SSIs in pediatric spine surgeries are tied to scoliosis etiology

Mary Ann Porucznik

Increase in gram-negative organisms indicates need to reconsider prophylaxis Learning from your experience is good; learning from the experiences of others is even better. So that their experiences might enable others to better identify and address modifiable risk factors for surgical site infections (SSIs), three tertiary care children’s hospitals conducted a retrospective cohort study of more than 1,350 spinal instrumentation procedures for scoliosis (Fig. 1). Michael G.

A closer look at bursitis

Terry Stanton

JAAOS article reviews diagnostic, treatment options Bursitis is a common cause of pain of the knee (prepatellar), elbow (olecranon), hip (trochanteric), and heel (retrocalcaneal). The diagnosis must differentiate bursitis from arthritis, tendinitis, fracture, tendon or ligament injury, infection, and neoplasm. Bursitis may be septic or nonseptic, and distinguishing between the two forms can be challenging.

Returning to duty after open tibial fractures

Peter Pollack

Patients treated with limb salvage or amputation have comparable rates of return “If you have a severe lower extremity injury, whether you choose to undergo amputation or limb salvage, it is unlikely that you will return to duty,” said LTC Joseph R. Hsu, MD, who presented his paper on “Return to Military Service Following Type III Open Tibia Fracture” at the Limb Lengthening and Reconstruction Society’s Specialty Day at the AAOS Annual Meeting.

Meetings and Course Listings

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

What’s your Diagnosis?

In this feature, AAOS Now publishes a series of images, challenging readers to diagnose the condition depicted. The images for this month’s challenge were submitted by Waldo Floyd III, MD, and Charles E. Hancock, MD, who provide the following information: Despite increasing bilateral wrist swelling, a 43-year-old man continued to do significant manual labor. The right wrist swelling became massive, and he sought medical evaluation.

Retained pediatric hardware increases difficulty of THA

Mary Ann Porucznik

Study finds longer surgical times and hospital stays, more complications Leaving orthopaedic implants in children may have an impact on later total hip arthroplasty (THA) surgery, according to the results of a study presented at the 2011 annual meeting of the Pediatric Orthopaedic Society of North America.

Telling the difference: MRSA or MSSA osteomyelitis

Mary Ann Porucznik

Predictive algorithm works for one hospital…but will it work for others? Quickly identifying whether osteomyelitis is caused by methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-sensitive S aureus (MSSA) is critical to delivering appropriate treatment. During the 2011 annual meeting of the Pediatric Orthopaedic Society of North America, Mininder S.

Don’t overlook epidemiologic differences

Howard R. Epps, MD

Proposed algorithm may not apply to other centers Dr. Kocher and colleagues should be applauded for attempting to help guide empiric antibiotic treatment for acute hematogenous osteomyelitis before culture results become available. The small number of patients with MRSA infections (8 percent) included in this paper, however, makes the applicability of these data to other centers questionable. Sheldon L.

Second Look—Clinical News and Views

If you missed these Headline News Now items the first time around, AAOS Now gives you a second chance to review them. Headline News Now—the AAOS thrice-weekly, online update of news of interest to orthopaedic surgeons—brings you the latest on clinical, socioeconomic, and political issues, as well as important announcements from AAOS.

Registry study of knee replacements finds increase in VTE over decade

Terry Stanton

Despite chemical prophylaxis, final rate may be considered “high” Advances in thromboprophylaxis and improved adherence to prophylactic guidelines should theoretically lead to lower rates of venous thromboembolism (VTE). However, a large-scale Danish study published in the July 6 issue of The Journal of Bone and Joint Surgery–American shows that the incidence of VTE among knee arthroplasty patients actually increased over the 10-year study period (1997–2007), from 0.

Fusion leads to more adjacent-segment disease than arthroplasty

Terry Stanton

Clinical implications for spine patients not clear A complete explanation of adjacent-segment degenerative disk disease and the impact of surgical fusion remains elusive. Although some patients develop symptomatic degenerative disease at levels adjacent to fusions, the effects of the fusion itself and the underlying degenerative disease are difficult to separate as factors. A study in the July 6 Journal of Bone and Joint Surgery–American may provide some clarity.

Fellowship recipients sharpen skills abroad

Maureen Leahy

Five-city tour focuses on care and treatment of athletes Last November, Kevin M. Doulens, MD, and Lutul D. Farrow, MD, completed the 2010 European Federation of Sport Traumatology (EFOST) Travelling Fellowship, sponsored by EFOST and DonJoy Orthopedics. The fellowship facilitates the exchange of information and ideas between U.S.

Improve surgical safety by using CRM

Dirk H. Alander, MD; Robert Brooks, MD, PhD, MBA; David B. Carmack, MD; Col. Joseph Legan, MD

Crew (team) resource management and the orthopaedic surgeon Safety in the medical field has been a much debated topic since the late 1990s, due to a continuing and unacceptably large number of preventable medical errors. The traditional drivers for improving outcomes—retrospective analyses of morbidity and mortality—were insufficient to address the impact of technology and the explosion of diagnostic and treatment options.

Making the Case for Orthopaedic Procedures

Madeleine Lovette

The explosive growth in the number of costly orthopaedic procedures—including joint replacements, back surgeries, and other treatments—has attracted the attention of legislators, payers, employers, and experts in both health care and economics. Without scientific evidence to support the effectiveness of these procedures, many of these critics are beginning to ask questions.