The impact of social media in orthopaedics In recent years, alternative forms of impact measurement, known as “altmetrics”, have been proposed as a potential supplement to the more traditional citation-based metric system in determining the influence of orthopaedic literature on the community. As social media grows increasingly more pervasive into mainstream society, so too does its presence in the health care field, especially in the realm of orthopaedics; therefore, it is necessary to determine the influence social media has both on orthopaedic care and the dissemination of orthopaedic literature to the academic community.

Orthopaedic foot and ankle surgeons’ approach to elective surgery in the smoking patient population: a survey study Background: The changes in healthcare by which physicians may be rewarded or fined based on outcomes compared with national average outcomes give surgeons more incentive to engage patients in practices that will improve results. Smoking cessation has been linked to improvements in surgical outcomes, and the perioperative period may offer the greatest opportunity to achieve cessation. The purpose of this study was to assess the approach of orthopaedic foot and ankle surgeons to smoking patients with foot and ankle conditions. Methods: An e-mail was sent to members of the American Orthopaedic Foot and Ankle Society (AOFAS) with an embedded link to a survey that allowed anonymous responses. Responses were collected during several time points. The survey questions yielded categorical answers that were either dichotomous or multiple choice. Results: Of 1892 possible respondents, 785 participated in the survey, an overall response rate of 41.5%. Some questions had fewer responses dependent on answering yes or no to a previous question. Seven hundred and eight (91.5%) of 774 surgeons reported worse outcomes in smokers; 437 (60.4%) of 724 reported counseling all smoking patients, and 696 (96.5%) of 721 when planning surgery; 616 (79.2%) of 778 would delay or deny surgery based on tobacco use; and 321 (49.5%) of 648 never check systemic nicotine levels preoperatively, 50 (7.7%) always check before surgery, 57 (8.8%) check frequently, and 34% check only rarely or on occasion. Conclusions: Achieving smoking cessation is an important factor in reducing perioperative complications and improving outcomes. Orthopaedic foot and ankle surgeons recognize this and most are likely to delay bony procedures at least 4 wk to allow cessation. Most foot and ankle surgeons counsel their smoking patients to quit before surgery, but many do not use other promising options (such as nicotine replacement and supervised cessation programs) to achieve this goal. Level of Evidence: Level IV, case study.

In-office wide-awake hand surgery versus traditional surgery in the operating room: a comparison of clinical outcomes and healthcare costs at an academic institution Background: Our study compared clinical outcomes and healthcare costs of A1 pulley release performed wide-awake in an office setting to A1 pulley release performed in an operating room with monitored anesthesia care (MAC) at a United States academic institution. Methods: A retrospective chart review was performed on consecutive patients who underwent single-digit A1 pulley release wide-awake in an office setting or in an ambulatory surgical center with MAC. Clinical outcomes were assessed using the modified Disabilities Arm Shoulder and Hand (DASH) scores and a telephone questionnaire. Hospital financial records were reviewed for all patients and the summation of professional fee, anesthesiology fee, and hospital fee was calculated to determine healthcare cost. Financial comparisons were stratified by insurance carriers. Results: There were 76 patients with complete records: 43 wide-awake, 33 traditional. Both groups had significant improvement in postoperative quick DASH scores. When asked about subsequent surgery, 100% of wide-awake patients and 68% of traditional patients reported they would prefer to be wide-awake. Eighty percent of wide-awake patients said the procedure was less painful or comparable to a procedure at the dentist. Eighty-four percent of wide-awake patients said their experience was better than they expected, compared to 23% of traditional patients. The traditional group had significantly higher total healthcare costs ($2148.62 vs. $607.65), a more than 250% increase in healthcare spending. Professional reimbursement was significantly higher in the wide-awake group ($607.65 vs. $298.83). Conclusions: A1 pulley release performed with patients wide-awake in an office setting led to higher patient satisfaction, decreased healthcare spending and higher physician reimbursement than when performed in an operating room with sedation.

