scholarly journals Risk Factors Associated With Complications After Operative Treatment of Multiligament Knee Injury

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712199420
Author(s):  
Neel K. Patel ◽  
Jayson Lian ◽  
Michael Nickoli ◽  
Ravi Vaswani ◽  
James J. Irrgang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Knee Injury ◽  
Treatment Algorithm ◽  
Significant Risk ◽  
Timing Of Surgery ◽  
Surgical Reconstruction ◽  
Fisher Exact Test ◽  
Initial Surgery ◽  
Multiligament Knee Injury ◽  
Time From Injury

Background: Many factors can affect clinical outcomes and complications after a complex multiligament knee injury (MLKI). Certain aspects of the treatment algorithm for MLKI, such as the timing of surgery, remain controversial. Purpose: To determine the risk factors for common complications after MLKI reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective review was conducted on 134 patients with MLKI who underwent reconstruction between 2011 and 2018 at a single academic center. Patients included in the review had a planned surgical reconstruction of >1 ligament based on clinical examination and magnetic resonance imaging. Complications were categorized as (1) wound infection requiring irrigation and debridement, (2) arthrofibrosis requiring manipulation under anesthesia and/or lysis of adhesions, (3) deep venous thrombosis, (4) need for removal of hardware, and (5) revision ligament surgery. The potential risk factors for complications included patient characteristics, injury pattern categorized according to Schenck classification (knee dislocation [KD] I–KD IV), and timing of surgery. Significant risk factors for complications were analyzed by t test, chi-square test, and Fisher exact test. Results: A total of 108 patients met the inclusion criteria; of these, 29.6% experienced at least 1 complication. Smoking (odds ratio [OR], 3.20 [95% CI, 1.28-8.02]; P = .01) and planned staged surgery (OR, 2.71 [95% CI, 1.04-7.04]; P = .04) significantly increased the overall risk of complication, while increased time from injury to surgery (OR, 0.99 [95% CI, 0.98-0.998]; P < .01) significantly decreased the risk. Increasing time from injury to surgery (OR, 0.99 [95% CI, 0.97-0.998]; P = .02) also led to a slightly but significantly decreased risk for arthrofibrosis. Conclusion: The study findings suggest that smoking, decreased time from injury to initial surgery, and planned staged procedures may increase the rate of complications. Further studies are needed to determine which changes in the treatment algorithm are most effective to reduce the complication rate in patients.

Venous Thromboembolism and High Grade Gliomas

1993 ◽  
Vol 70 (03) ◽  
pp. 393-396 ◽  
Author(s):  
Mandeep S Dhami ◽  
Robert D Bona ◽  
John A Calogero ◽  
Richard M Hellman
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Medical Center ◽  
Significant Risk ◽  
Bleeding Complications ◽  
Fisher Exact Test ◽  
High Grade ◽  
Chi Square ◽  
Exact Test ◽  
High Grade Gliomas

SummaryA retrospective study was done to determine the incidence of and the risk factors predisposing to clinical venous thromboembolism (VTE) in patients treated for high grade gliomas. Medical records of 68 consecutive patients diagnosed and treated at Saint Francis Hospital and Medical Center from January 1986 to June 1991 were reviewed. The follow up was to time of death or at least 6 months (up to December 1991). All clinically suspected episodes of VTE were confirmed by objective tests. Sixteen episodes of VTE were detected in 13 patients for an overall episode rate of 23.5%. Administration of chemotherapy (p = 0.027, two tailed Fisher exact test) and presence of paresis (p = 0.031, two tailed Fisher exact test) were statistically significant risk factors for the development of VTE. Thrombotic events were more likely to occur in the paretic limb and this difference was statistically significant (p = 0.00049, chi square test, with Yates correction). No major bleeding complications were seen in the nine episodes treated with long term anticoagulation.We conclude that venous thromboembolic complications are frequently encountered in patients being treated for high grade gliomas and the presence of paresis and the administration of chemotherapy increases the risk of such complications.

