The Association of Cavovarus Foot Deformity With an Os Peroneum.

OBJECTIVE: We sought to assess whether the presence of an os peroneum is correlated with cavovarus foot alignment in patients without a neurologic explanation for their foot shape. We hypothesized that a large os peroneum would increase the power of the peroneus longus and lead to a forefoot-driven, hindfoot varus deformity. MATERIALS AND METHODS: This was a retrospective cohort study conducted at a single institution and reviewed patients with 3 weightbearing views of the foot on plain radiography. Patients were characterized into having either no os peroneum (235), a small os peroneum (18), or a large os peroneum (23). The control group included the first 101 of the 235 patients without an os peroneum based on a power analysis of the primary outcome, which was the difference in the mean Meary's angle (lateral talo-first metatarsal angle) between groups. The kite angle (anterior-posterior [AP] talocalcaneal angle), as well as 4 other angles were measured as secondary outcomes. RESULTS: Those with a large os peroneum had on a mean 7.7° (P < .01) more apex dorsal angulation of Meary's angle than controls, and a kite angle 4.2° varus to that of the control group. There were no differences between the small os peroneum and control groups. CONCLUSION: These findings add to the existing literature surrounding the etiology of cavovarus foot shape and link the presence of an ossified os peroneum, an oftentimes incidental radiographic finding, to cavovarus foot deformity in those without an underlying neurologic diagnosis. LEVELS OF EVIDENCE: Therapeutic, Level III: Retrospective Case-Control.

Financial Toxicity Is Common in Patients After Tibia Fracture.

OBJECTIVES: To evaluate the presence of financial distress and identify risk factors for financial toxicity in patients after tibial shaft fracture. DESIGN: A cross-sectional analysis. SETTING: Level I trauma center. PATIENTS: All patients within 4 years after tibial shaft fracture (open, closed, or fracture that required flap reconstruction). INTERVENTION: Injury-related financial distress. MAIN OUTCOME MEASUREMENTS: Financial distress related to the injury, as reported by the patient in a binary question. Financial toxicity using the LIMB-Q, scored from 0 to 100, with higher scores indicating more financial toxicity. RESULTS: Data were collected from 142 patients after tibial shaft fracture [44% closed (n = 62), 41% open (n = 58), and 15% flap (n = 22)]. The mean age was 44 years (SD 17), 61% were men, and the mean time from injury was 15 months. Financial distress was reported by 64% of patients (95% confidence interval, 56% to 72%). Financial toxicity did not differ by fracture severity ( P = 0.12). Medical complications were associated with a 14-point increase in financial toxicity ( P = 0.04). Age older than 65 years (-15 points, P = 0.03) and incomes of $70,000 or more ($70,000-$99,999, -15 points, P = 0.02; >$100,000, -19 points, P < 0.01) protected against financial toxicity. CONCLUSION: We observed financial distress levels more than twice the proportion observed after cancer. Medical complications, lower incomes, and younger age were associated with increased financial toxicity. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Does iliosacral screw removal reduce postoperative pain in unstable pelvic fracture patients? A matched prospective cohort study.

BACKGROUND: To compare pain and function in patients with unstable posterior pelvic fractures stabilized with posterior fixation who undergo iliosacral screw removal versus those who retain their iliosacral screws. METHODS: A prospective observational cohort study identified 59 patients who reported pain at least 4 months after iliosacral screw fixation of an unstable posterior pelvic ring fracture from 2015-2019. The primary intervention was iliosacral screw removal versus a matched iliosacral screw retention control group. Patient-reported pain was measured with the 10-point Brief Pain Inventory, and patient-reported function was measured with the Majeed Pelvic Outcome Score. Both measured within 6 months of the intervention. RESULTS: Before iliosacral screw removal, the mean pain was 4.7 (SD, 3.0) compared with 4.7 (SD, 3.0) in the matched control group. Following iliosacral screw removal, the average pain in the screw removal group was 3.7 (SD, 2.7) and 3.3 (SD, 2.5) in the matched control group. We found no evidence that iliosacral screw removal reduced pain in this population (mean difference, 0.2 points; 95% CI, -1.0 to 1.5; p = 0.71). In addition, the improvement in function after iliosacral screw removal was not statistically indistinguishable from zero (mean difference, 3.1 points; 95% CI, -4.6 to 10.9; p = 0.42). CONCLUSIONS: The results suggest that iliosacral screw removal offers no significant pelvic pain or function benefit when compared with a matched control group. Surgeons should consider these data when managing patients with pelvic pain who are candidates for iliosacral screw removal.