Return to play following operative management of anterior shoulder instability in overhead athletes-A systematic review.

Background: The purpose of this study was to systematically review the rate and timing of return to play in overhead athletes following operative management of anterior shoulder instability. Methods: A systematic literature search based on PRISMA guidelines, utilizing the EMBASE, MEDLINE, and The Cochrane Library Databases. Eligible for inclusion were clinical studies reporting on return to play among overhead athletes following arthroscopic Bankart repair, open Latarjet procedure or Remplissage procedure. Results: There are 23 studies included with 961 patients. Among those undergoing arthroscopic Bankart repair, the rate of return to play was 86.2%, with 70.6% returning to the same level of play and the mean time to return to play was 7.1 months. Among those undergoing an open Latarjet procedure, the rate of return to play was 80.9%, with 77.7% returning to the same level of play and the mean time to return to play was 5.1 months. Among those undergoing a Remplissage procedure, the rate of return to play was 70.6%, with 70.0% returning to the same level of play or mean time to return to play. Discussion: Overall, there were high rates of return to play following operative management of anterior shoulder instability in overhead athletes.

Patient-Reported Outcomes After Surgical Treatment of Early Osteoarthritis of the First Carpometacarpal Joint.

BACKGROUND: The goals of this study are to describe the reoperation rates in patients who underwent Wilson osteotomy compared with patients who underwent carpometacarpal (CMC) arthroplasty for early-stage arthritis and to evaluate the factors influencing the patient-reported outcomes. METHODS: Retrospectively, 52 patients who underwent surgery for stage I/II osteoarthritis of the thumb carpometacarpal were identified, consisting of 17 (33%) patients who underwent Wilson osteotomy and 35 (67%) who underwent carpometacarpal arthroplasty. A total of 28 (55%) patients completed the outcome questionnaires, consisting of 11 (39%) patients who underwent Wilson osteotomy and 17 (61%) patients who underwent carpometacarpal arthroplasty. We performed a multivariable linear regression model to identify factors associated with the Numeric Rating Scale (NRS) pain intensity at final follow-up. RESULTS: Among the patients who underwent CMC arthroplasty, 2 had a reoperation. Among the patients who underwent Wilson osteotomy, 3 had a reoperation. Among the patients who completed the outcome questionnaires, the median quick Disabilities of the Arm, Shoulder and Hand score was 10 and the median NRS Pain Intensity score was 0. In multivariable analysis, the postoperative Patient-Reported Outcomes Measurement Information System Pain Interference (PROMIS PI) was independently associated with higher postoperative NRS pain scores. CONCLUSION: In younger patients with stage I/II CMC osteoarthritis, Wilson osteotomy may be a reasonable alternative to CMC arthroplasty. Outcomes were similar between both groups at mid-term follow-up, with only a slightly higher pain score in the osteotomy group. In patients with stage I/II carpometacarpal osteoarthritis, the PROMIS PI is the main factor indicating successful outcomes.

Additional Treatment after Collagenase Injections and Needle Fasciotomy for Dupuytren's Disease: A Retrospective Cohort Study.

Introduction The aim of this study was to assess the rate of additional treatment after collagenase injection and needle fasciotomy, and what factors are associated with additional procedures for recurrence. Materials and Methods We retrospectively identified 201 adult patients who underwent collagenase injection and 19 patients who underwent needle fasciotomy for Dupuytren's disease from 2012 to 2014. Outcomes included additional treatment of the same ray for either recurrence or persistence of contracture. To evaluate associated factors, we performed a bivariate analysis. Results Additional treatment after collagenase injection for recurrence was performed in 24% of fingers at a median of 23 months (interquartile range [IQR]: 10.8-36.1) and was associated with bilateral disease ( p = 0.008). Additional treatment for persistence was performed in 5.6% at a median of 1.9 months (IQR: 1.1-3.2). Additional treatment for recurrence after needle fasciotomy was performed in 13% of fingers at a median of 28.2 months (IQR: 27.5-28.2) and 4.2% for persistence at 1.1 months. Fingers treated with needle fasciotomy were more likely to undergo secondary open fasciectomy (13% vs. 5.1%, p = 0.022). Conclusion Additional treatment after collagenase injections was performed in 29% of fingers, mostly another collagenase injection, and was associated with bilateral disease. After needle fasciotomy, 17% of patients underwent additional treatment, primarily open partial fasciectomy.

