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Roebke AJ, Bates N, Jurenovich K, Yu E, Karnes J, Khan S, Kman N, Groth A, Martin KD. Cervical Spinal Immobilization: A Head-to-Head Comparison of a One-Step Spray-on Foam Splint Versus Structural Aluminum Malleable Splint Immobilization. Mil Med 2023; 188:e2987-e2991. [PMID: 36943370 DOI: 10.1093/milmed/usad081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/12/2023] [Accepted: 03/08/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Cervical spine immobilization in a low-resource environment is difficult secondary to limited equipment, prolonged transportation, and secondary complications. A structural aluminum malleable (SAM) splint is commonly utilized because of its availability and multipurpose intention. A one-step spray-on foam immobilization technique (Fast Cast) has been shown to be effective in lower-extremity splinting. The aim of this study was to demonstrate the ability of the Fast Cast to effectively immobilize the cervical spine in a head-to-head comparison against the SAM splint. We hypothesized that there would be no difference in surgeon scoring between Fast Cast and SAM splints for the immobilization of the cervical spine. METHODS This was a cadaveric experimental comparative study that compared a SAM splint versus Fast Cast for the immobilization of an unstable cervical spine. Each of the three cadaveric specimens had a corpectomy without fixation performed. A board-certified emergency medicine physician specialized in disaster medicine performed all SAM immobilizations. An orthopedic surgeon performed Fast Cast immobilizations. Each method of immobilization was done on each cadaver. Lateral fluoroscopic imaging was taken before and after immobilization and after log roll/gravity stress. Five board-certified orthopedic surgeons served as graders to independently score each splint. A 5-point Likert scale based on 10 splinting criteria (50 total points possible) was utilized to evaluate cervical spine immobilization. The lead statistical analyst was blinded to the immobilization groups. The statistical significance was assessed via a Wilcoxon signed-rank test and chi-square Fisher's exact test with significance between groups set at α < .05. Inter-rater reliability of the Likert scale results was assessed with the interclass correlation coefficient. RESULTS Inter-rater reliability for the current Likert scale in the evaluation of cervical spine stabilization was good (interclass correlation coefficient = 0.76). For the cumulative Likert scale score, Fast Cast (32 [28-34]) exhibited a higher total score than SAM (44 [42-47]; P < .01). Likewise, Fast Cast exhibited a greater likelihood of higher Likert scores within each individual question as compared to SAM (P ≤ 0.04). In 100% of cases, raters indicated that Fast Cast passed the gravity stress examination without intrinsic loss of reduction or splinting material, whereas 33% of SAM passed (P < .01). In 100% of cases, raters indicated that Fast Cast passed the initial radiographic alignment following immobilization, whereas 66% of SAM passed (P = .04). In 100% of cases, raters indicated that Fast Cast passed radiographic alignment after the gravity stress examination, whereas 47% of SAM passed (P < .01). CONCLUSION The Fast Cast exceeded our expectations and was shown to be rated not equivalent but superior to SAM splint immobilization for the cervical spine. This has significant clinical implications as the single-step spray-on foam is easy to transport and has multifaceted applications. It also eliminates pressure points and circumferential wrapping and obstruction to airway/vascular access while immobilizing the cervical spine and allowing for radiographic examination. Further studies are needed for human use and application.
