scholarly journals Optimal Treatment and Management of Proximal Fifth Metatarsal Fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0006
Author(s):  
Reinout Heijboer ◽  
Sofie Breuking ◽  
Noortje Hagemeijer ◽  
Daniel Guss ◽  
Christopher DiGiovanni
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Propensity Score ◽  
Conservative Treatment ◽  
Propensity Score Matching ◽  
Avulsion Fracture ◽  
Diaphyseal Fracture ◽  
Factors Associated ◽  
Metatarsal Fractures ◽  
Diaphyseal Fractures

Category: Midfoot/Forefoot Introduction/Purpose: Proximal fifth metatarsal fractures (PFMF) are among the most common fractures of the foot, and may be subdivided into tuberosity avulsion fracture, Jones fracture, and proximal diaphyseal fracture. However, for Jones fractures and proximal diaphyseal fractures optimal treatment is still debated in literature. The Torg criteria are used in deciding to treat surgically or conservative, whereby Torg type I and II indicates conservative treatment, and type III indicates surgical treatment. Yet failure rates of both management options vary and derive from small study groups. The aim of this study was to compare failure rates after surgical- and conservative treatment of Jones fractures and proximal diaphyseal fractures, to evaluate the incidence of treatment failure, and to assess factors associated with healing difficulties of PFMF. Methods: A total of 1,133 adult patients that were diagnosed and treated for PFMF between 2005 and 2015 in a tertiary care foot and ankle referral center were included. Retrospective chart review recorded patient demographics, suspected risk factors for impaired healing of PFMF (rheumatoid arthritis, diabetes mellitus, osteoporosis, nutritional and hormonal disorders, foot deformities, (neuropathic) arthropathy of the foot and/or ankle and peripheral neuropathy of the lower extremity), and treatment indication. Multivariable logistic regression analysis was used to determine factors associated with healing difficulties. Propensity score matching was used to minimize selection bias between treatments in Jones fractures and proximal diaphyseal fractures. Results: In total, 489(43.2%) patients were diagnosed with a tuberosity avulsion fracture, 391(34.5%) patients with a Jones fracture and 253(22.3%) patients with a proximal diaphyseal fracture. In the tuberosity fracture group, a nonunion was found in 5.3%(25/473) of the patients treated conservatively and in 0%(0/16) treated operatively. For the Jones fractures and proximal diaphyseal fractures the non-union rate for conservative treatment was 10%(35/337) and 5.9%(14/238), and for surgical treatment 11%(6/54) and 0%(0/15), respectively. No independent risk factors for complicating the healing process of PFMF were identified. With propensity score matching, 37 patients treated operatively were matched to 37 patients undergoing conservative treatment. The risk for a nonunion was lower in the operative group compared to the conservative treatment group (relative risk 0.8, P=0.006). Conclusion: In this propensity-matched cohort, surgical treatment for Jones fractures and proximal diaphyseal fractures were associated with better fracture healing compared to conservative treatment. In addition, no factors were found to be associated with healing difficulties of proximal fifth metatarsal fractures.

scholarly journals Effect of childhood overweight on distal metaphyseal radius fractures treated by closed reduction

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yu Liu ◽  
Chunjie Liu ◽  
Dongmei Guo ◽  
Ning Wang ◽  
Ying Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Conservative Treatment ◽  
Closed Reduction ◽  
Pediatric Population ◽  
Normal Weight ◽  
Medical Community ◽  
Overweight Children ◽  
Radius Fractures

Abstract Background The medical community has recognized overweight as an epidemic negatively affecting a large proportion of the pediatric population, but few studies have been performed to investigate the relationship between overweight and failure of conservative treatment for distal radius fractures (DRFs). This study was performed to investigate the effect of overweight on the outcome of conservative treatment for DRFs in children. Methods We performed a retrospective study of children with closed displaced distal metaphyseal radius fractures in our hospital from January 2015 to May 2020. Closed reduction was initially performed; if closed reduction failed, surgical treatment was performed. Patients were followed up regularly after treatment, and redisplacement was diagnosed on the basis of imaging findings. Potential risk factors for redisplacement were collected and analyzed. Results In total, 142 children were included in this study. The final reduction procedure failed in 21 patients, all of whom finally underwent surgical treatment. The incidences of failed final reduction and fair reduction were significantly higher in the overweight/obesity group than in the normal-weight group (P = 0.046 and P = 0.041, respectively). During follow-up, 32 (26.4%) patients developed redisplacement after closed reduction and cast immobilization. The three risk factors associated with the incidence of redisplacement were overweight/obesity [odds ratio (OR), 2.149; 95% confidence interval (CI), 1.320–3.498], an associated ulnar fracture (OR, 2.127; 95% CI, 1.169–3.870), and a three-point index of ≥ 0.40 (OR, 3.272; 95% CI, 1.975–5.421). Conclusions Overweight increases the risk of reduction failure and decreases the reduction effect. Overweight children were two times more likely to develop redisplacement than normal-weight children in the present study. Thus, overweight children may benefit from stricter clinical follow-up and perhaps a lower threshold for surgical intervention.

