Occupational Outcomes and Return to Running After Operative Management of Lisfranc Injuries in a High-Demand Population

2020 ◽  
pp. 193864002093307
Author(s):  
Logan Koehler ◽  
Brian R. Waterman ◽  
Nicholas A. Kusnezov ◽  
James A. Blair ◽  
Philip J. Belmont ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Military Service ◽  
Univariate Analysis ◽  
Active Duty ◽  
High Demand ◽  
Military Health ◽  
Occupational Outcomes ◽  
Fracture Dislocations ◽  
Lisfranc Injuries

Background: Literature evaluating outcomes following operative fixation of Lisfranc injuries has demonstrated high rates of chronic disability, particularly in those returning to prior levels of physical function. The purpose of this study is to evaluate the occupational outcomes and return to running after open reduction and internal fixation (ORIF) or arthrodesis for Lisfranc fracture-dislocations in a moderate- to high-demand military cohort. Methods: All active-duty servicemembers undergoing ORIF or primary arthrodesis (Current Procedural Terminology 28615 and 28730, respectively) for confirmed Lisfranc fracture-dislocations (International Classification of Diseases, Ninth Revision codes 838.03 or 838.13) with minimum 2-year follow-up were isolated from the Military Health System. Demographic and surgical variables were recorded. Return to military function, return to running, perioperative morbidity, and rates of reoperation for complication were the outcomes of interest. Univariate analysis followed by multivariate logistic regression determined the association between patient demographics, type of fracture fixation (ie, ORIF vs arthrodesis) and functional outcomes, including medical separation. Results: Among Lisfranc injuries, 64 patients underwent ORIF while 6 underwent primary arthrodeses with a mean age of 28.1 years. At mean follow-up of 3.5 years (range, 2.0-6.3 years), 20% of servicemembers underwent medical separation due to limitations related to their injuries. body mass index (BMI) ≥30 kg/m2 (OR 17.67; 95% CI, 3.69-84.53) and Army or Marines service branch (OR 3.86; 95% CI, 1.08-13.86) were significant independent predictors for medical separation. Among servicemembers undergoing ORIF or primary arthrodeses, 69% returned to occupationally required daily running during the follow-up period. Servicemembers with a BMI <30 kg/m2 were more likely to return to running (OR 13.14, 95% CI, 2.50-69.19). Radiographic evidence of posttraumatic Lisfranc osteoarthritis occurred in 10 (16%) servicemembers who underwent internal fixation, and 82% of ORIF patients underwent implant removal. Conclusions: At mean 3.5-year follow-up, 80% of servicemembers undergoing ORIF or primary arthrodeses for Lisfranc injuries remained on active duty or successfully completed their military service, and 69% were able to resume occupationally required daily running. Surgeons should preoperatively counsel patients with these injuries on the possibility of persistent long-term disability. Levels of Evidence: Level IV: Retrospective series

scholarly journals Perilunate Dislocations and Perilunate Fracture Dislocations in the U.S. Military

2017 ◽  
Vol 07 (01) ◽  
pp. 057-065 ◽  
Author(s):  
John Dunn ◽  
Nicholas Kusnezov ◽  
Elizabeth Polfer ◽  
Justin Orr ◽  
Miguel Pirela-Cruz ◽  
...  
Keyword(s):  
Military Service ◽  
Return To Sport ◽  
High Demand ◽  
Military Population ◽  
Level Of Evidence ◽  
Military Health ◽  
Excellent Outcome ◽  
Fracture Dislocations ◽  
The U.S