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Affiliation(s)
- Austin J Roebke
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH 43202, USA
| | - Nathaniel Bates
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH 43202, USA
| | - Kathryn Jurenovich
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH 43202, USA
| | - Elizabeth Yu
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH 43202, USA
| | - Jonathan Karnes
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH 43202, USA
| | - Safdar Khan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH 43202, USA
| | - Nicholas Kman
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43202, USA
| | - Adam Groth
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH 43202, USA
| | - Kevin D Martin
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH 43202, USA
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Mickley JP, Lynch DJ, Gordon AM, Roebke AJ, Goyal KS. Fracture Gap Closure and Reduction Are Affected by the Orientation of the Headless Compression Screw. Hand (N Y) 2023:15589447221150504. [PMID: 36692082 DOI: 10.1177/15589447221150504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND We evaluated the impact of a variable-pitch headless screw's angle of insertion relative to the fracture plane on fracture gap closure and reduction. METHODS Variable-pitch, fully threaded headless screws were inserted into polyurethane blocks of "normal" bone model density using a custom jig. Separate trials were completed with a 28-mm screw placed perpendicular and oblique/longitudinal to varying fracture planes (0°, 15°, 30°, 45°, and 60°). Fluoroscopic images were taken after each turn during screw insertion and analyzed. Initial screw push-off, residual fracture gap at optimal fracture gap reduction, and malreduction were determined in each trial. Statistical analysis was performed via a 1-way analysis of variance followed by Student t tests. RESULTS Malreduction was found to be significantly different between the perpendicular (1.88 mm ± 1.38) and the oblique/longitudinal (0.58 mm ± 0.23) screws. The malreduction increased for the perpendicular screw as the fracture angle increased (60° > 45°=30° > 15° > 0°). Residual fracture gap at optimal fracture gap reduction was also found to be significantly different between the perpendicular (0.97 ± 0.42) and oblique/longitudinal (1.43 ± 1.14) screws. The residual fracture gap increased for the oblique/longitudinal screw as the fracture angle increased, although the oblique/longitudinal screw with a 60° fracture angle was the only configuration significantly larger than all the other configurations. Screw push-off was not found to be significantly different between the oblique/longitudinal screw and perpendicular screw trials. CONCLUSIONS The perpendicular screw had a larger malreduction that increased with fracture angle, whereas the oblique/longitudinal screw had a larger residual fracture gap that increased with fracture angle.
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Affiliation(s)
- John P Mickley
- The Ohio State University College of Medicine, Columbus, USA
| | - Daniel J Lynch
- The Ohio State University College of Medicine, Columbus, USA
| | - Adam M Gordon
- The Ohio State University Wexner Medical Center, Columbus, USA
| | - Austin J Roebke
- The Ohio State University Wexner Medical Center, Columbus, USA
| | - Kanu S Goyal
- The Ohio State University Wexner Medical Center, Columbus, USA
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Lynch D, Mickley JP, Gordon A, Roebke AJ, Goyal KS. The Effect of Derotational Kirschner Wires on Fracture Gap Reduction With Variable-Pitch Headless Screws. J Hand Surg Am 2023; 48:86.e1-86.e7. [PMID: 34802813 DOI: 10.1016/j.jhsa.2021.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 07/06/2021] [Accepted: 09/09/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE We evaluated the impact of angled derotational Kirschner wires (K-wires) on fracture gap reduction with variable-pitch headless screws. METHODS Fully threaded variable-pitch headless screws (20 and 28 mm) were inserted into "normal" bone models of polyurethane blocks. In separate trials, derotational K-wires were inserted at predetermined angles of 0°, 15°, 30°, and 40° and compared with each other, with no K-wire as a control. Fluoroscopic images taken after each screw turn were analyzed. The optimal fracture gap closure, initial screw push-off, and screw back-out gap creation were determined and compared at various derotational K-wire angles. RESULTS Initial screw push-off due to screw insertion and screw back-out gap creation were not significantly affected by the angle of the derotational K-wire. With a 20-mm screw, only a 40° derotational K-wire led to significantly less gap closure compared with control and with 0°, 15°, and 30° derotational K-wires. It led to an approximately 60% decrease in gap closure compared with no K-wire. With the 28-mm screw, compared with no K-wire, 15° and 30° derotational K-wires led to statistically significant decreases in gap closure (approximately 25%), whereas a 40° derotational K-wire led to an approximately 60% decrease. With the 28-mm screw, the 40° derotational K-wire also led to a statistically significant smaller gap closure when compared with 0°, 15°, and 30° derotational K-wires. CONCLUSIONS A derotational K-wire placed in parallel to the planned trajectory of a headless compression screw does not affect fracture gap closure. With greater angulation of the derotational K-wire, the fracture gap is still closed, but less tightly. CLINICAL RELEVANCE Derotational K-wires can help prevent fracture fragment rotation during headless compression screw insertion. At small deviations from parallel (≤30°), fracture gap closure achieved by the screw is minimally affected. At greater angles (ie, 40°), fracture gap closure may be substantially reduced, preventing fracture compression.
