Leopold, S. S., Porcher, R., Gebhardt, M. C., Gioe, T. J., Manner, P. A., Rimnac, C. M., & Wongworawat, M. D. (2020). Editorial: Opposites Attract at CORR®-Machine Learning and Qualitative Research.. Clinical Orthopaedics and Related Research, 478(10), 2193-2196. https://doi.org/10.1097/CORR.0000000000001466 (Original work published 2020)
Publications by Year: 2020
2020
Kaiser, P. B., Newman, E. T., Haggerty, C., Appleton, P. T., Wixted, J. J., Weaver, M. J., & Rodriguez, E. K. (2020). A Limited Fixation, Olecranon Sparing Approach, for Management of Geriatric Intra-Articular Distal Humerus Fractures.. Geriatric Orthopaedic Surgery & Rehabilitation, 11, 2151459320950063. https://doi.org/10.1177/2151459320950063 (Original work published 2020)
PURPOSE: We propose that geriatric comminuted intra-articular distal humerus fractures can be effectively treated with a limited fixation approach aimed at achieving varus/valgus stability with columnar fixation, but allowing intra-articular comminution to heal by secondary congruency against an intact olecranon, thus avoiding an olecranon osteotomy.
METHODS: Fifty-six elderly patients with AO 13-C type fractures, who underwent surgical fixation with ≥12-months of follow-up were retrospectively reviewed. Thirty patients were treated with intra-articular open reduction internal fixation (ORIF) with an olecranon osteotomy and 26 patients were treated with our limited fixation (L-ORIF) approach. Outcomes were range of motion (ROM), complications, additional surgery, and patient-reported outcome measures (PROMIS).
RESULTS: At final follow-up, the average elbow ROM was 97° (40°-155°) in the ORIF group and 86.5° (20°-145°) in the L-ORIF group. There was a trend toward more complications and additional surgery in the ORIF group. PROMIS scores for pain were 53.1 and 52.14, and PROMIS functional scores were 41.7 and 41.4 in the ORIF and L-ORIF group respectively. No differences in outcomes were statistically significant.
CONCLUSION: A limited fixation technique based on achieving varus/valgus stability with columnar fixation, demonstrated equivalent outcomes in elderly patients with intra-articular distal humerus fractures when compared to intra-articular ORIF with an olecranon osteotomy.
Candela, V., Longo, U. G., Di Naro, C., Facchinetti, G., Marchetti, A., Sciotti, G., Santamaria, G., Piergentili, I., De Marinis, M. G., Nazarian, A., & Denaro, V. (2020). A Historical Analysis of Randomized Controlled Trials in Rotator Cuff Tears.. International Journal of Environmental Research and Public Health, 17(18). https://doi.org/10.3390/ijerph17186863 (Original work published 2020)
Background and objectives: Our research aimed to evaluate the quality of reporting of randomized controlled trials (RCTs) linked to rotator cuff (RC) tears. The present study analyzed factors connected to the quality of the RCTs and trends in the quality of reporting through time. Materials and Methods: The online databases used to search all RCTs on the topic of RC surgery completed until March 2020 were PubMed and Ovid (MEDLINE). The quality of reporting was evaluated using the modified Coleman methodology score (MCMS) and the consolidated standards of reporting trials (CONSORT). Results: The online search found 957 articles. Finally, 183 studies were included in the quantitative synthesis. A total of 97 (53%) of 183 studies had a level of evidence I and 86 (47%) of 183 studies had a level of evidence II, according to the Oxford Center of Evidence Based Medicine (EBM). A statistically significant difference in MCMS between articles written before 2010 and articles written after 2010 was found. Articles written after 2010 had, on average, the highest Coleman score. The average number of CONSORT checklist items for each article across all analyzed RCTs was 21.67. The 37 studies completed up to 2010 averaged a number of checklist items of 19.97 and the studies completed between 2011 and 2019 averaged a number of checklist items of 22.10. A statistically significant difference in the number of checklist items between articles written before 2010 and articles written after 2010 was found. Articles written after 2010 had on average more checklist items. However, low correlation (0.26) between the number of checklist items for each article and the respective Coleman score was found. On the other hand, articles with the CONSORT diagram had a significantly high Coleman score. Conclusions: An improvement in the quantity and quality of RCTs relating to RC surgery over the analyzed period was found.
Challa, S. T., Appleton, P., Rodriguez, E. K., & Wixted, J. (2020). The efficacy of an anti-protrusio plate in patients with anterior column posterior hemitransverse and associated both column acetabular fractures.. Journal of Clinical Orthopaedics and Trauma, 11(6), 1158-1161. https://doi.org/10.1016/j.jcot.2020.10.036 (Original work published 2020)
INTRODUCTION: Acetabular fractures in the elderly population are particularly challenging for orthopedic fracture surgeons to treat. Anterior column posterior hemitransverse (ACH) and both column (BC) fractures account for over 70% of these injuries in geriatric patients. Nonoperative management of these injuries has a mortality of about 79% and patients generally have a minimal chance of return to independent living. The aim of our study was to identify the degree of protrusio deformity geriatric patients with these injuries present with and if indirect reduction through a Stoppa approach was sufficient to improve protrusio deformity.
METHODS: Patients older than 60 years of age who had ACH and BC pattern acetabular fractures treated at the BIDMC in Boston, MA between 2015 and 2020 were included in this study. Pelvic AP and Judet views were reviewed at injury and each available post-operative follow up. We modified the femoral head extrusion index and used its inverse to measure the level of protrusio at each time point (-FHEI). Patient outcomes were also graded as excellent, good, fair and poor based on post-operative follow up.
RESULTS: Sixteen patients were included based on above criteria and average -FHEI at injury was 34.85% and decreased significantly to an average of 21.5% postoperatively and remained stable at all follow up points. At one year follow up (n = 2), the mean -FHEI was 18.15%. Most patients had good (4) or excellent (9) outcomes.
CONCLUSIONS: We present short term results of indirect reduction of ACH and BC acetabular fractures in geriatric patients using a PRO quadrilateral surface plate, which was largely successful in controlling the primary protrusio deformity seen in these patients. This allowed for restoration of the anterior column, with limited surgical morbidity through a relatively simple and straightforward surgical approach.