Faculty Bibliography

The purpose of this study is to evaluate incidence, preoperative laboratory markers, and outcomes of patients who positively cultured pathogens (PCP) at time of surgery for long bone fracture nonunion. Two-hundred and eighty-eight patients were enrolled in a trauma study on long bone nonunion. Two-hundred and sixteen of those 288 patients were cultured at the time of fracture nonunion surgery. Laboratory data were collected prior to intervention and infectious laboratory markers ordered on patients suspected for infection. Patients were followed for one year. Wound complications, antibiotic use, healing, function, and re-admission for further surgery were assessed. Cultures returned positive on 59 patients (representing 20.5% of the 288 patient cohort or 27.3% of the 216 patients cultured in the operative suite). More PCP's (47.5%; 28 of 59) developed wound complications, with greater mean antibiotic duration and more frequent returns to the OR averaging 1.3 procedures per patient. Twelve-month follow-up was obtained on 249 of the 288 (86.5%) and PCPs reported globally worse function. Patients who PCP at the time of operative management for long bone nonunion was a prognostic indicator of poorer long-term functional outcomes.

Purpose/UNASSIGNED:To identify patient characteristics associated with adverse events in Achilles tendon rupture (ATR) surgical repair cases. Methods/UNASSIGNED:A high risk (HR) cohort group of ATR patients were compared to healthy controls in the ACSNSQIP database with multivariate regression analysis. Results/UNASSIGNED:Overall, 2% (n = 23) of the group sustained an AE postoperatively, most commonly superficial SSI (0.9%, n = 10). Multivariate analysis did not reveal any patient characteristics to be significantly associated with the occurrence of an AE or superficial SSI. Conclusions/UNASSIGNED:Obesity, diabetes and a history of smoking did not predispose patients to significantly more AEs in the 30 day postoperative period following ATR repair in this study.

BACKGROUND:Post-traumatic elbow contracture is a debilitating complication after elbow trauma. The purpose of this study was to characterize the affected patient population, operative management, and outcomes after operative elbow contracture release for treatment of post-traumatic elbow contracture. METHODS:A retrospective record review was conducted to identify all patients who underwent post-traumatic elbow contracture release performed by 1 of 3 surgeons at one academic medical center. Patient demographics, injuries, operative details, outcomes, and complications were recorded. RESULTS:The study included 103 patients who met inclusion criteria. At the time of contracture release, patients were a mean age of 45.2 ± 15.6 years. Contracture release resulted in a significant mean increase to elbow extension/flexion arc of motion of 52° ± 18° (P < .0005). Not including recurrence of contracture, a subsequent complication occurred in 10 patients (10%). Radiographic recurrence of heterotopic ossification (HO) occurred in 14 patients (14%) after release. Ten patients (11%) elected to undergo a secondary operation to gain more motion. CONCLUSION/CONCLUSIONS:Soft tissue and bony elbow contracture release is effective. Patients with post-traumatic elbow contracture can make significant gains to their arc of motion after contracture release surgery and can expect to recover a functional elbow arc of motion. Patients with severe preoperative contracture may benefit from concomitant ulnar nerve decompression. HO prophylaxis did not affect the rate of HO recurrence or ultimate elbow range of motion. However, patients must be counseled that contracture may reoccur, and some patients may require or elect to have more than one procedure to achieve functional motion.

Treatment of traumatic bone defects is dictated by a multitude of clinical factors including the defect size, patient comorbidities, soft tissue condition, and the possibility of infection present in the defect. With a variety of treatment strategies described, it is critical to choose the approach that will maximize outcomes in addressing this difficult problem. When addressing small-scale defects, bone grafting is the primary treatment. For large-scale defects, there are two major options to consider: induced membrane technique and distraction osteogenesis. Choosing between these two techniques should be based on the associated soft tissue injury, the local vascularity, and the possibility of residual infection. This review will focus on the current management principles and strategies in the treatment of bone defects after orthopedic trauma and the existing literature to support each of these treatment options.

BACKGROUND:Whereas most radial head fractures are stable injuries, they sometimes occur as part of complex injury patterns with associated elbow instability. Radial head arthroplasty has been favored in patients with unreconstructable radial head fractures and unstable elbow injuries. The purpose of this study was to review radiographic outcomes, functional outcomes, and complications after radial head arthroplasty for radial head fracture in unstable elbow injuries. METHODS:This study was a retrospective review of radial head fractures treated with radial head arthroplasty by a single surgeon during a 15-year period. Demographics of the patients, injury details, operative reports, radiographic and clinical outcomes, and any complications were recorded. Patients were divided into stable and unstable elbow injury groups. RESULTS:A total of 68 patients were included. There were 50 unstable fractures that were compared with 18 stable fractures. Patients with unstable radial head fractures with associated elbow dislocation achieved mean flexion and mean forearm rotational arc of motion similar to that of patients with stable radial head fractures. However, supination loss was greater in the unstable group than in the stable fracture group, with a mean difference of 10°. Radiographic outcomes and complication rates did not differ between injury groups. There was no observed decrease in implant longevity in patients with unstable elbow injuries. CONCLUSIONS:Radial head arthroplasty is an effective option for treatment of unstable elbow injuries, with recovery of functional elbow range of motion and no difference in complication rate or implant survivorship compared with those patients with stable injuries.

