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1. Factors Predictive of Early Complications Following Total Ankle Arthroplasty

Author

Christopher Del Balso MBBS, MSc, Mansur M. Halai BSc (Hons), MBChB, Mark D. MacLeod MD, David W. Sanders MD, MSc, and Abdel Rahman Lawendy MD, PhD

Subjects
Orthopedic surgery, RD701-811
Abstract

Background: The safety of outpatient total ankle arthroplasty (TAA), and factors predictive of early complications are poorly understood. The objective of this study was to determine the frequency of early complications in patients undergoing outpatient TAA compared to a matched inpatient TAA cohort. Factors predictive of early complications following TAA are elucidated. Methods: A retrospective review of prospectively collected data from the 2011-2018 American College of Surgeons–National Surgical Quality Improvement Program (ACS-NSQIP) database was performed. An unadjusted analysis comparing complication rates in outpatient, and inpatient TAA was performed followed by a propensity score–matched cohort analysis. A multivariate logistic regression model was then used to identify significant independent predictors for complications, reoperation, and readmission following TAA. Results: A total of 1487 patients (198 outpatient, 1289 inpatient) undergoing TAA were included in the study. Inpatient TAA was associated with increased 30-day readmission compared with outpatient TAA (3.54% vs 0.51%, P = .032) in a matched cohort analysis. Thirty-eight (2.6%) patients had a minor complication, with 16 (1.1%) patients having a major complication after TAR. Nineteen (1.3%) patients underwent reoperation, and 42 (2.8%) patients were readmitted within 30 days of the index TAR. Multivariate analysis identified factors predictive of early complications to include length of stay (LOS) >2 days, smoking, hypertension, bleeding disorders, and diabetes mellitus. Conclusion: From this relatively limited data set, outpatient TAA appears to be safe for management of end-stage ankle arthritis in select patients. Inpatient status was associated with an increased rate of 30-day readmission following TAA. Postoperative length of stay >2 days, smoking, hypertension, bleeding disorders, and diabetes mellitus were identified to be associated with early postoperative complications following TAA in this cohort. Level of Evidence Level III, retrospective cohort study.

Published
2022
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2. Accelerated surgery versus standard care in hip fracture (HIP ATTACK-1) : a kidney substudy of a randomized clinical trial

