Plantar Medial Avulsion Fragment Associated With Tongue-Type Calcaneus Fractures

2019 ◽  
Vol 40 (6) ◽  
pp. 634-640 ◽  
Author(s):  
Mark R. Adams ◽  
Kenneth L. Koury ◽  
Jaydev B. Mistry ◽  
William Braaksma ◽  
John S. Hwang ◽  
...  
Keyword(s):  
Retrospective Chart Review ◽  
Plantar Fascia ◽  
Calcaneal Fractures ◽  
Level Of Evidence ◽  
Fracture Fragment ◽  
Avulsion Fractures ◽  
Distinct Level ◽  
Level I ◽  
Calcaneus Fractures ◽  
Essex Lopresti

Background: The plantar fascia attaches to the tuberosity of the calcaneus, which produces a distinct plantar medial avulsion (PMA) fracture fragment in certain calcaneal fractures. We hypothesized that tongue-type fractures, as described by the Essex-Lopresti classification, were more likely to be associated with this PMA fracture than joint depression fractures. Methods: A retrospective chart review was performed at 2 distinct Level I trauma centers to identify patients sustaining calcaneal fractures. Radiographs were then reviewed to determine the Essex-Lopresti classification, OTA classification, and presence of a PMA fracture. Results: The review yielded 271 total patients with 121 (44.6%) tongue-type (TT), 110 (40.6%) joint depression (JD), and 40 (14.8%) fractures not classifiable by the Essex-Lopresti classification. In the TT group, 73.6% of the patients had the PMA fracture whereas only 8.2% of JD and 15.0% of nonclassifiable fractures demonstrated a PMA fragment ( P < .001). Conclusion: Plantar medial avulsion fractures occurred in 38.4% of the calcaneal fractures reviewed with a significantly greater proportion occurring in TT (73.6%) as opposed to JD (8.2%). Given the plantar fascia attachment to the PMA fragment, there may be clinical significance to identifying this fracture and changing treatment management; however, this requires further investigation. Level of Evidence: Level III, comparative study.

scholarly journals Intra-articular Calcaneus Fractures: Current Concepts Review

2020 ◽  
Vol 5 (3) ◽  
pp. 247301142092733
Author(s):  
Paul R. Allegra ◽  
Sebastian Rivera ◽  
Sohil S. Desai ◽  
Amiethab Aiyer ◽  
Jonathan Kaplan ◽  
...  
Keyword(s):  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Treatment Strategies ◽  
Late Complications ◽  
Classification Systems ◽  
Surgical Approaches ◽  
Calcaneal Fractures ◽  
Level Of Evidence ◽  
Tarsal Bones ◽  
Calcaneus Fractures

Calcaneal fractures are the most common fracture of the tarsal bones and represent 1% to 2% of all fractures. Roughly 75% of these fractures include intra-articular involvement of the posterior facet of the calcaneus. Intra-articular calcaneal fractures are challenging injuries to manage for both patients and surgeons given their association with both early and late complications. This article aims to review the management, classification systems, surgical approaches, and care regarding intra-articular calcaneal fractures. A review of the current literature yielded treatment strategies that aim to reduce complications such as soft tissue injury or loss of articular reduction while maintaining satisfactory clinical outcomes. The purpose of this article is to review these current concepts in the management of intra-articular calcaneal fractures. Level of Evidence: Level V, expert opinion.

scholarly journals Inter-rater reliability of Böhler and Gissane angles in different calcaneal fracture according to the Essex-Lopresti and Sanders classifications

2021 ◽  
Vol 15 (2) ◽  
pp. 133-139
Author(s):  
Rui dos Santos Barroco ◽  
Bruno Rodrigues de Miranda ◽  
Herbert Amantéa Fernandes ◽  
Gregory Bittar Pessoa ◽  
Danilo Ryuko Cândido Nishikawa ◽  
...  
Keyword(s):  
Critical Angle ◽  
Correlation Coefficients ◽  
Calcaneal Fracture ◽  
Control Group ◽  
Calcaneal Fractures ◽  
Level Of Evidence ◽  
Rater Reliability ◽  
Ankle Surgery ◽  
Essex Lopresti ◽  
Böhler’S Angle

