Practice Of Orthopaedic Surgeons Research Articles

Management of Ankle Fractures – A Survey of Practices of Orthopaedic Surgeons in Nigeria

Management of Ankle Fractures – A Survey of Practices of Orthopaedic Surgeons in Nigeria

Primary anterior cruciate ligament repair: Current concepts

The renewed interest in ACL repair over the last two decades stems from advances in modern arthroscopic techniques and clinical studies that have provided evidence that the ACL can reliably heal, and patients can return to sport at a comparable rate to ACL reconstruction patients. The ability to maintain and utilize native ACL tissue, with proprioceptive capabilities, and the smaller drill tunnels needed to repair an ACL leads to an overall less invasive procedure and improved early rehabilitation. Additionally, repair avoids a variety of comorbidities associated with autograft harvest. This current concept review details modern techniques of ACL repair and their current studies, a review on the use of biologic enhancement in ACL repair, and other considerations to appropriately integrate ACL repair into the sports medicine orthopaedic surgeon's practice.

Surgical management during three phases of covid-19 pandemic with changing role of thoracic computerized tomography imaging in orthopaedic patient management: Lessons learned by orthopaedic surgeon

The coronavirus (Covid-19) pandemic has ravaged the whole world. It had affected the allied surgical branches that had to reinvent the protocols for patient management. Trauma being inevitable, needed urgent attention. The changing perspectives had a defining role in the direction of arthroplasty too.The pandemic has been considered into three different phases: 1. The acute phase of the lockdown; 2. The intermediate phase of surgical prioritization; 3. The late phase of surgical management post-vaccination.We deliberate on the impact of the pandemic on orthopaedic surgery and the role of Thoracic computerized tomography (Th-CT) imaging during Covid-19 on the surgical practice of orthopaedic surgeons. Th-CT had been useful imaging during the acute phase of lockdown in the pandemic to identify the asymptomatic Covid-19 infection and to gauge the severity of viral infection. We reviewed the guidelines formulated during each step and identified the lessons learned by the practicing orthopaedic surgeon. We further elaborate on the changes in the usage of Th-CT in the subsequent intermediate and late phases of the pandemic for orthopaedic surgeons. The critical consideration remained to achieve an uneventful recovery during the orthopaedic surgical management, to avoid the transmissibility of infection to the surgeon, and to protect the patient from the high morbidity and mortality of Covid-19 related illness. The Covid-19 pandemic has instigated orthopaedists to develop a holistic approach to deal with the new challenges during this pandemic era.

A Survey of Personal Health Habits, Wellness, and Burnout in Practicing Orthopaedic Surgeons—Are We Taking Care of Ourselves?

The personality traits of those who become orthopaedic surgeons may also lead to overwork, work-life balance issues, and burnout. Health and wellness practices of orthopaedic surgeons have not been widely explored. This study evaluated the personal health habits, wellness, and burnout of practicing orthopaedic surgeons in the United States. An anonymous self-assessment survey was completed by 234 practicing orthopaedic surgeon alumni from two large residency programs. The survey assessed exercise habits according to Centers for Disease Control and Prevention recommendations, compliance with preventive medical care practices according to the United States Preventive Services Task Force, prioritization of occupational wellness strategies, and the presence of burnout via an adapted Maslach Burnout Inventory. Survey responders' mean age was 52 years, 88% were male, and 93% had a body mass index <30 kg/m2. Surgeons were stratified according to practice type, years in practice, and subspecialty. Among orthopaedic surgeons, compliance with aerobic and strength exercise recommendations was 31%. Surgeons in academic practice were significantly (P = 0.007) less compliant with exercise recommendations (18%) compared with private (34%) or employed (43%) practicing surgeons. Most (71%) had seen their primary care provider within 2 years and were up to date on age-appropriate health care screening including a cholesterol check within 5 years (79%), colonoscopy (89%), and mammogram (92%). Protecting time away from work for family/friends and finding meaning in work were the most important wellness strategies. The overall burnout rate was 15% and remained not significantly different (P > 0.3) regardless of years in practice, practice type, or subspecialty. This survey study identifies practicing orthopaedic surgeons' health habits and wellness strategies, including limited compliance with aerobic and strength exercise recommendations. Orthopaedic surgeons should be aware of areas of diminished personal wellness to improve quality of life and avoid burnout.

