Missed Peritalar Injuries

Because of the complex anatomy of the foot, rarity of fractures of the foot, and subtle radiographic cues, foot injuries are commonly overlooked and mis/undiagnosed. This study seeks to investigate a patient population whose peritalar injuries, including fractures and dislocations, were missed on initial examination, in order to analyze factors of known, missed injuries and provide insight into methods for reducing the incidence of missed diagnoses. Surgical cases between January 1999 and May 2011 were queried and retrospectively reviewed to identify missed peritalar injuries. Of 1682 surgical cases reviewed, 27 patients with missed peritalar injury(ies), which were subsequently confirmed by imaging studies, were identified. Using the Orthopaedic Trauma Association classification, fracture and dislocation subtypes were classified. A medical record review was performed to assess demographic and surgical data elements. In this study population, 7 types of peritalar injuries (talus, calcaneal, navicular, and cuboid fractures as well as subtalar, calcaneocuboid, and talonavicular joint dislocations) were diagnosed in 27 patients. All patients required surgical intervention. Talus fractures were the most commonly missed injury. In patients with multiple peritalar injuries, there was a strong correlation between talus and navicular fractures (r = −0.60; P < .01) as well as a moderate correlation between talus fractures and calcaneocuboid dislocations (r = −0.46; P = .02). The presence of a calcaneal fracture significantly decreased the time to definitive diagnosis ( P = .01). Male patients’ diagnoses were delayed an average of 324 days and females 105 days ( P = .04). A moderate correlation was found between patient age at injury and time to diagnosis (r = −0.47; P = .04), with a decreased time to diagnosis as patient age increased. Significant factors were identified in this patient population, including patient sex and age, which may contribute to missed or delayed diagnosis in the clinical setting. Prompt and accurate diagnosis of peritalar injuries may improve long-term outcomes. Levels of Evidence: Care Management, Level V

Download Full-text

Impact of comorbidities and delay in diagnosis in elderly patients with pulmonary hypertension

ERJ Open Research ◽

10.1183/23120541.00100-2018 ◽

2018 ◽

Vol 4 (4) ◽

pp. 00100-2018 ◽

Cited By ~ 5

Author(s):

Marylise Ginoux ◽

Ségolène Turquier ◽

Nader Chebib ◽

Jean-Charles Glerant ◽

Julie Traclet ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Elderly Patients ◽

Age Groups ◽

Young Patients ◽

Age At Diagnosis ◽

Very Elderly ◽

Patient Age ◽

Delay In Diagnosis ◽

Patient Âgé ◽

Time To Diagnosis

Patient age at diagnosis of pulmonary hypertension is steadily increasing. The present study sought to analyse clinical characteristics, time to diagnosis and prognosis of pulmonary hypertension in elderly and very elderly patients.A study was conducted in a French regional referral centre for pulmonary hypertension. All consecutive patients diagnosed with pre-capillary pulmonary hypertension were included and categorised according to age: <65 years (“young”), 65–74 years (“elderly”) and ≥75 years (“very elderly”).Over a 4-year period, 248 patients were included: 101 (40.7%) were young, 82 (33.1%) were elderly and 65 (26.2%) were very elderly. The median age at diagnosis among the total population was 68 years. Compared with young patients, elderly and very elderly patients had a longer time to diagnosis (7±48, 9±21 and 16±32 months, respectively; p<0.001). Patients ≥75 years also more often had group 4 pulmonary hypertension. The median overall survival was 46±1.4 months, but was only 37±4.9 months in elderly patients and 28±4.7 months in very elderly patients. Survival from the first symptoms and survival adjusted to comorbidity was similar across age groups.Patient age should be taken into account when diagnosing pulmonary hypertension as it is associated with a specific clinical profile and a worse prognosis. The difference in prognosis is likely to be related to a delay in diagnosis and a greater number of comorbidities.

Download Full-text

COMPARISON OF RADIOFREQUENCY ABLATION AND CURETTAGE IN OSTEOID OSTEOMA IN CHILDREN

Acta Ortopédica Brasileira ◽

10.1590/1413-785220192702158113 ◽

2019 ◽

Vol 27 (2) ◽

pp. 100-103 ◽

Cited By ~ 1

Author(s):

Ferdi Göksel ◽

Ayşe Aycan ◽

Cenk Ermutlu ◽

Umut Hatay Gölge ◽

Bartu Sarısözen

Keyword(s):