Objective: To evaluate the inter-rater reliability and intra-class correlation coefficients (ICC) of Böhler’s angle and the critical angle of Gissane in calcaneal fractures, stratified by severity and by the Essex-Lopresti and Sanders classifications. Methods: Retrospective study of radiographs obtained from 97 patients: 67 with calcaneal fractures and 30 with normal lateral radiographs (used as a control group). Böhler’s angle and the angle of Gissane were measured by six raters: two orthopedic surgery residents, two musculoskeletal radiologists, a foot and ankle surgery fellow, and a senior consultant in foot surgery. Statistical analysis of inter-rater reliability was performed for the two angles, in the sample overall and stratified by the different radiographic and CT subtypes of calcaneal fractures. Results: For the angle of Gissane, the ICC was at best 0.400 (95% CI: 0.250 to 0.581) for normal radiographs, with poor agreement across all classifications and severity stratifications. For Böhler’s angle, the ICC values indicated weak to moderate agreement, with the best reproducibility obtained for the overall sample (0.740; 95% CI: 0.673 to 0.801). In Sanders type 1 fractures, the ICC was 0.704 (95% CI: 0.397 to 0.940), and in Sanders type 2 fractures, 0.762 (95% CI: 0.634 to 0.870). Conclusion: Böhler’s angle is more reproducible than the critical angle of Gissane, with greater inter-rater reliability among fractures deemed less severe on the Sanders classification, although the overall ICC ranged from weak to moderate at best. Level of Evidence III; Case Control Study; Diagnostic Studies.

Intra-articular Hematoma Block Compared to Procedural Sedation for Closed Reduction of Ankle Fractures

2018 ◽  
Vol 39 (10) ◽  
pp. 1162-1168 ◽  
Author(s):  
Lauren M. MacCormick ◽  
Taurean Baynard ◽  
Benjamin R. Williams ◽  
Sandy Vang ◽  
Min Xi ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Ankle Fracture ◽  
Retrospective Chart Review ◽  
Ankle Fractures ◽  
Fracture Dislocation ◽  
Procedural Sedation ◽  
Secondary Outcome ◽  
Level Of Evidence ◽  
Level I ◽  
Successful Reduction

Background: Initial treatment for a displaced ankle fracture is closed reduction and splinting. This is typically performed in conjunction with either an intra-articular hematoma block (IAHB) or procedural sedation (PS) to assist with pain control. The purpose of this study was to compare the safety of IAHB to PS and evaluate the efficiency and efficacy for each method. Methods: A retrospective chart review for ankle fractures requiring manipulation was performed for patients seen in a level I trauma center from 2005 to 2016. The primary outcome was rate of successful reduction. Several secondary outcome measures were defined: reduction attempts, time until successful reduction, time spent in the emergency department (ED), rate of hospital admission, and adverse events. The analysis included 221 patients who received IAHB and 114 patients who received PS. Results: The demographics between the 2 groups were similar, with the exception that more patients with a dislocation received PS, which prompted a subgroup analysis. This analysis demonstrated that patients with an ankle fracture and associated tibiotalar joint subluxation underwent closed reduction in a shorter period of time with the use of an IAHB compared with those receiving PS. In patients sustaining a tibiotalar fracture dislocation, patients receiving PS were successfully reduced with 1 reduction attempt more frequently than those receiving IAHB. Orthopedic surgeons also had higher rates of success on first attempt compared with ED providers. Conclusion: Both IAHB and PS were excellent options for analgesia that resulted in high rates of successful closed reduction of ankle fractures with adequate safety. IAHB can be considered a first-line agent for patients with an ankle fracture and associated joint subluxation. Level of Evidence: Level III, retrospective comparative series.

Complications Associated with Open Calcaneus Fractures

2011 ◽  
Vol 32 (11) ◽  
pp. 1052-1057 ◽  
Author(s):  
Brent Wiersema ◽  
David Brokaw ◽  
Timothy Weber ◽  
Telly Psaradellis ◽  
Carlo Panero ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Wound Infection ◽  
Complication Rate ◽  
Level Of Evidence ◽  
Fracture Stabilization ◽  
Superficial Wound ◽  
Lower Complication ◽  
Level I ◽  
Retrospective Comparative Study ◽  
Calcaneus Fractures

