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Jerjes W, Ramsay D, Stevenson H, Yousif A. Effect of chronic heavy tobacco smoking on ankle fracture healing. Foot Ankle Surg 2024; 30:343-348. [PMID: 38368158 DOI: 10.1016/j.fas.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/24/2024] [Accepted: 02/08/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION Tobacco smoking is linked to an elevated risk of osteomyelitis and delayed healing in long bone fractures. However, the impact of smoking on bone union and soft tissue recovery following ankle fractures remains unclear. This study presents a retrospective comparative analysis evaluating the effects of chronic heavy tobacco smoking on the healing process and outcomes of ankle fractures after surgical interventions. MATERIALS AND METHODS We examined 220 consecutive cases of chronic heavy smokers (CHS) with closed ankle fractures who were referred to our unit for further treatment. A control group, consisting of 220 age- and sex-matched individuals (non-smokers with closed ankle fractures), was identified for comparative analysis. We collected clinical data, including pre-existing comorbidities, Lauge-Hansen fracture classification, necessity for surgery, and the surgical procedures performed. The primary outcomes investigated were the time required for fracture union and wound healing. Secondary outcomes included postoperative complications such as prolonged pain, bleeding, swelling, infection, compartment syndrome, and neurovascular impairment, as well as the incidence of delayed union, non-union, and the need for further intervention. Both cohorts were monitored for a minimum of 24 months. RESULTS Our analysis revealed that the surgical cohort of chronic heavy smokers exhibited a statistically significant delay in fracture union compared to both the conservatively managed smokers and the control group. Further scrutiny of the surgical cohort of chronic smokers indicated a significant correlation between smoking and extended postoperative pain duration, persistent swelling at the fracture site, and both superficial and deep wound infections. Additionally, these patients experienced delays in both fracture union and wound healing when compared to the control group. Similarly, the conservatively managed chronic smokers showed a marginal increase in the incidence of post-injury pain duration, extended swelling at the fracture site, and delayed union compared to the control group. CONCLUSION Patients who are chronic heavy smokers and require surgical intervention for ankle fractures should be made aware of their increased risk for delayed fracture union and poor wound healing. Orthopedic surgeons should proactively encourage these patients to participate in smoking cessation programs.
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Affiliation(s)
- Waseem Jerjes
- Research and Development Unit, Hammersmith and Fulham Primary Care Network, United Kingdom.
| | | | | | - Aamr Yousif
- College of Pharmacy, University of Duhok, Duhok, Iraq; Emergency Teaching Hospital, Duhok, Iraq
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van der Horst A, Meijer L, van Os-Medendorp H, Jukema JS, Bohlmeijer E, Schreurs KM, Kelders S. Benefits, Recruitment, Dropout, and Acceptability of the Strength Back Digital Health Intervention for Patients Undergoing Spinal Surgery: Nonrandomized, Qualitative, and Quantitative Pilot Feasibility Study. JMIR Form Res 2024; 8:e54600. [PMID: 38324374 PMCID: PMC10882475 DOI: 10.2196/54600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Patients undergoing spinal surgery report high levels of insecurity, pain, stress, and anxiety before and after surgery. Unfortunately, there is no guarantee that surgery will resolve all issues; postsurgical recovery often entails moderate to severe postoperative pain, and some patients undergoing spinal surgery do not experience (long-term) pain relief after surgery. Therefore, focusing on sustainable coping skills and resilience is crucial for these patients. A digital health intervention based on acceptance and commitment therapy (ACT) and positive psychology (PP) was developed to enhance psychological flexibility and well-being and reduce postsurgical pain. OBJECTIVE The objective of this study was 3-fold: to explore the potential benefits for patients undergoing spinal surgery of the digital ACT and PP intervention Strength Back (research question [RQ] 1), explore the feasibility of a future randomized controlled trial in terms of recruitment and dropout (RQ 2), and assess the acceptability of Strength Back by patients undergoing spinal surgery (RQ 3). METHODS We used a nonrandomized experimental design with an intervention group (n=17) and a control group (n=20). To explore the potential benefits of the intervention, participants in both groups filled out questionnaires before and after surgery. These questionnaires included measurements of pain intensity (Numeric Pain Rating Scale), pain interference (Multidimensional Pain Inventory), anxiety and depression (Hospital Anxiety and Depression Scale), valued living (Engaged Living Scale), psychological flexibility (Psychological Inflexibility in Pain Scale), and mental well-being (Mental Health Continuum-Short Form). Semistructured interviews combined with log data and scores on the Twente Engagement With eHealth Technologies Scale were used to assess the acceptability of the intervention. RESULTS A significant improvement over time in emotional (V=99; P=.03) and overall (V=55; P=.004) well-being (Mental Health Continuum-Short Form) was observed only in the intervention group. In addition, the intervention group showed a significantly larger decline in pain intensity (Numeric Pain Rating Scale) than did the control group (U=75; P=.003). Of the available weekly modules on average 80% (12/15) was completed by patients undergoing spinal fusion and 67% (6/9) was completed by patients undergoing decompression surgery. A total of 68% (17/25) of the participants used the intervention until the final interview. Most participants (15/17, 88%) in the intervention group would recommend the intervention to future patients. CONCLUSIONS This pilot feasibility study showed that combining ACT and PP in a digital health intervention is promising for patients undergoing spinal surgery as the content was accepted by most of the participants and (larger) improvements in pain intensity and well-being were observed in the intervention group. A digital intervention for patients undergoing (spinal) surgery can use teachable moments, when patients are open to learning more about the surgery and rehabilitation afterward. A larger randomized controlled trial is now warranted.
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Affiliation(s)
- Annemieke van der Horst
- Research Group Smart Health, Saxion University of Applied Sciences, Deventer, Netherlands
- Department of Psychology, Health and Technology, Centre for eHealth & Well-being Research - Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Laura Meijer
- Research Group Smart Health, Saxion University of Applied Sciences, Deventer, Netherlands
| | | | - Jan S Jukema
- Research Group Smart Health, Saxion University of Applied Sciences, Deventer, Netherlands
| | - Ernst Bohlmeijer
- Department of Psychology, Health and Technology, Centre for eHealth & Well-being Research - Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Karlein Mg Schreurs
- Department of Psychology, Health and Technology, Centre for eHealth & Well-being Research - Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
- Roessingh Research & Development, Enschede, Netherlands
| | - Saskia Kelders
- Department of Psychology, Health and Technology, Centre for eHealth & Well-being Research - Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
- Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
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Cha SM, Pai A, Lee HJ, Shin HD. Non-vascularised corticocancellous (tricortical) iliac bone graft longer than 3 cm for non-union after failed surgical treatment. J Plast Reconstr Aesthet Surg 2024; 88:37-44. [PMID: 37950990 DOI: 10.1016/j.bjps.2023.10.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/03/2023] [Accepted: 10/07/2023] [Indexed: 11/13/2023]
Abstract
PURPOSE We hypothesised that traditional iliac tricortical bone grafts (no vascularised) still have a reasonable role in promoting satisfactory bony healing in non-union defects of certain sizes. Here, we report the clinical/radiological outcomes through a retrospective case series. METHODS We screened 74 patients with definitive non-union in the long bones of the upper extremities who visited the outpatient department from 2008 to 2018. Among these patients, 25 who met our inclusion/exclusion criteria were investigated. RESULTS The mean age was 51.92 years, and there were 12, 9, 1, and 3 lesions of the radius, ulna, clavicle, and humerus, respectively. The tools for primary fixations were plate and intramedullary nails in 24 and 1 patients, respectively. Six patients presented with atrophic non-union. The mean period from a previous surgery was 6.84 months. The mean defective bone sizes were 1.81 and 3.50 cm pre-debridement and post-debridement, respectively. All devices had locking plates longer than the previous plate, and the graft was concurrently fixed by screws in three patients. At a mean of 15.92 weeks after the revision surgery, all patients experienced union. At the final follow-up, the clinical outcomes were satisfactory. No significant differences in clinical outcomes were found according to the lesion, type of non-union, period from the previous surgery, or harvest length of the iliac bone. CONCLUSIONS If the proper indications and some technical aspects are considered, a non-vascularised iliac bone graft longer than 3 cm could still be a reasonable option for treating diaphyseal non-union of the upper extremities. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Soo Min Cha
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Centre, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Ashwin Pai
- Department of Plastic Surgery, West Suffolk NHS Foundation Trust, United Kingdom
| | - Hyun Jong Lee
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Centre, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Hyun Dae Shin
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Centre, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea.
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Zhuang T, Kamal RN. Strategies for Perioperative Optimization in Upper Extremity Fracture Care. Hand Clin 2023; 39:617-625. [PMID: 37827614 DOI: 10.1016/j.hcl.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Perioperative optimization in upper extremity fracture care must balance the need for timely treatment with the benefits of medical optimization. Care pathways directed at optimizing glycemic control, chronic anticoagulation, smoking history, nutrition, and frailty can reduce surgical risk in upper extremity fracture care. The development of multidisciplinary approaches that tie risk modification with risk stratification is needed.
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Affiliation(s)
- Thompson Zhuang
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, 450 Broadway Street MC: 6342, Redwood City, CA 94603, USA
| | - Robin N Kamal
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, 450 Broadway Street MC: 6342, Redwood City, CA 94603, USA.
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Baumann AN, Chen M, Ahorukomeye P, Furey CG, Cheng CW. Factors Associated With the Rate of Recovery After Cervical Decompression Surgery for Degenerative Cervical Myelopathy: A Retrospective Analysis. Cureus 2023; 15:e39654. [PMID: 37388584 PMCID: PMC10306316 DOI: 10.7759/cureus.39654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction Degenerative cervical myelopathy (DCM) is a debilitating spinal condition with a wide variety of symptoms that can differ greatly among individuals. Common symptoms include numbness, extremity weakness, loss of balance, and gait instability. Decompression surgeries are commonly indicated for the treatment of DCM with varying outcomes reported in the literature. However, there is little evidence on the rate of recovery defined as the time until improvement in symptoms such as numbness, balance, and strength after surgery for DCM. The purpose of this study was to determine the rate of neurological recovery after surgery for DCM and its subsequent association with various risk factors to guide clinicians while providing care and improve patient education. Methods This study was a retrospective case series (n=180 patients) examining patients who underwent cervical decompression surgery for DCM. All patients had a clinical presentation of DCM, were diagnosed with DCM, had radiographic degenerative changes and cervical stenosis, and received surgical management from 2010 to 2020 in a tertiary hospital system. Data recorded included age, smoking status, duration of pre-operative symptoms, preoperative and postoperative pain, and postoperative rate of recovery (days until improvement) in numbness, upper extremity strength, and balance. Results Patients (n=180) had an average age of 65.7 years (SD ±9.2 years, range 43-93 years). The mean ± standard deviation for the rate of recovery (days until improvement) in numbness, upper extremity strength, and balance was 84.5 ± 94.4 days, 50.6 ± 42.8 days, and 60.4 ± 69.9 days, respectively. There was only a marginally significant association between the rate of recovery for numbness after surgery and patient age (p=0.053). The average rate of recovery in numbness for patients older than 60 years was significantly longer than those younger than 60 years (99.3 versus 60.2 days). Preoperative smoking status was significantly associated with persistent moderate to severe pain (p=0.032) within the six-month postoperative period. No significant correlations were seen between the rate of recovery for balance or strength and patient age or preoperative duration of symptoms. Conclusion There was great variability in the rate of recovery for postoperative symptoms after surgery for DCM. A longer time for improvement in postoperative numbness was only marginally correlated with the increased patient age after surgery for DCM. There was no correlation found between strength or balance recovery times and patient age. Smoking status was associated with moderate to severe postoperative pain after surgery for DCM. Furthermore, the duration of preoperative symptoms was not associated with improvement in postoperative symptoms after surgery for DCM. More research is needed to determine factors impacting the rate of recovery after surgery for DCM.
