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Tsalkitzi E, Kitridis D, Heinz E, Hionidou C, Givissi K, Givissis P. The Metal in My Body: Patients' Perception and Attitude Toward Orthopedic Implants. Cureus 2024; 16:e56493. [PMID: 38638744 PMCID: PMC11026104 DOI: 10.7759/cureus.56493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION Metal implants are broadly used in orthopedics and traumatology to stabilize bone fragments. This study aimed to explore patients' awareness, body image, and overall experience of living with a metal implant after a fracture. METHODS A mixed methods convergent design (QUAN+QUAL) was adopted. A self-reported 30-item questionnaire was used to investigate patients' perception and apprehension of the implantation of orthopedic materials. To enlighten the quantitative findings, semi-structured interviews followed till data saturation. Quantitative and qualitative data were compared during the analysis phase. RESULTS Results showed that women's and elders' acceptance of the implants was greater than that of men and younger patients even in acute cases. The sense of superiority provided by the implant was mainly reported by the elderly (adjusted odds ratio (ORadj) for increasing age: 1.06; 95% CI: 1.02-1.1; p<0.01), and the sense of inferiority was mainly reported by young men (ORadj: 6.19; 95% CI: 2.36-16.22; p<0.01). Similarly, women and elderly mostly tended to answer that the injured limb felt stronger after the implant placement, while young men tended to answer a sense of weakness with the implant (ORadj for increasing age: 1.06; 95% CI: 1.03-1.09; ORadj for male gender: 4.67; 95% CI: 1.87-11.7; p<0.01 for both regressions). Most participants (56.6%) and mainly young participants, regardless of gender, expressed the desire to get the metal implants removed (ORadj for increasing age: 0.91; 95% CI: 0.89-0.95; p<0.01). Misinformation and misconception were also found in a high percentage of the questioned patients (48.1%). Thematic analysis of the interviews revealed that none of the participants directly attributed any change in their life, self, or body image to the implants. An altered body image was not reported. The most reported experience was the restriction of movement due to the accident or the subsequent physical weakness. CONCLUSION Despite the acceptance of the implant being great, the level of patient knowledge was fairly low. The present study highlights the importance of providing patients with information throughout their management to avoid misunderstandings. Age and gender did influence patients' perception of the implants. Personalized assessment is further needed to address body image issues after an implant placement procedure.
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Affiliation(s)
- Eleni Tsalkitzi
- Psychiatric Department, 424 Army General Training Hospital, Thessaloniki, GRC
| | - Dimitrios Kitridis
- Orthopedic Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GRC
- Orthopedics and Trauma Department, 424 Army General Training Hospital, Thessaloniki, GRC
| | - Elena Heinz
- Orthopedic Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Christina Hionidou
- Orthopedic Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Kornilia Givissi
- Orthopedic Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Panagiotis Givissis
- Orthopedic Department, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GRC
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Aamir J, Syziu A, Andritsos L, Caldwell R, Mason L. Tibialis posterior tendon entrapment in posterior malleolar and pilon injuries of the ankle: a retrospective analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:781-787. [PMID: 37698673 PMCID: PMC10858079 DOI: 10.1007/s00590-023-03714-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/22/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND The Tibialis Posterior tendon (TPT) is the only tendon to encounter the distal tibia and is therefore at greatest risk of injury in fractures of the distal tibia. Although TPT injury has been reported rarely with injuries around the ankle, they often have been missed and present late. AIM Our aim was to analyse the rate to TPT entrapment in fractures involving the posterior tibia, i.e. Pilon (PLM) and posterior malleolar fractures (PMF). METHODS A retrospective analysis of PMF and Pilon fractures over an 8-year period was undertaken. Patients who had undergone surgical fixation of their PMF or PLM were identified from 2014 to 2022, using our prospectively collected database. Any fracture which had undergone a preoperative CT was included. Analysis of their pre-operative CT imaging was utilised to identify TPT entrapment, where if < 50% of the tendon cross section was present in the fracture site, this was denoted as a minor entrapment and if ≥ 50% of the tendon was present in the fracture site was denoted as major. RESULTS A total of 363 patients were identified for further analysis, 220 who had a PMF and 143 with PLM injury. The incidence of TPT entrapment was 22% (n = 79) with 64 minor and 15 major entrapments. If the fracture line entered the TPT sheath, there was a 45% rate (72/172) of entrapment as compared to 3.7% (7/190) in fractures not entering the sheath (p < .001). There was no significant difference in TPT entrapment in PMF as compared to PML (p = 0.353). CONCLUSION In our assessment, we found significant prevalence of 22% of TPT entrapment in fractures involving the posterior tibia. PMF and PLF had no statistically significant difference in the rate of TPT entrapment. Additionally, we found that there was a significant risk of TPT entrapment when the CT images display the fracture line entering the tendon sheath. We recommend that surgeons consider taking care assessing pre-operative imaging to seek to identify the TPT and to assess intraoperatively where entrapment does occur.
