Complications Associated with Triple Arthrodesis Versus Non-Fusion Flatfoot Reconstruction: A Matched Cohort Study

Category: Hindfoot; Midfoot/Forefoot; Other Introduction/Purpose: Pes planovalgus is a very common deformity of the foot, often resulting from adult acquired flatfoot disorder (AAFD). This deformity in its early stages is treated conservatively with non-operatively modalities such as bracing, however in its later stages often requires surgical correction of the deformity in order to improve the pain and function of the extremity. Two commonly performed procedures in the correction of this type of deformity are a triple arthrodesis or joint sparing flatfoot reconstruction. The objective of this study was to identify whether differences existed in the financial burden or complication rates of non-fusion flatfoot reconstruction versus triple arthrodesis. Methods: The PearlDiver Database was queried from 2006-2013 to identify all Medicare patients who were admitted for a triple arthrodesis or non-fusion flatfoot reconstruction. 2308 patients were identified in each cohort and statistically matched in a 1:1 manner to control for influence of demographics and/or comorbidities. Postoperative complication rates (within 30 days) were evaluated and broken down into major (PE/DVT, MI, CVA, sepsis, mortality, nerve injury) and minor (UTI, PNA, hardware failure, transfusion, wound complications) categories. Additionally, total cost of care including cost of readmissions, and readmission within 30 days were evaluated. Results: No significant differences were noted in the postoperative complication rates between the two procedures within the first 30 days post-operatively in the initial univariate regression. There was a significant difference in the rate of 30 day readmission with 2.3% of triple arthrodeses being readmitted vs. 1.08% in the non-fusion joint reconstruction group (p=.002). Adjusted multivariate regression yielded similar results, with no significant differences in postoperative complication rates. The difference in readmission rate remained significant in the multivariate regression (OR 2.13, 95% CI 1.33-3.51, p=.002). Significant differences were also noted for mean total cost of care, with a higher mean total cost identified for the fusion group (x=7,868.0) compared to the reconstruction group (x=4,064.49, p<.001, Adjusted 𝛽𝛽 3,836.71, 95% CI 3,525.23 to 4,148.19, p<.001). Conclusion: This study compared triple arthrodesis versus joint-sparing flatfoot reconstruction. Within this study group there was no difference in complications between the two procedures. There was a significantly higher incidence of 30-day readmission in the triple arthrodesis group by about 2-fold. When comparing the total cost of care, there was a significantly higher cost associated with the triple arthrodesis, which cost on average about $3800 more than joint sparing flatfoot reconstruction. While revealing with regard to the aforementioned variables within the first 30 days post-operatively, further research needs to be conducted on the long term outcomes of these procedures. [Table: see text][Table: see text][Table: see text]

Download Full-text

A Novel and Safe Fibular Osteotomy for Total Ankle Replacement through Lateral Transfibular Approach

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00423 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0042

Author(s):

Federico G. Usuelli ◽

Jonathan RM Kaplan ◽

Camilla Maccario ◽

Luigi Manzi ◽

Cristian Indino

Keyword(s):

