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Benes G, Ghanem D, Badin D, Greenberg M, Honcharuk E. The Effect of Socioeconomic Deprivation on Radiographic Deformities in Children With Blount Disease. J Pediatr Orthop 2024; 44:254-259. [PMID: 38158726 DOI: 10.1097/bpo.0000000000002608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Blount disease can occur at any time during the growth process, primarily with a bimodal distribution in children younger than 4 years old and adolescents. The disease process most commonly presents in Black adolescents, with disease severity positively correlated with obesity. Given the known associations among race, obesity, and socioeconomic status, we investigated the relationship between the degree of social deprivation and severity of lower extremity deformities among a community-based cohort with Blount disease. METHODS A retrospective review of hospital records and radiographs of patients with previously untreated Blount disease was conducted. Patients were classified as having early-onset or late-onset Blount disease based on whether the lower limb deformity was noted before or after the age of 4 years. The area deprivation index (ADI), a nationally validated measure that assesses socioeconomic deprivation by residential neighborhood, was calculated for each patient as a surrogate for socioeconomic status. Higher state (range: 1 to 10) or national (range: 1 to 100) ADI corresponds to increased social deprivation. Full-length standing radiographs from index clinic visits were evaluated by 2 reviewers to measure frontal plane deformity. The association of ADI with various demographic and radiographic parameters was then analyzed. RESULTS Of the 65 patients with Blount disease, 48 (74%) children were Black and 17 (26%) were non-black children. Nineteen children (32 limbs) had early-onset and 46 children (62 limbs) had late-onset disease. Black patients had significantly higher mean state (7.6 vs. 5.4, P =0.009) and national (55.1 vs. 37.4, P =0.002) ADI values than non-black patients. Patients with severe socioeconomic deprivation had significantly greater mechanical axis deviation (66 mm vs. 51 mm, P =0.008). After controlling demographic and socioeconomic factors, the results of multivariate linear regression showed that only increased body mass index (β=0.19, 95% CI: 0.12-0.26, P <.001) and state ADI (β=0.021, 95% CI: 0.01-0.53, P =.043) were independently associated with greater varus deformity. CONCLUSIONS Socioeconomic deprivation was strongly associated with increased severity of varus deformity in children with late-onset Blount disease. Our analysis suggests that obesity and socioeconomic factors are the most influential with regard to disease progression. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Gregory Benes
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
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Benes G, Badin D, Marrache M, Lee RJ. Thinner Tibial Spine Fracture Fragments Are Associated With Risk of Fixation Failure. Arthrosc Sports Med Rehabil 2024; 6:100878. [PMID: 38328533 PMCID: PMC10844939 DOI: 10.1016/j.asmr.2023.100878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/20/2023] [Indexed: 02/09/2024] Open
Abstract
Purpose To determine the rate of and risk factors for failure of tibial spine fracture (TSF) repair. Methods This was a retrospective review of patients aged 18 years or younger with TSF who underwent arthroscopic repair performed by a single orthopaedic surgeon at a large tertiary academic hospital between 2015 and 2022. Demographic, clinical, injury, fracture, and surgical characteristics were collected. Coronal length and sagittal length and height of the fracture fragment were measured on preoperative plain radiographs and magnetic resonance imaging of the knee. Results Of 25 patients who underwent arthroscopic reduction with internal fixation of TSFs, 2 (8%) experienced fixation failure. In 16 (64%), internal fixation was performed with suture anchors, whereas 8 (32%) underwent internal fixation with screws. There were 19 male patients (76%). There were no differences in demographic factors (age, race, sex, and body mass index), injury characteristics (laterality, mechanism of injury, and activity causing injury), modified Meyers-McKeever fracture classification, or method of internal fixation between the group with fixation failure and the group without failure. Coronal length (14.2 mm vs 18 mm, P = .17) and sagittal length (13.9 mm vs 18.7 mm, P = .17) of the fracture fragment also did not differ significantly between groups. Sagittal height of the fracture fragment was thinner in patients with failure of fixation (4.3 mm) than in those without failure (8 mm) (P = .02). Conclusions Decreased bone thickness of the displaced fragment was associated with an increased likelihood of fixation failure. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Gregory Benes
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Daniel Badin
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Majd Marrache
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Rushyuan Jay Lee
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, U.S.A