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Affiliation(s)
- Anthony N Baumann
- Department of Rehabilitation Services, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Mingda Chen
- School of Medicine, Case Western Reserve University, Cleveland, USA
| | - Peter Ahorukomeye
- Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Christopher G Furey
- Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Christina W Cheng
- Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, USA
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Gariffo G, Bottai V, Falcinelli F, Di Sacco F, Cifali R, Troiano E, Capanna R, Mondanelli N, Giannotti S. Use of Teriparatide in preventing delayed bone healing and nonunion: a multicentric study on a series of 20 patients. BMC Musculoskelet Disord 2023; 24:184. [PMID: 36906529 PMCID: PMC10007805 DOI: 10.1186/s12891-023-06278-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/28/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Delayed bone healing and nonunions represent a great challenge for the orthopedic surgeon. In addition to traditional surgical approaches, increasing attention is being given to the use of systemic anabolic therapy with Teriparatide, whose efficacy in preventing osteoporotic fractures is widely validated and whose application as a promoter of bone healing has been described but it is still debated. The aim of the study was to evaluate bone healing in a series of patients with delayed unions or nonunions treated with Teriparatide in conjunction with eventual appropriate surgical procedure. METHODS Twenty patients with an unconsolidated fracture that were treated at our Institutions from 2011 to 2020 with Teriparatide were retrospectively included into the study. The pharmacological anabolic support was used off-label with a planned duration of 6 months; radiographic healing was evaluated at 1-, 3- and 6-months follow-up outpatient visits over plain radiographs. Also, eventual side-effects were registered. RESULTS Radiographic signs indicative of favorable evolution of the bone callus were observed as early as at 1 month of therapy in 15% of cases; at 3 months, healing progression was appreciated in 80% of cases and complete healing in 10%; at 6 months, 85% of delayed and nonunions had healed. In all patients, the anabolic therapy was well tolerated. CONCLUSIONS In accordance to Literature, this study suggests that Teriparatide plays a potentially important role in the treatment of some forms of delayed unions or nou-nions, even in the presence of failure of hardware. The results suggest a greater effect of the drug when associated with a condition in which the bone is in an active phase of callogenesis, or with a "revitalizing" treatment which represents a local (mechanical and/or biological) stimulus to the healing process. Despite the small sample size and the variety of cases, the efficacy of Teriparatide in treating delayed unions or nonunions emerged, highlighting how this anabolic therapy can represent a useful pharmacological support in the treatment of such a pathology. Although the results obtained are encouraging, further studies, particularly prospective and randomized, are needed to confirm the efficacy of the drug, and define a specific treatment algorithm.
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Affiliation(s)
- Gabriele Gariffo
- Second Orthopedic and Traumatology Clinic, University of Pisa, Pisa, Italy
| | - Vanna Bottai
- Second Orthopedic and Traumatology Clinic, University of Pisa, Pisa, Italy
| | | | - Federico Di Sacco
- Second Orthopedic and Traumatology Clinic, University of Pisa, Pisa, Italy
| | - Roberta Cifali
- Second Orthopedic and Traumatology Clinic, University of Pisa, Pisa, Italy
| | - Elisa Troiano
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy.,Section of Orthopedics, Azienda Ospedaliero-Universitaria Senese, Viale Mario Bracci 16, 53100, Siena, Italy
| | - Rodolfo Capanna
- Second Orthopedic and Traumatology Clinic, University of Pisa, Pisa, Italy
| | - Nicola Mondanelli
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy. .,Section of Orthopedics, Azienda Ospedaliero-Universitaria Senese, Viale Mario Bracci 16, 53100, Siena, Italy.
| | - Stefano Giannotti
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy.,Section of Orthopedics, Azienda Ospedaliero-Universitaria Senese, Viale Mario Bracci 16, 53100, Siena, Italy
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Acikan I, Yaman F, Dundar S, Ozercan IH, Atilgan SS. Protective effects of caffeic acid phenethyl ester (CAPE) and thymoquinone against cigarette smoke in experimental bone fracture healing. J Oral Biol Craniofac Res 2022; 12:610-616. [PMID: 35989976 DOI: 10.1016/j.jobcr.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 07/28/2022] [Accepted: 08/10/2022] [Indexed: 11/29/2022] Open
Abstract
This study investigated the protective characteristics of caffeic acid phenethyl ester (CAPE) and thymoquinone (TMQ) against the effects of cigarette smoke in recovery from bone fractures. Sixty Wistar albino rats were divided into six groups (n = 10). The rats' femur bones were fractured and then fixed with microplates and microscrews. In the CAPE group, CAPE was given by intraperitoneal injection for 30 days at a dose of 10 μmol/kg once a day. In the TMQ group, TMQ was given orogastrically for 30 days at a dose of 10 mg/kg once a day. In the cigarette groups, CAPE was given by intraperitoneal injection for 30 days at a dose of 10 μmol/kg once a day (CAPE-CG), TMQ was given orogastrically for 30 days at a dose of 10 mg/kg once a day (TMQ-CG), and controls were exposed to cigarette smoke three times a day for 8 min each time for 30 days. The controls received no postoperative treatment. The rats were sacrificed on the 30th day following surgery. According to the histopathological and immunohistochemical results, cigarette smoke had a negative impact on bone healing. TMQ and CAPE increased bone formation and reduced bone destruction. Therefore, TMQ and CAPE were found to be partially protective against the adverse effects of smoking on bone tissue.
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Affiliation(s)
- Izzet Acikan
- Kahramanmaras Sutcu Imam University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Kahramanmaras, Turkiye
| | - Ferhan Yaman
- Private Practice, Oral and Maxillofacial Surgery, Diyarbakir, Turkiye
| | - Serkan Dundar
- Firat University, Faculty of Dentistry, Department of Periodontology, Elazig, Turkiye
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The Effect of Smoking Status on Perioperative Morbidity and Mortality after Open and Endovascular Abdominal Aortic Aneurysm Repair. Ann Vasc Surg 2022; 88:373-384. [PMID: 36058453 DOI: 10.1016/j.avsg.2022.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study quantifies the extent to which active tobacco smoking is deleterious towards outcomes following open and endovascular AAA repair. METHODS Open and endovascular abdominal aortic aneurysm (AAA) repairs between January 2003 and June 2020 in the Vascular Quality Initiative (VQI) were queried. Rupture, symptomatic status, and lack of 90 day follow up were exclusions. Patients were then placed into one of six groups : open AAA with active smoking (n=3788); open AAA with prior smoking (n=4614); open AAA never smokers (817); endovascular AAA active smokers (n=14173); endovascular AAA former smokers (n=25,831); and, endovascular AAA never smokers (n=6064). Comparison of baseline characteristics, co-morbidities, and adverse outcomes across each of the 6 cohorts was performed with open AAA in active smokers serving as the reference. Sub-analysis investigating open AAA repair in active smokers relative to open AAA in patients confirmed in VQI to have quit smoking between 30 and 90 days before surgery was performed. Smoking cessation for a minimum of 30 days before surgery was required to fall into the former smoker category. RESULTS In comparing open AAA in active smokers to open AAA in former and never smokers, the active smokers experienced significantly higher rates of pneumonia (P<.001). Combined additive morbidity and mortality was highest (54%) in active smokers (P<.001 relative to all cohorts other than open AAA former smokers P=.21). Smoking status did not impact morbidity or mortality incidence across individuals undergoing EVAR. Binary logistic regression for all AAA patients (open and endovascular combined) revealed those with any history of smoking to be more likely to experience 90 day mortality (adjusted OR 2.5 (2.2-2.9), P<.001) relative to never-smokers. Active smokers were similarly more likely to experience 90 day mortality than prior/never smokers combined (OR 1.23 (1.07-1.38), P<.001). Mortality within 90 days was significantly more likely (P<.001) with aging, female gender, larger aneurysms, preoperative history of congestive heart failure, chronic obstructive pulmonary disease, chronic renal insufficiency, peripheral artery disease, body mass index under 20 and over 35 mg/kg2. Diabetes and coronary artery disease were also associated with 90 day mortality (P= .045 and .049 respectively). Quitting smoking between 30 and 90 days before open repair reduced combined additive morbidity and mortality relative to active smokers (OR 1.34, P =.038). CONCLUSIONS Smoking cessation 30 days before open AAA repair reduces perioperative morbidity and mortality. Smoking status does not impact morbidity and mortality in patients undergoing endovascular AAA repair. When combining all patients (open and endovascular), higher rates of 90 day mortality are associated with any history of smoking, aging, female gender and advanced pre-existing co-morbidities on multivariable analysis.
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Kemp APT, Ferreira VHC, Mobile RZ, Brandão TB, Sassi LM, Zarpellon A, Braz-Silva PH, Schussel JL. Risk factors for medication-related osteonecrosis of the jaw and salivary IL-6 IN cancer patients. Braz J Otorhinolaryngol 2022; 88:683-690. [PMID: 33189595 PMCID: PMC9483935 DOI: 10.1016/j.bjorl.2020.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/10/2020] [Accepted: 09/14/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction Medication-related osteonecrosis of the jaws is a severe complication of the use of antiresorptive and antiangiogenic therapy, with limited treatment options and great impact on patient’s quality pf life. Objective The aim of this study was to assess the risk factors associated with medication-related osteonecrosis of the jaws in oncologic patients undergoing bisphosphonate treatment. In addition, salivary levels of interleukin-6, IL-6, were measured to investigate their association with severity and risk of medication-related osteonecrosis of the jaws. Methods Case-control study with 74 patients with bone metastases from solid tumors and multiple myeloma was included. Patients were divided into three groups: 1) those undergoing bisphosphonate treatment with medication-related osteonecrosis of the jaws; 2) those undergoing bisphosphonate without medication-related osteonecrosis of the jaws; and 3) those with bisphosphonate pretreatment. The demographic and medical data of the patients were collected to assess risk. The clinical evaluation was performed to diagnose medication-related osteonecrosis of the jaws and unstimulated saliva was collected for quantification of IL-6. Results As result, it was observed that patients diagnosed with medication-related osteonecrosis of the jaws were submitted to higher number of bisphosphonate doses (p = 0.001) and monthly infusion protocol (p = 0.044; OR = 7.75). Patients who did not have routine followup with specialized dentists during therapy with bisphosphonate and smoking were associated with medication-related osteonecrosis of the jaws (p = 0.019; OR = 8.25 and p = 0.031; OR = 9.37 respectively). Group 1 had a higher frequency of treatment with chemotherapy and corticosteroids concomitant with bisphosphonate, and surgical dental procedures (p = 0.129). Salivary IL-6 levels showed no statistically significant difference between the groups (p = 0.571) or association with medication-related osteonecrosis of the jaws severity (p = 0.923). Conclusion A higher number of bisphosphonate cycles, monthly infusion protocol, no dental follow-up for oral health maintenance and smoking were associated with medication-related osteonecrosis of the jaws. Specialized dental follow up during bisphosphonate treatment has been shown to be an important factor in preventing this complication.
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Affiliation(s)
- Aristilia Pricila Tahara Kemp
- Universidade Federal do Paraná, Programa de Pós-Graduação em Odontologia, Departamento de Estomatologia, Curitiba, PR, Brazil; Instituto do Câncer do Estado de São Paulo, Serviço de Odontologia, São Paulo, SP, Brazil
| | - Vitor Hugo Candido Ferreira
- Universidade Federal do Paraná, Programa de Pós-Graduação em Odontologia, Departamento de Estomatologia, Curitiba, PR, Brazil
| | - Rafael Zancan Mobile
- Universidade Federal do Paraná, Programa de Pós-Graduação em Odontologia, Departamento de Estomatologia, Curitiba, PR, Brazil
| | - Thais Bianca Brandão
- Instituto do Câncer do Estado de São Paulo, Serviço de Odontologia, São Paulo, SP, Brazil
| | - Laurindo Moacir Sassi
- Hospital Erasto Gaerner, Departamento de Cirurgia Bucomaxilofacial, Curitiba, PR, Brazil
| | - Amanda Zarpellon
- Universidade de São Paulo, Faculdade de Odontologia, Divisão de Patologia Geral, Departamento de Estomatologia, São Paulo, SP, Brazil
| | - Paulo Henrique Braz-Silva
- Universidade de São Paulo, Faculdade de Odontologia, Divisão de Patologia Geral, Departamento de Estomatologia, São Paulo, SP, Brazil; Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Virologia, São Paulo, SP, Brazil
| | - Juliana Lucena Schussel
- Universidade Federal do Paraná, Programa de Pós-Graduação em Odontologia, Departamento de Estomatologia, Curitiba, PR, Brazil.
