Surgical Complications Associated With Atypical Femur Fractures Attributed to Bisphosphonate Use.

Complications of atypical femur fractures (AFFs) are common. AFFs often receive the same treatment as other femoral fractures; however, there appears to be a higher rate of adverse outcomes. Nine patients sustained a total of 13 AFFs, had documented bisphosphonate use before fracture, and had surgery between 2006 and 2012. Complications included continued pain, surgical revision, nonunion, malunion, deformity, or heterotopic ossification. The overall complication rate was 33.3%, with four of the 12 surgeries performed at this institution resulting in one nonunion and three minor complications. None of the primary fixations required revision. There was a higher complication rate for AFFs when compared with non-bisphosphonate-related intramedullary nail femur fracture fixations. This cohort demonstrated a lower rate of major complications compared to the literature. Using a reamed, statically locked nail, halting bisphosphonate medication, and allowing early weight bearing is a safe and efficacious method to treat atypical femur fractures. (Journal of Surgical Orthopaedic Advances 27(1):14-20, 2018).

More challenges since Wikipedia: the effects of exposure to internet information about the Rorschach on selected comprehensive system variables.

To determine the effects of reading the Wikipedia article on the Rorschach on Comprehensive System variables, participants in this study (recruited from parent-teacher associations, online message boards, and graduate schools; N = 50) were provided with either a copy of the Wikipedia article on the Rorschach (from April 2010) or an irrelevant article, then administered the Rorschach and instructed to "fake good." Monetary incentives were used to increase motivation to dissimulate. Initial results indicated that participants given the Wikipedia article produced a lower number of responses (R) and had higher scores on Populars, X+%, XA%, and WDA% as compared to controls. However, post-hoc analyses revealed that when the influence of Populars was controlled, significant differences for X+%, XA%, and WDA% disappeared. No significant differences were found for Form%, Zf, Blends, or PER, although post-hoc analyses controlling for differences in R revealed a significant difference between groups on Zf%. Limitations of the study and implications for clinical and forensic practice are discussed.

Challenges since Wikipedia: the availability of Rorschach information online and internet users' reactions to online media coverage of the Rorschach-Wikipedia debate.

We conducted 2 studies to assess the availability of Rorschach information online and Internet users' attitudes since the inkblots were published on Wikipedia. In the first study, the authors conducted 2 Google searches for Web sites containing Rorschach-related information. The top 88 results were classified by level of threat to test security; 19% posed a direct threat. The authors also found Web sites authored by psychologists that divulged sensitive Rorschach information. In the second study, 588 comments to online news stories covering the Rorschach-Wikipedia debate were coded as expressing favorable or unfavorable opinions regarding the field of psychology, psychologists, and the Rorschach. Eight percent of comments described unfavorable opinions toward psychology, 15% contained unfavorable opinions toward psychologists, and 35% portrayed unfavorable opinions of the Rorschach. Common themes and popular misconceptions of the Rorschach contained in these comments are described. Implications and recommendations for practice are discussed. Limitations, including the second study's narrow sample and self-selection bias, are also detailed.

A Prospective Evaluation of Intraoperative Indocyanine Green Fluorescence Angiography for Soft Tissue Sarcomas.

INTRODUCTION: Postoperative wound complications after resection of soft-tissue sarcomas are challenging. Indocyanine green (ICG) angiography has previously been used to predict wound complications, but not for soft-tissue sarcomas. We aimed to evaluate whether this technology could help lower wound complications after soft-tissue sarcoma resections. MATERIALS AND METHODS: We conducted a prospective study from 10/2017 to 9/2019 using ICG angiography during sarcoma resection surgery. Rates of wound complications were compared with a historical control consisting of surgeries before utilization of ICG angiography. RESULTS: A total of 88 patients were included in the study. We found significantly lower rates of infection (11.8% versus 38%; P = 0.03) and wound dehiscence (11.8% versus 42.3%; P = 0.02) in the ICG angiography cohort compared with the historical controls. CONCLUSION: ICG angiography use during soft-tissue sarcoma resections is promising technology and warrants further investigation to help reduce postoperative complications.

Intraoperative Indocyanine Green Fluorescence Angiography Is Sensitive for Predicting Postoperative Wound Complications in Soft-Tissue Sarcoma Surgery.

INTRODUCTION: Indocyanine green (ICG) angiography is a novel technology that has been predictive of postoperative wound complications. It is unknown whether this technology can successfully predict complications after sarcoma resection. In this study, we aimed to evaluate the sensitivity and specificity of ICG angiography in predicting postoperative wound complications after soft-tissue sarcoma resection. METHODS: A prospective cohort study of 23 patients was performed beginning October 2017 at our institution. Patients who underwent soft-tissue sarcoma resection were included. After tumor resection and wound closure, evaluation of tissue perfusion in skin edges was performed with ICG angiography. Wound complications were recorded in the postoperative follow-up. RESULTS: Eight patients developed postoperative wound complications. Six patients were predicted to have wound complications on the final ICG scans. The accuracy of ICG angiography was dependent on the anatomic location, with improved accuracy in the lower extremity. ICG angiography had a sensitivity of 50%, a specificity and a positive predictive value of 100%, and a negative predictive value of 70% for wound complications after soft-tissue sarcoma resections located in the lower extremity. CONCLUSION: ICG angiography has a high predictive value in the lower extremity for postoperative wound complications. LEVEL OF EVIDENCE: Level III, Diagnostic.

Midterm Outcomes of Ultrasound-guided Local Treatment for Infrapatellar Saphenous Neuroma Following Total Knee Arthroplasty.

BACKGROUND:  While total knee arthroplasty (TKA) is a reliable treatment for advanced knee arthritis, up to 19% of patients after TKA remain dissatisfied, especially with residual pain. A less known source of medial knee pain following TKA is infrapatellar saphenous neuroma. Ultrasound-guided local treatment with hydrodissection and corticosteroid injection is an effective short-term solution. Our primary aim was to evaluate the durability of local treatment by comparing numeric pain scores for medial knee pain after TKA at pretreatment, one month following treatment, and midterm follow-up. A secondary aim was to identify associations of patient characteristics with degree of change in numeric pain score.  Methods: Retrospective chart review was performed to identify patients who had symptomatic infrapatellar saphenous neuroma following TKA and were treated with ultrasound-guided local treatment by hydrodissection and corticosteroid injection between January 1, 2012, and January 1, 2016. Those with follow-up less than three years were excluded. Patients who were unable to return for midterm follow-up were called. Numeric pain scores for the medial knee were recorded. Patient demographics, medical history, revision TKA status, number of prior knee surgeries, narcotic use, psychiatric disorders, and current tobacco use were also collected. RESULTS: Of 32 identified patients, 29 (7 men, 22 women, median age 65.9 years) elected to participate in this study with a mean (SD) follow-up of 4.6 (0.8) years. The median (range) pretreatment pain score was 9 (5-10). After local treatment, the median (range) numeric pain score was significantly lower at both one-month and midterm follow-up (5; P<0.001). The initial response to treatment was durable given that the difference between one-month and midterm follow-up scores was not significant (P=0.47). Advanced age was associated with less overall pain relief from pretreatment to midterm follow-up, while female sex, history of fibromyalgia, and TKA revision prior to treatment were associated with worsening pain from one-month to midterm follow-up (P<0.05).  Conclusions: Patients who underwent ultrasound-guided local treatment with hydrodissection and corticosteroid injection for painful postoperative infrapatellar saphenous neuroma following TKA experienced significant numeric pain score reduction. Pain relief remained consistent from 1onemonth to midterm follow-up.  Level of Evidence: Level IV, Case Series.