Vol 3-2 Case Report

Fat Embolism Syndrome Complicated by Acute Pulmonary Thromboembolism after Bilateral Femoral Shaft Fractures: Two Nightmares in The Same Patient

Aamir Shafi*, Jawhar Ul Islam, Wani Abdul Ahad, Aariba Zahoor

Department of General Medicine, SKIMS Medical College and Hospital, Bemina, Srinagar, Jammu & Kashmir, India

Fat embolism syndrome (FES) is an uncommon but fatal complication usually in orthopedic trauma especially after a long bone fracture. A high level of suspicion should be kept in mind when a patient of long bone fracture develops hypoxia, confusion or rash in the absence of infection and other causes of respiratory failure. Concomitant FES and pulmonary thromboembolism (PTE) is a more rarer entity in comparison to FES and pulmonary thromboembolism as separate entities. There are few cases reported in literature wherein patients developed concomitant FES and pulmonary embolism. Almost in all cases fat embolism syndrome and pulmonary embolism occurred either simultaneously or pulmonary thromboembolism was complicated by FES. We report a case wherein patient initially developed FES pre-operatively which was later on complicated by acute pulmonary thromboembolism in the post-operative period.

DOI: 10.29245/2767-5130/2022/2.1161 View / Download Pdf
Vol 3-2 Systematic Review

Low Rates of Reporting and Analyzing Race and Ethnicity in Hand Surgery Randomized Controlled Trials: A Systematic Review

Aneesh G. Patankar1*, Suleiman Y. Sudah2, Christopher R. Michel2, David S. Constantinescu3, Mariano E. Menendez4, Jeremy B. Ruskin5, Ajul Shah6

1Rutgers, Robert Wood Johnson Medical School, Piscataway, NJ, USA

2Department of Orthopedics, Monmouth Medical Center, Long Branch, NJ, USA

3Department of Orthopedic Surgery, University of Miami, Miami, FL, USA

4Midwest Orthopaedics at Rush, Rush University, Chicago, IL, USA

5Central Jersey Hand Surgery, Eatontown, NJ, USA

6The Center for Hand and Upper Extremity Surgery, Institute for Advanced Reconstruction, Shrewsbury, NJ, USA

Purpose: Sociodemographic factors have been shown to influence musculoskeletal health. However, little is known regarding the frequency of reporting and analysis of certain sociodemographic variables (e.g., age, sex, height, weight, body mass index (BMI), race, and ethnicity) in randomized clinical trials (RCTs) pertaining to hand surgery. The purpose of this study was to assess the rate of reporting and analysis of these variables in RCTs published in the Journal of Hand Surgery (JHS).

Methods: A systematic review was conducted of RCTs published in JHS between 2015 and 2021. For each study, we determined whether the following sociodemographic variables were reported and/or analyzed: age, sex, height, weight, BMI, race, and ethnicity. Frequencies were reported by year and as a cumulative total. Studies were evaluated using the Cochrane risk-of-bias tool.

Results: A total of 45 RCTs met inclusion criteria, with about half (53.3%) originating from the United States. Age (97.8%) and sex (91.1%) were the most frequently reported sociodemographic variables, followed by race (17.8%), BMI (11.1%), and ethnicity (8.9%). Age (17.8%) was the most frequently analyzed variable, followed by sex (13.3%), and race (4.4%); the remaining variables were not analyzed in any study.

Conclusions: While age and sex are reported at a high rate, only about 1 in 4 RCTs published in JHS report either race or ethnicity. All sociodemographic variables were infrequently included as part of statistical analysis. The significance of these findings should be recognized and used to interpret and enhance the methodology of future RCTs.

DOI: 10.29245/2767-5130/2022/2.1160 View / Download Pdf
Vol 3-2 Mini Review

Sex-specific Considerations for Shoulder Instability and Adhesive Capsulitis in Females

Kathryn A. Barth, Claire D. Eliasberg, Karen M. Sutton*

Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA

There has been an increasing focus on sex-specific differences within the context of sports medicine. Differences exist between the sexes leading to disparities in the types of injuries female athletes sustain and the rates at which they experience them. Recognition and awareness of subtle differences between the sexes can lead to a more nuanced diagnosis and treatment of such injuries. The purpose of this study is to review shoulder pathologies that are relevant to the female athlete, specifically adhesive capsulitis, multidirectional instability, and traumatic unidirectional shoulder instability, and highlight the differences in diagnosis, treatment, and outcomes between the sexes. Women suffer from adhesive capsulitis at a greater rate than men and there are risk factors such as breast cancer surgery that are unique to women. Females are much more likely to experience atraumatic shoulder instability than their male counterparts. While females represent a minority of patients who suffer traumatic unidirectional shoulder instability, they should not be overlooked with regards to this condition. There are challenges related to the diagnosis and treatment of these pathologies that are distinctive to female athletes.

DOI: 10.29245/2767-5130/2022/2.1130 View / Download Pdf
Vol 3-2 Commentary

Commentary: “The Impact of Surgical Trainee Involvement in Total Knee Arthroplasty: A Systematic Review of Surgical Efficacy, Patient Safety, and Outcomes”

Ryan S. Marder, Neil V. Shah, Aditya V. Maheshwari*

Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, USA

DOI: 10.29245/2767-5130/2022/2.1159 View / Download Pdf
Vol 3-2 Review Article

Combining All Available Clinical Outcomes on Cervical Disc Arthroplasty: A Systematic Review and Meta-Analysis

Jenna M. Wahbeh1,2, Claire J. Bogosian1,3, Natalie M. Kistler1,4, Sang-Hyun Park1,5, Edward Ebramzadeh1,4,5, Sophia N. Sangiorgio1,2,5*

1The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children in Alliance with UCLA, Los Angeles, CA, USA

2Department of Bioengineering, University of California, Los Angeles, CA, USA

3Department of Bioengineering, University of California, Berkeley, CA, USA

4Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA

5Department of Orthopaedic Surgery, University of California, Los Angeles, CA, USA

Background: Reviews of total disc arthroplasty (TDA) performance have focused on prospective randomized controlled trials (RCTs), excluding potentially important clinical information reported by others. The goal of the present study was to perform a comprehensive review, including both RCTs and non-randomized cohorts with more than five years of clinical outcome. We further explored the differences in outcome between prospective RCT and non-randomized, including retrospective studies.

Methods: A systematic literature review was performed following PRISMA guidelines. Inclusion criteria were: clinical follow-up ≥ 5 years with quantitative clinical and radiographic outcome. All studies that met these criteria, including retrospective and non-randomized studies, were included, for a total of 62 studies. As anterior cervical discectomies and fusion (ACDF) was included as a control group in the majority of the studies, comparisons between TDA and ACDF were conducted.

Results: Overall, there was a statistically significant difference between the rates of secondary surgeries reported for prospective RCTs and all other studies, with reoperation rates of 5.4% for prospective RCT studies v. 7.5% in all others (P<0.01). Including all studies, the reoperation rate for TDA patients was 5.6% and for fusion patients (included as control groups), 7.8%, (P=0.06). Overall, the reported incidence of adjacent segment degeneration was 26.2% in TDA patients and 43.9% in fusion patients (P<0.001).

Conclusions: These findings demonstrated the need for including all available data to assess the current outcomes of cervical disc arthroplasty and account for potential biases.

DOI: 10.29245/2767-5130/2022/2.1158 View / Download Pdf