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Sankey T, Sanchez T, McGee AS, Scheinberg M, Underwood M, Young M, Shah A. Factors Influencing PROMIS Scores and Patient Reported Outcomes Following Surgical Intervention of Isolated Lisfranc Injury: Minimum 2 Year Follow-up. J Foot Ankle Surg 2024; 63:359-365. [PMID: 38246337 DOI: 10.1053/j.jfas.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024]
Abstract
Lisfranc injuries are rare but significant foot injuries, as they often result from polytrauma patients, and are often misdiagnosed, which further complicate their evaluation and contribute to their propensity towards disability. It is recommended that, on diagnosis, Lisfranc injuries be treated as soon as possible to decrease the risk of future chronic pain, disability, or osteoarthritis. Our study evaluated patients who completed the patient reported outcome measurement information systems (PROMIS) along with the foot function index (FFI) following operative fixation for Lisfranc injury. Fifty-one patients between 2010 and 2020 met inclusion criteria and were selected for this study, with completion. Utilizing the electronic medical record (EMR), patient charts were reviewed to obtain basic patient demographic information and comorbidities. Operative reports were reviewed to determine which procedure was performed for definitive fixation. Primary arthrodesis was associated with a significant decrease in complication rates (p = .025) when compared to ORIF. Females, arthrodesis, and procedures using a home run (HR) screw were independent risk factors for significantly higher reports of PROMIS pain interference. Arthrodesis also was associated with lower PROMIS pain interference scores. Arthrodesis and males exhibited higher scores in all FFI categories. Our results provide evidence that patient reported outcomes following Lisfranc surgery reported via PROMIS, FFI and VAS scores are independently influenced by patient demographics, comorbidities, and surgical variables. Analysis of potential associations between these patient characteristics and PROMIS and FFI scores provides evidence for physicians to manage patient expectations prior to operative treatment of a nonpolytraumatic Lisfranc injury.
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Affiliation(s)
- Turner Sankey
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL
| | - Thomas Sanchez
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL
| | - Andrew S McGee
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL
| | - Mila Scheinberg
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL
| | - Meghan Underwood
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL
| | - Matt Young
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL
| | - Ashish Shah
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL.
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Yoon YC, Tucker NJ, Kim YJ, Pollard TG, Mauffrey C, Parry JA. Surgical complications after fixation of minimally displaced lateral compression type 1 pelvic ring injuries. Eur J Orthop Surg Traumatol 2024:10.1007/s00590-024-03915-9. [PMID: 38573380 DOI: 10.1007/s00590-024-03915-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/14/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE To review surgical complications after fixation of stress-positive minimally displaced (< 1 cm) lateral compression type 1 (LC1) pelvic ring injuries. METHODS A retrospective study at a level one trauma center identified patients who received surgical fixation of isolated LC1 pelvic ring injuries. Surgical complications and additional procedures were reviewed. RESULTS Sixty patients were included. The median age was 61 years (Interquartile range 40-70), 65% (n = 39) were women, and 57% (n = 34) had high-energy mechanisms. Anterior-posterior, posterior-only, and anterior-only fixation constructs were used in 77% (n = 46), 15% (n = 9), and 8% (n = 5) of patients. Anterior fixation was performed with rami screw fixation in 82% (49/60), external fixation in 2% (1/60), and open reduction and plate fixation in 2% (1/60). There were 15 surgical complications in 23% (14/60), and 12 additional procedures in 17% (10/60). Complications included loss of reduction ≥ 1 cm (8%), symptomatic hematomas (8%), symptomatic backout of unicortical retrograde rami screws (5%), deep infection of the pelvic space after a retrograde rami screw (1.6%), and iatrogenic L5 nerve injury (1.6%). All losses of reduction involved geriatric females with distal rami fractures sustained in ground-level falls. Loss of reduction was found to be more likely in patients with low energy mechanisms (proportional difference (PD) 62%, 95% confidence interval (CI) 18% to 76%; p = 0.01) and 2 versus 1 posterior pelvic screws (PD 36%; CI 0.4% to 75%; p = 0.03). CONCLUSIONS Surgical complications and additional procedures routinely occurred after fixation of LC1 injuries. Patients should be appropriately counseled on the risks of surgical fixation of these controversial injuries. LEVEL OF EVIDENCE Diagnostic, Level III.
