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Lin Y, Gao J, Zheng H, Guo Y, Liu Z, Sun T. Evaluating Fibular Intramedullary Nails vs Traditional Plating in Geriatric Ankle Fractures: A 12-Year Single-Center Retrospective Study. Foot Ankle Int 2024; 45:824-832. [PMID: 38721810 DOI: 10.1177/10711007241247849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
BACKGROUND This study evaluates the outcomes of fibular intramedullary nails (IMNs) compared to traditional plates and screws (PS) in the surgical treatment of unstable ankle injuries in patients aged ≥65 years. METHOD We conducted a retrospective study involving 32 elderly patients with unstable ankle fractures treated with IMNs from 2010 to 2022. A comparison was made with 125 case-control patients treated with PS during the same period. Outcomes compared included postoperative wound and nonwound complications, surgical reduction, union rates, implant removal rates, and the Olerud Molander Ankle Score (OMAS) at a minimum follow-up of 2 years. RESULTS The IMN group had a higher incidence of high-energy injuries, open fractures, concomitant surgery, and perioperative transfusion requirements than the PS group. Additionally, the IMN group developed fewer wound-related (3.1% vs 20% in the PS group, P = .043) and non-wound-related complications (18.8% vs 39.2% in the PS group, P = .030). Both groups had similar initial weightbearing restrictions, fracture union times, mean OMAS scores, rates of malunion or nonunion, and delayed implant removal times. Notably, there were significant differences in the quality and adequacy of mortise alignment between the groups (good: 53.1% in IMN group vs 79.2% in PS group, fair: 46.9% in IMN group vs 20.8% in PS group, P = .006). CONCLUSION Although the IMN group had an inferior outcome in the quality and adequacy of mortise reduction compared with the PS group, elderly patients with ankle fractures treated with IMN showed comparable functional outcomes to those treated with PS but with lower complication rates. Future research in this area will provide vital information for developing optimal treatment strategies, thereby improving the overall care of elderly patients with ankle fractures.
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Affiliation(s)
- Yiyun Lin
- Department of Orthopedic Surgery, Senior Department of Orthopedics, the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Jie Gao
- Department of Orthopedic Surgery, Senior Department of Orthopedics, the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Huayong Zheng
- Department of Orthopedic Surgery, Senior Department of Orthopedics, the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Yongzhi Guo
- Department of Orthopedic Surgery, Senior Department of Orthopedics, the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Zhi Liu
- Department of Orthopedic Surgery, Senior Department of Orthopedics, the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Tiansheng Sun
- Department of Orthopedic Surgery, Senior Department of Orthopedics, the Seventh Medical Center of PLA General Hospital, Beijing, China
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Gundtoft PH, Erichsen JL, Terndrup M, Walsøe L, Pedersen L, Viberg B, Ørts A, Abrahamsen C. Comparison of four patient reported outcome measures in patients with ankle fracture: A study on patient preferences and psychometric properties. Foot Ankle Surg 2024:S1268-7731(24)00151-6. [PMID: 39013738 DOI: 10.1016/j.fas.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 06/11/2024] [Accepted: 07/04/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND The aim was to assess psychometric properties of Manchester Oxford Foot Questionnaire (MOXFQ), the Self-reported Foot and Ankle Score (SEFAS), the Olerud Molander Ankle Score (OMAS), and the Forgotten Joint Score (FJS) in adults with ankle fractures. METHODS Patients received all four questionnaires 6, 12, 14, 24, 52, and 104 weeks following an ankle fracture. According to COSMIN guidelines, statistical tests were performed to assess floor- and ceiling effects, structural validity, construct validity and reliability. Cognitive interview was performed with 9 patients. RESULTS MOXFQ showed best model fit in Confirmatory Factor Analysis. When testing construct validity, all hypotheses were accepted except for OMAS and FJS. All questionnaires had an almost perfect test-retest reliability (Interclass Correlation Coefficient 0.81 to 0.91) and Cronbach's alpha ranged from 0.76 to 0.95. MOXFQ was the best rated questionnaire. CONCLUSION All questionnaires performed well and we recommend MOXFQ for future use in ankle fracture studies. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Per Hviid Gundtoft
- Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark; Department of Orthopaedic Surgery, Lillebaelt Hospital - Kolding, Denmark.
