The quality of upper extremity orthopedic care in liability claims filed and claims paid.

Purpose: To review a series of closed liability claims for upper extremity conditions to guide improvements for upper extremity care and thereby reduce the frequency of paid claims.

Methods: The authors, a team of 3 orthopedic surgeons and 3 nonphysician investigators experienced in closed claims research, investigated 108 closed upper extremity liability claims from a large United States-wide insurer for events that occurred between 1996 and 2009. We sought to determine the types of conditions, treatments, and surgeon factors common to claims made and claims paid.

Origin of propionibacterium in surgical wounds and evidence-based approach for culturing propionibacterium from surgical sites.

Background: To explore the origin of Propionibacterium in surgical wounds and to suggest an optimized strategy for culturing this organism at the time of revision surgery, we studied the presence of this organism on the skin and in the surgical wounds of patients who underwent revision arthroplasty for reasons other than apparent infection.

Methods: Specimens were cultured in broth and on aerobic and anaerobic media. The presence and degree of positivity of Propionibacterium cultures were correlated with sex.

Demographics of disclosure of conflicts of interest at the 2011 annual meeting of the American Academy of Orthopaedic Surgeons.

Background: There is growing concern regarding conflicts of interest in orthopaedic research and education. Because of their potential influence on orthopaedic practice, conflicts of interest among participants in the educational programs of the American Academy of Orthopaedic Surgeons (AAOS) are of particular interest.

Methods: We analyzed the voluntarily disclosed conflicts of interest listed in the Final Program of the 2011 Annual Meeting of the AAOS for the relevant program committees as well as for presentations in the disciplines of pediatric orthopaedic surgery, spine, and sports medicine/arthroscopy.

Lessons regarding the safety of orthopaedic patient care: an analysis of four hundred and sixty-four closed malpractice claims.

Background: An orthopaedic malpractice claim alleges that the patient sustained a preventable iatrogenic injury. The analysis of a representative series of malpractice claims provides a unique view of alleged orthopaedic adverse events, revealing what can potentially go wrong across a spectrum of practice settings and anatomic locations. The goal of this study was to identify high-impact targets in order to institute measures to reduce claims through efforts focused on patient safety.

Prognostic factors for bacterial cultures positive for Propionibacterium acnes and other organisms in a large series of revision shoulder arthroplasties performed for stiffness, pain, or loosening.

Background: Propionibacterium acnes has been grown on culture in half of the reported cases of chronic infection associated with shoulder arthroplasty. The presence of this organism can be overlooked because its subtle presentation may not suggest the need for culture or because, in contrast to many orthopaedic infections, multiple tissue samples and weeks of culture incubation are often necessary to recover this organism. Surgical decisions regarding implant revision and antibiotic therapy must be made before the results of intraoperative cultures are known.

The prognosis for improvement in comfort and function after the ream-and-run arthroplasty for glenohumeral arthritis: an analysis of 176 consecutive cases.

Background: Knowledge of the factors affecting the prognosis for improvement in function and comfort with time after shoulder arthroplasty is important to clinical decision-making. This study sought to identify some of these factors in 176 consecutive patients undergoing the ream-and-run procedure.

Methods: The time course for improvement in patient function and comfort was determined for the entire group as well as for subsets by sex, age, diagnosis, preoperative function, and surgery date.