Incidence of Achilles tendon rupture: 25-year regional analysis with a focus on bilateral ruptures.

OBJECTIVE: We aimed to fill the research gap regarding the incidence of Achilles tendon rupture (ATR), which is reportedly increasing, as there is a lack of data on the incidence of ATR and no data on bilateral ruptures in our region. METHODS: We determined the incidence of complete ATR among 273,485 people during 1991 to 2015. RESULTS: In the study period, 524 patients (486 [92.75%] men and 38 [7.25%] women, average age 39.03±10.86 [range 20-83] years, = sex ratio 12.8:1) were treated for ATR in our study area. The average incidence was 7.77 per 100,000 person-years, with an increasing trend until 2008 and peak incidence of 11.33 per 100,000 person-years. Most injuries (67.04%) occurred while performing sports activities. In total, 7 (1.34%) patients (six men [1.23%] and one woman [2.63%]) experienced ruptures on both sides, an average of 5.1 years apart; the average age at the second rupture was 57.71±16.69 (range 39-83) years, with a calculated incidence for bilateral ATR of 0.1 per 100,000 person-years. CONCLUSIONS: The incidence of complete ATR in our study region increased gradually between 1991 and 2008, after which it declined. Bilateral ATR during that period was a very rare injury.

Traumatic Brain Injury during the SARS-CoV-2 Pandemics in Slovenia: A Single Center Study.

(1) Background: The SARS-CoV-2 pandemic had a significant impact on the management of traumatic brain injury (TBI). We aimed to compare the clinical characteristics and outcomes of TBI patients before and during the SARS-CoV-2 pandemic.; (2) Methods: We analyzed depicted data from existing medical records on sex, age, mechanism of injury, clinical performance at admission and discharge, neuroimaging, laboratory values at admission, mortality, duration of hospitalization, and referrals after discharge from the traumatology department for all adult patients during the SARS-CoV-2 pandemic and a year before. Variables were compared using the Chi-square or t-test between both groups.; (3) Results: Most patients had mild (n = 477), followed by moderate (11) and severe (11) TBI. Mild TBI was less frequent during the SARS-CoV-2 period (n = 174 vs. n = 303). The incidence of high falls increased during the SARS-CoV-2 period (14.5% vs. 24.7%; p < 0.05) in the group with mild TBI. Patients had similar mean Glasgow Coma Scales (GCS), Glasgow Outcome Scales-Extended (GOSE), and glucose levels at admission before and during the pandemic. Serum ethanol levels were significantly lower during the SARS-CoV-2 period (1.3 ± 0.7 mmol/L vs. 0.7 ± 1.2 mmol/L; p < 0.001). At discharge, the mean GCS was significantly lower (14.7 ± 1.8 vs. 14.1 ± 0.5; p < 0.05) for patients treated during the SARS-CoV-2 period than before the SARS-CoV-2 period. There were no differences in GOSE; (4) Conclusions: our results demonstrated a significant impact of SARS-CoV-2 pandemic on the frequency, mechanism, and consequences of TBI, and may help improve care for our patients.

Comparison of craniofacial morphology in individuals with and without hypodontia with a special focus on the number of congenitally missing teeth.

Background: Hypodontia might negatively affect dental function and esthetics, what might affect patients' self-esteem, communication behavior, professional performance and thus quality of life. The aim of this study was to estimate the influence of number of congenital missing teeth on dentofacial features. Methods: Lateral cephalograms of 60 individuals with hypodontia (study group) and 40 individuals without hypodontia (control group) were analyzed. Patients in the study group were divided into two subgroups according to the number of missing teeth (group A with hypodontia 1 to 4 teeth and group B with hypodontia 5 or more teeth). Cephalometric data were compared among the study and control groups and statistically analyzed. Results: The results in the present study revealed a significantly shorter and more retrognathic maxilla, more prognathic chin position, more retruded incisors in both jaws, large interincisal angle, straighter facial convexity as well as more retruded upper and lower lips in the group B compared with the control group. In the group A only chin position was significantly more prognathic compared with the control group. Conclusions: According to the results of present study impact of hypodontia on the craniofacial morphology and consequently on facial esthetics was found statistically significantly greater in patients with 5 or more congenitally missing teeth.