| | | | - Mads Terndrup
- Department of Orthopaedic Surgery, Hvidovre Hospital, Denmark
| | - Lauritz Walsøe
- Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark
| | - Lasse Pedersen
- Department of Orthopaedic Surgery, Odense University Hospital, Denmark
| | - Bjarke Viberg
- Department of Orthopaedic Surgery, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Orthopaedic Surgery, Lillebaelt Hospital - Kolding, Denmark
| | - Alice Ørts
- Department of Orthopaedic Surgery, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Charlotte Abrahamsen
- Department of Orthopaedic Surgery, Lillebaelt Hospital - Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Denmark
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Takahashi Y, Takegami Y, Tokutake K, Asami Y, Takahashi H, Kato M, Kanemura T, Imagama S. Analysis of Calcaneal Avulsion Fractures Treated Surgically and Nonsurgically: A Retrospective Multicenter Study. JB JS Open Access 2024; 9:e23.00127. [PMID: 38988332 PMCID: PMC11233096 DOI: 10.2106/jbjs.oa.23.00127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024] Open
Abstract
Background Calcaneal avulsion fractures (CAvFs) at the Achilles tendon insertion are among the more challenging fractures to treat. Although rare, they often require reoperation. The optimal treatment, including nonsurgical procedures and better implants for surgical procedures in the treatment of CAvFs, remains to be established. Therefore, our study aimed to (1) perform a descriptive evaluation of CAvFs, including cases managed nonsurgically, and (2) assess surgical procedures, including the incidence of complications and reoperation for surgically treated CAvFs. Methods In this multicenter retrospective study, we collected data of patients with CAvFs treated at 9 hospitals from 2012 to 2022. We performed a descriptive study of CAvFs and compared postoperative complications and reoperation rates for multiple surgical techniques and implants. The size of the bone fragments was quantified. Results The data of 70 patients with CAvFs were analyzed; 20 patients were treated nonsurgically, and 50 were treated surgically. The mean age of patients was 68.5 years; 67% of the patients were female. Nineteen percent of the patients had diabetes, and 19% had osteoporosis. The incidence of postoperative complications was 30%, with infection in 14%, necrosis in 26%, and loss of reduction in 18%. The reoperation rate was 22%. Surgical techniques with use of cannulated cancellous screws were performed in 80% of the surgical cases. Cannulated cancellous screw (CCS) fixation alone resulted in a reoperation rate of 35%, whereas additional augmentation, including washers with CCS fixation, resulted in a reoperation rate of 10%. CCS fixation was successfully performed, although suture anchors were used in some cases with smaller fragments. Conclusions CAvFs occurred more frequently in older women and had a high rate of postoperative complications. A combination of CCS with augmentation was more effective at reducing postoperative complications than CCS fixation alone, even when the bone fragment size was small. Level of Evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Yu Takahashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Katsuhiro Tokutake
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuta Asami
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hidetane Takahashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mihoko Kato
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tokumi Kanemura
- Department of Orthopaedic Surgery, Konan Kosei Hospital, Aichi, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Saliba I, Cannell S, Valentin E, Dagher T, Bauer T, Anract P, Feruglio S, Vialle R, Moussellard HP, Hardy A. Validation of the Ankle Ligament Reconstruction-Return to Sports after Injury (ALR-RSI) Score as a Tool to Assess Psychological Readiness to Return to Sport in an Active Population After Ankle Fracture Surgery: A Cross-sectional Study. J Foot Ankle Surg 2024; 63:295-299. [PMID: 38151113 DOI: 10.1053/j.jfas.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/05/2023] [Accepted: 12/18/2023] [Indexed: 12/29/2023]
Abstract
Ankle injuries account for 15% to 25% of all sports injuries resulting in significant pain and loss of function. The purpose of this cross-sectional study was to validate a scale to help surgeons quantify the psychological readiness to Return To Sport (RTS) in patients undergoing ankle fracture surgery. ALR-RSI was used to assess the psychological readiness for RTS in athletic patients who underwent ankle fracture fixation between January 2020 and January 2021. Participants filled out ALR-RSI and 2 Patient-Related Outcome Measurement (PROM) tools: Olerud-Molander Ankle Score (OMAS) and Self-Reported Foot and Ankle Score (SEFAS). A total of 93 patients were included. There was a strong correlation between ALR-RSI and both OMAS and SEFAS, with Pearson coefficients of r = 0.58 and 0.53, respectively. ALR-RSI was significantly higher in the RTS group than in those who no longer practiced their main preinjury sport. Moreover, the discriminant validity of ALR-RSI (AUC = 0.81) was better than that of the SEFAS and OMAS (AUC = 0.64 and 0.65, respectively, p = .001). The intra-class correlation coefficient ρ of 0.94 showed excellent reproducibility. At an optimal cutoff value of 76.7, ALR-RSI had a sensitivity of 81% and a specificity of 75% with a Youden index of 0.56. In conclusion, ALR-RSI was a valid and reproducible tool to evaluate the psychological readiness for RTS in an active population after an ankle fracture. This score could help surgeons identify athletes who may have unfavorable postoperative outcomes and provide support on the ability to RTS.
