Management of Blunt Traumatic Abdominal Wall Hernias: An Analysis of the National Trauma Data Bank.

BACKGROUND: Blunt traumatic abdominal wall hernias (TAWH) are uncommon injuries with variable presentation and unstandardized management. Few national systematic descriptive studies have been conducted about TAWH. We present a retrospective descriptive study utilizing the National Trauma Data Bank (NTDB) to better characterize risk factors associated with TAWH and management practices. METHODS: The NTDB (years 2016-2019) was examined for adult blunt trauma patients who had TAWH. Data included demographics, trauma-specific variables, management strategies, and outcome measures. Descriptive statistics were performed by univariate analysis. RESULTS: 2 871 367 adult blunt trauma patients were identified in the NTDB dataset. 206 had abdominal wall hernias (<.01%). Compared with the overall blunt trauma cohort, patients with TAWH had higher body mass index (BMI) and Injury Severity Scores (ISS), were more likely to be male, and had a higher mortality rate. 44 patients (21%) underwent operative management during their initial admission. Surgically managed patients were younger, had higher ISS and BMI, and were more likely to have concomitant intra-abdominal injuries. The few patients who had laparoscopic surgery had significantly higher BMI. Patients managed operatively had longer hospital and ICU lengths of stay and increased incidence of medical complications. CONCLUSIONS: TAWH is an uncommon complication of blunt abdominal trauma, associated with higher BMI, ISS, and increased mortality. Initial operative management was pursued in 21% of cases, more often in younger, more severely injured patients with other intra-abdominal injuries. Evidence-based guidelines, based on multicenter prospective studies with longer follow-up, should be developed for management of these unique injuries.

Effect of Comorbid Chronic Low Back Pain on Patient-Reported Outcome and Gait Parameters in Patients With Symptomatic Knee Osteoarthritis.

Knee osteoarthritis and chronic low back pain are common and often coexist. There are limited studies on the impact of coexisting musculoskeletal disorders on gait parameters and its association with self-assessed functional outcome. This study compared gait parameters, self-assessed functional outcome measurements, and quality-of-life scales between patients with knee osteoarthritis against those with coexisting knee osteoarthritis and chronic low back pain using gait analysis, Western Ontario and McMaster Osteoarthritis Index, and Short Form-36. Three hundred sixty-seven patients underwent gait analysis after the question-based functional outcome measurement. Pain, function, and quality of life were worse in the coexisting knee osteoarthritis and chronic low back pain group (n = 197) compared with the knee osteoarthritis only group (n = 170, P = 0.017, P = 0.004, P < 0.001, P = 0.004, respectively). The coexisting knee osteoarthritis and chronic low back pain group had significantly lower gait velocity and cadence than the knee osteoarthritis group (P = 0.028 and P = 0.003). The Western Ontario and McMaster Osteoarthritis Index Pain subscore was associated with gait velocity (P < 0.001) in the knee osteoarthritis group, whereas Short Form-36 physical composite was associated with gait velocity (P < 0.001) in the coexisting knee osteoarthritis and chronic low back pain group. Comorbid chronic low back pain in patients with knee osteoarthritis was associated with worse pain, function, quality of life, gait velocity, and cadence. Compared with the Western Ontario and McMaster Osteoarthritis Index, Short Form-36 may be a more suitable tool to track mobility outcome measure, such as gait velocity, in the management of the coexisting knee osteoarthritis and chronic low back pain.