Current Requirements and Attitudes Toward Research: A Survey-Based Analysis of Orthopedic Surgery Programs.

Objective The Accreditation Council for Graduate Medical Education (ACGME) guidelines require scholarly activity but do not specify what research-related activity is necessary to meet this requirement. The current components and opinions regarding research and its implementation that qualify as scholarly activity are unknown among US orthopedic surgery programs. We aimed to survey program directors of orthopedic surgery programs to evaluate and better understand the current state of research during training. Design A survey was sent to the program directors of all ACGME-accredited orthopedic surgery between 2019 and 2020 with questions evaluating each program's research requirements and barriers to improvement. Results One-hundred eighteen (N=118) surveys were collected from 94 academic (79.6%) and 24 community (21.4%) programs. Although nearly all (97.5%) programs required research for graduation, only 45% of them allotted protected time: 52 academic programs (55.3%) allotted a median of nine weeks (interquartile range (IQR): 8-12 weeks) of dedicated time and 13 community programs (54.2%) allotted six weeks (IQR: 4-28 weeks) (p=0.595). We distinguished dedicated research as either consecutive weeks or a formal research track for a year. All programs indicated a desire for an increased focus on basic science compared to the current focus on outcomes-based research (p=0.04). The greatest identified obstacle to research improvement reported by community programs was faculty and resource commitment (p=0.003). The overall level of satisfaction with the current research experience among directors is 50.8%. Conclusion Despite differences between academic and community programs, directors agree on shifting the focus of research toward basic science. To improve preclinical research, additional time may be required, and individualized improvement plans should be undertaken at academic and community programs alike.

Joint-sparing versus nonjoint-sparing reconstruction of the radius following oncologic resection: A systematic review.

BACKGROUND AND OBJECTIVES: Reconstructions of the distal radius are uncommon procedures. This systematic review compares joints-sparing (JS) versus nonjoint-sparing (NJS) reconstructions following oncologic resection of the distal radius. METHODS: A search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Collected outcomes included patient-reported outcome measures (PROMs), range of motion and grip strength, and complication and reoperation rates. RESULTS: A total of 52 nonrandomized cohort studies (n = 715) were included. PROMs were comparable between the cohorts, while the range of flexion-extension was greater in JS reconstructions (78.1° vs. 25.6°) and the range of pronation-supination was greater in NJS reconstructions (133.6° vs. 109.8°). Relative grip strength was greater following JS reconstruction (65.0% vs. 56.4%). About one in sixteen of the JS reconstructions were eventually revised to an NJS construct. CONCLUSIONS: This systematic review demonstrates that JS reconstructive techniques can offer satisfying results in patients treated for oncologic distal radius defects. However, about 6% of JS reconstructions are eventually revised to a NJS construct. Further investigation is warranted to identify factors that affect or predict these findings, to aid in future in treatment selection and reduce the common need for reoperations following these procedures.

Complications and Factors Associated with Reoperation following Total Wrist Fusion.