The impact of a meta-analysis on orthopaedic surgeons' practice with regards to vancomycin graft pre-soaking in anterior cruciate ligament reconstruction: A paper questionnaire survey study.

Understanding the impact of orthopaedic scientific research is vital in identifying facilitators and barriers to its implementation in clinical practice. A meta-analysis was carried out which showed that presoaking hamstring (HT) autografts in vancomycin was associated with a 10-fold reduction in infection rate in anterior cruciate ligament (ACL) reconstruction. Our aim was to determine the practice of orthopaedic surgeons with regards to vancomycin presoaking and explore whether they would adopt the findings of this meta-analysis. A paper questionnaire survey was administered to attendees of an annual EFORT podium presentation of the meta-analysis findings. Descriptive statistics were used to summarize the characteristics of respondents and their responses. A total of 29 senior surgeons/subspecialists performing a median of 40 ACL reconstructions per year completed the survey of whom 7 (24.1%) had encountered an ACL graft infection in the previous 2 years and 14 (48.3%) in the previous 5 years. Only 3 (10.3%) presoaked the ACL graft with an antibiotic. About 1/4 of those who up to then did not pre-soak the graft (6/26, 23.1%) would consider changing their practice to pre-soaking with vancomycin, with similar findings (5/20, 25.0%) in those that used a HT autograft as their first choice. Orthopaedic surgeons are receptive to the findings of a meta-analysis reporting on the effectiveness of vancomycin graft presoaking in ACL reconstruction, which can thus have a substantial impact upon clinical care. Addressing concerns about vancomycin induced graft toxicity and comparing the pre-soaking effect to that of specific intravenous antibiotic regimens may further enhance the uptake of this practice.

Implementation of data collection for the Italian Arthroplasty Registry. Learning curve of 5 surgical centers

Introduction. Arthroplasty registries are widely recognized as an effective tool, providing a constant flow of data that can guide the clinical practice of orthopedic surgeons. Despite their usefulness, their implementation in Italy has historically proved to be laborious. In fact, many surgeons are unwilling to participate, claiming as reason for this inertia the additional work needed in an already overloaded clinical practice. Material and methods. Five operators from five different hospitals without any previous experience with arthroplasty registries entered all the data relevant to the joint replacements performed in their structures in a dedicated online platform and measured the time needed for any input. The learning curve for each operator was then drawn.Results. After the input of 20 procedures, all operators reached a plateau of about 2-3 minutes to record a single intervention. Conclusions. The modest amount of time required to compile registry data sheet should not represent a limitation for surgeons to enter the information into a national registry.

Local Trends in Total Joint Arthroplasty and Orthopaedic Surgeon Distribution in the United States.

Introduction:Total joint arthroplasty (TJA) volume and the number of orthopaedic surgeons in the United States have increased in recent years, but local growth variation has not been studied. This study assesses recent changes in state-level distribution of orthopaedic surgeons in the United States and corresponding local trends in TJA volume.Methods:Data from the National Inpatient Sample database (2000 to 2014) were reviewed. Urban versus rural setting and teaching versus nonteaching hospitals were identified among TJA procedures for comparison. Data from the American Academy of Orthopaedic Surgeons (2002 to 2016) detailing orthopaedic surgeon practice location were evaluated, and linear regression analysis was used to correlate state population data with orthopaedic surgeon density.Results:From 2000 to 2014, there was a 0.1% to 0.3% (P < 0.01) annual decrease in the proportion of TJA procedures conducted in rural hospitals. No notable change was observed in the proportion of TJA procedures conducted at urban teaching versus nonteaching hospitals. Linear regression analysis demonstrated that decreased state population was associated with higher orthopaedic surgeon density (adjusted R2 = 0.114, P < 0.01). States with a higher percentage of population living in rural areas had a lower density of orthopaedic surgeons in the South region and a higher density of orthopaedic surgeons in the remainder of the county.Conclusions:Less populated, rural states have a higher density of orthopaedic surgeons than states with increased population and less rural areas. Although TJA volume has increased since 2000, the proportion of TJA procedures conducted at rural hospitals has decreased. No change was found in the proportion of TJA procedures conducted at urban teaching versus nonteaching hospitals. This may indicate that more patients living in rural areas are seeking TJA care in urban centers. Future studies are needed to confirm this and ensure that patients living in rural areas have appropriate access to TJA care.

