1
|
Otoukesh B, Moshiri SF, Jahangiri B, Jafarlou KM, Amiri S, Baniasadi N, Heshmat Ghahderijani B. Digital monitoring of weight-bearing improves success rates and reduces complications in lower extremity surgeries. Eur J Transl Myol 2023; 33:11974. [PMID: 37962019 PMCID: PMC10811639 DOI: 10.4081/ejtm.2023.11974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
The aim of this study is to develop a digital monitoring system to track weight and evaluate its impact on postoperative outcomes after lower extremity surgeries (LES). This parallel randomized controlled trial enrolled 266 patients who underwent LES (fracture or joint replacement) at our medical center between March 11, 2022, and January 10, 2023. Patients were randomly assigned to the intervention and control groups in a 1:1 ratio. The intervention group (n=116) used a cane and shoes equipped with a weight-bearing system after lower limb surgery, while the control group (n=116) used a simple cane and shoes without a weight-bearing system. The primary outcomes included callus formation, duration of union, and success rate of union in the two groups. The intervention group had a significantly higher rate of complete surgical success than the control group (93.9% vs. 79.3%, p=0.001). The intervention group also had a significantly lower risk of non-union than the control group (OR: 2.33, 95% CI: 1.14, 3.48, p=0.001). The mean duration of surgery until the time of union and the meantime of callus formation was significantly lower in the intervention group (p=0.01). The use of a digital monitoring system for weighing in LES significantly increased the success rate and reduced post-operative complications. Therefore, incorporating this system can enhance the rehabilitation process and prevent revision surgeries in patients with LES.
Collapse
Affiliation(s)
- Babak Otoukesh
- Department of Orthopedics Surgery, Iran University of Medical Sciences, Tehran.
| | | | | | | | - Shayan Amiri
- Shohadaye Haftom-e-Tir Hospital, School of Medicine, Iran University of Medical Sciences, Tehran.
| | - Nadieh Baniasadi
- Non-Communicable Diseases Research Center, Bam University of Medical Sciences, Bam.
| | | |
Collapse
|
2
|
Sharfman ZT, Parsikia A, Rocker TN, Kahn MD, Sokol SC, Stone ME, McNelis J, Sen MK, Dimitroulias A. Increased morbidity and mortality in elderly patients with lower extremity trauma and associated injuries: A review of 420,066 patients from the national trauma database. Injury 2021; 52:757-766. [PMID: 33069394 DOI: 10.1016/j.injury.2020.10.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/20/2020] [Accepted: 10/07/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There is a paucity of research addressing the morbidity and mortality associated with polytrauma in elderly patients. This study aimed to compare the outcomes of elderly trauma patients with an isolated lower extremity fracture, to patients lower extremity fractures and associated musculoskeletal injuries. METHODS This study is a retrospective review from the National Trauma Database (NTDB) between 2008 and 2014. ICD 9 codes were used to identify patients 65 years and older with lower extremity fractures. Patients were categorize patients into three sub groups: patients with isolated lower extremity fractures (ILE), patients with two or more (multiple) lower extremity fractures (MLE) and, patients with at least one upper and at least one lower extremity fracture (ULE). Groups were stratified into patients age 65-80 and patients >80 years of age. RESULTS A total 420,066 patients were included in analysis with 356,120 ILE fracture patients, 27,958 MLE fracture patients, and 35,988 ULE fracture patients. The MLE group reported the highest dispatch to ACS level 1 trauma centers at 31.8% followed by the ULE group at 28.5% and the ILE group at 24.7% of patients (p<0.001). The overall rate of complications was highest in the MLE group followed by the ULE and then the ILE group (41.4%, 40.3%, 36.1%, respectively p<0.001). Motility rates in patients >80 years old in the MLE group and ULE group were similar (1.483 vs 1.4432). However, in the 65-80 year group the odds of mortality was 1.260 in the MLE group and 1.450 in the ULE group (p<0.001), such that the odds of mortality after sustaining a MLE fracture increases with age, whereas this effect was not seen in the ULE group. CONCLUSION Patients who sustained MLE and ULE fractures, had increased mortality, complications and in hospital care requirements as compared to patients with isolated lower extremity injuries. These outcomes are comparable between ULE and MLE fracture patients over the age of 80 however patients 65-80 with ULE fractures had increased mortality as compared patients 65-80 with MLE fractures. Understanding the unique considerations and requirements of elderly trauma patients is vital to providing successful outcomes.
