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Williamson JN, Grunst MM, Lynn J, Williamson GA, Blanck RV, Wilken JM. Predictors of long-term pain and function in individuals who received a custom dynamic orthosis and device-centric care pathway. Prosthet Orthot Int 2024; 48:372-379. [PMID: 37934175 DOI: 10.1097/pxr.0000000000000290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 07/20/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Carbon fiber custom dynamic orthoses (CDOs) have been shown to effectively reduce pain and improve function in military service members with lower-limb impairment, but data are limited for civilians. OBJECTIVES To evaluate the long-term outcomes of individuals who completed a CDO-centric care pathway in a civilian clinic by comparing baseline pain, mobility, and function with outcomes at long-term follow-up. To identify baseline characteristics and postintervention outcomes predictive of outcomes at long-term follow-up. METHODS Records of 131 adult patients who received a CDO and CDO-centric training were reviewed. Patient-reported measures of pain and physical function and timed assessment of walking and agility collected during routine clinical care were extracted. These patients were contacted on average 4 (±1) years postintervention to complete a survey including measures of pain and physical function. RESULTS The 63 participants who responded reported improved or greatly improved function, maximum pain, and typical pain on average, irrespective of age or sex ( P < 0.001). Change in function from baseline to long-term follow-up was predicted by short-term change in function (35.1% of the variance; P < 0.001). Change in pain from baseline to long-term follow-up was predicted by baseline typical pain and change in four square step test time (63% of variance; P < 0.001). CONCLUSIONS Most survey respondents reported positive outcomes. Long-term pain reduction and improved function were predicted by baseline status and by short-term changes associated with receiving a CDO and completing an intensive training program.
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Affiliation(s)
- Jared N Williamson
- Health Sciences Program, Rocky Mountain University of Health Professions, Provo, UT
| | - Megan M Grunst
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa, Iowa City, IA
| | - Jeffrey Lynn
- Department of Exercise and Rehabilitative Sciences, Slippery Rock University, Slippery Rock, PA
| | | | | | - Jason M Wilken
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa, Iowa City, IA
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Olutoye OO, Eriksson E, Menchaca AD, Kirsner RS, Tanaka R, Schultz G, Weir D, Wagner TL, Fabia RB, Naik-Mathuria B, Liu PY, Ead JK, Adebayo T, Armstrong DG, McMullin N, Samora JB, Akingba AG. Management of Acute Wounds-Expert Panel Consensus Statement. Adv Wound Care (New Rochelle) 2024. [PMID: 38618741 DOI: 10.1089/wound.2023.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Abstract
Significance: The Wound Healing Foundation recognized the need for consensus-based unbiased recommendations for the treatment of wounds. As a first step, a consensus on the treatment of chronic wounds was developed and published in 2022. The current publication on acute wounds represents the second step in this process. Acute wounds may result from any number of conditions, including burns, military and combat operations, and trauma to specific areas of the body. The management of acute wounds requires timely and evidence-driven intervention to achieve optimal clinical outcomes. This consensus statement provides the clinician with the necessary foundational approaches to the causes, diagnosis, and therapeutic management of acute wounds. Presented in a structured format, this is a useful guide for clinicians and learners in all patient care settings. Recent Advances: Recent advances in the management of acute wounds have centered on stabilization and treatment in the military and combat environment. Specifically, advancements in hemostasis, resuscitation, and the mitigation of infection risk through timely initiation of antibiotics and avoidance of high-pressure irrigation in contaminated soft tissue injury. Critical Issues: Critical issues include infection control, pain management, and the unique considerations for the management of acute wounds in pediatric patients. Future Directions: Future directions include new approaches to preventing the progression and conversion of burns through the use of specific gel formulations. Additionally, the use of three-dimensional bioprinting and photo-modulation for reconstruction is a promising area for continued discovery.
