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JAYPEE JOURNALS
International Scientific Journals from Jaypee
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1.  Retrospective Comparative Study
Concomitant Hip Arthroscopy and Periacetabular Osteotomy: Is there a Difference in Perioperative Complications compared with Periacetabular Osteotomy Alone?
Julie A Neumann MD, Kathleen D Rickert MD, Kendall E Bradley MD, Brian D Lewis MD, Monet A France MD, Steven A Olson MD
[Year:2017] [Month:July-June] [Volume:7 ] [Number:1] [Pages:63] [Pages No:51-57] [No of Hits : 1474]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10017-1083 | FREE

ABSTRACT

Purpose: To evaluate the safety of hip arthroscopy combined with a periacetabular osteotomy (PAO) compared with PAO alone in treating concomitant intra-articular pathology in hip dysplasia.

Materials and methods: Forty-one patients (46 hips) with symptomatic hip dysplasia were retrospectively reviewed. Pre- and postoperative radiographic data and intraoperative data consisting of estimated blood loss, intraoperative and postoperative blood transfusions, operative time, and length of hospital stay were recorded. The complications occurring within the first 3 months after surgery including lateral femoral cutaneous and pudendal nerve neuropraxia, wound complications, and reoperations were recorded. Additionally, rates of deep venous thrombosis and other major adverse outcomes (myocardial infarction, pulmonary embolism, stroke, death) were examined.

Results: Twenty-one patients (24 hips) underwent PAO alone. Twenty patients (22 hips) underwent hip arthroscopy followed immediately by PAO. There were no significant differences in the 90-day complication rates between the two groups, comparing the rate of neuropraxia (p = 0.155) and wound complications (p = 0.6). Operative time for PAO alone was 179 minutes (standard deviation [SD] ± 37) compared with 251 minutes (SD ± 52) for combined hip arthroscopy and PAO (p < 0.001). No incidence of deep vein thrombosis or major adverse events was noted in either group. Preoperative lateral center edge angle (LCEA) and acetabular index (AI) were 14° and 20° respectively, in the PAO-alone group and 19° and 16° respectively, in the combined group. Postoperatively, LCEA was 29° in the PAOalone group and 30° in the combined group. Postoperative AI was 11° in the PAO-alone group and 5° in the combined group.

Conclusion: This study demonstrates that hip arthroscopy in combination with PAO to treat intra-articular pathology shows no difference in 90-day complication rates when compared with PAO alone.

Level of evidence: Level III, retrospective comparative study Keywords:

Neumann JA, Rickert KD, Bradley KE, Lewis BD, France MA, Olson SA. Concomitant Hip Arthroscopy and Periacetabular Osteotomy: Is there a Difference in Perioperative Complications compared with Periacetabular Osteotomy Alone? The Duke Orthop J 2017;7(1):51-57.

Source of support: Nil

Conflict of interest: None

 
2.  Review Article
Risks and Benefits of the Different Types of Gloves used in the Perioperative Setting
Daniel J Blizzard MD, Perez Agaba BS, Michael P Morwood MD, Jennifer L Jerele MD, Robert D Zura MD
[Year:2017] [Month:July-June] [Volume:7 ] [Number:1] [Pages:63] [Pages No:3-10] [No of Hits : 511]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10017-1074 | FREE

ABSTRACT

The role of powder gloves in allergic reactions, infections, wound healing and granuloma formation has been known for many years. Despite a gradual shift away from powder gloves over the last several decades, many healthcare professionals and facilities continue to use powder gloves as the FDA has continued to refrain from issuing a comprehensive formal ban. However, recent advancements in glove technology and position statements by professional societies have continued the push for removal of powder gloves from all clinical and surgical settings and will hopefully entirely eradicate usage in the coming years.

Keywords: Glove, Infection, Operating room, Surgical glove.

Blizzard DJ, Agaba P, Morwood MP, Jerele JL, Zura RD. Risks and Benefits of the different Types of Gloves used in the Perioperative Setting. The Duke Orthop J 2017;7(1):3-10.

