IVC filter placement in patients undergoing surgical treatment of bone or soft-tissue tumors.

BACKGROUND AND OBJECTIVES: Patients with cancer to bone or soft tissues undergoing orthopedic procedures may be unable to receive pharmacologic prophylaxis for venous thromboembolism (VTE). Inferior vena cava (IVC) filters may be an effective method to prevent fatal pulmonary embolism (PE) in these patients. METHODS: Retrospective chart review performed for patients surgically treated for malignant disease of bone or soft tissue who had IVC filter placement. Type of surgery, anatomic region, and development of wound complications requiring repeat surgery were analyzed. RESULTS: From 2007 to 2018, 286 patients received IVC filters. Ten (3.5%) patients suffered deep vein thrombus (DVT) postoperatively. There was no acute fatal PE. Two patients suffered PE at 2 and 99 days postoperatively. Risk of DVT was comparable following surgery with endoprosthesis versus open reduction and internal fixation (p = 0.056) and with soft tissue versus bone involvement (p = 0.620). Three filter-related complications occurred. Patients disease at the femur had the highest rate of DVT. CONCLUSIONS: Following treatment of malignant disease of bone or soft-tissues, two patients with IVC filter placement experienced nonfatal PE and three patients experienced filter-related complications. No patients in this series experienced a fatal PE.

Non-spinal musculoskeletal malpractice suits against radiologists in the USA--rates, anatomic locations, and payments in a survey of 8,265 radiologists.

The objective of this study was to present the characteristics of non-spinal musculoskeletal malpractice suits with attention to rates, anatomic location, and payments in a survey of 8,265 radiologists. The malpractice histories of 8,265 radiologists from 36 states were evaluated from credentialing data required of all radiologists participating in the network of One Call Medical, Inc., a broker for imaging tests in workmen's compensation cases. Twenty six hundred of the 8,265 radiologists (31.5 %) had at least one suit. Of the 4,741 total claims, 627 (13.2 %) were related to the bones and soft tissues. Four hundred seventeen (66.1 %) of them involved the musculoskeletal system other than the spine. A cause was known for 400. Of these, 91.8 % (367/400) resulted from an alleged failure to diagnose. The foot was the most common site with a rate 6.00 cases/1,000 radiologist's person years (95 % confidence interval (CI), 4.68-7.68), and the hip was second with a rate of 5.30 cases/1,000 person years (95 % CI, 4.15-6.76). The highest median payment related to ankle injuries with a median settlement of $72,500 (interquartile range (IQR), $40,000-$161,250). The state in which the highest median settlement occurred was Maryland ($125,000; IQR, $95,000-$230,000)) whereas Utah had the highest rate of suits (5.24 cases per 1,000 person years; CI, 3.03-9.04). Claims regarding foot and hip injury were the most common, but ankle settlements incurred the highest awards.

Readability assessment of internet-based patient education materials related to uterine artery embolization.

PURPOSE: To determine the readability of Internet-based patient education materials (IPEMs) created by United States hospitals and universities and clinical practices and miscellaneous health care-associated Web sites regarding uterine artery embolization (UAE) as a marker for IPEMs in general. METHODS AND METHODS: Two hundred unique Web sites were evaluated for patient-related articles on UAE. Web sites produced by US hospitals and universities and clinical practices, as well as miscellaneous health care-associated Web sites meeting the Health on the Net Foundation Code of Conduct criteria were included in the database. By using mathematical regression algorithms based on word and sentence length to quantitatively analyze reading materials for language intricacy, readability of 40 UAE-related IPEMs was assessed with four indices: Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), Simple Measure of Gobbledygook (SMOG), and Gunning Frequency of Gobbledygook (GFOG). Scores were evaluated against national recommendations, and intergroup analysis was performed. RESULTS: None of the IPEMs were written at or below the sixth-grade reading level, based on FKGL. The mean readability scores were as follows: FRES, 43.98; FKGL, 10.76; SMOG, 13.63; and GFOG, 14.55. These scores indicate that the readability of UAE IPEMs is written at an advanced level, significantly above the recommended 6th grade reading level (P<.05) determined by the United States Department of Health and Human Services. CONCLUSIONS: IPEMs related to UAE generated by hospitals, clinical practices, and miscellaneous health care-associated Web sites are written above the recommended sixth grade level. IPEMs for other disease entities may also reflect similar results.

