Rotator cuff repair: what questions are patients asking online and where are they getting their answers?

Background This study analyzed questions searched by rotator cuff patients and determined types and quality of websites providing information. Methods Three strings related to rotator cuff repair were explored by Google Search. Result pages were collected under the “People also ask” function for frequent questions and associated webpages. Questions were categorized using Rothwell classification and topical subcategorization. Webpages were evaluated by Journal of the American Medical Association (JAMA) benchmark criteria for source quality. Results One hundred twenty “People also ask” questions were collected with associated webpages. Using the Rothwell classification of questions, queries were organized into fact (41.7%), value (31.7%), and policy (26.7%). The most common webpage categories were academic (28.3%) and medical practice (27.5%). The most common question subcategories were timeline of recovery (21.7%), indications/management (21.7%), and pain (18.3%). Average JAMA score for all 120 webpages was 1.50. Journal articles had the highest average JAMA score (3.77), while commercial websites had the lowest JAMA score (0.91). The most commonly suggested question for rotator cuff repair/surgery was, “Is rotator cuff surgery worth having?,” while the most commonly suggested question for rotator cuff repair pain was, “What happens if a rotator cuff is not repaired?” Conclusions The most commonly asked questions pertaining to rotator cuff repair evaluate management options and relate to timeline of recovery and pain management. Most information is provided by medical practice, academic, and medical information websites, which have highly variable reliability. By understanding questions their patients search online, surgeons can tailor preoperative education to patient concerns and improve postoperative outcomes. Level of evidence IV

Internet search analytics for shoulder arthroplasty: what questions are patients asking?

Background Common questions about shoulder arthroplasty (SA) searched online by patients and the quality of this content are unknown. The purpose of this study is to uncover questions SA patients search online and determine types and quality of webpages encountered. Methods The “People also ask” section of Google Search was queried to return 900 questions and associated webpages for general, anatomic, and reverse SA. Questions and webpages were categorized using the Rothwell classification of questions and assessed for quality using the Journal of the American Medical Association (JAMA) benchmark criteria. Results According to Rothwell classification, the composition of questions was fact (54.0%), value (24.7%), and policy (21.3%). The most common webpage categories were medical practice (24.6%), academic (23.2%), and medical information sites (14.4%). Journal articles represented 8.9% of results. The average JAMA score for all webpages was 1.69. Journals had the highest average JAMA score (3.91), while medical practice sites had the lowest (0.89). The most common question was, “How long does it take to recover from shoulder replacement?” Conclusions The most common questions SA patients ask online involve specific postoperative activities and the timeline of recovery. Most information is from low-quality, non-peer-reviewed websites, highlighting the need for improvement in online resources. By understanding the questions patients are asking online, surgeons can tailor preoperative education to common patient concerns and improve postoperative outcomes. Level of evidence IV

Dorsal Plate Fixation for Distal Interphalangeal Joint Arthrodesis of the Fingers and Thumb

Arthrodesis is generally the most accepted surgical option for treatment of degenerative and traumatic conditions involving the distal interphalangeal joint of the fingers or the interphalangeal joint of the thumb. Ideal position of arthrodesis is thought to be slightly flexed to improve power, fine pinch, and grip. Different techniques have been described for distal finger joint arthrodesis, with most surgeons using straight intramedullary implants that obligate the joint to be positioned in neutral extension. In this article, we describe the operative technique to perform a distal finger joint arthrodesis in slight flexion using dorsal plate fixation. We also discuss a case of a patient with distal finger joint arthrodesis

Does radial head implant fixation affect functional outcomes? A systematic review and meta-analysis

Radial head arthroplasty is used in the treatment of nonreconstructible radial head fractures. Although traditional implants have been loosely fixed, smooth stemmed implants functioning more as spacers, modern designs have introduced press-fit, tapered implants that articulate at the capitellum with more rigidly maintained congruity. Cemented implants also use rigid initial fixation. This study was conducted to help determine which fixation method results in better functional outcomes: “fixed” or “unfixed.” A systematic review and meta-analysis was used. We identified 63 articles via 3 databases. Ten non-English or articles with insufficient text were excluded, and 17 others did not contain sufficient data or follow-up. The remaining 36 articles were qualitatively and quantitatively reviewed. We identified 36 populations, with 878 unduplicated patients: 522 fixed and 356 unfixed. Respectively, mean follow-up in months was 46.2 and 37.4. Average Mayo Elbow Performance Scores were 85.9 and 88.2 (P = .08). Average Disabilities of the Arm, Shoulder and Hand scores were 17.1 and 18.7 (P = .47). Average final flexion/extension arcs were 119.1° and 115.8° (P = .08). Revision rates were 7.9% and 3.1%, and complication rates were 25.5% and 13.2%. Relative risks of revision and complications for the fixed cohort were 2.48 (P = .006) and 1.88 (P < 0.0001), respectively. Implant fixation type does not appear to affect functional outcomes of radial head arthroplasty. However, rigidly fixing the implant may increase the risks of revision and complications

