Preoperative Echocardiogram Does Not Contribute to Surgical Risk Assessment in Patients With Large Curve Scoliosis and No Cardiac Risk Factors.

OBJECTIVE: Severe scoliosis can affect thoracic organs, potentially leading to cardiovascular abnormalities. Thus, echocardiograms have been suggested for use in preoperative screening in patients with significant scoliosis. However, the utility of preoperative heart screenings in patients without known or suspected heart problems is not well understood. This study aims to find the incidence of cardiac findings in patients with severe scoliosis ≥90° without cardiac history. METHODS: A single-institution retrospective chart review was performed. Inclusion criteria were scoliosis patients with curves ≥90 degrees and a screening echocardiogram performed within 6 months of spine surgery. Patients with a previous cardiac history, diagnosis associated with cardiac comorbidities (eg, connective tissue disease), or major coronal curves <90 degrees were excluded. Echocardiogram reports and perioperative clinical notes from involved services (including orthopaedics, cardiology, and anesthesia) were reviewed. Any postoperative use of vasopressors and reasons for their use were recorded. RESULTS: Overall, 50 patients met the inclusion criteria. The mean age at surgery was 14.0 ± 4.9 years old (range: 2 to 33). The mean major curve was 108 ± 19 degrees (range: 90 to 160 degrees). A normal echocardiogram was seen in 38 (76%), whereas 6 patients (12%) had mild dilation of the aortic sinus or root, 4 (8%) had mild valvular regurgitation, 1 patient had a small atrial septal defect, and 1 had a trace pericardial effusion. No patient had any changes made to their perioperative plan and one patient was advised to see a cardiologist postoperatively. Postoperatively, 8 patients (16%) received vasopressors to raise blood pressure to meet preset goal MAP, but only one of these 8 had a positive echocardiogram (mild valvular insufficiency), which was not seen as a contributing factor to the use of pressors. CONCLUSIONS: This study suggests that screening echocardiograms for patients without a cardiac history or related symptoms does not contribute to the evaluation of perioperative risk or anesthetic management. Creating clear, evidence-based guidelines for the utilization of perioperative testing, like echocardiograms, can reduce the social, time, and financial burdens on families. Such guidelines are vital for appropriate risk assessment and proper utilization of health care resources. LEVEL OF EVIDENCE: Level III.

A Comparison of 2 Abbreviated Methods for Assessing Adolescent Bone Age: The Shorthand Bone Age Method and the SickKids/Columbia Method.

BACKGROUND: Radiographic assessment of bone age is critically important to decision-making on the type and timing of operative interventions in pediatric orthopaedics. The current widely accepted method for determining bone age is time and resource-intensive. This study sought to assess the reliability and accuracy of 2 abbreviated methods, the Shorthand Bone Age (SBA) and the SickKids/Columbia (SKC) methods, to the widely accepted Greulich and Pyle (GP) method. METHODS: Standard posteroanterior radiographs of the left hand of 125 adolescent males and 125 adolescent females were compiled, with bone ages determined by the GP method ranging from 9 to 16 years for males and 8 to 14 years for females. Blinded to the chronologic age and GP bone age of each child, the bone age for each radiograph was determined using the SBA and SKC methods by an orthopaedic surgery resident, 2 pediatric orthopaedic surgeons, and a musculoskeletal radiologist. Measurements were then repeated 2 weeks later after rerandomization of the radiographs. Intrarater and interrater reliability for the 2 abbreviated methods as well as the agreement between all 3 methods were calculated using weighted κ values. Mean absolute differences between methods were also calculated. RESULTS: Both bone age methods demonstrated substantial to almost perfect intrarater reliability, with a weighted κ ranging from 0.79 to 0.93 for the SBA method and from 0.82 to 0.96 for the SKC method. Interrater reliability was moderate to substantial (weighted κ: 0.55 to 0.84) for the SBA method and substantial to almost perfect (weighted κ: 0.67 to 0.92) for the SKC method. Agreement between the 3 methods was substantial for all raters and all comparisons. The mean absolute difference, been GP-derived and SBA-derived bone age, was 7.6±7.8 months, as compared with 8.8±7.4 months between GP-derived and SKC-derived bone ages. CONCLUSIONS: The SBA and SKC methods have comparable reliability, and both correlate well to the widely accepted GP methods and to each other. However, they have relatively large absolute differences when compared with the GP method. These methods offer simple, efficient, and affordable estimates for bone age determination, but at best provide an estimate to be used in the appropriate setting. LEVEL OF EVIDENCE: Diagnostic study-level III.

Mortality Rate Increase in Elderly Patients With Hip Fractures Presenting During the COVID-19 Pandemic to a Hospital in the United States Epicenter: Minimum 30-day Follow Up Comparative Study.

