Prevalence and Predictors of Multimodal Treatment Among U.S. Adults Newly Diagnosed With ADHD.

Introduction: Although a combined treatment of prescription medication and psychotherapy provides long-term benefits for adults with attention deficit/hyperactivity disorder (ADHD), little is known about the prevalence of receiving such multimodal treatment. This study investigated trends in the prevalence and correlates of multimodal treatment among U.S.

Early Postoperative Infections After Closed Reduction and Percutaneous Pinning in Type II and Type III Pediatric Supracondylar Humerus Fractures.

Background: Supracondylar humerus fractures (SCHF) are the most common elbow fracture type in children, and one of the most common pediatric fracture types overall. Excellent outcomes are generally reported with closed reduction and pinning (CRPP), but the technique involves leaving the pins outside the skin. External pins can act as a nidus for infection.

All-epiphyseal versus trans-epiphyseal screw fixation for tillaux fractures: Does it matter?

Background: Tillaux fractures occur primarily in adolescents due to the pattern of physeal closure and are classified as Salter-Harris type III physeal fractures. Operative management with screw fixation is recommended for more than 2 mm of displacement or more than 1 mm of translation. However, the efficacy and complications of trans-physeal all-physeal screw fixation have not been investigated extensively.

Pediatric osteoarticular infection: trend in surgically treated patients and association of methicillin-resistant Staphylococcus aureus with requirement of secondary procedures.

Acute pediatric osteoarticular infection demonstrates variability in both presentation and response to treatment. Many respond to antibiotics ± single operation, while some require multiple surgeries. Currently, it is difficult to predict who may require additional procedures.

Tension Band Plate (TBP)-guided Hemiepiphysiodesis in Blount Disease: 10-Year Single-center Experience With a Systematic Review of Literature.

Background: Primary treatment for Blount disease has changed in the last decade from osteotomies or staples to tension band plate (TBP)-guided hemiepiphysiodesis. However, implant-related issues have been frequently reported with Blount cases. The purpose of our study is to evaluate the surgical failure rates of TBP in Blount disease and characterize predictors for failure.

Who Gets Compartment Syndrome?: A Retrospective Analysis of the National and Local Incidence of Compartment Syndrome in Patients With Supracondylar Humerus Fractures.

Purpose: Although acute compartment syndrome (ACS) is associated with pediatric supracondylar humerus (SCH) fractures, there are limited data describing its incidence and risk factors. The purpose of our study was to report the local and national incidence of ACS with SCH and floating elbow (concomitant SCH and forearm) fracture patterns and the associated risk factors.

Methods: We retrospectively queried data for SCH fracture patients over a 4-year period from our institution (a level I pediatric trauma center) and the National Trauma Data Bank (NTDB).

Impact of Social Support and Pain Coping Abilityon Length of Stay and Discharge Disposition following Hip and Knee Arthroplasty A Prospective Study.

Introduction: While there are many factors known to predict the outcomes of hip and knee arthroplasty procedures, there is a growing interest in predictors that take into consideration the social and psychological preparedness of patients prior to surgery. This study's aim was to determine whether patients' preoperative social support and pain catastrophizing characteristics are independently associated with the outcomes of postoperative length of stay or discharge disposition following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Methods: Data on a prospective sample of 189 THA and TKA adult patients using the pain catastrophizing scale and the medical outcomes study social support expectation score were analyzed.

Effect of Tranexamic Acid on Transfusion Rates Following Total Joint Arthroplasty: A Cost and Comparative Effectiveness Analysis.

Tranexamic acid (TXA) is used to reduce blood loss in orthopedic total joint arthroplasty (TJA). This study evaluates the effectiveness of TXA in reducing transfusions and hospital cost in TJA. Participants undergoing elective TJA were stratified into 2 cohorts: those not receiving and those receiving intravenous TXA.

Interventions to improve hospital patient satisfaction with healthcare providers and systems: a systematic review.

Background: Many hospital systems seek to improve patient satisfaction as assessed by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. A systematic review of the current experimental evidence could inform these efforts and does not yet exist.

Methods: We conducted a systematic review of the literature by searching electronic databases, including MEDLINE and EMBASE, the six databases of the Cochrane Library and grey literature databases.

The Present and Future of Genomics in Adult Reconstructive Orthopaedic Surgery.

As of 2015, members of the "baby boomer generation" comprise 75 million people in the growing United States population. Many of these individuals will be facing the need for total hip or knee replacement. Currently, the age of onset of osteoarthritis continues to decrease and the need for total joint replacements continues to increase.

Disparities in Discharge Destination After Lower Extremity Joint Arthroplasty: Analysis of 7924 Patients in an Urban Setting.

Background: Discharge destination is an important factor to consider to maximize care coordination and manage patient expectations after total joint arthroplasty (TJA). It also has significant impact on the cost-effectiveness of these procedures given the significant cost of post-acute inpatient care. Therefore, understanding factors that impact discharge destination after TJA is critical.

Orthopedic Implant Waste: Analysis and Quantification.

The steadily increasing demand for orthopedic surgeries and declining rates of reimbursement by Medicare and other insurance providers have led many hospitals to look for ways to control the cost of these surgeries. We reviewed administrative records for a 1-year period and recorded total number of surgical cases, number of cases in which an implant was wasted, and cost of each wasted implant. We determined cost incurred because of implant waste, percentage of cases that involved waste, percentage of total implant cost wasted, and average cost of waste per case.

Management of Modifiable Risk Factors Prior to Primary Hip and Knee Arthroplasty: A Readmission Risk Assessment Tool.

