OBJECTIVE: The purpose of this retrospective study was to identify opioid prescribing practices, determine the number of morphine milliequivalents (MMEs) prescribed by orthopaedic/non-orthopaedic members to narcotic naive and previously exposed patients and provide narcotic prescribing recommendations.
METHODS: Patients over 18 years old with an isolated femur fracture sustained between 2013 and 2015 were identified using the CPT code 27506. Prescribing information was obtained from the State Controlled Substance Monitoring Database (CSMD). Descriptive analysis of MMEs was then performed. Outliers and patients without prescriptions from orthopaedic providers were excluded to eliminate skewing of data. Mean and standard deviations were then calculated for patients without a history of opiates prescribed within 1 year of injury and for patients with a history of opiates prescribed within 1 year prior to the injury.
RESULTS: 45% (40/88) of patients were opiate exposed at the time of injury. Previously exposed patients received 1491 MMEs (SD 1044, median 1350, range 210 - 5140) and non-exposed received 1363 MMEs (SD 977.2, median 1260, range 105 - 4935) from orthopaedic providers (p=0.1473). Non-orthopedists prescribed 530 MMEs (SD 780.7, median 140, range 0 - 3515) to previously exposed patients and 175 MMEs (SD 393, median 140, range 0 - 1890) to patients without exposure (p<.0001).
CONCLUSION: Patients with prior history are more likely to be prescribed more opiates after femoral shaft fracture treatment. We recommend a protocol of prescribing half the mean of MMEs currently prescribed by orthopedists equating to 47 (711 MMEs) pills of oxycodone 10 mg in up to three prescriptions.
... purposes useful in the 'real world') currently applied in physical rehabilitation of patients after traumaticbone and soft tissue injuries AbstractText: PubMed, Embase, the Cochrane Library and CINAHL were searched ... possible AbstractText: Serious games seem a safe alternative or addition to conventional physiotherapy after traumaticbone and soft tissue injury.
... evaluated implications of geriatric risk screening followed by CGA in a university hospital department of orthopedics and trauma surgery AbstractText: Three hundred and eighty-one patients ≥75 years admitted to the Department of Orthopedics and Trauma Surgery of the University Hospital Essen received Identification of Seniors at Risk (ISAR) Screening followed ...
Neuroscience (3), Muscular and Skeletal Diseases (3), more mentions
... from podium presentation was 23.4 months, and the most common journals of publication were Journal of OrthopaedicTrauma (45.4%) and The Journal of Bone & Joint Surgery (15.3%) AbstractText: The publication rate of the podium ... annual meetings are an opportunity for early access to high-quality research in the area of orthopaedictrauma.
... semitendinosus (ST) tendons significantly contribute to sagittal, coronal, and/or rotational knee stability in the setting of ACLR with a concurrent partial medial collateral ligament (MCL) injury AbstractText: Controlled laboratory study AbstractText: Twelve human cadaveric knees were subject to static forces applied to the tibia including an anterior-directed force as ...
AbstractText: To describe the incidence of overuse musculoskeletalinjuries in service members with combat-related lower limb amputation AbstractText ... International Classification of Diseases, Ninth Revision [ICD-9]) associated with musculoskeletal overuse injuries of the lumbar spine, upper limb, and lower limb regions ... injury AbstractText: The overall incidence of developing at least one musculoskeletal overuse injury within the first year after lower limb amputation was between ...
AbstractText: The etiologies and epidemiology of traumatic cervical spine fracture have not been described with sufficient power or recency ... spinal cord injuries (SCIs), concurrent injuries, treatments, and complications of traumatic cervical spine fractures AbstractText: Retrospective review of the Nationwide Inpatient Sample ... Demographics, incidence, etiology, fracture levels, concurrent injuries, surgical procedures, and complications were analyzed.
Muscular and Skeletal Diseases (2), Blood Disorders and Hematology (1) Central Cord Syndrome (1), Anemia (1), Spinal Cord Injuries (1), more mentions
AbstractText: The physical demands of professional tennis combined with high training/match loads can contribute to musculoskeletalinjury... Lower limb (51%) and muscle/tendon (50%) injuries were the most common site and type of injury. Common specific injury site subcategories were the thigh, shoulder/clavicle, ankle and knee in order of frequency.
The Gustilo-Anderson system was developed to identify the degree of injury of open fractures and can be utilized to guide initial antibiotic therapy. Few studies have been published evaluating the potential impact of emergency medicine pharmacists in trauma, and currently no study has evaluated a pharmacist's influence on antibiotic selection and timing for open fractures AbstractText: The objective of ...
Two, respectively, 72- and 76-year-old men with recently diagnosed high-risk prostate cancer were referred for primary staging with Ga-prostate-specific membrane antigen (PSMA) PET/CT. In both patients, the PET scans revealed increased Ga-PSMA uptake in, respectively, 3 and 4 rib fractures, characteristically placed as "pearls on a string." These cases illustrate important pitfalls when reporting PSMA PET.