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Affiliation(s)
- Daniel Lynch
- Ohio State University College of Medicine, Columbus, OH
| | | | - Adam Gordon
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Austin J Roebke
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Kanu S Goyal
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH.
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Roebke AJ, Malik AT, Khan SN, Yu E. Does a Reported Penicillin Allergy Affect Outcomes Following Elective Posterior Lumbar Fusions? Int J Spine Surg 2022; 16:1023-1028. [PMID: 35831066 PMCID: PMC9807058 DOI: 10.14444/8326] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Patients with a reported penicillin allergy (PA) receive alternative antibiotics that may not be as effective as cephalosporins for surgical site infection (SSI) prophylaxis. While patient-reported PA has been correlated to increased complications in other fields, this has not been conclusively shown in spine surgery. We investigate the impact of PA on 90-day complications and inpatient charges/costs after elective posterior lumbar fusion between PA and non-PA cohorts. METHODS The 2005 to 2014 SAF100 database was queried using International Classification of Diseases, Ninth Edition (ICD-9) procedure codes to identify patients undergoing elective posterior lumbar fusions. The reported PA ICD-9 code was used to divide the study sample into a PA cohort and non-PA cohort. Multivariate logistic regression analyses were used to assess significant differences in 90-day complications between PA and non-PA groups after controlling for confounding factors. Generalized linear regression modeling was used to assess for differences in inpatient charges and costs. RESULTS A total of 286,042 patients, 7497 (2.6%) of whom reported a PA, who underwent elective posterior lumbar fusions were included. Following adjustment for confounding factors, patients in the PA group had significantly higher odds of experiencing SSIs (3.8% vs 3.1%, OR 1.20 [95% CI 1.07-1.36]; P = 0.002), urinary tract infections (12.3% vs 10.0%, OR 1.16 [95% CI 1.08-1.24]; P < 0.001), sepsis (1.5% vs 1.2%, OR 1.24 [95% CI 1.02-1.50]; P = 0.026), acute kidney injuries (3.8% vs 3.2%, OR 1.19 [95% CI 1.05-1.34]; P = 0.006), readmissions (9.8% vs 8.5%, OR 1.15 [95% CI 1.07-1.25]; P < 0.001), increased inpatient charges (+$4340; P < 0.001), and increased reimbursements (+$1221; P < 0.001). CONCLUSIONS Patients with a reported PA experienced significantly higher rates of 90-day complications and cost following elective posterior lumbar fusion. The findings of the study highlight the importance of preoperative PA testing to minimize the use of alternative antibiotics and potentially improve patient outcomes. CLINICAL RELEVANCE Patients should be tested for penicillin allergy to minimize the use of alternative antibiotics among patients with a reported PA. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Austin J. Roebke
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Azeem T. Malik
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Safdar N. Khan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Elizabeth Yu
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA, Elizabeth Yu, Department of Orthopaedics, Division of Spine, Director of the Orthopaedic Minimally Invasive Spine Surgery Service, 376 W 10th Ave, Columbus, OH 43210, USA;
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Munsch MA, Via GG, Roebke AJ, Everhart JS, Ryan JM, Vasileff WK. Patient-specific factors, but neither regional anesthesia nor hip-specific cryotherapy, predict postoperative opioid requirements after hip arthroscopy for femoroacetabular impingement (FAI) syndrome. J Clin Orthop Trauma 2022; 28:101848. [PMID: 35378774 PMCID: PMC8976140 DOI: 10.1016/j.jcot.2022.101848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 01/10/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022] Open
Abstract
