James Ficke - Academia.edu (original) (raw)

Papers by James Ficke

PubMed, 2016

The Military Orthopaedic Trauma Registry (MOTR) orginally began as part of the Department of Defe... more The Military Orthopaedic Trauma Registry (MOTR) orginally began as part of the Department of Defense Trauma Registry (DoDTR) and became a live registry in 2013. As a quality improvement process, this study examined MOTR data for 20 female amputees compared with DoDTR data. The DoDTR provided diagnosis and procedure codes as a list but no details. The MOTR provided additional data, including specific limb, fracture classifications, and associated injuries per limb. The MOTR allowed for construction of a treatment time line for each limb, including number and timing of debridements, antibiotics, and implant types. Orthopaedic-specific complications were also coded more frequently in the MOTR and clearly identified with a specific injury and treatment. During initial quality control checks, the MOTR provides a greater volume and granularity of detail for orthopaedic-specific injury and treatment information, indicating that the MOTR is on track to provide a valuable repository for data-driven orthopaedic management of combat injury.

JB & JS open access, 2020

PubMed, 2012

The severe Dismounted Complex Blast Injury (DCBI) is characterized by high-energy injuries to the... more The severe Dismounted Complex Blast Injury (DCBI) is characterized by high-energy injuries to the bilateral lower extremities (usually proximal transfemoral amputations) and/or upper extremity (usually involving the non-dominant side), in addition to open pelvic injuries, genitourinary, and abdominal trauma. Initial resuscitation and multidisciplinary surgical management appear to be the keys to survival. Definitive treatment follows general principals of open wound management and includes decontamination through aggressive and frequent debridement, hemorrhage control, viable tissue preservation, and appropriate timing of wound closure. These devastating injuries are associated with paradoxically favorable survival rates, but associated injuries and higher amputation levels lead to more difficult reconstructive challenges.

Foot and Ankle Surgery, Aug 1, 2019

Orthopedics, 2023

The purpose of this study was to assess the association between social media presence (Twitter an... more The purpose of this study was to assess the association between social media presence (Twitter and Instagram), diversity in orthopedic surgery residency programs, and the number of applications received by a program. Data from Twitter and Instagram for 179 orthopedic residency programs accredited by the Accreditation Council for Graduate Medical Education were collected, including the presence of a social media account, date of first post, number of posts, and number of followers. Residency program data were collected from the Association of American Medical Colleges Residency Explorer Tool and included percentage of Whiteresidents, percentage of male residents, residency ranking, and number of applications submitted during the 2019 application cycle. Bivariate and multivariable analyses were performed with adjustment for program ranking. Of 179 residency programs, 34.6% (n=62) had Twitter, and 16.7% (n=30) had Instagram. Overall, 39.7% (n=71) had a social media presence, defined as having at least one of the two forms of social media. Programs with social media presences had higher average rankings (48.1 vs 99.6 rank, P <.001). After adjusting for program ranking, social media presence was associated with increased applications during the 2019 application cycle (odds ratio [OR]=2.76, P =.010). Social media presence was associated with increased odds of gender diversity (OR=3.07, P =.047) and racial diversity (OR=2.21, P =.041). Individually, Twitter presence was associated with increased odds of gender (OR=4.81, P =.018) and racial diversity (OR=4.00, P =.021), but Instagram was not ( P >.05). Social media presence is associated with more residency program applications and increased resident diversity. Social media can be used to highlight inclusivity measures and related opportunities. [ Orthopedics . 2023;46(1):47–53.]

