scholarly journals Risk factors associated with transport gap bending deformity after bone transport in the treatment of lower extremity bone defects caused by infection

2021 ◽  
Author(s):  
Kai Liu ◽  
Yanshi Liu ◽  
Feiyu Cai ◽  
Chenchen Fan ◽  
Alimujiang Abulaiti ◽  
...  
Keyword(s):  
Risk Factors ◽  
External Fixator ◽  
Lower Limb ◽  
Lower Extremities ◽  
Bone Defects ◽  
Bone Transport ◽  
Bone Infection ◽  
Limb Bone ◽  
Factors Associated ◽  
Independent Risk Factors

Abstract Background: The objective of this study was to observe the efficacy of bone transport using Orthofix external fixator in the treatment of lower limb bone defects caused by infection, and analyze the mechanism and risk factors of transport gap bending deformity (TGBD).Methods: From January 2008 to December 2019, 326 cases of infected bone defects of the lower extremities were treated by bone transport in our medical institution. The location and other relevant information of TGBD were collected, summarized, and analyzed. The Association for the Study and Application of the Method of Ilizarov (ASAMI) standard was applied to assess the bone and functional outcomes. Results: A total of 326 patients have reconstructed the bone defects in the lower extremities successfully, with a mean size of 6.2 centimeters (3.4 - 9.1 cm). TGBD was observed in 42 patients (12.8%) after removing the external fixator, including 32 tibias and 10 femurs, after a mean follow-up of 28.6 months (22 – 47 months). Age>45years, BMI>25kg/m2, defect of the tibia, diabetes, osteoporosis, glucocorticoid intake, duration of bone infection>24months, EFT>9months, EFI>1.8months/cm were associated significantly with a higher incidence of TGBD in the binary logistic regression analysis. The independent risk factors associated with TGBD included age>45 years, BMI>25 kg/m2, defect of tibia, diabetes, osteoporosis. Conclusions: The bone transport using the Orthofix external fixator is a safe and practical method in the treatment of lower limb bone defects caused by infection. The incidence of TGBD was 12.8%, and the top five risk factors included defect of tibia, BMI>25kg/m2, duration of bone infection>24 months, age>45years, and diabetes. Age>45years, BMI>25kg/m2, defect of tibia, osteoporosis, diabetes were the independent risk factors. The higher incidence of TGBD may be associated with more risk factors.

scholarly journals Efficacy Comparison of Trifocal Bone Transport Using Unilateral External Fixator for Femoral and Tibial Bone Defects Caused by Infection

2021 ◽  
Author(s):  
Kai Liu ◽  
Yanshi Liu ◽  
Feiyu Cai ◽  
Chenchen Fan ◽  
Peng Ren ◽  
...  
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Lower Limb ◽  
Functional Outcomes ◽  
Bone Defects ◽  
Bone Transport ◽  
Limb Bone ◽  
The Mean ◽  
Fair Poor

Abstract Background: This study aimed to evaluate the clinical and functional outcomes of patients with critical femoral and tibial bone defects treated by trifocal bone transport using the Ilizarov method.Methods: In a retrospective comparative study, 39 patients treated for lower limb bone non-union with bone loss measuring between 6 and 14 cm were included. Depending on the location of bone transport, the patients were divided into the femur group (n =18) and tibia groups (n =21). The demographics data, intraoperative records, and postoperative outcomes were documented and compared between the two groups. At the last follow-up, the bone and functional outcomes were evaluated according to the criterion given by the Association for the Study and Application of the Method of the Ilizarov (ASAMI) and postoperative complications evaluated by Paley classification.Results: The average follow-up time was 26.1 months (range 17–34 months) since the unilateral external fixators were removed. The mean size of the bone defect was 8.3 cm in the femur group, and 7.5 cm in the tibia group. All bone defects were reconstructed successfully. The mean time in external fixation in the femur group was 334.4 days, and in the tibia group was 344.6 days. The external fixation index (EFI) measured 55.9 days/cm in the femur group and 65 days/cm in the tibia group. A statistically significant difference of bone grade was found between the two groups (excellent/good/fair/poor, 3/11/3/1 vs 2/13/4/2, P<0.05), as well as the function grade in two groups (excellent/good/fair/poor/failure, 3/14/1/0 vs 4/13/3/1, P<0.05). According to the ASAMI classification, the clinical and functional results in the femur group were better than in the tibia group. The complication rate of the two groups was 94.4% vs 76.2% (femur vs tibia). One femur and five tibias were performed additional surgery because of delayed union and axial deviation. Conclusions: The trifocal bone transport using the unilateral external fixator is a reliable treatment in the management of post-traumatic and post-infection lower limb bone defects (>6cm). In the comparison of the tibia, the trifocal bone transport treatment period of the femur was shorter, the functional recovery was better and the risk of minor complications was higher.