Author

Flavia K. Borges, P.J. Devereaux, Meaghan Cuerden, Jessica M. Sontrop, Mohit Bhandari, Ernesto Guerra-Farfán, Ameen Patel, Alben Sigamani, Masood Umer, John Neary, Maria Tiboni, Vikas Tandon, Mmampapatla Thomas Ramokgopa, Parag Sancheti, Abdel-Rahman Lawendy, Mariano Balaguer-Castro, Richard Jenkinson, Paweł Ślęczka, Aamer Nabi Nur, Gavin C.A. Wood, Robert J. Feibel, John Stephen McMahon, Bruce M. Biccard, Alessandro Ortalda, Wojciech Szczeklik, Chew Yin Wang, Jordi Tomás-Hernández, Jessica Vincent, Valerie Harvey, Shirley Pettit, Kumar Balasubramanian, Gerard Slobogean, Amit X. Garg, Laurent Veevaete, Bernard le Polain de Waroux, Patricia Lavand'homme, Olivier Cornu, Karim Tribak, Jean C. Yombi, Nassim Touil, Jigme T. Bhutia, Carol Clinckaert, Dirk De Clippeleir, Maike Reu, Leslie P. Gauthier, Victoria RA. Avram, Mitchell Winemaker, Daniel M. Tushinski, Justin de Beer, Andrew Worster, Diane L. Simpson, Kim A. Alvarado, Krysten K. Gregus, Kelly H. Lawrence, Darryl P. Leong, Philip G. Joseph, Patrick Magloire, Benjamin Deheshi, Stuart Bisland, Thomas J. Wood, David AJ. Wilson, Sandra N. Ofori, Jessica Spence, Emmanuelle Duceppe, Maria E. Tiboni, John D. Neary, Anthony Adili, David D. Cowan, Vickas Khanna, Amna Zaki, Janet C. Farrell, Anne Marie MacDonald, David Conen, Steven CW. Wong, Arsha Karbassi, Douglas S. Wright, Harsha Shanthanna, Javier Ganame, Andrew Cheung, Ryan Coughlin, Moin Khan, Spencer Wikkerink, Faraaz A. Quraishi, Waleed Kishta, Emil Schemitsch, Timothy Carey, Mark D. Macleod, David W. Sanders, Edward Vasarhelyi, Debra Bartley, George K. Dresser, Christina Tieszer, Richard J. Jenkinson, Steven Shadowitz, Jacques S. Lee, Stephen Choi, Hans J. Kreder, Markku Nousiainen, Monica R. Kunz, Ravianne Tuazon, Mopina Shrikumar, Bheeshma Ravi, David Wasserstein, David J.G. Stephen, Diane Nam, Patrick D.G. Henry, Gavin CA. Wood, Stephen M. Mann, Melanie T. Jaeger, Marco LA. Sivilotti, Christopher A. Smith, Christopher C. Frank, Heather Grant, Leone Ploeg, Jeff D. Yach, Mark M. Harrison, Aaron R. Campbell, Ryan T. Bicknell, Davide D. Bardana, Katie McIlquham, Catherine Gallant, Samantha Halman, Venkatesh Thiruganasambandamoorth, Sara Ruggiero, William J. Hadden, Brian PJ. Chen, Stephanie A. Coupal, Stephen J. McMahon, Lisa M. McLean, Hemant R. Shirali, Syed Y. Haider, Crystal A. Smith, Evan Watts, David J. Santone, Kevin Koo, Allan J. Yee, Ademilola N. Oyenubi, Aaron Nauth, Emil H. Schemitsch, Timothy R. Daniels, Sarah E. Ward, Jeremy A. Hall, Henry Ahn, Daniel B. Whelan, Amit Atrey, Amir Khoshbin, David Puskas, Kurt Droll, Claude Cullinan, Jubin Payendeh, Tina Lefrancois, Lise Mozzon, Travis Marion, Michael J. Jacka, James Greene, Matthew Menon, Robert Stiegelmahr, Derek Dillane, Marleen Irwin, Lauren Beaupre, Chad P. Coles, Kelly Trask, Shelley MacDonald, J.A.I. Trenholm, William Oxner, C.G. Richardson, Niloofar Dehghan, Mehdi Sadoughi, Achal Sharma, Neil J. White, Loretta Olivieri, Stephen B. Hunt, Thomas R. Turgeon, Eric R. Bohm, Sarah Tran, Stephen M. Giilck, Tom Hupel, Pierre Guy, Peter J. O'Brien, Andrew W. Duncan, Gordon A. Crawford, Junlin Zhou, Yanrui Zhao, Yang Liu, Lei Shan, Anshi Wu, Juan M. Muñoz, Philippe Chaudier, Marion Douplat, Michel Henri Fessy, Vincent Piriou, Lucie Louboutin, Jean Stephane David, Arnaud Friggeri, Anthony Viste, Charles Hervé Vacheron, Frankie Ka Li Leung, Christian Xinshuo Fang, Dennis King Hang Yee, Parag K. Sancheti, Chetan V. Pradhan, Atul A. Patil, Chetan P. Puram, Madhav P. Borate, Kiran B. Kudrimoti, Bharati A. Adhye, Himanshu V. Dongre, Bobby John, Valsamma Abraham, Ritesh A. Pandey, Arti Rajkumar, Preetha E. George, Manesh Stephen, Nitheesh Chandran, Mohammed Ashraf, A.M. Georgekutty, Ahamad S. Sulthan, S. Adinarayanan, Deep Sharma, Satish P. Barnawal, Srinivasan Swaminathan, Prasanna U. Bidkar, Sandeep K. Mishra, Jagdish Menon, M. Niranjan, Z.K. Varghese, Santosh A. Hiremath, N.C. Madhusudhan, Abhijit Jawali, Kingsly R. Gnanadurai, Carolin E. George, Tatarao Maddipati, K.P. Mary, Vijay Sharma, Kamran Farooque, Rajesh Malhotra, Samarth Mittal, Chavi Sawhney, Babita Gupta, Purva Mathur, Shivanand Gamangati, Vijaylaxmi Tripathy, Prem H. Menon, Mandeep S. Dhillon, Devendra K. Chouhan, Sharanu Patil, Ravi Narayan, Purushotham Lal, Prashanth N. Bilchod, Surya U. Singh, Uttam V. Gattu, Ravi P. Dashputra, Prashant V. Rahate, Maurizio Turiel, Riccardo Accetta, Paolo Perazzo, Daniele Stella, Marika Bonadies, Chiara Colombo, Giuseppe De Blasio, Stefania Fozzato, Fabio Pino, Ilaria Morelli, Francesco De Donato, Eleonora Colnaghi, Vincenzo Salini, Giacomo Placella, Giuseppe Giardina, Gaetano Lombardi, Anna Marcato, Luca Guzzetti, Ilaria Rivetti, Massimiliano Greco, H.M. Khor, Hou Yee Lai, C.S. Kumar, K.H. Chee, P.S. Loh, Kit Mun Tan, Simmrat Singh, Li Lian Foo, Komella Prakasam, Sook Hui Chaw, Meng-Li Lee, Joanne HL. Ngim, Huck Wee Boon, Im Im Chin, Ydo V. Kleinlugtenbelt, Ellie BM. Landman, Elvira R. Flikweert, Herbert W. Roerdink, Roy BG. Brokelman, Hannie F. Elskamp-Meijerman, Bas Staffhorst, Jan-Hein MG. Cobben, Dilshad Begum, Anila Anjum, Pervaiz M. Hashmi, Tashfeen Ahmed, Haroon U. Rashid, Mujahid J. Khattak, Rizwan H. Rashid, Riaz H. Lakdawala, Shahryar Noordin, Naveed M. Juman, Robyna I. Khan, Muhammad M. Riaz, Syedah S. Bokhari, Ayesha Almas, Hussain Wahab, Arif Ali, Hammad N. Khan, Eraj K. Khan, Kholood A. Janjua, Sajjad H. Orakzai, Abdus S. Khan, Khawaja J. Mustafa, Mian A. Sohail, Muhammad Umar, Siddra A. Khan, Muhammad Ashraf, Muhammad K. Khan, Muhammad Shiraz, Ahmad Furgan, Piotr Dąbek, Adam Kumoń, Wojciech Satora, Wojciech Ambroży, Mariusz Święch, Jacek Rycombel, Adrian Grzelak, Ilona Nowak-Kózka, Jaroslaw Gucwa, Waldemar Machala, Mmampapatla T. Ramokgopa, Gregory B. Firth, Mwalimu Karera, Maria Fourtounas, Virsen Singh, Anna Biscardi, Muhammad N. Iqbal, Ryan J. Campbell, Matimba L. Maluleke, Carien Moller, Lerato Nhlapo, Sithombo Maqungo, Margot Flint, Marcin B. Nejthardt, Sean Chetty, Stephen Venter, Ernesto Guerra-Farfan, Jordi Tomas-Hernandez, Yaiza Garcia-Sanchez, Miriam Garrido Clua, Vicente Molero-Garcia, Jordi Teixidor-Serra, Maria del Mar Villar-Casares, Jordi Selga Marsa, Juan A. Porcel-Vazquez, Jose-Vicente Andres- Peiro, Jaume Mestre-Torres, Patricia Guilabert, M Luisa Paños Gozalo, Luis Abarca, Nuria Martin, Gemma Usua, Pilar Lalueza-Broto, Judith Sanchez-Raya, Jorge Nuñez Camarena, Antoni Fraguas-Castany, Carlos Piedra Calle, Diego Soza Leiva, Maria Garcia Carrasco, Montsant Jornet-Gibert, Montserrat Monfort-Mira, Alfons Gasset-Teixidor, Francesc Antoni Marcano-Fernández, Isabel Simó- Sánchez, Begoña Mari-Alfonso, Christian Yela-Verdú, Raúl Pellejero-García, Júlia Casas-Codina, Ruben Iglesias- Sanjuan, Pau Balcells-Nolla, Oriol Vila-Sánchez, Mercè Bertrana de Bustos, Pablo Castillón, Martí Bernaus, Saioa Quintas, Olga Gómez, Jordi Salvador, Javier Abarca, Cristina Estrada, Marga Novellas, Francesc Anglès, Alfred Dealbert, Oscar Macho, Alexia Ivanov, Esther Valldosera, Marta Arroyo, Borja Pey, Antoni Yuste, Llorenç Mateo, Julio De Caso, Rafael Anaya, J.L. Higa-Sansone, Angelica Millan, Victoria Baños, Sergio Herrera-Mateo, Hector J. Aguado, Virginia García-Virto, Clarisa Simón-Pérez, Sergio Chavez, María Bragado, María Plata, Enrique Guerado, Encarnacion Cruz, Juan R. Cano, Jose M. Bogallo, Paphon Sa-ngasoongsong, Noratep Kulachote, Norachart Sirisreetreerux, Nachapan Pengrung, Theerawat Chalacheewa, Vanlapa Arnuntasupakul, Teerapat Yingchoncharoen, Bundit Naratreekoon, Miriam A. Kadry, Surendini Thayaparan, Victor Babu, Arash Aframian, Souad Bentoumi, Amrinder Sayan, Ihab Abdlaziz, Marcela P. Vizcaychipi, Patricia Correia, Shashank Patil, Kevin Haire, Amy SE. Mayor, Sally Dillingham, Laura Nicholson, Ben T. Brooke, Joby John, Shashi K. Nanjayan, Martyn J. Parker, Susan O'Sullivan, Meir T. Marmor, Amir Matityahu, Robert T. McClellan, Curt Comstock, Anthony Ding, Paul Toogood, Robert O’Toole, Marcus Sciadini, Jason Nascone, Nathan O’Hara, Scott P. Ryan, Molly E. Clark, Charles Cassidy, Konstantin Balonov, Tristan Weaver, Laura S. Phieffer, Sergio D. Bergese, Andrew J. Marcantonio, Shrikant I. Bangdiwala, Michael H. McGillion, Sanela Dragic-Taylor, Chelsea Maxwell, Sarah Molnar, Jennifer R. Wells, Patrice Forget, Paul Landais, Giovanni Landoni, Ekaterine Popova, Iain K. Moppett, Robin Roberts, null Chairperson, Finlay McAlister, David Sackett, James Wright, UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire, UCL - SSS/IREC/NMSK - Neuro-musculo-skeletal Lab, UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Service d'anesthésiologie, UCL - (SLuc) Service d'orthopédie et de traumatologie de l'appareil locomoteur, and UCL - (SLuc) Service de médecine interne générale

Subjects
Hip Fractures, Nephrology, Humans, Pelvic Bones, Kidney
Abstract

To the Editor: Acute kidney injury (AKI) is a lesser-known complication of hip fracture that may come about owing to decreased kidney perfusion and heightened inflammation from trauma, pain, bleeding, and fasting. Approximately 15%-20% of patients undergoing surgery for a hip fracture develop AKI, with 0.5%-1.8% receiving dialysis. [...]

