1

Orthopaedics Current Awareness

Newsletter

December 2015

2

Training Calendar 2016

The Library and Information Service provides free specialist information skills training

for all UHBristol staff and students.

To book a place, email: library@uhbristol.nhs.uk

If you’re unable to attend we also provide one-to-one or small group sessions. Contact

library@uhbristol.nhs.uk to arrange a session.

Literature Searching

An in-depth guide to formulating an effective search strategy and getting the most out of searching key healthcare databases.

Understanding Articles

How to assess the strengths and weaknesses of research methods.

Examining different research de-signs, bias and validity, and frameworks for systematically ap-praising a medical paper.

Medical Statistics

A basic introduction to the key statistics in medical articles.

Giving an overview of statistics that compare risk, test confidence, analyse clinical investigations, and test difference.

Information Resources

A comprehensive overview of Li-brary subscription resources, freely available online resources and ‘grey literature’.

January (1pm)

Mon 4th Literature Searching Tues 12th Understanding articles Weds 20th Statistics Thurs 28th Information resources

February (12pm)

Fri 5th Literature Searching Mon 8th Understanding articles Tues 16th Statistics Weds 24th Information resources

March (1pm)

Thurs 3rd Literature Searching Fri 11th Understanding articles Mon 14th Statistics Tues 22nd Information resources Weds 30th Literature Searching

April (12pm)

Thurs 7th Understanding articles Fri 15th Statistics Mon 18th Information resources Tues 26th Literature Searching

May (1pm)

Weds 4th Understanding articles Thurs 12th Statistics Fri 20th Information resources Tues 31st Literature Searching

June (12pm) Weds 8th Understanding articles Thurs 16th Statistics Fri 24th Information resources

3

Contents

Your Friendly Local Librarian… ................................................................................................................ 3

New Activity in Up-to-Date ................................................................................................................. 5

Current Awareness Database Articles related to Orthopaedics ............................................................. 6

Medical ............................................................................................................................................ 6

Patient care and management ...................................................................................................... 15

Other ............................................................................................................................................. 17

Journal Tables of Contents .................................................................................................................... 25

Journal of Bone and Joint Surgery; Vol. 97, iss. 15, August 2015 ....... Error! Bookmark not defined.

Journal of Orthopaedic Trauma; Vol. 29, iss. 8, Augustl 2015 ............. Error! Bookmark not defined.

Injury; Vol. 46, iss. 8, August 2015 ...................................................... Error! Bookmark not defined.

Strategies in Trauma and Limb Construction; Vol. 10, iss. 1, April 2015 ............ Error! Bookmark not

defined.

Clinical Orthopaedics and Related Research; Vol. 473, iss. 8, August 2015 ..... Error! Bookmark not

defined.

Your Friendly Local Librarian

Whatever your information needs, the library is here to help. As your outreach librarian I offer

literature searching services as well as training and guidance in searching the evidence and critical

appraisal – just email me at library@uhbristol.nhs.uk

OUTREACH: Your Outreach Librarian can help facilitate evidence-based practise for all in the

Orthopaedics team, as well as assisting with academic study and research. We can help with

literature searching, obtaining journal articles and books, and setting up individual current

awareness alerts. We also offer one-to-one or small group training in literature searching,

accessing electronic journals, and critical appraisal. Get in touch: library@uhbristol.nhs.uk

LITERATURE SEARCHING: We provide a literature searching service for any library member. For

those embarking on their own research it is advisable to book some time with one of the librarians

for a 1 to 1 session where we can guide you through the process of creating a well-focused literature

research and introduce you to the health databases access via NHS Evidence.

Please email requests to library@uhbristol.nhs.uk

4

To access electronic resources you need an NHS Athens username and password

To register, click on the link:

https://openathens.nice.org.uk/

You need to register using an NHS PC and an NHS email address.

Registration is a quick, simple process, and will give you access to a huge range of online subscription resources, including:

UpToDate

Dynamed

NHS Evidence

Anatomy.tv

E-journals

E-books

For more information or help with setting up your Athens account, email: Library@uhbristol.nhs.uk

5

New Activity in Up-to-Date

General principles of acute fracture management

Authors: Richard Derby, MD; Anthony Beutler, MD

Literature review current through: Nov 2015. | This topic last updated: Aug 13, 2014.

INTRODUCTION — Patients with suspected fractures require urgent and sometimes emergent evaluation to determine if serious complicating conditions exist. Such conditions, including any neurovascular injury, often require immediate surgical consultation [1,2]. Nevertheless, many fractures are uncomplicated and can be managed effectively in a non-surgical setting.

The acute management of uncomplicated fractures is reviewed below and involves the following steps:

●Initial clinical assessment

●Radiographic assessment

●Immobilization

●Pain management

●Patient education and follow-up care

Basic concepts of fracture healing, the proper way to describe fractures based upon clinical findings and radiographic appearance, pediatric fracture management, and the basic principles of long-term fracture management are discussed separately.

Fibula fractures

Author: Karl B Fields, MD

Literature review current through: Nov 2015. | This topic last updated: Jun 29, 2015.

INTRODUCTION — Fibular fractures, particularly those involving the ankle and the shaft just proximal, are common. They often result from minor trauma. Initial management is often provided by primary care and emergency clinicians, who must therefore be familiar with these injuries.

The diagnosis and management of fibular fractures is discussed here. Ankle fractures and sprains, stress fractures of the fibula, and fibula fractures in children are reviewed separately.

6

Current Awareness Database Articles

related to Orthopaedics

Below is a selection of articles related to orthopaedics recently added to the healthcare databases,

grouped in the following categories:

Medical

Patient care and management

Other

If you would like any of the following articles in full text, or if you would like a more focused

search on your own topic, then get in touch: library@uhbristol.nhs.uk

Medical

Title: Evaluation of a short dynamic (18)F-fluoride PET/CT scanning method to assess bone metabolic activity in spinal orthopedics.

Citation: Annals of nuclear medicine, Nov 2015, vol. 29, no. 9, p. 799-809 (November 2015)

Author(s): Peters, Marloes J M, Wierts, Roel, Jutten, Elisabeth M C, Halders, Servé G E A, Willems, Paul C P H, Brans, Boudewijn

Abstract: A complication after spinal fusion surgery is pseudarthrosis, but its radiological diagnosis is of limited value. (18)F-fluoride PET with its ability to assess bone metabolism activity could be of value. The goal of this study was to assess the clinical feasibility of calculating the static standardized uptake value (SUV) from a short dynamic scan without the use of blood sampling, thereby obtaining all dynamic and static parameters in a scan of only 30 min. This approach was tested on a retrospective patient population with persisting pain after spinal fusion surgery. In 16 patients, SUVs (SUVmax, SUVmean) and kinetic parameters (K 1, k 2, k 3, v b, K i,NLR, K 1/k 2, k 3/(k 2 + k 3), K i,patlak) were derived from static and dynamic PET/CT scans of operated and control regions of the spine, after intravenous administration of 156-214 MBq (18)F-fluoride. Parameter differences between control and operated regions, as well as between pseudarthrosis and fused segments were evaluated. SUVmean at 30 and 60 min was calculated from kinetic parameters obtained from the dynamic data set (SUVmean,2TCM). Agreement between measured and calculated SUVs was evaluated through Bland-Altman plots. Overall, statistically significant differences between control and operated regions were observed for SUVmax, SUVmean, K i,NLR, K i,patlak, K 1/k 2 and k 3/(k 2 + k 3). Diagnostic CT showed pseudarthrosis in 6/16 patients, while in 10/16 patients, segments were fused. Of all parameters, only those regarding the incorporation of bone [K i,NLR, K i,patlak, k 3/(k 2 + k 3)] differed statistically significant in

7

the intervertebral disc space between the pseudarthrosis and fused patients group. The mean values of the patient-specific blood clearance rate [Formula: see text] differed statistically significant between the pseudarthrosis and the fusion group, with a p value of 0.011. This may correspond with the lack of statistical significance of the SUV values between pseudarthrosis and fused patients. Bland-Altman plots show that calculated SUVmean,2TCM values corresponded well with the measured SUVmean values. This study shows the feasibility of a 30-min dynamic (18)F-fluoride PET/CT scanning and this may provide dynamic parameters clinically relevant to the diagnosis of pseudarthrosis.

