Faculty Bibliography

BACKGROUND:Zygomatic arch (ZA) fractures are a common facial fracture, and reduction is typically performed blind via a Gillies or Keen approach. Postoperative confirmation of reduction thus requires advanced imaging, which may not be readily available in all settings. Thus, there exists a need for an effective, low-cost imaging paradigm to employ in these clinical scenarios. Herein, we introduce the ultrasonic arch reduction (USA Reduction) for ZA fractures. METHODS:All consecutive patients with ZA fractures undergoing a USA Reduction at a single public hospital were reviewed. Patients were operated on by two plastic surgeons. A standard Gillies approach was used in all cases in conjunction with real-time intraoperative ultrasound. All relevant patient data were collected and analyzed. RESULTS:Two patients were included in our study. Patient 1 was a 43-year-old man who was assaulted and sustained a right comminuted zygomatic arch fracture without concomitant trauma. Patient 2 was a 35-year-old man who was hit by a train and sustained a left comminuted ZA fracture in addition to traumatic subarachnoid hemorrhage. Both fractures were successfully reduced under ultrasound guidance in under 1 hour of operating room (OR) time without necessitating the use of postoperative CT. To date, both patients endorse positive postoperative satisfaction with their results. CONCLUSIONS:Intraoperative ultrasound is a safe and effective tool for confirming reduction of ZA fractures in a resource-limited practice while obviating the need for additional radiation. Further investigations to standardize the technique and approach will be useful to optimize this intraoperative adjunct.

OBJECTIVES/UNASSIGNED:Outside of the association of SS-A antibody with congenital heart block, little is known about adverse maternal and neonatal outcomes, in patients with Sjogren's disease (SjD). Our study involved collaboration with maternal-fetal medicine (MFM). METHODS/UNASSIGNED:-test and Fisher's exact test. RESULTS/UNASSIGNED:48 patients were included: 12 SjD patients and 36 controls. APO was significantly increased in SjD with one preterm birth, one fetal growth restriction, and one limb anomaly; non-SjD had one cardiac anomaly. There were no cases of CHB. SjD patients were more likely to be delivered by cesarean delivery. CONCLUSION/UNASSIGNED:There was an increased risk of APO in SjD patients compared with controls. No significant difference in neonatal outcomes was found. We speculate that placental pathology may play a role in pathophysiology and future studies should be performed. KEY POINTS/UNASSIGNED:There was an increased risk of APO in SjD patients compared with controls.No significant difference in neonatal outcomes was found.We speculate that placental pathology may play a role in pathophysiology, prompting future studies.

BACKGROUND & AIMS/OBJECTIVE:There is significant variability in the immediate post-operative and long-term management of patients undergoing per-oral endoscopic myotomy (POEM), largely stemming from the lack of high-quality evidence. We aimed to establish a consensus on several important questions on the after care of post-POEM patients through a modified Delphi process. METHODS:A steering committee developed an initial questionnaire consisting of 5 domains (33 statements): post-POEM admission/discharge, indication for immediate post-POEM esophagram, peri-procedural medications and diet resumption, clinic follow-up recommendations, and post-POEM reflux surveillance and management. A total of 34 experts participated in the 2 rounds of the Delphi process, with quantitative and qualitative data analyzed for each round to achieve consensus. RESULTS:A total of 23 statements achieved a high degree of consensus. Overall, the expert panel agreed on the following: (1) same-day discharge after POEM can be considered in select patients; (2) a single dose of prophylactic antibiotics may be as effective as a short course; (3) a modified diet can be advanced as tolerated; and (4) all patients should be followed in clinic and undergo objective testing for surveillance and management of reflux. Consensus could not be achieved on the indication of post-POEM esophagram to evaluate for leak. CONCLUSIONS:The results of this Delphi process established expert agreement on several important issues and provides practical guidance on key aspects in the care of patients following POEM.

The cost of healthcare spending in foot and ankle surgery continues to rise. Several recent studies about cost effectiveness have been published. These may be difficult to understand and analyze without a background in business and healthcare economics. The goal of this narrative review is to provide the fundamentals for understanding and interpreting healthcare economic studies by defining key terminology and providing examples in the field of foot and ankle surgery. Foot and ankle surgeons should be familiar with the elements that comprise cost-effectiveness for providers, clinicians, researchers, and economists in caring for patients and making healthcare-related decisions.

BACKGROUND & AIMS/OBJECTIVE:Delayed diagnosis of inflammatory bowel disease (IBD) leads to prolonged symptoms and worse long-term outcomes. We sought to evaluate whether race, ethnicity, disease type, and social factors are associated with delayed diagnosis of pediatric IBD. METHODS:We performed a cross-sectional study of newly diagnosed pediatric patients with IBD at 22 United States sites from 2019 to 2022. Parents/guardians reported race, ethnicity, time between symptom onset and diagnosis, and other social determinants of health. Through bivariate and multivariable analyses using generalized estimating equations, we evaluated associations between these factors and diagnosis time defined as ≤60 days, 61 to 180 days, 181 to 365 days, and >365 days. RESULTS:We enrolled 869 participants (mean age at diagnosis, 13.1 years; 52% male; 57% Crohn's disease [CD]; 34% ulcerative colitis [UC]; 8% Hispanic; 30% non-White). Overall, the mean time to diagnosis was 265.9 days. After adjustment, factors associated with longer diagnosis time included CD vs UC (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.9-3.5), 2 or more other health conditions (OR, 1.7; 95% CI, 1.1-2.7), and longer travel time to clinic (>1 hour [OR, 1.7; 95% CI, 1.2-2.4], >2 hours (OR, 1.8; 95% CI, 1.2-2.9] each vs <30 minutes). There was no association with race, ethnicity, birth country, sex, parent education, household income, insurance type, health literacy, and health system distrust. CONCLUSIONS:Consistent with prior literature, diagnostic delay is longer for CD than UC. Reassuringly, time to diagnosis is equitable across racioethnic groups. New models of diagnostic care are needed for communities affected by longer travel times.