Short Form ◽

Weight Bearing ◽

Hardware Removal ◽

Composite Score ◽

Wound Complications ◽

X Rays ◽

Fibular Osteotomy ◽

Significant Difference ◽

Primary Lateral ◽

Reconstruction Group

Category: Ankle Arthritis Introduction/Purpose: The lateral transfibular total ankle arthroplasty (TAA) has been reported on with good short term outcomes. One key downside to the lateral TAA is the rate of symptomatic hardware and wound issues requiring hardware removal seen with the short oblique fibular osteotomy. Therefore, we report on a comparative cohort study of lateral TAA using the traditional short oblique fibular osteotomy to a long oblique fibular osteotomy, termed Foot and Ankle Reconstruction Group Osteotomy (FARG). Methods: Retrospective identification of primary lateral transfibular TAA performed by a single surgeon from May 2013 to October 2016 with minimum 2 years follow-up. Clinical assessment included patient demographics, wound complications, need for hardware removal, visual analogue scale, American Orthopaedic Foot & Ankle Society score, Short Form-12 Mental Composite Score, and Short Form-12 Physical Composite Score. Radiographic assessment included weight bearing x-rays to assess tibiotalar alignment, implant alignment, and fibular osteotomy healing. Results: A total of 159 primary lateral TAA were identified. The short oblique fibular osteotomy was used in 50 cases and the FARG osteotomy in 109 cases. Implant survival was 100% and there were no fibular osteotomy nonunions in both groups. There was improvement in all clinical parameters in both groups with no significant difference between groups in any of these parameters. The radiographic measures showed excellent alignment at all time points in both groups with no significant difference between groups. There was a significant difference between groups in the rate of wound dehiscence and rate of hardware removal for any reason with the FARG osteotomy having a lower rate of both compared to the short oblique fibular osteotomy. Conclusion: Modification of the traditional fibular osteotomy to the long oblique Foot & Ankle Reconstruction Group fibular osteotomy has excellent 2-year survival with good clinical and radiographic outcomes yet provides decreased rates of wound complications and decreased rates of symptomatic fibular hardware compared to the traditional short oblique fibular osteotomy.

Download Full-text

Complications Associated with Lisfranc Injury Open Reduction Internal Fixation versus Primary Arthrodesis: A Matched Cohort Study

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00392 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0039

Author(s):

William V. Probasco ◽

Benjamin E. Stein ◽

Cyrus Fassihi ◽

Nazia Hossain

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Perioperative Complications ◽

Financial Burden ◽

Length Of Hospital Stay ◽

Cost Of Care ◽

Wound Complications ◽

Prior History ◽

Inpatient Setting ◽

Hardware Failure

Category: Trauma; Midfoot/Forefoot Introduction/Purpose: Lisfranc injuries are complex injuries of the midfoot in which the optimal course of treatment remains controversial. The objective of this study was to identify whether open reduction and internal fixation (ORIF) was associated with greater risk for surgical complications and/or greater financial burden in comparison to a primary arthrodesis (PA). Methods: A retrospective database review was conducted using the PearlDiver database to identify all Medicare patients who underwent a Lisfranc ORIF or PA in an inpatient setting from 2006-2013. Exclusion criteria included age >85 years and a prior history of foot or ankle trauma/infection/malignancy within 5 years of index surgery. Patients were matched in a 1:1 statistical manner to precisely control for potential influence of comorbidities and demographics, resulting in two cohorts with 2746 patients in each. Perioperative complications (within 30 days) were compared between the cohorts, in addition to the respective costs associated with each procedure. Complications were broken down into major (PE/DVT, MI, CVA, sepsis, mortality, nerve injury) or minor (UTI, PNA, hardware failure, transfusion, wound complications) categories. Results: No significant differences in major perioperative complications were noted between the two procedures. Significant differences were however noted in the incidence of minor perioperative complications, including higher rates of hardware failure (OR 0.26 (CI 95%, 0.07-0.752, P=0.021) and transfusion (OR 0.37 (CI 95%, 0.13-0.94, P=0.045) in the ORIF cohort. There was additionally a higher incidence of 30 day readmission (OR 0.35 (CI 95%, 0.24-0.51, P<0.001) with ORIF. Length of hospital stay (LOS) was shorter in the PA cohort (x̅; = 2.59 days) compared to the ORIF cohort (x̅; = 5.58 days, p < 0.001). Higher mean total hospital costs were noted for ORIF (x̅ = $66,342.56) compared to PA (x̅ = $40,761.65, p < 0.001). Conclusion: Within our study population, ORIF has a significantly higher rate of hardware failure and transfusion, and 2.5 times the risk of readmission within 30 days. When comparing the total cost of care, there was a significantly greater cost with ORIF. LOS was also significantly longer in the ORIF group. One weakness of this study was the ability to account for patients <65, as these were pooled into a single age group by the database. While revealing with regard to the aforementioned variables, further research still needs to be conducted on the functional outcomes of these procedures. [Table: see text][Table: see text][Table: see text]

