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Gerken ALH, Hattemer MA, Weiß C, Sigl M, Zach S, Keese M, Nowak K, Reißfelder C, Rahbari NN, Schwenke K. The impact of class I compression stockings on the peripheral microperfusion of the lower limb: A prospective pilot study. JOURNAL OF VASCULAR NURSING 2023; 41:212-218. [PMID: 38072575 DOI: 10.1016/j.jvn.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/13/2023] [Accepted: 08/22/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE The use of medical compression stockings (MCS) in patients with peripheral arterial disease (PAD) and diabetes is the subject of an ongoing critical debate. While reducing leg edema of various origins by improving venous back flow, there is a concern about additional arterial flow obstruction when compression therapy is applied in pre-existing PAD. The aim of this study is to obtain further information on the use of class I MCS in patients with advanced PAD and to evaluate the framework conditions for a safe application. METHODS The total collective (n = 55) of this prospective, clinical cohort study consisted of 24 patients with PAD Fontaine stage IIb and higher studied before revascularization, of whom 16 patients were examined again after revascularization, and 15 healthy participants included for reference. The microperfusion of the lower extremity of all participants was examined in a supine, elevated, and sitting position using the oxygen to see (O2C) method. RESULTS The results indicate that leg positioning had the strongest influence on microcirculation (SO2 and flow: p = 0.0001), whereas MCS had no significant effect on the perfusion parameters (SO2: p = 0.9936; flow: p = 0.4967) and did not lead to a deterioration of values into critical ranges. CONCLUSION Mild medical compression therapy appears to be feasible even in patients with advanced PAD. Larger studies are warranted to observe any long-term effects, in particular for the treatment of reperfusion edema after revascularization.
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Affiliation(s)
- Andreas Lutz Heinrich Gerken
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany.
| | - Michelle Ann Hattemer
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany
| | - Christel Weiß
- Department of Biometry and Statistics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany
| | - Martin Sigl
- First Department of Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany
| | - Sebastian Zach
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany
| | - Michael Keese
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany; European Center for Angioscience, Medical Faculty Mannheim, Heidelberg University, Ludolf-Krehl-Straße 13-17, D-68167 Mannheim, Germany
| | - Kai Nowak
- Department of Surgery, RoMed Hospital Rosenheim, Pettenkoferstraße 10, D-83022 Rosenheim, Germany
| | - Christoph Reißfelder
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany
| | - Nuh N Rahbari
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany
| | - Kay Schwenke
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany
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Holroyd KL, Meeson RL, Pead MJ, Mukherjee L, Ferguson JF, Kulendra E. Risk Factors Associated with Plantar Necrosis following Tarsal Arthrodesis in Dogs. Vet Comp Orthop Traumatol 2023; 36:257-265. [PMID: 37142232 DOI: 10.1055/s-0043-57222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVES The aim of this study was to define landmarks of the intermetatarsal channel of the dorsal pedal artery and to assess whether damage to the dorsal pedal artery during metatarsal screw placement in dogs undergoing pan- and partial-tarsal arthrodesis (PanTA/ParTA) could be a mechanism in the development of plantar necrosis. STUDY DESIGN This study was divided in to two parts: (1) ex-vivo anatomical study: 19 canine cadavers, (2) retrospective clinical study: 39 dogs. Cadaveric dissection documented the mean intermetatarsal channel position. Metatarsal screw position was evaluated on postoperative radiographs of dogs after PanTA or ParTA. Screw position, arthrodesis type and surgical approach were assessed for their impact on complications, including plantar necrosis. RESULTS The mean proximal and distal extent of the intermetatarsal channel lies between 4.3% ± 1.9 and 22.8% ± 2.9 the length of metatarsal III (MTIII) respectively. The intermetatarsal channel lies within the most proximal 25% of MTIII in 95% of cases. At least one screw risked damaging the mean intermetatarsal channel position in 92% of dogs; 8% of these dogs went on to develop plantar necrosis. The mean screw position did not differ between ParTA cases with or without plantar necrosis (p > 0.05). CONCLUSION Violation of the intermetatarsal channel is possible during metatarsal screw placement. Care should be taken when placing screws in the proximal 25% of the metatarsals, specifically avoiding exiting dorsally between MTII and MTIII and across the distal region of the intermetatarsal channel, where the perforating metatarsal artery passes interosseously, as damage may contribute to the aetiology of plantar necrosis.