Stercoral colitis is an inflammatory reaction secondary to fecal impaction and almost always occurs in the setting of chronic constipation. Luminal distention caused by dense and dehydrated stool compresses the vascular supply of the distal colon, resulting in bowel ischemia and ulceration. Stercoral colitis primarily affects elderly patients, but it can be seen in any patient with decreased bowel motility, with risk factors including neurodegenerative disorders, chronic medical diseases, malignancy, immobility, and the use of narcotic or anticholinergic medications. Patients most often present with abdominal pain and tenderness. However, the presentation is often nonspecific and can include nongastrointestinal symptoms. Due to the common presence of comorbidities, a thorough history and physical examination findings may be difficult to obtain. Imaging, especially CT, plays a vital role in the diagnosis of stercoral colitis, demonstrating hallmark features such as fecal impaction and a large colorectal stool burden. Mural thickening (>3 mm) and other CT signs of inflammation aid in diagnosis, although findings including perirectal fat stranding can be nonspecific. Signs of perforation, including mural discontinuity, extraluminal air, and extraluminal stool collections, can also be identified. Other potential complications include obstruction, bleeding, fistulas, and urinary tract involvement secondary to mass effect. The overlap of findings between stercoral colitis and other colonic diseases, particularly diverticulitis and malignancy, can sometimes make diagnosis challenging. Identification of fecal impaction and associated inflammatory changes helps in distinguishing stercoral colitis from other pathologic conditions. Prompt diagnosis of stercoral colitis and its complications allows appropriate management, which can range from preventive measures to emergent surgical treatment. ^©RSNA, 2025 Supplemental material is available for this article.

Background Expedited Partner Therapy (EPT) is the practice of treating sexual partner(s) of patients diagnosed with STIs without examining the partner(s) and is effective in reducing reinfection. It has been permissible in Virginia since 2020. This study aimed to assess knowledge and practices surrounding prescription of EPT at an academic medical center in Virginia before and after an online learning module. Methods Data were obtained via online anonymous RedCap surveys. The first was distributed via e-mail to providers who regularly diagnose and treat STIs at an academic medical center in Virginia. The survey assessed provider knowledge and practices regarding EPT and preference of future education. On the basis of the results, an online learning module with information on EPT was created and distributed to the same population of providers. The module contained pre- and post-module surveys evaluating participant knowledge of the legal status, methods of prescription, and attitudes surrounding EPT. Results The initial survey showed that 10% of participants were aware of the new legal status of EPT. In terms of EPT prescription, 4% always prescribed EPT, 14% prescribed it sometimes, and 61% never prescribed it. In the pre-module survey, 31% of respondents correctly identified one option for prescription of EPT. Knowledge surrounding the legal status and prescription methods was significantly improved in the post-module responses, with 100% of participants able to identify one correct prescription option. Conclusion These results show knowledge gaps surrounding the Virginia EPT provision and policy change. These gaps improved with the implementation of an online learning module. Further evaluation is needed to assess the continued implementation of EPT.

OBJECTIVE/UNASSIGNED:Sentinel lymph node biopsy (SLNB) for endometrial cancer staging may identify isolated tumor cells (ITCs). Although guidelines do not classify nodes with ITCs as positive, earlier papers reported that a significant proportion of gynecologic oncologists treat ITCs as they would positive nodes. The objective of this study was to examine practice patterns and determine if the presence of ITCs in endometrial cancer affects adjuvant treatment decision-making. METHODS/UNASSIGNED:test, and logistic regression were used with significance set at p < 0.05. RESULTS/UNASSIGNED:Of seven hundred thirty-four patients included, ITCs were identified in 41 patients (5.6 %). Deep myometrial invasion (61.0 % vs 20.5 %, p < 0.001) and lymphovascular invasion (58.4 % vs 17.7 %, p < 0.001) were more common in patients with ITCs than in those with negative lymph nodes. Patients with ITCs were more likely to receive adjuvant treatment (30 of 41, 73.2 % vs 289 of 693, 41.7 %, p < 0.001). When controlling for age, stage, histology, grade, and lymphovascular space invasion, ITCs were not associated with an increased likelihood of adjuvant therapy receipt. CONCLUSIONS/UNASSIGNED:Although patients with ITCs were more likely to receive adjuvant treatment, this was accounted for by other clinical and histological factors. Clinicians were likely to make decisions based on established risk factors, and more data are needed on the role of ITCs in the landscape of molecularly based decision making.