180 Retrograde Hindfoot Nailing for the Treatment of Acute Ankle Fractures in the Elderly - a Systematic Review and Meta-Analysis

Aim

Fragility ankle fractures are traditionally managed conservatively or with open reduction internal fixation (ORIF). Tibiotalocalcaneal (TTC) nailing is an alternative option for the geriatric patient. This meta-analysis provides the most detailed analysis of hindfoot nailing for fragility ankle fractures.

Method

A systematic search was performed on MEDLINE, EMBASE, Cochrane Library, Scopus, Web of Science, identifying fourteen studies for inclusion. Studies including patients over 60 with a fragility ankle fracture, treated with TTC nail were included. Patients with a previous fracture of the ipsilateral limb, fibular nails, and pathological fractures were excluded.

Meta-regression analyses were performed to explore sources of heterogeneity, and publication bias was assessed using Egger's test.

Results

312 ankle fractures were included. The mean age was 77.3 (32–101) years. 26.9% were male, and 41.9% were diabetics. The pooled proportion of superficial infection, deep infection, implant failure, malunion, and all-cause mortality was 0.10 (95%CI:0.06–0.16; I2=44%), 0.08 (95%CI:0.06–0.11, I2=0%), 0.11 (95%CI:0.07–0.15,I2=0%), 0.11 (95%CI:0.06–0.18; I2=51%), and 0.27 (95%CI:0.20–0.34; I2=11%), respectively. The pooled mean post-operative OMAS score was 54.07 (95%CI:48.98–59.16; I2=85%). The best-fitting meta-regression model included age and percentage of male patients as covariates (p=0.0263), and were inversely correlated with higher OMAS scores. Egger's test (p=0.56) showed no significant publication bias.

Conclusions

TTC nailing is an adequate alternative option for fragility ankle fracture management. However, current evidence includes mainly case series with inconsistent outcome measures reported and post-operative rehabilitation protocols. Prospective RCTs with long follow-up times and large cohort sizes are needed to clearly guide the use of TTC nailing for ankle fractures.

1319 Factors Associated with Mortality in Older Patients Sustaining Pelvic or Acetabular Fractures

Introduction

This study aimed to investigate potential factors, including delay to surgical stabilisation, affecting mortality in older patients sustaining pelvic or acetabular (PA) fractures.

Method

A retrospective review of the Trauma Audit and Research Network (TARN) database was performed to identify older patients (aged 65 and over) sustaining PA fractures treated surgically in a UK Major Trauma Centre (MTC) between 2015 and 2019. Chi-squared and Fisher tests were used to compare 1-year mortality rates following operative intervention between patients treated within 72-hours and after 72-hours. Kaplan-Meier curves were used to visualise survival probability; significant predictors of survival were found using Cox proportional hazard models.

Results

Of 564 older patients with PA fractures, 70 met the inclusion criteria. The mean age was 76.1 years. The overall 1-year mortality rate was 20%. When patients were grouped by time to surgery, there was no statistically significant difference in 1-year mortality. Patients whose surgery was delayed more than 72-hours were more likely to have longer hospital stays (p = 0.002) or to have suffered from polytrauma (p = 0.025). Age, Charlson Co-morbidities Index and pre-op mobility status were associated with statistically significant differences in overall mortality. Patient gender, mechanism of injury, polytrauma and head injury were not significant predictors of mortality.

Conclusions

Surgical intervention within 72-hours of injury did not result in decreased mortality in older patients with PA fractures. The 1–year mortality rate between older PA fractures and hip fractures was comparable. Consideration should be given to a combined multidisciplinary approach to managing these patients.

In situ characterisation of pathogen dynamics during a Pacific oyster mortality syndrome episode

Significant mortality of Crassostrea gigas juveniles is observed systematically every year worldwide. Pacific Oyster Mortality Syndrome (POMS) is caused by Ostreid Herpesvirus 1 (OsHV-1) infection leading to immune suppression, followed by bacteraemia caused by a consortium of opportunistic bacteria. Using an in-situ approach and pelagic chambers, our aim in this study was to identify pathogen dynamics in oyster flesh and in the water column during the course of a mortality episode in the Mediterranean Thau lagoon (France). OsHV-1 concentrations in oyster flesh increased before the first clinical symptoms of the disease appeared, reached maximum concentrations during the moribund phase and the mortality peak. The structure of the bacterial community associated with oyster flesh changed in favour of bacterial genera previously associated with oyster mortality including Vibrio, Arcobacter, Psychrobium, and Psychrilyobacter. During the oyster mortality episode, releases of OsHV-1 and opportunistic bacteria were observed, in succession, in the water surrounding the oyster lanterns. These releases may favour the spread of disease within oyster farms and potentially impact other marine species, thereby reducing marine biodiversity in shellfish farming areas.

An environmental scan of emergency response systems and services in remote First Nations communities in Northern Ontario

Background: Approximately 24,000 Ontarians live in remote Indigenous communities with no road access. These communities are a subset of Nishnawbe Aski Nation (NAN), a political grouping of 49 First Nations communities in Northern Ontario, Canada. Limited information is available regarding the status of emergency care in these communities.

Objective: We aimed to understand emergency response systems, services, and training in remote NAN communities.

Design: We used an environmental scan approach to compile information from multiple sources including community-based participatory research. This included the analysis of data collected from key informant interviews (n=10) with First Nations community health leaders and a multi-stakeholder roundtable meeting (n=33) in October 2013.

Results: Qualitative analysis of the interview data revealed four issues related to emergency response systems and training: (1) inequity in response capacity and services, (2) lack of formalised dispatch systems, (3) turnover and burnout in volunteer emergency services, and (4) challenges related to first aid training. Roundtable stakeholders supported the development of a community-based emergency care system to address gaps.

Conclusions: Existing first response, paramedical, and ambulance service models do not meet the unique geographical, epidemiological and cultural needs in most NAN communities. Sustainable, context-appropriate, and culturally relevant emergency care systems are needed.

Pseudotumor of the sellar and parasellar areas

A 54-year-old woman who had symptoms of intermittent meningeal irritation and hypopituitarism was found to have a sellar mass histologically consistent with pseudotumor. The lesion appears to have originated in the sphenoid sinus and subsequently to have spread intracranially, causing bony erosion. To our knowledge, this is the first description of pseudotumor occurring as a sellar mass.

Evaluating the Use of a Data Base System With Community Health Nursing Students

The Data Base Management System for community diagnosis was used during two academic semesters with 80 baccalaureate nursing students. At the end of the two semesters the DBMS was evaluated from feedback obtained through faculty discussions, final student papers and oral presentations. The DBMS met the goals established to evaluate the tool. The clarification of categories for essential data is an ongoing process.