The effect of the ankle syndesmosis reduction quality on the short-term functional outcome following ankle fractures.

INTRODUCTION: A few radiographic techniques have been proposed to evaluate ankle syndesmosis reduction. The purpose of this study was to analyze post-operatively with CT-scanning the quality of ankle syndesmotic reduction. Moreover, to assess the impact of quality of syndesmotic reduction to functional outcome. MATERIALS AND METHODS: A prospective cohort study focused on patients older than 17 years with lateral and medial malleolar fracture with verified syndesmotic disruption. EXCLUSION CRITERIA: open fracture, concomitant injury, surgery delayed for more than 24 hours, additional posterior malleolar fracture, ASA score of ≥ 3, complication requiring revision surgery, articular step or gap of ≥ 2mm on the postoperative CT scans. RESULTS: Out of 41 patients, 34 participants completed the follow-up. There was a male predominance (20 patients - 58.82%) and the mean age was 48.46±16.1 years (range (20-72 years). 22 patients (64.71%) have sustained type B fracture, while in 12 patients (35.29%) the fracture was of a type C. The reduction was classified as anatomical in 26 patients (76.50%), while in 8 patients (23.50%) the reduction of the syndesmosis was non-anatomical. In those 26 patients in whom the reduction was anatomical, 17 (65.39%) were males and there were 18 (66.67%) type B fractures. In the patients with non-anatomical reduction, 3 patients (37.5%) were of a male gender and there was the equal number of type B and C fractures. The statistical analysis showed significantly favorable scores for both AOFAS score and VAS scale for the patients with anatomical reduction. CONCLUSION: Functional analysis showed a strong association with the CT observed reduction quality and both the AOFAS score and VAS scale. Further studies are desirable to provide further evidence in relation to the findings of this study.

Long-Term Results With the Use of Modified Percutaneous Repair of the Ruptured Achilles Tendon Under Local Anaesthesia (15-Year Analysis With 270 Cases).

Controversy regarding the optimal treatment of fresh total Achilles tendon rupture remains. This article presents results with the use of modified percutaneous Achilles tendon repair under local anesthesia performed from January 1991 to December 2005 with a 2- to 10-year follow-up. There were 270 procedures in 247 male patients (92.51%) and 20 female patients (7.49%), mean ± SD age 38.7 ± 11.56 (range 20 to 83) years, in all consecutively treated patients within 7 days after acute total rupture; 3 patients sustained ruptures on both sides in different periods. Postoperative care consisted of wearing a cast or soft cast or functional immobilization for 6 weeks. The procedure was well tolerated in all patients. There were 3 (1.11%) complete and 5 (1.85%) partial repeat ruptures (8 [2.96%] altogether). Fourteen patients (5.18%) developed transient sural neuritis that spontaneously resolved in 2 to 10 months. One case (0.3%) of deep venous thrombosis was successfully treated. There were 25 (9.36%) major and minor complications altogether, with no cases of increased postoperative dorsiflexion, deep infection, or necrosis. Forty-four patients (16.48%) had a slightly decreased range of ankle motion, and 216 (80.89%) patients, including all high-caliber athletes, resumed all their previous activities. The mean American Orthopedic Foot and Ankle Society hindfoot-ankle score was 96.10 points. Long-term results of the analyzed modified method suggest a reasonable treatment option for acute total Achilles tendon ruptures, with a low number of complications and repeat rupture rate and return to preinjury activities comparable to those of open procedures.

Hypodontia phenotype in patients with epithelial ovarian cancer.