Nerve Injury Complicating Multiligament Knee Injury: Current Concepts and Treatment Algorithm

2013 ◽  
Vol 21 (6) ◽  
pp. 343-354
Author(s):  
William Randolph Mook ◽  
Cassandra A. Ligh ◽  
Claude T. Moorman ◽  
Fraser J. Leversedge
Keyword(s):  
Nerve Injury ◽  
Knee Injury ◽  
Treatment Algorithm ◽  
Multiligament Knee Injury

scholarly journals No association between seniority of surgeon and postoperative recurrence of chronic subdural haematoma

2015 ◽  
Vol 97 (8) ◽  
pp. 584-588 ◽  
Author(s):  
I Phang ◽  
R Sivakumaran ◽  
MC Papadopoulos
Keyword(s):  
Risk Factors ◽  
Subdural Haematoma ◽  
Early Stage ◽  
Significant Risk ◽  
Working Hours ◽  
Significant Risk Factor ◽  
Chronic Subdural Haematoma ◽  
Timing Of Surgery ◽  
Related Factors ◽  
Burr Holes

Introduction Neurosurgical trainees should achieve competency in chronic subdural haematoma (CSDH) drainage at an early stage in training. The effect of surgeon seniority on recurrence following surgical drainage of CSDH was examined. Methods All CSDH cases performed at St George’s Hospital in London between March 2009 and March 2012 were analysed. Recurrence was defined as clinical deterioration with computed tomography evidence of CSDH requiring reoperation within six months. The following risk factors were considered: seniority of primary and supervising surgeons, timing of surgery (working hours, outside working hours), patient related factors (age, antiplatelets, warfarin) and operative factors (general vs local anaesthesia, burr holes vs craniotomy, drain use). For recurrent cases, we examined the distance of the cranial opening from the thickest part of the CSDH. Results A total of 239 patients (median age: 79 years, range: 33–98 years) had 275 CSDH drainage operations. The overall recurrence rate was 13.1%. The median time between the initial procedure and reoperation was 16 days (range: 1–161 days). The only statistically significant risk factor for recurrence was antiplatelets (odds ratio: 2.62, 95% confidence interval: 1.13–6.10, p<0.05). Warfarin, grade of surgeon, timing of surgery, type of anaesthesia, type of operation and use of drains were not significant risk factors. In 26% of recurrent CSDH cases, the burr holes or craniotomy flaps were placed with borderline accuracy. Conclusions CSDH drainage is a suitable case for neurosurgical trainees to perform without increasing the chance of recurrence.

scholarly journals Study of risk factors in post-laparotomy wound dehiscence

2018 ◽  
Vol 5 (7) ◽  
pp. 2513
Author(s):  
Siddharth Verma ◽  
Sagar Manohar Patil ◽  
Ankur Bhardwaj
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Wound Dehiscence ◽  
Clinical History ◽  
Duodenal Perforation ◽  
High Morbidity ◽  
Abdominal Wound ◽  
Mortality And Morbidity ◽  
Initial Surgery ◽  
Abdominal Wound Dehiscence

Background: Wound dehiscence/burst abdomen is a very serious post-operative complication associated with high morbidity and mortality. The need for this study is to highlight the risk factors for wound dehiscence and remedial measures to prevent or reduce the incidence of wound dehiscence. This will certainly reduce mortality and morbidity in the form of prolonged hospital stay, increased economic burden on health care resources.Methods: This is a prospective and observational study involving all those who have developed abdomen wound dehiscence after initial surgery, an elaborative study of these cases with regard to date of admission, clinical history regarding the mode of presentation, significant risk factors, investigations, time of surgery and type of surgery postoperatively, study of diagnosis and day of diagnosis of wound dehiscence is done till the patient is discharged from the hospital. The collected data is analysed and statistics were made according to need.Results: The incidence of abdominal wound dehiscence is more common in male patients in 4th to 5th decade. Patients with peritonitis due to duodenal perforation, complicated appendicitis, pyoperitoneum and intestinal obstruction and carried higher risk of abdominal wound dehiscence. Abdominal wound dehiscence was more common in patients operated in emergency. Patients with intra-abdominal infection, anaemia, hypoalbuminemia, jaundice had higher incidence of wound dehiscence.Conclusions: Wound dehiscence can be prevented by improving nutritional status of patient, proper surgical technique, controlling infections and correcting co-morbid conditions. 

