Fibula-Only Fixation for a Very Distal Tibia-Fibula Fracture: A Case Report.

A 70-year-old patient with multiple medical problems presented to us with displaced closed very distal tibia and fibula fractures and a prior total knee replacement on the affected extremity. We treated the patient with an isolated fibula open reduction and internal fixation. At a 1-year follow-up, both the tibial and fibular fractures had healed, and the patient had an excellent outcome. "Fibula-only" fixation of very distal tibia-fibula fractures appears to be a viable option to manage these difficult fractures. The novelty of the case report lies in that this technique has not been described previously in the literature.

Postoperative Radiographic Evaluation Following Adult Spine Deformity Correction: The Impact on Subsequent Management and Associated Risk of Radiation Exposure.

BACKGROUND: During the follow-up visits after Adult Spine Deformity (ASD) surgery, obtaining surveillance radiographs is a usual practice, and this study tried to identify evidence to support or refute such practice. METHODS: This is a retrospective, diagnostic case series (Level IV) of 49 patients. We identified the abnormal radiographic findings and their association with need for revision surgery. We determined the odds of obtaining an abnormal radiographs that lead to revision surgery at each of the given time intervals of follow-up. We also estimated the risk versus benefit of obtaining radiographs at each of the given time intervals of follow-up. RESULTS: We identified a total of 11 individual types of abnormal postoperative radiographic findings. Of them, the two radiographic findings that always needed revision surgery because of the associated clinical presentation were pedicle screw pullout and bilateral rod fracture. One abnormal radiographic finding that was never associated with revision surgery was the halo around a pedicle screw. In each of the given postoperative time intervals of follow-up at which the routine radiographs were obtained, we noted that the odds of noticing abnormal radiographic finding that lead to revision surgery was always >1. We found that the cumulative hazard rate for exposure to radiation was significantly higher during the initial follow-up visits when compared to subsequent follow-up visits. CONCLUSION: This study finds evidence to support the practice of routine postoperative radiographic evaluation of patients who come for follow-up after ASD surgery.

Inadvertent Perioperative Hypothermia During Orthopedic Surgery.

Inadvertent perioperative hypothermia is a significant problem in patients undergoing either emergency or elective orthopedic surgery, and is associated with increased morbidity and mortality. Though in general the incidence of inadvertent perioperative hypothermia in postoperative recovery rooms has been decreasing over the last 2 decades, it still remains a significant risk in certain specialty practices, such as orthopedic surgery. This review article summarizes the currently available evidence on the incidence, risk factors, and complications of inadvertent perioperative hypothermia. Also, the effective preventive strategies in dealing with inadvertent perioperative hypothermia are reviewed and essential clinical guidelines to be followed are summarized.

Bridging multimodal pain management provides 48-hour pain control in patients undergoing total shoulder replacement.

BACKGROUND: We report our experience with a bridging multimodal pain management program that provides comprehensive 48-hour pain control in patients undergoing total shoulder replacement (TSR). METHODS: The study included all patients undergoing unilateral TSR by 1 surgeon between May 2015 and April 2017. There were 62 patients (23 men, 39 women) with an average age of 68 years (range 38-92 years). Of these, 31 underwent standard nonconstrained TSR and 31 underwent reverse TSR. The bridging multimodal pain management protocol included scalene block regional anesthesia using 0.25% bupivacaine enhanced with 4 mg of dexamethasone, application of 20 mg of liposomal bupivacaine diluted with 40 mL of normal saline in the periarticular soft tissues at time of closure, scheduled 24 hours of intravenous acetaminophen and ketorolac, and immediate cryotherapy. Parameters measured included hospital length of stay, postoperative use of intravenous narcotics, and 30-day hospital readmission. RESULTS: The median length of stay was 1 day (range, 1-6; average, 1.5 days). Overall, 41 patients (66%) were discharged on postoperative day 1. Intravenous narcotics were required postoperatively in 22 patients (35.5%). There were no 30-day readmissions. CONCLUSION: This bridging multimodal pain management protocol resulted in a length of stay of 1 day for 66% of patients, even for higher-risk patients with American Society of Anesthesiologists Physical Status Classification III (63%). Of the 62 patients, 64% (n = 40) did not require postoperative intravenous narcotics. For properly selected patients, this program may be considered for performing TSR as an ambulatory procedure.