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Affiliation(s)
- Junaid Aamir
- Liverpool Orthopaedic Trauma Service, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Anxhela Syziu
- School and Medicine, University of Liverpool, Liverpool, UK
| | - Loukas Andritsos
- Liverpool Orthopaedic Trauma Service, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Robyn Caldwell
- Liverpool Orthopaedic Trauma Service, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Lyndon Mason
- Liverpool Orthopaedic Trauma Service, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK.
- School and Medicine, University of Liverpool, Liverpool, UK.
- Department of Trauma and Orthopaedics, Aintree University Hospital, Liverpool, UK.
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Scheinberg M, Sanchez T, Sankey T, Underwood M, Young M, Earla R, Singh S, Shah A. Patient-Reported Outcomes Following Open Broström-Gould Procedure: Minimum 5-Year Follow-Up. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241228272. [PMID: 38323104 PMCID: PMC10846174 DOI: 10.1177/24730114241228272] [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] [Indexed: 02/08/2024] Open
Abstract
Background Ankle sprains are a common musculoskeletal injury among the general population and often involve the lateral ligament complex. Although the majority of ankle sprains are treated successfully with nonsurgical conservative measures, an estimated 5% to 20% of ankle injuries ultimately develop chronic lateral ankle instability (CAI). Multiple surgical treatment modalities for the lateral ankle complex exist, such as anatomical and nonanatomical reconstruction. The current gold standard for primary surgical repair is the Broström-Gould procedure. This is the first article to provide PROMIS scores following BG and the largest study with 5-year outcomes for an open BG. Methods This was a descriptive study of a retrospective cohort of patients undergoing a BG with a minimum follow-up of 5 years. Patient-reported outcome instruments collected postoperatively were PROMIS Pain, Physical Function, Depression, and FAAM. Further preoperative clinic characteristics were analyzed to correlate with the final outcome. The electronic medical record was queried for Current Procedural Terminology (CPT) code 27698 (Broström-Gould) from January 2010 to June 2017. Surveys were conducted in the clinic and through phone interviews. Patient charts were reviewed to obtain basic patient demographic information including sex, age, race, and body mass index (BMI). The following preoperative variables were recorded: history of prior CAI procedures, history of major trauma, duration of symptoms, number of diagnosed ankle sprains, other collagen pathologies, generalized ligament laxity, participation in sports/activity level, peroneal subluxation, clinically diagnosed peroneus longus or brevis tendinopathy, deltoid ligament injury, anterior ankle impingement, and posterior ankle impingement. The PROMIS and Foot and Ankle Ability Measure (FAAM) scores were obtained with a combination of clinic and phone interviews. Data were aggregated in Microsoft Excel and entered in R (version 4.2.0) for statistical analysis. Results Our results show that the minimum 5-year patient-reported PROMIS scores for patients following a Broström-Gould procedure are as follows: PROMIS physical function, 50.5; PROMIS pain interference, 48.2; and PROMIS depression, 38.2. This indicates, at a minimum, that patients 5 years removed from the procedure are within 1 SD of the general population in regard to PROMIS physical function and pain. Our patient-reported FAAM, activities of daily living, and FAAM sports scores were 59.6 and 13.0 respectively. Preoperative magnetic resonance imaging (MRI) findings were recorded. Arthroscopic examination was performed before lateral ligaments reconstruction for patients with intra-articular pathologies confirmed on MRI. Conclusion The findings from our study offer evidence supporting the effectiveness of the Broström-Gould procedure to be associated with normal physical function, even 5 years after surgery. Furthermore, our research identified specific factors such as tobacco use, diabetes, and sports participation that independently correlated with reported outcome measures. These insights enable physicians to better manage patient expectations and tailor treatment strategies accordingly. Our study establishes a foundation for future prospective research endeavors that aim to leverage the PROMIS system for comprehensive outcome assessments. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Mila Scheinberg
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, AL, USA
| | - Thomas Sanchez
- Department of Family Medicine, Lexington Medical Center, West Columbia, SC, USA
| | - Turner Sankey
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, AL, USA
| | - Meghan Underwood
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, AL, USA
| | - Matthew Young
- School of Medicine, University of Alabama at Birmingham, AL, USA
| | | | - Swapnil Singh
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, AL, USA
| | - Ashish Shah
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, AL, USA
