Comparison of Nylon Suture Versus 2 Fibrin Glue Products for Delayed Nerve Coaptation in an Animal Model.

PURPOSE: To compare 2 different, commercially available fibrin glue products with nylon suture with regard to repair strength, muscle function, and axon regeneration after delayed nerve repair in an animal model. METHODS: A total of 120 Lewis rats underwent transection of the sciatic nerve. On day 3 after transection, the nerves were reexposed. A primary repair was performed on 40 rats from each group using nylon suture, Tisseel fibrin glue, or Evicel fibrin glue. On days 0, 3, and 7 after repair, 10 rats from each group underwent burst strength testing. Seventy days after repair, 10 rats from each group underwent functional muscle testing and histomorphic analysis of the nerve, with the contralateral limb serving as the control. RESULTS: There was no significant difference in burst strength among the groups on days 0 and 3. On day 7, the burst strength of the Evicel and nylon suture groups was significantly greater than that of the Tisseel group. There were 5 total coaptation failures in both fibrin glue groups and none in the suture group. Seventy days after repair, tetanic muscle strength, muscle mass, axon inner diameter, and g-ratio were equivalent among all groups. Axon counts were equivalent between the nylon suture and Evicel groups, although in the nylon group axon counts were higher than for the Tisseel group. CONCLUSIONS: In an animal model with a 3-day delay in nerve repair, although dehiscences occurred, when the initial repair held, fibrin glue was not inferior to nylon suture with regard to repair strength and muscle recovery. CLINICAL RELEVANCE: Historical concerns regarding spontaneous fibrin glue-based nerve repair dehiscences are well-founded. However, when coaptation is maintained, commercially available fibrin glues support nerve regeneration.

Effect of State Legislation on Discharge Opioid Prescriptions After Total Hip and Knee Arthroplasties.

BACKGROUND: Recent literature suggests that state-level legislation is effective in reducing postoperative opioid prescribing after total joint arthroplasty but has not addressed the effect on opioid antagonist coprescribing. This study aims to describe the change in postoperative opioid and opioid antagonist prescribing patterns after total joint arthroplasty following passage of state-level opioid-limiting legislation and to determine the comorbidities associated with increased opioid prescribing in this population. METHODS: Billing data were used to identify all patients who underwent primary total hip or knee arthroplasty admitted between March 2016 and March 2018 at our institution. The data were divided into 2 cohorts comprising the year before (671 subjects) and after (713 subjects) the legislation. Discharge prescriptions were reviewed, and the median morphine milligram equivalents (MME) per day and naloxone prescriptions were recorded. International Classification of Diseases codes were used to identify comorbid conditions of interest present during previous inpatient or outpatient encounters. RESULTS: There was a significant reduction in both the minimum and maximum median MME per day after introduction of state legislation and a substantial increase in opioid antagonist coprescription. Total knee arthroplasty, younger age, male sex, chronic pain disorders, post-traumatic stress disorder, and prior opioid abuse were correlated with increased opioid prescribing. CONCLUSION: Our findings suggest that state-level legislation is effective in decreasing the MME per day prescribed and increasing opioid antagonist coprescription in the postoperative period for patients undergoing total hip and knee arthroplasties at our institution. These changes may lead to a decrease in opioid-related morbidity and mortality in the patient population undergoing total hip and knee arthroplasties.

Parallel Plating of Simulated Distal Humerus Fractures Demonstrates Increased Stiffness Relative to Orthogonal Plating With a Distal Humerus Locking Plate System.

OBJECTIVES: This study compared the stiffness of precontoured parallel and orthogonal locking plate configurations in cyclic torsion and bending, and then extension to failure. METHODS: Tests were conducted on 9 matched pairs of cadaveric humeri. A 10 mm block of bone was excised from the distal humerus metaphysis to simulate comminution, and fractures were repaired in matched fashion using parallel or orthogonal Biomet ALPS distal humerus locking plates (Biomet, Inc, Warsaw, IN). Specimens were tested at 0.5 degree per second up to ±2 N-m in internal and external rotation for 20 cycles, then in flexion and extension cantilevered bending at 1 mm/s to ±50 N, followed by bending at 1 mm/s to failure in extension. RESULTS: Torsional stiffness of the parallel configuration group was greater than the orthogonal configuration in both internal and external rotation (P < 0.0001). Also, stiffness in bending was significantly greater in the parallel configuration group in both flexion and extension (P < 0.0001). In extension to failure testing, the parallel plate construct stiffness was significantly greater than the orthogonal configuration (P < 0.005). CONCLUSIONS: The parallel plate configuration demonstrated significantly greater stiffness than the orthogonal plate configuration in torsion and bending using locked distal humerus plates. This greater stiffness may prove desirable in the postoperative management of patients with comminuted distal humerus fractures, providing a stable anatomic reconstruction of the joint to allow early range of motion.