Article
    DOI: 10.5435/JAAOS-D-21-01143
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 10
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    Practical Guide to Delivering Surgical Skills Courses in a Low-Income Country: Knowledge Gained From a Surgical Education Partnership in Haiti
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Journal of Orthopaedic Trauma Vol. 32, No. 7 ( 2018-10), p. S18-S20
    Details
    In: Journal of Orthopaedic Trauma, Ovid Technologies (Wolters Kluwer Health), Vol. 32, No. 7 ( 2018-10), p. S18-S20
    Abstract: Routine surgical skills training is known to advance a surgeon's technical proficiency. However, orthopaedic providers in low-income countries have limited access to skills training programs. International academic partnerships can augment locally available orthopaedic education, improving the quality of and capacity to deliver orthopaedic care in low-income countries. The objective of this study is to provide a practical guide to delivering an orthopaedic skills training course in a low-resource setting. The information provided is based on the experiences of the authors, along with specific feedback from previous course participants in Haiti.
    Type of Medium: Online Resource
    ISSN: 0890-5339
    URL: Article
    DOI: 10.1097/BOT.0000000000001289
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
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