Background Perilunate dislocations and perilunate fracture dislocations (PLDs/PLFDs) are rare and often associated with poor outcomes. Heretofore, these outcomes have not been evaluated in a high-demand military population. Questions/Purpose The purpose of this study was to evaluate the outcomes in a young, active population after sustaining PLD/PLFD injuries. Patients and Methods We retrospectively reviewed the U.S. military service members who underwent surgical treatment for a PLD/PLFD (Current Procedural Terminology codes 25695 and 25685) between June 1, 2010, and June 1, 2014 through the Military Health System Management Analysis and Reporting Tool (M2) database, capturing patients with a minimum 2-year follow-up. Patient characteristics and outcomes were gathered; however, radiographic analysis was not possible. Results In this study, 40 patients (40 wrists) were included with an average follow-up of 47.8 months. The average age was 28.8 years. Twenty-two injuries (55%) were PLFD and 22 (55%) cases involved the nondominant extremity. On initial presentation, 11 (27.5%) were missed and 50% of patients were presented with acute carpal tunnel syndrome. Range of motion (ROM) was 74% and grip strength was 65% compared with the contralateral wrist; 78% reported pain with activity and only 55% remained on active duty status at final follow-up. Injuries to the nondominant extremity were significantly more likely to experience a good to excellent outcome and regained a more ROM. Patients with ligamentous PLD had less pain at rest and were more likely to return to sport. Conclusion Worse outcomes can be expected for PLD/PLFD of the dominant extremity, transscaphoid PLFD, greater arc injuries, and those undergoing pinning alone. A high-demand patient may expect worse functional results with a higher degree of limitation postoperatively. Level of Evidence The level of evidence is therapeutic IV.

Results of Treatment of Chronic Dorsal Fracture-Dislocations of the Proximal Interphalangeal Joints of the Fingers

1998 ◽  
Vol 23 (6) ◽  
pp. 798-801 ◽  
Author(s):  
O. ISHIDA ◽  
Y. IKUTA
Keyword(s):  
Articular Cartilage ◽  
Internal Fixation ◽  
Open Reduction ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Fracture Dislocation ◽  
Results Of Treatment ◽  
Palmar Plate ◽  
Fracture Dislocations

We reviewed 20 cases of chronic dorsal fracture-dislocation of the proximal interphalangeal joint, with a mean follow-up period of 74 months. In patients without comminuted palmar fragments, open reduction and internal fixation or osteotomy of the malunited fragment provided good results. In treating patients with damaged articular cartilage or with comminuted palmar fragments by palmar plate arthroplasty, poor results were obtained because of secondary osteoarthritic changes.

scholarly journals PERIACETABULAR OSTEOTOMY IN ACTIVE DUTY U.S. MILITARY PERSONNEL: A SINGLE CENTER’S EXPERIENCE WITH A MINIMUM OF TWO YEARS FOLLOW-UP

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0014
Author(s):  
Andrew S. Murtha ◽  
Matthew R. Schmitz
Keyword(s):  
United States ◽  
Military Service ◽  
Periacetabular Osteotomy ◽  
The United States ◽  
Active Duty ◽  
Service Members ◽  
Military Service Members ◽  
Active Service ◽  
The Impact

Background: The primary focus of periacetabular osteotomy (PAO) literature has been survivorship until hip arthroplasty. This endpoint overlooks its impact on young, active patients. Hypothesis/Purpose: This study sought to assess the impact of the PAO on the careers of active duty members of the United States Armed Forces. Methods: A retrospective review identified 38 patients who underwent PAO performed by a single surgeon at an academic, military medical center from January 2014 through April 2017. Twenty-one of the patients were active duty United States military service members (16 female, 5 male) and had a minimum 28 months of post-operative follow-up at the time of review. Preoperative and postoperative duty restrictions were noted and referrals to the U.S Army and U.S. Air Force Medical Evaluation Boards (MEB) were queried. Results: The average age at surgery was 25.6 years (range, 19-40y). Preoperatively, sixteen patients (94.1%) were on duty restrictions, one had been referred to the MEB, and records were not available on three patients who separated from the military prior to review. Average follow-up was 3.4 years (range, 2.3 – 5.4y). Among the patients without a preoperative MEB referral, 85.0% remained on active duty (n = 12) or completed their military service commitment (n=5). Of the fourteen patients with temporary duty restrictions preoperatively, 35.7% (n=5) were relieved of their restrictions and returned to full duty and 50% (n=7) were retained on active service with permanent duty restrictions. Such permanent duty restrictions typically consisted of modifications to the aerobic component of the semiannual military fitness testing. Six patients (28.6%) were referred to the MEB including one who was referred prior to PAO. Of these patients, two were deemed fit to retain on active service with permanent duty restrictions, two were medically separated for non-hip conditions, and two were medically separated for a hip condition. The average Veteran Affairs (VA) disability score related to hip pathology in patients referred to MEB was 16% (range 0-40%). Conclusion: This is the first study to look at the PAO in active duty military service members. In patients with symptomatic acetabular dysplasia, PAO may provide an opportunity to relieve preoperative duty restrictions and allow for continued military service. Further study with the inclusion of patient reported outcomes are necessary assess the impact of the procedure in this active patient population.

