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2.
J Craniovertebr Junction Spine ; 13(1): 94-100, 2022.
Article in English | MEDLINE | ID: mdl-35386246

ABSTRACT

Study Design: The study design is a retrospective cohort study. Objective: To compare patient-reported outcomes between patients with mild versus moderate-to-severe myelopathy following surgery for cervical spondylotic myelopathy (CSM). Summary of Background Data: Recent studies have demonstrated that decompression for CSM leads to improved quality of life when measured by patient-reported outcomes. However, it is unknown if preoperative myelopathy classification is predictive of superior postoperative improvements. Materials and Methods: A retrospective review of patients treated surgically for CSM at a single institution from 2014 to 2015 was performed. Preoperative myelopathy severity was classified according to the modified Japanese Orthopaedic Association (mJOA) scale as either mild (≥15) or moderate-to-severe (<15). Other outcomes included neck disability index (NDI), 12-item short-form survey (SF-12), and visual analog scale (VAS) for arm and neck pain. Differences in outcomes were tested by linear mixed-effects models followed by pairwise comparisons using least square means. Multiple linear regression determined whether any baseline outcomes or demographics predicted postoperative mJOA. Results: There were 67 patients with mild and 50 patients with moderate-to-severe myelopathy. Preoperatively, patients with moderate-to-severe myelopathy reported significantly worse outcomes compared to the mild group for NDI, Physical Component Score (PCS-12), and VAS arm (P = 0.031). While both groups experienced improvements in NDI, PCS-12, VAS Arm and Neck after surgery, only the moderate-to-severe patients achieved improved mJOA (+3.1 points, P < 0.001). However, mJOA was significantly worse in the moderate-to-severe when compared to the mild group postoperatively (-1.2 points, P = 0.017). Both younger age (P = 0.017, ß-coefficient = -0.05) and higher preoperative mJOA (P < 0.001, ß-coefficient = 0.37) predicted higher postoperative mJOA. Conclusions: Although patients with moderate-to-severe myelopathy improved for all outcomes, they did not achieve normal absolute neurological function, indicating potential irreversible spinal cord changes. Early surgical intervention should be considered in patients with mild myelopathy if they seek to prevent progressive neurological decline over time.

3.
J Am Acad Orthop Surg ; 29(17): 758-766, 2021 Sep 01.
Article in English | MEDLINE | ID: mdl-33428349

ABSTRACT

INTRODUCTION: The movement toward reducing healthcare expenditures has led to an increased volume of outpatient anterior cervical diskectomy and fusions (ACDFs). Appropriateness for outpatient surgery can be gauged based on the duration of recovery each patient will likely need. METHODS: Patients undergoing 1- or 2-level ACDFs were retrospectively identified at a single Level I spine surgery referral institution. Length of stay (LOS) was categorized binarily as either less than two midnights or two or more midnights. The data were split into training (80%) and test (20%) sets. Two multivariate regressions and three machine learning models were developed to predict a probability of LOS ≥ 2 based on preoperative patient characteristics. Using each model, coefficients were computed for each risk factor based on the training data set and used to create a calculatable ACDF Predictive Scoring System (APSS). Performance of each APSS was then evaluated on a subsample of the data set withheld from training. Decision curve analysis was done to evaluate benefit across probability thresholds for the best performing model. RESULTS: In the final analysis, 1,516 patients had a LOS <2 and 643 had a LOS ≥2. Patient characteristics used for predictive modeling were American Society of Anesthesiologists score, age, body mass index, sex, procedure type, history of chronic pulmonary disease, depression, diabetes, hypertension, and hypothyroidism. The best performing APSS was modeled after a lasso regression. When applied to the withheld test data set, the APSS-lasso had an area under the curve from the receiver operating characteristic curve of 0.68, with a specificity of 0.78 and a sensitivity of 0.49. The calculated APSS scores ranged between 0 and 45 and corresponded to a probability of LOS ≥2 between 4% and 97%. CONCLUSION: Using classic statistics and machine learning, this scoring system provides a platform for stratifying patients undergoing ACDF into an inpatient or outpatient surgical setting.