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Affiliation(s)
- Kate L Holroyd
- Anderson Moores Veterinary Specialists, Winchester, United Kingdom
| | | | | | | | | | - Elvin Kulendra
- North Downs Specialist Referrals, Bletchingley, United Kingdom
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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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Su CH, Chen YC, Yang YH, Wang CY, Ko PW, Huang PJ, Liaw CC, Liao WL, Cheng TL, Lee DY, Lo LC, Hsieh CL. Effect of the traditional Chinese herb Helminthostachys zeylanica on postsurgical recovery in patients with ankle fracture: A double-blinded randomized controlled clinical trial. JOURNAL OF ETHNOPHARMACOLOGY 2022; 295:115435. [PMID: 35671862 DOI: 10.1016/j.jep.2022.115435] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/24/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Helminthostachys zeylanica (HZ), which is also called "Dao-Di-U-Gon" in Taiwan, has anti-inflammatory and antiedema effects and is commonly used to treat edema in patients with fractures. The ugonin K component of HZ can induce osteogenesis and promote bone mineralization, its therapeutic effect, however, its therapeutic effect remains unclear. Therefore, the purpose of the present study was to investigate the effect of HZ on functional recovery in patients with ankle fractures requiring surgical treatment. METHODS A double-blinded, randomized, controlled study was conducted. A total of 45 patients with ankle fractures requiring surgical treatment were assigned to either the control group (n = 23 patients), which received the oral administration of HZ placebo 1.0 g t.i.d. for 42 days continuously, or to the treatment group (22 patients), which received HZ for 42 days. RESULTS The serum amino-terminal propeptide of type 1 procollagen (PINP) levels were similar in the first assessment (V1) between the control (45.90 ± 16.31 ng/mL) and treatment groups (52.61 ± 21.02 ng/mL; p = 0.240); the differences in PINP level between the third assessment (V3) and V1 were greater in the treatment group (35.84 ± 24.56 ng/mL) than in the control group (16.34 ± 11.97 ng/mL; p = 0.002). Radiographic healing time (RHT) was 9.09 ± 1.15 weeks in the treatment group, which was shorter than the 9.91 ± 0.79 weeks (p = 0.012) in the control group. CONCLUSION Oral administration of HZ for 42 days can increase serum PINP level and reduce the RHT. Therefore, HZ can be used to treat patients with ankle fractures requiring surgical treatment. However, a larger sample size is needed in future studies.
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Affiliation(s)
- Chin-Horng Su
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan; Orthopaedic Department, Yuan-Lin Christian Hospital, Changhua County, 510, Taiwan.
| | - Ya-Chih Chen
- Nursing Department, Yuan-Lin Christian Hospital, Changhua County, 510, Taiwan.
| | - Ya-Hui Yang
- Nursing Department, Yuan-Lin Christian Hospital, Changhua County, 510, Taiwan.
| | - Chun-Yi Wang
- Orthopaedic Department, Yuan-Lin Christian Hospital, Changhua County, 510, Taiwan.
| | - Po-Wei Ko
- Orthopaedic Department, Yuan-Lin Christian Hospital, Changhua County, 510, Taiwan.
| | - Peng-Ju Huang
- Orthopedic Department, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan.
| | - Chih-Chuang Liaw
- Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung, 804, Taiwan.
| | - Wen-Ling Liao
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan.
| | - Tsung-Lin Cheng
- Institute of Statistics and Information Science, National Changhua University of Education, Taiwan.
| | - Der-Yen Lee
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan.
| | - Lun-Chien Lo
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan; Department of Chinese Medicine, China Medical University Hospital, Taichung, 40447, Taiwan.
| | - Ching-Liang Hsieh
- Department of Chinese Medicine, China Medical University Hospital, Taichung, 40447, Taiwan; Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan; Chinese Medicine Research Center, China Medical University, Taichung, 40402, Taiwan.
