1
|
Admiraal M, Smulders PSH, Rutten MVH, de Groot EK, Heine Y, Baumann HM, van der Vegt VHC, Halm JA, Hermanns H, Schepers T, Hollmann MW, Hermanides J, Ten Hoope W. The effectiveness of ambulatory continuous popliteal sciatic nerve blockade on patient-reported overall benefit of analgesia in patients undergoing foot or ankle surgery (CAREFREE trial); a randomized, open label, non-inferiority trial. J Clin Anesth 2024; 95:111451. [PMID: 38574504 DOI: 10.1016/j.jclinane.2024.111451] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/22/2023] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Abstract
STUDY OBJECTIVE Management of pain after foot and ankle surgery remains a concern for patients and healthcare professionals. This study determined the effectiveness of ambulatory continuous popliteal sciatic nerve blockade, compared to standard of care, on overall benefit of analgesia score (OBAS) in patients undergoing foot or ankle surgery. We hypothesized that usage of ambulatory continuous popliteal sciatic nerve blockade is non-inferior to standard of care. DESIGN Single center, randomized, non-inferiority trial. SETTING Tertiary hospital in the Netherlands. PATIENTS Patients were enrolled if ≥18 years and scheduled for elective inpatient foot or ankle surgery. INTERVENTION Patients were randomized to ambulatory continuous popliteal sciatic nerve blockade or standard of care. MEASUREMENTS The primary outcome was the difference in OBAS, which includes pain, side effects of analgesics, and patient satisfaction, measured daily from the first to the third day after surgery. A non-inferiority margin of 2 was set as the upper limit for the 90% confidence interval of the difference in OBAS score. Mixed-effects modeling was employed to analyze differences in OBAS scores over time. Secondary outcome was the difference in opioid consumption. MAIN RESULTS Patients were randomized to standard of care (n = 22), or ambulatory continuous popliteal sciatic nerve blockade (n = 22). Analyzing the first three postoperative days, the OBAS was significantly lower over time in the ambulatory continuous popliteal sciatic nerve blockade group compared to standard of care, demonstrating non-inferiority (-1.9 points, 90% CI -3.1 to -0.7). During the first five postoperative days, patients with ambulatory continuous popliteal sciatic nerve blockade consumed significantly fewer opioids over time compared to standard of care (-8.7 oral morphine milligram equivalents; 95% CI -16.1 to -1.4). CONCLUSIONS Ambulatory continuous popliteal sciatic nerve blockade is non-inferior to standard of care with single shot popliteal sciatic nerve blockade on patient-reported overall benefit of analgesia.
Collapse
Affiliation(s)
- Manouk Admiraal
- Department of Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Pascal S H Smulders
- Department of Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Martin V H Rutten
- Department of Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Eelko K de Groot
- Department of Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Yvonne Heine
- Department of Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Holger M Baumann
- Department of Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Vincent H C van der Vegt
- Department of Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Jens A Halm
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Henning Hermanns
- Department of Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Tim Schepers
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Markus W Hollmann
- Department of Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Jeroen Hermanides
- Department of Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Werner Ten Hoope
- Department of Anesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Anesthesiology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, the Netherlands
| |
Collapse
|
2
|
Penning D, Molendijk J, Halm JA, Schepers T. Measuring External Rotation of the Fibula and Fibular Length in Bilateral Computed Tomography Scans: How Reliable Is This Method? J Orthop Trauma 2024; 38:205-209. [PMID: 38306014 PMCID: PMC10942176 DOI: 10.1097/bot.0000000000002774] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/11/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVES During ankle fracture surgery, goals include accurate reduction and fixation of the fibula regarding rotation and fibular length. Bilateral postoperative computed tomography (CT) can be performed to assess fibular rotation using the talar dome angle, and fibular length. The aim of this study was to compare side-to-side differences of the fibular rotation and fibular length using bilateral CT scans of uninjured ankles. METHODS DESIGN Retrospective. SETTING Single center, Level I Academic Trauma Center. PATIENT SELECTION CRITERIA Patients with bilateral CT scans of uninjured ankles. OUTCOME MEASURES AND COMPARISONS External rotation using the Nault talar dome method and fibular length using the coronal method of Prior et al. The average, difference, and ratio (injured side/healthy side) and interobserver variability were calculated. RESULTS There were 83 patients included (166 ankles, mean age 47 years, 77.1% male). A random set of 66 ankles (33 CT scans) were used to measure interobserver variability. The mean degrees of external rotation ranged from 6.6 to 7.7, mean difference ranged from 1.4 to 3.4 degrees, mean ratio ranged from 1.1 to 1.5, and interobserver variability ranged from 0.27 to 0.65. For fibular length, the mean ranged from 24.6 to 25.8 mm, mean difference in fibular length ranged from 0.5 to 2.1 mm, mean ratio ranged from 1.0 to 1.1 mm, and interobserver variability ranged from 0.45 to 0.73. CONCLUSIONS Using bilateral ankle CT scans, mean differences in fibular rotation using the Nault talar dome method were 1.4-3.4 degrees. The distal fibular length had a mean difference between both sides of 0.5-2.1 mm. Although the intraclass correlation's were low, the interleg differences between patients were small, making them useful for clinical practice. LEVEL OF EVIDENCE Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Diederick Penning
- Trauma Unit, Department of Surgery, Amsterdam UMC location Meibergdreef, Amsterdam, the Netherlands
| | | | | | | |
Collapse
|
3
|
Kwee E, Borgdorff M, Schepers T, Halm JA, Winters HAH, Weenink RP, Ridderikhof ML, Giannakópoulos GF. Adjunctive hyperbaric oxygen therapy in the management of severe lower limb soft tissue injuries: a systematic review. Eur J Trauma Emerg Surg 2024:10.1007/s00068-023-02426-2. [PMID: 38386077 DOI: 10.1007/s00068-023-02426-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 12/11/2023] [Indexed: 02/23/2024]
Abstract
PURPOSE Traumatic crush injuries of the lower limb often accompany severe complications. The incorporation of hyperbaric oxygen therapy to standard trauma care may have the potential to diminish injury-related complications and improve outcome in such cases. This systematic review aims to evaluate the effectiveness of hyperbaric oxygen therapy in the management of severe lower limb soft tissue injuries. METHODS The electronic databases Medline, Embase and Cochrane Library were searched to identify studies involving patients with crush-associated sever lower limb soft tissue injuries who received hyperbaric oxygen therapy in conjunction with standard trauma care. Relevant data on type of injury, hyperbaric oxygen therapy protocol and outcome related to wound healing were extracted. RESULTS In total seven studies met the inclusion criteria, involving 229 patients. The studies included two randomized clinical trials, one retrospective cohort study, three case series and one case report. The randomized placebo-controlled clinical trial showed a significant increase in wound healing and decrease in the need for additional surgical interventions in the patient group receiving hyperbaric oxygen therapy when compared to those undergoing sham therapy. The randomized non-placebo-controlled clinical trial revealed that early hyperbaric oxygen therapy reduces tissue necrosis and the likelihood of long-term complications. The retrospective cohort study indicated that hyperbaric oxygen therapy effectively reduces infection rates and the need for additional surgical interventions. The case series and case report presented beneficial results with regard to wound healing when hyperbaric oxygen therapy was added to the treatment regimen. CONCLUSION Hyperbaric oxygen therapy is generally considered a safe therapeutic intervention and seems to have a beneficial effect on wound healing in severe lower limb soft tissue injuries when implemented as an addition to standard trauma care.
Collapse
Affiliation(s)
- Esmee Kwee
- Trauma Unit, Department of Surgery, Amsterdam UMC (Location AMC), J1A-214 Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Marieke Borgdorff
- Department of Plastic, Reconstructive Surgery and Handsurgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Tim Schepers
- Trauma Unit, Department of Surgery, Amsterdam UMC (Location AMC), J1A-214 Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jens A Halm
- Trauma Unit, Department of Surgery, Amsterdam UMC (Location AMC), J1A-214 Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Hay A H Winters
- Department of Plastic, Reconstructive Surgery and Handsurgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Robert P Weenink
- Department of Hyperbaric Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Anesthesiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Milan L Ridderikhof
- Department of Hyperbaric Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Emergency Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Georgios F Giannakópoulos
- Trauma Unit, Department of Surgery, Amsterdam UMC (Location AMC), J1A-214 Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| |
Collapse
|
4
|
Lotfalla A, Halm JA, Schepers T, Giannakópoulos GF. Parameters influencing health-related quality of life after severe trauma: a systematic review (part II). Eur J Trauma Emerg Surg 2024; 50:93-106. [PMID: 37188975 PMCID: PMC10923745 DOI: 10.1007/s00068-023-02276-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION It is increasingly recognized that health-related quality of life (HRQoL) is a relevant outcome to study in populations comprising severely injured patients. Although some studies have readily demonstrated a compromised HRQoL in those patients, evidence regarding factors that predict HRQoL is scarce. This hinders attempts to prepare patient-specific plans that may aid in revalidation and improved life satisfaction. In this review, we present identified predictors of HRQoL in patients that have suffered severe trauma. METHODS The search strategy included a database search until the 1st of January 2022 in the Cochrane Library, EMBASE, PubMed, and Web of Science, and reference checking. Studies were eligible for inclusion when (HR)QoL was studied in patients with major, multiple, or severe injury and/or polytrauma, as defined by authors by means of an Injury Severity Score (ISS) cut-off value. The results will be discussed in a narrative manner. RESULTS A total of 1583 articles were reviewed. Of those, 90 were included and used for analysis. In total, 23 possible predictors were identified. The following parameters predicted reduced HRQoL in severely injured patients and came forward in at least more than three studies: higher age, female gender, lower extremity injuries, higher rate of injury severity, lower achieved educational level, presence of (pre-existing) comorbidities and mental illness, longer duration of hospital stay, and high level of disability. CONCLUSION Age, gender, injured body region, and severity of injury were found to be good predictors of health-related quality of life in severely injured patients. A patient-centered approach, based on individual, demographic, and disease-specific predictors, is highly recommended.
Collapse
Affiliation(s)
- Annesimone Lotfalla
- Department of Trauma Surgery, Trauma Unit, Amsterdam University Medical Center, Location Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Jens Anthony Halm
- Department of Trauma Surgery, Trauma Unit, Amsterdam University Medical Center, Location Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Tim Schepers
- Department of Trauma Surgery, Trauma Unit, Amsterdam University Medical Center, Location Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Georgios Fredericus Giannakópoulos
- Department of Trauma Surgery, Trauma Unit, Amsterdam University Medical Center, Location Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| |
Collapse
|
5
|
Baboeram NSVL, Sanders FRK, Wellenberg RHH, Dobbe JGG, Streekstra GJ, Maas M, Schepers T. Primary arthrodesis versus open reduction and internal fixation following intra-articular calcaneal fractures: a weight-bearing CT analysis. Arch Orthop Trauma Surg 2024; 144:755-762. [PMID: 38129717 DOI: 10.1007/s00402-023-05120-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/29/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To compare primary arthrodesis (PA) versus open reduction and internal fixation (ORIF) in displaced intra-articular calcaneal fractures (DIACFs), based on clinical outcome and 2D and 3D geometrical analyses obtained from weight-bearing (WB) cone-beam CT images. MATERIALS AND METHODS In this prospective study, 40 patients with surgically treated calcaneal fractures were included, consisting of 20 PA and 20 ORIF patients. Weight-bearing cone-beam CT-images of the left and right hindfoot and forefoot were acquired on a Planmed Verity cone-beam CT-scanner after a minimum of 1-year follow-up. Automated 2D and 3D geometric analyses, i.e., (minimal and average) talo-navicular joint space, calcaneal pitch (CP), and Meary's angle (MA), were obtained for injured and healthy feet. Clinical outcomes were measured using the EQ5D and FFI questionnaires. RESULTS Overall, there were no differences in baseline patient characteristics apart from age (p < 0.005). The calcaneal pitch in 2D after treatment by ORIF (13.8° ± 5.6) was closer to the uninjured side (18.1° ± 5.5) compared to PA (10.9° ± 4.5) (p < 0.001). Meary's angle in 2D was closer to the uninjured side (8.7° ± 6.3) after surgery in the PA cohort (7.0° ± 5.8) compared to the ORIF cohort (15.5° ± 5.9) (p = 0.046). In 3D measurements, CP was significantly decreased for both cohorts after surgery (- 4.09° ± 6.2) (p = 0.001). MA was not significantly affected overall or between cohorts in 3D. Clinical outcomes were not significantly different between the ORIF and PA cohorts. None of the radiographic measurements in 2D or 3D correlated with any of the clinical outcomes studied. CONCLUSION Three-dimensional WB CT imaging enables functional 2D and 3D analyses under natural load in patients with complex calcaneal fractures. Based on clinical outcome, both PA and ORIF appear viable treatment options. Clinical correlation with geometrical outcomes remains to be established.