Journal of the American Academy of Orthopaedic Surgeons, Mar 1, 2022

Background: The goals of this study were to compare the utilization and costs of ambulatory surge... more Background: The goals of this study were to compare the utilization and costs of ambulatory surgery centers (ASCs) versus hospital outpatient department (HOPD) for commonly performed outpatient orthopaedic surgical procedures. Methods: Commercially insured patients undergoing elective, outpatient orthopaedic surgery were queried using an administrative claims database. We queried the following surgeries: carpal tunnel release, lumbar microdiskectomy, anterior cruciate ligament reconstruction, knee arthroscopy, arthroscopic rotator cuff repair, and bunion repair. Total costs were defined as the sum of all payments for a surgical episode. Professional fees were defined as payments to the primary orthopaedic surgeon and technical fees as all other payments. Comparisons between ASC and HOPD reimbursements were conducted using bivariate statistics and generalized linear models controlling for patient age, sex, and Elixhauser comorbidity index. Results: Among 990,980 cases of outpatient orthopaedic surgery done from 2013 to 2018, the utilization rate of ASCs increased from 31% to 34% across all procedures assessed: compound annual growth rate of 3.3% for lumbar microdiscectomy, 1.8% for knee arthroscopy, 1.4% for anterior cruciate ligament, 1.4% for carpal tunnel release, 1.2% for arthroscopic rotator cuff repair, and 0.5% for bunion repair (P < 0.001 for all). The average total costs were 26% lower at ASCs than HOPDs (P < 0.001 for each procedure). The average technical fees were 33% lower at ASCs than HOPDs (P < 0.001 for each procedure). Both total costs and technical fees were less for ASCs than HOPDs after controlling for patient age, sex, and Elixhauser comorbidity index (P < 0.001 for each procedure). Over the study period, the mean total costs at HOPDs increased by 2.5% yearly, whereas the mean total costs at ASCs decreased by 0.1% yearly. The average surgeon professional fees declined in both care settings over time. Conclusion: From 2013 to 2018, there was an increase in ASC utilization for common outpatient orthopaedic surgeries. ASCs were overall less costly than HOPDs for outpatient orthopaedic surgeries. Level of Evidence: IV

Trauma, Jul 10, 2023

Introduction Racial and ethnic disparities remain a major problem in orthopedic surgery, driving ... more Introduction Racial and ethnic disparities remain a major problem in orthopedic surgery, driving inequitable resource distribution, disparate clinical outcomes, and increased healthcare costs. The objective of this study was to investigate potential racial/ethnic disparities in the incidence and injury patterns of orthopedic lower extremity trauma (LET) in the United States over the past 10 years, as well as differences in final disposition outcomes. Materials and Methods The National Electronic Injury Surveillance System database was queried for all orthopedic LET presenting to U.S. emergency departments from 2010 to 2020. Incidence rate ratios (IRR) were used to compare incidence rates between racial/ethnic groups. Multivariate logistic regression was performed to compare disposition outcomes. Results Black/African Americans (Black/AAs) consistently experienced the highest incidence of LET over the 10-year period analyzed (709.108 per 100,000 person-years), followed by Whites (547.159 per 100,000 person-years). Furthermore, Black/AAs had the highest incidence of polytrauma (114.19 per 100,000 person-years), over 1.7x greater than Whites (IRR: 1.73 [95% confidence interval (CI): 1.72–1.75]). Black/AAs had over 2-fold higher odds of death after LET compared to Whites (adjusted odds ratio [aOR] 2.15 [95% CI: 1.78–2.59]). By 2019 to 2020, the incidence of deaths among Black/AAs reached more than triple that of Whites (IRR: 3.50 [95% CI: 2.74–4.46]). Black/AAs were also the most likely to be discharged against medical advice (AMA) (aOR: 1.94 [95% CI: 1.92–1.96]), and the least likely to be admitted as inpatients (aOR: 0.683 [95% CI: 0.679–0.688]). Conclusions Despite Black/AAs experiencing a disproportionately higher incidence of LET and over 2-fold greater odds of death compared to Whites, they were also the most likely to be discharged AMA and least likely to be admitted as inpatients. Understanding the effects of conscious/unconscious biases and the importance of effective communication and patient education may help physicians ensure that injuries in this patient population are not prematurely discharged, potentially improving clinical outcomes, and reducing mortality. Level of Evidence III.

Springer eBooks, 2015

Osteoarthritis is a prevalent condition affecting thousands of Americans. The age-associated inci... more Osteoarthritis is a prevalent condition affecting thousands of Americans. The age-associated incidence of arthritis is higher for those serving in the US military compared to the civilian population. Arthritis, both degenerative and post-traumatic, has long been recognized as a primary source of disability for individuals medically discharged from active duty military service. For past and current war veterans, arthritis is among the top causes of medical disability. Given the characteristics and frequency of extremity injuries sustained in recent military conflicts, a majority of arthritis-related disabilities following combat injury are post-traumatic in nature. Because of rigorous physical demands of military training and occupations even outside of combat, the rate of sports-type injuries is higher in the military versus the civilian population. Both combat and noncombat physical demands contribute to the post-traumatic arthritis risk for active duty military personnel and affect the ability of wounded service members to continue active duty service.