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Li J, Jia G, Dong W, Zhao F, Zhao Z, Yu X, Zhu C, Li J, Liu S, Jiang X, Liu G. Incidence and risk factors of delayed wound healing in patients who underwent unicompartmental knee arthroplasty. Int Wound J 2022; 20:508-515. [PMID: 35941751 PMCID: PMC9885450 DOI: 10.1111/iwj.13898] [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: 06/15/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 02/03/2023] Open
Abstract
Unicompartmental knee arthroplasty (UKA) has been proven as an ideal alternative surgical procedure to treat symptomatic isolated knee osteoarthritis, and recently this technique has gained its popularity. However, postoperative complications would inevitably compromise the effectiveness and patients' satisfaction. The objective of this study is to demonstrate the incidence and risk factors of delayed wound healing (DWH) after UKA. This retrospective cohort study was conducted from February 2021 to May 2022 and a total of 211 patients were enrolled. Demographic characteristics, operation-related variables, and laboratory indexes were extracted. Receiver operating characteristic analysis was performed to detect the optimum cut-off value for continuous variables. Univariate and multivariate logistic regression analysis was performed to demonstrate the risk factors of DWH. There were 155 female and 56 male patients with an average age of 64. 6 ± 6.9 years included in this study. After 6.6 ± 4.9 months' follow-up, 12 cases of DWH were observed which indicated an incidence of DWH of 5.7%, mean wound healing duration for 12 patients was 43.1 ± 19.3 days. In the univariate analysis, age > 62.5 years, postoperative hospital stay < 5.5 days, surgical incision < 10.5 cm, barbed suture, body mass index (BMI) > 32.0 kg/m2 , operation duration > 102.5 minutes, intraoperative blood loss > 102.5 mL, preoperative white blood cell count > 5.95*109 /L, preoperative seroglobulin (GLB) > 29.6 g/L, postoperative total protein < 63.4 g/L, postoperative serum albumin < 36.4 g/L, and postoperative GLB > 26.8 g/L were significantly different between patients with and without DWH (P < .05). In final multivariate logistic analysis, results showed that intraoperative blood loss > 102.5 mL (odds ratio [OR], 3.09; P = .001), postoperative hospital stay < 5.5 days (OR, 1.74; P = .014), surgical incision < 10.5 cm (OR, 1.67; P = .000), and BMI > 32.0 kg/m2 (OR, 4.47; P = .022) were independent risk factors for DWH. DWH prolongs hospital stay in UKA patients and increases healthcare expenditure; also affected the implementation schedule of postoperative functional exercise plans. Surgeons should identify patients at risk, meanwhile, make timely and correct clinical interventions to decrease the incidence of this complication.
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Affiliation(s)
- Jia Li
- Department of Orthopedic SurgeryThe First Hospital of Hebei Medical UniversityShijiazhuangHebeiPR China
| | - Guoxing Jia
- Department of Orthopedic SurgeryThe First Hospital of Hebei Medical UniversityShijiazhuangHebeiPR China
| | - Wei Dong
- Department of Orthopedic SurgeryThe First Hospital of Hebei Medical UniversityShijiazhuangHebeiPR China
| | - Feng Zhao
- Department of Orthopedic SurgeryThe First Hospital of Hebei Medical UniversityShijiazhuangHebeiPR China
| | - Zhenshuan Zhao
- Department of Orthopedic SurgeryThe First Hospital of Hebei Medical UniversityShijiazhuangHebeiPR China
| | - Xiaoguang Yu
- Department of Orthopedic SurgeryThe First Hospital of Hebei Medical UniversityShijiazhuangHebeiPR China
| | - Chaohua Zhu
- Department of Orthopedic SurgeryThe First Hospital of Hebei Medical UniversityShijiazhuangHebeiPR China
| | - Jun Li
- Department of Orthopedic SurgeryThe First Hospital of Hebei Medical UniversityShijiazhuangHebeiPR China
| | - Sen Liu
- Department of Orthopedic SurgeryThe First Hospital of Hebei Medical UniversityShijiazhuangHebeiPR China
| | - Xiangming Jiang
- Lingshui Hospital of First Hospital of Hebei Medical UniversityLingshuiHainanPR China
| | - Guobin Liu
- Department of Orthopedic SurgeryThe First Hospital of Hebei Medical UniversityShijiazhuangHebeiPR China
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Song K, Zhu B, Jiang Q, Xiong J, Shi H. The radiographic soft tissue thickness is associated with wound complications after open reduction and internal fixation of patella fractures. BMC Musculoskelet Disord 2022; 23:539. [PMID: 35668370 PMCID: PMC9169402 DOI: 10.1186/s12891-022-05498-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
