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expected that lower pain scores would increase anxiety. This may suggest that cast-intolerant patients experience or report their anxiety as pain. These findings may explain why some patients suffer from pain that cannot be explained by an underlying physiologic process and is resistant to traditional pain management. A multidisciplinary approach, including psychological and psychosocial assessments, may help identify nonphysiologic components to pain. An accurate diagnosis for the cause of pain may lead to nonpharmacological interventions and therefore reduce opioid use and overall costs and improve patient outcomes.
As more adults undergo surgical fixation of clavicle fractures with improved outcomes, interest is renewed in managing clavicle fractures in adolescents. The medial clavicular physis does not fuse until 23 to 25years of age, but studies report minimal clavicular growth during adolescence-studies that employed cross-sectional methodologies, which cannot not capture growth in patients over time. The assumption that clavicle length at each stage is uniform, as is the final overall length, may not be accurate if the age groups studied comprise various ethnicities, socioeconomic status, or height.

We sought to quantify longitudinal clavicular growth on serial radiographs in adolescents and young adults. Our hypothesis was that substantial clavicular growth would be seen beyond the age of 12 years.

We conducted a longitudinal case series of non-syndromic patients in a single orthopedic clinic and analyzed serial radiographic images of the clavicles. For ethical reasons, only patients with non-neuromuscular scmm/year, or 1.7%/year; and at ages 20 to 25years, growth was 0.2mm/year or 0.1%/year. We could not detect the age of terminal growth in either sex because growth was ongoing in most patients in the oldest group.

We found substantial clavicular growth potential after age 18years, when growth is thought to be nearly finished, as well as remodeling potential even up to age 25years. Further research is needed, but our findings suggest that strategies for managing clavicle fracture in adults may not be applied universally to adolescents and young adults.
We found substantial clavicular growth potential after age 18 years, when growth is thought to be nearly finished, as well as remodeling potential even up to age 25 years. Further research is needed, but our findings suggest that strategies for managing clavicle fracture in adults may not be applied universally to adolescents and young adults.
Observational studies constitute the majority of the orthopedic literature, each type distinct in terms of what it can and cannot measure. Case-control studies select participants based on outcome status, not exposure status,and therefore differ from other observational studies in theiraims, limitations, and conclusions. Misclassification of a different kind of study as a case-control study can lead to misinterpretation of the data and misreporting of its level of evidence (LOE), either "overselling" or "underselling" its importance.

We sought to answer three questions (1) How frequently do studies reported to be orthopedic case-control studies actually reflect other study designs? (2) What factors might be associated with misclassification? (3) How does study design misclassification affect LOE reporting?

A bibliometric analysis was performed to identify all studies published in 75 orthopedic journals over a one-year period (January 2017 through December 2017) that included the term "case-control" in tcontrol design frequently have another study design, and this pattern is consistent across subspecialties. Enhanced rigor in accuratelydefining study designs in orthopedics could be achieved through training and stricter review processes.
Studies reported in the orthopedic literature to have a case-control design frequently have another study design, and this pattern is consistent across subspecialties. Enhanced rigor in accurately defining study designs in orthopedics could be achieved through training and stricter review processes.
Smartphones offer the possibility of assessing recovery of mobility after total hip or knee arthroplasty (THA or TKA) passively and reliably, as well as facilitating the collection of patient-reported outcome measures (PROMs) with greater frequency.

We investigated the feasibility of using mobile technology to collect daily step data and biweekly PROMs to track recovery after total joint arthroplasty.

Pre- and post-operative daily steps were recorded in prospectively enrolled patients (128 THA and 139 TKA) via an app, which uses the phone's accelerometer. During 6-month follow-up, patients also completed PROMs (the pain numeric rating scale, the Hip Disability and Osteoarthritis Outcome Score Joint Replacement [HOOS JR] and the Knee Injury and Osteoarthritis Outcome Score Joint Replacement [KOOS JR]), and HOOS or KOOS JR quality of life domain via a mobile-enabled web link.

At least 6months of follow-up was completed by 65% for THA and 68% for TKA patients. Reasons for non-completion included time comable to ensure that patients always carried their phones limited our analysis of the step counts.
In total knee arthroplasty (TKA), advances in posterior-stabilized (PS) knee implant designs address patellofemoral mechanics and cam-post engagement in an effort to reduce patellofemoral pain and improve knee kinematics. see more Such modifications may include improved femoral rollback, improved femoral dislocation resistance, minimized wear, and improved longevity.

In this study, we compared a newer PS knee design that incorporates a left and right specific femoral component and smoother trochlear groove to improve patellofemoral mechanics with an older PS design in order to assess patellofemoral pain, manipulation rates, and revision rates.

