Background
In 2012, the American Orthopaedic Foot & Ankle Society
®
established a national network for collecting and sharing data on treatment outcomes and improving patient care. One of the ...network’s initiatives is to explore the use of computerized adaptive tests (CATs) for patient-level outcome reporting.
Questions/purposes
We determined whether the CAT from the NIH Patient Reported Outcome Measurement Information System
®
(PROMIS
®
) Physical Function (PF) item bank provides efficient, reliable, valid, precise, and adequately covered point estimates of patients’ physical function.
Methods
After informed consent, 288 patients with a mean age of 51 years (range, 18–81 years) undergoing surgery for common foot and ankle problems completed a web-based questionnaire. Efficiency was determined by time for test administration. Reliability was assessed with person and item reliability estimates. Validity evaluation included content validity from expert review and construct validity measured against the PROMIS
®
Pain CAT and patient responses based on tradeoff perceptions. Precision was assessed by standard error of measurement (SEM) across patients’ physical function levels. Instrument coverage was based on a person-item map.
Results
Average time of test administration was 47 seconds. Reliability was 0.96 for person and 0.99 for item. Construct validity against the Pain CAT had an r value of −0.657 (p < 0.001). Precision had an SEM of less than 3.3 (equivalent to a Cronbach’s alpha of ≥ 0.90) across a broad range of function. Concerning coverage, the ceiling effect was 0.32% and there was no floor effect.
Conclusions
The PROMIS
®
PF CAT appears to be an excellent method for measuring outcomes for patients with foot and ankle surgery. Further validation of the PROMIS
®
item banks may ultimately provide a valid and reliable tool for measuring patient-reported outcomes after injuries and treatment.
Level of Evidence
Level III, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.
Syzygium cumini (L.) Skeels is an important medicinal plant utilized in the health care systems of Pakistan, India, Sri Lanka, and Bangladesh. S. cumini have been used to treat renal issues, ...indigestion, diabetes, dysentery, and employed in folk medicine to treat inflammations. It is known to anticipate antioxidant, anti-inflammatory, anticancer, anti-diabetic, anti-bacterial, antifungal, activities, and radioprotective activities.
We examined the in vitro anti-inflammatory activities of S. cumini fruit extracts, evaluated using membrane stabilization, egg albumin denaturation, and bovine serum albumin denaturation assays. In vivo anti-inflammatory activity was also assessed, using murine models of carrageenan, formaldehyde, and PGE2 induced paw edema. Fractionation of active extracts was performed using HPLC, followed by LC-ESI-MS/MS analysis to identify the bioactive compounds responsible for anti-inflammatory activity.
The crude methanolic extract showed stronger in vitro and in vivo anti-inflammatory activities compared to other extracts. The most potent effects were observed in the formaldehyde induced paw edema assay wherein methanolic extract and standard indomethacin induced 72% and 88% inhibition against paw edema volume in comparison to control (normal saline) respectively. In the bovine serum albumin denaturation assay the methanolic extract induced 82% inhibition against denaturation as compared to control (phosphate buffer) while standard diclofenac sodium induced 98% inhibition. In contrast, 50% v/v MeOH:H2O or 100% dichloromethane extracts displayed moderate to weak effects in the anti-inflammatory models. HPLC fractionation provided 6 active sub-fractions, four (MF2, MF3, MF6, MF7) from the 100% methanolic extract and two (HAF1, HAF3) from the 50% methanolic extract. The MF2, MF7, and HAF1 sub-fractions displayed potent activity in all studied in vitro assays. LC-ESI-MS-MS analysis tentatively identified delphinidin 3-glucoside, peonidin-3,5-diglucoside, gallic acid, liquitrigenin, scopoletin, umbelliferon, and rosmanol from the 100% methanolic fractions. Myricetin, catechin, quinic acid, chlorogenic acid, ellagic acid, gallic acid, and caffeic acid were identified in the 50% methanolic fractions.
These results demonstrate that S. cumini fruit extracts are a rich source of bioactive compounds that are worthy of further investigation as leads for anti-inflammatory drug discovery.
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1. An on-farm assessment of keel bone, feet, plumage and skin damage was conducted in layers in small furnished cages to evaluate welfare implications.
2. Thirteen farms participated, all housing ...Lohmann LSL layers in systems allowing 8 or 10 hens per cage.
3. Each flock was visited at three different ages: 32, 62 and 77 weeks. During each visit, 100 hens were examined for keel bone fractures and deviations, plumage damage, body wounds, foot pad lesions, bumble feet, missing toes and toe wounds.
4. A deterioration with age of the condition of the plumage and keel bone was found (P < 0.001). At 77 weeks of age, 16% of the birds had poor plumage, and 43% of the birds had keel bone damage. In contrast, foot pad lesions were most prevalent at 32 weeks of age (13%), whereas the other foot injuries and body wounds remained at a relatively low level throughout the three ages examined.
