Orthopaedic Setting Research Articles

Open-Label Randomized Clinical Trial to Assess the Effects of Preoperative Acupuncture in High Anxiety Patients Undergoing Total Knee or Hip Arthroplasty.

Background: Preoperative state anxiety is a known predisposing factor for enhanced postoperative pain and hindered recovery following total knee or hip replacement. Acupuncture administered preoperatively has been associated with reduced anxiety in surgical studies, yet evidence of its efficacy in the orthopedic surgical setting is limited. Objective: This study investigated the effects of preoperative acupuncture on preoperative anxiety and pain and compared acute postoperative pain between acupuncture and control patient groups. Design: Parallel-arm, open-label, randomized controlled trial. Setting: Bone and Joint Institute, Hartford Hospital, Hartford, CT. Participants: Sixty middle-aged and elderly men and women with clinically validated preoperative anxiety undergoing elective total hip or knee replacement. Intervention: One-to-one randomization to preoperative acupuncture (n = 30) or no acupuncture treatment (n = 30) on the day of surgery. Coprimary outcomes: Anxiety before and after preoperative acupuncture using the visual analog scale and postsurgical pain using the numeric pain scale. Secondary outcomes: Incidence of acupuncture-related complications, pain before and after acupuncture, nausea and vomiting incidence, opioid consumption, anxiolytics and antiemetics use, and patient satisfaction. Results: Patients reported lower anxiety and pain preoperatively following acupuncture compared with before treatment (both p < 0.001). Postoperatively, the acupuncture group reported lower pain in the first 3 h than the control group, although this difference was not statistically significant. No significant differences in postoperative complications or patient satisfaction were observed between the study groups. Most patients were satisfied with the acupuncture treatment and reported a likelihood of considering preoperative acupuncture for future surgeries. Conclusions: These preliminary findings support that preoperative acupuncture is a safe and effective means to reduce perioperative anxiety and pain in patients undergoing total hip or knee replacement surgery. Additional studies should be conducted to best determine the value of preoperative acupuncture in total hip or knee patients presenting with surgically related anxiety. Clinical Trial Registration: ClinicalTrials.gov (10/31/2023, NCT06099223).

Is the continuity of the therapist-patient relationship relevant for the discharge outcome in orthopaedic physical rehabilitation?

Continuity of care has been linked to patient satisfaction and self-reported outcomes. Following hip fractures in the elderly, rehabilitation aims at restoring patients' mobility and independence at the pre-fracture level and at the earliest possible time. Despite the potential role of physiotherapists' continuity on functional outcomes, this correlation has not yet been studied in an acute orthopaedic setting. Guaranteeing the presence of the same physical therapist on individual patients is challenging from an organizational point of view. An observational retrospective study was conducted on 129 aged patients (84 ± 8years) who underwent surgery for proximal hip fracture. Indicators of outcomes were ILOA score at discharge, length of stay and achievement of rehabilitation goals as defined by the Individual Rehabilitation Project. The number of physical therapists taking care of patients was monitored during the patient's hospital stay. No correlation was found between the number of physical therapists and functional goals at discharge. The frequent change of physical therapists providing rehabilitation to elderly patients who underwent surgery for hip fragile fracture is not related to functional outcomes.

Test-Retest Reliability and Concurrent Validity of the Health Leads Screening Tool in Outpatient Orthopedic Physical Therapy Patients