BACKGROUND: Ovarian cancer is usually diagnosed in an advanced stage and the present clinical and diagnostic molecular markers for early OC screening are insufficient. The aim of this study was to identify potential relationship between the hypodontia and epithelial ovarian cancer (EOC). PATIENTS AND METHODS: A retrospective study was conducted on 120 patients with EOC treated at the Department of Gynaecologic and Breast Oncology at the University Clinical Centre and 120 gynaecological healthy women (control group) of the same mean age. Women in both groups were reviewed for the presence of hypodontia and the patients with EOC also for clinicopathological characteristics of EOC according to hypodontia phenotype. RESULTS: Hypodontia was diagnosed in 23 (19.2%) of patients with EOC and 8 (6.7%) controls (p = 0.004; odds ratio [OR] = 3.32; confidence interval [CI], 1.42-7.76). There was no statistically significant difference in patients with EOC with or without hypodontia regarding histological subtype (p = 0.220); they differed in regard to FIGO stage (p = 0.014; OR =3.26; CI, 1.23-8.64) and tumour differentiation grade (p = 0.042; OR = 3.1; CI, 1.01-9.53). Also, bilateral occurrence of EOC was more common than unilateral occurrence in women with hypodontia (p = 0.021; OR = 2.9; CI, 1.15-7.36). We also found statistically significant difference between the ovarian cancer group and control group in presence of other malignant tumours in subjects (p < 0.001). CONCLUSIONS: The results of the study suggest a statistical association between EOC and hypodontia phenotype. Hypodontia might serve as a risk factor for EOC detection.

Hypodontia prevalence and pattern in women with epithelial ovarian cancer.

OBJECTIVE: To analyze the possible association between hypodontia and epithelial ovarian cancer (EOC), with the special interest in hypodontia pattern. MATERIALS AND METHODS: One hundred twenty women with EOC treated at the Department of Gynecologic and Breast Oncology at the University Clinical Centre and 120 gynecologically healthy women of the same average age were reviewed for the presence and pattern of hypodontia. Collected data were analyzed for frequency, tooth type, location per jaw and side, number of missing teeth per person, and family history of hypodontia. RESULTS: The results of the study showed prevalence of hypodontia in 19.2% of women with EOC and in 6.7% of women in the control group (P  =  .004). The most frequently missing teeth for women with EOC and women in the control group were maxillary second premolars and maxillary lateral incisors, respectively. Unilateral occurrence of hypodontia was more common than bilateral occurrence in women with EOC (P  =  .034). Of women with EOC and hypodontia, 21.7% reported a positive family history of hypodontia compared with no report in the control group of women with hypodontia (P  =  .150). CONCLUSIONS: The results statistically support possible association between EOC and hypodontia. Because hypdontia can be recognized early in life, this finding could possibly help in earlier detection of EOC, resulting in better prognosis and treatment in earlier stages of the disease. Earlier EOC diagnosis and treatment could save many lives.

Individualized anterior cruciate ligament surgery: a prospective study comparing anatomic single- and double-bundle reconstruction.

BACKGROUND: Reconstruction of the anterior cruciate ligament (ACL) has become a commonly performed procedure. However, biomechanical studies have demonstrated that conventional single-bundle ACL reconstruction techniques are only successful in limiting anterior tibial translation but less effective for restoring rotatory laxity. PURPOSE: This study aimed to compare the results of single- and double-bundle ACL reconstruction using an anatomic technique, individualized based on the patient's native ACL size. The authors hypothesized that there would be no difference between the results of anatomic single-bundle (ASB) and anatomic double-bundle (ADB) reconstruction when the surgical technique is individualized. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Depending on intraoperative measurements of the ACL insertion site size, patients were selected for either ASB (n = 32) or ADB (n = 69) ACL reconstruction. In all groups, hamstring tendons autograft was used with suspensory fixation on the femoral side and bioabsorbable interference screw fixation on the tibial side. The outcomes were evaluated by an independent blinded observer using the Lysholm score, subjective International Knee Documentation Committee (IKDC) form, KT-1000 arthrometer for anteroposterior stability, and pivot-shift test for rotational stability. The average follow-up was 30 months (range, 26-34 months). There were no statistically significant differences in the baseline demographics of the 2 groups. RESULTS: There was no significant difference between the ADB and ASB groups for Lysholm score (93.9 vs 93.5), subjective IKDC score (93.3 vs 93.1), anterior tibial translation (1.5- vs 1.6-mm side-to-side difference), and pivot shift (92% vs 90% with negative pivot-shift examination). CONCLUSION: Anatomic double-bundle reconstruction is not superior to anatomic single-bundle reconstruction when an individualized ACL reconstruction technique is used.