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Affiliation(s)
- Oluyinka O Olutoye
- Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Elof Eriksson
- Harvard Medical School, Cambridge, Massachusetts, USA
| | - Alicia D Menchaca
- Department of General Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Robert S Kirsner
- University of Miami Hospital and Clinics Wound Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rica Tanaka
- Juntendo University Graduate School of Medicine, Division of Regenerative Therapy, Department of Plastic & Reconstructive Surgery, Juntendo University Hospital Podiatry Center, Tokyo, Japan
| | - Greg Schultz
- University of Florida, Gainesville, Florida, USA
| | - Dot Weir
- Saratoga Hospital Center for Wound Healing and Hyperbaric Medicine, Saratoga Springs, New York, USA
| | - Tracey L Wagner
- Department of Pediatrics, Section of Emergency Medicine, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Renata B Fabia
- Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | | | - Paul Y Liu
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - J Karim Ead
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Temitope Adebayo
- Temple University School of Podiatric Medicine, Philadelphia, Pennsylvania, USA
| | - David G Armstrong
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Neil McMullin
- Plastic Surgery Consultant to the Surgeon General of the Army, Evans Army Community Hospital, Fort Carson, Colorado, USA
| | - Julie Balch Samora
- Department of Orthopedics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - A George Akingba
- Department of Vascular Surgery, VA Medical Center, Washington, District of Columbia, USA
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Stahel PF, Kaufman AM. Contemporary management of open extremity fractures: What you need to know. J Trauma Acute Care Surg 2024; 97:11-22. [PMID: 38374531 DOI: 10.1097/ta.0000000000004288] [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: 02/21/2024]
Abstract
ABSTRACT Open extremity fractures are high-risk injuries prone to significant complications, including soft tissue loss, bone defects, infection, infected nonunion, and the necessity for limb amputation. Large-scale multicenter prospective studies from the Lower Extremity Assessment Project and the Major Extremity Trauma Research Consortium have provided novel scientific insights pertinent to the timeliness and appropriateness of specific treatment modalities aimed at improving outcomes of patients with open extremity injuries. These include the imperative for early administration of intravenous antibiotics within 3 hours of injury, preferably within 1 hour of hospital admission. Unlike the proven value of early antibiotics, the time to initial surgical debridement does not appear to affect infection rates and patient outcomes. Recent evidence-based consensus guidelines from the American Academy of Orthopedic Surgeons provide scientific guidance for preventing surgical site infections in patients with open extremity fractures and support the decision making of limb salvage versus amputation in critical open extremity injuries. Patient survival represents the overarching priority in the management of any trauma patient with associated orthopedic injuries. Therefore, the timing and modality of managing open fractures must take into account the patient's physiology, response to resuscitation, and overall injury burden. The present review was designed to provide a state-of-the-art overview on the recommended diagnostic workup and management strategies for patients with open extremity fractures, based on the current scientific evidence.
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Affiliation(s)
- Philip F Stahel
- From the Department of Surgery (P.F.S.), Brody School of Medicine, East Carolina University, Greenville, North Carolina; College of Osteopathic Medicine (P.F.S.), Rocky Vista University, Parker, Colorado; and Mission Health, HCA Healthcare (P.F.S., A.M.K.), North Carolina Division, Asheville, North Carolina
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Peairs EM, Chari T, Kuehn SJ, Valan B, Rowe DG, Hurley ET, Aitchison AH, Paul AV, Henriquez A, Hendren S, Lentz TA, Péan CA, DeBaun M. The association of pre-existing mental health conditions and patient outcomes after lower extremity orthopaedic trauma: a scoping review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1111-1120. [PMID: 37955721 DOI: 10.1007/s00590-023-03768-8] [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: 08/18/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Existing research has established a correlation between post-traumatic mental health conditions, including anxiety and depression, and various aspects of recovery, such as pain exacerbations, reduced functional recovery, and lowered patient satisfaction. However, the influence of pre-existing mental health conditions on orthopaedic trauma outcomes has not been thoroughly investigated. The objective of this study was to systematically review literature addressing the association between pre-existing mental health conditions and patient outcomes following surgical interventions for lower extremity fractures in non-geriatric populations. METHODS A systematic literature review was conducted using Medline, Embase, and Scopus databases following PRISMA-ScR guidelines to select studies that examined lower extremity orthopaedic trauma outcomes in relation to pre-existing mental health conditions. Studies that evaluated patients with surgically treated lower extremity fractures and a history of mental health conditions such as anxiety, depression, or mood disorders were included. Studies with a mean patient age above 65 years of age were excluded to focus on non-geriatric injury patterns. RESULTS The systematic review identified 12 studies investigating the relationship between surgical outcomes of orthopaedic lower extremity fractures and pre-existing mental health disorders in non-geriatric populations. Studies included patients with pelvis, femur, tibia, and ankle fractures. A majority (83%) of these studies demonstrated that patients with pre-existing mental health diagnoses had inferior functional outcomes, heightened pain levels, or an increase in postoperative complications. DISCUSSION The presence of pre-existing mental health conditions, particularly anxiety and depression, may predispose orthopaedic trauma patients to an elevated risk of suboptimal functional outcomes, increased pain, or complications after surgical intervention for lower extremity fractures. Future research should focus on interventions that mitigate the impact of mental health conditions on orthopaedic outcomes and patient wellness in this population.
