NFL Study Sheds Light on Syndesmotic Sprains

Terry Stanton

A study of ankle sprains sustained by National Football League (NFL) players suggests that aggressive nonsurgical treatment is advisable for syndesmotic sprains. Although these injuries may require longer rehabilitation periods than lateral ankle sprains, the study reports that time away from play may not be as prolonged as previously reported in professional football players.

Smoking, Workers’ Comp Status Push Disability and Pain Scores Up

Terry Stanton

A review of more than 13,000 patients undergoing treatment for spine pain found that patients who smoked had the worst disability scores, followed by previous smokers; nonsmokers had the least pain. The study, conducted by Mark L. Prasarn, MD, and colleagues and presented at the AAOS 2012 Annual Meeting, also found that patients with workers’ compensation claims or litigation—so-called “secondary gain” issues—had worse pain and disability scores than other patients.

Second Look—Clinical News and Views

New tool to reduce wrong-site surgeries The Joint Commission has released a new tool designed to help healthcare organizations identify, measure, and reduce risks in key processes that can contribute to a wrong-site surgery. The Targeted Solutions Tool™ can help identify and eliminate risks in all phases of the surgery process. The tool is available to all Joint Commission-accredited hospitals. Biomarker linked to knee OA A study in the Journal of Biological Chemistry (Feb.

Meetings and Course Listings

General MAY 2–6 Association of Bone and Joint Surgeons Annual Meeting Charleston Place Hotel, Charleston, S.C. Website: www.abjs.org MAY 17–19 Arthroscopy Association of North America (AANA) Annual Meeting Orlando World Center Marriot, Orlando, Fla. Website: www.aana.org MAY 18 AAOS What’s Cooking with Fragility Fractures and Other Interesting Stuff Hyatt Regency Philadelphia at Penn’s Landing, Philadelphia Course director: Joseph M.

Midfoot Sprains in NFL Players: Treatment and Severity

Return to play without surgery seen in grade 2 Lisfranc injuries Terry Stanton A study presented at the American Orthopaedic Foot & Ankle Society Specialty Day found that professional football players who sustain minor midfoot sprains and are managed conservatively may return to play within 3 weeks. Results also showed that players with severe injuries involving frank diastasis underwent surgery more than 90 percent of the time. Daryl C.

Hip Problems: When Is It Time to Operate?

Take all factors into account; don’t rush into surgery Peter Pollack “In my opinion, determining when hip arthroscopy is indicated depends on several factors,” said J. W. Thomas Byrd, MD, who discussed the topic during the American Orthopaedic Society for Sports Medicine Specialty Day program. “The first is to verify that the patient’s condition is truly a hip problem. “That seems obvious,” continued Dr. Byrd, “but one study we conducted [Clinics in Sports Medicine, Oct.

RSA patients with positive intraoperative cultures at low risk for recurrent infection

Study results suggest prolonged antibiotic therapy may not be necessary Maureen Leahy Patients undergoing one-stage revision shoulder arthroplasty (RSA) who had positive intraoperative cultures, but were not treated with long-term postoperative antibiotics for infection, are at low risk for recurrent infections. This suggests that postoperative antimicrobial treatment strategies may not be necessary in these patients. The study results were presented by Matthew J.

Pro Athletes and FAI Surgery: Getting Back in the Game

Understanding FAI and choosing surgical candidates carefully are critical for success Jennie McKee Many different factors affect the ability of a professional athlete to return to high-level activities after femoral acetabular impingement (FAI) surgery, according to Marc J. Philippon, MD, who spoke at the Arthroscopy Association of North America 2012 Specialty Day program. Orthopaedists must understand the movements involved in an athlete’s sport, said Dr.

TKA in Younger Patients: Real, but Reasonable?

The evidence and the alternatives to TKA in patients younger than age 65 Mary Ann Porucznik Over the last two decades, the volume of total knee arthroplasty (TKA) procedures has increased dramatically—and the percentage of TKA patients who are younger than age 65 has also risen substantially. During a joint Specialty Day program moderated by Carlos J.