Source of support: Nil

Conflict of interest: None

 
3.  Clinical Study
Independent Analysis of the Dorr Classification of Proximal Femoral Morphology: A Reliability Study
Jason M Jennings MD DPT, Ramon A Ruberte Thiele MD MS, Evgeny Krynetskiy MD, Samuel S Wellman MD, David E Attarian MD FACS, Michael P Bolognesi MD
[Year:2016] [Month:July-June] [Volume:6 ] [Number:1] [Pages:68] [Pages No:12-16] [No of Hits : 975]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10017-1063 | FREE

ABSTRACT

The purpose of this study was to assess the inter- and intraobserver reliability through visual perception of a previously described classification system of proximal femoral morphology. The interobserver reliability ranged from slight to moderate across testing. Experience appears to play a role as the intratester reliability did not differ with fellowship trained attending physicians, but differences were seen with junior- and senior-level residents. The diversity of the proximal femoral morphology likely represents a continuum rather than three distinct shapes. This may imply that for many proximal femoral canals, characterization of a single type may not be possible. Further research is warranted to determine the clinical significance of these findings.

Keywords: Bone quality, Proximal femoral morphology, Total hip arthroplasty.

How to cite this article:Jennings JM, Thiele RAR, Krynetskiy E, Wellman SS, Attarian DE, Bolognesi MP. Independent Analysis of the Dorr Classification of Proximal Femoral Morphology: A Reliability Study. The Duke Orthop J 2016;6(1):12-16.

Source of support: Nil

Conflict of interest: None

 
4.  Technical Report
Technical Aspects of Addressing Multiligament Knee Instability
Travis J Dekker MD, Beau J Kildow MD, Evan M Guerrero MD, Claude T Moorman III MD
[Year:2016] [Month:July-June] [Volume:6 ] [Number:1] [Pages:68] [Pages No:47-53] [No of Hits : 842]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10017-1069 | FREE

ABSTRACT

Multiligament Knee Injuries (MLKI) are rare but devastating injuries that require both acute and chronic management. These injuries necessitate operative management with individual patient factors dictating management in an acute (<6weeks) versus chronic (>6 weeks) time frame. Anterior cruciate ligament, posterior cruciate ligament and posterolateral corner reconstruction remains the gold standard for operative management while most medial collateral ligament injuries can be managed non-operatively. Graft fixation sequence is essential in re-tensioning the soft tissues to allow for a functional and balanced knee post-operatively- the PCL is first fixed in flexion, followed by the ACL in extension, and then lastly, the PLC and MCL are addressed as needed. This review paper highlights technical considerations demonstrated in two case reports to include timing of surgery, graft selection and sequence of graft fixation.

Keywords: Graft fixation sequence, Graft selection, Multligament knee injury, Technical considerations.

How to cite this article:Dekker TJ, Kildow BJ, Guerrero EM, Moorman CT III. Technical Aspects of Addressing Multiligament Knee Instability. The Duke Orthop J 2016;6(1):47-53.

Source of support: Nil

Conflict of interest: None

 
5.  Clinical Study
Economic Analysis of Accuracy and Cost of Ultrasound-guided Intraarticular Hip Injections
Lauren Porras MD, Blake R Boggess DO
[Year:2016] [Month:July-June] [Volume:6 ] [Number:1] [Pages:68] [Pages No:35-40] [No of Hits : 769]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10017-1067 | FREE

ABSTRACT

Background: Ultrasonography is an increasingly valuable tool for the diagnosis and treatment of musculoskeletal disorders. In the past, ultrasound has been used for diagnostic purposes, with increasing use of image guidance for joint injections.

Hypothesis: Ultrasound-guided intraarticular native nontraumatic hip injections are equally as accurate with less cost as other diagnostic imaging modalities including fluoroscopicguided injections.

Design: This analysis was based on a meta-analysis of the accuracy of the different imaging modalities. Initially a search was performed for intraarticular hip injections in PubMed, Embase, and ClinicalTrials.gov. Injection accuracy rates between groups were analyzed via proportional meta-analysis. For the economic analysis, compensation data were determined from estimated charges from Duke University Medical Center.

Results: Compared with gold standards of accurate injections (such as fluoroscopic and computed tomography-guided injections), ultrasound is 97% as accurate (confidence interval 93%, 99%). Based on 2014 reimbursement data, reimbursement for large-joint intraarticular injection averages $61.99 (37.38£, 47.18€) ($49.20-$76.31). Fluoroscopic global reimbursement averages $105.32 (63.51£, 80.13€) ($76.75-$134.72). Ultrasound guidance global reimbursement averages $75.99 (45.86£, 57.83€) ($57.95-$93.15).