Published
2022

3. Wound Surface Area as a Risk Factor for Flap Complications among Patients with Open Fractures

Author

Bernhard Flatøy, Dominique M. Rouleau, Ripley Worman, Eric Ritchie, Brian Drew, Hilde Apold, J. Adam Smitherman, Kyle J. Jeray, P Beaumont, Kim Madden, Arjun Patil, Karine Tardif, Brad Pilkey, Cathrine Aga, Alexandre Denault, Fathima Adamsahib, Joseph O'Neill, James R. Ringler, Claude T. Moorman, Brian Mullis, Håvard Furunes, Jason Stoneback, Paul A. Martineau, S. Brennan McClure, Karyn Moon, Greg Etherington, Rejean Dumais, Ivan S. Tarkin, Stephanie L. Tanner, Terry Axelrod, Joy M. Bradford-Johnson, Chantal Théorêt, Ellen Langslet, Ali Al-Ashtari, Valda Frizzell, Ria De Gorter, Michel Malo, M.M. (Molly M.) Moore, Andrew R. Evans, Ramnov Andreson, Lauren C. Leffler, Nigar Sultana, Michelle Arakgi, Richard Freeman, Scott E Porter, John Murnaghan, Lisa K. Cannada, Joseph Alderete, Desmond Kwok, Michael D. McKee, Deepali Nassikars, Michael J. Bosse, Richard Jenkinson, Kevin Kuhn, Michael H. Weber, David R. Goetz, Robert Marien, Eric Lenczner, Katrine Milner, Gregory J. Della Rocca, Ajay Gupta, Farhad Moola, Torben Ianssen, Saam Morshed, Meir Marmor, Stephen P. Kingwell, Chetan Metha, Michael Connally, J. David Amirault, François Vézina, Oliver Muller, Joseph R. Hsu, Catherine Coady, Grant E. Garrigues, Diane Nam, Lori Kramer Clark, Taylor Vlack, J. Scott Broderick, Bang Hoang, Rebecca G. Snider, Anne Christine Brekke, Richard T. Laughlin, Ida Sletten, Lisa Buckingham, Jason Vourazeris, Gordon H. Guyatt, Darius Viskontas, Asgeir Amundsen, Travis C. Burns, Elton R Edwards, Edward J. Harvey, David Stephen, Eugene Wai, Michael R. Jabara, Andrea Garza, Austin D. Hill, Kevin R. Gurr, Stephen D. Walter, David J. Bielema, Karl D Shively, John Sadler, Mark D Macleod, Geir Aasmund Hjorthaug, Anthony Beardmore, Markku T Nousiainen, Vivek V. Jabade, Rani Rai, Kelly Trask, Julia Lee, Rena L. Stewart, Paula McKay, Emil H. Schemitsch, Sheila Sprague, Allen Diane, Sebastian Rodriguez-Elizalde, Ryan T. Bicknell, Nicolas Patenaude, Kevin L. Kirk, Paul Tornetta, Joshua A. Baumfeld, Christopher S. Bailey, Douglas G. Altman, Monica Kunz, Robert E. Turcotte, Kristen Walick, David P. Zamorano, Vinod Arora, Bernard Laliberté, Max Talbot, Jerald R. Westberg, Tore Fjalestad, Benjamin B. Barden, Chetan Prabhakar Puram, Andrew Gong, Shalini Ramasunder, Petter Iversen, R. Lee Murphy, Jean François Joncas, Timothy J. Miller, Raymond A. Pensy, Michael J. Maughon, Lori Wood, Robert G. McCormack, Dmitry Tuder, Veronica M R Wadey, Timothy Carey, Kristoff Reid, Patrick Henry, Anthony S. Rhorer, Marc André Magalhaes-Grave, Vinit Yadav, Michael J. Prayson, John Clarke-Jenssen, Vera Halvorsen, Kerry Tai, Narayan J. Karne, Stéphane Leduc, Kathryn Hornbuckle, Melissa M. Earles, Joel S. Finkelstein, Robin R. Richards, Joseph Cox, Tor Nicolaysen, Lisa Blackrick, Arthur Kreitenberg, Aaron T. Creek, Debra L. Sietsema, Peder Bogsti, Mark Glazebrook, Donna Lopez, Martin Bédard, Michael L. Beckish, Jonathan Kwong, Peter A. Siska, John A. Tanksley, Brett D. Crist, François Cabana, Mary Fan, Annie Deshaies, Debra Bartley, Nurit Shadmi, Wesley G. Lackey, Henry Ahn, Rachel M. Reilly, Linda K. Anderson, Dustin M. Price, Frede Frihagen, Brian E. Brigman, David Nelles, Mickey S Cho, Jeff Anglen, Kevin K. Kruse, Melanie MacNevin, Jonathan L. Foret, Jan Egil Brattgjerd, John F. Tilzey, Garland K. Gudger, Steve Rocha, G. Yves Laflamme, Kelly L. Apostle, Utku Kandemir, Aaron Nauth, Ivan Wong, Brian J. Miller, Rudy Reindl, Krishan Rajaratnam, Marie Eve Roger, William D. Fisher, Ash Moaveni, Patrick Yoon, David Sanders, Julia Foxall, Otis Wang, Shea A. Bielby, Maria Manson, Yvonne M. Murtha, Nikoletta Leontaritis, Russell Miller, Terrence J. Endres, Andrew H. Schmidt, Laurie Barron, David Alexander, Dennis W. Mann, H. Michael Lemke, Benjamin S. Koch, Gilbert Ortega, Nikia Hawkins Malone, Rina L. Harman, A. Navaladi Shankar, Parag Sancheti, Mauri Zomar, Dave Brown, Matthan Mammen, Dana J. Farrell, Piotr A Blachut, John D. Adams, Zoe Murdoch, Tom Treseder, Scott T. Watson, Fredrik Nilsen, Matthew Denkers, Wade Gofton, Jennifer Downey, Raymond Topp, Garth Johnson, Sissel Knuts, Raman Johal, Prerana N. Patel, Harvinder Bedi, Milena R. Vicente, Michael Tanzer, Markus Bischoff, Anders Lippert, Pascale Lévesque-Bernier, Hélène Côté, Brian Jolley, Gilbert Moatshe, Christina Tieszer, Richard C. Mather, Roman Trimba, Mohit Bhandari, Henry M Broekhuyse, Janos P. Ertl, Patrick M. Osborn, Michael Biddulph, Neeraj Jain, Grant W. Bennett, Gerard P. Slobogean, Samuel B. Adams, Kelly M. Sullivan, Atul Patil, Warren Kactmas, Mahesh Bhatia, Murat Pekmezci, Siraj Sayeed, David S. Ruch, Lawrence K. O'Malley, Jonas Rydinge, Michael Charlton, Michael S. Kain, Vivek Tyagi, Kathleen Markley, Rajiv Gandhi, Pierre Ranger, Mathias Russ, Dale Williams, Peter Jarzem, Lauren A. Nastoff, Craig Donohue, Gunnar B. Flugsrud, Bernard LaRue, Shelley MacDonald, Trevor Stone, Amy Svotelis, Stéphane Pelet, Mark J. Lemos, Michael Gross, Dean C. Taylor, Matthew Ross, Luc Petitclerc, Robert K. Lark, Jane E. Walker, Pierre Lavallée, Wesley Ghent, Fraser J. Leversedge, C. Glen Richardson, Deanna Lawson, Martin Tynan, Eric Meinberg, Stephen Doig, Jason A. Lowe, Veronica Place, Tim Dwyer, Jeffrey T. Leary, J Andrew I Trenholm, Andrew Chia, William M. Oxner, Richard Holtby, Thomas F. Varecka, Justin W. Langan, Ted Tufescu, Melanese Leonard, Lu Ton, Jeremy A. Hall, S. Samuel Bederman, Steve Csongvay, Bertrand Perey, Adam Dowrick, Stephen H. Finley, Steven A. Olson, Katherine M. Bedigrew, James P. Stannard, Phelan Shea, Leslie Dillender, Dory Boyer, Damian Rispoli, Ashley Carr, Steven Papp, Trigg McClellan, Clifford B. Jones, Erik Nott, Nitin N. Bhatia, Deeba Pourmand, Kelly A Lefaivre, Michael J. Dunbar, Peter J O'Brien, Luc Bédard, Chad P. Coles, Doug Li, Drew Bednar, Albert Yee, Bill Ristevski, Tod Gerlinger, Benoit Benoit, Aaron R. Campbell, Mette Renate Andersen, James P. Waddell, Jean Lamontagne, David A. Volgas, Diane Heels-Ansdell, Andrew J. Marcantonio, Alison P. Toth, David R. Pichora, Min Zhan, Harsha Malempati, Lars Nordsletten, Richard W. Gurich, Kiran M. Doshi, Robert J. Teasdall, Earl R. Bogoch, Matthew D. Karam, David M. Conner, Hans J. Kreder, Guri Ranum Ekås, Dylan J. Watson, Linda Lépine, Tanya Nix, Chris Graham, Tigist Belaye, Are Haukåen Stødle, Aravin Duraikannan, John Magne Hoseth, Nathan N O'Hara, Erick G. Torres, Elise Berg Vesterhus, Anthony E. Johnson, William Min, Michael Ford, Leslie Barnes, Jessica Goldstein, Anil Rai, Samuel G. Agnew, Thomas M. Schaller, Hamish Curry, S. Matthew Hollenbeck, Lorra M. Sharp, Fiona Howells, Abdel Lawendy, Donald Gajewski, Richard Coughlin, Max Esser, Chard Harbour, Stéphane Ricard, Gerald Reardon, Luc Lemire, Julie Fournier, Raely Moon, Brad Petrisor, James R. Ficke, Greg Berry, David Johnston, Allan Hammond, Jennifer T. Hidy, K. Rai, Daniel B. Whelan, Marius Molund, John S. Garfi, Greg Maytok, R. Saravana, Eugene Ek, Matthew Robinson, Emily Keener, Mark Burman, Frédéric Balg, Jeffrey O. Anglen, Fiona Houghton, Stacee W. Clawson, Morten Smedsrud, Claire Sage, Ross Leighton, Timothy R. Daniels, Lyle T. Jackson, Susan Liew, Neelam Jhangiani, Anoop Dubey, Richard M. Wilk, Robert D. Zura, Julian Sernik, Kim Hemlock, and Michael P. Bolognesi

