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Pickleball and the Rising Incidence of Achilles Tendon Injuries in the Elderly. 回力球与老年人跟腱损伤发病率的上升。
Pub Date : 2024-10-08 DOI: 10.1177/19386400241286591
Joseph A S McCahon, Mark Miller, Samantha Riebesell, David I Pedowitz, Selene G Parekh, Joseph N Daniel

Background: With its rising popularity of pickleball, particularly in the aging population, comes concern for potential injuries that previously rarely affected this patient cohort. The purpose of this study was to investigate the trends of pickleball-related Achilles tendon injuries.

Methods: A retrospective case series was performed to determine the trends associated with pickleball-related Achilles tendon injuries over the last 10 years. A database search of all Achilles tendon ruptures (ICD-10 S86.0) presenting to a large, multistate, subspecialty referral orthopaedic clinic between January 2013 and June 2023 were identified and included in the study. Pickleball-related injuries were identified via query and confirmed with manual chart review. The incidence of pickleball-related injuries, as well as patient demographics and rate of surgery was determined and compared with the total population during that time period.

Results: A total of 2684 patients who suffered an Achilles tendon injury between January 2013 and June 2023 were identified, with 43 patients meeting the inclusion criteria for pickleball-related Achilles tendon ruptures. The number and overall incidence of pickleball-related Achilles tendon injuries has been increasing since 2016, excluding 2020 where there was a large decrease likely due to the COVID-19 epidemic. Pickleball was associated with older age at time of injury (64.5 vs 48.6, P < .001) as well as a lower BMI (26.6 vs 29.4, P < .001). In addition, patients who sustained a pickleball-related Achilles tendon injury were more likely to undergo surgery (67.4% vs 45.4%, P = .008).

Conclusion: The rising popularity of pickleball and its associated injuries poses a significant risk to the aging population, with Achilles tendon injuries occurring in older individuals and resulting in a higher likelihood of undergoing surgery.

Level of evidence: IV; retrospective case-series.

背景:随着皮球运动的普及,尤其是在老年人群中的普及,人们开始关注皮球运动可能造成的损伤,而这些损伤以前很少影响到这一患者群体。本研究的目的是调查与皮球相关的跟腱损伤的趋势:方法:研究人员进行了一项回顾性病例系列研究,以确定过去 10 年中与皮球相关的跟腱损伤的发展趋势。通过数据库搜索,确定了2013年1月至2023年6月期间在一家大型多州亚专科骨科转诊诊所就诊的所有跟腱断裂病例(ICD-10 S86.0),并将其纳入研究。通过查询确定了与皮球相关的损伤,并通过人工病历审查进行了确认。研究确定了与皮球有关的损伤发生率、患者人口统计学特征和手术率,并将其与该时间段内的总人数进行了比较:结果:共发现了 2684 名在 2013 年 1 月至 2023 年 6 月期间跟腱受伤的患者,其中 43 名患者符合与皮球相关的跟腱断裂的纳入标准。自2016年以来,挑球相关跟腱损伤的数量和总体发病率一直在增加,但2020年除外,因为2020年可能由于COVID-19的流行而出现大幅下降。挑球运动与受伤时年龄较大(64.5 岁 vs 48.6 岁,P < .001)以及体重指数较低(26.6 vs 29.4,P < .001)有关。此外,跟腱受伤的患者更有可能接受手术治疗(67.4% 对 45.4%,P = .008):结论:皮球运动及其相关损伤的日益流行给老龄人口带来了巨大风险,跟腱损伤多发生在老年人身上,导致接受手术的可能性更高:证据级别:IV;回顾性病例系列。
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引用次数: 0
Opioid Prescribing Trends Among Workers' Compensation Patients Undergoing Foot and Ankle Surgery. 接受足踝手术的工伤赔偿患者的阿片类药物处方趋势。
Pub Date : 2024-10-08 DOI: 10.1177/19386400241286594
Tyler M Goodwin, Daniel T Miles, Richard D Murray, Andrew W Wilson, Jesse F Doty

Background: The purpose of this study was to evaluate opioid usage and prescribing trends among workers' compensation (WC) patients who underwent foot or ankle operative procedures compared with a control group.