Title: Comparison of effects and complications of unilateral versus standard spinal anesthesia in orthopedic surgery of lower limbs.

Citation: Brazilian journal of anesthesiology (Elsevier), Nov 2015, vol. 65, no. 6, p. 535-536

Author(s): Nunes Guimaraes, Gabriel Magalhaes

Title: Orthopedic asymmetry and clavicle length.

Citation: Clinical anatomy (New York, N.Y.), Nov 2015, vol. 28, no. 8, p. 964.

Author(s): Loh, Jing L, Wong, Keng L, Hwang, Stephen, Shen, Liang, Murphy, Diarmuid P,

Title: Antimicrobial efficacy of preoperative skin antisepsis and clonal relationship to postantiseptic skin-and-wound flora in patients undergoing clean orthopedic surgery.

Citation: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, Nov 2015, vol. 34, no. 11, p. 2265-2273

Author(s): Daeschlein, G, Napp, M, Layer, F, von Podewils, S, Haase, H, Spitzmueller, R, Assadian, O, Kasch, R, Werner, G, Jünger, M, Hinz, P, Ekkernkamp, A

Abstract: Nosocomial surgical site infections (SSI) are still important complications in surgery. The underlying mechanisms are not fully understood. The aim of this study was to elucidate the possible role of skin flora surviving preoperative antisepsis as a possible cause of SSI. We conducted a two-phase prospective clinical trial in patients undergoing clean orthopedic surgery at a university trauma center in northern Germany. Quantitative swab samples were taken from pre- and postantiseptic skin and, additionally, from the wound base, wound margin, and the suture of 137 patients. Seventy-four patients during phase I and 63 during phase II were investigated. Microbial growth, species spectrum, and antibiotic susceptibility were analyzed. In phase two, the clonal relationship of strains was additionally analyzed. 18.0 % of the swab samples were positive for bacterial growth in the wound base, 24.5 % in the margin, and 27.3 % in the suture. Only 65.5 % of patients showed a 100 % reduction of the skin flora after antisepsis. The microbial spectrum in all postantiseptic samples was dominated by coagulase-negative staphylococci (CoNS). Clonally related staphylococci were detected in ten patients [nine CoNS, one methicillin-susceptible Staphylococcus aureus (MSSA)]. Six of ten patients were suspected of having transmitted identical clones from skin flora into the wound. Ethanol-based antisepsis results in unexpected high levels of skin flora, which can be transmitted into the wound during surgery causing yet unexplained SSI. Keeping with the concept of zero tolerance, further

8

studies are needed in order to understand the origin of this flora to allow further reduction of SSI.

Title: Preparation and bioactive properties of chitosan and casein phosphopeptides composite coatings for orthopedic implants.

Citation: Carbohydrate polymers, Nov 2015, vol. 133, p. 236-244

Author(s): Qin, Liguo, Dong, Huanhuan, Mu, Ziqing, Zhang, Yali, Dong, Guangneng

Abstract: Using the layer-by-layer deposition method, functional chitosan/casein phospopeptides (CS/CPP) composite coatings were produced on Co-Cr-Mo alloy. The CS/CPP composite coatings had the dendritic topography, and were quite hydrophilic. Zeta potential measurements showed the composite coatings were negative charged at neural pH. XPS results indicated that the CS/CPP composite coatings were covalently bond to the substrate. When MC3T3-E1 cells were seeded on the CS/CPP composite coatings, no cytotoxicity was observed. The bone morphogenetic protein-2 (BMP-2) mRNA expression was significantly up-regulated in MC3T3-E1 cells cultured on the composite coatings and it was twice as much as that of cells cultured on the bare substrate. The expression of osteoprotegerin (OPG) mRNA and the ratio of OPG/receptor activator of nuclear factor-κB ligand (RNAKL) mRNA were increased 5-fold and 55-fold, respectively. These results suggested the CS/CPP composite coatings may have potential application in cobalt matrix orthopaedic implants. Copyright © 2015 Elsevier Ltd. All rights reserved.

Title: Silicon oxide based materials for controlled release in orthopedic procedures.

Citation: Advanced drug delivery reviews, Nov 2015, vol. 94, p. 96-115 (November 1, 2015)

Author(s): Qu, Haibo, Bhattacharyya, Sanjib, Ducheyne, Paul

Abstract: By virtue of excellent tissue responses in bone tissue, silicon oxide (silica) based materials have been used for bone tissue engineering. Creating nanoscale porosity within silica based materials expands their applications into the realm of controlled release area. This additional benefit of silica based materials widens their application in the orthopedic fields in a major way. This review discusses the various chemical and physical forms of silica based controlled release materials, the release mechanisms, the applications in orthopedic procedures and their overall biocompatibility. Copyright © 2015 Elsevier B.V. All rights reserved.

Title: Administration of antibiotic agents before intraoperative sampling in orthopedic infections alters culture results.

Citation: The Journal of infection, Nov 2015, vol. 71, no. 5, p. 518-525 (November 2015)

Author(s): Al-Mayahi, Mohamed, Cian, Anais, Lipsky, Benjamin A, Suvà, Domizio,

Abstract: Many physicians and surgeons think that prescribing antibiotics before intraoperative sampling does not alter the microbiological results. Case-control study of adult patients hospitalized with orthopedic infections. Among 2740 episodes of orthopedic infections, 1167 (43%) had received antibiotic therapy before surgical sampling. Among

9

these, 220 (19%) grew no pathogens while the proportion of culture-negative results in the 2573 who had no preoperative antibiotic therapy was only 6%. By multivariate analyses, pre-operative antibiotic exposure was associated with significantly more culture-negative results (odds ratio 2.8, 95% confidence interval 2.1-3.7), more non-fermenting rods and skin commensals (odds ratio 2.8 and 3.0, respectively). Even a single pre-operative dose of antibiotic was significantly associated with subsequent culture-negative results (19/93 vs. 297/2350; χ(2)-test, p = 0.01) and skin commensals (17/74 vs. 274/2350; p = 0.01) compared to episodes without preceding prophylaxis. Prior antibiotic use, including single-dose prophylactic administrations, is three-fold associated with culture-negative results, non-fermenting rods and resistant skin commensals. Copyright © 2015 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Title: Should preoperative duplex for orthopedic operations be performed? The answer seems to be negative.