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Benes G, Schmerler J, Harris AB, Margalit A, Lee RJ. Flexible nailing: Pushing the indications for diametaphyseal lower-extremity fractures. Medicine (Baltimore) 2024; 103:e37417. [PMID: 38489726 PMCID: PMC10939545 DOI: 10.1097/md.0000000000037417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/19/2023] [Accepted: 02/07/2024] [Indexed: 03/17/2024] Open
Abstract
Elastic stable intramedullary nailing (ESIN) has been shown to be an effective form of surgical management for lower-extremity diametaphyseal fractures in pediatric patients, but studies are limited because ESIN treatment for these fractures is relatively uncommon. We sought to determine whether ESIN can be used effectively in the most distal or proximal short-segment forms of these fractures. We queried the electronic medical record system at Johns Hopkins Hospital using Current Procedural Terminology codes for femur and tibia fractures treated with ESIN in patients under 18 years old between January 2015 and October 2022. Preoperative and postoperative radiographs were subsequently reviewed to identify patients with a proximal or distal third femoral or tibial shaft fracture treated with ESIN and to define criteria for short-segment diametaphyseal fractures. We used Beaty radiological criteria to evaluate radiographic outcomes and Flynn titanium elastic nails (TENs) outcome scale to assess clinical recovery after radiographic evidence of union. There were 43 children who met the inclusion criteria. Among them, 10 patients had short-segment diametaphyseal fractures. There were 22 (51.2%) who sustained femur fractures and 21 (48.8%) who sustained tibia fractures. Using Beaty radiologic criteria, ESIN was associated with more satisfactory outcomes in patients with distal or proximal third shaft fractures (32/33) than in patients with short-segment diametaphyseal fractures (7/10) (P = .03). Using the TENs outcome scale, 21 (63.4%) patients with distal or proximal third shaft fractures had excellent results, 11 (33.3%) had satisfactory results, and 1 (3%) had a poor result. Among patients with short-segment diametaphyseal fractures, 4 (40%) had excellent results, 5 (50%) had satisfactory results, and 1 (10%) had a poor result. There were no differences in TENs outcomes between the groups (P = .24). Patients with short-segment lower-extremity diametaphyseal fractures treated with ESIN had worse radiographic outcomes but did no worse clinically than patients with distal or proximal third shaft fractures. Consequently, ESIN should be considered a safe and effective surgical management option for pediatric patients with even the most distal or proximal forms of these fractures.
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Affiliation(s)
- Gregory Benes
- Johns Hopkins University Department of Orthopaedic Surgery, Baltimore, MD
| | - Jessica Schmerler
- Johns Hopkins University Department of Orthopaedic Surgery, Baltimore, MD
| | - Andrew B. Harris
- Johns Hopkins University Department of Orthopaedic Surgery, Baltimore, MD
| | - Adam Margalit
- Johns Hopkins University Department of Orthopaedic Surgery, Baltimore, MD
| | - Rushyuan Jay Lee
- Johns Hopkins University Department of Orthopaedic Surgery, Baltimore, MD
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Ghanem D, Rogers DL, Benes G, Siler B, Lobaton G, Shafiq B. Gluteal compartment syndrome: who is most at risk? Eur J Orthop Surg Traumatol 2024; 34:773-779. [PMID: 37695367 DOI: 10.1007/s00590-023-03704-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/17/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE Gluteal compartment syndrome (GCS) is a rare but devastating condition with a paucity of literature to help guide diagnosis and management. This study aims to identify and describe the risk factors and patient characteristics associated with GCS to facilitate early diagnosis. METHODS This is a retrospective case series of patients undergoing gluteal compartment release between 2015 and 2022 at an academic Level I trauma center. Chart reviews were performed to extract data on patient demographics, presenting symptoms, risk factors, operative findings, and postoperative outcomes. RESULTS 14 cases of GCS were identified. 12 (85.7%) were male, with a mean age of 39.4 ± 13 years and a mean BMI of 25.1 ± 4.1 kg/m2. 12 (85.7%) patients did not present as traumas and only 3 had ≥ 1 fracture. 9 patients reported drug use. Hemoglobin (Hgb) (11.7 ± 4 g/dL) was generally low (5 had Hgb < 10 g/dL). Creatine kinase (49,617 ± 60,068 units/L) was consistently elevated in all cases, and lactate (2.8 ± 1.6 mmol/L) was elevated in 9. 13 had non-viable muscle requiring debridement. Postoperatively, the mean ICU length of stay was 12 ± 23 days. 2 patients died during admission and all remaining patients required discharge to rehabilitation facilities. CONCLUSION GCS is more likely to present in a young to middle-aged, otherwise healthy, male using drugs who is either found down or experienced an iatrogenic injury. Recognizing that GCS is different from that of the leg, in terms of etiology, may help avoid delays in diagnosis and treatment.
