scholarly journals The Perceived Effectiveness of a Short-term Orthopaedic Foot and Ankle Mission Trip to Kenya

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0023
Author(s):  
Eric C. Gokcen ◽  
Joshua C. Luginbuhl ◽  
Joshua C. Luginbuhl
Keyword(s):  
Orthopaedic Surgery ◽  
Ankle Instability ◽  
Foot And Ankle ◽  
Perceived Effectiveness ◽  
Educational Impact ◽  
Short Term ◽  
Surgical Mission ◽  
Ankle Surgery ◽  
Orthopaedic Residency ◽  
The Impact

Category: Other Introduction/Purpose: Short-term surgical mission trips have become increasingly common, with many benefits seen by the hosts and the visitors when trips are done properly. However, few visitors ever attempt to measure the impact of their visit other than to list the surgeries that were performed. This study was performed to determine the perceived educational impact on orthopaedic attendings and residents of a Kenyan internationally accredited orthopaedic residency program and to determine the hosts’ opinions on the effectiveness of orthopaedic short-term trips. Methods: A survey was developed and distributed to four host attending surgeons and 9 host residents at the beginning of an orthopaedic mission trip. The visitors included four attending orthopaedic foot and ankle surgeons from various US sites, and two orthopaedic surgery residents from one US program. Using a scale from 1-10, with 1 meaning definitely No, and 10 meaning definitely Yes, hosts were asked if they felt there was a need for more foot and ankle training in Kenya. A post-trip survey was distributed to the host attendings and residents to determine perceived competency in five topics of foot and ankle pathology. Results: When hosts were asked if they felt there was a need for more foot and ankle training in Kenya, attendings responded an average 8.3, and residents 9.4. When asked if a short-term trip would improve foot and ankle care for the community, attendings responded 7.8, and residents 7.9. A post-trip survey was completed by one attending and 3 residents to determine their perceived competency in five topics of foot and ankle pathology. Overall, they averaged an increase of +2.0 on the scale in their competency for all topics. The highest increase was with ankle instability and hallux valgus at +3.0, and the lowest increase was with Achilles pathology at +0.75. Conclusion: The survey supported the hypothesis that short-term orthopaedic foot and ankle surgery trips to this program are helpful according to the hosts. Furthermore, understanding the competencies of the hosts can help the visitors develop more impactful teaching by focusing on the topics of need. Further studies such as this should be routinely performed with medical trips to help determine their effectiveness.

Excess Opioid Disposal Following Orthopaedic Surgery: A Randomized Clinical Trial

2020 ◽  
pp. 193864002098092
Author(s):  
Cornelia Keyser ◽  
Abhiram Bhashyam ◽  
Abdurrahman Abdurrob ◽  
Jeremy T. Smith ◽  
Eric Bluman ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Orthopaedic Surgery ◽  
Control Group ◽  
Foot And Ankle ◽  
Opioid Medication ◽  
Ankle Surgery ◽  
Randomized Control ◽  
Level I ◽  
To Receive ◽  
Experimental Group

Background Previous research indicates low disposal rates of excess postoperative narcotics, leaving them available for diversion or abuse. This study examined the effect of introducing a portable disposal device on excess opiate opioid disposal rates after lower extremity orthopaedic surgery. Methods This was a single site randomized control trial within an outpatient orthopaedic clinic. All patients 18 years or older, undergoing outpatient foot and ankle surgery between December 1, 2017 and August 1, 2018 were eligible. Patients were prospectively enrolled and randomized to receive standard opioid disposal instructions or a drug deactivation device at 2-week postoperative appointments. Participants completed an anonymous survey at 6-week postoperative appointments. Results Of the 75 patients surveyed, 68% (n = 26) of the experimental group and 56% (n = 21) of the control group had unused opioid medication. Of these, 84.6% of patients who were given Deterra Drug Deactivation System deactivation pouches safely disposed of excess medication, compared with 38% of controls (P = .003). When asked if they would use a disposal device for excess medication in the future, 97.4% (n = 37) of the experimental and 83.8% (n = 31) of the control group reported that they would. Conclusions Providing a portable disposal device with postoperative narcotic prescriptions may increase safe disposal rates of excess opioid medication following lower extremity orthopaedic surgery. Levels of Evidence Level I

scholarly journals Medical Malpractice Trends in Foot and Ankle Surgery

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0004
Author(s):  
Rishin J. Kadakia ◽  
Keith Orland ◽  
Akhil Sharma ◽  
Jie Chen ◽  
Craig C. Akoh ◽  
...  
Keyword(s):  
Medical Malpractice ◽  
Orthopaedic Surgery ◽  
Nonoperative Treatment ◽  
Anatomical Location ◽  
Foot And Ankle ◽  
Common Complication ◽  
Adult Females ◽  
Forefoot Surgery ◽  
Ankle Surgery ◽  
Malpractice Claims

