An Assessment of Normal Tibiofibular Anatomy on Lateral Fluoroscopy

2020 ◽  
Vol 41 (7) ◽  
pp. 866-869 ◽  
Author(s):  
Charles Cogan ◽  
Tiffany Liu ◽  
Paul Toogood
Keyword(s):  
Fracture Fixation ◽  
Ankle Fracture ◽  
Anatomic Variation ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Contralateral Side ◽  
Lateral View ◽  
Posterior Border ◽  
Level Of Evidence ◽  
Tibial Plafond

Background: Intraoperative identification of syndesmotic malreduction during ankle fracture fixation can be challenging. Prior studies describe the normal tibiofibular relationship on anteroposterior and mortise views to aid assessment, but the normal anatomic variation on the lateral view has not been well defined. The aim of this study was to describe the normal anatomy of the lateral radiographic view of the ankle, focusing on the relative position of the fibula and tibial plafond. Methods: We retrospectively identified consecutive adults undergoing ankle fracture open reduction internal fixation in 2011-2018. Two independent observers assessed the tibiofibular relationship on perfect lateral images of the uninjured side. Measurements were made in pixels, converted into millimeters using published parameters, and averaged for analysis. Reliability was calculated using Pearson correlation coefficients. Results: Of 751 cases of adult ankle fracture fixation identified, 50 patients had perfect lateral images of the contralateral side. In 11 patients (22%), the posterior border of the fibula intersected precisely at the posterior edge of the tibial plafond. Ten patients (20%) had anterior intersections, whereas 29 (58%) had posterior intersections. The intersection was within ±2 mm of the plafond edge in 27 patients (54%). Intrarater reliability was 0.86 and 0.93. Interrater reliability was 0.88. Conclusion: In most ankles, the posterior border of the fibula intersects the posterior extent of the tibial plafond within 2 mm. If more than 2 mm away, one should query malreduction, especially if anterior. This method of intraoperative assessment may decrease the occurrence of syndesmotic malreduction. Level of Evidence: Level III, comparative series.

Variability in the Reporting Terminology of Adverse Events and Complications in Ankle Fracture Fixation: A Systematic Review

2019 ◽  
Vol 41 (2) ◽  
pp. 170-176
Author(s):  
Stefan A. St George ◽  
Hooman Sadr ◽  
Chayanin Angthong ◽  
Murray Penner ◽  
Peter Salat ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Fracture Fixation ◽  
Ankle Fracture ◽  
Soft Tissue Injuries ◽  
Classification Systems ◽  
Level Of Evidence ◽  
Implant Complications ◽  
Frequency Of Use ◽  
Standardized Reporting

Background: Classification systems for the reporting of surgical complications have been developed and adapted for many surgical subspecialties. The purpose of this systematic review was to examine the variability and frequency of reporting terms used to describe adverse events and complications in ankle fracture fixation. We hypothesized that the terminology used would be highly variable and inconsistent, corroborating previous results that have suggested a need for standardized reporting terminology in orthopedics. Methods: Ankle fracture outcome studies meeting predetermined inclusion and exclusion criteria were selected for analysis by 2 independent observers. Terms used to define adverse events and complications were identified and recorded. Discrepancies were resolved by consensus with the aid of a third observer. All terms were then compiled and assessed for variability and frequency of use throughout the studies involved. Reporting terminology was subsequently grouped into 10 categories. Results: In the 48 studies analyzed, 301 distinct terms were utilized to describe complications or adverse events. Of these terms, 74.4% (224/301) were found in a single study each. Only 1 term, “infection,” was present in 50% of studies, and only 19 of 301 terms (6.3%) were used in at least 10% of papers. The category that was most frequently reported was “infection,” with 89.6% of studies reporting on this type of adverse event using 25 distinct terms. Other categories were “wound healing complications” (72.9% of papers, 38 terms), “bone/joint complications” (66.7% of papers, 35 terms), “hardware/implant complications” (56.3% of papers, 47 terms), “revision” (56.3% of papers, 35 terms), “cartilage/soft tissue injuries” (45.8% of papers, 31 terms), “reduction/alignment issues” (45.8% of papers, 29 terms), “medical complications” (43.8% of papers, 32 terms), “pain” (29.2% of papers, 16 terms), and “other complications” (20.8% of papers, 13 terms). There was a 78.6% interobserver agreement in the identification of terms across the 48 studies included. Conclusion: The reporting terminology utilized to describe complications and adverse events in ankle fracture fixation was found to be highly variable and inconsistent. This variability prevents accurate reporting of complications and adverse events and makes the analysis of potential outcomes difficult. The development of standardized reporting terminology in orthopedics would be instrumental in addressing these challenges and allow for more accurate and consistent outcome reporting. Level of Evidence: Level III; systematic review of Level III studies and above.

