Anatomical Structures at Risk in Percutaneous Distal Bunionette Correction.

Bunionette deformity is an incredibly pervasive issue in our society with almost a quarter of individuals being affected by it. As it is so common, there are numerous techniques and approaches to correct the deformity. Currently, there is a growing trend that favors percutaneous osteotomy of the bunionette. As there are multiple osteotomy sites, there are anatomical considerations that must be made at each one. The purpose of this study was to investigate the anatomic structures at risk during distal osteotomy of bunionette deformity using a Shannon burr. Using 11 fresh cadaver specimens, the fifth metatarsal was accessed through a carefully marked portal. A Shannon burr was employed for the osteotomy. Dissections were performed to assess potential damage to critical structures, including the lateral dorsal cutaneous nerve (LDCN), abductor digiti minimi (ADM), and extensor digitorum longus (EDL). Measurements were taken from the osteotomy site to each structure. The distal osteotomy site was on average greater than 8 mm from the EDL and ADM, whereas it was 1.64 mm from the LDCN. The Shannon burr made contact with and transected the LDCN on 2 occasions. However, previous studies have highlighted potential anatomical variations of the LDCN that arise distally. The study underscored the challenges posed by minimally invasive approaches to treating bunionette deformity and highlighted the need for cautious consideration when using percutaneous methods.Level of Clinical Evidence: 5.

Variations in opioid prescribing after total joint arthroplasty: An Observational study.

Background: This study aimed to analyze the prescribing patterns of opioids by different categories of providers for postoperative pain after primary total hip and knee arthroplasty (THA, TKA) at a single institution. Methods: A retrospective review was conducted on 1774 patients who underwent primary THA or TKA between 2014 and 2019 at a single, level one academic trauma center. Patients were excluded for additional procedures within 90 days of the index surgery. Patient demographics, operative variables, and opioid prescriptions were collected and analyzed. Generalized linear models accounting for within-person correlations were used to model the association between patient age, prescriber, etiology, opioid category, and mean morphine milligram equivalent (MME) prescribed. Results: The mean MME prescribed per patient up to 90 days postoperatively was 1591. Significant variations were observed in prescribing habits based on patient gender, age, prescriber category, and drug type. Females were prescribed more MMEs than males (CI 8.58, 667.16; p = 0.0443) and patients 65 years or younger received higher MMEs compared to those above 65 (CI 231.11, 926.48; p = 0.0011). Non-orthopedic physicians prescribed higher MMEs than orthopedic surgeons (CI 402.76, 1219.48; p < 0.0001). Hydrocodone and oxycodone prescriptions had significantly higher MMEs than tramadol prescriptions (CI 446.33, 719.52; p < 0.0001 and CI 681.09, 1065.26; p < 0.0001, respectively). Conclusion: These findings suggest the need for standardized guidelines and interventions to address variations in opioid prescribing practices for postoperative pain control. Understanding baseline prescription habits can help guide efforts to optimize pain management and reduce opioid overprescribing in the surgical setting.

High Research Productivity During Orthopaedic Surgery Residency May Be Predicted by Number of Publications as a Medical Student.

Introduction: Orthopaedic applicants have increased the average number of publications on their residency application to compete with the growing competitiveness of the field. The purpose of this study was to assess whether research productivity before orthopaedic residency and caliber of one's institution is correlated with academic productivity during residency. Methods: Scopus was used to extract publication metrics. Quantity and quality (how often the publications were cited) were analyzed at 2 different time periods: before and during residency. All subjects in the study had graduated an ACGME-accredited orthopaedic surgery residency in 2021. Military residents, international medical graduates, and residents not listed on their department's website were excluded. Residents were categorized as both high (≥2 publications) or low (<2 publications) publishers according to their pre-residency publications. They were also categorized based on their program's Jones et al. research productivity ranking. Results: For the 758 residents, the median number of publications was 0 (Interquartile Range [IQR]: 0-2) and 3 (IQR: 1-6) before and during residency, respectively. High publishing medical students had more publications during training than low publishers (6 [IQR: 3-14] and 2 [IQR: 1-4], p < 0.001). Residents at higher ranked programs also had more publications (4 [IQR: 2-9] and 2 [IQR: 0-4], p < 0.001). High publishing students now training at lower ranked institutions had more publications during residency than low publishers who trained at more productive institutions (4 [IQR: 1-9] and 3 [IQR: 1-6], p < 0.001). Conclusion: Having 2 or more publications before residency is correlated with an increased number of publications during residency. While attending a higher academically productive program is associated with increased resident publications, a high publishing medical student would be expected to have more publications during residency than a low publishing student, regardless of program rank. Notably, most matched applicants continue to have zero publications before matriculation.

Anatomical Structures at Risk in Percutaneous Preparation Talonavicular Fusion.