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Bastías GF, Sepúlveda S, Bruna S, Contreras M, Hube M, Cuchacovich N, Bergeret JP, Fuentes P. Comparison of complications and reoperations in AO/OTA 43.C3 pilon fractures treated with conventional ORIF versus minimally invasive hexapod ring fixation. Injury 2023; 54 Suppl 6:110884. [PMID: 38143151 DOI: 10.1016/j.injury.2023.110884] [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: 03/01/2023] [Revised: 06/04/2023] [Accepted: 06/04/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Controversy exists regarding the optimal management of AO/OTA 43. C3 pilon fractures. Open reduction and internal fixation (ORIF) is the gold standard treatment, but serious soft tissue and infectious complications have been previously reported. Minimally invasive strategies using hexapod ring fixation (HRF) with supplemental limited internal fixation have been used to reduce the incidence of complications. Previous studies have included heterogeneous types of pilon fractures, with non-comminuted injuries being more likely to be treated with ORIF and complex fractures receiving HRF treatment. To our knowledge, no studies have compared the complications and reoperation rates between ORIF and HRF exclusively for C3 fractures. METHODS Retrospective study comparing 53 patients treated for AO/OTA 43.C3 pilon fracture with ORIF or HRF in a trauma level I center with at least a two-year follow-up. Patients treated between January 2015 and January 2019 received ORIF and those treated between January 2019 and January 2021 received HRF. Complications were divided into two groups: minor (superficial infection and malalignment) and major (non-union, deep infection, and amputation). Reoperations, prevalence of ankle osteoarthritis, and requirement for ankle arthrodesis/total ankle replacement were registered. RESULTS We included 30 and 23 patients in the ORIF and HRF groups, respectively. The overall complication rate was similar in both groups, with 50% and 56,5% of the patients having complications in the ORIF and HRF groups, respectively (p:0,63). Minor complications were significantly more prevalent in the HRF group (p<0,001) whilst the ORIF group had a significantly higher rate of major complications (p<0,01). Superficial infections were highly prevalent in the HRF group (47,8%), as they were related to half-pin or K-wire infections. Deep infection was present only in the ORIF group, with 20% of the patients developing this major complication (p:0,03). Non-union rate, reoperations, ankle osteoarthritis, and the need for arthrodesis or ankle replacement showed no significant differences. CONCLUSION In AO/OTA 43.C3 fractures, HRF is safe and effective, achieving high union rates with a significantly lower rate of major complications compared to ORIF. According to our results, ORIF should be used cautiously for these types of fractures, considering the increased risk of deep infection.
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Affiliation(s)
- Gonzalo F Bastías
- Department of Orthopedic Surgery, Foot and Ankle Unit, Hospital del Trabajador, Santiago, Chile; Centro de Excelencia en Reconstrucción Ósea, Santiago, Chile.
| | - Sebastián Sepúlveda
- Department of Orthopedic Surgery, Foot and Ankle Unit, Hospital de Puerto Montt; Clínica Andes Salud Puerto Montt, Puerto Montt, Chile
| | - Sergio Bruna
- Department of Orthopedic Surgery, Hospital del Trabajador, Santiago, Chile
| | - Martin Contreras
- Department of Orthopedic Surgery, Hospital del Trabajador, Santiago, Chile
| | - Maximiliano Hube
- Department of Orthopedic Surgery, Foot and Ankle Unit, Hospital del Trabajador, Santiago, Chile; Centro de Excelencia en Reconstrucción Ósea, Santiago, Chile
| | - Natalio Cuchacovich
- Department of Orthopedic Surgery, Foot and Ankle Unit, Hospital del Trabajador, Santiago, Chile; Centro de Excelencia en Reconstrucción Ósea, Santiago, Chile
| | - Juan Pedro Bergeret
- Department of Orthopedic Surgery, Foot and Ankle Unit, Hospital del Trabajador, Santiago, Chile
| | - Patricio Fuentes
- Department of Orthopedic Surgery, Foot and Ankle Unit, Hospital del Trabajador, Santiago, Chile; Centro de Excelencia en Reconstrucción Ósea, Santiago, Chile
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Otsubo R, Hashida R, Murotani K, Iwanaga S, Hirota K, Koya S, Tsukada Y, Ogata Y, Yokosuka K, Yoshida T, Nakae I, Fudo T, Morito S, Shimazaki T, Yamada K, Sato K, Matsuse H, Shiba N, Hiraoka K. Phase angle is related to physical function and quality of life in preoperative patients with lumbar spinal stenosis. Sci Rep 2023; 13:13909. [PMID: 37626144 PMCID: PMC10457364 DOI: 10.1038/s41598-023-40629-0] [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: 12/06/2022] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
Lumbar spinal stenosis (LSS) can interfere with daily life and quality of life (QOL). Evaluating physical function and QOL and helping patients to improve is the focus of rehabilitation. Phase angle (PhA) assessment is widely used to measure body composition and is considered an indicator of physical function and QOL. This study investigated the relationship between PhA and physical function, physical activity, and QOL in patients with LSS. PhA, handgrip strength, walking speed, Timed Up and Go test (TUG), Life Space Assessment (LSA), Prognostic Nutritional Index (PNI), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), and EQ-5D were assessed and statistically analyzed. The study included 133 patients with LSS. Multiple regression analysis of PhA adjusted for age, sex, and body mass index (Model 1) and for Model 1 + PNI (Model 2) showed significant correlations (P < 0.05) with handgrip strength, walking speed, TUG, and LSA. Regarding QOL, PhA was significantly correlated (P < 0.05) with lumbar function in JOABPEQ. PhA was associated with physical function and QOL in patients with LSS and might be a new clinical indicator in this population.