Midterm Functional Outcome of the Linked Semiconstrained Distal Radioulnar Joint Prosthesis

2021 ◽  
Author(s):  
Jaak Warlop ◽  
Maarten Van Nuffel ◽  
Luc De Smet ◽  
Ilse Degreef
Keyword(s):  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Visual Analog Scale Score ◽  
Distal Radioulnar Joint ◽  
Pinch Strength ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
Therapeutic Study ◽  
And Function

Abstract Background A painful unstable distal radioulnar joint (DRUJ) can seriously compromise hand and wrist function. The semiconstrained prosthesis was developed to restore DRUJ function. To date, most outcome reports are coauthored by the designer. Questions Does independent reporting confirm the promising results of the semiconstrained DRUJ prosthesis? Are complication and failure rates acceptable? Patients and Methods We evaluated patients with the semiconstrained DRUJ implant and a minimum follow-up of 2 years. We monitored patient satisfaction and function with functionality questionnaires and measured wrist range of motion, grip, and key pinch strength. Statistical analysis was done using descriptive statistics, Pearson correlation coefficients, linear and logistic regression. Results We included 41 patients with 42 implants. Mean follow-up was 46 months (range: 24–102 months). Eighty percent of wrist had undergone previous surgery. We found a mean pronation of 83 degrees (0–90 degrees), supination of 70 degrees (0–90 degrees), flexion of 42 degrees (0–90 degrees), extension of 49 degrees (0–90 degrees), ulnar deviation of 24 degrees (0–60 degrees), and radial deviation of 14 degrees (0–40 degrees). Grip and key pinch strength were 20.1 (1–50 kg) and 6 kg (1–12 kg), respectively. Average patient-rated wrist and hand evaluation score was 42.7 (0–95), disabilities of the arm, shoulder and hand score was 38 (0–88), and visual analog scale score was 3.6 (0–8). We found a 43% complication rate (mostly minor: ulnar or radial tendinopathy, temporary hypoesthesia) with 24% reoperation and 92% prosthesis survival rate. Conclusion The linked semiconstrained DRUJ prosthesis has its value in the surgical treatment of DRUJ failure. Currently, most implants are used in secondary surgery and multioperated wrists. More research is required to assess the value of the DRUJ prosthesis as a primary procedure. Level of evidence This is a level IV, therapeutic study.

Patient Outcomes Following Ankle Fracture Fixation

2021 ◽  
pp. 107110072110030
Author(s):  
Han Hong Chong ◽  
Melinda Y.T. Hau ◽  
Pranav Mishra ◽  
Paul Rai ◽  
Jitendra Mangwani
Keyword(s):  
Functional Outcome ◽  
Predictive Factors ◽  
Fracture Fixation ◽  
Functional Outcomes ◽  
Ankle Fracture ◽  
Negative Impact ◽  
P Value ◽  
Patient Counseling ◽  
Level Of Evidence ◽  
Patient Reported

Background: Several studies have reported on potential negative predictive factors of functional outcomes after ankle fracture fixation. However, there is minimal patient-reported data on long-term outcomes. This study aimed to evaluate potential risk factors leading to a poor patient-reported functional outcome at 2 and 5 years following ankle fracture fixation. Methods: We conducted a prospective cohort study over a 5-year period on patients undergoing open reduction and internal fixation for unstable ankle fractures. Patient demographics, medical comorbidities, fracture pattern, and fixation quality were recorded and analyzed. Patients were followed up at 2 and 5 years. Data collected include the Olerud-Molander Ankle Score (OMAS), Lower Extremity Functional Scale (LEFS), ongoing issues, and the need for further intervention. A P value <.05 was considered statistically significant. Results: Out of 180 patients, follow-up data were available for 82 (46%) patients at 2 years and 94 (52%) patients at 5 years. At 2 years, age ≥60 years was a predictor of worse LEFS, while a body mass index ≥30 was a predictor of worse OMAS. Severely deformed ankle at presentation showed worse OMAS and LEFS score. However, these predictive factors were not significant at 5 years. An anatomically reduced ankle fracture fixation was more likely to have a better functional outcome at the 2- and 5-year follow-ups. A reduction in OMAS at 2 years was predictive of possible ongoing issues following surgery, which in turn increased the odds of worsening OMAS at 5 years. Conclusion: Achieving adequate fracture reduction during fixation is crucial for better ankle functional recovery postinjury. In this cohort, we found that patients who undergo ankle fracture fixation will have an ongoing negative impact on their functional and physical capacity at both 2 and 5 years postoperatively. Appropriate patient counseling is necessary to prepare them for the expected functional outcomes. Level of Evidence: Level II, prognostic.