Collapse
Affiliation(s)
- N S V L Baboeram
- Department of Trauma Surgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
| | - F R K Sanders
- Department of Trauma Surgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - R H H Wellenberg
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - J G G Dobbe
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - G J Streekstra
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - M Maas
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - T Schepers
- Department of Trauma Surgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| |
Collapse
|
6
|
Eelsing R, Ahmadi AM, Halm JA, Schepers T. Geographical Differences in Wound Complication Rates Following the Sinus Tarsi Approach in Displaced Intra-articular Calcaneal Fractures: A Systematic Review of the Literature. Clin Orthop Surg 2024; 16:134-140. [PMID: 38304215 PMCID: PMC10825260 DOI: 10.4055/cios23241] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/12/2023] [Indexed: 02/03/2024] Open
Abstract
Background The sinus tarsi approach (STA) has gained popularity for the treatment of displaced intra-articular calcaneal fractures. No large studies comparing wound complications worldwide after STA surgery are available. The aim of this systematic review was to compare postoperative wound complication (POWC) and postoperative wound infection (POWI) rates following STA surgery between continents and countries and their differences in climate. Methods A literature search was performed using the databases of PubMed, Embase, and the Cochrane Library. Studies published before January 1, 2000, including < 10 patients and written in a language other than English were excluded. Results In total, 86 studies containing 4,392 surgeries via STA from 20 different countries were included. The mean POWC was 5.9% and the mean POWI was 4.4%. The highest median POWC rate was in North America (8.5%) and the lowest in South America (2.0%). No significant differences were found in the POWC and POWI rates between countries (p = 0.178 and p = 0.570, respectively), but significant differences were found between the POWC and POWI rates between continents (p = 0.011 and p = 0.036, respectively). The number of surgeries per year and climate differences, as represented by mean local temperature, were not correlated with both the POWC/POWI rates and functional outcome scores. Conclusions Significant differences between the POWC and POWI rates were found between continents but not between individual countries. With a mean POWC of 5.9% and a mean POWI rate of 4.4%, STA has an intrinsic low risk for complications given the minimally invasive nature of the approach and is inevitably becoming the gold standard for calcaneal surgery.
Collapse
Affiliation(s)
- Robin Eelsing
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, Netherlands
| | - Ahmad Masih Ahmadi
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, Netherlands
| | - Jens Anthony Halm
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, Netherlands
| | - Tim Schepers
- Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, Netherlands
| |
Collapse
|
7
|
van den Heuvel S, Penning D, Sanders F, van Veen R, Sosef N, van Dijkman B, Schepers T. Functional outcome of routine versus on-demand removal of the syndesmotic screw. Bone Jt Open 2023; 4:957-963. [PMID: 38108322 PMCID: PMC10726379 DOI: 10.1302/2633-1462.412.bjo-2023-0061] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Aims The primary aim of this study was to present the mid-term follow-up of a multicentre randomized controlled trial (RCT) which compared the functional outcome following routine removal (RR) to the outcome following on-demand removal (ODR) of the syndesmotic screw (SS). Methods All patients included in the 'ROutine vs on DEmand removal Of the syndesmotic screw' (RODEO) trial received the Olerud-Molander Ankle Score (OMAS), American Orthopaedic Foot and Ankle Hindfoot Score (AOFAS), Foot and Ankle Outcome Score (FAOS), and EuroQol five-dimension questionnaire (EQ-5D). Out of the 152 patients, 109 (71.7%) completed the mid-term follow-up questionnaire and were included in this study (53 treated with RR and 56 with ODR). Median follow-up was 50 months (interquartile range 43.0 to 56.0) since the initial surgical treatment of the acute syndesmotic injury. The primary outcome of this study consisted of the OMAS scores of the two groups. Results The median OMAS score was 85.0 for patients treated with RR, and 90.0 for patients treated with ODR (p = 0.384), indicating no significant difference between ODR and RR. The secondary outcome measures included the AOFAS (88.0 in the RR group and 90.0 for ODR; p = 0.722), FAOS (87.5 in the RR group and 92.9 for ODR; p = 0.399), and EQ-5D (0.87 in the RR group and 0.96 for ODR; p = 0.092). Conclusion This study demonstrated no functional difference comparing ODR to RR in syndesmotic injuries at a four year follow-up period, which supports the results of the primary RODEO trial. ODR should be the standard practice after syndesmotic screw fixation.
Collapse
Affiliation(s)
- Stein van den Heuvel
- Trauma Unit, Department of Surgery. Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - Diederick Penning
- Trauma Unit, Department of Surgery. Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - Fay Sanders
- Trauma Unit, Department of Surgery. Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - Ruben van Veen
- Department of Trauma Surgery, OLVG, Amsterdam, the Netherlands
| | - Nico Sosef
- Department of Trauma Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - Bart van Dijkman
- Department of Trauma Surgery, Flevoziekenhuis, Almere, the Netherlands
| | - Tim Schepers
- Trauma Unit, Department of Surgery. Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, the Netherlands
| | - On behalf of the RODEO Collaborator group
- Trauma Unit, Department of Surgery. Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, the Netherlands
- Department of Trauma Surgery, OLVG, Amsterdam, the Netherlands
- Department of Trauma Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
- Department of Trauma Surgery, Flevoziekenhuis, Almere, the Netherlands
| |
Collapse
|
8
|
Ruhe MM, Veldhuis LI, Azijli-Abdelloui K, Schepers T, Ridderikhof ML. Prehospital analgesia in suspected hip fracture patients: adherence to national prehospital pain management guidelines. Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02385-8. [PMID: 37957364 DOI: 10.1007/s00068-023-02385-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/17/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE Patients with hip fractures frequently present at the emergency department (ED). Despite high pain scores, prehospital pain management is often inadequate and insufficient. In the Netherlands, the emergency medical services (EMS) exhibit a high level of training, supported by a comprehensive pain treatment protocol. This study aimed to assess adherence to the protocol and hypothesized that prehospital pain management in hip fracture patients was both sufficient and adequate. METHODS This was a retrospective observational cohort study of patients with suspected hip fractures. The median differences in numerical rating scale (NRS) pain scores between the initial score in the ambulance and upon arrival at the ED were compared. Furthermore, adherence to the ambulance pain protocol was studied. RESULTS From September 2016 to March 2021, 436 ambulance-transported hip fracture patients were included, of whom 81% received analgesics by EMS. The median initial pain score measured by EMS was 8; this number decreased to 5 at ED presentation, a significant decrease (ρ < 0.001). In case a prehospital NRS pain score was assessed, 66.5% of the patients were treated according to the protocol. In 80% of patients, the protocol was not followed correctly, primarily due to missing NRS pain scores. CONCLUSION In suspected hip fracture patients, initial prehospital pain scores were high and most patients received analgesics from EMS. This resulted in a significant decrease in pain. In nearly 67% of patients in whom an NRS pain score was assessed in the prehospital phase, pain management was according to protocol. However, in 80% of the total population the pain protocol was not adhered to, mainly due to missing NRS pain scores.
Collapse
Affiliation(s)
- Michelle Manon Ruhe
- Department of Emergency Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Lars I Veldhuis
- Department of Emergency Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Kaoutar Azijli-Abdelloui
- Department of Emergency Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Tim Schepers
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Milan L Ridderikhof
- Department of Emergency Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
| |
Collapse
|
9
|
Meijer HA, Obdeijn MC, van Loon J, van den Heuvel SB, van den Brink LC, Schijven MP, Goslings JC, Schepers T. Rehabilitation after Distal Radius Fractures: Opportunities for Improvement. J Wrist Surg 2023; 12:460-473. [PMID: 37841352 PMCID: PMC10569825 DOI: 10.1055/s-0043-1769925] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/09/2023] [Indexed: 10/17/2023]
Abstract
Background Exercises are frequently prescribed to regain function; yet there is no consensus on a standardized protocol, and adherence is low. Smart technology innovations, such as mobile applications, may be useful to provide home-based patient support in rehabilitation after distal radius fractures. Purposes Our purpose was to establish the potential of digital innovations for support and monitoring of patients and treatment adherence in rehabilitation programs, and additionally, to compare the current practice among physiotherapists to the various wrist exercise regimens and their effectiveness as described in the literature. Methods Standard practice, including the use of support tools for treatment adherence, was evaluated using a nationwide survey. Then, scientific databases were searched using "distal radius fracture" and "physiotherapy" or "exercise therapy," and related search terms, up until 23 March 2023. Results of the survey and literature review were compared. Results The survey was completed by 92 therapists. Nonstandardized support tools were used by 81.6% of respondents; 53.2% used some form of technology, including taking photos on the patients' smartphone for home reference. In the literature review, 23 studies were included, of which five described an exercise protocol. Treatment adherence was not reported in any of the included studies. Two studies described the use of smart technology or support tools. Conclusions There is no consensus on a standardized exercise protocol for rehabilitation after distal radius fractures, neither from a systematic literature search nor from a nationwide survey. Smart technology may facilitate monitoring of patients and exercise adherence, hereby supporting self-efficacy and improving adherence and outcomes.
Collapse
Affiliation(s)
- Henriëtte A.W. Meijer
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Miryam C. Obdeijn
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Justin van Loon
- Department of Orthopaedic Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | | | - Lianne C. van den Brink
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Marlies P. Schijven
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, The Netherlands
- Amsterdam Gastroenterology and Metabolism, Amsterdam, The Netherlands
| | - J. Carel Goslings
- Department of Trauma Surgery, OLVG Hospital, Amsterdam, The Netherlands
| | - Tim Schepers
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
| |
Collapse
|
10
|
Deutekom FE, Ridderikhof ML, Van Etten-Jamaludin F, Schepers T. Accuracy of ultrasound in diagnosing ankle injuries in emergency care. Emerg Med J 2023; 40:569-575. [PMID: 37173124 DOI: 10.1136/emermed-2022-212516] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 04/29/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Ankle injuries are one of the most common presentations in the ED. Although fractures can be ruled out using the Ottawa Ankle Rules, the specificity is low, which means many patients may still receive unnecessary radiographs. Even once fractures are ruled out, assessment of ankle stability is recommended to rule out ruptures, but the anterior drawer test has only moderate sensitivity and low specificity and should be performed only after swelling has receded. Ultrasound could be a reliable, cheap and radiation free alternative to diagnose fractures and ligamentous injuries. The purpose of this systematic review was to investigate the accuracy of ultrasound in diagnosing ankle injuries. METHODS Medline, Embase and the Cochrane Library were searched up to 15 February 2022 to include studies of patients of 16 years or older presenting to the ED with acute ankle or foot injury, who underwent ultrasound and had diagnostic accuracy as outcome. No restrictions were applied for date and language. Risk of bias and quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluations approach were assessed. RESULTS Thirteen studies evaluating 1455 patients with bony injuries were included. In 10 studies, the reported sensitivity for fracture was >90%, but varied among studies between 76% (95% CI 63% to 86%) and 100% (95% CI 29% to 100%). In nine studies, the reported specificity was at least 91%, but varied between 85% (95% CI 74% to 92%) and 100% (95% CI 88% to 100%).Six studies including 337 patients examined the use of ultrasound for ligamentous injuries and found a sensitivity and specificity >94% and 100%. Overall quality of evidence for both bony and ligamentous injuries was low and very low. CONCLUSION Ultrasound has the potential to be a reliable method for diagnosing foot and ankle injuries, however, higher grade evidence is needed. PROSPERO REGISTRATION NUMBER CRD42020215258.
Collapse
Affiliation(s)
- Fenna E Deutekom
- Faculty of medicine, University of Amsterdam, Amsterdam, The Netherlands
- Emergency Medicine, Amsterdam UMC-Locatie AMC, Amsterdam, The Netherlands
| | | | | | - Tim Schepers
- Trauma Surgery, Amsterdam UMC-Locatie AMC, Amsterdam, The Netherlands
| |
Collapse
|
11
|
Eelsing R, Aronius LB, Halm JA, Schepers T. Implant Choice and Outcomes of the Sinus Tarsi Approach for Displaced Intra-articular Calcaneal Fractures. Foot Ankle Int 2023; 44:738-744. [PMID: 37254513 PMCID: PMC10394952 DOI: 10.1177/10711007231176276] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Operative fixation of displaced intra-articular calcaneal fractures is considered the gold standard, for which multiple fixation methods are available. This study compares the (functional) outcome of screw fixation (SF), plate fixation (PF), and anatomical plate fixation (APF) via the sinus tarsi approach (STA). METHODS A total of 239 patients (265 fractured calcanei) who received surgical treatment of a displaced intra-articular calcaneal fracture via STA between 2011 and 2022 were included. RESULTS Böhler angle (BA) measured immediately postoperatively (BA post-OR) and the decrease in BA at 1 year (∆BA) differed significantly in favor of PF/APF compared with SF (BA post-OR: SF vs PF P = .010 and SF vs APF P = .001; ∆BA: SF vs PF P = .032 and SF vs APF P = .042). Implant removal surgery was performed significantly less in the APF group as compared to the SF/PF groups (APF vs SF/PF; 9.9% vs 22.9%/23.7%, P = .015). Surgical site infections and secondary arthrodesis of the subtalar joint occurred equally in the 3 groups. Furthermore, the mean American Orthopaedic Foot & Ankle Society ankle-hindfoot scale, Foot Function Index score, and EuroQOL-5D-index / visual analog scale score, did not differ notably between SF, PF, and APF. CONCLUSION The results show that both PF and APF are favored over SF because of an improved correction of BA measured directly postoperatively, a lower secondary loss of BA and, for APF, a lower implant removal rate. There was no difference in the rate of surgical site infections, need for secondary arthrodesis, nor functional outcome scores between different implants using the STA. LEVEL OF EVIDENCE Level III, retrospective cohort study.