Download Full-text

Comparison of early versus standard timing for silicone stent removal following External Dacrocystorhinostomy under local anaesthesia

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v11i1.25413 ◽

2019 ◽

Vol 11 (1) ◽

pp. 24-28

Author(s):

Ben Limbu ◽

Hannah S Lyons ◽

Mohan Krishna Shrestha ◽

Geoffrey C Tabin ◽

Rohit Saiju

Keyword(s):

Success Rate ◽

Financial Burden ◽

Controlled Trial ◽

Nasolacrimal Duct ◽

Complication Rates ◽

Tube Removal ◽

Significant Difference ◽

Silicone Stent ◽

Group A ◽

Group B

Introduction: The first line treatment for nasolacrimal duct obstruction (NLDO) is external dacrocystorhinostomy (DCR). Following DCR, patients are required to return to Tilganga Institute of Ophthalmology (TIO) six weeks postoperatively for the removal of a silicone stent. As the majority of patients travel large distances at significant cost to reach TIO, most often patients remain within Kathmandu during this six weeks interval. This places a large financial burden on patients. Methods: A randomized controlled trial was designed to compare patient outcomes after early (two weeks postoperatively) versus standard (six weeks postoperatively) removal of silicone stents. 50 selected patients were randomized into two equal groups. Results: At the time of publication, 31 patients (14 in group A and 17 in group B) had completed three months follow up. A success rate of 92.9% was noted in Group A and a success rate of 94.1% observed in group B. No significant difference was found between the two groups for success rate and rate of complications. Conclusion: Early tube removal post DCR appears to cause no significant difference in outcome or complication rates compared to standard tube removal.

Download Full-text

Effect of Obesity on Perioperative Outcomes After Robotic-Assisted Pulmonary Lobectomy

Surgical Innovation ◽

10.1177/1553350616687435 ◽

2017 ◽

Vol 24 (2) ◽

pp. 122-132 ◽

Cited By ~ 2

Author(s):

Bryce Montané ◽

Kavian Toosi ◽

Frank O. Velez-Cubian ◽

Maria F. Echavarria ◽

Matthew R. Thau ◽

...

Keyword(s):

Postoperative Complication ◽

Normal Weight ◽

World Health ◽

Perioperative Outcomes ◽

Complication Rates ◽

Pulmonary Lobectomy ◽

Intraoperative Complication ◽

Robotic Assisted ◽

Conversion Rates ◽

Significant Difference

Objective. We investigated whether higher body mass index (BMI) affects perioperative and postoperative outcomes after robotic-assisted video-thoracoscopic pulmonary lobectomy. Methods. We retrospectively studied all patients who underwent robotic-assisted pulmonary lobectomy by one surgeon between September 2010 and January 2015. Patients were grouped according to the World Health Organization’s definition of obesity, with “obese” being defined as BMI >30.0 kg/m2. Perioperative outcomes, including intraoperative estimated blood loss (EBL) and postoperative complication rates, were compared. Results. Over 53 months, 287 patients underwent robotic-assisted pulmonary lobectomy, with 7 patients categorized as “underweight,” 94 patients categorized as “normal weight,” 106 patients categorized as “overweight,” and 80 patients categorized as “obese.” Because of the relatively low sample size, “underweight” patients were excluded from this study, leaving a total cohort of 280 patients. There was no significant difference in intraoperative complication rates, conversion rates, perioperative outcomes, or postoperative complication rates among the 3 groups, except for lower risk of prolonged air leaks ≥7 days and higher risk of pneumonia in patients with obesity. Conclusions. Patients with obesity do not have increased risk of intraoperative or postoperative complications, except for pneumonia, compared with “normal weight” and “overweight” patients. Robotic-assisted pulmonary lobectomy is safe and effective for patients with high BMI.