Background We sought to determine whether regional nerve block, cryotherapy variant, or patient-specific factors predict postoperative opioid requirements and pain control following hip arthroscopy. Methods 104 patients underwent hip arthroscopy with (n = 31) or without (n = 73) regional block and received cryotherapy with a universal pad [joint non-specific; no compression (n = 60)] or circumferential hip/groin wrap with intermittent compression (n = 44). Outcomes included total opioid prescription amounts, requests for refills, and unplanned clinical encounters for postoperative pain within 45 days of surgery. Multivariate modeling was used to determine the effect of perioperative regional nerve block and type of cryotherapy device on outcomes after adjusting for patient demographics, previous opioid use, mental health disorder history, and surgery length. Results The average amount of 5 mg oxycodone pill equivalents prescribed within 45 days of surgery was 40.5 (SD 14.8); 36% requested refills, 20% presented to another physician, and 21% called the surgeon's office due to pain. Neither the hip-specific cryotherapy pad nor regional block was predictive of opioid amounts prescribed, refill requests, or unplanned clinical encounters due to pain. Refill requests within 45 days were more common with baseline opioid use (p < 0.001), increased age (p = 0.007), and mental health disorder history (p = 0.008). Total opioid amounts prescribed within 45 days were higher with workers compensation (p = 0.03), a larger initial opioid prescription (p < 0.001), baseline opioid use (p < 0.001), history of mental health disorder (p = 0.02), and increased age (p = 0.02). Together, these variables explained 61% of the variance in opioid amounts prescribed. Conclusion Patient factors are strong predictors of postoperative opioid requirements after hip arthroscopy. Postoperative opioid prescription amounts, opioid refill requests, and pain-related calls or office visits were not affected by use of a perioperative regional nerve block or type of cryotherapy delivery system. Level of evidence III, retrospective cohort study.
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Affiliation(s)
- Maria A. Munsch
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Garrhett G. Via
- Department of Orthopaedic Surgery, Wright State University, Dayton, OH, USA
| | - Austin J. Roebke
- Department of Orthopedics, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | | | - John M. Ryan
- Department of Orthopedics, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - W. Kelton Vasileff
- Department of Orthopedics, The Ohio State Wexner Medical Center, Columbus, OH, USA
- Corresponding author. Department of Orthopaedics, The Ohio State University Jameson Crane Sports Medicine Institute, 2835 Fred Taylor Drive, Columbus, OH, 43202, USA.
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Roebke AJ, Samade R, Altman PR, Jain SA, Goyal KS, Speeckaert AL. Role of Dynamic Stabilizers of the Elbow in Radiocapitellar Joint Alignment: A Prospective In Vivo Study. J Hand Surg Am 2022:S0363-5023(22)00052-1. [PMID: 35337695 DOI: 10.1016/j.jhsa.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/08/2021] [Accepted: 01/19/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the effect of dynamic stabilizers of the elbow on radiocapitellar joint alignment, before and after the administration of regional anesthesia. METHODS At a single institution, 14 patients were prospectively enrolled in a study using a within-subjects control design. Before performing a supraclavicular regional block, 10 fluoroscopic images (1 anteroposterior and 9 lateral views) of the elbow were obtained for each patient. The lateral images were obtained with the forearm in maximal supination, neutral rotation, and maximal pronation, and these forearm positions were repeated for 3 elbow positions: (1) full extension; (2) flexion to 90°, with 0° of shoulder internal rotation; and (3) flexion to 90°, with 90° of shoulder internal rotation. After obtaining the 10 initial images, a block was performed to achieve less than 3/5 motor strength of the imaged extremity, followed by obtaining the same 10 images in each patient. Radiocapitellar ratio, defined as the minimal distance between the right bisector of the radial head and the center of the capitellum divided by the diameter of the capitellum, was measured in each image. RESULTS The 14 patients had a mean age of 47.8 ± 15.7 years, and 10 (71.4%) patients were women. A difference between radiocapitellar ratios measured before and after the regional block administration was observed for all lateral images (-1.0% ± 7.2% to -2.2% ± 8.0%), although this difference was less than the minimum clinically important difference. CONCLUSIONS Paralysis of the dynamic stabilizers of the elbow produces a difference in the radiocapitellar joint alignment, but this did not reach the minimum clinically important difference. CLINICAL RELEVANCE Paralysis of the dynamic stabilizers of the elbow via a supraclavicular nerve block produces no clinically relevant effect on the radiocapitellar alignment of uninjured elbows.
