scholarly journals True Antiglide Fixation of Weber B Ankle Fractures has Lower Rates of Removal of Hardware

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0019
Author(s):  
Graham J. DeKeyser ◽  
Patrick Kellam ◽  
Thomas F. Higgins ◽  
David Rothberg ◽  
Justin Haller ◽  
...  
Keyword(s):  
Relative Risk ◽  
Average Length ◽  
Lateral Malleolus ◽  
Hardware Removal ◽  
Bony Union ◽  
Distal Fragment ◽  
Lateral Plate ◽  
Distal Screw ◽  
Plate Group

Category: Trauma; Ankle Introduction/Purpose: Plating of unstable OTA/AO 44-B1 lateral malleolus fractures has been associated with pain, peroneal irritation, and subsequent hardware removal. There has been speculation that this is due to the prominent plate and distal screw placement. Previous studies have looked at posterior vs lateral plate position but have had fairly low numbers in each group. The purpose of this study was to retrospectively compare the rates of hardware removal in unstable OTA/AO-type 44-B1 lateral malleolus fractures fixed with a posterior, true anti-glide plate with no screws in the distal segment versus those that were fixed with a similarly placed posterior, neutralization construct that included screws in the distal fragment thus evaluating the role of the distal screw in rates of hardware removal. Methods: Skeletally mature patients that were treated for an isolated OTA/AO 44-B1 fracture over a ten-year period (2007- 2017) were reviewed. Fractures treated with a single posterior plate were included and those fixed with a direct lateral plate were excluded. We evaluated post-op radiographs to determine application of a true anti-glide plate or a neutralization plate with screws in the distal fragment. Radiographic follow-up was used to determine bony union, malunion and need for hardware removal. Hardware removal was determined as entire plate removal; isolated syndesmotic screw removal was not included. Patients were excluded if they had less than six months of follow up. Relative risk was determined for the rate of hardware removal based on fixation technique. Results: There were 548 OTA/AO 44-B1 fractures treated over the course of ten years (2007-2017). After screening, 88 patients were included in the study. The majority of excluded patients lacked adequate follow-up. Average age of the cohort was 46 years old (range 17-84), with 47 females and 41 males included. Average length of follow up was forty months (range 6.1- 140.3). There were 28 patients in the true anti-glide plate group and sixty in the neutralization plate group. Five (18%) in the anti- glide plate group and 19 (32%) in the neutralization plate underwent a second procedure of hardware removal. Relative risk of hardware removal was 0.56 (95% CI 0.23-1.36, p=0.2). There was a 100% union rate with 0% malunion in both groups. Conclusion: Anti-glide plating has a near 50% relative risk reduction in the rate of hardware removal when compared to posterior based neutralization plating. Fractures fixed with or without distal screws had equivalent excellent results related to bony union and alignment. A true anti-glide plating construct should be considered as a safe and effective way of managing OTA/AO 44-B1 lateral malleolus fractures with a lower relative risk of a second operation for hardware removal.

Osteonecrosis of the Talus: Treatment by Hindfoot Fusion

1996 ◽  
Vol 17 (5) ◽  
pp. 275-282 ◽  
Author(s):  
Marc W. Urquhart ◽  
Michael A. Mont ◽  
James D. Michelson ◽  
Kenneth A. Krackow ◽  
David S. Hungerford
Keyword(s):  
Chronic Osteomyelitis ◽  
Average Length ◽  
Excellent Result ◽  
Bony Union ◽  
Intravenous Antibiotics ◽  
Long Time ◽  
Subsequent Revision ◽  
Cosmetic Outcomes ◽  
Hindfoot Fusion

