Search

Eric J Kim,1 Arjun Ganga,1 Chaerim Kang,2 William Elnemer,3 James Y Lee,4 Yasmyne C Ronquillo,5 Phillip C Hoopes,5 Majid Moshirfar5– 7 1Division of Ophthalmology, Warren Alpert Medical School at Brown University, Providence, RI, USA; 2Program in Liberal Medical Education, Brown University, Providence, RI, USA; 3Johns Hopkins School of Medicine, Baltimore, MD, USA; 4Brown University, Providence, RI, USA; 5Hoopes Vision Research Center, Draper, UT, USA; 6John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA; 7Utah Lions Eye Bank, Murray, UT, USACorrespondence: Eric J Kim, Division of Ophthalmology, Warren Alpert Medical School at Brown University, Providence, RI, USA, Tel +1 978-289-0659, Email eric_kim2@brown.eduPurpose: Motorcycle-related injuries involving the eye and orbit are not well characterized, with a paucity of prospective studies focusing specifically on motorcycle-associated eye injuries nor literature reviews having been conducted on the subject. To better understand the injury types and descriptive characteristics of patients experiencing motorcycle-associated eye injuries, we sought to conduct a narrative review.Methods: The research team utilized the following databases: PubMed, EMBASE, and Web of Science to query for English articles from peer-reviewed journals that provided some patient data regarding eye injury due to motorcycle or moped accidents or usage.Results: A total of 65 studies were included in our qualitative synthesis. Of these studies, 40 (61.5%) were case reports, 20 retrospective case series (30.8%), and five (7.69%) were observational prospective studies. Among the 25 retrospective and prospective studies, 12 (48.0%) of these studies primarily focused on motorcycle-associated injuries. These 65 studies described a wide variety of motorcycle-associated eye injuries, including but not limited to orbital fractures and associated sequelae, foreign bodies, vitreoretinal trauma, neuro-ophthalmic trauma, corneal injuries, open globe injuries, lacerations, and globe avulsions.Conclusion: The current state of the literature indicates that knowledge regarding the ocular manifestations of motorcycle accidents is limited to mostly case reports and few retrospective cohort studies focused specifically on motorcycle-associated eye injuries. However, it is evident that the types of motorcycle-associated eye injuries are legion and predominantly seen in adult males, potentially leading to severe injuries and loss of vision and blindness.Keywords: motorcycle, ocular injury, eye, trauma, orbital fracture, ruptured globe, corneal injury, vitreoretinal damage, vehicular accidents

Aims & Objectives: This study characterized the independent association between insurance type and healthcare outcomes in patients undergoing total joint arthroplasty (TJA)., Materials &methods: National data identified patients who underwent total hip, knee, shoulder, elbow, ankle or wrist joint arthroplasty surgery from 2012 to 2020 for osteoarthritis. Medicaid, Medicare≥65 years old, Medicare<65 years old, and uninsured patients were matched to privately insured patients based on age, sex, and comorbidities. Multivariable analysis, controlled for various characteristics, was conducted to quantify various outcome measures by payer status., Results: Medicaid patients had greater odds of cardiac, genitourinary, hematoma/hemorrhage/seroma, respiratory, and wound dehiscence complications than privately insured (odds ratio [OR]: 1.5, 1.2, 1.6, 1.3, 1.5, respectively; p < 0.01). Medicare patients ≥65 years old had greater odds of cardiac and wound dehiscence complications but fewer central nervous system and genitourinary complications and post-operative infections than privately insured (OR:1.2, 1.2, 0.3, 0.8, 0.7, respectively; p < 0.01). Medicare<65 years old patients had greater odds of cardiac, gastrointestinal, genitourinary, hematoma/hemorrhage/seroma, post-operative anemia, respiratory, and wound dehiscence complications than privately insured (OR: 1.2, 1.4, 1.2, 1.4, 1.2, 1.7, 1.6, respectively; p < 0.01). Medicare≥65, Medicare<65, and Medicaid patients had $2,243, $3,849, and $1170 more total charges, respectively (p < 0.01)., Conclusion: Despite Medicaid expansion through the 2014 Affordable Care Act, marked disparities in complications after TJA between individuals with and without private insurance still exist. Medicare<65 and Medicaid cohorts demonstrated higher complication rates than private payers, possibly attributable to barriers in healthcare such as patient education, access to healthcare, and social determinants of health., Competing Interests: MB has other financial or non-financial interests in Arthrex, Inc., Smith & Nephew, and Stryker. US reports grants or contracts from Fx Shoulder, Thieme, and Tigon Medical; consulting fees from Tigon Medical and Fx Shoulder; payment or honoraria from Fx Shoulder; board or committee membership at AAOS, American Shoulder and Elbow Surgeons, and IASES; stock or stock options from ROM3, Sonogen, and Tigon Medical; other financial or material support from DePuy, a Johnson & Johnson company; and research support from Fx Shoulder. All other authors have no conflicts to declare., (© 2024 Published by Elsevier B.V. on behalf of Professor P K Surendran Memorial Education Foundation.)