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Pittet T, Cook S, Khatchatourov G, Theumann N. Percutaneous Cementoplasty to Treat Sternal Instability After Cardiac Surgery. Front Cardiovasc Med 2022; 9:822540. [PMID: 35211528 PMCID: PMC8862144 DOI: 10.3389/fcvm.2022.822540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionAlthough rare, sternal pseudarthrosis is encountered after cardiac surgery and impacts the quality of life by triggering motion-dependent chest pain. We thought to describe its treatment by percutaneous cementoplasty and report the clinical follow-up of patients treated in our institution.MethodsThis case series is a retrospective study based on five patients who benefited from a sternal cementoplasty as a treatment for symptomatic pseudarthrosis after cardiac surgery. The progression of the symptoms was assessed during clinical follow-up using the Quebec back pain disability (QBPD) scale and Visual Analog Scale (VAS).ResultsNone of the patients presented evidence of local complications or neurological disorders. The intra- et post-operative images show no major leak of the cement, no embolism and no damage to the internal mammary artery or the heart. All patients described an improved quality of life due to reduced pain in all-day clinical activities. The QBPD scores improved from 54.8 ± 29.3 to 30.0 ± 17.4 (p = 0.02) and the VAS from 7.0 ± 2.8 to 1.6 ± 1.6 (p = 0.01). Furthermore, three out of five patients could completely stop taking analgesics.ConclusionSternal pseudarthrosis is a debilitating affliction that may complicate sternotomy after cardiac surgery. This series demonstrates that a more conservative approach such as cementoplasty can be successful in terms of reducing pain, and constitutes a promising technique in selected cases.
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Affiliation(s)
- Thaïs Pittet
- Cardiology Department, University Fribourg, Fribourg, Switzerland
| | - Stéphane Cook
- Cardiology Department, University Fribourg, Fribourg, Switzerland
- Hirslanden Clinics Lausanne, Lausanne, Switzerland
- *Correspondence: Stéphane Cook
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Sadeghifar A, Sheibani M, Joukar S, Dabiri S, Alavi S, Azari O, Vosoghi D, Zeynali Y, Zeynali Y, Shahraki M, Torghabe A, Rostamzadeh F, Nasri A. The Effect of Waterpipe Tobacco Smoking on Bone Healing Following Femoral Fractures in Male Rats. Front Surg 2021; 8:722446. [PMID: 34671637 PMCID: PMC8520932 DOI: 10.3389/fsurg.2021.722446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Given the increasing use of waterpipe tobacco smoking in the world and its unknown effects on bone healing, this study investigated the repairing of femoral bone fractures in rats exposed to waterpipe tobacco smoking (WTS). Main Methods: This study involved 40 male Wistar rats that were divided into two groups, including the femoral fracture (Fx) and the Fx + WTS groups. Each group was divided into two subgroups that were evaluated for bone healing 28 and 42 days after femoral fracture. After fixing the fractured femur, the healing process was evaluated by radiography, pathological indicators, and a measurement of the blood levels of vascular endothelial growth factor (VEGF), parathyroid hormone (PTH), Ca ++, transforming growth factor-beta (TGF-β), and insulin-like growth factor 1 (IGF-1). Additionally, the density of VEGF and CD34 in fracture tissue was investigated by immunohistochemistry. Key Findings: Radiographic findings showed that factors related to the earlier stages of bone healing had higher scores in the Fx + WTS28 and 42 subgroups in comparison to the Fx groups. The density of VEGF and CD34 showed that the angiogenesis processes were different in the bone fracture area and callus tissue in the Fx +WTS subgroups. The serum levels of VEGF, TGF-β, and IGF-1 were significantly lower in the Fx +WTS42 group, and PTH in the Fx +WTS28 group was higher than that in the other groups. Significance: The findings showed the disturbance and delay in the femoral fracture union in rats exposed to hookah smoke. This is partly due to the reduction of molecular stimuli of bone synthesis and the attenuation of quantitative angiogenesis.
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Affiliation(s)
- Amirreza Sadeghifar
- Orthopedic Department, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohamad Sheibani
- Orthopedic Department, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Siyavash Joukar
- Physiology Research Center, Institute of Basic and Clinical Physiology Sciences, and Department of Physiology and Pharmacology, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Shahriar Dabiri
- Pathology Department and Stem Cell Research Center, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Samanehsadat Alavi
- Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Omid Azari
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Darioush Vosoghi
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Yas Zeynali
- Physiology Research Center, Institute of Basic and Clinical Physiology Sciences, and Department of Physiology and Pharmacology, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Yasman Zeynali
- Physiology Research Center, Institute of Basic and Clinical Physiology Sciences, and Department of Physiology and Pharmacology, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohamad Shahraki
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Amirhesam Torghabe
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Farzaneh Rostamzadeh
- Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Alireza Nasri
- Pathology Department and Stem Cell Research Center, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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12
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McConaghy K, Kunze KN, Murray T, Molloy R, Piuzzi NS. Smoking Cessation Initiatives in Total Joint Arthroplasty: An Evidence-Based Review. JBJS Rev 2021; 9:01874474-202108000-00012. [PMID: 34449441 DOI: 10.2106/jbjs.rvw.21.00009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» As smoking increases the risk of adverse events and leads to increased hospital costs following total joint arthroplasty (TJA), many institutions have introduced perioperative smoking cessation initiatives. Although such programs have been demonstrated to improve outcomes for smokers undergoing TJA, the optimal approach, duration, and timing of smoking cessation models have not been well-defined. » Overall, initiating a smoking cessation program 4 weeks preoperatively is likely adequate to provide clinically meaningful reductions in postoperative complications for smokers following TJA, although longer periods of cessation should be encouraged if feasible. » Patients brought in for emergency surgical treatment who cannot participate in a preoperative intervention may still benefit from an intervention instituted in the immediate postoperative period. » Cotinine testing may provide some benefit for encouraging successful smoking cessation and validating self-reported smoking status, although its utility is limited by its short half-life. Further study is needed to determine the value of other measures of cessation such as carbon monoxide breath testing. » Smoking cessation programs instituted prior to TJA have been demonstrated to be cost-effective over both the short and long term.
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Affiliation(s)
- Kara McConaghy
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Kyle N Kunze
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Trevor Murray
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Robert Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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13
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Dudareva M, Hotchen A, McNally M, Hartmann-Boyce J, Scarborough M, Collins G. Systematic review of risk prediction studies in bone and joint infection: are modifiable prognostic factors useful in predicting recurrence? J Bone Jt Infect 2021; 6:257-271. [PMID: 34285868 PMCID: PMC8283517 DOI: 10.5194/jbji-6-257-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/29/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Classification systems for orthopaedic infection include patient health status, but there is no consensus about which comorbidities affect prognosis. Modifiable factors including substance use, glycaemic control, malnutrition and obesity may predict post-operative recovery from infection. Aim: This systematic review aimed (1) to critically appraise clinical prediction models for individual prognosis following surgical treatment for orthopaedic infection where an implant is not retained; (2) to understand the usefulness of modifiable prognostic factors for predicting treatment success. Methods: EMBASE and MEDLINE databases were searched for clinical prediction and prognostic studies in adults with orthopaedic infections. Infection recurrence or re-infection after at least 6 months was the primary outcome. The estimated odds ratios for the primary outcome in participants with modifiable prognostic factors were extracted and the direction of the effect reported. Results: Thirty-five retrospective prognostic cohort studies of 92 693 patients were included, of which two reported clinical prediction models. No studies were at low risk of bias, and no externally validated prediction models were identified. Most focused on prosthetic joint infection. A positive association was reported between body mass index and infection recurrence in 19 of 22 studies, similarly in 8 of 14 studies reporting smoking history and 3 of 4 studies reporting alcohol intake. Glycaemic control and malnutrition were rarely considered. Conclusion: Modifiable aspects of patient health appear to predict outcomes after surgery for orthopaedic infection. There is a need to understand which factors may have a causal effect. Development and validation of clinical prediction models that include participant health status will facilitate treatment decisions for orthopaedic infections.
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Affiliation(s)
- Maria Dudareva
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics,
Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University
Hospitals NHS Foundation Trust, Oxford, UK
| | - Andrew Hotchen
- Division of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital,
Cambridge University Hospitals, Cambridge, UK
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University
Hospitals NHS Foundation Trust, Oxford, UK
| | - Martin A. McNally
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University
Hospitals NHS Foundation Trust, Oxford, UK
| | - Jamie Hartmann-Boyce
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health
Sciences, University of Oxford, Oxford, UK
| | - Matthew Scarborough
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University
Hospitals NHS Foundation Trust, Oxford, UK
| | - Gary Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics,
Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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14
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Morris TM, Marlborough FJ, Montgomery RJ, Allison KP, Eardley WGP. Smoking and the patient with a complex lower limb injury. Injury 2021; 52:814-824. [PMID: 33495022 DOI: 10.1016/j.injury.2020.12.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/11/2020] [Accepted: 12/23/2020] [Indexed: 02/02/2023]
Abstract
Smoking is known to increase the risk of peri-operative complications in Orthoplastic surgery by impairing bone and wound healing. The effects of nicotine replacement therapies (NRTs) and electronic cigarettes (e-cigarettes) has been less well established. Previous reviews have examined the relationship between smoking and bone and wound healing separately. This review provides surgeons with a comprehensive and contemporaneous account of how smoking in all forms interacts with all aspects of complex lower limb trauma. We provide a guide for surgeons to refer to during the consent process to enable them to tailor information towards smokers in such a way that the patient may understand the risks involved with their surgical treatment. We update the literature with recently discovered methods of monitoring and treating the troublesome complications that occur more commonly in smokers effected by trauma.
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Affiliation(s)
- Timothy M Morris
- Orthoplastic Surgery Department, James Cook University Hospital, Marton Road, Middlesbrough, England, TS4 3BW.
| | - Fergal J Marlborough
- Orthoplastic Surgery Department, James Cook University Hospital, Marton Road, Middlesbrough, England, TS4 3BW
| | - Richard J Montgomery
- Orthoplastic Surgery Department, James Cook University Hospital, Marton Road, Middlesbrough, England, TS4 3BW
| | - Keith P Allison
- Orthoplastic Surgery Department, James Cook University Hospital, Marton Road, Middlesbrough, England, TS4 3BW
| | - William G P Eardley
- Orthoplastic Surgery Department, James Cook University Hospital, Marton Road, Middlesbrough, England, TS4 3BW
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15
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Robinson A, Slight RD, Husband AK, Slight SP. Designing the Optimal Digital Health Intervention for Patients' Use Before and After Elective Orthopedic Surgery: Qualitative Study. J Med Internet Res 2021; 23:e25885. [PMID: 33683208 PMCID: PMC7985803 DOI: 10.2196/25885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 02/06/2023] Open
Abstract
Background Health behavior changes made by patients during the perioperative period can impact the outcomes and success of elective surgeries. However, there remains a limited understanding of how best to support patients during this time, particularly through the use of digital health interventions. Recognizing and understanding the potential unmet needs of elective orthopedic surgery patients is central to motivating healthier behavior change, improving recovery, and optimizing overall surgical success in the short and long term. Objective The aim of this study is to explore patient perspectives on technology features that would help support them to change their lifestyle behaviors during the pre- and postoperative periods, and that could potentially maintain long-term healthy lifestyles following recovery. Methods Semistructured interviews with pre- and postoperative elective orthopedic patients were conducted between May and June 2020 using telephone and video call–based software. Patient perspectives on the use of digital technologies to complement current surgical care and support with lifestyle behavior changes were discussed. Interviews were audio recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes from the data, with QSR NVivo software (version 12) facilitating data management. Ethical approval was obtained from the National Health Service Health Research Authority. Results A total of 18 participants were interviewed. Four themes were developed from the data regarding the design and functionality of digital technologies to best support the perioperative journey. These center around an intervention’s ability to incorporate interactive, user-centered features; direct a descriptive and structured recovery; enable customizable, patient-controlled settings; and deliver both general and specific surgical advice in a timely manner. Interventions that are initiated preoperatively and continued postoperatively were perceived as beneficial. Interventions designed with personalized milestones were found to better guide patients through a structured recovery. Individualized tailoring of preparatory and recovery information was desired by patients with previously high levels of physical activity before surgery. The use of personalized progression-based exercises further encouraged physical recovery; game-like rewards and incentives were regarded as motivational for making and sustaining health behavior change. In-built video calling and messaging features offered connectivity with peers and clinicians for supported care delivery. Conclusions Specific intervention design and functionality features can provide better, structured support for elective orthopedic patients across the entire surgical journey and beyond. This study provides much-needed evidence relating to the optimal design and timing of digital interventions for elective orthopedic surgical patients. Findings from this study suggest a desire for personalized perioperative care, in turn, supporting patients to make health behavior changes to optimize surgical success. These findings should be used to influence future co-design projects to enable the design and implementation of patient-focused, tailored, and targeted digital health technologies within modern health care settings.