scholarly journals Preoperative incidence and risk factors of deep vein thrombosis in patients with an isolated patella fracture

2021 ◽  
Author(s):  
Weijie Yang ◽  
Qun Wei ◽  
Haicheng Wang ◽  
Chao Li ◽  
Kai Ding ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lower Extremities ◽  
Control Group ◽  
Case Group ◽  
Patellar Fracture ◽  
Related Factors ◽  
Factors Associated ◽  
Vein Thrombosis ◽  
Laboratory Test Results ◽  
Independent Risk Factors

Abstract Background The purpose of this study was to investigate the incidence, location, and related factors of preoperative deep venous thrombosis (DVT) in patients with isolated patellar fractures. Methods Patients with an isolated patellar fracture, admitted between January 2013 and December 2019 at our institution, were retrospectively analyzed. Upon admission, patients underwent routine Doppler ultrasound scanning (DUS) of the bilateral lower extremities to detect DVT; those with DVT were assigned to the case group and those without DVT to the control group. Data on demographics, comorbidities, and laboratory test results upon admission were extracted. Differences between the two groups were evaluated using univariate analyses, and independent risk factors associated with DVT were identified by logistic regression analysis. Results During the study window, 827 patients were included, of whom 5.8% (48/827) were found to have preoperative DVT. Among those with DVT, 85.4% (41/48), 8.3 % (4/48), and 6.3% (3/48) occurred in the injured, non-injured, and bilateral lower extremities, respectively. Multivariate analysis showed that age (each increase of 1 year) (odds ratio, OR = 1.02), residential area (OR = 5.00), delay of injury to DUS (in each day, OR = 1.33), and elevated plasma D-dimer level (> 0.5 µg/mL, OR = 2.47) were independent risk factors associated with DVT. Conclusions Despite the low prevalence of DVT after an isolated patellar fracture, this study underscores the importance of identifying those with a high risk of DVT, especially those with multiple identifiable factors, as well as the early targeted use of thromboembolic agents, to reduce DVT occurrence.

scholarly journals Risk factors of ankle osteoarthritis in the treatment of critical bone defects using ilizarov technique

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Kai Liu ◽  
Feiyu Cai ◽  
Yanshi Liu ◽  
Alimujiang Abulaiti ◽  
Peng Ren ◽  
...  
Keyword(s):  
Risk Factors ◽  
External Fixator ◽  
Bone Defects ◽  
Bone Transport ◽  
Postoperative Management ◽  
Additional Treatment ◽  
Ilizarov Technique ◽  
Ankle Osteoarthritis ◽  
Scale Scores ◽  
Critical Bone Defects

Abstract Background Distraction osteogenesis using the Ilizarov external circular fixator has been applied in lower limb reconstructive surgery widely. The increasing ankle osteoarthritis (OA) progression and severity are often associated with the period of external fixator and the greater relative instability of the ankle joint, but few studies have quantified risk factors directly during this technique. Methods The study was conducted on 236 patients who underwent bone transport surgery for tibias using the Ilizarov external circular fixator from 2008 to 2018. The cumulative incidence of ankle OA diagnoses in patients after the Ilizarov technique treatment was calculated and stratified by risk factors from preoperative and postoperative management. After the data were significant through the Mann-Whitney U test analyzed, odds ratios were calculated using logistic regression to describe factors associated with the OA diagnosis including gender, age, BMI, location of bone defect, diabetes, hypertension, osteoporosis, the history of metal allergy and glucocorticoid intake, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-HF scale scores, defect size (DS), the type of bone transport, the bone union time, external fixator time (EFT), and external fixator index (EFI). Results There were 199 males and 37 females with a mean age of 47 years (range 28–59 years). Out of 236 patients, 49 had an additional treatment for ankle OA after the Ilizarov technique treatment of bone defects (average follow-up time 2.1 years, range 1.6–4.2 years). The incidence of postoperative ankle OA was 20.8 %, with 19 patients classified as K&L grade 3 and seven patients as grade 4. The top five risk factors included double-level bone transport (OR3.79, P = 0.005), EFI > 50days/cm (OR3.17, P = 0.015), age > 45years (OR2.29, P = 0.032), osteoporosis (OR1.58, P < 0.001), BMI > 25 (OR1.34, P < 0.001). Male, BMI > 25, diabetes, osteoporosis, and AOFAS ankle-HF scale scores are the independent risk factors. Conclusions Ilizarov external circular fixator is a safe and effective method of treatment for critical bone defects. The double level bone transport, EFI > 50days/cm, age > 45years, osteoporosis, BMI > 25 are the top five relevant risk factors of ankle OA. The probability of developing ankle OA among patients having three or more risk factors is 50–70 %.