Background Displaced patella fracture is commonly treated with open reduction and internal fixation (ORIF). Wound complications after surgery often lead to prolonged hospitalization and dissatisfaction of patients. Periarticular adiposity and swelling may be associated with wound complications. The purpose of this study is to determine the relationship between periarticular soft tissue thickness and wound complications after ORIF of patella fractures. Methods We retrospectively studied 237 patients undergoing ORIF for patella fractures from June 2017 to February 2021 at our institution. We established periarticular soft tissue thickness ratio (PSTTR) to evaluate soft tissue status on lateral knee X-ray radiographs. Univariate analysis was performed to identify the association between PSTTR and postoperative wound complication. A receiver-operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of PSTTR. Results The incidence of postoperative wound complication was 10.5%. Minor wound complication occurred in 24 patients, and major wound complication occurred in one patient. The average femoral PSTTR (fPSTTR) was 0.94 ± 0.17 and the average tibial PSTTR (tPSTTR) was 0.66 ± 0.16. fPSTTR proved to be associated with postoperative wound complication. In the ROC analysis of fPSTTR predicting postoperative wound complication, the area under curve (AUC) was 0.676, which indicated a moderate predictive value. Conclusions PSTTR was a feasible method to assess periarticular soft tissue. The increased fPSTTR was associated with wound complications after ORIF of patella fractures.
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Halvachizadeh S, Klingebiel FKL, Pfeifer R, Gosteli M, Schuerle S, Cinelli P, Zelle BA, Pape HC. The local soft tissue status and the prediction of local complications following fractures of the ankle region. Injury 2022; 53:1789-1795. [PMID: 35382943 DOI: 10.1016/j.injury.2022.03.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/10/2022] [Accepted: 03/22/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Well-known risk factors (RF) for soft tissue complications following surgical treatment of fracture of the ankle region include diabetes, smoking, and the local soft tissue status. A weighted analysis might provide a risk profile that guides the surgical treatment strategy. The aim of this meta-analysis was to provide a risk profile for soft tissue complications following closed fractures of the ankle region. METHODS This review provides a meta-analysis of studies that investigate potential risk factors for complications in fractures of the ankle region. INCLUSION CRITERIA Original articles that were published between 2000 and 2020 in English or German language that calculated odds ratios (OR) of RF for soft tissue complications. Further, this study only includes articles that investigated fractures of the ankle region including pilon fracture, calcaneal fractures, and fractures of the malleoli. This study excluded articles that provide exploratory analyses, narrative reviews, and case reports. RF were stratified as patient specific systemic RF (PSS), patient specific local RF (PSL), and non-patient specific RF (NPS). PSS RF includes comorbidities, American society of anaesthesiology (ASA), requirement of medication, additional injuries, and smoking or substance abuse. PSL RF includes soft tissue status, wounds, and associated complications. NPS RF includes duration of surgery, staged procedure, or time to definitive surgery. Random effect (RE) models were utilized to summarize the effect measure (OR) for each group or specific RF. RESULTS Out of 1352 unique articles, 34 were included for quantitative analyses. Out of 370 complications, the most commonly assessed RF were comorbidities (34.6%). Local soft tissue status accounted for 7.5% of all complications. The overall rate for complication was 10.9% (standard deviation, SD 8.7%). PSS RF had an OR of 1.04 (95%CI 1.01 to 1.06, p = 0.006), PSL an OR of 1.79 (95% 1.28 to 2.49, p = 0.0006), and NPS RF an OR of 1.01 (95%CI 0.97 to 1.05, p = 0.595). Additional injuries did not predict complications (OR 1.23, 95%CI 0.44 to 3.45, p = 0.516). The most predictive RF were open fracture (OR 3.47, 95%CI 1.64 to 7.34, p < 0.001), followed by local tissue damage (OR 3.05, 95%CI 1.23 to 40.92, p = 0.04), and diabetes (OR 2.3, 95%CI 1.1 to 4.79, p = 0.26). CONCLUSION Among all RFs for regional soft tissue complications, the most predictive is the local soft tissue status, while additional injuries or NPS RF were less predictive. The soft tissue damage can be quantified and outweighs the cofactors described in previous publications. The soft tissue status appears to have a more important role in the decision making of the treatment strategy when compared with comorbidities such as diabetes.