Background: Literature on open calcaneus fractures is limited and inconsistent. This study's purpose was to report complications such as osteomyelitis, amputations, and soft tissue infections in open calcaneus fractures that were treated at a Level I Trauma Center. Methods: From January 1995 through December 2007, 1,157 calcaneus fractures were identified with 127 fractures being open (11.0%). Average followup time was 9.1 (range, 2 to 53) months. All open fractures were treated by a similar protocol of intravenous (IV) antibiotics, emergent irrigation and debridement (I&D), initial fracture stabilization if possible, subsequent I&Ds as needed, and delayed definitive fixation. One hundred fifteen open calcaneus fractures in 112 patients had sufficient followup for study inclusion. For this study complications were classified into four categories: superficial infections, deep infections, osteomyelitis, and amputations. Results: Medial based wounds occurred in 63 (54.8%) fractures. The overall complication rate was 23.5% with 16 fractures (13.9%) requiring a reoperation. Eleven (9.6%) fractures experienced superficial wound infection and 14 (12.2%) had deep wound infection. Six (5.2%) amputations were required with three being for either soft tissue infection or wound necrosis. Culture-positive osteomyelitis occurred in six (5.2%) patients. Conclusion: Utilizing a standardized protocol, open calcaneus fractures were found to have a lower complication rate than has been previously reported. Level of Evidence: III, Retrospective Comparative Study

scholarly journals Patient-Reported Outcomes and Early Complications After Synthetic Cartilage Device Implantation

2020 ◽  
Vol 5 (3) ◽  
pp. 247301142093069
Author(s):  
William M. Engasser ◽  
J. Chris Coetzee ◽  
Patrick B. Ebeling ◽  
Bryan D. Den Hartog ◽  
Jeffrey D. Seybold ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Hallux Rigidus ◽  
Early Complications ◽  
Level Of Evidence ◽  
Device Implantation ◽  
Patient Reported ◽  
Level I

Background: Previous Level I studies show promising results for the use of a hydrogel synthetic cartilage implant (SCI) for the treatment of hallux rigidus. A recent independent retrospective review has put those results into question, however. The purpose of this article is to report patient-reported outcomes and early complications using this implant so as to add to the paucity of data in the literature regarding this implant. Methods: This was a retrospective chart review of patients undergoing hydrogel synthetic cartilage implant for the treatment of hallux rigidus from July 2017 to November 2018. Data collected included patient demographics, radiographic grading, and outcomes: Veterans Rand 12 Item Health Survey (VR-12), Foot and Ankle Ability Measure (FAAM), visual analog scale (VAS), patient satisfaction, and complications. Fifty-four patients (59 feet) with an average age of 57.6 (range, 39-78) years were analyzed. The average latest follow-up was 18.9 (range, 3-31.3) months. Body mass index was 26.7 (range, 18.7-35.2). None were diabetic and 5 were smokers. Results: The mean outcome improvements were 6.5 points (VR-12 Physical), 17.2 points (FAAM ADL), 27.4 points (FAAM Sport), and 18.4 points (VAS) ( P < .01 for each). Scores were significantly improved from preoperatively to most recent follow-up for FAAM ADL (71.0 vs 88.2 points), FAAM Sports (44.6 vs 72.0 points), and VAS (49.4 vs 31.0) ( P < .01). Overall, 72.5% patients would definitely or probably have the operation again. Ten patients (18.5%) went on to have revision surgery. Of these, 7 patients were revised to an arthrodesis, and 1 metal hemiarthroplasty and 2 implants were removed because of infection. Conclusion: Synthetic cartilage implantation for the treatment of hallux rigidus demonstrated improved pain and outcome scores at short-term follow-up. Reoperation and conversion to fusion rates were comparable to prior studies. Level of Evidence: Level IV, case series.

An Overview of Amish Mortalities at a Level I Trauma Center

2021 ◽  
pp. 000313482110472
Author(s):  
Madison E. Morgan ◽  
Catherine Ting Brown ◽  
Larissa Whitney ◽  
Kelly Bonneville ◽  
Lindsey L. Perea
Keyword(s):  
Trauma Center ◽  
Chart Review ◽  
Trauma Registry ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Trauma Patients ◽  
Injury Patterns ◽  
Level Of Evidence ◽  
Trauma Mortality ◽  
Level I