Methods: A retrospective review was conducted for WC and non-WC patients who underwent foot or ankle procedures in a single academic orthopaedic surgery practice. Outcome measures were total morphine milligram equivalents (MME) and number of opioid prescriptions.

Results: A total of 118 patients were identified, including 51 patients in the WC group and 67 in the non-WC group. After index surgery, 67% (34 of 51) of WC patients had 2 or more additional opioid prescriptions compared to 39% (26 of 67) of non-WC patients (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.4-6.7; P = .003). Collectively, there were greater prescriptions of oxycodone MME (P = .002) and hydrocodone MME (P = .07) in the WC cohort.

Conclusions: Workers' compensation patients seem to be prescribed and consume opioids at a higher rate postoperatively. It is important for treating physicians to be aware of these trends, and discussions with patients regarding expected opioid use when planning surgical intervention may be beneficial. Physicians may need to set expectations preoperatively and suggest there are limits on the amount of opioids that can safely be prescribed.

Level of evidence: Level III, Retrospective cohort study, Prognostic.

研究背景本研究的目的是评估与对照组相比,接受足部或踝部手术的工伤赔偿(WC)患者中阿片类药物的使用和处方趋势:方法: 对在一家学术骨科诊所接受足部或踝部手术的工伤赔偿患者和非工伤赔偿患者进行回顾性研究。衡量结果的指标是吗啡毫克当量(MME)总量和阿片类药物处方数量:共确定了 118 名患者,其中 WC 组 51 人,非 WC 组 67 人。在索引手术后,67% 的 WC 患者(51 例中的 34 例)有 2 个或 2 个以上额外的阿片类药物处方,而非 WC 患者的这一比例为 39%(67 例中的 26 例)(几率比 [OR],3.1;95% 置信区间 [CI],1.4-6.7;P = .003)。总体而言,工伤患者队列中的羟考酮MME(P = .002)和氢可酮MME(P = .07)处方量更大:结论:工伤患者的术后阿片类药物处方和使用率似乎更高。主治医生必须意识到这些趋势,在计划手术治疗时与患者讨论阿片类药物的预期用量可能会有所帮助。医生可能需要在术前设定期望值,并建议对可安全处方的阿片类药物用量进行限制:III级,回顾性队列研究,预后性。
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引用次数: 0
Timing of Fracture Fixation in Ankle Fracture-Dislocations. 踝关节骨折脱位的骨折固定时机。
Pub Date : 2024-10-05 DOI: 10.1177/19386400241273105
Diederick Penning, Jasper Tausendfreund, M Azad Naryapragi, Kostan W Reisinger, Pieter Joosse, Erik Tanis, Tim Schepers

Ankle fracture-dislocations may require delayed internal fixation. Our aim was to compare acute open reduction and internal fixation (ORIF) with delayed ORIF, using external fixation or cast splint in ankle fracture-dislocations. Factors that affect the rates of re-operation and Surgical site infection (SSI) were identified. In this retrospective cohort study, patients were included with open and closed ankle fracture-dislocations treated with ORIF from two large peripheral hospitals and one academic center in the Netherlands. This study included 447 patients with an ankle fracture-dislocation. In the multivariate analysis, the difference between surgery <48 hours compared to bridging with cast or external fixation had no significant influence on unscheduled re-operation or SSI. Higher body mass index (BMI) and open fractures had a significant positive correlation with re-operation while diabetes mellitus (DM) and open fractures correlated with SSI. In patients with open fractures, there was also no significant difference in outcome between acute or delayed internal fixation. We suggest that it is safe to perform primary ORIF on all dislocated ankle fractures if the soft tissue injury allows surgery within 48 hours. When significant swelling is present, patients with well-reduced fractures and with no soft tissue injury could be treated safely with a cast until delayed ORIF is possible.Level of Evidence: Therapeutic level 2B (retrospective cohort study).