Category: Other Introduction/Purpose: Medical malpractice lawsuits can place significant economic and psychologic burden on a provider. Orthopaedic surgery is one of the most common subspecialties involved in malpractice claims. There is currently no study examining malpractice lawsuits within foot and ankle surgery. Accordingly, the purpose of this work is to examine trends in malpractice claims in foot and ankle surgery. Methods: The Westlaw legal database was queried for lawsuits pertaining to foot and ankle surgery from 2008 to 2018. Only cases involving medical malpractice were included for analysis. All available details pertaining to the cases were collected. This included plaintiff demographic and geographic data. Details regarding the cases were also collected such as anatomical location, pathology, complications, and case outcomes. Results: Forty nine malpractice lawsuits pertaining to foot and ankle were identified. Most plaintiffs in these cases were adult females, and the majority of cases occurred in the northeast (53.1%). The most common anatomical region involved in claims involved the forefoot (29%). The majority of these claims involved surgery (65%). Infection was the most common complication seen in claims (22%). The jury ruled in favor of the defendant surgeon in most cases (73%). Conclusion: This is the first study to examine trends in medical malpractice within foot and ankle surgery. Infection was the most frequent complication seen in claims and forefoot surgery was the most common anatomic location. A large portion of claims resulted after nonoperative treatment. A better understanding of the trends within malpractice claims is crucial to developing strategies for prevention.

Variability in Foot and Ankle Case Volume in Orthopaedic Residency Training

2017 ◽  
Vol 10 (6) ◽  
pp. 531-537 ◽  
Author(s):  
Steven F. DeFroda ◽  
Joseph A. Gil ◽  
Brad D. Blankenhorn ◽  
Alan H. Daniels
Keyword(s):  
Orthopaedic Surgery ◽  
Rapid Development ◽  
Foot And Ankle ◽  
Case Volume ◽  
New Techniques ◽  
Surgical Residency ◽  
Surgical Case ◽  
Orthopaedic Residency ◽  
Case Logs ◽  
Ankle And Foot

Surgical case volume during orthopaedic surgical residency is a concern among trainees and program directors alike. With an ongoing trend toward further subspecialization and the rapid development of new techniques and devices, the breadth of procedures that residents are exposed to continues to increase. Accreditation Council for Graduate Medical Education surgical case logs from 2009 to 2013 for graduating orthopaedic surgery residents were examined to assess the national averages of orthopaedic procedures logged by graduating orthopaedic surgery residents in the leg/ankle and foot/toes categories. This investigation revealed that there was an 8% increase in the total number of leg/ankle cases and 12% increase in foot/toes cases performed by graduating orthopaedic surgery residents, which has not significantly increased from 2009 to 2013. Across years examined in this study, significant variability existed between the 10th and 90th percentiles for total foot and ankle resident case exposure (P < .05), particularly within ankle arthroscopy, where there was a 15-fold difference in the number of arthroscopy cases performed by residents in the 90th percentile compared with the 10th percentile. The overall volume of foot and ankle cases performed by graduating orthopaedic surgery residents has increased despite not being statistically significantly from 2009 to 2013. Levels of Evidence: Level III: Cohort study

Influence of Complications and Revision Surgery on Fulfillment of Expectations in Foot and Ankle Surgery

2021 ◽  
pp. 107110072098523
Author(s):  
Bopha Chrea ◽  
Jonathan Day ◽  
Jensen Henry ◽  
Elizabeth Cody ◽  
Scott Ellis ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Pain Management ◽  
Postoperative Complications ◽  
Postoperative Complication ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Initial Surgery ◽  
Ankle Surgery ◽  
Patient Reported ◽  
The Impact