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Affiliation(s)
- Ryota Otsubo
- Division of Rehabilitation, Kurume University Hospital, 67 Asahi-machi, Kurume, Fukuoka, Japan, 830-0011
| | - Ryuki Hashida
- Division of Rehabilitation, Kurume University Hospital, 67 Asahi-machi, Kurume, Fukuoka, Japan, 830-0011.
- Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan.
| | - Kenta Murotani
- Biostatistics Center, Kurume University, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Sohei Iwanaga
- Division of Rehabilitation, Kurume University Hospital, 67 Asahi-machi, Kurume, Fukuoka, Japan, 830-0011
- Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Keisuke Hirota
- Division of Rehabilitation, Kurume University Hospital, 67 Asahi-machi, Kurume, Fukuoka, Japan, 830-0011
| | - Shunji Koya
- Division of Rehabilitation, Kurume University Hospital, 67 Asahi-machi, Kurume, Fukuoka, Japan, 830-0011
| | - Yuya Tsukada
- Institute of Health and Sports Sciences, Kurume University, Kurume, Japan
| | - Yuta Ogata
- Division of Rehabilitation, Kurume University Medical Center, Kurume, Japan
| | - Kimiaki Yokosuka
- Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Tatsuhiro Yoshida
- Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Ichiro Nakae
- Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Takuma Fudo
- Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Shinji Morito
- Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Takahiro Shimazaki
- Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Kei Yamada
- Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Kimiaki Sato
- Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Hiroo Matsuse
- Division of Rehabilitation, Kurume University Hospital, 67 Asahi-machi, Kurume, Fukuoka, Japan, 830-0011
- Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Naoto Shiba
- Division of Rehabilitation, Kurume University Hospital, 67 Asahi-machi, Kurume, Fukuoka, Japan, 830-0011
- Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
| | - Koji Hiraoka
- Department of Orthopaedics, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan
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Czerwonka N, Desai SS, Arciero E, Greisberg J, Trofa DP, Chien BY. Contemporary Review: An Overview of the Utility of Patient-Reported Outcome Measurement Information System (PROMIS) in Foot and Ankle Surgery. Foot Ankle Int 2023; 44:554-564. [PMID: 37114948 DOI: 10.1177/10711007231165752] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Patient-Reported Outcome Measurement Information System (PROMIS) has favorable psychometric and administrative properties in orthopaedic clinical research. It facilitates clinically meaningful data collection while minimizing administration time and survey fatigue and improving compliance. PROMIS is a critical component of patient-centered care and shared decision making, as it provides enhanced communication and engagement between patients and providers. As a validated instrument, it may also aid in measuring value-based health care quality. The goal of the current work is to provide an overview of PROMIS metrics used in orthopaedic foot and ankle, including advantages and disadvantages compared to legacy scales and PROMIS's applicability in specific foot and ankle conditions based on psychometric properties. We provide a review of the literature regarding the utilization of PROMIS as an outcome measure for specific foot and ankle procedures and conditions.
