News From ACFAS

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Early bird rates for the ACFAS 2012 Annual Scientific Conference end after January 10, 2012! Register today to save $70 or more on your ticket to:

• Trusted, respected speakers
• Cutting edge clinical and practice management topics
• Lively debates and hands-on workshops
• Up to 34 CME hours

Make your plans now to discover knowledge and skills in San Antonio, February 29-March 4, 2012. Just call 800-421-2237 or visit the conference home page at the web link below.

Visit ACFAS e-Learning any time of day or night to refresh your knowledge with the latest additions to the online library:

• Podcast: 10 Years After Residency
  Hear the ‘behind the scenes’ of five physicians speaking candidly on what they’ve learned and their perceptions versus reality 10 years post residency.

• Scientific Session Video: Pediatric Flatfoot
  Demystify surgery on the pediatric flatfoot as you explore five physicians’ perspectives.

ACFAS members can earn continuing education contact hours at no cost with selected materials on the website. Visit often to browse the resources at your fingertips in video, podcast, and DVD at acfas.org/elearning.

Foot and Ankle Surgery

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Researchers sought to determined whether remission criteria underestimate foot involvement in rheumatoid arthritis (RA). Some 123 RA patients were assessed at baseline and six months after commencing a response driven combination DMARD protocol. Remission was assessed using criteria for the 28 joint Disease Activity Score [DAS28(ESR)], Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI) as well as the Boolean based 1981 ACR and the proposed 2011 ACR/EULAR criteria. At six months, the 1981 ACR and 2011 ACR/EULAR which utilize full joint counts (including feet) classified the least number of patients as being in remission (12-14 percent), with minimal evidence of foot synovitis in these patients. In contrast, foot synovitis was present in a substantial proportion of patients (>20 percent) meeting DAS28, SDAI, CDAI and the 2011 ACR/ EULAR criteria (clinical or trial) calculated using 28 joint counts. The new 2011 ACR/EULAR remission criteria (Boolean and SDAI≤3.3) behaved differently in terms of detecting residual foot synovitis.


Researchers hypothesized that correction of neglected congenital foot deformity using the Taylor spatial frame (TSF) would decrease morbidity, facilitate correction, and minimize treatment time in children from remote regions with extremely rigid deformed feet. They recounted their experience with the management of 11 such feet (Dimeglio type IV) in nine children with an average age of 9.2 years using the TSF. Six children had associated leg length discrepancy, which was corrected by concomitant tibial lengthening. All feet underwent soft tissue releases, whereas forefoot and/or hindfoot osteotomies were performed in seven feet. All children attained plantigrade, functional feet, and were fully ambulatory and capable of wearing normal footwear. Complications were minor consisting of pin tract infections, residual metatarsus varus in three, and wound dehiscence in one. There were no neurovascular events. This was attributed to the slower three-plane correction using the TSF technique as well as the elimination of the need for plaster immobilization thus allowing direct monitoring of the foot and limb.


Researchers assessed the long-term (20 years) outcome of closed reduction and immobilization in 19 patients with an isolated fracture of the posterior malleolus of the ankle treated at a single hospital between 1985 and 1990. There were excellent or good results in 14 patients (74 percent) according to the Olerud score, in 18 patients (95 percent) according to loaded dorsal and plantar range of movement assessment, in 16 patients (84 percent) as judged by the Cedell score, and for osteoarthritis 18 patients (95 percent) had an excellent or good score. There were no poor outcomes. There was no correlation between the size of the fracture gap and the proportion of the tibiotalar contact area when compared with the clinical results (gap size: rho values -0.16 to 0.04, p ≥ 0.51; tibiotalar contact area: rho values -0.20 to -0.03, p ≥ 0.4).


Researchers compared the participation in sports and recreational activities in patients who underwent either ankle arthrodesis (AAD) or total ankle replacement (TAR) for end-stage osteoarthritis of the ankle. A total of 41 patients (21 ankle arthrodesis /20 TAR) were examined at 34.5 (SD18.0) months after surgery. In the AAD group, 86 percent were active in sports preoperatively and in the TAR group this number was 76 percent. Postoperatively in both groups 76 percent were active in sports (AAD, p=0.08). The UCLA score was 7.0 (± 1.9) in the AAD group and 6.8 (± 1.8) in the TAR group (p=0.78). The AOFAS score reached 75.6 (± 14) in the AAD group and 75.6 (± 16) in the TAR group (p=0.97). The ankle activity score decrease was statistically significant for both groups (p=0.047).

