Trends in the treatment of proximal humerus fractures from 2010 to 2020.

BACKGROUND: The incidence of proximal humerus fractures (PHF) is continuing to rise due to shifts towards a more aged population as well as advancements in surgical treatment options. The purpose of this study is to examine and compare trends in the treatment of PHFs (nonoperative vs. operative; different surgical treatments) across different age groups over the last decade (2010-2020). METHODS: The New York Statewide Planning and Research Cooperative System (SPARCS) database was queried using International Classification of Diseases and Current Procedural Terminology codes to identify all patients presenting with or undergoing surgery for PHF between 2010 and 2020. Treatment trends, demographics, and insurance information were analyzed during the study period. Comparisons were made between operative and nonoperative trends with respect to the number and type of surgeries performed among 3 age groups: ≤49 years, 50-64 years, and ≥65 years. The rate of postoperative complications and reoperations was evaluated and compared among different surgical treatments for patients with a minimum 1-year postoperative follow-up. RESULTS: A total of 92,308 patients with a mean age of 67.8 ± 16.8 years were included. Over the last decade, there was no significant increase in the percentage of PHFs treated with surgery. A total of 15,523 PHFs (16.82%) were treated operatively, and these patients, compared with the nonoperative cohort, were younger (64.9 years vs. 68.4 years, P < .001), more likely to be White (80.2% vs. 74.7%, P < .001), and more likely to have private insurance (41.4% vs. 32.0%, P < .001). For patients ≤49 years old, trends in operative treatment have remained stable with internal fixation (IF) as the most used surgical modality. For patients 50-64 years old, we observed a gradual decline in the use of hemiarthroplasty (HA), with a corresponding increase in the use of reverse total shoulder arthroplasty (rTSA), but IF continued to be the most used operative modality. In patients over 65 years, a steep decline in the use of IF and HA was noted during the first half of the decade along with a significant exponential increase in the use of rTSA, which surpassed the use of IF in 2019. Despite the increase in the use of rTSA, no differences in rate of surgical complications were noted between rTSA and IF (χ2 = 0.245, P = .621) or reoperations (χ2 = 0.112, P = .730). CONCLUSION: Nonsurgical treatment remains the mainstay treatment of PHFs. Although there is no increase in the prevalence of operative treatment in patients ≥50 years in the last decade, there is an exponential increase in the use of rTSA with a corresponding decrease in HA and IF, a trend more substantial in patients ≥65 years compared with patients between 50 and 64 years.

Is fantasy baseball score a viable outcome measure for professional baseball pitchers after undergoing Tommy John surgery?

Hypothesis and Background: Although on-field performance metrics are useful in measuring overall success of ulnar collateral ligament (UCL) reconstruction (UCLR) in professional baseball pitchers, they may not comprehensively quantify athletic performance after returning to playing in the league. To utilize fantasy baseball score (FBS) as a novel and objective outcome to assess the quality of return to play in major league baseball (MLB) pitchers who went back to professional pitching after UCLR. Methods: This is a retrospective observational cohort study of 216 established MLB pitchers who underwent UCLR while in the MLB between the years 1974 and 2018. Pitchers who either started in at least 45 games or pitched 90 relief games in the 3 years leading up to injury were included. FBS was calculated using 3 different scoring methods: ESPN (Entertainment and Sports Programming Network) (FBS-ESPN), Yahoo (FBS-Yahoo), and CBS (Columbia Broadcasting System) (FBS-CBS). Return to play, games played, innings pitched, earned runs, strikeouts, walks, hits allowed, hit batsman, and quality starts were also collected. Performance records were compiled for 3 years prior to and after the return to MLB. Players' pre-injury performance was used as a historic control group. Multivariate linear regression analysis was used to detect trends between seasons, controlling for year of surgery, and number of games. Results: The mean age of the cohort at the time of surgery was 30.0 ± 3.5 years. One hundred seventy-nine of 216 players (83%) returned to MLB play, taking an average of 16.6 ± 5.8 months. One hundred thirty-six of 179 (76%) remained in the league for 3 seasons. After adjusting for year of surgery, pitchers earned significantly fewer points for FBS-CBS (616.45 ± 332.42 vs. 389.12 ± 341.06; P < .001), FBS-Yahoo (801.90 ± 416.88 vs. 492.57 ± 428.40; P < .001), and FBS-ESPN (552.76 ± 275.77 vs. 344.19 ± 300.45; P < .001) after their injury. Also pitchers played in fewer games, pitched fewer innings, and had a decline in all measured on-field performance statistics. Conclusion: FBS may represent a useful outcome measure to objectively assess the quality of return to play in a professional baseball pitcher who returned to play in MLB after UCLR.

An Assessment of the State of Current Practice in Coagulation Laboratories.

OBJECTIVES: To assess the state of current practice in coagulation laboratories regarding three pressing issues: staffing, handling Ebola specimens, and testing/billing for tests that measure direct oral anticoagulants (DOAC). METHODS: A survey and analysis of specialized coagulation laboratories in North America was conducted. RESULTS: Approximately 4,000 special coagulation tests-per-technologist-per-year was rated as either a "good" staffing level or "adequate-but-ideally-need-more" employees. Requiring technologists to perform more than that was rated as an "inadequate" staffing level. For Ebola patients, coagulation testing is mostly performed by point-of-care. Only 26.1% would perform coagulation tests for Ebola specimens within their laboratory (rather than at the bed side or a separate designated space outside the laboratory). Coagulation tests offered for Ebola patients were limited: prothrombin time (63.0% of laboratories), activated partial thromboplastin time (37.0%), D-dimer (13.0%), and fibrinogen (8.7%); 26.1% of laboratories did not offer any coagulation tests for Ebola patients. Approximately 35% of special coagulation laboratories bill for at least one laboratory test for DOACs: 33% bill for an anti-Xa calibrated with rivaroxaban, 17% bill for an anti-Xa calibrated with apixaban, and 27% bill for at least one of several tests for dabigatran. Approximately 48% do not offer any tests for DOACs. CONCLUSIONS: These results may help laboratories negotiate for additional technologists if needed, prepare for Ebola specimens, and manage the demand for laboratory tests for new DOAC anticoagulants.