Orthopedics
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Aspirin and unfractionated heparin (UH) are accepted options for venous thromboembolism (VTE) prophylaxis after total joint arthroplasty (TJA). The use of aspirin in addition to UH in preventing VTE after TJA has yet to be studied. The primary objective of this study was to determine VTE rates in patients receiving aspirin monotherapy and those receiving aspirin and UH combination therapy immediately following TJA. ⋯ Aspirin and UH combination therapy did not decrease VTE incidence compared with aspirin monotherapy. Additionally, there was greater perioperative blood loss and an increased rate of blood transfusion in patients receiving UH. On the basis of these findings, the authors do not recommend UH as an additional mode of VTE prophylaxis when prescribing aspirin after elective TJA. [Orthopedics. 2018; 41(3):171-176.].
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The objective of this investigation was to examine the characteristics that place patients at risk for unanticipated inpatient admission after outpatient arthroscopic rotator cuff repair. This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program data sets from years 2012 to 2015. Patients were included in the study based on the presence of a primary Current Procedural Terminology code for rotator cuff repair (23410, 23412, 23420, and 29827). ⋯ The primary outcome variable was admission after outpatient surgery (defined as length of initial hospital stay >0). This study examined risk factors for unanticipated admission following rotator cuff repair, finding that age of 65 years or older, female sex, hypertension, body mass index of 35 kg/m2 or greater, American Society of Anesthesiologists classification of 2 or greater, and open surgical technique were significant predictors of admission, whereas monitored anesthesia care and regional anesthesia were associated with decreased odds of admission. Identifying patients with these characteristics will be critical in risk adjusting the anticipated cost of the episode of care in outpatient rotator cuff repair. [Orthopedics. 2018; 41(3):164-168.].
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Ankle fractures are among the most common injuries requiring operative management. Implant choices include one-third tubular plates and anatomically precontoured plates. Although cadaveric studies have not revealed biomechanical differences between various plate constructs, there are substantial cost differences. ⋯ Across the United States, use of only one-third tubular plating over anatomic plating would result in statistically significant savings of $38,729,517 (95% confidence interval, $38,704,773-$38,754,261; P<.0001). General use of one-third tubular plating instead of anatomic plating whenever possible for fibula fractures could result in cost savings of up to nearly $40 million annually in the United States. Unless clinically justifiable on a per-case basis, or until the advent of studies showing substantial clinical benefit, there currently is no reason for the increased expense from widespread use of anatomic plating for fractures amenable to one-third tubular plating. [Orthopedics. 2018; 41(2):e252-e256.].
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Popliteal artery entrapment syndrome is a condition in which compression of the popliteal neurovascular structures results in symptoms of lower extremity claudication by way of a constricting anatomic structure or a hypertrophied surrounding musculature. This diagnosis is often missed or misdiagnosed because popliteal artery entrapment syndrome has a presentation similar to that of exertional compartment syndrome. ⋯ She had successful surgical treatment and returned to a high level of sport. This article describes popliteal artery entrapment syndrome, emphasizes the importance of a thorough history and physical examination to elucidate the diagnosis, and provides information that may lead to the identification of individuals who will benefit from surgical intervention. [Orthopedics. 2018; 41(2):e295-e298.].
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The purpose of this study was to define the trends in fracture complexity and overall injury severity of orthopedic trauma patients at a level I trauma center. A retrospective review of a prospectively collected trauma database was performed to determine the Injury Severity Score (ISS) and AO/OTA classification of the most common fractures among all patients presenting from 1995 to 1999 and from 2008 to 2012. Inclusion criteria were lower extremity fractures of the femur and tibia and pelvic fractures within the years of interest. ⋯ The complexity of certain lower extremity fractures and the severity of injury of patients treated at this referral institution are high and continue to increase. As US health care economics continue to change, with provider and hospital reimbursements shifting toward a patient outcomes basis with potential penalties for complications and readmissions, hospitals and providers must recognize these trends. Trauma centers must continue to measure the complexity of fracture care provided to properly risk-stratify their patient population. [Orthopedics. 2018; 41(2):e211-e216.].