Quality of life after fracture-related infection of the foot

The impact of preoperative anxiety and depression on the prognosis of patients with painful accessory navicular

OBJECTIVE

This study evaluated the clinical efficacy of modified Kidner procedures for painful accessory navicular(AN) syndrome. Furthermore, it investigated the differences between patients' pre- and post-operatively, analyzing the impact on post-operative pain and functional recovery.

METHODS

This study included 50 patients diagnosed with painful AN and treated with the modified Kidner procedure at the Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an, between May 2014 and May 2023. All patients were assessed using the Hospital Anxiety and Depression Scale (HADS), Visual Analogue Scale(VAS), and American Orthopaedic Foot & Ankle Society Midfoot Scale (AOFAS) before and after surgery. Patients were divided into two groups based on the presence of preoperative anxiety/depression symptoms. Patients without preoperative anxiety/depression were assigned to Group A, while those with preoperative anxiety/depression were assigned to Group B. The baseline data, pain, functional activity, and psychological status scores of both groups were compared, and a correlation analysis was conducted to identify factors associated with anxiety/depression.

RESULTS

Out of 50 patients with painful AN syndrome who completed follow-up, 28 exhibited symptoms of anxiety/depression preoperatively, resulting in an incidence rate of 56%.Both Group A and Group B patients showed significant improvements in all postoperative evaluation metrics compared to preoperative levels (p < 0.05), yet the overall prognosis for Group B was poorer than that for Group A.There were significant differences in the degree of improvement in pain, functional activity, and anxiety/depression between the two groups(p < 0.05).female patients had a significantly higher prevalence of anxiety than male patients (p < 0.05).

CONCLUSION

Modified Kidner surgery can significantly improve the function, pain, and psychological status of patients with painful AN.However, patients with less favorable preoperative psychological status tend to have less satisfactory outcomes.Patients with preoperative anxiety or depression symptoms experience more significant pain relief after surgery, while those without such symptoms show better functional recovery.Moreover, female patients with painful AN have a higher incidence of preoperative anxiety.Future research should further explore the impact of preoperative psychological interventions on outcomes.

Fracture-Related Infections in the Foot and Ankle

Fracture-related infection (FRI) poses significant challenges in the management of foot and ankle fractures, potentially leading to functional impairment and heightened health care expenses. This review addresses the diagnosis, risk factors, and management strategies for FRI. Surgical management involves multidisciplinary collaboration, emphasizing debridement, antimicrobial therapy, and implant removal when indicated. Specific considerations for limited soft tissue coverage, tenuous blood supply, and fracture type in the foot and the ankle underscore the importance of tailored approaches to optimize outcomes and reduce complications in FRI management.

Mental health implications of fracture-related infections : a longitudinal quality of life study

Aims

Fracture-related infections (FRIs) are a major concern for patients and healthcare systems, yet their impact on mental health has been largely overlooked. This study aimed to assess the longitudinal impact of FRI on patients' quality of life.

Methods

A prospective study was conducted at a level 1 trauma centre between January 2020 and December 2022. In total, 56 patients participated, with quality of life assessed at five timepoints: one week preoperatively, and one, three, six, and 12 months postoperatively. Statistical analysis was performed using repeated measures analysis of variance (ANOVA) with adjusted post-hoc analysis.

Results

The preoperative Physical Component Summary score on the 36-Item Short-Form Health Survey questionnaire (SF-36) was 26.71, increasing to 30.40 at one month, remaining stable at three months. A modest increase was observed at six months (32.45, p = 0.003), but it decreased to 29.72 at 12 months. The preoperative Mental Component Summary score (SF-36) was 46.48, decreasing to 39.89 at one month (p = 0.027) and to 36.03 at three months (p ≤ 0.001). However, it improved at six (42.74) and 12 months (44.05). Positive changes were seen in EuroQol five-dimension questionnaire (EQ-5D) subdimensions, such as mobility, self-care, usual activities, and pain/discomfort, while anxiety/depression scores decreased over time. The EQ-5D visual analogue scale (VAS) score increased to 62.79 at six months (p ≤ 0.001) and decreased to 58.2 at 12 months (p = 0.011).

Conclusion

FRIs substantially affect mental health and quality of life, particularly during the initial three months of treatment. This study emphasizes the importance of addressing psychological aspects early in FRI management, advocating for holistic care encompassing both physical and psychological aspects of treatment.

Fracture-related infection in revision proximal femoral intramedullary nails

BACKGROUND

The proximal femoral nail is a commonly used fixation device for extra-capsular neck of femur fractures at our UK NHS Trust. Fracture-related infection (FRI) is a catastrophic complication that can be associated with internal fixation. FRI is often diagnosed late, and causes significant impact on the patient and healthcare system, leading to extended hospital stays, reduced quality of life, high healthcare costs and increased mortality and morbidity.

