CORRelations is a community as much as it is a newsletter.
As the editor, I learn from our advisors and contributors — special thanks to each of them — but also from our readers. We enjoy seeing what works by following usage data, and we thought we’d pass that bit of crowd-sourced wisdom back to you in the form of the two most-read posts in each subspecialty from 2023.
Use this to grab some important insights you may have missed, refresh a topic you may have seen, or even dip into one of the other subspecialty feeds, which you can always add to your subscription at no additional cost under the "Account" tab in the desktop version.
There were a few ties in the counts, which I resolved by not covering any posts here that also made last week’s list of 12 practice-changing posts.
And as last week, we’ll limit the coverage here to one key finding on each, so be sure to read the CORRelations posts we link to for bits of context and more about how to apply the discoveries in practice.
A recent survey of CORRelations readers found that 94% would recommend CORRelations to a colleague. These posts are a great place to start — forward them on to anyone whom you think might want to check us out.
Happy New Year to you, from all of us here at CORRelations.
- Tenodesis for SLAP Tears in the Elite Overhead Athlete. Very nice results in a tough group to treat; these findings tip the debate away from tenotomy, but be sure to read the CORRelations post for some key caveats.
- When and How to Use PRP for Rotator Cuff Tendinopathy and Partial-thickness Tears. CORRelations readers are aware of my reservations about PRP for this indication based on meta-analysis of RCT data, but PRP remains in wide use nonetheless, and this study’s key finding — don’t bother with PRP if it’s a partial-thickness tear — was interesting and robust.
Foot & Ankle
- When to Skip Transmetatarsal Amputation in Patients With Diabetes. Half of these patients went on to have a revision of the amputation to a higher level, with the key factor being the patient’s Charlson comorbidity index (CCI). The CORRelations post points you to a freely available online CCI calculator that gives you the answer in less than 10 seconds. Don't miss.
- Avoid the Accessory Posterolateral Portal in Posterior Ankle Hindfoot Scopes. CORRelations posts sometimes are about what not to do, and this is a great example. The sinus tarsi accessory portal seems a safer choice to avoid potentially serious nerve injuries when you're looking for an accessory portal to help distract the subtalar joint.
Fractures & Trauma
- Patients Happier If They Can Keep Their Old Orthopaedic Hardware. That this one made the list surprised me, but upon reflection, it makes sense. It’s the CORRelations sweet spot — a simple, practical step that surgeons can do to increase patients’ satisfaction. Be sure to read the post for the important legal implications of offering patients the option of taking home these expensive little souvenirs.
- “Trochanteric” Recon Nails May Need a New Name. This neat real-world-practical study looked at three widely used nails and found that starting medial to the tip of the trochanter for “trochanteric-start” reconstruction nails helps avoid varus displacement. There’s more to it, so read the post, but CORRelations’ advisor in Fractures & Trauma, Jaimo Ahn, MD, validated the findings with: “Nice pearl, especially considering how often we see incorrect starting sites!”
- Great Evidence to Guide Shared Decision-making About Endoscopic CTR. The risk of reoperation following endoscopic carpal tunnel release is higher than it is after open release, but the absolute magnitude of that risk is small, prompting the recommendation to “ask a patient what (s)he prioritizes most — lowest-possible risk of reoperation or fastest-possible recovery from surgery — and guide the choice based on that.”
- To Send or Not to Send (Pathology) — That is the Question. The ganglions were (nearly) all ganglions, and none were cancers, but in a larger study that we cover in the post, that wasn’t the case. Healthcare systems may prefer that surgeons not send routine specimens for histopathological analysis, but remember that it’s those systems that save money, while the surgeons bear the small (but non-zero) risk of being accused of malpractice.
- Skip the Antibiotic Prophylaxis Before Colonoscopy in Arthroplasty Patients. This study represents the most-definitive answer we have (and are likely to get) on this question, which comes up all the time. Following the recommendations here doesn't increase the risk of prosthetic joint infection, and may reduce the likelihood of older patients getting potentially fatal C. difficile colitis.
- THA for Femoral Neck Fracture — Not All It’s Cracked Up to Be. This one might be as much for your non-arthroplasty partners as for you (perhaps that's why it was read so avidly?), so feel free to forward it along to them. Shared decision-making in a nutshell: “If I do a THA rather than a hemiarthroplasty, you’re less likely to have hip pain (though you’ll probably be okay either way), but the ‘cost’ of that benefit is a higher risk of dislocation.” Your non-arthroplasty partners will see this as a well-done, generalizable study showing why hemiarthroplasty remains a perfectly reasonable choice for most patients and their surgeons.
- Another Diagnosis to Worry About: Sarcopenia. One in four patients in this series had sarcopenia, and they were at risk for some serious problems (including a 5x reduction in the odds of benefiting from surgery and a fourfold increase in the odds of worsening rather than improving after surgery). The post links to a nice review to help those in busy practices make this important diagnosis efficiently.
- Managing High Expectations Before Spine Surgery. The article was a tough read, which is why CORRelations is here to boil it down for you. Bullet summary: Most patients having decompression with or without fusion have important expectations that go unmet. Check out the post to see what factors you can identify before surgery so you can coach patients to better results than these authors got.
Special thanks to CORRelations’ Advisors and Contributors
- Jaimo Ahn, MD — Fractures/Trauma
- Brian Gilmer, MD — Arthroscopy/Sports
- Greg Guyton, MD — Foot & Ankle
- Desirae McKee, MD — Hand
- Charlie Reitman, MD — Spine
- Julie Barnes, JD — Practical Economics
- Douglas W. Lundy, MD, MBA – My Take
- Maggie Shi, MS — Chart of the Week and Graphic Design
- Montri D. Wongworawat, MD — Chart of the Week
We couldn’t do it without you.