Diagnostic Evaluation of Prosthetic Joint Infections of the Shoulder: What Does the Literature Say?

The total number of patients with a total shoulder arthroplasty (TSA) is increasing, and the number of patients experiencing a (TSA) prosthetic joint infection (PJI) also will increase. It is important that physicians know how to identify signs of infection, know the common pathogens, and know how to work up a shoulder PJI. This publication reviewed the current literature about presenting signs and symptoms, common shoulder pathogens and how they differ from total knee and hip pathogens, and what images, tests, and procedures can aid in identification of infection.

How to Recognize, Correct, and Avoid Intraoperative Complications During Anterior Cruciate Ligament Reconstructions.

Technical complications are a leading cause of graft failure following anterior cruciate ligament reconstructions. Complications can occur during any phase of the procedure, from graft harvesting to tunnel preparation to graft fixation. Predicting potential causes of technical difficulty and developing strategies to avoid potential pitfalls can limit the number of intraoperative complications. If adverse events do occur intraoperatively, prompt recognition and treatment can lead to favorable outcomes. It is important to discuss strategies to understand potential complications and develop tactics to avoid and correct adverse events that can occur during anterior cruciate ligament reconstruction.

Overlapping Surgery for Distal Radius Fractures: Is It Safe?

Patients who underwent distal radius fracture (open reduction and internal fixation [ORIF]) at a Level 1 trauma center deemed "overlapping" (greater than 30 minutes overlap) were compared against consecutive cases. Unplanned return to surgery within 1 year was the primary outcome. Sixty-two patients were included in the overlapping group and 37 in the consecutive group. There was no difference in unplanned return to surgery 1 year following procedure with three cases (5%) in the overlapping group and one case (3%) in the consecutive group. There was a significant difference (p = 0.02) in procedure time between the overlapping group (151 + 54 minutes) and nonoverlapping group (126 + 35 minutes). There was no difference in infection, readmission, nonunion, malunion, deep infection, or superficial infection between groups. Based on a post-hoc power analysis with p < 0.05 and power at 80%, 2,691 patients would be needed to determine if there is truly no difference between groups. (Journal of Surgical Orthopaedic Advances 31(2):127-130, 2022).

Treatment of type III supracondylar humerus fractures: adherence and limitations of American Academy of Orthopedic Surgeons Appropriate Use Criteria App.

The American Academy of Orthopedic Surgeons (AAOS) published Appropriate Use Criteria (AUC) in 2014 to aid physicians in the management of pediatric supracondylar humerus fractures. AUC should be evaluated in real practice, and if necessary modified based on identified problems. This study compares AAOS AUC recommendations with actual treatment performed in a cohort of patients treated for type III supracondylar humerus fractures. Medical record review of patients treated for type III supracondylar humerus fractures at our hospital from 2009 to 2016. Criteria required by the AAOS AUC were collected and entered into the AAOS AUC web-based application to determine the 'appropriateness' and score of each treatment. These were compared with the actual treatment the patient received. Over the study period, 585 patients (mean age: 6.5 years, 51% male, 49% female) were treated for type III supracondylar humerus fractures. Of the 585 cases, 561 (95.9%) were classified as 'appropriate', 24 (4.1%) as 'maybe appropriate', and 0 (0%) as 'rarely appropriate'. Of the 'maybe appropriate' cases there was a significant decrease in the proportion that deviated from the AUC over time (P = 0.0076). The main reasons for deviation were that an open reduction was performed due to difficulty with closed reduction (75% of deviations) or the surgery was not performed emergently (25% of deviations). The vague definition of 'emergent' and not allowing for open reduction if needed are limitations of the AUC that should be clarified or improved by the AAOS.