The purpose of this study was to compare mortality and complication rates among geriatric patients who sustained a hip fracture before the coronavirus disease (COVID-19) pandemic began to those who presented during the peak of the pandemic. Patients greater than or equal to 50 years of age who presented with a diagnosis of hip fracture from March 16, 2020 to May 1, 2020 were compared with a historical control group who presented between December 1, 2019 and January 16, 2020. Minimum follow up was 30 days. The primary outcome was a 30-day mortality rate. Thirty-day mortality was significantly different between groups, with no deaths of 24 patients in the pre-COVID-19 cohort versus six deaths of 23 patients (26.1%) in the COVID-19 cohort (chi-squared test, p-value = 0.02). The study concluded that the COVID-19 pandemic increased mortality risk for geriatric hip fracture patients. (Journal of Surgical Orthopaedic Advances 32(4):232-237, 2023).

Ring finger metacarpal fracture iatrogenic rotation using an ulnar gutter splint: A cadaveric study.

STUDY DESIGN: Cohort cadaveric study. INTRODUCTION: Ring finger metacarpal fractures are often treated with ulnar gutter orthoses incorporating the ring and small fingers. Iatrogenic pronation of the distal metacarpal fragment may occur from overzealous orthotic "molding", resulting in a crossover deformity of the ring finger over the small finger. PURPOSE OF THE STUDY: The goal of this cadaveric study is to determine whether including the middle finger in an ulnar gutter orthotic could lessen the chances of iatrogenic ring finger metacarpal fracture rotation. METHODS: Transverse ring finger metacarpal shaft fractures were created in 24 cadaver hands. The ring and small fingers were then placed into an intrinsic plus position, simulating the application of an ulnar gutter orthotic. Weights of 2.5, 5, and 10 pounds were applied to the ring and small fingers to simulate iatrogenic-induced fracture pronation. The amount of rotational displacement at the fracture was measured, and the protocol was repeated, including the middle finger in the intrinsic plus position. Mann-Whitney-Wilcoxon test was used for statistical analysis. RESULTS: There was an increase in distal fragment rotation with increasing weight. Fracture displacement was greater with the 2-finger position than the 3-finger at all weight levels; this reached statistical significance at 10 lbs (2.8 vs 1.8 mm). CONCLUSIONS: Application of an ulnar gutter orthotic including only ring and small fingers can rotate the distal fragment of a ring finger metacarpal shaft fracture such that overlap could occur with the small finger. Including the middle finger in ulnar gutter splints will mitigate against the rotation of the ring finger metacarpal shaft fracture.

Non-operative Management of Adult Both Bone Forearm Fractures - A Case Report and Literature Review.

INTRODUCTION: Adult both bone forearm fractures (BBFF) are common injuries that are typically treated with operative fixation given their instability. Non-displaced fractures can be theoretically treated non-operatively, but there is no literature demonstrating treatment outcomes of such fractures. CASE REPORT: We present a case of non-displaced BBFF in a 23-year-old Caucasian male adult who was treated with cast immobilization and concomitant ultrasound stimulator use; this patient went on to have solid fracture healing without complication. CONCLUSION: Based on this case, we demonstrate that non-operative management of non-displaced BBFF in adult patients is an option if close follow-up is available. This is significant for the fields of both orthopedic and plastic surgery, as there is little concrete evidence of outcomes of such non-displaced fractures in hand surgery literature.

A Systematic Review of the Orthopedic Literature Involving National Hockey League Players.

BACKGROUND: Orthopedic injuries of National Hockey League (NHL) players are common and may significantly affect players' health and careers. Evidence-based injury management is important in guiding players' timely return to sport and their ability to play at their pre-injury levels of competition. PURPOSE: To summarize all data published between January 1980 and March 2020 on orthopedic injuries experienced by professional ice hockey players competing in the NHL. STUDY DESIGN: Systematic review. METHODS: A literature review of studies examining orthopedic injuries in the NHL was performed using the Embase, PubMed, and CINAHL databases. The review included studies focusing on NHL players and players attending the NHL Combine and preseason NHL team camps. Studies pertaining to non-orthopedic injuries and case reports were excluded. RESULTS: A total of 39 articles met the inclusion criteria and were analyzed. The articles were divided by anatomic site of injury for further analysis: hip and pelvis (24%), general/other (14%), ankle (10%), knee (10%), foot (7%), shoulder (7%), thigh (7%), trunk (7%), spine (6%), elbow (4%), and hand and wrist (4%). The majority of articles were Level IV Evidence (51.3%), followed by Level III Evidence (38.5%). Most studies obtained data from publicly available internet resources (24.7%), player medical records (19.5%) or surveys of team physicians and athletic trainers (15.5%). A much smaller number of studies utilized the NHL Injury Surveillance System (NHLISS) (6.5%) or the Athlete Health Management System (AHMS) (2.6%). CONCLUSION: This systematic review provides NHL team physicians with a single source of the current literature regarding orthopedic injuries in NHL players. Most research was published on hip and pelvis (24%) injuries, did not utilize the NHLISS and consisted of Level IV Evidence.