scholarly journals Radiological Outcome Measures Indicate Advantages of Precontoured Locking Compression Plates in Elderly Patients With Split-Depression Fractures to the Lateral Tibial Plateau (AO41B3)

2021 ◽  
Vol 12 ◽  
pp. 215145932110439
Author(s):  
Wolf C. Prall ◽  
Thomas Kusmenkov ◽  
Maximilian Rieger ◽  
Florian Haasters ◽  
Hermann O. Mayr ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Outcome Measures ◽  
Tibial Plateau ◽  
Young Patients ◽  
Joint Surface ◽  
Secondary Outcome ◽  
Radiological Outcome ◽  
Lateral Tibial Plateau ◽  
Significant Deterioration ◽  
Locking Compression Plates

Background Split-depression fractures to the lateral tibial plateau (AO41B3) often feature severe joint surface destructions. Precontoured locking compression plates (LCPs) are designed for optimum support of the reduced joint surface and have especially been emphasized in reduced bone quality. A lack of evidence still inhibits their broad utilization in elderly patients. Thus, aim of the present study was to investigate the implant-specific radiological outcomes of AO41B3-fractures in young versus elderly patients. Methods The hospital’s database was screened for isolated AO41B3-factures, open reduction and internal fixation (ORIF), and radiological follow-up ≥12 months. CT-scans, radiographs, and patients’ records were analyzed. Patients were attributed as young (18–49) or elderly (≥50 years). Additional subgrouping was carried out into precontoured LCP and conventional implants. The Rasmussen Radiological Score (RRS) after 12 months was set as primary outcome parameter. The RRS postoperatively and the medial proximal tibial angle (MPTA) postoperatively and after 12 months were secondary outcome parameters. Results Fifty nine consecutive patients were included (26 young, 38.2 ± 7.8 years; 33 elderly, 61.3 ± 9.4 years). There were no significant differences regarding mean size and depression depth of the lateral joint surface fragments. Prior to implant-specific subgrouping, the radiological outcome measures revealed no significant differences between young (RRS = 7.7 ± 1.7; MPTA = 90.3 ± 2.3°) and elderly (RRS = 7.2 ± 1.7; MPTA = 90.5 ± 3.3°). After implant-specific subgrouping, the radiological outcome revealed significantly impaired results in young patients with conventional implants (RRS(C) = 6.9 ± 1.6, RRS(LCP) = 8.5 ± 1.5, P = .015; MPTA(C) = 91.5 ± 1.9°, MPTA(LCP) = 89.1 ± 2.1°, P = .01). The effect was even more pronounced in elderly patients, with highly significant deterioration of the radiological outcome measures for conventional implants compared to precontoured LCP (RRS(C) = 5.7 ± 1.6, RRS(LCP) = 8.2 ± .8, P < .001; MPTA(C) = 92.6 ± 4.2°, MPTA(LCP) = 89.2 ± 1.4°, P = .002). Conclusion Utilizing precontoured LCP in the treatment of AO41B3-fractures is associated with improved radiological outcomes. This effect is significant in young but even more pronounced in elderly patients. Consequently, precontoured LCP should closely be considered in any AO41B3-fracture, but especially in elderly patients.

scholarly journals Schatzker II tibial plateau fractures: Anatomically precontoured 3.5 mm locking compression plates allow for improved patient outcome

2018 ◽  
Vol 6 (4_suppl2) ◽  
pp. 2325967118S0002
Author(s):  
Wolf Christian Prall ◽  
Thomas Kusmenkov ◽  
Julian Fürmetz ◽  
Hermann O. Mayr ◽  
Wolfgang Böcker
Keyword(s):  
Patient Outcome ◽  
Internal Fixation ◽  
Tibial Plateau ◽  
Joint Surface ◽  
Lateral Tibial Plateau ◽  
Locking Compression Plates ◽  
Bone Graft Substitutes ◽  
The Mean ◽  
Group B