Collapse
Affiliation(s)
- Robin Eelsing
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, the Netherlands
| | - Loran B. Aronius
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, the Netherlands
| | - Jens A. Halm
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, the Netherlands
| | - Tim Schepers
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, the Netherlands
| |
Collapse
|
12
|
Raghoebar II, Dubois L, de Lange J, Schepers T, Don Griot P, Essig H, Rozema F. The Effectiveness of Three-Dimensional Osteosynthesis Plates versus Conventional Plates for the Treatment of Skeletal Fractures: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:4661. [PMID: 37510776 PMCID: PMC10380957 DOI: 10.3390/jcm12144661] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/07/2023] [Accepted: 06/25/2023] [Indexed: 07/30/2023] Open
Abstract
PURPOSE To assess the difference between preformed anatomically shaped osteosynthesis plates and patient-specific implants versus conventional flat plates for the treatment of skeletal fractures in terms of anatomical reduction, operation time, approach, patient outcomes, and complications. MATERIAL AND METHODS MEDLINE (1950 to February 2023), EMBASE (1966 to February 2023), and the Cochrane Central Register of Controlled Trials (inception to February 2023) databases were searched. Eligible studies were randomised clinical trials, prospective controlled clinical trials, and prospective and retrospective cohort studies (n ≥ 10). Inclusion criteria were studies reporting the outcomes of preformed anatomically shaped osteosynthesis plates and patient-specific implants versus conventional flat plates after treating skeletal fractures. Outcome measures included anatomical reduction, stability, operation time, hospitalisation days, patients' outcomes, and complications. Two independent reviewers assessed the abstracts and analysed the complete texts and methodologies of the included studies. RESULTS In total, 21 out of the 5181 primarily selected articles matched the inclusion criteria. A meta-analysis revealed a significant difference in operation time in favour of the preformed anatomical plates and patient-specific implants versus conventional plates. Significant differences in operation time were found for the orbital (95% CI: -50.70-7.49, p = 0.008), upper limb (95% CI: -17.91-6.13, p < 0.0001), and lower limb extremity groups (95% CI: -20.40-15.11, p < 0.00001). The mean difference in the rate of anatomical reduction in the lower limb extremity group (95% CI: 1.04-7.62, p = 0.04) was also in favour of using preformed anatomical plates and patient-specific implants versus conventional plates. CONCLUSIONS This systematic review showed a significant mean difference in surgery time favouring the use of preformed anatomical plates and patient-specific implants for orbital, upper, and lower limb extremity fractures. Additionally, preformed anatomical plates and patient-specific implants in the lower limb group result in a significantly higher rate of anatomical reduction versus conventional flat plates.
Collapse
Affiliation(s)
- Iva Ilse Raghoebar
- Academic Center for Dentistry (ACTA), University of Amsterdam, 1012 WX Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Leander Dubois
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Tim Schepers
- Department of Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, 1012 WX Amsterdam, The Netherlands
| | - Peter Don Griot
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, 1012 WX Amsterdam, The Netherlands
| | - Harald Essig
- Department of Oral and Maxillofacial Surgery, University Hospital Zuerich, Frauenklinikstrasse 24, 8091 Zürich, Switzerland
| | - Frederik Rozema
- Academic Center for Dentistry (ACTA), University of Amsterdam, 1012 WX Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| |
Collapse
|
13
|
Barbachan Mansur NS, Godoy-Santos AL, Schepers T. High-Ankle Sprain and Syndesmotic Instability: How Far Have We Come with Diagnosis and Treatment? Foot Ankle Clin 2023; 28:369-403. [PMID: 37137630 DOI: 10.1016/j.fcl.2023.01.006] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Probably one of the most controversial subjects in the orthopedic field is the distal tibiofibular articulation. Even though its most primary knowledge can be a matter of enormous debate, it is in the diagnosis and treatment most of the disagreements reign. Distinguishing between injury and instability remains challenging as well as an optimal clinical decision regarding surgical intervention. The last years presented technology and that was able to bring body to an already well-developed scientifical rationale. In this review article, we aim to demonstrate the current data behind syndesmotic instability in the ligament scenario, whereas using few fracture concepts.
Collapse
Affiliation(s)
- Nacime Salomao Barbachan Mansur
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Brazil; University of Iowa, Carver College of Medicine, USA.
| | | | - Tim Schepers
- Trauma Unit, Department of Surgery, Amsterdam UMC Location J1A-214 Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| |
Collapse
|
14
|
Schepers T, Eelsing R, Halm JA. Do calcaneal angles on lateral radiographs predict outcome following intra-articular calcaneal fractures? J Orthop 2023; 36:130-131. [PMID: 36748093 PMCID: PMC9898572 DOI: 10.1016/j.jor.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Affiliation(s)
- Tim Schepers
- Trauma Unit, Department of Surgery, Amsterdam UMC location Meibergdreef, Amsterdam, the Netherlands
| | - Robin Eelsing
- Trauma Unit, Department of Surgery, Amsterdam UMC location Meibergdreef, Amsterdam, the Netherlands
| | - Jens A. Halm
- Trauma Unit, Department of Surgery, Amsterdam UMC location Meibergdreef, Amsterdam, the Netherlands
| |
Collapse
|
15
|
Penning D, Jonker CAL, Buijsman R, Halm JA, Schepers T. Minifragment plating of the fibula in unstable ankle fractures. Arch Orthop Trauma Surg 2023; 143:1499-1504. [PMID: 35224664 PMCID: PMC9958153 DOI: 10.1007/s00402-022-04397-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/14/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Only 6.4-17% of the load is transmitted through the fibula when weight-bearing. Plate fixation of distal fibular fractures using minifragments (≤ 2.8 mm) could lead to similar reduction with less implant removal (IR) rates, compared to small-fragment plates (3.5 mm). We hypothesized that the use of minifragment plates is at least similar in unscheduled secondary surgery. MATERIALS AND METHODS In this retrospective cohort study, all patients with surgically treated distal fibular fractures between October 2015 and March 2021 were included. Patients treated with plate fixation using minifragments and patients treated with small-fragment plates were compared regarding the following outcomes: secondary dislocation, malreduction, implant malposition, nonunion, surgical site infections (SSI) and IR. RESULTS Sixty-five patients (54.2%) received a minifragment implant (≤ 2.8 mm) and 55 patients (45.8%) received a small-fragment implant (3.5 mm). There were no patients needing secondary surgery in the minifragment group compared to 9 patients following fixation using small-fragment implants (3 with secondary dislocation, 5 with malreduction and 1 with malposition, p = 0.001). SSI rates were 3.1% for minifragment and 9.1% for small-fragment implants (p = 0.161). Implant removal was performed significantly less often following use of minifragment implants (17.8% and 53.2%, p < 0.001). CONCLUSIONS In this cohort, minifragment plate fixation for distal fibular fractures is an adequate fixation method offering stable fixation with significant lower need for implant removal and comparable complications to small-fragment plates, although an adequately powered randomized controlled study is needed for implementation in a clinical setting. LEVEL OF EVIDENCE Therapeutic, III.
Collapse
Affiliation(s)
- D. Penning
- Trauma Unit Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - C. A. L. Jonker
- Trauma Unit Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - R. Buijsman
- Department of Traumasurgery, Tergooi MC, Van Riebeeckweg 212, 1213 XZ Hilversum, The Netherlands
| | - J. A. Halm
- Trauma Unit Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - T. Schepers
- Trauma Unit Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| |
Collapse
|
16
|
Baumbach SF, Hamberger MA, Polzer H, Schepers T. Letter to the Editor: Can Weightbearing Cone-beam CT Reliably Differentiate Between Stable and Unstable Syndesmotic Ankle Injuries? A Systematic Review and Meta-analysis. Clin Orthop Relat Res 2022; 480:2465-2467. [PMID: 36190511 PMCID: PMC10538888 DOI: 10.1097/corr.0000000000002442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/12/2022] [Indexed: 11/22/2022]
Affiliation(s)
| | | | - Hans Polzer
- Department of Trauma Surgery, Ludwig Maximilian University Hospital, Munich, Germany
| | - Tim Schepers
- Trauma Unit, Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
17
|
Lotfalla A, Halm J, Schepers T, Giannakópoulos G. Health-related quality of life after severe trauma and available PROMS: an updated review (part I). Eur J Trauma Emerg Surg 2022; 49:747-761. [PMID: 36445397 PMCID: PMC10175342 DOI: 10.1007/s00068-022-02178-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/11/2022] [Indexed: 11/30/2022]
Abstract
Abstract
Introduction
Throughout the years, a decreasing trend in mortality rate has been demonstrated in patients suffering severe trauma. This increases the relevance of documentation of other outcomes for this population, including patient-reported outcome measures (PROMs), such as health-related quality of life (HRQoL). The aim of this review was to summarize the results of the studies that have been conducted regarding HRQoL in severely injured patients (as defined by the articles’ authors). Also, we present the instruments that are used most frequently to assess HRQoL in patients suffering severe trauma.
Methods
A literature search was conducted in the Cochrane Library, EMBASE, PubMed, and Web of Science for articles published from inception until the 1st of January 2022. Reference lists of included articles were reviewed as well. Studies were considered eligible when a population of patients with major, multiple or severe injury and/or polytrauma was included, well-defined by means of an ISS-threshold, and the outcome of interest was described in terms of (HR)QoL. A narrative design was chosen for this review.
Results
The search strategy identified 1583 articles, which were reduced to 113 after application of the eligibility criteria. In total, nineteen instruments were used to assess HRQoL. The SF-36 was used most frequently, followed by the EQ-5D and SF-12. HRQoL in patients with severe trauma was often compared to normative population norms or pre-injury status, and was found to be reduced in both cases, regardless of the tool used to assess this outcome. Some studies demonstrated higher scoring of the patients over time, suggesting improved HRQoL after considerable time after severe trauma.
Conclusion
HRQoL in severely injured patients is overall reduced, regardless of the instrument used to assess it. The instruments that were used most frequently to assess HRQoL were the SF-36 and EQ-5D. Future research is needed to shed light on the consequences of the reduced HRQoL in this population. We recommend routine assessment and documentation of HRQoL in severely injured patients.
Collapse
|
18
|
Engelmann EWM, Roelofs A, Posthuma J, Schepers T. Evaluation of Functional Outcome and Complications in Bridge Plating Compared to Transarticular Screws for Lisfranc Injuries: A Systematic Review and Meta-analysis. J Foot Ankle Surg 2022; 61:1267-1274. [PMID: 35459613 DOI: 10.1053/j.jfas.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 02/03/2023]
Abstract
The optimal treatment strategy of Lisfranc injury is still in debate. This study aimed to compare the functional outcome and complications of dorsal bridge plating (BP) and transarticular screws (TAS). A systematic review and meta-analysis of the present literature was performed. PubMed, EMBASE, and Cochrane databases were searched using set search criteria and date range January 2000 to July 26, 2021. Randomized controlled trials (RCTs) and observational comparative studies concerning the outcome of dorsal BP and TAS for the fixation of Lisfranc injuries were eligible for inclusion. Random effect models were used to analyze pooled data. Forest plots using 95% confidence intervals (CI) were created to illustrate mean differences and odds ratios. Four observational studies were eligible for inclusion, including 111 patients in the BP group and 87 patients in the TAS group. American Orthopaedic Foot & Ankle Society (AOFAS) score was significantly higher in the BP group (mean difference 7.08, 95% CI 1.50-12.66, p = .01). Osteoarthritis was significantly less common in the BP group compared to the TAS group (odds ratio 0.45, 95% CI 0.22-0.94, p = .03). No significant difference was found between the groups in terms of postoperative infection, hardware removal, chronic pain, and secondary arthrodesis. Dorsal bridge plating of fractures in the Lisfranc joint may lead to better functional outcome and a lower incidence of post-traumatic arthritis when compared to transarticular screws. A larger body of high-quality evidence is required to independently analyze the severity of fractures in the different columns involved and subsequent outcomes of operative management.
