Postoperative Outcome of the Modified Broström Procedure in the Active Duty Military Population: A Retrospective Cohort Study.

Ankle sprains are common injuries and typically treated conservatively. Chronic ankle instability, however, can require surgery when nonoperative measures fail. We evaluated the clinical outcomes of an active duty population in a retrospective study of patients who had undergone a modified Broström procedure at our facility from January 2010 through April 2014 by a single surgeon. The electronic medical records and Army E-profile database were reviewed to determine whether the patients had returned to active duty and whether they had any permanent postoperative lower extremity activity restrictions. A total of 127 patients met the inclusion criteria and had undergone the modified Broström procedure during the study period; 34 (26.8%) separated from the military postoperatively. Of these 34 patients, 23 (18.1%) were unfit for reasons related to their ankle and 11 (8.7%) required military separation for reasons unrelated to their ankle. Thus, 93 patients (73.2%) were able to remain on active duty after undergoing the Broström procedure. Of the 93 patients able to remain on active duty, 38 (40.9%) required activity modifications and 55 (59.1%) were able to return to full duty. Chronic ankle instability in active duty patients can be severely limiting. The modified Broström procedure can provide significant improvement in symptoms and allow patients to remain on active duty. In our high-demand population, ~73% of patients were able to remain on active duty after their injury and subsequent surgery, 60% of whom returned to their previous level of duty without any physical restrictions.

Three-Year Analysis of Value and Utilization After Development of an Ultrasound-Based Orthopedic Injection Clinic.

INTRODUCTION: Sonography is an effective method of diagnosing and treating musculoskeletal conditions, and the use of ultrasound has been shown to improve the accuracy, safety, and efficacy of both therapeutic and diagnostic injections. In 2012, we established an injection clinic at our institution to address our growing need for diagnostic and therapeutic injections. METHODS: We performed an analysis of value and utilization following the development of an orthopedic injection clinic. This included an evaluation of the cost of materials, equipment, and training required to develop and run the clinic, and an analysis of the services rendered and relative value units (RVUs) generated over 3 fiscal years (FYs). RESULTS: The cost to develop the clinic was $42,498.30. The cost to run the clinic thereafter was $16.90 to $21.60 per injection. By the end of FY 2012, 60% of providers performed at least 1 injection under ultrasound guidance. Every successive year thereafter, 100% of providers were using ultrasound guidance. In FY 2012, we performed 738 injections, 5.4% used ultrasound guidance and generated a total of 1,786.36 RVUs. In FY 2013, we performed 1,814 injections, 17.6% used ultrasound guidance, and generated a total of 7,224.5 RVUs. In FY 2014, we performed 2,821 injections, 25.2% used ultrasound guidance, and generated 13,786.82 RVUs. RVUs generated solely from ultrasound guided injections were 463.2 (2012), 3,694 (2013), 8,221.8 (2014). Injection accuracy was at least 98%. Average time until injection was 0 days. CONCLUSION: The cost to start an injection clinic is modest, with the potential for large annual growth and early return on investment, and can generate significant revenue by recapturing RVUs that would otherwise be lost to outside referrals. Furthermore, it helps to increase clinic throughput, maximize services rendered during a single patient visit improving the overall quality of their encounter, expands the clinical practice of our midlevel providers, offloads clinical time for surgical providers, and can help expedite clinical decision making.

Level I trauma center internal campaign to increase safe driving by staff.

A 3-month internal campaign at our trauma center was conducted to improve employee motor vehicle safety and have employees serve as community role models. The injury-prevention coordinator and trauma program manager developed and implemented a campaign of high-visibility events. Effectiveness was evaluated through pre- and postcampaign surveys and seat belt-use observation and observation at 1 year. Although survey responses did not change, observed seat belt use increased significantly from 79% to 87%, with maintenance at 1 year (89%). No direct causal effect can be proven, but the campaign appears to have increased employee seat belt use.

Effects of Chemical Control, Cultivar Resistance, and Structure of Cultivar Root System on Black Shank Incidence of Tobacco.

Black shank, caused by the hemibiotrophic oomycete Phytophthora parasitica var. nicotianae, is a major disease of tobacco (Nicotiana tabacum). The rise of race 1 in the late 1990s, after extensive cropping of cultivars possessing the Php gene, confirming immunity to race 0 of P. parasitica var. nicotianae, imposed new challenges to black shank management. The effects of tobacco cultivars and chemical controls with mefenoxam (Ridomil Gold) on black shank incidence were investigated in naturally infested fields. Twenty-five cultivars were tested and the highest resistance for races 0 and 1 of P. parasitica var. nicotianae was provided by RJR 75 and SP 227 based on field and laboratory studies. When race 1 was prevalent, mefenoxam was effective to control black shank. An initial application at an early stage of tobacco growth, such as a few days before or after transplant, was essential to successfully control the disease. In greenhouse experiments, cultivars carrying the Php gene produced fewer and shorter adventitious roots than cultivars possessing only partial resistance to all races of P. parasitica var. nicotianae. Strategies such as use of mefenoxam, especially at an early stage, when adventitious roots are emerging, and planting a cultivar with high partial resistance or possessing the Ph gene when race 1 or race 0, respectively, predominates are critical factors in reducing loss due to P. parasitica var. nicotianae.