Flexible Fixation Technique for Lisfranc Injuries

2019 ◽  
Vol 40 (11) ◽  
pp. 1338-1345 ◽  
Author(s):  
Connor Delman ◽  
Midhat Patel ◽  
Mark Campbell ◽  
Christopher Kreulen ◽  
Eric Giza
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Treatment Options ◽  
Percutaneous Pinning ◽  
Fixation Device ◽  
Fixation Technique ◽  
Level Of Evidence ◽  
Fracture Dislocations ◽  
Lisfranc Injuries ◽  
Joint Treatment

Injuries to the Lisfranc complex range from purely ligamentous disruptions to fracture-dislocations of the tarsometatarsal joint. Treatment options include closed/open reduction with percutaneous pinning, open reduction and internal fixation (ORIF), and primary arthrodesis. We present a ligament reinforcement technique utilizing a flexible fixation device for the treatment of ligamentous Lisfranc injuries. Level of Evidence: Level V, expert opinion.

An Attempt to use the MMPI as a Predictor of Failure in Military Training

1972 ◽  
Vol 121 (564) ◽  
pp. 553-557 ◽  
Author(s):  
John P. Callan
Keyword(s):  
World War Ii ◽  
Military Service ◽  
Military Training ◽  
Active Duty ◽  
Continuous Observation ◽  
World War ◽  
Prolonged Observation ◽  
Psychiatric Screening

During World War II psychiatric screening to exclude ineffective soldiers from active duty consisted of interviews of three to six minutes duration. These interviews were described as successful by Bloomberg and Hyde (1), and by Leavitt (2). But six years later Bloomberg admitted that induction screening had proved ineffective, and suggested continuous observation for the first six months of military service to separate those who would adjust from those who would not (3). This concept of prolonged observation was supported by the wartime findings of Egan et al. (4) and Aita (5). Egan's group examined the records of 2,054 men who had been psychiatrically rejected on the basis of a short interview, but who later served; 79.4 per cent rendered satisfactory service. Aita's five-year follow-up showed that of 100 soldiers considered borderline on interview 21 per cent failed to render satisfactory service and of 100 considered satisfactory 5 per cent failed. If the questionable risk hundred had been rejected the Army would have lost 49 average and 30 outstanding soldiers. It seemed, therefore, more profitable for the Army to risk retaining ineffectives than to attempt to weed them out completely on the basis of brief psychiatric interviews.

