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Covarrubias O, Andrade NS, Mo KC, Dhanjani S, Olson J, Musharbash FN, Sachdev R, Kebaish KM, Skolasky RL, Neuman BJ. Abnormal Postoperative PROMIS Scores are Associated With Patient Satisfaction in Adult Spinal Deformity and Degenerative Spine Patients. Spine (Phila Pa 1976) 2024; 49:689-693. [PMID: 37530118 DOI: 10.1097/brs.0000000000004783] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/08/2023] [Indexed: 08/03/2023]
Abstract
STUDY DESIGN Retrospective review. OBJECTIVES To evaluate (1) patient satisfaction after adult spine surgery; (2) associations between the number of abnormal PROMIS domain scores and postoperative satisfaction; and (3) associations between the normalization of a patient's worst preoperative PROMIS domain score and postoperative satisfaction. SUMMARY OF BACKGROUND DATA Although "legacy" patient-reported outcome measures correlate with patient satisfaction after adult spine surgery, it is unclear whether PROMIS scores do. MATERIALS AND METHODS We included 1119 patients treated operatively for degenerative spine disease (DSD) or adult spinal deformity (ASD) from 2014 to 2019 at our tertiary hospital who completed questionnaires preoperatively and at ≥1 postoperative time points up to two years. Postoperative satisfaction was measured in ASD patients using items 21 and 22 from the SRS 22-revised questionnaire and in DSD patients using the NASS Patient Satisfaction Index. The "Worst" preoperative PROMIS domain was that with the greatest clinically negative deviation from the mean. "Normalization" was a postoperative score within 1 SD of the general population mean. Multivariate logistic regression identified factors associated with satisfaction. RESULTS Satisfaction was reported by 88% of DSD and 86% of ASD patients at initial postoperative follow-up; this proportion did not change during the first year after surgery. We observed an inverse relationship between postoperative satisfaction and the number of abnormal PROMIS domains at all postoperative time points beyond 6 weeks. Only among ASD patients was normalization of the worst preoperative PROMIS domain associated with greater odds of satisfaction at all time points up to one year. CONCLUSION The proportion of DSD and ASD patients satisfied postoperatively did not change from six weeks to 1 year. Normalizing the worst preoperative PROMIS domain and minimizing the number of abnormal postoperative PROMIS scores may reduce the number of dissatisfied patients. PROMIS data can guide perioperative patient management to improve satisfaction. LEVEL OF EVIDENCE Level-3.
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Affiliation(s)
- Oscar Covarrubias
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
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Chang K, Covarrubias O, Scott D, Paller D, Green A. Latarjet Procedure: Biomechanical Evaluation of 2 Screw Coracoid Fixation. J Shoulder Elbow Surg 2024:S1058-2746(24)00318-5. [PMID: 38710366 DOI: 10.1016/j.jse.2024.03.035] [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: 11/30/2023] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Coracoid nonunion is a relevant complication following the Latarjet procedure and is influenced by multiple factors, including the method of graft fixation. AIMS The purpose of this study was to evaluate and characterize the biomechanical properties of various two-screw fixation constructs used for coracoid graft fixation in the Latarjet procedure. METHODS Forty model scapulae (Sawbones Inc., Vashon, WA, USA) were used for this study. A 15 percent anterior inferior glenoid bone defect was created. The coracoid was osteotomized at the juncture of the vertical and horizontal aspects, transferred to the anterior-inferior edge of the glenoid, and fixed with either two 3.5 mm fully threaded cannulated cortical screws (FTCS), two 3.5 mm fully threaded solid cortical screws (FTSS), two 3.5 mm partially threaded cannulated screws (PTCS), or two 4.5 mm partially threaded malleolar screws (MS). Biomechanical testing was performed with an Instron materials testing machine (Instron Corp., Norwood, MA) by applying loads to the lateral aspect of the transferred coracoid graft. The constructs were preconditioned with non-destructive cyclical loading (0-20N) to determine construct stiffness. After 100 cycles of dynamic loading, the construct was loaded to failure to determine ultimate failure load, yield displacement, and mode of failure. RESULTS All failures were associated with plastic deformation of the screws and coracoid graft fracture. There was a significantly lower initial stiffness for PTCS compared to MS (186±49.3 N/mm vs 280±65.5 N/mm, p=0.01) but no significant differences among the other constructs. There was no difference in ultimate failure load (p=0.18) or yield displacement (p=0.05) among constructs. CONCLUSION Two screw coracoid fixation of the coracoid in a simulated classic Latarjet procedure with 3.5 mm fully threaded cortical and cannulated screws is comparable to 4.5 mm malleolar screws in strength, stiffness, and displacement at failure. On the other hand, partially threaded 3.5 mm cannulated screws provide inferior fixation stiffness and could potentially affect clinical outcomes.