Flexible IM Nailing for Pediatric Tibial Fractures: Pearls and Pitfalls

Maureen Leahy

Most tibial fractures in children can be successfully treated with closed reduction and cast immobilization. Surgery is indicated, however, when the fracture is irreducible, unstable, open with soft tissue injury, or associated with multiple injuries, according to Martin J. Herman, MD, of St. Christopher’s Hospital for Children in Philadelphia. Surgical options include percutaneous pinning, external fixation, plating, and increasingly, flexible intramedullary (IM) nailing.

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 Nicholas Larsen, MD, a resident member at the University of Tennessee-Campbell Clinic. Dr. Larsen also provided the following information: The patient is a 7-year-old girl with a 1-month history of increasing pain in her left leg. The pain increases when she spends long periods on her feet and resolves with rest.

MOC Deadline: May 1

Diplomates whose certification will expire in 2013, 2014, or 2015 and who plan to take the American Board of Orthopaedic Surgery (ABOS) Maintenance of Certification™ (MOC) examination in 2013 must submit an examination application and application fee via www.abos.org by May 1, 2012. The late application deadline is May 15, 2012; a late fee applies.

Decreasing the Risk of Cerebral Deoxygenation during Shoulder Surgery

Maureen Leahy

Using regional anesthesia and sedation, rather than general anesthesia, for patients undergoing shoulder surgery in the beach-chair position reduces the risk of cerebral deoxygenation, according to study results presented by Jason L. Koh, MD, of the NorthShore University Health System, during the American Shoulder and Elbow (ASES) Specialty Day. This suggests that avoiding the use of general anesthesia may reduce the risk of ischemic neurologic injury in this patient population.

IMGs Must Be Accountable for Meeting U.S. Standards

William A. Grana, MD, MPH

Our nation’s physician shortage has resulted in a large medically underserved population. The problem will only get worse with federal healthcare reform as more physicians opt out of federally sponsored plans or choose to not accept new patients in these plans. The Educational Commission for Foreign Medical Graduates (ECFMG) has established minimum standards for International Medical Graduates (IMGs) to be eligible to practice in the United Sates.

Advanced Helmet Designs Don’t Appear to Reduce Concussion

Peter Pollack

“Advanced helmet technology has not affected the concussion rate or the rate of intracranial injury among high school and college football players,” said John R. Fowler, MD, a PGY-5 resident at Temple Orthopaedics & Sports Medicine in Philadelphia. “Our data suggest that we need further research to determine the predisposing profiles for mild traumatic brain injury (MTBI), postconcussion syndrome, catastrophic brain injury, and chronic sequelae.” Dr.

Communication Strategies for Difficult Physician-Patient Interactions

Maureen Leahy

The success of physician-patient relationships is predicated on effective communication. This is especially important when physicians must deliver bad news to a patient or family, deal with patients who are angry or seeking drugs, or handle patients who don’t adhere to treatment due to financial concerns.

SPORT Results Are Good News for Spine Patients

Mary Ann Porucznik

The Spine Patient Outcomes Research Trial (SPORT), a multicenter, randomized controlled trial, studied the outcomes of the surgical and nonsurgical management of three conditions: intervertebral disk herniation (IDH), degenerative spondylolisthesis (DS), and lumbar spinal stenosis (SPS).

Autograft or Allograft for ACL Reconstruction?

Jennie McKee

Whether to use an autograft or an allograft in anterior cruciate ligament (ACL) reconstruction is still controversial. Although patella tendon autograft has long been considered the gold standard, allograft safety has improved significantly in the last 15 years, making it a viable option in some patients, according to Mark D. Miller, MD, who reported on the latest information on autograft and allograft tissue and offered tips on selecting an allograft tissue bank during the 2012 Arthroscopy Association of North America Specialty Day Program.

Evolving Care During a Decade at War

Madeleine Lovette

During the decade since terrorists attacked the World Trade Centers in New York City and the Pentagon in Washington, D.C., more than 32,000 service members have been wounded in action as part of Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF). Although Dec. 15, 2011, marked the end of the military mission in Iraq and current operations in Afghanistan are winding down, the medical mission to treat and rehabilitate those wounded continues.