scholarly journals Evaluation of Potential Risk Factors Causing Abdominal Wound Dehiscence

2020 ◽  
Vol 3 (1) ◽  
pp. 21-25
Author(s):  
Ajay Kumar Jha ◽  
Santosh Kumar ◽  
Ajit Kumar Sinha
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Wound Dehiscence ◽  
Clinical History ◽  
Duodenal Perforation ◽  
High Morbidity ◽  
Abdominal Wound ◽  
Initial Surgery ◽  
Abdominal Wound Dehiscence ◽  
Intra Abdominal Infection

Background: Wound dehiscence/burst abdomen is a very serious post-operative complication associated with high morbidity and mortality. The aim of this study was to highlight the risk factors for wound dehiscence and remedial measures to prevent or reduce the incidence of wound dehiscence. Subjects and Methods: This is a prospective and observational study involving all those who have developed abdomen wound dehiscence after initial surgery, an elaborative study of these cases with regard to date of admission, clinical history regarding the   mode of presentation, significant risk factors, investigations, time of surgery and type of surgery postoperatively, study of diagnosis and day   of diagnosis of wound dehiscence is done till the patient is discharged from the hospital. The collected data is analysed and statistics were  made according to need. Results: The incidence of abdominal wound dehiscence is more common in male patients in 4th to 5th decade. Patients with peritonitis due to duodenal perforation, complicated appendicitis, pyoperitoneum and intestinal obstruction carried higher risk of abdominal wound dehiscence. Abdominal wound dehiscence was more common in patients operated in emergency. Patients with intra-abdominal infection, anaemia, hypoalbuminaemia, jaundice had higher incidence of wound dehiscence. Conclusion: Wound dehiscence can be prevented by improving nutritional status of patient, proper surgical technique, controlling infections and correcting co-morbid conditions.

scholarly journals Risk Factors Associated with Diabetic Foot Disease in Diabetes Patients: First National Study in Oman

2021 ◽  
Vol 7 (2) ◽  
Author(s):  
Abdullah Rashid Al Jabri ◽  
Adhra Al Mawali
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Blood Cholesterol ◽  
National Study ◽  
Fisher Exact Test ◽  
Retrospective Case ◽  
Total Blood ◽  
Record System ◽  
Exact Test ◽  
Foot Disease

Objectives: The aim of this study is to identify the correlation betweenmultiple risk factors in the development of DFD in Oman. It also, aims to Identify the effect of having multiple significant risk factors on the disease progression and to explore which risk factor shows the highest correlation with disease development. Methods: A retrospective case–control study was conducted with 100patients and 200 controls. Data of the participants was extracted from hospital’s Electronic Patient Record System (Alshifa) from 2000 to 2018. Chi square, Fisher exact test,Odds Ratio and Multiple regression analysis were used to determine the significance of various risk factors. Rusults: Having a HbA1c > 7, Body Mass Index > 30 kg/m2 (BMI), and blood pressure over 140/90 mmHg showed a strong correlation with the development of DFD. Other risk factors such as age of diabetes, gender, total blood cholesterol, triglyceride levels, LDL, and HDL did not show anysignificant correlation with DFD.   Conclusion: Risk factors for DFD are highly prevalent in our society, controlling these risk factors could minimize the morbidity and the mortality related to this disease as well as reducing the economic impact related to it. Proper education for those at a higher risk could play an important role in the control of this disease.