Background: Expandable lumbar interbody cages (ELICs) are commonly used for interbody fusion and provide lordotic correction by lengthening the anterior column of the vertebral spine. We sought to identify unique failure mechanisms and significant differences in the types of complications associated with ELICs as reported to the Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) Database., Materials and Methods: The MAUDE Database was analyzed for complication reports submitted for ELIC systems between January 2013 and July 2023. Reports were categorized by manufacturer, brand name, type of expandable cage, type of complication, year of complication, and reporter identity. Reports that were duplicated or had insufficient information were excluded from analysis. The top 5 manufacturers with the most implant-related complications were independently analyzed and compared., Results: A total of 821 reports were analyzed. The top 5 complications reported across all manufacturers were cage breakage during insertion (25.7%), postoperative migration without collapse (16.0%), postoperative collapse (15.6%), inserter breakage (11.1%), and tubing problems (3.0%). A significant difference was detected in complication type between manufacturers (χ 2 =557, P <.001). The largest number of reports (120, 14.6%) was in 2016., Conclusion: With FDA approval of novel ELIC systems and the adoption of newer surgical techniques, understanding the range of potential complications is paramount in ensuring patient safety. This study of the MAUDE Database provides a comprehensive summary of adverse reported events associated with ELICs during the past decade. [ Orthopedics . 202x;4x(x):xx-xx.].

Introduction: Nerve palsies are potential consequences of fractures that can result in temporary loss of muscular function. Nerve palsies have not been extensively described in the context of tibial tubercle fractures in the pediatric population. Although the symptoms accompanying nerve palsies concern patients, evidence suggests that non-operative management often results in full functional recovery over time. Our case contributes to the available literature to demonstrate this point, even when neurologic deficits seem abnormally prolonged., Case Report: We describe a case of isolated left extensor hallucis longus (EHL) palsy in a 15-year-old African American male patient, who initially presented to our institution's emergency department with a left knee injury. While playing basketball, he sustained a left proximal fibular shaft fracture with a displaced tibial tubercle. Open reduction and internal fixation is the name of the procedure and is considered singular; however, he developed an EHL palsy that persisted for 3 months postoperatively. Nerve conduction studies found substantial left peroneal neuropathy. The patient received physical therapy throughout this time. With nothing other than non-operative management, he recovered full function 7 months after the initial injury with no further complications., Conclusion: We are aware of only 3 other published reports of isolated EHL palsy, each with unique causes. Our report may be one of the first documented cases of a tibial tubercle fracture with peroneal nerve palsy resulting in an isolated EHL deficit. It is important for clinicians and patients to be aware that even prolonged nerve and muscular deficits can be expected to resolve with non-operative management., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Background: Tobacco use significantly increases the rate of wound complications in patients undergoing total ankle arthroplasty (TAA). Preoperative optimization through smoking cessation programs significantly minimizes the rate of infection and improves wound healing in arthroplasty procedures. Despite its