踝关节骨折脱位可能需要延迟内固定。我们的目的是比较急性开放复位内固定术(ORIF)和延迟开放复位内固定术(ORIF)在踝关节骨折脱位中使用外固定或石膏夹板的情况。研究发现了影响再次手术率和手术部位感染(SSI)的因素。在这项回顾性队列研究中,纳入了荷兰两家大型外围医院和一家学术中心采用 ORIF 治疗的开放性和闭合性踝关节骨折脱位患者。该研究共纳入 447 名踝关节骨折脱位患者。在多变量分析中,手术与手术之间的差异证据等级为2B:治疗级别:2B(回顾性队列研究)。
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引用次数: 0
Effects of Parallax and Distortion in Total Ankle Arthroplasty. 全踝关节置换术中视差和扭曲的影响
Pub Date : 2024-10-03 DOI: 10.1177/19386400241274262
Joseph R Brown, Zachary P Hill, Ross Groeschl, Brian Steginsky, Robert W Mendicino

Background: Surgeons rely on intraoperative fluoroscopy to assist in placement of implant components during total ankle arthroplasty (TAA). Parallax alters the direction of an object when viewed from two different points, resulting in image distortion. The purpose of this study was to evaluate parallax/distortion in intraoperative fluoroscopic images during TAA.

Methods: A retrospective review of all TAAs performed by two surgeons (R.W.M. and B.S.) from August 2019 to April 2023 were reviewed. Intraoperative fluoroscopic anteroposterior (AP) ankle views were evaluated for any obvious parallax image distortion. Cases with obvious parallax distortion were included for angular evaluation of AP intraoperative fluoroscopic and first postoperative plain films. The tibia was marked at 2-centimeter intervals to create zones from the proximal stem of the implant. The anatomical axis of the tibia (AAT) was drawn at the mid-diaphysis. The anatomic lateral distal tibial angle (aLDTA) and anatomic axis deviation (AAD) were measured for each zone.

Results: A total of 22 TAAs were performed during the study period. Four cases were excluded due to inadequate imaging, leaving a total of 18 TAAs for review. We found 6 of 18 (33.3%) cases had obvious parallax distortion. We found the average aLDTA was 90.9° (84°-101°). At the most proximal tibial zone, the average aLDTA was 94° (91°-101°). We found the average AAD was 4.7 (0.5-17.2) mm. The AAD ranged from 0.5 to 17.2 mm lateral to 0.8 to 8.2 mm medial. Postoperative plain film radiographs displayed a normal aLDTA and an AAT centered within the ankle joint.

Conclusion: Parallax can distort the appearance of the tibia on fluoroscopic images. Deviation from the normal aLDTA and anatomical axis should be anticipated. Surgeons should be aware of the potential impact of parallax and ways to mitigate these effects.

背景:外科医生在进行全踝关节置换术(TAA)时,需要依靠术中透视来协助植入部件的放置。视差会改变从两个不同点观察物体的方向,从而导致图像失真。本研究旨在评估 TAA 术中透视图像的视差/失真:方法:对两位外科医生(R.W.M. 和 B.S.)在 2019 年 8 月至 2023 年 4 月期间实施的所有 TAA 进行回顾性审查。术中透视踝关节前方(AP)视图,评估是否存在明显的视差图像失真。有明显视差变形的病例被纳入术中透视和术后首次平片的角度评估。以 2 厘米的间隔标记胫骨,以便从植入物的近端柄开始创建区域。在干骺端中部绘制胫骨解剖轴线(AAT)。测量每个区域的解剖外侧胫骨远端角度(aLDTA)和解剖轴偏差(AAD):研究期间共进行了22例TAA。有四例因成像不充分而被排除,因此共有 18 例 TAAs 需要复查。我们发现 18 例中有 6 例(33.3%)存在明显的视差失真。我们发现平均 aLDTA 为 90.9°(84°-101°)。在胫骨最近端区域,平均 aLDTA 为 94° (91°-101°)。我们发现AAD的平均值为4.7(0.5-17.2)毫米。AAD范围从外侧0.5至17.2毫米到内侧0.8至8.2毫米。术后X光平片显示正常的aLDTA和以踝关节为中心的AAT:结论:视差会扭曲胫骨在透视图像上的外观。应预见到与正常 aLDTA 和解剖轴线的偏差。外科医生应了解视差的潜在影响以及减轻这些影响的方法。
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引用次数: 0
Effects of Pilates Exercise Training on Static Balance and Lower Limbs Proprioception in Adult Females With and Without Flexible Flatfeet. 普拉提运动训练对患有和不患有灵活扁平足的成年女性的静态平衡和下肢运动感觉的影响。
Pub Date : 2024-09-26 DOI: 10.1177/19386400241279930
Maryam Ghorbani, Rasoul Yaali, Hassan Sadeghi, Urs Granacher