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Affiliation(s)
- Yong-Cheol Yoon
- Department of Orthopaedics, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Nicholas J Tucker
- Department of Orthopaedics, Denver Health Medical Center, 777 Bannock St MC 0188, Denver, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Ye Joon Kim
- Department of Orthopaedics, Denver Health Medical Center, 777 Bannock St MC 0188, Denver, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Tom G Pollard
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Cyril Mauffrey
- Department of Orthopaedics, Denver Health Medical Center, 777 Bannock St MC 0188, Denver, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Joshua A Parry
- Department of Orthopaedics, Denver Health Medical Center, 777 Bannock St MC 0188, Denver, CO, USA.
- University of Colorado School of Medicine, Aurora, CO, USA.
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Bhogadi SK, El-Qawaqzeh K, Colosimo C, Hosseinpour H, Magnotti LJ, Spencer AL, Anand T, Ditillo M, Alizai Q, Nelson A, Joseph B. Pediatric Acute Compartment Syndrome in Long Bone Fractures: Who is at Risk? J Surg Res 2024; 298:53-62. [PMID: 38569424 DOI: 10.1016/j.jss.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 12/14/2023] [Accepted: 01/16/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION There is a paucity of large-scale data on the factors that suggest an impending or underlying extremity pediatric acute compartment syndrome (ACS). In addition, literature regarding the timing of operative fixation and the risk of ACS is mixed. We aimed to describe the factors associated with pediatric ACS. METHODS Analysis of 2017-2019 Trauma Quality Improvement Program. We included patients aged <18 y diagnosed with upper extremity (UE) and lower extremity (LE) fractures. Burns and insect bites/stings were excluded. Multivariable regression analyses were performed to identify the predictors of ACS. RESULTS 61,537 had LE fractures, of which 0.5% developed ACS. 76,216 had UE fractures, of which 0.16% developed ACS. Multivariable regression analyses identified increasing age, male gender, motorcycle collision, and pedestrian struck mechanisms of injury, comminuted and open fractures, tibial and concurrent tibial and fibular fractures, forearm fractures, and operative fixation as predictors of ACS (P value <0.05). Among LE fractures, 34% underwent open reduction internal fixation (time to operation = 14 [8-20] hours), and 2.1% underwent ExFix (time to operation = 9 [4-17] hours). Among UE fractures, 54% underwent open reduction internal fixation (time to operation = 11 [6-16] hours), and 1.9% underwent ExFix (time to operation = 9 [4-14] hours). Every hour delay in operative fixation of UE and LE fractures was associated with a 0.4% increase in the adjusted odds of ACS (P value <0.05). CONCLUSIONS Our results may aid clinicians in recognizing children who are "at risk" for ACS. Future studies are warranted to explore the optimal timing for the operative fixation of long bone fractures to minimize the risk of pediatric ACS.
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Affiliation(s)
- Sai Krishna Bhogadi
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Khaled El-Qawaqzeh
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Christina Colosimo
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Hamidreza Hosseinpour
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Louis J Magnotti
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Audrey L Spencer
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Tanya Anand
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Michael Ditillo
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Qaidar Alizai
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Adam Nelson
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Bellal Joseph
- Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
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Alejandrez A, Refaat M, Vue Y. Operative outcomes and fracture patterns in dysmorphic sacrums. Injury 2024; 55:111170. [PMID: 37951017 DOI: 10.1016/j.injury.2023.111170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/13/2023] [Accepted: 10/27/2023] [Indexed: 11/13/2023]
Abstract
