Introduction:From 2000 to 2010, the cohort of patients aged 85 to 94 years had the fastest growth rate increasing in size by approximately 30%. The need for total knee arthroplasty (TKA) continues to increase with a larger percentage of patients older than 80 years requiring TKA. The purpose of our study was to examine the rate and risks of 30-day complications and unplanned readmission in patients older than 80 years.Materials and Methods:The National Surgical Quality Improvement Project database for the years 2008 to 2014 was queried for patients older than 80 years undergoing TKA. The risks of major complications, minor complications, bleeding occurrences, unplanned readmissions, and deaths over a 30-day period were examined using univariate and multivariate analyses.Results:Overall, 12 026 patients were included for analysis. In all, 422 (3.5%) experienced a major complication, 2316 (19.3%) experienced a minor complication, 2074 (17.2%) had a bleeding occurrence requiring transfusion, and 566 (4.7%) experienced an unplanned readmission. Thirty-eight (0.3%) deaths were recorded. There were no significant risk factors for major complications. Patients with an American Society of Anesthesiologists (ASA) >2 (odds ratio [OR]: 1.43 [1.239-1.651]), patients older than 84 years (OR: 1.240 [1.072-1.434]), and patients receiving general anesthesia (OR: 1.191 [1.035-1.370]) had increased risks of minor complications. Patients with a body mass index >30 (OR: 0.640 [0.532-0.770]) and men (OR: 0.815 [0.706-0.941]) had reduced rates of minor complications. Increased risk of unplanned readmission occurred in patients with chronic obstructive pulmonary disease (OR: 1.694 [1.007-2.850]) and congestive heart failure (OR: 3.030 [1.121-8.192]). Increased risk of death was seen in patients with an ASA >2 (OR: 8.9 [1.144-69.82]).Discussion/Conclusion:Elderly patients undergoing TKA have high complication and readmission rates. Surgeons should convey these increased risk factors and rates of complications in elective TKAs to their elderly patients and work with primary care physicians to mitigate these risks.

In the presence of a Galeazzi fracture, a reduced/stable DRUJ needs to be critically assessed as more than half of irreducible DRUJs in a Galeazzi fracture-dislocation were missed either pre- or intraoperatively.

Introduction: As the US population ages, the need for total hip arthroplasty (THA) is predicted to increase by 174% by 2030. The purpose of our study was to examine the rate and risks of 30-day complications and unplanned readmission in patients over the age of 80 years old. Materials and Methods: The National Surgical Quality Improvement Project database for the years 2008 to 2014 was queried for patients over the age of 80 undergoing THA. The risks of major complications, minor complications, bleeding occurrences, unplanned readmissions, and deaths over a 30-day period were examined using univariate and multivariate analyses. Results: A total of 7730 patients were included for analysis; 324 (4.2%) patients experienced a major complication, 1944 (25.1%) patients experienced a minor complication, 1776 (22.9%) patients had a bleeding occurrence requiring transfusion, and 376 (4.9%) patients experienced an unplanned readmission to the hospital within 30 days. A total of 33 (0.4%) patient deaths were recorded within 30 days postoperatively. Patients with congestive heart failure were at increased risk for developing a major complication, odds ratio (OR) 3.618 (1.052-12.437), and postoperative death, OR 11.920 (1.362-104.322). Patients with an American Society of Anesthesiologists >2, OR: 1.351 (1.131-1.613), and an operative time greater than 120 minutes, OR: 1.346 (1.084-1.670), had increased risks of minor complications. Patients with a body mass index greater than 30 had reduced rates of minor complications, OR: 0.609 (0.486-0.763). Increased risk of unplanned readmission was seen in patients with chronic obstructive pulmonary disease, OR: 2.403 (1.324-4.359). Discussion/Conclusion: Elderly patients undergoing THA have high complication and readmission rates. Surgeons should convey these increased risk factors and rates of complications in elective THAs to their elderly patients and work with primary care physicians to mitigate these risks.

We conducted a thorough review of the literature to examine the risks and complications associated with the use of Gardner-Wells Tongs (GWT). Twenty-three articles were included in this review for final analysis. One article reported a 37.5% (6/16) incidence rate of minor complications with the usage of GWTs, which included pin loosening, asymmetrical pin positioning, and superficial infections. Various cases reported more serious yet rare complications, including perforation of the skull, brain abscesses, and neurovascular damage. Overall, the complication rate is low, and often associated with only minor and transient complications, which can be easily managed. Therefore, we conclude that GWT are safe and effective, with only rare, more serious complications reported in the literature.

This was a retrospective study of data prospectively collected from 2012 to 2016 from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. The objective was to evaluate the effect of pediatric fellowship training on 30-day perioperative morbidity and mortality following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Several pathways exist in North America by which physicians acquire the clinical and technical skills to manage AIS surgically. Previous work has noted that surgeons with pediatric fellowship training tend to perform the bulk of pediatric spine surgeries. However, no study has been performed that examines if pediatric fellowship training (PFT) has an impact on early postoperative outcomes. A total of 14,194 AIS surgical patients were identified from the ACS NSQIP database. A cohort receiving isolated PSF was abstracted from this group and separated into 3 groups according to surgeon training: (1) ped+ (with PFT, n=4455); (2) ped-(without PFT, n=325); and (3) ped+match (patients selected from ped+ matched to ped- for age, sex, and fusion levels, n=325). The groups were compared for 30-day perioperative morbidity and mortality. No significant differences were noted for the 3 groups in terms of wound infections, length of hospital stay, readmissions, and unplanned returns to the operating room. Ped+match and ped- groups had no difference in neurologic injury rates. However, the ped+ and ped+match groups had significantly lower rates of blood transfusion and average volume of blood lost compared with the ped- group. Surgeons with pediatric fellowship training have a significantly lower average blood loss volume and blood transfusion rate in PSF for AIS than surgeons without such training. Understanding that different training pathways for surgeons may directly impact operative outcomes invites further examination of surgical education in North America to improve training consistency. [ Orthopedics . 2020;43(5):e454–e459.]