In the operative treatment of split depression factures to the lateral tibial plateau, the reconstruction of the depressed joint surface is eagerly sought after. The subchondral bony defect often requires bone grafting or bone graft substitutes. At least equally important is the achievement of an internal fixation that provides the greatest possible support for the fragile joint surface fragments. The design of the anatomically precontoured locking compression plates features a higher number of locking screws underneath the joint surface and permits the screw placement closer to the subchondral zone compared to conventional plates. Whether the altered design results in better patient outcome is analysed in this study. Our databank was searched for Schatzker II fractures from 2012 until 2015. Patients that underwent open reduction and internal fixation with anatomically precontoured 3.5 mm locking compression plates (A) or conventional 4,5 mm L-shaped locking compression plates and screws (B) were included and retrospectively evaluated. CT-scans, radiographs in two planes and in full length standing mode, if available, were analysed. Details of the operative procedures and secondary events were determined. Objective outcome parameters were collected from the patient records, subjective outcome parameters were assessed in a survey and WOMAC as well as Rasmussen functional knee scores were calculated. A total of 36 patients were included (A=20, B=16). The mean patient age, the ratio male to female and the mean follow up were comparable. CT-scans revealed an equal mean size of the depressed joint surface (A: 23.7 x 25.3 mm; B: 23.9 x 24.0 mm) and maximal depression depth (11.2 and 11.8 mm). The duration of the operation, the frequency of utilizing bone grafts or bone graft substitutes and of lateral meniscus repair as well as the rate of subsequent implant removal were also comparable. In the early postoperative controls, the radiological assessment according to Rasmussen revealed a mean score of 9.1 (A) and of 8.5 (B). During follow up, the mean score decreased to 8.1 and 6.7 for A and B, respectively. This difference was statistically significant (p<0.05). A valgus deviation was more often observed in group B. Both, the WOMAC and the Rasmussen functional knee score revealed lower mean values for group B in the final evaluation. The progressive decrease of the Rasmussen radiological score for the conventional 4,5 mm L-shaped locking compression plates and screws was predominantly due to a secondary loss of reduction and an increasing valgus deviation. The altered design of the anatomically precontoured 3.5 mm locking compression plate seems to prevent more sufficiently the reduced joint surface fragments from sintering over time. The anatomically precontoured 3.5 mm locking compression plate allows for improved patient outcome and should closely be considered for internal fixation of split depression fractures to the lateral tibial plateau.

scholarly journals The effect of patient, fracture and surgery on outcomes of high energy neck of femur fractures in patients aged 15–50

2018 ◽  
Vol 29 (1) ◽  
pp. 77-82 ◽  
Author(s):  
Wayne Hoskins ◽  
Johnny Rayner ◽  
Rohan Sheehy ◽  
Harry Claireaux ◽  
Roger Bingham ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Outcome Measures ◽  
Surgical Procedures ◽  
Young Patients ◽  
Significant Risk ◽  
High Energy ◽  
Femoral Neck Fractures ◽  
Secondary Outcome ◽  
Femur Fractures

Introduction: High-energy femoral neck fractures in young patients can be devastating, with the risk of osteonecrosis, nonunion, malunion and lifelong morbidity. The aim of this study is to define the effects of patient, fracture and surgical factors on the outcome of high-energy femoral neck fractures in patients aged from 15 to 50 years. Methods: A retrospective review was conducted of high-energy femoral neck fractures in patients aged 15–50 managed surgically at a Level 1 Trauma Centre, using a prospectively recorded trauma database. Low energy trauma (including falls from <1 m), medical conditions adversely affecting bone density, and pathological fractures were excluded. A clinical and radiological review was performed. The primary outcome measures were the development of osteonecrosis or nonunion leading to total hip arthroplasty (THA). Secondary outcome measures included osteotomy or other surgical procedures, quality of reduction and malunion. Results: 32 patients meeting the inclusion criteria were identified between January 2008 and July 2015. The mean follow-up was 58.5 months (range 980–3,048 days). 3 patients (9.4%) required THA. No other surgical procedures were performed. None of the 29 other patients developed radiologically apparent osteonecrosis. Fracture type, displacement, anatomical reduction and fixation type were not statistically significant risk factors affecting these outcomes. For all patients, an average of 8% loss of femoral neck height and 10% femoral neck offset were seen. Conclusions: At a mean 4.9-year follow-up, the incidence of high-energy femoral neck fractures leading to THA was 9.4%, as a consequence of osteonecrosis or nonunion. Malunion was common.

