Complete sternal-sparing left ventricular assist device implantation is associated with improved postoperative mobility

Left ventricular assist device (LVAD) implantation via a complete sternal-sparing (CSS) technique is gaining interest due to several potential benefits. We hypothesized that the CSS approach for HeartMate 3 (HM3) LVAD implantation improves postoperative mobility and physical independence compared to full sternotomy (FS). We retrospectively reviewed patients who were implanted with a commercial HM3 at our institution from September 2017 to August 2018. The Activity Measure for Post-Acute Care short forms and Functional Independence Measure scores were used to assess the patient’s physical limitations postoperatively. A total of 43 patients were included in the study: 27 (63%) CSS patients and 16 (37%) FS patients. At postoperative day 3, the CSS cohort demonstrated improved mobility based on Activity Measure for Post-Acute Care scores compared to the FS group; 40% of the CSS cohort versus 67% of the FS cohort remained 100% impaired. The CSS cohort also demonstrated greater postoperative independence in the Functional Independence Measure sit-to-stand metric with 78% of the CSS cohort achieving modified or complete independence by postoperative day 15 compared to only 21% of the FS patients. These early data suggest that the CSS approach for HM3 LVAD implantation improves postoperative mobility and functional independence compared to FS.

Treatment with and without stabilizing lumbar spinal orthosis after one- or two-level spondylodesis: A randomized controlled trial

BACKGROUND AND OBJECTIVE: Musculature affected during spondylodesis surgery may benefit and recover faster if supported by spine orthosis postoperatively. METHODS: This prospective study included 50 consecutive patients undergoing one- or two-level spondylodesis. The intervention group received a lumbar spine orthosis (n= 23), while the control group remained without orthosis (n= 27). Patients were assessed for pain (Visual Analogue Scale, VAS), Oswestry Disability index (ODI) as well as the use of analgesics. RESULTS: Patients wearing an orthosis postoperatively reported a higher degree of subjective stability. However, both intervention as well as control group did not show any significant differences for each of the follow-up points regarding VAS, ODI or the use of analgesics. CONCLUSION: Wearing an orthosis has neither impact on subjective pain, the need for analgesics nor for postoperative functionality. However, patients reported that they profited from wearing the orthosis by feeling more stable, thereby nicely improving their postoperative mobility. Thus, novel patient reported outcome measures have to be developed to assess these features in future studies.

Mobility Limitation After Surgery for Degenerative Pathology of the Ankle, Hindfoot, and Midfoot vs Total Hip Arthroplasty

Background: Surgery for degenerative foot and ankle conditions often results in a lengthy recovery. Current outcome measures do not accurately assess postoperative mobility, especially in older patients. The Life-Space Assessment (LSA), a questionnaire quantifying patients’ mobility after a medical event, was used in this study to assess perioperative mobility in total hip arthroplasty (THA) and foot and ankle surgery patients. We hypothesized that patients undergoing elective foot and ankle surgery would have greater postoperative mobility limitation than THA patients. Methods: Preoperative, 3-month, and 6-month postoperative LSA data were collected from THA and foot and ankle cohorts. Twelve-month postoperative data were obtained for the foot and ankle group as well. Patient demographics were recorded, and data were analyzed using a Mann-Whitney U test. Results: Twenty-eight degenerative foot and ankle operative patients and 38 THA patients met inclusion criteria. Only patients aged ≥60 years were included in this study. The mean preoperative LSA score was lower in the foot and ankle group (68.8) compared with THA (74.0), although the difference was not statistically significant ( P = .602). THA patients showed a significant increase in LSA score from preoperative (74) to 6 months postoperation (95.9) ( P = .003); however, foot and ankle patients showed no significant difference between preoperative (68.8) and 6-month (61.2) scores ( P = .468). Twelve months postoperatively, foot and ankle patients showed improvement in LSA score (88.3) compared with preoperation ( P = .065). Conclusion: Compared with THA, recovery of mobility after foot and ankle surgery was slower. THA patients exhibited improved mobility as early as 3 months after surgery, whereas foot and ankle patients did not show full improvement until 12 months. This work will assist the foot and ankle specialist in educating patients about challenges in mobility during their recovery from surgery. Level of Evidence: Level II, prospective cohort study.