The Youth Throwing Score: Validating Injury Assessment in Young Baseball Players

2016 ◽  
Vol 45 (2) ◽  
pp. 317-324 ◽  
Author(s):  
Christopher S. Ahmad ◽  
Ajay S. Padaki ◽  
Manish S. Noticewala ◽  
Eric C. Makhni ◽  
Charles A. Popkin
Keyword(s):  
Upper Extremity ◽  
Assessment Tool ◽  
Pearson Correlation ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Importance Rating ◽  
Extremity Injury ◽  
Level Of Evidence ◽  
Baseball Players ◽  
Upper Extremity Injury

Background: Epidemic levels of shoulder and elbow injuries have been reported recently in youth and adolescent baseball players. Despite the concerning frequency of these injuries, no instrument has been validated to assess upper extremity injury in this patient population. Purpose/Hypothesis: The purpose of this study was to validate an upper extremity assessment tool specifically designed for young baseball players. We hypothesized that this tool will be both reliable and valid. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The Youth Throwing Score (YTS) was constructed by an interdisciplinary team of providers and coaches as a tool to assess upper extremity injury in youth and adolescent baseball players (age range, 10-18 years). The psychometric properties of the test were then determined. Results: A total of 223 players completed the final survey. The players’ mean age was 14.3 ± 2.7 years. Pilot analysis showed that none of the 14 questions received a mean athlete importance rating less than 3 of 5, and the final survey read at a Flesch-Kincaid level of 4.1, which is appropriate for patients aged 9 years and older. The players self-assigned their injury status, resulting in a mean instrument score of 59.7 ± 8.4 for the 148 players “playing without pain,” 42.0 ± 11.5 for the 60 players “playing with pain,” and 40.4 ± 10.5 for the 15 players “not playing due to pain.” Players playing without pain scored significantly higher than those playing with pain and those not playing due to pain ( P < .001). Psychometric analysis showed a test-retest intraclass correlation coefficient of 0.90 and a Cronbach alpha intra-item reliability coefficient of 0.93, indicating excellent reliability and internal consistency. Pearson correlation coefficients of 0.65, 0.62, and 0.31 were calculated between the YTS and the Pediatric Outcomes Data Collection Instrument sports/physical functioning module, the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow score, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, respectively. Injured players scored a mean of 9.4 points higher after treatment ( P < .001), and players who improved in their self-assigned pain categorization scored 16.5 points higher ( P < .001). Conclusion: The YTS is the first valid and reliable instrument for assessing young baseball players’ upper extremity health.

scholarly journals A Comparison of Patients from Argentina and Germany to Assess Factors Impacting Brachial Plexus and Brain Injury

2019 ◽  
Vol 14 (01) ◽  
pp. e39-e46
Author(s):  
Mariano Socolovsky ◽  
Gregor Antoniadis ◽  
Ana Lovaglio ◽  
Gregor Durner ◽  
Gonzalo Bonilla ◽  
...  
Keyword(s):  
Brain Injury ◽  
Brachial Plexus ◽  
Brain Injuries ◽  
Injury Severity ◽  
Pearson Correlation ◽  
Young Patients ◽  
Correlation Coefficients ◽  
Case Control Studies ◽  
Level Of Evidence ◽  
Two Populations

Background Traumatic brachial plexus injuries (BPIs) represent a major cause of disability in young patients. The purpose of this study was to compare two populations (from Argentina and Germany) who suffered a traumatic BPI after a motorcycle accident to identify predictors of BPI and brain injury severity. Methods Univariate and multivariable intergroup comparisons were conducted, and odds ratios were calculated to assess the associations between the different demographic, morphometric, and trauma-related variables, and the type and severity of patients' injuries. Pearson correlation coefficients were generated to identify statistically significant correlations. Results A total of 187 patients were analyzed, 139 from Argentina and 48 from Germany. The two countries differed significantly in age and several morphometric and trauma-related variables. The clinical presentation was also convincingly different in the two countries. The following three variables remained as statistically significant predictors of a complete (vs. partial) BPI: living in Argentina (p < 0.001), presenting prior to 2015 (p = 0.004), and greater estimated speed at the time of impact (p = 0.074). As for BPIs, a disproportionate percentage (85.6%) of more severe brain injuries occurred in Argentinian patients (p < 0.001) and among those whose accident involved striking a stationary vertical object. Conclusions This study identified several factors that might be considered when planning governmental policies and education initiatives to reduce BPI and brain injuries related to motorcycle use. Level of evidence II-2 (evidence obtained from case–control studies).