Citation: Thrombosis research, Nov 2015, vol. 136, no. 5, p. 841-842 (November 2015)

Author(s): Markel, Arie

Title: Dual-Energy Computed Tomography-How Accurate Is Gemstone Spectrum Imaging Metal Artefact Reduction? Its Application to Orthopedic Metal Implants.

Citation: Journal of computer assisted tomography, Nov 2015, vol. 39, no. 6, p. 925-935

Author(s): Dabirrahmani, Danè, Magnussen, John, Appleyard, Richard Charles

Abstract: To assess the accuracy and suitability of dual-energy computed tomography (DECT) in scanning metals used in orthopedic implants. Four metal phantoms (Cobalt Chrome, Titanium Grade 5, Stainless Steel 316, and Stainless Steel 630), commonly used materials in orthopedic implants, were scanned by conventional, polychromatic CT as well as Gemstone Spectrum Imaging (GSI) DECT, with and without metal artefact reduction software (MARS). Scans were assessed for artefact based on Hounsfield unit values; and surfaces generated, based on a Canny edge detection algorithm. Two separate metal implants were also scanned and assessed for dimensional accuracy. Conventional, polychromatic CT, and GSI DECT (without MARS) scans displayed major beam hardening in the presence of all four metals. The GSI DECT with MARS showed very clear and reproducible boundaries with minimal noise surrounding the metal phantoms. However, geometric analysis found overestimation of the dimensions, volume, and surface area for most of the metal phantoms. Titanium displayed the least artefact, compared to the other metals, in all scan scenarios. Although metal artefact reduction using GSI DECT looks superior to conventional CT, when measured objectively, it was shown to overestimate geometries and skew dimensions. The GSI DECT with MARS should be used with caution, especially when assessing questions of implant shape or wear.

Title: Biomechanical and bioactivity concepts of polyetheretherketone composites for use in orthopedic implants-a review.

10

Citation: Journal of biomedical materials research. Part A, Nov 2015, vol. 103, no. 11, p. 3689-3702 (November 2015)

Author(s): Abdullah, Mohamed Ruslan, Goharian, Amirhossein, Abdul Kadir, Mohammed

Abstract: The use of polyetheretherketone (PEEK) composites in the trauma plating system, total replacement implants, and tissue scaffolds has found great interest among researchers. In recent years (2008 afterward), this type of composites has been examined for suitability as substitute material over stainless steel, titanium alloys, ultra high molecular weight polyethylene, or even biodegradable materials in orthopedic implant applications. Biomechanical and bioactivity concepts were contemplated for the development of PEEK orthopedic implants and a few primary clinical studies reported the clinical outcomes of PEEK-based orthopedic implants. This study aims to review and discuss the recent concepts and contribute further concepts in terms of biomechanical and bioactivity challenges for the development of PEEK and PEEK composites in orthopedic implants. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 103A: 3689-3702, 2015. © 2015 Wiley Periodicals, Inc.

Title: Pathogenic potential of Escherichia coli clinical strains from orthopedic implant infections towards human osteoblastic cells.

Citation: Pathogens and disease, Nov 2015, vol. 73, no. 8, p. ftv065. (November 2015)

Author(s): Crémet, Lise, Broquet, Alexis, Brulin, Bénédicte, Jacqueline, Cédric,

Abstract: Escherichia coli is one of the first causes of Gram-negative orthopedic implant infections (OII), but little is known about the pathogenicity of this species in such infections that are increasing due to the ageing of the population. We report how this pathogen interacts with human osteoblastic MG-63 cells in vitro, by comparing 20 OII E. coli strains to two Staphylococcus aureus and two Pseudomonas aeruginosa strains. LDH release assay revealed that 6/20 (30%) OII E. coli induced MG-63 cell lysis whereas none of the four control strains was cytotoxic after 4 h of coculture. This high cytotoxicity was associated with hemolytic properties and linked to hlyA gene expression. We further showed by gentamicin protection assay and confocal microscopy that the non-cytotoxic E. coli were not able to invade MG-63 cells unlike S. aureus strains (internalization rate <0.01% for the non-cytotoxic E. coli versus 8.88 ± 2.31% and 4.60 ± 0.42% for both S. aureus). The non-cytotoxic E. coli also demonstrated low adherence rates (<7%), the most adherent E. coli eliciting higher IL-6 and TNF-α mRNA expression in the osteoblastic cells. Either highly cytotoxic or slightly invasive OII E. coli do not show the same infection strategies as S. aureus towards osteoblasts. © FEMS 2015. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Title: Pitavastatin attenuates monocyte activation in response to orthopedic implant‐derived wear particles by suppressing the NF‐κB signaling pathway.

Citation: Molecular medicine reports, Nov 2015, vol. 12, no. 5, p. 6932-6938

Author(s): Zhang, Zehua, Dai, Fei, Cheng, Peng, Luo, Fei, Hou, Tianyong, Zhou, Qiang,

11

Abstract: Aseptic loosening secondary to particle‐induced periprosthetic osteolysis is considered to be the primary cause of long‐term implant failure in orthopedic surgery. Implant‐derived wear particles activate and recruit macrophages and osteoclasts, which cause a persistent inflammatory response with bone destruction that is followed by a loosening of the implant. Thus, strategies for inhibiting macrophage and osteoclast function may provide a therapeutic benefit for preventing aseptic loosening. The aim of the present study was to determine the effects of pitavastatin on the activation and cytokine response of polymethyl methacrylate (PMMA) particle‐induced monocytes. Peripheral blood monocytes were obtained and treated with PMMA and pitavastatin. ELISA demonstrated that pitavastatin inhibited mRNA and protein expression of interleukin (IL)‐1β, IL‐6 and tumor necrosis factor‐α. Western blot analysis and immunofluorescence staining demonstrated that pitavastatin downregulated inhibitor of κB phosphorylation and degradation, and nuclear factor κ‐light‐chain‐enhancer of activated B cells (NF‐κB) p65 translocation. Together, these results indicate that pitavastatin may attenuate monocyte activation in response to orthopedic implant wear particles by suppression of the NF‐κB signaling pathway.

Title: Prevalence, Timing, Causes, and Outcomes of Hyponatremia in Hospitalized Orthopaedic Surgery Patients.