Background: It is well known that flatfeet are associated with a higher incidence of lower limb injuries in different populations. Thus, we examine how Pilates exercise training affects static balance and ankle and knee proprioception in females with and without flexible flatfeet. Study Design. Case series; Level of evidence.

Methods: This quasi-experimental study involves 91 healthy 18- to 25-year-old female university students. The Navicular Drop Test was used to diagnose flatfeet. Pilates included core strength, balance, and flexibility exercises for 16 weeks. Static balance was assessed using the sharpened Romberg test and ankle and knee joint proprioception were measured using joint position reproduction tests. The Wilcoxon test indicated within-group pre-post improvements in static balance, and ankle and knee joint proprioception in the Pilates and the healthy control group (P < .05).

Results: The between-group comparisons at post-test showed significant differences for joint position reproduction test of the dorsiflexion (P < .05, η2 = 0.10) and the plantarflexion (P < 0.05, η2 = 0.08) in favor of the healthy controls group. Joint proprioception of ankle and knee was positively correlated with increasing static balance in the healthy control group.

Conclusion: The results showed that Pilates has the potential to improve static balance, and ankle and knee proprioception. However, it did not improve postural control and proprioception in individuals with flatfeet. Our findings advise combining Pilates with other interventions to develop flexible flatfeet in females.

Levels of evidence: Level I.

