Opioid Consumption Patterns and Prolonged Opioid Use Among Opioid-Naïve Ankle Fracture Patients.

Introduction: Previous literature has demonstrated an association between acute opioid exposure and the risk of long-term opioid use. Here, the investigators assess immediate postoperative opioid consumption patterns as well as the incidence of prolonged opioid use among opioid-naïve patients following ankle fracture surgery.

Methods: Included patients underwent outpatient open reduction and internal fixation of an ankle or tibial plafond fracture over a 1-year period.

Coding Education in Residency and in Practice Improves Accuracy of Coding in Orthopedic Surgery.

The goal of training in orthopedic residency is to produce surgeons who are proficient in all aspects of the practice of orthopedic surgery; however, most residents receive either inadequate or no training in medical coding. The purpose of this study was to determine how well orthopedic residents code when compared with practicing surgeons and to identify whether coding education improves accuracy in medical coding. A mock coding survey was developed using commonly encountered orthopedic clinical scenarios.

Medial Femoral Condyle Periosteal Free Flap for the Treatment of Talus Avascular Necrosis.

Background: In patients with avascular necrosis (AVN) of the talus in the precollapse stage unresponsive to conservative measures, joint preservation should be considered. Good results have previously been reported for vascularized bone grafting. The medial femoral condyle (MFC) free flap has recently been introduced, which consists of corticoperiosteal bone.

How Does Perioperative Ketorolac Affect Opioid Consumption and Pain Management After Ankle Fracture Surgery?

Background: The investigation of nonnarcotic drug regimens for postoperative pain management is important in addressing the opioid epidemic. NSAIDs can be a powerful adjunct in managing postoperative pain, but the possibility of delayed bone healing is a major concern for orthopaedic surgeons. Our recent retrospective study on ketorolac administration demonstrated that the NSAID is not associated with an increased risk of delayed union or nonunion after ankle fracture surgery.

Postoperative Opioid Consumption in Opioid-Naïve Patients Undergoing Hallux Valgus Correction.

Background: Postoperative pain management following orthopedic surgeries can be challenging, and the opioid epidemic has made it essential to better individualize opioid prescriptions by patient and procedure. The purpose of this subgroup analysis of a prospective study was to investigate immediate postoperative opioid pill consumption and prolonged use in patients undergoing operative correction of hallux valgus (HV).

Methods: Patients undergoing outpatient HV correction procedures with 5 fellowship-trained foot and ankle surgeons over a 1-year period were included.

Prospective Evaluation of Utilization Patterns and Prescribing Guidelines of Opioid Consumption Following Orthopedic Foot and Ankle Surgery.

Background: Overprescription of narcotic pain medication is a major culprit in the present opioid epidemic plaguing the United States. The current literature on lower extremity opioid usage has limitations and would benefit from additional study. The purpose of our study was to prospectively assess opioid consumption patterns following outpatient orthopedic foot and ankle procedures.

Reverse Sural Adipofascial Flaps with Acellular Dermal Matrix and Negative-Pressure Wound Therapy.

The reverse sural adipofascial flap (RSAF) is used to reconstruct challenging wounds of the foot and ankle. It offers several advantages over the traditional reverse sural flap, including less venous congestion. To complete the reconstruction, split-thickness skin grafting (STSG) may be done immediately or in a delayed fashion; however, both scenarios result in suboptimal take rates and prolonged healing.

The Influence of Wait Time on Patient Satisfaction in the Orthopedic Clinic.

Introduction: Patient satisfaction is of increasing importance in the delivery of quality healthcare and may influence provider reimbursement. The purpose of this study is to examine how patient wait time relates to their level of satisfaction and likelihood to recommend an orthopedic clinic to others.

Methods: A retrospective analysis was performed on standardized new patient survey data collected at a single orthopedic clinic from June 2011 through October 2014.

Driving After Hallux Valgus Surgery.

Background: The purpose of the study was to determine when patients can safely return to driving after first metatarsal osteotomy for hallux valgus correction.