Subject(s)
Cervical Vertebrae , Spinal Fusion , Cervical Vertebrae/surgery , Diskectomy , Humans , Length of Stay , Retrospective Studies , Spinal Fusion/adverse effects
4.
Am J Med Qual ; 36(2): 103-109, 2021.
Article in English | MEDLINE | ID: mdl-32452696

ABSTRACT

Performance on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey can affect up to 33% of a physician's reimbursement from the Centers for Medicare & Medicaid Services. At this pseudo-private orthopedic practice, the authors characterized how physicians often achieve drastically different scores between HCAHPS and an Internal Patient Satisfaction Questionnaire (IPSQ). Eighteen physicians were ranked separately according to percentage of top-box scores on HCAHPS and IPSQ. There was an inverse relationship between physician rank for the 2 surveys according to Spearman correlation coefficient (ρ = -0.36, P = .15). Qualitative subanalysis indicated that although "physician interaction" was the most common reason for negative comments on HCAHPS, "ancillary staff" and "workflow" concerns were common on IPSQ. The outpatient setting remains a critical component in achieving high-quality orthopedic care. Consequently, HCAHPS alone may not be a sufficient indicator of patient satisfaction for orthopedic and other subspecialty practices.


Subject(s)
Orthopedics , Patient Satisfaction , Aged , Humans , Medicare , Retrospective Studies , Surveys and Questionnaires , United States
5.
Clin Spine Surg ; 34(3): 87-91, 2021 04 01.
Article in English | MEDLINE | ID: mdl-33027092

ABSTRACT

Safe spine surgery is possible during the COVID-19 pandemic. Certain urgent procedures must still be performed during this challenging time to prevent permanent long-term disability or death for patients. Precautions must be taken in the operating room to optimize safety, including the use of personal protective equipment and appropriate room setup and anesthesia and equipment optimization. Evidence-based guidelines to create a safe operative paradigm for use in future viral outbreaks are paramount.


Subject(s)
COVID-19/prevention & control , Orthopedic Procedures/methods , Practice Guidelines as Topic , Spinal Diseases/surgery , Air Filters , Airway Extubation , Electrocoagulation , Fluoroscopy , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Intraoperative Neurophysiological Monitoring , Intubation, Intratracheal , N95 Respirators , Operating Rooms , Personal Protective Equipment , Postoperative Care , SARS-CoV-2 , Ventilation
6.
Clin Spine Surg ; 33(7): 258-264, 2020 08.
Article in English | MEDLINE | ID: mdl-32235169

ABSTRACT

The management of acute spinal cord injury requires a multidisciplinary approach to maximize patient outcomes and potential. Treatment of this injury involves both surgical and medical intervention. Medical intervention in acute spinal cord injury is aimed at decreasing the neurotoxic environment that occurs as part of the secondary injury. New neuroregenerative therapies are being developed.


Subject(s)
Spinal Cord Injuries/surgery , Combined Modality Therapy , Decompression, Surgical , Humans , Spinal Cord Injuries/rehabilitation
7.
Clin Spine Surg ; 33(5): E206-E212, 2020 06.
Article in English | MEDLINE | ID: mdl-31180993

ABSTRACT

In July of 2018, the Second International Consensus Meeting on Musculoskeletal Infection convened in Philadelphia, PA to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 7 focused on wound care, for which this article provides the recommendations, voting results, and rationales.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Orthopedic Procedures/adverse effects , Surgical Wound Infection/drug therapy , Surgical Wound Infection/prevention & control , Consensus , Humans , Orthopedics , Philadelphia , Prosthesis Failure , Societies, Medical , Spine/surgery , Wound Healing
8.
Clin Spine Surg ; 33(5): E191-E198, 2020 06.
Article in English | MEDLINE | ID: mdl-31385851

ABSTRACT

In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA was held to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 8 questions focused on general principles in spine surgery, for which this article provides the recommendations, voting results, and rationales.