Download Full-text

Analysis of Outcomes in Adolescents and Young Adults With Pilonidal Disease

Frontiers in Surgery ◽

10.3389/fsurg.2021.613605 ◽

2021 ◽

Vol 8 ◽

Author(s):

Mackenzie N. Abraham ◽

Steven L. Raymond ◽

Russell B. Hawkins ◽

Atif Iqbal ◽

Shawn D. Larson ◽

...

Keyword(s):

Young Adults ◽

Older Patients ◽

Pilonidal Disease ◽

Wound Complication ◽

Wound Complications ◽

Complication Rates ◽

Recurrence Rates ◽

Significant Difference ◽

Secondary Healing ◽

Age And Sex

Purpose: Numerous definitive surgical techniques exist for the treatment of pilonidal disease with varied recurrence rates and wound complications. Due to the wide array of techniques and lack of consensus on the best approach, we proposed to study our experience treating pilonidal disease in adolescents and young adults.Methods: A retrospective analysis was conducted of patients 10–24 years old treated at a tertiary medical center from 2011 to 2016. Data including demographics, management, and outcomes were collected and analyzed. Primary outcome was recurrence of disease.Results: One hundred and thirty three patients with pilonidal disease underwent operative management. Fifty one percent underwent primary closure and 49% healed by secondary intention with no significant difference in recurrence rates (primary 18%, secondary 11%; p = 0.3245). Secondary healing patients had significantly lower wound complication rates (primary 51%, secondary 23%; p = 0.0012). After accounting for sex, race, weight, and operative technique, age was predictive of disease recurrence with an adjusted odds ratio (OR) of 0.706 (0.560–0.888; p = 0.003). Age and sex were both predictive of wound complications. Older patients had decreased risk of wound complication (adjusted OR 0.806, 95% CI 0.684–0.951; p = 0.0105), and male patients had increased risk of wound complication (adjusted OR 2.902, 95% CI 1.001–8.409; p = 0.0497).Conclusion: In summary, there is no significant difference in the recurrence rates between operative techniques for pilonidal disease. Older patients have decreased risk of recurrence following intervention. Wound complication rates are lower in patients undergoing secondary healing, though this may be better explained by differences in age and sex. Additional research investigating newer, minimally-invasive techniques needs to be pursued.

Download Full-text

Does Concurrent Distal Tibiofibular Joint Arthrodesis Affect the Nonunion and Complication Rates of Tibiotalar Arthrodesis?

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00367 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0036

Author(s):

Julie Neumann ◽

Maxwell Weinberg ◽

Chong Zhang ◽

Charles Saltzman ◽

Alexej Barg

Keyword(s):

Wound Complication ◽

Ankle Arthrodesis ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Wound Complications ◽