Primary repair of multiligament knee injury with InternalBrace ligament augmentation

2022 ◽  
Vol 15 (1) ◽  
pp. e247173
Author(s):  
Paul Andre Paterson-Byrne ◽  
William Thomas Wilson ◽  
Graeme Philip Hopper ◽  
Gordon M MacKay
Keyword(s):  
Knee Injury ◽  
Primary Repair ◽  
Knee Dislocation ◽  
High Energy ◽  
Surgical Reconstruction ◽  
Ligament Augmentation ◽  
Multiligament Knee Injury ◽  
Returning To Work ◽  
Viable Approach ◽  
Arterial Damage

Multiligament injury of the knee usually occurs as a result of high-energy trauma causing tibiofemoral dislocation. These are rare but potentially limb-threatening injuries, frequently involving nerve or arterial damage and often leading to severe complex instability. Management generally favours surgical reconstruction of the affected ligaments, with controversy regarding optimal treatment. We present a severe multiligament knee injury (Schenk classification KD-IV involving both cruciate and both collateral ligaments) in a competitive showjumper. A combined arthroscopic/open technique of single-stage surgical repair and suture augmentation was used, repairing all affected ligaments. The patient made an excellent recovery, returning to work after 12 weeks and riding after 22 weeks. After 5-year follow-up, she has regained her previous level of competition without subsequent injury. Multiligament repair with suture augmentation is a viable approach to the management of knee dislocation injuries. We propose that this could provide superior outcomes to traditional reconstruction techniques using autograft or synthetic reconstruction.

Multiligament Knee Injury: Should Surgical Reconstruction Be Acute or Delayed?

2009 ◽  
pp. 648-658 ◽  
Author(s):  
JACQUELYN MARSH ◽  
LYNDSAY SOMERVILLE ◽  
J. ROBERT GIFFIN ◽  
DIANNE BRYANT
Keyword(s):  
Knee Injury ◽  
Surgical Reconstruction ◽  
Multiligament Knee Injury

Development and Assessment of Novel Multiligament Knee Injury Reconstruction Graft Constructs and Techniques

2020 ◽  
Author(s):  
James L. Cook ◽  
Cristi R. Cook ◽  
Chantelle C. Bozynski ◽  
Will A. Bezold ◽  
James P. Stannard
Keyword(s):  
Knee Injury ◽  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Lateral Collateral Ligament ◽  
Surgical Reconstruction ◽  
Collateral Ligament ◽  
Element Analysis ◽  
Posterior Oblique Ligament ◽  
Computed Tomographic ◽  
Multiligament Knee Injury

AbstractMultiligament knee injury (MLKI) typically requires surgical reconstruction to achieve the optimal outcomes for patients. Revision and failure rates after surgical reconstruction for MLKI can be as high as 40%, suggesting the need for improvements in graft constructs and implantation techniques. This study assessed novel graft constructs and surgical implantation and fixation techniques for anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), posterior medial corner (PMC), and posterior lateral corner (PLC) reconstruction. Study objectives were (1) to describe each construct and technique in detail, and (2) to optimize MLKI reconstruction surgical techniques using these constructs so as to consistently implant grafts in correct anatomical locations while preserving bone stock and minimizing overlap. Cadaveric knees (n = 3) were instrumented to perform arthroscopic-assisted and open surgical creation of sockets and tunnels for all components of MLKI reconstruction using our novel techniques. Sockets and tunnels with potential for overlap were identified and assessed to measure the minimum distances between them using gross, computed tomographic, and finite element analysis-based measurements. Percentage of bone volume spared for each knee was also calculated. Femoral PLC-lateral collateral ligament and femoral PMC sockets, as well as tibial PCL and tibial PMC posterior oblique ligament sockets, were at high risk for overlap. Femoral ACL and femoral PLC lateral collateral ligament sockets and tibial popliteal tendon and tibial posterior oblique ligament sockets were at moderate risk for overlap. However, with careful planning based on awareness of at-risk MLKI graft combinations in conjunction with protection of the socket/tunnel and trajectory adjustment using fluoroscopic guidance, the novel constructs and techniques allow for consistent surgical reconstruction of all major ligaments in MLKIs such that socket and tunnel overlap can be consistently avoided. As such, the potential advantages of the constructs, including improved graft-to-bone integration, capabilities for sequential tensioning of the graft, and bone sparing effects, can be implemented.

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