Spinal-related malpractice suits against radiologists in the USA-rates, anatomic location, percent of adverse judgments, and average payments.

To present overall rates, anatomic location, percent of adverse settlements to the radiologists, and average payments to the plaintiff in spinal-related malpractice suits in a survey of 8,265 radiologists. The malpractice histories of 8,265 radiologists from 36 states were evaluated from credentialing data required of all radiologists participating in the network of One Call Medical Incorporated, a broker for CT/MR in workmen's compensation cases. Two hundred twenty-six of the 8,265 radiologists (31.5 %) had at least one suit. Of the 4,741 total claims, 627 (13.2 %) were related to the bones and adjacent soft tissue. Two hundred and ten (32.9 %) involved the spine. Of these, 70.2 % (134/191) were settled in favor of the plaintiff. One hundred and sixteen (68.2 %) involved the cervical spine with an average settlement of $483,156. Lumbar cases accounted for 28 (16.5 %) of spinal suits, with an average settlement of $119,272. Thoracic cases (26) accounted for only 15.3 % of spinal cases and had an average settlement of $481,608. An allegation of spinal malpractice resulting in a settlement or judgment against the radiologist occurred at a rate of 29.5 cases per 1,000 radiologists' person years. Of the three spinal regions, the cervical spine was the most frequent anatomic site of a malpractice suit and among all those cases settled incurred the highest payment in judgment to the plaintiff.

Statin-related muscle complications masquerading as soft tissue sarcomas.

Musculoskeletal injuries are a known side effect of long-term statin use. These injuries include sudden, atraumatic muscle rupture which can cause extremity hematomas that motivate patients to seek evaluation and physicians to send referrals for oncologic workup. We discuss two cases where malignancy was suspected rather than statin-induced muscle injury. Using these cases as examples, we discuss subtleties between the two diagnoses so that muscle rupture may be considered prior to subspecialist referral. This paper aims to serve as a reminder and guide for physicians who encounter long-term statin users with nonspecific, improving musculoskeletal symptoms and hemorrhagic MRI findings that lack nodular or mass-like enhancements. While referral to orthopedic oncology is always encouraged in cases of uncertainty, it may not always be necessary.

Cemented-augmented fixation of metastatic humeral lesions without segmental bone loss results in reliable outcomes.

Background: Treatment of metastatic lesions to the humerus is dependent on patient's pain, lesion size and location, and post-operative functional goals. Surgical options include plate or nail fixation [open reduction internal fixation (ORIF)], or endoprosthetic replacement (EPR), with cement augmentation. The objective of this study was to perform a single institution retrospective analysis of outcomes by method of reconstruction, tumor volume, and pathologic diagnosis. Methods: The records of 229 consecutive patients treated surgically for appendicular metastatic disease from 2005-2018 at our musculoskeletal oncology center were retrospectively reviewed following institutional review board (IRB) approval. Indications for surgical treatment at the humerus included patients who presented with impending and displaced pathologic fractures. Results: Sixty patients (34 male, 26 female) with a mean age of 62.9±12.2 were identified who were treated surgically at the proximal (n=21), diaphyseal (n=29), or distal (n=10) humerus. Forty-nine (82%) patients presented with displaced pathologic fractures. The remaining eleven patients had a mean Mirels score of 9.5. There was no difference in overall complication rate between EPR or ORIF [4/36 (11%) versus 2/24 (8%); P=0.725]. Mean Musculoskeletal Tumor Society (MSTS) scores were 83% for both EPR and ORIF, with no differences in subgroup analyses at the proximal, diaphyseal, or distal humerus. Patients with cortical destruction on anterior posterior (AP) and lateral imaging were at increased risk for mechanical failure [2/6 (33%) versus 0/18 (0%), P=0.015]. Conclusions: In conclusion, when pathologic pattern permits, cement-augmented fixation allows for stabilization of pathologic bone, while minimizing risk of soft-tissue detachment, while EPR resulted in similar outcomes in patients with more extensive bone destruction. Increased tumor volume was associated with lower MSTS scores.

Modified Rotationplasty as a Composite Free Flap for Femur and Thigh Reconstruction.