scholarly journals Is there difference and correlation between medial and lateral tibial plateau coronal obliquity in native knee? A radiographic study

2021 ◽  
Vol 28 ◽  
pp. 221049172110569
Author(s):  
Thomas Ka Chun Leung ◽  
Will Wai Hong Lau ◽  
Wing Chiu Fung ◽  
Vincent Wai Kwan Chan ◽  
Amy Cheung ◽  
...  
Keyword(s):  
Knee Joint ◽  
Tibial Plateau ◽  
Articular Surface ◽  
Young Patients ◽  
Joint Line ◽  
Significant Implication ◽  
Lateral Tibial Plateau ◽  
Radiographic Measurements ◽  
Significant Difference ◽  
Joint Line Obliquity

Background/Purpose Knee joint line is commonly defined as a tangent to medial and lateral tibial plateaus in various radiographic measurements. We aim to investigate radiographic differences between medial and lateral knee joint line coronal obliquity. It has significant implication on radiographic analysis following unicompartmental knee arthroplasty. Methods We analysed the knee radiographs of 48 young patients (mean age 25.1 + /-5.6 years) with 50 anterior cruciate ligament-deficient knees. Medial and lateral tibial plateau coronal obliquity were defined as angles between femoral knee joint line and the tangent to articular surface of each tibial plateau. Mediolateral differences and linear correlation were analysed. Results Significant difference was found between medial (mean = -1.5, SD = 2.4 degrees) and lateral obliquity (mean =  + 0.6, SD = 3.0 degrees) ( p < 0.001). The mean mediolateral difference was 3.1 degrees (SD = 2.8, range 0–11.8 degrees), without significant correlation (r = 0.085, p = 0.56). Conclusion Mediolateral differences exist in knee joint line obliquity. Each compartment should be considered separately when measuring knee joint line obliquity.

scholarly journals Comparison of articular exposure through extended lateral approaches to the tibial plateau

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0031
Author(s):  
Jannik Frings ◽  
Matthias Krause ◽  
Hüseyin Isik ◽  
Karl-Heinz Frosch
Keyword(s):  
Soft Tissue ◽  
Tibial Plateau ◽  
Articular Surface ◽  
Lateral Collateral Ligament ◽  
Joint Surface ◽  
Anatomical Reconstruction ◽  
Anterolateral Approach ◽  
Popliteus Tendon ◽  
Lateral Tibial Plateau ◽  
Lateral Epicondyle

Aims and Objectives: Comminuted lateral tibial plateau fractures pose a challenge to surgeons, resulting in non-anatomical reductions in 70-89% of all cases. Anatomical reconstruction requires the direct visualization of the joint after a fragment reduction, which is impaired using the common anterolateral approach. Although numerous lateral extended approaches are described, there is currently no data on which approach provides better visibility of the posterolateral tibial plateau. The aim of this study was to evaluate, which parts of the tibial plateau can be visualized with the use of the lateral femoral epicondyle osteotomy or the fibula osteotomy? Further, the study investigated wether the combined osteotomy of the femoral footprints of the lateral collateral ligament (LCL) and popliteus tendon (PLT) provide better access to the posterolateral joint surface than the isolated osteotomy of the femoral LCL footprint or the fibula osteotomy? Materials and Methods: Extended lateral (femoral or fibular LCL osteotomy) and posterolateral (additional femoral osteotomy of the PLT tendon) approaches were performed on twelve human cadaver knee joints. After preparing of each surgical approach, the visible joint surface was marked with diathermy. The tibial plateau was disarticulated and the markings were measured digitally with open-source processing software. Differences in mean values were tested with a paired t-test (p < 0.05). Results: The greatest articular exposition was realized by the fibula osteotomy (1011.52 ± 227.05 mm2 [86.64 ± 4.84%] compared to either osteotomy of LCL and PLT (p = 0.036) or LCL alone (p<0.001). The lateral femoral epicondyle osteotomy of the LCL including the PLT (937.45 ± 237.84 mm2 [80.29 ± 8.25 %]) exposed a significantly larger articular surface of the lateral tibial plateau than without the PLT (755.71 ± 183.06 mm2 [64.73 ± 6.51 %], p < 0.001). Conclusion: The fibula osteotomy provides the greatest articular visibility of the lateral tibial plateau compared to the lateral epicondyle osteotomy of the femoral LCL and PLT attachments. This small benefit should be critically balanced against the considerably greater soft tissue damage caused by the fibula osteotomy. The lateral femoral epicondyle osteotomy including the LCL and PLT increases lateral articular visualization without risk to neurovascular or posterolateral soft tissue structures and represents an important extended approach to treat comminuted lateral plateau fractures.