INTRODUCTION Sacral dysmorphism has been previously reported to occur in 30 % to 40 % of adult patients. It has been described by 6 widely accepted parameters on outlet x-ray views of the pelvis: steep alar slope, retained S1-S2 disk, presence of mamillary bodies, sacralized L5, tongue in groove SI joint, and non-round neural foramina. Studies have focused on the importance of identifying dysmorphism for safe treatment of fractures in pelvises with dysmorphic upper sacral segments. Less is known regarding whether dysmorphism may be protective against trauma. To our knowledge no studies have focused on how dysmorphic sacrums fracture compared to non-dysmorphic (ND) sacrums, and whether operative rates are different. AIMS To assess the rate of operative fixation of sacral fractures between pelvises with dysmorphic and ND sacrums, as well as whether a difference exists in fracture morphology between groups. DESIGN/METHODS This is a retrospective cohort study out of a single level 1 trauma center. Study participants consisted of those sustaining a pelvic ring injury who were 18 years or older in which orthopaedics was consulted, had CT imaging available, and did not have isolated acetabulum fractures. 355 subjects were included of 671 reviewed pelvic ring injuries. Sacrums were deemed dysmorphic if they met at least one of the six dysmorphic features, and it was determined whether they underwent operative intervention. Fracture classifications and patterning were identified on CT imaging. P values were set <0.05. RESULTS We found that 44 % of inclusions had a dysmorphic sacrum with the most common feature to be a steep alar slope (68 %). 17.17 % of subjects with a ND sacrum underwent treatment versus 16.56 % for dysmorphic sacrums. No statistical difference regarding operative fixation rates was uncovered (p = .879). However, we found a difference in fracture patterns regarding ipsilateral posterior SI joint widening (p = 0.020). CONCLUSION Our study suggests that sacral dysmorphism is not protective against operative fixation based on no difference in operative rates between groups. However, our data supports that pelvises with dysmorphic sacrums may fracture differently based on the difference observed regarding other pelvic ring injuries.
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Affiliation(s)
- Alejandro Alejandrez
- UC San Francisco School of Medicine, PGY-1 Intern, 155 N Fresno St, Fresno, CA 93701, United States.
| | | | - Yeng Vue
- UCSF Fresno Orthopaedic Surgery, United States
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Bui GA, Huang JI. Intramedullary Screw Fixation of Metacarpal and Phalangeal Fractures. Hand Clin 2023; 39:475-488. [PMID: 37827601 DOI: 10.1016/j.hcl.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Metacarpal and phalangeal fractures are the second and third most common hand and wrist fractures seen in the emergency department. There are a multitude of operative fixation methods for metacarpal and phalangeal fractures, including closed reduction percutaneous pinning, open reduction internal fixation, external fixation, and intramedullary screw fixation. Although intramedullary fixation is a relatively new surgical technique, it is gaining in popularity as it allows patients to resume range of motion early in the postoperative period with excellent clinical outcomes.
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Affiliation(s)
- Gabrielle Anne Bui
- Department of Orthopedics and Sports Medicine, University of Washington Medical Center, 908 Jefferson Street, Ninth Floor, Seattle, WA 98104, USA
| | - Jerry I Huang
- Department of Orthopedics and Sports Medicine, University of Washington Medical Center, 4245 Roosevelt Way Northeast, Box 354740, Seattle, WA 98105, USA.
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Mesregah MK. Rates of readmission and reoperation after operative management of midshaft clavicle fractures in adolescents. World J Orthop 2022; 13:775-776. [PMID: 36159617 PMCID: PMC9453280 DOI: 10.5312/wjo.v13.i8.775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/21/2022] [Accepted: 07/31/2022] [Indexed: 02/06/2023] Open
Abstract
The present letter to the editor is a commentary on the study titled “Rates of readmission and reoperation after operative management of midshaft clavicle fractures in adolescents”. There is a debate over whether surgical treatment of clavicle shaft fractures improves clinical outcomes in adolescents. The readmission and reoperation rates following surgery should be identified.
