Intraoperative Cryotherapy in the Treatment of Metastatic Renal Cell Carcinoma of the Bone.

Osseous metastases in renal cell carcinoma (RCC) are a heterogeneous mix of cells with hypervascular and rapidly destructive properties that frequently exhibit resistance to both radiation and chemotherapy. Despite this, some patients with isolated and oligometastatic disease have the potential to be cured. Regardless, aggressive metastatic control is critical to minimizing morbidity and mortality for all patients with metastatic RCC. Percutaneous cryoprobes were developed as a minimally invasive technique for both pain relief and tumor control. However, there is little evidence describing an alternative use of this technology in the operating room to assist with open tumor resections, and no formal role for its use in orthopedics exists. Therefore, the authors added this modality to their intraoperative treatment of osseous RCC to investigate whether it would influence their ability to obtain local metastatic control. The authors performed a retrospective chart review of prospectively obtained data to evaluate the role of intraoperative cryotherapy in the treatment of osseous RCC. From 2004 to 2017, cryotherapy was used in 43 procedures, alleviating the need for additional radiation 84% (36 of 43) of the time. Local tumor control was achieved in 100% (43 of 43) of cases. There were 2 wound-related complications and 1 pathologic fracture. Despite the study's limitations, the authors believe that cryotherapy contributed to the reliability and reproducibility of their intralesional resections. Given the palliative, and potentially curative, opportunities afforded by complete locoregional tumor control, the authors support further investigation into the use of intraoperative cryotherapy to treat osseous metastases secondary to RCC. [Orthopedics. 2021;44(5):e645-e652.].

Concussion management in collegiate student-athletes: return-to-academics recommendations.

Concussions in collegiate athletics can affect student-athletes both on the field and in the classroom. As policies are made to outline return-to-play decisions and timelines, this article will make the case that return-to-academics should also be included and follow a step-wise protocol. Complete cognitive rest is a cornerstone of concussion recovery and slow reintroduction to academics should precede return-to-play. The college structure allows for student-athletes to begin small doses of cognitive activity after the recommended complete cognitive rest. It is recommended that return-to-academics involves a team approach to help the student-athlete navigate the responsibilities of course work while healing from a brain injury.

Prevalence of methicillin-resistant Staphylococcus aureus among orthopedic patients at a large academic hospital.

Community-based methicillin-resistant Staphylococcus aureus (MRSA) contributes to postoperative surgical site infections, and it is therefore important to eliminate nasal carriage of MRSA before surgery. A total of 678 nasal swabs were performed on elective orthopedic patients undergoing surgery with the usage of metal implants. Thirty-eight specimens (5.6%) were positive for MRSA and 146 (21.5%) were positive for methicillin-sensitive S aureus (MSSA). A slow increase in the number of MSSA was noted between 2006 and 2007. Positive cases of MRSA nasal carriage were treated with nasal mupirocin ointment and chlorhexidine baths or showers for 5 days prior to surgery.