Conclusion: Ultrasound-guided hip injections are an accurate technique for alleviating hip pain at less cost. In an era of increasing concern for health care expenditures, finding an accurate, effective, and cost-friendly alternative has the potential for widespread adaptation and practice.

Keywords: Accuracy, Cost analysis, Guided injections, Musculoskeletal ultrasound.

How to cite this article:Porras L, Boggess B. Economic Analysis of Accuracy and Cost of Ultrasound-guided Intraarticular Hip Injections. The Duke Orthop J 2016;6(1):35-40.

Source of support: The Duke University Internal Medicine Research Grant funded this study.

Conflict of interest: Dr Boggess maintains industry relationships with GE, SonoSite, Bioventus, and Arthrex although none provided funding. For the remaining authors none were declared.

 
6.  Technical Report
Technique for Combined Hip Arthroscopy and Periacetabular Osteotomy for the Patient with Hip Dysplasia and Intraarticular Pathology
Brian D Lewis MD, Steven A Olson MD
[Year:2016] [Month:July-June] [Volume:6 ] [Number:1] [Pages:68] [Pages No:41-46] [No of Hits : 557]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10017-1068 | FREE

ABSTRACT

The Bernese periacetabular osteotomy (PAO) is a powerful technique for correcting acetabular coverage in patients with developmental dysplasia of the hip. However, there is increasing recognition of additional intraarticular pathologies that may contribute to ongoing pain. For this reason, for the last 3 years, we have combined hip arthroscopy with PAO to treat intraarticular pathology along with improving acetabular coverage. Our technique is reviewed below.

Keywords: Arthroscopy, Dysplasia, Hip, Osteotomy.

How to cite this article:Lewis BD, Olson SA. Technique for Combined Hip Arthroscopy and Periacetabular Osteotomy for the Patient with Hip Dysplasia and Intraarticular Pathology. The Duke Orthop J 2016;6(1):41-46.

Source of support: Nil

Conflict of interest: None

 
7.  Clinical Study
A Clinical Trial Evaluation of Pager versus Smart-device Efficacy in an Academic Hospital Setting
Kamran S Hamid MD MPH, Benedict U Nwachukwu MD MBA, Eugene Hsu MD MBA, Sayon Dutta MD MBA, Sharon N Babcock MD, Brett W Baker MD, Andrew D Wohler BS, Ralph B D’Agostino Jr PhD, Jason E Lang MD
[Year:2016] [Month:July-June] [Volume:6 ] [Number:1] [Pages:68] [Pages No:1-6] [No of Hits : 530]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10017-1061 | FREE

ABSTRACT

Introduction: Health care delivery is contingent on efficient communication among providers. We hypothesized that using smart-device two-way communication would result in faster provider responses when compared with alphanumeric paging among resident physicians in an academic medical center.

Methods: Resident physicians were given an Apple iPad Mini smart device with a Health Insurance Portability and Accountability Act-compliant smart-device two-way communication application. Patient care messages were randomized for transmission via smart-device two-way texting or standard one-way paging. Physician response time was recorded as the primary outcome measure.

Results: The study was halted after participation of the first 24 residents due to safety concerns. A technical glitch was identified in which the smart devices automatically powered off to conserve battery life. The first 72 smart devices to first 37 pager communication response times were similar (8 vs 6 minutes, p = 0.43). In analysis of responses within 5 minutes of c ommunication ( the t ime s mart d evices p owered o ff), smart-device responses occurred significantly faster (1 vs 2 minutes, p < 0.05) but the response frequency was less in the smart-device group (33 vs 62%, p < 0.05), and thus the study was ended early due to safety concerns.

Discussion: Based on our initial findings, smart devices have potential to improve communication but technical issues must be addressed prior to usage as the sole means of communication.

Keywords: Academic, Communication, Device, Hospital, iPad, Pager, Trial, Smart.

How to cite this article:Hamid KS, Nwachukwu BU, Hsu E, Dutta S, Babcock SN, Baker BW, Wohler AD, D’Agostino RB Jr, Lang JE. A Clinical Trial Evaluation of Pager vs S mart-device E fficacy i n a n Academic Hospital Setting. The Duke Orthop J 2016;6(1):1-6.

Source of support: This study was funded by an intramural IRSC grant at Wake Forest Baptist Medical Center.