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Affiliation(s)
- Anna Robinson
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, United Kingdom.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Robert D Slight
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Andrew K Husband
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, United Kingdom.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sarah P Slight
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, United Kingdom.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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16
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Cha SM, Shin HD, Lee SH, Ga IH. Factors predictive for union of basal fracture of the ulnar styloid process after distal radial fracture fixation using a volar locking plate. Injury 2021; 52:524-531. [PMID: 33268076 DOI: 10.1016/j.injury.2020.10.088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 10/11/2020] [Accepted: 10/18/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Some basal ulnar styloid fractures (USFs) achieve union without surgical fixation when accompanying distal radius fractures (DRFs) are treated via placement of volar locking plates (VLPs). The purpose of this study was to seek factors predictive of such healing through the retrospective case-control study. METHODS We evaluated 203 patients who received VLPs to treat DRFs in our institute from March 2010 to February 2018; Group 1 contained "union" patients and Group 2 contained "nonunion" patients. Basic demographic, radiological, and operative variables were compared. At the final follow-up (at least 2 years postoperatively), pain was scored using a visual analog scale (VAS). Scores on the Disabilities of the Arm, Shoulder, and Hand (DASH) instrument; grip strengths; and demerit points of the Gartland and Werley system were compared between groups. RESULTS Group 1 consisted of 58 patients and Group 2 consisted of 147 patients. Univariate analysis showed that age, bone mineral density (BMD), and Gaulke USF classification significantly differed between groups (all p < 0.05). Multivariate analysis showed that BMD (p < 0.001, odds ratio [OR] = 0.214, 95% confidence interval [95% CI] = 0.126-0.363) and Gaulke classification (p < .001, OR = 0.092, 95% CI = 0.034-0.250) were significantly associated with USF union, which was significantly higher in patients with mean BMD ≥ -0.12 (the cutoff value) and type IIC USFs. However, postoperative clinical outcomes at the final follow-up did not differ significantly between groups (all p > 0.05). CONCLUSIONS Approximately 30% (58/205) of basal USFs associated with DRFs united after VLPs alone were placed to treat the DRFs. BMD ≥ -0.12 independently predicted union. Type IIC USFs exhibited more union than other fracture types. Additional surgical fixation of a basal USF accompanied by a DRF treated via VLP placement may be unnecessary, especially if BMD is good and fracture type is IIC. LEVEL OF EVIDENCE Level III, Case-control study.
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Affiliation(s)
- Soo Min Cha
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Hyun Dae Shin
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea.
| | - Seung Hoo Lee
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - In Ho Ga
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
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17
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Zhuang T, Ku S, Shapiro LM, Hu SS, Cabell A, Kamal RN. A Cost-Effectiveness Analysis of Smoking-Cessation Interventions Prior to Posterolateral Lumbar Fusion. J Bone Joint Surg Am 2020; 102:2032-2042. [PMID: 33038088 PMCID: PMC8136338 DOI: 10.2106/jbjs.20.00393] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Smoking cessation represents an opportunity to reduce both short and long-term effects of smoking on complications after lumbar fusion and smoking-related morbidity and mortality. However, the cost-effectiveness of smoking-cessation interventions prior to lumbar fusion is not fully known. METHODS We created a decision-analytic Markov model to evaluate the cost-effectiveness of 5 smoking-cessation strategies (behavioral counseling, nicotine replacement therapy [NRT], bupropion or varenicline monotherapy, and a combined intervention) prior to single-level, instrumented lumbar posterolateral fusion (PLF) from the health payer perspective. Probabilities, costs, and utilities were obtained from published sources. We calculated the costs and quality-adjusted life years (QALYs) associated with each strategy over multiple time horizons and accounted for uncertainty with probabilistic sensitivity analyses (PSAs) consisting of 10,000 second-order Monte Carlo simulations. RESULTS Every smoking-cessation intervention was more effective and less costly than usual care at the lifetime horizon. In the short term, behavioral counseling, NRT, varenicline monotherapy, and the combined intervention were also cost-saving, while bupropion monotherapy was more effective but more costly than usual care. The mean lifetime cost savings for behavioral counseling, NRT, bupropion monotherapy, varenicline monotherapy, and the combined intervention were $3,291 (standard deviation [SD], $868), $2,571 (SD, $479), $2,851 (SD, $830), $6,767 (SD, $1,604), and $34,923 (SD, $4,248), respectively. The minimum efficacy threshold (relative risk for smoking cessation) for lifetime cost savings varied from 1.01 (behavioral counseling) to 1.15 (varenicline monotherapy). A PSA revealed that the combined smoking-cessation intervention was always more effective and less costly than usual care. CONCLUSIONS Even brief smoking-cessation interventions yield large short-term and long-term cost savings. Smoking-cessation interventions prior to PLF can both reduce costs and improve patient outcomes as health payers/systems shift toward value-based reimbursement (e.g., bundled payments) or population health models. LEVEL OF EVIDENCE Economic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Thompson Zhuang
- VOICES Health Policy Research Center (T.Z., S.K., L.M.S, and R.N.K.), Department of Orthopaedic Surgery (T.Z., S.K., L.M.S., S.S.H., A.C., and R.N.K.), Stanford University, Redwood City, California
| | - Seul Ku
- VOICES Health Policy Research Center (T.Z., S.K., L.M.S, and R.N.K.), Department of Orthopaedic Surgery (T.Z., S.K., L.M.S., S.S.H., A.C., and R.N.K.), Stanford University, Redwood City, California
| | - Lauren M. Shapiro
- VOICES Health Policy Research Center (T.Z., S.K., L.M.S, and R.N.K.), Department of Orthopaedic Surgery (T.Z., S.K., L.M.S., S.S.H., A.C., and R.N.K.), Stanford University, Redwood City, California
| | - Serena S. Hu
- VOICES Health Policy Research Center (T.Z., S.K., L.M.S, and R.N.K.), Department of Orthopaedic Surgery (T.Z., S.K., L.M.S., S.S.H., A.C., and R.N.K.), Stanford University, Redwood City, California
| | - Akaila Cabell
- VOICES Health Policy Research Center (T.Z., S.K., L.M.S, and R.N.K.), Department of Orthopaedic Surgery (T.Z., S.K., L.M.S., S.S.H., A.C., and R.N.K.), Stanford University, Redwood City, California
| | - Robin N. Kamal
- VOICES Health Policy Research Center (T.Z., S.K., L.M.S, and R.N.K.), Department of Orthopaedic Surgery (T.Z., S.K., L.M.S., S.S.H., A.C., and R.N.K.), Stanford University, Redwood City, California
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18
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Kiyota Y, Muramatsu H, Sato Y, Kobayashi T, Miyamoto K, Iwamoto T, Matsumoto M, Nakamura M, Tateno H, Sato K, Miyamoto T. Smoking cessation increases levels of osteocalcin and uncarboxylated osteocalcin in human sera. Sci Rep 2020; 10:16845. [PMID: 33033284 PMCID: PMC7546721 DOI: 10.1038/s41598-020-73789-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/16/2020] [Indexed: 12/14/2022] Open
Abstract
Smoking is thought to be a risk factor for osteoporosis development; however, the consequences of stopping smoking for bone homeostasis remain unknown. Here we conducted two separate human studies and show that bone mineral density was significantly lower in smokers than in non-smokers. The first was an observational study of pre- and post-menopausal healthy female smokers and non-smokers; the second included 139 current smokers determined to stop smoking. In the second study, levels of bone formation markers such as osteocalcin and uncarboxylated osteocalcin significantly increased after successful smoking cessation, as verified by significantly reduced levels of serum cotinine, a nicotine metabolite. Moreover, nicotine administration to mice reduced bone mineral density and significantly increased the number of osteoclasts in bone. Reduced bone mass phenotypes seen in nicotine-treated mice were significantly increased following nicotine withdrawal, an outcome accompanied by significantly reduced serum levels of tartrate-resistant acid phosphatase, a bone resorption marker. Taken together, our findings suggest that bone homeostasis is perturbed but can be rescued by smoking cessation.
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Affiliation(s)
- Yasuhiro Kiyota
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroyasu Muramatsu
- Chuo Naika Clinic, 2-7-8 Nihon-bashi Ningyou-chou, Chuo-ku, Tokyo, 103-0013, Japan
| | - Yuiko Sato
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Advanced Therapy for Musculoskeletal Disorders II, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Musculoskeletal Reconstruction and Regeneration Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tami Kobayashi
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Advanced Therapy for Musculoskeletal Disorders II, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Musculoskeletal Reconstruction and Regeneration Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kana Miyamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takuji Iwamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroki Tateno
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazuki Sato
- Institute for Integrated Sports Medicine, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Takeshi Miyamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan. .,Department of Advanced Therapy for Musculoskeletal Disorders II, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan. .,Department of Musculoskeletal Reconstruction and Regeneration Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan. .,Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
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19
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Cha SM, Shin HD, Ahn BK. Refracture after plate removal following ulnar shortening osteotomy for ulnar impaction syndrome - a retrospective case-control study. J Plast Surg Hand Surg 2020; 55:48-55. [PMID: 33019843 DOI: 10.1080/2000656x.2020.1828900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Soo Min Cha
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hyun Dae Shin
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Byung Kuk Ahn
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
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20
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Kemp SE, Urband CE, Haase LR, Obermeier MC, Sikka RS, Tompkins M. Normative values of the Western Ontario Rotator Cuff (WORC) Index for the general population in the USA. J ISAKOS 2020. [DOI: 10.1136/jisakos-2019-000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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21
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Chang CJ, Jou IM, Wu TT, Su FC, Tai TW. Cigarette smoke inhalation impairs angiogenesis in early bone healing processes and delays fracture union. Bone Joint Res 2020; 9:99-107. [PMID: 32435462 PMCID: PMC7229299 DOI: 10.1302/2046-3758.93.bjr-2019-0089.r1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aims Cigarette smoking has a negative impact on the skeletal system, causes a decrease in bone mass in both young and old patients, and is considered a risk factor for the development of osteoporosis. In addition, it disturbs the bone healing process and prolongs the healing time after fractures. The mechanisms by which cigarette smoking impairs fracture healing are not fully understood. There are few studies reporting the effects of cigarette smoking on new blood vessel formation during the early stage of fracture healing. We tested the hypothesis that cigarette smoke inhalation may suppress angiogenesis and delay fracture healing. Methods We established a custom-made chamber with airflow for rats to inhale cigarette smoke continuously, and tested our hypothesis using a femoral osteotomy model, radiograph and microCT imaging, and various biomechanical and biological tests. Results In the smoking group, Western blot analysis and immunohistochemical staining revealed less expression of vascular endothelial growth factor (VEGF) and von Willebrand factor (vWF). The smoking group also had a lower microvessel density than the control group. Image and biochemical analysis also demonstrated delayed bone healing. Conclusion Cigarette smoke inhalation was associated with decreased expression of angiogenic markers in the early bone healing phase and with impaired bone healing. Cite this article:Bone Joint Res. 2020;9(3):99–107.
