Orthopedic Reviews https://www.pagepress.org/journals/index.php/or <p><strong>Orthopedic Reviews</strong> is an Open Access, online-only, peer-reviewed journal that considers articles concerned with any aspect of orthopedics, as well as diagnosis and treatment, trauma, surgical procedures, arthroscopy, sports medicine, rehabilitation, pediatric and geriatric orthopedics. All bone-related molecular and cell biology, genetics, pathophysiology and epidemiology papers are also welcome.&nbsp;The journal publishes original articles, brief reports, reviews and case reports of general interest.</p> en-US <p><strong>PAGEPress</strong> has chosen to apply the&nbsp;<a href="http://creativecommons.org/licenses/by-nc/4.0/" target="_blank" rel="noopener"><strong>Creative Commons Attribution NonCommercial 4.0 International License</strong></a>&nbsp;(CC BY-NC 4.0) to all manuscripts to be published.<br><br> An Open Access Publication is one that meets the following two conditions:</p> <ol> <li>the author(s) and copyright holder(s) grant(s) to all users a free, irrevocable, worldwide, perpetual right of access to, and a license to copy, use, distribute, transmit and display the work publicly and to make and distribute derivative works, in any digital medium for any responsible purpose, subject to proper attribution of authorship, as well as the right to make small numbers of printed copies for their personal use.</li> <li>a complete version of the work and all supplemental materials, including a copy of the permission as stated above, in a suitable standard electronic format is deposited immediately upon initial publication in at least one online repository that is supported by an academic institution, scholarly society, government agency, or other well-established organization that seeks to enable open access, unrestricted distribution, interoperability, and long-term archiving.</li> </ol> <p>Authors who publish with this journal agree to the following terms:</p> <ol> <li>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li> <li>Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li> <li>Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.</li> </ol> emanuela.fusinato@pagepress.org (Emanuela Fusinato) tiziano.taccini@pagepress.org (Tiziano Taccini) Wed, 05 Sep 2018 13:43:35 +0200 OJS 3.1.1.4 http://blogs.law.harvard.edu/tech/rss 60 Simultaneous bilateral minimally invasive total hip arthroplasty: A comprehensive review of the literature https://www.pagepress.org/journals/index.php/or/article/view/7677 Several studies have reported that minimally- invasive total hip arthroplasty (MISTHA) may significantly reduce postoperative pain and results in faster postoperative rehabilitation when compared with the traditional lateral or posterior approach. Regarding bilateral hip osteoarthritis, there is still no consensus whether simultaneous bilateral MIS-THA can be established as the treatment of choice. Therefore, we searched the international databases of Pubmed, Medline, and Cochrane Database of Systematic Reviews using the key words minimally invasive bilateral total hip arthroplasty. From the initial 23 articles we found five clinical studies which met our inclusion criteria. From the perspective of possible intra- and postoperative complications, one-stage bilateral MIS THA was equally safe or safer than two-stage interventions. In addition, from a clinical outcome perspective, the one-stage procedure can be considered to be preferable. Higher blood transfusion requirements, which were expected following the standard bilateral simultaneous THA, seemed to be minimized with the simultaneous bilateral MIS THA. The supine position of the patient minimized the mean operation time. Approaches using the lateral decubitus position of the patient should be avoided in simultaneous bilateral THA due to the increased operation time. There is a lack of randomized, controlled clinical trials, comparing simultaneous bilateral MIS THA with staged bilateral MIS THA. Although simultaneous bilateral MIS THA seems to be efficacious, cost-effective and safe, more clinical trials are required to establish its superiority over the sequential MIS THA. Michael-Alexander Malahias, Kulapat Chulsomlee, Fritz Thorey ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 https://www.pagepress.org/journals/index.php/or/article/view/7677 Tue, 25 Sep 2018 16:01:49 +0200 Osteoid osteoma: Contemporary management https://www.pagepress.org/journals/index.php/or/article/view/7496 Osteoid osteoma is a benign bone-forming tumor with hallmark of tumor cells directly forming mature bone. Osteoid osteoma accounts for around 5% of all bone tumors and 11% of benign bone tumors with a male predilection. It occurs predominantly in long bones of the appendicular skeleton. According to Musculoskeletal Tumor Society staging system for benign tumors, osteoid osteoma is a stage-2 lesion. It is classified based on location as cortical, cancellous, or subperiosteal. Nocturnal pain is the most common symptom that usually responds to salicyclates and non-steroidal anti-inflammatory medications. CT is the modality of choice not only for diagnosis but also for specifying location of the lesion, i.e. cortical vs sub periosteal or medullary. Non-operative treatment can be considered as an option since the natural history of osteoid osteoma is that of spontaneous