Nonoperative Treatment of Gastric Emphysema

Acute gastric dilatation is the radiological finding of a massively enlarged stomach as seen on plain film X-ray or a computerized tomography scan of the abdomen. It is a rare entity with high mortality if not treated promptly and is often not reported due to a lack of physician awareness. It can occur due to both mechanical obstruction of the gastric outflow tract, or due to nonmechanical causes, such as eating disorders and gastroparesis. Acute hyperglycemia without diagnosed gastroparesis, such as in patients with diabetic ketoacidosis, may also predispose to acute gastric dilatation. Prompt placement of a nasogastric tube can help deter its serious complications of gastric emphysema, ischemia, and/or perforation. We present our experience of 2 patients who presented with severe hyperglycemia and were found to have acute gastric dilation on imaging. Only one of the patients was treated with nasogastric tube placement for decompression and eventually made a full recovery.

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Predictors of Management of Distal Radius Fractures in Patients Aged >65 Years

Hand ◽

10.1177/15589447211017217 ◽

2021 ◽

pp. 155894472110172

Author(s):

Amanda Walsh ◽

Nelson Merchan ◽

David N. Bernstein ◽

Bailey Ingalls ◽

Carl M. Harper ◽

...

Keyword(s):

Distal Radius ◽

Operative Management ◽

Nonoperative Treatment ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Total N ◽

Fracture Characteristics ◽

Time Period ◽

Tertiary Center ◽

Comorbidity Index

Background Treatment of distal radius fractures (DRFs) in patients aged >65 years is controversial. The purpose of this study was to identify what patient and fracture characteristics may influence the decision to pursue surgical versus nonsurgical treatment in patients aged >65 years sustaining a DRF. Methods We queried our institutional DRF database for patients aged >65 years who presented to a single academic, tertiary center hand clinic over a 5-year period. In all, 164 patients treated operatively were identified, and 162 patients treated nonoperatively during the same time period were selected for comparison (total N = 326). Demographic variables and fracture-specific variables were recorded. Patient and fracture characteristics between the groups were compared to determine which variables were associated with each treatment modality (operative or nonoperative). Results The average age in our cohort was 72 (SD: 11) years, and 274 patients (67%) were women. The average Charlson Comorbidity Index (CCI) was 4.1 (SD: 2.1). The CCI is a validated tool that predicts 1-year mortality based on patient age and a list of 22 weighted comorbidities. Factors associated with operative treatment in our population were largely related to the severity of the injury and included increasing dorsal tilt (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.05-1.12; P < .001) and AO Classification type C fractures (OR, 5.42; 95% CI, 2.35-11.61; P < .001). Increasing CCI was the only factor independently associated with nonoperative management (OR, 0.84; 95% CI, 0.72-0.997; P = .046). Conclusion Fracture severity is a strong driver in the decision to pursue operative management in patients aged >65 years, whereas increasing CCI predicts nonoperative treatment.

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Serum C-reactive protein and WBC count in conservatively and operatively managed bacterial spondylodiscitis

Journal of Orthopaedic Surgery ◽

10.1177/2309499020968296 ◽

2020 ◽

Vol 29 (1) ◽

pp. 230949902096829

Author(s):

Christina van Gerven ◽

Kevin Eid ◽

Tobias Krüger ◽

Michael Fell ◽

Daniel Kendoff ◽

...

Keyword(s):

Antibiotic Treatment ◽

Serum Levels ◽

Blood Chemistry ◽

Nonoperative Treatment ◽

C Reactive Protein ◽

Disc Disease ◽

Reactive Protein ◽

Postoperative Serum ◽

Wbc Count ◽

And Control

Purpose: C-reactive protein (CRP) and white blood cell (WBC) count are routine blood chemistry parameters in monitoring infection. Little is known about the natural history of their serum levels in conservative and operative spondylodiscitis treatment. Methods: Pre- and postoperative serum levels of CRP and WBC count in 145 patients with spondylodiscitis were retrospectively assessed. One hundred and four patients were treated by debridement, spondylodesis, and an antibiotic regime, 41 only with a brace and antibiotics. The results of the surgical group were compared to 156 patients fused for degenerative disc disease (DDD). Results: Surgery had a significant effect on peak postoperative CRP levels. In surgically managed patients, CRP peaked at 2–3 days after surgery (spondylodiscitis: pre-OP: 90 mg/dl vs. post-OP days 2–3: 146 mg/dl; DDD: 9 mg/dl vs. 141 mg/dl; p < 0.001), followed by a sharp decline. Although values were higher for spondylodiscitis patients, dynamics of CRP values were similar in both groups. Nonoperative treatment showed a slower decline. Surgically managed spondylodiscitis showed a higher success rate in identifying bacteria. Specific antibiotic treatment led to a more predictable decline of CRP values. WBC did not show an interpretable profile. Conclusion: CRP is a predictable serum parameter in patients with spondylodiscitis. WBC count is unspecific. Initial CRP increase after surgery is of little value in monitoring infection. A preoperative CRP value, and control once during the first 3 days after surgery is sufficient. Closer monitoring should then be continued. Should a decline not be observed, therapy needs to be scrutinized, antibiotic treatment reassessed, and concomitant infection contemplated.

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Outcome after nonoperative treatment of stable Lisfranc injuries. A prospective cohort study

Foot and Ankle Surgery ◽

10.1016/j.fas.2021.03.017 ◽

2021 ◽

Author(s):

Are H. Stødle ◽

Kjetil H. Hvaal ◽

Helga Brøgger ◽

Jan Erik Madsen ◽

Elisabeth Ellingsen Husebye

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Nonoperative Treatment ◽

Lisfranc Injuries

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Medical Malpractice Trends in Foot and Ankle Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00048 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0004

Author(s):

Rishin J. Kadakia ◽

Keith Orland ◽

Akhil Sharma ◽

Jie Chen ◽

Craig C. Akoh ◽

...

Keyword(s):

Medical Malpractice ◽

Orthopaedic Surgery ◽

Nonoperative Treatment ◽

Anatomical Location ◽

Foot And Ankle ◽

Common Complication ◽

Adult Females ◽

Forefoot Surgery ◽

Ankle Surgery ◽

Malpractice Claims

Category: Other Introduction/Purpose: Medical malpractice lawsuits can place significant economic and psychologic burden on a provider. Orthopaedic surgery is one of the most common subspecialties involved in malpractice claims. There is currently no study examining malpractice lawsuits within foot and ankle surgery. Accordingly, the purpose of this work is to examine trends in malpractice claims in foot and ankle surgery. Methods: The Westlaw legal database was queried for lawsuits pertaining to foot and ankle surgery from 2008 to 2018. Only cases involving medical malpractice were included for analysis. All available details pertaining to the cases were collected. This included plaintiff demographic and geographic data. Details regarding the cases were also collected such as anatomical location, pathology, complications, and case outcomes. Results: Forty nine malpractice lawsuits pertaining to foot and ankle were identified. Most plaintiffs in these cases were adult females, and the majority of cases occurred in the northeast (53.1%). The most common anatomical region involved in claims involved the forefoot (29%). The majority of these claims involved surgery (65%). Infection was the most common complication seen in claims (22%). The jury ruled in favor of the defendant surgeon in most cases (73%). Conclusion: This is the first study to examine trends in medical malpractice within foot and ankle surgery. Infection was the most frequent complication seen in claims and forefoot surgery was the most common anatomic location. A large portion of claims resulted after nonoperative treatment. A better understanding of the trends within malpractice claims is crucial to developing strategies for prevention.

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