Complication Rates ◽

Vein Thrombosis ◽

Significant Difference ◽

Tibiotalar Arthrodesis ◽

End Stage

Category: Ankle Introduction/Purpose: Tibiotalar arthrodesis is generally a successful treatment option for patients with end stage ankle arthritis. However, there is a 9% risk of nonunion in patients undergoing primary tibiotalar arthrodesis. To date, it is unclear whether concurrent distal tibio-fibular joint arthrodesis affects this nonunion rate as there have been no studies directly comparing patients with and without arthrodesis of the distal tibio-fibular joint. The purpose of this clinical study is to compare the rate of nonunion in patients with a distal tibio-fibular fusion to those without a distal tibio-fibular fusion in the setting of a primary, open ankle arthrodesis. The hypothesis of this study was that the addition of a distal tibio-fibular fusion would decrease the nonunion rate in patients undergoing open ankle arthrodesis. Methods: This is a retrospective review of 521 consecutive patients from October 2002 to April 2016. 366 ankles from 354 unique patients met inclusion criteria. All patients underwent primary, open tibiotalar arthrodesis. 250 patients underwent open tibiotalar arthrodesis with a distal tibio-fibular fusion and 116 patients underwent open tibiotalar arthrodesis without a distal tibio-fibular fusion. Age, gender, body mass index, smoking, and preoperative radiographic deformity were controlled. The primary outcome measure was nonunion rate of tibiotalar arthrodesis. Secondary outcome measures were time to union, rate of wound complications, and rate of development of post-operative deep vein thrombosis (DVT)/Pulmonary embolism (PE). Results: Average age of the patients was 56.2 +/- 14.2 years. Mean follow-up time was 33.8 months. Unions were assessed on routine post-operative radiographs and by clinical examination. If there was a concern for nonunion, computerized tomography scan was utilized for further assessment. Nonunion rate of patients who had the distal tibio-fibular joint included was 19/250 (8%) and nonunion rate of those who did not have the distal tibio-fibular joint fused was 14/116 (12%) (p=0.16). There was no significant difference between those who had the distal tibio-fibular joint included versus who did not in wound complication rate (27% vs 31%, p=0.40), time to union (4.9 weeks versus 5 weeks, p =0.54), and DVT/PE rate (5% vs 3%, p=0.41), respectively [Table 1]. There were no major complications. Conclusion: To our knowledge, this is the first study directly comparing nonunion rates and complication rates in patients who underwent primary, open ankle arthrodesis with and without distal tibio-fibular joint arthrodesis. In this study, inclusion of the distal tibio-fibular joint in tibiotalar arthrodesis does not affect nonunion rate in patients undergoing primary, open ankle arthrodesis. Additionally, inclusion of the distal tibio-fibular joint does not affect rate of wound complication, time to union, and DVT/PE rate.

Download Full-text

Outcomes following abdominoperineal resection 6 years retrospective study at a rural district general hospital

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20210862 ◽

2021 ◽

Vol 9 (3) ◽

pp. 665

Author(s):

Deeksha Arora ◽

Michael Tang ◽

Thomas Seddon ◽

Milind Rao

Keyword(s):

Retrospective Study ◽

Wound Closure ◽

Surgical Techniques ◽

Perineal Wound ◽

Biological Mesh ◽

Wound Complications ◽

Complication Rates ◽

Patient Factors ◽

Mesh Group ◽

Significant Difference

Background: A range of surgical techniques are used for perineal wound closure following Abdominoperineal Excision of the Rectum (APER). The aim of this study was to assess the safety and effectiveness of using a biological mesh for perineal wound closure and to compare the outcomes following conventional suture and mesh closure of the perineal wound.Methods: A single-centre retrospective study of a cohort of patients undergoing surgery for low rectal cancer between January 2013 and December 2018. Patient records were analysed for outcomes including perineal complication rates, length of hospital stay and impact of patient factors on complication rates in mesh vs no mesh group.Results: Of the total 43 patients included in the study, 13 (30%) had a conventional perineal closure whereas 30 patients (70%) had a biological mesh reconstruction. Early perineal wound complications were seen in 21/43 (49%) patients. Of those, 6 (29%) patients were in the no mesh group compared to 15 (71%) patients in the mesh group (p = 0.81). 84% of the patients who received neo adjuvant radiotherapy (NART) developed perineal wound infection. There was no statistically significant difference in the mesh and no mesh groups. None of the patient factors, other than preoperative anaemia, had a statistically significant association with the rate of complications in either of the groups.Conclusions: There was no statistically significant difference in the complication rate between primary and biological mesh closure. Biological mesh is safe for perineal reconstruction following APER.

Download Full-text

Acute Myeloid Leukemia in the Elderly: Trends in Mortality Rates, Hospital Cost, Length of Stay, and Complication Rates in Patients Aged 60 and Older

Blood ◽

10.1182/blood.v128.22.2359.2359 ◽

2016 ◽

Vol 128 (22) ◽

pp. 2359-2359

Author(s):

Ankit Shah ◽

Stuthi Perimbeti ◽

Parshva Patel ◽

Rachel Nathan ◽

Seema Niphadkar ◽

...

