Death of the P Value? Bayesian Statistics for Orthopaedic Surgeons.

Statistical interpretation is foundational to evidence-based medicine. Frequentist (P value testing) and Bayesian statistics are two major approaches for hypothesis testing. Studies analyzed with Bayesian methods are increasingly common with a 4-fold increase in the past 10 years.

Spine Injuries Sustained After Falls While Crossing the U.S.-Mexico Border.

This study is to report the demographics, incidence, and patterns of spinal injuries associated with border crossings resulting from a fall from a significant height. A retrospective cohort study was performed at a Level I trauma center from January 2016 to December 2021 to identify all patients who fell from a significant height while traversing the U.S.

Acromial Morphology Does Not Correlate with Age at Time of Rotator Cuff Tear: A Cross-Sectional Study.

Background: The purpose of this study was to determine if scapular anatomy differs between younger and older patients with atraumatic full-thickness supraspinatus tears.

Methods: The critical shoulder angle, acromial index and lateral acromial angle were measured on standardized radiographs of two groups of patients who underwent arthroscopic repair of full-thickness degenerative supraspinatus tears. Group 1 included 61 patients under the age of 50 years while Group 2 included 45 patients over the age of 70 years.

Primary Repair versus Reverse End-to-Side Coaptation by Anterior Interosseous Nerve Transfer in Proximal Ulnar Nerve Injuries.

Background: Proximal ulnar nerve lacerations are challenging to treat because of the complex integration of sensory and motor function in the hand. The purpose of this study was to compare primary repair and primary repair plus anterior interosseous nerve (AIN) reverse end-to-side (RETS) coaptation in the setting of proximal ulnar nerve injuries.

Methods: A prospective cohort study was performed of all patients at a single, academic, level I trauma center from 2014 to 2018 presenting with isolated complete ulnar nerve lacerations.

Correction of Cubitus Varus Using Computer-Assisted Hexapod Multiplanar External Fixators: A Report of 3 Cases.

Case: Three male patients, 8-, 13-, and 18-year-old, all developed posttraumatic cubitus varus elbow deformity after distal humerus supracondylar fractures. Each underwent a distal humerus osteotomy with application of a hexapod external fixator to gradually correct the deformity.

Conclusion: In patients with cubitus varus malunion, the stability of the hexapod external fixation, percutaneous nature of the osteotomy, and availability of running a residual computer-assisted program provides a consistent technique for deformity correction.

Common Finger Injuries: Treatment Guidelines for Emergency and Primary Care Providers.

Introduction: Finger and hand injuries are among the most common musculoskeletal conditions presenting to emergency departments and primary care providers. Many rural and community hospitals may not have immediate access to an orthopedic surgeon on-site. Furthermore, military treatment facilities, both within the continental United States and in austere deployment environments, face similar challenges.

The Association of H-index and Academic Rank Among Full-time Academic Foot and Ankle Surgeons Affiliated with Fellowship Programs.

The purpose of this study is to investigate the association between Hirsch index (h-index) and academic rank among foot and ankle surgeons affiliated with American Orthopaedic Foot and Ankle Society (AOFAS) fellowship programs. The total number of publications, academic rank, years in practice, fellowship training pedigree, and h-indices of 176 foot and ankle surgeons from 48 AOFAS fellowship programs were recorded, and statistical analysis was performed. We found a strong association between total number of publications and h-index.

Post-operative Immobilization in Total Elbow Arthroplasty for Rheumatoid Arthritis: A Systematic Review of Outcomes.

The purpose of this analysis is to determine the effect of length of immobilization following total elbow arthroplasty (TEA) for rheumatoid arthritis on the outcomes, complications, and survival of the implant. A review of TEA literature was performed. Post-operative motion was categorized into three groups: no post-operative immobilization (group 1), short-term 2-5 days immobilization (group 2), and extended 7-14 days immobilization (group 3).

Traumatic Finger Amputation in the U.S. Military.

Introduction: Finger amputations can lead to loss of work time and suboptimal function, particularly in the active duty military. There is a paucity of epidemiologic and outcome data for these injuries. The purposes of this study are to define key demographic data pertaining to transphalangeal finger amputations in the U.

Pharmacologic Treatments in Upper Extremity Complex Regional Pain Syndrome: A Review and Analysis of Quality of Evidence.

Background: The purpose of this study was to assess the quality of evidence informing on common pharmacologic modalities used in upper extremity complex regional pain syndrome (CRPS).

Methods: A literature search was performed for primary prospective trials that reported on the pharmacologic treatment of CRPS type I and II specific to the upper extremity. Thirty-one trials were included and evaluated by 2 independent reviewers according to the Oxford Levels of Evidence (LOE), modified Coleman Methodology Score, and the revised Consolidated Standards of Reporting Trials (CONSORT) score.

Qualitative analysis of randomized controlled trials informing recommendations for venous thromboembolism prophylaxis after distal lower extremity injuries.

Purpose: The purpose of this study is to assess the quality of evidence to stratify recommendations for chemoprophylaxis following distal lower extremity trauma.

Methods: Literature review identified primary studies investigating venous thromboembolism (VTE) chemoprophylaxis following traumatic injury distal to the knee. Inclusion criteria were randomized controlled trials in adult patients treated with and without operative intervention.

Ten-Year Trends in Level of Evidence in Hand Surgery.