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Affiliation(s)
- Diane Ghanem
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, 21287, USA.
| | - Davis L Rogers
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Gregory Benes
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Brad Siler
- School of Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Gilberto Lobaton
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Babar Shafiq
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, 21287, USA
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Benes G, ElNemer W, Avendano J, Hsu N, Aiyer A. Research Productivity and Impact in Foot and Ankle Surgery: Insights From Relative Citation Ratio Analysis of Recent Fellowship Graduates. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202402000-00003. [PMID: 38323927 PMCID: PMC10846775 DOI: 10.5435/jaaosglobal-d-23-00280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/20/2023] [Indexed: 02/08/2024]
Abstract
INTRODUCTION The relative citation ratio (RCR), a novel bibliometric tool supported by the National Institute of Health, provides a standardized approach to evaluate research productivity and impact across different fields. This study aims to evaluate RCR of fellowship-trained foot and ankle orthopaedic surgeons to analyze the influence of various surgeon demographics. METHODS Fellow names listed on the American Orthopaedic Foot and Ankle Society website were extracted from the year 2008 to 2009 to the year 2022 to 2023. Demographic information for each fellow was collected including sex, degree type, and academic title. The iCite database developed by the National Institute of Health was used to obtain total publications, mean RCR, weighted RCR, and change in RCR after fellowship graduation for each fellow. Univariate and multivariate analysis was conducted to predict these four parameters based on sex, degree type, academic position, and career longevity. RESULTS Of the 820 fellows, 674 (82%) were male. Most fellows (n = 587, 71%) did not go on to hold academic positions. Multivariate analysis revealed that male sex (β = 2.32, P < 0.001), holding an academic position (β = 6.44, P < 0.001), holding a PhD (β = 22.96, P < 0.001), and a shorter length time since graduation (β = -0.50, P < 0.001) were independent predictors of number of total publications. Holding a DO degree was an independent predictor of decreased mean RCR (β = 0.39, P = 0.039). Finally, multivariate analysis revealed that male sex (β = 4.05, P = 0.003), a career in academics (β = 4.61, P < 0.001), and a shorter time since graduation (β = -0.45, P = 0.001) were associated with a larger weighted RCR. DISCUSSION The findings highlight the importance of addressing gender disparities and promoting research opportunities across different programs. Moreover, academic institutions should provide adequate support and mentorship to early-career foot and ankle-trained orthopaedic surgeons to foster sustained research productivity.
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Affiliation(s)
- Gregory Benes
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - William ElNemer
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - John Avendano
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Nigel Hsu
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Amiethab Aiyer
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
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Harris AB, Benes G, Ghanem D, Cartagena-Reyes M, Jain A, Laporte DM. Using a Modern Linked Research Database to Examine Gender Disparities in Orthopaedic Grant Funding from 2010 to 2022. J Bone Joint Surg Am 2024; 106:39-46. [PMID: 37801587 DOI: 10.2106/jbjs.23.00358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
BACKGROUND Gender disparities in research grant funding persist in many disciplines. With use of the Dimensions database, we sought to examine the extent of gender disparities in U.S. orthopaedic grant funding from 2010 onward. Our aim was to provide insights into the extent of gender disparities in the field of orthopaedic research and to highlight the potential need for future action to address these disparities. METHODS Using orthopaedic-related search terms, we queried all U.S. grants awarded for orthopaedic research from 2010 to 2022. A total of 22,326 results were then manually screened to exclude those without a direct focus on orthopaedic research. The amounts received per principal investigator were reported in U.S. dollars and adjusted for inflation. Author gender was predicted with use of the Genderize.io algorithm application programming interface. The iCite Relative Citation Ratio (RCR) was utilized to assess the impact of the publications linked to each grant. RESULTS A total of 1,723 grants were included. Men principal investigators received significantly higher median funding per grant in 2011, 2012, and 2013; however, this trend reversed with women receiving nonsignificantly higher funding in 2015, 2017, 2018, 2021, and 2022. In 2020, women received significantly higher median funding per grant than men ($166,234 versus $121,384; p = 0.04). Throughout the 13-year period, men principal investigators accounted for approximately 71% of grants, with a very weak increasing trend in the percent of grants attributed to women (R 2 = 0.16; p < 0.001). Grants with men principal investigators resulted in more publications than those with women principal investigators (mean publications, 11.1 versus 6.6; p = 0.001). Publications resulting from grants awarded to men had a significantly higher mean RCR than those resulting from grants awarded to women (2.42 versus 2.09; p = 0.04). CONCLUSIONS There was no significant difference in the median amounts of funding per grant awarded to men and to women in 7 of the past 8 years, despite significantly greater funding per grant having been awarded to men from 2011 to 2013. Men principal investigators accounted for the majority of grants received during the study period, although this proportion was lower than the proportion of men among orthopaedic surgeons in 2022. This study could inform initiatives aimed at promoting equity in grant funding for orthopaedic research.