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Affiliation(s)
- Natalia Czerwonka
- New York Medical College, Valhalla, NY, USA
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York-Presbyterian, New York, NY, USA
| | - Sohil S Desai
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York-Presbyterian, New York, NY, USA
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Emily Arciero
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York-Presbyterian, New York, NY, USA
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Justin Greisberg
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York-Presbyterian, New York, NY, USA
| | - David P Trofa
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York-Presbyterian, New York, NY, USA
| | - Bonnie Y Chien
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York-Presbyterian, New York, NY, USA
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Kellam PJ, Cutshall ZA, Dekeyser GJ, Rothberg DL, Higgins TF, Haller JM, Marchand LS. Recovery Curve for Patients With Pilon Fractures Using Patient-Reported Outcome Measurement Information System. Foot Ankle Int 2023; 44:317-321. [PMID: 36932665 DOI: 10.1177/10711007231156424] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
BACKGROUND The time frame in which patients can expect functional improvement after open reduction internal fixation (ORIF) of pilon fractures is unclear. The purpose of this study was to determine the trajectory and rate at which patients' physical function improves up to 2 years postinjury. METHODS The patients studied sustained a unilateral, isolated pilon fractures (AO/OTA 43B/C) and followed at a level 1 trauma center over a 5-year period (2015-2020). Patient-Reported Outcomes Measurement Information Systems (PROMIS) Physical Function (PF) scores from these patients at defined follow-up times of immediately, 6 weeks, 3 months, 6 months, 1 year, and 2 years after surgery defined the cohorts and were retrospectively studied. RESULTS There were 160 patients with PROMIS scores immediately postoperatively, 143 patients at 6 weeks, 146 patients at 12 weeks, 97 at 24 weeks, 84 at 1 year, and 45 at 2 years postoperatively. The average PROMIS PF score was 28 immediately postoperatively, 30 at 6 weeks, 36 at 3 months, 40 at 6 months, 41 at 1 year, and 39 at 2 years. There was a significant difference between PROMIS PF scores between 6 weeks and 3 months (P < .001), and between 3 and 6 months (P < .001). Otherwise, no significant differences were detected between consecutive time points. CONCLUSION Patients with isolated pilon fractures demonstrate the majority of their improvement in terms of physical function between 6 weeks and 6 months postoperatively. No significant difference was detected in PF scores after 6 months postoperatively up to 2 years. Furthermore, the mean PROMIS PF score of patients 2 years after recovery was approximately 1 SD below the population average. This information is helpful in counseling patients and setting expectations for recovery after pilon fractures. LEVEL OF EVIDENCE Level III, prognostic.
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Affiliation(s)
- Patrick J Kellam
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Zachary A Cutshall
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Graham J Dekeyser
- Department of Orthopaedic Surgery, Oregon Health Sciences University, Portland, Oregon, USA
| | - David L Rothberg
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Thomas F Higgins
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Justin M Haller
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Lucas S Marchand
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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Clough EJ, Kasture S, Dalal R. Clinical and Patient reported outcomes following open reduction and internal fixation for distal tibial intra-articular fractures. Foot (Edinb) 2023; 54:101972. [PMID: 36827890 DOI: 10.1016/j.foot.2023.101972] [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: 06/19/2022] [Revised: 11/13/2022] [Accepted: 02/03/2023] [Indexed: 02/13/2023]
Abstract
INTRODUCTION Intra-articular distal tibial plafond fractures are rare injuries, provide a challenge for the surgeon and can often have poor outcomes. The aim of this paper was to report long term patient reported functional outcomes, health related quality of life (QoL) scores and rates of complications in order to fully counsel the patient on likely outcomes and set realistic post-operative expectations for the patient. METHODS We conducted a retrospective review of 20 patients with distal tibial intra-articular fractures that presented to our institution between September 2014 and September 2020. All patients underwent open reduction and internal fixation (ORIF). Clinical, radiological and patient reported outcome measures (PROMS), quality of life (QoL) scores and complications were collected. RESULTS The mean age of the patients at the time of surgery was 50.6 years (24-71). There were 7 males and 13 females. There were 4 open and 16 closed fractures. There were 7 Rüedi and Allgöwer (RA) Type 1, 9 Type 2 and 4 Type 3 fractures. The mean follow-up was 3.8 years [1-7]. The mean OMAS score was 54.3, reaching a peak at 2 years from injury. The mean QoL score (EQ5D5L) was 0.602, representing only 70 % of aged matched, UK population based norms. CONCLUSIONS Whilst clinical outcomes are comparable with other studies, this report highlights this is a devastating injury, with most people taking 2 years to reach peak recovery. QoL outcome scores only reach 70 % normal and only 35 % of patients return to within 10 % of age matched population based norms.
