Causal language and inferences in observational rotator cuff database studies published from 2013 to 2022.

Background: The use of large multi-institutional databases in rotator cuff repair (RCR) research is expanding, but these studies are observational and cannot establish causation. This study examines the prevalence of causal language in clinical RCR database studies published from 2013 to 2022.

Methods: Administrative database and clinical registry studies on RCR published in eight orthopaedic journals from 2013 to 2022 were systematically identified and graded by two reviewers for the presence, absence, or inconsistent use of causal language in both the title/abstract and the full text.

Coin Test: A Complementary Examination for Assessing Upper Extremity Function in Cervical Myelopathy.

Study Design: A prospective observational study.

Objectives: To explore the potential utility of the Coin Test as a valuable tool for assessing and diagnosing cervical spondylotic myelopathy (CSM).

Methods: In the first cohort, 36 patients with balance issues were assessed for CSM using the new Coin Test.

Clinical and Radiographic Outcomes After Hindfoot and Ankle Arthrodesis Using Cellular Bone Allograft Augmentation: A Short Report.

Background: Nonunion after ankle or hindfoot arthrodesis is associated with poor outcomes. Cellular bone allograft is an alternative to autograft for use in these procedures. The purpose of this study was to prospectively evaluate the early efficacy and safety of cellular bone allograft use in hindfoot and ankle arthrodesis procedures.

Owner experience and veterinary involvement with unlicensed GS-441524 treatment of feline infectious peritonitis: a prospective cohort study.

Introduction: Feline Infectious Peritonitis (FIP) has historically been a fatal coronavirus disease in cats. In recent years, the therapeutic agent GS-441524, developed by Gilead Sciences, was found to be a successful treatment for FIP in most patients in clinical trials. However, this particular drug has remained stalled in the therapeutic pipeline, leaving patients and cat owners without a licensed medication.

Postoperative pain score does not correlate with injury severity in isolated tibial plateau fractures.

Purpose: Appropriate management of acute postoperative pain is critical for patient care and practice management. The purpose of this study was to determine whether postoperative pain score correlates with injury severity in tibial plateau fractures.

Methods: A retrospective review of prospectively collected data was completed at a single academic level one trauma center.

Association of Timing of Hindfoot Arthrodesis and Early Reoperation Rates for Total Ankle Arthroplasty.

Background: Prior literature has demonstrated that ipsilateral hindfoot arthrodesis may increase the risk for reoperation after total ankle arthroplasty (TAA) and that simultaneous hindfoot arthrodesis with TAA could result in short-term clinical and radiologic improvements. The purpose of this study is to compare the reoperation rates after TAA with prior hindfoot arthrodesis vs simultaneous arthrodesis and TAA.

Methods: Patients who underwent primary TAA were identified in the PearlDiver database.

Unlicensed antiviral products used for the at-home treatment of feline infectious peritonitis contain GS-441524 at significantly different amounts than advertised.

Objective: To analyze the content of unlicensed GS-441524-like products being used as a largely successful at-home treatment for cats suspected to have FIP. The remdesivir content and pH were also measured.

Sample: 127 injectable and oral samples from 30 of the most popular brands of black market producers.

Timing of Olecranon Fracture Fixation Does Not Affect Early Complication or Reoperation Rates.

Purpose: Surgical fixation of olecranon fractures can lead to soft-tissue complications and return to the operating room for hardware removal. While some risk factors of complications after olecranon fracture fixation have been described, the effects of fixation timing on complications and reoperation have not been evaluated. The purpose of the present study was to assess whether the timing of olecranon fracture fixation affects complication and reoperation rates.

Impact of Opioid Use on Duration of Therapy and Overall Survival for Patients with Advanced Non-Small Cell Lung Cancer Treated with Immune Checkpoint Inhibitors.

Immune checkpoint inhibitors (ICI) have significantly improved outcomes in advanced non-small cell lung cancer (NSCLC). We evaluated the effect of opioid use on outcomes in patients receiving ICI either alone or with chemotherapy. We conducted a retrospective review of 209 patients with advanced NSCLC who received an ICI at the University of Virginia between 1 February 2015 and 1 January 2020.

Basal cortisol levels do not predict adrenal responsiveness in acute decompensated cirrhosis.

Objective: Morning total cortisol (TC) levels have been shown to predict adrenal dysfunction (AD) in the general population, but their utility in cirrhosis is unknown.

Methods: A retrospective cohort study was performed including all noncritically ill patients at our institution between 2011 and 2022 admitted with acute decompensated cirrhosis who underwent standard-dose adrenocorticotropic hormone (ACTH) stimulation testing. Adrenal dysfunction was defined as an increase in TC (delta TC) level <9 µg/dl 60 minutes after ACTH dosing.