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Affiliation(s)
- Kenny Chang
- Alpert Medical School, Brown University, Providence, RI, USA
| | - Oscar Covarrubias
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, RI, USA
| | - Douglas Scott
- Beaufort Orthopedic Sport and Spine, Hilton Head, SC, USA
| | - David Paller
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, RI, USA
| | - Andrew Green
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, RI, USA.
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Ghuman N, Atagu N, Sachdev R, Covarrubias O, Gregg L, Brookmeyer C, Johnson P, Gomez E. 'That's just the Ovary!' and other cases of mistaken identity on CT of the female pelvis. Curr Probl Diagn Radiol 2024; 53:422-435. [PMID: 38365459 DOI: 10.1067/j.cpradiol.2024.01.021] [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: 11/30/2023] [Accepted: 01/16/2024] [Indexed: 02/18/2024]
Abstract
CT is often the first imaging test in female patients with lower abdominal and pelvic pain because of the wide availability of CT and differential diagnoses that span both gynecologic and gastrointestinal disease. Pathology within the female pelvis may be difficult to diagnose on CT owing to suboptimal delineation of anatomy in comparison to MRI and ultrasound. These challenges are confounded by overlapping imaging features of a wide range of gynecologic entities and can lead to diagnostic dilemmas. High value CT interpretation will direct the clinician to the best next diagnostic step as ultrasound and MRI provide superior soft tissue delineation. Other imaging modalities, laboratory investigations, or tissue sampling may be necessary to definitively characterize indeterminate lesions. In this review, we illustrate various cases of mistaken identity on CT of the female pelvis involving the ovaries, uterus, and peritoneal cavity while highlighting clinical pearls that may aid the radiologist in arriving at the correct diagnosis and avoiding potential pitfalls.
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Affiliation(s)
- Naveen Ghuman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Norman Atagu
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Rahul Sachdev
- St.Agnes Medical Center, Department of Internal Medicine, Fresno, CA, USA
| | - Oscar Covarrubias
- Medical Student, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lydia Gregg
- Johns Hopkins Department of Art as Applied to Medicine and Division of Interventional Neuroradiology, Baltimore, MD, USA
| | - Claire Brookmeyer
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pamela Johnson
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erin Gomez
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Ghanem D, Covarrubias O, Maxson R, Sabharwal S, Shafiq B. Readability of Trauma-related Patient Education Materials From the American Academy of Orthopaedic Surgeons and Orthopaedic Trauma Association Websites. J Am Acad Orthop Surg 2024:00124635-990000000-00946. [PMID: 38684136 DOI: 10.5435/jaaos-d-23-00449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/03/2023] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION Web-based resources serve as a fundamental educational platform for orthopaedic trauma patients; however, they are frequently written above the recommended sixth-grade reading level, and previous studies have demonstrated this for the American Academy of Orthopaedic Surgeons (AAOS) web-based articles. In this study, we perform an updated assessment of the readability of AAOS trauma-related educational articles as compared with injury-matched education materials developed by the Orthopaedic Trauma Association (OTA). METHODS All 46 AAOS trauma-related web-based (https://www.orthoinfo.org/) patient education articles were analyzed for readability. Two independent reviewers used (1) the Flesch-Kincaid Grade Level (FKGL) and (2) the Flesch Reading Ease (FRE) algorithms to calculate the readability level. Mean readability scores were compared across body part categories. A one-sample t-test was done to compare mean FKGL with the recommended sixth-grade readability level and the average American adult reading level. A two-sample t-test was used to compare the readability scores of the AAOS trauma-related articles with those of the OTA. RESULTS The average (SD) FKGL and FRE for the AAOS articles were 8.9 (0.74) and 57.2 (5.8), respectively. All articles were written above the sixth-grade reading level. The average readability of the AAOS articles was significantly greater than the recommended sixth-grade reading level (P < 0.001). The average FKGL and FRE for all AAOS articles were significantly higher compared with those of the OTA articles (8.9 ± 0.74 versus 8.1 ± 1.14, P < 0.001 and 57.2 ± 5.8 versus 65.6 ± 6.6, P < 0.001, respectively). Excellent agreement was observed between raters for the FKGL 0.956 (95% confidence interval, 0.922 to 0.975) and FRE 0.993 (95% confidence interval, 0.987 to 0.996). DISCUSSION Our findings suggest that after almost a decade, the readability of the AAOS trauma-related articles remains unchanged. The AAOS and OTA trauma patient education materials have high readability levels and may be too difficult for patient comprehension. A need remains to improve the readability of these commonly used trauma education materials.