背景:众所周知,在不同人群中,扁平足与较高的下肢损伤发生率有关。因此,我们研究了普拉提运动训练如何影响患有和不患有灵活扁平足的女性的静态平衡以及踝关节和膝关节本体感觉。研究设计。病例系列;证据级别:这项准实验研究涉及 91 名 18 至 25 岁的健康女大学生。采用蹄弓下坠测试诊断扁平足。普拉提包括核心力量、平衡和柔韧性练习,为期 16 周。使用锐化朗伯格测试评估静态平衡,使用关节位置再现测试测量踝关节和膝关节本体感觉。Wilcoxon 检验表明,普拉提组和健康对照组的静态平衡、踝关节和膝关节本体感觉在组内前后均有改善(P < .05):结果:普拉提组和健康对照组的静态平衡、踝关节和膝关节本体感觉在测试后的组间比较显示,普拉提组在背伸(P < 0.05,η2 = 0.10)和跖屈(P < 0.05,η2 = 0.08)的关节位置再现测试中优势明显。在健康对照组中,踝关节和膝关节的本体感觉与静态平衡的提高呈正相关:结果表明,普拉提具有改善静态平衡、踝关节和膝关节本体感觉的潜力。然而,普拉提并不能改善扁平足患者的姿势控制和本体感觉。我们的研究结果建议将普拉提与其他干预措施相结合,以培养女性灵活的扁平足:证据等级:一级。
{"title":"Effects of Pilates Exercise Training on Static Balance and Lower Limbs Proprioception in Adult Females With and Without Flexible Flatfeet.","authors":"Maryam Ghorbani, Rasoul Yaali, Hassan Sadeghi, Urs Granacher","doi":"10.1177/19386400241279930","DOIUrl":"https://doi.org/10.1177/19386400241279930","url":null,"abstract":"<p><strong>Background: </strong>It is well known that flatfeet are associated with a higher incidence of lower limb injuries in different populations. Thus, we examine how Pilates exercise training affects static balance and ankle and knee proprioception in females with and without flexible flatfeet. Study Design. Case series; Level of evidence.</p><p><strong>Methods: </strong>This quasi-experimental study involves 91 healthy 18- to 25-year-old female university students. The Navicular Drop Test was used to diagnose flatfeet. Pilates included core strength, balance, and flexibility exercises for 16 weeks. Static balance was assessed using the sharpened Romberg test and ankle and knee joint proprioception were measured using joint position reproduction tests. The Wilcoxon test indicated within-group pre-post improvements in static balance, and ankle and knee joint proprioception in the Pilates and the healthy control group (P < .05).</p><p><strong>Results: </strong>The between-group comparisons at post-test showed significant differences for joint position reproduction test of the dorsiflexion (P < .05, η<sup>2</sup> = 0.10) and the plantarflexion (P < 0.05, η<sup>2</sup> = 0.08) in favor of the healthy controls group. Joint proprioception of ankle and knee was positively correlated with increasing static balance in the healthy control group.</p><p><strong>Conclusion: </strong>The results showed that Pilates has the potential to improve static balance, and ankle and knee proprioception. However, it did not improve postural control and proprioception in individuals with flatfeet. Our findings advise combining Pilates with other interventions to develop flexible flatfeet in females.</p><p><strong>Levels of evidence: </strong>Level I.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400241279930"},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Traumatic Periprosthetic Fractures Following Total Ankle Replacement A Systematic Review and Proposed Classification. 全踝关节置换术后的创伤性假体周围骨折 系统回顾与分类建议
Pub Date : 2024-09-23 DOI: 10.1177/19386400241280357
Zachary P Hill, Joseph R Brown, Daniel DeGenova, Benjamin C Taylor, Robert Mendicino, Isaac Korb

Total ankle replacements (TAR) are increasingly utilized, but postoperative traumatic periprosthetic fractures remain a rare yet challenging complication. This systematic review aims to address the gap in literature by proposing a comprehensive classification system for these fractures, considering implant stability, fracture location, and surrounding bone quality. A systematic review identified 13 cases from 9 studies meeting inclusion criteria. Fractures were categorized using the proposed Hill-Brown classification: Type A (talus or fibula), Type B (distal tibial component), and Type C (diaphysis/proximal tibial metaphysis). Implant stability was a key factor, with Type B fractures further classified as B1 (stable), B2 (unstable with adequate bone stock), and B3 (unstable with poor bone stock). Most fractures occurred at or near the distal tibial component (Type B), with implant stability largely dependent on fracture location and bone quality. Surgical fixation, particularly minimally invasive plate osteosynthesis (MIPO) with locking plates, was the preferred treatment for stable implants, showing low complication rates. Unstable implants often required revision TAR or conversion to arthrodesis. Surgical intervention is recommended following all traumatic periprosthetic fractures in the setting of a TAR. Bone quality, particularly in patients with rheumatoid arthritis or osteoporosis, significantly impacted treatment decisions. Our findings emphasize the importance of fracture location, implant stability, and bone quality in managing these fractures. Future multicenter studies are necessary to validate this classification system and refine treatment protocols.Level of Evidence: Level III.