Knee rotationplasty is a suitable reconstructive and limb salvage procedure for infected femur and knee prostheses. It involves external rotation of the lower limb with an intact neurovascular bundle to function as a knee joint. Functionally, it has better outcomes when compared to alternate options like above knee amputation. It results in better cortical reorganization and superior stance mechanics, enabling a more efficient gait and better quality of life. Here we report a 57-yr-old male who underwent modified rotationplasty for an infected knee endoprosthesis as a composite lower leg free flap.

Evaluation of Intra-articular Fracture Extension After Gunshot Wounds to the Lower Extremity: Plain Radiographs Versus Computer Tomography.

OBJECTIVE: This study was to compare the use of computer tomography with plain radiographs for the evaluation of intra-articular extension of long bone fractures in the lower extremity after low-energy gunshot wounds. DESIGN: Retrospective chart and radiographic review. SETTING: Level 1 Trauma Center. PATIENTS/PARTICIPANTS: Data were collected from a single institution from 2000 to 2014. Inclusion criteria consisted of patients greater than 17 years of age, low-velocity gunshot injuries causing fracture of the femur or tibia, plain radiographs with adequate films, and computed tomography (CT) imaging of the fracture. This consisted of 133 patients with 140 fractures. INTERVENTION: Intra-articular fracture extension was evaluated on initial plain radiographs and CTs. MAIN OUTCOME MEASURES: Comparison of "gold standard" CT with all reviewers' evaluation of plain radiographs. RESULTS: There were 140 total fractures; 108 were femoral fractures and 32 were tibial fractures. By comparing plain radiographs with the gold standard CT, the reviewers demonstrated correct diagnosis in 85% of intra-articular fractures and 96% of non-intra-articular fractures. In addition, the reviewers accurately diagnosed 70.8% of intra-articular extensions in the diaphysis and 70.5% in the metaphysis. The sensitivity and specificity for plain radiographs were 85.3% and 96.0%, respectively, for all locations. Metaphyseal and diaphyseal fractures demonstrated the poorest sensitivity at 80.7% and 82.1%, respectively. CONCLUSIONS: Low-energy gunshot wounds with fractures in the diaphyseal of the distal femur and all metaphyseal fractures warrant CT evaluation to better examine for intra-articular fracture extension. LEVEL OF EVIDENCE: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Analysis of the Sherlock II tip location system for inserting peripherally inserted central venous catheters.

Peripherally inserted central catheters (PICCs) are frequently placed at the bedside. The purpose of our study was to evaluate the efficacy of the Sherlock II tip location system (Bard Access Systems, Salt Lake City, UT), which offers electromagnetic detection of the PICC tip to assist the operator in guiding the tip to a desired location. We performed a retrospective review of patients who had a bedside PICC using the Sherlock II tip location system. Three hundred seventy-five of 384 patients (97.7%) had the catheter tip positioned appropriately. Our results suggest that the Sherlock II tip location system is an efficacious system for bedside PICC placement.

Malpractice suits in chest radiology: an evaluation of the histories of 8265 radiologists.

PURPOSE: The aim of this study was to present rates of claims, causes of error, percentage of cases resulting in a judgment, and average payments made by radiologists in chest-related malpractice cases in a survey of 8265 radiologists. MATERIALS AND METHODS: The malpractice histories of 8265 radiologists were evaluated from the credentialing files of One-Call Medical Inc., a preferred provider organization for computed tomography/magnetic resonance imaging in workers' compensation cases. RESULTS: Of the 8265 radiologists, 2680 (32.4%) had at least 1 malpractice suit. Of those who were sued, the rate of claims was 55.1 per 1000 person years. The rate of thorax-related suits was 6.6 claims per 1000 radiology practice years (95% confidence interval, 6.0-7.2). There were 496 suits encompassing 48 different causes. Errors in diagnosis comprised 78.0% of the causes. Failure to diagnose lung cancer was by far the most frequent diagnostic error, representing 211 cases or 42.5%. Of the 496 cases, an outcome was known in 417. Sixty-one percent of these were settled in favor of the plaintiff, with a mean payment of $277,230 (95% confidence interval, 226,967-338,614). CONCLUSIONS: Errors in diagnosis, and among them failure to diagnose lung cancer, were by far the most common reasons for initiating a malpractice suit against radiologists related to the thorax and its contents.