A retrospective comparative study of patient satisfaction following ambulatory outpatient and inpatient total shoulder arthroplasty Background: Little is known about patient perceptions of outpatient total shoulder arthroplasty (TSA). We evaluated patient-reported satisfaction with TSA in a freestanding ambulatory surgery center (ASC) and an inpatient (INPT) setting. Methods: Patients were mailed a survey regarding hospital admission, surgical site infections, and medical problems after surgery, as well as their satisfaction with the surgery and location. Patients were asked if, given the opportunity, they would change the location of their surgery. Results: Thirty-five patients with ASC surgery and 46 with INPT surgery completed the survey. Satisfaction regarding location and outcomes of surgery was similar, with no differences in readmission rates, need for medical care after surgery, or surgical site infections. A high percentage of patients in the INPT group would have changed their surgery location to an ASC setting. Conclusions: Patients were very satisfied with TSA, as well as the environment of their surgery (ASC or INPT). If given a choice, however, the ASC group preferred having their surgery in the ASC setting, while a high percentage of patients in the INPT group would have preferred to change to an ASC setting. Level of Evidence: Level III. Retrospective comparative study.

Evaluation of opioid disposal opportunities in the United States Background: We sought to determine whether caregivers, pharmacies, and law enforcement authorities would accept the return of unused opioids, and whether pharmacies provide patient education regarding the return of unused opioids. Methods: The pharmacies of every children’s hospital in the United States, along with a large sample of chain pharmacies, nonchain pharmacies, and police stations in every state were contacted to determine if their facility would accept unused opioids. Results: One thousand four hundred and seventy-seven phone calls were successfully placed to 858 pharmacies (436 chain, 422 nonchain), 431 police stations, and 188 children’s hospitals in all 50 states. Overall, only 415 of the 1477 (28%) of the contacted locations offered to take the medication. Police stations offered to take the opioids at a significantly higher rate (60%, P<0.001) than pharmacies (15%) or children’s hospitals (11%). There was also a significant difference in pharmacy types, with independent pharmacies having a higher take-back rate (24%, P<0.001) than retail chain pharmacies (7%). Finally, 78% of children’s hospital pharmacies reported that they recommend proper disposal of any unused opioids at the time the medication is dispensed compared to only 29% of chain and nonchain pharmacies (P<0.0001). Conclusions: This study demonstrated that only 28% of children’s hospital pharmacies, police stations, and commercial pharmacies across the country would accept the return of unused opioids. Only 29% of commercial pharmacies reported educating patients about options to return unused opioids. Patients would benefit from more consistent and better-publicized efforts to secure the return of unused medications.

A new generation of orthopaedic surgeons: “: T-model: ” No abstract available

Preoperative imaging of traumatic anterior shoulder instability: Diagnostic effectiveness of magnetic resonance arthrography and comparison with conventional magnetic resonance imaging and arthroscopy Background: Associated injuries of traumatic anterior shoulder dislocations play an important role in predicting recurrent instability. MRI has proved popular for imaging of suspected abnormalities. MR arthrography (MRA) has been suggested to be more sensitive than MRI in the detection of labral tears and other capsular lesions. In this study, we aimed to assess prospectively the diagnostic effectiveness of MRA in the preoperative planning of traumatic anterior shoulder instability compared with conventional MRI and arthroscopy. Methods: Shoulder MRI and MRA in 100 patients (73 men and 27 women; mean age, 27 yr) with shoulder dislocations were evaluated by two musculoskeletal radiologists who were blinded to arthroscopic findings, which represented the reference standard. An arthroscopic surgeon blinded to the imaging findings evaluated the osseous abnormalities involving the humeral head and glenoid, anterior labroligamentous lesions, and capsular lesions. Sensitivity, specificity, accuracy, and positive and negative predictive values of each imaging study were calculated for each elemental lesion and compared using a paired McNemar test. Results: When comparing the sensitivity and accuracy values of the MRA and MRI for the detection of these elemental lesions, all values of MRA were higher than those of MRI (P<0.01). However, when comparing the specificity values, both MRI and MRA were highly specific (100%) in diagnosing bony Bankart lesions and anterior labroligamentous periosteal sleeve avulsions. MRI missed Perthes lesions, humeral avulsions of the anterior glenohumeral ligament, and glenoid avulsions of the anterior glenohumeral ligament. Conclusions: Despite being invasive, MRA is considerably more useful in the identification and categorization of different elemental lesions of traumatic chronic anterior shoulder instability.