OBJECTIVE: To determine the test-retest reliability and concurrent validity of the Health Leads Screening Tool. DESIGN: Primary survey data collected between September 2021 and May 2022 with participants who received outpatient orthopedic physical therapy in a public hospital system. Participants completed the Health Leads Screening Tool (HLST) and the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) at 1 physical therapy visit to examine the concurrent validity of the HLST. They completed the HLST again at a follow-up visit to examine its test-retest reliability. METHODS: Paper surveys were used to collect information from participants who were over 18 years of age, spoke and read English or Spanish, and were receiving outpatient orthopedic physical therapy. Fifty-two participants completed the surveys to examine concurrent validity and 50 participants completed the surveys for test-retest reliability. Cohen’s kappa statistics were used to examine agreement. RESULTS: The HLST had excellent test-retest reliability for all 9 domains, with kappa values ranging from 0.91 to 1.00. It had greater than moderate concurrent validity (k&gt;0.6) with the PRAPARE for 6 of 9 domains, including food, utilities, health care, transportation, employment, and mental health. CONCLUSIONS: The Health Leads Screening Tool demonstrated excellent test-retest reliability and moderate concurrent validity for 6 out of 9 domains and, thus, could be a feasible social needs screening tool in outpatient orthopedic physical therapy settings. JOSPT Open 2024;2(4):340-347. Epub 24 May 2024. doi:10.2519/josptopen.2024.1241

Comparison of the effects of recombinant human epidermal growth factor (rhEGF) and alendronate sodium on tibial fracture healing in rats: an experimental study

Purpose: The objective of this study is to compare the effects of recombinant human epidermal growth factor (rhEGF) on bone healing with those of alendronate, a bisphosphonate widely used in practice. Materials and Methods: An iatrogenic fracture was created in the tibial shaft of 24 Sprague-Dawley rats with osteotome and fixed with an intramedullary Kirschner wire (K-wire). After surgery, Group 1 was given 0.2 mg/kg/day of oral alendronate sodium on postoperative Day 1 to 28, Group 2 received a single dose of 0.5 mg/kg of intraosseous rhEGF on postoperative Days 1 and 14, and Group 3 was followed for a total of four weeks with oral saline. At the end of Week 4, the animals were euthanized and the lower extremities were removed by stripping the soft tissues without damaging the callus. Tissue samples of groups were prepared and and stained with hematoxylin-eosin. After staining, histological scoring was performed to evaluate the degree of union. Results: Alendronate sodium group demonstrated a mean histological score of 6.95± 1.28. The rhEGF group had a lower mean score of 4.85±1.66. The placebo group exhibited the least progress in bone healing with a mean score of 4.10±1.68. The histological score was significantly higher in the alendronate sodium group compared to both the rhEGF and placebo groups. There was also a statistically significant difference between the rhEGF and placebo groups in terms of scores. Conclusion: Alendronate sodium enhanced fracture healing processes in rats. The role of rhEGF in bone healing requires further exploration. As the understanding of bisphosphonates and growth factors in bone healing evolves, the strategies for optimizing patient care in orthopedic settings are expected to be developed.

An Evaluation Of Social Work Facilitated Peer Support Groupwork With Older Adult Inpatients In Orthopaedic Rehabilitation

Abstract Background Social work psychosocial assessments highlighted an elevated prevalence of patients experiencing low mood, isolation, and the impact of their hospital admission. Groupwork is an effective evidenced based social work tool. As psychological factors can impact acute and longer-term recovery, peer support groupwork was piloted to address these issues. This research aims to determine the success of the inclusion of social work facilitated peer support groupwork within the orthopaedic geriatric rehabilitation setting. Methods One pilot and three peer support groupwork sessions were held with 4-6 participants per group. Patients were identified with support from multidisciplinary team colleagues. Patients were over 65 years of age, medically stable and were an inpatient on the orthopaedic rehabilitation ward without any contraindications to attendance. A patient led thematic approach informed each session. Structured feedback forms were given to all participants which provided both quantitative and qualitative data. Results 100% of patients found that peer support groupwork was a beneficial addition to orthopaedic rehabilitation. Patients recognised the benefit of sharing their experiences and emotions with one another. 95% of patients said that they would reattend and many recognised the motivating influence of this forum. 17 out of 19 patients found that the peer support groupwork directly improved their mood. An incidental finding determined a better understanding of the patient and assisted social workers in identifying patients who required more focused holistic support. Conclusion Social work facilitated peer support groupwork assists in motivating and improving the mood of older adults engaging with inpatient orthopaedic rehabilitation. It was a resource efficient method which improved the psychological factors experienced by older adults in this setting. The patient led approach and careful consideration and planning generated the groups’ success. This approach has numerous benefits to the overall patient experience and has scope to be utilised within other gerontological settings.

