Faculty Bibliography

OBJECTIVES/OBJECTIVE:To compare the efficacy of an infraclavicular single-shot nerve block to a continuous infusion through an OnQ infusion pump for rebound pain (between 12 and 24 hours postoperatively) and postoperative narcotic analgesia requirements in distal radius fractures. DESIGN/METHODS:Prospective randomized control trial. SETTINGS/METHODS:Performed at 2 hospitals affiliated with a large urban academic medical center. PATIENTS/METHODS:Fifty patients undergoing operative fixation of distal radius fractures (OTA/AO type 23B/C). INTERVENTION/METHODS:Patients were randomized to receive either an infraclavicular block as a single shot (SSB group) or a continuous infusion through an OnQ pump (OnQ group). MAIN OUTCOME MEASURES/METHODS:Visual analog scale (0-10) pain levels and amount of pain medication taken. RESULTS:At all time points after discharge, mean postoperative pain scores were lower in the OnQ group versus the SSB group but did not reach statistical significance. At 12 hours postoperatively, the SSB group and OnQ group pain scores, respectively, were 5.2 and 4.1 (P = 0.1615). At 24 hours, the pain scores for the SSB and OnQ group, respectively, were 5.4 and 4.8 (P = 0.1918). At these same time points, the Percocet taken were the same at 1.3 and 2.3 (P = 0.8328 and 0.8617). Overall 5 of 24 patients in the OnQ group had pump malfunctions with 4 being removed before 48 hours. CONCLUSION/CONCLUSIONS:OnQ pump is not associated with statistically improved postoperative pain control compared with a single nerve block for distal radius fractures and did not address rebound pain. LEVEL OF EVIDENCE/METHODS:Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Anterior cruciate ligament (ACL) injuries are among the most commonly studied orthopaedic injuries. Despite having an excellent prognosis, complications do occur. The timely recognition and management of complications is imperative to ensure the success of reconstruction. Avoiding such complications requires thorough preoperative planning, proficient technical skills to properly manage intraoperative complications, and an extensive knowledge of possible postoperative complications.

Although studies have revealed high readability levels of orthopedic patient education materials, no study has evaluated sports medicine-related patient education materials. We conducted a study to assess the readability of sports medicine-related patient education materials from the American Academy of Orthopaedic Surgeons (AAOS) and the American Orthopaedic Society for Sports Medicine (AOSSM). All sports medicine patient education articles available online in 2012 from the AAOS and the AOSSM, including the Stop Sports Injuries Campaign (STOP), were identified, and their readability was assessed with the Flesch-Kinkaid (FK) readability test. Mean overall FK grade level of the 170 articles reviewed (104 from AAOS, 36 from AOSSM, 30 from STOP) was 10.2. Mean FK levels for the 3 sources were 9.5 (AAOS), 11.0 (AOSSM), and 11.5 (STOP) (P = .16). Fifteen (8.8%) of the 170 articles had a readability level at or below eighth grade (average reading level of US adults); only 2 (1.2%) of the 170 articles were at or below the recommended sixth-grade level. The majority of sports medicine-related patient education materials from AAOS and AOSSM had reading levels higher than recommended, indicating that the majority of the patient population may find it difficult to comprehend these articles.

We sought to assess the readability levels of arthroscopy-related patient education materials available on the Web sites of the American Academy of Orthopaedic Surgeons (AAOS) and the Arthroscopy Association of North America (AANA). We identified all articles related to arthroscopy available in 2012 from the online patient education libraries of AAOS and AANA. After performing follow-up editing, we assessed each article with the Flesch-Kincaid (FK) readability test. Mean readability levels of the articles from the AAOS Web site and the AANA Web site were compared. We also determined the number of articles with readability levels at or below the eighth-grade level (the average reading ability of the US adult population) and sixth-grade level (the widely recommended level for patient education materials). Intraobserver reliability and interobserver reliability of FK grade assessment were evaluated. A total of 62 articles were reviewed (43 from AAOS and 19 from AANA). The mean overall FK grade level was 10.2 (range, 5.2 to 12). The AAOS articles had a mean FK grade level of 9.6 (range, 5.2 to 12), whereas the AANA articles had a mean FK grade level of 11.4 (range, 8.7 to 12); the difference was significant (P < .0001). Only 3 articles had a readability level at or below the eighth-grade level and only 1 was at or below the sixth-grade level; all were from AAOS. Intraobserver reliability and interobserver reliability were excellent (intraclass correlation coefficient of 1 for both). Online patient education materials related to arthroscopy from AAOS and AANA may be written at a level too difficult for a large portion of the patient population to comprehend.