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Affiliation(s)
- Diane Ghanem
- From the Department of Orthopaedic Surgery, The Johns Hopkins Hospital (Ghanem, Sabharwal, and Shafiq), and the School of Medicine, The Johns Hopkins University, Baltimore, MD (Covarrubias, and Maxson)
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Hoffman R, Covarrubias O, Agaisse T, Portnoff B, Green A. How Anatomic Should Anatomic Total Shoulder Arthroplasty Be? Evaluation of Humeral Head Reconstruction With the Perfect Circle. J Shoulder Elbow Surg 2024:S1058-2746(24)00225-8. [PMID: 38554996 DOI: 10.1016/j.jse.2024.03.009] [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: 11/14/2023] [Revised: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Humeral implant designs for anatomic total shoulder arthroplasty (aTSA) focus on anatomic reconstruction of the articular segment. Likewise, the pathoanatomy of advanced glenohumeral osteoarthritis (GHOA) often results in humeral head deformity. We hypothesized the anatomic reconstruction of the humeral head in aTSA risks overstuffing the glenohumeral joint. METHODS 97 cases (52 females) of primary GHOA in patients treated with aTSA were evaluated. Preoperative computed tomography (CT) scans were used to classify glenoid morphology according to the Walch classification. Coronal plane images in the plane of the humerus were used to determine the anatomic perfect circle as described by Youderian et al. Humeral head thinning was determined as the distance from the center of rotation (COR) of the perfect circle to the nearest point along the humeral articular surface. aTSA was modeled with a predicted anatomic humeral head and a simulated 4 mm polyethylene glenoid component. The change in the position of the native humerus was determined. Wilcoxon Rank Sum tests were used to evaluate differences in humeral head thinning and humeral lateralization between monoconcave and biconcave glenoid morphologies. Spearman's rank correlation coefficients were used to assess the relationship between humeral head thinning with preoperative active forward elevation and external rotation. RESULTS The mean radius of the perfect circle was 25.0±2.1 mm. There was a mean thinning of 2.4±2.0 mm (Range -1.7-8.3). Mean percent thinning of the humeral head was 9.4%±7.7%. The mean humeral lateralization was 6.4±2.0 mm. Humeral head thinning was not significantly associated with active forward elevation (r=-0.15, p=0.14) or active external rotation (r= -0.12, p=0.25). There were no significant differences in the percentage of humeral head thinning (p=0.324) or humeral lateralization (p=0.350) between concentric and eccentric glenoid wear patterns CONCLUSIONS: Utilization of the perfect circle as a guide in aTSA may risk excessive lateralization of the humerus and overstuffing the glenohumeral joint. This may have implications for subscapularis repair and healing, as well as glenoid implant and rotator cuff longevity. These findings call into question whether recreation of normal glenohumeral anatomy in aTSA is appropriate for all patients. Humeral head reconstruction in aTSA should account for glenohumeral joint volume and soft tissue contracture.
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Affiliation(s)
- Ryan Hoffman
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, RI, USA
| | - Oscar Covarrubias
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, RI, USA
| | - Ty Agaisse
- Alpert Medical School, Brown University, Providence, RI, USA
| | - Brandon Portnoff
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, RI, USA
| | - Andrew Green
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, RI, USA.