Lower Extremity Traumatic Wound Management: Relative Significance of Negative Pressure Wound Therapy in the Orthopedic Setting.

Significance: Lower extremity traumatic wounds are associated with numerous perioperative challenges. Their etiologies determine the characteristics and extent of the injury. The timing of subsequent surgical intervention and wound healing optimization after lower extremity trauma are integral to successful perioperative lower extremity wound management. Recent Advances: Managing trauma to the lower extremities uses a multidisciplinary surgical approach. The objective of this review is to summarize lower limb trauma assessment, advancements in lower extremity trauma management, and the clinical applications of advanced wound care in lower limb traumatic wounds. The advent of lower limb reconstruction and the development of advanced wound care modalities have helped to improve the management of these complex injuries. Critical Issues: The extensive involvement of bone, soft tissues, nerves, and blood vessels of severe lower extremity trauma wounds presents a challenge for clinicians in both the acute care setting and during patient rehabilitation. If not properly managed, these injuries may be subject to a decline in limb function and may possibly result in limb loss. To reveal developing limb-threatening conditions, serial examinations should be performed. Future Directions: The majority of lower limb traumatic wound will benefit from the perioperative administration of an appropriate negative pressure wound therapy (NPWT)-based system, which can help to promote granulation tissue and remove wound exudate before definitive closure and/or reconstruction. NPWT should be included as an important adjunct in the surgical management of lower limb traumatic wounds.

Institutional influences on healthcare service innovation: Lessons from German rehabilitation clinics.

In view of the growing need for rehabilitation worldwide due to demographic changes and health trends, healthcare organizations are facing increasing pressure to innovate. This study focuses on the institutional dynamics shaping service innovation in orthopedic rehabilitation settings in Germany. Using Scott's framework of institutional pillars and carriers, we conduct a multiple case study analysis. Based on interviews with physicians and managers from six different clinics, conducted in two rounds and supplemented by secondary data analysis, we investigate the influence of regulative, normative, and cultural-cognitive institutions on healthcare service innovation. By distinguishing between the various institutional barriers and facilitators, our research provides valuable insights for healthcare practitioners and managers, equipping them with the necessary knowledge to effectively navigate and utilize the institutional environment.

Patient Experience and Satisfaction with Orthopedic Services at a Community (Rural) Setting Hospital-How Is It Different from Urban Setting.

Patient experience and satisfaction are the keystones in evaluating the effectiveness of clinical care in musculoskeletal medicine. Although all orthopedic settings work on the same principles of providing safe and quality health care, community hospitals represent a unique environment. There may be key differences with regard to patient experience between these settings. Accessibility to care, choices of provider, personalized care, availability of and access to resources, cultural and social variances, and waiting times are a few of the many elements that may impact patient experience and satisfaction. This narrative review aims to explore the core differences in these settings and how they can reflect on patient experience and satisfaction.

Enhancing orthopedic care: The impact of introducing nurse practitioners

IntroductionOrthopedic surgery constitutes a significant portion of surgical interventions globally, driven by aging populations (Spence et al., 2019). Nurse practitioners (NPs) have emerged as essential team members in orthopedic surgery, offering expertise and advanced training. PurposeThis paper describes a practice development initiative that saw the integration of NPs to the orthopedic team to provide postoperative care to patients undergoing hip and knee arthroplasty procedures. MethodsAggregate data was collected from electronic health records and from online surveys. ResultsUsing descriptive and inferential statistics our data analysis revealed significant improvements post-NP implementation. Monthly surgeries increased by 41.6%, indicating enhanced access to care. The average length of stay decreased statistically for both hip and knee surgeries (p < 0.001), resulting in substantial cost savings and streamlined resource utilization. The readmission rate post-discharge also decreased by 41.6%, reflecting improved continuity of care facilitated by NPs. Surveys among healthcare staff demonstrated positive feedback regarding NP integration, highlighting improved accessibility, bed utilization, and timely treatment of medical issues. ConclusionThis study underscores the multifaceted benefits of NP integration in orthopedic care, including enhanced patient outcomes, improved healthcare efficiency, and positive impacts on the healthcare team dynamics. Continued investment in NP programs in orthopedic settings is crucial for further optimizing care delivery and patient outcomes. Advocating for the expansion of the NP role in orthopedic surgery will contribute to elevating the standard of care in this specialty.

