News From ACFAS

---

If you attended ACFAS 2022 in person, you can now claim your Continuing Education Contact Hours (CME). To claim your CME, log in to acfas.org and choose CME Information under Latest News and Information in the left sidebar of the home page. You will then be directed to the ACFAS Education Documentation and CME Tracking Center where you can print your certificate and list of sessions attended.

Please note, if you registered for ACFAS 2022 through the On-Demand Package, you will be prompted to complete a short quiz for each session you view. Upon completion, you will receive your certificate through the learning management system.

If you have questions regarding your online CME certificate/transcript, contact Sheila Alegria at sheila.alegria@acfas.org or Maggie Hjelm at hjelm@acfas.org in the ACFAS Education Department. Common Pathologies: How to Resolve and Maximize Function by Restoring Structure is coming to Berkeley Heights, NJ April 29-30!

This course combines case presentations, lightning lectures, hands-on labs and opportunities to share knowledge for you to gain insight into the depth and breadth of your current foot and ankle knowledge. You’ll walk away with a better understanding of contributing factors associated with foot and ankle surgery complications and be able to apply new skills to help you maximize function and restore structure.

Don’t miss us in Berkeley Heights! Visit acfas.org/ComingToYou to see the course brochure, where we’re headed next, and to register today.

Foot and Ankle Surgery

---

A study unveiled the largest cohort of US ankle fracture surgery patients to date with a comparison between lab-verified COVID-19-positive and COVID-19-negative cases, using data from the National COVID Cohort Collaborative. A total of 8.4 million patient records was analyzed, identifying 4,735 adults with ankle fracture surgery. The COVID-19-positive group of 158 patients had significantly longer times to surgery and longer hospitalization than the COVID-19-negative group. The rate of 30-day mortality was also higher in the COVID-19-positive group. The average delay was about one day and increased length of hospitalization was about four days. Few perioperative events were seen in either group. The risks associated with COVID-19 were generally quantifiable but insubstantial.


Multiple studies have found inconsistencies in the Lauge-Hansen ankle fracture classification system's ability to anticipate fracture patterns based on the mechanism of injury. A retrospective cohort study sought to ascertain an association between the posterior malleolar fracture pattern with fracture types described by Lauge-Hansen. The authors reviewed patients with trimalleolar ankle fractures as diagnosed using computed tomography (CT) scans. Every individual posterior malleolar fracture was assessed on CT imaging and described using both the Haraguchi and Bartonicek-Rammelt classification systems. Of the 153 patients identified with trimalleolar ankle fractures, 70 percent were female, average age was 51 years and the mean body mass index was 30 kilograms/square meter. No significant association between the Lauge-Hansen injury mechanism and either the Bartonicek-Rammelt or the Haraguchi trimalleolar ankle fracture classification systems was identified.


Research was conducted to build an articulated statistical shape model of the normal distal tibiofibular joint with inclusion of ligamentous morphometry; to explore the effect of weightbearing on the distal tibiofibular joint alignment; and to identify differences in predicted syndesmotic ligament length of patients with syndesmotic lesions with respect to normative data. Training data included 75 non-weightbearing computed tomography (CT) scans from asymptomatic controls, 13 weightbearing CT scans from patients with syndesmotic ankle injury and 13 from their weightbearing healthy contralateral side. The presented skeletal shape model described the training data with an accuracy of 0.23 ± 0.028 millimeters Mean prediction accuracy of ligament insertions was 0.53 ± 0.12 millimeters. Outcomes also revealed increased tibiofibular diastasis in healthy ankles after weight-bearing and a statistically significant difference in anterior syndesmotic ligament length between ankles with syndesmotic lesions and healthy controls. Significant correlation between presence of syndesmotic injury and the positional alignment between the distal tibia and fibula was noted as well.

Practice Management

---

Burnout and depression, stress in and out of the office, and the ravages of the COVID-19 pandemic have contributed to many physicians feeling despair and hopelessness, which can contribute to having suicidal thoughts. Medscape surveyed more than 13,000 physicians who were frank in sharing their experiences about what led them to consider suicide, how they handled those thoughts, how they try to stay mentally healthy, and how they help colleagues who are going through a dark time.