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Affiliation(s)
- Austin J Roebke
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Richard Samade
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Perry R Altman
- Department of Orthopaedic Surgery, Beaumont Orthopedic Institute, Royal Oak, MI
| | - Sonu A Jain
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH; Department of Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Kanu S Goyal
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Amy L Speeckaert
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH.
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Kopechek KJ, Roebke AJ, Sridharan M, Samade R, Goyal KS, Neviaser AS, Bishop JY, Cvetanovich GL. The effect of patient factors on opioid use after anatomic and reverse shoulder arthroplasty. JSES Int 2021; 5:930-935. [PMID: 34505108 PMCID: PMC8411060 DOI: 10.1016/j.jseint.2021.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Prolonged opioid use can lead to suboptimal outcomes after total shoulder arthroplasty (TSA), and thus, reduced consumption is desirable. Our primary aims were to determine if differences in total morphine equivalent doses existed owing to (1) age less than or greater than 65 years, (2) sex, and (3) TSA type - reverse or anatomic total shoulder arthroplasty. We also characterized potential risk factors for (1) visiting another provider for pain, (2) pain control 6 weeks postoperatively, and (3) needing an opioid refill. Methods A retrospective cohort study of 100 patients who underwent TSA (reverse total shoulder arthroplasty N 1 = 50; anatomic total shoulder arthroplasty N 2 = 50) between 1 July 2018 and 31 December 2018 was performed. Demographics, perioperative treatments, and postoperative opioid prescriptions were recorded. Primary hypotheses were evaluated with Wilcoxon-Mann-Whitney testing. Univariate and multivariate analyses assessed potential risk factors for the 3 outcomes of interest. Results were given in adjusted odds ratios (aORs), 95% confidence intervals (CIs), and P values. Results There was a difference (P = .009) in total morphine equivalent doses used (in 5-milligram oxycodone tablets) between patients who were younger than 65 years of age (median: 83 tablets, interquartile range: 62-140) and those who were older than 65 years of age (median: 65 tablets, interquartile range: 52-90). Unemployment (aOR = 4.68, CI: 1.5-14.2, P = .006) and age less than 65 years (aOR = 4.18, CI: 1.6-11.2, P = .004) were independent risk factors for inadequate pain control 6 weeks postoperatively. Two independent risk factors for needing an opiate prescription refill after discharge were unemployment (aOR = 4.56, CI: 1.5-13.8, P = .007) and preoperative opiate use (aOR = 3.95, CI: 1.4-11.0, P = .009). Conclusion After TSA, morphine equivalent dose usage is higher for patients younger than 65 years of age, and several risk factors exist for requiring a refill and having inadequate pain control 6 weeks postoperatively. Prospective studies using these data to guide interventions may be beneficial.