High in-hospital preoperative anxiety levels are not associated with an increased length of stay or readmission following primary shoulder arthroplasty

BackgroundAnxiety is prevalent in our society, affecting all facets of patients’ lives. There is, however, a paucity of literature exploring how anxiety extends into the orthopedic perioperative setting. We sought to analyze a subset of patients undergoing primary shoulder arthroplasty to determine whether correlations exist between anxiety, patient characteristics, time spent in the hospital, and likelihood of returning to the hospital after discharge. MethodsAfter obtaining institutional review board approval, our hospital prospectively identified and approached all patients undergoing total shoulder arthroplasty between February and June of 2023. Patients completed the Visual Analog Scale for Anxiety (VAS-A) and Amsterdam Preoperative Anxiety and Information Scale (APAIS), two validated tools used to assess preoperative anxiety levels and need for information, in the preoperative holding area before surgery. Patient demographics, hospital length of stay (LOS), and 30-day readmission rate were collected and analyzed. ResultsA total of 79 patients were enrolled. Nineteen percent of patients were found to be anxious using the APAIS tool, while 37.7% of patients were found to be anxious using the VAS-A tool. No significant correlation was found between APAIS or VAS-A anxiety scoring and hospital LOS. No significant correlation was found between APAIS or VAS-A anxiety scoring and 30-day readmission rate. A significant correlation was found between APAIS anxiety scoring and body mass index (BMI), as well as VAS-A scoring and BMI. However, no significant correlation was found between BMI and hospital LOS or between BMI and 30-day readmission rate. ConclusionOur study did not find a statistically significant correlation between immediate preoperative anxiety levels in patients undergoing shoulder arthroplasty and their length of stay or 30-day readmission rate. We did discover a linear relationship between patient BMI and their preoperative anxiety scores; however, no significant direct correlation was found between a patient’s BMI and their length of stay or their 30-day readmission rate. Our findings suggest that higher levels of preoperative anxiety should not preclude a patient from the benefits of consideration of early discharge planning such as same-day total shoulder replacement.

Maximizing Satisfaction in Orthopedic Outpatient Clinics: Evidence From Ireland.

Background Patient satisfaction is a critical metric in healthcare, reflecting the quality of care provided and influencing clinical outcomes and healthcare utilization. In orthopedic outpatient clinics, patient satisfaction affects patient adherence to treatment plans and overall health outcomes. This study aims to identify and analyze key factors influencing patient satisfaction in orthopedic outpatient clinics. Methodology This cross-sectional study was conducted from April to May 2024 across 10 orthopedic outpatient clinics. In this study, family members were included as respondents to the Patient Satisfaction Questionnaire (PSQ) when patients were unable to complete the survey due to age, cognitive impairment, or physical disabilities. This approach was adopted to ensure that the experiences of all patients, particularly minors, elderly individuals, and those with disabilities, were accurately captured. The PSQ assessed various aspects of patient satisfaction, including communication, treatment plans, addressing concerns, clinic environment, and overall satisfaction. Quantitative data were analyzed using SPSS version 27.0 (IBM Corp., Armonk, NY, USA). Results The study included 172 respondents. High levels of overall satisfaction were reported, with 142 (82.6%) respondents very satisfied and 28 (16.2%) somewhat satisfied. Significant associations were found between overall satisfaction and several factors, namely, effective communication, thorough explanation of treatment plans, addressing patient concerns, and a clean, comfortable clinic environment. Shorter waiting times were also associated with higher satisfaction. Regression analysis revealed that staff rating and the thoroughness of treatment plans were significant predictors of overall satisfaction. Conclusions Effective communication, thorough treatment explanations, addressing patient concerns, and maintaining a clean clinic environment are key determinants of patient satisfaction in orthopedic outpatient clinics. Reducing waiting times and investing in staff training on communication and empathetic care can further enhance patient satisfaction. These findings provide valuable insights for healthcare providers and administrators aiming to improve patient experiences in orthopedic outpatient settings. Further research is recommended to explore these relationships in diverse settings and develop targeted interventions.