There are five steps that health information technology (IT) leaders can undertake to set up a strong telehealth practice infrastructure, starting with widening their patient base. Virtual care services enable doctors to see patients regardless of their location, which can help patients based in typically underserved rural areas. The second step involves strategic telehealth investments that may require a dramatic revamp of physicians' workflows and systems. Constructing a dedicated Remote Patient Monitoring program that upholds the clinical care process and patient experience is the third step, and it should be the IT team's responsibility to provide remote patients with the tools to help them easily transmit data. In the fourth step, provider IT leaders should outfit clinicians with data visualization tools that put patient information in context and emphasize the most relevant data. The fifth and final step is to remove hindrances to care via a robust digital front door.


With staff shortages still in force, more practices are turning to virtual solutions like remote-operated virtual assistants. Among the arduous tasks they can ably perform is scheduling appointments by being readily available to field calls, schedule patients, retrieve messages, return calls and keep health records updated within a practice's electronic medical record platform. Virtual assistants can also direct incoming fax requests for medical records, lab orders, diagnostic reports, prescription refills and more. Other tasks they can perform include verification of insurance eligibility and prior authorization, as well as coordinating referrals. Some practices even delegate tasks on personal "to do" lists to virtual assistants, like booking airplane tickets, placing orders and making appointments.

Health Policy and Reimbursement

---

Congress reached a deal on a $1.5 trillion package to fund the government, which includes an extension of Medicare coverage of telehealth services for 151 days after the end of the public health emergency, allowing beneficiaries to continue accessing care from their homes, at least temporarily. The measure will also allow hospitals that fell out of the 340B Drug Discount Program during the pandemic due to a change in patient mix and volume to stay in the program through the end of the year. However, the package does not include a delay of Medicare payment cuts, which are set to partially resume in April.


Despite shouldering many of the responsibilities of the COVID-19 pandemic, the average wage for healthcare workers in the United States is behind those in other industries, research out of the University of Indiana shows. Compared to 2019, healthcare wages increased by 5 percent, versus the national average of 6.7 percent in 2020. Last year, the increase was 1.5 percent, versus 6.9 percent nationally. Results of the study also found that healthcare employment declined in mid-2020 to 21.1 million jobs.

Medicine, Drugs and Devices

---

Hospitals around the country are experiencing shortages of widely used saline products because of supply chain bottlenecks and rising demand during the Omicron surge. Pharmacists and saline manufacturers anticipate the shortages of saline bags and vials will decrease as the Omicron surge subsides. Lauren Russ, a spokesperson for saline bag supplier Baxter, said the company is doing everything possible to augment production and expedite shipping, while a spokesperson for saline manufacturer Fresenius SE said its facilities are operating at full capacity. Pfizer, a leading supplier of small saline vials, said it used many of its containers for COVID-19 vaccines over the past year, which contributed to the shortages. Pfizer has increased vial production and hopes to see supplies increase by this spring. Children's Mercy Kansas City in Missouri currently has roughly 70 percent of the saline it typically needs, said Bethany Baker, PharmD, the hospital's director of pharmacy clinical services. The shortage is complicating care for healthcare workers because they need to use larger I.V. vials and bags for pediatric patients because the smaller sizes usually run out first. Erin Fox, PharmD, senior pharmacy director at Salt Lake City-based University of Utah Health, said the shortages create "a very frustrating situation for staff" who "are already overworked and doing 100 other things."


Virtual reality (VR) increasingly is being used in the healthcare sector, from telemedicine to training. Researchers at the Georgia Institute of Technology (Georgia Tech) have developed the Motus system, which aims to make rehabilitation exercises fun, immersive and challenging through VR games. Georgia Tech's Nick Housley said, "The headset tells you really critical things, like how much force someone's muscle can put out. It can also tailor an intervention—for example, if someone has difficulty picking up a cup of coffee, you can guide them in real time." Meanwhile, neurosurgeons at the Cleveland Clinic use VR to practice surgery, and Ohio State University's College of Medicine is using VR to train physicians and first responders to assist in emergencies. However, there are some challenges associated with VR use in healthcare, with Mount Sinai Hospital's Daniel Katz citing the lack of an "app store" for medical education.