➤ The selection of an agent for prophylaxis against venous thromboembolism (VTE) is a balance between efficacy and safety. The goal is to prevent symptomatic VTE while limiting the risk of bleeding. ➤ The optimal agent for VTE prophylaxis has not been identified. The American College of Chest Physicians guidelines recommend that, after total hip or total knee arthroplasty, patients receive at least 10 to 14 days of 1 of the following prophylaxis agents: aspirin, adjusted-dose vitamin K antagonist, apixaban, dabigatran, fondaparinux, low-molecular-weight heparin, low-dose unfractionated heparin, rivaroxaban, or portable home mechanical compression. ➤ The use of aspirin for VTE prophylaxis has increased in popularity over the past decade because it is effective, and it is an oral agent that does not require monitoring. The true efficacy of aspirin needs to be determined in multicenter randomized clinical trials. ➤ Validated risk stratification protocols are essential to identify the safest and most effective regimen for VTE prophylaxis for individual patients. There is no consensus regarding the optimal method for risk stratification; the selection of a prophylaxis agent should be determined by shared decision-making with the patient to balance the risk of thrombosis versus bleeding. ➤ Patients with atrial fibrillation being treated with chronic warfarin therapy or direct oral anticoagulants should stop the agent 3 to 5 days prior to surgery. Patients do not typically require bridging therapy prior to surgery.

Objective: The objective of this study is to assess differences in complication profiles between 3-level posterior column osteotomy (PCO) and single-level pedicle subtraction osteotomy (PSO) as both are reported to provide similar degrees of sagittal correction.Methods: The PearlDiver database was queried retrospectively using International Classification of Disease, 9th and 10th edition and Current Procedural Terminology codes to identify patients who underwent PCO or PSO for degenerative spine disease. Patients under age 18 or with history of spinal malignancy, infection, or trauma were excluded. Patients were separated into 2 cohorts, 3-level PCO or single-level PSO, matched at a 1:1 ratio based on age, sex, Elixhauser comorbidity index, and number of fused posterior segments. Thirtyday systemic and procedure-related complications were compared.Results: Matching resulted in 631 patients for each cohort. PCO patients had decreased odds of respiratory (odds ratio [OR], 0.58; 95% confidence interval [CI], 0.43–0.82; p = 0.001) and renal complications (OR, 0.59; 95% CI, 0.40–0.88; p = 0.009) compared to PSO patients. There was no significant difference in cardiac complications, sepsis, pressure ulcer, dural tear, delirium, neurologic injuries, postoperative hematoma, postoperative anemia, or overall complications.Conclusion: Patients who undergo 3-level PCO have decreased respiratory and renal complications compared to single-level PSO. No differences were found in the other complications studied. Considering both procedures achieve similar sagittal correction, surgeons should be aware that 3-level PCO offers an improved safety profile compared to single-level PSO.

Elective hand surgery encompasses a large volume of orthopaedic cases annually. Carpal tunnel syndrome, ganglion cysts, and trigger digits are some of the most common pathologies treated by hand surgeons. In the midst of the COVID-19 pandemic, patient's interest in elective hand surgery for these conditions is uncertain. The objective of this study is to use Google Trends to track online interest in elective hand surgery in the United States during the COVID-19 pandemic. Online search trends regarding elective orthopaedic hand surgery were obtained via Google Trends from November 2019 to November 2020. Three common hand pathologies in lay terms ("carpal tunnel," "‘ganglion cyst’ + ‘wrist cyst,’" and "trigger finger") and three hand surgery-specific keywords ("hand surgery," "carpal tunnel surgery," and "trigger finger surgery") were used as search terms. The search volume index (SVI) graphs for the United States for both sets of search terms were then generated from the Google Trends data and compared to the seven-day average of new COVID-19 cases per day as reported by the CDC. A separate SVI graph was then created for the search term "coronavirus” and was compared against both sets of search terms as above. Search trends for all elective hand pathologies and surgery-specific keywords remained constant from November 2019 to the beginning of March 2020 and then decreased significantly within a one-month period following the peak in COVID-19 cases the week of March 15, 2020. Search trends for these keywords increased to baseline levels over the next few months. The search trend for "coronavirus" demonstrated a small search volume index peak of 13 during January 2020 followed by the maximum peak of 100 during the week of March 15, 2020, corresponding to the decrease in search trends of elective hand surgery at that time. Online interest in elective hand surgery remained constant prior to the COVID-19 pandemic; however, there was a marked decrease in search trends of elective hand surgery with the rise in daily reported COVID-19 cases, suggesting that patient's interest in elective hand surgery decreased with the onset of the pandemic.

Treatment of a painful neuroma is a challenging problem for both the patient and the providers. Current surgical treatment options typically include excision of the neuroma and stump relation. However, with both treatment options, patients have high rates of persistent pain and rates of neuroma recurrence. We describe two patients with neuromas treated with our acellular nerve allograft reconstruction technique. This technique involves the excision of the neuroma and bridging the proximal nerve end to the surrounding tissue with an acellular nerve allograft. Both patients had immediate resolution of their neuropathic pain that was maintained at their final follow-up. Acellular nerve allograft reconstruction is a promising treatment option for the treatment of painful neuromas.

Ex vivo regional gene therapy is a promising tissue-engineering strategy for bone regeneration: osteogenic mesenchymal stem cells (MSCs) can be genetically modified to express an osteoinductive stimulus (e.g., bone morphogenetic protein-2), seeded onto an osteoconductive scaffold, and then implanted into a bone defect to exert a therapeutic effect. Compared to recombinant human BMP-2 (rhBMP-2), which is approved for clinical use, regional gene therapy may have unique benefits related to the addition of MSCs and the sustained release of BMP-2. However, the cellular and transcriptional mechanisms regulating the response to these two strategies for BMP-2 mediated bone regeneration are largely unknown. Here, for the first time, we performed single-cell RNA sequencing (10x Genomics) of hematoma tissue in six rats with critical-sized femoral defects that were treated with either regional gene therapy or rhBMP-2. Our unbiased bioinformatic analysis of 2393 filtered cells in each group revealed treatment-specific differences in their cellular composition, transcriptional profiles, and cellular communication patterns. Gene therapy treatment induced a more robust chondrogenic response, as well as a decrease in the proportion of fibroblasts and the expression of profibrotic pathways. Additionally, gene therapy was associated with an anti-inflammatory microenvironment; macrophages expressing canonical anti-inflammatory markers were more common in the gene therapy group. In contrast, pro-inflammatory markers were more highly expressed in the rhBMP-2 group. Collectively, the results of our study may offer insights into the unique pathways through which ex vivo regional gene therapy can augment bone regeneration compared to rhBMP-2. Furthermore, an improved understanding of the cellular pathways involved in segmental bone defect healing may allow for the further optimization of regional gene therapy or other bone repair strategies.