Methods: After institutional review board approval, 60 patients undergoing right first metatarsal osteotomy for hallux valgus correction surgery were recruited prospectively. Patients' brake reaction time (BRT) was tested at 6 weeks and repeated until patients achieved a passing BRT.

The Periosteal Medial Femoral Condyle Free Flap: A New Option for Soft Tissue Reconstruction of the Distal Lower Extremity.

Background: Small (<30 cm) soft tissue defects of the distal leg, foot, and ankle pose a complicated issue with regard to wound healing. Multiple flaps have been proposed for reconstruction of these wounds with varying levels of success. The medial femoral condyle flap is a free bone flap supplied by the descending geniculate artery.

Midterm Outcome of the Agility Total Ankle Arthroplasty.

Background: Ankle arthritis is a debilitating condition that causes severe functional impairment. While arthrodesis has been the gold standard of surgical treatment for this condition, significant improvements in total ankle arthroplasty have made it a viable alternative. The purpose of this study was to look at the midterm follow-up of the Agility total ankle.

Metatarsophalangeal Fusion Techniques with First Metatarsal Bone Loss/Defects.

First metatarsophalangeal joint disorder is a common cause of chronic forefoot pain that is frequently encountered in the orthopedic clinic. Numerous surgical techniques have been described to improve patient pain and function in this regard, including prosthetic joint replacement, resection arthroplasty, and arthrodesis. When these procedures fail, surgeons can be confronted with significant first metatarsal bone loss/defects.

Radiographic Outcomes of Postoperative Taping Following Hallux Valgus Correction.

Background: Traditionally, hallux valgus operative correction has been accompanied by serial spica taping of the great toe during the postoperative period.

Methods: We retrospectively reviewed 187 adult patients who underwent proximal first metatarsal osteotomy with a modified McBride procedure in 2008-2009 (n = 83) and 2011-2012 (n = 104). Postoperatively, to maintain the corrected position of the hallux, patients from 2008 through 2009 underwent weekly spica taping, while patients from 2011 through 2012 utilized a toe separator.

The use of allograft in joint-preserving surgery for ankle osteochondral lesions and osteoarthritis.

The surgical management of young patients with large osteochondral lesions of the talus or end-stage osteoarthritis of the ankle joint presents a challenge to the orthopedic surgeon because these are well-recognized sources of pain and dysfunction. Procedures designed to address these disorders either have a limited role because of poor success rates or have significant implications, such as with the total ankle arthroplasty. Fresh osteochondral allografts allow defective tissue to be anatomically matched and reconstructed through transplantation.

The RAM classification: a novel, systematic approach to the adult-acquired flatfoot.

In summary, prior classifications have provided broad guidelines for treating the AAFF without accounting for case-specific variables in determining a treatment plan. The current system breaks down the deformity into three independent levels of involvement: the rearfoot, the ankle, and the midfoot. Via a simple, easy to remember, and reproducible schema based off the original Johnson and Strom classification, each level can be independently evaluated and a patient-specific surgical treatment plan can be formulated based on our most current understanding of the AAFF.

Overdiagnosis of pulmonary embolism: evaluation of a hypoxia algorithm designed to avoid this catastrophic problem.

Background: We observed a substantial increase in the incidence of pulmonary embolism (PE) after total joint arthroplasty (TJA) when multidetector computerized tomography (MDCT) replaced ventilation-perfusion (V/Q) scans as the diagnostic modality of choice. We questioned whether this resulted from the detection of clinically unimportant PE with the more sensitive MDCT and in 2007 instituted a hypoxia protocol to enhance the detection of PE.

Questions/purposes: We determined whether this new hypoxia protocol increased the specificity of our workups for suspected clinically important PE in the immediate postoperative period without affecting patient morbidity and mortality.

Biophysical measurement of brain tumor cohesion.

An advantage of using 3D multicellular spheres to study tumor biology is that they better approximate the interactions encountered by cells in vivo. Our previous studies have shown that the process of spheroid formation is governed by the same thermodynamic principles driving the formation of liquid droplets. This liquid-like behavior enables us to measure a key property influencing tumor behavior, namely, intercellular cohesion.