Background: Fulfillment of patients’ expectations following foot and ankle surgery has been previously studied, and shown to be an effective modality in assessing patient-reported outcomes (PROs). Although this assessment has been shown to correlate well with patient satisfaction and other validated PROs, the impact of postoperative complications on fulfillment of expectations is unknown. The aim of this study is to therefore investigate the impact of postoperative complications on fulfillment of patients’ expectations. Methods: Preoperatively, patients completed a validated Foot and Ankle Expectations Survey consisting of 23 questions encompassing domains including pain, ambulation, daily function, exercise, and shoe wear. At 2 years postoperatively, patients answered how much improvement they received for each item cited preoperatively. A fulfillment proportion (FP) was calculated as the amount of improvement received versus the amount of improvement expected. Chart review was performed to identify patient demographics, comorbidities, pain management, and postoperative complications, which were classified as minor (infection requiring antibiotics) or major (return to operating room for revision, deep infection). FP in patients with a complication was compared to patients who did not experience a complication. In addition, the Foot and Ankle Outcomes Score (FAOS), satisfaction, and Delighted-Terrible scale (how they would feel if asked to spend the rest of their life with their current foot/ankle symptom) were collected at final follow-up. Of the 271 patients (mean age 55.4 years, 65% female), 31 (11.4%, mean age 53.6, 58% female) had a postoperative complication: 25 major (19 revisions, 6 deep infections requiring irrigation and debridement), 4 minor (4 superficial infections requiring antibiotics), and 2 major and minor (revision and superficial infection). Average time from complication to completion of fulfillment survey was 15 (±3.6) months. The groups were similar in diagnoses. Results: Complications were associated with significantly worse FP (0.69 ± 0.45 vs 0.86 ± 0.40, P = .02). Having a complication significantly correlated with worse satisfaction, Delighted-Terrible scale, and FP ( P < .001). FAOS domains were similar between groups preoperatively; postoperatively, patients without complications had significantly higher Activities of Daily Living and Quality of Life scores ( P < .05). Demographically, there was no difference in age, sex, body mass index, Charlson Comorbidity Index, depression/anxiety, or pain management between the 2 groups. Conclusion: Our data suggests that postoperative complications following foot and ankle surgery were associated with worse patient-reported fulfillment of their operative expectations even after recovery from the initial surgery and complication. This finding is independent of preoperative expectations, and correlates with patient satisfaction with their procedure. Therefore, while patient-perceived fulfillment following foot and ankle surgery is multifactorial, the incidence of a postoperative complication negatively impacts fulfillment as well as satisfaction following surgery. Level of Evidence: Level II, prospective comparative series.

Impact of Vancomycin Treatment on Human Mesenchymal Stromal Cells During Osteogenic Differentiation

2018 ◽  
Vol 39 (8) ◽  
pp. 954-959 ◽  
Author(s):  
Jason T. Bariteau ◽  
Rishin J. Kadakia ◽  
Brian C. Traub ◽  
Manjula Viggeswarapu ◽  
Nick J. Willett
Keyword(s):  
Cell Viability ◽  
Osteogenic Differentiation ◽  
Mesenchymal Stromal Cells ◽  
Stromal Cells ◽  
Foot And Ankle ◽  
Treatment Groups ◽  
Human Mesenchymal Stromal Cells ◽  
Ankle Surgery ◽  
The Impact ◽  
Vancomycin Treatment

Background: Vancomycin is frequently applied locally to the operative site during foot and ankle procedures to help prevent infection. Although the efficacy of locally applied vancomycin has been demonstrated in spine surgery, there is no consensus on dosing and indication within foot and ankle surgery. Osteogenic differentiation of human mesenchymal stromal cells (hMSCs) is key to healing of both fractures and arthrodesis. The purpose of this research was to determine the impact of vancomycin on human hMSCs during the process of osteogenic differentiation. Methods: hMSCs were cultured in osteogenic differentiation media to promote osteogenic differentiation. Cells were treated with vancomycin at differing concentrations of 0, 50, 500, and 5000 µg/mL. Viability and cell growth were assessed via LIVE/DEAD viability/cytotoxicity kit (Invitrogen, Waltham, MA) after 1, 3, and 7 days of vancomycin treatment. Differentiation and mineralization was assessed via alizarin red staining after 21 days of treatment. Mean cell viability, cell number, and mineralization were compared between treatment groups using 1-way analysis of variance and the Tukey-Kramer method for post hoc pairwise comparisons. Results: At the highest concentrations of vancomycin, there was a significant reduction in cell viability and proliferation after 3 days compared with all other treatment groups. Mineralization was also significantly decreased with higher doses of vancomycin. Conclusion: At high concentrations, vancomycin may impair hMSC viability and osteogenic differentiation. Clinical Relevance: Surgeons should exercise caution and consider the limited soft tissue envelope when applying vancomycin locally during foot and ankle surgery, especially during arthrodesis procedures.

scholarly journals The impact of COVID-19 on Foot and Ankle Surgery in a Major Trauma Centre

The Foot ◽  
2021 ◽  
pp. 101772
Author(s):  
Howard Stringer ◽  
Andrew Molloy ◽  
Joanne Craven ◽  
John Moorehead ◽  
Alasdair Santini ◽  
...  
Keyword(s):  
Major Trauma ◽  
Trauma Centre ◽  
Foot And Ankle ◽  
Major Trauma Centre ◽  
Ankle Surgery ◽  
The Impact

scholarly journals Impact of Postoperative Complications on Fulfillment of Expectations after Orthopaedic Foot and Ankle Surgery

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0016
Author(s):  
Bopha Chrea ◽  
Jensen K. Henry ◽  
Jonathan Day ◽  
Andrew R. Roney ◽  
Elizabeth Cody ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Pain Management ◽  
Postoperative Complications ◽  
Patient Reported Outcomes ◽  
Foot And Ankle ◽  
Ankle Surgery ◽  
Patient Reported ◽  
Removal Of Hardware ◽  
Preoperative Expectations ◽  
The Impact

