Orthopedics
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A recent study that evaluated the risk of facing a malpractice claim by physician specialty found that orthopedic surgeons were at a significantly greater risk of being sued than other medical specialists. To date, no studies have characterized trends in orthopedic surgery malpractice claims. The Westlaw legal database was used to locate state and federal jury verdicts and settlements related to medical malpractice and orthopedic surgery from 2010 to 2016. ⋯ The jury found in favor of the defendant orthopedic surgeon in most cases. Procedural error and/or negligence were cited most commonly by the plaintiffs as the bases for the claims. Verdicts in favor of the plaintiffs resulted in payouts nearly double those of settlements. [Orthopedics. 2018; 41(5):e615-e620.].
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Randomized Controlled Trial Comparative Study
The Prolonged Analgesic Efficacy of an Ultrasound-Guided Single-Shot Adductor Canal Block in Patients Undergoing Total Knee Arthroplasty.
In this prospective, randomized, placebo-controlled study, the authors compared the analgesic efficacy of the single-shot adductor canal block (SS-ACB) vs the continuous adductor canal block (C-ACB) with intermittent boluses during the 72-hour postoperative period. Seventy-five patients randomly received the following: a single shot of 20 mL of 0.5% ropivacaine preoperatively followed by intermittent saline boluses at 12 hours and 24 hours postoperatively (SS-ACB group); 20 mL of 0.5% ropivacaine preoperatively and 12 hours and 24 hours postoperatively (C-ACB group); or saline preoperatively and postoperatively (control group). The primary outcome was visual analog scale pain scores with movement on postoperative day 1. ⋯ Further, each adductor canal catheter cost $80. Patients who received a single block reported more satisfaction with their pain-relief treatment. Given the similar analgesic effect but better quadriceps muscle strength, easier execution, and higher patient satisfaction, the SS-ACB may be more suitable for total knee arthroplasty patients than the C-ACB. [Orthopedics. 2018; 41(5):e607-e614.].
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Comparative Study
Anatomic Total Shoulder Arthroplasty Versus Reverse Total Shoulder Arthroplasty for Post-Capsulorrhaphy Arthropathy.
Post-capsulorrhaphy arthropathy is a long-term sequela that can develop after open anterior stabilization surgeries, which have historically been performed. The purpose of this study was to compare anatomic total shoulder arthroplasty (ATSA) with reverse total shoulder arthroplasty (RTSA) for the treatment of post-capsulorrhaphy arthropathy. There were 19 patients in the ATSA cohort and 20 in the RTSA cohort. ⋯ For post-capsulorrhaphy arthropathy, patients treated with ATSA and patients treated with RTSA had comparable improvements in outcome scores and range of motion. However, the complication rate was higher in the ATSA group. All complications in the ATSA cohort were related to subscapularis insufficiency and postoperative anterior instability problems, resulting in a higher revision rate in this cohort (16%) compared with the RTSA cohort (0%). [Orthopedics. 2018; 41(5):275-280.].
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Randomized Controlled Trial Comparative Study
A Comparison of Clinical and Radiological Outcomes of Minimally Invasive and Conventional Plate Osteosynthesis for Midshaft Clavicle Fractures.
Thirty patients with displaced midshaft clavicle fractures were prospectively enrolled in this study. Fifteen were randomly assigned to the minimally invasive plate osteosynthesis group and 15 to the conventional plate osteosynthesis group. Constant score, visual analog scale satisfaction score, operative time, scar length, and complications, including hypoesthesia, were evaluated at least 1 year postoperatively to determine functional outcomes and time to bone union as a radiological outcome. ⋯ In the minimally invasive plate osteosynthesis group, time to bone union was significantly correlated with the gap interval (P=.004) and the number of fracture fragments (P=.002). Minimally invasive plate osteosynthesis showed some superiority over conventional plate fixation for midshaft clavicle fractures, having a shorter operative time and scar length. The time to bone union was influenced by the reduction status and the number of fracture fragments in the minimally invasive plate osteosynthesis group. [Orthopedics. 2018; 41(5):e649-e654.].
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In recent years, there has been an increasing trend toward subspecialization in orthopedic surgery via fellowships. This study sought to characterize sex, ethnic, and racial representation within each fellowship program and to examine their changes over time to identify trends and/or gaps. Demographic data were obtained from the National Graduate Medical Education Census. ⋯ Asian and female fellows preferred specific subspecialties over others. These data are presented as an initial step in determining factors that attract minority groups to different orthopedic subspecialties. Further research should define specific factors and identify ways to increase minority distribution among fellowship programs. [Orthopedics. 2018; 41(5):282-288.].