Background:
Gastrocnemius recession is commonly performed for a variety of pathologies of the foot and ankle, yet studies characterizing risk factors associated with patient-reported outcomes are ...limited. In this cohort study, patient outcomes were compared against the general population for PROMIS scores with correlation analysis comparing demographics and comorbidities. Our primary goal in this study is to identify risk factors associated with poor patient-reported outcomes following isolated gastrocnemius recession for patients with plantar fasciitis or insertional Achilles tendinopathy.
Methods:
A total of 189 patients met inclusion criteria. The open Strayer method was preferred. However, if the myotendinous junction could not be adequately visualized without expanding the excision, then a Baumann procedure was performed. The decision between the two did not depend on preoperative contracture. Patient demographics and visual analog scale (VAS) scores were obtained via the electronic medical record. Telephone interviews were completed to collect postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) and Foot Function Index (FFI) scores. The data were analyzed using the type 3 SS analysis of variance test to identify individual patient factors associated with reduced PROMIS, FFI, and VAS scores.
Results:
No demographic variables were found to be significantly associated with postoperative complications. Patients who reported tobacco use at the time of surgery had significantly decreased postoperative PROMIS physical function (P = .01), PROMIS pain interference (P < .05), total FFI scores (P < .0001), and each individual FFI component score. Patients undergoing their first foot and ankle surgeries reported numerous significant postoperative outcomes, including decreased PROMIS pain interference (P = .03), higher PROMIS depression (P = .04), and lower FFI pain scores (P = .04). Hypertension was significantly associated with an increased FFI disability score (P = .03) and, along with body mass index (BMI) >30 (P < .05) and peripheral neuropathy (P = .03), significantly higher FFI activity limitation scores (P = .01). Pre- and postoperative VAS scores demonstrated improvement in patient-reported pain from a mean of 5.53 to 2.11, respectively (P < .001).
Conclusion:
We found in this cohort that numerous patient factors were independently associated with differences in patient-reported outcomes following a Strayer gastrocnemius recession performed for plantar fasciitis or insertional Achilles tendinopathy. These factors include, but are not limited to, tobacco use, prior foot and ankle surgeries, and BMI. This study strengthens previous reports demonstrating the efficacy of isolated gastrocnemius recession and elucidates variables that may affect patient-reported outcomes.
Level of Evidence:
Level III, retrospective cohort study.
Ankle sprains are a common musculoskeletal injury among the general population and often involve the lateral ligament complex. Although the majority of ankle sprains are treated successfully with ...nonsurgical conservative measures, an estimated 5% to 20% of ankle injuries ultimately develop chronic lateral ankle instability (CAI). Multiple surgical treatment modalities for the lateral ankle complex exist, such as anatomical and nonanatomical reconstruction. The current gold standard for primary surgical repair is the Broström-Gould procedure. This is the first article to provide PROMIS scores following BG and the largest study with 5-year outcomes for an open BG.
This was a descriptive study of a retrospective cohort of patients undergoing a BG with a minimum follow-up of 5 years. Patient-reported outcome instruments collected postoperatively were PROMIS Pain, Physical Function, Depression, and FAAM. Further preoperative clinic characteristics were analyzed to correlate with the final outcome. The electronic medical record was queried for
(
) code 27698 (Broström-Gould) from January 2010 to June 2017. Surveys were conducted in the clinic and through phone interviews. Patient charts were reviewed to obtain basic patient demographic information including sex, age, race, and body mass index (BMI). The following preoperative variables were recorded: history of prior CAI procedures, history of major trauma, duration of symptoms, number of diagnosed ankle sprains, other collagen pathologies, generalized ligament laxity, participation in sports/activity level, peroneal subluxation, clinically diagnosed peroneus longus or brevis tendinopathy, deltoid ligament injury, anterior ankle impingement, and posterior ankle impingement. The PROMIS and Foot and Ankle Ability Measure (FAAM) scores were obtained with a combination of clinic and phone interviews. Data were aggregated in Microsoft Excel and entered in R (version 4.2.0) for statistical analysis.