Subject(s)
Orthopedic Procedures/adverse effects , Orthopedics/methods , Spine/surgery , Surgical Wound Infection/prevention & control , Anti-Bacterial Agents/therapeutic use , Consensus , Consensus Development Conferences as Topic , Humans , Orthopedics/standards , Osteomyelitis/microbiology , Philadelphia , Postoperative Period , Propionibacterium acnes , Societies, Medical , Surgical Wound Infection/drug therapy
9.
Clin Spine Surg ; 33(5): E213-E225, 2020 06.
Article in English | MEDLINE | ID: mdl-31464694

ABSTRACT

In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 11 focused on risk factors and prevention questions in spine surgery, for which this article provides the recommendations, voting results, and rationales.


Subject(s)
Orthopedic Procedures/adverse effects , Spine/surgery , Surgical Wound Infection/prevention & control , Surgical Wound Infection/therapy , Algorithms , Antirheumatic Agents , Consensus , Diarrhea/prevention & control , Humans , Methicillin-Resistant Staphylococcus aureus , Orthopedics , Perioperative Period , Philadelphia , Propionibacterium acnes , Psoas Muscles/pathology , Risk Assessment , Risk Factors , Systematic Reviews as Topic , Tuberculosis, Spinal/complications , Tuberculosis, Spinal/drug therapy
10.
Clin Spine Surg ; 33(4): 163-171, 2020 05.
Article in English | MEDLINE | ID: mdl-31404014

ABSTRACT

In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA was held to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 9 focused on implants questions in spine surgery, for which this article provides the recommendations, voting results, and rationales.


Subject(s)
Orthopedics/standards , Prostheses and Implants/adverse effects , Prosthesis Design , Prosthesis Failure , Spine/surgery , Surgical Wound Infection/prevention & control , Allografts , Anti-Bacterial Agents/therapeutic use , Bone Substitutes , Humans , Meningitis, Bacterial/etiology , Philadelphia , Postoperative Period , Risk Factors , Surgical Wound Infection/therapy
11.
Clin Spine Surg ; 33(3): E116-E126, 2020 04.
Article in English | MEDLINE | ID: mdl-31393278

ABSTRACT

In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA was held to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 17 focused on the use of antibiotics in spine surgery, for which this article provides the recommendations, voting results, and rationales.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Practice Guidelines as Topic , Spinal Fusion , Surgical Wound Infection/prevention & control , Humans
12.
Clin Spine Surg ; 33(4): 146-149, 2020 05.
Article in English | MEDLINE | ID: mdl-31436561

ABSTRACT

The instrumentation of C2 is technically challenging given the anatomic complexity of the upper cervical spine. Although the placement of C2 pedicle screws may be safer than transarticular screw placement, the inconsistent location of the transverse foramen and vertebral artery precludes placement of such screws in up to 26% of patients. In cases where vertebral artery anatomy prevents the safe placement of a pedicle screw, a pars screw is an excellent alternative. However, pars screws must stop short of the vertebral foramen, limiting the typical length of these screws to only 14-18 mm. The associated purchase and rigidity are compromised compared with the pedicle screw. A modified C2 fixation technique was developed by our group which we have named the C2 "parsicle" screw reflecting the hybrid nature of the screw incorporating aspects of pars and pedicle screw fixation.


Subject(s)
Atlanto-Axial Joint/surgery , Axis, Cervical Vertebra/surgery , Cervical Vertebrae/surgery , Fracture Fixation, Internal/adverse effects , Pedicle Screws , Vertebral Artery , Equipment Design , Fracture Fixation, Internal/methods , Humans , Intraoperative Period , Joint Instability/surgery , Postoperative Complications/prevention & control , Spinal Fusion/methods
13.
Clin Spine Surg ; 33(3): 102-103, 2020 04.
Article in English | MEDLINE | ID: mdl-29553943

ABSTRACT

Achieving an osseous fusion across the lumbosacral spine is still challenging in spine surgery. For the long multisegmental fusion surgery, it is crucial to build a robust and substantial foundation, which sometimes necessitates the distal spinal fixation to the pelvis. The pelvic fixation technique involves advancing the screw through the alar, thereby providing more purchase across the sacroiliac joint and into the ilium. The S2 alar iliac screws can obtain immediate stability and proper biomechanical strength of constructs. Here we demonstrated our experience of how to place the S2 alar iliac screw accurately as well as some pitfalls and pearls of this technique.