Journal of Orthopaedic Trauma, Apr 1, 2017

Journal of Surgical Research, Dec 1, 2021

Background The COVID-19 pandemic led to large-scale cancellation and deferral of elective surgeri... more Background The COVID-19 pandemic led to large-scale cancellation and deferral of elective surgeries. We quantified volume declines, and subsequent recoveries, across all hospitals in Maryland. Materials and Methods Data on elective inpatient surgical volumes were assembled from the Maryland Health Service Cost Review Commission for years 2019-2020. The data covered all hospitals in the state. We compared the volume of elective inpatient surgeries in the second (Q2) and fourth quarters (Q4) of 2020 to those same quarters in 2019. Analysis was stratified by patient, hospital, and service characteristics. Results Surgical volumes were 55.8% lower in 2020 Q2 than in 2019 Q2. Differences were largest for orthopedic surgeries (74.3% decline), those on Medicare (61.4%), and in urban hospitals (57.3%). By 2020 Q4, volumes for most service lines were within 15% of volumes in 2019 Q4. Orthopedic surgery remained most affected (44.5% below levels in 2019 Q4) and Plastic Surgery (21.9% lower). Conclusions COVID-19 led to large volume declines across hospitals in Maryland followed by a partial recovery. We observed large variability, particularly across service lines. These results can help contextualize case-specific experiences and inform research studying potential health effects of these delays and cancellations.

Journal of the American Academy of Orthopaedic Surgeons, 2012

Journal of Surgical Education, Sep 1, 2020

The journal of trauma and acute care surgery, Dec 1, 2012

Journal of Trauma-injury Infection and Critical Care, Aug 1, 2011

The journal of trauma and acute care surgery, Aug 16, 2022

medRxiv (Cold Spring Harbor Laboratory), Jul 10, 2022

Foot & Ankle Orthopaedics, Apr 1, 2022

Background:Citation analysis is a useful way of evaluating the impact, importance, and merit of a... more Background:Citation analysis is a useful way of evaluating the impact, importance, and merit of articles within a medical specialty. Our study identified and analyzed the most-cited articles on ankle arthroplasty implants to evaluate their importance in the field of ankle arthroplasty research.Methods:Using the keywords “ankle arthroplasty” and “ankle replacement” and the search period 1970-2021, we found 3728 articles on ankle arthroplasty implants in the Scopus, Web of Science, and MEDLINE/PubMed databases. We included original articles, reviews, clinical trials, and case reports in the study. We retrieved the 50 most-cited articles published during the time frame and then screened them for studies of specific ankle arthroplasty implants and their postoperative outcomes. We also recorded and analyzed the articles’ subjects, authorship, journals, countries of origin, and years of publication.Results:The 50 most-cited articles were published between 1983 and 2014, with the majority (33) published between 2000 and 2010. They generated 9012 citations in the literature. The most-cited study accounted for 497 citations; the mean number of citations per article was 180.24 ± 76.24. Twenty-three (46%) of the articles addressed postoperative outcomes following a specific type of arthroplasty implant. Arthroplasty implant studies accounted for 4726 citations, or 52.4% of the citations of the 50 articles. The most frequently studied arthroplasty implant was STAR (15), followed by Agility (7), Buechel Pappas (5), and Salto (4). STAR accounted for 3311 citations, or 37% of the total citations of the 50 articles.Conclusion:Ankle arthroplasty research has made great progress in the past 2 decades, particularly in the area of postoperative outcomes of specific ankle implants, but continued research and publication on additional arthroplasty implants should become a priority.Level of Evidence:Level V, Review Article.