Citation: The Journal of bone and joint surgery. American volume, Nov 2015, vol. 97, no. 22, p. 1824-1832 (November 18, 2015)

Author(s): Hennrikus, Eileen, Ou, George, Kinney, Bradley, Lehman, Erik, Grunfeld, Robert,

Abstract: Hyponatremia is common among orthopaedic patients and is associated with adverse clinical outcomes. We examined the prevalence, timing, causes, and outcomes of hyponatremia in adult hospitalized orthopaedic surgery patients. We evaluated the medical records of 1067 consecutive orthopaedic surgery patients admitted to a tertiary academic institution. The medical records were reviewed to investigate hyponatremia (serum sodium <135 mEq/L) that (1) had been present on hospital admission or (2) had developed postoperatively. The primary outcomes were the prevalence and timing of, and risk factors for, presentation with or development of hyponatremia. Secondary outcomes were hospital length of stay, total hospital cost, and discharge disposition. Multivariable logistic regression models were used to assess the variables associated with hyponatremia and the effects of hyponatremia on clinical outcomes. Of the 1067 patients, seventy-one (7%) had preoperative hyponatremia and 319 (30%) developed hyponatremia postoperatively. Of the latter, 298 (93%) developed hyponatremia within forty-eight hours postoperatively. Compared with patients with normonatremia, those who presented with hyponatremia, on the average, were older (67.2 versus 60.5 years, p < 0.001), had longer hospital stays (4.6 versus 3.3 days, p < 0.001), incurred higher hospital costs ($19,200 versus $17,000, p = 0.006), and were more likely to be discharged to an extended-care facility (odds ratio [OR] = 2.87, p < 0.001). Developing hyponatremia postoperatively resulted, on average, in a longer hospital stay (3.7 versus 3.3 days, p = 0.002) and greater hospital cost ($18,800 versus $17,000, p < 0.001). Age (OR = 1.13 per decade, p = 0.012), spine surgery (OR = 2.76 versus knee, p < 0.001), hip surgery (OR = 1.76 versus knee, p < 0.001), and the amount of lactated Ringer solution used (OR = 1.16, p = 0.002) increased the risk of developing hyponatremia. Hyponatremia in orthopaedic patients is associated with longer, costlier hospitalizations.

12

The factors that significantly increased the risk of developing postoperative hyponatremia were an older age, spine fusion, hip arthroplasty, and the amount of lactated Ringer solution used. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Title: The risk of adverse events in orthopaedic trauma varies by anatomic region of surgery: an analysis of fifty thousand four hundred and twenty one patients.

Citation: International orthopaedics, Nov 2015, vol. 39, no. 11, p. 2153-2159

Author(s): Lakomkin, Nikita, Greenberg, Sarah E, Obremskey, William T, Sethi, Manish K

Abstract: Despite the high-risk nature of orthopaedic trauma, there is a dearth of data exploring adverse events following these interventions. With the current shift towards a reimbursement model grounded on episode-based payments, physicians may face financial penalties for higher rates of peri-operative complications and subsequent hospitalisations. The purpose of this study was thus to assess whether complication rates varied by anatomic region of surgery and to subsequently determine the pre-operative risk factors that elevated patients' chances of developing complications in these regions. A total of 50,421 orthopaedic trauma patients treated between 2006 and 2013 were identified in the American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) database. Minor and major complications, demographics, surgical variables and pre-operative comorbidities were collected. Chi-square analyses identified pre-operative differences between the three regions. Multivariate regressions identified risk factors that significantly predicted adverse events. Hip and pelvis (HP) patients were found to be approximately seven times more likely to develop a peri-operative complication than upper extremity (UE) patients [odds ratio (OR) 7.38, 95 % confidence interval (CI) 6.33-8.10, p < 0.001]. In addition, lower extremity (LE) patients were found to be almost three times as likely to develop any complication compared to UE patients (OR 2.80, 95 % CI 2.53-3.09, p < 0.001). Certain risk factors, such as chronic obstructive pulmonary disease (COPD) and the presence of a bleeding disorder, were significantly correlated with the development of all adverse events for all anatomic regions (p < 0.001). There is a significant difference in complication rates between the three cohorts of orthopaedic trauma patients. In addition, the predictability of certain risk factors varied between the three regions. prognostic level II.

Title: CORR Insights(®): Which Fixation Device is Preferred for Surgical Treatment of Intertrochanteric Hip Fractures in the United States? A Survey of Orthopaedic Surgeons.

Citation: Clinical orthopaedics and related research, Nov 2015, vol. 473, no. 11, p. 3656-3657 (November 2015)

Author(s): Prasad, Kodali Siva R K

Title: Randomized controlled trial of vagal modulation by sham feeding in elective non-gastrointestinal (orthopaedic) surgery.

Citation: British journal of anaesthesia, Nov 2015, vol. 115, no. 5, p. 727-735

13

Author(s): Karmali, S, Jenkins, N, Sciusco, A, John, J, Haddad, F, Ackland, G L, POM-X Study Investigators

Abstract: Enhanced recovery, in part, aims to reduce postoperative gastrointestinal dysfunction (PGID). Acquired - or established- vagal dysfunction may contribute to PGID, even for surgery not involving the gastrointestinal tract. However, direct evidence for this is lacking. We hypothesized that chewing gum reduces morbidity (including PGID) by preserving efferent vagal neural activity postoperatively after elective orthopaedic surgery. In a two-centre randomized controlled trial (n=106), we explored whether patients randomized to prescribed chewing gum for five days postoperatively sustained less morbidity (primary outcome, defined by the Postoperative Morbidity Survey), PGID and faster time to become morbidity free (secondary outcomes). In a subset of patients (n=38), cardiac parasympathetic activity was measured by serial Holter monitoring and assessed using time and frequency domain analyses. Between September 2011 and April 2014, 106 patients were randomized to chewing gum or control. The primary clinical outcome did not differ between groups, with similar morbidity occurring between patients randomized to control (26/30) and chewing gum (21/28; absolute risk reduction (ARR):13% (95%C I:- 6-32); P=0.26). However, chewing gum reduced PGID (ARR:20% (95% CI: 1-38); P=0.049). Chewing gum reduced time to become morbidity-free (relative risk (RR): 1.62 (95% CI: 1.02-2.58); P=0.04) and was associated with a higher proportion of parasympathetic activity contributing to heart rate variability (11% (95% CI: 1-20); P=0.03). Chewing gum did not alter overall morbidity, but reduced PGID. These data show for the first time that prescription of sham feeding preserves vagal activity in surgery not directly involving the gastrointestinal tract. ISRCTN20301599. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Title: Litigation costs of wrong-site surgery and other non-technical errors in orthopaedic operating theatres.

Citation: Annals of the Royal College of Surgeons of England, Nov 2015, vol. 97, no. 8, p. 592-597 (November 2015)

Author(s): Harrison, W D, Narayan, B, Newton, A W, Banks, J V, Cheung, G

Abstract: Introduction This study reviews the litigation costs of avoidable errors in orthopaedic operating theatres (OOTs) in England and Wales from 1995 to 2010 using the National Health Service Litigation Authority Database. Materials and methods Litigation specifically against non-technical errors (NTEs) in OOTs and issues regarding obtaining adequate consent was identified and analysed for the year of incident, compensation fee, cost of legal defence, and likelihood of compensation. Results There were 550 claims relating to consent and NTEs in OOTs. Negligence was related to consent (n=126), wrong-site surgery (104), injuries in the OOT (54), foreign body left in situ (54), diathermy and skin-preparation burns (54), operator error (40), incorrect equipment (25), medication errors (15) and tourniquet injuries (10). Mean cost per claim was £40,322. Cumulative cost for all cases was £20 million. Wrong-site surgery was error that elicited the most successful litigation (89% of cases). Litigation relating to implantation of an incorrect prosthesis (eg

14

right-sided prosthesis in a left knee) cost £2.9 million. Prevalence of litigation against NTEs has declined since 2007. Conclusions Improved patient-safety strategies such as the World Health Organization Surgical Checklist may be responsible for the recent reduction in prevalence of litigation for NTEs. However, addition of a specific feature in orthopaedic surgery, an 'implant time-out' could translate into a cost benefit for National Health Service hospital trusts and improve patient safety.

