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Heinig O, Feicht E, Mahamid A, Liberson R, Picard C, Liberson A. Treatment of a compound calcaneus fracture Sanders IV with an external circular fixator and calcaneal osteotomy. Trauma Case Rep 2023; 46:100850. [PMID: 37333494 PMCID: PMC10272509 DOI: 10.1016/j.tcr.2023.100850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/20/2023] Open
Abstract
Compound Gustilo-type III intra-articular calcaneus fractures are challenging to treat. Anatomical reduction of the subtalar joint increases the chances of a better functional outcome and is traditionally achieved by an open reduction and plating. Conversely, ORIF is associated with a high risk of infection and even amputation. In our case study, we present the treatment of a Gustilo-type III intra-articular calcaneus fracture with a circular external fixator and a temporary antibiotic cement spacer for fracture reduction and stabilization. Active bio-glass was implanted to fill bone loss and to prevent infection. A closing-wedge calcaneal tuberosity osteotomy was used to facilitate wound closure. We paid special attention to reducing the posterior facet. The patient returned to work and full ambulation five months post-injury.
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Affiliation(s)
- Ofer Heinig
- Foot & Ankle Unite, Laniado University Hospital, Adelson Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Elia Feicht
- Foot & Ankle Unite, Laniado University Hospital, Adelson Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Assil Mahamid
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Roman Liberson
- Foot & Ankle Unite, Laniado University Hospital, Adelson Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Claude Picard
- Foot & Ankle Unite, Laniado University Hospital, Adelson Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Aharon Liberson
- Foot & Ankle Unite, Laniado University Hospital, Adelson Faculty of Health Sciences, Ariel University, Ariel, Israel
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Yaari L, Dolev A, Kittani M, Yassin M, Gbaren M, Feicht E, Haviv B. Preoperative pain sensitivity questionnaire helps customize pain management after arthroscopic partial meniscectomy. Knee Surg Sports Traumatol Arthrosc 2021; 29:4198-4204. [PMID: 33704517 DOI: 10.1007/s00167-021-06438-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/07/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate correlations between preoperative pain sensitivity and postoperative analgesic consumption together with pain perception shortly after arthroscopic partial meniscectomy in non-arthritic knees. METHODS Ninety-nine patients who underwent primary arthroscopic meniscectomy were prospectively divided into three postoperative treatment groups that were prescribed with betamethasone injection (at the end of surgery), oral celecoxib or rescue analgesia (control). Preoperative pain sensitivity was evaluated by pain sensitivity questionnaires (PSQ). Patients were followed for the first three postoperative weeks to evaluate knee injury and osteoarthritis outcome score (KOOS) pain scores and analgesics consumption. Statistical analysis included correlations among preoperative pain sensitivity, postoperative pain levels and analgesics consumption. A receiver operating characteristic curve was plotted to investigate the cutoff values of the PSQ score to predict insufficient postoperative pain reduction. RESULTS There were no differences at baseline among all study groups in age, sex, BMI, level of activity, comorbidities and surgical findings. At the final follow-up, KOOS pain scores improved in all groups (p < 0.001). Mean final KOOS pain scores were 76.1 ± 15.2 for the betamethasone group, 70.8 ± 12.6 for the celecoxib group and 78.7 ± 11.6 for the control group. No differences in scores were observed among groups (n.s.). In the control group, a negative correlation was observed between PSQ score and KOOS-pain scores at the end of the follow-up in addition to a positive correlation between PSQ score and rescue analgesia consumption at the first postoperative week. The optimal cutoff value for PSQ score to predict insufficient improvement in KOOS-pain subscale was 5.0 points. CONCLUSIONS A cutoff value of pain sensitivity questionnaire score above 5.0 points was determined to identify patients with higher sensitivity to pain who underwent arthroscopic partial meniscectomy. These patients reported relatively increased pain and consumed more rescue analgesics postoperatively unless treated with a single intraoperative corticosteroids injection or oral non-steroidal anti-inflammatories. Therefore, surgeons can use pain sensitivity questionnaire score as a preoperative tool to identify patients with high sensitivity to pain and customize their postoperative analgesics protocol to better fit their pain levels. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Lee Yaari
- Arthroscopy and Sports Injuries Unit, Rabin Medical Center, Hasharon Hospital, 7 Keren Kayemet St, 49372, Petach-Tikva, Israel
- Orthopedic Department, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
- Orthopedic Department, Rabin Medical Center, Hasharon Hospital, Petach-Tikva, Israel
| | - Amir Dolev
- Orthopedic Department, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
- Orthopedic Department, Rabin Medical Center, Hasharon Hospital, Petach-Tikva, Israel
| | - Mohamed Kittani
- Arthroscopy and Sports Injuries Unit, Rabin Medical Center, Hasharon Hospital, 7 Keren Kayemet St, 49372, Petach-Tikva, Israel
- Orthopedic Department, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
- Orthopedic Department, Rabin Medical Center, Hasharon Hospital, Petach-Tikva, Israel
| | - Mustafa Yassin
- Arthroscopy and Sports Injuries Unit, Rabin Medical Center, Hasharon Hospital, 7 Keren Kayemet St, 49372, Petach-Tikva, Israel
- Orthopedic Department, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
- Orthopedic Department, Rabin Medical Center, Hasharon Hospital, Petach-Tikva, Israel
| | - Mahmod Gbaren
- Orthopedic Department, Rabin Medical Center, Hasharon Hospital, Petach-Tikva, Israel
| | - Elia Feicht
- Orthopedic Department, Rabin Medical Center, Hasharon Hospital, Petach-Tikva, Israel
| | - Barak Haviv
- Arthroscopy and Sports Injuries Unit, Rabin Medical Center, Hasharon Hospital, 7 Keren Kayemet St, 49372, Petach-Tikva, Israel.
