Clinical outcomes following ankle fracture: a cross-sectional observational study.
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ABSTRACT:
SUBMITTER: Segal G
PROVIDER: S-EPMC4252004 | biostudies-literature | 2014
REPOSITORIES: biostudies-literature
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Clinical outcomes following ankle fracture: a cross-sectional observational study.
Segal Ganit G Elbaz Avi A Parsi Alon A Heller Ziv Z Palmanovich Ezequiel E Nyska Meir M Feldbrin Zeev Z Kish Benjamin B
Journal of foot and ankle research 20141128 1
<h4>Background</h4>The purpose of the current study was to examine objective and subjective differences between three severity groups of ankle fractures patients compared to healthy controls.<h4>Methods</h4>This was a case-controlled study. 92 patients with an ankle fracture injury of which 41 patients were eligible to participate in the study. 72 healthy people served as controls. All patients underwent a computerized gait test, completed self-assessment questionnaires (The Foot and Ankle Outco ...[more]
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Project description:BackgroundAnkle fractures are one of the most common orthopedic injuries, and although most patients have a satisfactory outcome following operative fixation, there are patients that have persistent pain despite anatomic reduction. Intra-articular injuries have been suggested as one potential cause of these suboptimal outcomes. Our study assesses the clinical impact of performing an ankle arthroscopy during ankle fracture open reduction and internal fixation (ORIF).MethodsThis was a retrospective chart review of all patients who underwent operative fixation of a bimalleolar or trimalleolar ankle fracture at our institution from 2014 through 2018. We extracted all demographic data, fracture pattern, operative procedures performed, tourniquet times, arthroscopic findings and any arthroscopic interventions. We then conducted a phone and e-mail survey. Our study included 213 total patients (142 traditional ORIF, 71 ORIF plus arthroscopy) with an average age of 40 years. The average follow-up was 32.4 months with a survey follow-up rate of 50.7% (110/213).ResultsThe average tourniquet time for the arthroscopy cohort was 10 minutes longer (89 minutes vs 79 minutes). During the arthroscopy, there was a 28% (20/71) rate of full-thickness osteochondral lesions, 33% (24/71) rate of loose bodies, and a 49% (35/71) rate of partial-thickness cartilage injury. The mean Patient Reported Outcome Information System (PROMIS) physical function score among Weber B fibula fractures was 45.8 and 42.3 in the arthroscopy and nonarthroscopy groups, respectively (P = .012). In addition, the patient satisfaction rate in Weber B fibula fractures was higher in those patients who underwent arthroscopy compared with ORIF alone (93% vs 75%, P = .05). Patients who had a tibiotalar joint dislocation at the time of the ankle fracture had a significantly higher PROMIS physical function score (46.6 vs 40.2, P = .005) when their surgery included arthroscopy.ConclusionAnkle arthroscopy at the time of ORIF led to statistically significant improvements in patient-reported outcomes for Weber B fibula fractures and ankle dislocations. There was no increase in complication rates and the arthroscopy took 10 minutes longer on average.Level of evidenceLevel III, retrospective cohort study.