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Xie L, Liu G, Wang X, Luo Z, Li Y, Wang X, Zhang F. Development of a nomogram to predict surgical site infection after open reduction and internal fixation for closed pilon fracture: a prospective single-center study. J Orthop Surg Res 2023; 18:110. [PMID: 36793098 PMCID: PMC9933287 DOI: 10.1186/s13018-023-03598-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND To explore the risk factors and develop a nomogram in order to predict surgical site infection (SSI) after open reduction and internal fixation (ORIF) for closed pilon fractures (CPF). METHODS A prospective cohort study with one-year follow-up was carried out in a provincial trauma center. From January 2019 to January 2021, 417 adult patients with CPFs receiving ORIF were enrolled. A Whitney U test or t test, Pearson chi-square test, and multiple logistic regression analyses were gradually used for screening the adjusted factors of SSI. A nomogram model was built to predict the risk of SSI, and the concordance index (C-index), the receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA) were used for evaluating the prediction performance and consistency of the nomogram model. The bootstrap method was employed to test the validity of the nomogram. RESULTS The incidence of SSI after ORIF for CPFs was 7.2% (30/417): 4.1% (17/417) of superficial SSIs and 3.1% (13/417) of deep SSIs. The most common pathogenic bacteria were Staphylococcus aureus (36.6%, 11/30). The multivariate analysis showed tourniquet use, longer preoperative stay, lower preoperative albumin (ALB), higher preoperative body mass index (BMI) and hypersensitive C-reactive protein (Hs-CRP) were independent risk factors of SSI. Additionally, the C-index and bootstrap value of the nomogram model were 0.838 and 0.820, respectively. Finally, the calibration curve indicated that the actual diagnosed SSI had good consistency with the predicted probability, and the DCA showed that the nomogram had clinical value. CONCLUSIONS Tourniquet use, longer preoperative stay, lower preoperative ALB, higher preoperative BMI and Hs-CRP were five independent risk factors of SSI after closed pilon fractures treated by ORIF. These five predictors are shown on the nomogram, with which we may be able to further prevent the CPS patients from SSI. Trial registration NO 2018-026-1, October /24/2018, prospectively registered. The study was registered in October 24, 2018. The study protocol was designed based on the Declaration of Helsinki and admitted by the Institutional Review Board. The ethics committee approved the study on factors related to fracture healing in orthopedic surgery. Data analyzed in the present study were acquired from the patients who underwent open reduction and internal fixation from January 2019 to January 2021.
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Affiliation(s)
- Lei Xie
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 Hebei Province People’s Republic of China
| | - Guofeng Liu
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 Hebei Province People’s Republic of China ,The Sixth Department of Orthopaedic Surgery, The HanDan Central Hospital, HanDan, Hebei Province People’s Republic of China
| | - Xin Wang
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 Hebei Province People’s Republic of China
| | - Zixuan Luo
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 Hebei Province People’s Republic of China
| | - Yansen Li
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 Hebei Province People’s Republic of China
| | - Xiaomeng Wang
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 Hebei Province People’s Republic of China
| | - Fengqi Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei Province, People's Republic of China.
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10
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Johnson LG, Kearney MM, Allen NB, Adams SB. Three-Year Follow-Up of a Traumatic Critical-Sized Tibial Bone Defect Treated with a 3D Printed Titanium Cage: A Case Report. JBJS Case Connect 2023; 13:01709767-202303000-00048. [PMID: 36812355 DOI: 10.2106/jbjs.cc.22.00077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
CASE We report a case involving a 21-year-old woman who sustained a Grade III open pilon fracture of the left ankle during a motor vehicle accident that resulted in a 12-cm critical-sized bone defect (CSD) that was successfully treated with a three-dimensional (3D) printed titanium alloy (Ti-6Al-4V) cage, a tibiotalocalcaneal intramedullary nail, and autogenous and allograft bone. The patient's reported outcome measures were comparable with those reported for non-CSD injuries at 3-year follow-up. The authors conclude that 3D printed titanium cages offers a unique approach to traumatic limb salvage for tibial CSD. CONCLUSIONS 3D printing offers a novel solution to CSDs. To the best of our knowledge, this case report details the largest 3D printed cage, to date, used to treat tibial bone loss. This report describes a unique approach to traumatic limb salvage with favorable patient-reported outcomes and evidence of radiographic fusion at a 3-year follow up.
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Affiliation(s)
- Lindsey G Johnson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.,Campbell University School of Osteopathic Medicine, Lillington, North Carolina
| | - Molly M Kearney
- Campbell University School of Osteopathic Medicine, Lillington, North Carolina
| | - Nicholas B Allen
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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11
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Wheelwright JC, Christensen GV, Cizik AM, Zhang C, Marchand LS, Haller JM. Significant Factors of High Performance Outcomes for Tibial Plafond Fractures. Foot Ankle Int 2022; 43:1261-1268. [PMID: 35869643 PMCID: PMC10563871 DOI: 10.1177/10711007221112924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Limited research exists about high performance postsurgical tibial plafond fractures. This study aimed to identify aspects of the plafond fracture injury and care associated with "high performance" based on Patient Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) scores. METHODS Tibial plafond fracture patients with minimum 12-month follow-up treated at a level 1 trauma center from 2006 to 2019 were categorized into high (top 25%) vs average-low (AL) (bottom 75%) performers based on PROMIS PF scores. Demographics and fracture characteristics of high and AL performers were compared. Variables with a P value less than .1 were used in stepwise logistic regressions. RESULTS The final cohort of 198 patients was divided into high (n=51) and AL (n=147) performers based on PF scores. The mean PF scores for the high and AL groups were 58 (SD=5.3) and 41.9 (SD=6.5), respectively. The mean PROMIS Pain Interference scores for the high performers and AL were 43.3 (SD=4.9) and 56.8 (SD=8.6) (P < .001), respectively. FAAM activities of daily living (high 95.4 [SD=5.5] vs AL 70.4 [SD=19.8], P < .001) and FAAM sports (high 76.8 [SD=21.3] vs AL 27.3 [SD=28.9], P < .001) subscale scores were significantly greater in the high-performing group. Sex, age, marital status, and diabetes were nonsignificant factors in univariate analysis. Significant demographic factors associated with high performance from univariate analysis were Caucasian race, private insurance, no tobacco use, lower body mass index (BMI), and mechanism of injury. Patients with fracture characteristics of OTA 43C (complete articular) fractures, bone loss, open fractures, or nonexcellent reduction were significantly less likely to be high performers. Additionally, less than excellent reductions were more common in more complex fracture patterns. Multivariable regression modeling showed that higher BMI, OTA/AO 43-C (complete articular) fracture classification, and open fracture were significant independent risk factors for reducing likelihood of high performance. CONCLUSION Significant independent factors associated with high performance after tibial plafond fracture are lower BMI, closed fracture, and OTA/AO 43-B (partial articular) fracture.
