Computed tomography changes diagnosis, management and surgical planning of ankle fractures.

PURPOSE: To demonstrate how the use of adjunctive Computed Tomography (CT) can modify diagnosis, treatment options, and operative planning of ankle fractures in comparison with conventional radiographs (CR) in isolation. MATERIALS AND METHODS: A total of 53 patients diagnosed with an ankle fracture between 2011 and 2016, were assessed with CT and CR. Evaluations of the fractures using CR in isolation and CR combined with CT were compared using different readers. Fractures were assessed in terms of type, displacement, size, associated injuries, treatment, patient position and surgical planning. RESULTS: The medial malleolus fractures characteristics (posteromedial fragment and anterior colliculus), the presence of posterior malleolus fracture and its characteristics (displacement, size, posteromedial or posterolateral segment) (ps < 0.042), syndesmosis injury (p < 0.001), and the absence of deltoid ligament lesion (p < 0.001), were more evident with the combination of CT and radiographs. There was an increase in operative indication (p = 0.007), prone positioning (p = 0.002), posterior malleolus surgical treatment (p < 0.001), posterolateral approach for the lateral malleolus (p = 0.003), and syndesmosis fixation (p = 0.020) with the association of CT and CR, among all groups of expertise, with a high interobserver reliability (> 0.75). CONCLUSIONS: The CR may fail to demonstrate subtle lesions, such as posterior malleolus fractures and syndesmotic injuries. The CT evaluation increases the diagnostic precision and improves the quality of information the surgeon receives, what might positively affect patient care. LEVEL OF EVIDENCE III: Retrospective Comparative Study.

Prevalence of osteoporosis risk factors and treatment among women aged 50 years and older.

We conducted a cross-sectional, retrospective review to evaluate screening, diagnosis, and treatment of 389 women aged 50 years or older at risk for osteoporosis in a large primary care practice. Records randomly selected from a computerized database were reviewed for drug history, age, height, weight, and osteoporosis-related diagnoses, symptoms, and risk factors. Among the 389 women, 255 (65.5%) were receiving bone-preserving treatment (247 estrogen replacement exclusively). Most (70.4%) were white, with an average age of 61 years, and an average of 3.3 risk factors for osteoporosis. Risk factors were postmenopausal status 94%, age 65 years or older 53%, hysterectomy 39%, cigarette smoking 33%, and physical inactivity 30%. By logistic regression, the only positive predictor of antiresorptive therapy was hysterectomy (adjusted odds ratio [AOR] 2.52, 95% confidence interval [CI] 1.54-4.14). Negative predictors were physical inactivity (AOR 0.44, 95% CI 0.25-0.71), rheumatoid arthritis (AOR 0.31, 95% CI 0.12-0.79), and age 65 years and older (AOR 0.54, 95% CI 0.34-0.86). Controlling for age, women with four or more risk factors were 62% less likely to be receiving antiresorptive treatment (AOR 0.38, 95% CI 0.23-0.64) than those with fewer risk factors.

A model for teaching medical students ambulatory care geriatrics.

Several recent articles have called attention to the negative attitudes which are fostered by teaching geriatrics primarily in a long-term care facility. A transportable model has been developed using a multidisciplinary team for teaching ambulatory care geriatrics in a clinic within a congregate housing facility. This model has contributed to more positive attitudes towards geriatrics health care on the part of the students.