The cost-effectiveness of the arthroscopic Bankart versus open Latarjet in the treatment of primary shoulder instability.

Background: The purpose of this study was to conduct a cost-effectiveness analysis of the arthroscopic Bankart and the open Latarjet in the treatment of primary shoulder instability.

Methods: This cost-effectiveness study used a Markov decision chain and Monte-Carlo simulation. Existing literature was reviewed to determine the survivorship and complication rates of these procedures.

Digital Tomography for Detection of Acute Occult Scaphoid Fractures.

Diagnosis of occult scaphoid fractures remains a challenge. Traditional management consisting of 2 weeks of immobilization and repeat radiographs results in unnecessary immobilization of many patients without fracture. Magnetic resonance imaging (MRI) is sensitive but expensive.

Redefining Optimal Nail to Medullary Canal Diameter Ratio in Stainless Steel Flexible Intramedullary Nailing of Pediatric Femur Fractures.

Purpose: The ideal canal fill for flexible intramedullary fixation of pediatric femoral shaft fractures is considered to be 80% based upon relatively few clinical studies. The purpose of this study is to assess the relationship between the summed nail to intramedullary canal diameter (ND/MCD) ratio and alignment at radiographic union following flexible intramedullary nailing (FIMN) of pediatric femoral shaft fractures.

Methods: An Internal Review Board approved, retrospective review of a consecutive series of patients who sustained a femoral shaft fracture treated by retrograde, stainless steel FIMN was performed at a single level 1 pediatric trauma center from 2005 to 2012.

Think time: A novel approach to analysis of clinicians' behavior after reduction of drug-drug interaction alerts.

Objectives: Pharmacologic interaction alerting offers the potential for safer medication prescribing, but research reveals persistent concerns regarding alert fatigue. Research studies have tried various strategies to resolve this problem, with low overall success. We examined the effects of targeted alert reduction on clinician behavior in a resource constrained hospital.

Clinical Validation of the Glenoid Track Concept in Anterior Glenohumeral Instability.

Background: Glenoid and humeral bone loss are well-described risk factors for failure of arthroscopic shoulder stabilization. Recently, consideration of the interactions of these types of bone loss (bipolar bone loss) has been used to determine if a lesion is "on-track" or "off-track." The purpose of this study was to study the relationship of the glenoid track to the outcomes of arthroscopic Bankart reconstructions.

Measuring the operational impact of digitized hospital records: a mixed methods study.

Background: Digitized (scanned) medical records have been seen as a means for hospitals to reduce costs and improve access to records. However, clinical usability of digitized records can potentially have negative effects on productivity.

Methods: Data were collected during follow-up outpatient consultations in two NHS hospitals by non-clinical observers using a work sampling approach in which pre-defined categories of clinician time usage were specified.

Big Data, Big Problems: Incorporating Mission, Values, and Culture in Provider Affiliations.

This article explores how integration of data from clinical registries and electronic health records produces a quality impact within orthopedic practices. Data are differentiated from information, and several types of data that are collected and used in orthopedic outcome measurement are defined. Furthermore, the concept of comparative effectiveness and its impact on orthopedic clinical research are assessed.

Computerised Provider Order Entry Adoption Rates Favourably Impact Length of Stay.

Background Research regarding return on investment for electronic health records (EHRs) is sparse.Objective To extend previously established research and examine rigorously whether increasing the adoption of computer-based provider/prescriber order entry (CPOE) leads to a decrease in length of stay (LOS), and to demonstrate that the two are inversely and bidirectionally proportional even while other efforts to decrease LOS are in place.Method The study assessed CPOE, LOS and case mix index (CMI) data in a community hospital in the United States, using a mature and nearly fully deployed vendor product EHR.

Flexible Intramedullary Nails for Femur Fractures in Pediatric Patients Heavier Than 100 Pounds.

Background: Flexible intramedullary nailing (FIMN) of femoral shaft fractures in children >100 pounds remains controversial. The purpose of this study is to assess the relationship between patient weight and alignment at radiographic union following Ender's FIMN of pediatric femoral shaft fractures.

Methods: An IRB approved, retrospective review of all patients who sustained a femoral shaft fracture treated by retrograde, stainless-steel Ender's FIMN was performed at a level 1 pediatric trauma center from 2005 to 2012.

Autograft Versus Allograft Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Clinical Study With a Minimum 10-Year Follow-up.

Background: The use of allografts for anterior cruciate ligament (ACL) reconstruction in young athletes is controversial. No long-term results have been published comparing tibialis posterior allografts to hamstring autografts.

Purpose: To evaluate the long-term results of primary ACL reconstruction using either an allograft or autograft.

Outcomes After Surgical Treatment of Adolescent Intra-articular Distal Humerus Fractures.

Background: To determine the radiographic and clinical outcomes of the surgical management of adolescent intra-articular distal humerus fractures.

Methods: We performed a retrospective review of the clinical and radiographic outcomes of 31 consecutive adolescent patients surgically treated for acute distal humerus intra-articular fractures. Nine patients returned for objective measures of range of motion, strength testing, and completion of validated outcome scores including the Mayo Elbow Performance Score (MEPS); The Disabilities of the Arm, Shoulder, and Hand Score (DASH); and the SF-36.

Optimal Care Mother-Baby and Outcomes through Community-wide Data Sharing, Interoperability and Connectivity.

The power of interoperable systems with data/information integration, central to achieving the goals of Telehealth, is illustrated through mutually beneficial sharing between Labor & Delivery (L&D) and Obstetrics (OBs) Clinics. Data shared between L&D and OB brought improved practice patterns and outcomes, and increased satisfaction at both. Staffing and skillsets were significantly improved by knowing complications arriving and anticipated volumes.

