Screws-Only Primary Subtalar Arthrodesis for Calcaneus Fractures

Background: The management of displaced intraarticular calcaneus fractures (DIACFs) is a difficult problem with disappointing results from open reduction internal fixation (ORIF). Alternatively, ORIF with primary subtalar arthrodesis (PSTA) has gained increasing popularity. The purpose of this study is to review patient-centered and radiographic outcomes of ORIF plus PSTA using only screws through a sinus tarsi approach. Methods: A retrospective study of patients who underwent ORIF+PSTA for DIACFs was conducted. The same surgical technique was used in all cases consisting of only screws; no plates were used. Delayed surgeries past 8 weeks were excluded. Demographic and radiographic data were collected including worker’s compensation claims. Plain radiographs were used to characterize injuries and review outcomes. Results: Seventy-nine DIACFs underwent PSTA with a median follow-up of 200 days (n = 69 patients). Median time to weightbearing was 57.5 days postoperatively. Ten fractures were documented as Sanders II, 36 as Sanders III, and 32 as Sanders IV. Sixty-eight fractures (86.1%) achieved fusion on radiographs at a median of 126.5 (range, 54-518) days. Thirty-nine fractures (57.3%) demonstrated radiographic fusion in all 3 predefined locations. Nine of the 14 worker’s compensation patients returned to work within the period of observation. There were 8 complications: 3 requiring a secondary operation. Eleven of 79 fractures treated did not go on to achieve radiographic union. Conclusion: In this retrospective case series, we found that screws-only primary subtalar arthrodesis for the treatment of DIACFs through a sinus tarsi approach was associated with relatively high rates of return to work and radiographic fusion. Level of Evidence: Level IV, retrospective case series.

Time to Achieving Clinically Significant Outcomes after Meniscal Allograft Transplantation

Objectives: Meniscal allograft transplantation (MAT) is a surgical treatment option for patients with meniscus deficiencies. Prior studies have defined clinically significant outcomes such as minimal clinical important difference (MCID) and patient acceptable symptomatic state (PASS) for commonly administered patient reported outcome measures (PROMs) after MAT. The purpose of this study was to determine the time to achieving MCID and PASS and to identify any risk factors affecting achievement in patients undergoing MAT. Methods: A prospectively maintained MAT registry was retrospectively reviewed from April 2014-May 2020. Patients who underwent revision MAT or did not complete preoperative PROMs were excluded. International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were administered preoperatively and at 6-months, 1-year, and 2-years postoperatively. Previously defined MCID and PASS thresholds were utilized and Kaplan-Meier survival curve analysis with interval censoring was used to calculate the cumulative percentages of MCID, and PASS achievement at each follow-up time interval (5-7, 11-13, and 23-25 months). Results: Eighty-four patients (mean age: 28.2±9.7) were included. Time to MCID and PASS is presented in Table 1. Previously reported PASS values for KOOS Pain, Symptoms, and Sport did not reach an AUC>0.70 and thus were not included in analysis. Worker’s compensation status was found to delay time to achieving MCID for all PROs (HR=0.238-0.305, P=0.008-0.020) and PASS for KOOS Symptoms (HR=0.171, P = 0.026) and IKDC (HR=1.88, P<0.001) (Table 2 and 3). Higher preoperative PRO score was associated with mildly delaying the time to achieving MCID for all PROs (HR=0.947-0.970, P<0.001), while higher preoperative PRO scores were associated with shorter time to achieving PASS on KOOS Symptoms and KOOS QOL (HR=1.030-1.043, P=0.001). Greater BMI (HR=0.946, P=0.020) and the number of focal chondral defects (HR=0.083-0.255, P=0.007-0.029) was associated with delayed MCID for KOOS ADL and QOL, respectively, while concomitant realignment surgery decreased time to MCID on KOOS Sports (HR=2.542, P=0.008). Conclusions: This study defined the time to achieving MCID and PASS on IKDC and KOOS subscores for patients undergoing MAT. Worker’s compensation status, BMI, and the presence of focal chondral defects may prolong time to achievement of MCID and PASS after MAT. [Table: see text][Table: see text][Table: see text]

Return to work after arthroscopic rotator cuff repair in a worker’s compensation population

By focusing on arthroscopic rotator cuff repair in a worker’s compensation patient population that are without personal injuries, previous ipsi-lateral shoulder injury, any concomitant pathologies or being federal employees, the rate of return-to-work (RTW) can be better isolated as an outcome of the surgery. RTW rate for a consecutive 50 patient cohort was 98% with 58% achieving full duty. A single patient with a frozen shoulder was unable to return to work at any level. These RTW rates contrast with several previous studies that reported significantly lower RTW rates for workers with compensation than workers without compensation. All but three patients improved their UCLA scores after the repair.