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Affiliation(s)
- Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, Egypt
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Zhang L, Xiong JX, Zhou X, Xiong LJ, Yu L. Biomechanical comparison of screw, tightrope and novel double endobutton in the treatment of tibiofibular syndesmotic injuries. Injury 2021; 52:2813-9. [PMID: 34176638 DOI: 10.1016/j.injury.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/19/2021] [Accepted: 06/12/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Adequate reduction and stabilization of the syndesmosis are significant to prevent early degeneration of the ankle joint and get better clinical outcomes. However, the routine surgical methods have diffierent limitations. The purpose of this study was to develop a novel double Endobutton fixation to treat the distal tibiofibular syndesmotic injuries, and determine whether the novel double Endobutton fixation demonstrates a better biomechanical property compare with the intact syndesmosis, the screw fixation and the Tightrope fixation. METHODS Twenty-four normal fresh-frozen ankle specimens with a mean age of 42 ± 8 (range, 28-62) years were randomly divided equally into four groups: (1) the intact group, (2) the screw group, (3) the Tightrope group, (4) the Endobutton group. 3D printer technology was used to establish the personalized distal tibiofibular syndesmotic navigation modules to determine the accurate bone tunnel. Axial loading was applied in five ankle positions: neutral position, dorsiflexion, plantar flexion, varus and valgus. Rotation torque was applied in two ankle rotation of the neutral position: internal and external. RESULTS In most situations, the displacements of the intact group were larger than the screw group, the Tightrope group and the Endobutton group (P < .05), and the displacements of the screw group were smaller than other three groups (P < .05). The displacements of the double Endobutton group were slightly larger than the Tightrope group but no significant differences were found between these two groups except in the dorsiflexion position of axial loading experiments (P < .05). The novel double Endobutton fixation was steadier than intact syndesmosis and more micromotional than screw fixation. CONCLUSION Our study demonstrated that the novel double Endobutton can be considered as the better fixation in treatment of distal tibiofibular syndesmotic injuries. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Gaumé M, Descamps J, Donadio J, Rousseau MA, Boyer P. A comparative study of fixation methods in adults with two-thirds distal isolated ulnar shaft fractures with a minimum of 2 year follow-up. Injury 2020; 51:964-970. [PMID: 32093940 DOI: 10.1016/j.injury.2020.02.085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/16/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Adult isolated ulnar shaft fractures (IUSF) are rare. There remains a need to establish the best methods to manage these fractures. The aim of this study was to compare two forms of treatment for IUSF: intramedullary stabilization by k-wire (IMF) versus Open Reduction Internal Fixation by plating (ORIF), in order to identify differences in clinical (1) and radiological outcomes (2), as well as comparative costs (3). HYPOTHESIS The hypothesis of this study was assessing whether intramedullary stabilization was as feasible as plating in the treatment of isolated ulnar shaft fractures in clinical practice. PATIENTS AND METHODS A retrospective analysis was undertaken on patients diagnosed IUSF between January 2015 and March 2017 with a minimum of 2 years follow-up. They were treated with IMF (group 1) or ORIF (group 2). Demographic information, clinical outcomes and complications were collected. Cost, including implant cost, operative time, sterilization and inpatient stay were compared. Radiographs were reviewed to evaluate axial angulation, shortening, displacement and residual deformity. RESULTS 54 patients with a mean age of 41.2 years were treated by IMF (27/54) and ORIF (27/54). The mechanism of injury included high-energy (55%) and low-energy falls (45%). AO/OTA 2018 fracture classification was simple (39/54), wedge (14/54) and complex (1/54). The locations were 37/54 (70%) distal third and 17/54 (30%) mid-shaft fractures. There was no significant difference pre and post-operatively between the 2 groups regarding radiologic criteria. 3 cases of non-union, 4 delay-union and 1 regional complex syndrome occurred in group 2. No complication was reported in group 1. The function determined by range of motion (ROM) at wrist and elbow was excellent in 72% (group 1) and 80% (group2), 18% satisfactory in group 1 and 20% in group 2. There was no difference for QuickDASH and pain. Implant removal was necessary in 70% of patients without sequelae in nailing, 11% after plating. Average operation time was 29 ± 5 min for ORIF and 18 ± 6 min for IMF. Total estimated cost per patient was 3678.4€ for IMF and 7051.9€ for ORIF. CONCLUSIONS Compared with ORIF, IMF significantly reduced the operation time and cost with lower complications. TYPE OF STUDY Retrospective study. TYPE OF PROOF Level 4.
