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Venugopal NK, O'Leary S, Robledo A, Husain A, Tom RB, Nuti SA, Jupiter DC, Panchbhavi VK. Safe driving recommendations following lower extremity orthopedic surgery: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:59-66. [PMID: 37639004 DOI: 10.1007/s00590-023-03705-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/17/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE We analyzed the published literature on return-to-driving (RTD) recommendations following lower extremity orthopedic surgery, including knee and hip arthroplasty and ankle and foot surgery. METHODS We conducted a PubMed MEDLINE database search for the relevant literature spanning from 1988 to 2022. Data were extracted from the selected articles independently by six investigators, and the mean, standard deviation, and range of RTD recommendations for each surgical region and procedure were calculated. RESULTS The 34 studies included in our review evaluated brake response time, reaction time, movement time, braking force, and other parameters. Average RTD recommendations in weeks were: hip surgeries, 4.1 (± 2.7); foot surgeries, 6.67 (± 0.94); Achilles surgeries, 6.67 (± 0.25); ankle surgeries, 4 (± 2); knee surgeries, 5.42 (± 0.77); and multiple lower extremity surgeries, 3.85 (± 0.15). CONCLUSION Our findings can assist physicians in providing informed recommendations to patients, promoting safe driving practices, and optimizing postoperative recovery. LEVEL OF EVIDENCE Therapeutic, Level III: Retrospective comparative study.
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Affiliation(s)
- Navneet K Venugopal
- John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Sean O'Leary
- John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA.
| | - Ariadna Robledo
- Department of Neurosurgery, The University of Texas Medical Branch, 1005 Harborside Dr, Fifth Floor, Galveston, TX, 77555, USA
| | - Adam Husain
- John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Roshan B Tom
- John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Shiva A Nuti
- John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Daniel C Jupiter
- Department of Biostatistics and Data Science, The University of Texas Medical Branch, 700 Harborside Drive, Ewing Hall 1.134, Galveston, TX, 77555-1148, USA
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 301 University Blvd, Route 0165, Galveston, TX, 77555-0165, USA
| | - Vinod K Panchbhavi
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, 301 University Blvd, Route 0165, Galveston, TX, 77555-0165, USA
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Reb CW, McDonald E, Shakked RJ, Winters BS, Pedowitz DI, Raikin SM, Daniel JN. Brake Response Time Recovery After Achilles Tendon Repair. Foot Ankle Spec 2020; 13:188-192. [PMID: 31014108 DOI: 10.1177/1938640019843316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background. This study evaluated when patients' brake response time (BRT) recovers after right Achilles repair. Methods. Institutional review board-approved prospective study of 60 patients. Assessments included visual analogue scale pain (VAS) score, Achilles Tendon Total Rupture Score (ATRS), and a driver readiness survey. Emergent brake pedal operation was simulated at 6 weeks postoperatively and repeated until patients achieved a passing BRT. Results. Fifty-seven patients completed the study. At 6 weeks, 54 of 59 (91.5%) patients had a passing BRT with a mean of 0.60 seconds (SD 0.08 seconds). Five (8.5%) patients had a failing BRT with a significantly higher mean of 0.95 seconds (SD 0.13 seconds, P = .01). At first testing, all patients were ambulating in a walking boot with removable heel wedges. Those who passed were using significantly fewer wedges (mean 1.9 vs 2.6 wedges, P = .04). Mean VAS pain scores (Passed: 1.1, SD 1.57, vs Failed: 2.8, SD 3.35, P = .32) were not significantly different. The mean ATRS was significantly lower among those who passed (63.7, SD 16.7, vs 85.4, SD 11.1, P = .01. Three patients repeated testing at a mean 7.3 weeks (range 6.7-8). All achieved passing times (mean 0.68 seconds, range 0.55 to 0.77 seconds). The driving readiness survey was 100% sensitive but 31.3% specific for passing BRT. Its positive predictive value was 80%, and its negative predictive value was 100%. Conclusion. BRT normalizes around 6 to 7 weeks after open right Achilles tendon repair. The ATRS and driver readiness questionnaire corresponded to achieving a passing BRT. Levels of Evidence: Prognostic Level II: Prospective Cohort Study.
