The 12 Practice-changing Posts of Christmas

“On the first day of Christmas, CORRelations brought to me . . .”

We’ll spare you the song and deliver instead our first dose of holiday cheer in the form of the 12 CORRelations posts — two per subspecialty area — we thought were most immediately practice-changing. For those of you who celebrate Kwanzaa, Chanukah, or just the fact that the days are getting a little longer instead of shorter, we trust you’ll forgive the specific holiday reference. ’Tis the season, after all.

Next week, we’ll share the 12 most-read posts of the year, again two per specialty, as well as our most-read features from 2023. With a few exceptions, we’ll be taking a break during this season, and will be back full steam ahead starting in January.

In all of these, for reasons of space, we’ll limit the coverage to one or two interesting bits here to tease the content, so be sure to read the full linked CORRelations posts, since, as our readers know, CORRelations isn’t a journal scan — it’s all about the context we share (“How’s It Stack Up?”) and the practical implementation suggestions we offer (“What’s Our Take?”).

Happy holidays from the CORRelations team.

Arthroscopy/Sports

• Strong Evidence Favors Surgery After One Shoulder Dislocation. This meta-analysis of RCTs found surgical stabilization of first-time shoulder dislocations resulted in far less recurrent instability (6% versus 47%) and subsequent surgery for instability (4% versus 31%); the findings are limited to men, as they experience the large majority of traumatic dislocations.
• IV Tranexamic Acid is Likely Safer Than Intra-articular TXA Before Arthroscopic Surgery. In the holiday spirit, we’re going “BOGO”" (buy one, get one), since this really was two posts in one — it covered an earlier article showing TXA improved the view during arthroscopic cuff repair, and refined on it by pointing out that IV TXA is probably just as good as intra-articular but avoids the risk of cartilage injury.

Foot & Ankle

• A Bad Actor — Talar Neck Fracture With Proximal Extension. These fractures are seeing you, so make sure you see them, as they carry a terrible prognosis. CORRelations’ related coverage of this topic in the Fractures & Trauma section has some great visuals.
• How to Decide When Not to Operate on Achilles Tendon Ruptures. A handy algorithm (summarized in the CORRelations post) along with when and how to use it. This is another BOGO since this post points to our coverage of the most-definitive RCT on the topic, a summary of which might make a very nice patient handout on this tricky decision.

Fractures & Trauma

• A Nice Pearl for Tough Supracondylar Femur Fractures. “A great technical trick,” according to CORRelations’ Advisor in Fractures & Trauma; the post gives a step-by-step rundown of how to place a percutaneous medial-column screw in a way that saves time and trouble.
• Breathing Room Between ORIF and Flap Coverage for IIIB Open Tibia Fractures Is About 48 Hours. Key messages here for call-takers in terms of practical surgical suggestions as well as medicolegal air cover.

Hand

• ICYMI: Surgery for Wrist Fractures — An Evidence-based Look at Very Active Patients. Age was a poor proxy for functional demand (activity level), but the Rapid Assessment of Physical Activity is a quick, 9-item tool that works; easily deployed in the office setting (and available for download through the CORRelations post), it helps you pick who is likely to do well with surgery, and who might be better off without it.
• Deciding Whether to Operate if a Personal Injury Claim is Open. One surprising finding and some good practical tips on a common problem.

Joint Replacement

• ICYMI: Pinning of Valgus-impacted Femoral Neck Fractures May Be the Wrong Approach. This surprising post would change my algorithm for these fractures: protected weightbearing with crutches or a walker for those who can, and arthroplasty (hemi or THA) for those who cannot, which we covered in another CORRelations post.
• A Useful Radiographic (and Physical) Finding to Avoid Trouble After DAA THA. The “pannus sign” (a visible pannus extending below the upper/cephalad edge of the pubic symphysis on supine x-rays) was associated with order-of-magnitude level increases in infection and fracture after direct-anterior THA. Here’s hoping that the new year will bring wider insurance coverage of weight-loss drugs, and that we’ll see some better-quality research about them.

Spine

• FAQs for MIS Lumbar Spine Patients — Print This One Out! A don’t-miss post for those who do MIS approaches to lumbar spine surgery, both for some perspective about a study with an unusual design, as well as for a nice patient handout informed by the best-available evidence.
• Better Identifying Patients Who Are Going to Do Worse. In case you’re wondering how we do on the empathy meter, it’s better if you don’t ask. Instead, check out the easy-to-use, quick (<1 minute), in-office questionnaire (B-MEPS) mentioned at the end of this CORRelations post to help you identify patients with emotional distress, and let it guide your go/no-go decisions about elective spinal surgery; see this related CORRelations post for other practical tips on this key topic.