BACKGROUND: The stability of the hindfoot greatly relies on the integrity of the talonavicular joint. Pathologies affecting this joint often necessitate fusion. Our study explores the risks posed to neurovascular and tendon structures during simulated percutaneous talonavicular joint preparation for fusion. METHODS: In 9 fresh cadaver specimens, the talonavicular joint was accessed through two portals. A 2-mm Shannon burr was employed for joint surface preparation with distraction provided by a pin-based distractor. Dissections were performed to assess potential damage to critical structures, including the dorsalis pedis artery, superficial and deep peroneal nerves, extensor hallucis longus (EHL), and tibialis anterior (TA) tendons. RESULTS: The dorsal portal site was found to be significantly closer to important structures compared to the medial portal site. The Shannon burr made contact with various structures, with a single transection identified for both deep and superficial peroneal nerve branches. During the dorsal portal site approach, potential injury to the EHL tendon was identified as concern. CONCLUSION: This study sheds light on the potential risks associated with percutaneous dorsal and medial joint preparation approaches using a Shannon burr.Level of Evidence:Level V, mechanism-based reasoning..

The economic and clinical impact of fast- versus slow-setting cement in primary total knee arthroplasty.

INTRODUCTION: New bone cement products have been developed attempting to shorten their setting time and thus cut down time in the operating room. This study determines whether faster-setting bone cement shortens time in the operating room, and whether the quantity used compromises postoperative TKA outcomes. Additionally, this study looks at cost analyses of the quantity of bone cement used in TKA procedures. MATERIALS AND METHODS: One-hundred and sixty patients at a single institution with primary TKA surgeries between January 2019 and December 2021, and a clinic follow-up of at least one year, were identified. Five cement products used in this time period were identified and categorized by fast- or slow-setting products if their set times were marketed below or above six minutes, respectively. RESULTS: Estimated blood loss was higher in patients receiving fast-setting cements (160.0 vs 126.4 mL; p = 0.0009); however, operative time showed no difference between the cohorts (88.2 vs 89.2 min; p = 0.99). Fewer bags of cement were used for the fast cohort (1.3 vs 1.8 bags; p < 0.0001). The fast group was significantly cheaper on average per patient only when comparing between antibiotic bone cements (p = 0.007). No differences were found in postoperative outcomes between the two groups. CONCLUSIONS: No differences were found in operative times between the fast and slow cemented groups. Fewer bags of faster-setting cement only proved cost saving relative to other antibiotic bone cements studied. Nonetheless, decreased usage of fast cement did not result in any different postoperative outcomes compared to slow cements. LEVEL OF EVIDENCE: III.

Femoral stem taper geometry and porous coating in cementless direct anterior primary total hip arthroplasty.

Objective: This study aims to compare the clinical outcomes and complications between a fully coated, dual-tapered hip stem versus a proximally coated, triple-tapered hip stem in patients undergoing cementless direct anterior (DA) primary total hip arthroplasty (THA). Methods: A retrospective analysis was conducted on patients who underwent primary THA with either a fully coated, dual-tapered hip stem or a proximally coated, triple-tapered stem with at least a 1-year follow up. Exclusion criteria included any patients that did not receive either femoral stem, those undergoing bilateral THA, those with a surgical approach other than DA, those with an indication other than osteoarthritis, avascular necrosis (AVN), or femoral neck fracture, and those that had a cemented femoral component. Complications and clinical outcomes were assessed. Statistical analyses were conducted to identify significant differences between the groups. Results: A total of 95 patients were included in the study. The average ages for the dual-tapered and triple-tapered stem cohorts were 63.6 and 59.5, respectively (p = 0.168). At 1-year follow-up, no significant differences were seen between the groups in terms of ambulatory status, ROM, and patient satisfaction (p = 0.414, p = 0.106, and p = 0.126). 6 (18 %) of the patients receiving the dual-tapered, fully coated hip stem had at least one complication while 8 (13 %) of the triple-tapered, proximally coated hip stem patients did (p = 0.550). Conclusion: Both hip stem cohorts demonstrated comparable clinical outcomes and complication rates in patients undergoing primary DA THA and we believe that either hip stem may be a reasonable choice for patients. Future studies with larger sample sizes and longer follow-up periods are warranted to validate these findings.

Femoral Neck Fracture in the Setting of Plasmacytoma: A Case Report.

Solitary bone plasmacytoma (SBP) is a proliferation of monoclonal plasma cells found in a solitary osteolytic lesion. These osteolytic lesions can present as either bone pain or pathological fracture. We present this interesting case of a 63-year-old male that was found to have a plasmacytoma confined to the femoral neck following the presentation of a pathological fracture. After surgical resection and biopsy, we placed a distally fixating hemiarthroplasty. To our knowledge, there is only one other reported case of a pathological fracture of the femoral neck due to plasmacytoma.