Subjects
Adult, Male, medicine.medical_specialty, Soft Tissue Injuries, Limb salvage, Treatment outcome, Aftercare, Wound surface, Surgical Flaps, Fractures, Open, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, Medicine and Health Sciences, medicine, Humans, 030212 general & internal medicine, Risk factor, Aged, integumentary system, business.industry, Open surgery, Trauma center, Middle Aged, Limb Salvage, Surgery, Logistic Models, Treatment Outcome, 030220 oncology & carcinogenesis, Shock (circulatory), Female, medicine.symptom, business
Abstract

Copyright © 2018 by the American Society of Plastic Surgeons. Background: Soft-tissue complications often dictate the success of limb salvage and the overall outcome of open fractures. Based on prior work at the R Adams Cowley Shock Trauma Center, the authors hypothesize that wounds larger than 200 cm2 are associated with a greater likelihood of both flap-related reoperation and wound complications among patients requiring soft-tissue reconstruction with a rotational flap or free tissue transfer. Methods: This study was a secondary analysis of Fluid Lavage in Open Wounds trial data that included all patients who received a rotational or free tissue flap transfer for an open fracture. The primary outcome was flap-related reoperation within 12 months of injury. The secondary outcome was wound complication, which included events treated operatively or nonoperatively. Multivariable logistic regression was used to assess the association between wound size and outcomes, adjusting for confounders. Results: Seventeen percent of the 112 patients required a flap-related reoperation. A wound size greater than 200 cm2 was not associated with reoperation in an unadjusted model (p = 0.64) or adjusting for Gustilo type (p = 0.70). The sample had an overall wound complication rate of 47.3 percent. Patients with a wound size of greater than 200 cm2 were three times more likely to experience wound complications (OR, 3.05; 95 percent CI, 1.08 to 8.62; p = 0.04) when adjusting for moderate to severe wound contamination and wound closure in the operating room. Conclusion: The findings of this study demonstrate that wound surface area is an integral determinant for wound complication following soft-tissue flap treatment, but found no association between wound surface area and flap-related reoperation rates.

Published
2018
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4. First Place: A prospective, randomized controlled trial of the impact of written discharge instructions for postoperative opioids on patient pain satisfaction and on minimizing opioid risk exposure in orthopaedic surgery

Author

Mark D Macleod, Supriya Singh, Abdel Rehman Lawendy, David Sanders, Collin Clarke, and Christina Tieszer

Subjects
medicine.medical_specialty, business.industry, 030208 emergency & critical care medicine, General Medicine, law.invention, 03 medical and health sciences, 0302 clinical medicine, Opioid, Randomized controlled trial, 030202 anesthesiology, law, Orthopedic surgery, Physical therapy, Risk exposure, Medicine, Orthopedics and Sports Medicine, Discharge instructions, business, medicine.drug
Published
2018
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5. Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial

Author

Flavia K Borges, Mohit Bhandari, Ernesto Guerra-Farfan, Ameen Patel, Alben Sigamani, Masood Umer, Maria E Tiboni, Maria del Mar Villar-Casares, Vikas Tandon, Jordi Tomas-Hernandez, Jordi Teixidor-Serra, Victoria RA Avram, Mitchell Winemaker, Mmampapatla T Ramokgopa, Wojciech Szczeklik, Giovanni Landoni, Chew Yin Wang, Dilshad Begum, John D Neary, Anthony Adili, Parag K Sancheti, Abdel-Rahman Lawendy, Mariano Balaguer-Castro, Paweł Ślęczka, Richard J Jenkinson, Aamer Nabi Nur, Gavin CA Wood, Robert J Feibel, Stephen J McMahon, Alen Sigamani, Ekaterine Popova, Bruce M Biccard, Iain K Moppett, Patrice Forget, Paul Landais, Michael H McGillion, Jessica Vincent, Kumar Balasubramanian, Valerie Harvey, Yaiza Garcia-Sanchez, Shirley M Pettit, Leslie P Gauthier, Gordon H Guyatt, David Conen, Amit X Garg, Shrikant I Bangdiwala, Emilie P Belley-Cote, Maura Marcucci, Andre Lamy, Richard Whitlock, Yannick Le Manach, Dean A Fergusson, Salim Yusuf, PJ Devereaux, Laurent Veevaete, Bernard le Polain de Waroux, Patricia Lavand'homme, Olivier Cornu, Karim Tribak, Jean Cyr Yombi, Nassim Touil, Maike Reul, Jigme Tshering Bhutia, Carol Clinckaert, Dirk De Clippeleir, Justin de Beer, Diane L Simpson, Andrew Worster, Kim A Alvarado, Krysten K Gregus, Kelly H Lawrence, Darryl P Leong, Philip G Joseph, Patrick Magloire, Benjamin Deheshi, Stuart Bisland, Thomas J Wood, Daniel M Tushinski, David AJ Wilson, Clive Kearon, David D Cowan, Vickas Khanna, Amna Zaki, Janet C Farrell, Anne Marie MacDonald, Steven CW Wong, Arsha Karbassi, Douglas Steven Wright, Harsha Shanthanna, Ryan Coughlin, Moin Khan, Spencer Wikkerink, Faraaz A Quraishi, Waleed Kishta, Emil Schemitsch, Timothy Carey, Mark D Macleod, David W Sanders, Edward Vasarhelyi, Debra Bartley, George K Dresser, Christina Tieszer, Steven Shadowitz, Jacques S Lee, Stephen Choi, Hans J Kreder, Markku Nousiainen, Monica R Kunz, Ravianne Tuazon, Mopina Shrikumar, Bheeshma Ravi, David Wasserstein, David JG Stephen, Diane Nam, Patrick DG Henry, Stephen M Mann, Melanie T Jaeger, Marco LA Sivilotti, Christopher A Smith, Christopher C Frank, Heather Grant, Leone Ploeg, Jeff D Yach, Mark M Harrison, Aaron R Campbell, Ryan T Bicknell, Davide D Bardana, Katie McIlquham, Catherine Gallant, Samantha Halman, Venkatesh Thiruganasambandamoorth, Sara Ruggiero, William J Hadden, Brian P-J Chen, Stephanie A Coupal, Lisa M McLean, Hemant R Shirali, Syed Y Haider, Crystal A Smith, Evan Watts, David J Santone, Kevin Koo, Allan J Yee, Ademilola N Oyenubi, Aaron Nauth, Emil H Schemitsch, Timothy R Daniels, Sarah E Ward, Jeremy A Hall, Henry Ahn, Daniel B Whelan, Amit Atrey, Amir Khoshbin, David Puskas, Kurt Droll, Claude Cullinan, Jubin Payendeh, Tina Lefrancois, Lise Mozzon, Travis Marion, Michael J Jacka, James Greene, Matthew Menon, Robert Stiegelmahr, Derek Dillane, Marleen Irwin, Lauren Beaupre, Chad P Coles, Kelly Trask, Shelley MacDonald, J Andrew I Trenholm, William Oxner, C Glen Richardson, Niloofar Dehghan, Mehdi Sadoughi, Achal Sharma, Neil J White, Loretta Olivieri, Stephen B Hunt, Thomas R Turgeon, Eric R Bohm, Sarah Tran, Stephen M Giilck, Tom Hupel, Pierre Guy, Peter J O'Brien, Andrew W Duncan, Gordon A Crawford, Junlin Zhou, Yanrui Zhao, Yang Liu, Lei Shan, Anshi Wu, Juan Manuel Muñoz, Philippe Chaudier, Marion Douplat, Michel Henri Fessy, Vincent Piriou, Lucie Louboutin, Jean Stephane David, Arnaud Friggeri, Sebastien Beroud, Jean Marie Fayet, Frankie Ka Li Leung, Christian Xinshuo Fang, Dennis King Hang Yee, Parag Kantilal Sancheti, Chetan Vijay Pradhan, Atul Ashok Patil, Chetan Prabhakar Puram, Madhav Pandurang Borate, Kiran Bhalchandra Kudrimoti, Bharati Anil Adhye, Himanshu Vijaykumar Dongre, Bobby John, Valsamma Abraham, Ritesh Arvind Pandey, Arti Rajkumar, Preetha Elizabeth George, Manesh Stephen, Nitheesh Chandran, Mohammed Ashraf, AM Georgekutty, Ahamad Shaheel Sulthan, S Adinarayanan, Deep Sharma, Satish Prasad Barnawal, Srinivasan Swaminathan, Prasanna Udupi Bidkar, Sandeep Kumar Mishra, Jagdish Menon, Niranjan M, Varghese Zachariah K, Santosh Angad Hiremath, Madhusudhan NC, Abhijit Jawali, Kingsly Robert Gnanadurai, Carolin Elizabeth George, Tatarao Maddipati, Mary KP KP, Vijay Sharma, Kamran Farooque, Rajesh Malhotra, Samarth Mittal, Chavi Sawhney, Babita Gupta, Purva Mathur, Shivanand Gamangati, Vijaylaxmi Tripathy, Prem Haridas Menon, Mandeep S Dhillon, Devendra K Chouhan, Sharanu Patil, Ravi Narayan, Purushotham Lal, Prashanth Nabhirajappa Bilchod, Surya Udai Singh, Uttam Vaidya Gattu, Ravi Prabhakar Dashputra, Prashant Vitthal Rahate, Maurizio Turiel, Giuseppe De Blasio, Riccardo Accetta, Paolo Perazzo, Daniele Stella, Marika Bonadies, Chiara Colombo, Stefania Fozzato, Fabio Pino, Ilaria Morelli, Eleonora Colnaghi, Vincenzo Salini, Giuseppe Denaro, Luigi Beretta, Giacomo Placella, Giuseppe Giardina, Mirko Binda, Anna Marcato, Luca Guzzetti, Fabio Piccirillo, Maurizio Cecconi, HM Khor, Hou Yee Lai, CS Kumar, KH Chee, PS Loh, Kit Mun Tan, Simmrat Singh, Li Lian Foo, Komella Prakasam, Sook Hui Chaw, Meng-Li Lee, Joanne HL Ngim, Huck Wee Boon, Im Im Chin, Ydo V Kleinlugtenbelt, Ellie BM Landman, Elvira R Flikweert, Herbert W Roerdink, Roy B.G. Brokelman, Hannie F Elskamp-Meijerman, Maarten R Horst, Jan-Hein MG Cobben, Anila Anjum, Pervaiz Mehmood Hashmi, Tashfeen Ahmed, Haroon Ur Rashid, Mujahid Jamil Khattak, Rizwan Haroon Rashid, Riaz Hussain Lakdawala, Shahryar Noordin, Naveed Muhammed Juman, Robyna Irshad Khan, Muhammad Mehmood Riaz, Syedah Saira Bokhari, Ayesha Almas, Hussain Wahab, Arif Ali, Hammad Naqi Khan, Eraj Khurshid Khan, Kholood Abid Janjua, Sajjad Hassan Orakzai, Abdus Salam Khan, Khawaja Junaid Mustafa, Mian Amjad Sohail, Muhammad Umar, Siddra Ahmed Khan, Muhammad Ashraf, Muhammad Kashif Khan, Muhammad Shiraz, Ahmad Furgan, Piotr Dąbek, Adam Kumoń, Wojciech Satora, Wojciech Ambroży, Mariusz Święch, Jacek Rycombel, Adrian Grzelak, Jaroslaw Gucwa, Waldemar Machala, Mmampapatla Thomas Ramokgopa, Gregory Bodley Firth, Mwalimu Karera, Maria Fourtounas, Virsen Singh, Anna Biscardi, Muhammad Nasir Iqbal, Ryan Jonathan Campbell, Matimba Lenny Maluleke, Carien Moller, Lerato Nhlapo, Sithombo Maqungo, Margot Flint, Marcin B Nejthardt, Sean Chetty, Rubendren Naidoo, Miriam Garrido Clua, Vicente Molero-Garcia, Joan Minguell-Monyart, Jordi Selga Marsa, Juan A Porcel-Vazquez, Jose-Vicente Andres-Peiro, Marc Aguilar, Jaume Mestre-Torres, Maria J Colomina, Patricia Guilabert, M Luisa Paños Gozalo, Luis Abarca, Nuria Martin, Gemma Usua, Pedro Martinez-Ripol, MA Gonzalez Posada, Pilar Lalueza-Broto, Judith Sanchez-Raya, Jorge Nuñez Camarena, Antoni Fraguas-Castany, Pere Torner, Monsant Jornet-Gibert, Jorge Serrano-Sanz, Jaume Cámara-Cabrera, Mònica Salomó-Domènech, Christian Yela-Verdú, Anna Peig-Font, Laura Ricol, Anna Carreras-Castañer, Luis Martínez-Sañudo, Susana Herranz, Carlos Feijoo-Massó, Mònica Sianes-Gallén, Pablo Castillón, Martí Bernaus, Saioa Quintas, Olga Gómez, Jordi Salvador, Javiera Abarca, Cristina Estrada, Marga Novellas, Mercè Torra, Alfred Dealbert, Oscar Macho, Alexia Ivanov, Esther Valldosera, Marta Arroyo, Borja Pey, Antoni Yuste, Llorenç Mateo, Julio De Caso, Rafael Anaya, JL Higa-Sansone, Angelica Millan, Victoria Baños, Sergio Herrera-Mateo, Hector J Aguado, Gonzalo Martinez-Municio, Ricardo León, Silvia Santiago-Maniega, Ana Zabalza, Gregorio Labrador, Enrique Guerado, Encarnacion Cruz, Juan Ramon Cano, Jose Manuel Bogallo, Paphon Sa-ngasoongsong, Noratep Kulachote, Norachart Sirisreetreerux, Nachapan Pengrung, Theerawat Chalacheewa, Vanlapa Arnuntasupakul, Teerapat Yingchoncharoen, Bundit Naratreekoon, Miriam Adel Kadry, Surendini Thayaparan, Ihab Abdlaziz, Arash Aframian, Arjuna Imbuldeniya, Souad Bentoumi, Sherif Omran, Marcela Paola Vizcaychipi, Patricia Correia, Shashank Patil, Kevin Haire, Amy SE Mayor, Sally Dillingham, Laura Nicholson, Mohamed Elnaggar, Joby John, Shashi Kumar Nanjayan, Martyn J Parker, Susan O'Sullivan, Meir T Marmor, Amir Matityahu, Robert Trigg McClellan, Curt Comstock, Anthony Ding, Paul Toogood, Gerard Slobogean, Katherine Joseph, Robert O'Toole, Marcus Sciadini, Scott P Ryan, Molly E Clark, Charles Cassidy, Konstantin Balonov, Sergio D Bergese, Laura S Phieffer, Alicia A Gonzalez Zacarias, Andrew J Marcantonio, Sanela Dragic-Taylor, Chelsea Maxwell, Sarah Molnar, Jennifer R Wells, Sandra N Ofori, Stephen S Yang, Michael K Wang, Emmanuelle Duceppe, Jessica Spence, Javiera P Vasquez, Francesc Marcano-Fernández, Hyungjoo Ham, Carlos Prada, Terence CH Yung, Isidro Sanz Pérez, Michael J Bosch, Michael R Prystajecky, Chinmoy Chowdhury, James S Khan, Steffan F Stella, Behrouz Heidary, Allen Tran, Katarzyna Wawrzycka-Adamczyk, Yu Chiao Peter Chen, Aránzazu González-Osuna, Grzegorz Biedroń, Anna Wludarczyk, Marco Lefebvre, Jaclyn A Ernst, Bas Staffhorst, Jason D Woodfine, Emad M Alwafi, Marko Mrkobrada, Simon Parlow, Robin Roberts, Finlay McAlister, David Sackett, James Wright, (HIP ATTACK, Investigators), Landoni, G., Faculty of Medicine and Pharmacy, Orthopaedics - Traumatology, Supporting clinical sciences, Emergency Medicine, UCL - SSS/IONS - Institute of NeuroScience, UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire, UCL - SSS/IREC/NMSK - Neuro-musculo-skeletal Lab, UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Service d'anesthésiologie, UCL - (SLuc) Service d'orthopédie et de traumatologie de l'appareil locomoteur, and UCL - (SLuc) Service de médecine interne générale