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Affiliation(s)
- John C. Wheelwright
- Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, UT
| | | | - Amy M. Cizik
- Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, UT
| | - Chong Zhang
- Biostatistical Analyst, University of Utah Health, Salt Lake City, UT
| | - Lucas S. Marchand
- Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, UT
| | - Justin M. Haller
- Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, UT
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12
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Christensen GV, Wheelwright JC, Rothberg DL, Higgins TF, Marchand LS, Haller JM. Syndesmotic Injury in Tibial Plafond Fractures Is Associated With Worse Patient Outcomes. J Orthop Trauma 2022; 36:469-473. [PMID: 35149618 PMCID: PMC9357226 DOI: 10.1097/bot.0000000000002356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To present long-term patient-reported outcomes of tibial plafond fractures with and without concomitant ankle syndesmotic injury. DESIGN Retrospective cohort study. SETTING Academic Level 1 trauma center. PATIENTS/PARTICIPANTS One hundred ninety-seven patients with tibial plafond fractures (OTA/AO 43-B and 43-C) treated with definitive surgical fixation were contacted by telephone or email to obtain patient-reported outcome scores at a minimum follow-up of 1 year. Of those contacted, 148 (75%) had an intact syndesmosis, whereas 49 (25%) experienced a syndesmotic injury. INTERVENTION The intervention involved open reduction internal fixation of the tibial plafond with syndesmosis repair when indicated. MAIN OUTCOME MEASUREMENT The main outcome measurement included patient-reported ankle pain and function using Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference and physical function (PF). RESULTS The cohort including patients with syndesmotic injury had significantly more open fractures (syndesmotic injury = 39%, no syndesmotic injury = 16%, P = 0.001), higher rates of end-stage reconstruction (syndesmotic injury = 27%, no syndesmotic injury = 10%, P = 0.004), and worse PROMIS PF (syndesmotic injury = 42.5 [SD = 8.0], no syndesmotic injury = 47.1 [SD = 9.6], P = 0.045) scores at final follow-up when compared with the cohort comprising patients with no syndesmotic injury. Patients with syndesmotic injury trended toward higher rates of postoperative infection, but this association was not statistically significant. There was no difference between the groups in nonunion or PROMIS pain interference scores. CONCLUSION Patients with a tibial plafond fracture and concomitant syndesmotic injury had significantly worse PROMIS PF scores, more end-stage ankle reconstructions, and more open fractures. Syndesmotic injury in the setting of tibial plafond fractures portends worse patient outcomes. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Garrett V. Christensen
- Research Associate, Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, UT
| | - John C. Wheelwright
- Research Associate, Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, UT
| | - David L. Rothberg
- Associate Professor, Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, UT
| | - Thomas F. Higgins
- Professor, Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, UT
| | - Lucas S. Marchand
- Instructor, Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, UT
| | - Justin M. Haller
- Assistant Professor, Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, UT
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13
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Houwen T, de Munter L, Lansink KWW, de Jongh MAC. There are more things in physical function and pain: a systematic review on physical, mental and social health within the orthopedic fracture population using PROMIS. J Patient Rep Outcomes 2022; 6:34. [PMID: 35384568 PMCID: PMC8986932 DOI: 10.1186/s41687-022-00440-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background The Patient-Reported Outcomes Information System (PROMIS®) is more and more extensively being used in medical literature in patients with an orthopedic fracture. Yet, many articles studied heterogeneous groups with chronic orthopedic disorders in which fracture patients were included as well. At this moment, there is no systematic overview of the exact use of PROMIS measures in the orthopedic fracture population. Therefore this review aimed to provide an overview of the PROMIS health domains physical health, mental health and social health in patients suffering an orthopedic fracture.