scholarly journals Mortality risk estimation in acute calculous cholecystitis: beyond the Tokyo Guidelines

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ana María González-Castillo ◽  
Juan Sancho-Insenser ◽  
Maite De Miguel-Palacio ◽  
Josep-Ricard Morera-Casaponsa ◽  
Estela Membrilla-Fernández ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Propensity Score ◽  
Mortality Risk ◽  
Characteristic Curve ◽  
Chronic Obstructive ◽  
Tokyo Guidelines ◽  
Acute Calculous Cholecystitis ◽  
Calculous Cholecystitis ◽  
Non Surgical Treatment

Abstract Background Acute calculous cholecystitis (ACC) is the second most frequent surgical condition in emergency departments. The recommended treatment is the early laparoscopic cholecystectomy; however, the Tokyo Guidelines (TG) advocate for different initial treatments in some subgroups of patients without a strong evidence that all patients will benefit from them. There is no clear consensus in the literature about who is the unfit patient for surgical treatment. The primary aim of the study is to identify the risk factors for mortality in ACC and compare them with Tokyo Guidelines (TG) classification. Methods Retrospective unicentric cohort study of patients emergently admitted with and ACC during 1 January 2011 to 31 December 2016. The study comprised 963 patients. Primary outcome was the mortality after the diagnosis. A propensity score method was used to avoid confounding factors comparing surgical treatment and non-surgical treatment. Results The overall mortality was 3.6%. Mortality was associated with older age (68 + IQR 27 vs. 83 + IQR 5.5; P = 0.001) and higher Charlson Comorbidity Index (3.5 + 5.3 vs. 0+2; P = 0.001). A logistic regression model isolated four mortality risk factors (ACME): chronic obstructive pulmonary disease (OR 4.66 95% CI 1.7–12.8 P = 0.001), dementia (OR 4.12; 95% CI 1.34–12.7, P = 0.001), age > 80 years (OR 1.12: 95% CI 1.02–1.21, P = 0.001) and the need of preoperative vasoactive amines (OR 9.9: 95% CI 3.5–28.3, P = 0.001) which predicted the mortality in a 92% of the patients. The receiver operating characteristic curve yielded an area of 88% significantly higher that 68% (P = 0.003) from the TG classification. When comparing subgroups selected using propensity score matching with the same morbidity and severity of ACC, mortality was higher in the non-surgical treatment group. (26.2% vs. 10.5%). Conclusions Mortality was higher in ACC patients treated with non-surgical treatment. ACME identifies high-risk patients. The validation to ACME with a prospective multicenter study population could allow us to create a new alternative guideline to TG for treating ACC. Trial registration Retrospectively registered and recorded in Clinical Trials. NCT04744441

scholarly journals Surgical Resection Significantly Promotes the Overall Survival of Patients with Hepatocellular Carcinoma: A Propensity Score Matching Analysis

2021 ◽  
Author(s):  
Pei-Min Hsieh ◽  
Hung-Yu Lin ◽  
Chao-Ming Hung ◽  
Gin-Ho Lo ◽  
I-Cheng Lu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Surgical Resection ◽  
Cox Regression ◽  
Survival Rates ◽  
Hbv Infection ◽  
Cox Regression Analysis