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Suresh KV, Covarrubias O, Mun F, LaPorte DM, Aiyer AA. Preference Signaling Survey of Program Directors-After the Match. J Am Acad Orthop Surg 2024; 32:220-227. [PMID: 38175998 DOI: 10.5435/jaaos-d-23-00579] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/11/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION The 2022 to 2023 orthopaedic residency cycle implemented a preference signaling program (PSP), allowing applicants to send "signals" to up to 30 programs to demonstrate their genuine interest. With the conclusion of the 2022 to 2023 cycle, the primary purpose of this study was to analyze program director (PD) perceptions of the PSP after the match cycle and provide a retrospective evaluation of the effects of the PSP on the orthopaedic resident selection process. METHODS A 21-question survey was distributed to 98 PDs (32.7% response rate). Contact information was obtained from a national database. RESULTS Most respondents (96.9%) participated in the American Orthopaedic Association's PSP. The majority (93.7%) view preference signaling as a positive change. Most PDs (56.2%) reported a decreased number in applications received compared with previous years. Receiving a preference signal was ranked among the most important factors in resident selection, and most PDs agreed that preference signaling should be used to screen applicants (84.4%) and differentiate similar applicants (96.8%). Moreover, 65.6% of PDs indicated that they would not rank or invite applicants to interview without a signal or completion of a formal away rotation. PDs report that in the 2022 to 2023 cycle, 98.5% of applicants who matched at their program had sent a preference signal. DISCUSSION Preference signaling was one of the most important factors assessed during its inaugural application cycle and is anticipated to remain a key tool for screening and differentiating candidates. Applicants should strategically select signal recipients to enhance their success in the match.
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Affiliation(s)
- Krishna V Suresh
- From the Department of Orthopaedic Surgery, The Johns Hopkins Hospital (Suresh, Mun, LaPorte, and Aiyer), and the School of Medicine, The Johns Hopkins University, Baltimore, MD (Covarrubias)
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Daher M, Covarrubias O, Herber A, Oh I, Gianakos AL. Platelet-Rich Plasma vs Extracorporeal Shock Wave Therapy in the Treatment of Plantar Fasciitis at 3-6 Months: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Foot Ankle Int 2024:10711007241231959. [PMID: 38419209 DOI: 10.1177/10711007241231959] [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: 03/02/2024]
Abstract
BACKGROUND Plantar fasciitis (PF) is a common foot disorder with variability in treatment strategy. Two effective management techniques include platelet-rich plasma (PRP) injections and extracorporeal shock wave therapy (ESWT). The purpose of this meta-analysis is to compare the effectiveness of PRP vs ESWT in the management of PF. METHODS A systematic search was performed of PubMed, Cochrane, and Google Scholar for randomized controlled trials comparing PRP to ESWT. Studies met inclusion criteria if mean and SDs for visual analog scale (VAS) pain scores and plantar fascia thickness (PFT) were reported. Mean differences were used to compare VAS pain score and PFT between PRP and ESWT. RESULTS Six randomized controlled trials, comparing a total of 214 subjects in the PRP group and 218 subjects in the ESWT group, were analyzed. A significantly greater statistical improvement was seen in the PRP group in VAS pain (mean difference = -0.67 [95% CI -1.16, -0.18], P = .007) and plantar fascia thickness (PFT) (mean difference = -0.56 [95% CI -0.77, -0.35], P < .001). CONCLUSION PRP had a statistically higher pain reduction than ESWT, but the difference does not reach clinical significance in this meta-analysis.