Journal of Trauma-injury Infection and Critical Care, Aug 1, 2011

Journal of Orthopaedic Trauma, Oct 1, 2016

Journal of Foot & Ankle Surgery, Aug 1, 2023

PubMed, 2016

The Military Orthopaedic Trauma Registry (MOTR) orginally began as part of the Department of Defe... more The Military Orthopaedic Trauma Registry (MOTR) orginally began as part of the Department of Defense Trauma Registry (DoDTR) and became a live registry in 2013. As a quality improvement process, this study examined MOTR data for 20 female amputees compared with DoDTR data. The DoDTR provided diagnosis and procedure codes as a list but no details. The MOTR provided additional data, including specific limb, fracture classifications, and associated injuries per limb. The MOTR allowed for construction of a treatment time line for each limb, including number and timing of debridements, antibiotics, and implant types. Orthopaedic-specific complications were also coded more frequently in the MOTR and clearly identified with a specific injury and treatment. During initial quality control checks, the MOTR provides a greater volume and granularity of detail for orthopaedic-specific injury and treatment information, indicating that the MOTR is on track to provide a valuable repository for data-driven orthopaedic management of combat injury.

JB & JS open access, 2020

PubMed, 2012

The severe Dismounted Complex Blast Injury (DCBI) is characterized by high-energy injuries to the... more The severe Dismounted Complex Blast Injury (DCBI) is characterized by high-energy injuries to the bilateral lower extremities (usually proximal transfemoral amputations) and/or upper extremity (usually involving the non-dominant side), in addition to open pelvic injuries, genitourinary, and abdominal trauma. Initial resuscitation and multidisciplinary surgical management appear to be the keys to survival. Definitive treatment follows general principals of open wound management and includes decontamination through aggressive and frequent debridement, hemorrhage control, viable tissue preservation, and appropriate timing of wound closure. These devastating injuries are associated with paradoxically favorable survival rates, but associated injuries and higher amputation levels lead to more difficult reconstructive challenges.

Foot and Ankle Surgery, Aug 1, 2019

Orthopedics, 2023

The purpose of this study was to assess the association between social media presence (Twitter an... more The purpose of this study was to assess the association between social media presence (Twitter and Instagram), diversity in orthopedic surgery residency programs, and the number of applications received by a program. Data from Twitter and Instagram for 179 orthopedic residency programs accredited by the Accreditation Council for Graduate Medical Education were collected, including the presence of a social media account, date of first post, number of posts, and number of followers. Residency program data were collected from the Association of American Medical Colleges Residency Explorer Tool and included percentage of Whiteresidents, percentage of male residents, residency ranking, and number of applications submitted during the 2019 application cycle. Bivariate and multivariable analyses were performed with adjustment for program ranking. Of 179 residency programs, 34.6% (n=62) had Twitter, and 16.7% (n=30) had Instagram. Overall, 39.7% (n=71) had a social media presence, defined as having at least one of the two forms of social media. Programs with social media presences had higher average rankings (48.1 vs 99.6 rank, P <.001). After adjusting for program ranking, social media presence was associated with increased applications during the 2019 application cycle (odds ratio [OR]=2.76, P =.010). Social media presence was associated with increased odds of gender diversity (OR=3.07, P =.047) and racial diversity (OR=2.21, P =.041). Individually, Twitter presence was associated with increased odds of gender (OR=4.81, P =.018) and racial diversity (OR=4.00, P =.021), but Instagram was not ( P >.05). Social media presence is associated with more residency program applications and increased resident diversity. Social media can be used to highlight inclusivity measures and related opportunities. [ Orthopedics . 2023;46(1):47–53.]

