Is the ‘gold standard’ losing its luster?

Annie Hayashi

Pelvic packing may produce better results than pelvic angiography “People with pelvic fractures come into our emergency department from a helicopter or ambulance and are in the operating room within 20 minutes,” reported Maj. Patrick Osborn, MD, at the recent Orthopaedic Trauma Association annual meeting.

Making a case for the artificial disk

Peter Pollack

Is it an expensive fusion or a viable alternative? As a principal investigator for the U.S. Food and Drug Administration’s clinical trials on using spinal artificial disks in the treatment of degenerative disk disease, Fabien D. Bitan, MD, is well-qualified to discuss the issues surrounding disk replacement as an alternative to spinal fusion. “It’s probably the number one controversy in spine surgery today,” he said.

Fight infections: Engage in hand-to-hand combat

the AAOS Patient Safety Committee

Surgeons should lead by example: Follow hand hygiene guidelines The concept of good hand hygiene is familiar to all healthcare workers, particularly surgeons, who are meticulous about scrubbing before operating. Good hand hygiene, however, should extend beyond the operating theater into hospital rooms and office settings.

Hand-hygiene recommendations

Indications for hand washing and hand antisepsis Hands that are visibly dirty or contaminated with proteinaceous material or are visibly soiled with blood or other body fluids should be washed with a nonantimicrobial (or antimicrobial) soap and water. If hands are not visibly soiled, an alcohol-based hand rub should be used for routine decontamination in all other clinical situations.

SECOND LOOK

In case you missed these news items the first time around, AAOS Now gives you a second chance to review them. Links are available online at www.aaos.org/now. Stay current by subscribing to Headline News, the AAOS thrice-weekly online update of news of interest to orthopaedic surgeons. Headline News brings you the latest on clinical, socioeconomic, and political issues, as well as important announcements from AAOS. Subscribe to Headline News at www.aaos.org/news/news.

Courses address knee, wrist injuries

Two skills courses scheduled for spring 2008 provide you with the opportunity to improve your surgical techniques in the treatment of knee injuries in athletes and wrist injuries. Getting patients back in the game Refine your techniques for treating complex knee injuries in athletes of all ages at the Knee Injuries in Athletes: Cutting Edge Techniques for Restoring Function and Avoiding Complications course, April 3–5, 2008, at the Orthopaedic Learning Center (OLC) in Rosemont, Ill.

Meetings and Course Listings

Listed below are upcoming continuing medical education (CME) courses and orthopaedic meetings through June 2008. For more information about AAOS-sponsored courses, contact the AAOS customer service department at (800) 626-6726, visit the CME course section of the AAOS Web site at www.aaos.org/courses, or contact the source listed. For more information about other CME courses or orthopaedic meetings, contact the source provided.

Counterpoint: Gold standard still shines

Paul Tornetta III, MD

Blood loss in patients with pelvic injuries is quite complex. Most patients have multiple injuries, and estimates of the contribution of the pelvic injury to morbidity and mortality are wide ranging. Even in hemodynamically unstable patients, the pelvis is not the most likely source of mortality. In the short presentation at the Orthopaedic Trauma Association annual meeting, this complex issue could not be fully addressed.

Cardiac testing before hip fracture surgery of little value

Annie Hayashi

Testing delays surgery, doesn’t lead to interventions S. Andrew Sems, MD Retrospective, case-controlled study The retrospective, case-controlled study of 973 patients who sustained proximal femur fractures between the years 2001 and 2006 involved 54 patients (average age 81.7 years) who had preoperative cardiac stress testing—dobutamine stress echocardiograms (DSE) or sestamibi scans—and 919 patients (average age 83.2 years) who had no testing (control group).

Get ready for MOC with the 2008 OSAE

With its basis in Orthopaedic Knowledge Update 9 (OKU 9) and other leading orthopaedic publications, the 2008 Orthopaedic Self-Assessment Examination—Scored and Recorded is the most convenient and economical way to review all areas of orthopaedics and thoroughly prepare for the American Board of Orthopaedic Surgery Maintenance of Certification™ (MOC). It is also a valuable tool for residents and fellows to prepare for first-time certification.

Helping children walk ... around the world

Jennie McKee

International Clubfoot Symposium focuses on congenital defect The International Clubfoot Symposium, held at the University of Iowa in September, brought together a diverse group of scientists, clinicians, and policy makers to advance the general understanding of clubfoot, a common condition that affects approximately one per 1,000 newborns.

Ponseti method revolutionizes clubfoot care

Jennie McKee

Nonsurgical treatment is inexpensive, widely applicable, and effective For decades, the only treatment for idiopathic congenital talipes equinovarus, commonly known as clubfoot, was surgery to adjust the tendons, ligaments, and joints in the foot and ankle. But the work of Ignacio V. Ponseti, MD, would change the lives of patients with clubfoot around the world. Developing the Ponseti method When Dr.

Traumatic fractures and fixation: A new look from Europe

Annie Hayashi

Careful selection of fixation according to initial assessment strongly advised Orthopaedic trauma surgeons have struggled to determine the best method and timing for definitive fixation of major fractures in patients with multiple traumas. A 6-year study, conducted in 10 European Level I trauma centers, has concluded that the “the surgical management of the femur fracture [must] be adapted to the clinical condition of the multiple trauma patient.”

When bad things happen to good people

Annie Hayashi

Reduced patient functioning increases caregiver burden “Being an orthopaedic traumatologist involves far more than fixing a guy’s left intertrochanteric fracture after he has fallen off a ladder,” says Bruce Ziran, MD. “It’s helping this man’s wife—who is his sole caregiver—identify the resources so the house they have shared for 50 years is not lost to Medicaid subrogation.” Dr. Ziran has expanded his “patient-centered” care to include the often burdened and forgotten “caregiver.”

Hardware for hip fractures: Screws, plates, and nails

Peter Pollack

The debate extends to economy and effectiveness When selecting from the wide variety of options for the treatment of intertrochanteric hip fractures, orthopaedic surgeons should keep two criteria—efficacy and cost-effectiveness—in mind, according to Kenneth A. Egol, MD. “In evaluating new implant technology, we have to ask whether the added expense to the healthcare system actually leads to improved outcomes,” he said.