The Stigma of Digital Amputation: A Survey of Amputees with Analysis of Risk Factors

Purpose: We aimed to quantify the stigma associated with digital amputation using the Neuro-QOL Stigma patient-reported outcomes instrument and examine the patient and injury factors associated with a more severe amputation stigma experience. Methods: This descriptive retrospective cohort study analyzed 164 patients who underwent digital amputation. Records were reviewed for age at amputation, sex, indication, laterality, level, number of amputated digits, and a diagnosis of depression that preceded amputation. Enrolled patients remotely completed the Neuro-QOL stigma computer adaptive test, a battery of PROMIS instruments, and a questionnaire clarifying personal/injury details. Multivariable analysis was used to identity factors associated with a more severe stigma experience.Results: Among 164 digital amputees enrolled, the observed mean Neuro-QOL Stigma score of 47.2 +/- 8 is slightly below the population mean of 50. Younger age, a worker’s compensation claim, and a diagnosis of depression at the time of amputation are each independently associated with a more severe stigma experience after digital amputation. Neither socioeconomic variables, anatomic details of the injury, nor mechanism were independently associated with Neuro-QOL Stigma. Conclusions: While we have previously targeted patients with more severe injuries for discussion of coping with physical stigma, our findings suggest that attention should perhaps instead be focused on digital amputees who are young, depressed, and/or involved with worker’s compensation. A surgeon may be of service to the at-risk patient by offering referral to a mental health provider who can offer depression treatment and/or support the patient’s process of coping and adjustment.

SAT0574 RISK FACTORS ASSOCIATED WITH OPIOID USE AMONG WORKER’S COMPENSATION: A LITERATURE REVIEW

Background:To increase recovery and return to work after an occupational accident or injury, a worker’s compensation claim provides individualised management plan involving multiple kinds of treatment. These plans can consist of the prescription of opioids to reduce inflammation, provide pain relief and increase functionality within a short period of time to aid return to work. Recently, there have been growing concerns about the misuse of opioids in managing pain symptoms by both the insurance industry and the general community. Studies from North America have indicated the prescription and management of opioid consumption among workers compensation claimants can cause more harm to functionality and reduce recovery to return to work, often leading to misuse, dependency or overdosing (Dembe, Wickizer, Sieck, Partridge & Balchick (2012)].Objectives:The aims of this abstract are to provide a comprehensive literature review of the studies that have examined: 1) the prevalence of opioid use among worker compensations claimants and, 2) identify predictors of long-term opioid use among the workers compensation claimants.Methods:A search strategy, with terms associated with “worker compensation”, “opioids” “prevalence” and/or “risk factors” were used to search through relevant databases such as CINAHL, Cochrane, Embase, MEDLINE, PsycINFO, Scopus and Web of Science from database inception to January 2020. Duplicates were excluded. Two researchers retrieved, screened for eligibility and reviewed the results accordingly using a staged approach. Systematic review registration number PROSPERO registry number: CRD42013004137.Results:The search yielded 2857 records. After the initial screening, 125 full-text articles were assessed by two independent reviewers. The inclusion criteria were met by nine studies1-9. All studies conducted retrospective cohort studies using workers compensation claimant’s data, ranging from 54,931, to 100,357 reports, either over a short 12-month period to over 11 years, with no reporting of response rate or recruitment rates. All studies examined the association of being exposure to opioids from the date of the workers injury(7), ranging from 30 to 730 days or from 0 days to 4 or more years1 4-9. Carnide et al (2018)2 was the only study to investigate opioid exposure before and after injury as a predictor of future long term use. Among those who examined work-opioid related factors (4) found workers compensation reports with work disability for more than 14 days where more likely to become a long term opioid uses (OR: 2.17 [95% CI:1.52–3.10])1. Kraut et al7 on the other hand, found being a worker’s compensation claimant increased the risk of being prescribed ≥ 120 morphine equivalents (ME) per day (ME/D) (OR: 2.06 [95% CI: 1.58 - 2.69]), than those who were not in workers compensation program. Another study found, initial days of supply of opioids from 5 to 20 or more days was strongly associated with long term use of opioids (OR: 28.94 [95%CI, 23.44-35.72])5. While a study by Heins et al (2015)6 examined receiving opioids within the first month, people with back injuries were less likely to become a long-term opioid user (OR: 0.67 [95% CI: 0.59 – 0.76]), while those with shoulder injury were at risk (OR: 1.29 [95% CI: 1.06 – 1.58]).Conclusion:There are a number of reliable prevalence studies among workers compensation settings indicating opioid use is below 20 percent however, there remains inconsistencies when examining predictors of long term or persistent opioid use. After reviewing the literature, a validity of studies will be conducted and graded by two authors independently using a standardised checklist to complete a systematic review for publication which will assist with managing opioid use among work compensation claimants and managers.Disclosure of Interests:None declared