MRI of the Elbow: Interpretation of Common Orthopaedic Injuries.

MRI is a valuable diagnostic tool that has become an essential part of an orthopaedic surgeon's practice. When acquired in the appropriate clinical setting, an MRI can direct patient management as surgical versus nonsurgical, guide surgical decision making, and even predict patient outcomes. The quality of MRI obtained and quality of the radiology report received varies. Ultimately, the orthopaedic surgeon must interpret the available imaging and apply these findings to treat the patient. The current day practicing orthopaedic surgeon should be familiar with interpreting common MRIs. Although subspecialized orthopaedic surgeons usually have experience and understanding of MRIs in their field, the general orthopaedic surgeon and those in-training will encounter the gamut of musculoskeletal MRIs. This review focuses on common injuries that can occur in the elbow and provides an approach to minimize missed findings.

Orthopaedic Group Practice Size Is Increasing

PurposeTo analyze recent trends in orthopaedic surgery consolidation and quantify these changes temporally and geographically from 2012 to 2020.MethodsWe performed a retrospective cross-sectional analysis of orthopaedic surgeon practice size in the United States using 2012 and 2020 data obtained from the Physician Compare database.ResultsAlthough we observed an increase from 21,216 unique orthopaedic surgeons in 2012 to 21,553 in 2020 (1.6% increase), the number of practices experienced a large decrease from 7,299 practices in 2012 to 5,829 in 2020 (20.1% decrease). The proportion of orthopaedic surgeons working in solo practices decreased from 13.2% (2,790) in 2012 to 7.4% (1,595) in 2020, and the proportion of orthopaedic surgeons working in groups sized 2 to 24 decreased from 35.3% (7,482) in 2012 to 22.2% (4,775) in 2020. In contrast, groups sized 25 to 99 have grown from 20.7% (4,387) of all orthopaedic surgeons to 23.4% (5,048) in 2020. Groups sized 100 to 499 have increased from 16.9% (3,593) in 2012 to 24.1% (5,190) in 2020, whereas groups sized 500 or greater have grown from 14% (2,964) in 2012 to 22.9% (4,945) in 2020. The number of unique group practices showed a significant decrease in the number of solo groups, which comprised 43.8% (3,200) of the total number of individual practices in 2012, decreasing to 32% (1,886) in 2020. All other groups increased in number and proportionally from 2012 to 2020.ConclusionsThis study shows that over the period from 2012 to 2020, there has been a substantial trend of orthopaedic surgeons shifting to increasing practice sizes, potentially indicating that more orthopaedic surgeons are working for large health care organizations rather than small independent practices.Clinical RelevanceThe impact of these changes should be examined to determine large-scale effects on patient care, payment models, access, and outcomes, along with physician compensation, lifestyle, and satisfaction.

Saudi orthopedic surgeons’ knowledge, attitude, and practice regarding surgical antibiotic prophylaxis

Objectives: The objectives of the study were to evaluate the knowledge, attitudes, and practice of orthopedic surgeons practicing in Saudi Arabia regarding surgical antibiotic prophylaxis (SAP). Methods: A cross-sectional study was conducted on certified and under-training orthopedic surgeons registered in the Saudi Council for Health Specialties. An email, including an online validated self-administered survey using a voluntary response sampling technique, was sent between November 2020 and January 2021. The questionnaire comprised 12 questions that tested knowledge regarding SAP, five questions that analyzed surgeon attitudes toward SAP, and three questions on SAP-related practice. Results: This study included 271 orthopedic surgeons from different areas of Saudi Arabia. The majority of respondents were registrars (or equivalent) (n = 92; 33.9%), and most of them were male (n = 257; 94.8%). Almost 95% of respondents reported that SAP was indicated for internal fixation, spinal surgeries, and prosthetic joint replacement. Moreover, 82.7% of the respondents stated that cefazolin was considered the first-line SAP. Almost 85% of the respondents demonstrated a positive attitude toward SAP, with a mean score of 2.48. However, 87.5% of them believed that adhering to SAP general guidelines would reduce the rate of infection in orthopedic surgeries. Almost 53% of respondents reported using only one guideline as a reference in their surgical practice. Moreover, 41.3% of surgeons switched between guidelines depending on the surgery. Conclusion: This study revealed adequate knowledge and a positive attitude toward SAP among orthopedic surgeons. However, a discrepancy in the practice habits of orthopedic surgeons was observed, which is explained by non-adherence to SAP protocols. Common guidelines that can be used by all orthopedic surgeons need to be developed and implemented to reduce surgical site infections and non-adherence to SAP protocols. This task can be done by a general trusted body like the Saudi Orthopedic Association.