utility, minimal research has examined the cost-effectiveness of preoperative smoking cessation programs to reduce the need for extracapsular irrigation and debridement (I&D) due to wound complications following TAA., Methods: The cost of an I&D procedure was obtained from our institution's purchasing records. Baseline wound complication rates among tobacco users who have undergone TAA and smoking cessation program cost were obtained from literature. A break-even economic analysis was performed to determine the absolute risk reduction (ARR) to economically justify the implementation of preoperative smoking cessation programs. Different smoking cessation program and I&D costs were tested to account for variations in each factor. ARR was then used to calculate the number needed to treat (NNT) to prevent a single I&D while remaining cost-effective., Results: Smoking cessation programs were determined to be economically justified if it prevents 1 I&D surgery out of 8 TAAs among tobacco users (ARR = 12.66%) in the early postoperative period (<30 days). ARR was the same at the literature high (27.3%) and weighted literature average (13.3%) complication rates when using the cost of I&D surgery at our institution ($1757.13) and the literature value for a smoking cessation program ($222.45). Cost-effectiveness was maintained with higher I&D surgery costs and lower costs of smoking cessation treatment., Conclusion: Our model's input data suggest that the routine use of smoking cessation programs among tobacco users undergoing TAA is cost-effective for risk reduction of I&D surgery in the early postoperative period. This intervention was also found to be economically warranted with higher I&D costs and lower smoking cessation program costs than those found in the literature and at our institution. Level of Evidence: Level III, economic and decision analysis., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Disclosure forms for all authors are available online., (© The Author(s) 2024.)

Background: Body mass index (BMI) has been shown to influence risk for revision total hip arthroplasty (rTHA), but few studies have specifically examined which causes of rTHA are most likely in different BMI classes. We hypothesized that patients in different BMI classes would undergo rTHA for disparate reasons., Methods: Ninety-eight thousand six hundred seventy patients undergoing rTHA over 2006-2020 were identified in the National Inpatient Sample. Patients were classified as underweight, normal-weight, overweight/obese, or morbidly obese. Multivariable logistic regression was used to analyze the impact of BMI on rTHA for periprosthetic joint infection (PJI), dislocation, periprosthetic fracture (PPF), aseptic loosening, or mechanical complications. Analyses were adjusted for age, sex, race/ethnicity, socioeconomic status, insurance, geographic region, and comorbidities., Results: Compared to normal-weight patients, underweight patients were 131% more likely to have a revision due to dislocation and 63% more likely due to PPF. Overweight/obese patients were 19% less likely to have a revision due to dislocation and 10% more likely due to PJI. Cause for revision in morbidly obese patients was 4s1% less likely to be due to dislocation, 8% less likely due to mechanical complications, and 90% more likely due to PJI., Conclusions: Overweight/obese and morbidly obese patients were more likely to undergo rTHA for PJI and less likely for mechanical reasons compared to normal weight patients. Underweight patients were more likely to undergo rTHA for dislocation or PPF. Understanding the differences in cause for rTHA among the BMI classes can aid in patient-specific optimization and management to reduce postoperative complications., Level of Evidence: III., (© 2024. The Author(s).)

