The Iowa orthopaedic journal最新文献

Background: The current classification system of progressive collapsing foot deformity (PCFD) is comprised of 5 possible classes. PCFD is understood to be a complex, three-dimensional deformity occurring in many regions along the foot and ankle. The question remains whether a deformity in one area impacts other areas. The objective of this study is to assess how each one of the classes is influenced by other classes by evaluating each associated angular measurement. We hypothesized that positive and linear correlations would occur for each class with at least one other class and that this influence would be high.

Methods: We retrospectively assessed weight bearing CT (WBCT) measurements of 32 feet with PCFD diagnosis. The classes and their associated radiographic measurements were defined as follows: class A (hindfoot valgus) measured by the hindfoot moment arm (HMA), class B (midfoot abduction) measured by the talonavicular coverage angle (TNCA), class C (medial column instability) measured by Meary's angle, class D (peritalar sub-luxation) measured by the medial facet uncoverage (MFU), and class E (ankle valgus) measured using the talar tilt angle (TTA). Multivariate analyses were completed comparing each class measurement to the other classes. A p-value <0.05 was considered significant.

Results: Class A showed substantial positive correlation with class C (ρ=0.71; R²=0.576; p=0.001). Class B was substantially correlated with class D (ρ=0.74; R²=0.613; p=0.001). Class C showed a substantial positive correlation with class A (ρ=0.71; R²=0.576; p=0.001) and class D (ρ=0.75; R²=0.559; p=0.001). Class D showed substantial positive correlation with class B and class C (ρ=0.74; R²=0.613; p=0.001), (ρ=0.75; R²=0.559; p=0.001) respectively. Class E did not show correlation with class B, C or D (ρ=0.24; R²=0.074; p=0.059), (ρ=0.17; R²=0.071; p=0.179), and (ρ=0.22; R²=0.022; p=0.082) respectively.

Conclusion: This study was able to find relations between components of PCFD deformity with exception of ankle valgus (Class E). Measurements associated with each class were influenced by others, and in some instances with pronounced strength. The presented data may support the notion that PCFD is a three-dimensional complex deformity and suggests a possible relation among its ostensibly independent features. Level of Evidence: III.

Background: Cannabis is the most commonly used recreational drug in the USA. Studies evaluating cannabis use and its impact on outcomes following cervical spinal fusion (CF) are limited. This study sought to assess the impact of isolated (exclusive) cannabis use on postoperative outcomes following CF by analyzing outcomes like complications, readmissions, and revisions.

Methods: The New York Statewide Planning and Research Cooperative System (SPARCS) was queried for patients who underwent CF between January 2009 and September 2013. Inclusion criteria were age ≥18 years and either a minimum 90-day (for complications and readmissions) or 2-year (for revisions) follow-up surveillance. Patients with systemic disease, osteomyelitis, cancer, trauma, and concomitant substance or polysubstance abuse/dependence were excluded. Patients with a preoperative International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) diagnosis of isolated cannabis abuse (Cannabis) or dependence were identified. The primary outcome measures were 90-day complications, 90-day readmissions, and two-year revisions following CF. Cannabis patients were 1:1 propensity score-matched by age, gender, race, Deyo score, surgical approach, and tobacco use to non-cannabis users and compared for outcomes. Multivariate binary stepwise logistic regression models identified independent predictors of outcomes.

Results: 432 patients (n=216 each) with comparable age, sex, Deyo scores, tobacco use, and distribution of anterior or posterior surgical approaches were identified (all p>0.05). Cannabis patients were predominantly Black (27.8% vs. 12.0%), primarily utilized Medicaid (29.6% vs. 12.5%), and had longer LOS (3.0 vs. 1.9 days), all p≤0.001. Both cohorts experienced comparable rates of 90-day medical and surgical, as well as overall complications (5.6% vs. 3.7%) and two-year revisions (4.2% vs. 2.8%, p=0.430), but isolated cannabis patients had higher 90-day readmission rates (11.6% vs. 6.0%, p=0.042). Isolated cannabis use independently predicted 90-day readmission (Odds Ratio=2.0), but did not predict any 90-day complications or two year revisions (all p>0.05).

Conclusion: Isolated baseline cannabis dependence/abuse was associated with increased risk of 90-day readmission following CF. Further investigation of the physiologic impact of cannabis on musculoskeletal patients may elucidate significant contributory factors. Level of Evidence: III.

Background: Radiotherapy for tumor treatment in or near bones often causes osteopenia and/or osteoporosis, and the resulting increased bone fragility can lead to pathologic fractures. Bone mineral density (BMD) is often used to screen for fracture risk, but no conclusive relationship has been established between BMD and the microstructural/ biomechanical changes in irradiated bone. Understanding the effects of radiation dosing regimen on the bone structure-strength relationship would improve the ability to reduce fracture-related complications resulting from cancer treatment.

Methods: Thirty-two C57B6J mice aged 10 - 12 weeks old were randomized to single dose (1 x 25 Gy) and fractionated dose (5 x 5 Gy) irradiation groups. Right hindlimbs were irradiated while the contralateral hindlimbs served as the non-irradiated control. Twelve weeks after irradiation, BMD and bone microstructure were assessed with micro-computed tomography, and mechanical strength/stiffness was assessed with a torsion test. The effects of radiation dosing regimen on bone microstructure and strength were assessed using ANOVA, and bone strength-structure relationships were investigated through correlation analysis of microstructural and mechanical parameters.

