Does Time to Theatre Affect The Ability to Achieve Fracture Reduction in Tibial Plateau Fractures?

AimsThe primary aim of this study was to assess the effect of time to surgery on fracture reduction, assessed as residual articular step, in cases of tibial plateau fracture (TPF). The secondary aim was to assess the effect of pre-operative demographics and residual articular step on patient reported outcomes (PROMs) following TPF.MethodBetween 2006 and 2017 all surgically treated TPF patients managed by a single surgeon at our institution were prospectively consented for the study of fracture outcomes. Timing to surgical intervention, reduction of articular step, age, gender, medical background, fracture classification, mechanism of injury and PROMs (Lysholm Scores and Knee Injury and Osteoarthritis Outcome Scores (KOOS)) were recorded and analysed. Reduction of articular step, defined as <2mm, was assessed by a single blinded examiner using measurements on plain radiographs on PACS.ResultsOne hundred seventeen patients were enrolled, 52 with Schatzker II, four with Schatzker IV and 61 with Schatzker VI fractures. Patients were followed-up to a mean time of 3.9 years. The ability to achieve fracture reduction was negatively influenced by time to theatre with the odds of achieving reduction decreasing 17% each day post-injury (p = 0.002). An increased time to theatre was associated with reduced Lysholm scores at the one-year mark (p = 0.01). The ability to achieve fracture reduction did not influence PROMs within the study period.ConclusionDelay in surgical fixation negatively affects fracture reduction in TPF and may delay recovery. However, residual articular step did not influence the investigated PROMs in the cohort investigated over the mid-term (mean of 3.9 years).

Download Full-text

Does Time to Theatre Affect the Ability to Achieve Fracture Reduction in Tibial Plateau Fractures?

Journal of Clinical Medicine ◽

10.3390/jcm11010138 ◽

2021 ◽

Vol 11 (1) ◽

pp. 138

Author(s):

David Stuart Kitchen ◽

Jack Richards ◽

Peter J. Smitham ◽

Gerald J. Atkins ◽

Lucian B. Solomon

Keyword(s):

Knee Injury ◽

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Soft Tissue Injuries ◽

Fracture Reduction ◽

Post Injury ◽

Outcome Scores ◽

Plateau Fracture ◽

Surgical Fixation ◽

One Year

Surgical management of displaced tibial plateau fracture (TPF) is often delayed due to accompanying soft tissue injuries sustained at the time of injury. The primary aim of this study was to assess the effect of time to surgery on fracture reduction in cases of TPF. The secondary aim was to assess the effect of preoperative demographics and residual articular step on Lysholm Scores and Knee Injury and Osteoarthritis Outcome Scores (KOOS) following fixation. Patients between 2006 and 2017, managed by a single surgeon, were prospectively enrolled in the study. Reduction of articular step, defined as <2 mm, was assessed by a single blinded examiner. A total of 117 patients were enrolled, 52 with Schatzker II, 4 with Schatzker IV, and 61 with Schatzker VI fractures. Patients were followed up to a mean of 3.9 years. Analysis showed that the ability to achieve fracture reduction was negatively influenced by time to theatre, with the odds of achieving reduction decreasing 17% with each subsequent day post injury (p = 0.002). Furthermore, an increased time to theatre was associated with a reduced Lysholm score at one year (p = 0.01). The ability to achieve fracture reduction did not influence PROMs within the study period. We conclude that delay in surgical fixation negatively affects fracture reduction in TPF and may delay recovery. However, residual articular step does not necessarily influence PROMs over the mid-term.

Download Full-text

Patient function continues to improve over the first five years following tibial plateau fracture managed by open reduction and internal fixation

The Bone & Joint Journal ◽

10.1302/0301-620x.102b5.bjj-2019-1385.r1 ◽

2020 ◽

Vol 102-B (5) ◽

pp. 632-637 ◽

Cited By ~ 2

Author(s):

L. J. Gonzalez ◽

K. Hildebrandt ◽

K. Carlock ◽

S. R. Konda ◽

K. A. Egol

Keyword(s):

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Tibial Plateau Fractures ◽

Term Outcome ◽

Patient Reported ◽

Schatzker Classification ◽

Plateau Fracture ◽

One Year

Aims Tibial plateau fractures are serious injuries about the knee that have the potential to affect patients’ long-term function. To our knowledge, this is the first study to use patient-reported outcomes (PROs) with a musculoskeletal focus to assess the long-term outcome, as compared to a short-term outcome baseline, of tibial plateau fractures treated using modern techniques. Methods In total, 102 patients who sustained a displaced tibial plateau fracture and underwent operative repair by one of three orthopaedic traumatologists at a large, academic medical centre and had a minimum of five-year follow-up were identified. Breakdown of patients by Schatzker classification is as follows: two (1.9%) Schatzker I, 54 (50.9%) Schatzker II, two (1.9%) Schatzker III, 13 (12.3%) Schatzker IV, nine (8.5%) Schatzker V, and 26 (24.5%) Schatzker VI. Follow-up data obtained included: Visual Analogue Scale (VAS) or Numeric Rating Scale (NRS) pain scores, Short Musculoskeletal Functional Assessment (SMFA), and knee range of movement (ROM). Data at latest follow-up were then compared to 12-month data using a paired t-test. Results Patient-reported functional outcomes as assessed by overall SMFA were statistically significantly improved at five years (p < 0.001) compared with one-year data from the same patients. Patients additionally reported an improvement in the Standardized Mobility Index (p < 0.001), Standardized Emotional Index (p < 0.001), as well as improvement in Standardized Bothersome Index (p = 0.003) between the first year and latest follow-up. Patient-reported pain and knee ROM were similar at five years to their one-year follow-up. In total, 15 of the patients had undergone subsequent orthopaedic surgery for their knees at the time of most recent follow-up. Of note, only one patient had undergone knee arthroplasty following plateau fixation related to post-traumatic osteoarthritis (OA). Conclusion Knee pain following tibial plateau fracture stabilizes at one year. However, PROs continue to improve beyond one year following tibial plateau fracture, at least in a statistical sense, if not also clinically. Patients displayed statistical improvement across nearly all SMFA index scores at their minimum five-year follow-up compared with their one-year follow-up. Cite this article: Bone Joint J 2020;102-B(5):632–637.