scholarly journals Donepezil for mild cognitive impairment in Parkinson’s disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kyoungwon Baik ◽  
Seon Myeong Kim ◽  
Jin Ho Jung ◽  
Yang Hyun Lee ◽  
Seok Jong Chung ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Treatment Group ◽  
Outcome Measures ◽  
Rating Scale ◽  
Secondary Outcome ◽  
Control Group ◽  
Significant Difference

AbstractWe investigated the efficacy of donepezil for mild cognitive impairment in Parkinson’s disease (PD-MCI). This was a prospective, non-randomized, open-label, two-arm study. Eighty PD-MCI patients were assigned to either a treatment or control group. The treatment group received donepezil for 48 weeks. The primary outcome measures were the Korean version of Mini-Mental State Exam and Montreal Cognitive Assessment scores. Secondary outcome measures were the Clinical Dementia Rating, Unified Parkinson’s Disease Rating Scale part III, Clinical Global Impression scores. Progression of dementia was assessed at 48-week. Comprehensive neuropsychological tests and electroencephalography (EEG) were performed at baseline and after 48 weeks. The spectral power ratio of the theta to beta2 band (TB2R) in the electroencephalogram was analyzed. There was no significant difference in the primary and secondary outcome measures between the two groups. However, the treatment group showed a significant decrease in TB2R at bilateral frontotemporoparietal channels compared to the control group. Although we could not demonstrate improvements in the cognitive functions, donepezil treatment had a modulatory effect on the EEG in PD-MCI patients. EEG might be a sensitive biomarker for detecting changes in PD-MCI after donepezil treatment.

Three-Dimensional Printing in Cleft Care: A Systematic Review

2021 ◽  
pp. 105566562110131
Author(s):  
Farrukh R. Virani ◽  
Evan C. Chua ◽  
Mary Roz Timbang ◽  
Tsung-yen Hsieh ◽  
Craig W. Senders
Keyword(s):  
Systematic Review ◽  
3D Printing ◽  
Clinical Outcomes ◽  
Outcome Measures ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Secondary Outcome ◽  
Exclusion Criteria ◽  
3 Dimensional ◽  
Dimensional Printing