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Affiliation(s)
- Mohammad Daher
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Oscar Covarrubias
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Agustin Herber
- School of Osteopathic medicine, Midwestern University, Chicago, IL, USA
| | - Irvin Oh
- Department of Foot and Ankle Surgery, Yale University, New Haven, CT, USA
| | - Arianna L Gianakos
- Department of Foot and Ankle Surgery, Yale University, New Haven, CT, USA
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Herber A, Covarrubias O, Daher M, Tung WS, Gianakos AL. Platelet rich plasma therapy versus other modalities for treatment of plantar fasciitis: A systematic review and meta-analysis. Foot Ankle Surg 2024:S1268-7731(24)00031-6. [PMID: 38395675 DOI: 10.1016/j.fas.2024.02.004] [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: 01/07/2024] [Revised: 02/04/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Plantar fasciitis (PF) is the most common cause of heel pain in adults. There are numerous non-operative treatments available including platelet rich plasma (PRP) injections. PPR has demonstrated effectiveness for a range of musculoskeletal conditions including plantar fasciitis. PURPOSE/OBJECTIVE To compare the effectiveness of PRP to other conservative treatment options for the management of PF. METHODS A systematic search of PubMed and Google Scholar was performed for randomized control trials (RCT) comparing PRP to other treatment modalities. Studies met inclusion criteria if mean and standard deviations for visual analog scale (VAS) pain scores, plantar fascia thickness (PFT), Foot Function Index (FFI), or American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score were reported. Mean differences (MD) were used to compare VAS pain, PFT, FFI, and AOFAS between PRP and other treatments. RESULTS Twenty-one RCTs which altogether included 1356 patients were included in the meta-analysis. PRP demonstrated significantly greater improvements in VAS pain scores compared to extracorporeal shock wave therapy (ESWT) (SMD: 0.86; CI: [0.30, 1.41]; p = 0.002), corticosteroid injections (CSI) (SMD: 1.08; CI: [0.05, 2.11]; p = 0.04), and placebo (SMD: 3.42; CI: [2.53, 4.31]; p < 0.00001). In terms of FFI, no significant differences existed among PRP, ESWT, CSI, dextrose prolotherapy (DPT), and meridian trigger points (MTP) in enhancing foot functionality. However, PRP demonstrated a marked advantage over phonophoresis, showing a substantial improvement in FFI scores (SMD: 3.07, 95% CI: 2.34-3.81). PRP did not demonstrate superiority over ESWT, CSI, or MTP for improving PFT, but it was notably more effective than phonophoresis (SMD: 3.18, 95% CI: 2.43-3.94). PRP demonstrated significantly greater improvements in AOFAS scores over CSI (SMD: 3.31, CI: [1.35, 5.27], p = 0.0009) and placebo (SMD: 3.75; CI: [2.81, 4.70]; p < 0.00001). CONCLUSION PRP is more effective than CSI, ESWT, and placebo in reducing VAS and more effective than CSI and placebo in improving AOFAS. PRP did not demonstrate a consistent advantage across all outcome measures, such as PFT and FFI. These findings underscore the complexity of PF treatment and call for a more standardized approach to PRP preparation and outcome measurement. LEVEL OF EVIDENCE Level I Meta-Analysis.
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Affiliation(s)
- Agustin Herber
- Department of Surgery, University of Arizona College of Medicine - Phoenix, Phoenix, AZ 85004, USA.
| | - Oscar Covarrubias
- Department of Orthopedics, Brown University, Providence, RI 02906, USA
| | - Mohammad Daher
- Department of Orthopedics, Brown University, Providence, RI 02906, USA
| | - Wei Shao Tung
- Department of Orthopaedics and Rehabilitation, Yale University, New Haven, CT 06510, USA
| | - Arianna L Gianakos
- Department of Orthopaedics and Rehabilitation, Yale University, New Haven, CT 06510, USA
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Shu HT, Ghanem D, Rogers DL, Covarrubias O, Izard P, Hacquebord J, Lim P, Gupta R, Osgood GM, Shafiq B. Failure after operative repair is higher for ballistic femoral neck fractures than for closed, blunt-injury fractures: a multicenter retrospective cohort study. Trauma Surg Acute Care Open 2024; 9:e001241. [PMID: 38347891 PMCID: PMC10860054 DOI: 10.1136/tsaco-2023-001241] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Introduction The purpose of this study was to describe the outcomes after operative repair of ballistic femoral neck fractures. To better highlight the devastating nature of these injuries, we compared a cohort of ballistic femoral neck fractures to a cohort of young, closed, blunt-injury