全踝关节置换术(TAR)的使用率越来越高,但术后创伤性假体周围骨折仍是一种罕见但具有挑战性的并发症。本系统性综述旨在通过对这些骨折提出一个全面的分类系统,并考虑到植入物的稳定性、骨折位置和周围骨质,从而填补文献空白。系统性综述从符合纳入标准的 9 项研究中确定了 13 个病例。根据希尔-布朗提出的分类方法对骨折进行了分类:A型(距骨或腓骨)、B型(胫骨远端组件)和C型(干骺端/胫骨近端干骺端)。植入物的稳定性是一个关键因素,B型骨折进一步分为B1(稳定)、B2(不稳定,骨量充足)和B3(不稳定,骨量不足)。大多数骨折发生在胫骨远端或附近(B 型),植入物的稳定性主要取决于骨折位置和骨质。手术固定,尤其是使用锁定钢板的微创钢板骨合成术(MIPO),是稳定型植入物的首选治疗方法,并发症发生率较低。不稳定的植入物通常需要翻修 TAR 或改用关节固定术。建议在所有创伤性假体周围骨折的TAR治疗后进行手术干预。骨质,尤其是类风湿性关节炎或骨质疏松症患者的骨质,对治疗决定有很大影响。我们的研究结果强调了骨折位置、植入物稳定性和骨质对处理这些骨折的重要性。未来有必要开展多中心研究,以验证这一分类系统并完善治疗方案:证据等级:三级。
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引用次数: 0
Exploring Revision Total Ankle Arthroplasty Failures A Comparison Between Failed and Successful Revision Cases. 探索翻修全踝关节置换术失败案例 失败与成功翻修案例的比较
Pub Date : 2024-09-20 DOI: 10.1177/19386400241274551
Kevin A Wu, Albert T Anastasio, James K DeOrio, James A Nunley, Mark E Easley, Samuel B Adams

This study assesses the comorbidities that are associated with failed revision total ankle arthroplasty (TAA) and explores the outcomes following a failed revision TAA. A retrospective analysis was conducted on a cohort of patients who underwent a revision TAA at a single institution from 2008 to 2022. Patients were identified as having revision failure if they required explantation, below-knee amputation (BKA), or a revision of either metal component. Statistical analysis was performed to identify any significant differences and summarize outcomes. The study included a total of 87 patients who underwent revision TAA with 12 patients who subsequently experienced revision failure. The revision TAA failure rate was 13.8%. There were higher rates of former smokers (58.3%; n = 7) and a history of diabetes (33.3%; n = 4) in the failure cohort, although these differences did not reach statistical significance. Limb salvage procedures were achieved in 11 cases (91.7%). Approaches for failed revision TAAs included arthrodesis (n = 5) with 2 isolated ankle arthrodesis (AA) and 3 tibio-talo-calcaneal (TTC) arthrodesis, an additional revision arthroplasty (n = 6), or amputation (n = 1). Ankle arthroplasty retention was successful in 6 cases (50.0%). Our results demonstrate that a second revision approach was chosen in half of the cases, underscoring its viability as a successful intervention according to patient preferences.Level of Evidence: III.

本研究评估了与翻修性全踝关节置换术(TAA)失败相关的合并症,并探讨了翻修性全踝关节置换术失败后的治疗效果。研究对2008年至2022年期间在一家医疗机构接受翻修全踝关节置换术的患者进行了回顾性分析。如果患者需要切除、膝下截肢(BKA)或翻修任一金属组件,则被认定为翻修失败。研究人员进行了统计分析,以确定任何显著差异并总结结果。该研究共纳入了 87 位接受翻修 TAA 的患者,其中 12 位患者随后经历了翻修失败。翻修 TAA 失败率为 13.8%。在失败的患者队列中,曾经吸烟者(58.3%;n = 7)和有糖尿病史者(33.3%;n = 4)的比例较高,但这些差异未达到统计学意义。11例(91.7%)患者进行了肢体挽救手术。翻修TAA失败的方法包括关节固定术(5例),其中2例为孤立踝关节固定术(AA),3例为胫骨-跗骨-踝关节固定术(TTC),另外1例为翻修关节成形术(6例),或截肢(1例)。6例(50.0%)成功进行了踝关节置换术保留。我们的研究结果表明,有一半的病例选择了第二次翻修方法,这说明根据患者的偏好,第二次翻修是一种成功的干预方法:证据等级:III。
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引用次数: 0
Navigating Ankle Fracture Surgery in the Shadow of COVID-19. 在 COVID-19 的阴影下指导踝关节骨折手术。
Pub Date : 2024-09-20 DOI: 10.1177/19386400241274539
Justin P Chan, Henry Hoang, Amanda Anderson, Andrew R Hsu

Background: This case control study aimed to evaluate the impact of preoperative COVID-19 diagnosis on postoperative complications in patients undergoing ankle fracture surgery using the National COVID-19 Cohort Collaborative (N3C) database. The investigation focused on the interplay between COVID-19 diagnosis timing, patient characteristics, and clinical outcomes, particularly considering the potential mechanisms by which COVID-19 may contribute to increased complications.