Objective: To determine the current applications of 3-dimensional (3D) printing in the care of patients with cleft lip and palate. We also reviewed 3D printing limitations, financial analysis, and future implications. Design: Retrospective systematic review. Methods: Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used by 3 independent reviewers. Articles were identified from Cochrane library, Ovid Medline, and Embase. Search terms included 3D printing, 3 dimensional printing, additive manufacturing, rapid prototyping, cleft lip, and cleft palate. Exclusion criteria included articles not in English, animal studies, reviews without original data, oral presentations, abstracts, opinion pieces, and articles without relevance to 3D printing or cleft lip and palate. Main Outcome Measures: Primary outcome measure was the purpose of 3D printing in the care of patients with cleft lip and palate. Secondary outcome measures were cost analysis and clinical outcomes. Results: Eight-four articles were identified, and 39 met inclusion/exclusion criteria. Eleven studies used 3D printing models for nasoalveolar molding. Patient-specific implants were developed via 3D printing in 6 articles. Surgical planning was conducted via 3D printing in 8 studies. Eight articles utilized 3D printing for anatomic models/educational purposes. 3-Dimensional printed models were used for surgical simulation/training in 6 articles. Bioprinting was utilized in 4 studies. Secondary outcome of cost was addressed in 8 articles. Conclusion: 3-Dimensional printing for the care of patients with cleft lip and palate has several applications. Potential advantages of utilizing this technology are demonstrated; however, literature is largely descriptive in nature with few clinical outcome measures. Future direction should be aimed at standardized reporting to include clinical outcomes, cost, material, printing method, and results.

scholarly journals Effect of ultraprocessed food intake on cardiometabolic risk is mediated by diet quality: a cross-sectional study

2021 ◽  
pp. bmjnph-2020-000225
Author(s):  
Jennifer Griffin ◽  
Anwar Albaloul ◽  
Alexandra Kopytek ◽  
Paul Elliott ◽  
Gary Frost
Keyword(s):  
Food Intake ◽  
Energy Intake ◽  
Food Consumption ◽  
Outcome Measures ◽  
Diet Quality ◽  
Cardiometabolic Risk ◽  
Saturated Fat ◽  
Secondary Outcome ◽  
Cross Sectional ◽  
Occupational Cohort

ObjectiveTo examine the effect of the consumption of ultraprocessed food on diet quality, and cardiometabolic risk (CMR) in an occupational cohort.DesignCross-sectional.SettingOccupational cohort.Participants53 163 British police force employees enrolled (2004–2012) into the Airwave Health Monitoring Study. A total of 28 forces across the UK agreed to participate. 9009 participants with available 7-day diet record data and complete co-variate data are reported in this study.Main outcome measuresA CMR and Dietary Approaches to Stop Hypertension score were treated as continuous variables and used to generate measures of cardiometabolic health and diet quality. Secondary outcome measures include percentage of energy from fat, saturated fat, carbohydrate, protein and non-milk extrinsic sugars (NMES) and fibre grams per 1000 kcal of energy intake.ResultsIn this cohort, 58.3%±11.6 of total energy intake was derived from ultraprocessed (NOVA 4) foods. Ultraprocessed food intake was negatively correlated with diet quality (r=−0.32, p<0.001), fibre (r=−0.20, p<0.001) and protein (r = −0.40, p<0.001) and positively correlated with fat (r=0.18, p<0.001), saturated fat (r=0.14, p<0.001) and nmes (r=0.10, p<0.001) intake . Multivariable analysis suggests a positive association between ultraprocessed food (NOVA 4) consumption and CMR. However, this main effect was no longer observed after adjustment for diet quality (p=0.209). Findings from mediation analysis indicate that the effect of ultraprocessed food (NOVA 4) intake on CMR is mediated by diet quality (p<0.001).ConclusionsUltraprocessed food consumption is associated with a deterioration in diet quality and positively associated with CMR, although this association is mediated by and dependent on the quality of the diet. The negative impact of ultraprocessed food consumption on diet quality needs to be addressed and controlled studies are needed to fully comprehend whether the relationship between ultraprocessed food consumption and health is independent to its relationship with poor diet quality.

scholarly journals Impact of cardiovascular disease and risk factors on fatal outcomes in patients with COVID-19 according to age: a systematic review and meta-analysis

Heart ◽  
2020 ◽  
pp. heartjnl-2020-317901
Author(s):  
SungA Bae ◽  
So Ree Kim ◽  
Mi-Na Kim ◽  
Wan Joo Shim ◽  
Seong-Mi Park
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Relative Risk ◽  
Elderly Patients ◽  
Meta Analysis ◽  
Fatal Outcome ◽  
Young Patients ◽  
Lower Prevalence ◽  
Prevalence Rates ◽  
The Impact