Our results show that the minimum 5-year patient-reported PROMIS scores for patients following a Broström-Gould procedure are as follows: PROMIS physical function, 50.5; PROMIS pain interference, 48.2; and PROMIS depression, 38.2. This indicates, at a minimum, that patients 5 years removed from the procedure are within 1 SD of the general population in regard to PROMIS physical function and pain. Our patient-reported FAAM, activities of daily living, and FAAM sports scores were 59.6 and 13.0 respectively. Preoperative magnetic resonance imaging (MRI) findings were recorded. Arthroscopic examination was performed before lateral ligaments reconstruction for patients with intra-articular pathologies confirmed on MRI.
The findings from our study offer evidence supporting the effectiveness of the Broström-Gould procedure to be associated with normal physical function, even 5 years after surgery. Furthermore, our research identified specific factors such as tobacco use, diabetes, and sports participation that independently correlated with reported outcome measures. These insights enable physicians to better manage patient expectations and tailor treatment strategies accordingly. Our study establishes a foundation for future prospective research endeavors that aim to leverage the PROMIS system for comprehensive outcome assessments.
Level III, retrospective cohort study.
Abstract Study Objectives To compare the efficacy of continuous radiofrequency (CRF) thermocoagulation with pulsed radiofrequency (PRF) in the treatment of lumbar facet syndrome. Design Prospective, ...randomized, double-blinded study. Setting Ambulatory pain clinic at a level-I trauma center and teaching institution. Patients 50 ASA physical status I, II, and III patients, at least 18 years of age, scheduled to undergo CRF or PRF for lumbar back pain. Interventions Target facet joints were identified with oblique radiographic views. Continuous radiofrequency thermocoagulation was delivered at 80°C for 75 seconds, while PRF was delivered at 42°C with a pulse duration of 20 ms and pulse rate of two Hz for 120 seconds. Measurements Visual analog scale (VAS) pain assessment and Oswestry Low Back Pain and Disability Questionnaire (OSW) were administered at baseline and then at three months. Comparisons between groups and within groups were made of the relative percentage improvement in VAS and OSW scores. Main Results No significant differences in the relative percentage improvement were noted between groups in either VAS ( P = 0.46) or OSW scores ( P = 0.35). Within the PRF group, comparisons of the relative change over time for both VAS ( P = 0.21) and OSW scores ( P = 0.61) were not significant. However, within the CRF group, VAS ( P = 0.02) and OSW scores ( P = 0.03) showed significant improvement. Conclusions Although there was no significant difference between CRF and PRF therapy in long-term outcome in the treatment of lumbar facet syndrome, there was a greater improvement over time noted within the CRF group.
The sensitivity of the Deep Underground Neutrino Experiment (DUNE) to neutrino oscillation is determined, based on a full simulation, reconstruction, and event selection of the far detector and a ...full simulation and parameterized analysis of the near detector. Detailed uncertainties due to the flux prediction, neutrino interaction model, and detector effects are included. DUNE will resolve the neutrino mass ordering to a precision of 5
σ
, for all
δ
CP
values, after 2 years of running with the nominal detector design and beam configuration. It has the potential to observe charge-parity violation in the neutrino sector to a precision of 3
σ
(5
σ
) after an exposure of 5 (10) years, for 50% of all
δ
CP
values. It will also make precise measurements of other parameters governing long-baseline neutrino oscillation, and after an exposure of 15 years will achieve a similar sensitivity to
sin
2
2
θ
13
to current reactor experiments.
The Deep Underground Neutrino Experiment (DUNE), a 40-kton underground liquid argon time projection chamber experiment, will be sensitive to the electron-neutrino flavor component of the burst of ...neutrinos expected from the next Galactic core-collapse supernova. Such an observation will bring unique insight into the astrophysics of core collapse as well as into the properties of neutrinos. The general capabilities of DUNE for neutrino detection in the relevant few- to few-tens-of-MeV neutrino energy range will be described. As an example, DUNE’s ability to constrain the
ν
e
spectral parameters of the neutrino burst will be considered.