Subjects
Postoperative Complications/epidemiology, Male, Internationality, Femoral Neck Fractures/epidemiology, Arthroplasty, Replacement, Hip, Myocardial Ischemia, Comorbidity, Time-to-Treatment/statistics & numerical data, 030204 cardiovascular system & hematology, law.invention, Fracture Fixation, Internal, Postoperative Complications, 0302 clinical medicine, Randomized controlled trial, Residence Characteristics, law, Activities of Daily Living, Fracture fixation, Risk of mortality, Medicine and Health Sciences, Fracture Fixation, Internal/methods, Sepsis/epidemiology, 030212 general & internal medicine, Cardiovascular Diseases/mortality, Stroke, Aged, 80 and over, Hip fracture, Residence Characteristics/statistics & numerical data, Infections/epidemiology, General Medicine, Middle Aged, Open Fracture Reduction, Treatment Outcome, Cardiovascular Diseases, Diabetes Mellitus/epidemiology, Female, medicine.medical_specialty, Hip Fractures/epidemiology, Postoperative Hemorrhage, Infections, Early Medical Intervention/methods, Time-to-Treatment, 03 medical and health sciences, Arthroplasty, Replacement, Hip/methods, Early Medical Intervention, Sepsis, Diabetes Mellitus, medicine, Humans, Mortality, Myocardial Ischemia/epidemiology, Aged, Proportional Hazards Models, Postoperative Hemorrhage/epidemiology, Hip Fractures, Proportional hazards model, business.industry, Hemiarthroplasty/methods, Dementia/epidemiology, Delirium, Delirium/epidemiology, medicine.disease, Femoral Neck Fractures, Nursing Homes, Surgery, Open Fracture Reduction/methods, Dementia, Observational study, Hemiarthroplasty, business
Abstract

© 2020 Elsevier Ltd Background: Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. Methods: HIP ATTACK was an international, randomised, controlled trial done at 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were aged 45 years or older were eligible. Research personnel randomly assigned patients (1:1) through a central computerised randomisation system using randomly varying block sizes to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. The coprimary outcomes were mortality and a composite of major complications (ie, mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Patients, health-care providers, and study staff were aware of treatment assignment, but outcome adjudicators were masked to treatment allocation. Patients were analysed according to the intention-to-treat principle. This study is registered at ClinicalTrials.gov (NCT02027896). Findings: Between March 14, 2014, and May 24, 2019, 27 701 patients were screened, of whom 7780 were eligible. 2970 of these were enrolled and randomly assigned to receive accelerated surgery (n=1487) or standard care (n=1483). The median time from hip fracture diagnosis to surgery was 6 h (IQR 4–9) in the accelerated-surgery group and 24 h (10–42) in the standard-care group (p

Published
2020

6. Short Versus Long InterTAN Fixation for Geriatric Intertrochanteric Hip Fractures: A Multicentre Head-to-Head Comparison

Author

David Sanders, Christina Tieszer, Wade Gofton, Darius Viskontas, Chad P. Coles, Michael Sellan, Steven Papp, Ross Leighton, Abdel Lawendy, Trevor Stone, Andrew Trenholm, Dianne Bryant, Tim Carey, Allan Liew, and Mark D Macleod

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, law.invention, Intramedullary rod, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Fracture fixation, Medicine and Health Sciences, Humans, Medicine, Internal fixation, Orthopedics and Sports Medicine, Femur, Prospective Studies, Aged, Retrospective Studies, Aged, 80 and over, 030222 orthopedics, Hip fracture, Hip Fractures, business.industry, intertrochanteric hip fractures, intramedullary nail, femur fractures, InterTAN, 030208 emergency & critical care medicine, Retrospective cohort study, Equipment Design, General Medicine, Middle Aged, medicine.disease, Functional Independence Measure, Fracture Fixation, Intramedullary, Surgery, Female, business
Abstract

OBJECTIVE To determine if geriatric intertrochanteric hip fracture patients achieve equivalent postoperative functional status after management with either a short (180-200 mm) or a long (260-460 mm) InterTAN intramedullary device. DESIGN Retrospective review of a prospective randomized control trial. SETTING Four Level I Trauma Centers. PATIENTS/PARTICIPANTS One hundred eight patients with OTA/AO classification 31A-1 and 31A-2 intertrochanteric hip fractures were included in the study. INTERVENTION Internal fixation using an IT device. MAIN OUTCOMES MEASURES Primary outcomes included Functional Independence Measure and Timed Up and Go. Secondary outcomes included blood loss, surgical time, length of stay, adverse events, and mortality. RESULTS Seventy-one short and 37 long IT patients met study inclusion criteria. Demographics were similar between groups. There was no difference in Functional Independence Measure or Timed Up and Go scores between the 2 IT groups at any of the time points collected. Mean operative time was lower in the short IT group than in the long IT group (60 vs. 73 minutes; P = 0.021). A higher proportion of long IT patients had reamed constructs (95% vs. 48% short IT, P < 0.001). Postoperative blood loss was significantly higher in the long IT group without a significant influence on the number of patients requiring transfusion (P = 0.582) or average units transfused (P = 0.982). There was no significant difference in the proportion of postoperative adverse events between the 2 cohorts despite a higher number of peri-implant femur fractures in the short IT group than in the long IT group (5 vs. 1, P = 0.350). CONCLUSIONS Postoperative functional status was not influenced by the length of IT device in the management of geriatric intertrochanteric hip fractures. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Published
2019