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Nangliya R, Nandanwar SP, Deshpande M. Multidisciplinary Management and Rehabilitation of Severe Crush Injury Resulting in Lisfranc Fracture: A Case Report. Cureus 2024; 16:e54473. [PMID: 38510868 PMCID: PMC10951743 DOI: 10.7759/cureus.54473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
A 58-year-old male patient was seriously injured in his left foot as a result of a passenger car accident, resulting in a Lisfranc fracture and complications on his left side. The initial injury resulted in a 20-cm laceration, severe pain, and severe swelling. After primary care at the government hospital, the patient was referred to Acharya Vinoba Bhave Rural Hospital (AVBRH) for further treatment. Clinical examination revealed infection, Lisfranc ligament rupture, bone exposure, restriction of movement, and muscle strength. His fracture was managed with Kirschner wire(K-wire) fixation surgically. A holistic physical management plan includes immobilization and a comprehensive medical program to reduce edema, muscle atrophy, and joint stiffness. Post physiotherapy showed significant improvements in joint function, muscle strength, and functional scores after rehabilitation. Outcome measures such as the Lower Extremity Functional Scale, Olerud-Molander Ankle Score, and Patient-Reported Outcomes Measurement Information System-29 are related to physical recovery, stress reduction, and healing as a whole-life treatment. These data highlight the importance of a collaborative, multidisciplinary approach in the effective management of Lisfranc fracture injuries and confirm the advantages of timely intervention and physical therapy for the benefit of these patients.
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Affiliation(s)
- Radha Nangliya
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sojwal P Nandanwar
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Maithili Deshpande
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Nguyen MQ, Broström A, Iversen MM, Harboe K, Paulsen A. Assessing the content validity of the Manchester-Oxford Foot Questionnaire in surgically treated ankle fracture patients: a qualitative study. J Orthop Surg Res 2023; 18:941. [PMID: 38066592 PMCID: PMC10704649 DOI: 10.1186/s13018-023-04418-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Roughly 10% of fractures in adults are ankle fractures. These injuries are found in both sexes and present with different fracture characteristics. The treatment varies with the patients' biology and fracture type, and the goals are to restore stability, prevent pain and maintain ankle function. Clinicians generally use outcomes like assessment of radiography, pain level, or function. The use of patient-reported outcome measures is increasing, and the Manchester-Oxford Foot Questionnaire (MOXFQ) has been shown to have good measurement properties when validated in patients with foot and ankle disorders. However, the instrument has not been validated for ankle fracture patients. This study aims to assess the content validity of the items in MOXFQ in surgically treated ankle fracture patients. METHODS A qualitative deductive design was used to investigate patients' response process of the MOXFQ. Individual interviews were conducted using cognitive interviewing based on the theoretical framework of the 4-step model by Tourangeau. Adult patients that were surgically treated for an ankle fracture between four weeks and 18 months were purposively sampled, and interviews followed a semi-structured interview guide. The predetermined categories were comprehension, retrieval, judgement, and response. RESULTS Seventeen respondents (65% females) were interviewed. Respondents' age ranged from 27 to 76 years. Some of the respondents in the early recovery phase were limited by post-operative restrictions and did not find the items in the walking/standing domain relevant. Respondents that were allowed weight-bearing as tolerated (WBAT) were able to recall relevant information for most items. Respondents with time since surgery more than 12 months had less pain and remembered fewer relevant episodes in the recall period. Items in the social interaction domain contained ambiguous questions and were generally considered less important by respondents. The summary index score lacked important concepts in measuring overall quality of life. CONCLUSIONS Pain was a central concept in the post-operative recovery of ankle fracture patients. The MOXFQ-subscales for pain and walking/standing had acceptable content validity in patients that were allowed WBAT. The social interaction-subscale and the summary index score had insufficient content validity for this patient population.
