What's New in Orthopaedic Trauma
John Weinlein and Andrew H. Schmidt J Bone Joint Surg Am. 2010;92:2247-2260. doi:10.2106/JBJS.J.00604
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What’s New in OrthopaedicTrauma
By John Weinlein, MD, and Andrew H. Schmidt, MD The ﬁeld of musculoskeletal trauma continues to beneﬁt from advances in basic science, improved methods of treatment (both operative and nonoperative), innovation in surgical devices, and more sophisticated research methodology, with emphasis on comparative clinical trials and appropriate assessment of outcomes. The emphasis on evidence-basedmanagement continues in the literature and in presentations at academic conferences. For this year’s summary of advances in orthopaedic traumatology, the authors again reviewed all issues of Acta Orthopaedica, Clinical Orthopaedics and Related Research, Injury, The Journal of Bone and Joint Surgery (both American and British volumes), Journal of Orthopaedic Trauma, Journal of Shoulder and ElbowSurgery, and The Journal of Trauma. Selected articles from other journals were also included. Finally, presentations from the annual meetings of the Orthopaedic Trauma Association (OTA) and the American Academy of Orthopaedic Surgeons (AAOS) were reviewed. Articles and presentations that represent Level-I and Level-II evidence are reviewed in this article along with other articles of clinicalimportance in the opinion of the authors. Outcomes The rigorous documentation of outcome, especially from the patient’s perspective, has been one of the major advances in orthopaedic surgery over the past decade. Two studies investigated differences between patient and surgeon perceptions of outcome after orthopaedic trauma. One study evaluated patients six months after they had sustained a ‘‘major’’fracture1. Surgeons were more satisﬁed with their patients’ progress than the patients themselves were. The only factor associated with surgeon satisfaction was fracture-healing. Objective injury and treatment factors were not associated with patient satisfaction in terms of progress. Attributing blame of the injury to others was associated with patient satisfaction in terms of
Specialty Update hasbeen developed in collaboration with the Board of Specialty Societies (BOS) of the American Academy of Orthopaedic Surgeons.
progress, whereas blame, the use of a lawyer, and female sex were associated with patient satisfaction in terms of recovery1. The Lower Extremity Assessment Project (LEAP) investigators reported data, obtained from their observational study of patients withlimb-threatening lower extremity injury, that documented the discrepancy between patient and surgeon perceptions of functional and cosmetic outcomes2. Several factors were predictive of discordance; some were associated with higher surgeon satisfaction whereas others were associated with greater patient satisfaction. Self-reported patient dissatisfaction with overall medical care was predictive of discordancein the perception of both overall and cosmetic outcomes between patients and surgeons. A third study assessed the outcomes of ‘‘after-hours’’ treatment of tibial and femoral shaft fractures with intramedullary nailing3. Patients undergoing femoral or tibial nailing at night had a higher rate of unplanned reoperation than those managed during the day, and patients with femoral fractures that were...