Download Full-text

Interpretation of patient-reported outcome measures for varicose vein surgery

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2011.011013 ◽

2011 ◽

Vol 27 (4) ◽

pp. 173-178 ◽

Cited By ~ 15

Author(s):

C Nesbitt ◽

W R W Wilson ◽

T A Lees ◽

G Stansby

Keyword(s):

Outcome Measures ◽

Varicose Vein ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Varicose Vein Surgery ◽

Patient Reported ◽

Potential Impact ◽

One Year ◽

The One ◽

Preoperative Score

Objectives Since 2009 the National Health Service (NHS) has been collecting patient-reported outcome measures (PROMs) following varicose vein interventions. The objective of this manuscript was to interrogate the one-year PROMs data with respect to varicose vein intervention and to discuss its potential impact on the provision of service. Methods We interrogated the one-year PROMs data with respect to potential impact on the provision of service. Results In total, 37,521 varicose vein operations were performed during the study period (1 April 2009–30 April 2010). A total of 15,808 preoperative questionnaires were completed and returned and 12,509 were linked to Hospital Episode Statistics episodes. A total of 8127 postoperative questionnaires were completed and linked to the preoperative questionnaires. For the EuroQuol (EQ) 5D questionnaire average preoperative score across the completed data-set was 0.773. The postoperative health gain was 0.094. Fifty-three percent of patients had improved postoperative scores, 33% reported no change, while 14% reported a reduction in their postoperative EQ-5D score. Pain/discomfort was the only domain where patients reported any negative symptoms; 72% (5390) reported pain/discomfort preoperatively and 37% (2804) postoperatively. In total, 62.6% (4685) reported no pain/discomfort following surgery A total of 7167 complete, linked and eligible data-sets were observed for the Aberdeen Varicose Vein Questionnaire (AVVQ). The average preoperative score was 18.75. The average postoperative score was 10.76. This represented a reduction in symptom scores of one-half following intervention. The lowest improvements were witnessed in patients with the lowest preoperative scores (least severe symptoms). Additional postoperative questions highlighted the improvements conferred from varicose vein surgery with 90.3% of patients reporting an improvement in their problems from varicose veins following surgery and 85% describing their operative results as excellent, very good or good. Conclusion These data have shown variable improvements following venous interventions. PROMs are likely to have significant implications for health care in the NHS on a number of levels including provision of funding and future planning of services.

Download Full-text

Postoperative weight bearing and patient reported outcomes at one year following tibial plateau fractures

Injury ◽

10.1016/j.injury.2017.05.024 ◽

2017 ◽

Vol 48 (7) ◽

pp. 1650-1656 ◽

Cited By ~ 13

Author(s):

Dominic Thewlis ◽

Francois Fraysse ◽

Stuart A. Callary ◽

Viju Daniel Verghese ◽

Claire F. Jones ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Tibial Plateau ◽

Weight Bearing ◽

Tibial Plateau Fractures ◽

Patient Reported ◽

One Year

Download Full-text

Prolonged concussion effects: Constellations of cognitive deficits detected up to year after injury

Journal of Concussion ◽

10.1177/20597002211006585 ◽

2021 ◽

Vol 5 ◽

pp. 205970022110065

Author(s):

Daniel D Leeds ◽

Annie Nguyen ◽

Christopher D’Lauro ◽

Jonathan C Jackson ◽

Brian R Johnson

Keyword(s):

Cognitive Abilities ◽

Cognitive Testing ◽

Support Vector ◽

Cognitive Measures ◽

Post Injury ◽

The Past ◽

Neurocognitive Assessment ◽

Non Linear ◽

One Year ◽

The One

Concussions are associated with an array of physical, emotional, cognitive, and sleep symptoms at multiple timescales. Cognitive recovery occurs relatively quickly – five-to-seven days on average. Yet, recent evidence suggests that some neurophysiological changes can be identified one year after a concussion. To that end, we examine more nuanced patterns in cognitive tests to determine whether cognitive abilities could identify a concussion within one-year post injury. A radial-basis (non-linear boundary) support vector machine classifier was trained to use cognitive performance measures to distinguish participants with no prior concussion from participants with prior concussion in the past year. After incorporating only 10 cognitive measures, or all 5 composite measures from the neurocognitive assessment (Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT)), over 90% accuracy was achieved in identifying both participants without prior concussions and participants with concussions in the past year, particularly when relying on non-linear patterns. Notably, classification accuracy stayed relatively constant between participants who had a concussion early or late in the one-year window. Thus, with substantial accuracy, a prior concussion can be identified using a non-linear combination of cognitive measures. Cognitive effects from concussion linger one-year post-injury, indicating the importance of continuing to follow concussion patients for many months after recovery and to take special note of constellations of cognitive abilities.

Download Full-text