femoral neck fractures treated with open reduction and internal fixation (ORIF). Methods Retrospective chart review identified all patients presenting with ballistic femoral neck fractures treated at three academic trauma centers between January 2016 and December 2021, as well as patients aged ≤50 with closed, blunt-injury femoral neck fractures who received ORIF. The primary outcome was failure of ORIF, which includes the diagnosis of non-union, avascular necrosis, conversion to total hip arthroplasty, and conversion to Girdlestone procedure. Additional outcomes included deep infection, postoperative osteoarthritis, and ambulatory status at last follow-up. Results Fourteen ballistic femoral neck fractures and 29 closed blunt injury fractures were identified. Of the ballistic fractures, 7 (50%) patients had a minimum of 1-year follow-up or met the failure criteria. Of the closed fractures, 16 (55%) patients had a minimum of 1-year follow-up or met the failure criteria. Median follow-up was 21 months. 58% of patients with ballistic fractures were active tobacco users. Five of 7 (71%) ballistic fractures failed, all of which involved non-union, whereas 8 of 16 (50%) closed fractures failed (p=0.340). No outcomes were significantly different between cohorts. Conclusion Our results demonstrate that ballistic femoral neck fractures are associated with high rates of non-union. Large-scale multicenter studies are necessary to better determine optimal treatment techniques for these fractures. Level of evidence Level III. Retrospective cohort study.
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Affiliation(s)
- Henry Tout Shu
- Orthopedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Diane Ghanem
- Orthopedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Davis L. Rogers
- Orthopedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Oscar Covarrubias
- Orthopedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Paul Izard
- Orthopaedic Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Jacques Hacquebord
- Orthopaedic Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Philip Lim
- Orthopaedic Surgery, University of California Irvine School of Medicine, Irvine, California, USA
| | - Ranjan Gupta
- Orthopaedic Surgery, University of California Irvine School of Medicine, Irvine, California, USA
| | - Greg M. Osgood
- Orthopedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Babar Shafiq
- Orthopedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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Shu HT, Covarrubias O, Shah MM, Muquit ST, Yang VB, Zhao X, Kagabo W, Shou BL, Kalra A, Whitman G, Kim BS, Cho SM, LaPorte DM, Shafiq B. What Factors Are Associated With Arterial Line-Related Limb Ischemia in Patients on Extracorporeal Membrane Oxygenation? A Single-Center Retrospective Cohort Study. J Cardiothorac Vasc Anesth 2023; 37:2489-2498. [PMID: 37735020 DOI: 10.1053/j.jvca.2023.08.131] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/27/2023] [Accepted: 08/14/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVES The primary purpose of this study was to identify factors associated with the development of arterial line-related limb ischemia in patients on extracorporeal membrane oxygenation (ECMO). The authors also sought to characterize and report the outcomes of patients who developed arterial line-related limb ischemia. DESIGN Retrospective cohort study. SETTING A single academic tertiary referral ECMO center. PARTICIPANTS Consecutive patients who were treated with ECMO over 6 years. INTERVENTIONS Use of arterial line. MEASUREMENTS AND MAIN RESULTS A total of 278 consecutive ECMO patients were included, with 19 (7%) patients developing arterial line-related limb ischemia during the ECMO run. Postcannulation Sequential Organ Failure Assessment (SOFA) (adjusted odds ratio [aOR] 1.20, 95% CI 1.08-1.32), Acute Physiology and Chronic Health Evaluation-II (aOR 0.84, 95% CI 0.74-0.95), and adjusted Vasopressor Dose Equivalence (aOR 1.03, 95% CI 1.01-1.05) scores were independently associated with the development of arterial line-associated limb ischemia. A SOFA score of ≥17 at the time of ECMO cannulation had an 80% sensitivity and 87% specificity for predicting arterial line-related limb ischemia. CONCLUSIONS Arterial line-related limb ischemia is much more common in ECMO patients than in the typical intensive care unit setting. The SOFA score may be useful in identifying which patients may be at risk for arterial line-related limb ischemia. As this was a single-center retrospective study, these results are inherently exploratory, and prospective multicenter studies are necessary to validate these results.