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Affiliation(s)
| | | | | | - Bruno Valan
- Duke University School of Medicine, Durham, NC, USA
| | - Dana G Rowe
- Duke University School of Medicine, Durham, NC, USA
| | - Eoghan T Hurley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Alexandra V Paul
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | | | | | - Trevor A Lentz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
- Duke Margolis Center for Health Policy, Durham, NC, USA
| | - Christian A Péan
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Margolis Center for Health Policy, Durham, NC, USA
| | - Malcolm DeBaun
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Reddy AK, Norris GR, Nayfa R, Sajjadi NB, Checketts JX, Scott JT, Hartwell M. The presence of person-centered language in orthopedic-related amputation research: a cross-sectional analysis. J Osteopath Med 2022; 123:235-242. [PMID: 36520046 DOI: 10.1515/jom-2022-0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022]
Abstract
Abstract
Context
Amputations are routine in orthopedics, specifically during trauma and when patients have recurrent surgical site infections. When undergoing amputations, patients must combat the psychosocial factors associated with the loss of an extremity, including stigmatization.
Objectives
This study analyzes the presence of person-centered language (PCL) within amputation-related orthopedic publications in the top orthopedic journals.
Methods
We conducted a cross-sectional analysis with a database search on February 14, 2021 utilizing PubMed. Utilizing a previously published search string, we isolated studies that were published in the top 20 orthopedic journals based on the Google h5-index. In addition to the top 20 orthopedic journals, we included the top two hand and foot & ankle journals in our search to incorporate more amputation literature. Our search yielded 687 returns. The sample was then randomized, and the first 300 studies that fit our inclusion criteria were examined for prespecified non-PCL terminology.
Results
Our results show that 157 (52.2%) studies were adherent to PCL according to the American Medical Association’s Manual of Style 10th Edition (AMAMS). Of the 143 (47.7%) studies that were not adherent to PCL, 51 studies (35.7%) had more than one type of non-PCL language. The term “amputee,” which is being labeled as identity-first language (IFL), was found in 101 articles (33.7%). Further investigation found that 73.3% (74/101) of the studies containing IFL were found to have other non-PCL terms. Of the other studies in the sample, non-PCL was found 34.7% (88/199) of the time. This analysis was done due to the discrepancies in stigmatization of the term “amputee.” No statistical association was found between adherence to PCL and study characteristics.
Conclusions
Our findings show that amputation literature within the top orthopedic journals has limited adherence to PCL. Additionally, the use of the term “amputee,” which is widely accepted by the amputation community, resulted in a greater rate of non-PCL terminology within orthopedic amputation literature. Efforts should be implemented within orthopedics to avoid the use of stigmatizing language, regarding individuals that underwent amputations, to minimize psychosocial stressors.
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Affiliation(s)
- Arjun K. Reddy
- Department of Orthopedic Surgery , Oklahoma State University Medical Center , Tulsa , OK , USA
- Office of Medical Student Research , Oklahoma State University Center for Health Sciences , Tulsa , OK , USA
| | - Grayson R. Norris
- Department of Orthopedic Surgery , Oklahoma State University Medical Center , Tulsa , OK , USA
| | - Rob Nayfa
- Department of Orthopedic Surgery , Oklahoma State University Medical Center , Tulsa , OK , USA
| | - Nicholas B. Sajjadi
- Office of Medical Student Research , Oklahoma State University Center for Health Sciences , Tulsa , OK , USA
| | - Jake X. Checketts
- Department of Orthopedic Surgery , Oklahoma State University Medical Center , Tulsa , OK , USA
| | - Jared T. Scott
- Department of Orthopedic Surgery , Oklahoma State University Medical Center , Tulsa , OK , USA
| | - Micah Hartwell
- Office of Medical Student Research , Oklahoma State University Center for Health Sciences at Cherokee Nation , Tahlequah , OK , USA
- Department of Psychiatry and Behavioral Sciences , Oklahoma State University Center for Health Sciences , Tulsa , OK , USA
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Patient Mental Health and Well-being: Its Impact on Orthopaedic Trauma Outcomes. J Orthop Trauma 2022; 36:S16-S18. [PMID: 36121326 DOI: 10.1097/bot.0000000000002450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 02/02/2023]
Abstract
A patient's mental health can have a significant impact on their orthopaedic trauma outcome. It is important for orthopaedic surgeons to identify patients at risk for a poor outcome based on their mental health, to include the presence of post-traumatic stress disorder, depression, and anxiety, among others. Although some behaviors such as catastrophizing have been associated with worse outcomes, others, such as possessing greater self-efficacy have been associated with improved outcomes. Because of the high prevalence of mental health conditions that can have a detrimental effect on outcome, screening should be routinely conducted and at-risk patients referred to appropriate resources in an effort to optimize outcomes.
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