Title: Which Fixation Device is Preferred for Surgical Treatment of Intertrochanteric Hip Fractures in the United States? A Survey of Orthopaedic Surgeons.

Citation: Clinical orthopaedics and related research, Nov 2015, vol. 473, no. 11, p. 3647-3655 (November 2015)

Author(s): Niu, Emily, Yang, Arthur, Harris, Alex H S, Bishop, Julius

Abstract: The best treatment for intertrochanteric hip fractures is controversial. The use of cephalomedullary nails has increased, whereas use of sliding hip screws has decreased despite the lack of evidence that cephalomedullary nails are more effective. As current orthopaedic trainees receive less exposure to sliding hip screws, this may continue to perpetuate the preferential use of cephalomedullary nails, with important implications for resident education, evidence-based best practices, and healthcare cost. We asked: (1) What are the current practice patterns in surgical treatment of intertrochanteric fractures among orthopaedic surgeons? (2) Do surgical practice patterns differ based on surgeon characteristics, practice setting, and other factors? (3) What is the rationale behind these surgical practice patterns? (4) What postoperative approaches do surgeons use for intertrochanteric fractures? A web-based survey containing 20 questions was distributed to active members of the American Academy of Orthopaedic Surgeons. Three thousand seven-hundred eighty-six of 10,321 invited surgeons participated in the survey (37%), with a 97% completion rate (3687 of 3784 responded to all questions in the survey). The survey elicited information regarding surgeon demographics, preferred management strategies, and decision-making rationale for intertrochanteric fractures. Surgeons use cephalomedullary nails most frequently for treatment of intertrochanteric hip fractures. Sixty-eight percent primarily use cephalomedullary nails, whereas only19% primarily use sliding hip screws, and the remaining 13% use cephalomedullary nails and sliding hip screws with equal frequency. The cephalomedullary nail was the dominant approach regardless of experience level or practice setting. Surgeons who practiced in a nonacademic setting (71% versus 58%; p < 0.001), did not supervise residents (71% versus 61%; p < 0.001), or treated more than five intertrochanteric fractures a month (78% versus 67%; p < 0.001) were more likely to use primarily cephalomedullary nails. Of the surgeons who used only cephalomedullary nails, ease of surgical technique (58%) was cited as the primary reason, whereas surgeons who used only sliding hip screws cite familiarity (44%) and improved outcomes (37%) as their primary reasons. Of those who use only short cephalomedullary nails, ease of technique (59%) was most frequently cited. Postoperatively, 67% allow the patient to bear weight as tolerated. Nearly all respondents (99.5%) use postoperative chemical thromboprophylaxis. Despite that either sliding hip screw or cephalomedullary nail fixation are associated with equivalent outcomes for most intertrochanteric femur fractures, the cephalomedullary nail has emerged as the preferred construct, with the majority of surgeons believing that a cephalomedullary nail is easier to use, associated with improved outcomes, or is

15

biomechanically superior to a sliding hip screw. The difference between what is evidence-based and what is done in clinical practice may be attributed to several factors, including financial considerations, educational experience, or inability of our current outcomes measures to reflect the experiences of surgeons. The educators, researchers, and policymakers among us must work harder to better define the roles of sliding hip screws and cephalomedullary nails and ensure that the increasing population with hip fractures receives high-quality and economically responsible care. Level V, therapeutic study.

Patient care and management

Title: Level of Perception of Individualized Care and Satisfaction With Nursing in Orthopaedic Surgery Patients.

Citation: Orthopedic nursing, Nov 2015, vol. 34, no. 6, p. 371-374 (2015 Nov-Dec)

Author(s): Tekin, Fatma, Findik, Ummu Yildiz

Abstract: Lately, individualized nursing care and patient satisfaction are important and current issues being discussed. But there is not enough information for patients undergoing orthopaedic surgery. The aim of this study was to determine the individualized care perception and satisfaction in nursing care levels in orthopaedic surgery patients. This descriptive cross-sectional study was conducted with 156 patients who underwent orthopaedic surgery. Data were collected using the personal information form, the Individualized Care Scale, and the Newcastle Satisfaction With Nursing Scale. The Spearman correlation analysis and descriptive statistics were performed. The mean individualized care and satisfaction with nursing care scores were found to be close to the preset maximum value, and it was determined that an increase in the level of awareness about nursing interventions and the level of perceived individualized care caused an increase in satisfaction levels regarding nursing care. Nurses should recognize the importance of performing individualized care in order to increase the level of satisfaction with nursing care in orthopaedic surgery patients.

Title: Effectiveness of Vitamin D Therapy in Orthopaedic Trauma Patients.

Citation: Journal of orthopaedic trauma, Nov 2015, vol. 29, no. 11, p. e451.

Author(s): Robertson, Daniel S, Jenkins, Tyler, Murtha, Yvonne M, Della Rocca, Gregory J,

Abstract: The purpose of this study was to determine the effectiveness of our vitamin D treatment protocol in managing low serum vitamin D levels in orthopaedic trauma patients. A retrospective review was conducted of all orthopaedic trauma patients at a university level I trauma center over 20 months. Patients were included if they had an initial and repeat 25-hydroxy (OH) vitamin D serum level available. Vitamin D deficiency was defined as serum 25-hydroxy vitamin D level with less than 20 ng/mL. Vitamin D insufficiency was defined as serum 25-hydroxy vitamin D level between 20 and 32 ng/mL. The standard regimen for all patients was over-the-counter vitamin D3 1000 IU and 1500 mg of calcium daily. Patients with vitamin D deficiency or insufficiency also received 50,000 IU of

16

ergocalciferol (D2) weekly until their 25-hydroxyvitamin D level normalized or their fracture healed. No compliance monitoring was performed except for questioning at each clinic visit. A total of 201 patients met the inclusion criteria. Thirty-two patients had a normal initial 25-hydroxyvitamin D level, and 84% maintained their normal level, whereas 16% became insufficient or deficient. There were 88 patients insufficient initially and 54.5% improved to normal and 8% became deficient. In the vitamin D deficiency group (81), 26% remained deficient and 74% improved to insufficient. The average increase in serum 25-OH vitamin D with treatment (in nanograms per milliliter) was statistically significant for both the insufficient and deficient groups. Vitamin D therapy improved the majority of the patients' vitamin D-25-OH level but did not normalize most. Patients with initial deficiency had the largest improvement. This study indicates that vigilance is required to adequately treat a low serum vitamin D-25-OH level. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Title: Thromboelastography for the monitoring of the antithrombotic effect of low-molecular-weight heparin after major orthopedic surgery.