Subject(s)
Bone Screws , Sacroiliac Joint , Spinal Fusion , Humans
14.
Clin Spine Surg ; 33(5): E199-E205, 2020 06.
Article in English | MEDLINE | ID: mdl-31567424

ABSTRACT

In July 2018, the Second International Consensus Meeting on Musculoskeletal Infection convened in Philadelphia, PA to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 15 focused on the use of imaging, tissue sampling, and biomarkers in spine surgery, for which this article provides the recommendations, voting results, and rationales.


Subject(s)
Spine/surgery , Surgical Wound Infection/diagnostic imaging , Surgical Wound Infection/prevention & control , Anti-Bacterial Agents/therapeutic use , Biomarkers/metabolism , Biopsy , Blood Sedimentation , C-Reactive Protein/metabolism , Consensus , Consensus Development Conferences as Topic , Humans , Magnetic Resonance Imaging , Orthopedics/standards , Philadelphia , Positron-Emission Tomography , Prosthesis Failure , Risk Factors , Societies, Medical , Surgical Wound Infection/blood , Tomography, X-Ray Computed , Wound Healing
15.
Neurosurgery ; 84(4): 827-835, 2019 04 01.
Article in English | MEDLINE | ID: mdl-30032187

ABSTRACT

Spinal arthrodesis is a major element of the spinal surgeon's practice. To attain successful fusion rates, attention must be paid to spinal segment immobilization and proper selection of bone graft. Autogenous bone graft (ie, ICBG), the "gold standard," with or without graft extenders and enhancers provides the foundation for most spinal fusions. ABG is the only graft option containing all 3 factors of new bone growth: osteoconductivity, osteoinductivity, and osteogenicity. While many bone graft alternatives function well as bone graft extenders, only growth factors proteins (ie, rhBMP-2 or OP-2) function as bone graft enhancers and substitutes. The search for optimal hybrid interbody cages, bone graft substitutes, autogenous or allogenic stem cells, and nanostructure scaffolds for release of growth factors continues.


Subject(s)
Bone Substitutes , Bone Transplantation , Spinal Fusion , Bone Morphogenetic Protein 2 , Humans , Recombinant Proteins , Spinal Diseases/surgery , Spine/surgery , Transforming Growth Factor beta
16.
Clin Orthop Relat Res ; 476(3): 453-462, 2018 03.
Article in English | MEDLINE | ID: mdl-29443839

