Scott A. Ritterman

Cost Benefit Analysis of Topical Tranexamic Acid in Primary Total Hip and Knee Arthroplasty

The purpose of this study was to provide a cost-benefit analysis of topical tranexamic acid (TXA) in primary total hip and knee arthroplasty patients. A retrospective cohort of 591 consecutive patients, 311 experimental and 280 control, revealed a transfusion rate reduction from 17.5% to 5.5%, increased postoperative hemoglobin, and decreased delta hemoglobin without an increase in adverse events (all P < 0.001). This led to saving

Paralytic ileus in the orthopaedic patient.

83.73 per patient based on transfusion costs alone after accounting for the cost of TXA. Hospital disposition to home compared to subacute nursing facility was also significantly increased by 9.3% (P < 0.02). We conclude that topical TXA reduces transfusion rate, increases home disposition, and reduces cost in primary hip and knee arthroplasty.

Hip Resection Arthroplasty

Paralytic ileus is marked by the cessation of bowel motility. This condition is a major clinical concern that may lead to severe patient morbidity in orthopaedic surgery and trauma patients. Ileus most commonly occurs following spinal surgery, traumatic injury, or lower extremity joint reconstruction, but it may also occur following minor orthopaedic procedures. Possible consequences of ileus include abdominal pain, malnutrition, prolonged hospital stay, hospital readmission, bowel perforation, and death. Therapies used in the treatment of ileus include minimization of opioids, early patient mobilization, pharmacologic intervention, and multidisciplinary care. Orthopaedic surgeons should be aware of the clinical signs and symptoms of paralytic ileus and should understand treatment principles of this relatively common adverse event.

J-splint use for temporizing management of pediatric femur fractures: a review of 18 cases.

Hip resection arthroplasty is an operative technique that can be a valuable tool for the treatment of complex hip disease. The relative rarity of the procedure makes prospective study of outcomes somewhat difficult. The purpose of this review was to gather, summarize, and analyze the entirety of cases and series published on the topic to date. Prior to the introduction of antibiotics in the 1940s, the treatment of extrapulmonary tuberculosis consisted of either isolation of the patient in a sanitarium or crude attempts at surgical debridement. Untreated infection led to pain, septic …

“Neck-Sparing” Total Hip Arthroplasty

Objectives Pediatric femoral fractures are common injuries encountered in the field and in emergency departments. Currently described temporizing management strategies include skeletal traction, skin traction, traction splinting, and posterior splinting, all of which are suboptimal in some instances. J-splinting femur fractures may be advantageous in temporizing management of pediatric femur fractures. The objective of this study was to evaluate the safety and effectiveness of J-splint use for temporizing management of pediatric femur fractures. Methods This study used a retrospective review of 18 pediatric patients with femur fractures treated with J-splinting in the emergency department. Patient age, weight, and presplinting and postsplinting pain scale ratings were recorded, as well as presplint and postsplint anteroposterior and lateral radiographic fracture angulation. Pain before and after J-splinting was compared using a paired t test. Results The mean age of this cohort was 5.4 years (range, 6 months-13 y), with a mean weight of 21.1 kg (range, 7.7–57 kg). In this cohort, there was a significant reduction in pain after reduction and splinting from a mean of 6 to a mean of 1 (P < 0.001). No significant difference in fracture alignment was noted after J-splinting. No complications were noted. Conclusions The J-splint is a reliable, simple, and rapidly applied splint that prevents many of the complications and downfalls of other described temporizing measures and helps to provide excellent pain management in the acute setting.

Predicting Pulmonary Embolus in Orthopedic Trauma Patients Using the Wells Score

Advanced arthritis of the hip joint can lead to profound changes in quality of life. Debilitating pain, stiffness, and altered gait biomechanics all affect the ability to stay mobile and maintain gainful employment; these concerns are magnified in younger patients with hip disease. While symptomatic hip arthritis typically affects older patients, there is a growing subset of active patients in their 30s, 40s, and 50s who are affected and were previously thought of as, “too young for a hip replacement.” Over the last several decades, advances in hip replacement surgery are allowing us to rethink that position.