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Affiliation(s)
- Chao-Jui Chang
- Department of Orthopaedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - I-Ming Jou
- Department of Orthopaedics, E-Da Hospital, Kaohsiung, Taiwan; Great East Gate Clinic, Tainan, Taiwan
| | - Tung-Tai Wu
- Institute of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Great East Gate Clinic, Tainan, Taiwan
| | | | - Ta-Wei Tai
- Department of Orthopaedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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22
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Kuo YH, Kuo CH, Chang HK, Tu TH, Fay LY, Chang CC, Cheng H, Wu CL, Lirng JF, Wu JC, Huang WC. Effects of smoking on pedicle screw-based dynamic stabilization: radiological and clinical evaluations of screw loosening in 306 patients. J Neurosurg Spine 2020; 33:398-405. [PMID: 32357328 DOI: 10.3171/2020.2.spine191380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 02/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cigarette smoking has been known to increase the risk of pseudarthrosis in spinal fusion. However, there is a paucity of data on the effects of smoking in dynamic stabilization following lumbar spine surgery. This study aimed to investigate the clinical outcomes and the incidence of screw loosening among patients who smoked. METHODS Consecutive patients who had lumbar spondylosis, recurrent disc herniations, or low-grade spondylolisthesis that was treated with 1- or 2-level surgical decompression and pedicle screw-based Dynesys dynamic stabilization (DDS) were retrospectively reviewed. Patients who did not complete the minimum 2 years of radiological and clinical evaluations were excluded. All screw loosening was determined by both radiographs and CT scans. Patient-reported outcomes, including visual analog scale (VAS) scores of back and leg pain, Japanese Orthopaedic Association (JOA) scores, and Oswestry Disability Index (ODI), were analyzed. Patients were grouped by smoking versus nonsmoking, and loosening versus intact screws, respectively. All radiological and clinical outcomes were compared between the groups. RESULTS A total of 306 patients (140 women), with a mean age of 60.2 ± 12.5 years, were analyzed during an average follow-up of 44 months. There were 34 smokers (9 women) and 272 nonsmokers (131 women, 48.2% more than the 26.5% of smokers, p = 0.017). Postoperatively, all the clinical outcomes improved (e.g., VAS back and leg pain, JOA scores, and ODI, all p < 0.001). The overall rate of screw loosening was 23.2% (71 patients), and patients who had loosened screws were older (61.7 ± 9.6 years vs 59.8 ± 13.2 years, p = 0.003) and had higher rates of diabetes mellitus (33.8% vs 21.7%, p = 0.038) than those who had intact DDS screws. Although the patients who smoked had similar clinical improvement (even better VAS scores in their legs, p = 0.038) and a nonsignificantly lower rate of screw loosening (17.7% and 23.9%, p = 0.416), the chances of secondary surgery for adjacent segment disease (ASD) were higher than for the nonsmokers (11.8% vs 1.5%, p < 0.001). CONCLUSIONS Smoking had no adverse effects on the improvements of clinical outcomes in the pedicle screw-based DDS surgery. For smokers, the rate of screw loosening trended lower (without significance), but the chances of secondary surgery for ASD were higher than for the nonsmoking patients. However, the optimal surgical strategy to stabilize the lumbar spine of smoking patients requires future investigation.
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Affiliation(s)
- Yi-Hsuan Kuo
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
| | - Chao-Hung Kuo
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
- 3Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang-Ming University
| | - Hsuan-Kan Chang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
- 4Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University
| | - Tsung-Hsi Tu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
- 6Taiwan International Graduate Program in Molecular Medicine, National Yang-Ming University and Academia Sinica; and
| | - Li-Yu Fay
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
- 5Institute of Pharmacology, National Yang-Ming University
| | - Chih-Chang Chang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
| | - Henrich Cheng
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
- 5Institute of Pharmacology, National Yang-Ming University
| | - Ching-Lan Wu
- 2School of Medicine, National Yang-Ming University
- 7Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jiing-Feng Lirng
- 2School of Medicine, National Yang-Ming University
- 7Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jau-Ching Wu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
| | - Wen-Cheng Huang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
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Corrective osteotomies of femur and tibia: which factors influence bone healing? Arch Orthop Trauma Surg 2020; 140:303-311. [PMID: 31317302 DOI: 10.1007/s00402-019-03217-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Corrective osteotomies of the lower limb are standard procedures in orthopedic surgery. Still, there is only limited research on factors affecting bone healing after osteotomies. We hypothesize that especially the location of the osteotomy, smoking status and BMI affect bone healing. MATERIAL AND METHODS The healing process of 547 patients who underwent osteotomies of the lower limb (259 female, 288 male; average 40.6 years, range 14-77) was evaluated. To assess bone healing, participants were divided into three groups by bone healing duration ( < 5/5-8/ > 8 months). Differences in healing duration related to the anatomic level of the osteotomy (diaphysis vs. metaphysis), age, gender, smoking status, BMI, and modus of the osteotomy (open vs. closed wedge) were tested for significance using an ordinal regression analysis. RESULTS A significant correlation between bone healing and the anatomical level of the osteotomy on femur and tibia and the patients' smoking status was found. The odds of the diaphysis considering bone healing was 0.187 (95% CI, 0.08-0.44) times that of the metaphysis (Wald χ2(1) = 14.597, p < 0.000). The odds ratio of smokers considering bone healing was 0.192 (95% CI, 0.11-0.33) times that of non-smokers (Wald χ2(1) = 35.420, p < 0.000). All other analyzed factors did not show a significant correlation with bone healing. CONCLUSIONS Smoking status and the localization of the osteotomy on femur and tibia (diaphysis vs. metaphysis) are significantly correlated with bone healing duration. In line with current literature emphasizing the detrimental effect of smoking on bone healing, our findings should encourage surgeons to think twice about the indication to perform osteotomies on smokers. Furthermore, if applicable, osteotomies should be performed in the metaphyseal areas of femur and tibia.
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Dolan RT, Butler JS, Vaccaro AR, White AP, Giele HP. Current Strategies for Reconstruction of Soft Tissue Defects of the Spine. Clin Spine Surg 2020; 33:9-19. [PMID: 31913180 DOI: 10.1097/bsd.0000000000000936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Spinal surgery has been revolutionized by advances in instrumentation, bone graft substitutes, and perioperative care. Extensive dissection, creation of large areas of dead space, and the use of instrumentation in compromised patients, however, predisposes to high rates of wound complications. Postoperative wound complications in patients undergoing complex spinal surgery can have devastating sequelae, including hardware exposure, meningitis, and unplanned reoperation. Recognition of high-risk patients and prediction of wound closure difficulties, combined with preemptive reconstructive surgical strategies may prevent complications. The purpose of this review is to discuss the principles of spine wound management and provide a synopsis of the soft tissue reconstructive strategies utilized in spinal surgery. We review the senior author's preferred reconstructive algorithm for the management of these complex wounds, in addition to outcomes data relating to the timing of reconstructive surgery.
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Affiliation(s)
- Roisin T Dolan
- Department of Plastic & Reconstructive Surgery, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Joseph S Butler
- National Spinal Injuries Unit, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Andrew P White
- Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Henk P Giele
- Department of Plastic & Reconstructive Surgery, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE To identify the differences in inpatient pain scores, narcotic consumption, and patient-reported outcomes (PROs) between tobacco users and nonusers following an anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA Previous studies have investigated tobacco use as a risk factor for negative postsurgical outcomes following spine surgery; however, few studies have analyzed the effects of tobacco on pain following ACDF. METHODS Patients undergoing primary, 1-level, or 2-level ACDF were retrospectively reviewed and stratified by tobacco use at the time of surgery. Inpatient pain scores and narcotic consumption were collected. Neck Disability Index and Visual Analogue Scale (VAS) neck and arm pain scores were collected preoperatively and at 6-week, 3-month, and 6-month follow-up visits. Differences in demographics and perioperative characteristics were assessed using χ analysis and multivariate linear regression. An association between immediate postoperative pain, narcotics consumption, and long-term PROs was tested for using multivariate linear regression. RESULTS A total of 192 patients were included and stratified by tobacco use: tobacco (n=25) and nontobacco (n=167). There were no significant differences in demographic and perioperative characteristics. No statistical differences were observed in inpatient VAS pain scores and narcotic consumption on postoperative day 0 and postoperative day 1. Preoperative VAS neck pain and arm pain was greater in tobacco users, however, improvements in neck and arm pain were similar in the postoperative period through 6-month follow-up. In addition, no statistical differences in Neck Disability Index were observed preoperatively or at any postoperative time points. CONCLUSIONS Our study suggests that tobacco use does not influence inpatient pain scores, narcotic consumption, and improvements in PROs following ACDF. As such, tobacco users and nonusers should receive similar postoperative pain management protocols following surgery. LEVEL OF EVIDENCE Level III.
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Orthopaedic foot and ankle surgeons’ approach to elective surgery in the smoking patient population: a survey study. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVE The objective of this study was to evaluate if a preoperative wellness bundle significantly decreases the risk of hospital acquired infections (HAI). BACKGROUND HAI threaten patient outcomes and are a significant burden to the healthcare system. Preoperative wellness efforts may significantly decrease the risk of infections. METHODS A group of 12,396 surgical patients received a wellness bundle in a roller bag during preoperative screening at an urban academic medical center. The wellness bundle consisted of a chlorhexidine bath solution, immuno-nutrition supplements, incentive spirometer, topical mupirocin for the nostrils, and smoking cessation information. Study staff performed structured patient interviews, observations, and standardized surveys at key intervals throughout the perioperative period. Statistics compare HAI outcomes of patients in the wellness program to a nonintervention group using the Fisher's exact test, logistic regression, and Poisson regression. RESULTS Patients in the nonintervention and intervention groups were similar in demographics, comorbidity, and type of operations. Compliance with each element was high (80% mupirocin, 72% immuno-nutrition, 71% chlorhexidine bath, 67% spirometer). The intervention group had statistically significant reductions in surgical site infections, Clostridium difficile, catheter associated urinary tract infections, and patient safety indicator 90. CONCLUSIONS A novel, preoperative, patient-centered wellness program dramatically reduced HAI in surgical patients at an urban academic medical center.
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Liang Z, Rong K, Gu W, Yu X, Fang R, Deng Y, Lu L. Surgical site infection following elective orthopaedic surgeries in geriatric patients: Incidence and associated risk factors. Int Wound J 2019; 16:773-780. [PMID: 30790453 PMCID: PMC7948685 DOI: 10.1111/iwj.13096] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 01/21/2019] [Accepted: 01/26/2019] [Indexed: 11/27/2022] Open
Abstract
The purposes of this study were to investigate the incidence of surgical site infection (SSI) following geriatric elective orthopaedic surgeries and identify the associated risk factors This was a retrospective two-institution study. Between January 2014 and September 2017, patients aged 60 years or older undergoing elective orthopaedic surgeries were included for data collection and analysis. SSI was identified through the review of patients' medical records for the index surgery and through the readmission diagnosis of SSI. Patients' demographics, characteristics of disease, surgery-related variables, and laboratory examination indexes were inquired and documented. Univariate and multivariate logistic analyses were performed to determine independent risk factors for SSI. There were 4818 patients undergoing elective orthopaedic surgeries, and within postoperative 1 year, 74 patients were identified to develop SSIs; therefore, the overall incidence of SSI was 3.64%, with 0.4% for deep and 1.1% for superficial infection. Staphylococcus aureus (25/47, 53.2%) and coagulase-negative staphylococci (11/47, 23.4%) were the most common causative pathogens; half of S. aureus SSIs were caused by Methicillin-resistant Staphylococcus aureus (MRSA) (12/25, 48.0%). Five risk factors were identified to be independently associated with SSI, including diabetes mellitus (odds ratio [OR], 3.7; 95% confidence interval [95% CI], 1.7-5.6), morbid obesity (OR, 2.6; 95% CI, 1.3-3.9), tobacco smoking (OR, 4.2; 95% CI, 2.1-6.4), surgical duration>75th percentile (OR, 1.9; 95% CI, 1.0-2.9), and ALB < 35.0 g/L (OR, 2.3; 95% CI, 1.3-3.4). We recommend the optimisation of modifiable risk factors such as morbid obesity, tobacco smoking, and lower serum albumin level prior to surgeries to reduce the risk of SSI.
