Vascular Safe Zone During Percutaneous Pinning of the Distal Femur.

PURPOSE: During percutaneous pinning of the pediatric distal femur, iatrogenic vascular damage in the medial thigh is a frequent concern. The proximity of a proximal-medial pin to these vessels has never been studied in children. This study describes a radiologic vascular safe zone that is easily visualized during surgery (wherein the superficial femoral vessels are safely posterior). METHODS: Patients ≤16 years old with magnetic resonance imaging of one or both femora between 2005 and 2020 were retrospectively reviewed. The "at-risk level" (ARL) was defined as the distal-most axial image with a femoral vessel anterior to the posterior condylar axis. A standardized retrograde lateral-to-medial pin was templated. A correlation matrix and least squares regression identified age and physeal width (PW) as ideal independent variables. A vascular safe zone above the medial femoral condyle (MFC) was modeled as a multiple of PW (i.e. x*PW) and needed to satisfy 3 age-dependent criteria: (1) at the ARL, the pin is medial to the vessels, (2) the pin exits the medial thigh before the ARL, and (3) the chosen "vascular safe zone" (x*PW) is always distal to the ARL. RESULTS: Forty-three patients averaging 7.1±3.9 (0.3-16) years old were included. Intra-Class correlation coefficients were excellent (0.92-0.98). All measurements strongly correlated with age ( r =0.76-0.92, P <0.001) and PW ( r =0.82-0.93, P <0.001). All patients satisfied criteria 1. Criteria 2 was satisfied in all patients ≥6 years old, 86% of children 4-5, and only 18% of children ≤3. In children >3 years old, the largest safe zone that satisfied criteria 3 was 2×PW. On average, the ARL was 2.5×PW (99% CI 2.3-2.7) above the MFC. The average ARL in children ≥6 years old was significantly higher than 2×PW (162 mm vs. 120 mm, P <0.001). CONCLUSION: During passage of a distal femur pin into the medial thigh, children ≥6 years old have a vascular safe zone that extends 2×PW proximal to the MFC. Surgeons should be cautious with medial pin placement in children 4-5 years old and, if possible, avoid this technique in children ≤3. LEVEL OF EVIDENCE: IV.

The effect of preoperative education on opioid consumption in patients undergoing arthroscopic rotator cuff repair: a prospective, randomized clinical trial-2-year follow-up.

BACKGROUND: With the recent opioid epidemic in the United States, measures by both government and medical providers are being taken to decrease the opioid dependence rate. Different methods have been proposed, including patient education and multimodal pain therapies. The purpose of this study was to determine whether preoperative opioid education reduces the risk of opioid dependence at 2 years following arthroscopic rotator cuff repair (ARCR). METHODS: This study was a 2-year follow-up of the 2018 Neer Award study that demonstrated the use of preoperative opioid education as a means to reduce postoperative opioid consumption after ARCR at 3-month follow-up. This was a prospective, single-center, single-blinded, parallel-group, 2-arm, randomized clinical trial with a 1:1 allocation ratio. To study the effect of preoperative opioid education on opioid dependence at 2 years, we randomized patients into 2 cohorts, a study cohort and a control cohort. Data were obtained with a review of prescription data-monitoring software and a patient telephone interview. RESULTS: Opioid education (P = .03; odds ratio, 0.37; 95% confidence interval, 0.14-0.90) was found to be an independent factor that is protective against opioid dependence. Study patients had a lower rate of opioid dependence (11.4%, 8 of 50) than control patients (25.7%, 18 of 50) (P = .05). Significantly fewer prescriptions were filled by study patients (mean, 2.9) than by control patients (mean, 6.3) (P = .03). Additionally, fewer pills were consumed by study patients (median, 60; interquartile range [IQR], 30, 132) than by control patients (median, 120; IQR, 30, 340) (P = .10). Finally, fewer morphine milligram equivalents were consumed by study patients (median, 375; IQR, 199, 1496) than by control patients (median, 725; IQR, 150, 2190) (P = .27). CONCLUSION: Our study found that patients who were preoperatively educated on opioid use were less likely to become opioid dependent at 2-year follow-up. Therefore, we demonstrated that opioid education does impart significant long-term benefits to patients undergoing ARCR.

Trends in Anterior Cruciate Ligament Injury and Recovery in Professional Snowboarders: The Extreme Sport of Snowboardcross.

Introduction  An anterior cruciate ligament (ACL) tear is a devastating injury for athletes that is predominantly low energy and non-contact in nature. ACL tears are one of the most well-researched injuries in sports, however, scant research has been done on competitive snowboarders. Boardercross is a relatively new sport introduced to the Winter Olympics in 2006. Initially, it entailed four snowboarders racing head-to-head down a course of obstacles in a race to the finish, with the top two riders advancing to the next rounds. It has since expanded to six racers traveling up to 60 mph and jumps up to 100 feet in length in a head-to-head race to the finish. This extreme sport puts its athletes at risk for serious injury, requiring investigation. Purpose Investigate the prevalence of ACL tears in the extreme sport of boardercross, evaluate sport-specific factors that may put athletes at higher risk, and report return to sport data. Methods An expedited IRB approval was obtained. A survey was distributed to athletes via e-mail to national/regional coaches of countries with competitive boardercross teams. Professional coaches distributed the survey and secondarily distributed it to athletes. Results Sixty-six competitive snowboardcross athletes responded to the email surveys 48.5% of respondents had torn their ACL at least once in their career. Of the female respondents, 55.6% suffered at least one ACL tear, and 43.6% of male respondents suffered at least one ACL tear. 31.2% suffered more than one ACL tear during their career. Of those who tore their ACL, 91.3% (p <0.001) tore their front leg. 100.0% of the respondent athletes returned to sport post-ACL reconstruction. Conclusion Professional boardercross racers are at a higher risk of tearing their ACL than other winter sport athletes, including alpine skiers. A predominance of ACL injuries occurred on the front leg during landing from an aerial maneuver. All respondent athletes returned to the sport after injury, with approximately half returning within six months. Although no statistical significance was achieved, the data provided trends on risk factors related to ACL injuries among snowboardcross athletes.

Women doctors' purses as an unrecognized fomite.

OBJECTIVE: Health care associated infections are serious problems for today's medical community. It is generally assumed that health care workers come in contact with pathologic bacteria and unwittingly transfer them to patients either directly with their hands, or indirectly through some inanimate object. If a doctor washes his or her hands before seeing a patient and then touches a colonized object, the benefit of hand washing may have been undone. Previous studies have identified stethoscopes, neck ties, mobile phones, keyboards, lab coats, and other commonly worn accessories as potential sources of disease transmission contributing to health care associated infections. Women doctors' purses have not previously been studied as a potential source of disease transmission. This study evaluated whether doctors' purses served as a potential source of disease transmission. METHODS: We performed a case-control study to determine if women doctors' purses were colonized more frequently than controls. Purses were obtained from women doctors who visit a hospital as part of their clinical responsibilities in the experimental group. Thirteen doctors fit the criteria of visiting an acute care facility while bringing a purse with them. Fourteen controls were non-health care women who had not visited a hospital in the past six months. RESULTS: We observed that nine of 13 doctors' purses were colonized with bacteria compared with two of 14 controls. CONCLUSIONS: This statistically significant finding demonstrates that there is a potential for a doctor's purse to serve as a vector for disease transmission. It is prudent for women health care workers to be aware that their purses may be a source of bacterial contamination. We, therefore, recommend that women practitioners use appropriate infection control measures whenever their purses are in the health care environment.