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Total knee arthroplasty (TKA) in cases of complex deformity (e.g., ligamentous laxity, posttraumatic arthritis) may require prostheses with inherent varus–valgus stability greater than that of traditional posterior stabilized or cruciate-retaining implants. Here, we investigate the clinical and radiographic outcomes of TKA using a midlevel constraint (MLC) prosthesis. A retrospective review of 53 patients (62 knees) who underwent primary TKA with an MLC implant was performed. Short tibial stem extensions were utilized in 49 knees, and 13 knees received no stem extension. Mean follow-up time was 31.6 months (standard deviation [SD] = 10.0, range = 24–53). Preoperative and postoperative range of motion (ROM) were assessed. Plain radiographs were reviewed for alignment, radiolucent lines, component loosening, and osteolysis. Patients who developed postoperative arthrofibrosis underwent manipulation under anesthesia (MUA). Failure was defined as instability, component loosening, or need for revision surgery. Mean ROM significantly improved from 114.1 degrees (SD = 19.7 degrees) preoperatively to 123.5 degrees (SD = 12.2 degrees) at final follow-up (t = −3.43, p = 0.001). Thirty-seven knees initially presented with varus deformity (mean = 7.5 degrees, SD = 4.8 degrees), whereas 23 had valgus deformity (mean = 10.6 degrees, SD = 6.5 degrees), and 2 knees had neutral alignment. Following surgery, mean alignment was 4.3 degrees valgus (SD = 1.7 degrees, range = 0–8 degrees), representing a statistically significant improvement (t = 5.29, p < 0.001). Six patients (9.7%) developed arthrofibrosis requiring MUA, which was irrespective of baseline ROM (p = 0.92) and consistent with 12% incidence reported in the literature. There were no significant differences in postoperative ROM (t = 0.38, p = 0.71), alignment (t = −0.22, p = 0.83), or incidence of arthrofibrosis (χ2 = 0.07, p = 0.79) between short-stemmed and nonstemmed implants. There was no radiographic evidence of radiolucent lines, component loosening, or osteolysis in any patients. No patients required revision surgery. Use of an MLC prosthesis with primary femoral component in TKA resulted in satisfactory clinical and radiographic results with no evidence of component loosening, osteolysis, instability, or need for revision at minimum 2-year follow-up.

Category: Ankle, Arthroscopy, Hindfoot, Lesser Toes, Midfoot/Forefoot, Sports, Trauma Introduction/Purpose: The occurrence of venous thromboembolisms (VTE) in the management of foot and ankle conditions can lead to serious and sometimes fatal complications. The reported incidence range of symptomatic deep venous thrombosis (DVT) following various foot and ankle procedures is wide, ranging from 0.01% to 23.4%. The incidence of asymptomatic DVT is likely higher and has been reported to be up to 34% in patients with Achilles ruptures. In line with the wide variability in incidence data, there remains a lack of consensus in determining the necessity to implement DVT prophylaxis after foot and ankle surgery. The purpose of this study was to examine the National Surgical Quality Improvement Program (NSQIP) database to assess the 30- day risk of VTE in foot and ankle surgery. Methods: The ACS-NSQIP database for the years 2011-2014 was queried for patients undergoing elective versus non-elective foot and ankle surgery with a total of 72 Current Procedural Terminology (CPT) codes included. Those undergoing procedures for an infectious process or oncologic procedures were excluded. A total of 18,632 cases were included for analysis in our study with 11,744 being elective and 6,888 non-elective surgeries. A univariate analysis of thromboembolic parameters included in the database was conducted to measure the difference between the two cohorts. Results: There were a total of 6,888 non-elective (36.97%) and 11,744 elective surgeries (63.03%). The incidence of DVT was 32 (0.33%) for elective and 39 (0.46%) for non-elective surgery with no statistical significance (P=0.37). The incidence of pulmonary embolisms (PE) was 24 (0.35%) for the non-elective and 20 (0.17%) for the elective group with the non-elective group having a statistically significant increase (P = 0.0156). The incidence of cerebral vascular accidents (CVA) was 8 (0.06%) for males and 1 (0.009%) for females with males having a statistically significant higher incidence of CVA (P = 0.0318). Patients under age 65 had a statistically higher risk (P = 0.0194) of a CVA occurrence with an odds ratio of 0.132 times greater than those over the age of 65. Conclusion: Non-elective Foot & Ankle surgery is an independent risk factor for pulmonary embolism. Males under the age of 65 years old are more likely to experience CVAs with residual deficits. However, the overall incidence of PE and CVA are exceedingly low in our study with an incidence of under half a percent. The incidence of DVT was also low, under 0.5% for the non-elective group and 0.33% for the elective group. Therefore, surgeons should weigh the risks and benefits of anticoagulation, especially in elective foot and ankle surgery, prior to the initiation of anticoagulation therapy.