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Affiliation(s)
- Henry T Shu
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Oscar Covarrubias
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Manuj M Shah
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Siam T Muquit
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Victor B Yang
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Xiyu Zhao
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Whitney Kagabo
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Benjamin L Shou
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andrew Kalra
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Glenn Whitman
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bo Soo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sung-Min Cho
- Division of Neuroscience Critical Care, Departments of Neurology and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dawn M LaPorte
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Babar Shafiq
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Ghanem D, Covarrubias O, Raad M, LaPorte D, Shafiq B. ChatGPT Performs at the Level of a Third-Year Orthopaedic Surgery Resident on the Orthopaedic In-Training Examination. JB JS Open Access 2023; 8:e23.00103. [PMID: 38638869 PMCID: PMC11025881 DOI: 10.2106/jbjs.oa.23.00103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
Introduction Publicly available AI language models such as ChatGPT have demonstrated utility in text generation and even problem-solving when provided with clear instructions. Amidst this transformative shift, the aim of this study is to assess ChatGPT's performance on the orthopaedic surgery in-training examination (OITE). Methods All 213 OITE 2021 web-based questions were retrieved from the AAOS-ResStudy website (https://www.aaos.org/education/examinations/ResStudy). Two independent reviewers copied and pasted the questions and response options into ChatGPT Plus (version 4.0) and recorded the generated answers. All media-containing questions were flagged and carefully examined. Twelve OITE media-containing questions that relied purely on images (clinical pictures, radiographs, MRIs, CT scans) and could not be rationalized from the clinical presentation were excluded. Cohen's Kappa coefficient was used to examine the agreement of ChatGPT-generated responses between reviewers. Descriptive statistics were used to summarize the performance (% correct) of ChatGPT Plus. The 2021 norm table was used to compare ChatGPT Plus' performance on the OITE to national orthopaedic surgery residents in that same year. Results A total of 201 questions were evaluated by ChatGPT Plus. Excellent agreement was observed between raters for the 201 ChatGPT-generated responses, with a Cohen's Kappa coefficient of 0.947. 45.8% (92/201) were media-containing questions. ChatGPT had an average overall score of 61.2% (123/201). Its score was 64.2% (70/109) on non-media questions. When compared to the performance of all national orthopaedic surgery residents in 2021, ChatGPT Plus performed at the level of an average PGY3. Discussion ChatGPT Plus is able to pass the OITE with an overall score of 61.2%, ranking at the level of a third-year orthopaedic surgery resident. It provided logical reasoning and justifications that may help residents improve their understanding of OITE cases and general orthopaedic principles. Further studies are still needed to examine their efficacy and impact on long-term learning and OITE/ABOS performance.
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Affiliation(s)
- Diane Ghanem
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Oscar Covarrubias
- School of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Micheal Raad
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Dawn LaPorte
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Babar Shafiq
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
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Olson JT, Covarrubias O, Mo KC, Schmerler J, Kurian SJ, Laporte D. Systematic YouTube Review - Trigger Finger Release. J Hand Surg Asian Pac Vol 2023; 28:342-349. [PMID: 37173138 DOI: 10.1142/s2424835523500315] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Background: With lack of regulation and incentivisation on YouTube for high-quality healthcare information, it is important to objectively evaluate the quality of information on trigger finger - a common condition for hand surgeon referral. Methods: YouTube was queried (11/21/2021) for videos on trigger finger release surgery. Videos were excluded if they were about unrelated topics or not in English. The most viewed 59 videos were categorised by source as physician or non-physician. Two independent reviewers quantified the reliability, quality and content of each video, with inter-rater reliability assessed using Kohen's Kappa test. Reliability was assessed using the Journal of the American Medical Association (JAMA) score. Quality was assessed using the DISCERN score with high-quality videos defined as those with scores in the sample upper 25th percentile. Content was assessed using the informational content score (ICS) with scores in the sample upper 25th