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Affiliation(s)
- Sascha Halvachizadeh
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Harald Tscherne laboratory for orthopaedic and trauma research, University of Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland.
| | - Felix Karl Ludwig Klingebiel
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Harald Tscherne laboratory for orthopaedic and trauma research, University of Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
| | - Roman Pfeifer
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Harald Tscherne laboratory for orthopaedic and trauma research, University of Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
| | - Martina Gosteli
- Harald Tscherne laboratory for orthopaedic and trauma research, University of Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
| | - Simone Schuerle
- Institute for translational medicine, Department of Health Science & Technology, ETH Zurich, Rämistrasse 101, Zürich 8092, Switzerland
| | - Paolo Cinelli
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Harald Tscherne laboratory for orthopaedic and trauma research, University of Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
| | - Boris A Zelle
- Department of Orthopaedics, UT Health San Antonio, San Antonio, Texas TX 78229, United States
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Harald Tscherne laboratory for orthopaedic and trauma research, University of Zurich, Sternwartstrasse 14, Zurich 8091, Switzerland
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Pilskog K, Gote TB, Odland HEJ, Fjeldsgaard KA, Dale H, Inderhaug E, Fevang JM. Association of Delayed Surgery for Ankle Fractures and Patient-Reported Outcomes. Foot Ankle Int 2022; 43:762-771. [PMID: 35184581 PMCID: PMC9168892 DOI: 10.1177/10711007211070540] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several studies probe the association between prolonged time to surgery and postoperative complications in ankle fractures, but little is known about how a longer wait time affects clinical outcomes. The present study aims to assess the association between time from injury to surgery and patient-reported outcomes after operative treatment of severe ankle fractures. METHOD Patients treated operatively for low-energy ankle fractures that also involve the posterior malleolus from 2014 to 2016 were included. Patient charts were reviewed for patient demographics, type of trauma, fracture characteristics, treatment given, and complications. Ankle function was evaluated on a follow-up visit by clinical examination, radiographs, and patient-reported outcome measures (Self-Reported Foot and Ankle Score [SEFAS], RAND-36, visual analog scale [VAS] of Pain, VAS of Satisfaction). We compared patients treated within 1 week to those treated later than a week from injury for analyses. RESULTS Follow-up visits of 130 patients were performed at mean 26 (SD 9) months after surgery. Patient demographics and fracture characteristics were similar between groups. Mean SEFAS was 34 (SD 10) in patients treated later than a week from injury vs 38 (SD 9) in those treated earlier (P = .012). Patients operated on later than 7 days from injury reported more pain (P = .008) and lower satisfaction than those treated earlier (P = .016). CONCLUSION In this retrospective patient series of low-energy ankle fractures with posterior malleolar fragments, we found that waiting >7 days for definitive surgery was associated with poorer clinical outcomes and more pain compared with those who had surgery earlier. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Kristian Pilskog
- Orthopedic department, Haukeland University Hospital, Norway,Clinical Institute 1, The University of Bergen,Kristian Pilskog, MD, Orthopedic Department, Haukeland University Hospital, Pb. 1400, Bergen, 5021, Norway.