5. Prevention of damage to the keel bone, plumage and foot pads should therefore be considered when aiming to improve welfare of laying hens housed in small furnished cages.
Aim
To evaluate the impact of surgical debridement on the microbiology of resection margins of an infected diabetic foot ulcer and to compare the use of marginal sampling as a guide for antimicrobial ...therapy.
Methods
Forty consecutive participants were studied. Tissue samples from infected diabetic foot ulcers were obtained at first contact by podiatrists. After surgical debridement to macroscopically healthy tissue, multiple samples were obtained from the margins of the residuum and also from excised non‐viable tissue. Debridement was done by a single surgeon. Bacterial species were classified according to pathogenic potential a priori into Red Group—Definite pathogen causing infection, Yellow Group—Likely to be causing infection if present in more than one specimen and Green Group –Commensals, not causing infection.
Results
There was a relative reduction of 49% (p = 0.002) in bacteria in the most pathogenic (red) group, and 59% (p = 0.002) in the yellow group in podiatry samples compared with resection specimen. Positive cultures from margins of the residuum were observed in 75% of cases. There was a relative reduction of 67% (p = 0.0001) in bacteria in the red and 48% (p = 0.06) in the yellow group in marginal samples from the residuum compared with podiatry samples.
Conclusions
After surgical debridement to healthy tissue, positive cultures from marginal tissue samples provided vital information on the presence of pathogenic bacteria. This allowed antibiotics to be individualised post‐surgical debridement.
Urgent consultations for foot injuries are common. Trauma injuries are often obvious, such as displaced or open fractures, dislocations, or tissue breakdown. However, they can also have a subtle ...presentation and still hide severe structural damage. This is the case of «benign» Lisfranc sprains, compartment syndrome or even tendon sections through an apparently benign wound. The purpose of this article is to help the primary care physician to be aware of these subtle and sometimes hidden injuries, to assist him in the diagnosis and to provide the keys to appropriate treatment.
Background
Ankle-foot orthoses (AFOs) are commonly prescribed during rehabilitation after limb salvage. AFO stiffness is selected to help mitigate gait deficiencies. A new custom dynamic AFO, the ...Intrepid Dynamic Exoskeletal Orthosis (IDEO), is available to injured service members but prescription guidelines are limited.
Questions/purposes
In this study we ask (1) does dynamic AFO stiffness affect gait parameters such as joint angles, moments, and powers; and (2) can a given dynamic AFO stiffness normalize gait mechanics to noninjured control subjects?
Methods
Thirteen patients with lower limb salvage (ankle arthrodesis, neuropathy, foot/ankle reconstruction, etc) after major lower extremity trauma and 13 control subjects who had no lower extremity trauma and wore no orthosis underwent gait analysis at a standardized speed. Patients wore their custom IDEO with posterior struts of three different stiffnesses: nominal (clinically prescribed stiffness), compliant (20% less stiff), and stiff (20% stiffer). Joint angles, moments, powers, and ground reaction forces were compared across the varying stiffnesses of the orthoses tested and between the patient and control groups.
Results
An increase in AFO compliance resulted in 20% to 26% less knee flexion relative to the nominal (p = 0.003) and stiff (p = 0.001) conditions, respectively. Ankle range of motion and power generation were, on average, 56% (p < 0.001) and 63% (p < 0.001), respectively, less than controls as a result of the relatively fixed ankle position.
Conclusions
Patients with limb salvage readily adapted to different dynamic AFO stiffnesses and demonstrated few biomechanical differences among conditions during walking. None of the stiffness conditions normalized gait to controls.
Clinical Relevance
The general lack of differences across a 40% range of strut stiffness suggests that orthotists do not need to invest large amounts of time identifying optimal device stiffness for patients who use dynamic AFOs for low-impact activities such as walking. However, choosing a stiffer strut may more readily translate to higher-impact activities and offer less chance of mechanical failure.
Injuries to the foot are common in the athletic population, accounting for approximately 16% of sporting injuries. The bony and ligamentous structures around the first and second tarsometatarsal ...(TMT) joints, or Lisfranc joint complex, are the most commonly involved in injuries to the midfoot because of the limited static and dynamic stability of this region. The appropriate management of Lisfranc or TMT joint injuries in athletes is controversial, with multiple classification schemes and treatment methods and little evidence-based guidelines to deliver appropriate care. This article reviews the current diagnosis and management principles for TMT injuries in the athletic population.
Background:
Operative fixation of displaced intra-articular calcaneal fractures is considered the gold standard, for which multiple fixation methods are available. This study compares the ...(functional) outcome of screw fixation (SF), plate fixation (PF), and anatomical plate fixation (APF) via the sinus tarsi approach (STA).
Methods:
A total of 239 patients (265 fractured calcanei) who received surgical treatment of a displaced intra-articular calcaneal fracture via STA between 2011 and 2022 were included.