Collapse
Affiliation(s)
| | - Anne Roelofs
- Trauma Unit, Amsterdam UMC, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Jelle Posthuma
- Trauma Unit, Amsterdam UMC, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Tim Schepers
- Trauma Unit, Amsterdam UMC, Location Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
19
|
de Jonge S, Schepers T. Patients with open fractures: an understudied population in surgical site preparation. Lancet 2022; 400:1285-1287. [PMID: 36244368 DOI: 10.1016/s0140-6736(22)01968-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Stijn de Jonge
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam 1105AZ, Netherlands.
| | - Tim Schepers
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam 1105AZ, Netherlands
| |
Collapse
|
20
|
Swords MP, Schepers T, Tomlinson MP, Shank JR. Surgical Fixation of Maisonneuve Fractures with a Screw Suture Fixation Device: Results of 10 Cases. Foot & Ankle Orthopaedics 2022. [DOI: 10.1177/2473011421s00964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Category: Trauma; Ankle; Sports Introduction/Purpose: Maisonneuve fractures consist of a fracture of the fibula in the proximal third with associated syndesmotic injury. Surgical management generally involves restoration of fibula length, reduction of the syndesmosis, and stabilization of the syndesmosis. Flexible fixation devices have gained popularity for syndesmotic fixation over the last several years. Current flexible fixation devices are not reliable for fixation of length unstable patterns of injury, like the Maisonneuve fracture. The purpose of the study was to evaluate the results of a new screw- suture syndesmotic device providing aperture fixation of the syndesmosis for fixation of Maisonneuve fractures. Methods: 10 consecutive patients with Maisonneuve injuries were treated with indirect restoration of fibula length, open reduction of the syndesmosis, and stabilization of the syndesmosis with the screw suture device. Talocrural angle and medial clear space was measured and recorded at time of injury, post operatively and 6 months. Rate of hardware removal was recorded.***2 patients are 2 months short of 6 months. both have healed their proximal fibula fractures so no changes to data are anticipated *** Results: There were 5 males and 5 females. 5 patients slipped on ice, 4 patients fell on uneven walking surfaces, 1 patient was in a motorcycle accident. 2 patients had associated posterior malleolus fractures, 1 was fixed with a posterior plate. 1 patient had a medial malleolus fracture repaired with 2 screws. 9 devices were placed independently. 1 device was inserted through a 4 hole 1/3 tubular plate. Average time to surgery was 12.3 days (range 5-24 days). Talocrural angles averaged 8.92 (4.8-14.5mm) on injury films, 13.8mm (10.6-17mm) post operatively and 13.5mm (10.6-16.6) at 6 months. Medial clear space measurement averaged 5.68mm (2-10mm) on injury films, 2.06mm (1.9-2.3mm) post operatively and 2.1mm (2-2.3mm) at 6 months. No devices required removal during the study period. Conclusion: The screw-suture device provided length stable fixation for treatment of Maisonneuve fracture patterns.
Collapse
|
21
|
Swords MP, Souleiman F, Zderic I, Pastor T, Gehweiler D, Galie J, Kent TJ, Gueorguiev B, Tomlinson MP, Schepers T. Novel Dynamic Screw-Suture Stabilization System for Syndesmotic Repair Provides Better Anteroposterior Translation and Axial Tibiofibular Joint Stability: A Human Cadaveric Study. Foot & Ankle Orthopaedics 2022. [DOI: 10.1177/2473011421s00963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Category: Ankle; Basic Sciences/Biologics; Trauma Introduction/Purpose: The quest for optimal treatment of acute distal tibiofibular syndesmotic disruptions is still in full progress. Using suture-button repair devices is one of the dynamic stabilization options, however, they may not be always appropriate for stabilization of length-unstable syndesmotic injuries. Recently, a novel screw-suture repair system was developed to address such issues. The aim of this study was to investigate its performance in comparison to a suture-button stabilization of unstable syndesmotic injuries. Methods: Eight pairs of human cadaveric lower legs were CT scanned under 700 N single-leg axial loading in five foot positions - neutral, 15° external/internal rotation and 20° dorsi-/plantarflexion - in 3 different states: (1) pre-injured (intact); (2) injured, characterized by complete syndesmosis and deltoid ligaments cuts simulating pronation-eversion injury types III and IV as well as supination-eversion injury type IV according to Lauge-Hansen; (3) reconstructed, using a screw-suture (FIBULINK, Group 1) or a suture-button (TightRope, Group 2) implants for syndesmotic stabilization, placed 20 mm proximal to the tibia plafond/joint surface. Following, all specimens were: (1) biomechanically tested over 5000 cycles under combined 1400 N axial and +-15° torsional loading; (2) rescanned. Clear space (diastasis), anterior tibiofibular distance, talar dome angle and fibular shortening were measured radiologically from CT scans. Anteroposterior, axial, mediolateral and torsional movements at the distal tibiofibular joint level were evaluated biomechanically via motion tracking. Results: In each group clear space increased significantly after injury (p <= 0.004) and became significantly smaller in reconstructed compared with both pre-injured and injured states (p <= 0.041). In addition, after reconstruction it was significantly smaller in Group 1 compared to Group 2 (p < 0.001). Anteroposterior (AP) and axial movements were significantly smaller in Group 1 compared with Group 2 (p < 0.001, Figure). No further significant differences were identified/detected between the groups (p >= 0.113). Conclusion: Although both implant systems demonstrate ability for stabilization of unstable syndesmotic injuries, the screw- suture reconstruction provides better anteroposterior translation and axial stability of the tibiofibular joint and maintains it over time under dynamic loading. Therefore, it could be considered as a valid option for treatment of syndesmotic disruptions.
Collapse
|
22
|
Walraven LFJ, Ridderikhof ML, Schepers T. Utility of Post-Splinting Conventional Radiographs in Adult Patients With Ankle Fractures Presenting to the Emergency Department. Foot Ankle Spec 2022:19386400221118898. [PMID: 36004619 DOI: 10.1177/19386400221118898] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Post-splinting radiographs are often performed in patients with ankle fractures to identify displacement that potentially occurs during splinting. The objective of this study was to investigate the significance of post-splinting conventional radiographs, with an emphasis on stable ankle fractures, not requiring reduction. METHODS A retrospective study in which all adult patients presenting with ankle fractures to the emergency department of a level 1 trauma center were included. The primary outcome was frequency of displacement at post-splinting radiographs. Secondary outcome was the rate of successful reduction attempts. RESULTS A total of 225 patients were included and the majority had a Supination-External Rotation (SER) type 2 or Weber B ankle fracture. One hundred fifty patients (mainly SER 2 fractures [68%] or Weber B [89%] fractures), were treated with a splint without fracture reduction. Post-splinting radiographs in these patients, as well as in all patients with a Supination-Adduction (SA) type 1 and 2 fractures, did not show loss of alignment. CONCLUSION Post-splinting radiographs are probably not necessary in any SA and SER type 2 or Weber A/B ankle fractures without medical clear space widening or need for reduction as no loss of alignment occurred when applying a splint. LEVEL OF EVIDENCE IV-Case Series.
Collapse
Affiliation(s)
| | - Milan Lennaert Ridderikhof
- Department of Emergency Medicine, Amsterdam UMC, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Tim Schepers
- Department of Trauma Surgery, Amsterdam UMC, Location Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
23
|
Penning D, Kleipool S, van Dieren S, Dingemans SM, Schepers T. The minimal clinically important difference (MCID) of the Olerud Molander Ankle Score (OMAS) in patients with unstable ankle fracture. Arch Orthop Trauma Surg 2022; 143:3103-3110. [PMID: 35821429 DOI: 10.1007/s00402-022-04533-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/18/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The Olerud Molander Ankle Score (OMAS) is a widely used validated Patient Reported Outcome Measure (PROM). For clinical research, it is important to determine the Minimal Clinically Important Difference (MCID). The objective of this study was to determine the MCID of the OMAS at several moments in the follow-up, in a cohort of patients that underwent open reduction and internal fixation of unstable ankle fractures with syndesmotic injury. MATERIALS AND METHODS Data for this descriptive study were extracted from a prospective randomized controlled trial, the RODEO trial. The Dutch version of the OMAS was completed at 3, 6 and 12-month follow-up and estimated at baseline. The used anchor-based methods were: mean change and ROC curve. The distribution-based methods were: 0.5SD and minimal detectable change (MDC). RESULTS This cohort included 148 patients. The mean OMAS score in the group with minimal improvement between 3 and 6 months was 15.0 (SD 17.5, 95%CI 9.4-20.6) and between 6 and 12 months 9.5 (SD 17.1, 95% CI 3.1-15.9). The ROC curve between 3 and 6 months resulted in a MCID of 12.5 (AUC 0.72) and between 6 and 12 months, the MCID was 7.5 (AUC 0.78). Using 0.5 SD, the MCID was 10.52 (SD 21.04) at 3 months, 11.37 (SD 22.73) at 6 months and 10.47 (SD 20.94) at 12 months. The MDC was 4.72 at 3 months, 5.20 at 6 months and 4.71 at 12 months. CONCLUSIONS The calculated MCID in patients following surgery for unstable ankle fractures ranges from 10.5 to 15.0 at 3-6-month follow-up and from 7.5 to 11.4 at 6-12-month follow-up, depending on moment and method.
Collapse
Affiliation(s)
- Diederick Penning
- Trauma Unit, Amsterdam University Medical Center, Location Meibergdreef, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | | | - Susan van Dieren
- Department of Clinical Epidemiology, Amsterdam University Medical Center, Location Meibergdreef, Amsterdam, The Netherlands
| | - Siem M Dingemans
- Trauma Unit, Amsterdam University Medical Center, Location Meibergdreef, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | | | - Tim Schepers
- Trauma Unit, Amsterdam University Medical Center, Location Meibergdreef, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| |
Collapse
|
24
|
Popal Z, Schepers T, Schie PV, Giannakopoulos GF, Halm JA. The use of routine laboratory testing in acute trauma care: A retrospective analysis. ULUS TRAVMA ACIL CER 2022; 28:954-959. [PMID: 35775666 PMCID: PMC10493847 DOI: 10.14744/tjtes.2021.14826] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 05/01/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND In more than 60 countries worldwide, laboratory testing plays a challenging and expensive role in trauma resus-citation. In 1995, the literature already suggested that routine laboratory testing may not be useful for most trauma patients. Our study hypothesized that still the need for some laboratory tests perhaps should be reconsidered. Therefore, the aim of this study was to create more insight in the distribution between normal and abnormal parameters for routine laboratory testing in trauma patient management. METHODS This retrospective analysis was performed at Amsterdam UMC, location AMC, an academic level 1 trauma center. Data concerning age, gender, American Society of Anesthesiologists (ASA) physical state classification system (ASA), Injury Severity Scores, Glasgow Coma Scales, mechanism of injury, presence of high-energy trauma, and type of injury (blunt or penetrating) were obtained. Laboratory parameters included comprehensive hematology, coagulation, arterial blood gas, kidney, and liver blood panels. Analytical focus was paid to the patient's vital status, the indication for an emergency intervention, and the risk of in-hospital mortality. RESULTS A total of 1287 patients were included in the study. Patients with unstable vital signs or who required emergency inter-vention were most often dealing with abnormalities in pO2, glucose, D-dimer, creatinine, and alcohol values. Mean corpuscular volume (MCV), international normalized ratio (INR), fibrinogen, and amylase were obtained in more than 80% of the patients, but in specific patient groups only abnormal in less than 9%. CONCLUSION Trauma patients suffer mainly from abnormal values of D-dimer, pO2, glucose, creatinine, and alcohol. By contrast, MCV, INR, amylase, fibrinogen, and thrombocytes are regularly obtained as well, but only abnormal in a small amount of trauma patients. These findings suggest reconsiderations and more accuracy in the performance of laboratory testing, especially for trauma patients with stable vital signs.
Collapse
Affiliation(s)
- Zar Popal
- Department of Trauma Surgery, Amsterdam UMC, Location AMC, Amsterdam-The Netherlands
| | - Tim Schepers
- Department of Trauma Surgery, Amsterdam UMC, Location AMC, Amsterdam-The Netherlands
| | - Peter Van Schie
- Department of Trauma Surgery, Amsterdam UMC, Location AMC, Amsterdam-The Netherlands
| | | | - Jens A. Halm
- Department of Trauma Surgery, Amsterdam UMC, Location AMC, Amsterdam-The Netherlands
| |
Collapse
|
25
|
Wijers O, Posthuma JJ, Engelmann EWM, Schepers T. Complications and Functional Outcome Following Operative Treatment of Talus Neck and Body Fractures: A Systematic Review. Foot & Ankle Orthopaedics 2022; 7:24730114221127201. [PMID: 36199382 PMCID: PMC9528034 DOI: 10.1177/24730114221127201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Central talar fractures are rare and often associated with impaired functional outcome. Despite recent advances in diagnosis and management of talus fractures, complications rates remain high and functional outcome is generally poor. This study aims to provide an overview of complication rates and functional outcome following operative treatment of talar neck and body fractures. This may help in clinical decision making by improving patients’ expectation management and tailored treatment strategies. Methods: A systematic review of the literature was conducted of studies published from January 2000 to July 2021 reporting functional outcome and/or complications following operative treatment of talar neck, body, or combined neck and body fractures. Keywords used were (Talar fracture) or (Talus fracture). Data on complication rates and functional outcome was extracted from selected articles. Results: A total of 28 articles were included in our analysis reporting 1086 operative treated talar fractures (755 neck [70%], 227 body fractures [21%], and 104 combined body and neck fractures [9%]). The mean follow-up was 48 (range 4-192) months. Complications occurred frequently with; 6% surgical site infection, 8% nonunion, 29% avascular necrosis, 64% osteoarthritis, and in 16% a secondary arthrodesis was necessary. A wide variety in functional outcome was reported; however, there seems to be a correlation between fracture classification and postoperative complications. Conclusion: Operative treatment of central talar fractures is associated with a high incidence of early and late complications and often leads to an impaired functional outcome. Standardization of talar fracture classification and scoring systems in combination with large sample-sized prospective studies are warranted to detect further predictive factors influencing tailormade treatment strategies and patient expectation management. Level of Evidence: Level III, Systematic review of case series and case-control studies.