Background: Preoperative risk stratification and optimization of preoperative care may be helpful in reducing readmission rates after primary total joint arthroplasty. Assessment of the predictive value of individual modifiable risk factors without a tool to assess cumulative risk may not provide proper risk stratification of patients with regard to potential readmissions. As part of a Perioperative Orthopaedic Surgical Home model, we developed a scoring system, the Readmission Risk Assessment Tool (RRAT), which allows for risk stratification in patients undergoing elective primary total joint arthroplasty at our institution.

Early Results of Medicare's Bundled Payment Initiative for a 90-Day Total Joint Arthroplasty Episode of Care.

Background: In 2011 Medicare initiated a Bundled Payment for Care Improvement (BPCI) program with the goal of introducing a payment model that would "lead to higher quality, more coordinated care at a lower cost to Medicare."

Methods: A Model 2 bundled payment initiative for Total Joint Replacement (TJR) was implemented at a large, tertiary, urban academic medical center. The episode of care includes all costs through 90 days following discharge.

Role of Sociodemographic, Co-morbid and Intraoperative Factors in Length of Stay Following Primary Total Hip Arthroplasty.

We aimed to examine and quantify the combined association of patient sociodemographic, preoperative comorbidities and intraoperative factors with extended and prolonged length of stay (LOS) following primary total hip arthroplasty. Longer LOS was associated with Age (≥65 years), BMI ≥30 kg/m(2), ASA score >2, minority race/ethnicity, low SES, general anesthesia, comorbidities of the Circulatory, Genitourinary and Respiratory systems, and operating time. Collectively, being of low SES, advanced age (≥65 years) and minority race/ethnicity was most significantly associated with prolonged LOS (>7 days).

Can Administrative Data Be Used to Analyze Complications Following Total Joint Arthroplasty?

We hypothesized that the Centers for Medicare and Medicaid Services Limited Dataset (CMS-LDS) could be used to validate the complications associated with total hip and knee arthroplasty (THA and TKA) endorsed by the Hip and Knee Societies. Using ICD-9 procedure and diagnosis codes, cases were extracted from the first three quarters of the 2009 CMS-LDS to allow all complications within 90-days be captured in the same calendar year. We were unable to validate the Hip and Knee Societies' complications as we could not connect readmissions or outpatient visits to index admissions.

The Combined Influence of Sociodemographic, Preoperative Comorbid and Intraoperative Factors on Longer Length of Stay After Elective Primary Total Knee Arthroplasty.

This study assessed the collective association of sociodemographic, preoperative comorbid and intraoperative factors with longer length of stay (LOS) following elective primary total knee arthroplasty. Sociodemographic characteristics examined on 2638 adult cases included age, race/ethnicity, gender and socioeconomic status (SES). Intraoperative factors included operating time and anesthesia type.

Evaluation of the first-generation AAOS clinical guidelines on the prophylaxis of venous thromboembolic events in patients undergoing total joint arthroplasty: experience with 3289 patients from a single institution.

Background: Patients undergoing total hip or total knee arthroplasty have risks that include venous thromboembolism. The American Academy of Orthopaedic Surgeons has promulgated guidelines for the preoperative assessment of patients with the primary objective of preventing pulmonary embolism. We aimed to evaluate and establish the utility of the first-generation American Academy of Orthopaedic Surgeons guidelines for the prophylaxis of venous thromboembolism in patients undergoing total joint arthroplasty at a single institution.

Can a hip and knee adult reconstruction orthopaedic surgeon sustain a practice comprised entirely of Medicare patients?

Reimbursement continues to decrease for orthopaedic surgeons specializing in total joint arthroplasty (TJA). Practice information from the Medical Group Management Association (MGMA) Cost Survey and Private practice Compensation Survey and CMS locality reimbursement data was used to develop a practice model for a TJA specialist performing 300 TJA per year (66% knees, 33% hips, 15% revision surgery), evaluating 3000 outpatient visits per year based on, current Medicare reimbursement rates. Our model shows that the anticipated physician compensation is well below the mean compensation reported for a TJA specialist irrespective of geographic location.

Focused risk analysis: regression model based on 5,314 total hip and knee arthroplasty patients from a single institution.

We aimed to identify significant demographic, preoperative comorbidity and surgical predictors for major complications for use in the development of a risk prediction tool for a well-defined population as Total Joint Arthroplasty (TJA) patients. Data on 5314 consecutive patients who underwent primary total hip or knee arthroplasty from October 1, 2008 through September 30, 2011 at a single institution were used in a multivariate regression analysis. The overall incidence of a primary endpoint (reoperation during same admission, extended length of stay, and 30-day readmission) was 3.

Multiple epidural lumbar chordomas without bone involvement in a 17-year-old female: a case report.

Background Context: Chordomas are rare slow-growing neoplasms or malignant tumors that arise from embryonic rudiments of the primitive notochord. They account for 1% to 4% of all primary malignant bone tumors. Surgery in addition to radiotherapy is often used as the optimum treatment but with marginal effectiveness as these tumors are relatively radioresistant.

Tenosynovial giant cell tumor of the thigh: positron emission tomography findings.

Tenosynovial giant cell tumors (TGCTs) are pigmented villonodular proliferative lesions originating from the synovium, bursa, or joint. TGCTs tend to be locally aggressive, and there is a chance for multiple occurrences, which often lead to impairment of joint function. In this article, we report the case of a diffuse-type extra-articular TGCT found in the thigh of a 36-year-old woman.