The current clinical practice of general orthopaedic surgeons in the treatment of lateral ankle sprain: a questionnaire survey in Miyazaki, Japan

BackgroundLateral ankle sprain (LAS) is one of the most common musculoskeletal injuries. Numerous studies regarding LAS have been performed. However, there are few studies evaluating the current clinical practice of orthopaedic surgeons regarding LAS. The purpose of this study was to evaluate the current clinical practice of general orthopaedic surgeons in the treatment of LAS.MethodsA questionnaire survey was conducted from September 2020 to December 2020 in Miyazaki, Japan, to evaluate the clinical practice of general orthopaedic surgeons in the treatment of LAS. The survey was composed of 12 questions that were developed with consideration of the recommendations in the current clinical practice guidelines (CPGs) published by the Dutch orthopaedic society. The questions in this study were focused on the diagnosis, conservative treatment, rehabilitation, and the criteria for return to sports (RTS).ResultsThe survey response rate was 82.7% (129/156). Among the respondents, 95.3% did not consider the Ottawa Ankle Rules in the decision to perform plain radiography for patients. Rehabilitation following LAS was performed in 58.9% of patients. Eighty-five (65.9%) of the surgeons used only one factor as the criterion for RTS. The absence of pain was the most frequently used criterion (45.7%). No objective criteria were used for the RTS decision in athletes with LAS.ConclusionsThe present study suggested that most general orthopaedic surgeons do not provide the care for patients with LAS recommended by the current CPGs. No objective criteria for the RTS decision are used for athletes with LAS.

The Delivery of Orthopaedic Care midst COVID-19 and Social Distancing.

In this paper we present the findings of a literature review covering articles published in the last three decades describing the application of telemedicine in orthopaedics. A review of the PubMed Central and Medline provided 75 articles studying the role of telemedicine, the majority directly examining the application of telemedicine in orthopaedic patients. We report the summarized findings of these studies, the financial and HIPAA considerations of using telemedicine, and provide an example of our single urban level-1 trauma center's strategy for incorporating telemedicine into the clinical practice of orthopaedic surgeons during the COVID-19 pandemic.

Occupational radiation exposure among orthopaedic and a need for heath promotional approach

Background: In medicine, radio-diagnosis and imaging is one of the vital tools used for the diagnostic purposes. In orthopaedic surgeries the use of intraoperative fluroscopy with C-arm is no doubt a beneficial technology but it comes with the occupational hazard of radiation exposure. This study therefore evaluates the awareness and practices of orthopaedic surgeons regarding occupational radiation exposure and its risks and the association of level of awareness and practices with various factors.Methods: A cross sectional study was conducted among orthopaedic surgeons using a pre-designed, pretested, semi-structured, self-administered questionnaire, disseminated online. Questions on awareness and practices of occupational radiation exposure and its risks were asked after obtaining consent. Data was analyzed using software statistical package for social sciences (SPSS) version 20 and a p value of &lt;0.05 was considered to be statistically significant.Results: 150 completed forms showed that though majority (63%) of the study participants had adequate knowledge about occupational radiation exposure, the level of practices was only 12%. A statistically significant association (p&lt;0.001) was found between years of experience and adequacy of knowledge and practices, regarding radiation exposure. Majority (91%) believed, adequate training and a health promotional approach could be beneficial.Conclusions: This study highlights the fact that occupational radiation exposure is an issue to be dealt with importance and thus the awareness and practices also needs to improve A health promotional approach with stringent rules needs to be taken to ensure adequate awareness and adequate practice among the orthopaedic surgeons.

