The influence of guidelines on opioid prescribing practices after pe-diatric anterior cruciate ligament reconstruction.

OBJECTIVE: To report opioid prescription patterns after pediatric anterior cruciate ligament reconstruction (ACLR) and identify if the implementation of the opioid prescribing guidelines (OPGs) modified these patterns. DESIGN: A retrospective chart review. SETTING: Level 1 Pediatric Trauma Center. PATIENTS: Pediatric patients who underwent primary ACLR at a single pediatric hospital system between the years 2016 and 2018 were included. Patients were excluded if they did not receive an opioid prescription from an orthopedic provider at the time of discharge or if they underwent an additional operative procedure within 90 days of the index surgery. Eighty-six patients met the criteria for a retrospective review. INTERVENTIONS: Opioid prescriptions were converted into morphine equivalent doses (MEDs) for standardization. MAIN OUTCOME MEASURE: The average MED prescribed at the time of discharge and during follow-up visits for pediatric patients undergoing ACLR. RESULTS: Patient's age was the only independent variable that had a significant relationship with discharge MED (p = 0.002) and predicted that MED at discharge increases by 20.7 units [confidence interval = 12.3-29.1] for each increasing year in patient age. Discharge MED prescribed after implementation of the OPG was found to be significantly less than discharge MED prescribed prior to the OPG through Wilcoxon rank-sum test (p < 0.001). CONCLUSIONS: Implementation of the OPG in Ohio led to a significant reduction in opioid doses prescribed to patients at all time points within 90 days of ACLR. However, these guidelines also led to a significant increase in the likelihood that post-OPG patients would receive an additional opioid prescription during follow-up within 90 days of surgery.

Perceptions of Preference Signaling in Orthopaedic Surgery: A Survey of Applicants and Program Directors.

INTRODUCTION: To improve transparency between candidates and training programs, a preference signaling program (PSP) was implemented before the 2022 to 2023 orthopaedic surgery match. The PSP allows applicants to 'signal' up to 30 programs, informing the program of the applicant's particular interest in interviewing for their available position(s). This study reports the perspectives of orthopaedic surgery residency applicants and program directors (PDs) on the effects of preference signaling on the orthopaedic match. METHODS: Electronic surveys were distributed to PDs and applicants. RESULTS: Almost all programs participated in the PSP (90%), and most of the applicants (97.6%) used 25 to 30 of their allotted preference signals. Most of the applicants (67.2%) thought that their likelihood of obtaining an interview was improved at 'signaled' programs but decreased at programs without a 'signal' designation (85.3%). Both applicants and PDs considered preference signaling to be one of the three most important factors for interview selection, along with Step 2 CK score and letters of recommendation. The applicants did not think that their likelihood of matching would improve with fewer allotted signaling tokens (35.2%), and 55.2% of PDs believed 21 to 30 tokens were optimal. CONCLUSION: Preference signaling is highly regarded by applicants and PDs. Signaling a program will likely improve an applicant's chance to interview. The optimal number of signaling tokens remains unknown, although both groups favored a larger allotment of tokens than has been seen in other specialties. Universal guidelines and recommendations for applicants and PDs would improve the utility of preference signaling.

Backout of Distal Interlocking Screws After Retrograde Femoral Nailing With a Novel Device: A Case Series.

OBJECTIVE: To report upon a series of patients who have experienced the backout of distal interlocking screws after retrograde femoral nailing with the DePuy Synthes RFN-Advanced Retrograde Femoral Nailing System (DePuy Synthes, Raynham, MA). DESIGN: Retrospective case series. PATIENTS: Twenty-seven skeletally mature patients with femoral shaft or distal femur fractures who underwent operative fixation with the DePuy Synthes RFN-Advanced Retrograde Femoral Nailing System with 8 patients subsequently experiencing backout of distal interlocking screws. INTERVENTION: The study intervention included retrospective review of patient charts and radiographs. MAIN OUTCOME MEASURE: The incidence rate of distal interlocking screw backout. RESULTS: Thirty percent of patients experienced the backout of at least 1 distal interlocking screw (mean: 1.625) after undergoing retrograde femoral nailing with the RFN-Advanced system. Thirteen total screws backed out postoperatively. Screw backout was identified an average of 61 days postoperatively (range: 30-139 days). All patients complained of implant prominence and pain along the medial or lateral aspect of the knee. Five patients elected to return to the operating room to remove the symptomatic implant. The oblique distal interlocking screws comprised 62% of screw backouts. CONCLUSIONS: Given the high incidence rate of this complication, the associated costs of reoperation, and patient discomfort, we believe that a further investigation into this implant complication is warranted. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Epidemiology of patellar dislocations in the United States from 2001 to 2020: results of a national emergency department database.

OBJECTIVES: Recent studies have shown an increasing incidence of patellar dislocations among children and adolescents. Updated, population-based studies of all patellar dislocations in the United States (US), however, are lacking. This study investigated recent trends in injury rates and demographics among patients sustaining patellar dislocations in the US from 2001 to 2020. METHODS: This descriptive epidemiologic study retrospectively analyzed the National Electronic Injury Surveillance System (NEISS) database to identify cases of acute patellar dislocations presenting to US Emergency Departments (EDs) from 2001 to 2020. Annual, overall, and age-adjusted incidence rates (IRs, expressed per 100,000 at-risk person-years) and additional patient/injury characteristics were analyzed. Average annual percent change (AAPC) estimates are presented to indicate the magnitude/direction of trends in annual injury rates. RESULTS: An estimated total of 159,529 patellar dislocations occurred over the study period for an overall IR of 2.58 (95% CI = 2.04-3.12). Accounting for population growth, the overall annual incidence increased significantly from 2.61 in 2001 to 3.0 in 2020 (AAPC = 2.8, p < 0.0001). When considering sex and age, statistically significant increases in annual IRs were observed among males aged 10-19 years (AAPC = 3.8, p < 0.0001), females aged 10-19 years (AAPC = 5.3, p < 0.0001), and females aged 20-29 years (AAPC = 3.5, p = 0.0152), while no significant changes were observed in any other age groups. Two-thirds of patellar dislocations involved sports-related injury mechanisms. The annual incidence of both sports-related and non-sports-related injuries increased significantly over the study period (sports-related: AAPC = 2.6, p = 0.0001; non-sports-related: AAPC = 3.4, p = 0.0001). Athletic patellar dislocations occurred most commonly in basketball and dance. CONCLUSION: The number of patients sustaining patellar dislocations is increasing in the US. Similar increasing trends were observed in both males and females aged 10-19 years, whereas injury rates increased in the third decade only among females. A large percentage of injuries occur during athletic activity, but both sports- and non-sports-related patellar dislocations are on the rise.

Gender- and region-specific changes in estrogen signaling in aging rat brain mitochondria.

Recently epidemiological studies suggest females lose neuroprotection from neurodegenerative diseases as they go through menopause. It has been hypothesized that this neuroprotection is hormone-dependent. The current study characterized cell signaling molecules downstream of estrogen receptor beta that are known to play a role in memory, PKC, ERK, and connexin-43, in regions of the brain associated with memory decline in an attempt to elucidate significant changes that occur post-estrus. Total whole cell lysates were compared to isolated mitochondrial protein because mitochondrial function is known to be altered during aging. As hypothesized, protein concentrations differed depending on age, gender, and brain region. Additionally, many of these changes occurred within mitochondria but not within whole cell lysates indicating that these are epigenetic alterations. These findings accentuate the complexity of aging and provide insight into the gender-specific cellular processes that occur throughout this process.