Journal of the American Academy of Orthopaedic Surgeons, Mar 1, 2022

Background: The goals of this study were to compare the utilization and costs of ambulatory surge... more Background: The goals of this study were to compare the utilization and costs of ambulatory surgery centers (ASCs) versus hospital outpatient department (HOPD) for commonly performed outpatient orthopaedic surgical procedures. Methods: Commercially insured patients undergoing elective, outpatient orthopaedic surgery were queried using an administrative claims database. We queried the following surgeries: carpal tunnel release, lumbar microdiskectomy, anterior cruciate ligament reconstruction, knee arthroscopy, arthroscopic rotator cuff repair, and bunion repair. Total costs were defined as the sum of all payments for a surgical episode. Professional fees were defined as payments to the primary orthopaedic surgeon and technical fees as all other payments. Comparisons between ASC and HOPD reimbursements were conducted using bivariate statistics and generalized linear models controlling for patient age, sex, and Elixhauser comorbidity index. Results: Among 990,980 cases of outpatient orthopaedic surgery done from 2013 to 2018, the utilization rate of ASCs increased from 31% to 34% across all procedures assessed: compound annual growth rate of 3.3% for lumbar microdiscectomy, 1.8% for knee arthroscopy, 1.4% for anterior cruciate ligament, 1.4% for carpal tunnel release, 1.2% for arthroscopic rotator cuff repair, and 0.5% for bunion repair (P < 0.001 for all). The average total costs were 26% lower at ASCs than HOPDs (P < 0.001 for each procedure). The average technical fees were 33% lower at ASCs than HOPDs (P < 0.001 for each procedure). Both total costs and technical fees were less for ASCs than HOPDs after controlling for patient age, sex, and Elixhauser comorbidity index (P < 0.001 for each procedure). Over the study period, the mean total costs at HOPDs increased by 2.5% yearly, whereas the mean total costs at ASCs decreased by 0.1% yearly. The average surgeon professional fees declined in both care settings over time. Conclusion: From 2013 to 2018, there was an increase in ASC utilization for common outpatient orthopaedic surgeries. ASCs were overall less costly than HOPDs for outpatient orthopaedic surgeries. Level of Evidence: IV

Trauma, Jul 10, 2023

Introduction Racial and ethnic disparities remain a major problem in orthopedic surgery, driving ... more Introduction Racial and ethnic disparities remain a major problem in orthopedic surgery, driving inequitable resource distribution, disparate clinical outcomes, and increased healthcare costs. The objective of this study was to investigate potential racial/ethnic disparities in the incidence and injury patterns of orthopedic lower extremity trauma (LET) in the United States over the past 10 years, as well as differences in final disposition outcomes. Materials and Methods The National Electronic Injury Surveillance System database was queried for all orthopedic LET presenting to U.S. emergency departments from 2010 to 2020. Incidence rate ratios (IRR) were used to compare incidence rates between racial/ethnic groups. Multivariate logistic regression was performed to compare disposition outcomes. Results Black/African Americans (Black/AAs) consistently experienced the highest incidence of LET over the 10-year period analyzed (709.108 per 100,000 person-years), followed by Whites (547.159 per 100,000 person-years). Furthermore, Black/AAs had the highest incidence of polytrauma (114.19 per 100,000 person-years), over 1.7x greater than Whites (IRR: 1.73 [95% confidence interval (CI): 1.72–1.75]). Black/AAs had over 2-fold higher odds of death after LET compared to Whites (adjusted odds ratio [aOR] 2.15 [95% CI: 1.78–2.59]). By 2019 to 2020, the incidence of deaths among Black/AAs reached more than triple that of Whites (IRR: 3.50 [95% CI: 2.74–4.46]). Black/AAs were also the most likely to be discharged against medical advice (AMA) (aOR: 1.94 [95% CI: 1.92–1.96]), and the least likely to be admitted as inpatients (aOR: 0.683 [95% CI: 0.679–0.688]). Conclusions Despite Black/AAs experiencing a disproportionately higher incidence of LET and over 2-fold greater odds of death compared to Whites, they were also the most likely to be discharged AMA and least likely to be admitted as inpatients. Understanding the effects of conscious/unconscious biases and the importance of effective communication and patient education may help physicians ensure that injuries in this patient population are not prematurely discharged, potentially improving clinical outcomes, and reducing mortality. Level of Evidence III.

Springer eBooks, 2015

Osteoarthritis is a prevalent condition affecting thousands of Americans. The age-associated inci... more Osteoarthritis is a prevalent condition affecting thousands of Americans. The age-associated incidence of arthritis is higher for those serving in the US military compared to the civilian population. Arthritis, both degenerative and post-traumatic, has long been recognized as a primary source of disability for individuals medically discharged from active duty military service. For past and current war veterans, arthritis is among the top causes of medical disability. Given the characteristics and frequency of extremity injuries sustained in recent military conflicts, a majority of arthritis-related disabilities following combat injury are post-traumatic in nature. Because of rigorous physical demands of military training and occupations even outside of combat, the rate of sports-type injuries is higher in the military versus the civilian population. Both combat and noncombat physical demands contribute to the post-traumatic arthritis risk for active duty military personnel and affect the ability of wounded service members to continue active duty service.