| | | | | | | | - Håvard Dale
- Orthopedic department, Haukeland University Hospital, Norway,Clinical Institute 1, The University of Bergen
| | - Eivind Inderhaug
- Orthopedic department, Haukeland University Hospital, Norway,Clinical Institute 1, The University of Bergen
| | - Jonas Meling Fevang
- Orthopedic department, Haukeland University Hospital, Norway,Clinical Institute 1, The University of Bergen
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Halvachizadeh S, Pfeifer R, Kalbas Y, Schuerle S, Cinelli P, Pape HC. Assessment of alternative techniques to quantify the effect of injury on soft tissue in closed ankle and pilon fractures. PLoS One 2022; 17:e0268359. [PMID: 35544530 PMCID: PMC9094508 DOI: 10.1371/journal.pone.0268359] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/27/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Local soft tissue status (STS) guides the timing for definitive surgical treatment strategies of fracture fixation around the ankle joint. The aim of this study was to assess different types of new technical devices in relation to the surgical treatment in closed ankle and pilon fractures. METHODS This study was designed as a cohort study. Adult patients admitted between February 1, 2019 and December 31, 2020 presenting with closed ankle fracture requiring surgical treatment were eligible. The exclusion criteria were previous injuries to the lower extremity, acute deep venous thrombosis, skin diseases, and delayed presentation (admission >24 hours after injury). Moderate-energy trauma includes injuries sustained during team sports, biking, and running. The primary outcome was the assessment of the degree of soft tissue involvement following closed fractures by comparing different techniques focusing on the ankle region and including ankle and pilon fractures. The variables of interest included the circumference of soft tissue swelling around the ankle, determined within a 5-mm range in the area of the medial and lateral malleolus and the bone-skin distance on a plain radiograph, determined by the largest distance from the malleolus to the border of the soft-tissue shadow. STS assessment included optical measures of local perfusion (O2C, Lea Inc. Germany) and tactile measures of mechanical characteristics (Myoton® tensiometer AS, Estonia). Measurements of Group Temp (temporary stabilization) and Group Def (definitive surgery) were taken on admission and prior to the treatment strategy decision. The contralateral non-injured ankle served as a control. The quality of assessment tools was quantified by calculating the smallest detectable change (SDC). RESULTS In total, 38 patients with a mean age of 40.4 (SD 17.8) years were included. The SDC was 3.2% (95%CI 2.5 to 3.8) for local blood flow and 1.1% (95%CI 0.4 to 1.7) for soft tissue stiffness. The circumference of the injured area at admission was significantly higher than that of the healthy site (28.2 [SD 3.4] cm versus 23.9 [SD 2.4] cm, p < 0.001). The local perfusion (blood flow 107.5 (SD 40.79 A.U. vs. 80.1 [SD 13.8] A.U., p = 0.009), and local dynamic stiffness of the skin (668.1 (SD 148.0) N/m vs 449.5 (SD 87.7) N/m, p < 0.001) were significantly higher at the injured site. In Group Temp, the local blood flow was significantly higher when compared with Group Def (109.6 [SD 39.8] vs. 94.5 [SD 13.0], p = 0.023). The dynamic stiffness of the soft tissue was significantly higher in Group Temp (679.4 N/m [SD 147.0] N/m vs. 573.0 N/m (SD 93.8) N/m, p < 0.001). The physical properties of STS were comparable among the fracture types. None of the included patients had local soft tissue complications. CONCLUSION Closed fractures of the ankle and the pilon are associated with an increase in local circulation and local soft tissue stiffness and tension. These changes of the STS following injury can be quantified in a standardized and reproducible manner.
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Affiliation(s)
- Sascha Halvachizadeh
- Department of Trauma, University Hospital Zurich, Raemistrasse, Zurich, Switzerland
- Harald Tscherne Laboratory, University of Zurich, Sternwartstrasse, Zurich, Switzerland
| | - Roman Pfeifer
- Department of Trauma, University Hospital Zurich, Raemistrasse, Zurich, Switzerland
- Harald Tscherne Laboratory, University of Zurich, Sternwartstrasse, Zurich, Switzerland
| | - Yannik Kalbas
- Department of Trauma, University Hospital Zurich, Raemistrasse, Zurich, Switzerland
| | - Simone Schuerle
- Institute of Translational Medicine, Department of Health Science & Technology, ETH Zurich, Zurich, Switzerland
| | - Paolo Cinelli
- Harald Tscherne Laboratory, University of Zurich, Sternwartstrasse, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, Raemistrasse, Zurich, Switzerland
- Harald Tscherne Laboratory, University of Zurich, Sternwartstrasse, Zurich, Switzerland
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Chen Y, Huang X, Chen Y, Shi C, Li H, Xu J, Li Y, Du Y, Cheng Y. Comparison of complications of early and delayed open reduction and internal fixation for treating pilon fracture: A protocol of systematic review and meta-analysis. PLoS One 2021; 16:e0258962. [PMID: 34793463 PMCID: PMC8601449 DOI: 10.1371/journal.pone.0258962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 10/08/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Tibial Pilon fractures are severe fractures accompanied by soft tissue injury. Although open reduction and internal fixation (ORIF) are effective in treating Pilon fractures, there is a controversy over time to surgery due to reported postoperative complications. However, there is no systematic review evaluating the difference of postoperative complications between early and delayed ORIF for treating pilon fractures. METHODS Relevant literature written in English will be searched through PubMed, Cochrane Library, Embase, MEDLINE, and Web of Science. The study aims to compare the effects and complications of early and delayed ORIF for treating fresh pilon fractures in adult patients. The primary outcome will be infection rate, fracture union time, nonunion and malunion rate. And the secondary outcome will be metalwork removal, amputation, and ankle function grade. Two reviewers will independently assess the eligibility of the studies according to the pre-defined inclusion and exclusion criteria. A meta-analysis for the available data will be conducted using Revman 5.3. To measure effect size, odds ratios (ORs) and mean difference will be used for dichotomous and continuous data, respectively. Statistical heterogeneity will be explored. And a random-effects model or a fixed-effects will be used in pooled data on the basis of the existence or absence of heterogeneity. Subgroup analysis will be conducted to identify sources of heterogeneity and sensitivity analysis to test the results' robustness. We will assess the risk of bias by four different quality assessment tools according to the study design. Publication bias will be evaluated by funnel plot. The study data will be stored in the Open Science Framework website. PROSPERO REGISTRATION NUMBER CRD42020207465.