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Affiliation(s)
- Andrew B Harris
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
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Benes G, Seidenstein A, Brandt A. Isolated Dysplasia Epiphysealis Hemimelica (Trevor Disease) of the Acetabulum: Literature Review. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202310000-00003. [PMID: 37801667 PMCID: PMC10558227 DOI: 10.5435/jaaosglobal-d-23-00138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
Dysplasia epiphysealis hemimelica (DEH), also known as Trevor disease, is a rare pathologic proliferation of cartilage with unknown etiology creating cartilaginous osteochondroma exostoses intra-articularly or juxta-articularly. Herein, we reviewed the literature about acetabular osteochondroma in children and report a case of a 9-year-old boy who presented to the orthopaedic clinic with complaints of gait disturbance, right hip discomfort, and with increasing severity and frequency of hip subluxation episodes over the course of a year. Imaging studies revealed dysplasia of the right hip with subluxation secondary to acetabular lesion. The patient underwent surgical hip dislocation to facilitate surgical excision of the lesion and reduce hip, and pathology confirmed osteochondroma with chondromatosis. We report the early follow-up for this patient and discuss the value of surgical hip dislocation to manage intra-articular bone or cartilage lesions.
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Affiliation(s)
- Gregory Benes
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
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Benes G, Saade R, Fayad LM, Sponseller PD. Case of the False Fracture: A Report of a Radiographic Stitching Error in a Scoliosis Patient. JBJS Case Connect 2023; 13:01709767-202309000-00043. [PMID: 37556572 DOI: 10.2106/jbjs.cc.23.00104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
CASE A 14-year-old boy with Marfan syndrome-associated scoliosis underwent postoperative imaging after scoliosis surgery. The lateral radiograph seemingly depicted a compression fracture of the L4 vertebra, despite the patient being asymptomatic. Further investigation with focused lumbar spine films, however, revealed a normal L4 vertebra. The apparent abnormality was attributed to an error in the image merging process. CONCLUSION Image stitching errors can lead to a false impression of structural abnormalities. It is crucial for radiology technologists and clinicians to exercise caution when reviewing digitally stitched images. We reiterate the recommendation for technicians to label stitched images and indicate overlapping regions, facilitating judicious and accurate radiographic assessment.