Activities and risk factors associated with fall-related injuries among US Army soldiers

2020 ◽  
pp. bmjmilitary-2020-001564
Author(s):  
Raina D Brooks ◽  
T Grier ◽  
B H Jones ◽  
M C Chervak
Keyword(s):  
Risk Factors ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Physically Active ◽  
Us Army ◽  
Factors Associated ◽  
Younger Age ◽  
Near Falls ◽  
Independent Risk Factors ◽  
Army Soldiers

IntroductionFalls/near falls are the second leading cause of hospitalisation and outpatient visits among US Army soldiers. While numerous studies have evaluated fall-related or near fall-related injuries among elderly adults, few have evaluated this association among young adults. The objective of this study is to describe the characteristics and risk factors associated with fall-related or near fall-related injuries among male US Army soldiers.MethodsThis is a cross-sectional study of male US Army Airborne Division soldiers (n=5187). Electronic surveys captured demographic, lifestyle, physical training (PT), fitness and injury data during spring/summer of 2016. Multiple logistic regression was used to identify independent risk factors of fall-related or near fall-related injuries, adjusting for potential confounders.ResultsPrimary findings indicated that activities and risk factors associated with fall-related or near fall-related injuries among soldiers included younger age (≤35 years), holding a job that required minimal lifting activities, slower 2-mile run times and not running during personal PT.ConclusionsThe findings from this study suggest that male US Army soldiers and other physically active men may benefit from (1) obtaining and/or maintaining higher aerobic endurance and muscular strength, and (2) training focused on preventing fall-related injuries during PT, road marching and sports/recreational activities. Moreover, prevention strategies and education should further target younger soldiers (≤35 years old), as younger age is not modifiable.

scholarly journals Effect of Instruction on Preventing Delayed Bleeding after Colorectal Polypectomy and Endoscopic Mucosal Resection

2021 ◽  
Vol 10 (5) ◽  
pp. 928
Author(s):  
Takuya Okugawa ◽  
Tadayuki Oshima ◽  
Keisuke Nakai ◽  
Hirotsugu Eda ◽  
Akio Tamura ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medical Records ◽  
Colorectal Polyp ◽  
Control Group ◽  
Single Center ◽  
Antithrombotic Agents ◽  
Delayed Bleeding ◽  
Factors Associated ◽  
Independent Risk Factors ◽  
Continuous Use

Background: The frequency of delayed bleeding after colorectal polypectomy has been reported as 0.6–2.8%. With the increasing performance of polypectomy under continuous use of antithrombotic agents, care is required regarding delayed post-polypectomy bleeding (DPPB). Better instruction to educate endoscopists is therefore needed. We aimed to evaluate the effect of instruction and factors associated with delayed bleeding after endoscopic colorectal polyp resection. Methods: This single-center, retrospective study was performed to assess instruction in checking complete hemostasis and risk factors for onset of DPPB. The incidence of delayed bleeding, comorbidities, and medications were evaluated from medical records. Characteristics of historical control patients and patients after instruction were compared. Results: A total of 3318 polyps in 1002 patients were evaluated. The control group comprised 1479 polyps in 458 patients and the after-instruction group comprised 1839 polyps in 544 patients. DPPB occurred in 1.1% of polyps in control, and 0.4% in after-instruction. Instruction significantly decreased delayed bleeding, particularly in cases with antithrombotic agents. Hot polypectomy, clip placement, and use of antithrombotic agents were significant independent risk factors for DPPB even after instruction. Conclusion: The rate of delayed bleeding significantly decreased after instruction to check for complete hemostasis. Even after instruction, delayed bleeding can still occur in cases with antithrombotic agents or hot polypectomy.

scholarly journals Treatment of diaphyseal forearm defects caused by infection using Ilizarov segmental bone transport technique

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yanshi Liu ◽  
Maimaiaili Yushan ◽  
Zhenhui Liu ◽  
Jialin Liu ◽  
Chuang Ma ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
External Fixator ◽  
Bone Defects ◽  
Bone Transport ◽  
Segmental Bone Transport ◽  
The Mean ◽  
Forearm Bone ◽  
Segmental Bone ◽  
Transport Technique