Comparison of Length of Stay and Discharge Disposition after Short-Segment Lumbar Fusion Surgery at Tertiary Care and Non-Tertiary Care Hospitals: A Propensity Score Matched Analysis.

A retrospective study. To compare the perioperative and postoperative outcomes among lumbar fusion patients treated at an orthopaedic specialty hospital (OSH), a hybrid community hospital (HCH), and a conventional community hospital in comparison to a tertiary care hospital (TCH). In spine surgery, strategies to reduce length of stay (LOS) include a myriad of pre-, intra-, and postoperative strategies that require a multidisciplinary infrastructure. The sum of these efforts has led to the creation of orthopedic specialty hospitals and protocols that have been adopted by community hospitals as well. There is a notable lack of information regarding the results of these efforts across different healthcare institution models. This was a retrospective study of patients undergoing elective one or two-level lumbar fusion between 2017 and 2022 at a large urban TCH, an OSH, a HCH, and a conventional CH. Data was collected on patient characteristics, demographics, comorbidities, BMI, smoking status, surgical type, surgical levels, surgery duration, hospital length of stay, readmissions, reoperations, and discharge status within a year. Patients across the four surgical settings were matched based on age, BMI, CCI, type of procedure, and number of levels fused. A total of 1435 patients met the inclusion criteria. Length of hospital stay was significantly longer at TCH compared to OSH, HCH, and CH by an average of 1-2 days (P<0.001). 90-day readmissions were higher at TCH compared to OSH (P=0.001). TCH patients also were less likely to be discharged home than OSH and HCH patients (P=0.001 and P=0.016, respectively). No significant differences were noted in 1-year reoperation rates across all hospital models. Shorter lengths of stays and more home discharges at the orthopaedic specialty hospital and community hospital settings did not compromise surgical quality or postoperative outcomes.

Patient perspectives on the role of orthopedic nurse practitioners: a cross-sectional study

BackgroundThe inclusion of nurse practitioners (NPs) specializing in orthopedics shows potential for improving the quality of care for orthopedic patients. A critical aspect of assessing the feasibility and acceptance of introducing NPs into orthopedic settings involves understanding patients’ perspectives on this role. This study aims to explore the receptiveness of orthopedic patients to treatment by orthopedic Nurse Practitioners (NPs). Additionally, it investigates potential associations between patients’ willingness to engage with NPs, their familiarity with the NPs role, perceptions of nursing, and satisfaction with orthopedic nursing care.MethodsThis cross-sectional study involved patients admitted to an orthopedic department in a central Israeli hospital between January and February 2023. Data was collected using a questionnaire consisting of five sections, validated by content experts. Statistical analyses, performed using SPSS, included descriptive statistics, independent samples t-tests, Pearson correlations, and linear regression.ResultsOrthopedic patient participants demonstrated a moderate willingness to undergo treatment by orthopedic NPs, with over two-thirds expressing strong openness. Patients displayed a high willingness for NPs to engage in various clinical tasks, albeit showing lesser enthusiasm for medication management and preoperative evaluation. Positive attitudes towards nurses and familiarity with the NP’s role emerged as significant predictors of patient receptiveness to NPs’ treatment.ConclusionPatient acceptance of orthopedic NPs varies across different aspects of care. While there is overall willingness to receive care from NPs, these nuanced preferences should be considered when implementing NPs in orthopedic settings. Awareness and positive perceptions play crucial roles in shaping patients’ willingness to receive care from these NPs.Trial registrationThe research doesn’t report the results of a health care intervention.