The results were reviewed for 11 ankles (10 patients) that had been treated with various hindfoot arthrodeses because of symptomatic osteonecrosis of the talus. Follow-up averaged 6.5 years (range, 2–15 years). A functional assessment using a modified Mazur grading system was performed both before surgery and at final follow-up. Data were also collected on the duration of the procedure, intraoperative findings, and the patient's assessment of postoperative cosmesis (excellent, good, fair, or poor). Radiographs were analyzed to determine the interval from the procedure until bony union. Nine of the 11 arthrodeses (82%) fused with the primary procedure and achieved excellent Mazur ratings (mean, 86 points; range, 81–90 points). The average interval until radiographic fusion was 7 months (range, 4–13 months). All eight patients (nine fusions) with successful fusions graded their cosmetic outcomes as excellent or good. The average length of the procedure was 148 minutes (range, 130–300 minutes), compared with an average of 92 minutes (range, 62–151 minutes) for ankle arthrodeses performed by the same surgeons in rheumatoid or osteoarthritic ankles ( P < 0.001) and 102 minutes (range, 75–164 minutes) from a report in the literature. Two of the procedures were complicated by nonunions secondary to infections. In one patient, after treatment by debridement and intravenous antibiotics, reinfection and chronic osteomyelitis developed with a subsequent below-knee amputation. The other patient was treated successfully with debridement, antibiotics, and subsequent revision arthrodesis, which fused solidly at 9 months with an excellent result. We conclude that hindfoot arthrodeses for osteonecrosis can be technically demanding, but, despite having a long time to bony union, they can have an excellent clinical outcome.

Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽  
2002 ◽  
Vol 8 (6) ◽  
pp. 255-258 ◽  
Author(s):  
Perruchoud ◽  
Vuilleumier ◽  
Givel
Keyword(s):  
Hospital Stay ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Healing Time ◽  
Incision And Drainage ◽  
The Mean ◽  
Primary Healing

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

scholarly journals Analysis of the relationship between surgeon procedure volume and complications after total knee arthroplasty using a propensity-matched cohort study

2021 ◽  
Vol 3 (1) ◽  
pp. e000072
Author(s):  
Tosan Okoro ◽  
Sebastian Tomescu ◽  
J Michael Paterson ◽  
Bheeshma Ravi
Keyword(s):  
Total Knee Arthroplasty ◽  
Cohort Study ◽  
Relative Risk ◽  
Knee Arthroplasty ◽  
Deep Infection ◽  
Matched Cohort ◽  
Surgical Infection ◽  
Matched Cohort Study ◽  
Total Knee

ObjectivesThis study aimed to identify a threshold in annual surgeon volume associated with increased risk of revision (for any cause) and deep infection requiring surgery following primary elective total knee arthroplasty (TKA).DesignA propensity score matched cohort study.SettingOntario, Canada.Participants169 713 persons who received a primary TKA between 2002 and 2016, with 3-year postoperative follow-up.Main outcome measuresRevision arthroplasty (for any cause), and the occurrence of deep surgical infection requiring surgery.ResultsBased on restricted cubic spline analysis, the threshold for increased probability of revision and deep infection requiring surgery was <70 cases/year. After matching of 51 658 TKA recipients from surgeons performing <70 cases/year to TKA recipients from surgeons with greater than 70 cases/year, patients in the former group had a higher rate of revision (for any cause, 2.23% (95% Confidence Interval (CI) 1.39 to 3.07) vs 1.70% (95% CI 0.85 to 2.55); Hazard Ratio (HR) 1.33, 95% CI 1.21 to 1.47, p<0.0001) and deep infection requiring surgery (1.29% (95% CI 0.44 to 2.14) vs 1.09% (95% CI 0.24 to 1.94); HR 1.33, 95% CI 1.17 to 1.51, p<0.0001).ConclusionsFor primary TKA recipients, cases performed by surgeons who had performed fewer than 70 TKAs in the year prior to the index TKA were at 31% increased relative risk of revision (for any cause), and 18% increased relative risk for deep surgical infection requiring surgery, at 3-year follow-up.

scholarly journals Risk Factors for Non-union in First MTPJ Arthrodesis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0035 ◽  
Author(s):  
Andrew Molloy ◽  
Clifford Butcher ◽  
Lyndon Mason
Keyword(s):  
Risk Factors ◽  
Relative Risk ◽  
Hallux Valgus ◽  
Locking Plate ◽  
Univariate Analysis ◽  
Dorsal Plate ◽  
First Metatarsophalangeal Joint ◽  
Non Union ◽  
Severe Hallux Valgus