Background The Amish population is a unique subset of patients that may require a specialized approach due to their lifestyle differences compared to the general population. With this reasoning, Amish mortalities may differ from typical trauma mortality patterns. We sought to provide an overview of Amish mortalities and hypothesized that there would be differences in injury patterns between mortalities and survivors. Methods All Amish trauma patients who presented and were captured by the trauma registry at our Level I trauma center over 20 years (1/2000-2004/2020) were analyzed. A retrospective chart review was subsequently performed. Patients who died were of interest to this study. Demographic and clinical variables were analyzed for the mortalities. Mortalities were then compared to Amish patients who survived. Results There were 1827 Amish trauma patients during the study period and, of these, 32 (1.75%) were mortalities. The top 3 mechanisms of injury leading to mortality were falls (34.4%), pedestrian struck (21.9%), and farming accidents (15.6%). Pediatric (age ≤ 14y) (25%) and geriatric (age ≥ 65y) (28.1%) had the highest percentage of mortalities. Mortalities in the Amish population were significantly older (mean age: 39 years vs 27 years, P = .003) and had significantly higher ISS (mean ISS: 29 vs 10, P < .001) compared to Amish patients who survived. Discussion The majority of mortalities occurred in the pediatric and geriatric age groups and were falls. Further intervention and outreach in the Amish population should be done to highlight this particular cause of mortality. Level of Evidence Level III, epidemiological.

Extensile Decompression of the Proximal and Distal Tarsal Tunnel Combined With Partial Plantar Fascia Release in the Treatment of Chronic Plantar Heel Pain

2013 ◽  
Vol 6 (1) ◽  
pp. 27-35 ◽  
Author(s):  
William R. Mook ◽  
Tenaja Gay ◽  
Selene G. Parekh
Keyword(s):  
Case Series ◽  
Retrospective Chart Review ◽  
Plantar Fascia ◽  
Heel Pain ◽  
Wound Complications ◽  
Tarsal Tunnel ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Residual Symptoms ◽  
The Mean

Background. Chronic heel pain that is recalcitrant to nonoperative measures is a rare but disabling condition. There are no reports in the literature of extensile proximal and distal tarsal tunnel release combined with partial plantar fasciotomy in the treatment of chronic heel pain. We present our results. Methods. A retrospective chart review was conducted, and charts were assessed for details of their presenting complaints, physical exam, diagnostic studies, medical history, Visual Analog Scale (VAS) scores for pain, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores, and complications. Results. The mean AOFAS ankle-hindfoot score was 86 ± 12.9 (range = 69-100). Of 15 heels, 10 (67%) had an excellent or good rating at the time of the last follow-up visit. One of 15 (7%) reported a poor outcome. The mean VAS pain score changed from 6.3 ± 3.1 to 1.4 ± 1.8 (P = .001). There were no wound complications or infections. Conclusion. This technique offers another operative option for chronic heel pain that is associated with satisfactory outcomes and rest pain relief. Despite reducing pain at rest in all patients, the majority of patients may be left with mild to moderate residual symptoms with activity that is similar to the outcomes of previously reported procedures. Level of Evidence: Therapeutic, Level IV, Retrospective case series

scholarly journals Are the First and Second Hip in Staged Bilateral Total Hip Arthroplasty Equal? A Hospital Adverse Event and Perioperative Risk Comparison

2021 ◽  
Author(s):  
Jesus M. Villa ◽  
Tejbir S. Pannu ◽  
Carlos A. Higuera ◽  
Juan C. Suarez ◽  
Preetesh D. Patel ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Adverse Events ◽  
Hip Arthroplasty ◽  
Retrospective Chart Review ◽  
Consecutive Series ◽  
Level Of Evidence ◽  
Exact Test ◽  
Total Hip ◽  
Discharge Disposition ◽  
The Mean

AbstractHospital adverse events remain a significant issue; even “minor events” may lead to increased costs. However, to the best of our knowledge, no previous investigation has compared perioperative events between the first and second hip in staged bilateral total hip arthroplasty (THA). In the current study, we perform such a comparison. A retrospective chart review was performed on a consecutive series of 172 patients (344 hips) who underwent staged bilateral THAs performed by two surgeons at a single institution (2010–2016). Based on chronological order of the staged arthroplasties, two groups were set apart: first-staged THA and second-staged THA. Baseline-demographics, length of stay (LOS), discharge disposition, hospital adverse events, and hospital transfusions were compared between groups. Statistical analyses were performed using independent t-tests, Fisher's exact test, and/or Pearson's chi-squared test. The mean time between staged surgeries was 465 days. There were no significant differences in baseline demographics between first-staged THA and second-staged THA groups (patients were their own controls). The mean LOS was significantly longer in the first-staged THA group than in the second (2.2 vs. 1.8 days; p < 0.001). Discharge (proportion) to a facility other than home was noticeably higher in the first-staged THA group, although not statistically significant (11.0 vs. 7.6%; p = 0.354). The rate of hospital adverse events in the first-staged THA group was almost twice that of the second (37.2 vs. 20.3%; p = 0.001). There were no significant differences in transfusion rates. However, these were consistently better in the second-staged THA group. When compared with the first THA, our findings suggest overall shorter LOS and fewer hospital adverse events following the second. Level of Evidence Level III.