7. A Multicenter Randomized Control Trial Comparing a Novel Intramedullary Device (InterTAN) Versus Conventional Treatment (Sliding Hip Screw) of Geriatric Hip Fractures

Author

Christina Tieszer, Kelly Trask, Julia Foxall, Ross Leighton, Darius Viskontas, Trevor Stone, Mark D Macleod, David W. Sanders, Christopher S. Bailey, Andrew Trenholm, Debra Bartley, Chad P. Coles, Steven Papp, Wade Gofton, Dianne Bryant, Kevin R. Gurr, Abdel Lawendy, Tim Carey, Mauri Zomar, and Allan Liew

Subjects
musculoskeletal diseases, Male, medicine.medical_specialty, Canada, InterTAN, Bone Screws, sliding hip screw, Prosthesis Design, law.invention, Intramedullary rod, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Risk Factors, intertrochanteric hip fractures, Fracture fixation, Activities of Daily Living, medicine, Prevalence, Medicine and Health Sciences, Humans, Orthopedics and Sports Medicine, 030212 general & internal medicine, Range of Motion, Articular, Geriatric Assessment, Aged, Aged, 80 and over, Fracture Healing, 030222 orthopedics, business.industry, Hip Fractures, Conventional treatment, Geriatric assessment, General Medicine, Recovery of Function, Length of Stay, Middle Aged, Surgery, Fracture Fixation, Intramedullary, Bone screws, Equipment Failure Analysis, Survival Rate, Treatment Outcome, Multicenter study, Female, business, Range of motion
Abstract

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Objectives: To compare outcomes in elderly patients with intertrochanteric hip fractures treated with either the sliding hip screw (SHS) or InterTAN intramedullary device (IT). Design: Prospective, randomized, multicenter clinical trial. Setting: Five level 1 trauma centers. Patients: Two hundred forty-nine patients 55 years of age or older with AO/OTA 31A1 (43) and OA/OTA 31A2 (206) fractures were prospectively enrolled and followed for 12 months. Intervention: Computer generated randomization to either IT (n = 123) or SHS (n = 126). Main Outcome Measurements: The Functional Independence Measure (FIM) and the Timed Up and Go test (TUG) were used to measure function and motor performance. Secondary outcome measures included femoral shortening, complications, and mortality. Results: Demographics, comorbidities, preinjury FIM scores and TUG scores were similar between groups. Patients (17.2%) who received an IT had limb shortening greater than 2 cm compared with 42.9% who received an SHS (P < 0.001). To determine the importance of preinjury function and fracture stability, we analyzed the subgroup of patients with the ability to walk 150 m independently preinjury and an OA/OTA 31A-2 fracture (n = 70). In this subgroup, patients treated with SHS had greater shortening and demonstrated poorer FIM and TUG scores compared with patients treated with an IT. Conclusions: Overall, most patients with intertrochanteric femur fractures can expect similar functional results whether treated with an intramedullary or extramedullary device. However, active, functional patients have an improved outcome when the InterTAN is used to treat their unstable intertrochanteric fracture. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Published
2017

8. Does Participation in a Randomized Clinical Trial Change Outcomes? An Evaluation of Patients Not Enrolled in the SPRINT Trial

Author

Pamela Leece, Diane Heels-Ansdell, Marc F. Swiontkowski, Rudolf W. Poolman, Kevin R. Gurr, Sheila Sprague, Michael J. Bosse, Mohit Bhandari, Tashay Mignott, Bruce D. Browner, Paul Tornetta, K. Kellie Leitch, Stuart Bailey, Carol Lin, Lisa Buckingham, Peter J O'Brien, Alan L. Jones, David W. Sanders, Mark D Macleod, Natalie Sidorkewicz, Jesse A. Berlin, Claire Bombardier, Charlene Bartha, Gordon H. Guyatt, Ken Konito, Helena Viveiros, Julie Agel, Timothy Carey, Brenda Gillespie, David Sanders, Emil H. Schemitsch, Natalie Ansell, Stephen D. Walter, Amsterdam Movement Sciences, Surgery, Other Research, Emergency Department, Orthopedic Surgery and Sports Medicine, and Other departments

Subjects
Male, medicine.medical_specialty, Canada, Nonunion, law.invention, Intramedullary rod, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Fracture fixation, Medicine and Health Sciences, Prevalence, Medicine, Humans, Orthopedics and Sports Medicine, 030212 general & internal medicine, reamed, Netherlands, Randomized Controlled Trials as Topic, business.industry, Patient Selection, General Medicine, Odds ratio, tibia fracture, Middle Aged, medicine.disease, unreamed, Confidence interval, United States, Surgery, Fracture Fixation, Intramedullary, Clinical trial, Tibial Fractures, Treatment Outcome, Sprint, nonunion, 030220 oncology & carcinogenesis, Female, Patient Participation, business, human activities
Abstract

© Copyright 2016 Wolters Kluwer Health, Inc. All rights reserved. Objectives: To determine the extent to which knowledge from clinical trial protocols is transferred to nonparticipating patients. Design: Retrospective review of prospectively collected data from a large clinical trial. Setting: Six level-1 international trauma centers. Methods: We compared rates and timing of reoperation in a subset of patients enrolled in the Study to Prospectively evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT) to concurrent patients who were eligible but not enrolled. This was a retrospective review of prospectively collected trial data. The records of 6 of the original SPRINT centers were searched for non-SPRINT patients who underwent intramedullary nailing of a closed tibial fracture. The rate and timing of reoperation were compared. A P < 0.05 was considered significant. Results: One hundred fourteen non-SPRINT patients were compared with 328 patients enrolled in SPRINT from those same sites. There were 7 reoperations (6.1%) in non-SPRINT patients versus 18 (5.2%) in SPRINT patients [odds ratio (OR) 1.19, 95% confidence interval (CI) 0.41 to 3.13; P 0.811]. There was no difference in the time to reoperation between the SPRINT and non-SPRINT patients (6.2 vs. 6.8 months, 95% CI of the difference -3.8 to 2.6; P 0.685) or in the proportion of patients who underwent reoperation before 6 months (29% vs. 43%; OR 1.75; 95% CI 0.18 to 15.41; P 0.647). Conclusions: Patients not enrolled in SPRINT had similarly low rates of reoperation for nonunion, and the average time to reoperation for both groups was longer than 6 months. A 6-month waiting period may have allowed slow-to-heal fractures adequate time to heal, thereby reducing the rate of diagnosis of nonunion. As such, this waiting period could contribute to lower-than-expected reoperation rates for nonunion. It is possible that clinical trials may beneficially influence the care of nonenrolled patients.

