Clinical news alert from the American Academy of Orthopaedic Surgeons

Below are highlights of orthopaedic research studies appearing in the April 18th issue of the Journal of Bone and Joint Surgery (JBJS), as well as the issue's full Table of Contents.

Since September 11, 2011, more than 1.9 million U.S. troops have been deployed to Iraq and Afghanistan, and nearly 65,000 have required medical evacuation from these conflicts. Many reports have focused on casualties, as well as musculoskeletal injuries sustained during combat. However a new study, appearing in the April 18th JBJS, looks at non-emergent musculoskeletal injuries that are incurred by military personnel during the course of a deployment and are reported only on return to the U.S. Orthopaedic non-emergent injuries include bone or joint pain, and don't necessarily need immediate emergency treatment.

In "Non-Emergent Orthopaedic Injuries Sustained by Soldiers in Operation Iraqi Freedom," authors evaluated 3,787 soldiers who returned from combat operations at the end of a 15-month deployment without having been medically evacuated. Their findings include:

• There were 731 orthopaedic surgical consultations for the evaluation of non-emergent injuries, and 140 operations were performed as a result of those consultations.
  • Consultations were lowest in the 18-23 year-old group, and rates generally increased with increasing age.
• 19 percent of all soldiers who completed a combat deployment required an orthopaedic surgical consultation on return, and 4 percent of soldiers required orthopaedic surgery.
  • More than half of the surgical procedures involved the knee or shoulder, with knee and shoulder arthroscopy, and surgery for the treatment of shoulder instability being the most common procedures needed.
• The authors conclude that deployment-associated injuries that do not require medical evacuation are predominately orthopaedic in nature, and potentially can represent as much as a burden to the healthcare system as musculoskeletal wounds sustained during combat.
• The authors also acknowledge that this study is based on a small sample, but if it was to be extrapolated to all soldiers deployed since 2001, more than 1.5 million orthopaedic surgical consultations and 68,000 surgical procedures could be anticipated.

Arthroscopy is a common surgical procedure in which a joint is viewed using a small camera. A new study estimates that nearly one million knee arthroscopies are done annually, and that this type of procedure has a relatively low risk for deep vein thrombosis (DVT), which is a blood clot deep within the extremities.

Appearing in the April 18th issue of the JBJS, "Incidence of Symptomatic Venous Thromboembolism after Elective Knee Arthroscopy," authors describe the incidence of symptomatic DVT and pulmonary embolism (PE) - - a complication that occurs when the blood clot to move to the lungs - - , and mortality after elective knee arthroscopy performed without thromboembolic prophylaxis.

• During a 27-month period, 21,794 arthroscopic knee procedures were identified. Patients who had a history of venous thromboembolism or who had received anticoagulation therapy (blood thinning) within 14 days prior to the surgery were excluded. 20,770 patients met the inclusion criteria.
  • 51 patients developed a DVT, and 35 developed a PE.
  • Incidence of DVT was higher in patients who were older than 50 years of age; and higher in female patients if they had been prescribed oral contraceptive medication.
• There was no difference in the incidence of DVT or PE on the basis of sex.
• Authors conclude that incidence of symptomatic VTE after knee arthroscopy is relatively low.

Operative versus Nonoperative Care of Displaced Midshaft Clavicular Fractures: A Meta-Analysis of Randomized Clinical Trials

Secondary rotator cuff dysfunction following total shoulder arthroplasty for primary osteoarthritis: results of a multicenter study with greater than 5-year follow-up

A Prospective Randomized Controlled Trial of Dynamic Versus Static Progressive Elbow Splinting for Posttraumatic Elbow Stiffness

Repair Integrity and Functional Outcomes after Arthroscopic Suture-Bridge Rotator Cuff Repair

Vascular Safe Zones for Surgical Dislocation in Children with Legg-Calve-Perthes

Outcomes and Prognostic Factors for a Consecutive Case Series of 115 Patients with Somatic Leiomyosarcoma

The Journal of Bone & Joint Surgery has been the most valued source of information for orthopaedic surgeons and researchers for over 100 years and is the gold standard in peer-reviewed scientific information in the field. JBJS is published twice a month online and in print. Abstracts are available online at (http://www.jbjs.org). Contact Michelle Hache for general information on JBJS at mhache@jbjs.org

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