percentile indicating more complete information. Two-sample t-tests and logistic regression were used to assess variations between sources. Results: Videos by physicians had higher DISCERN quality (42.6 ± 7.9, 36.4 ± 10.3; p = 0.02) and informational content (5.8 ± 2.6, 4.0 ± 1.7; p = 0.01) scores compared to those by non-physician sources. Videos by physicians were associated with increased odds of high-quality (Odds Ratio [OR] 5.7, 95% Confidence Interval [95% CI] 1.3-41.3) and provided more complete patient information (OR 6.3, 95% CI 1.4-48.9). The lowest DISCERN sub-scores for all videos were discussion of the uncertainties and risks associated with surgery. The lowest ICS for all videos were in the diagnosis of trigger finger (11.9%) and non-surgical prognosis (15.3%). Conclusions: Physician videos have more complete and higher quality information on trigger finger release. Additionally, discussion of treatment risks, areas of uncertainty, the diagnostic process, non-surgical prognosis and transparency on references used were identified as lacking content. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Jarod T Olson
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Kevin C Mo
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Shyam J Kurian
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dawn Laporte
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Xu AL, Covarrubias O, Yakkanti R, Aiyer AA. The Biomechanical Burden of Orthopaedic Procedures and Musculoskeletal Injuries Sustained by Surgeons: A Systematic Review. Foot & Ankle Orthopaedics 2022. [DOI: 10.1177/2473011421s01008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Category: Other; Trauma Introduction/Purpose: Orthopaedic surgeons are at high risk for experiencing work-related musculoskeletal injuries and chronic pain. This is largely due to daily exposure to repetitive large magnitude forces, altered posture from the use of leaded vests, and prolonged standing often in irregular body positions. We sought to synthesize available evidence regarding 1) the biomechanics of orthopaedic surgery and 2) musculoskeletal injuries sustained by orthopaedic surgeons with subsequent treatment and consequences. Methods: To conduct this systematic review, we queried four databases (PubMed, Embase, MEDLINE, and Web of Science) for original research studies presenting on the biomechanics of orthopaedic surgery or musculoskeletal injuries sustained by orthopaedic surgeons. Studies were excluded if they were not original research (i.e., reviews) or reported on injuries to patients, non-musculoskeletal injuries, or non-orthopaedic subspecialties. The literature search yielded 3,202 publications, 36 of which were included in the final analysis. Results: Eight studies reported on the biomechanics of orthopaedic surgery. Surgeons spent an average 41.6% of time slouched during surgeries. Head and whole spine angles were closest to natural standing position when using a microscope for visualization and with higher surgical field heights. Use of lead aprons resulted in a shifted weight distribution on the forefoot, gain in thoracic kyphosis, and increase in lateral deviation from postural loading. Twenty-eight studies reported on musculoskeletal conditions experienced by orthopaedic surgeons. The overall prevalence of musculoskeletal symptoms or injury involving any body region ranged from 44-97%. Prevalence by body region in decreasing order were as follows: lower back (15.2-89.5%), hip/thigh (4.4- 86.6%), neck (2.4-74%), hand/wrist (10.5-54%), shoulder (7.1-48.5%), elbow (3.1-28.3%), knee/lower leg (7.9-27.4%), and foot/ankle (7-25.7%). Of surgeons with any reported musculoskeletal symptom or injury, 27-65.7% required nonoperative treatment, 3.2- 34.3% required surgery, and 33.3-59.3% indicated that their operative performance was affected. Conclusion: The orthopaedic surgeon population experiences a high prevalence of musculoskeletal symptoms and injuries, likely secondary to the biomechanical burdens of tasks required of them during strenuous operations. Ergonomic interventions must be taken within the operating room to reduce this prevalence, increase the physical well-being of orthopaedic surgeons, and reduce the healthcare costs associated with time off work and early retirement as a result of musculoskeletal conditions.
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Kolarich A, Ring N, Pang S, Farhan A, Covarrubias O, Ng R, Solomon A, Gullotti D, Holly B, Hong K, Georgiades C. Abstract No. 195 National trends in transjugular intrahepatic portosystemic shunt placement, revision, and trainee procedure involvement. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Csendes A, Flores N, Eulufi A, Covarrubias O, Lazo M. [Acute peptic ulcer perforation: immediate and delayed results (author's transl)]. Rev Med Chil 1976; 104:523-7. [PMID: 1021815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Csendes A, Covarrubias O, Carvajal C. [The augmented histamine test in patients with incipient and advanced gastric cancer (author's transl)]. Rev Med Chil 1974; 102:690-2. [PMID: 4456519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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