scholarly journals Interobserver reliability of Diméglio and Pirani score and their subcomponents in the evaluation of idiopathic clubfoot in a clinical setting: a need for improved scoring systems

2019 ◽  
Vol 13 (5) ◽  
pp. 478-485
Author(s):  
C. Bettuzzi ◽  
C. N. Abati ◽  
G. Salvatori ◽  
A. Zanardi ◽  
M. Lampasi
Keyword(s):  
Clinical Setting ◽  
Interobserver Reliability ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Scoring Systems ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Level Of Evidence ◽  
Prevalence Index ◽  
Level I

Purpose Diméglio (DimS) and Pirani (PirS) scores are the most commonly used scoring systems for evaluation of clubfoot, with many centres performing both. Interobserver reliability of their global score has been rated high in a few studies, but agreement of their subcomponents has been poorly investigated. The aim of the study was to assess interrater reliability of global scores and of items in a clinical setting and to analyse overlapping features of the two scores. Methods Fifty-six consecutive idiopathic clubfeet undergoing correction using the Ponseti method were independently evaluated at each casting session by two trained paediatric orthopaedic surgeons using both scores. Interobserver reliability of collected data was analysed; a kappa coefficient > 0.60 was considered adequate. Results For DimS and PirS, the Pearson correlation coefficients were 0.87 and 0.91 (p < .0001) respectively, and kappa coefficients were 0.23 and 0.31. Among subcomponents, kappa values were rated > 0.60 only for equinus and curvature of lateral border in PirS; muscular abnormality in DimS was rated 0.74 but a high prevalence index (0.94) indicated influence of scarce prevalence of this feature. All other items showed k < 0.60 and were considered to be improved. For overlapping features: posterior and medial crease showed similar agreement in the two systems, items describing equinus and midfoot adduction were much more reliable in PirS than in DimS. Conclusions In a clinical setting, despite a high correlation of evaluations for total scores, the interobserver agreement of DimS and PirS was not adequate and only a few items were substantially reliable. Simultaneous use of two scores seemed redundant and some overlapping features showed different reliability according to criterion or scale used. Future scoring systems should improve these limitations. Level of Evidence Level I – Diagnostic studies

scholarly journals Minimally invasive technique for suprasyndesmotic ankle fracture fixation

2020 ◽  
Vol 14 (3) ◽  
pp. 274-277
Author(s):  
Renê Hobi ◽  
Rodolfo Galera ◽  
José Campos Filho ◽  
Leonardo Mugnol
Keyword(s):  
Minimally Invasive ◽  
Fracture Fixation ◽  
Ankle Fracture ◽  
Plantar Flexion ◽  
Case Series ◽  
Minimally Invasive Technique ◽  
Invasive Technique ◽  
Level Of Evidence ◽  
Osteosynthesis Material ◽  
The Mean

Objective: To evaluate the clinical and radiographic results of suprasyndesmotic ankle fracture fixation with a minimally invasive technique. Methods: Retrospective study of 11 patients with suprasyndesmotic fractures of the lateral malleolus who underwent surgery between 2016 and 2018. Retrospective analysis of medical records considered the following: radiographic assessments (preoperative, immediate postoperative, six weeks postoperative), clinical evaluation, and strength scale and movement test results. Results: Of the 18 patients qualified for inclusion, 7 failed to appear at the follow-up appointment and were excluded. The patients’ age varied from 20 to 53 years, and 72.7% were male. The trauma mechanisms included torsion (46% of the cases), automobile accidents (36.4%) and direct trauma (17.6%). The mean time between trauma and definitive surgery was 3.27 days. The mean talocrural angle in the preoperative period was 83.13º, ranging from 80.63º in the immediate postoperative period to 81.27º at 6 months postoperatively. Approximately 90% of the patients did not lose strength. Regarding the range of motion, the mean dorsiflexion and plantar flexion 6 months postoperatively were 10.72º and 34.4º, respectively. Conclusion: The minimally invasive technique had excellent technical results in patients treated surgically for ankle fractures and required smaller incisions than conventional surgery. Osteolysis or fatigue of the osteosynthesis material is a possibility with this technique, which generally occurred between three and four months postoperatively. Level of Evidence IV; Therapeutic Studies; Case series.