Collapse
Affiliation(s)
- Olivier Wijers
- Department of Traumasurgery, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - Jelle J. Posthuma
- Department of Traumasurgery, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - Esmee W. M. Engelmann
- Department of Traumasurgery, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - Tim Schepers
- Department of Traumasurgery, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| |
Collapse
|
26
|
van den Heuvel SBM, Penning D, Schepers T. Open Ankle Arthrodesis: A Retrospective Analysis Comparing Different Fixation Methods. J Foot Ankle Surg 2022; 61:233-238. [PMID: 34362652 DOI: 10.1053/j.jfas.2021.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 07/10/2021] [Indexed: 02/03/2023]
Abstract
A wide variation of surgical options, complications, and union rates are reported in the treatment of end-stage ankle arthritis. However, open ankle arthrodesis remains the golden standard for ankle arthritis. The purpose of this study was to evaluate the union rate and complication rate as well as identify potential risk factors for different methods of fixation in patients with end-stage ankle arthritis of different etiology. In total, 42 ankles of 41 patients with ankle osteoarthritis were included for this single-center retrospective study. The mean age was 50 years (range 22-75 years). Twenty patients were treated with screw-fixation, 14 with plate(s) and 8 with intramedullary nail. The results of this study showed an overall union rate of 97.6% (41 of the 42 operated ankles) and an overall complication rate of 21.4% (9 events). The mean follow-up time was 16 months (range 2.5-83.0 months). Complications consisted of 1 nonunion, 4 deep infections, 2 cases of wound dehiscence, 1 delayed union and 1 malalignment of the ankle joint. The plate-fixation group demonstrated significantly higher infections when compared with screw and intramedullary nail fixation (p = .017). There were no other significant variables for incidence of complications between patients in the uncomplicated and complicated group. This study achieved good clinical results for different methods of fixation in open ankle arthrodesis. In specific, the use of intramedullary nail provides excellent results for end-stage ankle arthritis with high union rate and a low complication rate.
Collapse
Affiliation(s)
- Stein B M van den Heuvel
- Medical Doctor, Trauma Unit, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Diederick Penning
- Medical Doctor, Trauma Unit, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Tim Schepers
- Trauma Surgeon, Trauma Unit, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| |
Collapse
|
27
|
Ivanov S, Stefanov A, Zderic I, Rodemund C, Schepers T, Gehweiler D, Dauwe J, Pastor T, Makelov B, Raykov D, Richards G, Gueorguiev B. Percutaneous fixation of intraarticular joint-depression calcaneal fractures with different screw configurations - a biomechanical human cadaveric analysis. Eur J Trauma Emerg Surg 2022; 48:3305-3315. [PMID: 35254460 DOI: 10.1007/s00068-022-01901-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/30/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to assess the biomechanical performance of different screw configurations for fixation of Sanders type II B joint-depression calcaneal fractures. METHODS Fifteen human cadaveric lower limbs were amputated and Sanders II B fractures were simulated. The specimens were randomized to three groups for fixation with different screw configurations. The calcanei in Group 1 were treated with two parallel longitudinal screws, entering superiorly the Achilles tendon insertion, and two screws fixing the intraarticular posterior facet fracture line. In Group 2 two screws entered the tuberosity inferiorly to the Achilles tendon insertion and two transverse screws fixed the posterior facet. In Group 3 two screws were inserted along the bone axis, one transverse screw fixed the posterior facet and one oblique screw was inserted from the posteroplantar part of the tuberosity supporting the posterolateral part of the posterior facet. All specimens were biomechanically tested to failure under progressively increasing cyclic loading. RESULTS Initial stiffness did not differ significantly between the groups, P = 0.152. Cycles to 2 mm plantar movement were significantly higher in both Group 1 (15,847 ± 5250) and Group 3 (13,323 ± 4363) compared with Group 2 (4875 ± 3480), P ≤ 0.048. No intraarticular displacement was observed in any group during testing. CONCLUSIONS From a biomechanical perspective, posterior facet support by means of buttress or superiorly inserted longitudinal screws results in less plantar movement between the calcaneal tuberosity and the anterior fragments. Inferiorly inserted longitudinal screws are associated with bigger interfragmentary movements.
Collapse
Affiliation(s)
- Stoyan Ivanov
- AO Research Institute Davos, Davos, Switzerland. .,Medical University Varna, Varna, Bulgaria.
| | - Aleksandar Stefanov
- AO Research Institute Davos, Davos, Switzerland.,University Multiprofile Hospital for Active Treatment and Emergency Medicine 'N. I. Pirogov', Sofia, Bulgaria
| | - Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland
| | | | - Tim Schepers
- Trauma Unit, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Jan Dauwe
- University Hospitals Leuven, Leuven, Belgium
| | - Torsten Pastor
- AO Research Institute Davos, Davos, Switzerland.,Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Biser Makelov
- Medical University Varna, Varna, Bulgaria.,University Multiprofile Hospital for Active Treatment 'S. Kirkovitch', Stara Zagora, Bulgaria
| | | | | | | |
Collapse
|
28
|
Abstract
Background. Ankle fractures are some of the most common injuries seen in the emergency department. Malunited ankle fractures are uncommon. Patients with malunion frequently present with multiple complaints. Radiographs often show abnormalities in anatomical alignment. Aim. To evaluate the anatomical alignment on radiographic imaging in patients with malunited ankle fractures. Secondary aims were to evaluate patient satisfaction after reconstruction and to investigate the relationships between radiological alignment and functional outcome. Methods. All consecutive patients (n = 25) treated for a fibula malunion between January 1, 2002, and September 1, 2017, were included. The primary outcome was anatomical alignment of the ankle mortise. The talocrural angle (TCA), talar tilt (TT), and medial clear space (MCS) were used to investigate to what extent revision surgery had improved alignment. The patient-related outcome measure consisted of the Olerud and Molander Ankle Score (OMAS). To assess quality of life (QoL) the EQ-5D-5L was used. Results. The median TCA was 78.4° before revision and 79.25° after revision; P = .297. The median TT was 2.95° before revision and 0.70° after; P < .001. The MCS before revision was 5.2 mm and 3.17 mm after; P < .000). The OMAS had a median of 67.5 points. Analysis of the QoL questionnaires yielded a score of 0.84 points. Conclusion. Anatomical alignment improves significantly after revision surgery of malunited ankles. Measurements of the TCA appeared less useful in determining the anatomical alignment. In our series, 60% of patients reported good to excellent results. The QoL scores of our patient were comparable to those in the healthy population in the Netherlands.Levels of Evidence: Level IV: Case series.
Collapse
Affiliation(s)
| | | | | | - Tim Schepers
- Tim Schepers, MD, PhD, Trauma Unit,
Department of Surgery, Amsterdam University Medical Center, Meibergdreef 9,
Amsterdam, 1105 AZ, Netherlands; e-mail:
| |
Collapse
|
29
|
Sanders FRK, Birnie MF, Dingemans SA, van den Bekerom MPJ, Parkkinen M, van Veen RN, Goslings JC, Schepers T. Functional outcome of routine versus on-demand removal of the syndesmotic screw: a multicentre randomized controlled trial. Bone Joint J 2021; 103-B:1709-1716. [PMID: 34719269 PMCID: PMC8528163 DOI: 10.1302/0301-620x.103b11.bjj-2021-0348.r2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Indexed: 12/21/2022]
Abstract
Aims The aim of this study was to investigate whether on-demand removal (ODR) is noninferior to routine removal (RR) of syndesmotic screws regarding functional outcome. Methods Adult patients (aged above 17 years) with traumatic syndesmotic injury, surgically treated within 14 days of trauma using one or two syndesmotic screws, were eligible (n = 490) for inclusion in this randomized controlled noninferiority trial. A total of 197 patients were randomized for either ODR (retaining the syndesmotic screw unless there were complaints warranting removal) or RR (screw removed at eight to 12 weeks after syndesmotic fixation), of whom 152 completed the study. The primary outcome was functional outcome at 12 months after screw placement, measured by the Olerud-Molander Ankle Score (OMAS). Results There were 152 patients included in final analysis (RR = 73; ODR = 79). Of these, 59.2% were male (n = 90), and the mean age was 46.9 years (SD 14.6). Median OMAS at 12 months after syndesmotic fixation was 85 (interquartile range (IQR) 60 to 95) for RR and 80 (IQR 65 to 100) for ODR. The noninferiority test indicated that the observed effect size was significantly within the equivalent bounds of -10 and 10 scale points (p < 0.001) for both the intention-to-treat and per-protocol, meaning that ODR was not inferior to RR. There were significantly more complications in the RR group (12/73) than in the ODR group (1/79) (p = 0.007). Conclusion ODR of the syndesmotic screw is not inferior to routine removal when it comes to functional outcome. Combined with the high complication rate of screw removal, this offers a strong argument to adopt on demand removal as standard practice of care after syndesmotic screw fixation. Cite this article: Bone Joint J 2021;103-B(11):1709–1716.
Collapse
Affiliation(s)
- Fay R K Sanders
- Trauma Unit, Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Merel F Birnie
- Trauma Unit, Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Siem A Dingemans
- Trauma Unit, Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Markus Parkkinen
- Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | | | - Tim Schepers
- Trauma Unit, Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
30
|
Misselyn D, De Buck S, Nijs S, Matricali G, Schepers T. 3D imaging added value in the treatment and diagnosis of displaced intra-articular calcaneal fractures (DIACF): measuring the orientation of the posterior talo-calcaneal facet in the space. Comput Methods Biomech Biomed Engin 2021; 25:215-220. [PMID: 34613852 DOI: 10.1080/10255842.2021.1946797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Measure the reduction quality of calcaneal fractures on 3 D segmented images. METHODS The Ethics Review Board approved this study and written informed consent was collected from all patients. Bilateral CT scans of fifty-four patients with unilateral displaced calcaneal fracture were obtained before and after osteosynthesis. Orientation angle of the posterior subtalar joint facet (PTC) of displaced intra-articular calcaneal fractures of 54 patients was measured on segmented 3 D images before and after surgery and compared to the uninjured side. This orientation angle (OAC) is the average of every normal vector of each point of the PTC, as compared to the main calcaneal axis (calculated by first principal component analysis). The PTC is a well-known anatomical structure, relatively easy to identify on 3 D imaging. RESULTS This OAC angle was low before surgery (mean= 95°, std dev= 6°), statistically significantly different from the uninjured side value, p < 0.001. The OAC angle of the operated bone was nearly equal to the uninjured side (mean= 103°, std dev= 5°), without any statistically significant difference between postoperative values and uninjured side values. We found linear correlation between the quality of the reduction when assessed with this OAC and the functional score (AOFAS) (Adjusted R2=0.62, p = 0.04). CONCLUSIONS This angle seems to be useful to quantify the quality of the operative reduction of displaced intra-articular calcaneal fractures.
Collapse
Affiliation(s)
| | - Stijn De Buck
- KU Leuven University Hospitals Leuven Gasthuisberg Campus, Leuven, Belgium
| | - Stefaan Nijs
- KU Leuven University Hospitals Leuven Gasthuisberg Campus, Leuven, Belgium
| | - Giovanni Matricali
- KU Leuven University Hospitals Leuven Gasthuisberg Campus, Leuven, Belgium
| | - Tim Schepers
- Traumatology, Amsterdam Universitair Medische Centra, Amsterdam, Netherlands
| |
Collapse
|
31
|
Eelsing R, Hemke R, Schepers T. The added value of SPECT/CT in the painful foot and ankle: A review of the literature. Foot Ankle Surg 2021; 27:715-722. [PMID: 33046381 DOI: 10.1016/j.fas.2020.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/14/2020] [Accepted: 09/21/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Foot and ankle injuries are common. Radiographic assessment is difficult because of the complex anatomy. In the past decade SPECT/CT made its introduction in assessing bone pathology, it combines both morphologic and pathologic imaging in one image aiming to increase sensitivity and specificity when compared with MRI or CT alone. The purpose of this review was to provide a literature overview on the diagnostic value of SPECT/CT in foot and ankle pathology. METHODS A literature search was conducted in the databases of PubMed and EMBASE between January 2004 and September 2019 for articles describing the diagnostic value of SPECT/CT in foot and ankle pathology. For assessment of methodological quality of each study included in the analysis, QUADAS-2 checklist was used. Main outcomes were change of management, improved diagnosis and symptomatic improvement. RESULTS A total of eight studies were identified describing the diagnostic value of SPECT/CT in foot and ankle pathology based on patient data. The combined analysis shows that change of management and improved diagnosis occurred in 48-62% and 40-79% of the patients when compared with other imaging modalities and/or clinical assessment. Symptomatic improvement due to treatment based on SPECT/CT findings occurred in 92% of the patients. CONCLUSION SPECT/CT is useful when diagnosis based on other imaging modalities is inconclusive or when treatment based on these modalities does not lead to the desired symptomatic improvement.