Lumbrical Tear in Major League Baseball Player Throwing 4-Seam Fastballs: A Case Report

We present the case of a major league pitcher with persistent finger pain, loss of pitch control, and loss of pitch velocity after an injury during a game. This pitcher only throws fastballs and prefers to only use a 4-seam technique. On examination of the affected hand, it is found that he had tenderness along the palmar iinterosseous near the base of the third metacarpal and no tenderness along the distribution of the flexor digitorum profundus (FDP) tendon. The patient had full range of motion of the third digit. Magnetic resonance imaging revealed partial thickness tears of the second and third lumbricals. Proposed injury was secondary to the 4-seam fastball technique, which pulls apart the FDP of the second and third digit, as well as the FDP of third and fourth digit. This increases the distance between the origins of the second and third lumbricals, leading to strain and tearing. The increased pitch count of the player also may have contributed to the injury. After rest and gradual tossing program, the pitcher was able to return to a preinjury level of function at 6 weeks. One year out from injury, the patient continued to pitch and remained pain free

Mycobacterium bolletii Osteomyelitis of the Metaphyseal Distal Radius Treated With Amikacin Antibiotic Beads

Mycobacterium bollettii, a subset of the group M. abscessus, is a slow-growing, nontuberculous mycobacterium that was first characterized in the early 2000s. We report a case of M. bollettii infection in an otherwise healthy 49-year-old man who sustained an open fracture of the right distal radius. After his initial surgery, the patient presented 1 month later with wound drainage requiring hardware removal and was treated with intravenous antibiotics. However, there was a persistent infection. We treated his osteomyelitis with debridement and placement of amikacin antibiotic beads. We selected this particularly uncommon antibiotic cement specifically to address the nontuberculous mycobacterium. The purpose of this report is to alert treating providers to the possibility of nontuberculous mycobacterium infections when an inflammatory process persists and to provide guidelines for the use of amikacin solution to produce antibiotic beads

Hypothyroidism Increases 90-Day Complications and Cost Following Primary Total Hip Arthroplasty

Abstract Hypothyroidism is common, and the incidence has been increasing annually in the United States. Abnormalities in thyroid hormone can have several effects on the endocrine, immune, and musculoskeletal systems of the body. The influence of hypothyroidism on outcomes following primary total hip arthroplasty (THA) is not well reported. The authors hypothesized that hypothyroidism was associated with a higher risk of postoperative complications and 90-day costs following primary THA. A retrospective review from 2005 to 2014 was performed using the Medicare Standard Analytical Files from the Pearl Diver database. Utilizing International Classification of Disease 9th revision (ICD-9) codes, the authors identified patients who underwent THA. Patients with a concurrent diagnosis of hypothyroidism were matched by age, gender, and Charlson's comorbidity index (CCI) to a control group. Ninety-day postoperative complications, readmission rates, complications related to implants, and cost of care were compared and assessed following primary THA between matched cohorts. Statistical analysis was performed using the programming language R (University of Auckland) to calculate odds ratios (OR) along with their respective 95% confidence intervals (95% CI), and p- values. A total of 383,898 patients underwent primary THA. Among them, 191,949 patients were diagnosed with hypothyroidism and 191,949 patients without hypothyroidism. Hypothyroidism was associated with greater odds of postoperative complications ( p  < 0.001), 90-day readmission rates ( p  < 0.001), implant related complications ( p   <  0.001), and total global 90-day episode of care cost (U.S. $17,549.96 vs.$16,645.01; p   <  0.001). This study demonstrated an increased risk of postoperative complications (medical or implant related), increased readmission rates, and higher costs among patients with hypothyroidism following primary THA. Surgeons should counsel patients and determine strategies to medically optimize patients to mitigate risk and decrease cost