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Affiliation(s)
- Mathilde Gaumé
- Orthopedics Department, Bichat Hospital, Paris Diderot University, Assistance Publique Hôpitaux de Paris, Paris, France.
| | - Jules Descamps
- Orthopedics Department, Bichat Hospital, Paris Diderot University, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Julia Donadio
- Orthopedics Department, Bichat Hospital, Paris Diderot University, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marc-Antoine Rousseau
- Orthopedics Department, Bichat Hospital, Paris Diderot University, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Patrick Boyer
- Orthopedics Department, Bichat Hospital, Paris Diderot University, Assistance Publique Hôpitaux de Paris, Paris, France
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Kalberer N, Frima H, Michelitsch C, Kloka J, Sommer C. Osteosynthesis of sternal fractures with double locking compression plate fixation: a retrospective cohort study. Eur J Orthop Surg Traumatol 2019; 30:75-81. [PMID: 31456035 DOI: 10.1007/s00590-019-02526-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 08/02/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE Sternal fractures are rare injuries and mostly treated non-operatively. In selected cases, internal fixation becomes necessary. No standard operative approach has been determined yet among experts. The aim of this study is to describe our treatment algorithm and results after operative stabilisation of sternal fractures with locking compression plates (LCP), mainly focusing on the functional outcome. METHODS A retrospective cohort study was conducted. We included all patients after operative stabilisation of a sternal fracture between 2008 and 2016. Endpoints were the functional outcome using the Activities of Daily Living (ADL) score, pain analysed by the numeric rating scale (NRS), breathing ability, complications and implant removal. RESULTS Eighteen out of 153 (12%) patients with a sternal fracture underwent operation. Three patients were lost to follow-up. Eleven out of 15 (73%) patients were treated with double straight LCP 3.5 mm implants and 4 (27%) patients with pre-countered LCP 3.5 mm implants. Mean follow-up was 57 months. The median ADL score was 1 (1-4), the median NRS was 0 (0-9), and respiratory complaints scored a median of 1 (1-4). No non-union, hardware failure or implant-related complication occurred. Post-operative complications were pneumonia (20%) and respiratory insufficiency (20%). Implants were removed in 4/15 (27%) patients; three times due to implant-related irritation, once on patient's request. CONCLUSION Operative stabilisation of sternal fractures with double LCP 3.5 mm provides excellent long-term functional results and seems to be an appropriate option for internal fixation. The rate of post-operative complications is low; however, 27% had a second operation for implant removal.
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Affiliation(s)
- Nina Kalberer
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
| | - Herman Frima
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland.
| | - Christian Michelitsch
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
| | - Jan Kloka
- Department of Anaesthesiology, Universitätsklinikum Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Christoph Sommer
- Department of Trauma Surgery, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
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Wijffels MME, Prins JTH, Polinder S, Blokhuis TJ, De Loos ER, Den Boer RH, Flikweert ER, Pull Ter Gunne AF, Ringburg AN, Spanjersberg WR, Van Huijstee PJ, Van Montfort G, Vermeulen J, Vos DI, Verhofstad MHJ, Van Lieshout EMM. Early fixation versus conservative therapy of multiple, simple rib fractures (FixCon): protocol for a multicenter randomized controlled trial. World J Emerg Surg 2019; 14:38. [PMID: 31384292 PMCID: PMC6668138 DOI: 10.1186/s13017-019-0258-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/22/2019] [Indexed: 12/22/2022] Open
Abstract
Background Multiple rib fractures are common injuries in both the young and elderly. Rib fractures account for 10% of all trauma admissions and are seen in up to 39% of patients after thoracic trauma. With morbidity and mortality rates increasing with the number of rib fractures as well as poor quality of life at long-term follow-up, multiple rib fractures pose a serious health hazard. Operative fixation of flail chest is beneficial over nonoperative treatment regarding, among others, pneumonia and both intensive care unit (ICU) and hospital length of stay. With no high-quality evidence on the effects of multiple simple rib fracture treatment, the optimal treatment modality remains unknown. This study sets out to investigate outcome of operative fixation versus nonoperative treatment of multiple simple rib fractures. Methods The proposed study is a multicenter randomized controlled trial. Patients will be eligible if they have three or more multiple simple rib fractures of which at least one is dislocated over one shaft width or with unbearable pain (visual analog scale (VAS) or numeric rating scale (NRS) > 6). Patients in the intervention group will be treated with open reduction and internal fixation. Pre- and postoperative care equals treatment in the control group. The control group will receive nonoperative treatment, consisting of pain management, bronchodilator inhalers, oxygen support or mechanical ventilation if needed, and pulmonary physical therapy. The primary outcome measure will be occurrence of pneumonia within 30 days after trauma. Secondary outcome measures are the need and duration of mechanical ventilation, thoracic pain and analgesics use, (recovery of) pulmonary function, hospital and ICU length of stay, thoracic injury-related and surgery-related complications and mortality, secondary interventions, quality of life, and cost-effectiveness comprising health care consumption and productivity loss. Follow-up visits will be standardized and daily during hospital admission, at 14 days and 1, 3, 6, and 12 months. Discussion With favorable results in flail chest patients, operative treatment may also be beneficial in patients with multiple simple rib fractures. The FixCon trial will be the first study to compare clinical, functional, and economic outcome between operative fixation and nonoperative treatment for multiple simple rib fractures. Trial registration www.trialregister.nl, NTR7248. Registered May 31, 2018.