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Affiliation(s)
- Zhiquan Liang
- Department of Hand and Foot SurgeryThe First Hospital of Jilin UniversityChangchunJilin ProvinceChina
| | - Kai Rong
- Department of Hand and Foot SurgeryThe First Hospital of Jilin UniversityChangchunJilin ProvinceChina
| | - Wenfei Gu
- Department of Spine Surgery, Traditional Chinese HospitalXinjiang Medical UniversityUrumqiXinjiangP.R. China
| | - Xin Yu
- Department of Hand and Foot SurgeryThe First Hospital of Jilin UniversityChangchunJilin ProvinceChina
| | - Rui Fang
- Department of Joint Surgery, Traditonal Chinese HospitalXinjiang Medical UniversityXinjiangP.R. China
| | - Yingjie Deng
- Department of Joint Surgery, Traditonal Chinese HospitalXinjiang Medical UniversityXinjiangP.R. China
| | - Laijin Lu
- Department of Hand and Foot SurgeryThe First Hospital of Jilin UniversityChangchunJilin ProvinceChina
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Spitzmüller R, Gümbel D, Güthoff C, Zaatreh S, Klinder A, Napp M, Bader R, Mittelmeier W, Ekkernkamp A, Kramer A, Stengel D. Duration of antibiotic treatment and risk of recurrence after surgical management of orthopaedic device infections: a multicenter case-control study. BMC Musculoskelet Disord 2019; 20:184. [PMID: 31043177 PMCID: PMC6495646 DOI: 10.1186/s12891-019-2574-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 04/15/2019] [Indexed: 11/10/2022] Open
Abstract
Background Device-related infections in orthopaedic and trauma surgery are a devastating complication with substantial impact on morbidity and mortality. Systemic suppressive antibiotic treatment is regarded an integral part of any surgical protocol intended to eradicate the infection. The optimal duration of antimicrobial treatment, however, remains unclear. In a multicenter case-control study, we aimed at analyzing the influence of the duration of antibiotic exposure on reinfection rates 1 year after curative surgery. Methods This investigation was part of a federally funded multidisciplinary network project aiming at reducing the spread of multi-resistant bacteria in the German Baltic region of Pomerania. We herein used hospital chart data from patients treated for infections of total joint arthroplasties or internal fracture fixation devices at three academic referral institutions. Subjects with recurrence of an implant-related infection within 1 year after the last surgical procedure were defined as case group, and patients without recurrence of an implant-related infection as control group. We placed a distinct focus on infection of open reduction and internal fixation (ORIF) constructs. Uni- and multivariate logistic regression analyses were employed for data modelling. Results Of 1279 potentially eligible patients, 269 were included in the overall analysis group, and 84 contributed to an extramedullary fracture-fixation-device sample. By multivariate analysis, male sex (odds ratio [OR] 2.06, 95% confidence interval [CI] 1.08 to 3.94, p = 0.029) and facture fixation device infections (OR 2.05, 95% CI 1.05 to 4.02, p = 0.036) remained independent predictors of reinfection. In the subgroup of infected ORIF constructs, univariate point estimates suggested a nearly 60% reduced odds of reinfection with systemic fluoroquinolones (OR 0.42, 95% CI 0.04 to 2.46) or rifampicin treatment (OR 0.41, 95% CI 0.08 to 2.12) for up to 31 days, although the width of confidence intervals prohibited robust statistical and clinical inferences. Conclusion The optimal duration of systemic antibiotic treatment with surgical concepts of curing wound and device-related orthopaedic infections is still unclear. The risk of reinfection in case of infected extramedullary fracture-fxation devices may be reduced with up to 31 days of systemic fluoroquinolones and rifampicin, although scientific proof needs a randomized trial with about 1400 subjects per group. Concerted efforts are needed to determine which antibiotics must be applied for how long after radical surgical sanitation to guarantee sustainable treatment success.
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Affiliation(s)
- Romy Spitzmüller
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany.
| | - Denis Gümbel
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany.,Department of Trauma and Orthopaedic Surgery, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Str 7, 12683, Berlin, Germany
| | - Claas Güthoff
- Center for Clinical Research, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Str 7, 12683, Berlin, Germany
| | - Sarah Zaatreh
- Department of Orthopaedics, University Medicine Rostock, Doberaner Str 142, 18057, Rostock, Germany
| | - Annett Klinder
- Department of Orthopaedics, University Medicine Rostock, Doberaner Str 142, 18057, Rostock, Germany
| | - Matthias Napp
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany
| | - Rainer Bader
- Department of Orthopaedics, University Medicine Rostock, Doberaner Str 142, 18057, Rostock, Germany
| | - Wolfram Mittelmeier
- Department of Orthopaedics, University Medicine Rostock, Doberaner Str 142, 18057, Rostock, Germany
| | - Axel Ekkernkamp
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany
| | - Axel Kramer
- Department of Hygiene and Environmental Medicine, University Medicine Greifswald, Walther-Rathenau-Str 49A, 17489, Greifswald, Germany
| | - Dirk Stengel
- BG Kliniken Group of Hospitals, Leipziger Pl 1, 10117, Berlin, Germany
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Hordyk PJ, Fuerbringer BA, Roukis TS. Clinical Management of Acute, Closed Displaced Intra-Articular Calcaneal Fractures. Clin Podiatr Med Surg 2019; 36:163-171. [PMID: 30784528 DOI: 10.1016/j.cpm.2018.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Performing a thorough clinical evaluation following an acute displaced intra-articular calcaneal fracture is paramount for optimal surgical timing and long-term outcome. Initial survey must entail a comprehensive evaluation to rule out concurrent injuries. Focused lower extremity examination must involve a complete neurovascular and soft tissue evaluation to identify such conditions as compartment syndrome or compromised integument, which necessitate urgent intervention. Establishing baseline radiographs and advanced imaging is vital for surgical planning. Once deemed stable, protocol-driven treatment is best to ensure proper control of pain and edema and adequate management of economic and patient safety concerns.
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Affiliation(s)
- Peter J Hordyk
- Podiatric Medicine and Surgery Department, Gundersen Healthcare System, 1330 North Superior Avenue, Tomah, WI 54660, USA
| | - Brent A Fuerbringer
- Podiatric Medicine and Surgery Department, Gundersen Healthcare System, 1330 North Superior Avenue, Tomah, WI 54660, USA
| | - Thomas S Roukis
- Orthopaedic Center, Gundersen Health System, Mail Stop: CO2-006, 1900 South Avenue, La Crosse, WI 54601, USA.
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Bolger C, Jones D, Czop S. Evaluation of an increased strut porosity silicate-substituted calcium phosphate, SiCaP EP, as a synthetic bone graft substitute in spinal fusion surgery: a prospective, open-label study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1733-1742. [DOI: 10.1007/s00586-019-05926-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 01/30/2019] [Indexed: 10/27/2022]
Abstract
Abstract
Purpose
Silicate-substituted calcium phosphate-enhanced porosity (SiCaP EP, Inductigraft™, Altapore) is a synthetic bone graft material with enhanced strut porosity of 31–47%. SiCaP EP remains to be fully clinically evaluated in patients undergoing instrumented posterolateral fusion (PLF) surgery. We conducted a prospective, open-label, non-randomised, multicentre clinical study to evaluate efficacy of SiCaP EP as bone grafting material in PLF surgery with instrumentation for treatment of spinal disorders.
Methods
Patients with degenerative disc disease, spondylolisthesis or spinal stenosis underwent PLF surgery with SiCaP EP. The primary endpoint was evaluated in the per protocol population (N = 102) as solid fusion at postoperative month 12 assessed using computed tomography scans, with motion assessed using flexion–extension radiographs. Clinical outcomes included the Oswestry Disability Index, 36-item short-form health survey for quality-of-life, visual analog scale for pain scores and neurological assessments. Adverse events were recorded.
Results
Successful fusion was achieved in 59/89 (66.3%) patients at month 6, 88/102 patients (86.3%) at month 12 (primary endpoint) and 87/96 (90.6%) patients at month 24. Disability and pain reduced following surgery. Quality-of-life improved and neurological function was maintained postoperatively. Forty-three (33.3%) of the 129 patients who underwent surgery experienced adverse events; back pain was most frequent (n = 10); nine and 14 patients experienced serious adverse events judged related to device and procedure, respectively.
Conclusions
Enhanced strut porosity SiCaP EP provided high (month 12: 86.3%) spinal fusion success rates in PLF surgery. Fusion success was associated with improved clinical outcomes in patients within 12 months, relative to baseline.
ClinicalTrials.gov identifier
NCT01452022
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.
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Kumar L, Kumar AH, Grant SA, Gadsden J. Updates in Enhanced Recovery Pathways for Total Knee Arthroplasty. Anesthesiol Clin 2018; 36:375-386. [PMID: 30092935 DOI: 10.1016/j.anclin.2018.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Enhanced recovery after surgery (ERAS) programs for orthopedics involve a multidisciplinary approach to accelerating return to function, reducing pain, improving patient comfort and satisfaction, reducing complications from the surgical procedure, reducing hospital length of stay, and reducing costs. ERAS pathways for patients receiving total knee arthroplasty are different from those having intracavitary surgery; they are less focused on fluid homeostasis and gut motility than they are with optimizing systemic and local analgesics and providing a balance between the highest quality pain control and accelerated return to ambulation.
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Affiliation(s)
- Lisa Kumar
- Regional Anesthesiology and Acute Pain Medicine, Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA
| | - Amanda H Kumar
- Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA
| | - Stuart A Grant
- Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA
| | - Jeff Gadsden
- Department of Anesthesiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA.
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A Novel In Vivo Model to Study Impaired Tissue Regeneration Mediated by Cigarette Smoke. Sci Rep 2018; 8:10926. [PMID: 30026555 PMCID: PMC6053433 DOI: 10.1038/s41598-018-28687-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/13/2018] [Indexed: 12/27/2022] Open
Abstract
Cigarette smoke is associated with several pathologies including chronic respiratory diseases and cancer. In addition, exposure to cigarette smoke is correlated with impaired wound healing, where a significant decrease in the regenerative capacity of smokers is well documented and broadly considered a negative risk factor after trauma or surgery. So far, some in vitro and in vivo models have been described to study how exposure to cigarette smoke diminishes the regenerative potential in different organisms. However, although useful, many of these models are difficult and expensive to implement and do not allow high-throughput screening approaches. In order to establish a reliable and accessible model, we have evaluated the effects of cigarette smoke extract (CSE) on zebrafish development and regeneration. In this work, zebrafish embryos and larvae were exposed to low doses of aqueous CSE showing severe developmental abnormalities in a dose-dependent manner. Furthermore, when adult zebrafish were subjected to caudal fin amputation, we observed a significant decrease in the regenerative capacity of animals exposed to CSE. The effect was exacerbated in male and aged fish compared to female or young organisms. The establishment of a zebrafish model to assess the consequences of cigarette smoke and its effects on animal physiology could provide a new tool to study the underlying mechanisms involved in impaired tissue regeneration, and aid the development of novel approaches to treat complications associated with cigarette smoke toxicity.
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Abstract
INTRODUCTION Articular cartilage lesions of the hip are difficult to effectively treat. Osteochondral allograft (OCA) transplantation in the knee has been associated with long-term success, but OCA for the hip has not been extensively studied. Here, we present the clinical and radiological outcomes from a cohort of 10 patients treated with fresh OCA transplants for large osteochondral defects of the femoral head and/or acetabulum. METHODS 10 patients who had undergone osteochondral allograft transplantation of the femoral head and/or acetabulum at our institution between 2013 and 2016 were identified from our Institutional Review Board-approved registry. Hip disability and Osteoarthritis Outcome Score (HOOS) was used to track patient progress. RESULTS 10 patients with an average clinical follow-up of 1.4 years were included in this study. 4 patients were treated solely with OCA plugs for femoral head defects, while the remaining 6 received femoral OCA plugs and at least 1 concomitant procedure for additional intraarticular pathology. 7 patients (70%) had successful functional outcomes, while 3 (30%) had unsuccessful outcomes and were subsequently converted to total hip arthroplasty (THA) 5 to 29 months after OCA. CONCLUSIONS OCA transplantation can be an effective treatment strategy for young, healthy individuals with articular cartilage lesions of the hip. Smoking, avascular necrosis aetiology, acetabular involvement and concomitant procedures may be risk factors for unsuccessful outcomes necessitating salvage with THA. Long-term clinical studies to refine indications and determine functional outcomes and survival rates are warranted.