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Affiliation(s)
- Kyle J Kopechek
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Austin J Roebke
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mathangi Sridharan
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Richard Samade
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kanu S Goyal
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Andrew S Neviaser
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Julie Y Bishop
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Gregory L Cvetanovich
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Reddy N, Evans T, Jefferson R, Roebke AJ, Jain SA. Social Media Use Among Academic Hand Surgeons. Journal of Hand Surgery Global Online 2021; 3:249-253. [PMID: 35415572 PMCID: PMC8991742 DOI: 10.1016/j.jhsg.2021.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/15/2021] [Indexed: 12/30/2022] Open
Abstract
Purpose Social media has become increasingly prevalent among the general population in the past decade. We examined the current prevalence of social media use among academic orthopedic-trained and plastic surgery-trained hand surgeons in the United States. Methods All publicly available hand surgery faculty across the nation were analyzed for their public social media usage, including Instagram, Facebook, Twitter, LinkedIn, and personal websites. Comparisons of social media usage between orthopedic-trained and plastic surgery-trained hand surgeons, male and female academic hand surgeons, hand surgeons from different regions of the United States (East, West, Midwest, and South), and years of experience were analyzed. Results A total of 469 academic hand surgeons were included. Among academic hand surgeons in the United States, LinkedIn was the most common platform used (40.3%), followed by Facebook (15.78%), a personal website (13.86%), Twitter (12.37%), and Instagram (4.05%). Plastic surgery hand surgeons had more of a presence than orthopedic hand surgeons on Instagram (8.26% vs 2.59%, P < .01)) and Twitter (19.01% vs 10.06%, P < .01). Male hand surgeons were more likely than female hand surgeons to use LinkedIn (41.19% vs 34.85%, P = .04). Southern (18.89%) and Eastern (14.36%) surgeons used personal websites more than Western (6.52%) and Midwestern (4.60%) surgeons (P = .03). Conclusions Despite the widely known use of social media among plastic and aesthetic surgeons, this study shows the use of web-based marketing strategies to be quite rare in the academic hand surgery setting. Clinical Relevance Our study shows that throughout the United States, academic hand surgeons use social media at low rates. We suggest that academic plastic surgery and orthopedic hand surgeons throughout the United States consider having a larger social media presence to expand advertising, improve patient education, and enhance networking among their practices. Social media can be a valuable tool and will likely only increase in popularity in the coming years.
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Affiliation(s)
- Nihaal Reddy
- The Ohio State University College of Medicine, Columbus, OH
| | - Tyler Evans
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
- Hand and Upper Extremity Center, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ryan Jefferson
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Austin J. Roebke
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Sonu A. Jain
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
- Hand and Upper Extremity Center, The Ohio State University Wexner Medical Center, Columbus, OH
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
- Corresponding author: Sonu A. Jain, MD, Department of Orthopaedics, Hand and Upper Extremity Center, and Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43212.
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Sridharan M, Samade R, J Kopechek K, Roebke AJ, Goyal KS, L Jones G, Y Bishop J, Cvetanovich GL. The Effect of Patient and Surgical Factors on Opioid Prescription Requests Following Arthroscopic Rotator Cuff Repair. Arthrosc Sports Med Rehabil 2021; 3:e707-e713. [PMID: 34195635 PMCID: PMC8220602 DOI: 10.1016/j.asmr.2021.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/15/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose To determine whether differences in total morphine equivalent doses (MEDs) prescribed after arthroscopic rotator cuff repair (RCR) existed because of age younger than or older than 55 years and sex and to characterize potential risk factors for needing an opioid medication refill, visiting a provider other than the surgeon (either in the emergency department or ambulatory settings), and postoperative pain control requiring opioids approximately 6 weeks from the date of surgery. Methods A retrospective cohort study of 100 patients who underwent arthroscopic RCR between July 1, 2018, to November 30, 2018, in a single institution was performed. Data including demographics, perioperative treatments, and postoperative opioid prescriptions were recorded. Our primary hypotheses were evaluated with the Wilcoxon-Mann-Whitney test. Univariate and multivariate analyses assessed