Strategies to increase response rates for patient‐reported outcome measures in orthopaedics: A scoping review

AbstractPurposeLow response rates remain a challenge for collecting patient‐reported outcome measures (PROMs). This review aimed to identify and synthesise the strategies to increase PROM response rates in orthopaedic populations or settings that have been evaluated in the peer‐reviewed literature. Such a synthesis can guide future research and provide a structure for future implementation evaluations.MethodsWe completed a scoping review of English‐language articles in peer‐reviewed journals published from 1 January 2013 to 30 October 2023 in PubMed, Embase via Ovid, and Scopus. Eligible articles had a primary focus on patients with orthopaedic conditions and/or described activities in an orthopaedic practice setting and had to present numeric data on response rates for (a) two or more strategies or (b) before and after a specific strategy.ResultsAcross 27 papers, the largest category of evaluated strategies was ‘administration modality’ (n = 16). Other categories of strategies included ‘administration setting’ (n = 5), ‘manual effort’ (n = 5), ‘reminder’ (n = 4), ‘invitation’ (n = 3), ‘automation’ (n = 3), ‘education and training’ (n = 3), ‘measure characteristic’ (n = 3), ‘incentive’ (n = 2), and ‘administration frequency’ (n = 1). Eighteen of 23 studies that completed significance testing identified a significant difference in favour of an intervention, but there were mixed findings across studies within categories.ConclusionOpportunities exist to evaluate categories of strategies beyond the technical modality of administration (e.g. paper vs. electronic) to increase response rates. Additionally, the review findings highlight the need for increased standardisation of terminology and improved specification of strategies and response rate outcomes for systematic implementation evaluations and cross‐institutional comparisons.

Ankle presentations in Awka, Nigeria; Treatment methods and outcome

Introduction: The ankle joint, integral to dynamic movement, is prone to a variety of pathologies due to its complex structure and the substantial load it bears during activities such as sprinting, where it can carry up to thirteen times the body's weight. Stability is maintained through passive components like ligaments and bony contours, as well as dynamic forces, including muscle action. Injuries, which can be categorized by systems like the Danis-Weber AO and Lauge-Hansen classifications, are common in diverse settings and can lead to conditions like post-traumatic osteoarthritis. This study explores the prevalence, management, and outcomes of ankle injuries in an orthopaedic hospital setting, aiming to enhance understanding and treatment approaches for these conditions. Methodology: This prospective study analyzed all ankle cases at an orthopaedic hospital in Awka, Nigeria, from 2017 to 2023. Patients were evaluated and diagnosed via history, physical examinations, and investigations, including X-rays classified by the Danis-Weber system. Treatments ranged from surgery, including ORIF and arthrodesis, to casting for undisplaced fractures. Result: This study found the mean age of patients presenting with ankle injuries to be 41.44 years, affecting a wide demographic from 10 to 78 years. Males comprised 60.6% of the cases, and civil servants, who constituted 33.3%, were predominantly affected. The major causes were road traffic accidents (45.5%) and falls (33.3%). Ankle injuries, primarily right bimalleolar fractures, were common and involved significant trauma history. Treatments included ORIF, arthrodesis, and casting, with a high success rate of 97% inpatient recovery and satisfaction, indicating effective treatment protocols for various ankle pathologies, including closed and open injuries. Conclusion: The study illustrates that ankle injuries, predominantly resulting from road traffic accidents and falls, affect a diverse demographic across all ages and occupations, with a majority being male and often involving previous trauma, with closed injuries being the most common and effectively treated primarily through ORIF.