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Affiliation(s)
- Mathieu M E Wijffels
- 1Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Jonne T H Prins
- 1Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Suzanne Polinder
- 2Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Taco J Blokhuis
- 3Department of Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Erik R De Loos
- 4Department of Surgery, Zuyderland Medisch Centrum, P.O. Box 5500, 6130 MB Sittard-Geleen, The Netherlands
| | - Roeland H Den Boer
- 5Department of Surgery, Spaarne Gasthuis, P.O. Box 417, 2000 AK Haarlem, The Netherlands
| | - Elvira R Flikweert
- 6Department of Surgery, Deventer Ziekenhuis, P.O. Box 5001, 7400 GC Deventer, The Netherlands
| | | | - Akkie N Ringburg
- 8Department of Surgery, Ikazia Ziekenhuis, P.O. Box 5009, 3008 AA Rotterdam, The Netherlands
| | | | - Pieter J Van Huijstee
- Department of Surgery, Haga Ziekenhuis, P.O. Box 40551, 2504 LN The Hague, The Netherlands
| | - Gust Van Montfort
- 11Department of Surgery, Catharina Ziekenhuis, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands
| | - Jefrey Vermeulen
- 12Department of Surgery, Maasstad Ziekenhuis, P.O. Box 9100, 3007 AC Rotterdam, The Netherlands
| | - Dagmar I Vos
- 13Department of Surgery, Amphia Ziekenhuis, P.O. Box 90158, 4800 RK Breda, The Netherlands
| | - Michael H J Verhofstad
- 1Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- 1Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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Harshavardhana NS, Rathnayake K, Tanagho A, Cree C. Quality assurance in segmental neck of femur fractures. Int J Health Care Qual Assur 2018; 31:474-482. [PMID: 29954275 DOI: 10.1108/ijhcqa-09-2017-0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to report a rare case of segmental neck of femur fracture (SNoFF) and highlight its quality assurance and governance implications with respect to national guidelines, care pathways and best practice tariff. Design/methodology/approach Case report of an SNoFF in a 67-year-old woman treated at a district general hospital (DGH) was used in this study. Findings SNoFF required additional implants that delayed the surgery by five days. The authors were unable to adhere to the British Orthopaedic Association standards for trauma and Scottish Inter-Collegiate Guidelines Network recommendations which indicate that all neck of femur fractures (NoFFs) be fixed within 48 h. Though the patient was discharged without any untoward event and had an uneventful recovery, this case led us to introspect and learn how best to avoid such an incident from repeating again. Research limitations/implications This case led to an overhaul of NoFF and trauma services. The local logistics was restructured to procure "Trochanteric grip plates" within 24 h to provide mandated quality of care in an effort towards improving patient experience/outcomes. Originality/value SNoFF are rare injuries and its diagnosis is either delayed or missed in at least 20 per cent of the cases on initial evaluation. The non-availability of additional implants readily on the shelf coupled with lack of a trauma bed at the tertiary centre resulted in an unacceptable delay from admission to definitive surgery. The authors recommend that all DGHs have a mechanism/emergency procurement procedure system in place to obtain the required instrumentation kits rapidly through a sharing scheme with regional hospitals or through implant vendor to avoid unacceptable delays to surgery.
