John M. DePasse

Assessment of Malpractice Claims Associated With Acute Compartment Syndrome

Background: Because acute compartment syndrome is one of the few limb-threatening and life-threatening orthopaedic conditions and is difficult to diagnose, it is a frequent source of litigation. Understanding the factors that lead to plaintiff verdicts and higher indemnity payments may improve patient care by identifying common pitfalls. Methods: The VerdictSearch legal claims database was queried for the term “compartment syndrome.” After 46 cases were excluded for missing information or irrelevancy, 139 cases were reviewed. The effects of plaintiff demographics, mechanism of injury, and complications were assessed. Results: Of 139 cases, 37 (27%) were settled, 69 (50%) resulted in a defendant ruling, and 33 (24%) resulted in a plaintiff ruling. Juries were more likely to rule in favor of juvenile plaintiffs than adult patients (P = 0.002) and female plaintiffs than male plaintiffs (P = 0.008), but indemnity payments were not affected by the age or sex of the plaintiff. Plaintiffs who experienced acute compartment syndrome as a complication of surgery were more likely to win their suit and receive higher awards (P < 0.05), compared with those in whom the condition developed as a result of trauma. Amputation or delay in diagnosis or treatment did not affect plaintiff verdicts or awards. Conclusion: Defendants were more likely to lose a lawsuit concerning the management of acute compartment syndrome if the patient was a woman or child or if acute compartment syndrome developed as a complication of a surgical procedure.

Perpendicular Iliac Screw Placement for Reinforcement of Spinopelvic Stabilization.

Iliac fixation is indicated to provide spinopelvic stabilization in select cases of long segment thoracolumbar spine fusion, spinal osteotomy/realignment, trauma, and instability caused by tumor or infection. Traditional iliac fixation with iliac screws or S2 alar/iliac (S2AI) screws may provide inadequate fixation in select clinical scenarios, such as severely compromised bone quality or spinopelvic dissociation. The purpose of this article is to describe the perpendicular iliac screw technique with ipsilateral iliac crest screw plus S2AI fixation. The technique may be applied for select individuals in cases of 3-column osteotomy in the lower lumbar spine, spinopelvic dissociation (caused by trauma, neoplasm, or Charcot arthropathy), and failure of previous iliac fixation and when anatomic constraints limit standard iliac screw or S2AI screw placement. [Orthopedics. 2016; 39(6):e1209-e1212.].

Orthopedic in-training examination question metrics and resident test performance

First administered in November 1963, the orthopedic in-training examination (OITE) is now distributed to more than 4000 residents in over 20 countries and has become important for evaluation of resident fund of knowledge. Several studies have assessed the effect of didactic programs on resident performance, but only recently has it become possible to assess detailed testtaking metrics such as time spent per question. Here, we report the first assessment of resident OITE performance utilizing this full electronic dataset from two large academic institutions. Full 2015 OITE score reports for all orthopedic surgery residents at two institutions were anonymized and compiled. For every question answered by each resident, the resident year, question content or domain, question result (correct or incorrect), and answer speed were recorded. Data were then analyzed to determine whether resident year, result, or domain affected answer speed and whether performance in each subspecialty domain varied based on resident year in training. Data was available for 46 residents and 12,650 questions. Mean answer speed for questions answered correctly, 54.0±48.1 s, was significantly faster than for questions answered incorrectly, 72.2±61.2 s (P<0.00001). When considering both correct and incorrect answers, PGY-1s were slower than all other years (P<0.02). Residents spent a mean of nearly 80 seconds on foot and ankle and shoulder and elbow questions, compared to only 40 seconds on basic science questions (P<0.05). In education, faster answer speed for questions is often considered a sign of mastery of the material and more confidence in the answer. Though faster answer speed was strongly associated with correct answers, this study demonstrates that answer speed is not reliably associated with resident year. While answer speed varies between domains, it is likely that the majority of this variation is due to question type as opposed to confidence. Nevertheless, it is possible that in domains with more tiered experience such as shoulder, answer speed correlates strongly with resident year and percentage correct.

Diagnostic Criteria and Clinical Outcomes in Sarcopenia Research: A Literature Review

By the sixth decade of life, nearly one quarter of the population has substantial muscle atrophy, or sarcopenia. Despite the creation of a standardized definition of sarcopenia by the European Working Group on Sarcopenia in Older People, variability may exist in the diagnostic criteria utilized for clinical sarcopenia research. The primary objectives of this review were to characterize diagnostic criteria used for measurement of sarcopenia in original studies, and to describe associations between sarcopenia and important clinical outcomes. We performed a literature review of the term “sarcopenia” in PubMed. Inclusion criteria were English language, original data, a clear and specific definition for diagnosing sarcopenia, and the analysis of sarcopenia’s effect on a clinical outcome. A total of 283 studies met inclusion criteria. More than half of the included sarcopenia investigations were level IV studies (54.1%), while 43.1% provided level II evidence. Under one third (27.6%) of studies examined sarcopenia with regard to surgical outcomes. In terms of diagnostic criteria for sarcopenia, 264 (93.3%) studies used measures of skeletal muscle mass, with dual energy X-ray absorptiometry (DEXA) being the most common modality (43.6%). Sarcopenia was found to be a consistent predictor of chronic disease progression, all-cause mortality, poorer functional outcomes, and postoperative complications. In conclusion, there is substantial evidence that sarcopenia impacts both medical and surgical outcomes. However, current research has utilized heterogeneous diagnostic criteria for sarcopenia. Further efforts to standardize the modalities used to diagnose sarcopenia in clinical research and practice will help strengthen our ability to study this important phenomenon.