Incarceration of the intermeniscal ligament in tibial eminence injury: a block to closed reduction identified using MRI

Archibald-Seiffer, Noah; Jacobs, John C.; Zbojniewicz, Andrew M.; Shea, Kevin G.

doi:10.1007/s00256-014-2014-3

Cited by 12 publications

(4 citation statements)

References 33 publications

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“…Our analysis demonstrated substantial variation in charges among states and nationally for various hand procedures with a larger CV than for Medicare payments in most states. These findings are consistent with prior studies in other orthopaedic subspecialties 6,8,9,16,17 and other medical disciplines, 18,19 although we assessed interphysician variation as opposed to interhospital variation, which was the method of comparison in prior studies. A recent analysis in hand surgery using the same database found substantial regional variation in Medicare payments for carpal tunnel release, trigger finger release, and basal joint arthroplasty 12 ; however, that study did not use coefficients of variation to quantify the extent of variation, did not assess the association of patient volume with charges and payments, and did not consider trigger finger injection and closed treatment of distal radius fractures.…”

Section: Discussionsupporting

confidence: 88%

Variation in Physician Charges and Medicare Payments for Hand Surgery

Menendez

Parrish

Ring

et al. 2019

Journal of Hand and Microsurgery

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Purpose To assess national and state-level variation in physician charges (full amounts requested before payments are negotiated) and Medicare payments for common hand procedures. Materials and Methods Using the Medicare Provider Utilization and Payment Data Public Use File for 2012, we evaluated national and state variations in physician charges and Medicare payments for carpal tunnel release, trigger finger release, trigger finger injection, closed treatment of distal radius fracture, and interposition arthroplasty, intercarpal or carpometacarpal joints. We assessed variation, using the coefficient of variation. We also determined the correlation between charges and payments, as well as the association of patient volume with charges and payments. Results There was wide state-level variation in physician charges for carpal tunnel release (11-fold), trigger finger release (9.6-fold), and trigger finger injection (5.5-fold). On a national level, physician charges varied substantially for carpal tunnel release, trigger finger release, trigger finger injection, closed treatment of distal radius fracture, and interposition arthroplasty, intercarpal or carpometacarpal joints. Medicare payments varied to a lesser extent. The correlations between physician charges and Medicare reimbursements were not strong. Weak to no correlations were noted between patient volume and both charges and payments. Conclusion Physician charges for hand surgery vary substantially across states and nationally, and they do not correlate well with Medicare payments and surgeon volume. As the health care market transitions toward more restrictive physician networks and high-deductible plans, protecting uninsured and out-of-network patients from unexpected, high medical bills should be a policy priority. Type of Study/Level of Evidence Economic/Decision Analysis, Level III study.

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Section: Discussionsupporting

confidence: 88%

Variation in Physician Charges and Medicare Payments for Hand Surgery

Menendez

Parrish

Ring

et al. 2019

Journal of Hand and Microsurgery

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“…The reason that TSA fractures fail closed reduction may be because of entrapment of the IML or menisci or osteochondral lesions. 3,11,17,19,20 In type II TSA fractures, up to 59% of patients have some degree of concomitant abnormalities, with meniscal or IML entrapment present in 26% to 40% of cases. 10,16,18 Surgical interventions are required in these cases for adequate fracture fixation, and they offer the opportunity for the treatment of concomitant abnormalities with early rehabilitation to prevent complications such as arthrofibrosis.…”

Section: Discussionmentioning

confidence: 99%

Knee Extension Does Not Reliably Reduce Acute Type II Tibial Spine Fractures: MRI Evaluation of Displacement During Extension Versus Resting Flexion

Cannamela

Quinlan

Maak

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: Type II tibial spine avulsion (TSA) fractures have traditionally been managed by first attempting to achieve closed reduction with extension and immobilization, with surgical indications reserved for those who fail to reduce within 3 mm. However, the frequency with which appropriate reduction can be achieved is largely unknown. Purpose: To evaluate changes in displacement of type II TSA fractures by comparing magnetic resonance imaging (MRI) scans obtained with the knee in flexion and in extension. Study Design: Case series; Level of evidence, 4. Methods: Ten patients with type II TSA fractures were identified. Fracture displacement was measured using 3 images for each patient: (1) initial lateral view radiography, (2) sagittal-plane MRI of the knee in resting flexion, and (3) sagittal-plane MRI of the knee in passive extension. Maximum displacement of the bony fragment was measured in the 2 MRI studies for all patients, and the corresponding change in displacement was calculated. Displacement in flexion was compared with displacement in extension using a paired-sample t test. Statistical significance was set at P < .05. Results: The displacement distance of the bony fragment was reduced by a mean of 0.97 mm on MRI when the knee was in extension compared with flexion in patients with type II TSA fractures ( P = .02). Mean displacement with extension was 6.14 mm, with no fractures reduced below 4 mm. The largest reduction observed was 2.80 mm. The displacement distance increased in 2 knees with extension. The intermeniscal ligament (IML) was entrapped in 4 of 10 patients; however, the amount of reduction achieved did not differ based on the presence of IML entrapment ( P = .85). Conclusion: While the amount of tibial spine displacement warranting surgical treatment can be debated, the study findings suggest that knee extension is not reliable in obtaining adequate closed reduction for type II TSA fractures. Management decisions may need to be based on the initial displacement distance of the fracture, with a lower threshold for operative treatment than previously recognized.

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“…Although recent trends have suggested less than half of pediatric orthopaedic surgeons perform closed reduction on Type 2 fractures, 12 prior publications suggest value in a closed reduction maneuver for a displaced TSF. [13][14][15] An improved understanding of soft tissue entrapment, [16][17][18] risk for nonunion, 10 and concomitant injuries 18,19 may have influenced surgeons to consider open or arthroscopic reduction and internal fixation over closed reduction.…”

Section: Closed Reduction Of Tibial Eminence Fracturesmentioning

confidence: 99%

Tibial Spine Fracture Management - Technical Tips and Tricks from the Tibial Spine Fracture Research Interest Group

Kushare¹,

Lee²,

Ellis³

et al. 2020

Journal of the Pediatric Orthopaedic Society of North America

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Tibial spine/eminence fractures are uncommon fractures, usually seen in patients with open physes and are considered as equivalent to ACL tear in adults. The aim of treatment is appropriate reduction of the fracture, restoring the ACL length for appropriate healing and avoiding complications. There are many techniques described to treat these fractures with no current consensus on the optimal method of fixation. The purpose of this paper was to describe and demonstrate with videos, various pearls, technical tricks, and tips by members of PRiSM tibial spine fracture research interest group which can help facilitate management of these fractures.

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Incarceration of the intermeniscal ligament in tibial eminence injury: a block to closed reduction identified using MRI

Cited by 12 publications

References 33 publications

Variation in Physician Charges and Medicare Payments for Hand Surgery

Variation in Physician Charges and Medicare Payments for Hand Surgery

Knee Extension Does Not Reliably Reduce Acute Type II Tibial Spine Fractures: MRI Evaluation of Displacement During Extension Versus Resting Flexion

Tibial Spine Fracture Management - Technical Tips and Tricks from the Tibial Spine Fracture Research Interest Group

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