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Affiliation(s)
| | | | | | - Calum Cree
- Dumfries and Galloway Royal Infirmary, Dumfries, UK
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Radha S, Shenouda M, Konan S, Lavelle J, Church S. Successful Treatment of Painful Synchondrosis of Bipartite Patella after Direct Trauma by Operative Fixation: A Series of Six Cases. Open Orthop J 2017; 11:390-396. [PMID: 28603570 PMCID: PMC5447901 DOI: 10.2174/1874325001711010390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/09/2017] [Accepted: 03/22/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction: The patella is the largest sesamoid bone in the body and may have one (77%) or multiple (23%) ossification centres. Patellar and patellofemoral joint abnormalities are a common cause of anterior knee pain but symptomatic bipartite patella is an uncommon problem. Case Series: We report a series of six cases of painful synchondrosis in bipartite patellae, all in keen athletes following a direct blow to the anterior aspect of the knee. A complete rupture of the synchondrosis with evidence of retropatellar chondral separation was seen on MRI scan in all cases. Successful surgical fixation was undertaken with complete resolution of symptoms in all patients at an average of three months post-operatively. Conclusion: Painful synchondrosis of a bipartite patella in young and active individuals following direct trauma is a relatively rare cause of anterior knee pain, but may be associated with significant morbidity. In cases refractory to non-operative management, successful symptomatic treatment can be achieved by operative fixation.
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Affiliation(s)
- Sarkhell Radha
- Department of Trauma & Orthopaedics, Chelsea & Westminster Hospital, London, UK
| | - Michael Shenouda
- Department of Trauma & Orthopaedics, Chelsea & Westminster Hospital, London, UK
| | - Sujith Konan
- Department of Trauma & Orthopaedics, Chelsea & Westminster Hospital, London, UK
| | - Jonathon Lavelle
- Department of Trauma & Orthopaedics, Chelsea & Westminster Hospital, London, UK
| | - Samuel Church
- Department of Trauma & Orthopaedics, Chelsea & Westminster Hospital, London, UK
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Coulibaly MO, Jones CB, Sietsema DL, Schildhauer TA. Results and complications of operative and non-operative navicular fracture treatment. Injury 2015; 46:1669-77. [PMID: 26058352 DOI: 10.1016/j.injury.2015.04.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/28/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Navicular fractures (NF) are uncommon. The purpose of this study was to compare results of operative (ORIF) and non-operative (NOT) treatment in NF. METHODS A retrospective analysis was undertaken on patients diagnosed with NF between March 2002 and June 2007 at a Level I teaching trauma centre. Clinical outcome consisted of functional ability and complications. RESULTS Eighty-eight patients with 90 fractures were identified including 56 males and 32 females with a mean age of 38 (range 17-72) and body mass index of 28.2 (range 18.7-48.9). Twenty-one of 90 (23.3%) injuries were isolated. Ten of 90 (11.1%) injuries were open. Treatment was 49/90 (55%) NOT and 41/90 (45.6%) ORIF. 11/41 (30%) ORIF required bone grafting. Complications included one ipsilateral deep vein thrombosis, one avascular necrosis, one nonunion, seven infections (two deep and five superficial), and 56 cases of secondary osteoarthrosis (SOA). ORIF had significantly more SOA (χ(2)=0.000). Secondary surgery was 25 hardware removals (16 for irritation, five for prominent or broken plates), nine arthrodeses/-plasties, two debridements for infection, and one tarsal tunnel release. Pain was present at final follow up in 39/90 (43.3%) feet. Work status was 64 without restrictions, 17 with restrictions, and 5 did not return to work. Sixty-two of 88 (69%) patients were able to wear normal shoes, which were related to return to work without restrictions (ρ=-0.508, p=0.000). Inability to return to previous work was related to pain (ρ=-0.394), SOA (ρ=-0.280), and poor reduction quality (ρ=-0.384) with significance at p<0.01. Increased BMI (>35) related to pain (ρ=0.250) and poor reduction quality (ρ=0.326) at a σ<0.05. CONCLUSIONS Despite modern surgical techniques, operative treatment of displaced fractures is at high risk for complications. Obesity, pain, and secondary osteoarthrosis determine shoe wear, return to function, and employment status. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Marlon O Coulibaly
- Orthopaedic Research Fellowship, Grand Rapids Medical Education and Research Center, Grand Rapids, MI, United States; Ruhr-University Bochum, University Hospital Bergmannsheil GmbH, Department of Traumatology, Bochum, Germany.
