Musculoskeletal Injuries and Depression in Athletes: The Correlation and Prevention It has been documented that athletic musculoskeletal injury can cause psychological consequences such as depression. Studies have shown athletes who experience injury report significantly greater rates of depression than noninjured athletes. Understanding athletes' psychosocial responses to injury will assist medical providers in assessing the athlete's holistic needs to ensure proper recovery and prevent further harm such as depression. The purposes of this article are to (1) assess the current literature on the correlation between depressive symptoms in adolescent and collegiate athletes with musculoskeletal injuries and (2) identify ways for providers to prevent injury and the correlated depression.

Addressing Obesity in Orthopedics Obesity predisposes to osteoarthritis, metabolic and cardiovascular disease. Pharmacological and surgical treatments for weight loss carry significant cost and risk. Treatment strategies based on the conventional model of obesity have not been effective as demonstrated by increasing rates of obesity. Intermittent energy restriction and a low carbohydrate diet have consistently demonstrated weight loss and improved metabolic and cardiovascular markers. Obesity comorbidities interfere with clearance for surgery and increase perioperative risk. There is an increasing trend of insurance denial without documented weight loss in obese patients. In order to effect significant change, there must be integration of weight management into all levels of care.

An Assessment of Long-Term Opioid Use Following Tibial Plateau Fracture Repair: An At-Risk Patient Population Based on Race/Ethnicity Objectives: Is there a difference in percentage of opioid use at 3 and 6 months among different races/ethnicities following tibial plateau fracture repair after controlling for potential confounders? Methods: Retrospective secondary data analysis of 18- to 65-year-old patients with operative tibial plateau fractures between 2006 and 2015 at a level-I trauma center. Exclusion criteria included preinjury opioid use or history of opioid dependence, American Society of Anesthesiologists class ≥3, renal or lower extremity neurological impairment, and/or rheumatoid arthritis. Three hundred fifteen operative tibial plateau fractures were identified and, following application of our exclusion criteria, final sample size was 211. Intervention included single-shot peripheral nerve block (PNB) vs. no PNB. Main outcome measurements were opioid use at 3 or 6 months compared among all race/ethnicities. Results: Black patients were less likely to be on prescription opioids than whites at both 3 months (p = 0.015, odds ratio [OR] = 0.396 [0.188 to 0.835]) and 6 months (p = 0.027, OR = 0.239 [0.067 to 0.852]). Hispanic patients did not differ statistically from white patients in having an opioid prescription at 3 or 6 months. Smokers were independently more likely to be on prescription opioids than nonsmokers at 6 months (p = 0.013, OR = 2.874 [1.245 to 6.635]). Conclusions: Disparities exist with regard to opioid use among white and black patients following lower extremity surgery, regardless of PNB status. White patients are at risk for long-term opioid use following tibial plateau fracture repair and black patients may not be receiving adequate pain control postoperatively. Smoking was found to be associated with long-term opioid use.

Orthopaedic Tips: A Comprehensive Review of Midshaft Clavicle Fractures Clavicle fracture is a common orthopaedic injury, which represents up to 5% of all fractures. The middle third of the clavicle is the most commonly fractured region, primarily because of its unique osseous anatomy and surrounding soft tissue attachments. Management of midshaft clavicle fractures has shifted substantially over the past 20 years, as the operative indications have become increasingly better defined with newer randomized controlled trials. This article presents a comprehensive review of the epidemiology, relevant anatomy, clinical assessment, and management of midshaft clavicle fractures.

Surgical Treatment of Slipped Capital Femoral Epiphysis: Modified Dunn Procedure Versus in Situ Fixation No abstract available

Osteogenesis Imperfecta: Differentiating Clinical Presentation From Non-Accidental Injury This paper focuses on differentiating the pathologic fractures of osteogenesis imperfecta (OI), a bone fragility disorder that manifests in childhood, from the fractures typically sustained due to child abuse and neglect. Both phenomena can present similarly, with poorly explained, atypical fractures for developmental age. However, OI involves additional, characteristic physical findings outside the skeletal system that can be clues to the diagnosis. By exploring the radiographic evidence in conjunction with clinical signs and symptoms of OI, this review of the literature details the workup necessary to diagnose and distinguish this condition from others without relying on genetic testing.

Osteoporosis Prevention of Chinese Immigrants in America No abstract available

Certification Review for the Ortho PA No abstract available

Arthroplasty Roundtable: Patellofemoral Arthroplasty The purpose of the JOPA Roundtable discussion is to give orthopaedic PAs an insight on how each participating editorial board members treat certain clinical scenarios in their current practice. For this Arthroplasty Roundtable, editorial board members with expertise in joint reconstruction will discuss patellofemoral arthroplasty. Participants will share their knowledge and experience on the topic. The roundtable discussion will start with a brief case presentation.

General Orthopaedic Roundtable: Workup of Recurrent Knee Effusions in a 57-Year-Old Male with Mild Knee Arthritis The purpose of the JOPA Roundtable discussion is to give orthopaedic PAs insight on how each participating editorial board member treats certain orthopaedic conditions in his or her current practice. In this General Orthopaedic Roundtable, editorial board members with a general orthopaedic practice discuss the management of recurrent knee effusions in a 57-year-old male with mild knee arthritis. Participants share their knowledge and experience on the topic.