potential risk factors for the 3 outcomes of interest. Results were given in adjusted odds ratios (aORs), 95% confidence intervals (CIs), and P values. Results There was a difference (P = .038) in total MEDs used (in 5 mg oxycodone tablets) between males (median 56 tablets; interquartile range, 50-98 tablets) and females (median 78 tablets; interquartile range, 56-116 tablets). Age younger than 55 years was a risk factor for seeking an opioid refill (OR = 2.51; CI, 1.11-5.66; P = .026). A significant risk factor for visiting another provider was preoperative opiate use (OR = 15.0; CI, 1.79-125.8; P = .013). Age younger than than 55 years (aOR = 2.51; CI, 1.01-6.02; P = .047), body mass index (aOR = 1.08; CI, 1.01-1.17; P = .046), and shorter surgical duration (aOR = 0.97; CI, 0.95-0.99, P =.007) were independent predictive factors for requiring opioids for pain control 6 weeks after surgery. Conclusions After arthroscopic RCR, MED prescription is higher for females than males. The risk factors for requesting opioid prescription refill for pain control 6 weeks after surgery were age younger than 55 years and shorter surgical duration. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
- Mathangi Sridharan
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Richard Samade
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Kyle J Kopechek
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Austin J Roebke
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Kanu S Goyal
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Grant L Jones
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Julie Y Bishop
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Gregory L Cvetanovich
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
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Roebke AJ, Via GG, Everhart JS, Munsch MA, Goyal KS, Glassman AH, Li M. Inpatient and outpatient opioid requirements after total joint replacement are strongly influenced by patient and surgical factors. Bone Jt Open 2020; 1:398-404. [PMID: 33215130 PMCID: PMC7659675 DOI: 10.1302/2633-1462.17.bjo-2020-0025.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aims Currently, there is no single, comprehensive national guideline for analgesic strategies for total joint replacement. We compared inpatient and outpatient opioid requirements following total hip arthroplasty (THA) versus total knee arthroplasty (TKA) in order to determine risk factors for increased inpatient and outpatient opioid requirements following total hip or knee arthroplasty. Methods Outcomes after 92 primary total knee (n = 49) and hip (n = 43) arthroplasties were analyzed. Patients with repeat surgery within 90 days were excluded. Opioid use was recorded while inpatient and 90 days postoperatively. Outcomes included total opioid use, refills, use beyond 90 days, and unplanned clinical encounters for uncontrolled pain. Multivariate modelling determined the effect of surgery, regional nerve block (RNB) or neuraxial anesthesia (NA), and non-opioid medications after adjusting for demographics, ength of stay, and baseline opioid use. Results TKAs had higher daily inpatient opioid use than THAs (in 5 mg oxycodone pill equivalents: median 12.0 vs 7.0; p < 0.001), and greater 90 day use (median 224.0 vs 100.5; p < 0.001). Opioid refills were more likely in TKA (84% vs 33%; p < 0.001). Patient who underwent TKA had higher independent risk of opioid use beyond 90 days than THA (adjusted OR 7.64; 95% SE 1.23 to 47.5; p = 0.01). Inpatient opioid use 24 hours before discharge was the strongest independent predictor of 90-day opioid use (p < 0.001). Surgical procedure, demographics, and baseline opioid use have greater influence on in/outpatient opioid demand than RNB, NA, or non-opioid analgesics. Conclusion Opioid use following TKA and THA is most strongly predicted by surgical and patient factors. TKA was associated with higher postoperative opioid requirements than THA. RNB and NA did not diminish total inpatient or 90-day postoperative opioid consumption. The use of acetaminophen, gabapentin, or NSAIDs did not significantly alter inpatient opioid requirements. Cite this article: Bone Joint Open 2020;1-7:398–404.
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Affiliation(s)
- Austin J Roebke
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Garrhett G Via
- Department of Orthopaedic Surgery, Wright State University, Dayton, Ohio, USA
| | - Joshua S Everhart
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Maria A Munsch
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kanu S Goyal
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Andrew H Glassman
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mengnai Li
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Abstract
Distal radius fractures with dorsal articular surface impaction comprise a difficult fracture pattern to operatively reduce using a standard volar approach. Distal radius open reduction internal fixation using a dorsal approach allows direct visualization and reduction. The surgical technique video presented demonstrates technical pearls for optimal visualization, reduction, and fixation.