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Affiliation(s)
- Gregory Benes
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Benes G, Shufflebarger HL, Shah SA, Yaszay B, Marks MC, Newton PO, Sponseller PD. Late Infection After Spinal Fusion for Adolescent Idiopathic Scoliosis: Implant Exchange Versus Removal. J Pediatr Orthop 2023:01241398-990000000-00293. [PMID: 37253710 DOI: 10.1097/bpo.0000000000002440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Late infection after posterior spinal arthrodesis for adolescent idiopathic scoliosis (AIS) is the leading cause of late revision. While implant removal and antibiotic therapy are usually curative, patients may experience deformity progression. The goal of this study was to compare outcomes after implant exchange (IE) or removal (IR) to treat late-onset (≥1 y postoperative) deep surgical site infection (SSI) after spinal arthrodesis in patients with AIS. METHODS Using a multicenter AIS registry, patients who underwent posterior spinal fusion between 2005 and 2019 and developed late deep SSI treated with IE or IR were identified. Radiographic, surgical, clinical, and patient-reported outcomes at most recent follow-up were compared. RESULTS Of 3,705 patients, 47 (1.3%) developed late infection 3.8±2.2 years (range 1 to 9.7 y) after index surgery. Mean follow-up after index surgery was 6.1 years, with 2.8 years (range 25 to 120 mo) of follow-up after revision surgery. Twenty-one patients were treated with IE and 26 with IR. At the latest follow-up, average major-curve loss of correction (1° vs 9°, P<0.001) and increase in kyphosis (1° vs. 8°, P=0.04) were smaller in the IE group than in the IR group. Two IR patients but no IE patients had reoperation. Patients who underwent IE had higher Scoliosis Research Society 22-Item Patient Questionnaire (SRS-22) total scores (4.38 vs. 3.81, P=0.02) as well as better subscores for self-image, function, and satisfaction at the latest follow-up than those who underwent IR only. There were no significant between-group differences in operative duration, estimated blood loss, length of hospital stay, or changes in SRS-22 total scores. No patient had a subsequent infection during the follow-up period. CONCLUSIONS When treating late-onset deep SSI after posterior spinal fusion for AIS, single-stage IE is associated with better maintenance of major curve correction, sagittal profile, and patient-reported outcomes and fewer reoperations compared with IR, with no significant differences in blood loss, operative duration, or length of stay. No time interval from index surgery to IR was observed where the corrected deformity remained stable. Both techniques were curative of infection. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Gregory Benes
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | | | - Suken A Shah
- Department of Orthopedic Surgery, Nemours Children's Health, Wilmington, DE
| | - Burt Yaszay
- Department of Orthopedics, Rady Children's Hospital of San Diego, San Diego, CA
| | | | - Peter O Newton
- Department of Orthopedics, Rady Children's Hospital of San Diego, San Diego, CA
| | - Paul D Sponseller
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
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Ataei A, Benes G, Destin G, Etienne J, Marler AC, Bank M, Engel LS, Modica M. Unusual presentation of a stanford type A aortic dissection. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00547-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Benes G. Risk of Duplicate ICD Codes for Orthopedic and Injury Related Research. Perspect Health Inf Manag 2023; 20:1e. [PMID: 37215338 PMCID: PMC9860468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The World Health Organization's International Classification of Diseases (ICD) has become the international standard diagnostic classification for reporting morbidity and mortality. In 2015, the United States transitioned from the 9th to 10th Revision. The update was necessary due to major structural limitations of the ICD-9 system. Concerns of the transition mainly centered around clinical usage and cost; however, there were concerns for overlapping codes with the same classification but different meanings between the two versions. Duplicate codes could pose an issue for big data retrospective studies that overlap between the two systems. Therefore, the goals of this study are to further explore and identify duplicate ICD codes between the systems. ICD-9-CM and ICD-10-CM code files were obtained from the Centers for Medicare & Medicaid Services. There were 14,567 ICD-9-CM codes and 91,737 unique ICD-10-CM codes tabulated. Duplicated items between the files were isolated. Four hundred sixty-nine duplicate codes were identified, consisting of 39 E Codes and 430 V Codes. These twin codes contain classifications for external causes of injury and factors influencing health status and contact with health services. Therefore, special attention should be drawn to retrospective research involving methods of injury spanning ICD-9 and ICD-10 systems.