Translational science in chronic tendinopathies

&lt;p&gt;Chronic tendinopathies involve majority of patients in clinical practice of orthopaedic surgeons and sports physicians. Translational medicine confers an emerging medical advance efficiently towards the clinician directly from scientists which may be used as a targeted therapy. The main objective of translational research from “bench to bedside” is to test novel inventions in humans. Our purpose in this article to understand the translational medicine approach for chronic tendinopathies in clinical aspects. Translational research in chronic tendinopathies is required certainly due to plenty of reasons. Newer advances and targeted approach to these tendon disorders may curtail the further degenerative process. It aids in earlier diagnosis and prevention of morbidity, early occupancy of occupational activity, lack of economical as well as recreational failure. Pre-disease level activity is ultimate goal of any therapy. Tendon pathophysiology is constantly evolving researched topic in both biochemical as well as molecular aspect. The basic fundamental understanding of complex process of tendon healing and regeneration is necessary for formulating a newer guideline. The cornerstone of treatment of tendinopathies is still non-operative management. Physical therapy, better pain control, NSAIDS are still primary choice for these conditions. Various biological therapy whenever used one should combined them with other appropriate options to obtain an optimum outcome.&lt;/p&gt;

Impact of screening COVID-19 on orthopedic trauma patients at the emergency department: A consecutive series from a level I trauma center.

Coronavirus disease 2019 (COVID-19) posed a major threat to the clinical practice of orthopedic surgeons, especially in the emergency department. We aim to present: (1) the criteria established by the Surgery Management Committee of Taipei Veterans General Hospital in response to COVID-19 and (2) the impact of COVID-19 screening on orthopedic trauma patients in the emergency department. From April 1 to April 30, 2020, all orthopedic trauma patients in the emergency department were screened for COVID-19 if they fulfilled any of the following: (1) travel from abroad within 14 days, (2) high-risk occupation, (3) contact or cluster history with a COVID-19-positive patient, and (4) any associated symptom, including fever up to 38°C, cough, sore throat, rhinorrhea, loss of taste or smell, muscle soreness, malaise, or shortness of breath. We recorded details on the injury, fever, management, and associated outcomes. Of the 163 orthopedic trauma patients presenting to the emergency department, 24 were screened for COVID-19; of these, 22 received surgery. Sixty-two patients received surgery without screening for COVID-19. Fever was the most common reason to screen for COVID-19 (N = 20; 83.3%). No patients were COVID-19 positive. Screened patients had a significantly longer mean interval from presentation to the emergency department to surgery (2.7 ± 2.5 vs. 1.5 ± 0.8 days, p = 0.037). Of the 20 patients screened because of fever, the focus was not identified in 12 (60.0%) patients. The other eight had urinary tract infection (N = 6; 27.2%), septic hip (N = 1; 4.6%), and concomitant pneumonia and urinary tract infection (N = 1; 4.6%). The mean duration of fever and hospital stay was 4.3 ± 4.6 and 8.7 ± 4.9 days, respectively. There were no thromboembolic events, surgical complications, or in-hospital mortality. We developed safe and reliable screening criteria for this COVID-19 pandemic. The delay in surgery was reasonable and did not adversely affect in-patient outcomes.

WEIGHT-BEARING CONE BEAM CT SCANS AND ITS USES IN ANKLE, FOOT, AND KNEE: AN UPDATE ARTICLE.

ABSTRACTImaging plays a key role in the preoperative diagnosis, surgical planning, and postsurgical assessment of the foot, ankle, and knee pathologies. Interpreting diagnostic imaging accurately is crucial for the clinical practice of orthopedic surgeons. Although among the most used imaging modalities, radiographic assessments are amenable to errors for various technical reasons and superposition of bones. Computed tomography (CT) is a conventional imaging procedure that provides high-resolution images, but fails in considering a truly weight-bearing (WB) condition. In an attempt to overcome this limitation, WB cone beam CT technology has being successfully employed in the clinical practice for the past decade. Besides economically viable and safe, the WB cone beam CT considers WB conditions and provides high-quality scans, thus allowing an equitable and correct interpretation. This review aims to address extensive description and discussion on WBCT, including imaging quality; costs; time consumption; and its applicability in common foot, ankle, and knee, conditions. With this technology increasing popularity, and considering the extensive literature on medical research, radiologists and orthopedic surgeons need to understand its potential applications and use it optimally. Level of Evidence III, Systematic review of level III studies.