Methods: This case control study included patients who underwent ankle fracture surgery using the N3C database. The cohort was divided into two groups: patients without COVID-19 diagnosis within 12 weeks of surgery (n = 16 806) and those with a positive COVID-19 diagnosis within 12 weeks of surgery (n = 369). Demographic factors were analyzed. Clinical outcomes encompassed deep vein thrombosis (DVT), sepsis, surgical site infection, bleeding, acute kidney injury, 30-day mortality, and 365-day mortality. Multivariate logistic regression analyses were conducted.

Results: The COVID-19-positive cohort displayed a slightly higher mean age (52.95 ± 18.43 vs 51.62 ± 18.36, P = .169) and body mass index (34.88 ± 9.99 vs 33.86 ± 8.80, P = .028) compared to the negative cohort. Although some outcomes, such as DVT and sepsis, demonstrated slightly higher frequencies in the COVID-19-positive group, these differences were not statistically significant. Adjusted odds ratios (AORs) for various COVID-19 diagnosis periods were generally not significant, except for a heightened risk of 30-day all-cause mortality associated with COVID-19 positivity within 0 to 2 weeks of surgery (AOR = 6.29, P = .003).

Conclusions: Preoperative COVID-19 diagnosis within 12 weeks did not exhibit a significant association with most postoperative complications. While this study did not unveil substantial COVID-19-related effects, acknowledging the broader context of the pandemic remains essential in guiding comprehensive patient care strategies.

Level of evidence: Level III.

背景:这项病例对照研究旨在利用国家 COVID-19 队列协作组织 (N3C) 数据库评估术前 COVID-19 诊断对接受踝关节骨折手术患者术后并发症的影响。调查的重点是 COVID-19 诊断时间、患者特征和临床结果之间的相互作用,特别是考虑 COVID-19 可能导致并发症增加的潜在机制:这项病例对照研究利用 N3C 数据库纳入了接受踝关节骨折手术的患者。研究对象分为两组:手术后 12 周内未确诊 COVID-19 的患者(n = 16 806)和手术后 12 周内确诊 COVID-19 阳性的患者(n = 369)。对人口统计学因素进行了分析。临床结果包括深静脉血栓 (DVT)、败血症、手术部位感染、出血、急性肾损伤、30 天死亡率和 365 天死亡率。进行了多变量逻辑回归分析:结果:与阴性队列相比,COVID-19阳性队列的平均年龄(52.95 ± 18.43 vs 51.62 ± 18.36,P = .169)和体重指数(34.88 ± 9.99 vs 33.86 ± 8.80,P = .028)略高。虽然 COVID-19 阳性组出现深静脉血栓和败血症等某些结果的频率略高,但这些差异并无统计学意义。除了术后0至2周内COVID-19阳性会增加30天全因死亡风险(AOR = 6.29,P = .003)外,COVID-19不同诊断时期的调整赔率(AORs)一般无显著性差异:结论:术前 12 周内的 COVID-19 诊断与大多数术后并发症无明显关联。虽然这项研究没有揭示出与 COVID-19 相关的实质性影响,但认识到这一流行病的大背景对于指导全面的患者护理策略仍然至关重要:证据等级:三级。
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引用次数: 0
The Influence of Resilience on Outcomes After Total Ankle Arthroplasty. 韧性对全踝关节置换术后效果的影响
Pub Date : 2024-09-18 DOI: 10.1177/19386400241274601
Joseph A S McCahon, Joseph Massaglia, Tara G Moncman, Samantha Riebesell, Selene G Parekh, David I Pedowitz, Joseph N Daniel

Background: Resiliency is the ability to recover from stressful events and has been shown to correlate with patient outcomes following certain orthopaedic procedures. The purpose of this study was to determine the relationship between resiliency and outcomes following TAA.