Background: The purposes of this study were to analyze the trends in Oxford level of evidence (LOE), LOE of most-cited articles, and association between LOE and journal impact factor (IF) and SCImago Journal Rank (SJR) over a 10-year period (2009-2018) in 3 prominent hand surgery journals, specifically () (), and () ().

Methods: All articles published from 2009 to 2018 in , and were reviewed for assigned or available LOE. Data were pooled and analyzed for trends in LOE; relationship among IF, SJR, and LOE; and citation density.

Bone Morphogenetic Protein in Scaphoid Nonunion: A Systematic Review.

 Scaphoid nonunion can lead to carpal collapse and osteoarthritis, a painfully debilitating problem. Bone morphogenetic protein (BMP) has been successfully implemented to augment bone healing in other circumstances, but its use in scaphoid nonunion has yielded conflicting results.  The purpose of this study is to assess the outcomes and complications of scaphoid nonunion treated surgically with BMP.

Variation in state and federal reimbursement in the United States in the treatment of upper extremity fractures.

Background: Medicare and Medicaid are 2 of the largest government-run health care programs in the United States. Although Medicare reimbursement is determined at the federal level by the Centers for Medicare & Medicaid Services, Medicaid reimbursement rates are set by each individual state. The purpose of this study is to compare Medicaid reimbursement rates with regional Medicare reimbursement rates for 12 orthopedic procedures performed to treat common fractures of the upper extremity.

Dorsal Bridge Plate for Distal Radius Fractures: A Systematic Review.

Purpose: This study presents patient demographics, injury characteristics, outcomes, and complications associated with dorsal bridge plating (DBP) in the treatment of distal radius fractures.

Methods: A literature search performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines identified 206 articles, 12 of which met inclusion criteria, accounting for 310 patients. Included articles contained the results of DBP for treatment of distal radius fractures with reported outcomes between 1988 and 2018.

Incidence and Management of Radial Nerve Palsies in Humeral Shaft Fractures: A Systematic Review.

Radial nerve palsies in closed humeral shaft fractures are common, with an incidence of 7%-17%. The management of radial nerve palsies in closed fractures is often expectant, with 70.7% spontaneously recovering within six months.

Prospective Single-Blinded Randomized Controlled Trial Comparing Pericapsular Injection Versus Lumbar Plexus Peripheral Nerve Block for Hip Arthroscopy.

Background: Hip arthroscopy has become the standard for the operative treatment of symptomatic femoroacetabular impingement. Given the high levels of postoperative pain associated with hip arthroscopy, optimal analgesia is critical to ensure patient comfort and safety after discharge.

Purpose/hypothesis: Our purpose was to perform a single-blinded randomized controlled trial comparing the use of pericapsular injection versus lumbar plexus blockade for postoperative pain control after arthroscopic surgery on the hip.

miR-206 enforces a slow muscle phenotype.

Striated muscle is a highly specialized collection of tissues with contractile properties that vary according to functional needs. Although muscle fiber types are established postnatally, lifelong plasticity facilitates stimulus-dependent adaptation. Functional adaptation requires molecular adaptation, which is partially provided by miRNA-mediated post-transcriptional regulation.

Factors Considered When Ranking Military Orthopedic Surgery Residency Candidates.

Introduction: The intangible personal characteristic grit has become a popular topic of concentration within contemporary psychology studies. Grit is defined as persistent work on a focused topic for an extended period of time until a desired goal is achieved. Its application to physician selection and development is not well known.

Primary and Revision Circumferential Labral Reconstruction for Femoroacetabular Impingement in Athletes: Return to Sport and Technique.

Purpose: To determine return-to-play rates and hip-specific outcomes in athlete hips with femoroacetabular impingement syndrome treated with circumferential labral reconstruction (CLR).

Methods: All consecutive patients who underwent CLR from January through December 2016 performed by the senior surgeon with complete 2-year outcome scores were identified. The hips of 57 non-athletes who underwent CLR were excluded from analysis, as were 165 patients who underwent labral repair and 4 patients who underwent labral debridement.

Bilateral Congenital Absence of Small Finger Flexor Digitorum Superficialis Tendons in a Trauma Patient.

The flexor digitorum superficialis (FDS) is the only muscle in the intermediate layer of the flexor compartment of the forearm. Its main function is flexion of the proximal interphalangeal (IP) joint. Variations of the FDS are common, and knowledge of these variations is necessary for hand surgeons because the little finger tendon of the FDS is commonly used in hand reconstruction surgery.

Hypothenar Hammer Syndrome in an Elderly Caucasian Female: A Case Report.

Hypothenar hammer syndrome (HHS) is a vascular disorder characterized by ulnar artery thrombosis or aneurysmal formation. It is most commonly reported in middle-aged males who suffer from repetitive trauma to the palm secondary to occupational or recreational activities. Most cases of HHS can be managed conservatively; however, surgical management is typically indicated for persistent symptoms following conservative measures, imminent vascular compromise, those who fail conservative treatment, or those in imminent danger of rupture.

Capitolunate Arthrodesis: A Systematic Review.

Purpose: To compile and review the indications, outcomes, and complications of capitolunate arthrodesis (CLA).

Methods: We performed a literature search identifying 33 articles, 6 of which met inclusion criteria, including 80 patients. Included publications contained the results of CLA with minimum 12-month follow-up between 2000 and 2018.