Static Non-articulating Knee Spacers Are Associated with a High Degree of Morbidity in Challenging Clinical Scenarios.

The morbidity associated with the use of static non-articulating knee spacers for the treatment of periprosthetic joint infection (PJI) in challenging clinical scenarios has not been well described. From 2011-2019, 63 molded block static spacers were utilized at two academic institutions for the treatment of PJI with associated severe soft tissue compromise (59%), collateral ligament deficiency (49%), extensor mechanism compromise (48%), or type 3 bone defects (44%). Complications and outcomes were assessed.

Relevance of the Updated Recursive Partitioning Analysis (U-RPA) Classification in the Contemporary Care of Patients with Brain Metastases.

Patients with brain metastases (BMETS) need information about the prognosis and potential value of treatment options to make informed therapeutic decisions, but tools to predict survival in contemporary practice are scarce. We propose an Updated Recursive Partitioning Analysis (U-RPA) instrument to predict survival and benefit from brain-directed treatment (BDT) of contemporary patients. This was a retrospective analysis of patients with BMETS treated between 2017 and 2019.

Climate and human mortality in Virginia, 2005-2020.

Using an extensive database of every resident death in Virginia from 2005 to 2020, climate-mortality relationships are examined for 12 climatically homogeneous regions within the Commonwealth. Each region is represented by a first-order weather station from which archived temperature and humidity data are used to generate a variety of biometeorologically relevant indices. Using these indices and other variables (such as air quality and heat and cold waves), daily mortality and climate relationships are modeled for each region over a 21-day lag period utilizing generalized additive models and distributed lag non-linear models.

Evaluation of a 30-day-mortality risk calculator for patients undergoing surgical fixation of fragility hip fractures.

Introduction: Hip fractures often occur in medically complex patients and can be associated with high perioperative mortality. Mortality risk assessment tools that are specific to hip fracture patients have not been extensively studied. The objective of this study is to evaluate a recently published 30-day mortality risk calculator (Hip Fracture Estimator of Mortality Amsterdam [HEMA]) in a group of patients treated at a university health system.

Cost-Conscious Colposcopy: A Single-Institution Review of Biopsy Submission Practices and Outcomes.

Objective: Distribution of cervical dysplasia may influence approach for excisional procedures. Separating colposcopy biopsies into multiple specimen cups for pathologic evaluation incurs additional costs. The authors aimed to determine whether the practice of separating biopsy specimens impacts patient outcomes.

The use of causal language and inferences in observational shoulder arthroplasty database studies.

Background: Over the last few decades, several databases and clinical registries have been used to generate studies for orthopedic surgery research including shoulder arthroplasty. Observational database studies present data that are best used to provide information regarding associations between variables but is unable to prove causation. Yet, there remains a tendency for authors to use causal language and conclusive statements in published shoulder arthroplasty literature using such databases.

Regional anesthesia provides limited decreases in opioid use following distal tibia and ankle fracture surgery.

Purpose: Regional anesthesia (RA) is used for pain control, but its impacts on the orthopedic trauma population are not well known. This study evaluated the impact of peripheral nerve blocks after distal tibia and ankle fracture repair on opioid use and pain scores and quantified the magnitude and duration of any changes.

Methods: This retrospective cohort study included patients treated operatively for distal tibia and ankle fractures over a 5-year period, both with and without peripheral nerve blocks.

The Impact of Robotic-Assisted Total Knee Arthroplasty on Resident Training.

Background: As robotic-assisted total knee replacement (rTKA) continues to gain popularity, the impact of this technology on resident education remains unknown. The purpose of this study was to describe trainee experience and perceptions of rTKA and its effect on surgical training.

Methods: Two hundred and twenty two senior orthopaedic residents attending a national board review course completed a 17-question survey regarding their experience and perceptions regarding rTKA.

Concordance in Distinguishing Actinic Keratosis from Squamous Cell Carcinoma in Situ on Mohs Histological Frozen Sections.

Background: Mohs surgeons routinely encounter squamous cell carcinoma at surgical margins and often base the decision to take another layer on the severity of atypia observed. Currently, no criteria exists for distinguishing borderline histological patterns that could be interpreted differently as actinic keratosis (AK), squamous cell carcinoma in situ (SCCIS), or AK with focal SCCIS.

Objective: To assess interrater concordance amongst Mohs surgeons in distinguishing AK from SCCIS when evaluating Mohs frozen sections.

Trends in fatal occupational injury rates among older workers before and after the Great Recession of 2008.

Background: Older workers experience higher rates of fatal occupational injury than younger workers worldwide. In North Carolina, the population of older workers more than doubled between 2000 and 2017. In 2008, the Great Recession changed occupational patterns among all age groups.