Results: Fractionated irradiation induced significantly greater losses in BMD in the femur (23% - male mice, p=0.016; 19% - female mice) and the tibia (18% - male mice; 6% - female mice) than the single-dose radiation. The associated reductions in trabecular bone volume (-38%) and trabecular number (-34% to -42%), and the increase in trabecular separation (23% to 29%) were only significant in the male mice with fractionated dosing. There was a significant reduction in fracture torque in the femurs of male (p=0.021) and female (p=0.0017) mice within the fractionated radiation group, but not in the single dose radiation groups. There was moderate correlation between bone microstructure and mechanical strength in the single-dose radiation group (r = 0.54 to 0.73), but no correlation in the fractionated dosing group (r=0.02 to 0.03).

Conclusion: Our data indicate more detrimental changes in bone microstructure and mechanical parameters in the fractionated irradiation group compared to the single dose group. This may suggest the potential for protecting bone if a needed therapeutic radiation dose can be delivered in a single session rather than administered in fractions.

Recently, firearm injuries in the United States have taken center stage in political debates and in the media. Much of the past epidemiological research on firearm injuries has focused primarily on the urban landscape. This study was undertaken to highlight the unique spectrum of firearm injuries seen at a rural level 1 trauma center to provide insight into prevalence, mechanism of injury, and seasonal variation. An IRB-approved retrospective study was performed of the trauma registry at a rural Level 1 hospital to identify all patients with firearm injuries from January 2002 to May 2014. Data obtained for each patient included demographics, injury date, a brief injury summary, and results of drug/ alcohol screening. Chart review was performed to confirm accuracy of the database and descriptive statistics were calculated to compare subgroups. During the 12 year study period, 408 patients with firearm injuries were treated at our hospital. There were 360 males and 48 females. Ages ranged from an infant to 90 years. Handguns were the most common type of firearm (49%). Mortality in this series was 19%. The median age for fatal and non-fatal wounds was 44 and 27 years, respectively. The three main causes of injury were accidental (36%), self-inflicted (33%), and assault (26%). Alcohol and drugs were commonly present. Hunting incidents accounted for 26% of accidents and most of these occurred while deer hunting in November and December. The demographics and mechanism of firearm injuries vary across the urban-rural continuum and it is important to identify these subgroups so targeted interventions can be pursued.

Background: The residency match is increasingly competitive. The interview is an essential component, yet little has been documented about the costs applicants incur during the interview process and it is unclear how they manage these expenses.

Objective: The purpose of this study was to define the economic burden of residency interviews for United States (U.S.) allopathic students participating in the 2016 Main Residency Match. We hypothesized that the financial burden of residency interviews varies based on specialty and plays a role in the applicant's ability to participate in all desired interviews.

Methods: A 26 question electronic survey was developed following pilot study of applicants to a single residency program. Following validation, the survey was distributed to administrative officials at all U.S. allopathic medical schools for circulation to senior students. Results were pooled for statistical analysis.

Results: We received responses from 759 U.S. allopathic seniors. A single interview most commonly costs $250 - $499. Most applicants incurred substantial interview related costs. Sixtyfour percent of respondents spent at least $2,500, while 13% spent $7,500 or more. Specialty competitiveness was predictive of higher interview costs. Seventy-one percent of respondents borrowed money to fund interview costs, and 41% declined interviews for financial reasons.

Conclusions: Senior medical students incur substantial costs to participate in residency interviews, often adding to already burdensome educational debt. We encourage residency programs, especially those in competitive specialty fields, to pursue cost reduction strategies. Additionally, medical schools should provide financial counseling to allow students to anticipate interview costs.

Introduction: Systemic Lupus Erythematosus (SLE) has been associated with increased complications following hip and knee arthroplasty. The Purpose of this study was to determine the extent to which SLE is a risk factor in outcomes following total joint arthroplasty (TJA).

Methods: The nationwide inpatient sample was used to identify a cohort of 505,841 patients who had a total hip arthroplasty (THA) or total knee arthroplasty (TKA) between 2009-2011. Of these patients, 2,284 patients (0.45%) had been previously diagnosed with SLE. The impact of SLE on short-term TJA outcomes was determined using multivariate logistic regression. Differences in discharge destination and length of stay were also evaluated.

Results: SLE patients were more likely to have an all-cause medical complication, (OR 1.9, p<0.0001) and more likely to have an all-cause surgical complication (OR 1.3, p<0.0001). SLE patients were four times more likely to become septic in the post-operative period (OR 3.8, p<0.0487). SLE patients were more likely to have a genitourinary complication (OR 1.7, p<0.0001) and bleeding complications requiring transfusion (OR 2.1, p<0.0001). Patients with SLE also had an increased length of stay (0.38 days, p<0.0001) and increased probability of discharging to a facility (OR 2.1, p<0.0001).

Discussion: Patients with SLE had an increased rate of both medical and surgical all-cause complications. Patients were specifically found to be at higher risk for sepsis, genitourinary complications, and blood transfusions. Future risk adjustment models should include SLE as a contributor to medical and surgical complications in the postoperative period.