Prospective randomized clinical evaluation of conventional single-bundle, anatomic single-bundle, and anatomic double-bundle anterior cruciate ligament reconstruction: 281 cases with 3- to 5-year follow-up.

BACKGROUND: Three different techniques of anterior cruciate ligament (ACL) reconstruction--conventional (transtibial) single bundle (CSB), anatomic single bundle (ASB), and anatomic double bundle (ADB)--have been described. PURPOSE: To determine if double-bundle reconstruction is needed to restore rotational stability or if anatomic placement of a single bundle can yield similar results. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: From December 2005 to December 2007, 320 patients were prospectively randomized into 3 groups: ADB, ASB, and CSB reconstruction. The average follow-up was 51.15 months (range, 39-63 months). At the final follow-up, 281 patients were available. In all groups, hamstring tendons were used with suspensory fixation on the femoral side and bioabsorbable interference screw fixation on the tibial side. The outcomes were evaluated by an independent blinded observer using the Lysholm score and subjective International Knee Documentation Committee (IKDC) form. The KT-1000 arthrometer was used to evaluate anteroposterior stability, and the pivot-shift test was used to determine rotational stability. RESULTS: Anatomic single-bundle reconstruction resulted in better anteroposterior and rotational stability than CSB reconstruction (average side-to-side difference for anterior tibial translation was 1.6 mm in the ASB group vs 2.0 mm in the CSB group; P = .002). Negative pivot shift was 66.7% vs 41.7% (P = .003). In other parameters, the differences between groups were not statistically significant. The results of the ADB group were also superior to the ASB group for anteroposterior and rotational stability (average side-to-side difference for anterior tibial translation was 1.2 mm in the ADB group vs 1.6 mm in the ASB group; P = .002). Negative pivot shift was 93.1% vs 66.7%, respectively (P < .001), and range of motion was also significantly different (P = .005). The Lysholm score was 90.9, 91.8, and 93.0 in the CSB, ASB, and ADB groups, respectively. The difference was significant only when we compared ADB and CSB (P = .025). Subjective IKDC scores were 90.2, 90.6, and 92.1 in the CSB, ASB, and ADB groups, respectively. The difference was not significant. CONCLUSION: Anatomic double-bundle ACL reconstruction is significantly superior to conventional single-bundle ACL reconstruction and better than anatomic single-bundle reconstruction. Anatomic single-bundle reconstruction was superior to conventional single-bundle reconstruction. However, these differences are small and may not be clinically relevant.

Incidence and outcome of operatively treated achilles tendon rupture in the elderly.

BACKGROUND: Very little has been published about Achilles tendon rupture in the elderly. Optimal therapy is controversial with conservative treatment generally recommended. The purpose of our study was to find the incidence and outcome of operatively treated Achilles tendon ruptures in the elderly. MATERIALS AND METHODS: We determined the incidence of a closed complete Achilles tendon rupture in a period from 1991 to 2000 in two centers caring for 572,929 people with 108,668 people over 60 years of age. RESULTS: In a 10-year period there were 434 ruptures, all of which were treated operatively: 146 in an open fashion and 288 percutaneously. The average incidence was 7.6 ruptures per 100,000 people. The average age of patients was 38.7 years, with a male-to-female ratio of 16.7:1. There were 14 ruptures in 13 patients older than 60 years, with the incidence of 1.28 ruptures per 100,000 people. Seven of the ruptures were operated on in an open way under spinal anesthesia and seven percutaneously under local anesthesia. The average age of the patients was 67.9 years, with a male-to-female ratio of 1.6:1 and the mean ASA score 1.64. There were no major complications in either group. One patient in the percutaneous group had transient sural nerve injury and one patient in the open group had a superficial infection. All of the patients returned to their previous activities, four of them with some limitations. The average AOFAS score was 93.1 points. CONCLUSION: Achilles tendon rupture in the elderly is a rare injury. Operative treatment can yield a successful outcome.