6 Perioperative Urinary Catheterisation in Hip Fracture Patients

Introduction There are currently no national guidelines, in the UK, advising when to catheterize hip fracture patients and when to trial without a catheter (TWOC). We audited the practice in a UK teaching hospital where there is a consultants’ consensus that all patients should be catheterized on the day of admission (or day of surgery; which is usually within 36 hours of admission) and TWOC as soon as possible within 72 hours postoperatively. We also correlated delays in TWOC with urinary tract infection (UTI) rates. Methods Audit of consecutive hip fracture patients who had undergone surgery. Patients who had long term indwelling urinary catheter were excluded. Data collected include: demographics and date and time of admission, catheterisation, operation and TWOC, also duration of catheter post operatively, reason if TWOC delayed and whether the patient had a UTI. Results 43 patients were included; 30 males and 13 females with a mean age of 82.9 and 83.9 years respectively. Urinary catheters were inserted in 100% of patients preoperatively. Overall 23% of patients had a UTI. There were more UTIs with prolonged catheterization. The results are summarised in the table. The reason for delaying a TWOC was not documented in any of patients’ notes. Discussion The low rate of TWOC within 72 hours can be attributed to:Lack of clear guidelinesReluctance to have a TWOC for older patients with poor postoperative mobility with concerns regarding inability to reach the toilet timely.Reluctance to have a TWOC for those who did not open their bowels postoperatively.Time and resources pressure. Conclusion and recommendations National guidelines for urinary catheterisation in hip fracture patients are needed meanwhile Orthopaedic Department guidelines will improve the care in these patients. Patients should have a urinary catheter “passport” documenting the date of insertion, expected date of TWOC and the reasons for delaying TWOC. It is important to educate the team about the importance of TWOC as early as possible and improve communication.

Risk analysis and clinical outcomes of intraoperative periprosthetic fractures: a retrospective study of 481 bipolar hemiarthroplasties

Background Intraoperative periprosthetic fractures (IPF) are a well-described complication following hip hemiarthroplasty. Our aims were to identify risk factors that characterize IPF and to investigate postoperative mobility. Methods We retrospectively reviewed 481 bipolar hemiarthroplasties for displaced femoral neck fractures; of which, 421 (87.5%) were performed without cement, from January 2013 to March 2018. Data on the patients’ demographics, comorbidities, femoral canal geometry (Dorr canal type, Canal Flare Index), surgeon’s experience (junior vs. senior surgeon), and timing of surgery (daytime vs. on-call duty) were obtained. In patients with intraoperative fractures, further information was obtained. Patient mobility was assessed using matched-pair analysis. Mobility was classified according to the NHFD mobility score. The chi-square test, Fisher’s exact test, and Fisher-Freeman-Halton exact test were used for comparison between categorical variables, while the Mann-Whitney U test was used for continuous variables. The data analysis was performed using SPSS. Results Of 481 procedures, 34 (7.1%) IPFs were encountered. The Dorr canal type C was identified as a significant risk factor (p = .004). Other risk factors included female sex (OR 2.30, 95% CI .872–6.079), stovepipe femur (OR 1.749, 95% CI .823–3.713), junior surgeon (OR 1.204, 95% CI .596–2.432), and on-call-duty surgery (OR 1.471, 95% CI .711–3.046), although none showed a significant difference. Of 34 IPFs, 25 (73.5%) were classified as Vancouver type A. The treatment of choice was cerclage wiring. Within the 12 matched pairs identified, the postoperative mobility was slightly worse for the IPF group (delta = .41). Conclusions IPF is a serious complication with bipolar hemiarthroplasty. The identification of risk factors preoperatively, in particular femur shape, is crucial and should be incorporated into the decision-making process.