healing. Surgical treatment is an option for patients with severe pain and those not responding to NSAIDs. Available surgical procedures include radiofrequency (RF) ablation, CT-guided percutaneous excision and en bloc resection. Shahryar Noordin, Salim Allana, Kiran Hilal, Naila Nadeem, Riaz Lakdawala, Anum Sadruddin, Nasir Uddin ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 https://www.pagepress.org/journals/index.php/or/article/view/7496 Tue, 25 Sep 2018 16:21:08 +0200 Assessment of malpractice claims associated with rotator cuff surgery https://www.pagepress.org/journals/index.php/or/article/view/7703 Rotator cuff surgery is a commonly performed and may lead to malpractice litigation. Despite this, there is a paucity of data evaluating outcomes of malpractice litigation following rotator cuff surgery. A retrospective investigation of the VerdictSearch legal claims database following rotator cuff surgery was performed. Plaintiff demographics, reason for litigation, and the effect of surgical complications were assessed as were the proportion of plaintiff rulings and size of payments. In total, 40 cases were analyzed. Mean age of plaintiffs was 52±11.2 years; 30 (75%) plaintiffs were male. Twenty-six cases (65% of suits) named pain and weakness as a complication of the procedure. In total, 60% (24) resulted in a defendant ruling, 25% (10) in a plaintiff ruling, and 15% (6) in a settlement. Total liabilities of the 40 cases were $15,365,321 with individual awards ranging from $75,000 to $5,000,000. Mean plaintiff award was $694,032±$586,835 (range: $75,000 to $1,900,000). Mean settlement amount was $1,404,167±$1,816,481 (range: $75,000 to $5,000,000). This study is the first examination of legal claims following rotator cuff surgery. Objective symptoms following surgery, such as decreased range of motion and rotator cuff weakness, as well as subjective complaints of pain and suffering were the most common reason for litigation, and when successful, led to indemnity payments averaging under $1 million each. David G. Deckey, Adam E.M. Eltorai, Joseph A. Gil, Alan H. Daniels ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 https://www.pagepress.org/journals/index.php/or/article/view/7703 Wed, 05 Sep 2018 13:43:34 +0200 Non-cognitive factors predicting success in orthopedic surgery residency https://www.pagepress.org/journals/index.php/or/article/view/7559 Admissions to orthopedic surgery is a highly competitive process. Traditionally measures such as United States Medical Licensing Examination (USMLE) Step 1, class rank, AOA status have been major determinants in the ranking process. However, these traditional objective measures show mixed correlation to clinical success in orthopedic surgery residency. There have been several studies on the cognitive factors and their correlation with success in residency. However, it is clear that residency requires more than objective cognition, emphasizing complex social interactions that are influenced by non-cognitive variables including personality, work ethic, etc. This review aims to summarize the current understanding of non-cognitive factors influencing performance in orthopaedic surgical residency. Benjamin Valley, Christopher Camp, Brian Grawe ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 https://www.pagepress.org/journals/index.php/or/article/view/7559 Wed, 05 Sep 2018 13:43:34 +0200 Knee kinematics in anatomic anterior cruciate ligament reconstruction with four- and five-strand hamstring tendon autografts https://www.pagepress.org/journals/index.php/or/article/view/7738 An alternative to the gold standard fourstrand hamstring tendon autograft for anterior cruciate ligament (ACL) reconstruction is the five-strand graft. The rationale for its use is to increase graft width to better restore the anatomical footprint and biomechanical properties of the native ACL when unable to create a four-strand graft of 8 mm in diameter. To date, there are no trials assessing the use of this wider graft and its effect on the kinematics of the knee. The aim of this study was to determine whether the use of a wider five-strand hamstring tendon autograft in ACL reconstructive surgery better replicated the kinematics of a normal non-injured knee than the gold standard four-strand graft. Forty-four patients (27 operative and 17 normal control) were recruited for this study over a 12-month period. Twenty patients underwent anterior cruciate ligament reconstruction with the four-strand hamstring tendon autograft construct and seven with the five-strand construct. All patients underwent kinematic testing using the KneeKG System (EMOVI, CA) according to a strict testing protocol. The operative group underwent testing at six (T1) and twelve (T2) weeks postoperatively. Analysis of variance was used to compare six degrees of freedom kinematic data across groups and correlations were made between kinematic data and intraoperatively measured graft width. Postoperative kinematic data revealed no statistically significant differences between graft types. At 12 weeks significant differences were seen between the four-strand and control group in the flexion/extension cycle in the preloading phase and at terminal stance. Significant correlations were seen between graft width and rotational stability at Preloading (Pearson’s r=0.415) and Maximum Internal Rotation (Femoral Width