Faculty Bibliography

BACKGROUND/UNASSIGNED:This study aims to investigate whether compensation is equitable among the most commonly performed orthopedic hand surgeries and when compared with general orthopedic procedures. METHODS/UNASSIGNED:tests were used to compare wRVU/h between cohorts. RESULTS/UNASSIGNED:= .007). CONCLUSIONS/UNASSIGNED:The 2020 Physician wRVU scale does not allocate proportional wRVUs to orthopedic hand procedures with longer mean operative times. There is a decrease in mean reimbursement rate for hand procedures with longer mean operative time. When compared with general orthopedic procedures, hand procedures have a lower mean wRVU/h and complication rate.

BACKGROUND CONTEXT/BACKGROUND:Vertebral hemangiomata are ubiquitous bone tumors. Often multiple, they are generally benign in nature and slow growing. They typically have a predictable radiographic appearance. Occasionally, hemangiomata may behave in a more aggressive manner, causing pathologic fracture or even symptoms/signs of nerve compression. In such cases, one must be careful not to assume that an atypical hemangioma is responsible. Coexisting, more malignant processes may be present and sometimes may be radiographically undetectable in the setting of acute fracture. This was the case in our patient. STUDY DESIGN/METHODS:Case report/university spine surgery center. METHODS:The patient underwent a corpectomy of her affected vertebra with conversion to a total spondylectomy when intraoperative frozen section was consistent with plasma cell neoplasm. A reconstruction with vertebral body replacement and fusion through anterior and posterior approaches was completed. Subsequently, the literature was reviewed for other cases of atypical hemangiomata to investigate the incidence of coexistent lesions. RESULTS:This patient presented with pain secondary to an unstable pathologic vertebral body fracture. Surgery to stabilize her spine was elected. Intraoperative recognition of abnormal-appearing tissue led to the diagnosis of a plasma cell neoplasm that was not seen on imaging. Coexistent in the same vertebra was hemangiomatous tissue that was visible on preoperative imaging. CONCLUSIONS:There are rare reports of aggressively behaving hemangiomata that mainly have occurred in the thoracic spine. There have been no reports of the coexistence of a hemangioma and a plasma cell tumor in the same vertebral level in the setting of acute compression fracture.

BACKGROUND:Lag screw fixation commonly is used to treat avulsion fractures of the posterior calcaneal tuberosity, but this method may not offer reliable fixation. This study compared the strength to failure of lag screws compared to lag screw fixation augmented with suture anchors in these fractures. METHODS:The calcanei and Achilles tendons of 12 fresh lower extremity cadaver matched pairs were dissected and removed. An oblique osteotomy was created in the calcaneus, and two 4.0-mm lag screws were placed nearly perpendicular to the plane of the fracture in the dorsal aspect of the calcaneus with 30 degrees of divergence between them. In the contralateral specimen, the same procedure was done, but with two suture anchors placed 1.5 to 2 mm distal to the osteotomy. A zigzag suture technique through the Achilles tendon was used. The specimens were mounted and placed in a load frame for monotonic loading to failure. A paired Student t-test and a Pearson correlation were used to analyze the data (p <or= 0.05). RESULTS:The specimens treated with lag screws alone failed at 251.3 (range 66 to 459) N whereas specimens repaired with lag screws and suture anchors failed at 441.6 (range 274 to 661; p = 0.01 N). CONCLUSIONS:Suture anchor augmentation significantly improved the strength of screw fixation of the calcaneal posterior tuberosity avulsion fractures. CLINICAL RELEVANCE/CONCLUSIONS:The use of suture anchor augmentation as described may improve the reliability of fixation in avulsion fractures of the posterior calcaneal tuberosity.