Computed Tomography Scans and Fixation Rates for Trimalleolar Ankle Fractures Over 10 Years at a Level 1 Trauma Center.

Background: The posterior malleolus component of the trimalleolar ankle fracture has posed a controversial topic for diagnostic imaging and surgical management. Preoperative computed tomography (CT) scans are used to better appreciate fracture morphology and may affect management techniques. No prior study has investigated the trend in preoperative CT scan use and the rates of posterior and syndesmotic fixation for trimalleolar injuries. Methods: This retrospective cohort study evaluated the use of preoperative CT scans and the rates of posterior and syndesmotic fixation for trimalleolar ankle fractures over a 10-year period at an adult level 1 trauma center. Patients surgically managed for ankle fractures with OTA/AO classifications of 44B3, 44C3.3, 44C1.3, 44C2.3, and 44A3 were identified and included using Current Procedural Terminology codes and a prospectively collected fracture registry. Demographic information, comorbidities, fixation methods, and use of preoperative CT scan were recorded. Comparative analyses were performed to assess for yearly differences in demographic characteristics along with changes in trends of preoperative CT scans and posterior and syndesmotic fixation. Results: A total of 1191 patients were included in the analyses. OTA/AO 44B3.2 fractures were the most common injuries (yearly range of 59.4%-80.1%). The rate of posterior fixation did not significantly increase during the study interval (1.4% growth per year [95% CI -0.27, 3.07]). However, the rate of preoperative CT scan use significantly increased by 2.76% (95% CI 1.99, 3.52) per year and the rate of syndesmotic fixation increased by 2.58% (95% CI 1.17, 3.99) per year. Fixation methods for both the syndesmosis and posterior malleolus changed during the study timeline. Conclusion: Despite a relatively stable rate of posterior fixation, the frequency of preoperative CT scans and use of syndesmotic fixation increased significantly over a 10-year study period. Level of Evidence: Level IV, descriptive pilot study.

Smoking status and maternal weight trajectories during pregnancy and postpartum: Preliminary results from a pilot study.

OBJECTIVE: To preliminarily examine throughout pregnancy and 12 months postpartum: 1) the critical timings of abnormal gestational weight gain (GWG) among quitters and non-quitters; 2) the consequences of abnormal GWG on weight retention during postpartum; 3) the potential difference in GWG by timing of quitting (early vs. late). METHODS: We included 59 pregnant smokers (49 quitters and 10 non-quitters) from two clinical pilot studies. Smoking status and weight were repeatedly measured throughout pregnancy and postpartum. Weight trajectories were analyzed using mixed models with smoking cessation status, pregnancy week or postpartum month, their interaction term, and potential confounders. RESULTS: At enrollment, mothers had a mean BMI of 28.7 (SD, 7.2) and mean age of 30.1 years (SD, 5.8). Both groups had a linear increase in GWG, but quitters had a much higher rate of GWG (0.87 vs. 0.22 pounds/week) than non-quitters throughout pregnancy. Before delivery, 63.3% of quitters and 20.0% of non-quitters had excessive total GWG, while 12.2% of quitters and 60.0% of non-quitters had inadequate total GWG (p-value=0.004). Early quitters (<21 weeks) had a higher risk of excessive GWG (85.0%) than late quitters (≥21 weeks, 36.4%) (p-value=0.026). After delivery, quitters' weight remained stable following a rapid weight loss, whereas non-quitters' weight increased continuously. CONCLUSIONS: Non-quitters have a high risk of inadequate GWG, while quitters, especially early quitters, have a high risk of excessive GWG. The group difference in weight trajectories lasted from conception to postpartum.

Sleep quality and health among pregnant smokers.

STUDY OBJECTIVES: We aimed to examine (1) sleep quality trends of pregnant smokers and (2) their associations with health outcomes. METHODS: A secondary analysis of 88 participants from the University at Buffalo Pregnancy and Smoking Cessation Study (nonrandomized clinical study) was performed. Sleep quality was measured with the Pittsburgh Sleep Quality Index (higher scores, worse quality) and sleep duration was self-reported repeatedly during pregnancy at preintervention, postintervention, and end-of-pregnancy visits. Participants were divided into 3 groups (until preintervention, until postintervention, until end-of-pregnancy). Maternal outcomes included gestational weight gain and smoking cessation. Infant outcomes included birth weight, gestational age, and Apgar score. RESULTS: There was a significant increase (P = .046) in Pittsburgh Sleep Quality Index score from postintervention (mean, 5.5 [standard deviation (SD), 2.6]) to end of pregnancy (6.6 [SD, 2.8]). Mean gestational weight gain was significantly lower for participants with poor sleep quality than those with good sleep quality (19.0 kg [SD, 21.3] vs 36.1 kg [SD, 22.8]; P = .008). Newborns with poor maternal sleep quality had a significantly lower mean 5-minute Apgar score (8.1 [SD, 1.3] vs 9.0 [SD, 0.0]; P = .021) than newborns with good maternal sleep quality. Preintervention sleep quality was not associated with smoking cessation, birth weight, or gestational age. Smoking cessation was almost half as prevalent in participants with insufficient sleep (< 7 hours/night) vs sufficient sleep duration (47.4% vs 92.3%, P = .011). CONCLUSIONS: Sleep quality worsened toward the end of pregnancy among smokers. Poor sleep might negatively influence gestational weight gain and Apgar score. Insufficient preintervention sleep might negatively influence smoking cessation. CITATION: Danilov M, Issany A, Mercado P, Haghdel A, Muzayad JK, Wen X. Sleep quality and health among pregnant smokers. J Clin Sleep Med. 2022;18(5):1343-1353.