Methods This systematic review was documented according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. We searched Embase, Medline, Web of Science Core Collection, and Cochrane Central Register of controlled Trials, CINAHL and Google Scholar in December 2020 using a combination of MeSH terms and specific index terms related to orthopedic fractures and PROMIS questionnaires. Inclusion criteria were available full text articles that were describing the use of any PROMIS questionnaires in both the adult and pediatric extremity fracture population. Results We included 51 relevant articles of which most were observational studies (n = 47, 92.2%). A single fracture population was included in 47 studies of which 9 involved ankle fractures (9/51; 17.6%), followed by humeral fractures (8/51; 15.7%), tibia fractures (6/51; 11.8%) and radial -or ulnar fractures (5/51; 9.8%). PROMIS Physical Function (n = 32, 32/51 = 62.7%) and PROMIS Pain Interference (n = 21, 21/51 = 41.2%) were most frequently used questionnaires. PROMIS measures concerning social (n = 5/51 = 9.8%) and mental health (10/51 = 19.6%) were much less often used as outcome measures in the fracture population. A gradually increasing use of PROMIS questionnaires in the orthopedic fracture population was seen since 2017. Conclusion Many different PROMIS measures on multiple domains are available and used in previous articles with orthopedic fracture patients. With physical function and pain interference as most popular PROMIS measures, it is important to emphasize that other health-domains such as mental and social health can also be essential to fracture patients. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00440-3.
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Affiliation(s)
- Thymen Houwen
- Network Emergency Care Brabant, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands. .,Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Leonie de Munter
- Department of Traumatology, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Hilvarenbeekseweg 60, 5022 GC, Tilburg, the Netherlands
| | - Koen W W Lansink
- Department of Surgery, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Hilvarenbeekseweg 60, 5022 GC, Tilburg, the Netherlands
| | - Mariska A C de Jongh
- Network Emergency Care Brabant, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
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14
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Sperring CP, Danford NC, Saltzman BM, Constant M, Dantzker NJ, Trofa DP. Patient-Reported Outcome Measurement Information System (PROMIS) in Orthopaedic Trauma Research. SICOT J 2021; 7:39. [PMID: 34269677 PMCID: PMC8284342 DOI: 10.1051/sicotj/2021035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/15/2021] [Indexed: 12/15/2022] Open
Abstract
This review describes the development, advantages and disadvantages, and applications of the Patient-Reported Outcome Measurement Information System (PROMIS) in orthopaedic trauma. PROMIS is a useful tool for quantifying outcomes in orthopedic trauma. It allows measurement of outcomes across multiple domains while minimizing administration time. PROMIS also reliably identifies clinical, social, and psychological risk factors for poor outcomes across a variety of orthopaedic injuries and disease states. However, PROMIS lacks specificity for certain anatomic regions and validation for mental health outcomes. It also is limited by ceiling effects in certain active patient populations. Orthopaedic traumatologists should be familiar with PROMIS, as its use is increasing and it is a valuable tool that can aid in clinical decision making.
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Affiliation(s)
- Colin P Sperring
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center/NY-Presbyterian Hospital, 622 West 168th Street, PH 11-1130, New York, 10032 NY, USA
| | - Nicholas C Danford
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center/NY-Presbyterian Hospital, 622 West 168th Street, PH 11-1130, New York, 10032 NY, USA
| | - Bryan M Saltzman
- Department of Orthopaedic Surgery, OrthoCarolina, 1915 Randolph Road, Charlotte, 28207 NC, USA
| | - Michael Constant
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center/NY-Presbyterian Hospital, 622 West 168th Street, PH 11-1130, New York, 10032 NY, USA
| | - Nicholas J Dantzker
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center/NY-Presbyterian Hospital, 622 West 168th Street, PH 11-1130, New York, 10032 NY, USA
| | - David P Trofa
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center/NY-Presbyterian Hospital, 622 West 168th Street, PH 11-1130, New York, 10032 NY, USA
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15
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Grushky AD, Im SJ, Steenburg SD, Chong S. Traumatic Injuries of the Foot and Ankle. Semin Roentgenol 2020; 56:47-69. [PMID: 33422183 DOI: 10.1053/j.ro.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alexander D Grushky
- Division of Emergency Radiology, Department of Radiology, University of Michigan, Ann Arbor, MI.
| | - Sharon J Im
- Department of Sports Medicine, Henry Ford Hospital, Detroit, MI
| | - Scott D Steenburg
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Indiana University Health, Indianapolis, IN
| | - Suzanne Chong
- Emergency Radiology Division, Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Indiana University Health, Indianapolis, IN
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