Results:
Böhler angle (BA) measured immediately postoperatively (BA post-OR) and the decrease in BA at 1 year (∆BA) differed significantly in favor of PF/APF compared with SF (BA post-OR: SF vs PF P = .010 and SF vs APF P = .001; ∆BA: SF vs PF P = .032 and SF vs APF P = .042). Implant removal surgery was performed significantly less in the APF group as compared to the SF/PF groups (APF vs SF/PF; 9.9% vs 22.9%/23.7%, P = .015). Surgical site infections and secondary arthrodesis of the subtalar joint occurred equally in the 3 groups. Furthermore, the mean American Orthopaedic Foot & Ankle Society ankle-hindfoot scale, Foot Function Index score, and EuroQOL-5D-index / visual analog scale score, did not differ notably between SF, PF, and APF.
Conclusion:
The results show that both PF and APF are favored over SF because of an improved correction of BA measured directly postoperatively, a lower secondary loss of BA and, for APF, a lower implant removal rate. There was no difference in the rate of surgical site infections, need for secondary arthrodesis, nor functional outcome scores between different implants using the STA.
Level of Evidence:
Level III, retrospective cohort study.
Foot and ankle injuries account for a large proportion of Emergency Department attendance. The aim of this study was to assess population-based trends in attendances due to foot and ankle injuries in ...the Netherlands since 1986, and to provide a detailed analysis of health care costs in these patients.
Age- and gender-standardized emergency attendance rates and incidence rates for hospital admission were calculated for each year of the study. Injury cases and hospital length of stay were extracted from the National Injury Surveillance System (non-hospitalized patients) and the National Medical Registration (hospitalized patients). Data were grouped into osseous and ligamentous injuries for foot and ankle separately. An incidence-based cost model was applied to calculate associated direct health care costs.
Since 1986 the overall emergency attendance rate decreased from 858 to 640 per 100,000 person years. In non-admitted patients (90% of cases), ligamentous injuries approximately halved, whereas osseous injuries increased by 28% (foot) and 25% (ankle). The incidence rate for hospital admission increased by 35%, mainly due to an almost doubling of osseous injuries. Attendance rates showed a peak in adolescents and adults until ~45 years of age in males and (less pronounced) in females. The total number of hospital days decreased to 58,708 days in 2010. Hospital length of stay (HLOS) increased with age and was highest for osseous injuries. HLOS was unaffected by gender, apart for longer stay in elderly females with an osseous ankle injury. Health care costs per case were highest for osseous injuries of the ankle (€ 3,461). Costs were higher for females and increased with age to € 6,023 in elderly males and € 10,949 in elderly females. Main cost determinants were in-hospital care (56% of total costs), rehabilitation/nursing care (15%), and physical therapy (12%).
Since 1986, the emergency attendance rate of foot and ankle injuries in the Netherlands decreased by 25%. Throughout the years, the attendance rate of (relatively simple) ligamentous injuries strongly reduced, whereas osseous injuries nearly doubled. Attendance rates and health care costs were gender- and age-related. Main cost determinants were in-hospital care, rehabilitation/nursing care, and physical therapy.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
Although Lisfranc injuries are uncommon, representing approximately 0.2% of all fractures, they are complex and can result in persistent pain, degenerative arthritis, and loss of function. ...Both open reduction and internal fixation (ORIF) and primary fusion have been proposed as treatment options for these injuries, but debate remains as to which approach is better.
Questions/purposes
We asked whether ORIF or primary fusion led to (1) fewer reoperations for hardware removal; (2) less frequent revision surgery; (3) higher patient outcome scores; and (4) more frequent anatomic reduction.
Methods
A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Three trials met the criteria for inclusion within the meta-analysis. Qualifying articles for the meta-analysis had data extracted independently by two authors (NS, AF). The quality of each study was assessed using the Center for Evidence Based Medicine’s evaluation strategy; data were extracted from articles rated as good and fair: two and one article, respectively.
Results
The risk ratio for hardware removal was 0.23 (95% confidence interval CI, 0.11–0.45; p < 0.001) indicating more hardware removal for ORIF than fusion. For other revision surgery, the risk ratio for ORIF was 0.36 (95% CI, 0.08–1.59; p = 0.18) favoring neither. Similarly, neither was favored using patient-reported outcomes; the standard mean difference was calculated to be 0.50 (95% CI, −2.13 to 3.12; p = 0.71). When considering the risk of nonanatomic alignment, neither was favored (risk ratio, 1.48; 95% CI, 0.34–6.38; p = 0.60).
Conclusions
The surgeon should consider the increased risk of hardware removal along with its associated morbidity and discuss this with the patient preoperatively when considering ORIF of Lisfranc injuries. Because no new trials have been performed since 2012, further randomized controlled trials will be needed improve our understanding of these interventions.
Level of Evidence
Level I, therapeutic study.
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