Trends and risk factors for opioid administration for non-emergent lower back pain

BACKGROUND Non-emergent low-back pain(LBP)is one of the most prevalent presenting complaints to the emergency department(ED)and has been shown to contribute to overcrowding in the ED as well as diverting attention away from more serious complaints.There has been an increasing focus in current literature regarding ED admission and opioid prescriptions for general complaints of pain,however,there is limited data concerning the trends over the last decade in ED admissions for non-emergent LBP as well as any subsequent opioid prescriptions by the ED for this complaint.AIM To determine trends in non-emergent ED visits for back pain;annual trends in opioid administration for patients presenting to the ED for back pain;and factors associated with receiving an opioid-based medication for non-emergent LBP in the ED METHODS Patients presenting to the ED for non-emergent LBP from 2010 to 2017 were retrospectively identified from the National Hospital Ambulatory Medical Care Survey database.The“year”variable was transformed to two-year intervals,and a weighted survey analysis was conducted utilizing the weighted variables to generate incidence estimates.Bivariate statistics were used to assess differences in count data,and logistic regression was performed to identify factors associated with patients being discharged from the ED with narcotics.Statistical significance was set to a P value of 0.05.RESULTS Out of a total of 41658475 total ED visits,3.8%(7726)met our inclusion and exclusion criteria.There was a decrease in the rates of non-emergent back pain to the ED from 4.05%of all cases during 2010 and 2011 to 3.56%during 2016 and 2017.The most common opioids prescribed over the period included hydrocodone-based medications(49.1%)and tramadol-based medications(16.9),with the combination of all other opioid types contributing to 35.7%of total opioids prescribed.Factors significantly associated with being prescribed narcotics included age over 43.84-years-old,higher income,private insurance,the obtainment of radiographic imaging in the ED,and region of the United States(all,P<0.05).Emergency departments located in the Midwest[odds ratio(OR):2.42,P<0.001],South(OR:2.35,<0.001),and West(OR:2.57,P<0.001)were more likely to prescribe opioid-based medications for non-emergent LBP compared to EDs in the Northeast.CONCLUSION From 2010 to 2017,there was a significant decrease in the number of nonemergent LBP ED visits,as well as a decrease in opioids prescribed at these visits.These findings may be attributed to the increased focus and regulatory guidelines on opioid prescription practices at both the federal and state levels.Since nonemergent LBP is still a highly common ED presentation,conclusions drawn from opioid prescription practices within this cohort is necessary for limiting unnecessary ED opioid prescriptions.

Mid-term results of sub-trochanteric valgus osteotomy for symptomatic late stages Legg-Calvé-Perthes disease

BACKGROUND The treatment of late stages of Legg-Calvé-Perthes disease(LCPD)is controversial.Although the concept of femoral head containment is a well-established technique of treatment,its use remains debatable in the late stages of the disease,as it does not improve symptoms in terms of limb length discrepancy and gait.AIM To assess the results of subtrochanteric valgus osteotomy in symptomatic patients with late-stage Perthes disease.METHODS From 2000 to 2007,36 symptomatic patients with late stage of Perthes disease were surgically treated with subtrochanteric valgus osteotomy and followed-up for 8 to 11 years using the IOWA score and range of motion(ROM)variables.The Mose classification was also assessed at the last follow-up to reflect possible remodeling.The patients were 8 years old or older at the time of surgery,in the post-fragmentation stage,and complaining of pain,limited ROM,Trendelenburg gait,and/or abductor weakness.RESULTS The preoperative IOWA score(average:53.3)markedly improved at the 1-year post follow-up period(average:85.41)and then slightly improved at the last follow-up(average:89.4)(P value<0.05).ROM improved,with internal rotation increased on average by 22°(from 10°preoperatively to 32°postoperatively)and abduction increased on average by 15.9°(from 25°preoperatively to 41°postoperatively).The mean Mose deviation of femoral heads was 4.1 mm at the end of the follow-up period.The tests used were the paired t-test and Pearson correlation test,where the level of significance was a P value less than 0.05.CONCLUSION Subtrochanteric valgus osteotomy can be a good option for symptomatic relief in patients with late-stage of LCPD.

Effect of lengthening along the anatomical axis of the femur and its clinical impact

AIM To review and study the effect of lengthening along the anatomical axis of long bones and its relation to the mechanical axis deviation.METHODS We try in this review to calculate and discuss the exact clinical impact of lengthening along the anatomical axis of the femur on affecting the limb alignment. Also we used a trigonometric formula to predict the change of the femoral distal anatomical mechanical angle(AMA) after lengthening along the anatomical axis. RESULTS Lengthening along the anatomical axis of the femur by 10% of its original length results in reduction in the distal femoral AMA by 0.57 degrees. There is no objective experimental scientific data to prove that the Mechanical axis is passing via the center of the hip to the center of the knee. There is wide variation in normal anatomical axis for different populations. In deformity correction, surgeons try to reproduce the normal usual bone shape to regain normal function, which is mainly anatomical axis. CONCLUSION Lengthening of the femur along its anatomical axis results in mild reduction of the distal femoral AMA. This may partially compensate for the expected mechanical axis lateralisation and hence justify its minimal clinical impact.

Virtual orthopedic assessment:Main principles and specific regions

Telemedicine was originally created as a way to treat patients who were located in remote places far away from local health facilities or in areas with shortages of medical professionals.Telemedicine is still used today to address those problems,and is increasingly becoming a tool for convenient medical care.With the emergence of pandemics,telemedicine became almost a mandatory and valuable option for continuing to provide medical care in various specialties.As the threat of pandemic progress has continued for months and may continue for years,it is essential to validate existing tools to maintain clinical assessment and patient treatment to avoid negative consequences of the lack of medical follow-up.Therefore,the establishment of a virtual assessment technique that can be conducted effectively is of outmost importance as a way of adapting to the current situation.This study evaluated the role of telemedicine in the assessment of various orthopedic pathologies by means of a systematic virtual evaluation.