Abstract Background: The benefits of surgical resection (SR) for various Barcelona Clinic Liver Cancer (BCLC) stages of hepatocellular carcinoma (HCC) remain unclear. We investigated the risk factors of overall survival (OS) and survival benefits of SR over nonsurgical treatments in patients with HCC of various BCLC stages.Methods: Overall, 2316 HCC patients were included, and their clinicopathological data and OS were recorded. OS was analyzed by the Kaplan-Meier method and Cox regression analysis. Propensity score matching (PSM) analysis was performed.Results: In total, 66 (2.8%), 865 (37.4%), 575 (24.8%) and 870 (35.0%) patients had BCLC stage 0, A, B, and C disease, respectively. Furthermore, 1302 (56.2%) of all patients, and 37 (56.9%), 472 (54.6%), 313 (54.4%) and 480 (59.3%) of patients with BCLC stage 0, A, B, and C disease, respectively, died. The median follow-up duration time was 20 (range 0-96) months for the total cohort and was subdivided into 52 (8-96), 32 (1-96), 19 (0-84), and 12 (0-79) months for BCLC stages 0, A, B, and C cohorts, respectively. The risk factors for OS were 1) SR and cirrhosis; 2) SR, cirrhosis, and Child-Pugh (C-P) class; 3) SR, hepatitis B virus (HBV) infection, and C-P class; and 4) SR, HBV infection, and C-P class for the BCLC stage 0, A, B, and C cohorts, respectively. Compared to non-SR treatment, SR resulted in significantly higher survival rates in all cohorts. The 5-year OS rates for SR vs non-SR were 44.0% vs 28.7%, 72.2% vs 42.6%, 42.6% vs 36.2, 44.6% vs 23.5%, and 41.4% vs 15.3% (all p-values<0.05) in the total and BCLC stage 0, A, B, and C cohorts, respectively. After PSM, SR resulted in significantly higher survival rates compared to non-SR treatment in various BCLC stages.Conclusion: SR conferred significant survival benefits to patients with HCC of various BCLC stages and should be considered a recommended treatment for select HCC patients, especially patients with BCLC stage B and C disease.

scholarly journals The effect of prophylactic hemoclip placement and risk factors of delayed post-polypectomy bleeding in polyps sized 6 to 20 millimeters: a propensity score matching analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Chun-Wei Chen ◽  
Chia-Jung Kuo ◽  
Cheng-Tang Chiu ◽  
Ming-Yao Su ◽  
Chun-Jung Lin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Major Complication ◽  
Potential Bias ◽  
Polyp Size ◽  
Propensity Score Matching Analysis ◽  
History Of ◽  
Snare Polypectomy

Abstract Background Delayed post-polypectomy bleeding (PPB) is a major complication of polypectomy. The effect of prophylactic hemoclipping on delayed PPB is uncertain. The aim of this study was to evaluate the effectiveness of prophylactic hemoclipping and identify the risk factors of delayed PPB. Methods Patients with polyps sized 6 to 20 mm underwent snare polypectomy from 2015 to 2017 were retrospectively reviewed. The patients with prophylactic hemoclipping for delayed PPB prevention were included in the clipping group, and those without prophylactic hemoclipping were included in the non-clipping group. The incidence of delayed PPB and time to bleeding were compared between the groups. Multivariate analysis was used to identify the risk factors of delayed PPB. Propensity score matching was used to minimize potential bias. Results After propensity score matching, 612 patients with 806 polyps were in the clipping group, and 576 patients with 806 polyps were in the non-clipping group. There were no significant differences in the incidence of delayed PPB and days to bleeding between two groups (0.8% vs 1.3%, p = 0.4; 3.4 ± 1.94 days vs 4.13 ± 3.39 days, p = 0.94). In the multivariate analysis, the polyp size [Odds ratio (OR):1.16, 95% confidence interval (CI):1.01–1.16, p = 0.03), multiple polypectomies (OR: 4.64, 95% CI:1.24–17.44, p = 0.02) and a history of anticoagulant use (OR:37.52, 95% CI:6.49–216.8, p < 0.001) were associated with delayed PPB. Conclusions In polyps sized 6 to 20 mm, prophylactic hemoclip placement did not decrease the risk of delayed PPB. Patients without risk factors including multiple polypectomies and anticoagulant use are no need to performing prophylactic hemoclipping.