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus occurs in up to 1 in 40 adults with 1st MTPJ arthrodesis being the gold standard operation for advanced disease. Our aim was to retrospectively identify risk factors for delayed / non-union of first metatarsophalangeal joint arthrodesis using a dorsal plate with cross screw. Methods: Case note and radiograph analysis was performed for operations between April 2014 and April 2016 with at least 6 months post-operative follow up. Union was defined as bridging bone across the fusion site on AP and lateral radiographic views with no movement or pain at the MTPJ on examination. All patients operations were performed or directly supervised by one of three fellowship trained consultant foot surgeons. Surgery was performed through a dorsal approach using a dorsal locking plate with compression screw. Blinded preoperative AP radiographs were analysed for the presence of a severe hallux valgus angle equal to or above 40 degrees. Intra-observer reliability was acceptable (95% CI: 1.6-2.3 degrees). Smoking and co-morbidities underwent univariate analysis for significance. Following initial result results, surgery in patients with arthritic hallux valgus were fixed using a separate plantar to dorsal / medial to lateral lag screw and dorsal locking plate Results: 71 patients with a mean age of 61 years (range, 29 to 81) comprised the initial patient group. Mean follow up time was 13 months for both union and nonunion groups (range 6 to 30 months). 7 patients were identified as delayed or nonunion (9.9%). All had hallux valgus angles of >25%. Age, diabetes, COPD and rheumatoid arthritis did not show significant associations with non-union. All smokers progressed to union (n = 17). Moderate to severe hallux valgus (relative risk: 1.29, p < 0.005) and under correction of >25 valgus at the MTPJ (relative risk: 14.44, p < 0.001) were significantly associated with non/delayed union. In the second group, 18 patients of similar demographics, there were no failure of reductions and 100% union rate Conclusion: Preoperative moderate to severe hallux valgus and under-correction of deformity are the most significant risk factors for non-union. The construct used for fixation needs to be chosen on the basis of the deforming forces. If so, excellent union rates can be achieved

scholarly journals Use of antidepressants among Finnish family caregivers: a nationwide register-based study

2021 ◽  
Author(s):  
Tuija M. Mikkola ◽  
Hannu Kautiainen ◽  
Minna Mänty ◽  
Mikaela B. von Bonsdorff ◽  
Hannu Koponen ◽  
...  
Keyword(s):  
Relative Risk ◽  
Family Caregivers ◽  
High Intensity ◽  
Matched Control ◽  
Age Groups ◽  
Control Population ◽  
Defined Daily Doses ◽  
Male Caregivers ◽  
And Gender

Abstract Purpose The purpose of this study was to compare the use of antidepressants over 6 years between family caregivers providing high-intensity care and a matched control population using register-based data. Methods The study includes all individuals, who received family caregiver’s allowance in Finland in 2012 (n = 29,846 females, mean age 66 years; n = 12,410 males, mean age 71 years) and a control population matched for age, sex, and municipality of residence (n = 59,141 females; n = 24,477 males). Information on purchases of antidepressants, including the number of defined daily doses (DDD) purchased, between 2012 and 2017 was obtained from the national drugs reimbursement register. Results During the follow-up, 28.5% of female caregivers and 23.5% of the female controls used antidepressants, while the numbers for males were 21.1% and 16.4%, respectively. Adjusted for socioeconomic status, female caregivers used 43.7 (95% confidence interval 42.4–45.0) and their controls used 36.2 (35.3–37.2) DDDs of antidepressants per person-year. Male caregivers used 29.6 (27.6–31.6) and their controls used 21.6 (20.2–23.0) DDDs of antidepressants per person-year. Among female caregivers, the relative risk for use of antidepressants was similar (about 1.3) from 20 to 70 years, after which the relative risk declined. In male caregivers, the relative risk was highest (about 1.4–1.5) between 45 and 65 years. Conclusions Family caregivers providing high-intensity care use more antidepressants and hence, are likely to have poorer mental health than the age-matched general population in virtually all age groups. However, the magnitude of the higher use varies as a function of age and gender.

scholarly journals Why do frail patients with chronic heart failure die and become hospitalised?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Sze ◽  
P Pellicori ◽  
J Zhang ◽  
J Weston ◽  
A.L Clark
Keyword(s):  
Heart Failure ◽  
Cause Of Death ◽  
Hospital Admissions ◽  
Average Length ◽  
Significant Proportion ◽  
Length Of Hospital Stay ◽  
Clinical Frailty Scale ◽  
Frail Patients ◽  
Increased Risk