Collapse
Affiliation(s)
- Zachary T Sharfman
- Division of Orthopaedic Surgery, NYC Health+Hospitals/Jacobi, Bronx, New York, USA; Department of Orthopedic Surgery, Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, New York, USA.
| | - Afshin Parsikia
- Division of Orthopaedic Surgery, NYC Health+Hospitals/Jacobi, Bronx, New York, USA; Division of Surgery, NYC Health+Hospitals/Jacobi, Bronx, New York, USA
| | - Ta'ir N Rocker
- Division of Orthopaedic Surgery, NYC Health+Hospitals/Jacobi, Bronx, New York, USA; Department of Orthopedic Surgery, Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mani D Kahn
- Division of Orthopaedic Surgery, NYC Health+Hospitals/Jacobi, Bronx, New York, USA; Department of Orthopedic Surgery, Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, New York, USA
| | - Shima C Sokol
- Division of Orthopaedic Surgery, NYC Health+Hospitals/Jacobi, Bronx, New York, USA
| | - Melvin E Stone
- Division of Surgery, NYC Health+Hospitals/Jacobi, Bronx, New York, USA
| | - John McNelis
- Division of Surgery, NYC Health+Hospitals/Jacobi, Bronx, New York, USA
| | - Milan K Sen
- Division of Orthopaedic Surgery, NYC Health+Hospitals/Jacobi, Bronx, New York, USA
| | | |
Collapse
|
3
|
Kimiafar K, Khadem-Rezaiyan M, Saberifar M, Mohammadi M, Zarei M, Omranzadeh A, Sarbaz M, Moradi A. The Prevalence of Lower Extremity Injuries in Mashhad: A Five-Year Study. THE ARCHIVES OF BONE AND JOINT SURGERY 2020; 8:716-721. [PMID: 33313353 DOI: 10.22038/abjs.2020.40230.2080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Injury is one of the leading causes of death and disability worldwide. Lower extremity injuries put a heavy burden on communities. The aim of this study is to assess the prevalence of lower extremity injuries in Mashhad, Iran. Methods The data from 57430 patients with lower extremity injuries from all traumatology hospitals in Mashhad were analyzed in this retrospective descriptive cross-sectional study to determine the prevalence of lower extremity injuries in Mashhad, Iran, between March 2011 and March 2015. Results The prevalence of lower extremity injury in the general population of Mashhad was 0.34%. The mean age of the casualties was 33.7±19.8 years, and 77.9% were male. Knee and lower leg injuries had the highest frequency (61%). The mean hospitalization period was 7.7±12.6 days. The highest mortality rate (MR) (2%) and discharge against medical advice (DAMA) (11%) were observed in hip and thigh injuries. DAMA (8.8% vs. 6.7%, P<0.001) and MR (1.7% vs. 1.5%, P=0.005) was higher in females. However, males had a longer hospitalization period (8±13) compared to females (6.8±10.1 days) (P<0.001). The prevalence rate was declining during the study period. Conclusion The downward trend of lower extremity injuries is promising; however, the higher mortality rate in females needs more attention. These findings can be used for better management of traumatic patients.