Citation: Anatolian journal of cardiology, Nov 2015, vol. 15, no. 11, p. 932-937

Author(s): Tekkesin, Nilgün, Tekkesin, Mustafa, Kaso, Güzin

Abstract: Low-molecular-weight heparins (LMWHs) are commonly used to prevent and manage postoperative thromboembolism. In general, monitoring of anticoagulant activity by anti-Xa testing is not done properly. Thromboelastography (TEG) evaluates the viscoelastic properties of blood during coagulation. The clinical application of TEG variables in monitoring LMWH treatment is not yet well defined. This prospective study was designed to systematically examine the correlation between anti-Xa and basic TEG parameters in monitoring LMWH treatment. We furthermore evaluated for the first time the usefulness of a composite TEG parameter, coagulation index (CI). Thirty patients undergoing unilateral or bilateral total knee replacement, admitted to the intensive care unit on a therapeutic dosage of subcutaneous enoxaparin (30-mg injections administered twice daily), were included into the study. TEG parameters and anti-Xa levels were measures at baseline and 4, 12, and 24 hours after the injection. This study demonstrates a significant correlation between CI and plasma anti-Xa activity in surgical patients treated with enoxaparin. Although the correlation was significant between r time and anti-Xa level only at Hour 4, CI was significant for each time interval (p<0.05). CI increased immediately after T0, peaking at Hour 4, and remained elevated (relative to baseline) at Hour 24 but still did not return to admission levels. The current study may be an important first step in order to use CI to measure LMWH activity. Meanwhile, the value and usefulness of TEG in predicting bleeding or thrombotic complications following major orthopedic surgery merit further investigation.

Title: Patient Reported Outcome in Health Services Research: A Prospective Study of Orthopedic Surgery in Routine Care in Switzerland.

Citation: Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, Nov 2015, vol. 18, no. 7, p. A652. (November 2015)

Author(s): Eichler, K, Hess, S, Twerenbold, C, Grobet, C, Flury, M, Wieser, S, Audigé, L

17

Title: The Relationship of Obesity to Increasing Health-Care Burden in the Setting of Orthopaedic Polytrauma.

Citation: The Journal of bone and joint surgery. American volume, Nov 2015, vol. 97, no. 22, p. e73. (November 18, 2015)

Author(s): Licht, Heather, Murray, Mark, Vassaur, John, Jupiter, Daniel C, Regner, Justin L,

Abstract: With the rise of obesity in the American population, there has been a proportionate increase of obesity in the trauma population. The purpose of this study was to use a computed tomography-based measurement of adiposity to determine if obesity is associated with an increased burden to the health-care system in patients with orthopaedic polytrauma. A prospective comprehensive trauma database at a level-I trauma center was utilized to identify 301 patients with polytrauma who had orthopaedic injuries and intensive care unit admission from 2006 to 2011. Routine thoracoabdominal computed tomographic scans allowed for measurement of the truncal adiposity volume. The truncal three-dimensional reconstruction body mass index was calculated from the computed tomography-based volumes based on a previously validated algorithm. A truncal three-dimensional reconstruction body mass index of <30 kg/m(2) denoted non-obese patients and ≥30 kg/m(2) denoted obese patients. The need for orthopaedic surgical procedure, in-hospital mortality, length of stay, hospital charges, and discharge disposition were compared between the two groups. Of the 301 patients, 21.6% were classified as obese (truncal three-dimensional reconstruction body mass index of ≥30 kg/m(2)). Higher truncal three-dimensional reconstruction body mass index was associated with longer hospital length of stay (p = 0.02), more days spent in the intensive care unit (p = 0.03), more frequent discharge to a long-term care facility (p < 0.0002), higher rate of orthopaedic surgical intervention (p < 0.01), and increased total hospital charges (p < 0.001). Computed tomographic scans, routinely obtained at the time of admission, can be utilized to calculate truncal adiposity and to investigate the impact of obesity on patients with polytrauma. Obese patients were found to have higher total hospital charges, longer hospital stays, discharge to a continuing-care facility, and a higher rate of orthopaedic surgical intervention. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Title: What's New in Orthopaedic Rehabilitation.

Citation: The Journal of bone and joint surgery. American volume, Nov 2015, vol. 97, no. 22, p. 1892-1898

Author(s): Kolman, Samuel, Spiegel, David, Namdari, Surena, Hosalkar, Harish,

Title: Obesity Is Associated With More Complications and Longer Hospital Stays After Orthopaedic Trauma.

Citation: Journal of orthopaedic trauma, Nov 2015, vol. 29, no. 11, p. 504-509

18

Author(s): Childs, Benjamin R, Nahm, Nickolas J, Dolenc, Andrea J, Vallier, Heather A

Abstract: The objective of this study was to characterize relationships between obesity and initial hospital stay, including complications, in patients with multiple system trauma and surgically treated fractures. Prospective, observational. Level 1 trauma center. Three hundred seventy-six patients with an Injury Severity Score greater than 16 and mechanically unstable high-energy fractures of the femur, pelvic ring, acetabulum, or spine requiring stabilization. Data for obese (body mass index ≥ 30) versus nonobese patients included presence of pneumonia, deep vein thrombosis, pulmonary embolism, infection, organ failure, and mortality. Days in ICU and hospital, days on ventilator, transfusions, and surgical details were documented. Complications occurred more often in obese patients (38.0% vs. 28.4%, P = 0.03), with more acute renal failure (5.70% vs. 1.38%, P = 0.02) and infection (11.4% vs. 5.50%, P = 0.04). Days in ICU and mechanical ventilation times were longer for obese patients (7.06 vs. 5.25 days, P = 0.05 and 4.92 vs. 2.90 days, P = 0.007, respectively). Mean total hospital stay was also longer for obese patients (12.3 vs. 9.79 days, P = 0.009). No significant differences in rates of mortality, multiple organ failure, or pulmonary complications were noted. Medically stable obese patients were almost twice as likely to experience delayed fracture fixation due to preference of the surgeon and were more likely to experience delay overall (26.0% vs. 16.1%; P = 0.02). Mean time from injury to fixation was 34.9 hours in obese patients versus 23.7 hours in nonobese patients (P = 0.03). Obesity was noted among 42% of our trauma patients. In obese patients, complications occurred more often and hospital and ICU stays were significantly longer. These increases are likely to be associated with greater hospital costs. Surgeon decision to delay procedures in medically stable obese patients may have contributed to these findings; definitive fixation was more likely to be delayed in obese patients. Further study to optimize the care of patients with increased body mass index may help to improve outcomes and minimize additional treatment expenses. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Title: Evaluation of the utility of the Estimation of Physiologic Ability and Surgical Stress score for predicting post-operative morbidity after orthopaedic surgery.

Citation: International orthopaedics, Nov 2015, vol. 39, no. 11, p. 2167-2172

Author(s): Nagata, Takehiro, Hirose, Jun, Nakamura, Takayuki, Tokunaga, Takuya,

Abstract: The purpose of this study was to investigate the utility of the Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system for predicting post-operative morbidity. We included 1,883 patients (mean age, 52.1 years) who underwent orthopaedic surgery. The post-operative complications were classified as surgical site and non-surgical site complications, and the relationship between the E-PASS scores and post-operative morbidity was investigated. The incidence of post-operative complications (n = 274) significantly increased with an increase in E-PASS scores (p < 0.001). The areas under the curve for the comprehensive risk score of the E-PASS scoring system for overall and non-surgical site complications were 0.777 and 0.794, respectively. The E-PASS scoring system showed some utility in predicting post-operative morbidity after general orthopaedic

19

surgery. However, creating a new risk score that is more suitable for orthopaedic surgery will be challenging.

Other

Title: A day in the life of orthopaedic and trauma practitioners: Advanced Nurse Practitioner Sarcoma.

Citation: International journal of orthopaedic and trauma nursing, Nov 2015, vol. 19, no. 4, p. 222-223 (November 2015)

Author(s): Stradling, Helen

Title: Galway Orthopaedic Nursing Conference.