Abstract Background The Ilizarov segmental bone transport technique can be applied in the reconstruction of the bone defects with less invasive fashion and more versatility compared to other methods, while most studies were focused on the lower extremity. The purpose of this study was to evaluate the effectiveness of the Ilizarov segmental bone transport technique in the treatment of diaphyseal forearm bone defects caused by infection. Methods This study included 12 patients with diaphyseal forearm bone defects caused by infection, who underwent bone transport procedures using the monolateral external fixator at our institution from January 2010 to January 2018, including 10 males and 2 females with a mean age of 39 years (range 23–57 years). Patient’s demographic data and clinical outcomes at least two years follow-up after removing the external fixator were collected and retrospectively analyzed. The functional results were evaluated by the questionnaire of Disability of Arm, Shoulder and Hand (DASH) and the modified Mayo wrist score (MWS) at the final follow-up. Results There were 10 radii and 2 ulnae bone transport procedures collected. The average defect size was 5.1 cm (4-6.5 cm). All patients were successfully followed up with a mean period of 28.2 months (24 to 36 months) and achieved infection-free union. There was no recurrence of infection observed. The mean external fixation time was 232.6 days (182 to 276 days), and the mean external fixation index was 46.3 days/cm (40.9 to 61.8 days/cm). The mean DASH score was 30.6(18 to 49) preoperative, while 13.8 (5 to 26) at the final follow-up. The average modified MWS improved from 68.8 (55 to 80) pre-operatively to 83.8 (65 to 90) at the final follow-up. All the differences between the preoperative and final scores were statistically significant (p < 0.05). Almost all the patients achieved satisfactory clinical outcomes and were able to perform activities of daily living. Conclusions Ilizarov segmental bone transport technique is an alternative and effective method for the treatment of diaphyseal forearm bone defects caused by infection, and this method acquired satisfactory clinical outcomes.

Physiological and psychological factors associated with onset of high-altitude headache in Chinese men upon acute high-altitude exposure at 3700 m

Cephalalgia ◽  
2016 ◽  
Vol 37 (4) ◽  
pp. 336-347 ◽  
Author(s):  
Wen-Yun Guo ◽  
Shi-Zhu Bian ◽  
Ji-Hang Zhang ◽  
Qian-ning Li ◽  
Jie Yu ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Altitude ◽  
Mood State ◽  
Physical Work ◽  
Internal Diameter ◽  
Physical Work Capacity ◽  
P Values ◽  
Factors Associated ◽  
Diastolic Velocity ◽  
Independent Risk Factors

Aim We aimed to identify clinical characteristics and risk factors associated with onset of high-altitude headache (HAH) after acute exposure at 3700 m. Method In two hours, 163 individuals ascended by plane to 3700 m. Demographic information, physiological and psychological measurements, cognitive function, physical work capacity tests and profile of mood states within one week prior to the departure and within 24 hours after arrival were examined. Results HAH patients featured significantly higher vertebral artery diastolic velocity (Vd), heart rate (HR) and pulmonary artery diameter. HAH was also associated with a more negative mood state, including scores for tension anxiety, depression, hostility, fatigue and confusion, as well as lower vigor (all p values <0.05). Furthermore, negative emotions were positively related to HAH severity. HAH slightly decreased cognitive functioning. HR, Vd, lack of vigor, confusion and self-reported anxiety (all p values <0.05) were independent risk factors for HAH. We have identified three independent baseline predictors for HAH including internal diameter of the left ventricle (LVD), Athens Insomnia Scale (AIS) and confusion score. Conclusions Higher HR, Vd, confusion and self-reported anxiety and insufficient vigor were independent risk factors for HAH. Furthermore, higher baseline LVD, AIS and confusion score are independent predictors of HAH.

scholarly journals Factors associated with 90-day acute ischemic stroke in patients ≥70 years old with total hip arthroplasty for hip fracture

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Rui He ◽  
Guoyou Wang ◽  
Ting Li ◽  
Huarui Shen ◽  
LijuanZhang
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Ischemic Stroke ◽  
Hip Fracture ◽  
Total Hip Arthroplasty ◽  
Older Age ◽  
Factors Associated ◽  
Independent Risk Factors ◽  
D Dimer

