Ketorolac and bone healing: a review of the basic science and clinical literature.

Although the efficacy of ketorolac in pain management and the short duration of use align well with current clinical practice guidelines, few studies have specifically evaluated the impact of ketorolac on bony union after fracture or surgery. The purpose of this study was to review the current basic science and clinical literature on the use of ketorolac for pain management after fracture and surgery and the subsequent risk of delayed union or nonunion. Animal studies demonstrate a dose-dependent risk of delayed union in rodents treated with high doses of ketorolac for 4 weeks or greater; however, with treatment for 7 days or low doses, there is no evidence of risk of delayed union or nonunion.

Are resident research projects correlated to future subspecialty choice in orthopaedic surgery? A ten-year retrospective review of a single centre's experience.

Aim: To determine (1) frequency of resident research projects being in the same orthopaedic subspecialty that they ultimately choose for fellowship and practice; (2) percentage of research projects that were published.

Methods: Resident Thesis Day programs were independently assessed by two reviewers from 2010 to 2020. Reviewers classified projects based on orthopaedic subspecialty: Spine, Joints, Trauma, Hand, Foot and Ankle, Sports, Pediatrics, Oncology, and Shoulder Elbow.

Challenges to the orthopedic resident workforce during the first wave of COVID-19 pandemic: Lessons learnt from a global cross-sectional survey.

Background: The COVID-19 pandemic has caused unprecedented concerns on the safety, well-being, quality of life(QOL), and training of the orthopedic resident physician workforce worldwide. Although orthopedic residency programs across the globe have attempted to redefine resident roles, educational priorities, and teaching methods, the global orthopedic residents' perspective with regards to their safety, well-being, QOL, and training, taking into account regional variances remains unknown.

Methods: A 56-item-questionnaire-based cross-sectional survey was conducted online during the COVID-19 pandemic involving 1193 orthopedic residents from 29 countries across six geographical regions to investigate the impact of the COVID-19 pandemic on the well-being, safety, and training of orthopedic residents at a global level, as well as to analyze the challenges confronted by orthopedic residency programs around the world to safeguard and train their resident workforce during this period.

A simple computational method to estimate stance velocity in running.

Running dynamical analyses typically approximate a runner's stance velocity as the average stride cycle velocity (the average running speed). That approximation necessarily overestimates stance velocity and biases subsequent results. Stance velocity is crucial in kinetic spring-mass analyses of running, where approximation of a runner's impact angle and calculation of leg stiffness require that input.

Bouncing behavior of sub-four minute milers.

Elite middle distance runners present as a unique population in which to explore biomechanical phenomena in relation to running speed, as their training and racing spans a broad spectrum of paces. However, there have been no comprehensive investigations of running mechanics across speeds within this population. Here, we used the spring-mass model of running to explore global mechanical behavior across speeds in these runners.

Improving spring-mass parameter estimation in running using nonlinear regression methods.

Runners are commonly modeled as spring-mass systems, but the traditional calculations of these models rely on discrete observations during the gait cycle (e.g. maximal vertical force) and simplifying assumptions (e.

Hand Infections: Epidemiology and Public Health Burden.

Upper extremity infections are common. Most infections can be effectively treated with minor surgical procedures and/or oral antibiotics; however, inappropriate or delayed care can result in significant, long-term morbidity. The basic principles of treating hand infections were described more than a century ago and most remain relevant today.

Occipital condyle screws: indications and technique.

Occipitocervical instability is a life threatening and disabling disorder caused by a myriad of pathologies. Restoring the anatomical integrity and stability of the occipitocervical junction (OCJ) is essential to achieve optimal clinical outcomes. Surgical stabilization of the OCJ is challenging and technically demanding.

How do global sagittal alignment and posture change after total hip arthroplasty?

Background: Postural change after total hip arthroplasty (THA) is still a matter of discussion. Previous studies have mainly concentrated on the pelvic motions. We report the post-operative changes of the global sagittal posture using pelvic, spinal, and lower extremities parameters.

Advances in Proximal Interphalangeal Joint Arthroplasty: Biomechanics and Biomaterials.

Proximal interphalangeal (PIP) joint arthritis is a debilitating condition. The complexity of the joint makes management particularly challenging. Treatment of PIP arthritis requires an understanding of the biomechanics of the joint.

Shoulder Injuries in the Overhead Throwing Athlete.

The overhead pitching motion is a coordinated sequence of movements that subjects the shoulder to extreme forces. The ultimate goal of this complex, dynamic activity is to generate high ball velocity and accuracy. In doing so, repetitive throwing can cause adaptive and pathologic changes in the thrower's shoulder.

Previous arthroscopic repair of femoro-acetabular impingement does not affect outcomes of total hip arthroplasty.

Background: Total hip arthroplasty (THA) is commonly elected following failed arthroscopic treatment of femoro-acetabular impingement (FAI). The purpose of this study was to evaluate post-operative outcomes of primary THA in patients who had previously undergone arthroscopic treatment for FAI.

Methods: A retrospective, matched case-control study was conducted.

How to perform a root cause analysis for workup and future prevention of medical errors: a review.