Collapse
Affiliation(s)
- Robin Eelsing
- Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Trauma Unit, Department of Surgery, Amsterdam, The Netherlands
| | - Robert Hemke
- Amsterdam University Medical Centers, Location AMC, Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Tim Schepers
- Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Trauma Unit, Department of Surgery, Amsterdam, The Netherlands.
| |
Collapse
|
32
|
Affiliation(s)
- Peter Marhofer
- From the Department of Anesthesiology Intensive Care Medicine, Orthopedic Hospital Speising, Vienna, Austria
| | - Jens Halm
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Georg C Feigl
- Institute of Anatomy and Clinical Morphology, University Witten/Herdecke, Witten, Germany
| | - Tim Schepers
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Markus W Hollmann
- Department of Anesthesiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
33
|
Misselyn D, Schepers T, Buckley R, Swords M, Matricali G, Nijs S. Three-Dimensional Imaging of Displaced Intra-articular Calcaneal Fractures Correlates With the Perioperative Diagnosis. Foot & Ankle Orthopaedics 2021; 6:24730114211019729. [PMID: 35097457 PMCID: PMC8564932 DOI: 10.1177/24730114211019729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Intra-articular calcaneal fractures are complex injuries, and CT imaging has become the standard imaging in the preoperative assessment. Most classifications of these fractures are CT-based but have been associated with limited interobserver agreement. Three-dimensional imaging has become widely available and may give a better perspective but often with 1 image only. There is not much evidence of the added value of this imaging, compared with the CT imaging. Methods: Eight experienced trauma surgeons assessed 28 different intra-articular calcaneal fractures, on conventional radiology (CR), CT, and 3-D imaging. All had extensive experience in the diagnosis and treatment of this difficult injury. The main questions concerned Sanders classification, the severity of the injury and the difficulty of the operative procedure, choice of approach, and choice of procedure. Results: The classical 2-D CT imaging of the fractures were associated with a higher Sanders classification ranking, compared with the 3-D imaging scores. However, the interobserver agreement, as measured by the Fleiss kappa, was low for all 3 imaging modalities. We found more frequent Sanders III and IV classifications with CT scan imaging compared with 3-D imaging or CR. The scores obtained after assessing 3-D imaging were also not statistically significantly different from the scores of a consensus achieved by 2 authors and based on the 3 imaging modalities and the perioperative diagnosis. Conclusion: The 3-D imaging may result in a more realistic view, reducing the frequency of classifying Sanders III fractures than with the 2-D CT imaging series. 3-D imaging may be more reliable than CT in the planning of operative treatment of displaced intra-articular calcaneal fractures. Level of Evidence: Level III.
Collapse
Affiliation(s)
- Dominique Misselyn
- Trauma Surgery Department, Gasthuisberg University Hospital, Herestraat, Leuven, Belgium
| | - Tim Schepers
- Amsterdam UMC location AMC Trauma Unit, Amsterdam, North Holland, the Netherlands
| | - Richard Buckley
- Division of Orthopedic Trauma Surgery, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Michael Swords
- Department of Orthopedic Surgery, Michigan Orthopedic Center, Sparrow Hospital, Lansing, MI, USA
| | - Giovanni Matricali
- Orthopaedic Surgery Department, Gasthuisberg University Hospital, Herestraat, Leuven, Belgium
| | - Stefaan Nijs
- Trauma Surgery Department, Gasthuisberg University Hospital, Herestraat, Leuven, Belgium
| |
Collapse
|
34
|
Daqiq O, Sanders FRK, Schepers T. How Does Mechanism of Injury Relate to Similar Fracture Patterns in Bilateral Displaced Intra-articular Calcaneal Fractures? J Foot Ankle Surg 2021; 59:1162-1166. [PMID: 32828628 DOI: 10.1053/j.jfas.2020.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/11/2019] [Accepted: 04/02/2020] [Indexed: 02/03/2023]
Abstract
Several biomechanical/cadaver studies have established a correlation between mechanism of injury and fracture classification in calcaneal fractures. However, this has never been backed up by clinical studies. In this study, the hypothesis is tested whether the alleged similar mechanism of injury for both feet in bilateral calcaneal fractures leads to similar fracture types. In this retrospective cross-sectional cohort study, patients with unilateral and bilateral calcaneal fractures treated between 2000 and 2017 were classified according to Essex-Lopresti and Sanders. Positive predictive values were computed, signifying the chance that the fracture type in the left foot corresponded to that in the right foot. These were compared to the a priori chance of a fracture type (percentage of fracture type in unilateral fractures) by constructing 95% confidence intervals of the positive predictive value of each fracture type. Of the 451 patients, 413 (91.6%) had unilateral and 38 (8.4%) bilateral calcaneal fractures. Mechanisms of injury were similar for uni- and bilateral fractures. Using the Essex-Lopresti fracture classification, 34 cases (90%) had the same classification in both feet, compared with 24 (63%) in the Sanders classification. The chance of a fracture type in the left, with the right foot as reference, was significantly larger than expected from a priori chance in the unilateral population. This leads to a new hypothesis, that, more than mechanism of injury, the magnitude of the impact and the position of the foot are important in predicting fracture classification in the calcaneus.
Collapse
Affiliation(s)
- Omid Daqiq
- Resident Surgery, Trauma Unit, Academic Medical Center location AMC, Amsterdam, the Netherlands
| | - Fay R K Sanders
- Resident Surgery, Trauma Unit, Academic Medical Center location AMC, Amsterdam, the Netherlands
| | - Tim Schepers
- Trauma Surgeon, Trauma Unit, Academic Medical Center location AMC, Amsterdam, the Netherlands.
| |
Collapse
|
35
|
Abstract
BACKGROUND Talar head fractures account for 2.6% to 10% of all talar fractures and are often associated with concomitant musculoskeletal injuries. The current literature only describes a total of 14 patients with talar head fractures and, with that, guidelines for management are lacking. The aim of the current study was to evaluate the management and long-term outcome of patients who have hindfoot trauma with concomitant talar head fractures. METHODS This study includes a retrospective cohort of patients with talar head fractures. Patient characteristics, trauma mechanism, fracture characteristics, treatment, follow-up, and complications were reported. Functional outcome was assessed using the Foot Function Index (FFI) and the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Quality of life was measured by the EuroQol-5D (EQ-5D). Twenty-one patients with acute fractures of the talar head were identified. The mean follow-up time was 4.9 years. RESULTS All patients sustained additional ipsilateral foot and/or ankle injuries. Fifteen patients had operative management of their talar head fracture. There were no postoperative wound infections and no cases of avascular necrosis. All fractures united, and 29% of patients developed posttraumatic osteoarthritis. The overall mean FFI score index was 34.2, and the mean AOFAS score was 70.7. The mean EQ-5D index score was 0.74. CONCLUSION Talar head fractures always coincided with other (foot) fractures. Management and long-term functional outcome were affected by the extent of associated injuries. Due to the low incidence and high complexity of talar head fractures, early referral to dedicated foot surgeons and centralization of complex foot surgery is recommended. LEVEL OF EVIDENCE Level IV, retrospective case series.
Collapse
Affiliation(s)
| | - Olivier Wijers
- Trauma Unit, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands
| | - Jelle Posthuma
- Trauma Unit, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands
| | - Tim Schepers
- Trauma Unit, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands
| |
Collapse
|
36
|
van den Heuvel SBM, Doorgakant A, Birnie MFN, Blundell CM, Schepers T. Open Ankle Arthrodesis: a Systematic Review of Approaches and Fixation Methods. Foot Ankle Surg 2021; 27:339-347. [PMID: 33419696 DOI: 10.1016/j.fas.2020.12.011] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/07/2020] [Accepted: 12/29/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Open ankle arthrodesis (OAA) remains the most widely used operation in end-stage ankle osteoarthritis. However, there is a large variation in terms of approach and fixation methods. The aim of this systematic review was to assess the effect of different approaches and fixation methods on the union rate, complication rate and functional outcome in OAA. METHODS A search of the online databases PubMed, Embase, and Cochrane library was performed to identify patients who underwent OAA with screw- and/or plate-fixation. RESULTS We identified 38 studies, including 1250 patients (1290 ankles). The union rate was 98% (95% CI 0.95-0.99) for the anterior, 96% (95% CI 0.92-0.98) for the lateral and 96% (95% CI 0.68-1.00) for the combined medial/lateral approach. Screw-fixation achieved an overall union rate of 96% (95% CI 0.93-0.98) and plate-fixation 99% (95% CI 0.96-0.99). The overall complication rate was 14%, 16% and 31% for the anterior, lateral and combined medial/lateral approaches respectively. It stood at 18% for screw-fixation and 9% for plate-fixation. The infection rate was 4%, 6% and 8% for the anterior, lateral and combined approaches respectively. Screw-fixation had an infection rate of 6% and plate-fixation 3%. The postoperative AOFAS scores were 76.8, 76.5 and 67.6 for the anterior, lateral and combined approaches respectively and 74.9 for screw- compared to 78.5 for plate-fixation. These differences did not reach statistical significance. CONCLUSION This study, the first of its kind, found little difference in terms of results between approach and fixation method used in OAA. LEVEL OF EVIDENCE Level IIa.
Collapse
Affiliation(s)
- Stein B M van den Heuvel
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands
| | - Ashtin Doorgakant
- Trauma and Orthopaedic Department, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, United Kingdom
| | - Merel F N Birnie
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands
| | - Chris M Blundell
- Sheffield Foot and Ankle Unit, Orthopaedic Department, Northern General Hospital, Sheffield, United Kingdom
| | - Tim Schepers
- Department of Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands.
| |
Collapse
|
37
|
Nooijen LE, Spierings KE, Sanders FRK, Dingemans SA, Halm JA, Schepers T. Determining the Correlation Between Lateral Radiograph Morphology and the Outcome Following Surgically Treated Intra-Articular Calcaneal Fractures. Foot Ankle Spec 2021; 14:105-113. [PMID: 31920101 PMCID: PMC8044625 DOI: 10.1177/1938640019897220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 11/16/2022]
Abstract
Purpose. It is currently still common practice to obtain conventional radiographs in the follow-up of surgically treated displaced intra-articular calcaneal fractures at regular intervals. There is, however, insufficient evidence that these radiographs can be used to predict functional outcome. The aim of the current study was to evaluate the correlation between the most commonly used angles on lateral radiographs and disease-specific patient-reported outcome measures (PROMs). Methods. Two available databases, containing a total of 233 patients, were used in this study. Eleven angles on the lateral images of the preoperative and at 1-year follow-up radiographs were measured. The 6 most commonly used angles were also measured immediately postoperatively. These 6 most commonly used angles were correlated with PROMs (American Orthopaedic Foot and Ankle Society hindfoot score, Foot Function Index) by a Spearman's rho analysis. After a Bonferroni correction was applied, a P value of <.0042 was considered to be statistically significant. Results. After exclusion of bilateral fractures, primary arthrodesis, open fractures, wound infections, other wound complications, nonavailable radiographs, and nonresponders, 86 patients remained. No significant correlations were found between the measured angles on the preoperative and at 1-year follow-up radiographs and the PROMs. Conclusion. No apparent correlation between lateral radiograph morphology and outcome was detected. Therefore, long-term follow-up radiographs after confirmed healing may be restricted to patients with persistent complaints on indication.Levels of Evidence: Prognostic, Level IV: Retrospective.