Pearson’s r=0.456 and Tibial Width Pearson’s r=0.476) at 12 weeks regardless of graft type. This study demonstrated that to achieve anatomic knee kinematics in primary ACL reconstruction in the first 12 weeks postoperatively, a technique to optimise autograft width using a five-strand hamstring tendon autograft is useful. A relationship was found between graft width and more stable rotational kinematics of the knee during walking, regardless of graft type. Anders Sideris, Ali Hamze, Nicky Bertollo, David Broe, William Walsh ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 https://www.pagepress.org/journals/index.php/or/article/view/7738 Wed, 05 Sep 2018 14:54:28 +0200 Physician and patients factors associated with outcome of spinal epidural abscess related malpractice litigation https://www.pagepress.org/journals/index.php/or/article/view/7693 Spinal epidural abscesses (SEA) can be challenging to diagnose and may result in serious adverse outcomes sometimes leading to neurologic compromise, sepsis, and even death. While SEA may lead to litigation for healthcare providers, little is known about the medicolegal factors predicting case outcome of SEA related litigation cases. Three large medicolegal databases (VerdictSearch, Westlaw, and LexisNexis) were queried for SEA-related malpractice cases. Plaintiff (patient) age, sex, previous infection history and clinical outcomes such as residual paraplegia/quadriplegia, and delay in diagnosis or treatment were examined. The relationship between these variables and the proportion of plaintiff rulings and size of indemnity payments were assessed. Of the 135 cases that met inclusion criteria, 29 (21.5%) settled, 59 (43.7%) resulted in a defendant ruling, and 47 (34.8%) resulted in a plaintiff ruling. Mean award for plaintiff rulings was $4,291,400 (95% CI, $5,860,129 to $2,722,671), which was significantly larger than mean awards for cases that settled out of court, $2,324,170 (95% CI, $3,206,124 to $1,442,217) (P&lt;0.05). The proportion of plaintiff verdicts and size of monetary awards were not significantly related to age or sex of the patient. A previously known infection was not significantly associated with the proportion of plaintiff verdicts or indemnity payments (P&gt;0.05). In contrast, plaintiff verdicts were more common for patients who became paraplegic or quadriplegic (P&lt;0.02) and were associated with significantly higher monetary awards (P&lt;0.05) relative to patients without paralysis. Plaintiff verdicts were also more common when cases had an associated delay in diagnosis (P=0.008) or delay in treatment (P&lt;0.001). Internists were the most commonly sued physician named in 20 (14.8%) suits, followed by anesthesiologists in 13 (9.6%) suits, emergency medicine physicians in 12 (8.9%) suits, family medicine physicians in 9 (6.7%) suits, neurosurgeons and orthopedic surgeons in 6 (4.4%) suits each, and multiple providers in 2 (1.5%) suits. The remaining lawsuits were against a hospital or another specialty not previously listed This investigation examined legal claims associated with SEA and found that the likelihood of a plaintiff verdict was significantly related to patient outcome (paralysis) and physician factors (delay in diagnosis or treatment compared). Additionally, paralyzed plaintiffs receive higher award payouts. Non-operative physicians, who are often responsible for initial diagnosis, were more frequently named in malpractice suits than surgeons. Increased awareness of the medicolegal implications of SEA can better prevent delays in diagnosis and treatment, and thus, alleged negligence-based lawsuits. Govind Shantharam, J. Mason DePasse, Adam E.M. Eltorai, Wesley M. Durand, Mark A. Palumbo, Alan H. Daniels ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 https://www.pagepress.org/journals/index.php/or/article/view/7693 Wed, 26 Sep 2018 08:10:41 +0200 Vertical patellar dislocation: A pediatric case report and review of the literature https://www.pagepress.org/journals/index.php/or/article/view/7688 Vertical patellar dislocations (VPDs) are a rare event, and even more so among pediatric female patients. There have been less than 30 vertical patellar dislocations reported in the literature since the first in 1844. In this type of dislocation, the patella rotates about its vertical axis with the articular surface facing either medially or laterally. The mechanism of injury for a VPD can be broadly divided into two themes: a twisting injury or direct impact to the medial or lateral edge of the patella. We present a 10-year-old girl with a VPD after experiencing a twisting injury when descending a playground slide. The purpose of this study is to present a case report and review of the literature on vertical patella dislocations, including mechanisms of injury and suggested methods of treatment. We aim to provide a comprehensive understanding of the various categories of patella dislocations to alleviate confusion when classifying patellar dislocations. Furthermore, we provide clear suggestions for reduction methods and techniques with regards to vertical patellar dislocations, including a suggested protocol for an irreducible patella. Ugochukwu N. Udogwu, Coleen S. Sabatini ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 https://www.pagepress.org/journals/index.php/or/article/view/7688 Wed, 05 Sep 2018 14:04:21 +0200