Cannabis Use in Patients With Distal Radius Fractures: A Moment of Unity?

BACKGROUND: As legalization of cannabis spreads, an increasing number of patients who use cannabis are being seen in the clinical setting. This study examined the impact of cannabis and tobacco use on postoperative complications following open reduction and internal fixation (ORIF) of distal radius fractures. METHODS: A national, all-payer database was queried to identify patients who underwent ORIF of a distal radius fracture between 2015 and 2020 (n = 970 747). Patients were stratified into the following groups: (1) tobacco use (n = 86 941), (2) cannabis use (n = 898), (3) tobacco and cannabis use (n = 9842), and (4) neither tobacco nor cannabis use ("control", 747 892). Multivariable logistic regression was used to identify risk factors for infection, nonunion, and malunion within the first postoperative year. RESULTS: Concomitant use of tobacco and cannabis was associated with a higher rate of nonunion (5.0%) compared to tobacco or cannabis use alone (P < .001). Multivariate analysis identified cannabis-only use (odds ratio [OR] 1.25), tobacco-only use (OR 2.17), and concurrent tobacco and cannabis use (OR 1.78) as risk factors for infection within the first postoperative year. Similarly, cannabis-only use (OR 1.47), tobacco-only use (OR 1.92), and concurrent tobacco and cannabis use (OR 2.52) were associated with an increased risk of malunion. CONCLUSIONS: Cannabis use is associated with an elevated risk of infection and malunion following operative management of a distal radius fracture. Concomitant use of cannabis and tobacco poses an elevated risk of nonunion and malunion compared to tobacco use alone.

Robust Randomized Controlled Data Is Lacking in Total Joint Arthroplasty.

INTRODUCTION: Randomized controlled trials (RCTs)are regarded as highest level of scientific evidence. There is belief that while prospective randomized control trials (PRCTs) are the gold standard for evaluating efficacy of interventions, there are very few conducted on lower extremity joint arthroplasty. However, there was a more than adequate amount (n=197) of published RCTs in knee arthroplasty during the 2021 calendar year. Therefore, we studied RCTs on knee arthroplasties for 2021 and assessed them for overall study topic reasons (i.e., devices as well as prostheses, rehabilitation, pain control, blood loss [tranexamic acid], and other), which were then subcategorized by: (1) country of origin; (2) sample size; and (3)whether or not they were follow-up studies. After this, we specifically focused on the studies (n=26) concerning devices or prostheses. METHODS: A search of PubMed on "knee arthroplasty" specifying "RCT" using their search function and dates between January 1, 2021 to December 24, 2021 resulted in the analyzed reports. A total of 17.3% reports analyzed rehabilitation methods while 28.4% studied pain control. A total of 20.3% examined blood loss topics and 20.8% investigated other topics. RESULTS: We found that 26 studies (13.2%) involved prosthetic design and implantation. Overall, only 15% knee arthroplasty RCTs were conducted in the United States, the mean total final sample size was 133±146 patients, and 7% were follow-up studies. None of the prostheses studies were performed in the United States, and the mean total final sample size of all of these studies was 86±54 patients, and 23% were follow-up studies. Total knee arthroplasty prospective RCTs were not performed in the United States. CONCLUSION: The authors believe that other study designs, such as database or registry analyses, are also appropriate in this rapidly advancing field of joint arthroplasty for the continuing evaluation and approval of new prostheses and techniques, while we await more PRCTs in our field.

CT Scan-Based Robotic-Arm Assisted Total Hip Arthroplasty: What Do Today's Highest-Quality Studies Tell Us?

INTRODUCTION: Total hip arthroplasty (THA) aims to restore function and reduce pain for patients suffering from hip pathologies. However, some procedures require revision THA, with the most common reasons including: mechanical failure, aseptic loosening, infection, and component malposition leading to dislocations. Computed tomography (CT) scan-based, three-dimensional imaging operating techniques can help address some of these issues by helping to provide more optimal implant positioning, which can potentially confer improved outcomes. To date, only a few studies have evaluated the utilization of CT scan-based robotic-arm assisted THA in total hip arthroplasty, and those that do are not necessarily of the high-methodological quality. Therefore, the purpose of this review was to select the most recent and good- to high-quality studies focusing on robotic-assisted THA, to help provide a more comprehensive representation of postoperative outcomes. Specifically, we evaluated each study independently as well as performed a cumulative assessment of this most recent high-quality data. MATERIALS AND METHODS: An extensive, cross-platform search of total hip arthroplasty on August 1, 2022 was performed. Studies were included only if they addressed robotic-assisted THA in comparison to manual techniques. Additional inclusion criteria consisted of studies scoring excellent (100 to 85 points) or good (84 to 70 points) based on their Coleman methodology score. Studies were evaluated as individual pieces of work, as well as a cumulative assessment. Specific outcomes evaluated were: component placement in safe zones, leg- length discrepancies, dislocation rates, clinical outcomes, patient clinical scores, patient-reported outcome measures (PROMS), lengths of stay, and costs. RESULTS: Overall, 24 studies were included for analyses. CT scan-based robotic-arm assisted THA had some potential key advantages as compared to manual techniques. Specifically, robotic-assisted THA was associated with more accurate component placement in safe zones, fewer chances of leg-length discrepancies, and lower risks of dislocation. Patient satisfaction and reported outcome measures were superior for CT scan-based robotic-arm assisted THA. Costs were also lower. Overall, 23 of 24 studies were positive for this technology, with one study of cases done between 2010 and 2014 more neutral. The robot led to positive findings for component placement in safe zones, leg-length discrepancies, dislocation rates, clinical outcomes, PROMS, lengths of stay, and costs. CONCLUSION: The current literature suggests potential advantages for CT scan-based robotic-arm assisted THA compared to manual THA. Surgeons should consider CT scan-based robotic-arm assisted THA for their patients given the multiple added benefits of improved clinical scores and PROMS, less dislocations (with a few exceptions reported), more component placements in safe zones, less leg-length discrepancies, decreased lengths of stay, and decreased episode-of-care costs.

The effects of language preference and home resources on foundational literacy retention during school holiday closures in Ghana: Lessons from the Complementary Basic Education Programme.

This article assesses the extent to which children's language preference and their home environment matter for literacy retention. Using data from the Complementary Basic Education (CBE) program in Ghana, the authors found that large numbers of disadvantaged students reverted to not even being able to read a single word following school closures over a four-month holiday period. Widening literacy gaps were found for girls who reported they did not receive instruction in a language that they understood or did not have the resources, support, or activities at home to enable them to continue to learn while schools were closed. For boys, widening literacy gaps were only influenced by resources, support, or activities at home, but not by language preferences. The article findings suggest that schools and teachers must pay closer attention to language preference, particularly for girls, in order to ensure that language of instruction is not a barrier to literacy retention. The article also provides further evidence to support the growing claims that home supports are essential for reducing inequities in learning outcomes during school closures.

Using educational transitions to estimate learning loss due to COVID-19 school closures: The case of Complementary Basic Education in Ghana.

Learning loss is expected for millions of children who have been out of school as a result of the current COVID-19 pandemic. Unfortunately, it is uncertain how much learning will be lost and how wide the gaps may be for disadvantaged children. This paper uses a unique longitudinal dataset to estimate learning loss during a three-month transition from Complementary Basic Education to government schools in Ghana. Our results show an average learning loss of 66 % of previous learning gains in foundational numeracy during this transition period. More importantly, we estimate widening gaps in learning loss according to lack of home learning support, as well as lack of home learning resources. Our results have implications for the provision of learning activities and support at home, not just during current school closures due to COVID-19, but also during transitions between academic years.