Collapse
Affiliation(s)
- Khalil Kimiafar
- Department of Medical Records and Health Information Technology, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Khadem-Rezaiyan
- Clinical Research Development Unit of Akbar Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Saberifar
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Mohammadi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammadsadegh Zarei
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Omranzadeh
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoumeh Sarbaz
- Department of Medical Records and Health Information Technology, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Moradi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
4
|
RETROSPECTIVE ANALYSIS OF PRIMARY FORENSIC MEDICAL EXAMINATIONS OF THE LOWER EXTREMITIES MECHANICAL TRAUMA. WORLD OF MEDICINE AND BIOLOGY 2020. [DOI: 10.26724/2079-8334-2020-3-73-120-125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
5
|
Narbey D, Habibi A, Chadebech P, Mekontso-Dessap A, Khellaf M, Lelièvre JD, Godeau B, Michel M, Galactéros F, Djoudi R, Bartolucci P, Pirenne F. Incidence and predictive score for delayed hemolytic transfusion reaction in adult patients with sickle cell disease. Am J Hematol 2017; 92:1340-1348. [PMID: 28924974 DOI: 10.1002/ajh.24908] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 01/20/2023]
Abstract
Delayed hemolytic transfusion reaction (DHTR) is a life-threatening complication of transfusion in sickle cell disease (SCD). The frequency of DHTR is underestimated because its symptoms mimic those of vaso-occlusive crisis and antibodies (Abs) are often not detectable. No predictive factors for identifying patients likely to develop DHTR have yet been defined. We conducted a prospective single-center observational study over 30 months in adult sickle cell patients. We included 694 transfusion episodes (TEs) in 311 patients, divided into occasional TEs (OTEs: 360) and chronic transfusion program (CTEs: 334). During follow-up, 15 cases of DHTR were recorded, exclusively after OTEs. DHTR incidence was 4.2% per OTE (95% CI [2.6; 6.9]) and 6.8% per patient during the 30 months of the study (95% CI [4.2; 11.3]). We studied 11 additional DHTR cases, to construct a predictive score for DHTR. The DHTR mortality is high, 3 (11.5%) of the 26 DHTR patients died. The variables retained in the multivariate model were history of DHTR, number of units previously transfused and immunization status before transfusion. The resulting DHTR-predictive score had an area under the ROC curve of 0.850 [95% CI: 0.780-0.930], a negative-predictive value of 98.4% and a positive-predictive value of 50%. We report in our study population, for the first time, the incidence of DHTR, and, its occurrence exclusively in occasionally transfused patients. We also describe a simple score for predicting DHTR in patients undergoing occasional transfusion, to facilitate the management of blood transfusion in SCD patients.
Collapse
Affiliation(s)
- David Narbey
- Etablissement Français du Sang; Créteil 94000 France
- Institut Mondor de Recherche Biomédicale, lnserm U955, Equipe 2; Créteil 94000 France
- Laboratory of Excellence GR-Ex; Paris F75739 France
| | - Anoosha Habibi
- Institut Mondor de Recherche Biomédicale, lnserm U955, Equipe 2; Créteil 94000 France
- Laboratory of Excellence GR-Ex; Paris F75739 France
- Reference Center for Sickle Cell Disease, Hôpital Henri Mondor; Créteil France
| | - Philippe Chadebech
- Etablissement Français du Sang; Créteil 94000 France
- Institut Mondor de Recherche Biomédicale, lnserm U955, Equipe 2; Créteil 94000 France
- Laboratory of Excellence GR-Ex; Paris F75739 France
| | - Armand Mekontso-Dessap
- Intensive Care Unit, Hôpital Henri Mondor; Créteil France
- IMRB, Groupe de recherche clinique CARMAS; Créteil France
- Université Paris Est Créteil, Faculté de Médecine
| | - Mehdi Khellaf
- Université Paris Est Créteil, Faculté de Médecine
- Emergency Unit, Hôpital Henri Mondor; Créteil France
| | - Jean-Daniel Lelièvre
- Université Paris Est Créteil, Faculté de Médecine
- Clinical Immunology Department; Hôpital Henri Mondor; Créteil France
| | - Bertrand Godeau
- Intensive Care Unit, Hôpital Henri Mondor; Créteil France
- Internal Medicine Department; Hôpital Henri Mondor; Créteil France
| | - Marc Michel
- Université Paris Est Créteil, Faculté de Médecine
- Internal Medicine Department; Hôpital Henri Mondor; Créteil France
| | - Frédéric Galactéros
- Institut Mondor de Recherche Biomédicale, lnserm U955, Equipe 2; Créteil 94000 France
- Laboratory of Excellence GR-Ex; Paris F75739 France
- Reference Center for Sickle Cell Disease, Hôpital Henri Mondor; Créteil France
- Université Paris Est Créteil, Faculté de Médecine
| | - Rachid Djoudi
- Etablissement Français du Sang; Créteil 94000 France
| | - Pablo Bartolucci
- Institut Mondor de Recherche Biomédicale, lnserm U955, Equipe 2; Créteil 94000 France
- Laboratory of Excellence GR-Ex; Paris F75739 France
- Reference Center for Sickle Cell Disease, Hôpital Henri Mondor; Créteil France
- Université Paris Est Créteil, Faculté de Médecine
| | - France Pirenne
- Etablissement Français du Sang; Créteil 94000 France
- Institut Mondor de Recherche Biomédicale, lnserm U955, Equipe 2; Créteil 94000 France
- Laboratory of Excellence GR-Ex; Paris F75739 France
- Université Paris Est Créteil, Faculté de Médecine
| |
Collapse
|