AIM

This study aims to evaluate whether failed proximal femoral nails treated at a major trauma centre in the United Kingdom are undergoing routine intraoperative microbiology sampling, as outlined by the FRI Consensus Group in 2020, and also to establish how often fracture-related infection is present in failed proximal femoral nails.

METHOD

Electronic patient record systems were reviewed over a 4-year period between 2018-2022 to identify patients who had a proximal femoral nailing, and those who required revision surgery. From this cohort, we then identified whether sampling had taken place during revision surgery, and the number of samples taken.

RESULTS

1041 proximal femoral nails were performed at our trust during the 4-year period. 60 of these implants failed, with 52 of these undergoing revision surgery at our hospital.  Only 56% cases had intra-operative samples taken for microbiology testing, with an average of 9 samples sent per case. Intra-operative sampling confirmed infection in 25% of cases with samples sent.  Of the cases requiring ≥ 3 operations, 75% of cases had confirmed infection.

DISCUSSION

The data shows that more can be done to ensure earlier diagnosis of fracture-related infection in failed proximal femoral nails. We should have a high suspicion of FRI in this cohort of patients. This study highlights the importance of a standardised protocol to ensure routine intra-operative sampling during proximal femoral nail revision surgery.

Long-Term Outcomes Following Single-Stage Reamed Intramedullary Exchange Nailing in Apparently Aseptic Femoral Shaft Nonunion with Unsuspected Proof of Bacteria

Background: The aim of this study was to evaluate detection rates and risk factors for unsuspected proof of bacteria, as well as clinical and radiologic outcomes following femoral shaft nonunion without clinical signs of infection treated by a single-stage surgical revision procedure including reamed intramedullary exchange nailing. Methods: A retrospective cohort study was performed in a European level I trauma center between January 2015 and December 2022. Fifty-eight patients were included who underwent reamed intramedullary exchange nailing as a single-step procedure for surgical revision of posttraumatic diaphyseal femoral nonunion without any indications of infection in medical history and without clinical signs of local infection. Clinical details of the patients were analyzed and functional and radiologic long-term outcomes were determined. Results: In all patients, with and without proof of bacteria osseous, healing could be observed. The physical component summary of the SF-12 demonstrated significantly better results at least one year after the final surgical revision in case of a negative bacterial culture during exchange nailing. Conclusions: Clinical long-term outcomes demonstrated a trend towards better results following femoral shaft nonunion revision if there was no evidence for the presence of low-grade infected nonunion. In this case, a single-stage surgical procedure may be recommended.

Analysis of fracture-related infections from Swedish insurance claims between 2011 and 2021

Fracture-related infections (FRI) pose a serious complication with an incidence of 1-2%. This study aimed to analyze compensation claims submitted to The Swedish National Patient Insurance Company (LÖF) because of FRI after closed/open reduction and internal fixation (C/ORIF) in the four most common fracture sites (proximal humerus, distal radius, hip, ankle). Patients registered in the LÖF database with a suspected FRI between 2011 and 2021 were identified by matching International Classification of Diseases and procedural codes indicative of a combination of fractures to the proximal humerus, distal radius, hip and ankle, C/ORIF and infection. Medical records were reviewed for fracture sites, pathogens and complications. Data from the Swedish Fracture Register (SFR) were extracted to estimate the proportion of reported claims to the presumed number of FRI. Of 122 FRI identified in the LÖF database, 34 were after C/ORIF in the proximal humerus, 12 in the distal radius, 28 in the hip and 48 in the ankle. LÖF compensated 111 patients (91%). Median time from C/ORIF to an FRI was 3 weeks (interquartile range 2-6), and 95% of all FRI occurred within 1 year after C/ORIF. Staphylococcus aureus was the most common pathogen in patients with a distal radius, hip and ankle FRI. In contrast, Cutibacterium spp. were the most common aetiology in FRI of the proximal humerus. The total number of fractures treated with C/ORIF in the four fracture sites registered in the SFR during 2021 was 18,711. Most of the FRI patients were diagnosed within the first year after C/ORIF, and 91% of the patients received compensation. Given an expected FRI incidence of 1-2%, our estimates with extrapolated data from the SFR indicate that < 10% of affected patients applied for compensation.

Hindfoot and Foot Arch Reconstruction by Atypical Subtalar Arthrodesis and Achilles Tendon Lengthening for a Severe Comminuted Calcaneal Fracture: A Case Report

Visual AbstractThis is a visual representation of the abstract.