Practice Management

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To maximize retirement income and ownership share of a practice, it is best that physicians develop a retirement and succession plan far in advance of when they would like to leave active practice. One option for doing so is for a physician to, if applicable, contact the company benefits agent or broker to consider getting benefits such as long-term disability, life insurance, and long-term care, and potentially, paying in full during high-earning years. Long-term care insurance can offer tax-deductible premiums while a physician is employed.

It is also wise for a physician to have a buy/sell agreement in place that would include stipulations on how the practice is valued; how it could be sold or transferred in the even of employment termination, disability, retirement or death; and how it should be dissolved if no agreement can be reached. Best practices in preparing for retirement and exiting active practice include diversifying source of incomes or benefits for after retirement. This can often be achieved through combining a 401K with non-qualified deferred compensation plans, after-tax plans, and investment in multiple asset classes to help the asset portfolio grow to compensate for future inflation. Options to consider in diversifying a portfolio include managed futures, private equity funds, and variable annuities.


Manhattan Research has found that there has been a rise in data breaches coinciding with the rise in physicians' use of smartphones and other mobile devices, though the reports did not indicate how many breaches were caused by these devices. These devices have two potential security risks, the first being that data can remain on a device and the second that the device can be used to access the electronic medical records of healthcare organizations. These risks are made more significant because the small size of devices makes them easier to lose, increasing the chances that this information will be accessed by a non-authorized individual.

To help prevent data breeches through smart phones it is important for physicians to participate in ensuring the security of the mobile devices they use to access data. Encryption software is available for mobile devices and prevents data from being read without an encryption key. Updated antivirus software and the use of password protection for device and data access are two protection methods that can also be implemented by a physician. Various medical societies offer resources that aide in developing the best practices for mobile device security, and some providers are finding that quarterly training meetings can help raise physician awareness of the problem and the ways to prevent data breeches.

Health Policy and Reimbursement

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President Barack Obama has signed a payroll tax-cut bill that averts a 27.4 percent cut in Medicare physician reimbursement after the House of Representatives approved the Temporary Payroll Tax Cut Continuation Act of 2011 by unanimous consent. The law prevents the cut in Medicare physician reimbursement by freezing federal payments to physicians at their current rates for two months. Peter Carmel, president of the American Medical Association, urged Congress to use the temporary extension period to enact a permanent fix to end the “sorry cycle of scheduled cuts and short-term patches.”


The Department of Health & Human Services has announced that 32 healthcare systems have been selected to participate as Pioneer Accountable Care Organizations (ACOs). The initiative will encourage primary care doctors, specialists, hospitals, and other caregivers to provide better, more coordinated care for people with Medicare and could save up to $1.1 billion over five years. The Pioneer ACO is an accelerated version of the original shared savings ACO program. It was developed after organizations experienced with coordinating patient care and managing risk complained that the ACO program was too stringent in its design.

Medicine, Drugs and Devices

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Functional magnetic resonance imaging of doctors' brains during their decision-making could help physicians learn to avoid diagnostic and treatment mistakes, according to a study published Nov. 23 in the journal PLoS One. Scans show that doctors who pay as much attention when making the wrong decisions as when they make the right one are more likely to deliver better care, said the researchers. They asked 35 nonsurgical physician specialists to try to determine when two fictional drugs would be effective at preventing a heart attack in patients with different ages, sexes, and histories, such as smoking or diabetes. The doctors' brains were scanned using MRI machines while answering. The scans shows that high-performing physicians who selected the right drug more than 75 percent of the time paid just as much attention when they erred as when they chose correctly. However, physicians with poor performance paid more attention while making the correct decision, with the nucleus accumbens -- the reward section of the brain -- lighting up on the scans more when they picked the right drug and just before making a correct choice.


For a November study for the Archives of Surgery, researchers analyzed data from 144 surgeons and 636 nonsurgeon physicians related to the completion of a substance abuse program within five years. Researchers had hypothesized that surgeons would have a higher success rate in these programs, but it turns out that the rate of success was similar between the two groups, as were the rates of relapse and reports to medical licensing board for not meeting monitoring agreements. Surgeons were, however, less likely to return to practice after a program, but researchers note that further study is needed to understand the reasoning behind this, though they did speculate that it was related to the difficulties for regaining credentials. The study found that surgeons were more likely to abuse alcohol than their counterparts, whereas nonsurgeons were more likely to abuse opioids.