A Topical Matter: Toxic Epidermal Necrolysis Ladizinski, Barry, MD; Sankey, Christopher, MD
The American journal of medicine,
10/2014, Letnik:
127, Številka:
10
Journal Article
Recenzirano
Odprti dostop
A complication of cancer chemotherapy led to a prolonged hospitalization for a 49-year-old man. The patient presented via the dermatology clinic with chills and a progressing diffuse body. rash. His ...medical history was significant for a diagnosis of grade IV glioblastoma made four months prior at the time of a new-onset seizure. He had recently been treated with vandetanib and temozolomide for the glioblastoma. His other medications included acetaminophen with oxycodone, omeprazole, levetiracetam, and dexamethasone. Here, Ladizinski and Sankey detail the assessment, diagnosis, and management of toxic epidermal necrolysis.
Category:
Hindfoot
Introduction/Purpose:
Talocalcaneal arthrodesis is the gold standard treatment for severe arthritis and has a wide range of techniques that have been described to achieve fusion. ...However, there is a lack of the complications associated with guide wire placement for the screw construct described in the literature. The aim of this study was to assess the proximity and structural damage to the various structures of the anterior foot resulting from guide wire placement in a top down subtalar arthrodesis procedure.
Methods:
Seven fresh-frozen below-the-knee cadaver specimens were randomly assigned to receive either a percutaneous or mini open approach for an antegrade subtalar screw placement. Blunt dissection was performed after each screw placement to determine the proximity of the anatomical structures of interest superficial peroneal nerve (SPN), deep peroneal nerve (DPN), dorsalis pedis artery (DPA), dorsalis pedis vein (DPV), extensor hallucis longus (EHL), and the tibialis anterior (TA) to the inserted hardware. The mean, standard deviation, and range for distances were calculated for all structures. Analysis of variance (ANOVA) was used to determine statistical significance.
Results:
Antegrade subtalar screw placement was performed percutaneously in four specimens and via a mini-open approach in three specimens. The guidewire was touching an anatomic structure of interest in the three specimens in the percutaneous groups and one specimen in the mini-open group. For the mini-open approach, the DPN, DPA, DPV, and EHL were uninjured but touching the guidewire on one cadaver. For the percutaneous approach, the DPN was uninjured but touching the guidewire on two cadavers, the DPA was uninjured but touching the guidewire on one cadaver and penetrated on a different cadaver, the DPV was uninjured but touching the guidewire on two cadavers and penetrated on a different cadaver, and the EHL was uninjured but touching the guidewire on one cadaver and penetrated on a different cadaver. Distance from each structure of interest to the screw head can be found in Table 1.
Conclusion:
This study shows the potential risks to anterior structures when placing an antegrade subtalar screw during fusion. We suggest that orthopedic surgeons exercise caution when performing critical steps of the procedure to minimize avoidable injury to structures of importance that may increase the morbidity of the patient.
Category:
Ankle
Introduction/Purpose:
Isolated lateral malleolus fractures are a common ankle fracture that a foot and ankle surgeon will encounter. Retrograde intramedullary fixation for unstable ...lateral malleolus fractures has become a viable option for patients at higher risk for potentially devastating wound complications. The aim of this cadaveric study was to assess the relative risk of injuring adjacent anatomic structures with percutaneous implantation of an intramedullary fibular screw for lateral malleolus fractures to minimize iatrogenic injury.
Methods:
Seven fresh-frozen below-the-knee cadaver specimens were used for this study. Prior to investigations, specimens were inspected with fluoroscopic radiographs for preexisting pathology or prior surgical intervention. Lateral dissection of the lateral malleolus was performed after screw placement to determine the proximity of the peroneus longus (PL), peroneus brevis (PB), and sural nerve (SN) to the inserted hardware. The mean, standard deviation, and range for distances were calculated for all structures. Analysis of variance (ANOVA) was used to determine statistical significance.
Results:
Percutaneous intramedullary fibular screw placement was performed in seven specimens, six females and one male, with an average age of 79.3 +- 8.1 years. Amongst the seven specimens, only one resulted in an injury to a structure of interest (sural nerve). The peroneus longus and peroneus brevis were not injured in any of the specimens. Table 1 shows the average distance between the guidewire and each structure of interest.
Conclusion:
This study shows the potential risks to lateral structures when placing an intramedullary fibular screw for unstable lateral malleolus fractures. We suggest that orthopedic surgeons exercise caution when performing critical steps of the procedure to minimize avoidable injury to structures of importance that may increase the morbidity of the patient.
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