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Affiliation(s)
- Yang Chen
- Department of Traumatology, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School of Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoyu Huang
- Department of Traumatology, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Yili Chen
- Department of Traumatology, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Changlong Shi
- Department of Traumatology, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Hao Li
- Department of Traumatology, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jingjing Xu
- Department of Traumatology, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Yongyao Li
- Department of Traumatology, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Yachao Du
- Department of Traumatology, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Yongzhong Cheng
- Department of Traumatology, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
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Vora M, Samineni AV, Sing D, Salavati S, Tornetta P. Spinal Anesthesia Associated With Increased Length of Stay Compared to General Anesthesia for Ankle Open Reduction Internal Fixation: A Propensity-Matched Analysis. J Foot Ankle Surg 2021; 60:350-353. [PMID: 33461921 DOI: 10.1053/j.jfas.2020.08.035] [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: 03/27/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 02/03/2023]
Abstract
General and spinal anesthesia are both utilized for patients undergoing open reduction internal fixation of the ankle, but there are little data comparing early complication rates. The purpose of this study was to compare duration of surgery, length of stay, and rates of postoperative adverse events within 30 days in patients undergoing open reduction internal fixation of ankle fracture using spinal versus general anesthesia. Adult patients who underwent open reduction internal fixation of a closed ankle fracture from 2012 to 2016 were retrospectively identified from American College of Surgeons National Surgical Quality Improvement Program. Duration of surgery, length of stay, 30-day adverse events, and unplanned readmissions were compared between patients who received general anesthesia and spinal anesthesia. Propensity adjustment with respect to known risk factors for complications and adjunctive regional block was used to match patients. Of the 10,795 patients included after applying the inclusion and exclusion criteria, 9862 (91.36%) received general anesthesia and 933 (8.64%) received spinal anesthesia. Using propensity-scored matching, 841 patients in the spinal cohort were matched to 3364 patients in the general cohort. Spinal anesthesia was associated with increased length of stay (+0.5 days, 95% confidence interval 0.23-0.77, p < .001). There were no differences in the rates of major/minor complications, mortality, transfusions, unplanned readmissions, or duration of surgery. General anesthesia is predominantly used for fixation of ankle fractures. While spinal anesthesia is associated with lower complication rates in hip and knee surgery, we found that it is associated with increased length of stay in patients undergoing open reduction internal fixation of the ankle within 30 days of surgery.
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Affiliation(s)
- Molly Vora
- Medical Student, Boston University School of Medicine, Boston, MA
| | | | - David Sing
- Resident, Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA.