Journal of Orthopaedic Trauma, Apr 1, 2017

Journal of Surgical Research, Dec 1, 2021

Background The COVID-19 pandemic led to large-scale cancellation and deferral of elective surgeri... more Background The COVID-19 pandemic led to large-scale cancellation and deferral of elective surgeries. We quantified volume declines, and subsequent recoveries, across all hospitals in Maryland. Materials and Methods Data on elective inpatient surgical volumes were assembled from the Maryland Health Service Cost Review Commission for years 2019-2020. The data covered all hospitals in the state. We compared the volume of elective inpatient surgeries in the second (Q2) and fourth quarters (Q4) of 2020 to those same quarters in 2019. Analysis was stratified by patient, hospital, and service characteristics. Results Surgical volumes were 55.8% lower in 2020 Q2 than in 2019 Q2. Differences were largest for orthopedic surgeries (74.3% decline), those on Medicare (61.4%), and in urban hospitals (57.3%). By 2020 Q4, volumes for most service lines were within 15% of volumes in 2019 Q4. Orthopedic surgery remained most affected (44.5% below levels in 2019 Q4) and Plastic Surgery (21.9% lower). Conclusions COVID-19 led to large volume declines across hospitals in Maryland followed by a partial recovery. We observed large variability, particularly across service lines. These results can help contextualize case-specific experiences and inform research studying potential health effects of these delays and cancellations.

Journal of the American Academy of Orthopaedic Surgeons, 2012

Journal of Surgical Education, Sep 1, 2020

The journal of trauma and acute care surgery, Dec 1, 2012

Journal of Trauma-injury Infection and Critical Care, Aug 1, 2011

The journal of trauma and acute care surgery, Aug 16, 2022

medRxiv (Cold Spring Harbor Laboratory), Jul 10, 2022

Foot & Ankle Orthopaedics, Apr 1, 2022

Background:Citation analysis is a useful way of evaluating the impact, importance, and merit of a... more Background:Citation analysis is a useful way of evaluating the impact, importance, and merit of articles within a medical specialty. Our study identified and analyzed the most-cited articles on ankle arthroplasty implants to evaluate their importance in the field of ankle arthroplasty research.Methods:Using the keywords “ankle arthroplasty” and “ankle replacement” and the search period 1970-2021, we found 3728 articles on ankle arthroplasty implants in the Scopus, Web of Science, and MEDLINE/PubMed databases. We included original articles, reviews, clinical trials, and case reports in the study. We retrieved the 50 most-cited articles published during the time frame and then screened them for studies of specific ankle arthroplasty implants and their postoperative outcomes. We also recorded and analyzed the articles’ subjects, authorship, journals, countries of origin, and years of publication.Results:The 50 most-cited articles were published between 1983 and 2014, with the majority (33) published between 2000 and 2010. They generated 9012 citations in the literature. The most-cited study accounted for 497 citations; the mean number of citations per article was 180.24 ± 76.24. Twenty-three (46%) of the articles addressed postoperative outcomes following a specific type of arthroplasty implant. Arthroplasty implant studies accounted for 4726 citations, or 52.4% of the citations of the 50 articles. The most frequently studied arthroplasty implant was STAR (15), followed by Agility (7), Buechel Pappas (5), and Salto (4). STAR accounted for 3311 citations, or 37% of the total citations of the 50 articles.Conclusion:Ankle arthroplasty research has made great progress in the past 2 decades, particularly in the area of postoperative outcomes of specific ankle implants, but continued research and publication on additional arthroplasty implants should become a priority.Level of Evidence:Level V, Review Article.

Journal of Trauma-injury Infection and Critical Care, Aug 1, 2011

Journal of Orthopaedic Trauma, Oct 1, 2016

Journal of Foot & Ankle Surgery, Aug 1, 2023