Reoperation Rate Differences Between Open Reduction Internal Fixation and Primary Arthrodesis of Lisfranc Injuries

2018 ◽  
Vol 39 (9) ◽  
pp. 1089-1096 ◽  
Author(s):  
Matteo Buda ◽  
Shaun Kink ◽  
Ruben Stavenuiter ◽  
Catharina Noortje Hagemeijer ◽  
Bonnie Chien ◽  
...  
Keyword(s):  
Risk Factors ◽  
Internal Fixation ◽  
Open Reduction ◽  
Open Reduction Internal Fixation ◽  
Hardware Removal ◽  
Patient Risk ◽  
Operation Room ◽  
Lisfranc Injuries ◽  
Reoperation Rates

Background: Controversy persists as to whether Lisfranc injuries are best treated with open reduction internal fixation (ORIF) versus primary arthrodesis (PA). Reoperation rates certainly influence this debate, but prior studies are often confounded by inclusion of hardware removal as a complication rather than as a planned, staged procedure inherent to ORIF. The primary aim of this study was to evaluate whether reoperation rates, excluding planned hardware removal, differ between ORIF and PA. A secondary aim was to evaluate patient risk factors associated with reoperation after operative treatment of Lisfranc injuries. Methods: Between July 1991 and July 2016, adult patients who sustained closed, isolated Lisfranc injuries with or without fractures and who underwent ORIF or PA with a minimum follow-up of 12 months were analyzed. Reoperation rates for reasons other than planned hardware removal were examined, as were patient risk factors predictive of reoperation. Two hundred seventeen patients met enrollment criteria (mean follow-up, 62.5 ± 43.1 months; range, 12-184), of which 163 (75.1%) underwent ORIF and 54 (24.9%) underwent PA. Results: Overall and including planned procedures, patients treated with ORIF had a significantly higher rate of return to the operation room (75.5%) as compared to those in the PA group (31.5%, P < .001). When excluding planned hardware removal, however, there was no difference in reoperation rates between the 2 groups (29.5% in the ORIF group and 29.6% in the PA group, P = 1). Risk factors correlating with unplanned return to the operation room included deep infection ( P = .009-.001), delayed wound healing ( P = .008), and high-energy trauma ( P = .01). Conclusion: When excluding planned removal of hardware, patients with Lisfranc injuries treated with ORIF did not demonstrate a higher rate of reoperation compared with those undergoing PA. Level of Evidence: Level III, retrospective comparative study

Occupational Outcomes and Return to Running Following Internal Fixation of Ankle Fractures in a High-Demand Population

2015 ◽  
Vol 36 (7) ◽  
pp. 780-786 ◽  
Author(s):  
Justin D. Orr ◽  
Nicholas A. Kusnezov ◽  
Brian R. Waterman ◽  
Julia O. Bader ◽  
David M. Romano ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Ankle Fractures ◽  
High Demand ◽  
Occupational Outcomes

scholarly journals Relationship Between Body Mass Index and Diagnosis of Obesity in the Military Health System Active Duty Population

2021 ◽  
Author(s):  
Daren Yang ◽  
Alexis Beauvais ◽  
Whitney L Forbes ◽  
Darrick Beckman ◽  
Jason Estes ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Health System ◽  
Body Mass ◽  
Military Service ◽  
Active Duty ◽  
Service Members ◽  
Data Repository ◽  
Military Health System ◽  
Military Health ◽  
The Military

ABSTRACT Objective The overall rate of obesity is rising in the USA; this is also reflected in the military population. It is important that providers appropriately diagnose obesity and discuss treatment options with their patients. The purpose of this study was to investigate diagnosis of obesity compared to documented body mass index (BMI) in the military health system. Methods Institutional review board approval was obtained by the 59th Medical Wing (Lackland Air Force Base, Texas) as an exempt study. This study included active duty military service members aged 18-65 years who sought outpatient care at a military treatment facility from September 2013 to August 2018 with a weight within the range of 31.8-226.8 kg and height between 121.9 and 215.9 cm. Data were collected from the Clinical Data Repository vitals and M2 encounter data to determine the percentage of each sub-population with a diagnosis of obesity according to BMI (≥30 kg/m2) and International Classification of Diseases diagnosis codes. Results Using BMI, 19.2% of female and 26.8% of male service members can be diagnosed with obesity; however, only 42.2% and 35.1%, respectively, with a BMI ≥30 was diagnosed as such. This discrepancy was consistent among all service branches and BMI ranges. Conclusion This study demonstrates that obesity is underdiagnosed compared to BMI. This may result in insufficient resources being provided to patients to reduce weight. Further investigation is warranted to identify causes of underdiagnosis and potential barriers to diagnosis.