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The best cited articles of the European Journal of Orthopaedic Surgery and Traumatology (EJOST): a bibliometric analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:533-544. [DOI: 10.1007/s00590-018-2147-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 02/05/2018] [Indexed: 12/19/2022]
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Rhon DI, Clewley D, Young JL, Sissel CD, Cook CE. Leveraging healthcare utilization to explore outcomes from musculoskeletal disorders: methodology for defining relevant variables from a health services data repository. BMC Med Inform Decis Mak 2018; 18:10. [PMID: 29386010 PMCID: PMC5793373 DOI: 10.1186/s12911-018-0588-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 01/17/2018] [Indexed: 12/29/2022] Open
Abstract
Background Large healthcare databases, with their ability to collect many variables from daily medical practice, greatly enable health services research. These longitudinal databases provide large cohorts and longitudinal time frames, allowing for highly pragmatic assessment of healthcare delivery. The purpose of this paper is to discuss the methodology related to the use of the United States Military Health System Data Repository (MDR) for longitudinal assessment of musculoskeletal clinical outcomes, as well as address challenges of using this data for outcomes research. Methods The Military Health System manages care for approximately 10 million beneficiaries worldwide. Multiple data sources pour into the MDR from multiple levels of care (inpatient, outpatient, military or civilian facility, combat theater, etc.) at the individual patient level. To provide meaningful and descriptive coding for longitudinal analysis, specific coding for timing and type of care, procedures, medications, and provider type must be performed. Assumptions often made in clinical trials do not apply to these cohorts, requiring additional steps in data preparation to reduce risk of bias. The MDR has a robust system in place to validate the quality and accuracy of its data, reducing risk of analytic error. Details for making this data suitable for analysis of longitudinal orthopaedic outcomes are provided. Results Although some limitations exist, proper preparation and understanding of the data can limit bias, and allow for robust and meaningful analyses. There is the potential for strong precision, as well as the ability to collect a wide range of variables in very large groups of patients otherwise not captured in traditional clinical trials. This approach contributes to the improved understanding of the accessibility, quality, and cost of care for those with orthopaedic conditions. Conclusion The MDR provides a robust pool of longitudinal healthcare data at the person-level. The benefits of using the MDR database appear to outweigh the limitations.
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Affiliation(s)
- Daniel I Rhon
- Center for the Intrepid, Brooke Army Medical Center, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA.
| | - Derek Clewley
- Baylor University, 3630 Stanley Road, Bldg 2841, Suite 1301; Joint Base San Antonio - Fort Sam Houston, San Antonio, TX, 78234, USA
| | - Jodi L Young
- Division of Physical Therapy, Department of Orthopedics, Duke University, 2200 W. Main Street, Durham, NC, 27701, USA
| | - Charles D Sissel
- Department of Physical Therapy, Arizona School of Health Sciences, 5850 E. Still Circle, Mesa, AZ, 85206, USA
| | - Chad E Cook
- Headquarters, U.S. Army Medical Command, Analysis & Evaluation Division, 3630 Stanley Road; Joint Base San Antonio - Fort Sam Houston, San Antonio, TX, 78234, USA
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Björk J, Juth N, Lynøe N. "Right to recommend, wrong to require"- an empirical and philosophical study of the views among physicians and the general public on smoking cessation as a condition for surgery. BMC Med Ethics 2018; 19:2. [PMID: 29310657 PMCID: PMC5759185 DOI: 10.1186/s12910-017-0237-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 12/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In many countries, there are health care initiatives to make smokers give up smoking in the peri-operative setting. There is empirical evidence that this may improve some, but not all, operative outcomes. However, it may be feared that some support for such policies stems from ethically questionable opinions, such as paternalism or anti-smoker sentiments. This study aimed at investigating the support for a policy of smoking cessation prior to surgery among Swedish physicians and members of the general public, as well as the reasons provided for this. METHODS A random sample of general practitioners and orthopaedic surgeons (n = 795) as well as members of the general public (n = 485) received a mail questionnaire. It contained a vignette case with a smoking 57-year old male farmer with hip osteoarthritis. The patient had been recommended hip replacement therapy, but told that in order to qualify for surgery he needed to give up smoking four weeks prior to and after surgery. The respondents were asked whether making such qualifying demands is acceptable, and asked to rate their agreement with pre-set arguments for and against this policy. RESULTS Response rates were 58.2% among physicians and 53.8% among the general public. Of these, 83.9% and 86.6%, respectively, agreed that surgery should be made conditional upon smoking cessation. Reference to the peri-operative risks associated with smoking was the most common argument given. However, there was also strong support for the argument that such a policy is mandated in order to achieve long term health gains. CONCLUSIONS There is strong support for a policy of smoking cessation prior to surgery in Sweden. This support is based on considerations of peri-operative risks as well as the general long term risks of smoking. This study indicates that paternalistic attitudes may inform some of the support for peri-operative smoking cessation policies and that at least some respondents seem to favour a "recommendation strategy" vis-à-vis smoking cessation prior to surgery rather than a "requirement strategy". The normative reasons speak in favour of the "recommendation strategy".
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Affiliation(s)
- Joar Björk
- Stockholm Centre for Healthcare Ethics (CHE), LIME, Karolinska Institutet, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden
- Department of Research and Development, Region Kronoberg, Sigfridsvägen 5, 352 57 Växjö, Sweden
| | - Niklas Juth
- Stockholm Centre for Healthcare Ethics (CHE), LIME, Karolinska Institutet, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden
| | - Niels Lynøe
- Stockholm Centre for Healthcare Ethics (CHE), LIME, Karolinska Institutet, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden
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Quit Smoking before Orthopaedic Surgery. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2017. [DOI: 10.1016/j.jotr.2017.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
BACKGROUND Spinal fusion surgery is performed about half a million times per year in the United States and millions more worldwide. It is an effective method for reducing pain, increasing stability, and correcting deformity in patients with various spinal conditions. In addition to being a well-established risk factor for a variety of medical conditions, smoking has deleterious effects on the bone healing of spinal fusions. This review aims to specifically analyze the ways in which smoking affects the outcomes of spinal fusion and to explore ways in which these negative consequences can be avoided. PURPOSE This article provides a complete understanding of the ways smoking affects spinal fusion from a biochemical and clinical perspective. Recommendations are also provided for ways in which surgeons can limit patient exposure to the most serious negative outcomes associated with cigarette smoking. STUDY DESIGN/SETTING This study was a retrospective literature review done using the NCBI database. The research was compiled at NYU Hospital for Joint Diseases and the NYU Center for Musculoskeletal Care. METHODS A comprehensive literature review was done spanning research on a variety of subjects related to smoking and spinal fusion surgery. The biochemistry of smoking and fusion healing were examined in great detail. In addition, both in vivo animal studies and human clinical studies were evaluated to explore fusion success related to the effects of smoking and its biochemical factors on spinal fusion surgery. RESULTS Smoking significantly increases the risk of pseudoarthrosis for patients undergoing both lumbar and cervical fusions. In addition to nonunion, smoking also increases the risk of other perioperative complications such as infection, adjacent-segment pathology, and dysphagia. Treatment options are available that can be explored to reduce the risk of smoking-related morbidity, such as nicotine replacement therapy and use of bone morphogenetic proteins (BMPs). CONCLUSIONS It has been clearly demonstrated from both a biochemical and clinical perspective that smoking increases the rate of perioperative complications for patients undergoing spinal fusion surgery, particularly pseudoarthosis. It has also been shown that there are certain approaches that can reduce the risk of morbidity. The most important recommendation is smoking cessation for four weeks after surgery. In addition, patients may be treated with certain surgical techniques, including the use of BMPs, to reduce the risk of pseudoarthrosis. Lastly, nicotine replacement therapy is an area of continued interest in relation to spinal fusion outcomes and more research needs to be done to determine its efficacy moving forward.
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Affiliation(s)
| | | | - John Bendo
- NYU Hospital for Joint Diseases, Manhattan, NY
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Hirota K, Yamakage M, Hashimoto S, Asai T, Isono S. Perioperative respiratory complications: current evidence and strategy discussed in 2017 JA symposium. J Anesth 2017; 32:132-136. [PMID: 29134423 DOI: 10.1007/s00540-017-2432-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 10/31/2017] [Indexed: 12/12/2022]
Abstract
Respiratory management during general anesthesia aims to safely secure the airway and maintain adequate ventilation to deliver oxygen to the vital organs, maintaining homeostasis even during surgery. Despite its clinical importance, anesthesiologists often encounter difficulties in properly managing respiration during the perioperative period, leading to severe respiratory complications. In this year's JA symposium, 5 editorial board members of Journal of Anesthesia (JA) who are experts in the field of respiratory management in anesthesia discussed the following topics: quitting smoking before surgery: exposure to passive smoke is damaging to children, ventilator-associated pneumonia, high inspiratory oxygen concentration and lung injury, aspiration pneumonia, and postoperative respiratory management strategy in patients with obstructive sleep apnea. We hope that this special article regarding this year's JA symposium may be useful for JA readers to manage clinical anesthesia on a daily basis.
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Affiliation(s)
- K Hirota
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, 036-8562, Japan.
| | - M Yamakage
- Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, 060-8543, Japan
| | - S Hashimoto
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
| | - T Asai
- Department of Anesthesiology, Dokkyo Medical University, Koshigaya Hospital, Koshigaya, 343-8555, Japan
| | - S Isono
- Department of Anesthesiology, Chiba University Graduate School of Medicine, Chiba, 263-8670, Japan
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Oladeji LO, Stannard JP, Cook CR, Kfuri M, Crist BD, Smith MJ, Cook JL. Effects of Autogenous Bone Marrow Aspirate Concentrate on Radiographic Integration of Femoral Condylar Osteochondral Allografts. Am J Sports Med 2017; 45:2797-2803. [PMID: 28737949 DOI: 10.1177/0363546517715725] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Transplantation of fresh osteochondral allografts (OCAs) is an attractive treatment option for symptomatic articular cartilage lesions in young, healthy patients. Because the lack of OCA bone integration can be a cause of treatment failure, methods for speeding and enhancing OCA bone integration to mitigate this potential complication are highly desirable. PURPOSE To determine if autogenous bone marrow aspirate concentrate (BMC) treatment of large femoral condylar OCAs would be associated with superior radiographic OCA bone integration compared with nontreated allografts during the critical first 6 months after surgery. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A review of patients enrolled in a prospective registry who were treated with transplantation of large OCAs to one or both femoral condyles at our institution from March 12, 2013 to March 14, 2016 was performed. Patients were stratified into 2 groups based on BMC treatment versus no BMC treatment; the treatment was nonrandomized and was rooted in a shift in practice and a continuing effort to optimize OCA transplantation at our institution. Patients were excluded if they did not have orthogonal view radiographs performed at 6 weeks, 3 months, and 6 months postoperatively. Each condyle undergoing OCA transplantation was assessed individually by an independent musculoskeletal radiologist, who was blinded to the treatment group and time point. OCAs were assessed with respect to graft integration (0%-100%; 0 = no integration, 100 = complete integration) and degree of sclerosis (0-3; 0 = normal, 1 = mild sclerosis, 2 = moderate sclerosis, and 3 = severe sclerosis) of the graft at each time point. RESULTS This study identified 17 condyles in 15 patients who underwent OCA transplantation without BMC and 29 condyles in 22 patients who underwent OCA transplantation with BMC. The BMC group had significantly ( P = .033) higher graft integration scores at 6 weeks, 3 months, and 6 months after surgery. Graft sclerosis was significantly ( P = .017) less in the BMC group at 6 weeks and 3 months, with no significant difference at 6 months after surgery. When combining the groups to examine the influence of smoking on graft integration, nonsmokers had significantly ( P = .007) higher graft integration scores at 6 months. CONCLUSION Large femoral condylar OCAs treated with autogenous BMC before implantation showed superior radiographic integration to bone and less sclerosis during the initial 6-month postoperative period. BMC treatment of OCAs may mitigate the failure of OCA bone healing.
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Affiliation(s)
- Lasun O Oladeji
- Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - James P Stannard
- Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA.,Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri, USA
| | - Cristi R Cook
- Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA.,Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri, USA
| | - Mauricio Kfuri
- Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Brett D Crist
- Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Matthew J Smith
- Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA.,Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri, USA
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Harting J, Fernandez F, Kelley R, Wiemken T, Peyrani P, Ramirez J. Telavancin for the treatment of methicillin-resistant Staphylococcus aureus bone and joint infections. Diagn Microbiol Infect Dis 2017; 89:294-299. [PMID: 29137718 DOI: 10.1016/j.diagmicrobio.2017.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/24/2017] [Accepted: 09/10/2017] [Indexed: 10/18/2022]
Abstract
This retrospective, case series describes our experience with the use of telavancin in patients with methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis and prosthetic joint infection. The primary objectives were clinical outcomes and adverse events (AEs), and a secondary outcome described microbiological susceptibility. Fourteen patients were enrolled. Median duration of therapy was 58 days, and four patients had concurrent bacteremia. End-of-treatment outcomes were available in 78% of patients, with a clinical success rate of 91%. Thirty-day and 12-month outcomes were also obtained. Seven patients experienced AEs. Infusion-related reactions were most common, and three AEs required discontinuation of therapy. All MRSA isolates had a telavancin MIC ≤0.06μg/ml, which is susceptible. This study indicates that telavancin may have a role in treatment of MRSA osteomyelitis and prosthetic joint infection. Our study describes clinical success and adverse events for long duration of therapy, up to 8 weeks.
