Is facet joint distraction a cause of postoperative axial neck pain after ACDF surgery?

Introduction: Intervertebral distraction in anterior cervical discectomy and fusion (ACDF) has been postulated to injure the degenerative facet joints posteriorly and increase postoperative pain and disability. This study aims to determine if there is a correlation between the amount of facet distraction and postoperative patient reported outcomes. Methods: A retrospective cohort analysis of patients undergoing ACDF for degenerative pathologies was performed. Each patient received lateral cervical spine x-rays at the immediate postoperative time point and were split into groups based on the amount of facet distraction measured on these films: Group A: \u3c 1.5 mm; Group B: 1.5-2.0 mm; and Group C: \u3e 2.0 mm. Patients reported outcome measures were obtained preoperatively and at 1-year postoperatively. Univariate and multivariate analyses were performed to compare outcomes between groups. Results: A total of 229 patients were included with an average follow-up of 19.8 [19.0, 20.7] months with a mean facet joint distraction of 1.7mm. There were 87 patients in Group A, 76 patients in Group B, and 66 patients in Group C. Patients significantly improved across all outcome measures from baseline to postoperatively (p \u3c 0.05). There was no difference between groups at any time point with respect to outcome scores (p \u3e 0.05). Multiple regression analysis did not identify increasing distraction as a predictor of patient outcomes. Conclusions: There were no significant differences between patient outcomes and the amount of facet distraction after ACDF surgery. Multivariate analysis did not find a correlation between facet distraction and overall HRQOL outcome

Proton Pump Inhibitor Use Affects Pseudarthrosis Rates and Influences Patient-Reported Outcomes.

Study Design: Retrospective cohort review. Objectives: Cervical pseudarthrosis is a frequent cause of need for revision anterior cervical discectomy and fusion (ACDF) and may lead to worse patient-reported outcomes. The effect of proton pump inhibitors on cervical fusion rates are unknown. The purpose of this study was to determine if patients taking PPIs have higher rates of nonunion after ACDF. Methods: A retrospective cohort review was performed to compare patients who were taking PPIs preoperatively with those not taking PPIs prior to ACDF. Patients younger than 18 years of age, those with less than 1-year follow-up, and those undergoing surgery for trauma, tumor, infection, or revision were excluded. The rates of clinically diagnosed pseudarthrosis and radiographic pseudarthrosis were compared between PPI groups. Patient outcomes, pseudarthrosis rates, and revision rates were compared between PPI groups using either multiple linear or logistic regression analysis, controlling for demographic and operative variables. Results: Out of 264 patients, 58 patients were in the PPI group and 206 were in the non-PPI group. A total of 23 (8.71%) patients were clinically diagnosed with pseudarthrosis with a significant difference between PPI and non-PPI groups (P = .009). Using multiple linear regression, PPI use was not found to significantly affect any patient-reported outcome measure. However, based on logistic regression, PPI use was found to increase the odds of clinically diagnosed pseudarthrosis (odds ratio 3.552, P = .014). Additionally, clinically diagnosed pseudarthrosis negatively influenced improvement in PCS-12 scores (P = .022). Conclusions: PPI use was found to be a significant predictor of clinically diagnosed pseudarthrosis following ACDF surgery. Furthermore, clinically diagnosed pseudarthrosis negatively influenced improvement in PCS-12 scores

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Economic Burden of Inpatient Admission of Ankle Fractures

Category: Trauma Introduction/Purpose: Ankle fractures are one of the most prevalent traumatic orthopaedic injuries. A large proportion of patients sustaining operative ankle fractures are admitted directly from the emergency room prior to surgical management. In our experience, however, many closed ankle injuries may be safely and effectively managed on an outpatient basis. This study aims to characterize the economic impact of routine inpatient admission of ankle fractures. Methods: A retrospective review of all closed ankle fracture surgery performed by a single foot and ankle fellowship trained surgeon at a tertiary level academic center in 2012 was conducted to identify patients requiring postoperative inpatient admission. The National Inpatient Sample was queried for operative lateral malleolus, bimalleolar, and trimalleolar ankle fractures in 2012 to evaluate national estimates and length of stay by age. The maximum allowable Medicare inpatient facility reimbursements and Medicare outpatient facility reimbursements were obtained from the Medicare Acute Inpatient Prospective Pricer and a Medicare Outpatient Pricer Code respectively. Private facility reimbursement rates were estimated at 139% of inpatient Medicare reimbursement and 280% of outpatient reimbursement as described in the literature. Surgeon and anesthesiologist fees were considered similar between both inpatient and outpatient groups. A unique stochastic decision tree model was derived from probabilities and associated costs and evaluated with modified Monte Carlo simulation. Results: Of 76 lateral malleolar, bimalleolar, and trimalleolar ankle fracture ORIF performed in 2012 by the senior author, 7 required admission due to polytrauma, medical comorbiditites or age. Of the 67 outpatient cases, all were discharged home the day of surgery. In the 2012 national cohort analyzed, 48,044 estimated inpatient admissions occurred postoperatively for closed ankle fractures. Median length of stay was three days, and associated with facility reimbursement ranging from $12,920 for Medicare lateral malleolus fractures to$18,613 for private reimbursement of trimalleolar fractures. Outpatient facility reimbursements per case were $4,125 for Medicare patients and$11,459 for private insurance patients. The national cohort’s inpatient admission accounted for $796,033,050 in reimbursements, while outpatient surgery would have been associated with$419,327,612 for treatment of these ankle fractures. Conclusion: Closed lateral malleolus, bimalleolar, and trimalleolar fractures may be safely and effectively treated as outpatient procedures. Routine perioperative admission for ankle fractures results in over $367 million of excess facility reimbursements annually in the US. Even if a conservative 25$282 million dollar excess economic burden annually. While certain cases necessitate inpatient admission, with value based decision making becoming increasingly the responsibility of the orthopaedic surgeon, understanding cost implications of inpatient ankle fracture management may result in savings to the US healthcare system and patients individually

Single Incision Distal Biceps Repair With Hemi-Krackow Suture Technique

Norge var okkupert av tyske myndigheter gjennom hele 2. verdenskrig og gjennom denne perioden oppsto det flere motstandsaksjoner mot okkupasjonsmakten. Motstanden i Norge kunne deles inn i sivil- og militær motstand, men disse begrepene ble først tatt i bruk etter krigen. Det denne oppgaven tar for seg er den sivile motstanden i Nord-Norge og skal finne svar på hvilke motstandssaker SD og Sipo var opptatte av å rapportere. Det blir dermed en tysk synsvinkel på oppfatningen av sivil motstand. Kildematerialet som er tatt i bruk er en samling av rapporter fra SD og Sipo. Disse rapportene handlet om næringsliv, kirke, NS, rettssystemet, sport, skole og motstand. Rapportene ble sendt fra Norge til øvre instanser i Tyskland. I disse rapportene blir ikke «sivil motstand» omtalt som noen eget begrep. Den går heller under begrepet «Gegner» eller motstand på norsk. Oppgaven går først frem med å danne et begrep for sivil motstand og deretter bruker man dette begrepet til å samle inn data fra kildesammlingen. Deretter vil oppgaven analysere hvilke saker eksplisitt SD og Sipo var opptatte av