A Comparison of Complications and Reoperations Between Open Reduction and Internal Fixation Versus Primary Arthrodesis Following Lisfranc Injury

2021 ◽  
pp. 193864002110582
Author(s):  
Eric So ◽  
Jonathan Lee ◽  
Michelle L. Pershing ◽  
Anson K. Chu ◽  
Matthew Wilson ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Retrospective Chart Review ◽  
Reoperation Rate ◽  
Complication Rates ◽  
Lisfranc Injury ◽  
Significant Difference ◽  
Lisfranc Injuries ◽  
Reoperation Rates

There is a lack of consensus in the literature regarding optimal treatment methods for Lisfranc injuries, and recent literature has emphasized the need to compare open reduction and internal fixation (ORIF) with primary arthrodesis (PA). The purpose of the current study is to compare reoperation and complication rates between ORIF and PA following Lisfranc injury in a private, outpatient, orthopaedic practice. A retrospective chart review was performed on patients undergoing operative intervention for Lisfranc injury between January 2009 and September 2015. A total of 196 patients met the inclusion criteria (130 ORIF, 66 PA), with a mean follow-up of 61.3 and 81.7 weeks, respectively. The ORIF group had a higher reoperation rate than the PA group, due to hardware removal. When hardware removals were excluded, the reoperation rate was similar. Postsurgical complications were compared between the 2 groups with no significant difference. In conclusion, ORIF and PA had similar complication rates. When hardware removals were excluded, the reoperation rates were similar, although hardware removals were more common in the ORIF group compared with the PA group. Levels of Evidence: Level III

Anteromedializing Tibial Tubercle Osteotomy for Patellofemoral Instability: Occupational and Functional Outcomes in U.S. Military Service Members

2017 ◽  
Vol 31 (04) ◽  
pp. 306-313 ◽  
Author(s):  
Philip Belmont ◽  
Julia Bader ◽  
Joseph Lanzi ◽  
Brett Owens ◽  
Brian Waterman ◽  
...  
Keyword(s):  
Military Service ◽  
Patellofemoral Instability ◽  
Active Duty ◽  
Service Members ◽  
Tibial Tubercle ◽  
Tibial Tubercle Osteotomy ◽  
Military Service Members ◽  
Patellar Subluxation ◽  
Pain Improvement

AbstractThis article sought to determine rates for return to work, pain relief, and recurrent patellofemoral instability for military service members undergoing tibial tubercle osteotomy (TTO) for persistent lateral patellar subluxation or dislocation. Patient demographic and surgical variables were isolated from the medical records of active duty service members with at least 2 years of postoperative follow-up, and correlated with return to work, pain improvement, recurrent patellofemoral instability, and perioperative complications. There were 51 service members (58 primary TTOs) with an average follow-up of 3.3 (range, 2.0–6.7) years. Service members had an average of 2.8 (1–12) instability events preoperatively. At a minimum of 2 years postoperatively, 41 (80%) military service members returned to full active duty service. Among the 58 TTOs, there was a 46% improvement in the patient-reported visual analog score from 4.1 to 2.2 (p < 0001). The postoperative recurrent instability rates were patellar dislocation (5.1%) and patellar subluxation (15.5%). Concomitant proximal realignment was performed in 48% of cases, which did not affect return to service, postoperative patellar instability events, or pain improvement (p > 0.05). The overall complication rate was 10%. Postoperative tibial fractures occurred in 6.9% of TTOs. At short- to mid-term follow-up, 80% of service members undergoing TTO for patellofemoral instability returned to military duty with significant improvement in pain scores and a moderate perioperative complication and postoperative instability rate. This study is a level IV therapeutic case series.

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