Citation: International journal of orthopaedic and trauma nursing, Nov 2015, vol. 19, no. 4, p. 224. (November 2015)

Author(s): Masterson, Rosemary

Title: Orthopaedic Healthcare Worldwide: The Role of Standardization in Improving Outcomes.

Citation: Clinical orthopaedics and related research, Nov 2015, vol. 473, no. 11, p. 3360-3363 (November 2015)

Author(s): Koenig, Karl M, Bozic, Kevin J

Title: Nicholas J. Giannestras (1908-1978): a distinguished orthopaedic surgeon, his work, life and times.

Citation: International orthopaedics, Nov 2015, vol. 39, no. 11, p. 2297-2302

Author(s): Markatos, Konstantinos, Efstathopoulos, Nikolaos, Kaseta, Kiriaki Maria, Nikolaou, Vasileios, Tsoucalas, Gregory, Sgantzos, Markos

Abstract: The purpose of our study was to summarize all the knowledge concerning the innovative pioneer in the field of orthopaedic surgery, Nicholas J. Giannestras (1908-1978). A thorough study of texts, medical books and reports, in the field of history of medicine, together with a review of the available literature in PubMed, was undertaken. Giannestras left his mark in the history of orthopaedics with his clinical work and his publications, mainly his treatise "Foot Disorders: Medical and Surgical Management" (1973), while his name lingers in Greece with the introduction of spine fusion with the use of metallic implants. He was an eminent university clinical professor of orthopaedics who had harmonically combined academic writing, teaching and clinical research in every field of orthopaedic surgery.

20

Title: The Evidence Base for the Prognosis and Treatment of Adolescent Idiopathic Scoliosis: The 2015 Orthopaedic Research and Education Foundation Clinical Research Award.

Citation: The Journal of bone and joint surgery. American volume, Nov 2015, vol. 97, no. 22, p. 1899-1903 (November 18, 2015)

Author(s): Weinstein, Stuart L, Dolan, Lori A

Title: Orthopaedic Nurse Certified List.

Citation: Orthopedic nursing, Nov 2015, vol. 34, no. 6, p. 377. (2015 Nov-Dec)

Title: Database and Registry Research in Orthopaedic Surgery: Part 2: Clinical Registry Data.

Citation: The Journal of bone and joint surgery. American volume, Nov 2015, vol. 97, no. 21, p. 1799-1808 (November 4, 2015)

Author(s): Pugely, Andrew J, Martin, Christopher T, Harwood, Jared, Ong, Kevin L,

Abstract: ➤ The use of large-scale national databases for observational research in orthopaedic surgery has grown substantially in the last decade, and the data sets can be

categorized as either administrative claims or clinical registries.➤ Clinical registries contain secondary data on patients with a specific diagnosis or procedure. The data are typically

used for patient outcome surveillance to improve patient safety and health-care quality.➤ Registries used in orthopaedic research exist at the regional, national, and international levels, and many were designed to specifically collect outcomes relevant to orthopaedics, such as short-term surgical complications, longer-term outcomes (implant survival or

reoperations), and patient-reported outcomes.➤ Although heterogeneous, clinical registries-in contrast to claims data-typically have a more robust list of variables, with relatively precise prospective data input, management infrastructure, and reporting

systems.➤ Some weaknesses of clinical registries include a smaller number of patients, inconstant follow-up duration, and use of sampling methods that may limit generalizability.

Within the U.S., national joint registry adoption has lagged international joint registries.➤ Given the changing health-care environment, it is likely that clinical registries will provide valuable information that has the potential to influence clinical practice improvement and health-care policy in the future. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Title: Quality and Safety in Orthopaedics: Learning and Teaching at the Same Time: AOA Critical Issues.

Citation: The Journal of bone and joint surgery. American volume, Nov 2015, vol. 97, no. 21, p. 1809-1815 (November 4, 2015)

Author(s): Black, Kevin P, Armstrong, April D, Hutzler, Lorraine, Egol, Kenneth A

Abstract: Increasing attention has been placed on providing higher quality and safer patient care. This requires the development of a new set of competencies to better understand and

21

navigate the system and lead the orthopaedic team. While still trying to learn and develop these competencies, the academic orthopaedist is also expected to model and teach them.The orthopaedic surgeon must understand what is being measured and why, both for purposes of providing better care and to eliminate unnecessary expense in the system. Metrics currently include hospital-acquired conditions, "never events," and thirty-day readmission rates. More will undoubtedly follow.Although commitment and excellence at the individual level are essential, the orthopaedist must think at the systems level to provide the highest value of care. A work culture characterized by respect and trust is essential to improved communication, teamwork, and confidential peer review. An increasing number of resources, both in print and electronic format, are available for us to understand what we can do now to improve quality and safety.Resident education in quality and safety is a fundamental component of the systems-based practice competency, the Next Accreditation System, and the Clinical Learning Environment Review. This needs to be longitudinally integrated into the curriculum and applied parallel to the development of resident knowledge and skill, and will be best learned if resident learning is experiential and taught within a genuine culture of quality and safety. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Title: Saline Soliloquy: Shaking Up Our Thoughts on Perioperative Hyponatremia: Commentary on an article by E. Hennrikus, MD, et al.: "Prevalence, Timing, Causes, and Outcomes of Hyponatremia in Hospitalized Orthopaedic Surgery Patients".

Citation: The Journal of bone and joint surgery. American volume, Nov 2015, vol. 97, no. 22, p. e74. (November 18, 2015)

Author(s): Tongue, John R

Title: Three-Dimensional Printing in Orthopedic Surgery.

Citation: Orthopedics, Nov 2015, vol. 38, no. 11, p. 684-687 (November 1, 2015)

Author(s): Eltorai, Adam E M, Nguyen, Eric, Daniels, Alan H

Abstract: Three-dimensional (3D) printing is emerging as a clinically promising technology for rapid prototyping of surgically implantable products. With this commercially available technology, computed tomography or magnetic resonance images can be used to create graspable objects from 3D reconstructed images. Models can enhance patients' understanding of their pathology and surgeon preoperative planning. Customized implants and casts can be made to match an individual's anatomy. This review outlines 3D printing, its current applications in orthopedics, and promising future directions. [Orthopedics. 2015; 38(11):684-687.]. Copyright 2015, SLACK Incorporated.

Title: How Useful are Orthopedic Surgery Residency Web Pages?

Citation: Journal of surgical education, Nov 2015, vol. 72, no. 6, p. 1185-1189

Author(s): Oladeji, Lasun O, Yu, Jonathan C, Oladeji, Afolayan K, Ponce, Brent A

22

Abstract: Medical students interested in orthopedic surgery residency positions frequently use the Internet as a modality to gather information about individual residency programs. Students often invest a painstaking amount of time and effort in determining programs that they are interested in, and the Internet is central to this process. Numerous studies have concluded that program websites are a valuable resource for residency and fellowship applicants. The purpose of the present study was to provide an update on the web pages of academic orthopedic surgery departments in the United States and to rate their utility in providing information on quality of education, faculty and resident information, environment, and applicant information. We reviewed existing websites for the 156 departments or divisions of orthopedic surgery that are currently accredited for resident education by the Accreditation Council for Graduate Medical Education. Each website was assessed for quality of information regarding quality of education, faculty and resident information, environment, and applicant information. We noted that 152 of the 156 departments (97%) had functioning websites that could be accessed. There was high variability regarding the comprehensiveness of orthopedic residency websites. Most of the orthopedic websites provided information on conference, didactics, and resident rotations. Less than 50% of programs provided information on resident call schedules, resident or faculty research and publications, resident hometowns, or resident salary. There is a lack of consistency regarding the content presented on orthopedic residency websites. As the competition for orthopedic websites continues to increase, applicants flock to the Internet to learn more about orthopedic websites in greater number. A well-constructed website has the potential to increase the caliber of students applying to a said program. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Title: Economic analysis of athletic team coverage by an orthopedic practice.