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Affiliation(s)
- Julie Harting
- Sullivan University College of Pharmacy, Louisville, KY; Division of Infectious Diseases, University of Louisville School of Medicine, University Hospital, Louisville, KY.
| | - Francisco Fernandez
- Division of Infectious Diseases, University of Louisville School of Medicine, University Hospital, Louisville, KY
| | - Rob Kelley
- Division of Infectious Diseases, University of Louisville School of Medicine, University Hospital, Louisville, KY
| | - Tim Wiemken
- Division of Infectious Diseases, University of Louisville School of Medicine, University Hospital, Louisville, KY
| | - Paula Peyrani
- Division of Infectious Diseases, University of Louisville School of Medicine, University Hospital, Louisville, KY
| | - Julio Ramirez
- Division of Infectious Diseases, University of Louisville School of Medicine, University Hospital, Louisville, KY
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Buchlak QD, Yanamadala V, Leveque JC, Edwards A, Nold K, Sethi R. The Seattle spine score: Predicting 30-day complication risk in adult spinal deformity surgery. J Clin Neurosci 2017; 43:247-255. [DOI: 10.1016/j.jocn.2017.06.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 06/08/2017] [Indexed: 01/01/2023]
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Truntzer J, Comer G, Kendra M, Johnson J, Behal R, Kamal RN. Perioperative Smoking Cessation and Clinical Care Pathway for Orthopaedic Surgery. JBJS Rev 2017; 5:e11. [DOI: 10.2106/jbjs.rvw.16.00122] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Cha SM, Shin HD, Hwang SJ. Temporary ipsilateral stiff shoulder after operative fixation of distal radial fractures. J Shoulder Elbow Surg 2017; 26:923-930. [PMID: 28526422 DOI: 10.1016/j.jse.2017.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/22/2017] [Accepted: 02/07/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study was conducted to identify variables affecting the development of temporary stiff shoulder after operative fixation for distal radial fractures (DRF). MATERIALS AND METHODS The study retrospectively analyzed 167 patients who had undergone internal fixation using volar locking plate for DRF between 2010 and 2013. Group 1 was denoted as the "normal group," and group 2 was denoted as the "stiff shoulder group." Basic demographic factors evaluated included age, sex, bone mineral density (BMD), and the dominancy. Also investigated were radiologic variables, including concurrent fractures of the styloid process, positive ulnar variances, classification of DRF, and morphologic type of the distal radioulnar joint. Finally, the type of plate, methods used for postoperative protection, and time of union were analyzed. RESULTS Group 1 consisted of 114 patients, and group 2 consisted of 53 patients. On overall univariate analysis, BMD, hand dominancy, and the protective methods after plating were significantly different between the 2 groups. On multivariate analysis, a lower BMD and injury on the nondominant side were significant factors for shoulder stiffness. Stiffness was significantly higher in patients with a mean BMD < -2.6 than in patients with a mean BMD ≥ -2.6. At the final follow-up, all of the 53 patients in group 2 were relieved of the symptoms of a stiff shoulder. CONCLUSIONS A lower BMD and injury on the nondominant distal radius were distinct factors for the development of a stiff shoulder after operative fixation in DRF. Fortunately, nonoperative treatments, such as stretching exercises/injections, were useful for the relief of these symptoms in the short-term follow-up.
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Affiliation(s)
- Soo Min Cha
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Hyun Dae Shin
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
| | - Sung Jin Hwang
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
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Cha SM, Shin HD, Ahn KJ. Prognostic Factors Affecting Union After Ulnar Shortening Osteotomy in Ulnar Impaction Syndrome: A Retrospective Case-Control Study. J Bone Joint Surg Am 2017; 99:638-647. [PMID: 28419031 DOI: 10.2106/jbjs.16.00366] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ulnar shortening osteotomy (USO) is a widely adopted procedure with excellent outcomes. However, delayed union or nonunion has occasionally been observed. The purpose of this retrospective case-control study was to identify variables affecting osseous consolidation after USO in patients with ulnar impaction syndrome. METHODS The study included 325 patients who had undergone USO between March 2008 and March 2014. We evaluated the association between union and basic demographic factors as well as preoperative pain (assessed on a visual analog scale [VAS]), range of wrist motion, grip strength, and modified Mayo wrist score. We also assessed the association of union with radiographic variables such as the degree of dorsal subluxation of the ulna, preoperative and postoperative ulnar variance, morphological type of the distal radioulnar joint, gap at the osteotomy site, and presence of newly developed arthritic changes during the follow-up period. Finally, variables associated with operative conditions, such as degeneration of the triangular fibrocartilage complex, use of a parallel double-blade saw, type of plate used for fixation, number of screws, and plate position on the volar or dorsal ulnar surface were investigated. RESULTS Ulnar union was achieved in 294 patients (group 1), and 31 patients had delayed union or nonunion (group 2). On univariate and multivariate analyses, smoking, low bone mineral density (BMD), a decreased range of motion of the wrist, and use of a double-blade saw were found to be significant factors for an adverse radiographic outcome (nonunion or delayed union). CONCLUSIONS Delayed union or nonunion occurred in about 10% of patients treated with USO. We suggest that it may be preferable to perform USO in nonsmokers, patients with normal bone density, and those without restricted wrist motion. Also, we recommend the use of a single-blade saw when performing the osteotomy. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Soo Min Cha
- 1Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
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A solution to the vessel shortage during free vascularized fibular grafting for reconstructing infected bone defects of the femur: Bridging with vein transplantation. Injury 2017; 48:486-494. [PMID: 27876350 DOI: 10.1016/j.injury.2016.10.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 10/16/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The present study aimed to evaluate the feasibility and clinical efficacy of bridging vein transplantation to deal with the vessel shortage during free vascularized fibular grafting for reconstructing infected bone defects of the femur. METHODS Twelve patients (aged 15-58 years) with infected bone defects of the femur (between 6.0 and 18.0cm) were recruited in this study. Vacuum sealing drainage were applied after extensive debridement of the infected bone defects and irrigated with 0.9% sodium chloride solution for 1-2 weeks. After the drainage was clear and the focal infections were controlled, the free vascularized fibula was harvested for reconstructing the femoral bone defects. The vascularized fibula was grafted and fixated appropriately at the recipient site. The autogenous great saphenous vein was harvested, one end was anastomosed and bridged the vascular pedicles of the fibular grafts, and the other end anastomosed the artery and/or the vein in the recipient healthy site. RESULTS Mean length of vein transplantation with vascularized fibular graft was 10.2 cm (range 7-15cm). All patients had good radiological healing without recorded nonunion or malunion. No patient developed deep infection or implant failure. Primary bone healing was achieved in 10 patients; however, 2 grafted fibular formed pseudarthrosis with the recipient femoral and then healed after a secondary surgery. One patient suffered from graft stress fracture after bone healing and healed after external fixation. After the mean follow-up of 30 months (9-72 months), according to the Enneking scoring system, clinical outcomes were excellent in 7 patients, good in 4 and fair in one. The functional recovery rate of the lesion limb was 89.4%. CONCLUSIONS Free vascularized fibular graft with vein transplantation bridged vascular pedicle can effectively repair the infected bone, improve blood supply to the bone defect site, and help control infection. It is a feasible and effective treatment for infected bone defects of the femur with poor soft tissue conditions, or blood supply vessel shortage.
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Abstract
BACKGROUND Percutaneous surgery to correct deformities of the forefoot presents the advantages of using a minimal incision, which involves less soft tissue damage and less risk of wound complications. For severe deformities, percutaneous techniques have not been proven as effective. We propose a technique for the treatment of severe hallux valgus. METHODS In a sample of 52 feet operated on 48 patients, we performed a double percutaneous osteotomy (closure proximal osteotomy and a distal Akin) or triple when a Reverdin-Isham osteotomy was added. We measured preoperatively the American Orthopaedic Foot & Ankle Society (AOFAS) score at the 1-year and 2-year follow-up, as well as the values of hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular ankle (DMAA), and shortening and elevation of the first metatarsal. The presence of metatarsalgia was recorded before and after the surgery. RESULTS HVA, IMA, and DMAA improved from 39.3 ± 7.1, 17.0 ± 2.0, and 16 ± 8.7 to 11.2 ± 6.2, 8.4 ± 3.4, and 8.3 ± 6.2, respectively. In 5 cases (10%), there was an elevation of the distal metatarsal bone, but only in 2 cases did a transfer metatarsalgia develop. There were no significant correlations between the amount of shortening and the presence of postoperative metatarsalgia. Scores on the AOFAS scale improved from 47.6 ± 5.6 to 89.7 ± 10.1 points. CONCLUSION The results are comparable to those reported with other more established techniques. Transfer metatarsalgia did not correlate with lifting or shortening of the metatarsal. We indicate the percutaneous technique for IMA above 15 degrees and increased DMAA or congruent joints. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Rodrigo Díaz Fernández
- 1 Universidad Católica de Valencia San Vicente Mártir, Catholic University of Valencia "Saint Vincent Martyr," Valencia, Spain.,2 Hospital de Manises, Valencia, Spain
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Smoking cessation advice in limb reconstruction: An opportunity not to be missed. Injury 2017; 48:345-348. [PMID: 28012552 DOI: 10.1016/j.injury.2016.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/09/2016] [Indexed: 02/02/2023]
Abstract
The adverse health effects of smoking are well known, including its effects on the musculoskeletal system. Limb reconstruction using external fixators is a high intensity process with high levels of patient contact time, complications and cost. The aim of this study was to examine smoking patterns in this group and in particular to assess trends in smoking cession. Data was collected from 41 patients all undergoing treatment using circular frame external fixation, for a variety of pathologies, most commonly acute tibial trauma. A patient reported questionnaire was used. Data was collected over a six-month period. In our population 56.1% of patients were smokers. During the study 47.8% patients stopped smoking and a further 39.1% decreased their smoking behaviour. 78.3% of patients could recall being given smoking cessation advice. In our group, 87% of patients were unaware of the effects of smoking on bone healing. Once made aware during discussion of proposed treatment, 73.9% stated that it was, in part, this knowledge that prompted them to positively change their smoking habits. The results of this study show that advice regarding smoking cessation during limb reconstruction treatment can potentially have a positive impact on patients smoking habits. The effect of smoking should be linked to the patient pathology and discussed during the consent process. Taking the time with the patient for this simple free intervention can have a positive impact on patient health, and potentially on the outcome of their current treatment, and is an opportunity not to be missed.
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Day of Surgery Admission in Total Joint Arthroplasty: Why Are Surgeries Cancelled? An Analysis of 3195 Planned Procedures and 114 Cancellations. Adv Orthop 2016; 2016:1424193. [PMID: 27974973 PMCID: PMC5128686 DOI: 10.1155/2016/1424193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/18/2016] [Indexed: 11/23/2022] Open
Abstract
Background. Day of surgery admission (DOSA) is becoming standard practice as a means of reducing cost in total joint arthroplasty. Aims. The aim of our study was to audit the use of DOSA in a specialty hospital and identify reasons for cancellation. Methods. A retrospective study of patients presenting for hip or knee arthroplasty between 2008 and 2013 was performed. All patients were assessed at the preoperative assessment clinic (PAC). Results. Of 3195 patients deemed fit for surgery, 114 patients (3.5%) had their surgery cancelled. Ninety-two cancellations (80%) were due to the patient being deemed medically unsuitable for surgery by the anaesthetist. Cardiac disease was the most common reason for cancellation (n = 27), followed by pulmonary disease (n = 22). 77 patients (67.5%) had their operation rescheduled and successfully performed in our institution at a later date. Conclusion. DOSA is associated with a low rate of cancellations on the day of surgery. Patients with cardiorespiratory comorbidities are at greatest risk of cancellation.
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