OBJECTIVES/OBJECTIVE:To investigate what factors are associated with continued long-term pain after fracture nonunion surgery. DESIGN/METHODS:Prospective cohort study. SETTING/METHODS:Single Academic Institution. PATIENTS/PARTICIPANTS/METHODS:Three hundred forty-one patients surgically treated for fracture nonunion were prospectively followed. Demographics, radiographic evaluations, VAS pain scores, and short musculoskeletal functional assessment (SMFA) scores were collected at routine intervals. Only patients who had a minimum of 1-year follow-up and complete healing were included this analysis. Patients were divided into a high-pain and low-pain cohort for comparison. Inclusion criteria for the high-pain cohort were defined as any patient who reported a pain score greater than one standard deviation above the mean. MAIN OUTCOME MEASURES/METHODS:Long-term VAS pain scores and factors contributing to increased patient-reported long-term VAS pain scores. RESULTS:Two hundred seventy patients met criteria and were included in this analysis, with 223 patients (82.6%) in the low-pain cohort and 47 patients (17.4%) in the high-pain cohort. The mean long-term pain score was 7.47 ± 1.2 in the high-pain group and 1.78 ± 1.9 in the low-pain group. Within the high-pain cohort, 55.6% of patients reported a net increase in pain from baseline to long-term follow-up compared with 10.5% in the low-pain cohort (P < 0.0005). High baseline pain score (P = 0.003), increased Charlson comorbidity index (CCI) (P = 0.008), lower income level (P = 0.014), and current smoking status (P = 0.033) were found to be significantly more prevalent in the high-pain cohort. CONCLUSIONS:Patients with higher baseline pain scores, elevated Charlson comorbidity index, lower income level or history of smoking are at an increased risk of reporting significant and potentially debilitating long-term pain after nonunion surgery. Although patients may expect complete relieve of pain, orthopaedic surgeons must inform patients of the possibility of experiencing pain 1 year or more postoperatively. LEVEL OF EVIDENCE/METHODS:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

OBJECTIVES/OBJECTIVE:To understand the personality factors associated with orthopedic surgery resident performance. DESIGN/METHODS:A prospective, cross-sectional survey of orthopedic surgery faculty that assessed their perceptions of the personality traits most highly associated with resident performance. Residents also completed a survey to determine their specific personality characteristics. A subset of faculty members rated the performance of those residents within their respective program on 5 dimensions. Multiple regression models tested the relationship between the set of resident personality measures and each aspect of performance; relative weights analyses were then performed to quantify the contribution of the individual personality measures to the total variance explained in each performance domain. Independent samples t-tests were conducted to examine differences between the personality characteristics of residents and those faculty identified as relevant to successful resident performance. SETTING/METHODS:throughout the United States. The level of clinical care provided by participating institutions varied. PARTICIPANTS/METHODS:Data from 175 faculty members and 266 residents across 12 programs were analyzed. RESULTS:The personality features of residents were related to faculty evaluations of resident performance (for all, p < 0.01); the full set of personality measures accounted for 4%-11% of the variance in ratings of resident performance. Particularly, the characteristics of agreeableness, neuroticism, and learning approach were found to be most important for explaining resident performance. Additionally, there were significant differences between the personality features that faculty members identified as important for resident performance and the personality features that residents possessed. CONCLUSION/CONCLUSIONS:Personality assessments can predict orthopedic surgery resident performance. However, results suggest the traits that faculty members value or reward among residents could be different from the traits associated with improved resident performance.

Objectives/UNASSIGNED:To quantify radiographic changes observed in humeral shaft frctures throughout course of treatment with functional bracing. Design/UNASSIGNED:Retrospective cohort study. Setting/UNASSIGNED:Level 1 Trauma Center and affiliated Tertiary Care Center. Patients/UNASSIGNED:72 retrospectively identified patients with fracture of the humeral diaphysis. Intervention/UNASSIGNED:Application of functional brace with radiographs obtained immediately after brace application and at 1 week, 2 weeks, 3 weeks, 6 weeks, 3 months, 6 months and 12 month follow-up.Main Outcome Measure: Fracture angulation, measured in the coronal and sagittal planes. Results/UNASSIGNED:522 radiographs from 72 patients were critically reviewed. All fractures were followed to healing. Sixty-six patients (92%) successfully healed their fractures with non-operative treatment. The average angulation on immediate post-brace X-ray was 12 degrees varus ad 7 degrees procurvatum. At final follow-up, average coronal angulation was 14 degrees and 4 degrees procurvatum. Fracture angulation changed a mean 2 degrees in the AP plane and 3 degrees in the sagittal plane over the course of care. Linear regression determined fracture angulation proceeds toward both varus and recurvatum at 0.01 degrees per day. Conclusion/UNASSIGNED:Humeral shaft fractures treated non-operatively heal with minimal change in angulation after brace application. If angulation on the post-brace radiograph is acceptable and there is no history of repeat trauma and no cosmetic deformity, radiographs may be utilized less frequently. Patients should be evaluated via history and physical exam at follow-up prior to the 6-week point, at which time regular radiographs (6 week, 3 month, 6 month, 12 month) should commence.

Introduction/UNASSIGNED:The purpose of this study was to analyze the effect of the admitting service on cost of care for hip fracture patients by comparing the cost difference between patients admitted to the medicine service versus those admitted to a surgical service. Methods/UNASSIGNED:value of <.05 as significant. Results/UNASSIGNED:= .034) compared to patients admitted to the medicine service. Discussions/UNASSIGNED:In our urban safety net hospital, hip fracture patients admitted to medicine service had longer lengths of stay and higher total hospitalization costs than patients who were admitted to surgery service. Conclusions/UNASSIGNED:This study highlights that the admitting service should be an area of focus for hospitals when developing programs to provide effective and cost-conscious care to hip fracture patients.