Skeletal traction pin diameter and deflection under load: a biomechanical evaluation with clinical correlation Background: There is scant literature to guide the placement of skeletal traction. The purpose of this study was to test a tensioned traction bow, a nontensioned traction bow, and a traction set up without a bow to measure the amount of pin deflection. By quantifying the deflection of various traction systems under load, guidelines can be provided regarding equipment selection for skeletal traction. The goal was to develop a protocol to minimize the equipment necessary and time to traction placement. Methods: A Sawbones® skeletal traction model was designed to measure the amount of deflection of Steinmann pins of various diameters using a Kirschner tensioning bow, a Böhler (nontensioning) device, and a simple design using only weight and nylon cord. Increasing weight was added to each system and deflection recorded. Data were then evaluated to determine the smallest pin diameter that can reasonably withstand a weight of 35 pounds using the cord-only traction design. Results: Overall, larger pins deflected less. When comparing the traction systems, the tensioned bow had the least deflection, followed by the nontensioned bow, and the cord-only system. In the cord-only system, the 2.8-mm pin was the smallest diameter that successfully withstood the maximum weight without failing. The cord-only design was left in place for 48 hr without further increase in deflection. Conclusions: A simple skeletal traction design consisting of a 2.8-mm smooth Steinmann pin, segment of nylon cord, and weight can be applied with limited tools in a safe and efficient manner.

Clinical outcome of delayed surgical treatment of grade III acromioclavicular joint dislocation with and without acromioclavicular capsule reconstruction Background: Surgical management of grade III acromioclavicular joint dislocation should be considered in patients who have significant deformity, tenting of the skin, or persistent pain despite nonsurgical management, or in patients who have a higher functional demand. Coracoclavicular ligament reconstruction alone may not be sufficient to prevent anteroposterior translation at the acromioclavicular joint despite preventing superior translation. Reconstruction of the acromioclavicular capsule may be necessary for additional joint stability. The aim of this study was to evaluate the necessity of the capsular reconstruction in the treatment of acromioclavicular dislocation. Methods: This is a retrospective comparative study between two groups. The first group, 14 patients, had anatomical coracoclavicular ligament reconstruction without capsular reconstruction. The second group, 19 patients, had capsular reconstruction in addition to acromioclavicular ligament reconstruction. Results: Pain, American Shoulder and Elbow Surgery, and Constant Shoulder scores were better in the second group. No cases of failure were reported in any group. Loss of reduction occurred in seven patients in first group (50%). Conclusions: Reconstruction of the acromioclavicular capsule in surgical treatment of grade III acromioclavicular joint dislocation may play an important role against loss of reduction.

Increasing number of fibroblast, capillary and collagen amount in Achilles tendons of rats with diabetic mellitus after application of stromal vascular fraction derived from adipose tissue Background: Achilles tendinopathy is common in diabetes mellitus and makes the tendon susceptible to rupture. Achilles tendon rupture healing is impaired in diabetics. Stromal vascular fraction can be an alternative treatment for Achilles tendon rupture in diabetic tendinopathy. Methods: Eighteen rats were used in this experimental study and divided into three groups: group 1, normoglycemia; group 2, diabetes mellitus; and group 3, diabetes mellitus injected with stromal vascular fraction. After 2 wk, we evaluated the fibroblasts, capillaries, and collagen. Results: The number of fibroblasts and capillaries and the amount of collagen were increased significantly in group 3 compared to group 1 and group 2 (P<0.05). Conclusions: Stromal vascular fraction increased the number of fibroblasts, angiogenesis, and the amount of collagen. Thus, stromal vascular fraction improved healing of Achilles tendon ruptures in rats with diabetic tendinopathy.