AbstractText: Osteoarthritis (OA) and meniscal and ligamentinjuries of the knee are the two most common knee disorders ... care for M17 knee osteoarthritis and S83 knee meniscal and ligamentinjury codes of the International Classification of Diseases, 10th revision (ICD ... highest incidence in females aged ≥60 years, whereas meniscal and ligamentinjuries of the knee were most prevalent among patients aged <20 ...
Muscular and Skeletal Diseases (5) Knee Osteoarthritis (3), Osteoarthritis (1), more mentions
PURPOSE: To investigate knee kinematics in response to physical examinations to determine the effect of anterolateral capsular injury and lateral extra-articular tenodesis (LET) in anterior cruciate ligament (ACL)-deficient and -reconstructed knees.
METHODS: Seven human lower limb cadavers were used in this study (mean age, 60 years; age range, 56-63 years). Physical examinations were performed, including the pivot-shift test, Lachman test, anterior drawer at 90°, and internal and external tibial rotation at 30°, 60°, and 90° of knee flexion. ACL injury and reconstruction and LET, all with and without an injured anterolateral capsule, were investigated. Tibial translation and rotation relative to the femur were measured by an electromagnetic tracking system during the physical examination.
RESULTS: Anterior translation of the lateral knee compartment and internal tibial rotation during the pivot-shift test were highest in combined ACL-deficient and anterolateral capsule-deficient knees (12.3 ± 7.4 mm and 16.3° ± 8.5°, respectively). With the presence of an anterolateral capsular injury, a combined ACL reconstruction and LET reduced the anterior translation of the lateral knee compartment during the pivot-shift test significantly (P = .042), whereas anatomic ACL reconstruction did not. Internal tibial rotation displayed overconstraint when a LET was performed, especially when the anterolateral capsule was intact.
CONCLUSIONS: ACL reconstruction in combination with a LET was able to reduce anterior tibial translation and internal tibial rotation in response to different physical examinations. However, combined ACL reconstruction and LET led to overconstraint of internal tibial rotation when the anterolateral capsule was intact. CLINICAL RELEVANCE: On the basis of our results, LET with ACL reconstruction restores stability in a combined ACL-injured and anterolateral capsule-injured knee. However, LET with ACL reconstruction overconstrains the knee in an isolated ACL injury.
... or chondral damage was determined from operative records, while collateral ligamentinjuries were determined by the treating surgeon's diagnosis after physical examination ... A 2-fold increase in the incidence of collateral ligamentinjury was identified between the 2 groups with 114 (67.5%) in ... 1.7%) in the noncontact group had a grade III collateral ligamentinjury (P < .001.
We present seven cases of a relatively rare swan neck deformity resulting from chronic radial collateral ligament (RCL) injury of the proximal interphalangeal (PIP) joint in the little finger. All patients were middle-aged women (mean 51 years old, range 42-55), and the duration between the initial injury and surgery was 20 years (range 5-40.
Muscular and Skeletal Diseases (1) Osteoarthritis (1), more mentions
... this study was to evaluate the clinical and functional outcomes of patients with large post-traumatic tibial bone defects managed by double-level bone transport using the Ilizarov technique AbstractText: We retrospectively reviewed ... AbstractText: Double-level bone transport is a safe, reliable, and successful method for large post-traumatic tibial bone defects.
PURPOSE: To report on the clinical and radiologic outcomes and complications after surgical treatment in National Football League (NFL) Combine athletes with a history of a scaphoid fracture.
METHODS: The medical records of 2,285 athletes participating in the NFL Combine from 2009 to 2015 were evaluated for a history of scaphoid, hand, or wrist injury. Clinical outcomes, including grip strength, pinch test, range of motion, and presence of pain and stiffness, were recorded. Imaging studies were evaluated for the percentage of healing, fixation treatment type, hardware complications, radiographic deformity, and presence of osteoarthritis.
RESULTS: Of the 2,285 athletes evaluated, 56 presented with a history of a scaphoid fracture. Most fractures were in the middle and proximal aspects of the scaphoid. Of the scaphoid fractures, 76% (43 players) were treated with screw fixation. Of the athletes, 36 (72%) had normal range of motion of the affected wrist, 52 (93%) reported no pain, and 44 (83%) reported no stiffness in the affected wrist. The grip strength and pinch strength were 91% and 96%, respectively, of the uninjured side. The fracture was healed in 75% of the cases; however, 34% had degenerative changes. Hardware complications were found in 15% of the athletes.
CONCLUSIONS: Good clinical outcomes can be achieved after scaphoid fractures in prospective NFL athletes. However, the rates of nonunion (25%), degenerative changes (34%), and hardware complications (15%) in this study suggest the need for close postoperative radiographic follow-up in this population of patients because their athletic demands may lead to higher rates of the aforementioned complications.
LEVEL OF EVIDENCE: Level IV, retrospective study.
Muscular and Skeletal Diseases (1) Osteoarthritis (1), more mentions
AbstractText: Bone stress injuries are common in high-level athletics AbstractText: To describe the demographics, frequency and anatomical location ... by volleyball players (16%), gymnastics (artistic) (12%) and other type of sports AbstractText: Twenty-five bone stress injuries were reported, more commonly in women, mostly in the lower extremities and most commonly in ...