Reliability of the Minimum Masking Level as Outcome Variable in Tinnitus Clinical Research

2020 ◽  
Vol 29 (3) ◽  
pp. 429-435
Author(s):  
Patricia C. Mancini ◽  
Richard S. Tyler ◽  
Hyung Jin Jun ◽  
Tang-Chuan Wang ◽  
Helena Ji ◽  
...  
Keyword(s):  
Standard Deviation ◽  
High Frequency ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Outcome Variable ◽  
Reliable Estimate ◽  
Moderate Correlation ◽  
Trained Subjects ◽  
The Relationship ◽  
Minimum Intensity

Purpose The minimum masking level (MML) is the minimum intensity of a stimulus required to just totally mask the tinnitus. Treatments aimed at reducing the tinnitus itself should attempt to measure the magnitude of the tinnitus. The objective of this study was to evaluate the reliability of the MML. Method Sample consisted of 59 tinnitus patients who reported stable tinnitus. We obtained MML measures on two visits, separated by about 2–3 weeks. We used two noise types: speech-shaped noise and high-frequency emphasis noise. We also investigated the relationship between the MML and tinnitus loudness estimates and the Tinnitus Handicap Questionnaire (THQ). Results There were differences across the different noise types. The within-session standard deviation averaged across subjects varied between 1.3 and 1.8 dB. Across the two sessions, the Pearson correlation coefficients, range was r = .84. There was a weak relationship between the dB SL MML and loudness, and between the MML and the THQ. A moderate correlation ( r = .44) was found between the THQ and loudness estimates. Conclusions We conclude that the dB SL MML can be a reliable estimate of tinnitus magnitude, with expected standard deviations in trained subjects of about 1.5 dB. It appears that the dB SL MML and loudness estimates are not closely related.

Comparative Responses to Squats Completed with Free Weights and an Exoskeleton

2020 ◽  
Vol 4 (1) ◽  
pp. 51-63
Author(s):  
Peter Neuhaus ◽  
Chris Jumonville ◽  
Rachel A. Perry ◽  
Roman Edwards ◽  
Jake L. Martin ◽  
...  
Keyword(s):  
Data Collection ◽  
Female Athletes ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Actual Data ◽  
Limited Data ◽  
Comparative Similarity ◽  
Insufficient Amount ◽  
Force Data ◽  
Familiarization Session

AbstractTo assess the comparative similarity of squat data collected as they wore a robotic exoskeleton, female athletes (n=14) did two exercise bouts spaced 14 days apart. Data from their exoskeleton workout was compared to a session they did with free weights. Each squat workout entailed a four-set, four-repetition paradigm with 60-second rest periods. Sets for each workout involved progressively heavier (22.5, 34, 45.5, 57 kg) loads. The same physiological, perceptual, and exercise performance dependent variables were measured and collected from both workouts. Per dependent variable, Pearson correlation coefficients, t-tests, and Cohen's d effect size compared the degree of similarity between values obtained from the exoskeleton and free weight workouts. Results show peak O2, heart rate, and peak force data produced the least variability. In contrast, far more inter-workout variability was noted for peak velocity, peak power, and electromyography (EMG) values. Overall, an insufficient amount of comparative similarity exists for data collected from both workouts. Due to the limited data similarity, the exoskeleton does not exhibit an acceptable degree of validity. Likely the cause for the limited similarity was due to the brief amount of familiarization subjects had to the exoskeleton prior to actual data collection. A familiarization session that accustomed subjects to squats done with the exoskeleton prior to actual data collection may have considerably improved the validity of data obtained from that device.

Leader-Member Exchange (LMX) Impact on Work-Home Interference in a South African Commuter Transport Engineering Company

2019 ◽  
Vol 43 ◽  
Author(s):  
Jan Christoff Visagie ◽  
Michael M. Jones ◽  
Herman L. Linde
Keyword(s):  
South African ◽  
Structural Equation ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Leader Member Exchange ◽  
Negative Consequences ◽  
Dyadic Relationship ◽  
Cross Sectional ◽  
Engineering Company ◽  
Member Exchange

The South African workplace is confronted with many leadership challenges, specifically those relating to the employment relationship between subordinates and their supervisors. A high-quality relationship is essential, considering the work-family spillovers employees experience. Limited research has been conducted on the potential positive and negative consequences of the leader-member exchange (LMX) dyadic relationship. In this study, we used a cross-sectional research design, and drew an employee sample (N = 120) from a commuter transport engineering company. A five-point Likert scale was employed and statistical analyses were carried out using the SAS statistical program. We calculated Pearson correlation coefficients and used structural equation modelling to test the proposed conceptual model to indicate possible correlations between the different variables. The main finding of the study was that the nature of the LMX relationship quality in the relevant company appeared to be high and positively related to work-home enrichment but negatively related to work-home conflict and role overload. The article concludes by making a number of suggestions to respond to challenges.

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