Methods: A retrospective analysis of patients undergoing primary TAA between April 2015 and September 2022 was performed (N = 83). Data included demographics, comorbidities, complications, preoperative and postoperative visual analog scale (VAS) pain and Foot and Ankle Ability Measure (FAAM) functional scores, Brief Resilience Scale (BRS) scores, and surgical satisfaction. Patients were defined as having low resilience (LR), normal resilience (NR), or high resilience (HR) based on a BRS score of <3, 3-4.30, and >4.3, respectively.

Results: High resilience patients had significantly higher postoperative FAAM ADL, Sports, and Overall scores as well as a significantly greater increase from preoperative scores compared with LR and NR patients. Low resilience patients had significantly lower FAAM Sports and Overall scores compared with normal and high resilience patients. BRS scores positively correlated with postoperative FAAM scores. We found no difference in satisfaction or VAS between the 3 cohorts. Multivariate regression analysis identified BRS scores to be an independent predictor for greater changes in FAAM scores following TAA.

Conclusion: Although functional improvements following TAA are expected, patients with higher resilience at baseline are more likely to experience greater improvements in functional outcomes following surgery.

Level of evidence: Level III.

背景:复原力是指从压力事件中恢复的能力,已被证明与某些骨科手术后患者的预后相关。本研究旨在确定恢复能力与 TAA 术后结果之间的关系:对2015年4月至2022年9月期间接受初级TAA手术的患者进行了回顾性分析(N = 83)。数据包括人口统计学、合并症、并发症、术前和术后视觉模拟量表(VAS)疼痛和足踝能力测量(FAAM)功能评分、简易复原力量表(BRS)评分和手术满意度。根据 BRS 评分 4.3 分,患者分别被定义为低复原力 (LR)、正常复原力 (NR) 或高复原力 (HR):与低复原力和正常复原力患者相比,高复原力患者的术后FAAM ADL、运动和综合评分明显更高,与术前评分相比也有明显提高。与正常和高复原力患者相比,低复原力患者的 FAAM 运动和综合评分明显较低。BRS 评分与术后 FAAM 评分呈正相关。我们发现三组患者在满意度或 VAS 方面没有差异。多变量回归分析发现,BRS评分是预测TAA术后FAAM评分变化较大的独立因素:结论:尽管TAA术后的功能改善是意料之中的,但基线复原力较高的患者更有可能在术后获得更大的功能改善:证据等级:III级。
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引用次数: 0
Gunshot Injury With Bone Defect of the First Metatarsal Bone A Presentation of 2 Cases Treated With an Iliac Crest Structural Graft, Internal Fixation, and Bone Morphogenic Protein 2. 枪伤伴第一跖骨骨质缺损--两例使用髂嵴结构移植、内固定和骨形态发生蛋白 2 治疗的病例。
Pub Date : 2024-09-18 DOI: 10.1177/19386400241278026
Elisabeth Ellingsen Husebye, Geir Stray Andreassen, Are Haukåen Stødle

Gunshot injuries to the foot with segmental bone defects can be challenging to treat. When the vascularity is intact and the soft tissues allows, the goal should be to reconstruct the bony defect. We present 2 cases of a gunshot injury to the foot with a defect of the first metatarsal bone. Both cases were treated, with favorable outcome, with a structural iliac crest graft, internal fixation, and bone morphogenic protein 2.Level of Evidence: V, cases series, technical.

足部枪伤伴有节段性骨缺损,治疗难度很大。如果血管完好且软组织条件允许,目标应该是重建骨缺损。我们介绍了两例第一跖骨缺损的足部枪伤病例。两例患者均接受了髂嵴结构移植、内固定和骨形态发生蛋白 2 的治疗,结果良好:证据级别:V,病例系列,技术。
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引用次数: 0
期刊
Foot & ankle specialist
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