Improved Immediate and Continued-Care Outcomes for Stroke through Community-Wide Data.

Strokes account for 1 of every 18 deaths in North America, and remain a major burden cost-wise and clinically for societies globally. Quicker and more clinically astute care for stroke leads to improved outcomes for the patient, families and the healthcare system at large. The intervention shared illustrates how a locally-programmable EMR with inherent community-wide communications capabilities leads to proven better outcomes for all.

Redefining "Critical" Bone Loss in Shoulder Instability: Functional Outcomes Worsen With "Subcritical" Bone Loss.

Background: Glenoid bone loss is a common finding in association with anterior shoulder instability. This loss has been identified as a predictor of failure after operative stabilization procedures. Historically, 20% to 25% has been accepted as the "critical" cutoff where glenoid bone loss should be addressed in a primary procedure.

The impact of tort reform and quality improvements on medical liability claims: a tale of 2 States.

The purpose of this study was to determine the effect of tort reform and quality improvement measures on medical liability claims in 2 groups of hospitals within the same multihospital organization: one in Texas, which implemented medical liability tort reform caps on noneconomic damages in 2003, and one in Louisiana, which did not undergo significant tort reform during the same time period. Significant reduction in medical liability claims per quarter in Texas was found after tort reform implementation (7.27 to 1.

Outcomes of long-arm casting versus double-sugar-tong splinting of acute pediatric distal forearm fractures.

Introduction: The traditional treatment after closed reduction of distal radius (DR) and distal both bone (DBB) forearm fractures has been application of a long-arm cast (LAC) or a short-arm cast (SAC). Splinting is another option that avoids the potential complications associated with casting. The purpose of this study is to evaluate the maintenance of reduction of DR or DBB fractures placed in a double-sugar-tong splint (DSTS) compared with a LAC in a pediatric population.

The Effect of Syndesmosis Screw Removal on the Reduction of the Distal Tibiofibular Joint: A Prospective Radiographic Study.

Background: Injury to the tibiofibular syndesmosis is frequent with rotational ankle injuries. Multiple studies have shown a high rate of syndesmotic malreduction with the placement of syndesmotic screws. There are no studies evaluating the reduction or malreduction of the syndesmosis after syndesmotic screw removal.

A computerized order entry system was adopted with high user satisfaction at an orthopedic teaching hospital.

Background: Computerized provider order entry (CPOE) has been considered essential for the reduction of medical errors and increased patient safety. Assessment of staff perception regarding a CPOE system is important for satisfaction and adoption. Incorporation of user feedback can greatly improve the functionality of a system and promote user satisfaction.

Return to an athletic lifestyle after osteochondral allograft transplantation of the knee.

Background: Osteochondral allograft transplantation (OATS) is a treatment option that provides the ability to restore large areas of hyaline cartilage anatomy and structure without donor site morbidity and promising results have been reported in returning patients to some previous activities. However, no study has reported on the durability of return to activity in a setting where it is an occupational requirement.

Hypothesis: Osteochondral allograft transplantation is less successful in returning patients to activity in a population in which physical fitness is a job requirement as opposed to a recreational goal.

Quality in orthopaedic surgery--an international perspective: AOA critical issues.

Quality is a hallmark of health care, although it is difficult to come to a consensus on who gets to define what "quality health care" is. Most health-care workers enter this field with the goal of improving the health of their patients (and the community), and while everyone tries to do the best job possible, we must continuously seek better methods and techniques for achieving better outcomes. The passion for continuous improvement is fundamental, but passion is not sufficient by itself.

Clavicular bone tunnel malposition leads to early failures in coracoclavicular ligament reconstructions.

Background: Modern techniques for the treatment of acromioclavicular (AC) joint dislocations have largely centered on free tendon graft reconstructions. Recent biomechanical studies have demonstrated that an anatomic reconstruction with 2 clavicular bone tunnels more closely matches the properties of native coracoclavicular (CC) ligaments than more traditional techniques. No study has analyzed tunnel position in regard to risk of early failure.

Early failures with single clavicular transosseous coracoclavicular ligament reconstruction.

Introduction: Coracoclavicular (CC) ligament reconstruction remains a challenging procedure. The ideal reconstruction is biomechanically strong, allows direct visualization of passage around the coracoid, and is minimally invasive. Few published reports have evaluated arthroscopic techniques with a single clavicular tunnel and transcoracoid reconstruction.

Snowboarding-related abdominal trauma in children.

Objective: Our aim was to identify the demographics, mechanism, and patterns of injury in children presenting with snowboarding injuries.

Methods: We conducted a retrospective chart review on children aged 6 to 21 years presenting to our level 1 pediatric trauma center between January 2000 and March 2007 with snowboarding-related injury. E-codes for snowboarding injuries identified patients.

Nurse practitioner roles in pediatric emergency departments: a national survey.

Objective: Emergency department (ED) visits continue to climb in the United States despite numerous primary care initiatives. A variety of staffing models including the utilization of nurse practitioners (NPs) and physician assistants (PAs) and the use of fast-track or express care are alternative methods of caring for the ED patients with less acute illness. Our objectives were to determine the prevalence of NPs in pediatric EDs (PEDs) and fast-track areas and to identify common procedures performed by NPs in PEDs.

Making sense out of the tonsillectomy literature.

Background: With the increase in new technology and changing indications for tonsillectomy, the literature has exploded during the last 20 years with scores of publications reporting the relative effectiveness of many different techniques. Despite this "wealth of information," no single technique has been adopted by most surgeons.

Objectives: To systematically analyze the usefulness of this literature of the past 20 years concerning tonsillectomy technique in children.