Using an Institute Model to Reduce the Incidence of Venous Thromboembolism Within a Large Hospital System.

Internal benchmarking showed that the Orthopedic Institute had an above average rate of venous thromboembolism (VTE) along with other institutes. The Orthopedic VTE Quality Team was assigned to investigate opportunities for improvement to share with other institutes. To investigate the issues and barriers to the administration of chemical and mechanical VTE prophylaxis, data collection included real-time point prevalence study, physician and nursing surveys, and electronic medical record audits. The results of the data collection indicated inconsistencies in nursing and patient care. Therefore a VTE policy and VTE educational poster was developed. In conjunction, nursing education will be completed to describe the best practice for sequential compression devices and anticoagulant therapies and documentation. The physician will be notified for refusals on either mechanical or chemical prophylaxis.

Knotless Suture Anchor Suspensionplasty for Basal Joint Arthritis A Prospective Case Series with Short-Term Outcomes.

BACKGROUND: The mainstay of surgical treatment for advanced basal joint arthritis is arthroplasty. Many differ- ent techniques of basal joint arthroplasty exist, but none has been determined to be superior to the others, and most methods used to maintain the post-trapeziectomy space require postoperative immobilization or pin fixation. In this article, we describe a knotless suture anchor suspen- sionplasty (KSAS) technique and present a prospective case series with short-term outcomes. The KSAS technique utilizes a suspension construct to maintain the post-trapeziectomy space, allowing for early mobilization without the need for pin fixation or casting. METHODS: Twenty-five patients underwent trapeziectomy with KSAS. Visual analog scale (VAS) for pain scores and Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) scores were recorded preoperatively and at multiple post- operative points. Grip and pinch strengths were recorded. Maintenance of the post-trapeziectomy space and subsidence were determined by comparing preoperative and postopera- tive radiographs. RESULTS: VAS pain scores were significantly reduced from baseline at all postoperative time points with a reduction from 6.54 to 1.47 at 20 to 24 weeks (p < 0.001). qDASH scores were also significantly decreased from baseline at all time points except for 1 week postoperatively with a re- duction from 57.71 to 12.27 at 20 to 24 weeks (p < 0.001). Grip strength improved from 80.43% compared to the non- operative side preoperatively to 90.36% at 6 months status post KSAS (p < 0.05). Radiographically, subsidence was 35.11% at final follow-up. CONCLUSIONS: Our data suggest that KSAS is a safe, effective, and reproducible basal joint arthroplasty tech- nique that allows for early mobilization while sufficiently maintaining the post-trapeziectomy space enough to prevent impingement of the first metacarpal on the scaphoid. Al- though there are limitations to this prospective case series, the data presented here warrant long-term outcome studies utilizing this technique.