Category: Other Introduction/Purpose: Fulfillment of patients’ expectations following foot and ankle surgery has been previously studied and validated in assessing patient-reported outcomes (PROs). While this assessment has been shown to correlate well with patient satisfaction and PROs, the impact of postoperative complications on fulfillment of expectations is unknown. The aim of this study is to therefore investigate the impact of postoperative complications on fulfillment of patients’ expectations. Methods: Preoperatively, patients completed a validated Foot and Ankle expectations survey consisting of 23 questions encompassing domains including pain, ambulation, daily function, exercise, and shoe wear. At 2 years postoperatively, patients answered how much improvement they received for each item cited preoperatively. A fulfillment proportion (FP) was calculated as the amount of improvement received versus the amount of improvement expected. The FP ranges from 0 (no expectations fulfilled), between 0 and 1 (expectations partially fulfilled), 1 (expectations met), to greater than 1 (expectations surpassed). In addition, patient-reported outcomes (FAOS), satisfaction, and Delighted-Terrible scale (how they would feel if asked to spend the rest of their life with their current foot/ankle symptom) were collected at final follow-up. Chart review was performed to identify patient demographics, comorbidities, pain management, and postoperative complications, which were classified as minor (infection requiring antibiotics) or major (unplanned return to OR, reoperation, or revision). Results: Of the 271 patients (mean age 55.4 years, 65% female), 31 (11.4%, mean age 53.6, 58% female) had a postoperative complication; 27 major (17 revisions, 10 removal of hardware due to pain/infection) and 6 minor (6 superficial infections requiring antibiotics). Complications were associated with significantly worse FP (0.69 +- 0.45 vs 0.86 +- 0.40, p=0.02). Average time from complication to completion of fulfillment survey was 15 (+-3.6) months. Having a complication significantly correlated with worse satisfaction, Delighted-Terrible scale, and FP (p<0.001). FAOS domains were similar preoperatively; postoperatively patients without complications had significantly higher ADL and QoL scores (p<0.05). Demographically, there was no difference in age, sex, BMI, Charlson Comorbidity Index, depression/anxiety, or pain management between the two groups. The groups were similar in diagnoses. Conclusion: Our data suggests that postoperative complications following foot and ankle surgery are associated with worse patient-reported fulfillment of their surgical expectations. This finding is independent of preoperative expectations, and correlates with several validated outcomes measures including patient satisfaction. Therefore, while patient fulfillment following foot and ankle surgery is multifactorial, the importance of preoperative education and counselling for potential complications should not be overlooked.

Time and State Legislation Have Decreased Opioid Prescribing in Elective Foot and Ankle Surgery in the United States

2021 ◽  
pp. 193864002110433
Author(s):  
Daniel J. Cunningham ◽  
Nicholas F. Kwon ◽  
Nicholas B. Allen ◽  
Andrew M. Hanselman ◽  
Samuel B. Adams
Keyword(s):  
United States ◽  
The United States ◽  
Opioid Epidemic ◽  
Foot And Ankle ◽  
Opioid Prescription ◽  
State Legislation ◽  
Filling Volume ◽  
Opioid Prescribing ◽  
Ankle Surgery ◽  
The Impact

Background Legislation in the United States has been enacted to reduce opioid overuse and abuse in the setting of the opioid epidemic, and a notable target has been opioid overprescription. However, the impact of this legislation on elective foot and ankle surgery is largely unknown. The purpose of this study was to evaluate the impact of opioid-limiting legislation on opioid prescribing in elective foot and ankle surgery. Methods The 90-day perioperative opioid prescription filling in oxycodone 5-mg equivalents was identified in all patients 18 years of age and older undergoing nontrauma, nonarthroplasty foot and ankle surgery from 2010 to 2019 using a commercial database. States with and without legislation were identified, and opioid prescription filling before and after the legislation were tabulated. Unadjusted and adjusted analyses were performed to evaluate the impact of time and state legislation on perioperative opioid prescribing in this patient population. Results Initial and cumulative opioid prescribing decreased significantly from 2010 to 2019 (39 vs 35.7 initial and 98.1 vs 55.7 cumulative). States with legislation had larger and more significant reductions in initial and cumulative opioid prescribing compared with states without legislation over similar time frames (41.6 to 35.1 with legislation vs 40.6 to 39.1 without legislation initial prescription filling volume and 87.7 to 62.8 vs 88.6 to 74.1 cumulative prescription filling volume). Conclusion State legislation and time have been associated with large, clinically relevant reductions in 90-day perioperative cumulative opioid prescription filling, although reductions in initial opioid prescription filing have remained low. These results encourage states without legislation to enact restraints to reduce the opioid epidemic. Levels of Evidence: Level III: Retrospective, prognostic cohort study

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