Citation: The Physician and sportsmedicine, Nov 2015, vol. 43, no. 4, p. 355-359

Author(s): Lombardi, Nicholas, Freedman, Kevin, Tucker, Brad, Austin, Luke, Eck, Brandon,

Abstract: Coverage of high school football by orthopedic sports medicine specialists is considered standard of care in many localities. Determining the economic viability of this endeavor has never been investigated. The primary purpose of the present investigation was to perform an economic analysis of local high school sports coverage by an orthopedic sports medicine practice. From January 2010 to June 2012, a prospective injury report database was used to collect sports injuries from five high school athletic programs covered by a single, private orthopedic sports medicine practice. Patients referred for orthopedic care were then tracked to determine expected cost of care (potential revenue). Evaluation and management codes and current procedure terminology codes were obtained to determine the value of physician visits and surgical care rendered. Overhead costs were calculated based on historical rates within our practice and incorporated to determine estimated profit. 19,165 athletic trainer contacts with athletes playing all sports, including both those 'on-field' and in the training room, resulted in 473 (2.5%) physician referrals. The covering orthopedic practice handled 89 (27.9%) of the orthopedic referrals. Of orthopedic physician referrals, 26 (5.4%) required orthopedic surgical treatment. The covering team practice handled 17/26 (65%) surgical cases. The total revenue collected by the covering team practice was $26,226.14. The overhead cost of treatment was $9441.41. Overall

23

estimated profit of orthopedic visits and treatment during this period for the covering practice was $16,784.73. The covering team practice handled 28% of the orthopedic referrals, 65% of the surgical cases and captured 59% of the potential profit. An increase in physician referrals could increase the benefit for orthopedic surgeons.

Title: Academic Characteristics of Orthopedic Team Physicians Affiliated With High School, Collegiate, and Professional Teams.

Citation: American journal of orthopedics (Belle Mead, N.J.), Nov 2015, vol. 44, no. 11, p. 510-514 (November 2015)

Author(s): Makhni, Eric C, Buza, John A, Byram, Ian, Ahmad, Christopher S

Abstract: We conducted a study to determine the academic involvement and research productivity of orthopedic team physicians at high school, college, and professional levels of sport. Through Internet and telephone queries, we identified 1054 team physicians from 362 institutions, including 120 randomly selected high schools and colleges and 122 professional teams (baseball, basketball, football, hockey). For all physicians included in the study, we performed a comprehensive search of the Internet and of a citation database to determine academic affiliations, number of publications, and h-index values. Of the 1054 physicians, 678 (64%) were orthopedic surgeons. Percentage of orthopedic team physicians affiliated with an academic medical center was highest in professional sports (64%; 173/270) followed by collegiate sports (36%; 98/275) and high school sports (20%; 27/133). Median number of publications per orthopedic team physician was significantly higher in professional sports (30.6) than in collegiate sports (10.7) or high school sports (6). Median number of publications by orthopedic physicians also varied by sport, with the highest number in Major League Baseball (37.9; range, 0-225) followed by the National Basketball Association (32.0; range, 0-227) and the National Football League (30.4; range, 0-460), with the lowest number within the National Hockey League (20.7; range, 0-144). Academic affiliation and research productivity of orthopedic team physicians vary by competition level and professional sporting league.

Title: Innovations in Orthopedics and Traumatology in China.

Citation: Chinese medical journal, Nov 2015, vol. 128, no. 21, p. 2841-2842, 0366-6999

Author(s): Zhang, Ying-Ze

Title: Do Politics Matter to an Orthopaedic Surgeon? (They Should!).

Citation: Journal of orthopaedic trauma, Nov 2015, vol. 29 Suppl 11, p. S3. (November 2015)

Author(s): Lee, Adam K, Sethi, Manish K

Abstract: Orthopaedic trauma care is intimately tied with health policy, and current changes with health care reform may change how trauma care is delivered. This article offers a brief history of modern health care and the implications of new policies on the practice of orthopaedic trauma.

24

Title: Getting Started in Orthopaedic Trauma Research.

Citation: Journal of orthopaedic trauma, Nov 2015, vol. 29 Suppl 11, p. S17

Author(s): Mir, Hassan R

Abstract: Incorporating research into practice as an orthopaedic trauma surgeon can be very fulfilling. There are challenges when getting started whether in a university or other practice setting. Understanding the various components of the research process is important before beginning and thereafter. This article reviews some of the issues that may be encountered and strategies to help.

25

Journal Tables of Contents

The most recent issues of the following journals:

Journal of Bone and Joint Surgery

Journal of Orthopaedic Trauma

Injury

Strategies in Trauma and Limb Construction

Clinical Orthopaedics and Related Research

Click on the links for abstracts. If you would like any of these papers in full text then get in touch: librarys@uhbristol.nhs.uk

Journal of Bone and Joint Surgery

Vol. 97, iss. 23, December 2015

http://jbjs.org/content/97/23?current-issue=y

Journal of Orthopaedic Trauma

Vol. 29, iss. 12, December 2015

http://journals.lww.com/jorthotrauma/pages/currenttoc.aspx

26

Injury

Vol. 46, iss. 12, December 2015

http://www.injuryjournal.com/current

Strategies in Trauma and Limb Construction

Vol. 10, iss. 3, November 2015

http://link.springer.com/journal/11751/10/3/page/1

Clinical Orthopaedics and Related Research

Vol. 473, iss. 12, December 2015

http://www.clinorthop.org/Journals/Current_Issue.html

27

UpToDate is the leading evidence-based clinical decision support system, designed for use at the point of care.

It contains more than 9,500 searchable topics across the following specialities:

Adult and paediatric emergency medicine Allergy and immunology Cardiovascular medicine Dermatology Drug therapy Endocrinology and diabetes mellitus Family medicine Gastroenterology and hepatology General surgery Geriatrics Haematology Hospital Medicine Infectious diseases Nephrology and hypertension Neurology Obstetrics and gynaecology Oncology Paediatrics Primary care internal medicine Psychiatry Pulmonary, critical care and sleep medicine Rheumatology

How to access UpToDate

You can access UpToDate from any computer via www.uptodate.com. You will need your NHS Athens username

(register through http://openathens.nice.org.uk/).

28

Library Opening Times

Staffed hours: 8am-5pm, Mon-Fri

Swipe-card access: 7am-11pm 7 days a week

Level 5, Education and Research Centre

University Hospitals Bristol

Contact your outreach librarian:

Jo Hooper, outreach librarian

library@uhbristol.nhs.uk Ext. 20103