Introduction: The relative citation ratio (RCR), a novel bibliometric tool supported by the National Institute of Health, provides a standardized approach to evaluate research productivity and impact across different fields. This study aims to evaluate RCR of fellowship-trained foot and ankle orthopaedic surgeons to analyze the influence of various surgeon demographics., Methods: Fellow names listed on the American Orthopaedic Foot and Ankle Society website were extracted from the year 2008 to 2009 to the year 2022 to 2023. Demographic information for each fellow was collected including sex, degree type, and academic title. The iCite database developed by the National Institute of Health was used to obtain total publications, mean RCR, weighted RCR, and change in RCR after fellowship graduation for each fellow. Univariate and multivariate analysis was conducted to predict these four parameters based on sex, degree type, academic position, and career longevity., Results: Of the 820 fellows, 674 (82%) were male. Most fellows (n = 587, 71%) did not go on to hold academic positions. Multivariate analysis revealed that male sex (β = 2.32, P < 0.001), holding an academic position (β = 6.44, P < 0.001), holding a PhD (β = 22.96, P < 0.001), and a shorter length time since graduation (β = -0.50, P < 0.001) were independent predictors of number of total publications. Holding a DO degree was an independent predictor of decreased mean RCR (β = 0.39, P = 0.039). Finally, multivariate analysis revealed that male sex (β = 4.05, P = 0.003), a career in academics (β = 4.61, P < 0.001), and a shorter time since graduation (β = -0.45, P = 0.001) were associated with a larger weighted RCR., Discussion: The findings highlight the importance of addressing gender disparities and promoting research opportunities across different programs. Moreover, academic institutions should provide adequate support and mentorship to early-career foot and ankle-trained orthopaedic surgeons to foster sustained research productivity., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Study Design: Retrospective Review of a National Database., Introduction: By utilizing a national database, this study aims to quantify the predictors of 30-day mortality after odontoid fixation and guide appropriate management for patients in whom the choice between operative and non-operative management is unclear., Methods: The American College of Surgeons National Surgical Quality Improvement Database was queried using Current Procedural Terminology (CPT) codes and International Classification of Disease (ICD) codes to identify patients 60 or older who underwent surgical fixation of an odontoid fracture from 2005 to 2020. Risk factors for mortality significant in univariate and subsequent multivariate analysis were used to develop a scoring system to predict post-operative mortality., Results: 608 patients were identified. Patients were split into a non-mortality 30 days post-op group, and into a mortality 30 days post-op group. The following risk factors were included in the scoring system: functional dependency, disseminated cancer, albumin less than 3.5, WBC count greater than 16 k, anterior surgical approach, and pre-op SIRS. Using a cutoff value of 2, the CAAD-16 score had a sensitivity and specificity of 82% and 81%, respectively. The ASA score, cutoff at 4, showed a sensitivity and specificity of 64% and 75% respectively., Conclusions: This sample of 294 patients represents one of the largest samples of odontoid fracture fixation patients available in the literature and comes from a nationally representative database. We structure relevant risk factors into the CAADS-16 score, which has the potential to be a clinically relevant tool to prevent short-term postoperative mortality., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This investigation assessed the availability and comprehensiveness of adult reconstruction fellowship websites. A list of adult reconstruction fellowship programs was compiled using 4 online directories: American Association of Hip and Knee Surgeons, San Francisco Match, Fellowship and Residency Electronic Interactive Database Access, and American Academy of Orthopaedic Surgeons. These directories and Google (Alphabet Inc, Menlo Park, California) searches were used to assess for the presence and functionality of websites for each program. Each website was reviewed for the presence of 21 variables related to education and recruitment. The relationship between several program characteristics and presence of a website or website comprehensiveness was evaluated. In total, 81 programs were identified, of which 80.2% (65 of 81) had a functional website and 19.8% (16 of 81) did not. The mean±SD number of variables present on a website was 11.3±3.8 of 21 total variables, equating to mean comprehensiveness of 54.0%. Fellowships affiliated with an orthopedic residency were more likely to have a website than those that were not (91.8% vs 62.5%, P=.001). Fellowships that were accredited by the Accreditation Council for Graduate Medical Education were more likely to have a website than those that were not (100.0% vs 73.8%, P=.009). Website comprehensiveness was not associated with any program characteristics assessed. This study highlights deficits in online resources available for adult reconstruction fellowship program information and the gap that exists between the current means of information sharing. Efforts to encourage an online presence and optimize a program's online content may be of benefit to prospective applicants and the program itself. [Orthopedics. 2020;43(5):e447-e453.]., (Copyright 2020, SLACK Incorporated.)