Patient-Specific Orthopaedic Surgery: An Economic Analysis on 3D Printing Devices

3D printed (3DP) devices are an exciting option for clinical use by orthopaedic surgeons. This study is an economic analysis with a specific focus on personalized surgery. Specifically, we survey the existing landscape of 3DP devices in orthopaedic surgery and explore the benefits of 3DP in preoperative planning and intraoperative instrumentation. We conclude that 3DP is both a financially viable and clinically beneficial aid to the practice of orthopaedic surgeons, provided medical practices and hospitals can overcome potentially high upfront fixed costs and initial delays in clinical adoption.

Developmental Dysplasia of the Hip: An Examination of Care Practices of Orthopaedic Surgeons in India.

We evaluated screening, referral and treatment practices for developmental dysplasia of the hip (DDH) in India by surveying Orthopaedic surgeons who treat patients with DDH. The survey assessed the timing of DDH presentation, resource availability, and current state of screening and diagnosis, which would help in the development of a DDH care pathway for India. An online survey was distributed to Orthopaedic surgeons practicing in India via email and administered onsite to those attending the annual conference of the Pediatric Orthopaedic Society of India in 2019. 173 completed surveys were received from surgeons practicing in a predominantly urban setting. 68.8% of respondents had performed initial evaluations on children with DDH aged over 1 year in the past 12months, and 49.1% had assessed children with DDH aged > 2years on initial presentation. There was no consistent use of established guidelines, with only 30% of respondents stating that a care pathway was in place at their institution. However, 91.9% would support the implementation of a care pathway developed in India, to decrease the incidence of delayed diagnosis and facilitate earlier intervention. 85% of respondents had ready access to ultrasound scans and 95.4% had access to X-rays. In India, there is still a large number of late-presenting cases of DDH, which could be improved with effective screening. The development of a care pathway for DDH in India is well-supported by Orthopaedic surgeons and may help decrease the incidence of late presenting cases; potentially improving outcomes, decreasing morbidity, and upskilling local practitioners.

Opioid Prescribing Practices of Orthopaedic Surgeons: Results of a National Survey.

Opioids are widely used after orthopaedic procedures. Nonmedical opioid use is a growing public health issue. An anonymous online survey was distributed by e-mail to the orthopaedic societies of all 50 states and several large private practices to assess practicing orthopaedic surgeons' opioid prescribing practices. A total of 555 orthopaedic surgeons practicing in 37 states responded. The most commonly prescribed opioid for both teenagers and adults was hydrocodone/acetaminophen. Of note, 42.3% reported that a patient they have prescribed opioids for developed an opioid dependency, whereas 35.3% do not believe that opioid use is a problem in their practice. Of note, 30.3% reported prescribing refills, and factors significantly associated with increased prescribing of refills included a greater number of years in practice (P < 0.001) and practicing in a suburban rather than an urban or rural environment (P = 0.03). Orthopaedic surgeons rarely prescribe any refills, tend to prescribe less opioids to teenagers than adults, and prescribe fairly uniformly for patients who are treated nonsurgically or undergo minor or arthroscopic surgery. They exhibit considerable variation in prescribing for fractures and major procedures.

The Management of large and massive rotator cuff tears- Current trends amongst UK shoulder surgeons

Background: Management of large and massive rotator cuff tears remains controversial. Such tears are often irreparable, and results of treatment are unpredictable. This study documents the current practice of orthopaedic surgeons in the British Elbow and Shoulder Society. Methods: A questionnaire was prepared pertaining to the management of large and massive rotator cuff tears with minimal degenerative changes in three age groups: Patients of 50 years (young), 65 years (still active), aged 75 years (elderly) were considered. Various risk factors for failure of repair were considered. Results: Physiotherapy and arthroscopic debridement were the most commonly selected management options in young and middle groups in cases of a large/massive rotator cuff tear. Patch repairs were offered by 30% of respondents overall. Latissimus dorsi transfer was utilised by 30%, 8% and 2% respectively in each age group. Reverse shoulder replacement was indicated by 8%, 36% and 76% respectively. Discussion: There was a marked inconsistency in the pre-op planning and number and choice of options between respondents. Most surgeons offered non-augmented repairs in a scenario where they admitted failure was likely. The need for a multicenter trial is widely recognised and 87% of respondents were willing to participate in such a trial.