Suspensory Device Fixation of Lisfranc Injuries in a Southeast Asian Urban Population: Patient-Reported Functional Outcomes.

Introduction Open reduction internal fixation (ORIF) and primary arthrodesis are two conventional options for the treatment of Lisfranc injuries. However, they are associated with implant-related complications. An alternative suspensory device construct using interosseous nonabsorbable sutures with endobuttons has been described with satisfactory results. This study aims to explore functional outcomes after suture button fixation of Lisfranc injuries in a Southeast Asian population. Methods This was a single-surgeon retrospective study of patients with Lisfranc injuries treated surgically using a suture button fixation technique between 2017 and 2019. Data collected included demographic information, pre-injury levels of activity, nature of injury, and type of surgery performed. The minimum postoperative follow-up was one year. The Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM) were used to evaluate patient-reported outcomes. Scores were reported in percentage (%) with median and interquartile range. Results Twenty-nine patients with a mean age of 29 years (21-76) were recruited. Sixteen underwent suture button fixation only (SB), and 13 underwent suture button fixation with intercuneiform screw fixation and plating (SBM). The median scores for the FAOS and FAAM questionnaires were at least 80% in all domains. Twenty-eight patients (97%) were able to return to pre-injury activity level, 27 patients (93%) were able to return to sports. Only one patient was not satisfied with the outcomes of surgery. No patients had post-traumatic arthritis or hardware failure necessitating implant removal at the final follow-up. Conclusion This study has demonstrated that treatment of Lisfranc injuries with a suspensory device construct resulted in good outcomes with 97% of patients being able to return to pre-injury activity levels, and 93% of patients being able to return to sports. It may not be necessary to perform primary arthrodesis in uncomplicated Lisfranc injuries. This technique is also advantageous as implant removal is not routinely required due to the design and biomechanical properties of suspensory devices.

Neonatal presentations to the paediatric emergency department in Singapore.

Introduction: This study aimed to characterise neonatal paediatric emergency department (PED) visits, analyse the main paediatric illnesses and establish associations of these demographics with the readmission rates and severity of their presentation. Methods: A retrospective analysis of neonates (aged <28 days) presenting to the PEDs of our hospital over seven months was performed. Associations between the clinical and demographic data of admissions to the PED and inpatient admissions were analysed. Results: In total, 1,200 neonates presented during the study period, 79.4% of whom presented at less than 15 days since birth. Length of stay in the PED was less than four hours for 94.0% of the neonates. Predominant triage categories comprised non-P1 cases (97.5%). The main diagnoses at the PED were neonatal jaundice (NNJ; 66.8%) and neonatal pyrexia (NNP; 14.6%), which corresponded to the main diagnoses upon discharge from the hospital: NNJ (68.4%) and NNP (19.6%). 48.2% of neonates were referred from polyclinics or other clinics. 57.7% of the neonates were admitted. Interestingly, 87.0% of the well babies who presented to the emergency department were brought in owing to parental concerns by the parents themselves, without prior consultation with the doctor. Conclusion: Outpatient management of NNJ can be considered. Caregivers should be provided better education regarding normal physiological characteristics of newborns through standardised educational materials. Other potential avenues for parents to seek medical advice, for example hotlines and ChatBots such as the recently piloted 'Urgent Paediatric Advice Line' online service, should be considered.

The Forgotten Joint Score-12 in Anterior Cruciate Ligament injuries.

PURPOSE: The Forgotten Joint Score (FJS-12) is a scoring system initially created to assess post arthroplasty outcomes. It has since been used to evaluate Anterior Cruciate Ligament surgery outcomes. Our study aims to evaluate the applicability and validity of the FJS-12 in post Anterior Cruciate Ligament reconstructed patients, and to assess correlation with established Patient Reported Outcome Measure Scores in the same population. DESIGN: Case series, level 3 evidence. METHODS: We conducted a cross sectional study across patients who had undergone Anterior Cruciate Ligament reconstruction and carried out the FJS-12 questionnaire by phone interview. Patients who had undergone primary Anterior Cruciate Ligament reconstruction were considered for the study. RESULTS: The average Forgotten Joint Score-12 for all 82 patients was 71.4 (±22.9), which corresponded to a normal distribution. The average Lysholm and Tegner score at the 2-year post-operative visit was 93.5 ± 9.5 and 5.8 ± 1.8 respectively and the distribution was non-normal. We noticed a large ceiling effect of 42.7% in the Lysholm scores, but only 8.4% in FJS-12. There was a weak correlation with Lysholm and a positive correlation with Tegner. CONCLUSIONS: Forgotten Joint Score-12 seems to be a promising patient reported outcome measure that can be used in evaluating post Anterior Cruciate Ligament reconstruction outcomes. It is more discerning than traditional scores and is easy to administer thus it can used in the clinical follow-up of patients. With the scores being normally distributed, it makes for a meaningful PROMS and would allow more accurate application of parametric statistical tests.