Radiofrequency Ablation ◽

Hospital Stay ◽

Osteoid Osteoma ◽

Demographic Data ◽

Adolescent And Young Adult ◽

Open Approach ◽

Patient Age ◽

Patient Âgé ◽

Surgical Data

ABSTRACT Objective: Osteoid osteoma, which is observed in the adolescent and young adult population as benign bone tumors, appears as a single nidus with a diameter < 2 cm and is treated with open surgery. However, technological advances in medicine have made it possible to apply less invasive procedures in surgery. Methods: Between 2006–2014, 24 patients < 18 years of age were treated for osteoid osteoma. Patient demographic data, surgical data, complications, and recurrences were noted. Results: Twenty-four patients (mean age, 11 [2–18] years) were treated and followed up for a mean 3.58 (range, 1–9) years. Mean patient age in the curettage group was 12.1 (range, 3–18) years. Mean operation length was 69.5 (range, 60–120) minutes. Mean hospital stay was 1.3 (range, 0–2) days. Mean patient age in the radiofrequency ablation (RFA) group was 10.7 (range, 2–17) years. Five patients were female and 8 were male. Mean operation length was 49.6 (range, 20–90) minutes. Mean hospital stay was 0.3 (range, 0–1) days. Mean follow-up time was 1.76 (range, 1–4) years. Mean operation length, hospital stay, and follow-up were significantly shorter in the RFA group. Conclusions: Considering reduced costs due to shorter hospitalization periods and the ability to reach anatomically difficult locations, percutaneous procedures are likely to replace the conventional open approach. Level of evidence: II, retrospective study.

Download Full-text

Impact of Age on Consent in a Geriatric Orthopaedic Trauma Patient Population

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211003065 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110030

Author(s):

Madeline M. McGovern ◽

Michael F. McTague ◽

Erin Stevens ◽

Juan Carlos Nunez Medina ◽

Esteban Franco-Garcia ◽

...

Keyword(s):

Health Care ◽

Decision Making ◽

Trauma Patient ◽

Patient Population ◽

Geriatric Patients ◽

Proxy Consent ◽

Health Care Proxy ◽

Patient Age ◽

Patient Âgé ◽

Health Care Proxies

Introduction: Persistent misconceptions of frailty and dementia in geriatric patients impact physician-patient communication and leave patients vulnerable to disempowerment. Physicians may inappropriately focus the discussion of treatment options to health care proxies instead of patients. Our study explores the consenting process in a decision-making capable orthogeriatric trauma patient population to determine if there is a relationship between increased patient age and surgical consent by health care proxy. Methods: Patients aged 65 and older who underwent operative orthopaedic fracture fixation between 1 of 2 Level 1 Trauma Centers were retrospectively reviewed. Decision-making capable status was defined as an absence of patient history of cognitive impairment and a negative patient pre-surgical Confusion Assessment Method (CAM) and Mini-Cog Assessment screen. Provider of surgical consent was the main outcome and was determined by signature on the consent form. Results: 510 patients were included, and 276 (54.1%) patients were deemed capable of consent. In 27 (9.8%) of 276 decision-capable patients, physicians obtained consent from health care proxies. 20 of these 27 patients (74.1%) were 80 years of age or older. However, in patients aged 70 to 79, only 7 health care proxies provided consent. (p = 0.07). For every unit increase in age, the log odds of proxy consent increased by .0008 (p < 0.001). Age (p < 0.001), income level (p = 0.03), and physical presence of proxy at consult (p < 0.001) were factors associated with significantly increased utilization of health care proxy provided consent. Language other than English was a significant predictor of proxy-provided consent (p = 0.035). 48 (22%) decision-making incapable patients provided their own surgical consent. Discussion: The positive linear association between age and health care proxy provided consent in cognitively intact geriatric orthopaedic patients indicates that increased patient age impacts the consenting process. Increased physician vigilance and adoption of institutional consenting guidelines can reinforce appropriate respect of geriatric patients’ consenting capacity.

Download Full-text

Young Patient Age as the Cause of Delayed Diagnosis of Gastrointestinal Carcinoma

Polish Journal of Surgery ◽

10.2478/v10035-012-0053-9 ◽

2012 ◽

Vol 84 (6) ◽

Author(s):

Konrad Zaręba ◽

Roman Bandurski ◽

Bogusław Kędra

Keyword(s):

Young Patient ◽

Delayed Diagnosis ◽

Gastrointestinal Carcinoma ◽

Patient Age ◽

Patient Âgé

Download Full-text

Patient Age May Indicate Basal Cell Nevus Syndrome

Skin & Allergy News ◽

10.1016/s0037-6337(06)71526-1 ◽

2006 ◽

Vol 37 (9) ◽

pp. 39

Author(s):

Diana Mahoney

Keyword(s):

Basal Cell ◽

Patient Age ◽

Basal Cell Nevus Syndrome ◽

Patient Âgé

Download Full-text

Researchers examine the influence of hospital surgery volume, procedure type, and patient age on surgical risk

PsycEXTRA Dataset ◽

10.1037/e556652006-011 ◽

2002 ◽

Keyword(s):

Patient Age ◽

Surgical Risk ◽

Patient Âgé ◽

Procedure Type

Download Full-text

Gestion orthopédique d’une ankylose de l’ATM chez l’enfant

Revue d Orthopédie Dento-Faciale ◽

10.1051/odf/2020041 ◽

2020 ◽

Vol 54 (4) ◽

pp. 407-418

Author(s):