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Affiliation(s)
- Garrhett G Via
- Department of Orthopaedic Surgery, Wright State University, Dayton, OH; and
| | - Austin J Roebke
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Abhishek Julka
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
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12
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Roebke AJ, Martin AS, Sarmast Z, Fisk E, Goyal KS. Lift-Off Screw Results in Accurate Sagittal Tilt Correction in a Distal Radius Fracture Model. J Hand Surg Am 2018; 43:523-528. [PMID: 29559327 DOI: 10.1016/j.jhsa.2018.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/18/2017] [Accepted: 02/06/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the accuracy of a distal-first open reduction internal plate fixation technique in achieving correction of volar tilt in dorsally angulated distal radius fractures. METHODS Twenty foam radius models were divided evenly into groups N (normal) and O (osteoporotic). Dorsally angulated extra-articular distal radius fractures were then created. Group O underwent further modification to simulate an osteoporotic model. After static pinning in various degrees of dorsal angulation, opaque fiducial markers were placed and fluoroscopy was used to measure prereduction volar tilt. A variation of the distal-first plate application technique was used where a lift-off screw (LOS) was placed in the proximal most locking hole and propped the proximal aspect of the plate by the screw's length. The LOS length corresponded to the volar tilt correction needed. After fracture reduction using this technique, we measured the volar tilt again. We then compared the actual volar tilt correction with what was predicted based on the LOS length used. We also compared the tilt correction accuracy in the normal and osteoporotic models. RESULTS Prereduction tilt ranged from 3° to 52° of dorsal tilt from normal (10° volar tilt). Corresponding LOSs ranged from 5 to 42 mm in length. Tilt correction correlated with screw length in a linear fashion (R = 0.9). The mean difference between actual and predicted tilt correction for a given screw length was 0.5° ± 3.0°, and the mean absolute difference was 2.4° ± 1.7° for all specimens. There was no difference between normal and osteoporotic models. CONCLUSIONS Prereduction dorsal tilt can be accurately corrected within a few degrees of the goal by using the distal-first technique with an LOS. The LOS length can be calculated, and this technique can potentially be used with any distal radius periarticular locking plate with locking options in the shaft. CLINICAL RELEVANCE A technique that provides accurate tilt correction would be of benefit to surgeons treating distal radius fractures with volar plates.
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Affiliation(s)
- Austin J Roebke
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Adam S Martin
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Zubair Sarmast
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Erica Fisk
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Kanu S Goyal
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH.
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Roebke AJ, Roebke LJ, Goyal KS. Fracture Gap Reduction With Variable-Pitch Headless Screws. J Hand Surg Am 2018; 43:385.e1-385.e8. [PMID: 29169719 DOI: 10.1016/j.jhsa.2017.10.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 09/18/2017] [Accepted: 10/17/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Fully threaded, variable-pitch, headless screws are used in many settings in surgery and have been extensively studied in this context, especially in regard to scaphoid fractures. However, it is not well understood how screw parameters such as diameter, length, and pitch variation, as well as technique parameters such as depth of drilling, affect gap closure. METHODS Acutrak 2 fully threaded variable-pitch headless screws of various diameters (Standard, Mini, and Micro) and lengths (16-28 mm) were inserted into polyurethane blocks of "normal" and "osteoporotic" bone model densities using a custom jig. Three drilling techniques (drill only through first block, 4 mm into second block, or completely through both blocks) were used. During screw insertion, fluoroscopic images were taken and later analyzed to measure gap reduction. The effect of backing the screw out after compression was evaluated. RESULTS Drilling at least 4 mm past the fracture site reduces distal fragment push-off compared with drilling only through the proximal fragment. There were no significant differences in gap closure in the normal versus the osteoporotic model. The Micro screw had a smaller gap closure than both the Standard and the Mini screws. After block contact and compression with 2 subsequent full forward turns, backing the screw out by only 1 full turn resulted in gapping between the blocks. CONCLUSIONS Intuitively, fully threaded headless variable-pitch screws can obtain compression between bone fragments only if the initial gap is less than the gap closed. Gap closure may be affected by drilling technique, screw size, and screw length. Fragment compression may be immediately lost if the screw is reversed. CLINICAL RELEVANCE We describe characteristics of variable-pitch headless screws that may assist the surgeon in screw choice and method of use.
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Affiliation(s)
- Austin J Roebke
- Medical Student Research Program, The Ohio State University College of Medicine, Columbus, OH
| | | | - Kanu S Goyal
- Division of Hand and Upper Extremity, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH.
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