Monday Weekly Update

Is twice-daily low-dose aspirin noninferior to a low-molecular-weight heparin for thromboprophylaxis after an extremity, acetabular, or pelvic fracture? Aspirin is noninferior to enoxaparin for thromboprophylaxis following inpatient treatment of a fracture. It is, of course, much cheaper, more convenient, and preferred by patients. The challenge will be convincing orthopedic surgeons that, in this case, "less is more." Major Extremity Trauma Research Consortium (METRC); O'Toole RV, Stein DM, et al. Aspirin or low-molecular-weight heparin for thromboprophylaxis after a fracture. N Engl J Med 2023;388(3):203-213.

How long do ankle arthroplasties last? Using national registry data linked to the national healthcare database, 90% of ankle arthroplasties last 5 years. 2b Jennison T, Ukoumunne O, Lamb S, Sharpe I, Goldberg AJ. How long do ankle arthroplasties last? Bone Joint J 2023;105-B(3):301-306.

In adults with prediabetes, can vitamin D supplementation decrease their likelihood of developing type 2 diabetes over several years? Vitamin D supplementation, over a median of 3 years, slightly reduces the diagnoses of diabetes in older people at risk of developing type 2 diabetes (NNT = 18 - 115). The benefit is greater in patients who achieve higher serum levels of vitamin D. Myhrvold SB, Brouwer EF, Andresen TKM, et al. Nonoperative or surgical treatment of acute Achilles’ tendon rupture. N Engl Med J 2022;386(15):1409-1420.

Is open repair or minimally invasive surgery better than nonoperative management for adults with acute Achilles tendon rupture? There is no clear benefit to surgery over nonoperative management for adults with acute Achilles tendon rupture. Symptomatic improvement is the same, and surgery trades more nerve injuries for a lower risk of re-rupture. Myhrvold SB, Brouwer EF, Andresen TKM, et al. Nonoperative or surgical treatment of acute Achilles’ tendon rupture. N Engl Med J 2022;386(15):1409-1420.

Are platelet-rich plasma injections, either single or multiple, more effective than saline injections in adults with early symptomatic degenerative joint disease of the knee? This is yet another study — this one of higher quality than the others — that finds PRP injections, singly or serially, to be no better than saline injections in improving outcomes in adults with mild radiographically confirmed degenerative joint disease of the knee. Lewis E, Merghani K, Robertson I, et al. The effectiveness of leucocyte-poor platelet-rich plasma injections on symptomatic early osteoarthritis of the knee: the PEAK randomized controlled trial. Bone Joint [...]

Is the combination of physical therapy and an ultrasonography-guided corticosteroid injection safe and beneficial for the treatment of Achilles tendinopathy? This study found that the addition of an ultrasonography-guided corticosteroid injection to standard physical therapy for the treatment of Achilles tendinopathy resulted in a significant improvement in the composite outcome of pain relief, increased function, and activity at 6 months compared with a placebo injection. However, pain during physical activity was not significantly improved with the steroid injection compared with the placebo at any time. Johannsen F, Olesen JL, Ohlenschlager TF, et al. Effect of ultrasonography-guided corticosteroid [...]

How do ibuprofen, ketorolac, and diclofenac compare for the treatment of acute, nonradicular low back pain in adults? This study found no differences among ibuprofen, ketorolac, and diclofenac in the primary outcome of overall clinical improvement at 5 days in adults presenting to the emergency department with acute, nonradicular low back pain. Some of the secondary outcomes favored ketorolac, however, leaving open the possibility that ketorolac is superior to ibuprofen and/or diclofenac. As the saying goes, "Absence of proof is not proof of absence." Irizarry E, Restivo A, Salama M, et al. A randomized controlled trial of [...]

Is there an association between gastric cancer and the use of proton pump inhibitors? This is the strongest evidence to date that there is a small but clinically significant increase in the risk of gastric cancer for patients taking a PPI (number needed to treat to harm = 1191 over 10 years). Physicians initiating anti-acid therapy for patients should begin with an H2RA, and if prescribing a PPI, should use the lowest dose and duration possible. Another recent study in the same journal using data from a Korean registry produced similar findings (Gut 2021;70:2066-2075 doi:10.1136/gutjnl-2020-323845). Abrahami D, McDonald EG, [...]

Is leukocyte-rich plasma less effective than leukocyte-poor plasma when injected into the knees of adults with osteoarthritis? In this study limited by the absence of a placebo wing, leukocyte-rich and leukocyte-poor PRP injections were comparably effective in relieving pain in adults with mild to moderate knee osteoarthritis. Since it is unclear whether this treatment is any better than placebo, the American College of Rheumatology strongly recommends against using PRP injections. Di Martino A, Boffa A, Andriolo L, et al. Leukocyte-rich versus leukocyte-poor platelet-rich plasma for the treatment of knee osteoarthritis: a double-blind randomized trial. Am J Sports [...]

Is an intramuscular glucocorticoid injection noninferior to an intra-articular glucocorticoid injection in reducing knee pain in adults with knee osteoarthritis? This study found that IA glucocorticoid injection may work better for reducing pain from knee OA at 1 month, but there was no significant difference in pain resolution between IA injection and IM injection at 2 months or 6 months. Wang Q, Mol MF, Bos PK, et al. Effect of intramuscular vs intra-articular glucocorticoid injection on pain among adults with knee osteoarthritis. The KIS randomized clinical trial. JAMA Network Open 2022;5(4):e224852 [...]