Pamela Villalon-Pooley ◽

Camila Hernandez-Veliz ◽

Maria Fernanda Pinto-Chavez ◽

Pierre Bourdiol

Keyword(s):

Patient Age ◽

Patient Âgé

Parmi les fractures cranio-faciales, celles affectant le condyle mandibulaire font partie des fractures les plus souvent rencontrées chez le patient en âge pédiatrique. L’évolution sans traitement peut produire une ankylose temporo-mandibulaire entraînant troubles fonctionnels et asymétrie de la croissance cranio-faciale. Le traitement traditionnellement chirurgical est d’un pronostic généralement réservé. Dans cet article est présenté le cas d’un patient, âgé de quatre ans, atteint d’ankylose fibreuse de l’articulation temporo-mandibulaire gauche, suite probable d’une fracture du col du condyle non-diagnostiquée. La libération fonctionnelle de la fibro-ankylose articulaire a été l’objectif de la première étape thérapeutique. Celle-ci a été suivie, à l’âge de sept ans, d’une distraction articulaire obtenue au moyen de butées occlusales controlatérales disposées côté droit. Ceci a produit un ajustement de la croissance dento-alvéolaire assurant à la fois un rattrapage du déficit de croissance unilatéral de départ et une néoformation condylienne par remodelage de l’articulation temporo-mandibulaire gauche. Quatre années après la mise en route de la phase orthopédique initiale, la fonction articulaire restaurée et l’équilibre facial obtenu restent stables chez ce jeune patient

Download Full-text

Hemmkörperentwicklung bei Hämophilie-Patienten nach Präparate wechsel

Hämostaseologie ◽

10.1055/s-0037-1619773 ◽

2012 ◽

Vol 32 (S 01) ◽

pp. S39-S42 ◽

Cited By ~ 1

Author(s):

S. Kocher ◽

G. Asmelash ◽

V. Makki ◽

S. Müller ◽

S. Krekeler ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Observational Study ◽

Retrospective Observational Study ◽

Frequent Change ◽

Patient Age ◽

Treatment Regimens ◽

Patient Âgé ◽

The Relationship ◽

Observation Period

SummaryThe retrospective observational study surveys the relationship between development of inhibitors in the treatment of haemophilia patients and risk factors such as changing FVIII products. A total of 119 patients were included in this study, 198 changes of FVIII products were evaluated. Results: During the observation period of 12 months none of the patients developed an inhibitor, which was temporally associated with a change of FVIII products. A frequent change of FVIII products didn’t lead to an increase in inhibitor risk. The change between plasmatic and recombinant preparations could not be confirmed as a risk factor. Furthermore, no correlation between treatment regimens, severity, patient age and comorbidities of the patients could be found.

Download Full-text

Hämophilie-Zentrum Bonn 1980 – 2009

Hämostaseologie ◽

10.1055/s-0037-1619741 ◽

2011 ◽

Vol 31 (S 01) ◽

pp. S4-S10 ◽

Cited By ~ 2

Author(s):

I. Besmens ◽

H.-H. Brackmann ◽

J. Oldenburg

Keyword(s):

Young Patients ◽

Severe Form ◽

Coagulation Disorder ◽

Care Providers ◽

Long Distance ◽

Patient Age ◽

Patient Âgé ◽

Number Of Patients ◽

Clotting Disorder ◽

Regional Character

SummaryThe Bonn Haemophilia Care Center provides patient care on a superregional level. The centre’s large service area is, in part, due to the introduction of haemophilia home treatment and related to this the individualized prophylaxis in children and adults by Egli and Brack-mann in Bonn in the early 1970s, that represented a milestone in German haemophilia therapy. Epidemiologic patient data from the two selected time points, 1980 and 2009, are evaluated to illustrate the change in the composition of the patient clientele. In 1980 a total of 639 patients were treated at the Bonn Haemophilia Center. 529 patients exhibited a severe form and 110 a non-severe form of the respective clotting disorder. In 2009 the Bonn Haemophilia Center took care for a total of 837 patients. There were 445 patients who suffered from a severe form of the considered clotting disorder while 392 showed a non-severe course. The number of less severely affected patients has increased significantly in 2009. Patients in 1980 were predominantly suffering from a severe form and most had to travel more than 150 km from their homes to the treatment center. In 2009 the number of patients living a medium-long distance from the care provider has significantly increased while the number of patients living more than 150km from the center has decreased. Comparing 2009 to 1980 a growth of the center’s regional character becomes apparent, especially when patient age and severity of the coagulation disorder are taken into consideration. The regional character was more strongly pronounced with milder disease severity and lower patient age. Due to the existence of well established primary haemophilia care in CCCs in Germany, the trend for the recent years is that the proportion of young patients that choose haemophilia care providers closer to their homes is increasing.

Download Full-text