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Affiliation(s)
- Michael Q Nguyen
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
- Department of Orthopedic Surgery, Stavanger University Hospital, Helse Stavanger HF, Stavanger, Norway.
- Department of Orthopedic Surgery, The Fracture Registry of Western Norway, Stavanger University Hospital, Helse Vest RHF, Stavanger, Norway.
| | - Anders Broström
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Marjolein M Iversen
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Centre on Patient-Reported Outcomes, Department of Research and Development, Haukeland University Hospital, Helse Bergen HF, Bergen, Norway
| | - Knut Harboe
- Department of Orthopedic Surgery, Stavanger University Hospital, Helse Stavanger HF, Stavanger, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Anesthesia, Stavanger University Hospital, Helse Stavanger HF, Stavanger, Norway
| | - Aksel Paulsen
- Department of Orthopedic Surgery, Stavanger University Hospital, Helse Stavanger HF, Stavanger, Norway
- Department of Orthopedic Surgery, The Fracture Registry of Western Norway, Stavanger University Hospital, Helse Vest RHF, Stavanger, Norway
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Rajai N, Ebadi A, Karimi L, Sajadi SA, Parandeh A. A systematic review of the measurement properties of self-care scales in nurses. BMC Nurs 2023; 22:288. [PMID: 37635260 PMCID: PMC10463637 DOI: 10.1186/s12912-023-01450-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 08/16/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Self-care is a necessary measure against occupational injuries of nurses and improves nursing performance at the bedside. Nurses have different scales to measure self-care, and researchers are confused about choosing valid and reliable scales. This systematic review aimed to evaluate the measurement properties of self-care scales in nurses to identify the best available scales. METHODS Four databases (PubMed, Web of Science, SCOPUS, and ProQuest) were systematically searched, with no date limiters, until 9 Jun 2023. A manual search was performed with Google Scholar and the reference list of articles to complete the search. Studies aiming to develop or determine the measurement properties of self-care in nurses were included. Based on Consensus-Based Standards for the Selection of Health Measurement Instruments, the methodological quality of the studies was determined, and the result of each study on a measurement property was rated (sufficient, insufficient, or indeterminate). The quality of the evidence was graded using a modified Grading of Recommendations Assessment, Development, and Evaluation approach (high, moderate, low, or very low). These processes were used to make recommendations and identify the best scale to assess self-care in nurses. RESULTS Out of 8601 articles, six articles with five different scales were included. Only internal consistency was reported across all scales. Criterion validity, measurement error, responsiveness, feasibility, and interpretability, were not reported in any of them. Content validity was reported only in two studies with inconsistent results and low-quality evidence. None of the scales had methodological quality with a rating of very good and sufficient high-quality evidence for all measurement properties. CONCLUSIONS None of the scales is strongly recommended to measure self-care in nurses. Only the Professional self-care scale is temporarily recommended until their quality is assessed in future studies. Considering that the content of the examined scales does not meet all the professional self-care needs of nurses, designing a valid, reliable, and specialized scale for nurses is needed.
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Affiliation(s)
- Nahid Rajai
- Student Research Committee, Nursing Faculty, Baqiyatallah University of Medical Science, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Leila Karimi
- Behavioral Sciences Research Center, Life style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Seyedeh Azam Sajadi
- Nursing Management Department, Nursing Faculty, Aja University of Medical Sciences, Tehran, Iran
| | - Akram Parandeh
- Medicine, Quran and Hadith Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, South Sheikh Bahai St, Mollasadra St., Vanak Square, Tehran, Iran.
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