scholarly journals Breast softness in patients randomised to postmastectomy breast reconstruction with an expander prosthesis or DIEP flap

2021 ◽  
Author(s):  
Linda Tallroth ◽  
Håkan Brorson ◽  
Nathalie Mobargha ◽  
Patrik Velander ◽  
Stina Klasson ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Subjective Evaluation ◽  
Objective Evaluation ◽  
Applanation Tonometry ◽  
Diep Flap ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Delayed Breast Reconstruction ◽  
Level I ◽  
Therapeutic Study

Abstract Background Objectively measured breast softness in reconstructed breasts and its relation to patients’ subjective satisfaction with breast softness has not yet been investigated. The aim of this study was to evaluate breast softness in patients 1 year following delayed breast reconstruction with an expander prosthesis (EP) or deep inferior epigastric perforator (DIEP) flap, using objective and subjective methods. Methods Seventy-three patients were randomised to breast reconstruction with an EP or DIEP flap between 2012 and 2018. Of these, 69 completed objective evaluation at a mean of 25 (standard deviation, SD 9.4) months following breast reconstruction. Objective evaluation included measurements of breast volume, jugulum-nipple distance, clavicular-submammary fold distance, ptosis and Baker scale grading. Breast softness was assessed with applanation tonometry. Subjective evaluation was performed using the BREAST-Q questionnaire. Results Objectively, DIEP flaps were significantly softer than EP breast reconstructions. Non-operated contralateral breasts were significantly softer compared with reconstructed breasts. In the subjective evaluation, the median score on the question (labelled 1.h) “How satisfied or dissatisfied have you been with the softness of your reconstructed breast (s)?” was higher in the DIEP flap group corresponding to greater satisfaction in this group. A fair correlation was found between the applanation tonometry and the patient-reported satisfaction with the reconstructed breast’s softness (rs = 0.37). Conclusions In terms of breast softness, breast reconstructions with DIEP flaps result in more satisfied patients. Concerning applanation tonometry as an objective tool for softness assessment, future studies on interobserver agreement are warranted. Level of evidence: Level I, therapeutic study

Evaluation of Cost-effectiveness and Clinical Value of Routine Histopathologic Examination of Septoplasty Specimens

2021 ◽  
pp. 019459982110129
Author(s):  
Randall S. Ruffner ◽  
Jessica W. Scordino
Keyword(s):  
Chart Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Clinical Value ◽  
Level Of Evidence ◽  
Significant Pathology ◽  
National Model ◽  
Routine Histopathologic Examination

Objectives During septoplasty, normal cartilage and bone are often sent for pathologic examination despite benign appearance. We explored pathology results following septoplasty from April 2016 to April 2018, examining clinical value and relevance, implications, and cost analysis. Study Design Retrospective chart review. Setting Single-institution academic medical center. Methods A retrospective chart review was compiled by using Current Procedural Terminology code 30520 for septoplasty for indication of nasal obstruction, deviated septum, and nasal deformity. Results A total of 236 consecutive cases were identified spanning a 2-year period. Septoplasty specimens were sent for pathology evaluation in 76 (31%). The decision to send a specimen for histopathology was largely physician dependent. No cases yielded unexpected or significant pathology that changed management. The average total charges for septoplasty were $10,200 at our institution, with 2.2% of procedural charges accounting for pathology preparation and review, averaging $225. Nationally, this results in an estimated charged cost of $58.5 million. The Centers for Medicare and Medicaid Services (CMS) reimbursement for septoplasty pathology charges was $46 in 2018, accounting for 1.3% of hospital-based reimbursements and 2.2% of ambulatory center reimbursements. With CMS as a national model for reimbursement, $11.8 million is spent yearly for septoplasty histopathology. Given that CMS reimbursement is significantly lower than private insurers, national total reimbursement is likely considerably higher. Conclusion Routine pathology review of routine septoplasty specimens is unnecessary, unremarkable, and wasteful. Correlation of the patient’s presentation and intraoperative findings should justify the need for pathology evaluation. This value-based approach can offer significant direct and indirect cost savings. Level of evidence 4.

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