Percutaneous versus open repair of the ruptured Achilles tendon: a comparative study.

BACKGROUND: Controversy regarding the optimal treatment of the fresh total Achilles tendon rupture remains. PURPOSE: To compare the results of percutaneous and open Achilles tendon repair. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: The results of 132 consecutive patients with acute complete Achilles tendon rupture who were operated on exclusively with modified percutaneous repair under local anesthesia from 1991 to 1997 and followed up for at least 2 years were compared to the results of 105 consecutive patients who were operated on exclusively with open repair under general or spinal anesthesia in the same period. RESULTS: There were significantly fewer major complications in the group of percutaneous repairs in comparison with the group of open repairs (4.5% vs 12.4%; P = .03), particularly necrosis (0% vs 5.6%; P = .019), and a lower total number of complications (9.7% vs 21%; P = .013). There were slightly more reruptures (3.7% vs 2.8%; P = .680) and sural nerve disturbances (4.5% vs 2.8%; P = .487) in the group of percutaneous repairs, with no statistically significant difference. Functional assessment using the American Orthopaedic Foot and Ankle Society scale and the Holz score showed no statistically significant difference. CONCLUSION: The results of the study support the choice of (modified) percutaneous suturing under local anesthesia as the method that brings comparable functional results to open repair, with a significantly lower rate of complications.

Incidence and outcome of rupture of the Achilles tendon.

We determined the incidence of complete rupture of the Achilles tendon in the Maribor region (273,609 inhabitants) between 1991 and 1996. During this period, 116 ruptures were treated at Maribor Teaching Hospital. The average incidence was 7 ruptures per 100,000 inhabitants, with a peak incidence of almost 9 per 100,000. Most injuries (65%) occurred during sports activities, with soccer as the major cause of rupture. The average age of patients was 37 years with a male-to-female ratio of 18:1. All patients underwent open surgical repair of the ruptured Achilles tendon, with a minimum follow-up of two years. 19.8% of cases developed complications and in 10.4% of these the complications were major. 1.9% of patients sustained a re-rupture. The mean AOFAS score was 96 points. The patients were subjectively very satisfied with their treatment in 88% of cases. Good functional results with a return to the usual pre-injury activities were achieved in 96% of patients.

Percutaneous suturing of the ruptured Achilles tendon under local anesthesia.

A prospective study of modified percutaneous Achilles tendon repair performed from 1991 to 1997 under local anesthesia with a minimum 2-year follow-up is presented. There were 134 procedures in 124 men and 8 women (mean age, 37 years) treated within 7 days after acute total rupture. Postoperative care consisted of wearing a cast or soft-cast immobilization for 6 weeks. The procedure was well tolerated in all patients. There was 1 (0.7%) complete and 4 (3%) partial reruptures. Six patients (4.5%) developed transient sural neuritis that spontaneously resolved in 3 to 10 months. One case of deep venous thrombosis was successfully treated. There were no cases of increased postoperative dorsiflexion, deep infection, or necrosis. Eighteen patients (14%) had a slightly decreased range of ankle motion; 129 (98%) patients, including all high-caliber athletes, resumed all their previous activities, 22 of them (17%) with some minor complaints. The mean American Orthopedic Foot and Ankle Society's ankle-hindfoot score was 96 points. The proposed method offers a reasonable treatment option for acute total Achilles tendon ruptures, with a low number of complications and a low risk of sural nerve injury. The rerupture rate and return to preinjury activities is comparable to open procedures.