Background Total wrist fusion can be elected to relieve pain in patients with osteoarthritis and rheumatoid arthritis. This study aimed to investigate the overall complications and the factors associated with reoperation and soft tissue complication after total wrist fusion. Methods We retrospectively identified adult patients who underwent total wrist fusion using Current Procedural Terminology (CPT) codes, International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and ICD-10) and verified these by medical chart review. We included patients ( n = 215) who were treated at a single institutional system from January 1, 2002 to January 1, 2019. The mean age was 53.3 ± 15.0 years and the median follow-up was 6.1 years (interquartile range [IQR] =1.7-9.0). The most common indications for wrist fusion included inflammatory arthritis ( n = 66, 31%), degenerative arthritis ( n = 59, 27%), and posttraumatic arthritis ( n = 47, 22%). All wrist fusions were performed using a dorsal fusion plate or dorsal spanning plate, either with a local autograft ( n = 167, 78%), iliac crest autograft ( n = 2, 1.0%), allograft ( n = 7, 3.3%), a combination of both ( n = 16, 7.4%), or without a graft ( n = 23, 11%). We performed a multivariable logistic regression to evaluate factors associated with reoperation. In addition, we performed a similar analysis to identify the factors associated with soft tissue complication after total wrist fusion. Results Forty-one (19%) patients underwent reoperation at a median of 6.9 months (IQR = 3.9-18). The indications included symptomatic implants ( n = 12, 27%), implant failures ( n = 8, 20%), infections ( n = 7, 17%), and nonunions ( n = 6, 15%). In multivariable analysis, total wrist fusion of the dominant hand (odds ratio [OR]: 2.2, 95% confidence interval [CI]: 1.1-4.7, p = 0.033) was associated with a higher reoperation rate. Soft tissue complications occurred in 20 patients (9.3%) consisting of hematomas ( n = 8, 3.7%), observed blistering ( n = 5, 2.3%), and observed wound dehiscence ( n = 4, 1.9%). In multivariable analysis, smoking (OR: 2.5, CI: 0.95-6.4, p = 0.010) was independently associated with soft tissue complication after total wrist fusion. Seventy-two (33%) patients had a postoperative complication including symptomatic hardware ( n = 16, 7.4%), implant failure ( n = 11, 5.1%), infection ( n = 11, 5.1%), nonunion ( n = 8, 3.7%), and carpal tunnel syndrome ( n = 4, 1.9%). Conclusion Roughly one-third (33%) of the patients undergoing total wrist fusion experience a postoperative complication and 19% of the patients underwent a reoperation. Total wrist fusion of the dominant hand results in higher reoperation rates. The risk of a soft tissue complication after total wrist fusion is increased in smokers.

Factors Associated with Mortality and Amputation Caused by Necrotizing Soft Tissue Infections of the Upper Extremity: A Retrospective Cohort Study.

BACKGROUND: It is unclear what the exact short-term outcomes of necrotizing soft tissue infections (NSTIs), also known and necrotizing fasciitis of the upper extremity, are and whether these are comparable to other anatomical regions. Therefore, the aim of this study is to assess factors associated with mortality within 30-days and amputation in patients with upper extremity NSTIs. METHODS: A retrospective study over a 20-year time period of all patients treated for NSTIs of the upper extremity was carried out. The primary outcomes were the 30-day mortality rate and the amputation rate in patients admitted to the hospital for upper extremity NSTIs. RESULTS: Within 20 years, 122 patients with NSTIs of the upper extremity were identified. Thirteen patients (11%) died and 17 patients (14%) underwent amputation. Independent risk factors for mortality were an American Society of Anesthesiologists (ASA) classification of 3 or higher (OR 9.26, 95% CI 1.64-52.31) and a base deficit of 3 meq/L or greater (OR 10.53, 95% CI 1.14-96.98). The independent risk factor for amputation was a NSTI of the non-dominant arm (OR 3.78, 95% CI 1.07-13.35). Length of hospital stay was 15 (IQR 9-21) days. CONCLUSION: Upper extremity NSTIs have a relatively low mortality rate, but a relatively high amputation rate compared to studies assessing NSTIs of all anatomical regions. ASA classification and base deficit at admission predict the prognosis of patients with upper extremity NSTIs, while a NSTI of the non-dominant side is a risk factor for limb loss.