| S-EPMC8697299 | biostudies-literature
Project description:IntroductionIntra-articular fractures are the leading etiology for posttraumatic osteoarthritis (PTOA) in the ankle. Elevation of proinflammatory cytokines following intra-articular fracture may lead to synovial catabolism and cartilage degradation. We aimed to compare cytokine levels in injured and healthy ankle joints, examine the longer-term cytokine levels in fractured ankles, and investigate the association between cytokine levels in fractured ankles and plasma.Materials and methodsIn this cross-sectional study, synovial fluid (SF) and plasma of forty-seven patients with acute intra-articular ankle fractures and eight patients undergoing implant removal were collected prior to surgery. We determined concentrations of sixteen inflammatory cytokines, two cartilage degradation proteins, and four metabolic proteins and compared the levels in acutely injured ankles with those of the healthy contralateral side or during metal removal. Cytokine levels in injured ankles were also compared to serum cytokine levels. Nonparametric Wilcoxon rank-sum and Spearman tests were used for statistical analysis, and a p value below 0.05 was considered significant.ResultsCompared to the healthy ankles, the synovial fluid in ankles with acute intra-articular fracture had elevated levels of several proinflammatory cytokines and proteases (IL-1β, IL-2, IL-6, IL-8, IL-12p70, TNF, IFNγ, MMP-1, MMP-3, and MMP-9) and anti-inflammatory cytokines (IL-1RA, IL-4, IL-10, and IL-13). The levels of cartilage degradation products (ACG, CTX-2) and metabolic mediators (TGF-β1 and TGF-β2) were also significantly higher. Synovial concentrations of ACG, IL-12-p70, IFNγ, IL-4, and bFGF correlated with serum levels. While most of the examined synovial cytokines were unchanged after implant removal, IL-4 and IL-6 levels were upregulated.ConclusionsWe show that an acute ankle fracture is followed by an inflammatory reaction and cartilage degeneration. These data contribute to the current understanding of the protein regulation behind the development of PTOA and is a further step towards supplementing the current surgical treatment. This cross-sectional study was "retrospectively registered" on the 31th October 2017 at ClinicalTrials.gov (NCT03769909). The registration was carried out after inclusion of the first patient and prior to finalization of patient recruitment and statistical analyses: https://clinicaltrials.gov/ct2/show/NCT03769909?term=NCT03769909&draw=2&rank=1.
| S-EPMC7811423 | biostudies-literature
Project description:BackgroundAnkle sprain is the most common lower limb injury in physically active individuals. Loss of function, decreased postural control (PC), strength deficit, and reduced range of motion (ROM) are common after acute lateral ankle sprains. Some patients experienced long lasting symptoms, with recurrent sprains, and episodes of giving-way: a condition known as chronic ankle instability (CAI). Evaluating the function in patients with CAI in the clinical environment is important to identify the severity of the condition, in addition to allowing to assess the effectiveness of a given treatment. The aim of this study was to investigate the validation of the Foot and Ankle Ability Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS) in terms of muscle strength, PC and ROM in adults with CAI.MethodsThis is a cross-sectional study. Individuals with CAI aged between 18 and 45 years were eligible. Individuals with CAI were identified using the Identification of Functional Ankle Instability (IdFAI). All patients filled in the FAAM and FAOS scores. Muscle strength was assessed by manual dynamometry, ROM by the Lunge test, PC by computerized posturography, modified Star Excursion Balance Test (mSEBT) and modified Balance Error Score System (mBESS).Results50 participants were enrolled in the present study. The mean age of the patients was 27.2 ± 6.3 years, and the mean body mass index was 26.4 ± 4.8 kg/m2. 58% (29 of 50) were men and 42% (21 of 50) women. 18 individuals had unilateral (36%) and 32 bilateral (64%) CAI. The results of FAAM were associated with MCT, mSEBT, invertor muscles strength, plantar flexor muscles strength, dorsiflexor muscles strength, and external hip rotator muscles strength (P < 0.05). The results of FAOS were associated with mSEBT, invertor muscles strength, plantar flexor muscles strength, dorsiflexor muscles strength, evertor muscles strength, and external hip rotator muscles strength, and mBEES (P < 0.05).ConclusionBoth the FAAM and FAOS demonstrated validity to evaluate postural control and muscle strength in patients with CAI, while no association was found in relation to ankle dorsiflexion.
| S-EPMC8781557 | biostudies-literature
Project description:BackgroundIsolated type B ankle fractures with no injury to the medial side are the most common type of ankle fracture.ObjectiveThis study aimed to determine if surgery is superior to non-surgical management for the treatment of these fractures.MethodsA pragmatic, multicentre, single-blinded, combined randomised controlled trial and observational study. