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Woodcroft-Brown V, Bell J, Pulle CR, Mitchell R, Close J, McDougall C, Hurring S, Sarkies M. Patient, surgical and hospital factors predicting actual first-day mobilisation after hip fracture surgery: An observational cohort study. Australas J Ageing 2024. [PMID: 38616338 DOI: 10.1111/ajag.13312] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES To examine patient, surgical and hospital factors associated with Day-1 postoperative mobility after hip fracture surgery in older adults. METHODS A cohort study using Australia and New Zealand Hip Fracture Registry was conducted. Participants were aged older than 50 years and underwent hip fracture surgery between 1 January 2020 and 31 December 2020 inclusive. The outcome was standing and step transferring out of bed onto a chair and/or walking Day-1 after hip fracture surgery. RESULTS Mean age was 82 years and 68% were women. Of 12,318 patients with hip fracture, 5981 (49%) actually mobilised Day-1. Odds of actual first-day mobilisation were lower for individuals usually walking with either stick or crutch (OR = 0.71, 95% CI 0.62-0.82) or two aids or frame (OR = 0.57, 95% CI 0.52-0.64) or wheelchair/bed bound (OR = 0.24, 95% CI 0.17-0.33); who had impaired cognition preadmission (OR = 0.57, 95% CI 0.51-0.64); from aged care facilities (OR = 0.59, 95% CI 0.52-0.67); had an American Society of Anaesthesiologists grade 2 (OR = 0.63, 95% CI 0.41-0.97), 3 (OR = 0.31, 95% CI 0.20-0.47) or 4 or 5 (OR = 0.21, 95% CI 0.14-0.32); surgery delay >48 h (OR = 0.81, 95% CI 0.71-0.91); and restricted/non-weight-bearing status immediately postoperatively (OR = 0.53, 95% CI 0.42-0.67). CONCLUSIONS Both non-modifiable and modifiable patient and surgical factors influence first-day mobilisation after hip fracture surgery. Reducing time to surgery might assist future quality improvement efforts to increase Day-1 postoperative mobility.
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Affiliation(s)
- Victoria Woodcroft-Brown
- The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Jack Bell
- The Prince Charles Hospital Allied Health Research Collaborative (AHRC), The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Chrysanth Ranjeev Pulle
- The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jacqueline Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Catherine McDougall
- The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Sarah Hurring
- Older Person's Health Specialist Service, Te Whatu Ora Waitaha, Canterbury, New Zealand
| | - Mitchell Sarkies
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Sydney School of Health Services, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Implementation Science Academy, Sydney Health Partners, Sydney, New South Wales, Australia
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Yoo SW, Kim T, Seo J, Oh H, Lee JH. Comparing quality of recovery and satisfaction between spinal anesthesia and nerve block in orthopedic below-knee surgery: A prospective controlled trial. Medicine (Baltimore) 2024; 103:e37573. [PMID: 38579041 PMCID: PMC10994455 DOI: 10.1097/md.0000000000037573] [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: 01/13/2024] [Accepted: 02/21/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Postoperative quality of recovery (QoR) and patient satisfaction have gained increasing significance in medical services. This study aimed to compare these 2 parameters between 2 types of regional anesthetics (spinal anesthesia and combined sciatic-femoral nerve block) in orthopedic lower knee surgery. METHODS A total of 101 patients were classified into 2 groups (combined sciatic-femoral nerve block, group N; spinal anesthesia, group S) according to patient preference. In group N, sciatic and femoral nerve blocks were performed on the popliteal and groin regions, respectively, under ultrasound guidance. Spinal anesthesia was performed in group S. The primary outcomes were QoR and patient satisfaction. QoR was measured using the Korean translation of the QoR-15K. Patient satisfaction was assessed using an 11-point Likert scale (0-10) and a dichotomous question addressing anesthesia preferences for future surgeries. RESULTS The physical independence of the postoperative QoR-15K was significantly higher in group N than in group S (14.2 vs 12.0, P = .04). On the 11-point Likert scale, group N scored 8.8, and group S scored 7.8 (P = .001). In the dichotomous question, 93.8% of the group N and 52.8% of the group S answered that they would like to choose the same anesthesia method for the next surgery (P < .001). In addition, fewer participants in group N complained of backache than those in group S, and the time to first urination after anesthesia was shorter in group N than in group S (P = .004, <.001, respectively). CONCLUSION Combined sciatic-femoral nerve block may provide better physical independence and satisfaction than spinal anesthesia in orthopedic below-knee surgeries.
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Affiliation(s)
- Seon Woo Yoo
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University–Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Taehoon Kim
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, South Korea
| | - Jongmin Seo
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, South Korea
| | - Hyunji Oh
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, South Korea
| | - Jun Ho Lee
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University–Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
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Kim HJ, Kim H, Park HS, Kim HJ, Ro YJ, Koh WU. Effective remimazolam loading dose for adequate sedation in regional anesthesia. Can J Anaesth 2024:10.1007/s12630-024-02698-1. [PMID: 38378937 DOI: 10.1007/s12630-024-02698-1] [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: 08/04/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 02/22/2024] Open
Abstract
PURPOSE Remimazolam is a novel ultrashort-acting sedative considered appropriate for continuous infusion during surgical procedures. Nevertheless, information regarding its loading dose for sedation during surgery is limited. We aimed to determine the 90% effective dose (ED90) of the remimazolam loading dose for sedation in patients undergoing limb surgery under regional anesthesia. METHODS We included 50 patients aged 19-80 yr undergoing limb surgery under regional anesthesia. After regional anesthesia, remimazolam besylate was administered at the assigned dose. For ten minutes after the initiation of loading, the level of sedation was evaluated using the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale. The primary outcome was the ED90 based on whether patients reached a MOAA/S score of ≤ 3 points (loss of response to verbal command) within ten minutes. The secondary outcomes were the ED50 and the estimated effect site and plasma concentration at the time of achieving successful sedation. RESULTS In total, 49 patients were included in the final analysis, and adequate sedation with the assigned loading dose was successful in 42 patients. The log-logistic function showed that the ED90 and ED50 were 0.617 mg·kg-1·hr-1 (95% confidence interval [CI], 0.511 to 0.722; 98% CI, 0.492 to 0.741) and 0.438 mg·kg-1·hr-1 (95% CI, 0.335 to 0.541; 98% CI, 0.315 to 0.560), respectively. CONCLUSION The ED90 of the remimazolam loading dose to achieve adequate sedation in patients undergoing limb surgery under regional anesthesia was 0.617 mg·kg-1·hr-1 (95% CI, 0.511 to 0.722; 98% CI, 0.492 to 0.741). STUDY REGISTRATION ClinicalTrials.gov (NCT05340335); first posted 22 April 2022.
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Affiliation(s)
- Ha-Jung Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyungtae Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyeok-Seong Park
- Department of Anesthesiology and Pain Medicine, Shihwa Medical Center, Siheung, Republic of Korea
| | - Hwa Jung Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Young-Jin Ro
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Won Uk Koh
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea.
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Kemp J, Barker C, Good N, Bain M. Graphical Association Analysis for Identifying Variation in Provider Claims for Joint Replacement Surgery. Stud Health Technol Inform 2024; 310:805-809. [PMID: 38269920 DOI: 10.3233/shti231076] [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: 01/26/2024]
Abstract
Identifying potentially fraudulent or wasteful medical insurance claims can be difficult due to the large amounts of data and human effort involved. We applied unsupervised machine learning to construct interpretable models which rank variations in medical provider claiming behaviour in the domain of unilateral joint replacement surgery, using data from the Australian Medicare Benefits Schedule. For each of three surgical procedures reference models of claims for each procedure were constructed and compared analytically to models of individual provider claims. Providers were ranked using a score based on fees for typical claims made in addition to those in the reference model. Evaluation of the results indicated that the top-ranked providers were likely to be unusual in their claiming patterns, with typical claims from outlying providers adding up to 192% to the cost of a procedure. The method is efficient, generalizable to other procedures and, being interpretable, integrates well into existing workflows.
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Affiliation(s)
- James Kemp
- University of New South Wales, Australia
| | | | - Norm Good
- Commonwealth Scientific and Industrial Research Organization, Australia
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Gibbs VN, Champaneria R, Sandercock J, Welton NJ, Geneen LJ, Brunskill SJ, Dorée C, Kimber C, Palmer AJ, Estcourt LJ. Pharmacological interventions for the prevention of bleeding in people undergoing elective hip or knee surgery: a systematic review and network meta-analysis. Cochrane Database Syst Rev 2024; 1:CD013295. [PMID: 38226724 PMCID: PMC10790339 DOI: 10.1002/14651858.cd013295.pub2] [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: 01/17/2024]
Abstract
BACKGROUND Hip and knee replacement surgery is a well-established means of improving quality of life, but is associated with a significant risk of bleeding. One-third of people are estimated to be anaemic before hip or knee replacement surgery; coupled with the blood lost during surgery, up to 90% of individuals are anaemic postoperatively. As a result, people undergoing orthopaedic surgery receive 3.9% of all packed red blood cell transfusions in the UK. Bleeding and the need for allogeneic blood transfusions has been shown to increase the risk of surgical site infection and mortality, and is associated with an increased duration of hospital stay and costs associated with surgery. Reducing blood loss during surgery may reduce the risk of allogeneic blood transfusion, reduce costs and improve outcomes following surgery. Several pharmacological interventions are available and currently employed as part of routine clinical care. OBJECTIVES To determine the relative efficacy of pharmacological interventions for preventing blood loss in elective primary or revision hip or knee replacement, and to identify optimal administration of interventions regarding timing, dose and route, using network meta-analysis (NMA) methodology. SEARCH METHODS We searched the following databases for randomised controlled trials (RCTs) and systematic reviews, from inception to 18 October 2022: CENTRAL (the Cochrane Library), MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Transfusion Evidence Library (Evidentia), ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP). SELECTION CRITERIA We included RCTs of people undergoing elective hip or knee surgery only. We excluded non-elective or emergency procedures, and studies published since 2010 that had not been prospectively registered (Cochrane Injuries policy). There were no restrictions on gender, ethnicity or age (adults only). We excluded studies that used standard of care as the comparator. Eligible interventions included: antifibrinolytics (tranexamic acid (TXA), aprotinin, epsilon-aminocaproic acid (EACA)), desmopressin, factor VIIa and XIII, fibrinogen, fibrin sealants and non-fibrin sealants. DATA COLLECTION AND ANALYSIS We performed the review according to standard Cochrane methodology. Two authors independently assessed trial eligibility and risk of bias, and extracted data. We assessed the certainty of the evidence using CINeMA. We presented direct (pairwise) results using RevMan Web and performed the NMA using BUGSnet. We were interested in the following primary outcomes: need for allogenic blood transfusion (up to 30 days) and all-cause mortality (deaths occurring up to 30 days after the operation), and the following secondary outcomes: mean number of transfusion episodes per person (up to 30 days), re-operation due to bleeding (within seven days), length of hospital stay and adverse events related to the intervention received. MAIN RESULTS We included a total of 102 studies. Twelve studies did not report the number of included participants; the other 90 studies included 8418 participants. Trials included more women (64%) than men (36%). In the NMA for allogeneic blood transfusion, we included 47 studies (4398 participants). Most studies examined TXA (58 arms, 56%). We found that TXA, given intra-articularly and orally at a total dose of greater than 3 g pre-incision, intraoperatively and postoperatively, ranked the highest, with an anticipated absolute effect of 147 fewer blood transfusions per 1000 people (150 fewer to 104 fewer) (53% chance of ranking 1st) within the NMA (risk ratio (RR) 0.02, 95% credible interval (CrI) 0 to 0.31; moderate-certainty evidence). This was followed by TXA given orally at a total dose of 3 g pre-incision and postoperatively (RR 0.06, 95% CrI 0.00 to 1.34; low-certainty evidence) and TXA given intravenously and orally at a total dose of greater than 3 g intraoperatively and postoperatively (RR 0.10, 95% CrI 0.02 to 0.55; low-certainty evidence). Aprotinin (RR 0.59, 95% CrI 0.36 to 0.96; low-certainty evidence), topical fibrin (RR 0.86, CrI 0.25 to 2.93; very low-certainty evidence) and EACA (RR 0.60, 95% CrI 0.29 to 1.27; very low-certainty evidence) were not shown to be as effective compared with TXA at reducing the risk of blood transfusion. We were unable to perform an NMA for our primary outcome all-cause mortality within 30 days of surgery due to the large number of studies with zero events, or because the outcome was not reported. In the NMA for deep vein thrombosis (DVT), we included 19 studies (2395 participants). Most studies examined TXA (27 arms, 64%). No studies assessed desmopressin, EACA or topical fibrin. We found that TXA given intravenously and orally at a total dose of greater than 3 g intraoperatively and postoperatively ranked the highest, with an anticipated absolute effect of 67 fewer DVTs per 1000 people (67 fewer to 34 more) (26% chance of ranking first) within the NMA (RR 0.16, 95% CrI 0.02 to 1.43; low-certainty evidence). This was followed by TXA given intravenously and intra-articularly at a total dose of 2 g pre-incision and intraoperatively (RR 0.21, 95% CrI 0.00 to 9.12; low-certainty evidence) and TXA given intravenously and intra-articularly, total dose greater than 3 g pre-incision, intraoperatively and postoperatively (RR 0.13, 95% CrI 0.01 to 3.11; low-certainty evidence). Aprotinin was not shown to be as effective compared with TXA (RR 0.67, 95% CrI 0.28 to 1.62; very low-certainty evidence). We were unable to perform an NMA for our secondary outcomes pulmonary embolism, myocardial infarction and CVA (stroke) within 30 days, mean number of transfusion episodes per person (up to 30 days), re-operation due to bleeding (within seven days), or length of hospital stay, due to the large number of studies with zero events, or because the outcome was not reported by enough studies to build a network. There are 30 ongoing trials planning to recruit 3776 participants, the majority examining TXA (26 trials). AUTHORS' CONCLUSIONS We found that of all the interventions studied, TXA is probably the most effective intervention for preventing bleeding in people undergoing hip or knee replacement surgery. Aprotinin and EACA may not be as effective as TXA at preventing the need for allogeneic blood transfusion. We were not able to draw strong conclusions on the optimal dose, route and timing of administration of TXA. We found that TXA given at higher doses tended to rank higher in the treatment hierarchy, and we also found that it may be more beneficial to use a mixed route of administration (oral and intra-articular, oral and intravenous, or intravenous and intra-articular). Oral administration may be as effective as intravenous administration of TXA. We found little to no evidence of harm associated with higher doses of tranexamic acid in the risk of DVT. However, we are not able to definitively draw these conclusions based on the trials included within this review.
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Affiliation(s)
- Victoria N Gibbs
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
| | - Rita Champaneria
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | - Josie Sandercock
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | - Nicky J Welton
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Louise J Geneen
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | - Susan J Brunskill
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | - Carolyn Dorée
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | - Catherine Kimber
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | - Antony Jr Palmer
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Lise J Estcourt
- Haematology/Transfusion Medicine, NHS Blood and Transplant, Oxford, UK
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Do A, Garzelli L, Garnier R, Court C, Sellam J, Miquel A, Berenbaum F. Inflammatory low back pain with radiculopathy revealing epidural disintegration of a bullet complicated by lead poisoning. RMD Open 2023; 9:e003119. [PMID: 38088246 PMCID: PMC10711883 DOI: 10.1136/rmdopen-2023-003119] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/14/2023] [Indexed: 12/18/2023] Open
Abstract
Inflammatory low back pain with radiculopathy is suggestive of cancer, infection or inflammatory diseases. We report a unique case of a 42-year-old patient with an acute inflammatory low back pain with bilateral radiculopathy associated with weight loss and abdominal pain, revealing the disintegration of a lead bullet along the epidural space and the S1 nerve root complicated by lead poisoning. Because of the high blood lead level of intoxication (>10 times over the usual lead levels) and the failure of repeated lead chelator cycles, a surgical treatment to remove bullet fragments was performed. It resulted in a significant decrease of pain and lead intoxication.
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Affiliation(s)
- Ariane Do
- Department of Rheumatology, Hospital Saint-Antoine, Paris, France
- Sorbonne University, Paris, France
| | | | - Robert Garnier
- Toxicovigilance Center, Hospital Fernand-Widal, Paris, France
| | - Charles Court
- Department of Orthopedic and Traumatology Surgery, Hospital Bicetre, Le Kremlin-Bicetre, France
- Paris-Saclay University, Gif-sur-Yvette, France
| | - Jérémie Sellam
- Department of Rheumatology, Hospital Saint-Antoine, Paris, France
- Sorbonne University, Paris, France
| | - Anne Miquel
- Department of Radiology, Hospital Saint-Antoine, Paris, France
| | - Francis Berenbaum
- Department of Rheumatology, Hospital Saint-Antoine, Paris, France
- Sorbonne University, Paris, France
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Ducrocq C, Luc F, Zeggay A, Petit M, Ould-Slimane M. Unusual Presentation of Lumbar Surgical Site Infection: A Case Study of Early Onset Pasteurella multocida Infection after Arthrodesis. Am J Case Rep 2023; 24:e941844. [PMID: 38053326 PMCID: PMC10711636 DOI: 10.12659/ajcr.941844] [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] [Received: 07/19/2023] [Revised: 10/31/2023] [Accepted: 10/17/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Infection is a serious surgical complication that significantly increases morbidity rates and health care expenses. Most human Pasteurella multocida infections are soft-tissue infections caused by dog or cat bites. Pasteurella multocida (P. multocida) is present in the oral, nasopharyngeal, and upper respiratory tract microbiota among cats, dogs, and other domestic or wild animals. Here, we report a case of lumbar surgical site infection caused by this bacterium. CASE REPORT A 70-year-old diabetic and overweight woman had a Pasteurella multocida surgical site infection after lumbar arthrodesis carried out for lumbar stenosis associated with spondylolisthesis. The patient had been in contact with her cat and claimed to have simply slept with it in her bed. Multiple antibiotic therapies and 3 debridement-irrigations with change of spinal implants during the last revision were needed. CONCLUSIONS Infections caused by P. multocida are rare and most often occur as a result of animal scratches or bites, but can sometimes occur after simple contact with an animal. Surgical site infection of spinal arthrodesis due to Pasteurella multocida implies treatment difficulties. In case of Pasteurella multocida infection of lumbar spinal arthrodesis, even in the early period, implant removal seems to be useful to limit the appearance of biofilm more specific to this micro-organism.
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Affiliation(s)
- Chloé Ducrocq
- Department of Orthopaedic Surgery, Spine Unit, Rouen University Hospital, Rouen, France
| | - François Luc
- Department of Pediatric Surgery, Rouen University Hospital, Rouen, France
| | - Abdeljalil Zeggay
- Department of Infectious and Tropical Diseases, Rouen University Hospital, Rouen, France
| | - Martin Petit
- Department of Orthopaedic Surgery, Spine Unit, Rouen University Hospital, Rouen, France
| | - Mourad Ould-Slimane
- Department of Orthopaedic Surgery, Spine Unit, Rouen University Hospital, Rouen, France
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Pawelke J, Vinayahalingam V, Heiss C, Budak M, El Khassawna T, Knapp G. Comparison of Nanocrystalline Hydroxyapatite Bone Graft with Empty Defects in Long Bone Fractures: A Retrospective Case-Control Study. Med Sci Monit 2023; 29:e941112. [PMID: 37872747 PMCID: PMC10612429 DOI: 10.12659/msm.941112] [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] [Received: 05/14/2023] [Accepted: 08/16/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND The regeneration of bone defects is indicated to restore lost tissue mass and functionality. Ostim®, an absorbable nanocrystalline hydroxyapatite (NCHA) paste, is indicated to enhance bone regeneration in bone defects due to trauma or surgery. This retrospective study of 110 patients with long-bone fracture defects presenting at a single trauma center between 2010 and 2012 aimed to compare outcomes with and without the use of Ostim® absorbable nanocrystalline hydroxyapatite paste. MATERIAL AND METHODS The study encompassed fractures in 110 patients - 55 patients received any defect augmentation (ED) and 55 patients were treated with NCHA augmentation. Fractures were located at the distal radius (66.4%, n=73), proximal humerus (5.5%, n=6), and proximal tibia (28.2%, n=31). Evaluating the clinical follow-up, the study encompassed post-surgery complications (eg, non-unions, infection). Bone healing was evaluated by conventional radiographs. RESULTS Postoperative complications occurred in 45.5% of patients regardless of the treatment (P=1.0). The non-union rate in both groups was 5.5% (n=8, P=1.0), and the risk for infection was lower in the NCHA group (3.6%, ED: n=3, NCHA: n=1, p=0.62). Patients suffered open fractures were treated in the NCHA group (100%, n=7, P=0.003). Radiological assessment demonstrated comparable healing of the fracture border, fracture gap, and articular surface (P>0.05). CONCLUSIONS The findings from this retrospective study support previous studies that have shown Ostim® absorbable nanocrystalline hydroxyapatite paste enhances outcomes and reduces the risk of complications when used to repair bone defects in long-bone fractures in trauma patients. NCHA paste augmentation is suitable for use in traumatic long-bone fractures.
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Affiliation(s)
- Jonas Pawelke
- Department of Experimental Trauma Surgery, Faculty of Medicine, Justus Liebig University, Giessen, Germany
| | - Vithusha Vinayahalingam
- Department of Experimental Trauma Surgery, Faculty of Medicine, Justus Liebig University, Giessen, Germany
| | - Christian Heiss
- Department of Experimental Trauma Surgery, Faculty of Medicine, Justus Liebig University, Giessen, Germany
- Department of Trauma, Hand and Reconstructive Surgery, Faculty of Medicine, Justus Liebig University, Giessen, Germany
| | - Matthäus Budak
- Department of Trauma, Hand and Reconstructive Surgery, Faculty of Medicine, Justus Liebig University, Giessen, Germany
| | - Thaqif El Khassawna
- Department of Experimental Trauma Surgery, Faculty of Medicine, Justus Liebig University, Giessen, Germany
| | - Gero Knapp
- Department of Trauma, Hand and Reconstructive Surgery, Faculty of Medicine, Justus Liebig University, Giessen, Germany
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Wilson SH, Sirianni JM, Bridges KH, Wolf BJ, Valente IE, Scofield MD. The impact of intraoperative N-acetylcysteine on opioid consumption following spine surgery: a randomized pilot trial. Pain Manag 2023; 13:593-602. [PMID: 37877260 PMCID: PMC10694787 DOI: 10.2217/pmt-2023-0061] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 08/22/2023] [Indexed: 10/26/2023] Open
Abstract
Aim: N-acetylcysteine (NAC) decreases inflammation and could augment perioperative analgesia. Materials & methods: This prospective pilot trial examined postoperative opioid consumption at 12 h following intraoperative NAC. In phase I, 20 adults scheduled for posterior spine surgery were randomized to NAC (0, 50, 100 and 150 mg/kg) to determine the optimal dose. In phase II, 30 patients were randomized to placebo or NAC (150 mg/kg). Opioid consumption, pain ratings and time to opioid rescue were recorded. Results: Postoperative opioid consumption was reduced in the NAC group 19.3% at 12 h and 20% at 18 and 36 h. Opioid consumption was reduced 22-24% in the NAC group at all times after adjusting for intraoperative opioid administration. NAC subjects reported lower pain scores relative to placebo. Conclusion: Subjects randomized to NAC consumed less postoperative opioids and reported less pain versus placebo. Larger randomized controlled trials are needed to further evaluate NAC for analgesia. Clinical Trial Registration: NCT04562597 (ClinicalTrials.gov).
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Affiliation(s)
- Sylvia H Wilson
- Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Joel M Sirianni
- Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Kathryn H Bridges
- Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Bethany J Wolf
- Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Isabella E Valente
- College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Michael D Scofield
- Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
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10
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Chen L, Zhang J. Retrospective Evaluation of Short-Course versus Traditional Preoperative Chemotherapy in Thoracolumbar Spinal Tuberculosis Patients. Med Sci Monit 2023; 29:e941003. [PMID: 37697647 PMCID: PMC10504853 DOI: 10.12659/msm.941003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/21/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Thoracolumbar spinal tuberculosis is a severe form of extrapulmonary tuberculosis requiring precise management strategies. Traditionally, patients undergo a 2-4 week course of preoperative quadruple chemotherapy before surgery. However, recent clinical practices have begun exploring the potential of a short-course (1-7 days) intensive preoperative chemotherapy regimen. This study aims to examine and compare the clinical effectiveness of both approaches, offering critical insights into the optimal preoperative chemotherapy duration. MATERIAL AND METHODS In this retrospective analysis, we examined the clinical data from 123 patients with surgically treated thoracolumbar spinal tuberculosis. Patients were categorized into two groups based on the duration of preoperative chemotherapy: the short-course intensive chemotherapy group (n=53, 1-7 days) and the traditional quadruple chemotherapy group (n=70, 2-4 weeks). We gathered and compared the pertinent clinical data from both groups to ascertain differences in clinical efficacy. RESULTS All 123 patients underwent follow-up for a duration averaging 2.8±0.7 years. Five patients experienced postoperative recurrence. Patients reported significant pain alleviation and overall good clinical outcomes. Among patients with neurological dysfunction, neurological symptoms were ameliorated, and the implanted devices were found to be effective. Bony fusion was observed in all the bone grafting regions. CONCLUSIONS For patients suffering from thoracolumbar spinal tuberculosis exhibiting progressive neurological deterioration, surgical intervention is deemed feasible after a brief period (usually 1-7 days) of intensive preoperative antitubercular therapy. This finding suggests that short-course intensive preoperative chemotherapy may serve as a viable approach in managing such cases.
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Hacker A, Irvine DS, MacDougal S, Thornton I. The Development of Fat Embolism Syndrome (FES) and Multiple Small Pulmonary Emboli Following Open Reduction Internal Fixation (ORIF) of a Left Femur Fracture: A Case Report. Cureus 2023; 15:e45551. [PMID: 37868491 PMCID: PMC10586472 DOI: 10.7759/cureus.45551] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Fat embolism syndrome (FES) is a rare but potentially life-threatening complication that can occur following orthopedic procedures, such as long bone fracture repairs. FES is caused by the release of fat globules into the bloodstream, leading to the obstruction of blood vessels and subsequent tissue damage. Pulmonary embolism (PE), a condition in which a blood clot travels to the lungs, is another potential complication of orthopedic procedures due to the mobilization of blood clots during surgery. We report the case of a 56-year-old female who presented to the emergency department with a left femur fracture following a mechanical fall and underwent open reduction internal fixation (ORIF) surgery for the fracture. The procedure was complicated by the development of FES and multiple small pulmonary emboli. The patient was managed postoperatively in the ICU, requiring support with multiple vasopressors and mechanical ventilation. She remained in the ICU for three days postoperatively and was discharged on postoperative day six to an inpatient rehabilitation facility.
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Affiliation(s)
- Aaron Hacker
- Anesthesiology, HCA Florida Westside Hospital, Plantation, USA
| | - Dylan S Irvine
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Scott MacDougal
- Anesthesiology, HCA Florida Westside Hospital, Plantation, USA
| | - Imani Thornton
- Anesthesiology and Critical Care, HCA Florida Westside Hospital, Plantation, USA
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12
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Núñez RYG, Córdova KRG, de Carvalho YK. Tridimensional models and radiographic study of dorsal laminectomy and thoracolumbar hemilaminectomy in dogs. Acta Cir Bras 2023; 38:e382623. [PMID: 37556719 PMCID: PMC10403244 DOI: 10.1590/acb382623] [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] [Received: 01/23/2023] [Accepted: 03/07/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE To create three-dimensional anatomical models of the thoracic and lumbar portions of the canine spine that reproduce the vertebral surgical approaches of dorsal laminectomy and hemilaminectomy, and to perform the respective radiographic evaluations of each approach. METHODS In a digital archive of the canine spine, digitally replicate the dorsal laminectomy and hemilaminectomy in the thoracic and lumbar portions and, then, make tridimensional prints of the vertebral models and obtain radiographs in three dorsoventral, ventrodorsal and laterolateral projections. RESULTS The anatomical models of the surgical spinal canal accesses of the thoracic and lumbar portions showed great fidelity to the natural bones. The created accesses have the proper shape, location and size, and their radiographic images showed similar radiodensities. CONCLUSIONS The replicas of the dorsal laminectomy and hemilaminectomy developed in the anatomical models in the thoracic and lumbar portions are able to represent the technical recommendations of the specialized literature, as well as their respective radiographic images, which have certain radiological properties that allow to make a deep radiological study. Therefore, the models are useful for neurosurgical training.
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Affiliation(s)
- Ricardo Ysaac García Núñez
- Universidade Federal do Acre – Graduate Program in Animal Health and Production – Rio Branco (AC), Brazil
| | | | - Yuri Karaccas de Carvalho
- Universidade Federal do Acre – Centro de Ciências Biológicas e da Natureza – Rio Branco (AC), Brazil
- Universidade Federal Fluminense – Faculdade de Medicina Veterinária – Departamento de Patologia e Clínica Veterinária – Niterói (RJ), Brazil
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13
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Lee M, Lee C, Lim J, Kim H, Choi YS, Kang H. Comparison of a Peripheral Nerve Block versus Spinal Anesthesia in Foot or Ankle Surgery: A Systematic Review and Meta-Analysis with a Trial Sequential Analysis. J Pers Med 2023; 13:1096. [PMID: 37511709 PMCID: PMC10381348 DOI: 10.3390/jpm13071096] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
Background: This systematic review and meta-analysis with trial sequential analysis (TSA) aimed to compare perioperative outcomes of peripheral nerve blocks (PNBs) and spinal anesthesia (SA) in elective foot and ankle surgery. Methods: The study protocol was registered in PROSPERO (CRD42021229597). Researchers independently searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials for relevant randomized controlled trials (RCTs). Results: Analysis of nine RCTs (n = 802; 399 PNBs, 403 SA) revealed significantly shorter block performance times (WMD: 7.470; 95% CI 6.072 to 8.868), the onset of sensory (WMD: 7.483; 95% CI 2.837 to 12.130) and motor blocks (WMD: 9.071; 95% CI 4.049 to 14.094), durations of sensory (WMD: 458.53; 95% CI 328.296 to 588.765) and motor blocks (WMD: 247.416; 95% CI 95.625 to 399.208), and significantly higher postoperative analgesic requirements (SMD: -1.091; 95% CI -1.634 to -0.549) in the SA group. Additionally, systolic blood pressure (SBP) at 30 min (WMD: 13.950; 95% CI 4.603 to 23.298) was lower in the SA group. Conclusions: The SA demonstrated shorter block performance time, faster onset and shorter duration of sensory and motor blocks, higher postoperative analgesic requirements, and lower SBP at 30 min compared to PNBs in elective foot and ankle surgery.
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Affiliation(s)
- Myeongjong Lee
- Department of Anesthesiology and Pain Medicine, Research Institute of Medical Science, Konkuk University School of Medicine, 82 Gugwondae-ro, Chungju 27376, Republic of Korea
| | - Cheol Lee
- Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, 895 Muwang-ro, Iksan 54538, Republic of Korea
| | - Junsung Lim
- Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, 895 Muwang-ro, Iksan 54538, Republic of Korea
| | - Hyungtae Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Yoo-Shin Choi
- Department of Surgery, Chung-Ang University College of Medicine, 84 Heukseok-ro, Dongjak-gu, Seoul 06911, Republic of Korea
| | - Hyun Kang
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, 84 Heukseok-ro, Dongjak-gu, Seoul 06911, Republic of Korea
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Cederqvist S, Flinkkilä T, Ylinen J, Kautiainen H, Tuominen A, Kiviranta I, Paloneva J. Response to: 'Correspondence on 'Non-surgical and surgical treatments for rotator cuff disease: a pragmatic randomised clinical trial with 2-year follow-up after initial rehabilitation'' by Randelli et al. Ann Rheum Dis 2023; 82:e103. [PMID: 33536163 DOI: 10.1136/annrheumdis-2020-219782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/23/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Sanna Cederqvist
- Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Tapio Flinkkilä
- Department of Orthopedics and Traumatology, Oulu University Hospital, Oulu, Finland
| | - Jari Ylinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyvaskyla, Central Finland, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
- Research Center, Folkhälsan, Helsinki, Finland
| | - Antti Tuominen
- Department of Surgery, Central Finland Hospital Nova, Jyvaskyla, Finland
| | - Ilkka Kiviranta
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
- Department of Orthopedics and Traumatology, University of Helsinki, Helsinki, Finland
| | - Juha Paloneva
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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15
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Randelli P, Coletto LA, Menon A, Caporali R. Correspondence on 'Non-surgical and surgical treatments for rotator cuff disease: a pragmatic randomised clinical trial with 2-year follow-up after initial rehabilitation'. Ann Rheum Dis 2023; 82:e102. [PMID: 33536162 DOI: 10.1136/annrheumdis-2020-219751] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Pietro Randelli
- 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Lavinia Agra Coletto
- Division of Clinical Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
- Dept. of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - Alessandra Menon
- 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
- Dept. of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
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Ayres JM, Dallman J, Nolte JA, Higginbotham N, Baker J, Horton G, Salava J, Sojka J, Templeton KJ, Malancea RI, Heddings A. Managing Post-Operative Pain in Orthopedic Patients: An International Comparison. Kans J Med 2023; 16:56-60. [PMID: 36845259 PMCID: PMC9957592 DOI: 10.17161/kjm.vol16.18744] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/26/2023] [Indexed: 02/24/2023] Open
Abstract
Introduction Opioids play a crucial role in post-operative pain management in America, but not in some other countries. We sought to determine if a discrepancy in opioid use between the United States (U.S.) and Romania, a country that administers opioids in a conservative fashion, would show in subjective pain control differences. Methods Between May 23, 2019, and November 23, 2019, 244 Romanian patients and 184 American patients underwent total hip arthroplasty or the surgical treatment of the following fractures: bimalleolar ankle, distal radius, femoral neck, intertrochanteric, and tibial-fibular. Opioid and non-opioid analgesic medication use and subjective pain scores during the first and second 24 hours after surgery were analyzed. Results Subjective pain scores for the first 24 hours were higher among patients in Romania compared to the U.S. (p < 0.0001), but Romanians reported lower pain scores than U.S. patients in the second 24-hours (p < 0.0001). The quantity of opioids given to U.S. patients did not differ significantly based on sex (p = 0.4258) or age (p = 0.0975). However, females reported higher pain scores than male patients following the studied procedures (p = 0.0181). No sex-based differences in pain scores were noted among Romanian patients. Conclusions Higher pain scores in American females, despite equivalent amounts of narcotics to their male counterparts, and the absence of a difference in Romanians suggested that the current American post-operative pain regimen may be tailored to the needs of male patients. In addition, it pointed to the impacts of gender, compared to sex, in pain experiences. Future research should look for the safest, most efficacious pain regimen suitable for all patients.
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Affiliation(s)
- Jack M. Ayres
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Johnathan Dallman
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Jack A. Nolte
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Nicholas Higginbotham
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Jordan Baker
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Greg Horton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Jonathon Salava
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - John Sojka
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Kimberly J. Templeton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Radu Ioan Malancea
- Department of Orthopedic Surgery, Spitalul Judetean de Urgenta Mavromati Botosani, Botosani, Romania
| | - Archie Heddings
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
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17
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Lawrence DC, Montazeripouragha A, Wai EK, Roffey DM, Phan KM, Phan P, Stratton A, Kingwell S, McIntosh G, Soroceanu A, Abraham E, Bailey CS, Christie S, Paquet J, Glennie A, Nataraj A, Hall H, Fisher C, Rampersaud YR, Thomas K, Manson N, Johnson M, Zarrabian M. Beneficial Effects of Preoperative Exercise on the Outcomes of Lumbar Fusion Spinal Surgery. Physiother Can 2023; 75:22-28. [PMID: 37250725 PMCID: PMC10211389 DOI: 10.3138/ptc-2021-0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/16/2021] [Revised: 08/03/2021] [Accepted: 08/18/2021] [Indexed: 02/11/2024]
Abstract
Purpose: To determine whether there was an association between self-reported preoperative exercise and postoperative outcomes after lumbar fusion spinal surgery. Method: We performed a retrospective multivariable analysis of the prospective Canadian Spine Outcomes and Research Network (CSORN) database of 2,203 patients who had elective single-level lumbar fusion spinal surgeries. We compared adverse events and hospital length of stay between patients who reported regular exercise (twice or more per week) prior to surgery ("Regular Exercise") to those exercising infrequently (once or less per week) ("Infrequent Exercise") or those who did no exercise ("No Exercise"). For all final analyses, we compared the Regular Exercise group to the combined Infrequent Exercise or No Exercise group. Results: After making adjustments for known confounding factors, we demonstrated that patients in the Regular Exercise group had fewer adverse events (adjusted odds ratio 0.72; 95% CI: 0.57, 0.91; p = 0.006) and significantly shorter lengths of stay (adjusted mean 2.2 vs. 2.5 d, p = 0.029) than the combined Infrequent Exercise or No Exercise group. Conclusions: Patients who exercised regularly twice or more per week prior to surgery had fewer postoperative adverse events and significantly shorter hospital lengths of stay compared to patients that exercised infrequently or did no exercise. Further study is required to determine effectiveness of a targeted prehabilitation programme.
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Affiliation(s)
| | | | - Eugene K. Wai
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Health Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Darren M. Roffey
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Health Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Kim M. Phan
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Philippe Phan
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Alexandra Stratton
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephen Kingwell
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Greg McIntosh
- Research Operations, Canadian Spine Outcomes Research Network, Markdale, Ontario, Canada
| | - Alex Soroceanu
- University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Edward Abraham
- Canada East Spine Center and Horizon Health Network, Dalhousie University, Saint John, New Brunswick, Canada
| | - Christopher S. Bailey
- Lawson Health Research Institute/London Health Sciences Centre, Division of Orthopaedics, Department of Surgery, Western University, London, Ontario, Canada
| | - Sean Christie
- Department of Surgery, Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jerome Paquet
- Hôpital de l’Enfant-Jésus, Laval University, Quebec City, Quebec, Canada
| | - Andrew Glennie
- Department of Surgery, Division of Orthopedics, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Hamilton Hall
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Charles Fisher
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Y. Raja Rampersaud
- Arthritis Program, Krembil Research Institute, University Health Network, Department of Surgery, Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kenneth Thomas
- University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Neil Manson
- Canada East Spine Center and Horizon Health Network, Dalhousie University, Saint John, New Brunswick, Canada
| | - Michael Johnson
- Winnipeg Spine Program Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mohammad Zarrabian
- Winnipeg Spine Program Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
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18
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Silva A, Sincari M, Peixoto I, Vaz M, Mendes E. Isthmic Spondylolisthesis in Young Gymnasts: A Report of Two Cases. Cureus 2023; 15:e35152. [PMID: 36950005 PMCID: PMC10027424 DOI: 10.7759/cureus.35152] [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] [Accepted: 02/14/2023] [Indexed: 02/20/2023] Open
Abstract
Isthmic spondylolisthesis is a condition characterized by the subluxation of one vertebral body over the adjacent inferior vertebral body, secondary to a defect in the pars interarticularis. This paper reports two cases of young acrobatic gymnasts who presented with long-term, progressive lumbosciatic pain and lower limb dysesthesia. One gymnast presented with additional neurogenic bladder dysfunction. Diagnostic testing revealed L5-S1 spondylolisthesis due to bilateral isthmic lysis in both gymnasts. Both underwent L4-S2 fixation followed by L5-S1 transdiscal arthrodesis with Rialto sacroiliac fusion system (Medtronic®, Minneapolis, MN, USA). Favorable evolution of neuromotor symptoms was observed after rehabilitation, with less residual neurological impairment in the case of higher-grade spondylolisthesis. This case series aims to emphasize the importance of recognizing this pathology in athletes as well as its correct management. Early surgical intervention can prevent the onset and progression of neurological deficits.
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Affiliation(s)
- Andreia Silva
- Physical Medicine and Rehabilitation Department, Tondela-Viseu Hospital Center, Viseu, PRT
| | - Marcel Sincari
- Neurosurgery Department, Tondela-Viseu Hospital Center, Viseu, PRT
| | - Irina Peixoto
- Physical Medicine and Rehabilitation Department, Tondela-Viseu Hospital Center, Viseu, PRT
| | - Mário Vaz
- Physical Medicine and Rehabilitation Department, Tondela-Viseu Hospital Center, Viseu, PRT
| | - Eduardo Mendes
- Orthopaedics and Traumatology Department, Tondela-Viseu Hospital Center, Viseu, PRT
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Davoudi A, Sajdeya R, Ison R, Hagen J, Rashidi P, Price CC, Tighe PJ. Fairness in the prediction of acute postoperative pain using machine learning models. Front Digit Health 2023; 4:970281. [PMID: 36714611 PMCID: PMC9874861 DOI: 10.3389/fdgth.2022.970281] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/24/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Overall performance of machine learning-based prediction models is promising; however, their generalizability and fairness must be vigorously investigated to ensure they perform sufficiently well for all patients. Objective This study aimed to evaluate prediction bias in machine learning models used for predicting acute postoperative pain. Method We conducted a retrospective review of electronic health records for patients undergoing orthopedic surgery from June 1, 2011, to June 30, 2019, at the University of Florida Health system/Shands Hospital. CatBoost machine learning models were trained for predicting the binary outcome of low (≤4) and high pain (>4). Model biases were assessed against seven protected attributes of age, sex, race, area deprivation index (ADI), speaking language, health literacy, and insurance type. Reweighing of protected attributes was investigated for reducing model bias compared with base models. Fairness metrics of equal opportunity, predictive parity, predictive equality, statistical parity, and overall accuracy equality were examined. Results The final dataset included 14,263 patients [age: 60.72 (16.03) years, 53.87% female, 39.13% low acute postoperative pain]. The machine learning model (area under the curve, 0.71) was biased in terms of age, race, ADI, and insurance type, but not in terms of sex, language, and health literacy. Despite promising overall performance in predicting acute postoperative pain, machine learning-based prediction models may be biased with respect to protected attributes. Conclusion These findings show the need to evaluate fairness in machine learning models involved in perioperative pain before they are implemented as clinical decision support tools.
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Affiliation(s)
- Anis Davoudi
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United Sates
| | - Ruba Sajdeya
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL, United States
| | - Ron Ison
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United Sates
| | - Jennifer Hagen
- Department of Orthopedic Surgery, University of Florida College of Medicine, Gainesville, FL, United States
| | - Parisa Rashidi
- Department of Biomedical Engineering, University of Florida Herbert Wertheim College of Engineering, Gainesville, FL, United States
| | - Catherine C. Price
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United Sates
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, FL, United States
| | - Patrick J. Tighe
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United Sates
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Muacevic A, Adler JR, Reese BL, Lindsey T. The Confidence and Accuracy of Medical Students Trained in Ultrasound or Landmarks for Performing Knee Aspiration. Cureus 2022; 14:e31722. [PMID: 36569740 PMCID: PMC9771572 DOI: 10.7759/cureus.31722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Medical students are trained using anatomical landmarks in order to perform many procedures, such as knee aspirations. With the growing popularity and use of ultrasound, the question arises whether training students with ultrasound instead of landmarks increases their skill. Previous research has shown increased accuracy and confidence in residents who trained with ultrasound compared to landmarks only. No studies to date have analyzed the effect of ultrasound learning versus landmark learning in medical students. Objective The purpose of this study is to analyze the confidence and accuracy of medical students when taught knee aspiration using ultrasound training compared to students taught with landmarks only. Methods The project was deemed exempt by the Edward Via College of Osteopathic Medicine (VCOM) Institutional Review Board (IRB) because it falls under the quality improvement category (IRB number 1806802-1). Subjects were randomized into two groups: one trained in ultrasound and one trained in landmarks for performing knee aspirations. Both groups were tested for accuracy by the ability to aspirate fluid from the model and the number of attempts; each student was given a maximum of three attempts. Documentation included the number of attempts for each student or "no fluid" for those exceeding three attempts. They were then surveyed for confidence. The study took place in an educational setting at VCOM-Carolinas. A total of 42 first-year medical students participated in this study. Results Fisher's exact test showed statistically significant results for confidence (p<0.001) between the ultrasound group (N=22) and non-ultrasound group (N=20) with a power of 0.285. The accuracy of aspirating fluid was not found to be statistically significant (p=0.4805). Conclusions Although no significant differences in the accuracy of knee aspirations at short term were seen, there was a clear improvement in student confidence and perceived capability of the skill. Those students who learned using ultrasound-guided techniques were more confident in their ability to accurately perform the technique when compared to their peers.
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Blanchette V, Houde L, Armstrong DG, Schmidt BM. Outcomes of Hallux Amputation Versus Partial First Ray Resection in People with Non-Healing Diabetic Foot Ulcers: A Pragmatic Observational Cohort Study. INT J LOW EXTR WOUND 2022:15347346221122859. [PMID: 36069031 PMCID: PMC10018408 DOI: 10.1177/15347346221122859] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There are few data comparing outcomes after hallux amputation or partial first ray resection after diabetic foot ulcer (DFU). In a similar context, the choice to perform one of these two surgeries is attributable to clinician preference based on experience and characteristics of the patient and the DFU. Therefore, the purpose of this study was to determine the more definitive surgery between hallux amputation and partial first ray resection. We abstracted data from a cohort of 70 patients followed for a 1-year postoperative period to support clinical practice. We also attempted to identify patient characteristics leading to these outcomes. Our results suggested no statistical difference between the type of surgery and outcomes such as recurrence of DFU and amputation at 3, 6, and 12 months or death. However, there was a statistically significantly increased likelihood of re-ulceration for patients with CAD who underwent hallux amputation (p = 0.02). There was also a significantly increased likelihood of re-ulceration for people with depression or a history when the partial ray resection was performed (p = 0.02). Patients with prior amputation showed a higher probability of undergoing another re-amputation with partial ray resection (p = 0.01). Although the trends that emerge from this project are limited to what is observed in this statistical context, where the number of patients included and the number of total observations per outcome were limited, it highlights interesting data for future research to inform clinical decisions to support best practices for the benefit of patients.
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Affiliation(s)
- Virginie Blanchette
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières, Canada, G9A 5H7
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, 1520 San Pablo, St. Los Angeles, CA, 90031, USA
| | - Louis Houde
- Department of Mathematic and Informatic, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières, Canada, G9A 5H7
| | - David G. Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, 1520 San Pablo, St. Los Angeles, CA, 90031, USA
| | - Brian M. Schmidt
- University of Michigan Medical School, Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, Domino’s Farms (Lobby C, Suite 1300) 24 Frank Lloyd Wright Drive, Ann Arbor, MI, 48106, USA
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22
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Bijlsma JW. EULAR 75-year anniversary: commentaries on ARD papers from 50 years ago. Ann Rheum Dis 2022; 81:annrheumdis-2022-222584. [PMID: 35820675 DOI: 10.1136/ard-2022-222584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/02/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Johannes Wj Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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23
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Mendez GM, Manske RC, Smith BS, Prohaska DJ. Supraspinatus Fatty Infiltration Correlation with Handgrip Strength, Shoulder Strength, and Validated Patient-Reported Outcome Measures in Patients with Rotator Cuff Tears. Kans J Med 2022; 15:155-159. [PMID: 35646246 PMCID: PMC9126862 DOI: 10.17161/kjm.vol15.16343] [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] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction The purpose of this study was to investigate the relationships between supraspinatus atrophy on magnetic resonance imaging (MRI) and other objective parameters in patients with rotator cuff tears. It was hypothesized that high-grade supraspinatus fatty infiltration would be correlated negatively with handgrip strength, shoulder strength, and patient-reported outcome measures (PROMs). Methods Patients with MRI-proven rotator cuff tears treated by a single sports medicine fellowship-trained orthopaedist at a single institution underwent comprehensive preoperative evaluation including bilateral handgrip and shoulder strength measurements with dynamometers and multiple online questionnaires from the Surgical Outcomes SystemTM (Arthrex, Naples, FL). Available shoulder MRIs were reviewed to grade supraspinatus fatty infiltration severity according to the 5-tier Goutallier system and an alternate 3-tier classification scheme. Difference analysis and Spearman (rho) rank order correlation were applied to the collected data to define the relationships between supraspinatus fatty infiltration and key variables including handgrip strength, shoulder strength, and scores derived from the shoulder PROMs. Results Ninety of the 121 patients enrolled in the study had shoulder MRIs available for review. There was no correlation found between supraspinatus fatty infiltration and handgrip strength, shoulder abduction strength, or any of the seven common shoulder PROM scores evaluated. There was statistically significant, albeit weak, correlation between MRI-derived fatty infiltration and shoulder external rotation strength. Conclusions Contrary to the hypothesis, high-grade supraspinatus fatty infiltration is largely unrelated to and should not be considered predictive of handgrip strength, shoulder strength, or common shoulder PROM scores.
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Affiliation(s)
- Gregory M Mendez
- Department of Orthopaedics, University of Kansas School of Medicine, Wichita, KS
| | - Robert C Manske
- Department of Physical Therapy, Wichita State University, Wichita, KS
| | - Barbara S Smith
- Department of Physical Therapy, Wichita State University, Wichita, KS
| | - Daniel J Prohaska
- Department of Orthopaedics, University of Kansas School of Medicine, Wichita, KS
- Advanced Orthopaedic Associates, Wichita, KS
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24
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Bunch CM, Moore EE, Moore HB, Neal MD, Thomas AV, Zackariya N, Zhao J, Zackariya S, Brenner TJ, Berquist M, Buckner H, Wiarda G, Fulkerson D, Huff W, Kwaan HC, Lankowicz G, Laubscher GJ, Lourens PJ, Pretorius E, Kotze MJ, Moolla MS, Sithole S, Maponga TG, Kell DB, Fox MD, Gillespie L, Khan RZ, Mamczak CN, March R, Macias R, Bull BS, Walsh MM. Immuno-Thrombotic Complications of COVID-19: Implications for Timing of Surgery and Anticoagulation. Front Surg 2022; 9:889999. [PMID: 35599794 PMCID: PMC9119324 DOI: 10.3389/fsurg.2022.889999] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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: 03/04/2022] [Accepted: 04/05/2022] [Indexed: 12/12/2022] Open
Abstract
Early in the coronavirus disease 2019 (COVID-19) pandemic, global governing bodies prioritized transmissibility-based precautions and hospital capacity as the foundation for delay of elective procedures. As elective surgical volumes increased, convalescent COVID-19 patients faced increased postoperative morbidity and mortality and clinicians had limited evidence for stratifying individual risk in this population. Clear evidence now demonstrates that those recovering from COVID-19 have increased postoperative morbidity and mortality. These data-in conjunction with the recent American Society of Anesthesiologists guidelines-offer the evidence necessary to expand the early pandemic guidelines and guide the surgeon's preoperative risk assessment. Here, we argue elective surgeries should still be delayed on a personalized basis to maximize postoperative outcomes. We outline a framework for stratifying the individual COVID-19 patient's fitness for surgery based on the symptoms and severity of acute or convalescent COVID-19 illness, coagulopathy assessment, and acuity of the surgical procedure. Although the most common manifestation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is COVID-19 pneumonitis, every system in the body is potentially afflicted by an endotheliitis. This endothelial derangement most often manifests as a hypercoagulable state on admission with associated occult and symptomatic venous and arterial thromboembolisms. The delicate balance between hyper and hypocoagulable states is defined by the local immune-thrombotic crosstalk that results commonly in a hemostatic derangement known as fibrinolytic shutdown. In tandem, the hemostatic derangements that occur during acute COVID-19 infection affect not only the timing of surgical procedures, but also the incidence of postoperative hemostatic complications related to COVID-19-associated coagulopathy (CAC). Traditional methods of thromboprophylaxis and treatment of thromboses after surgery require a tailored approach guided by an understanding of the pathophysiologic underpinnings of the COVID-19 patient. Likewise, a prolonged period of risk for developing hemostatic complications following hospitalization due to COVID-19 has resulted in guidelines from differing societies that recommend varying periods of delay following SARS-CoV-2 infection. In conclusion, we propose the perioperative, personalized assessment of COVID-19 patients' CAC using viscoelastic hemostatic assays and fluorescent microclot analysis.
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Affiliation(s)
- Connor M. Bunch
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States
| | - Ernest E. Moore
- Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO, United States
| | - Hunter B. Moore
- Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO, United States
| | - Matthew D. Neal
- Pittsburgh Trauma Research Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Anthony V. Thomas
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
| | - Nuha Zackariya
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
| | - Jonathan Zhao
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Sufyan Zackariya
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Toby J. Brenner
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Margaret Berquist
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Hallie Buckner
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Grant Wiarda
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Daniel Fulkerson
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
- Department of Neurosurgery, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Wei Huff
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
- Department of Neurosurgery, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Hau C. Kwaan
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Genevieve Lankowicz
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | | | | | - Etheresia Pretorius
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
- Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Maritha J. Kotze
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Muhammad S. Moolla
- Division of General Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Sithembiso Sithole
- Division of General Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Tongai G. Maponga
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Douglas B. Kell
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
- Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- The Novo Nordisk Foundation Centre for Biosustainability, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Mark D. Fox
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
| | - Laura Gillespie
- Department of Quality Assurance and Performance Improvement, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Rashid Z. Khan
- Department of Hematology, Michiana Hematology Oncology, Mishawaka, IN, United States
| | - Christiaan N. Mamczak
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
- Department of Orthopaedic Trauma, Memorial Hospital South Bend, South Bend, IN, United States
| | - Robert March
- Department of Cardiothoracic Surgery, St. Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Rachel Macias
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
- Department of Plastic and Reconstructive Surgery, St. Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Brian S. Bull
- Department of Pathology and Human Anatomy, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Mark M. Walsh
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
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25
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Fok MW, Cobb T, Bain GI. Endoscopic cubital tunnel decompression: state of the art. J ISAKOS 2021; 6:367-374. [PMID: 34794966 DOI: 10.1136/jisakos-2020-000506] [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: 08/07/2020] [Revised: 11/17/2020] [Accepted: 11/24/2020] [Indexed: 11/04/2022]
Abstract
Cubital tunnel syndrome is a common compressive neuropathy of the upper limb. Surgical decompression is indicated for patients who failed conservative therapy. Decompression in situ has shown to achieve comparable outcomes as decompression with anterior transposition in idiopathic cubital tunnel syndrome. Endoscopic cubital tunnel decompression has gained popularity in recent years, as surgeons can attain decompression of the ulnar nerve along its course using a small incision. Results from randomised controlled studies and systematic reviews, comparing endoscopic with open decompression in situ, are promising. Cases in which anterior transposition of the ulnar nerve is needed, an endoscopic technique can still be used by creating an additional volar portal, for the mobilisation of ulnar nerve. Early short-term results are encouraging. Further adequately powered, prospective, preferably double-blinded, randomised study are needed.
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Affiliation(s)
- Margaret W Fok
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Tyson Cobb
- Shoulder, Elbow, Wrist and Hand Center of Excellence, Clinton, Indiana, USA
| | - Gregory Ian Bain
- Department of Orthopaedic Surgery, Flinders University, North Adelaide, South Australia, Australia
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26
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Storti TM, Dias RG, Dantas GCD, Faria RSS, Simionatto JE, Paniago AF. Clinical Evaluation of the Reconstruction of the Biceps Brachii using Triceps Graft. Rev Bras Ortop 2021; 56:656-663. [PMID: 34733439 PMCID: PMC8558938 DOI: 10.1055/s-0041-1729566] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 10/28/2020] [Indexed: 10/26/2022] Open
Abstract
Objective Clinical and functional evaluation of the surgical treatment for chronic injury of the distal biceps brachii applying a surgical technique with grafting of the distal triceps brachii tendon. Methods A study based on a review of the medical records and clinical evaluation of the patients submitted to surgical treatment for chronic injury to the distal insertion of the biceps brachii between February 2015 and February 2017. In a 12-month-minimum postoperative follow-up, 7 patients were evaluated regarding the range of motion of the operated and non-operated elbows, flexion, upper-limb extension and supination with a digital dynamometer, the hook test, the satisfaction index, and the Disabilities of the Arm, Shoulder and Hand (DASH) and Mayo Elbow Performance Score (MEPS) intruments. Results During the postoperative functional evaluation, no patient reported dissatisfaction with the esthetic outcome of the incisions, and all of them were satisfied/very satisfied with the range of motion and strength of the operated limb. No neurovascular complications, surgical site infection or tendon rupture were observed. On the MEPS and DASH scales, all patients scored 100 and 0 respectively. The mean flexion was of 133.5° on the operated side, versus 139.2° on the non-operated side. The mean extension was of 5° on the operated side versus 0° on the non-operated side. The supination was of 86.5° versus 90°, and the pronation, 80° versus 80°, when comparing the operated and non-operated sides respectively. The mean flexion, extension and supination corresponded respectively to 92.5%, 96.4% and 86.8% of those of the non-operated limb. Conclusion Recosntruction of the distal biceps brachii with triceps grafting seems to be an effective and safe option for the treatment of chronic distal biceps injuries.
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Affiliation(s)
- Thiago Medeiros Storti
- Instituto de Pesquisa e Ensino, Hospital Ortopédico e Medicina Especializada, Brasília, DF, Brasil
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27
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Macedo RDR, Santos JPGD, Lobato ES, Mendes JP, Ikemoto RY, Rodrigues LMR. Application of 5% Lidocaine Adhesive Patch in Painful Surgical Scars: Clinical Trial. Rev Bras Ortop 2021; 56:601-614. [PMID: 34733432 PMCID: PMC8558943 DOI: 10.1055/s-0041-1735911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/05/2020] [Accepted: 03/08/2021] [Indexed: 10/27/2022] Open
Abstract
Objective The present paper aims to evaluate the use of a 5% lidocaine patch to treat neuropathic pain after orthopedic procedures in comparison with therapeutic massage over surgical incisions. Methods This is a prospective, randomized clinical trial with 37 patients who underwent orthopedic surgery from January 2015 to February 2017. The study included subjects aged 13 to 70 years old who underwent foot and ankle orthopedic surgery and presented neuropathic pain or hypersensitivity at the surgical incision site for at least 90 days after the procedure. All patients were assessed for pain (using the visual analog scale [VAS]) and quality of life (with the SF-36 questionnaire) at the beginning of the treatment and after 30, 60, and 90 days. Results Although the treatment improved pain in both groups, subjects using the lidocaine patch presented greater pain reduction over time. There were no statistically significant differences in the SF-36 questionnaire, with no significant evidence regarding functional capacity, physical aspects, vitality, emotional aspects, social aspects, general health condition, and mental health. The great advantage of the patch was the degree of personal satisfaction of the patients, with statistical relevance, probably due to the easy application and psychological effect of a drug therapy. Conclusion Lidocaine patches and massages are effective treatment methods for reducing scar tissue pain, with similar outcomes. The patches improved the degree of patient satisfaction. Level of Evidence 1. Prospective randomized clinical trial.
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Affiliation(s)
- Rafael da Rocha Macedo
- Departamento de Ortopedia e Traumatologia, Hospital Ipiranga, São Paulo, SP, Brasil.,Disciplina de Ortopedia e Traumatologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
| | | | - Emanuel Smith Lobato
- Departamento de Ortopedia e Traumatologia, Hospital Ipiranga, São Paulo, SP, Brasil
| | - João Pereira Mendes
- Departamento de Ortopedia e Traumatologia, Hospital Ipiranga, São Paulo, SP, Brasil
| | - Roberto Yukio Ikemoto
- Departamento de Ortopedia e Traumatologia, Hospital Ipiranga, São Paulo, SP, Brasil.,Disciplina de Ortopedia e Traumatologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
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28
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Krishnamoorthy V, Motika CO, Ohnuma T, McLean D, Ellis AR, Raghunathan K. Perioperative colloid choice and bleeding in patients undergoing musculoskeletal surgery: An observational administrative database study. Int J Crit Illn Inj Sci 2021; 11:223-228. [PMID: 35070912 PMCID: PMC8725802 DOI: 10.4103/ijciis.ijciis_178_20] [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: 10/23/2020] [Revised: 12/27/2020] [Accepted: 02/02/2021] [Indexed: 11/04/2022] Open
Abstract
Background The synthetic colloid hydroxyethyl starch (HES) received a black box warning, issued by the US Food and Drug Administration (FDA) in June 2013, in patients with sepsis, due to increased risk of bleeding, renal injury, and death. Risks of HES in populations undergoing noncardiac surgery are unclear. Here, we examine the association of colloid choice - human-derived albumin versus HES - with bleeding in musculoskeletal surgery. Methods Inpatient musculoskeletal surgical patients who received colloids on the day of surgery were included during a time period before the FDA warning on HES using the Premier Healthcare database. The exposure was type of colloids administered on the day of surgery: HES versus albumin. The primary outcome was major perioperative bleeding, measured on the 1st postoperative day through hospital discharge. The secondary outcomes included acute renal failure and postoperative length of stay >75th percentile. Results We identified 41,211 patients who received albumin (n = 12,803) and HES (n = 28,408) on the day of surgery. The propensity-weighted multivariable analysis demonstrated a reduced risk of major perioperative bleeding on the day after surgery following treatment with albumin versus HES (relative risk: 0.89 [95% confidence interval, 0.84-0.93]). No significant differences were observed in the secondary outcomes. Conclusion When compared with albumin, treatment with HES on the day of musculoskeletal surgery was associated with an increased risk of major perioperative bleeding on subsequent days. Given that HES continues to be used as a colloid in multiple patient populations worldwide, further studies examining the safety of HES versus albumin solutions are needed.
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Affiliation(s)
- Vijay Krishnamoorthy
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.,Critical Care and Perioperative Population Health Research Unit, Duke University, Durham, NC, USA
| | - Calvin O Motika
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Tetsu Ohnuma
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.,Critical Care and Perioperative Population Health Research Unit, Duke University, Durham, NC, USA
| | - Duncan McLean
- Department of Anesthesiology, The University of North Carolina, Chapel Hill, NC, USA
| | - Alan R Ellis
- School of Social Work, North Carolina State University, Raleigh, NC, USA
| | - Karthik Raghunathan
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.,Critical Care and Perioperative Population Health Research Unit, Duke University, Durham, NC, USA
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29
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Gunnlaugsdóttir SL, Erlendsdóttir H, Helgason KO, Geirsson ÁJ, Thors V, Guðmundsson S, Gottfreðsson M. Native joint infections in Iceland 2003-2017: an increase in postarthroscopic infections. Ann Rheum Dis 2021; 81:132-139. [PMID: 34535438 PMCID: PMC8762016 DOI: 10.1136/annrheumdis-2021-220820] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/20/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022]
Abstract
Objectives Nationwide study on the epidemiology, clinical characteristics and outcomes among patients with native joint infection (NJI) in Iceland, 2003–2017. Methods All positive synovial fluid culture results in Iceland were identified and medical records reviewed. Results A total of 299 NJI (40 children and 259 adults) were diagnosed in Iceland in 2003–2017, with a stable incidence of 6.3 cases/100 000/year, but marked gender difference among adults (33% women vs 67% men, p<0.001). The knee joint was most commonly affected, and Staphylococcus aureus was the most common isolate in both adults and children, followed by various streptococcal species in adults and Kingella kingae in children. NJI was iatrogenic in 34% of adults (88/259) but comprised 45% among 18–65 years and a stable incidence. Incidence of infections following arthroscopic procedures in adults increased significantly compared with the previous decade (9/100 000/year in 1990–2002 vs 25/100 000/year in 2003–2017, p<0.01) with no significant increase seen in risk per procedure. The proportion of postarthroscopic NJI was 0.17% overall but 0.24% for knee arthroscopy. Patients with postarthroscopic infection were more likely to undergo subsequent arthroplasty when compared with other patients with NJI (p=0.008). Conclusions The incidence of NJI in Iceland has remained stable. The proportion of iatrogenic infections is high, especially among young adults, with an increase seen in postarthroscopic infections when compared with the previous decade. Although rare, NJI following arthroscopy can be a devastating complication, with significant morbidity and these results, therefore, emphasise the need for firm indications when arthroscopic treatment is considered.
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Affiliation(s)
| | | | | | | | | | - Sigurður Guðmundsson
- Infectious Diseases, Landspitali, Reykjavik, Iceland.,Medicine, University of Iceland School of Health Sciences, Reykjavik, Iceland
| | - Magnús Gottfreðsson
- Infectious Diseases, Landspitali, Reykjavik, Iceland .,Medicine, University of Iceland School of Health Sciences, Reykjavik, Iceland
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30
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Lenihan M, Bellabarba C, Kleweno CP, McIntyre L, Robinson B, Mandell SP. Pelvic crush injury requiring hemicorporectomy. Trauma Surg Acute Care Open 2021; 6:e000740. [PMID: 34337158 PMCID: PMC8286788 DOI: 10.1136/tsaco-2021-000740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Megan Lenihan
- Surgery, Swedish Medical Center, Seattle, Washington, USA
| | - Carlo Bellabarba
- Orthopedics, Harborview Medical Center, Seattle, Washington, USA
| | - Conor P Kleweno
- Orthopedics, Harborview Medical Center, Seattle, Washington, USA
| | - Lisa McIntyre
- Surgery, Harborview Medical Center, Seattle, Washington, USA
| | - Bryce Robinson
- Surgery, Harborview Medical Center, Seattle, Washington, USA
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31
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Gourbault LJ, Fennelly JT, Stedman T, Price MJ, Ward AE. The Current UK Consensus on the Management of Weber B and Posterior Ankle Fractures: A Questionnaire Study as Part of the Acute Management of Ankle Fractures (AUGMENT) Audit. J Foot Ankle Surg 2021; 60:669-675. [PMID: 33573901 DOI: 10.1053/j.jfas.2020.04.023] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 03/31/2020] [Accepted: 04/18/2020] [Indexed: 02/03/2023]
Abstract
Ankle fractures are common conditions which are associated with significant morbidity when managed incorrectly. With the incidence due to triple by 2030, standards of practice were created by the British Orthopaedic Association and the British Orthopaedic Foot and Ankle Society to ensure optimal treatment. In spite of this, anecdotally there is still a variation in practice and therefore a questionnaire study was designed to explore clinician decision-making around Weber B and Posterior Malleolus ankle fractures. Five scenarios explored management regarding minimally and grossly displaced injuries, as well as the use of further imaging. The questionnaires were distributed via AUGMENT collaborators at their sites and at the British Orthopaedic Foot and Ankle Society congress 2018. About 315 questionnaires were completed and included in analysis. For Weber B injuries, overall there was a consensus across all respondents with minimally displaced and grossly displaced fractures being treated conservatively and operatively respectively. For Posterior Malleolus injuries, there was variation in practice between Foot and Ankle specialists and their non-Foot and Ankle colleagues. Computed tomography (CT) was more likely to be used to assess these injuries by specialists (97.50 vs 69.79%) and these injuries were more likely to be treated operatively across the board. This study identified key variation in practice of the management of Posterior Malleolar ankle fractures, including the use of imaging to further define the anatomy and the decision to operate. Foot and Ankle surgeons were more likely to organize CT scans and to surgically manage these injures.
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Affiliation(s)
| | | | - Tobias Stedman
- Registrar, Doncaster Royal Infirmary, Doncaster, United Kingdom
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Symeonidis PD, Papakostas ET, Marín Fermín T, Tsatlidou M, Terzidis I, Papadopoulos P. Arthroscopic os trigonum en-bloc removal outcomes at 6-month follow-up are better compared to Stieda's process resection in patients with posterior ankle impingement syndrome: a prospective comparative study. J ISAKOS 2021; 6:329-332. [PMID: 34193616 DOI: 10.1136/jisakos-2021-000619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the potential differences in American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and Foot Function Index (FFI) at 6-month and 12-month postoperative follow-up of arthroscopic treatment for posterior ankle impingement (PAIS) between os trigonum (OT) and Stieda's process (SP) patients. METHODS Thirty consecutive patients (32 ankles) treated in our Institution for PAIS with posterior arthroscopy were prospectively enrolled in the study from December 2012 to July 2019. Indications were patients with PAIS with persistent symptoms following conservative management. Exclusion criteria were the coexistence of concomitant pathologies and patients who underwent additional surgical procedures. An independent investigator interviewed and evaluated the patients according to the AOFAS hindfoot score and FFI preoperatively, at 6-month and 12-month follow-up. RESULTS Except for AOFAS scores in the SP group (MD (mean difference) 11.28, p=0.08), patients undergoing arthroscopic treatment for bony PAIS had an overall significant improvement in AOFAS score (OT MD 22.29, p<0.05) and FFI (OT MD -70.07, p<0.05; SP MD -50.96, p<0.05) from their preoperative scores at 6-month follow-up. Similarly, a significant improvement in AOFAS score (OT MD 5.78, p=0.01; SP MD 12.14, p<0.05) and FFI (OT MD -9.36, p=0.04; SP MD -26.43, p<0.05) was observed from the 6-month to 12-month follow-up in all groups. At 6-month follow-up, the OT group had significantly better FFI outcomes (MD -33.57, p=0.04) compared with the SP group. No differences were found by group when comparing AOFAS score and FFI score at 12-month follow-up. CONCLUSIONS When comparing patients undergoing OT excision or SP resection, better FFI outcomes were observed in the OT group at 6-month follow-up. LEVEL OF EVIDENCE Prospective comparative study. Level II.
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Affiliation(s)
| | - Emmanouil T Papakostas
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Sports Medicine Orthopaedics, TheMIS Orthopaedic Center, Thessaloniki, Greece
| | - Theodorakys Marín Fermín
- Sports Medicine Orthopaedics, TheMIS Orthopaedic Center, Thessaloniki, Greece .,Department of Traumatology, Hospital Universitario Periférico de Coche, Caracas, Venezuela
| | | | - Ioannis Terzidis
- St. Luke's Hospital, Thessaloniki, Greece.,Sports Medicine Orthopaedics, TheMIS Orthopaedic Center, Thessaloniki, Greece
| | - Pericles Papadopoulos
- 2nd Orthopedic Department, General Hospital of Thessaloniki Gennimatas, Thessaloniki, Greece
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Calvo E, Itoi E, Landreau P, Arce G, Yamamoto N, Ma J, Sparavalo S, Wong I. Anterior and posterior glenoid bone augmentation options for shoulder instability: state of the art. J ISAKOS 2021; 6:308-317. [PMID: 34145077 DOI: 10.1136/jisakos-2019-000413] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 11/05/2020] [Revised: 03/24/2021] [Accepted: 04/08/2021] [Indexed: 11/04/2022]
Abstract
Bony lesions are highly prevalent in anterior shoulder instability and can be a significant cause of failure of stabilisation procedures if they are not adequately addressed. The glenoid track concept describes the dynamic interaction between the humeral head and glenoid defects in anterior shoulder instability. It has been beneficial for understanding the role played by bone defects in this entity. As a consequence, the popularity of glenoid augmentation procedures aimed to treat anterior glenoid bone defects; reconstructing the anatomy of the glenohumeral joint has risen sharply in the last decade. Although bone defects are less common in posterior instability, posterior bone block procedures can be indicated to treat not only posterior bony lesions, attritional posterior glenoid erosion or dysplasia but also normal or retroverted glenoids to provide an extended glenoid surface to increase the glenohumeral stability. The purpose of this review was to analyse the rationale, current indications and results of surgical techniques aimed to augment the glenoid surface in patients diagnosed of either anterior or posterior instability by assessing a thorough review of modern literature. Classical techniques such as Latarjet or free bone block procedures have proven to be effective in augmenting the glenoid surface and consequently achieving adequate shoulder stability with good clinical outcomes and early return to athletic activity. Innovations in surgical techniques have permitted to perform these procedures arthroscopically. Arthroscopy provides the theoretical advantages of lower morbidity and faster recovery, as well as the identification and treatment of concomitant pathologies.
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Affiliation(s)
- Emilio Calvo
- Department of Orthopaedic Surgery and Traumatology, Instituto de Investigacion Sanitaria de la Fundacion Jimenez Diaz, Universidad Autonoma, Madrid, Spain
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | | | - Guillermo Arce
- Department of Orthopedic Surgery, Instituto Argentino de Diagnostico y Tratamiento (IADT), Buenos Aires, Argentina
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Jie Ma
- Division of Orthopaedic Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sara Sparavalo
- Division of Orthopaedic Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ivan Wong
- Division of Orthopaedic Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Cederqvist S, Flinkkilä T, Sormaala M, Ylinen J, Kautiainen H, Irmola T, Lehtokangas H, Liukkonen J, Pamilo K, Ridanpää T, Sirniö K, Leppilahti J, Kiviranta I, Paloneva J. Non-surgical and surgical treatments for rotator cuff disease: a pragmatic randomised clinical trial with 2-year follow-up after initial rehabilitation. Ann Rheum Dis 2021; 80:796-802. [PMID: 33272959 PMCID: PMC8142425 DOI: 10.1136/annrheumdis-2020-219099] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Rotator cuff disease (RCD) causes prolonged shoulder pain and disability in adults. RCD is a continuum ranging from tendinopathy to full-thickness tendon tear. Recent studies have shown that subacromial decompression and non-surgical treatments provide equivalent results in RCD without a full-thickness tendon lesion. However, the importance of surgery for full-thickness tendon tears remains unclear. METHODS In a pragmatic, randomised, controlled trial, 417 patients with subacromial pain underwent 3-month initial rehabilitation and MRI arthrography (MRA) for the diagnosis of RCD. Of these, 190 shoulders remained symptomatic and were randomised to non-surgical or surgical treatments. The primary outcomes were the mean changes in the Visual Analogue Scale for pain and the Constant Murley Score for shoulder function at the 2-year follow-up. RESULTS At the 2-year follow-up, both non-surgical and surgical treatments for RCD reduced pain and improved shoulder function. The scores differed between groups by 4 (95% CI -3 to 10, p=0.25) for pain and 3.4 (95% CI -0.4 to 7.1, p=0.077) for function. Among patients with full-thickness ruptures, the reduction in pain (13, 95% CI 5 to 22, p=0.002) and improvement in function (7.0, 95% CI 1.8 to 12.2, p=0.008) favoured surgery. CONCLUSIONS Non-surgical and surgical treatments for RCD provided equivalent improvements in pain and function. Therefore, we recommend non-surgical treatment as the primary choice for patients with RCD. However, surgery yielded superior improvement in pain and function for full-thickness rotator cuff rupture. Therefore, rotator cuff repair may be suggested after failed non-surgical treatment. TRIAL REGISTRATION DETAILS ClinicalTrials.gov, NCT00695981 and NCT00637013.
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Affiliation(s)
- Sanna Cederqvist
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Tapio Flinkkilä
- Department of Surgery, Division of Orthopaedic and Trauma Surgery, Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Markus Sormaala
- Department of Radiology, Helsinki University Hospital, Helsinki, Finland
| | - Jari Ylinen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyväskylä, Finland
| | - Hannu Kautiainen
- Research Center, Folkhälsan, Helsinki, Finland
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Tero Irmola
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Heidi Lehtokangas
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juho Liukkonen
- Department of Emergency Medicine, Central Finland Central Hospital, Jyväskylä, Finland
| | - Konsta Pamilo
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Tero Ridanpää
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Kai Sirniö
- Department of Surgery, Division of Orthopaedic and Trauma Surgery, Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Juhana Leppilahti
- Department of Surgery, Division of Orthopaedic and Trauma Surgery, Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Ilkka Kiviranta
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
- Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland
| | - Juha Paloneva
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Neogi T, Peloquin C, Ballal P, Boer CG. Response to: 'Correspondence on 'Warfarin use and risk of knee and hip replacements'' by Cheng and Zhang. Ann Rheum Dis 2021; 82:e151. [PMID: 33985943 PMCID: PMC8589856 DOI: 10.1136/annrheumdis-2021-220601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Tuhina Neogi
- Medicine-Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Christine Peloquin
- Medicine-Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Priyanka Ballal
- Medicine-Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Cindy Germaine Boer
- Internal Medicine, Genetic Laboratories, Erasmus MC, Rotterdam, The Netherlands
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LeVasseur MR, Mancini MR, Hawthorne BC, Romeo AA, Calvo E, Mazzocca AD. SLAP tears and return to sport and work: current concepts. J ISAKOS 2021; 6:204-211. [PMID: 34272296 DOI: 10.1136/jisakos-2020-000537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/02/2020] [Revised: 01/19/2021] [Accepted: 02/08/2021] [Indexed: 01/02/2023]
Abstract
Superior labrum, anterior and posterior (SLAP) lesions are common and identified in up to 26% of shoulder arthroscopies, with the greatest risk factor appearing to be overhead sporting activities. Symptomatic patients are treated with physical therapy and activity modification. However, after the failure of non-operative measures or when activity modification is precluded by athletic demands, SLAP tears have been managed with debridement, repair, biceps tenodesis or biceps tenotomy. Recently, there have been noticeable trends in the operative management of SLAP lesions with older patients receiving biceps tenodesis and younger patients undergoing SLAP repair, largely with suture anchors. For overhead athletes, particularly baseball players, SLAP lesions remain a difficult pathology to manage secondary to concomitant pathologies and unpredictable rates of return to play. As a consequence, the most appropriate surgical option in elite throwers is controversial. The objective of this current concepts review is to discuss the anatomy, mechanism of injury, presentation, diagnosis and treatment options of SLAP lesions and to present current literature on outcomes affecting return to sport and work.
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Affiliation(s)
- Matthew R LeVasseur
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Michael R Mancini
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Benjamin C Hawthorne
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Anthony A Romeo
- Musculoskeletal Institute, DuPage Medical Group, Downers Grove, Illinois, USA
| | - Emilio Calvo
- Department of Orthopaedic Surgery, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
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37
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Vermeşan D, Todor A, Andrei D, Niculescu M, Tudorache E, Haragus H. Effect of COVID-19 Pandemic on Orthopedic Surgery in Three Centers from Romania. Int J Environ Res Public Health 2021; 18:ijerph18042196. [PMID: 33672294 PMCID: PMC7926912 DOI: 10.3390/ijerph18042196] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/05/2021] [Accepted: 02/14/2021] [Indexed: 12/24/2022]
Abstract
The COVID-19 pandemic has put an enormous burden on healthcare systems. As a direct consequence, many elective procedures were cancelled and available resources were relocated to emergencies and COVID-19 patients. We aimed to analyze the impact on orthopedic surgery in Romania. We performed a retrospective analysis of orthopedics and trauma cases admitted over the first six months of 2019 and 2020 in three representative clinics. In total, there were 1900 patients: 1241 from Timisoara, 216 from Cluj-Napoca, and 443 from Bucharest. In April, activity for all cases in the regional trauma center dropped to 23.8% and stopped in the other two. No arthroscopies or elective joint replacements were performed in April. By June, hospital admissions resumed for trauma cases while arthroscopies and joint replacements still lagged behind.
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Affiliation(s)
- Dinu Vermeşan
- Department of Orthopedics and Trauma, Victor Babes University of Medicine and Pharmacy, Eftimie Murgu Square No 2, 300041 Timisoara, Romania; (D.V.); (H.H.)
| | - Adrian Todor
- Department of Orthopedics, Traumatology and Pediatric Orthopedics, Iuliu Hatieganu University of Medicine and Pharmacy, Victor Babes Str No 8, 400000 Cluj-Napoca, Romania;
| | - Diana Andrei
- Department of Rehabilitation and Physical Medicine, Victor Babeș University of Medicine and Pharmacy, EftimieMurgu Square No 2, 300041 Timișoara, Romania
- Correspondence: (D.A.); (M.N.)
| | - Marius Niculescu
- Faculty of Medicine, TituMaiorescu University, Dambovnicului Str No 22, District 4, 040441 Bucharest, Romania
- Correspondence: (D.A.); (M.N.)
| | - Emanuela Tudorache
- Department of Pulmonology, Victor Babeș University of Medicine and Pharmacy, Eftimie Murgu Square No 2, 300041 Timișoara, Romania;
| | - Horia Haragus
- Department of Orthopedics and Trauma, Victor Babes University of Medicine and Pharmacy, Eftimie Murgu Square No 2, 300041 Timisoara, Romania; (D.V.); (H.H.)
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Gheorghiu N, Socea B, Dimitriu MCT, Bacalbasa N, Stan G, Orban H. A finite element analysis for predicting outcomes of cemented total knee arthroplasty. Exp Ther Med 2021; 21:267. [PMID: 33603874 DOI: 10.3892/etm.2021.9698] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/09/2020] [Accepted: 11/11/2020] [Indexed: 11/06/2022] Open
Abstract
The study was designed to assess the validity of a finite element analysis for predicting the behavior of cemented knee implant used in total knee arthroplasty (TKA), for different mechanical loads, and correlation with clinical outcomes of this procedure. We conducted computational simulations using finite element analysis of two situations: i) The ideal prosthetic component positioning; and ii) variable varus tibial malposition, but with a balanced knee. A total of 80 cemented TKAs performed on 70 patients were divided into two groups. Patients from one group required secondary asymmetric tibial recut for balancing the prosthetic knee and patients from the other group, did not. In regards to the results, we observed no differences upon analysis of the postoperative results of the Knee Society Score (KSS), the angle between the femur and tibia, the range of motion and frontal laxity between groups. The finite element analysis showed that in a 3˚ varus inclination of the joint interline, but with a balanced knee, the maximum contact stress, measured on the tibial plateau surface, increased by 11% compared to the value of mechanical alignment. In conclusion, analysis of the computational model using finite elements showed predictable results of cemented TKA for the different situations of mechanical loads.
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Affiliation(s)
- Nicolae Gheorghiu
- Department of Orthopedics, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Orthopedics, Elias Emergency Clinical Hospital, 011416 Bucharest, Romania
| | - Bogdan Socea
- Department of Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Surgery, 'Sf. Pantelimon' Emergency Hospital, 021659 Bucharest, Romania
| | - Mihai C T Dimitriu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Pantelimon' Emergency Hospital, 021659 Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Dr. I. Cantacuzino' Clinical Hospital, 020475 Bucharest, Romania
| | - Gabriel Stan
- Department of Orthopedics, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Orthopedics, Elias Emergency Clinical Hospital, 011416 Bucharest, Romania
| | - Horia Orban
- Department of Orthopedics, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Orthopedics, Elias Emergency Clinical Hospital, 011416 Bucharest, Romania
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Harmouchi H, Bouazzaoui AE, Bensalah A, Badr A, Lakranbi M, Ouadnouni Y, Bouarhroum A, Smahi M. Intratracheal migration of two Kirschner wires after surgery for a clavicle fracture. Asian Cardiovasc Thorac Ann 2021; 29:428-430. [PMID: 33412892 DOI: 10.1177/0218492320987933] [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] [Indexed: 11/16/2022]
Abstract
Kirschner wire is frequently used in orthopedic surgery, and migration is not exceptional. Intrathoracic migration is well-known, especially after surgery on the shoulder girdle, however, intratracheal migration is extremely rare. We describe a case of intratracheal migration of two Kirschner wires in a 41-year-old man who had them placed two years previously for a right clavicle fracture. He experienced chest pain followed by hemoptysis. Thoracic computed tomography revealed intratracheal migration. Remove of the Kirschner wires was performed by a cervical-sternotomy approach. Prompt removal of migrated Kirschner wires must be carried out urgently to avoid fatal complications.
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Affiliation(s)
| | - Abderahime El Bouazzaoui
- Department of Anesthesiology and Intensive Care A4, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | | | - Alami Badr
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco.,Department of Radiology, CHU Hassan II, Fez-Morocco
| | - Marwane Lakranbi
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Yassine Ouadnouni
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Abdellatif Bouarhroum
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco.,Department of Vascular Surgery, CHU Hassan II Fez, Morocco
| | - Mohammed Smahi
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdallah University, Fez, Morocco
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Gade IL, Kold S, Severinsen MT, Kragholm KH, Torp‐Pedersen C, Kristensen SR, Riddersholm SJ. Venous thromboembolism after lower extremity orthopedic surgery: A population-based nationwide cohort study. Res Pract Thromb Haemost 2021; 5:148-158. [PMID: 33537539 PMCID: PMC7845063 DOI: 10.1002/rth2.12449] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 09/21/2020] [Accepted: 10/07/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) causes morbidity and mortality in the general population. Several events occur after lower limb orthopedic surgery, but the contribution from various types of lower limb surgery is not well known. OBJECTIVE To investigate the postoperative incidence of VTE for all types of lower extremity orthopedic surgery compared with the background population. METHODS Individual-level linkage of Danish nationwide register data for all Danish residents with first-time orthopedic surgery of the lower limb (1996-2017) and, for each of these, four controls from the general population matched on age, sex, and history of VTE. Adjusted hazard ratios (HR) compared the postoperative risk of VTE to the matched controls. RESULTS In total 7203 of the 1 012 823 patients with a first orthopedic procedure had a VTE within 180 days after surgery, corresponding to a postoperative cumulative incidence of 0.71% (95% confidence interval [CI], 0.70-0.73). The cumulative incidence of VTE among controls was 0.11% (95% CI, 0.11-0.12). The HR of VTE within the first 30 days after surgery below knee level was 20.5 (95% CI, 17.9-23.5) compared with matched controls. The HRs of VTE after minor distal procedures (eg, meniscectomy and arthroscopies) were 2.9 (95% CI, 1.9-4.4) to 7.1 (95% CI, 6.4-8.0). CONCLUSION All types of lower limb orthopedic surgery including minor distal procedures were associated with higher rates of VTE compared with matched controls, in particular within the first 30 days after surgery.
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Affiliation(s)
- Inger Lise Gade
- Department of Hematology and Clinical Cancer Research CenterAalborg University HospitalAalborgDenmark
- Department of Clinical BiochemistryAalborg University HospitalAalborgDenmark
| | - Søren Kold
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
- Department of Orthopedic SurgeryAalborg University HospitalAalborgDenmark
| | - Marianne T. Severinsen
- Department of Hematology and Clinical Cancer Research CenterAalborg University HospitalAalborgDenmark
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Kristian H. Kragholm
- Department of CardiologyNorth Denmark Regional HospitalHjørringDenmark
- Unit of Clinical BiostatisticsAalborg University HospitalAalborgDenmark
| | - Christian Torp‐Pedersen
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
- Unit of Clinical BiostatisticsAalborg University HospitalAalborgDenmark
- Department of Cardiology and Clinical InvestigationNorth Zealand HospitalHillerødDenmark
| | - Søren R. Kristensen
- Department of Clinical BiochemistryAalborg University HospitalAalborgDenmark
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
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Briggs BC, Cline DM, Stewardson KL, Kugler JA, Lefebvre C. Intern Orthopedic Rotation Versus Emergency Medicine Procedure Month: Which one Derives More Opportunity? J Med Educ Curric Dev 2021; 8:23821205211044607. [PMID: 34632063 PMCID: PMC8493426 DOI: 10.1177/23821205211044607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/19/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The American College of Graduate Medical Education (ACGME) defines 18 "key procedures" as requirements in emergency medicine (EM) residency programs. The post-graduate year-1 (PGY-1) curriculum provides an early foundation for EM trainees to gain procedural experience, but traditional PGY-1 rotations may not provide robust procedural opportunities. Our objective was to replace a traditional orthopedic rotation with a 4-week rotation that emphasized EM procedure acquisition and comprehension. Although all residents met ACGME procedural requirements before the curricular modification, the purpose of this month was to increase overall procedure numbers. The block contained dedicated procedure shifts in the emergency department as well as an asynchronous, self-directed learning course. We sought to compare the number of procedures performed by PGY-1 residents during their orthopedic rotation (the year before implementation), to the number of procedures performed during their procedure rotation (the year after implementation). METHODS The total number of procedures performed and logged by PGY-1 residents during the traditional orthopedic rotation (during the year prior to implementation of the new procedure rotation) were compared to the total number of procedures by the first class to undergo the new procedure rotation the following year. Thirty resident logs were reviewed (15 per class). Data were analyzed using SAS NPAR1WAY; Z < 0.05 was considered significant. RESULTS When compared to the orthopedic rotation, the procedure rotation had statistically significant higher numbers of procedures per resident (22, standard deviation [SD] 12, vs 11.4, SD 7.6; Z = 0.0177). A wide variety of nonorthopedic procedures accounted for the increased numbers, (13.6, SD 10.3, vs 0.9, SD 0.9; Z < 0.001). While the average number of orthopedic procedures was slightly less on the procedure rotation, there was no statistical difference (orthopedic rotation 10.13, procedure rotation 8.26; Z = 0.4605). Notably, fewer procedures were performed when 2 residents were on the procedure rotation at the same time (21 vs 10.1). CONCLUSION This analysis demonstrated a larger number and a wider variety of procedures performed by PGY-1 residents during a dedicated procedure rotation compared to a traditional orthopedic rotation. Furthermore, exposure to orthopedic procedures did not decline significantly. Limitations of the study include a modest number of subjects. Data may be limited by the consistency of procedure logging by individual residents. Further studies may assess procedural competency after PGY-1 year of training.
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Kocur E, Rozentryt P, Głogowska-Gruszka A. Risk factors for surgical site infection in patients after implant-related orthopedic procedures. Przegl Epidemiol 2021; 75:332-346. [PMID: 35170289 DOI: 10.32394/pe.75.30] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Surgical site infections (SSIs) in patients undergoing orthopedic surgeries limit the success of the treatment, and implant-related infections are considered one of the most difficult complications for treatment (1). Controlling the SSI risk factors opens an opportunity for proper assessment of the risk of SSI and how difficult it can be to avoid infection. AIM OF THE STUDY Determination of factors associated with the risk of surgical site infection in patients undergoing orthopedic surgery. MATERIAL AND METHODS The work is based on a retrospective analysis of medical records of 4,314 patients undergoing orthopedic surgery in the traumatology and orthopedic surgery department of the City Hospital in Zabrze in 2014-2017. RESULTS Surgical site infection has been diagnosed in 187 (4.3%) patients. A number of significant predictors of SSI have been revealed: body mass index with a 9% increase in the risk of SSI for each increase in BMI by 5kg/m2, positive history of orthopedic and non-orthopedic procedures in the past, with an increase in risk by 32% and 14%, respectively, waiting time in the ward for surgery, with an increase in the risk of SSI by 19% for each extension of hospitalization by 5 days, planned procedure and implantation endoprosthesis compared to osteosynthesis increased the risk by 15% and 9%, respectively. The only significant factor reducing the risk of SSI was the increased consumption of hand disinfectant. Here, for every 10 ml of increased consumption of this preparation, the risk of SSI was reduced by 28%. CONCLUSIONS 1. The SSI risk is related to both factors that can be modified and factors that cannot be changed. 2. Promotion of hand disinfection among hospital staff should become a priority in the prevention of nosocomial infections in every healthcare facility.
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Affiliation(s)
- Ewelina Kocur
- Municipal Hospital in Zabrze, Zamkowa 4
- Faculty of Medical Sciences in Zabrze, University of Technology in Katowice
| | - Piotr Rozentryt
- Department of Toxicology and Addictions, Faculty of Health Sciences in Bytom, Silesian Medical University in Katowice
- III Chair and Clinical Department of Cardiology, Silesian Center for Heart Diseases in Zabrze, ul. Marii Skłodowskiej-Curie 9
| | - Anna Głogowska-Gruszka
- Department of Toxicology and Addictions, Faculty of Health Sciences in Bytom, Silesian Medical University in Katowice
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Kane SM, Morris DV, Badana ANS. A Transarticular Approach to Posterior Sternoclavicular Dislocation: A Case Report. HSS J 2020; 16:490-497. [PMID: 33380985 PMCID: PMC7749927 DOI: 10.1007/s11420-020-09772-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Steven M. Kane
- Department of Orthopedics, Wellstar Atlanta Medical Center, Atlanta, GA USA
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Robinson A, Oksuz U, Slight R, Slight S, Husband A. Digital and Mobile Technologies to Promote Physical Health Behavior Change and Provide Psychological Support for Patients Undergoing Elective Surgery: Meta-Ethnography and Systematic Review. JMIR Mhealth Uhealth 2020; 8:e19237. [PMID: 33258787 PMCID: PMC7738263 DOI: 10.2196/19237] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/22/2020] [Accepted: 10/29/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Digital technology has influenced many aspects of modern living, including health care. In the context of elective surgeries, there is a strong association between preoperative physical and psychological preparedness, and improved postoperative outcomes. Health behavior changes made in the pre- and postoperative periods can be fundamental in determining the outcomes and success of elective surgeries. Understanding the potential unmet needs of patients undergoing elective surgery is central to motivating health behavior change. Integrating digital and mobile health technologies within the elective surgical pathway could be a strategy to remotely deliver this support to patients. OBJECTIVE This meta-ethnographic systematic review explores digital interventions supporting patients undergoing elective surgery with health behavior changes, specifically physical activity, weight loss, dietary intake, and psychological support. METHODS A literature search was conducted in October 2019 across 6 electronic databases (International Prospective Register of Systematic Reviews [PROSPERO]: CRD42020157813). Qualitative studies were included if they evaluated the use of digital technologies supporting behavior change in adult patients undergoing elective surgery during the pre- or postoperative period. Study quality was assessed using the Critical Appraisal Skills Programme tool. A meta-ethnographic approach was used to synthesize existing qualitative data, using the 7 phases of meta-ethnography by Noblit and Hare. Using this approach, along with reciprocal translation, enabled the development of 4 themes from the data. RESULTS A total of 18 studies were included covering bariatric (n=2, 11%), cancer (n=13, 72%), and orthopedic (n=3, 17%) surgeries. The 4 overarching themes appear to be key in understanding and determining the effectiveness of digital and mobile interventions to support surgical patients. To successfully motivate health behavior change, technologies should provide motivation and support, enable patient engagement, facilitate peer networking, and meet individualized patient needs. Self-regulatory features such as goal setting heightened patient motivation. The personalization of difficulty levels in virtual reality-based rehabilitation was positively received. Internet-based cognitive behavioral therapy reduced depression and distress in patients undergoing cancer surgery. Peer networking provided emotional support beyond that of patient-provider relationships, improving quality of life and care satisfaction. Patients expressed the desire for digital interventions to be individually tailored according to their physical and psychological needs, before and after surgery. CONCLUSIONS These findings have the potential to influence the future design of patient-centered digital and mobile health technologies and demonstrate a multipurpose role for digital technologies in the elective surgical pathway by motivating health behavior change and offering psychological support. Through the synthesis of patient suggestions, we highlight areas for digital technology optimization and emphasize the importance of content tailored to suit individual patients and surgical procedures. There is a significant rationale for involving patients in the cocreation of digital health technologies to enhance engagement, better support behavior change, and improve surgical outcomes.