The 50 Most Cited Articles in Meniscal Injury Research

Meniscal injuries are among the most common orthopaedic injuries, with a significant volume of published literature. To perform a comprehensive bibliometric analysis that appropriately evaluates the 50 most cited articles in meniscal research. Cross-sectional study. We performed a keyword search of the ISI Web of Knowledge database and then pared the results down to the 50 most cited articles using specific inclusion and exclusion criteria. Data extracted included title, first author, citation count, year of publication, topic, journal, article type, country of origin, and level of evidence. Correlation coefficients were calculated between publication date and citation density and between publication date and raw citation count. The 50 most cited articles were published from 1975 to 2013. The mean number of citations was 258.24 (range, 163-926; median, 225). The majority of articles were published in (19%), the (12%), and (14%). Most articles focused on either the anatomy and biomechanics of meniscal injury or on prevention and physical rehabilitation (12 papers each). The most popular fields of meniscal research involved anatomy/biomechanics and prevention/rehabilitation, and both are areas that will likely increase the probability of an article's being highly cited in the future. This study provided a quality selection of the most cited articles on meniscal injury and may provide a foundation for both beginner and senior clinician readers for further discussion and research

Morbid obesity and 1-year costs after elbow dislocation

Morbid obesity has been linked with serious associated injuries following dislocations of the knee. While similar devastating injuries have been observed following elbow dislocations in the obese, no study to date has characterized the financial impact of elbow dislocations in the morbidly obese population. The purpose of this study is to determine the impact of morbid obesity on 1-year costs related to elbow dislocation. A retrospective query of the Medicare Standard Analytic Files database was performed for patients sustaining elbow dislocation from 2005 to 2014. 1-year reimbursement costs from the initial open or closed reduction procedures were compared for morbidly obese (BMI ≥ 40 kg/m2) patients versus those without morbid obesity (BMI < 40 kg/m2). Cohorts were matched based on age and gender. Total reimbursement costs associated with a diagnosis of elbow dislocation and/or reduction were analyzed. We identified 182 morbidly obese patients and 422 patients without morbid obesity who underwent open or closed reduction for elbow dislocation. 102 patients with 1-year cost data remained in each cohort after matching. Mean 1-year reimbursement costs related to elbow dislocation were significantly greater in morbidly obese patients ($6227.43 vs$4225.71, p = 0.006). 1-year costs related to elbow dislocation are significantly higher in morbidly obese patients. The increased costs likely reflect the complexity of managing dislocations in the obese population. Difficulties maintaining closed reduction, longer and more challenging surgeries with a higher likelihood on intra- and post-operative complications, and a higher risk of peri-operative medical complications may all contribute to these increased costs

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P154. Fibromyalgia as a predictor of increased postoperative complications, readmission rates and hospital costs in patients undergoing posterior lumbar spine fusion

Fibromyalgia is associated with poor outcomes in patients undergoing various orthopedic procedures. No prior study has evaluated if this cohort has worse outcomes following spine surgery. The purpose of this study is to identify 90-day postoperative complications in patients with a history of fibromyalgia undergoing one- to two- level spine fusion. Retrospective database review. The Pearl Diver database (Pearl Diver Technologies, West Conshohocken, PA, USA) identified all patients undergoing one- to two- level spine from 2005 to 2014, from the Medicare provider. All patients with a history of fibromyalgia were also identified. Our consisted of two groups: patients with and without a history of fibromyalgia undergoing primary one- to two- level spine fusion. A total of 90-day medical complications were assessed including length of stay, readmission rates, and total cost of care. All patients in the database undergoing primary one- to two- level spine fusion were identified, in addition to all patients with a history of fibromyalgia 90days prior to their index procedure and having a diagnosis on the same day. This cohort served as our study group. Patients without a diagnosis of fibromyalgia undergoing one- to two- level spine fusion served as our control group. Patients from both cohorts were randomly matched based on age, gender, and comorbidities. Both groups were longitudinally followed for 90days to assess medical complications, readmission rates and total cost of care. Fibromyalgia patients had a greater total odds of postoperative complications within the first 90 days (OR: 2.05, p<.001). Day of surgery cost was also higher in patients with fibromyalgia ($95,036.93vs.$94,825.06, P=.021) Patients with fibromyalgia are at greater odds for postoperative complications 90days following surgery. Additionally, fibromyalgia patients are more likely to be readmitted to the hospital within the first 90days. Due to the complications caused by fibromyalgia, patients with this condition undergoing one- to two- level spine fusion incur a greater total cost of care on the day of the surgery and 90days after