Health Disparities in Nontraumatic Lower Extremity Amputations. A Systematic Review and Meta-Analysis.

BACKGROUND: Chronic diseases and their associated health outcomes have been known to disproportionately affect people of low socioeconomic status (SES) around the world. The authors aim to examine the association between SES and nontraumatic lower extremity amputation. METHODS: A search of current literature was performed in March 2022 across PubMed, Scopus, Embase, and Medline for relevant literature. Keywords included "socioeconomics", "income", "amputation", and "lower extremities". RESULTS: A total of 1,164,630 patients across 5 studies were incorporated into the meta-analysis of nontraumatic lower extremity amputation and SES. An additional 3 citations were used in the secondary analyses between gender and ethnicity and their relationship with amputation. An association was observed between low SES and nontraumatic lower extremity amputations, odds ratio (OR) = 1.168, (confidence interval [CI]: 1.153, 1.183) P ≤ 0.05. Gender and race subanalyses were also conducted, with associations found with men and non-Caucasians with amputation: OR = 1.044; [CI: 1.036, 1.053] P ≤ 0.05; race OR = 2.893; [CI: 2.866, 2.920] P ≤ 0.05. CONCLUSIONS: SES along with gender and race are associated with nontraumatic lower extremity amputation. These findings add additional perspectives for which populations are disproportionately affected by disease and subsequent health outcomes. The authors anticipate the results presented may further assist in future public health screening methods and interventions. LEVEL OF CLINICAL EVIDENCE: 2.

A Systematic Review and Meta-analysis of Total Ankle Arthroplasty or Ankle Arthrodesis for Treatment of Osteoarthritis in Patients With Diabetes.

Background: End-stage ankle osteoarthritis often requires one of 2 major surgical procedures: total ankle arthroplasty or ankle arthrodesis. Although the gold standard has been arthrodesis, patients with diabetes represent a unique cohort that requires additional considerations because of their decreased mobility and risk factors for cardiovascular complications. The purpose of this study is to review odds of major and minor adverse events for patients with diabetes and patients without diabetes in both total ankle arthroplasty and ankle arthrodesis. Methods: A total of 14 articles published between 2010 and 2020 were included in this review. Databases included PubMed, Scopus, MEDLINE/Embase, and Cochrane Library. Key words included ankle arthroplasty, total ankle arthroplasty, ankle arthrodesis, and diabetes. Results: The total number of procedures was 26 287, comprising 13 830 arthroplasty and 12 457 arthrodesis procedures. There was a significant association between patients with diabetes treated with arthrodesis and major adverse events (odds ratio [OR] 1.880, 95% CI 1.279, 2.762), whereas no significant association was observed between patients with diabetes treated with arthroplasty and major adverse events (OR 1.106, 95% CI 0.871, 1.404). Conclusion: This meta-analysis suggests patients with diabetes to be at significantly higher risk for major and minor adverse events after undergoing ankle arthrodesis. However, it suggests no significant differences in major adverse events between patients with diabetes and patients without diabetes having undergone total ankle arthroplasty. Level of Evidence: Level III, systematic review and meta-analysis.

A Systematic Review and Meta-Analysis of the Effectiveness of LRINEC Score for Predicting Upper and Lower Extremity Necrotizing Fasciitis.

This review and meta-analysis aims to assess the prognostic value of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score for detecting necrotizing fasciitis in the extremities. The LRINEC score has been validated in multiple studies as a clinical tool for differentiating necrotizing fasciitis from non-necrotizing infections however many studies do not specify the location of infection. As the prevalence of diabetes and diabetic foot infections continues to rise, the utility of LRINEC scores in these populations becomes of increased importance. Four databases were reviewed for citations between January 2010 and December 2020. English, full text articles reporting the diagnostic effects of LRINEC were utilized in the systematic review portion of this paper. Further inclusion of 2 × 2 tables and discussion specific to the extremities were applied for citations implemented in the meta-analysis. Of the 111 results, 12 citations (n = 932) were included in this review. The diagnostic sensitivity of the LRINEC score ranged from 36% to 77% while specificity ranged from 72% to 93%. Cumulative odds ratio for LRINEC ≥6 among the 4 studies assessing extremity necrotizing fasciitis was 4.3 with p value of <.05. Sensitivity, specificity, positive predictive value, and negative predictive value was 49.39%, 83.17%, 34.91%, and 89.99%, respectively. Accuracy, the classification by whether a patient was correctly classified, was 77.95%. LRINEC score is effective at distinguishing necrotizing fasciitis from other soft tissue infections however the LRINEC's score greatest clinical application may be its ability to rule out necrotizing fasciitis while its ability to accurately identify the presence of infection remains suboptimal.

Symmetrical peripheral gangrene of bilateral feet and unilateral hand after administration of vasopressors during septic shock.

We report a case of a 75-year-old Hispanic man treated for septic shock after undergoing surgery for impacted renal stones. He was given vasopressors and later developed symmetrical peripheral gangrene (SPG) on both his feet and left hand. SPG is a serious and rare condition presenting clinically as an acute onset of ischaemia with no vessel occlusion. Vasopressors are identified as a contributing factor in SPG development. The patient ultimately underwent transmetatarsal amputations of both feet and amputation of three digits on his left hand. Early monitoring and swift management of peripheral ischaemia are essential when using vasopressors for the treatment of septic shock.

Chigger mite infestation.

This article reports on a 45-year-old woman who presented with pruritus and was diagnosed as having chigger mite infestation, a rare condition. The chigger mite larvae were encountered while the patient was traveling in South America. A small erythematous area with a well-circumscribed papule in the sulcus of the second digit of the right foot was incised and drained. Follow-up examination showed relief of all symptoms, including pain and pruritus. This unusual case presentation underscores the need for all podiatric physicians to obtain a comprehensive history, including history of travel, along with performing a thorough physical examination.