Abstract Background Postoperative ischemic stroke is a devastating complication following total hip arthroplasty (THA). The purpose of the current study was to investigate the incidence of postoperative acute ischemic stroke (AIS) in patients ≥70 years old with THA for hip fracture after 90 days and independent risk factors associated with 90-day AIS. Methods A multicenter retrospective study was conducted, patients ≥70 years old with THA for hip fracture under general anesthesia were included from February 2017 to March 2020. Patients with AIS within 90 days after THA were identified as AIS group; patients with no AIS were identified as no AIS group. The baseline characteristics and risk factors were collected, multivariable logistic regression was used to identify independent risk factors of 90-dayAIS. Results: 2517 patients (mean age 76.18 ± 6.01) were eligible for inclusion in the study. 2.50% (63/2517) of patients had 90-day AIS. Compared with no AIS, older age, diabetes, hyperlipidemia, atrial fibrillation (AF) and higher D-dimer value were more likely in patients with AIS (P < 0.05), and anticoagulant use was fewer in patients with AIS. ROC curve analysis showed that the optimal cut point of D-dimer for AIS was D-dimer≥4.12 μg/ml. Multivariate logistic regression analysis showed that D-dimer≥4.12 μg/ml [adjusted odds ratio (aOR), 4.44; confidence interval (CI), 2.50–7.72; P < 0.001], older age (aOR, 1.08; 95%CI, 1.03–1.12; P < 0.001), hyperlipidemia (aOR, 2.28; 95%CI, 1.25–4.16; P = 0.007), atrial fibrillation (aOR, 5.84; 95% CI, 1.08–15.68; P = 0.001), and diabetes (aOR, 2.60; 95% CI, 1.56–4.39; P < 0.001) were associated with increased risk of 90-day AIS after THA. Conclusions In conclusion, we found that the incidence of 90-day AIS in patients≥70 years old with THA for hip fracture was 2.5%. Older age, diabetes, hyperlipidemia, AF and higher D-dimer value were independent risk factors for 90-day AIS in patients≥70 years old with THA for hip fracture.

scholarly journals Risk Factors Associated With Infection in Open Fractures of the Upper and Lower Extremities

2020 ◽  
Vol 4 (12) ◽  
pp. e20.00188
Author(s):  
Paul Tornetta ◽  
Gregory J. Della Rocca ◽  
Saam Morshed ◽  
Clifford Jones ◽  
Diane Heels-Ansdell ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lower Extremities ◽  
Open Fractures ◽  
Factors Associated ◽  
Upper And Lower Extremities

scholarly journals Incidence and locations of deep venous thrombosis of the lower extremity following surgeries of tibial plateau fractures: a prospective cohort study

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Junyong Li ◽  
Yanbin Zhu ◽  
Wei Chen ◽  
Kuo Zhao ◽  
Junzhe Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Tibial Plateau ◽  
Lower Extremities ◽  
Tibial Plateau Fractures ◽  
Targeted Prevention ◽  
Independent Risk Factors ◽  
Laboratory Biomarkers ◽  
Univariate Analyses

Abstract Objective To investigate the incidence of deep venous thrombosis (DVT) of the lower extremities following surgeries of tibial plateau fractures. Methods Retrospective analysis of the prospectively collected data on patients undergoing surgeries of tibial plateau fractures between October 2014 and December 2018 was conducted. Duplex ultrasonography (DUS) was used to screen for postoperative DVT of the bilateral lower extremities. Data on demographics, comorbidities, injury, surgery, and laboratory biomarkers at admission were collected. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors associated with DVT. Results Among 987 patients included, 46 (4.7%) had postoperative DVT, with incidence rate of 1.0% for proximal and 3.7% for distal DVT. The average interval between operation and DVT was 8.3 days (median, 5.8 days), ranging from 2 to 42 days. DVT involved the injured extremity in 39 (84.8%) patients, both the injured and uninjured extremity in 2 patients (4.3%) and only the uninjured extremity in 5 patients (10.9%). Five risk factors were identified to be associated with postoperative DVT, including age (≥ 41 vs < 41 years) (OR 3.08; 95% CI 1.43–6.61; p = 0.004), anesthesia (general vs regional) (OR 2.08; 95% CI 1.12–3.85; p = 0.021), hyponatremia (OR 2.21; 95% CI 1.21–4.06; p = 0.010), prolonged surgical time (OR 1.04; 95% CI 1.01–1.07; p = 0.017) and elevated D-dimer level (OR 2.79; 95% CI 1.34–4.83; p = 0.004). Conclusion These epidemiologic data may be helpful in individualized assessment, risk stratification, and development of targeted prevention programs.

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