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Affiliation(s)
- Christopher W Reb
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida (CWR).,Department of Orthopaedics, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (EM, RJS, BSW, DIP, SMR, JND)
| | - Elizabeth McDonald
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida (CWR).,Department of Orthopaedics, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (EM, RJS, BSW, DIP, SMR, JND)
| | - Rachel J Shakked
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida (CWR).,Department of Orthopaedics, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (EM, RJS, BSW, DIP, SMR, JND)
| | - Brian S Winters
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida (CWR).,Department of Orthopaedics, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (EM, RJS, BSW, DIP, SMR, JND)
| | - David I Pedowitz
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida (CWR).,Department of Orthopaedics, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (EM, RJS, BSW, DIP, SMR, JND)
| | - Steven M Raikin
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida (CWR).,Department of Orthopaedics, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (EM, RJS, BSW, DIP, SMR, JND)
| | - Joseph N Daniel
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida (CWR).,Department of Orthopaedics, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (EM, RJS, BSW, DIP, SMR, JND)
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Abstract
Postoperative management of hallux valgus varies widely. Setting preoperative expectations is an important aspect of attaining a successful outcome, but this is not routinely reviewed in the literature. This chapter offers suggestions on successfully navigating this area of patient care. Current concepts focus on pain control, immobilization, and return to activities. This chapter also reviews the current literature in these areas and sets out the authors' preferred management in the postoperative setting.
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Affiliation(s)
- William A Hester
- Sidney Kimmel Medical College, Thomas Jefferson University, The Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA
| | - David I Pedowitz
- Foot & Ankle Fellowship, Sidney Kimmel Medical College, Thomas Jefferson University, The Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
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[Evaluation of driving fitness in patients with musculoskeletal disorders : A systematic review]. Unfallchirurg 2019; 122:697-705. [PMID: 30341679 DOI: 10.1007/s00113-018-0571-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Driving a motor vehicle is one of the most important aspects of personal mobility in our society. However, there is a lack of evidence regarding driving fitness after orthopedic or trauma surgery-related diseases. Aim of this systematic review was to support the treating physician to determine the individual driving fitness in patients with musculosceletal disorders. MATERIAL AND METHODS A systematic analysis was performed using the PubMed database. Following a predefined algorithm, all relevant articles published from 2013 to 2018 were included. RESULTS The results were categorized according to the affected part of the body into I. lower extremity and II. upper extremity. Also, results were subcategorized into movement restrictions caused by external joint-braces, musculoskeletal diseases, and postoperative conditions. CONCLUSION This article supports the treating physician to individually determine the driving fitness in patients with musculoskeletal disorders. However, only a few standardized tests exist to individually determine the driving fitness in patients with musculoskeletal disorders. A particular shortcoming was observed for impairments of the upper extremity.
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Carroll JJ, McClain WD, Dowd TC. Patient Safety: Driving After Foot and Ankle Surgery. Orthop Clin North Am 2018; 49:527-539. [PMID: 30224014 DOI: 10.1016/j.ocl.2018.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This article provides a review of the existing literature regarding driving limitations following lower extremity orthopedic surgery. Medicolegal requirements and insurance recommendations are often vague and subject to interpretation. Several studies have examined the impact of surgery and immobilization on brake reaction time. This study summarizes the findings of these studies. Additionally, the authors consider the impact of lower extremity amputations and peripheral vascular disease on driving. Literature regarding opioid use, obesity, sleep apnea, increasing age, and distraction is also reviewed. An improved understanding of these topics will enhance the orthopedic surgeon's ability to counsel patients and optimize their safety.
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Affiliation(s)
- John J Carroll
- Department of Orthopaedic Surgery, SAUSHEC Orthopaedic Residency Program Position, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA.
| | - William D McClain
- Department of Orthopaedic Surgery, SAUSHEC Orthopaedic Residency Program Position, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA
| | - Thomas C Dowd
- Department of Orthopaedic Surgery, SAUSHEC Orthopaedic Residency Program Position, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA
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