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Affiliation(s)
- Anna Robinson
- School of Pharmacy, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Umay Oksuz
- School of Pharmacy, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Robert Slight
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Sarah Slight
- School of Pharmacy, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Andrew Husband
- School of Pharmacy, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Günsche JL, Pilz V, Hanstein T, Skripitz R. The variation of arthroplasty procedures in the OECD Countries: analysis of possible influencing factors by linear regression. Orthop Rev (Pavia) 2020; 12:8526. [PMID: 33312485 PMCID: PMC7726828 DOI: 10.4081/or.2020.8526] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/16/2020] [Indexed: 01/22/2023] Open
Abstract
Total hip and knee replacements (THR, TKR) are among the most common surgeries but incidence rates vary between OECD countries. Previous studies suggested economic factors to be most influential but did not take into account health care system related factors. Hence we analysed the possible influence of healthcare system related factors on the operation rate. We used OECD data for 27 countries and calculated Age-Standardized Incidence Rates (ASIR). In order to determine possible explanatory variables on the ASIRs we performed a stepwise blockwise linear regression. The ASIR of hip and knee replacement varies widely. We identified statistically significant determinants which influence the ASIR of THR in a positive manner: incidence and length of stay of coxarthrosis, ASIR of knee replacement, health expenditures, number of nurses and an etatistic social insurance. Diabetes prevalence, gross domestic product and number of doctor consultations, however, have a negative influence on the ASIR. TKR rate is positively influenced by health expenditures and incidence rate of gonarthrosis, negatively by the number of primary practitioners. We observed strong geographic disparities in the frequency of THR and THR that cannot be explained by age structure of the countries. Economic factors seem to play a secondary role while healthcare related factors have a greater influence.
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Affiliation(s)
- Jamie Lee Günsche
- Bavarian State Office for Statistics, Schweinfurt Office, Schweinfurt.,Heraeus Medical GmbH, Health Economics, Wehrheim
| | | | - Tim Hanstein
- Heraeus Medical GmbH, Health Economics, Wehrheim.,Rostock University Medical Center, Orthopedic Clinic and Policlinic; Rostock
| | - Ralf Skripitz
- Rostock University Medical Center, Orthopedic Clinic and Policlinic; Rostock.,Roland- Klinik, Centre forArthroplasty, Foot Surgery, Paediatric and General Orthopaedics, Bremen, Germany
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Bertiche P, Mohtadi N, Chan D, Hölmich P. Proximal hamstring tendon avulsion: state of the art. J ISAKOS 2020; 6:237-246. [PMID: 34272300 DOI: 10.1136/jisakos-2019-000420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/02/2020] [Revised: 09/17/2020] [Accepted: 09/24/2020] [Indexed: 11/04/2022]
Abstract
Complete proximal hamstring tendon avulsions from the ischial tuberosity, though infrequent, are the most severe type of hamstring muscle injury in the field of sport medicine. These serious injuries are commonly associated with a delayed or even misdiagnosis, despite obvious clinical findings. The published literature favours surgical repair even though the studies represent lower levels of evidence. Non-surgical treatment is a viable option for lower physical demand patients. This state-of-the-art article reviews the relevant anatomy, the clinical assessment including specific physical examination signs and diagnostic testing in patients suspected of a proximal hamstring avulsion. Up-to-date evidence is reviewed to address surgical and non-surgical treatment options and outcome assessment. The authors provide a detailed description of what would be considered the current worldwide standard of care; an open, suture-anchor-based repair of the avulsed tendon complex (semitendinosus, long head of biceps femoris and semimembranosus) securely to the ischial tuberosity. Also included are surgical tips and tricks, with advice on postsurgical management and rehabilitation. Future perspectives should involve higher quality, prospective research to better define the indications for surgery, evaluate the emerging role of endoscopic repair and disclose complications along with measuring patient-reported outcomes.
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Affiliation(s)
- Pablo Bertiche
- Department of Sport Medicine and Arthroscopic Surgery, Sanatorio Allende, Cordoba, Argentina
| | - Nicholas Mohtadi
- University of Calgary Sport Medicine Centre, Calgary, Alberta, Canada
| | - Denise Chan
- University of Calgary Sport Medicine Centre, Calgary, Alberta, Canada
| | - Per Hölmich
- Sports Orthopedic Research Center, Copenhagen, Denmark.,Department of Orthopedic Surgery, Arthroscopic Center Hvidovre, Hvidovre, Denmark
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Uçkay I, Vakalopoulos K, Gjika E. Response to: 'Short duration antibiotic therapy for native joint arthritis cause by Neisseria infection?' by Durcours et al. Ann Rheum Dis 2020; 81:e231. [PMID: 32988834 DOI: 10.1136/annrheumdis-2020-218882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Ilker Uçkay
- Infectiology, Uniklinik Balgrist, Zurich, Switzerland
| | | | - Ergys Gjika
- Hand Surgery Unit, Geneva University Hospitals, Geneva, Switzerland
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Longstaffe R, Dickerson P, Thigpen CA, Shanley E, Kissenberth MJ, Folk J, Pill SG. Both open and endoscopic gluteal tendon repairs lead to functional improvement with similar failure rates: a systematic review. J ISAKOS 2020; 6:28-34. [PMID: 33833043 DOI: 10.1136/jisakos-2020-000474] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 04/11/2020] [Revised: 07/12/2020] [Accepted: 07/29/2020] [Indexed: 11/03/2022]
Abstract
IMPORTANCE Operative treatment of gluteal tendon tears is becomingly increasingly more common with varying surgical techniques and rehabilitation protocols. OBJECTIVE To perform a systematic review of gluteal tendon repair as it relates to tear characteristics, rehabilitation protocols, patient-reported outcomes, satisfaction, resolution of gait deviation and complication rates. EVIDENCE REVIEW A comprehensive literature search of PubMed and Embase/MEDLINE was used to identify all literature pertaining to gluteal tendon repair. A total of 389 articles were identified. FINDINGS A total of 22 studies (611 hips) were included in this review. The majority of tears were noted to be partial thickness (77.9% vs 22.1%). Both arthroscopic and open repair demonstrated improvements in functional outcomes. Within studies documenting gait deviation, 54% were noted to have gait deviation preoperatively, of which approximately 70% had resolution following repair. On average, abduction strength increased almost one whole grade (0.84) following repair. Overall complication rate was found to be 5.2% (20 of 388 hips). Endoscopic repair demonstrated a decreased complication rate compared with open (0.7% vs 7.8%). Retear rate was found to be 3.8%, with open repair having a slightly increased rate compared with endoscopic repair (3.4% vs 4.1%). CONCLUSIONS AND RELEVANCE The majority of tears tend to be partial thickness with involvement of gluteus medius in almost all cases and concomitant involvement of gluteus minimus in close to half of cases. Both endoscopic and open gluteal tendon repairs resulted in improvements in outcomes and functional improvement. Retear rates were similar between the two repair techniques, while endoscopic repair demonstrated a lower complication rate. LEVEL OF EVIDENCE Level IV, systematic review.
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Affiliation(s)
- Robert Longstaffe
- University of Manitoba Department of Surgery, Section Orthopaedics, Pan Am Clinic, Winnipeg, Manitoba, Canada
| | - Patrick Dickerson
- Prisma Health Steadman Hawkins Clinic of the Carolinas, Greenville, South Carolina, USA
| | - Charles A Thigpen
- Prisma Health Steadman Hawkins Clinic of the Carolinas, Greenville, South Carolina, USA.,ATI Physical Therapy, Greenville, South Carolina, USA
| | - Ellen Shanley
- Prisma Health Steadman Hawkins Clinic of the Carolinas, Greenville, South Carolina, USA.,ATI Physical Therapy, Greenville, South Carolina, USA
| | - Michael J Kissenberth
- Prisma Health Steadman Hawkins Clinic of the Carolinas, Greenville, South Carolina, USA
| | - Jason Folk
- Prisma Health Steadman Hawkins Clinic of the Carolinas, Greenville, South Carolina, USA
| | - Stephan G Pill
- Prisma Health Steadman Hawkins Clinic of the Carolinas, Greenville, South Carolina, USA
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Siegel MA, Balach T, Sweeney KR, Nystrom LM, Colman MW. Sacroiliac joint cut accuracy: Comparing new technologies in an idealized sawbones model. J Surg Oncol 2020; 122:1218-1225. [PMID: 32761627 DOI: 10.1002/jso.26124] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/25/2020] [Accepted: 07/07/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES The anatomical complexity of the pelvis creates challenges for orthopaedic oncologists to accurately and safely resect tumors involving the sacroiliac joint. Current technology may help overcome these obstacles. METHODS Four fellowship-trained orthopaedic oncologists performed 22 all-posterior sacroiliac cuts using freehand, computerized navigation, and patient-specific cutting guides on a Sawbones male pelvis model. Cut accuracies to preoperative planned margins were analyzed via a high-resolution optical scanner. Soft tissue damage was determined by visually inspecting the Sawbones foam placed on the far side of the cut. RESULTS Within 5 mm of the margins, the freehand technique resulted in 67.0% cut accuracy, the navigation technique had 71.1%, and the patient-specific cutting guide technique had 85.6% (P = .093). Within 2 mm, the techniques showed an accuracy of 25.8%, 32.5%, and 47.5%, respectively (P = .022). Regarding soft tissue damage, the freehand technique exhibited minimal penetration damage for 16.7% of the cuts, while navigation and patient-specific guide techniques exhibited 25.0% and 75.0%, respectively (P = .046). Years of surgical experience of the operator (1-7) did not influence the cut accuracy for any method. CONCLUSIONS Under ideal conditions, patient-specific guide technology possesses the same or better accuracy as other cutting techniques as well as the circumvention of soft tissue damage.
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Affiliation(s)
- Matthew A Siegel
- Department of Orthopaedic Surgery, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Tessa Balach
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, Illinois
| | - Kyle R Sweeney
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas, Kansas
| | | | - Matthew W Colman
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
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Barbosa LG, Frazão CDS. Impact of demonstration in a realistic simulation environment as a postoperative education in patients' experience. Einstein (Sao Paulo) 2020; 18:eAO4831. [PMID: 32215467 PMCID: PMC7069733 DOI: 10.31744/einstein_journal/2020ao4831] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 10/01/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the impact of training in the Practical Life Room on patients experience during hospitalization. METHODS Subjects submitted to orthopedic surgeries were randomized to two groups (Control and Intervention) in the postoperative period. The Control Group received only the printed guidelines regarding the postoperative period, and the Intervention Group received the printed guidelines and a demonstration and training session with a physical therapist, in an environment created to simulate a house and its rooms (living room, bedroom, kitchen, laundry and bathroom). The participants of both groups answered the questionnaire Hospital Consumer Assessment of Healthcare Providers and Systems on the day of discharge. RESULTS Sixty-eight subjects were included in the study, 30 (44.1%) in the Control Group and 38 (55.9%) in the Intervention Group. The Hospital Consumer Assessment of Healthcare Providers and Systems questionnaire score showed no significant difference between the groups (p=0.496). CONCLUSION There was no influence of the proposed intervention on the results of the Hospital Consumer Assessment of Healthcare Providers and Systems questionnaire, perhaps because of the limitation of the instrument or due to the fact it was employed when patients were still hospitalized. However, by reports from patients in the Intervention Group about felling better prepared and safer for performing daily activities, it is believed that patient education approaches through demonstration should be included as part of the process to prepare for discharge, whenever possible.
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Affiliation(s)
- Luciana Gardin Barbosa
- Associação de Assistência à Criança DeficienteSão PauloSPBrazil Associação de Assistência à Criança Deficiente , São Paulo , SP , Brazil .
| | - Cinthya da Silva Frazão
- Associação de Assistência à Criança DeficienteSão PauloSPBrazil Associação de Assistência à Criança Deficiente , São Paulo , SP , Brazil .
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