Published
2016

9. Intraoperative Diagnosis of Syndesmosis Injuries in External Rotation Ankle Fractures

Author

David W. Sanders, Jeanette Lydestadt, Mark D Macleod, Andrea Domonkos, and Richard J Jenkinson

Subjects
Adult, Male, medicine.medical_specialty, Syndesmosis, Adolescent, Rotation, Radiography, Stress testing, Sensitivity and Specificity, Fractures, Bone, Fixation (surgical), Humans, Medicine, Fluoroscopy, Orthopedics and Sports Medicine, Ankle Injuries, Physical Examination, Aged, Aged, 80 and over, Intraoperative Care, medicine.diagnostic_test, business.industry, Trauma center, Reproducibility of Results, General Medicine, Middle Aged, Prognosis, Surgery, medicine.anatomical_structure, Syndesmotic screw, Surgery, Computer-Assisted, Ligaments, Articular, Female, Ankle, business
Abstract

Objective This study was designed to compare intraoperative fluoroscopic stress testing, static radiographs, and biomechanical criteria for the diagnosis of distal tibiofibular syndesmotic instability associated with external rotation type ankle fractures. Design Prospective, consecutive series. Setting Academic level 1 trauma center. Patients/participants Thirty-eight skeletally mature patients with unstable unilateral external rotation ankle fractures were prospectively recruited. Intervention Before surgery, the treating surgeon detailed the operative treatment plan, including need for syndesmotic fixation. In pronation-external rotation injuries, biomechanical criteria were applied to predict syndesmotic instability. Ankles were examined using intraoperative fluoroscopic external rotation stress tests. The contralateral uninjured limb was used as a control. A 7.2-Nm force was applied for the external rotation stress examination. Stress testing was performed after lateral malleolar fixation and repeated after medial and syndesmotic fixation. Main outcome measures The incidence of syndesmotic instability was determined based on radiographic clear space measurements and compared with previously published criteria. Results Intraoperative fluoroscopy detected unpredicted syndesmotic instability in 37% of ankles. In supination-external rotation (OTA 44B) injuries, unpredicted syndesmosis instability was found in 10 of 30 patients (33%). In pronation-external rotation injuries (OTA 44C), 4 of 7 patients (57%) were associated with syndesmosis disruption not predicted by biomechanical criteria. In bimalleolar fractures, syndesmosis fixation improved stability compared with rigid bimalleolar fixation alone (P Conclusions Preoperative radiographs and biomechanical criteria are unable to routinely predict the presence or absence of syndesmosis instability. Rigid bimalleolar fixation was frequently not sufficient to stabilize syndesmotic disruption. Intraoperative stress fluoroscopy is a valuable tool for detection of unstable syndesmotic injuries.

Published
2005
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11. CONTRIBUTORS

Author

Henry Ahn, Ghassan B. Alami, Sahal Altamimi, George S. Athwal, Greg K. Berry, Mohit Bhandari, Piotr A. Blachut, Richard A. Boyle, Henry M. Broekhuyse, Richard E. Buckley, Chad P. Coles, Paul J. Duffy, Willliam N. Dust, Alun Evans, Wade Gofton, Christina Goldstein, Chris Graham, Pierre Guy, Jeremy A. Hall, Edward J. Harvey, Michael A. Hickey, Richard Jenkinson, Michael Kelly, Graham J.W. King, Hans J. Kreder, Paul R.T. Kuzyk, G. Yves Laflamme, Abdel-Rahman Lawendy, Kelly A. Lefaivre, Ross K. Leighton, Allan S.L. Liew, Mark D. MacLeod, Dean G. Malish, Scott J. Mandel, Gerard March, Rod Martin, Paul A. Martineau, Randy Mascarenhas, Paul K. Mathew, Robert G. McCormack, Michael D. McKee, Peter J. O'Brien, Kostas P. Panagiotopoulos, Steven Papp, Brad Petrisor, Brad Pilkey, Rudolf Reindl, Dominique M. Rouleau, Marie-Ève Rouleau, David W. Sanders, Emil H. Schemitsch, Rajrishi Sharma, David J.G. Stephen, Trevor B. Stone, Ayman M. Tadros, Max Talbot, James Vernon, James P. Waddell, Don W. Weber, Neil J. White, and Jeff Yach

Published
2010
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12. Comminuted talar neck fractures: a mechanical comparison of fixation techniques

Author

Mark D Macleod, Ian C. Cooper, James A. Johnson, David W. Sanders, Mohammed Attiah, Louis M. Ferreira, and Gonzalo Valdivia

Subjects
Adult, Male, Heel, Long bone, Bone Screws, In Vitro Techniques, Talus, Fixation (surgical), Fracture Fixation, Internal, Fractures, Bone, Cadaver, Tensile Strength, Fracture fixation, Bone plate, medicine, Humans, Orthopedics and Sports Medicine, Fractures, Comminuted, Aged, Orthodontics, Aged, 80 and over, business.industry, Biomechanics, General Medicine, Anatomy, Middle Aged, Biomechanical Phenomena, medicine.anatomical_structure, Treatment Outcome, Surgery, Female, Stress, Mechanical, Cadaveric spasm, business, Bone Plates
Abstract

Objective: To compare the mechanical performance of 3 fixation techniques for comminuted talar neck fractures. Design: In vitro biomechanical study. Setting: Bioengineering research laboratory. Participants: Thirty previously frozen human cadaveric tali were osteotomized across the talar neck. A wedge of bone 2 cm long and extending 50% of the medial to lateral and superior to inferior dimension of the talus was removed to create an unstable, comminuted fracture. Intervention: The specimens were randomized to one of 3 fixation groups. The first group was fixed with 3 anterior-to-posterior screws. The second group was fixed with 2 cannulated screws inserted from posterior to anterior. The third group was fixed with 1 screw from anterior to posterior and a medially applied blade plate. Specimens were embedded in acrylic cement and mounted on an Instron mechanical testing machine. Loading was applied in the dorsal-medial direction to failure. Main Outcome Measures: For each specimen, the load-displacement curve, yield point, and 3 mm displacement point were recorded in response to controlled dorsal-medial loading to failure. Stiffness was calculated as the linear portion of the slope of the load (kN) versus displacement (mm) curve. Statistical analysis of the data was conducted using analysis of variance. Results: The mean yield point of each of the fixation techniques tested exceeded 1.4 kN. No statistically significant difference was found between the fixation methods, even when variations in age and sex were considered. Conclusions: The mean yield point of the fixation techniques tested exceeds the theoretical stress across the talar neck during active motion. Anterior plate fixation provided equivalent stability to posterior screw fixation.

Published
2007

13. High tibial osteotomy with use of the Taylor Spatial Frame external fixator for osteoarthritis of the knee

Author

Darius G, Viskontas, Mark D, MacLeod, and David W, Sanders

Subjects
Male, External Fixators, Knee Joint, Tibia, Bone Malalignment, Equipment Design, Middle Aged, Osteoarthritis, Knee, Osteotomy, Radiography, Joint Deformities, Acquired, Humans, Original Article, Retrospective Studies
Abstract

High tibial osteotomy (HTO) is used to treat medial compartment osteoarthritis of the knee in active patients with varus alignment. In this study we review the clinical and radiographic outcomes associated with the Taylor Spatial Frame (SmithNephew), and its use in HTOs, and we include an illustrative case report.In 7 patients with medial compartment osteoarthritis of the knee and varus alignment, the Taylor Spatial Frame was applied to the tibia in the operating room and a proximal tibial osteotomy was performed. Patients followed a computer-generated turning schedule until the desired correction was achieved. The frame was removed when the osteotomy site had healed. The lower extremity measure (LEM) was used to assess physical function. Clinical outcome measures relating to the Taylor Spatial Frame included latency, time to correction, time in the frame, number of residual corrections and complications. Radiographic outcomes included preoperative Resnick grades of osteoarthritis, pre- and post-correction limb alignment and tibial slope measurements.Average (and standard deviation) LEM grade at a mean 41 (14) months follow-up after correction was 94% (5%). Average latency was 8 days, time to correction was 15 days, time in the frame was 23 weeks and number of residual corrections was 1.3. Complications were similar to those for external fixators. Radiographic correction goals were met in all patients.The Taylor Spatial Frame is a valuable asset when using HTO to treat medial compartment osteoarthritis of the knee.

Published
2006

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