ObjectivePrevious studies that evaluated cardiovascular risk factors considered age as a potential confounder. We aimed to investigate the impact of cardiovascular disease (CVD) and its risk factors on fatal outcomes according to age in patients with COVID-19.MethodsA systematic literature review and meta-analysis was performed on data collected from PubMed and Embase databases up to 11 June 2020. All observational studies (case series or cohort studies) that assessed in-hospital patients were included, except those involving the paediatric population. Prevalence rates of comorbid diseases and clinical outcomes were stratified by mean patient age in each study (ranges: <50 years, 50–60 years and ≥60 years). The primary outcome measure was a composite fatal outcome of severe COVID-19 or death.ResultsWe included 51 studies with a total of 48 317 patients with confirmed COVID-19 infection. Overall, the relative risk of developing severe COVID-19 or death was significantly higher in patients with risk factors for CVD (hypertension: OR 2.50, 95% CI 2.15 to 2.90; diabetes: 2.25, 95% CI 1.89 to 2.69) and CVD (3.11, 95% 2.55 to 3.79). Younger patients had a lower prevalence of hypertension, diabetes and CVD compared with older patients; however, the relative risk of fatal outcomes was higher among the former.ConclusionsThe results of the meta-analysis suggest that CVD and its risk factors (hypertension and diabetes) were closely related to fatal outcomes in COVID-19 for patients across all ages. Although young patients had lower prevalence rates of cardiovascular comorbidities than elderly patients, relative risk of fatal outcome in young patients with hypertension, diabetes and CVD was higher than in elderly patients.Prospero registration numberCRD42020198152.

scholarly journals Implementation of patient-reported outcome measures and patient-reported experience measures in melanoma clinical quality registries: a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e040751
Author(s):  
Zachary Blood ◽  
Anh Tran ◽  
Lauren Caleo ◽  
Robyn Saw ◽  
Mbathio Dieng ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Outcome Measures ◽  
Cutaneous Melanoma ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Secondary Outcome ◽  
Clinical Quality ◽  
Patient Reported ◽  
Eortc Qlq

ObjectivesTo identify patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in clinical quality registries, for people with cutaneous melanoma, to inform a new Australian Melanoma Clinical Outcomes Registry; and describe opportunities and challenges of routine PROM/PREM collection, especially in primary care.DesignSystematic review.Primary and secondary outcome measuresWhich PROMs and PREMs are used in clinical quality registries for people with cutaneous melanoma, how they are collected, frequency of collection, participant recruitment methods and funding models for each registry.Results1134 studies were identified from MEDLINE, PreMEDLINE, Embase, PsychInfo, Cochrane Database of Abstracts of Reviews of Effects databases and TUFTS Cost-Effectiveness Analysis Registry, alongside grey literature, from database inception to 5th February 2020. Following screening, 14 studies were included, identifying four relevant registries: Dutch Melanoma Registry, Adelphi Real-World Disease-Specific Programme (Melanoma), Patient-Reported Outcomes Following Initial treatment and Long-term Evaluation of Survivorship Registry, and Cancer Experience Registry. These used seven PROMs: EuroQol-5 Dimensions, Functional Assessment of Cancer-General (FACT-G) and FACT-Melanoma (FACT-M), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Cancer 30 (EORTC QLQ-C30), Fatigue Assessment Scale Hospital Anxiety and Depression Scale, Patient-Reported Outcome Measures Information System-29 and one PREM; EORTC QLQ-Information Module 26. PROMs/PREMs in registries were reported to improve transparency of care; facilitate clinical auditing for quality assessment; enable cost-effectiveness analyses and create large-scale research platforms. Challenges included resource burden for data entry and potential collection bias toward younger, more affluent respondents. Feedback from patients with melanoma highlighted the relevance of PROMs/PREMs in assessing patient outcomes and patient experiences.ConclusionsClinical registries indicate PROMs/PREMs for melanoma care can be incorporated and address important gaps, however cost and collection bias may limit generalisability.PROSPERO registration numberCRD42018086737.

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