Collapse
Affiliation(s)
| | | | | | | | | | - Tim Schepers
- Tim Schepers, MD, PhD, Trauma Unit, Amsterdam UMC, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands; e-mail:
| |
Collapse
|
38
|
Sanders FRK, Penning D, Backes M, Dingemans SA, van Dieren S, Eskes AM, Goslings JC, Kloen P, Mathôt RAA, Schep NWL, Spijkerman IJB, Schepers T. Wound infection following implant removal of foot, ankle, lower leg or patella; a protocol for a multicenter randomized controlled trial investigating the (cost-)effectiveness of 2 g of prophylactic cefazolin compared to placebo (WIFI-2 trial). BMC Surg 2021; 21:69. [PMID: 33522909 PMCID: PMC7849087 DOI: 10.1186/s12893-020-01024-y] [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] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background Elective implant removal (IR) after fracture fixation is one of the most common procedures within (orthopedic) trauma surgery. The rate of surgical site infections (SSIs) in this procedure is quite high, especially below the level of the knee. Antibiotic prophylaxis is not routinely prescribed, even though it has proved to lower SSI rates in other (orthopedic) trauma surgical procedures. The primary objective is to study the effectiveness of a single intravenous dose of 2 g of cefazolin on SSIs after IR following fixation of foot, ankle and/or lower leg fractures. Methods This is a multicenter, double-blind placebo controlled trial with a superiority design, including adult patients undergoing elective implant removal after fixation of a fracture of foot, ankle, lower leg or patella. Exclusion criteria are: an active infection, current antibiotic treatment, or a medical condition contraindicating prophylaxis with cefazolin including allergy. Patients are randomized to receive a single preoperative intravenous dose of either 2 g of cefazolin or a placebo (NaCl). The primary analysis will be an intention-to-treat comparison of the proportion of patients with a SSI at 90 days after IR in both groups. Discussion If 2 g of prophylactic cefazolin proves to be both effective and cost-effective in preventing SSI, this would have implications for current guidelines. Combined with the high infection rate of IR which previous studies have shown, it would be sufficiently substantiated for guidelines to suggest protocolled use of prophylactic antibiotics in IR of foot, ankle, lower leg or patella. Trial registration Nederlands Trial Register (NTR): NL8284, registered on 9th of January 2020, https://www.trialregister.nl/trial/8284
Collapse
Affiliation(s)
- Fay R K Sanders
- Trauma Surgery, Amsterdam UMC, Loc. AMC, G4-137, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Diederick Penning
- Trauma Surgery, Amsterdam UMC, Loc. AMC, G4-137, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Manouk Backes
- Trauma Surgery, Amsterdam UMC, Loc. AMC, G4-137, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Siem A Dingemans
- Trauma Surgery, Amsterdam UMC, Loc. AMC, G4-137, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Susan van Dieren
- Trauma Surgery, Amsterdam UMC, Loc. AMC, G4-137, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Anne M Eskes
- Trauma Surgery, Amsterdam UMC, Loc. AMC, G4-137, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - J Carel Goslings
- Trauma Surgery, OLVG, Loc. West, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - Peter Kloen
- Orthopedic Surgery, Amsterdam UMC, Loc. AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Ron A A Mathôt
- Hospital Pharmacy, Amsterdam UMC, Loc. AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Niels W L Schep
- Trauma Surgery, Maasstad Ziekenhuis, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - Ingrid J B Spijkerman
- Medical Microbiology, Amsterdam UMC, Loc. AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Tim Schepers
- Trauma Surgery, Amsterdam UMC, Loc. AMC, G4-137, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| |
Collapse
|
39
|
Beerekamp MSH, Halm JA, Schepers T. Response to "Letter Regarding: Intraoperative Effect of 2D vs 3D Fluoroscopy on Quality of Reduction and Patient-Related Outcome in Calcaneal Fracture Surgery". Foot Ankle Int 2021; 42:246-247. [PMID: 33567237 PMCID: PMC7876638 DOI: 10.1177/1071100720985824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
40
|
Abstract
The quest for the best treatment of displaced intraarticular calcaneal fractures continues. The open reduction and internal fixation of displaced intraarticular calcaneal fractures yields the best results if anatomic reduction is obtained and complications are avoided. The sinus tarsi approach is becoming the new gold standard. In cases with severe comminution or when anatomic reduction cannot be obtained, a primary subtalar arthrodesis is a valuable option, if the overall anatomy of the calcaneus is corrected first. This review discusses the open reduction and internal fixation of displaced intraarticular calcaneal fractures and the indications and technique of the primary arthrodesis.
Collapse
Affiliation(s)
- Tim Schepers
- Trauma Unit, Amsterdam UMC Location AMC, Room G5-250, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| |
Collapse
|
41
|
Dingemans SA, Birnie MFN, Sanders FRK, van den Bekerom MPJ, Backes M, van Beeck E, Bloemers FW, van Dijkman B, Flikweert E, Haverkamp D, Holtslag HR, Hoogendoorn JM, Joosse P, Parkkinen M, Roukema G, Sosef N, Twigt BA, van Veen RN, van der Veen AH, Vermeulen J, Winkelhagen J, van der Zwaard BC, van Dieren S, Goslings JC, Schepers T. Correction to: Routine versus on demand removal of the syndesmotic screw; a protocol for an international randomised controlled trial (RODEO-trial). BMC Musculoskelet Disord 2020; 21:520. [PMID: 32758205 PMCID: PMC7409494 DOI: 10.1186/s12891-020-03516-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S A Dingemans
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - M F N Birnie
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - F R K Sanders
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - M P J van den Bekerom
- Department of Orthopedic Surgery, OLVG, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands
| | - M Backes
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - E van Beeck
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - F W Bloemers
- Department of Surgery, Trauma Unit, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - B van Dijkman
- Department of Surgery, Flevo Hospital, P.O. Box 3005, 1300 EG, Almere, The Netherlands
| | - E Flikweert
- Department of Surgery, Deventer Hospital, P.O. Box 5001, 7400 GC, Deventer, The Netherlands
| | - D Haverkamp
- Department of Surgery, Slotervaart Hospital, P.O. Box 90440, 1006 BK, Amsterdam, The Netherlands
| | - H R Holtslag
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - J M Hoogendoorn
- Department of Surgery, Haaglanden MC, P.O. Box 432, 2501 CK, The Hague, The Netherlands
| | - P Joosse
- Department of Surgery, Noordwest Hospital Group, P.O. Box 501, 1815 JD, Alkmaar, The Netherlands
| | - M Parkkinen
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland
| | - G Roukema
- Department of Surgery, Maasstad Hospital, P.O. Box 9100, 3007 AC, Rotterdam, The Netherlands
| | - N Sosef
- Department of Surgery, Spaarne Hospital, P.O. Box 770, 2130 AT, Hoofddorp, The Netherlands
| | - B A Twigt
- Department of Surgery, BovenIJ Hospital, P.O. Box 37610, 1030 BD, Amsterdam, The Netherlands
| | - R N van Veen
- Department of Surgery, OLVG, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands
| | - A H van der Veen
- Department of Surgery, Catharina Hospital, P.O. Box 1350, 5602 ZA, Eindhoven, The Netherlands
| | - J Vermeulen
- Department of Surgery, Spaarne Hospital, P.O. Box 770, 2130 AT, Hoofddorp, The Netherlands
| | - J Winkelhagen
- Department of Surgery, Westfries Hospital, P.O. Box 600, 1620 AR, Hoorn, The Netherlands
| | - B C van der Zwaard
- Department of Orthopaedics, Jeroen Bosch Hospital, P.O. Box 90153, 5200 ME, 's-Hertogenbosch, The Netherlands
| | - S van Dieren
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - J C Goslings
- Department of Orthopedic Surgery, OLVG, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands
| | - T Schepers
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| |
Collapse
|
42
|
Halm JA, Beerekamp MSH, de Muinck-Keijzer RJ, Beenen LFM, Maas M, Goslings JC, Schepers T. Intraoperative Effect of 2D vs 3D Fluoroscopy on Quality of Reduction and Patient-Related Outcome in Calcaneal Fracture Surgery. Foot Ankle Int 2020; 41:954-963. [PMID: 32517492 PMCID: PMC7406967 DOI: 10.1177/1071100720926111] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Three-dimensional (3D) fluoroscopy is thought to be advantageous in the open reduction and internal fixation (ORIF) of calcaneal fractures. The goal of this multicenter randomized controlled trial was to investigate the clinical effect of additional intraoperative 3D fluoroscopy on postoperative quality of reduction and fixation and patient-reported outcome as compared to conventional 2-dimensional (2D) fluoroscopy in patients with intra-articular fractures of the calcaneus. METHODS Patients were randomized to 3D or conventional 2D fluoroscopy during operative treatment of calcaneal fractures. Primary outcome was the difference in quality of fracture reduction and implant position on postoperative computed tomography (CT). Secondary endpoints included intraoperative corrections (prior to wound closure), complications, and revision surgery (after wound closure). Function and patient-reported outcome were evaluated after surgery and included range of motion, Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot & Ankle Society (AOFAS) score, Short-Form 36 (SF-36) questionnaires, and Kellgren-Lawrence posttraumatic osteoarthritis classification. A total of 102 calcaneal fractures were included in the study in 100 patients. Fifty fractures were randomized to the 3D group and 52 to the 2D group. RESULTS There was a statistically significant difference in duration of surgery between the groups (2D 125 min vs 3D 147 min; P < .001). After 3D fluoroscopy, a total of 57 intraoperative corrections were performed in 28 patients (56%). The postoperative CT scan revealed an indication for additional revision of reduction or implant position in 69% of the 3D group vs 60% in the 2D fluoroscopy group. At 2 years, there was no difference in number of revision surgery, complications, FAOS, AOFAS score, SF-36 score, or posttraumatic osteoarthritis. CONCLUSION The use of intraoperative 3D fluoroscopy in the treatment of intra-articular calcaneal fractures prolongs the operative procedures without improving the quality of reduction and fixation. There was no benefit of intraoperative 3D fluoroscopy with regard to postoperative complications, quality of life, functional outcome, or posttraumatic osteoarthritis.Level of Evidence: Level I, prospective randomized controlled study.
Collapse
Affiliation(s)
- Jens A. Halm
- Trauma Unit, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands,Jens A. Halm, MD, PhD, Trauma Unit, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands.
| | - M. Suzan H. Beerekamp
- Trauma Unit, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | | | - Ludo F. M. Beenen
- Department of Radiology, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | - Mario Maas
- Department of Radiology, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | - J. Carel Goslings
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Tim Schepers
- Trauma Unit, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| |
Collapse
|
43
|
Wijers O, Posthuma JJ, De Haas MBJ, Halm JA, Schepers T. Lateral Process Fracture of the Talus: A Case Series and Review of the Literature. J Foot Ankle Surg 2020; 59:136-141. [PMID: 31668959 DOI: 10.1053/j.jfas.2019.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/23/2019] [Indexed: 02/03/2023]
Abstract
Fracture of the lateral process of the talus (LPFT) is a frequently overlooked injury that can lead to severe complaints if not treated adequately. The aim of this study was to evaluate treatment and long-term outcomes of LPFT through a review of the literature. Furthermore, we propose a modified classification based on severity and intra- or extra-articular location of LPFT. Patients diagnosed with LPFT and treated at a Level 1 trauma center between 2001 and 2018 were included. Fracture and treatment characteristics were recorded in combination with functional outcome and quality of life after a mean follow-up of 5.5 (range 0.8 to 17.2) years. A comprehensive literature search was performed to identify all case series regarding patients with LPFT; 36 patients were included. According to our modified classification, 1 patient had type 1A (2.8%), 6 patients had type 1B (16.7%), 10 patients had type 2 (27.8%), 11 patients had type 3 (30.6%), 6 patients had type 4A (16.7%), and 2 patients had type 4B (5.6%). Twenty-eight patients underwent operative fixation (78%). The median American Orthopaedic Foot and Ankle Society Hindfoot Score was 75 (range 12 to 100). The median Foot Function Index was 2 (range 0 to 9). The median score for the EuroQol-5D was 0.8 (range -0.5 to 1), and the median score for health status component was 75 (range 30 to 98). There is some room for conservative treatment of LPFT; however, we strongly believe that this should be considered only for nondisplaced, small-fragment, and extra-articular fractures. Surgical treatment leads to an overall good (long-term) outcome.
Collapse
Affiliation(s)
- Olivier Wijers
- Surgeon-in-Training, Trauma Unit, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands
| | - Jelle J Posthuma
- Surgeon-in-Training, Trauma Unit, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands
| | - Mathijs B J De Haas
- General Physician, Trauma Unit, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands
| | - Jens A Halm
- Surgeon, Trauma Unit, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands
| | - Tim Schepers
- Surgeon, Trauma Unit, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands.
| |
Collapse
|
44
|
Spierings KE, Sanders FRK, Nosewicz TL, Schepers T. Risk factors for surgical site infections with the Sinus Tarsi Approach in displaced intra-articular calcaneal fractures; a prospective cohort study with a minimum of one year follow-up. Injury 2020; 51:1676-1680. [PMID: 32471686 DOI: 10.1016/j.injury.2020.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/02/2020] [Accepted: 05/02/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND In the last decade, the sinus tarsi approach (STA) has gained interest over the extensile lateral approach (ELA) in the operative treatment of displaced intra-articular calcaneal fractures (DIACF's), mainly because of the lower rate of surgical site infections (SSIs). However, most studies are small and retrospective. The aim of this study was to evaluate the rate of SSIs of the STA in a large, prospective series of patients and to identify predictors for SSIs. METHODS In this prospective cohort study, all consecutive patients who were operatively treated for a DIACF in our Level 1 trauma center between August 2012 and January 2019 were included and followed for at least one year. All operative procedures were performed by two specialized foot and ankle trauma surgeons using the STA. Using multinomial logistic regression, risk factors for SSIs were identified. RESULTS A total of 237 calcaneal fractures in 214 patients were included, of which 179 underwent open reduction and internal fixation and 58 a primary arthrodesis. Most patients were male (73.6%) and the mean age was 45.9 years. There were 16 patients that developed a SSI (6.8%), of which 9 (3.8%) were deep and 7 (3%) were superficial infections. The multivariate analysis pointed out that surgery within one week after injury increased the chance of a SSI, as well as an ASA of 2 or higher and more than 150 cc of blood loss during the procedure. CONCLUSION This study confirms the low risk of SSI in DIACFs treated via STA. Significant predictors for SSIs were surgery within one week after injury, ASA of 2 or higher and blood loss > 150cc.