Keyword(s):

Bone Marrow ◽

Length Of Stay ◽

Hospital Mortality ◽

Bone Marrow Transplant ◽

Marrow Transplant ◽

Teaching Hospitals ◽

Complication Rates ◽

Total Cost ◽

Significant Difference ◽

Acute Myeloid

Abstract Background: Acute myeloid leukemia (AML) is associated with a high mortality rate. Advancing age is a risk factor associated with poor prognosis and an increased rate of chemotherapy-related complications in patients with AML. We aimed to evaluate trends in cost of hospitalizations, length of stay, mortality rates, and complication rates in patients aged 60 years and older who were admitted for active AML. We also sought to elucidate differences in these outcomes in teaching and non-teaching institutions. Methods:We queried the Nationwide Inpatient Sample (NIS) between 1999 and 2013 using the ICD-9 codes 205.00, 205.01, 206.00, and 206.01 for acute myeloid and acute monocytic leukemias in the primary diagnosis field. Admission data regarding total cost, length of stay (LOS), and in-hospital mortality was extracted. This data was trended over the 15-year interval and comparisons were made between teaching and nonteaching institutions. Incidence of in-hospital complications including clostridium difficile infection (CDI), bacteremia, sepsis, pneumonia, venous thromboembolism (VTE), neutropenic fever, candidiasis, urinary tract infection (UTI), and acute respiratory failure were determined and compared in subsets of teaching and nonteaching hospitals. Frequency of bone marrow transplant was also determined in both hospital settings. Results: A total of 51,684 (weighted n=247,747) admissions for AML occurred from 1999-2013. Of these 31,004 admissions (weighted n=148,683) were in patients aged 60 and older. Most of these elderly admissions occurred at teaching institutions (n=17,593, weighted n=84,829). In-hospital mortality was higher in patients aged 60 and greater (23.68%) compared to those less than 60 (13.7% (p<.0001)). For patients 60 and older, mortality has decreased by approximately 40% during the 15-year interval (p<.0001). Specifically, in-hospital mortality was 30.21% in 1999 and 18.05% in 2013. In comparing teaching and non-teaching hospitals, mortality rate was not found to have a statistically significant difference (p=.4473). Complication rates due to VTE, bacteremia, febrile neutropenia, pneumonia, and UTI increased during this time period. Rates of CDI and candidiasis did not have a statistically significant difference over time. Rates of acute respiratory failure, neutropenic fever, bacteremia, VTE, sepsis, and CDI were higher at teaching than at non-teaching institutions (p<.0001). Rates of UTI were higher at non-teaching (9.62%) than at teaching institutions (8.43% (p=.004)). Differences in the rate of pneumonia and candidiasis were not statistically significant between the two hospital settings. Rates of bone marrow transplant have roughly doubled from .23% in 1999 to .51% in 2013 (p=.0079) and occurred more frequently in teaching (0.54%) than in non-teaching (0.24%) hospitals (p=.0017). Mean LOS (days) is relatively unchanged over the 15- year interval (p=.2277), however, cost has increased dramatically (p=.0001). Total cost in 1999 was $46,833(±1,508), whereas in 2013 it was $146,965(±4,296). Mean LOS and cost were higher at teaching (17.16, $122,257±1,221) compared with nonteaching (10.57, $65,448±993) institutions (p=.0001). Conclusions: For patients admitted with a primary diagnosis of active AML, in-hospital mortality was markedly higher in patients aged 60 and older compared with those less than 60. In the elderly, in-hospital mortality decreased dramatically between 1999 and 2013. Many factors may contribute to the decrease in mortality in this population including the use of less-aggressive cytotoxic chemotherapy, such as low-dose cytarabine or hypomethylating agents, improved adherence to preventative practices including the use of high-efficiency particulate air filtration, and prophylactic antibiotics. In patients older than 60, LOS and total cost were higher in teaching institutions, although in-hospital mortality was similar. In general, complication rates were higher at teaching hospitals, which may be a consequence of increased medical complexity and more aggressive therapy offered at these hospitals. For instance, bone marrow transplant rates were much higher in teaching than in non-teaching hospitals. Further research is required to determine the exact factors and practice differences contributing to the discrepancies between teaching and non-teaching institutions. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Comparison of open reduction and internal fixation versus closed reduction and percutaneous fixation for medial malleolus fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000286 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Andrew Matson ◽

