Developing a predictive model for wound healing

Jeffrey Mark Smith, MD

Lessons from military research can improve care for all You did everything that you were trained to do as a surgeon. Your patient’s complex traumatic wound was treated with serial débridement and irrigations. The associated fracture was stabilized. Negative pressure therapy was applied and the wound was closed or covered with a flap. But instead of healing, the wound went on to dehisce. What went wrong?

Atypical stress fractures: Predictors of ‘silent’ disease

Jennie McKee

Stress fracture site linked to osteopenia in young, female athletes Atypical stress fractures—in the femur, acetabulum, sacrum, spine, or ribs—are more likely to occur in young, athletic women with underlying bone mineral density (BMD) abnormalities, according to the results of a paper presented at the 2009 Annual Meeting. Lead investigator Pamela Sherman, MD, said this finding has important implications for treating low bone density in young women.

Women may benefit from earlier TKA

Carolyn Rogers

Gender bias may contribute to sex-based disparity in TKA utilization, outcomes Delay in treatment for osteoarthritis (OA) of the knee may have a negative influence on function and knee scores of women who undergo total knee arthroplasty (TKA). Initiation of treatment at an earlier stage could have a beneficial effect on knee function in female patients, according to a study presented at the 2009 Annual Meeting in Las Vegas. Brian S.

The impact of standardized implant labels

Kent Jason Lowry, MD; Michael S. McGrath, MD; William M. Mihalko, MD, PhD

Benefits include improved patient safety and reduced costs During the past 20 years, the success rates of many orthopaedic procedures improved as new materials and techniques developed. Complications and medical errors do occur, however, and surgeons continually seek methods to avoid or reduce them. Some complications occur from preventable errors by the operating team, such as opening or implanting the wrong medical device.

Screening for MRSA: An idea whose time has come?

Robert Brooks, MD, PhD, MBA

Reducing surgical site infections with simple protocols The number of hospital admissions associated with methicillin-resistant Staphylococcus aureus (MRSA) has exploded in the last decade, roughly tripling every 5 years. S. aureus is the most common single pathogen in surgical site infections (SSIs), and methicillin-resistant S. aureus often represents 30 percent to 50 percent of all S. aureus SSIs.

(Don’t) stop the presses!

Jennie McKee

Researchers must avoid sullying the integrity of orthopaedic literature James D. Heckman, MD, had a simple message when he addressed attendees of the 2008 annual meeting of the American Orthopaedic Foot and Ankle Society: orthopaedists and other researchers must adhere to ethical guidelines to preserve the integrity of the scientific literature. Dr.

Second look

Exercise benefits TKA, OA patients Exercise can help patients recover after total knee arthroplasty (TKA), according to a study published in the Feb. 15, 2009 issue of Arthritis Care & Research.

SpotCheck: The role of CAS in TKA

Does computer-assisted surgery (CAS) make you a better surgeon? Is it really necessary to improve outcomes for total knee arthroplasty (TKA)? What role should CAS play in TKA? Kenneth A. Krackow, MD The State University of New York at Buffalo Total knee arthroplasty is perhaps the orthopaedic procedure that requires the most particular, complicated, and accurate instrumentation.

How to avoid an ‘MOC meltdown’

Jennie McKee

Tips for managing the Maintenance of Certification™ process Consider this scenario: One day next fall, you have lunch with a colleague who, like you, plans to take the Maintenance of Certification™ (MOC) cognitive examination in 2011.

Meetings and Course Listings

For more information about other CME courses or orthopaedic meetings listed, contact the source provided. Meetings and courses sponsored by Board of Specialty Societies members and regional orthopaedic organizations may be listed in the print version of AAOS Now. Send information, including contact name and e-mail address to: AAOS Now 6300 N. River Rd. Rosemont, Ill. 60018-4262 Fax: (847) 823-8033 E-mail: aaoscomm@aaos.

AAOS adopts online course evaluations

Howard Mevis

“Green” approach will make it easier to get credits Last year, the Academy’s Council on Education approved a new policy requiring participants in courses with continuing medical education (CME) credits to complete and submit a course evaluation form to receive the credits.

Fluorescent real-time imaging could transform sarcoma treatment

Annie Hayashi*

“Glowing proteins” allow investigators to visualize dynamics of cancer cells “Real-time in vivo imaging of sarcoma cells has enabled us to visualize cell mobility, invasion, metastasis, and angiogenesis,” said Katsuhiro Hayashi, MD. “If this technology were applied to orthopaedic surgery, it would enable surgeons to visualize nerve or vessels with fluorescent protein and avoid injuring or damaging them.” Dr.

Timing a factor in outcomes disparities

Some minority groups wait too long for surgery The potential for gender and racial disparities is an issue of primary concern for orthopaedic surgeons. According to a poster presentation at the 2009 Annual Meeting, Hispanic and African-American patients tend to have poorer joint function before undergoing hip or knee replacement surgery, and female patients have less preoperative joint function than male patients across ethnic groups.

Don’t rely on stated shoe size

Children at risk for foot deformity due to wrong size shoes Many young children are wearing shoes that are too small, according to the results of a study presented at the 2009 AAOS Annual Meeting. As a result, these children may be at high risk for having serious foot deformities. “Improper footwear is well recognized to be an extrinsic factor regarding the development of forefoot deformities.

New codes reveal unexpected causes for revision THA

Annie Hayashi

Wear is not primary reason for THA failure Despite continued improvements in surgical technique and implant devices, revisions to total hip arthroplasty (THA) procedures in the United States have not decreased. In fact, as the patient population has expanded to include younger, more active individuals along with growing numbers of “baby boomers,” revisions are expected to significantly increase over the next several decades, according to Kevin J. Bozic, MD, MBA.

TKA outcomes in younger patients: Too optimistic?

Peter Pollack

Revision rates may only tell part of the story Commonly accepted rates of successful outcomes after total knee arthroplasty (TKA) in younger patients may be excessively optimistic, and revision rates provide only part of the full outcome picture, according to Andrew J. Price, PhD, FRCS, in a paper he presented at the 2009 AAOS Annual Meeting. Revision is often considered the endpoint for survival for TKA.

Obesity and distal radius fractures: A bad combination

Annie Hayashi

Obesity affects outcomes after distal radius fracture surgical treatment The first study to examine the impact of obesity on outcomes after surgical treatment of distal radius fractures finds worse outcomes for obese patients than for their non-obese counterparts. “Based on our data, obese patients appear to have some worse outcomes than non-obese patients 1 year following operative fixation of distal radius fractures,” said Kenneth A. Egol, MD.

New report issued on orthopaedic ED care

AOA Institute calls for community-based solutions The American Orthopaedic Association’s (AOA) Orthopaedic Institute of Medicine (OIOM) recently released the results of an in-depth study into the challenges surrounding emergency department (ED) coverage. The report also provides possible solutions and recommendations for addressing this crisis, as well as actual case studies.

EWI-IV highlights advances in combat care

Lindsay Law; Mary Ann Porucznik

Wounded warrior recounts road to recovery “I would not be here today, if not for the professionalism of those surgeons deployed in the war zone,” admitted CPT Raymond O’Donnell, the first patient to participate in the Extremity War Injuries (EWI) symposia sponsored by the AAOS, the Orthopaedic Trauma Association, and the Society of Military Orthopaedic Surgeons. Capt.