Abstract Background Frailty is common in patients with heart failure (HF) and is associated with increased morbidity and mortality. A better understanding of the causes of hospitalisations and death in frail patients might help to tailor interventional strategies for these at-risk patients. Purpose We studied the cause of death and hospitalisations in ambulatory patients with HF and frailty. Methods We assessed frailty using the clinical frailty scale (CFS) in consecutive HF patients attending a routine follow-up visit. Those with CFS ≥5 were classified as frail. Mortality and hospitalisations were ascertained from medical records (updated systematically using an NHS electronic database), discharge letters, autopsy reports and death certificates. We studied the primary cause of death and hospitalisations within one year of enrolment. Results 467 patients (67% male, median (IQR) age 76 (69–82) years, median (IQR) NT-proBNP 1156 (469–2463) ng/L) were enrolled. 206 (44%) patients were frail. Frail patients were more likely to not receive or receive suboptimal doses of ACEi/ARB and Beta-blockers; while non-frail patients were more likely to be treated with optimal doses. At 1-year follow up, there were 56 deaths and 322 hospitalisations, of which 46 (82%) and 215 (67%) occurred in frail patients. Frailty was associated with an increased risk of all-cause mortality (HR (95% CI): 4.27 (2.60–7.01)) and combined mortality/ hospitalisation (HR (95% CI): 2.85 (2.14–3.80)), all p&lt;0.001. 57% (n=26) of frail patients died of cardiovascular causes (of which 58% were due to HF progression); although deaths due to non-cardiovascular causes (43%, n=20), especially severe infections, were also common (26%, n=12). (Figure 1) The proportion of frail patients who had non-elective hospital admissions within 1 year was more than double that of non-frail patients (46% (n=96) vs 21% (n=54); p&lt;0.001). Compared to non-frail patients, frail patients had more recurrent (≥2) hospitalisations (28% (n=59) vs 9% (n=24); p&lt;0.001) but median (IQR) average length of hospital stay was not significantly different (frail: 6 (4–11) vs non-frail: 6 (2–12) days, p=0.50). A large proportion of hospitalisations (64%, n=137) in frail patients were due to non-cardiovascular causes (of which 34%, 30% and 20% were due to infections, falls and comorbidities respectively). Of cardiovascular hospitalisations (36%, n=78), the majority were due to decompensated HF (67%, n=46). (Figure 1) Conclusion Frailty is common in patients with HF and is associated with an increased risk of mortality and recurrent hospitalisations. A significant proportion suffered non-cardiovascular deaths and hospitalisations. This implies that interventions targeted at HF alone can only have limited impact on outcomes in frail patients. Figure 1 Funding Acknowledgement Type of funding source: None

Posterior Lumbar Interbody Fusion Using an En-Bloc Resected Lamina as an Interbody Spacer in Combination with Spinal Instruments

1998 ◽  
Vol 02 (04) ◽  
pp. 325-332
Author(s):  
Shigeru Hirabayashi ◽  
Kiyoshi Kumano ◽  
Takeshi Uchida
Keyword(s):  
Interbody Fusion ◽  
Spinous Process ◽  
Degenerative Spondylolisthesis ◽  
Spinal Instrumentation ◽  
Posterior Lumbar Interbody Fusion ◽  
Bony Union ◽  
Lumbar Interbody Fusion ◽  
En Bloc ◽  
Time Of Operation

We developed a new method of posterior lumbar interbody fusion (PLIF) using an en-bloc resected lamina with or without a hydroxyapatite block as an interbody spacer instead of auto-iliac bone, in combination with rigid-type spinal instrumentation. The purpose of this study was to evaluate the effectiveness of our method. There were 23 patients (13 males, 10 females, age at the time of operation: 21–71 years, mean 50.5 years; follow-up: 1–4 years, mean 2 years and 3 months). In 10 patients with spondylolitic spondylolisthesis and 3 patients with spondylolysis, the floating lamina was resected enbloc by mid-line splitting. In 7 patients with degenerative spondylolisthesis and 3 patients with unstable spine, a cleavage was made at the isthmus and then the complex of lamina and inferior spinous process was resected en-bloc. Seventeen patients with olisthesis underwent reduction. PLIF was performed at the L4/L5 level in 10 patients and the L5/S1 level in 13 patients. Sixteen patients with preoperative low back pain recovered, except for one patient with instability at the adjacent vertebra. All of the seven patients with preoperative gait disturbance recovered. The ratio of olisthesis changed from preoperative 30% to postoperative 18% on average. Good bony union was obtained in both the patients with and those without a hydroxyapatite spacer. Posterior lumbar interbody fusion using an en-bloc resected lamina as an interbody spacer in combination with rigid-type spinal instrumentation was useful.