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Benes G, David J, Synowicz M, Betech A, Dasa V, Krause PC, Jones D, Hall L, Leslie L, Chapple AG. Race and Age Impact Osteoporosis Screening Rates in Women Prior to Hip Fracture. Arch Osteoporos 2022; 17:34. [PMID: 35150320 DOI: 10.1007/s11657-022-01076-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/08/2022] [Indexed: 02/03/2023]
Abstract
Bone mineral density screening and clinical risk factors are important to stratify individuals for increased risk of fracture. In a population with no history of fractures or baseline bone density measurement, black women were less likely to be screened than white counterparts prior to hip fracture. PURPOSE To evaluate overall BMD (bone mineral density) screening rates within two years of hip fracture and to identify any disparities for osteoporosis screening or treatment in a female cohort who were eligible for screening under insurance and national recommendations. METHODS Data were obtained from 1,109 female patients listed in the Research Action for Health Network (REACHnet) database, which consists of multiple health partner systems in Louisiana and Texas. Patients < 65 years old or with a history of hip fracture or osteoporosis diagnosis, screening or treatment more than 2 years before hip fracture were removed. RESULTS Only 223 (20.1%) females were screened within the two years prior to hip fracture. Additionally, only 23 (10%) of the screened patients received treatment, despite 187 (86.6%) patients being diagnosed with osteoporosis or osteopenia. Screening rates reached a maximum of 27.9% in the 75-80 age group, while the 90 + age group had the lowest screening rates of 12%. We found a quadratic relationship between age and screening rates, indicating that the screening rate increases in age until age 72 and then decreases starkly. After adjusting for potential confounders, we found that black patients had significantly decreased screening rates compared to white patients (adjusted OR = .454, 95% CI = .227-.908, p value = .026) which held in general and for patient ages 65-97. CONCLUSION Despite national recommendations, overall BMD screening rates among women prior to hip fracture are low. If individuals are not initially screened when eligible, they are less likely to ever be screened prior to fracture. Clinicians should address racial disparities by recommending more screening to otherwise healthy black patients above the age of 65. Lastly, treatment rates need to increase among those diagnosed with osteoporosis since all patients went on to hip fracture.
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Affiliation(s)
- Gregory Benes
- Louisiana State University Health Sciences Center School of Medicine, 1901 Perdido St, New Orleans, LA, 70112, USA.
| | - Justin David
- Louisiana State University Health Sciences Center School of Medicine, 1901 Perdido St, New Orleans, LA, 70112, USA
| | - Molly Synowicz
- University of Toledo General Surgery Residency Program, Toledo, OH, USA
| | - Alex Betech
- Orthopedics Department, School of Medicine, LSU Health Sciences Center, New Orleans, LA, USA
| | - Vinod Dasa
- Orthopedics Department, School of Medicine, LSU Health Sciences Center, New Orleans, LA, USA
| | - Peter C Krause
- Orthopedics Department, School of Medicine, LSU Health Sciences Center, New Orleans, LA, USA
| | - Deryk Jones
- Ochsner Sports Medicine Institute, Jefferson, LA, USA
| | - Lauren Hall
- Baylor Scott & White Health Research Institute, Dallas, TX, USA
| | - Lauren Leslie
- Ochsner Sports Medicine Institute, Jefferson, LA, USA
| | - Andrew G Chapple
- Orthopedics Department, School of Medicine, LSU Health Sciences Center, New Orleans, LA, USA.,Biostatistics Program, School of Public Health, LSU Health Sciences Center, New Orleans, LA, USA
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Drouault Y, Guillet G, Morel P, Vilmer C, Benes G, Trinquet F. [Comparison of the analgesic efficacy of EMLA 5% cream and lidocaine infiltration for biopsy of the genital mucosa]. Ann Dermatol Venereol 1998; 124:448-51. [PMID: 9739907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare the analgesic efficacy of EMLA 5 p. 100 cream versus Xylocaïne 1 p. 100 infiltration for biopsies of the genital mucosa. PATIENTS AND METHODS 63 adult patients were randomized. EMLA (0.3-5 g) was applied during 7-12 minutes, and Xylocaïne 1 p. 100 (0.2-5 ml) was infiltrated 0-10 minutes before biopsy. Pain during the anaesthetic procedure and the biopsy was assessed by the patient using a Visual Analogue Scale. RESULTS Pain scores were significantly lower with EMLA application than Xylocaïne infiltration, but infiltration resulted in better surgical anaesthesia. The combined pain scores (anaesthetic procedure and biopsy) were lower in the EMLA group, but this difference failed to reach statistical significance. CONCLUSION EMLA is a less painful anaesthetic procedure than infiltration, but has a lower analgesic efficacy. EMLA can be used as an alternative to infiltration for biopsies of the genital mucosa.
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Gyenes V, Benes G, Unger P. [Conservative therapy of ranulae]. Fogorv Sz 1972; 65:353-6. [PMID: 4508452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Gyenes V, Bartha M, Benes G. [Some problems concerning hemorrhagic diathesis]. Fogorv Sz 1967; 60:169-74. [PMID: 5298901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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