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Background: Heterotopic ossification in the elbow, often caused by trauma or neurogenic factors, can lead to limited range of motion and physical impairment, while severe cases may result in debilitating loss of function. Complete bony ankylosis of the elbow, though rare, presents challenges in treatment due to complex anatomy and high recurrence rates, with limited literature on management and outcomes. This study retrospectively investigates cases of elbow ankylosis secondary to heterotopic ossification, assessing long-term functional outcomes following operative intervention and standardized rehabilitation. Methods: A retrospective case series was performed on patients who underwent surgical excision of heterotopic ossification of the elbow at our institution. Outcomes of interest were intraoperative flexion-extension arc, flexion-extension arc at the final long-term postoperative follow-up, visual analog scale pain scores at long-term follow-up, and Mayo Elbow Performance scores at long-term follow-up. The Wilcoxon signed-rank test was performed to identify a statistically significant difference between arc of motion achieved intraoperatively and the arc of motion maintained at the final long-term postoperative follow-up. Results: Between September 1999 and July 2021, 107 patients underwent operative resection for heterotopic ossification around the elbow, with 13 patients (16 elbows) exhibiting complete ankylosis at time of surgery. Patients were followed up for a minimum of 2 years. Long-term outcomes demonstrated an average visual analog scale pain score of 1.4 +/− 1.7, and an average Mayo Elbow Performance score of 85.9 +/−12.8, with 75% of cases maintaining at least 100 degrees of flexion-extension arc at the final long-term postoperative follow-up. On average, the flexion-extension arc of motion at the final follow-up was preserved at 95% of intraoperative levels. Patients did have an average residual flexion contracture of 18 +/− 9 degrees at the final follow-up. Conclusion: Surgical excision for complete elbow ankylosis secondary to heterotopic ossification presents challenges due to potential complications. Our study shows favorable long-term outcomes in pain scores, range of motion, and Mayo Elbow Performance scores. Despite reported complications in the literature, our series exhibited no adverse events, supporting operative excision as a standard treatment with overall fair to excellent outcomes. Further research, particularly involving multicenter, randomized, prospective studies, is warranted to refine protocols and understand predictors for improved outcomes in this patient population.

Purpose: To evaluate whether cataract surgery is associated with decreased risks of central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO) development using the American Academy of Ophthalmology Intelligent Research in Sight (IRIS®) Registry. Design: Retrospective database study of the IRIS Registry data. Participants: Patients in the IRIS Registry who underwent cataract surgery and 1:1 matched control participants from the IRIS Registry using a decision tree classifier as a propensity model. Methods: Control and treatment groups initially were selected using Current Procedural Terminology codes for uncomplicated cataract surgery and other straightforward criteria. To accomplish treatment–control matching, a decision tree classifier was trained to classify patients as treatment versus control based on a set of chosen predictors for treatment, where best-corrected visual acuity and age were the most important predictors. Treatment and control participants subsequently were matched using the classifier, the visit dates, and the identifications of the practice. Cox regression was performed on the matched groups to measure the hazard ratio (HR) of retinal vein occlusion development adjusted for age, sex, race, primary insurance type, and previous diagnosis of diabetic retinopathy (DR), glaucoma, and narrow angles. Main Outcome Measure: The HR of retinal vein occlusion developing in patients who underwent cataract surgery compared with matched control participants. Results: The HRs for CRVO and BRVO developing in patients who underwent cataract surgery compared with matched control participants who did not during the first year after either cataract surgery or baseline visit were 1.26 [95% confidence interval [CI], 1.16–1.38; P < 0.001] and 1.27 [95% CI, 1.19–1.36; P < 0.001], respectively, after controlling for age, sex, race, insurance, and history of DR, glaucoma, and narrow angles. Diabetic retinopathy was the strongest predictor associated with CRVO (2.79 [95% CI, 2.43–3.20; P < 0.001]) and BRVO (2.35 [95% CI, 2.09–2.64; P < 0.001]) development after cataract surgery. Conclusions: Cataract surgery is associated with a small increase in risk of retinal vein occlusions within the first year; however, the incidence is low and likely not clinically significant.

Category: Trauma; Ankle Introduction/Purpose: There is a high prevalence of Chronic Kidney Disease (CKD) in orthopaedic trauma patients. The purpose of this study was to assess mortality and postoperative complications amongst patients with moderate-to-severe CKD including end stage renal disease (ESRD) following surgical fixation of ankle fractures. We hypothesized that there would not be a significant difference in outcomes in patients with moderate-to-severe CKD. Methods: Patients at an academic Level 1 trauma center between 2008-2019 who underwent operative fixation of an ankle fracture and had a diagnosis of CKD were retrospectively identified. All patients with moderate-to-severe CKD (stages III-V) prior to injury were included. A randomly selected group of patients with mild CKD (stages I/II) served as a control group. Demographics, age adjusted Charlson Comorbidity Index (CCI), fracture type, complications (including deep infection, hardware failure, non-union/malunion, amputation), and mortality within 2 years from surgery were collected. Results were compared using ANOVA and Fisher’s exact tests, and mortality was adjusted for age, race, CCI, and BMI using logistic regression. Results: A total of 42 patients with mild CKD and 47 with moderate-to-severe CKD were included. The overall complication rates were not significantly different between the groups (26% vs 32%, p=0.64), Return to the OR (10% vs 17%, p=0.36) and amputation (0% vs 2%, p=1.0) were not significantly different between the groups. There were higher rates of deep infection, but this was not statistically significant One-year and two-year mortality rates were near equivalent between groups (7% vs 9%, p=1.0 and 10% vs 13%, p=0.74). Conclusion: Following surgical fixation of an ankle fracture, patients with moderate-to-severe CKD do not appear to have increased rates of mortality or overall complications than patients with mild CKD. This data can be useful to counsel patients with ankle fractures and moderate-to-severe CKD and ESRD.