ABSTRACT

BACKGROUND: Patients with geriatric hip fractures may be at increased risk for postoperative Clostridium difficile colitis, which can cause severe morbidity and can influence hospital quality metrics. However, to our knowledge, no large database study has calculated the incidence of, factors associated with, and effect of C. difficile colitis on geriatric patients undergoing hip fracture surgery. QUESTIONS/PURPOSES: To use a large national database with in-hospital and postdischarge data (National Surgical Quality Improvement Program [NSQIP®]) to (1) determine the incidence and timing of C. difficile colitis in geriatric patients who underwent surgery for hip fracture, (2) identify preoperative and postoperative factors associated with the development of C. difficile colitis in these patients, and (3) test for an association between C. difficile colitis and postoperative length of stay, 30-day readmission, and 30-day mortality. PATIENTS AND METHODS: This is a retrospective study. Patients who were 65 years or older who underwent hip fracture surgery were identified in the 2015 NSQIP database. The primary outcome was a diagnosis of C. difficile colitis during the 30-day postoperative period. Preoperative and procedural factors were tested for association with the development of C. difficile colitis through a backward stepwise multivariate model. Perioperative antibiotic type and duration were not included in the model, as this information was not recorded in the NSQIP. The association between C. difficile colitis and postoperative length of stay, 30-day readmission, and 30-day mortality were tested through multivariate regressions, which adjusted for preoperative and procedural characteristics such as age, comorbidities, and surgical procedure. A total of 6928 patients who were 65 years or older and underwent hip fracture surgery were identified. RESULTS: The incidence of postoperative C. difficile colitis was 1.05% (95% CI, 0.81%-1.29%; 73 of 6928 patients). Of patients who had C. difficile colitis develop, 64% (47 of 73 patients) were diagnosed postdischarge and 79% (58 of 73 patients) did not have a preceding infectious diagnosis. Preoperative factors identifiable before surgery that were associated with the development of C. difficile colitis included admission from any type of chronic care facility (versus admitted from home; relative risk [RR] = 1.98; 95% CI, 1.11-3.55; p = 0.027), current smoker within 1 year (RR = 1.95; 95% CI, 1.03-3.69; p = 0.041), and preoperative anemia (RR = 1.76; 95% CI, 1.07-2.92; p = 0.027). Patients who had pneumonia (RR = 2.58; 95% CI, 1.20-5.53; p = 0.015), sepsis (RR = 4.20; 95% CI, 1.27-13.82; p = 0.018), or "any infection" (RR = 2.26; 95% CI, 1.26-4.03; p = 0.006) develop after hip fracture were more likely to have C. difficile colitis develop. Development of C. difficile colitis was associated with greater postoperative length of stay (22 versus 5 days; p < 0.001), 30-day readmission (RR = 3.41; 95% CI, 2.17-5.36; p < 0.001), and 30-day mortality (15% [11 of 73 patients] versus 6% [439 of 6855 patients]; RR = 2.16; 95% CI, 1.22-3.80; p = 0.008). CONCLUSIONS: C. difficile colitis is a serious infection after hip fracture surgery in geriatric patients that is associated with 15% mortality. Patients at high risk, such as those admitted from any type of chronic care facility, those who had preoperative anemia, and current smokers within 1 year, should be targeted with preventative measures. From previous studies, these measures include enforcing strict hand hygiene with soap and water (not alcohol sanitizers) if a provider is caring for patients at high risk and those who are C. difficile-positive. Further, other studies have shown that certain antibiotics, such as fluoroquinolones and cephalosporins, can predispose patients to C. difficile colitis. These medications perhaps should be avoided when prescribing prophylactic antibiotics or managing infections in patients at high risk. Future prospective studies should aim to determine the best prophylactic antibiotic regimens, probiotic formula, and discharge timing that minimize postoperative C. difficile colitis in patients with hip fractures. LEVEL OF EVIDENCE: Level III, therapeutic study.


Subject(s)
Anti-Bacterial Agents/adverse effects , Enterocolitis, Pseudomembranous/epidemiology , Hip Fractures/surgery , Age Factors , Aged , Aged, 80 and over , Comorbidity , Databases, Factual , Enterocolitis, Pseudomembranous/diagnosis , Enterocolitis, Pseudomembranous/microbiology , Enterocolitis, Pseudomembranous/mortality , Female , Hip Fractures/diagnosis , Hip Fractures/epidemiology , Humans , Incidence , Length of Stay , Male , Patient Readmission , Retrospective Studies , Risk Assessment , Risk Factors , Smoking/adverse effects , Time Factors , Treatment Outcome , United States/epidemiology
17.
Spine (Phila Pa 1976) ; 43(12): 861-868, 2018 06 15.
Article in English | MEDLINE | ID: mdl-28953711

ABSTRACT

STUDY DESIGN: A retrospective study of prospectively collected data. OBJECTIVE: The aim of this study was to utilize a large national database with post-hospitalization follow-up data [National Surgical Quality Improvement Program (NSQIP)] to determine the incidence, risk factors, timing, and clinical impact of Clostridium difficile colitis in spine surgery patients. SUMMARY OF BACKGROUND DATA: Recent literature has suggested an increased incidence of C. difficile infections. However, there has been a lack of large cohort studies defining the incidence and impact of C. difficile colitis in patients undergoing spine surgery. METHODS: Patients who underwent spine surgical procedures in the 2015 NSQIP database were identified. The primary outcome was a diagnosis of C. difficile colitis within the 30-day postoperative period. Independent risk factors for development of C. difficile colitis were identified using multivariate regression. Postoperative length of stay and rate of 30-day readmission were compared between patients who did and did not develop C. difficile colitis. RESULTS: A total of 23,981 patients who underwent spine surgical procedures were identified. The incidence of C. difficile colitis was approximately 0.11% [95% confidence interval (95% CI), 0.07-0.16]. Of the cases that developed C. difficile colitis, 70% were diagnosed postdischarge and 88% had not had a pre-existing infection diagnosed. Independent risk factors for the development of C. difficile colitis were combined anterior/posterior lumbar fusion procedures [odds ratio (OR) = 12.29, 95% CI = 2.22-68.13, P = 0.010], greater age (most notably ≥76 years old, OR = 10.31, 95% CI = 3.06-34.76, P < 0.001), hypoalbuminemia (OR = 6.40, 95% CI = 2.49-16.43, P < 0.001), and anemia (OR = 2.39, 95% CI = 1.13-5.05, P = 0.023). The development of C. difficile colitis was associated with greater length of stay (2.2 vs. 12.5 days; P < 0.001) and increased 30-day readmission (OR = 8.21, 95% CI = 3.14-21.45, P < 0.001). CONCLUSION: C. difficile was diagnosed in 0.11% of patients undergoing spine surgery. The majority of these cases occurred after discharge and in patients not having prior infection diagnoses. High-risk patients should be monitored and targeted with preventative interventions accordingly. LEVEL OF EVIDENCE: 3.