scholarly journals Daily sodium consumption and CVD mortality in the general population: systematic review and meta-analysis of prospective studies

2014 ◽  
Vol 18 (4) ◽  
pp. 695-704 ◽  
Author(s):  
Rosana Poggio ◽  
Laura Gutierrez ◽  
María G Matta ◽  
Natalia Elorriaga ◽  
Vilma Irazola ◽  
...  
Keyword(s):  
Systematic Review ◽  
Relative Risk ◽  
General Population ◽  
Prospective Studies ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Random Effects Models ◽  
Meta Regression ◽  
Cvd Mortality

AbstractObjectiveThe purpose of the present study was to determine whether elevated dietary Na intake could be associated with CVD mortality.DesignWe performed a systematic review and meta-analysis of prospective studies representing the general population. The adjusted relative risks and their 95 % confidence intervals were pooled by the inverse variance method using random-effects models. Heterogeneity, publication bias, subgroup and meta-regression analyses were performed.SettingsMEDLINE (since 1973), Embase (since 1975), the Cochrane Library (since 1976), ISI Web of Science, Google Scholar (until September 2013) and secondary referencing were searched for inclusion in the study.SubjectEleven prospective studies with 229 785 participants and average follow-up period of 13·37 years (range 5·5–19 years).ResultsHigher Na intake was significantly associated with higher CVD mortality (relative risk=1·12; 95 % CI 1·06, 1·19). In the sensitivity analysis, the exclusion of studies with important relative weights did not significantly affect the results (relative risk=1·08; 95 % CI 1·01, 1·15). The meta-regression analysis showed that for every increase of 10 mmol/d in Na intake, CVD mortality increased significantly by 1 % (P=0·016). Age, hypertensive status and length of follow-up were also associated with increased CVD mortality.ConclusionsHigher Na intake was associated with higher CVD mortality in the general population; this result suggests a reduction in Na intake to prevent CVD mortality from any cause.

scholarly journals Repetition of deliberate self-harm and subsequent suicide risk: Long-term follow-up study of 11 583 patients

2004 ◽  
Vol 185 (1) ◽  
pp. 70-75 ◽  
Author(s):  
Daniel Louis Zahl ◽  
Keith Hawton
Keyword(s):  
Relative Risk ◽  
Suicide Risk ◽  
Single Episode ◽  
Deliberate Self Harm ◽  
Young Females ◽  
Follow Up Study ◽  
Increased Risk ◽  
Self Harm

BackgroundRepetition of deliberate self-harm (DSH) is a risk factor for suicide. Little information is available on the risk for specific groups of people who deliberately harm themselves repeatedly.AimsTo investigate the long-term risk of suicide associated with repetition of DSH by gender, age and frequency of repetition.MethodA mortality follow-up study to the year 2000 was conducted on 11583 people who presented to the general hospital in Oxford between 1978 and 1997. Repetition of DSH was determined from reported episodes prior to the index episode and episodes presenting to the same hospital during the follow-up period. Deaths were identified through national registers.ResultsThirty-nine percent of patients repeated the DSH. They were at greater relative risk of suicide than the single-episode DSH group (2.24; 95% CI 1.77–2.84). The relative risk of suicide in the repeated DSH group compared with the single-episode DSH group was greater in females (3.5; 95% C11.3–2.4) than males (1.8; 95% C1 2.3–5.3) and was inversely related to age (up to 54 years). Suicide risk increased further with multiple repeat episodes of DSH in females.ConclusionsRepetition of DSH is associated with an increased risk of suicide in males and females. Repetition may be a better indicator of risk in females, especially young females.

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