Conflict of interest: None

 
8.  Review Article
Current Trends in the Management of Lumbar Spine Injuries in Athletes
Michael A Gallizzi MD MS, Lindsay T Kleeman MD, Daniel J Blizzard MD MS, Melissa M Erickson MD
[Year:2015] [Month:July-June] [Volume:5 ] [Number:1] [Pages:72] [Pages No:63-67] [No of Hits : 2770]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10017-1058 | FREE

ABSTRACT

Lumbar spine injuries are prevalent among athletes and are likely to increase with the rising popularity of extreme sports. It is important for physicians to understand the basic anatomy of the lumbar spine along with the injury patterns that can occur with axial loading, hyperflexion and flexion-distraction forces. The majority of low back injuries in athletes are due to muscle strains and rarely need further treatment. Athletes that are subjected to repetitive hyperextension forces are at risk for spondylolysis with or without spondylolisthesis which requires further imaging to determine need for surgical intervention. Lumbar disk herniations are usually from axial forces and can be result in surgical emergencies, if they cause compression on the spinal cord or conus. Lumbar spine fractures can vary from stress fractures of the endplates to burst fractures or fracturedislocations which require surgical intervention, if associated with neurologic deficit or instability. Similar to the management of cervical spine injuries, patients with a suspected lumbar injury should be evaluated systematically with full spine precautions and careful neurologic examination to determine need for transfer to higher care center.

Keywords: Athlete, Lumbar, Lumbar spine, Sports, Sports injury, Management.

Gallizzi MA, Kleeman LT, Blizzard DJ, Erickson MM. Current Trends in the Management of Lumbar Spine Injuries in Athletes. The Duke Orthop J 2015;5(1):63-67.

Source of support: Nil

Conflict of interest: None

 
9.  Review Article
Cervical Spine Injuries in Sports
Lindsay T Kleeman MD, Michael A Gallizzi MD MS, Daniel J Blizzard MD MS, Melissa M Erickson MD
[Year:2015] [Month:July-June] [Volume:5 ] [Number:1] [Pages:72] [Pages No:58-62] [No of Hits : 2628]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10017-1057 | FREE

ABSTRACT

Injuries to the cervical spine in athletes are rare but potentially devastating outcomes resulting from involvement in sports activities. New rules and regulations implemented by national sports organizations have helped to decrease the rate of cervical spine and spinal cord injuries sustained by athletes. A basic understanding of cervical spine anatomy, physical examination and spine precautions is necessary for any physician evaluating athletes on the field to determine if transfer to higher level of care is needed. It is particularly important to know the systematic protocol for spine immobilization, neurologic exam and helmet removal in a patient with a suspected cervical spine injury. While cervical strain is the most common cervical spine injury, physicians should be familiar with the presentation for other injuries, such as Burner’s syndrome (Stinger), cervical disk herniation, transient quadriplegia and cervical spine fractures or dislocations. Special consideration is needed when evaluating patients with Down syndrome as they are at higher risk for atlantoaxial instability. Determination of when an athlete can return to play is patient-specific with early return to play allowed only in a completely asymptomatic patient.

Keywords: Athlete, Cervical, Cervical spine, Sports, Sports injury, Management.

Kleeman LT, Gallizzi MA, Blizzard DJ, Erickson MM. Cervical Spine Injuries in Sports. The Duke Orthop J 2015;5(1):58-62.

Source of support: Nil

Conflict of interest: None

 
10.  Technical Report
Pantalar Arthrodesis: Surgical Technique and Review of Literature
Glenn Shi MD, Christopher E Gross MD, Jeannie Huh MD MSc, Selene G Parekh MD MBA
[Year:2015] [Month:July-June] [Volume:5 ] [Number:1] [Pages:72] [Pages No:48-52] [No of Hits : 2596]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10017-1055 | FREE

ABSTRACT

Surgical options for treatment of tibiotalar, subtalar, and transverse tarsal joint arthritis are limited. Pantalar arthrodesis can produce a stable and braceable if not painless foot in the plantigrade position. This article presents a review of etiology, clinical evaluation, procedural technique and outcomes reported in literature.

Keywords: Pantalar, Arthrodesis, Fusion, Technique.

Shi G, Gross CE, Huh J, Parekh SG. Pantalar Arthrodesis: Surgical Technique and Review of Literature. The Duke Orthop J 2015;5(1):48-52.

Source of support: Nil

Conflict of interest: None

 
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