Collapse
Affiliation(s)
- K E Spierings
- Amsterdam UMC, University of Amsterdam, trauma unit, Meibergdreef 9, Amsterdam,1105 AZ, The Netherlands
| | - F R K Sanders
- Amsterdam UMC, University of Amsterdam, trauma unit, Meibergdreef 9, Amsterdam,1105 AZ, The Netherlands
| | - T L Nosewicz
- Amsterdam UMC, University of Amsterdam, trauma unit, Meibergdreef 9, Amsterdam,1105 AZ, The Netherlands
| | - T Schepers
- Amsterdam UMC, University of Amsterdam, trauma unit, Meibergdreef 9, Amsterdam,1105 AZ, The Netherlands.
| |
Collapse
|
45
|
Sanders FRK, Kistemaker RMG, van 't Hul M, Schepers T. Comparison of 2g vs 1 g of Prophylactic Cefazolin in Surgical Site Infections in Trauma Surgery Below the Knee. Foot Ankle Int 2020; 41:582-589. [PMID: 32026706 DOI: 10.1177/1071100720903723] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The rate of surgical site infections (SSIs) after foot or ankle surgery remains high, despite the implementation of antibiotic prophylaxis. Recently, guidelines suggest a single dose of 2 g instead of 1 g of cefazolin for implant surgery; this decision is largely based on pharmacokinetic studies. However, the clinical effect of this higher dose has never been investigated in foot and ankle surgery. This retrospective cohort study investigated the effect of 2 g compared with 1 g of prophylactic cefazolin on the incidence of SSIs in foot and ankle surgery. METHODS All patients undergoing trauma-related surgery of the foot, ankle, or lower leg between September 2015 and March 2019 were included. The primary outcome was the incidence of an SSI. SSIs were compared between patients receiving 1 g and 2 g of cefazolin as surgical prophylaxis, using a propensity score to correct for possible confounders. RESULTS A total of 293 patients received 1 g and 126 patients received 2 g of cefazolin. The overall number of SSIs was 19 (6.5%) in the 1-g group and 6 (4.8%) in the 2-g group. Corrected for possible confounders, this was not statistically significant (OR, 0.770; P = .608). CONCLUSION Even though the decrease in SSI rate from 6.5% to 4.8% was found not to be statistically significant, it might be clinically relevant considering the reduction in morbidity, mortality, and healthcare costs. Research linking pharmacokinetic and clinical results of prophylactic cefazolin is needed to establish whether or not the current recommendations and guidelines are sufficient for preventing SSIs in foot and ankle surgery. LEVEL OF EVIDENCE Level III, retrospective comparative series.
Collapse
Affiliation(s)
- Fay R K Sanders
- Amsterdam UMC, University of Amsterdam, Trauma Unit, Amsterdam, The Netherlands
| | | | - Mirjam van 't Hul
- Amsterdam UMC, University of Amsterdam, Trauma Unit, Amsterdam, The Netherlands
| | - Tim Schepers
- Amsterdam UMC, University of Amsterdam, Trauma Unit, Amsterdam, The Netherlands
| |
Collapse
|
46
|
Abstract
Cuboid fractures rarely occur in isolation, and a high index of suspicion for the presence of Chopart, Lisfranc, or complex midfoot injuries should be raised. The cuboid is the cornerstone of the lateral column and acts as a bridge between the lateral column and the transverse plantar arch. Its most important role is maintenance of lateral column length and associated motion in the midtarsal and tarsometatarsal joints. To date, a classification system that is validated for clinical practice (i.e., guidance for management and prediction of outcome and prognosis) is lacking. The principles of operative treatment are restoration of articular congruity, lateral column length, and stability of the Chopart and Lisfranc joints. Nonoperative management is reserved for nondisplaced articular fractures (<1 mm) or avulsion fractures that are caused by low-energy trauma.
Collapse
Affiliation(s)
- Esmee W M Engelmann
- Trauma Unit, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Stefan Rammelt
- University Center for Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Tim Schepers
- Trauma Unit, Amsterdam University Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
47
|
Sanders FRK, Peters JJ, Schallig W, Mittlmeier T, Schepers T. What is the added value of pedobarography for assessing functional outcome of displaced intra-articular calcaneal fractures? A systematic review of existing literature. Clin Biomech (Bristol, Avon) 2020; 72:8-15. [PMID: 31783218 DOI: 10.1016/j.clinbiomech.2019.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/14/2019] [Accepted: 11/19/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Displaced intra-articular calcaneal fractures often result in permanent disability, reduced quality of life and high socio-economic costs. Since they often result in a change in geometry of the foot, pedobarography may be useful in predicting outcome at an early stage. The aim of this study was to examine whether a correlation exists between pedobarography and functional outcomes in patients with a displaced intra-articular fracture. METHODS In this systematic review, studies were included when they investigated the correlation between pedobarography and functional outcome in displaced intra-articular calcaneal fractures. Excluded were studies on <10 patients or on animals/cadavers. Collected were baseline patient/treatment characteristics, pedobarographic data (peak pressures, maximum force and centre of pressure) and functional outcome scores. FINDINGS Out of 153 abstracts, 40 remained for full text screening and 9 were included. Pedobarographic measurements (pressure plate or insoles) showed a lateralization of centre of pressure, decreased pressures underneath the hindfoot, first and second toe and increased pressure underneath the midfoot and forefoot. Correlations with functional outcome were found in some combined pedobarographic results (entire foot/multiple measurements), but hardly in pressures underneath specific foot areas. INTERPRETATION Even though increased or decreased pressures in specific areas of the foot may not be directly related to functional outcome, combined scores often did. For pedobarography to serve as a prediction tool, it should be more standardised. However, assessing centre of pressure and altered peak pressures underneath the foot, may be useful in developing customized aids such as insoles, aiming for a more individualized improvement.
Collapse
Affiliation(s)
- Fay R K Sanders
- Amsterdam UMC, Univ. of Amsterdam, Trauma Unit, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Jess J Peters
- Amsterdam UMC, Univ. of Amsterdam, Trauma Unit, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Wouter Schallig
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Amsterdam UMC, Univ. of Amsterdam, Department of Radiology and Nucleair Medicine, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Thomas Mittlmeier
- Rostock University Medical Center, Dept. of Trauma, Hand and Reconstructive Surgery, Schillingallee 35, 18057 Rostock, Germany
| | - Tim Schepers
- Amsterdam UMC, Univ. of Amsterdam, Trauma Unit, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| |
Collapse
|
48
|
Schepers T. Pandemic Lockdown Does Not Flatten the Curve of Complex Foot Ankle Injuries. J Foot Ankle Surg 2020; 59:878. [PMID: 32736974 PMCID: PMC7313491 DOI: 10.1053/j.jfas.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Tim Schepers
- Address correspondence to: Tim Schepers, MD, PhD, Trauma Unit, Amsterdam UMC Location AMC, Meibergdreef 9, Amsterdam, the Netherlands
| |
Collapse
|
49
|
Sanders FRK, Van't Hul M, Kistemaker RMG, Schepers T. Seasonal effect on the incidence of post-operative wound complications after trauma-related surgery of the foot, ankle and lower leg. Arch Orthop Trauma Surg 2020; 140:1677-1685. [PMID: 32152664 PMCID: PMC7560940 DOI: 10.1007/s00402-020-03395-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Post-operative wound complications remain among the most common complications of orthopedic (trauma) surgery. Recently, studies have suggested environmental factors such as season to be of influence on wound complications. Patients operated in summer are reported to have more wound complications, compared to other seasons. The aim of this study was to identify if "seasonality" was a significant predictor for wound complications in this cohort of trauma-related foot/ankle procedures. MATERIALS AND METHODS This retrospective cohort study included all patients undergoing trauma-related surgery (e.g. fracture fixation, arthrodesis, implant removal) of the foot, ankle or lower leg. Procedures were performed at a Level 1 Trauma Center between September 2015 until March 2019. Potential risk factors/confounders were identified using univariate analysis. Procedures were divided into two groups: (1) performed in summer (June, July or August), (2) other seasons (September-May). The number of surgical wound complications (FRIs, SSIs or wound dehiscence) was compared between the two groups, corrected for confounders, using multivariate regression. RESULTS A total of 599 procedures were included, mostly performed in the hindfoot (47.6%). Patients were on average 46 years old, and mostly male (60.8%). The total number of wound complications was 43 (7.2%). Age, alcohol abuse, open fracture and no tourniquet use were independent predicting factors. No difference in wound complications was found between summer and other seasons, neither in univariate analysis [4 (3.2%) vs 39 (8.2%), p = 0.086] nor when corrected for predicting factors as confounders (p = 0.096). CONCLUSIONS No seasonality could be identified in the rate of wound complications after trauma surgery of the lower leg, ankle and foot in this cohort. This lack of effect might result from the temperate climate of this cohort. Larger temperature and precipitation differences may influence wound complications to a larger extent. However, previous studies suggesting seasonality in wound complications might also be based on coincidence.
Collapse
Affiliation(s)
- Fay Ruth Katharina Sanders
- Amsterdam UMC, University of Amsterdam, Trauma Unit, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Mirjam Van't Hul
- Amsterdam UMC, University of Amsterdam, Trauma Unit, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | | | - Tim Schepers
- Amsterdam UMC, University of Amsterdam, Trauma Unit, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| |
Collapse
|
50
|
Oehme F, Schütze K, Link BC, Frima H, Schepers T, Rhemrev S, Rickman M, Babst R, Beeres FJP. Perception of quality of intraoperative fluoroscopy and the influence on postoperative management: an international survey. Eur J Trauma Emerg Surg 2019; 47:1073-1079. [PMID: 31863134 DOI: 10.1007/s00068-019-01286-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 12/11/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Intraoperative precise visualization of fractures and assessment of the quality of reduction is essential in orthopedic trauma surgery. Fluoroscopic skills will lead to an increased detection rate of minimal abnormalities needing revision intraoperatively. The definition of fluoroscopic skills and the interpretation of acceptable "minimal abnormalities" remains somehow unclear. The purpose of this study was to analyze the subjective quality assessment of intraoperative radiographs (IR) and whether they are influenced by cultural and demographic factors. Furthermore, we aimed to answer the question whether the indication for revision surgery is international comparable or rather influenceable by cultural aspects. METHODS Intraoperative radiographs of 30 patients operated for an ankle or radius fracture were selected for an international survey. In total, 22 patients were randomly selected from an already existing database and eligible for inclusion if reduction was accomplished during initial operation without planed revision. Eight patients of this group had undergone an unplanned revision surgery (26.6%). Fifteen orthopedic trauma surgeons from three different countries answered this survey. All raters were senior consultants. RESULTS The quality of reduction was rated as good in both the AP (7.95 of 10) and lateral (7.84 of 10) views. The inter-observer reliability was substantially weaker in Country B (kappa of 0.23) compared to Countries A (p value < 0.05) and C (range 0.33-0.43). In only 33% of the cases the raters requested a postoperative radiograph. This was significantly fewer (p value < 0.001) in Country A. The frequency of postoperative requested CT's was comparable between the countries. CONCLUSION This study showed acceptable IR assessment in terms of quality rating. Furthermore, it revealed substantial differences in the postoperative decision-making process in different countries, especially regarding the necessity for postoperative radiographs. This suggests that definition for indication of revision surgery is culturally influenced.
Collapse
Affiliation(s)
- Florian Oehme
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, P.O. Box 6000, Spitalstrasse 16, CH-6000, Luzern, Switzerland. .,Department for Visceral, Thoracic and Vascular surgery, University Hospital Carl Gustav Carus, Dresden, Germany.
| | - Konrad Schütze
- Department of Trauma Surgery, University Hospital Ulm, P.O. Box 89081, Albert-Einstein-Allee 23, D-89081, Ulm, Germany
| | - Björn Christian Link
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, P.O. Box 6000, Spitalstrasse 16, CH-6000, Luzern, Switzerland
| | - Herman Frima
- Department of Surgery, Cantonal Hospital Graubünden, P.O.Box 170, Loëstrasse 170, CH-7000, Chur, Switzerland
| | - Tim Schepers
- Department of Surgery-Traumatology, Amsterdam Medical Centre, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands
| | - Steven Rhemrev
- Department of Surgery, Medical Center Haaglanden, Lijnbaan 32, 2512, The Hague, VA, The Netherlands
| | - Mark Rickman
- Centre for Orthopaedic and Trauma Research, University of Adelaide & Royal Adelaide Hospital, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Reto Babst
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, P.O. Box 6000, Spitalstrasse 16, CH-6000, Luzern, Switzerland
| | - Frank Joseph Paulus Beeres
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, P.O. Box 6000, Spitalstrasse 16, CH-6000, Luzern, Switzerland
| |
Collapse
|