Using an institutional database, we retrospectively identified TKAs performed by the same surgeon using the Logic
PS knee system and theolder Optetrak PS knee system (Exactech Inc., Gainesville, FL, USA), with a minimum 2-year follow-up. Clinical outcomes for each cohort were measured using the Knee Society Clinical Rating System, University of California Los Angeles Actp (5.6% vs. 11.8%, respectively). In addition, manipulation rates differed significantly between the Logic and Optetrak groups (0.34% vs. 10.70%, respectively). The revision rates were 1.15% for the Logic group and 2.0% for the Optetrak group. However, there was a significant difference in rates of revision performed because of osteolysis, favoring the Logic group (0.07% vs. 0.6%). The Kaplan-Meier survivorship curve shows a significant difference in time until revision between the Logic and Optetrak groups.

Design modifications to improve patellofemoral mechanics demonstrated significant improvements in overall pain and patellofemoral pain and reduced manipulation rates post-operatively.
Design modifications to improve patellofemoral mechanics demonstrated significant improvements in overall pain and patellofemoral pain and reduced manipulation rates post-operatively.
Brachial plexus injury (BPI) is a life-altering event, and surgical treatment of BPI is costly ($66 million nationwide in 2006 alone). Despite the sizable costs associated with surgically treated BPI, the incidence of such cases in adults in the USA remains unknown.

We sought to provide an estimate of the national incidence of surgically treated BPI in the USA and to determine whether changes have occurred over time.

We sought to identify privately insured adults ages 18 through 64 years who underwent BPI surgery between 2008 and 2014 in the IBM® MarketScan® Commercial Database. We then extrapolated those data to the same age group in the general population (all insurance types were considered), using data from the National Health Interview Survey and a study on the proportion of BPI surgery cases covered by private insurance to estimate the national incidence. We also used the Cochran-Armitage trend test to evaluate for statistically significant changes in BPI incidence over time in MarketScan private of disease epidemiology and societal and financial impact.
Medication management, a complex yet essential part of patient care, requires that clinicians and patients understand indication, dosage, frequency, and adverse effects in order to maximize benefits and minimize errors, as well as to transition patients from hospital to home. Clinical pharmacists improve care transitions and safety by interacting with patients, prescribers, and nurses on medication management and self-care. link2 However, little is known on the use of clinical pharmacists on interdisciplinary teams at the unit level within orthopedics.

This study sought to measure the impact of unit-based clinical pharmacists on patient perceptions of communication specific to medication during hospitalization at an orthopedic specialty hospital and on the frequency of medication errors.

A retrospective, quasi-experimental, two-group evaluative design with nonequivalent controls was used. Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data on six inpatient units was analyzed 6months before ammunication about and understanding of their medications.
Professional basketball players are at increased risk for knee injuries. Epidemiologic data exist on the prevalence of such injuries in players in the National Basketball Association (NBA), but little is known about how these injuries affect athletes before after retirement.

The goals of this study were to evaluate the rates and characteristics of knee injury before and during NBA players' careers and how those injuries correspond to knee injury, pain, or surgery, as well as quality of life, after retirement.

A cross-sectional survey study was performed. The survey instrument was designed with the aid of a multidisciplinary focus group. Data collected included patient demographics; length of professional career; injuries before, during, and after the athletes' NBA careers; and post-retirement quality of life, assessed using the EQ-5D and Tegner Activity Scale. The survey was distributed electronically to 900 retired NBA athletes. link3 Descriptive statistics were used to present means and proportions, and mulcognizing and treating knee injuries in these athletes.
A majority of retired NBA athletes in our study had knee pain, and many needed operative management during and after their NBA careers. NBA players score lower on quality-of-life measures than average North American men of similar age. Further research is needed to elucidate the best strategies for recognizing and treating knee injuries in these athletes.
Hip arthritis is one of the major causes of disability worldwide. Hip resurfacing arthroplasty (HRA) has emerged in recent years as an alternative to total hip arthroplasty (THA), but complications of HRA have limited the patient population to younger male patients with primary osteoarthritis and large hip anatomy. How the functional benefits of HRA in this population compare with those of THA is not entirely clear.

The primary aim of this study was to determine whether there were differences in hip disability and patient satisfaction with surgery between these two groups at 2 years after surgery, using patient-reported outcome measures (PROMs) and subjective measures of patient satisfaction. Additionally, we sought to determine whether there were differences in post-operative discharge disposition, revision rates, or adverse events.

We searched an institutional database to identify patients undergoing unilateral HRA or THA between January 2007 and July 2011 who met today's recommended criteria for HRA younger male patients with large-enough hip anatomy to make surgery viable (a femoral head of at least 48 mm in HRA patients and, in THA patients, an acetabular shell size of 54 mm, the minimum outer shell size that could accommodate a femoral head component of 48 mm; for matching purposes, acetabular shell size in THA was used as a surrogate for the femoral head size used in HRA).
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