Is the Charlson comorbidity index a good predictor of mortality and adverse effects in proximal humerus fractures?

INTRODUCTION: Proximal humerus fractures (PHF) are frequent in elderly patients. This population also suffers from a series of associated comorbidities, and PHF increases morbidity and mortality. The Charlson Comorbidity Index (CCI) is a tool used for calculating comorbidity and therefore the mortality risk. HYPOTHESIS: Our hypothesis is that CCI is a good predictor of mortality in patients suffering from PHF, and that there is a relationship between CCI and the development of adverse events. PATIENTS AND METHODS: A retrospective study with prospective data collection of 354 patients who had been diagnosed and treated for a single PHF between August 1st, 2013 and July 31st, 2015 was carried out at our hospital. The minimum follow-up was 24 months (mean 51.1 months). This study included all patients regardless the severity of the fracture, the treatment performed (surgical or conservative treatment) or whether the patient had been admitted to the hospital or was treated as an outpatient. Adverse effects and mortality data were collected and the CCI was calculated. RESULTS: Patients with high CCI (>5) had a higher mortality risk 4.6 (95% CI [2.4-9.0]) compared to those with CCI<5. During follow-up, 40 (11%) patients died, being the mean follow-up of the patients overall 4.3 years 95% CI [4.1-4.4]. Patients suffering from systemic complications had a higher CCI average (p=0.001) compared to those who did not present adverse effects (HR=6.6; 95% CI [3.5-12.4]). No statistically significant relationship between the type of fracture (p=0.473) and mortality was found. CONCLUSION: In our study CCI has proven to be a good predictor of mortality and there is a relationship between CCI and the development of adverse effects in patients suffering from PHF, which maybe should be taken into consideration in our therapeutic decision making. LEVEL OF EVIDENCE: IV, retrospective observational study.

Long-term results of total knee arthroplasty after failed high tibial osteotomy.

PURPOSE: Sometimes, total knee replacement (TKR) is performed after a tibial osteotomy. It is not known if the osteotomy influences the clinical process of a TKR. The aim of this study was to look at the clinical outcome of a TKR after high tibial osteotomy (HTO) compared to a TKR with no HTO. METHODS: Between 1995 and 2005, 41 post-HTO TKRs (group A) with a minimum follow-up of ten years were selected. In parallel, it was selected a control group undergoing simple TKR, consisting of 41 patients (group B) matched with group A. The Knee Society Knee Score (KS), Knee Score Functional Score (FS), the Oxford Knee Score (OKS), and the range of motion (ROM) were used for evaluation at one, five and ten years after surgery. The Insall-Salvatti ratio (ISR), the posterior tibial slope (PTS), and the joint height line (JHL) were also measured both pre-operatively and post-operatively. RESULTS: No differences were found between both groups in KS, FS, OKS, and ROM at the pre-operative stage or at any of the post-operative controls. Higher patellar height was found in group A, both pre-operatively and post-operatively (p < 0.005), and the same for PTS pre-operative (p < 0.001) and post-operative (p < 0.05). No differences were found regarding the JHL. Post-operative differences were found among the post-HTO subgroups at the FS (p < 0.02), the OKS (p < 0.05), and the ROM (p < 0.01) as a function of whether there was a varus or a valgus deformity before the TKR. CONCLUSION: A HTO was not determinant for having a worse outcome at the TKR, even when there were radiographic differences. The coronal alignment with valgus deformity pre-TKR after a HTO showed better functional results than in the case of varus deformity. Level of evidence III.

Do Postoperative Hallux Angles Correlate With Outcome in MP1 Fusion? Our Experience With 71 Cases.

PURPOSE: To determine if the postoperative alignment of the hallux influences the final clinical outcome of hallux metatarsophalangeal joint (first MTPJ) arthrodesis. METHODS: A total of 71 consecutive cases (hallux rigidus) were studied in stages 3 and 4. They were operated through arthrodesis between 2008 and 2014. The follow-up mean was 7.3 years. The AOFAS (American Orthopaedic Foot and Ankle Society) test was performed preintervention and per annum. In radiology, both the hallux valgus angle and the dorsiflexion angle of the first MTPJ were studied. Furthermore, clinical outcomes were evaluated according to the type of implant used. RESULTS: Preoperative AOFAS score was 27.5, rising to 91.3 after the intervention ( P < .01). The improvement test average was 63.6. There were 17 local complications (23%), 7 of them were considered to be major complications (9%), 6 of which needed reoperation (8.5%). The dorsiflexion angle postoperative mean was 21.7°. The hallux valgus angle postoperative mean was 10.9°. No correlations between both angles, and improved AOFAS score or complications ( P > .4 and P > .5, respectively), were found. Patients who had a dorsiflexion angle higher than 20° had greater improvement in the AOFAS score compared with those who had angles lower than 20° (64.5 vs 59.6 points). Nevertheless, this result was not statistically significant ( P = .059). No differences in AOFAS score improvement regarding arthrodesis plate ( P > .1) were found. CONCLUSION: First MTPJ arthrodesis is a good alternative for patients in advanced hallux rigidus stages when conservative treatment fails. We could not confirm if a better postoperative alignment may influence in clinical outcomes. However, better results are obtained with dorsiflexion angle greater than 20° than with those with less than 20°. Likewise, any differences between the 2 arthrodesis plates have been able to confirm. LEVELS OF EVIDENCE: Level III: Retrospective cohort study.