Lateral Radial Head Subluxation as a Complication Following Proximal Ulnar Osteotomy or Ostectomy in Eight Dogs

Objectives The aim of this study was to report the complication of lateral radial head subluxation following proximal ulnar osteotomy (PUOO) or proximal ulnar ostectomy (PUOE) in eight dogs. Materials and Methods Case records and diagnostic imaging of dogs developing lateral radial head subluxation following PUOO (n = 7) or PUOE (n = 2) were retrospectively reviewed. Information pertaining to clinical history, signalment, presenting condition, lameness grade, diagnostic imaging and initial surgery details, postoperative complications and their management were retrieved. Outcomes were established from subsequent clinical histories or telephone interviews with referring veterinarians. Comparison was made to a single-centre cohort without lateral radial head subluxation following PUOO or PUOE. Results Eight dogs (median age: 9.5 months [range: 6 months–6 years], median weight 7.7 kg [range: 5–28 kg]) were included. Six dogs had a PUOO performed; five dogs had unilateral surgery and one had bilateral surgery. Two dogs had unilateral PUOE surgery. Median time to diagnosis of lateral radial head subluxation following surgery was 6.5 weeks (range: 2–20 weeks). Five of the eight dogs had surgical revision of lateral radial head subluxation. Resolution of lateral radial head subluxation was achieved in four dogs, with three achieving acceptable to good mobility. One dog had poor postoperative mobility. A fifth dog remained lame after revision surgery failure. Three dogs did not have revision surgery; two underwent limb amputation and one dog remained lame as revision surgery was declined. Clinical Significance Lateral radial head subluxation is a potentially severe postoperative complication following PUOO or PUOE.

Proximal femur fractures - effect of preoperative mental status of patients on postoperative mobility of patients

<p class="abstract"><strong>Background:</strong> In the elderly population, proximal femur fractures are most common which can result in increase of morbidity and mortality. Pre and postoperative mobility patterns, also depends upon the Mental Status of the patient. Incidence of Mental health disorders of patient can increases with age and co morbidities. The aim of the study was to evaluate the effect and relationship of preoperative mental status, on postoperative mobility in proximal femur fracture patients. On null hypothesis; there exists no co-relation between pre-operative mental status on pre and postoperative mobility those had surgery for proximal femur fractures.</p><p class="abstract"><strong>Methods:</strong> This is a retrospective study, carried out during the period of 14^th March, 2016 to 14^th March, 2017 at BIRRD (T) Hospital. All the patients who underwent proximal femur fracture surgeries were included in the study. Patients were evaluated for Abbreviated Mental Score Test pre-operatively. Mobility patterns were before injury and after surgery evaluated in patients with proximal femur fractures. Postoperatively patients were followed up to one year.<strong></strong></p><p class="abstract"><strong>Results:</strong> 50 patients were included into the study, where 12 patients could not present to follow-up due to various reasons, thus we have complete data of 38 patients. There is significant reduction in mobility status of individuals i.e. from 6.18 (preoperative pre fracture mobility) to 5.36 (postoperative mobility). Average abbreviated mental test score is 7.55. There exists a correlation between the variables.</p><p class="abstract"><strong>Conclusions:</strong> Null hypothesis remains rejected. There is statistically significant relationship between the variables (pre and postoperative mobility, and abbreviated mental test score), which appears to be positive correlation.</p>

Suture-button devices are at least as effective as screws for fixation of acute syndesmotic injuries: a systematic review

ImportanceSuture-button devices gained popularity for fixation of acute syndesmotic injuries, but screw fixation remains the gold standard for treatment. It is not clear if these devices are superior or at least as effective in the treatment of such injuries.ObjectiveThis review aims to determine if current evidence supports the use of suture-button devices instead of screws in the treatment of acute syndesmotic injuries and what advantages they may bring.Evidence reviewAll studies comparing screw with suture-button fixation in acute syndesmotic injuries and reporting imaging parameters of maintenance of reduction, functional outcomes, complications and/or reintervention rates were selected. Cochrane Review Library,Turning Research Into Practice, Medline, PubMed, Web of Knowledge, ScienceDirect, Google Scholar and Ovid databases were searched for dates up to, and including, September 2017. Relevance was screened by title and abstract. Secondary review from the references of the selected articles was performed. Risk of bias was assessed with the Cochrane Library checklists. Data on complications, reoperations, and clinical and imaging outcomes were extracted.FindingsSuture-button devices are a valid alternative to stabilise acute syndesmosis injuries and may provide many advantages; there is a consistent trend to better clinical outcomes and significantly higher postoperative mobility, earlier weight-bearing and return to work, more accurate anatomical reduction, and decreased risk of loss of reduction.Conclusions and relevanceSuture-button devices are at least as effective as screws for fixation of acute syndesmotic injuries.Level of evidenceLevel II.