Accountable Operating Room Teams.

With Medicare reimbursement diminishing and the aging population consuming more health care, hospitals continue to push for reforms to improve the efficiency of health care delivery, decrease consumption, and elevate the quality of care. Operating rooms command a large share of hospital resources but are also major revenue generators. Surgical care has evolved to become more efficient and accountable.

Prevalence of Bacterial Contamination of Casting Material in a Pediatric Population.

Surgical site infection is a relatively common and devastating complication following pediatric orthopedic surgery. Many infections have been determined to be the result of settled airborne particles on surgical equipment and the sterile field. Fiberglass casts are commonly used orthopedic fixation devices before and after surgery; however, fiberglass casting material is expelled during the removal process and represents an uninvestigated area for the possibility of cast saw dust as a source of airborne bacterial contamination in an operating room setting.

Biomechanical strength comparison of pedicle screw augmentation using poly-dicalcium phosphate dihydrate (P-DCPD) and polymethylmethacrylate (PMMA) cements.

Study Design: A basic science, hypothesis-driven experimental study of the biomechanics of two bone cements in their ability to augment pedicle screws in bone foam.

Objective: The purpose of our study was to compare the pullout and torque resistance of conventional pedicle screws (CPS) augmented with either polymethylmethacrylate (PMMA) or poly-dicalcium phosphate dihydrate (P-DCPD) cement in polyurethane foam blocks mimicking osteoporotic bone. P-DCPD cement has attractive safety characteristics such as non-exothermic curing and drug-eluting capacity.

Review article: Patient characteristics that act as risk factors for intraoperative complications in hip, knee, and shoulder arthroplasties.

The number of annual THA's, TKA's, and TSA's is set to increase significantly by the year 2030, making it imperative to understand the risks for negative outcomes in these procedures. While research has studied the patient risk factors for perioperative and postoperative complications, there has been relatively little research for intraoperative complications. After a thorough literature review, the most supported finding was that patients with a BMI >30 had significantly more intraoperative blood loss than those with a BMI <30.

Analgesia Use in Children with Acute Long Bone Fractures in the Pediatric Emergency Department.

Background: Practice variation exists in pain management of children with long bone fractures (LBFs).

Objective: The objectives of this study were to describe current pain management in children with LBFs and the factors associated with the undertreatment of pain.

Methods: We retrospectively studied children (aged 0-18 years) with a diagnosis of LBF in a pediatric emergency department (PED) from November 2015 through August 2016.

Review article: Current literature on surgical checklists and handoff tools and application for orthopaedic surgery.

Despite the adaptation of checklists for specific surgeries being developed, there remains a lack of an available standard for an orthopaedic-specific checklist. Benefits of implementing checklists include cost-effectiveness as well as the ability to significantly reduce both mortality and complication rates in a variety of healthcare settings. The aim of this review is to analyze the evidence surrounding the effectiveness of checklists as well as recommend for the development of a standard checklist for specific orthopaedic surgeries such as total joint arthroplasty (TJA).

Professional Formation of Physicians Focused on Improving Care: How Do We Get There?

As the Accreditation Council for Graduate Medical Education (ACGME) and National Academy of Medicine (NAM) increase emphasis on quality improvement (QI), continuing medical education must also adapt to meet these increasing demands. In fellowship programs and for attending physicians, QI initiatives exist but are more rare compared with initiatives during residency programs, and they are even more rare for orthopedic surgery residents, fellows, and attending physicians. A QI curriculum should be in place at all stages of continuing medical education, as they help meet the criteria of the ACGME and NAM and promote better clinical practice and minimize errors.

A comparison of the functional health of children with Costello syndrome in 1999 and in 2015.

Costello Syndrome is a rare congenital condition characterized by failure-to-thrive, cardiac abnormalities, distinctive facial features, predisposition to malignant tumors, and developmental delay. In 1999, we analyzed the functional health in a cohort of 18 patients. Since then, a mutation in the HRAS gene has been found to be causative, medical management has been refined, and the level of awareness has increased.

A comparison of the fixation stability of multiple screw constructs for two types of pelvic osteotomies.

Periacetabular osteotomies are performed to improve femoral head coverage in a variety of clinical conditions. The stability of the osteotomy fragment between Ganz's periacetabular osteotomy was compared with that of Tonnis's triple innominate osteotomy under simulated weight-bearing conditions with a variety of screw constructs using three-dimensional analysis of fragment displacement and angular rotation. Generally, small amounts of displacement (<2 mm) and angular rotation (<3 degrees) were encountered for each fixation technique.

Freedom of acetabular fragment rotation following three surgical techniques for correction of congenital deformities of the hip.

Femoral head coverage achieved with an acetabular osteotomy for hip dysplasia is achieved by acetabular rotation that can be restricted by osteotomy orientation and soft tissue attachments to the acetabular fragment. Procedures that allow excess rotation or motion in an undesirable direction (especially external rotation) may have undesirable consequences. Rotational aspects of these procedures have not been well described and are not well appreciated radiographically.

Costello syndrome: orthopaedic manifestations and functional health.

Sixteen individuals with Costello syndrome underwent a complete history, physical examination, and medical record review. Medical history and record review were performed for two additional children with Costello syndrome. The POSNA Functional Health Outcome Questionnaire Baseline Assessment was completed by the parents of all 18 children.

Meniscal allograft transplantation. Two- to eight-year results.

We evaluated 18 of 23 patients who had undergone cryopreserved meniscal allograft transplantation for compartmental pain after total meniscectomy 2 to 8 years (mean, 5.4) after the operation. The Short Form-36 scores revealed a decrease in pain with a significant improvement in function, although function remained limited.