Subject(s)
Clostridioides difficile/isolation & purification , Colitis/epidemiology , Enterocolitis, Pseudomembranous/epidemiology , Orthopedic Procedures/adverse effects , Spine/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Colitis/etiology , Enterocolitis, Pseudomembranous/etiology , Female , Humans , Incidence , Male , Middle Aged , Retrospective Studies , Risk Factors , Young Adult
18.
J Clin Orthop Trauma ; 8(3): 225-231, 2017.
Article in English | MEDLINE | ID: mdl-28951639

ABSTRACT

This is the first large-scale study to define the injured population and examine associated injuries for patients with tibial shaft fractures. Patients over 18 years of age in the National Trauma Data Bank (NTDB) who presented with tibial shaft fractures during 2011 and 2012 were identified. Modified Charlson Comorbidity Index (CCI), mechanism of injury (MOI), injury severity score (ISS), and specific associated injuries were described. Multivariate logistic regression was used to identify predictors of mortality.

20.
Orthopedics ; 40(3): e506-e512, 2017 May 01.
Article in English | MEDLINE | ID: mdl-28358976

ABSTRACT

The spectrum of injuries associated with femoral shaft fractures and those injuries' association with mortality have not been well delineated previously. Patients in the National Trauma Data Bank who presented with femoral shaft fractures from 2011 to 2012 were analyzed in 3 age groups (18-39, 40-64, and 65+ years). For each group, modified Charlson Comorbidity Index (CCI), mechanism of injury (MOI), injury severity score (ISS), and associated injuries were reported. Multivariate logistic regression was used to identify predictors of mortality. Among the 26,357 patients with femoral shaft fractures, modified CCIs gradually increased with increasing age category and ISS decreased. Motor vehicle accidents were the most common MOI in the younger 2 age groups, whereas falls were the most common MOI in the 65 years and older age group. The top 3 associated bony injuries for the study cohort as a whole were tibia/fibula (20.5%), ribs/sternum (19.1%), and non-shaft femur (18.9%, of which 5.8% of the total cohort were femoral neck) fractures. The top 3 associated internal organ injuries were lung (18.9%), intracranial (13.5%), and liver (6.2%), injuries. A multivariate mortality analysis showed that increasing age, increasing comorbidity burden, and associated injuries all had independent associations with mortality. The injuries most associated with mortality were thoracic organ injuries (adjusted odds ratio [AOR]=3.53), head injuries (AOR=2.93), abdominal organ injuries (AOR=2.78), and pelvic fractures (AOR=1.80). This study used a large, nationwide sample of trauma patients to profile injuries associated with femoral shaft fractures. Associations between injuries and mortality underscore the importance of these findings. [Orthopedics. 2017; 40(3):e506-e512.].


Subject(s)
Abdominal Injuries/mortality , Femoral Fractures/mortality , Femoral Neck Fractures/complications , Multiple Trauma/mortality , Pelvic Bones/injuries , Thoracic Injuries/complications , Abdominal Injuries/complications , Accidental Falls , Accidents, Traffic , Adolescent , Adult , Aged , Cohort Studies , Comorbidity , Femoral Fractures/complications , Humans , Injury Severity Score , Logistic Models , Middle Aged , Multiple Trauma/complications , Young Adult
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