The Impact of Prolotherapy and Steroid Injection on De Quervain's Tenosynovitis: A Retrospective Outcome Study

Aim: Patients with De Quervain's stenosing tenosynovitis (DQT) experience problems in daily living activities due to the chronic inflammatory process and tenderness around the wrist. This study aimed to compare the effects of prolotherapy and steroid injection on short-term functional outcomes in DQT patients. Methods: In this retrospective study between January 2022 and 2023, a cohort of 34 patients with complete demographic data and elbow pain and functional scores, which were recorded at pre-treatment, two weeks, and six weeks post-treatment, was divided into the steroid injection (n=17) and prolotherapy (n=17) groups. Demographic and clinical data of all patients were recorded. The outcomes of the Visual Analogue Scale (VAS) score for wrist pain, Quick Disability Assessment of Arm, Shoulder, and Hand Problems (QuickDASH), and the Health Assessment Questionnaire (HAQ) for wrist functions were examined. Results: Initial assessments did not reveal any differences between groups in terms of VAS (p=0.756), QuickDASH (p=0.168), and HAQ (p=0.615). In the second week post-treatment, there was a significant reduction in VAS, QuickDASH, and HAQ in steroid injection compared to the prolotherapy (p=0.001). This difference continued at sixth-week post-treatment; VAS (p=0.007), QuickDASH (p=0.003), and HAQ (p=0.011) were found to be significantly lower in steroid injection than in the prolotherapy. Conclusion:Our findings underscore the superior effectiveness of steroid injection compared to prolotherapy in reducing wrist pain and improving functional outcomes in patients with DQT. These findings benefit orthopedic settings in choosing treatment options logically, though further research is needed to understand long-term effects and mechanisms.

An Effective Program to Reduce Malpractice Claims and Payments in a Large Orthopaedic Practice.

High reliability in health care requires a balance between intentionally designed systems and individual professional accountability. One element of accountability includes a process for addressing clinicians whose practices are associated with a disproportionate share of patient complaints. This study aimed to evaluate the impact of the Patient Advocacy Reporting System (PARS), a tiered intervention model to reduce patient complaints about clinicians. A retrospective cohort study was conducted involving a southeastern U.S. orthopaedic group practice. The study assessed the implementation of the PARS program and subsequent malpractice claims from 2004 to 2020. The implementation of PARS was associated with an 83% reduction in malpractice claims cost per high-risk clinician after intervention (p = 0.05; Wilcoxon rank sum test). The overall practice group experienced an 87% reduction in mean annual claims cost per clinician (p = 0.007; segmented regression). The successful adoption required essential elements such as PARS champions, peer messengers, an Office of Patient Affairs, and a clear statement of practice values and professionalism expectations at the time of onboarding. The PARS program was successfully adopted within a surgical specialty group as a part of ongoing risk prevention and management efforts. The period following PARS was associated with a retrospectively measured reduction in malpractice claim costs. The PARS program can be effectively implemented in a large, single-specialty orthopaedic practice setting and, although not necessarily causal, was, in our case, associated with a period of reduced malpractice claim costs. We have learned in previous research that there are clear links between professionalism and patient outcomes (e.g., surgical complications), but agree that the focus here on medical malpractice is not directly clinical.

Therapy deserts: A call to action to address inequitable access to therapy services among pediatric orthopaedic patients