Providing quality patient care is a basic tenant of medical and surgical practice. Multiple orthopaedic programs, including The Patient Safety Committee of the American Academy of Orthopaedic Surgeons (AAOS), have been implemented to measure quality of surgical care, as well as reduce the incidence of medical errors. Structured Root Cause Analysis (RCA) has become a recent area of interest and, if performed thoroughly, has been shown to reduce surgical errors across many subspecialties.

Post-operative medical and surgical complications after primary total joint arthroplasty in solid organ transplant recipients: a case series.

Purpose: In a series of solid organ transplant (SOT) recipients who underwent a subsequent primary total joint arthroplasty (TJA) procedure, this study aimed to determine: (1) 90-day morbidity and mortality after primary total knee or hip arthroplasty (TKA and THA), (2) overall post-operative infection rates, and (3) how complication and infection rates compared across primary TJA procedure and type of transplant organ.

Methods: The University of Michigan Health System database was retrospectively searched using current procedural terminology codes for any primary TKA or THA performed at the institution in years 2000-2012 in a patient who previously received a successful SOT at any hospital.

Results: The search yielded 44 arthroplasties performed in 29 SOT recipients (average age 54.

Atypical femur fractures in patients receiving bisphosphonate therapy: etiology and management.

Osteoporosis is a growing problem that is projected to affect more than 50% of American adults by 2020. Bisphosphonate therapy is currently the primary mode of treating osteoporosis in this population. While bisphosphonate therapy has been successful in increasing bone mineral density, data has shown an increased risk of atypical femur fractures with prolonged therapy.

Trends in primary and revision knee arthroplasty among orthopaedic surgeons who take the American Board of Orthopaedics part II exam.

Purpose: A certified list of all operative cases performed within a six month period is required of surgeons by the American Board of Orthopaedic Surgery (ABOS) as a prerequisite to taking the Part II Oral Examination. Using the data on these cases collected and maintained by ABOS, this study assessed the influence of prior fellowship training in adult reconstruction on the volume and surgeon-reported complication rate of knee joint arthroplasty cases over time.

Methods: All data were self reported to a secure Internet database (SCRIBE) by candidates who applied to take Part II of the ABOS Examination for the first time.

Scapular Winging: Evaluation and Treatment: AAOS Exhibit Selection.

Scapular winging is a rare, underreported, and debilitating disorder that produces abnormal scapulothoracic kinematics, which can lead to shoulder weakness, decreased range of motion, and substantial pain. Although there are numerous underlying etiologies, injuries to the long thoracic nerve or spinal accessory nerve are the most common, with resultant neuromuscular imbalance in the scapulothoracic stabilizing muscles. Early diagnosis followed by initiation of a treatment algorithm is important for successful outcomes.

High Risk of Failure With Bimodular Femoral Components in THA.

Background: The bimodular femoral neck implant (modularity in the neck section and prosthetic head) offers several implant advantages to the surgeon performing THAs, however, there have been reports of failure of bimodular femoral implants involving neck fractures or adverse tissue reaction to metal debris. We aimed to assess the results of the bimodular implants used in the THAs we performed.

Questions/purposes: We asked: (1) What is the survivorship of the PROFEMUR(®) bimodular femoral neck stems? (2) What are the modes of failure of this bimodular femoral neck implant? (3) What are the major risk factors for the major modes of failure of this device?

Methods: Between 2003 and 2009, we used one family of bimodular femoral neck stems for all primary THAs (PROFEMUR(®) Z and PROFEMUR(®) E).

Spastic foot and ankle deformities: evaluation and treatment.

Spastic foot and ankle deformities can occur from various causes and have profound effects on individuals and society. Presentations can vary clinically and a thorough clinical evaluation, potentially with a dynamic electromyogram, is essential to selecting the most appropriate treatment. Nonoperative treatments, such as orthotics, casting, oral medications, and nerve blocks, can be effective but surgery is indicated if they are no longer effective.

Patient impressions of reimbursement for orthopedic spine surgeons.

The study aim was to understand patient impressions of reimbursement to orthopedic spine surgeons. Our findings revealed that the majority of patients significantly overestimate the amount surgeons are reimbursed per procedure. Despite this, most feel that surgeons are appropriately compensated.

Intra-articular fractures of the hand.

Fractures of the hand are common injuries and in particular, fractures involving the articular surfaces can present difficulties to the orthopedic surgeon in practice. Although the treatment of these fractures needs to be individualized based on fracture pattern and location, the goals for these fractures are to restore the alignment, stability, and congruity and to allow for early motion to prevent stiffness and traumatic arthritis. This article classifies the various types of intra-articular hand fractures as well as the workup and management of these injuries.

Conflict of interest in the assessment of hyaluronic acid injections for osteoarthritis of the knee: an updated systematic review.

The search results of a recent systematic review of prospective, randomized, placebo-controlled trials on hyaluronic acid injections for knee arthritis were updated and reviewed for funding source and qualitative conclusions. Forty-eight studies were identified; 30 (62.5%) were industry funded, and 3 (6.

The musculoskeletal effects of cigarette smoking.

➤ Cigarette smoking decreases bone mineral density and increases the risk of sustaining a fracture or tendon injury, with partial reversibility of these risks with long-term cessation of smoking. ➤ Cigarette smoking increases the risk for perioperative complications, nonunion and delayed union of fractures, infection, and soft-tissue and wound-healing complications. ➤ Brief preoperative cessation of smoking may mitigate these perioperative risks.