| | - Clifford B Jones
- Orthopaedic Associates of Michigan, Grand Rapids, MI, United States; Michigan State University, College of Human Medicine, Department of Surgery, Grand Rapids, MI, United States
| | - Debra L Sietsema
- Orthopaedic Associates of Michigan, Grand Rapids, MI, United States; Michigan State University, College of Human Medicine, Department of Surgery, Grand Rapids, MI, United States
| | - Thomas A Schildhauer
- Ruhr-University Bochum, University Hospital Bergmannsheil GmbH, Department of Traumatology, Bochum, Germany
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Abstract
BACKGROUND Adult isolated ulnar shaft fractures (IUSFs) are uncommon, and treatment remains controversial. The purpose of this study was to compare results of operative (reduction internal fixation (RIF)) and nonoperative treatment (NOT) in patients with IUSF. MATERIAL AND METHODS A retrospective case-control analysis was undertaken on patients diagnosed with IUSF between 2002 and 2008 at a Level I teaching trauma center. Clinical outcomes consisted of complications and functional ability. RESULTS Seventy patients had a mean age of 44.6 years (18-86) and a body mass index (BMI) of 27.9 (17-47). The mechanism of injury included high-energy injuries (60/70, 85.7%), low-energy falls (8/70, 11.4%), and sports (2/70, 2.9%). Treatment consisted of 33/70 (47.1%) NOT and 37/70 (52.9%) RIF. The AO/OTA fracture classification was 48 A1, 20 B2, and two C1. The level of activity (LOA) was 60 without restrictions, six with restrictions, and three who did not return to work. The function determined by range of motion was 55/70 (78.6%) full, 11 slightly limited, and one severely limited. A total of 14 nonunions (NUs) and 17 malunions (MUs) occurred. NOT was associated with NU (χ(2)=0.001) and MU (χ(2)=0.000), respectively. Fracture angulation ≥8° was related to the inability to return to previous LOA (ρ=0.406, p=0.001). Secondary displacement >2mm contributed to MU (R(2)=0.238, p=0.000) and NU (R(2)=0.076, p=0.021). NU was related to a minor functional result (ρ=0.315, p=0.009). CONCLUSIONS IUSF treatment remains challenging in the adult population. Nonoperative treatment of displaced fractures produces a high risk of complications, and the fracture characteristics determine patient outcome. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Marlon O Coulibaly
- Orthopaedic Research Fellowship, Grand Rapids Medical Education and Research Center, Grand Rapids, MI, USA; Ruhr-University Bochum, University Hospital Bergmannsheil GmbH, Department of Traumatology, Bochum, Germany.
| | - Clifford B Jones
- Orthopaedic Associates of Michigan, Grand Rapids, MI, USA; Michigan State University, College of Human Medicine, Department of Surgery, Grand Rapids, MI, USA
| | - Debra L Sietsema
- Orthopaedic Associates of Michigan, Grand Rapids, MI, USA; Michigan State University, College of Human Medicine, Department of Surgery, Grand Rapids, MI, USA
| | - Thomas A Schildhauer
- Ruhr-University Bochum, University Hospital Bergmannsheil GmbH, Department of Traumatology, Bochum, Germany
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Abstract
Scaphoid fractures are the most common carpal bone fracture, usually occurring in young men, although the incidence in women has increased over the past decade. Snuffbox tenderness and/or pain with axial loading of the thumb should be treated as a scaphoid fracture until proved otherwise and the diagnosis confirmed with serial radiographs and/or advanced imaging. Nearly all displaced scaphoid fractures should undergo operative intervention to reduce the risk of nonunion. Nondisplaced fractures have high union rates with cast treatment, but require extended periods of immobilization. Consideration may be given to operative fixation of these fractures to allow early return to sport.
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Affiliation(s)
- John R Fowler
- Department of Orthopaedics, University of Pittsburgh, Suite 1010, Kaufmann Building, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA.
| | - Thomas B Hughes
- University of Pittsburgh School of Medicine, Orthopaedic Specialists, University of Pittsburgh Medical Center, 9104 Babcock Boulevard, Suite 5113, Pittsburgh, PA 15237, USA
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