Risk factors associated with the severity of adverse drug reactions by Xiyanping injection: A propensity score-matched analysis

2020 ◽  
Vol 250 ◽  
pp. 112424 ◽  
Author(s):  
Rui Zheng ◽  
Liyuan Tao ◽  
Joey S.W. Kwong ◽  
Changming Zhong ◽  
Chengyu Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Propensity Score ◽  
Adverse Drug Reactions ◽  
Drug Reactions ◽  
Factors Associated

scholarly journals The Risk Factors Associated with Nonunion after Surgical Treatment for Distal Fibular Fractures

2018 ◽  
Vol 22 (3) ◽  
pp. 95
Author(s):  
Jun Young Lee ◽  
Kwi Youn Choi ◽  
Sinwook Kang ◽  
Kang Yeol Ko
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Factors Associated

scholarly journals Impact of Preexisting Cognitive Impairment and Race/Ethnicity on Functional Outcomes Following Intracerebral Hemorrhage

Stroke ◽  
2021 ◽  
Vol 52 (2) ◽  
pp. 603-610
Author(s):  
Russell P. Sawyer ◽  
Eunji Yim ◽  
Elisheva Coleman ◽  
Stacie L. Demel ◽  
Padmini Sekar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Propensity Score ◽  
Intracerebral Hemorrhage ◽  
Propensity Score Matching ◽  
Scale Score ◽  
Functional Outcomes ◽  
Cognitively Impaired ◽  
Modified Rankin Scale ◽  
Race Ethnicity

Background and Purpose: In intracerebral hemorrhage (ICH), preexisting cognitive impairment has been identified as a risk factor for increased mortality and morbidity. However, previous studies examined predominantly White populations; therefore, the prevalence and effect of preICH cognitive impairment has not been studied in a multiethnic cohort. This limits the generalizability of previous findings. We sought to investigate the role of preexisting cognitive impairment in a multiethnic population on short-term mortality and functional outcomes after ICH. Methods: Patients with ICH were prospectively enrolled as cases for the GERFHS III (Genetic and Environmental Risk Factors for Hemorrhagic Stroke) Study and the Ethnic/Racial Variations of ICH (ERICH) Study. Cognitive impairment before ICH was defined as positive history of dementia or treatment with donepezil, galantamine, memantine, or rivastigmine on chart abstraction or baseline interview. Specific outcomes—modified Rankin Scale score at 3 months (0–2 versus ≥3), Barthel Index score (<100 versus 100) at 3 months, and withdrawal of care—were analyzed using multivariable logistic regression. Propensity score matching and analysis was done because of imbalances between cognitively impaired and cognitively intact groups. Results: Of the 3537 cases of ICH, 304 patients had cognitive impairment predating ICH. Cognitively impaired subjects were more likely to experience withdrawal of care during hospitalization, and for survivors, greater disability (modified Rankin Scale score of ≥3) and lower Barthel scores after ICH. After propensity score matching, preexisting cognitive impairment was associated with a lower modified Rankin Scale at 3 months in the White, Black, and Hispanic subgroups. Conclusions: Preexisting cognitive impairment was associated with loss of independence 3-month post-ICH, when matching for risk factors of cognitive impairment, in the White, Black, and Hispanic subgroups. This suggests that preexisting cognitive impairment has a negative effect in obtaining functional independence following ICH, irrespective of race/ethnicity.

scholarly journals Risk Factor Analysis of Brucellosis in Hulunbuir, China, Using the Propensity Score Matching Method

2021 ◽  
Vol 14 (6) ◽  
Author(s):  
Li Peng ◽  
Xiuwen Liang ◽  
Lei Zhu ◽  
Chen Liang ◽  
Chenfang Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Disease Transmission ◽  
Large Scale ◽  
Zoonotic Diseases ◽  
Protective Measures ◽  
Risk Of Disease ◽  
Self Protection ◽  
Epidemiological Characteristics

Background: Brucellosis is the most widespread zoonosis worldwide and one of the most neglected zoonotic diseases. At present, large-scale farms are growing rapidly, increasing the risk of disease transmission. Objectives: In this study, the propensity score matching (PSM) method was used to analyze the epidemiological characteristics of brucellosis and explore the risk factors of brucellosis infection in Hulunbuir, Inner Mongolia, China. Methods: A questionnaire for brucellosis was designed based on general knowledge and the protection of key groups of brucellosis. Epidata 13.0 software was used to establish the questionnaire, and propensity score matching was used to select cases that met the requirements of case-controls. Results: A total of 152 cases and 456 controls were included. The results of the study show that feeding livestock, carrying lambs regularly, and raising livestock without protective measures can increase the risk of brucellosis infection. Conclusions: Behavioral factors are the main risk factors for brucellosis, and livestock keepers should strengthen self-protection when working.

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