Stephen Barchick ◽

Samuel Adams

Keyword(s):

Internal Fixation ◽

External Fixation ◽

Closed Reduction ◽

Open Reduction ◽

Wound Complications ◽

Complication Rates ◽

Percutaneous Fixation ◽

Open Injury ◽

Increased Risk ◽

Significant Difference

Category: Ankle, Trauma Introduction/Purpose: Open approaches are often used for the operative treatment of medial malleolar (MM) fractures. Compared to percutaneous approaches, open approaches may entail an increased risk of operative morbidity, postoperative pain, wound complications, and reoperation for hardware removal. However, inherent to minimally invasive or percutaneous techniques is incomplete fracture visualizationwhich may hinder acceptable reduction. In this study, we aimed to compare patients treated with closed reduction and percutaneous fixation (CRPF) to those patients treated with traditional open reduction and internal fixation (ORIF). We hypothesized that the two groups would be similar with regard to patient factors, injury variables, and outcomes. Methods: The study group consisted of 184 consecutive patients who met inclusion criteria and were treated with operative fixation of a MM fracture from 2011-2015 at a single institution. Forty underwent CRPF and 144 underwent ORIF. Patient demographics, injury characteristics, treatment methods, and outcome variables were recorded through review of patient charts, radiographs, and operative reports. Results: Patient variables were similar between groups except for years of age, which was greater on average in the CRPF group (55 vs. 48, p = 0.03). The CRPF treatment group had a higher rate of initial open injury (22% vs. 7%, p<0.01), a lower rate of MM fracture comminution (12% vs. 29%, p = 0.03), and a higher rate of provisional external fixation (35% vs. 14%, p<0.01). There was no statistically significant difference observed between the CRPF and ORIF groups with regard to outcomes including: nonunion (2% vs. 3%), malunion (10% vs. 5%), time to union (10 weeks, each), removal of hardware (8% vs. 14%), or wound complications (0% vs. 4%). Conclusion: Both CRPF and ORIF resulted in acceptable radiographic outcomes and low complication rates for the treatment of MM fractures. Compared to the ORIF group, patients in the CRPF group on average were older and more often had comminution, open fractures, and provisional external fixation.

Download Full-text

Economic Burden Of Prosthetic Joint Infection Following Primary Total Knee Replacement In Pakistan

10.21203/rs.2.22421/v1 ◽

2020 ◽

Author(s):

faizan iqbal ◽

bilal shafiq ◽

shahid noor ◽

Nasir ahmed ◽

zulfiqar ali ◽

...

Keyword(s):

Prosthetic Joint Infection ◽

Economic Burden ◽

Financial Burden ◽

Joint Infection ◽

Categorical Variables ◽

Total Cost ◽

Prosthetic Joint ◽

Significant Difference ◽

Total Knee ◽

Primary Total Knee

Abstract BACKGROUND: The financial burden of prosthetic joint infection after joint replacement in developed countries is well known. There is a need to evaluate the economic burden in developing countries like Pakistan. MATERIALS AND METHODS: Cases performed during this study are divided into two groups. 1. Uneventful primary total knee arthroplasty. 2. Prosthetic joint infection treated with two stage revision. Categorical variables were compared through Chi-square and Fisher Exact test. Continuous variables were compared using Mann-Whitney test. Multivariable regression analysis was done to identify the variable that places major financial burden on patient economy. RESULTS: The total cost of revision surgery for prosthetic joint infection considering twice hospitalization is found to be 7, 91, 353 ± 89,136 rupees. The total cost of uneventful arthroplasty is found to be 3, 50, 289± 32,123 rupees. We observed significant difference with respect to economic details between two groups. CONCLUSION: Measures should be undertaken to reduce PJI by encouraging healthcare providers to consider evidence based protocols to prevent PJI and financial constraints associated with these events.

Download Full-text