| | - Seroos Salavati
- Anesthesiologist, Director of Regional Anesthesiology, Assistant Professor, Boston Medical Center, Boston, MA
| | - Paul Tornetta
- Orthopaedic Surgeon, Chief, Chair, and Professor of Orthopaedic Surgery, Boston Medical Center, Boston, MA
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Lin KC, Li YS, Tarng YW. Safety and Efficacy of Prophylactic Closed Incision Negative Pressure Therapy after Acute Fracture Surgery. Injury 2020; 51:1805-1811. [PMID: 32507454 DOI: 10.1016/j.injury.2020.05.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Soft tissue swelling after acute fracture surgery is a challenge which may increase wound dehiscence, delay early range of motion, and increase infection rate postoperatively. This study investigates closed incision negative pressure therapy (ciNPT) using wide-range cover over the incision site and the peripheral swelling trauma zone to promote early active motion and to mitigate joint stiffness, bulla formation, and tendon adhesion. METHODS Twenty-nine patients were enrolled between January 2018 and December 2018. Patients with high-energy soft tissue trauma and comminuted fractures over distal end of limbs (hand and foot; wrist and ankle) or muscle scarcity areas (tibial shaft or patella) were included. ciNPT was applied over closed incisions in the operating room and subatmospheric pressure (-125 mmHg) initiated continuously for 5~7 days. RESULTS In hand and foot patients (n= 8), active motion over all fingers or toes occurred after post-operative Day 2. Mild swelling without any bullous formation was observed over the dorsal aspect of hand. In wrist and ankle patients (n= 16), flexion angle over the finger joints over 90 degrees was observed after 5 days post-surgery. For patients with tibial shaft comminuted fractures with impending compartment syndrome, early active motion of knee and ankle joint was observed as soft tissue swelling and distension pain had subsided after surgery. CONCLUSION The prophylactic ciNPT use in the trauma area after surgery reduced postoperative distension pain and improved early range of motion of the tendon and joint in these patients.
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Affiliation(s)
- Kai Cheng Lin
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, 386, Da-Chung 1st Road, Kaohsiung City, 813, Taiwan, ROC
| | - Yi-Syuan Li
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, 386, Da-Chung 1st Road, Kaohsiung City, 813, Taiwan, ROC
| | - Yih-Wen Tarng
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, 386, Da-Chung 1st Road, Kaohsiung City, 813, Taiwan, ROC; Department of Orthopaedics, National Defense Medical Center, 161, Section 6, Minquan E Rd, Neihu District, Taipei City, Taiwan 114 Taipei city, Taiwan Republic of China.
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Spierings KE, Sanders FRK, Nosewicz TL, Schepers T. Risk factors for surgical site infections with the Sinus Tarsi Approach in displaced intra-articular calcaneal fractures; a prospective cohort study with a minimum of one year follow-up. Injury 2020; 51:1676-1680. [PMID: 32471686 DOI: 10.1016/j.injury.2020.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/02/2020] [Accepted: 05/02/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND In the last decade, the sinus tarsi approach (STA) has gained interest over the extensile lateral approach (ELA) in the operative treatment of displaced intra-articular calcaneal fractures (DIACF's), mainly because of the lower rate of surgical site infections (SSIs). However, most studies are small and retrospective. The aim of this study was to evaluate the rate of SSIs of the STA in a large, prospective series of patients and to identify predictors for SSIs. METHODS In this prospective cohort study, all consecutive patients who were operatively treated for a DIACF in our Level 1 trauma center between August 2012 and January 2019 were included and followed for at least one year. All operative procedures were performed by two specialized foot and ankle trauma surgeons using the STA. Using multinomial logistic regression, risk factors for SSIs were identified. RESULTS A total of 237 calcaneal fractures in 214 patients were included, of which 179 underwent open reduction and internal fixation and 58 a primary arthrodesis. Most patients were male (73.6%) and the mean age was 45.9 years. There were 16 patients that developed a SSI (6.8%), of which 9 (3.8%) were deep and 7 (3%) were superficial infections. The multivariate analysis pointed out that surgery within one week after injury increased the chance of a SSI, as well as an ASA of 2 or higher and more than 150 cc of blood loss during the procedure. CONCLUSION This study confirms the low risk of SSI in DIACFs treated via STA. Significant predictors for SSIs were surgery within one week after injury, ASA of 2 or higher and blood loss > 150cc.
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Affiliation(s)
- K E Spierings
- Amsterdam UMC, University of Amsterdam, trauma unit, Meibergdreef 9, Amsterdam,1105 AZ, The Netherlands
| | - F R K Sanders
- Amsterdam UMC, University of Amsterdam, trauma unit, Meibergdreef 9, Amsterdam,1105 AZ, The Netherlands
| | - T L Nosewicz
- Amsterdam UMC, University of Amsterdam, trauma unit, Meibergdreef 9, Amsterdam,1105 AZ, The Netherlands
| | - T Schepers
- Amsterdam UMC, University of Amsterdam, trauma unit, Meibergdreef 9, Amsterdam,1105 AZ, The Netherlands.
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