Background"Food deserts" are areas with limited access to affordable and healthy foods, disproportionately affecting low-income and ethnic minority communities in the United States. Analogous disparities exist in other disciplines. Our interprofessional team observed "therapy deserts” in orthopaedic and rehabilitation settings, wherein pediatric patients (particularly those with Medicaid-type insurance) appeared to lack equal access to physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) services. Inadequate access to therapy services places patients at risk for worse outcomes. MethodsWe conducted a quality improvement project to assess pediatric patients’ access to therapy care in our region. We surveyed all local PT, OT, and SLP clinics identified from a comprehensive listserv maintained by pediatric therapy teams in our institution. Using a scripted questionnaire, we contacted 113 PT, 38 OT, and 82 SLP clinics external to our institution, collecting data on accepted conditions, appointment waitlist periods, and accepted insurance types. Our primary objective was to determine the percentage of clinics that accepted patients with Medicaid-type insurance. We supplemented our survey with an examination of the Area Deprivation Index (ADI) for each clinic location. Results59 PT clinics (52%), 15 OT clinics (39%), and 36 SLP clinics (44%) completed the survey. Clinics often had limited capacity to care for medically complex conditions. Waitlist times varied, with a median wait of 1 week for PT services, 1 month for OT services, and immediate availability for SLP services. Only 14% of responding PT clinics, 53% of OT clinics, and 22% of SLP clinics accepted patients with Medicaid-type insurance. Insufficient reimbursement rates were frequently cited as the reason for not accepting Medicaid-type insurance. Waitlist times were longer for PT and SLP clinics that accepted Medicaid-type insurance compared to those that did not. Moreover, clinics that accepted Medicaid-type insurance were, on average, in more disadvantaged locations. ConclusionsOur findings suggest the existence of “therapy deserts,” where limited access to therapy services is influenced by insurance type and patient complexity. These restrictions likely exacerbate existing health disparities and illustrate a systemic problem rooted in complex social drivers of health. Addressing "therapy deserts" requires collaborative efforts from multidisciplinary teams. Level of EvidenceLevel III

The role of preoperative magnetic resonance imaging in the prediction of triple hamstring tendon graft size in patients undergoing anterior cruciate ligament reconstruction: a prospective study

Background Hamstring tendon grafts are efficacious and safe options for the reconstruction of anterior cruciate ligament (ACL) tears. However, a minimum graft size of seven millimeters is required to enhance its outcomes. Therefore, it is crucial to seek an effective and noninvasive way to predict the graft size to properly choose the reconstruction method. Patients and methods We prospectively included the data of 93 cases undergoing ACL reconstruction using triple hamstring graft. The measured graft size was correlated with cross-sectional area (CSA) of gracilis (G) and semitendinosus (ST), measured by magnetic resonance imaging (MRI) before the operation. Results The measured CSA of G and ST had mean values of 7.07 (range, 4–10.3) and 11.35 millimeters (range, 7.8–17.6), respectively. The combined CSA ranged between 12 and 27.6 mm (mean = 18.41). The cutoff point that was correlated with a graft diameter greater than or equal to 8 was a combined CSA of 16.9 mm. A significant positive correlation was detected between graft diameter and patients’ weight, height, G CSA, ST CSA, and combined CSA. The area under the curve was 0.8, 0.801, and 0.833 for G CSA, ST CSA, and combined CSA, respectively. Linear regression analysis showed the reliable ability of MRI parameters to predict graft diameter. Conclusion MRI has a reliable predictive ability for the hamstring graft size used in ACL reconstruction. Its application should be encouraged in the orthopedic setting for such patients.

"I Feel Like I Have Lost Part Of My Identity" - A Qualitative Study Exploring The Impact Of Chronic Ankle Instability.

Lateral ankle sprain is the most common ankle injury and up to 40% of those who sustain a lateral ankle sprain will develop chronic ankle instability (CAI). The aim of this study was to explore the thoughts and expectations of CAI-patients concerning their condition and expectations of care in an orthopedic setting. . Qualitative study. Nine semi-structured one-to-one interviews were conducted with CAI-patients who were referred to an orthopedic setting. Interviews were recorded, transcribed, and analyzed using systematic text condensation with an inductive goal free approach. . Seven themes emerged. The themes were Injury history and symptoms (Lateral ankle sprain during sport, pain and instability), Information from health professional (conflicting information about management and prognosis), Management (mental and physical challenges), Expectation and hope (explanation of symptoms, prognosis and imaging to provide clarification of condition), Activity and participation (restriction in sport and daily life and feelings of uncertainty), Support (support from family/friends) and Identity (low ability to participate in sport and social life result in loss of identity). . The impact of CAI exceeds an experience of pain and instability. Patients experienced loss of identity, having to manage uncertainty regarding their diagnosis and prognosis and had hopes of being able to explain their condition. . Not applicable.