- Orthopedic Department, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.
- Orthopedic Department, Rabin Medical Center, Hasharon Hospital, Petach-Tikva, Israel.
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Dolev A, Yaari L, Kittani M, Yassin M, Gbaren M, Feicht E, Shemesh S, Haviv B. Efficacy of Anti-inflammatory Treatment Versus Rescue Analgesia After Arthroscopic Partial Meniscectomy in Nonarthritic Knees: A 3-Arm Controlled Study. Orthop J Sports Med 2021; 9:2325967121991545. [PMID: 33796593 PMCID: PMC7983444 DOI: 10.1177/2325967121991545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/13/2020] [Indexed: 11/17/2022] Open
Abstract
Background There is currently no consensus regarding the appropriate treatment for postoperative pain after arthroscopic partial meniscectomy (APM). Prescribing a mild non-anti-inflammatory protocol of rescue analgesia may be sufficient to avoid the side effects of opioids or anti-inflammatories. Purpose/Hypothesis The purpose was to compare the efficacy of pain reduction after APM in nonarthritic knees using betamethasone or celecoxib as anti-inflammatory analgesics versus acetaminophen or tramadol as rescue analgesics. The hypothesis was that there is no advantage for anti-inflammatories in achieving postoperative immediate pain relief after APM in nonarthritic knees compared with a simple nonopioid treatment. Study Design Cohort study; Level of evidence, 2. Methods This 3-arm controlled study evaluated postoperative pain levels and analgesic consumption in patients who underwent primary APM (under general anesthesia) at a single institution from December 2018 to December 2019. Patients were prospectively divided into 3 treatment groups: (1) betamethasone injection at the end of the procedure, (2) oral celecoxib prescription, or (3) neither treatment (control). All groups were instructed to take supplementary acetaminophen as needed. Patients were also allowed to take tramadol as needed to evaluate the need for opioids. At postoperative weeks 1, 2, and 3, patients completed the Knee injury and Osteoarthritis Outcome Score (KOOS) Pain subscale, and results were compared between time points and groups. Results A total of 99 patients were included in the treatment groups: betamethasone group (32 patients), celecoxib group (30 patients), and control group (37 patients). At baseline, there were no statistically significant differences between the groups in age, sex, body mass index, level of activity, comorbidities, or surgical findings. KOOS Pain scores improved at every time point for all 3 groups (P < .001), and no differences in scores were observed among groups. The consumption of acetaminophen or tramadol as rescue analgesia throughout the follow-up period was negligible among groups. Conclusion During the first 3 postoperative weeks after APM in nonarthritic knees, pain was efficiently controlled by betamethasone or celecoxib; however, pain was also efficiently controlled by minimal consumption of acetaminophen with negligible use of tramadol. Therefore, acetaminophen could be prescribed as an effective first-line postoperative analgesic after APM.
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Affiliation(s)
- Amir Dolev
- Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petach Tikva, Israel.,Orthopedic Department, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lee Yaari
- Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petach Tikva, Israel.,Orthopedic Department, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mohamed Kittani
- Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petach Tikva, Israel.,Orthopedic Department, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mustafa Yassin
- Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petach Tikva, Israel.,Orthopedic Department, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mahmod Gbaren
- Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petach Tikva, Israel.,Orthopedic Department, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elia Feicht
- Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petach Tikva, Israel.,Orthopedic Department, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Shemesh
- Orthopedic Department, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barak Haviv
- Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petach Tikva, Israel.,Orthopedic Department, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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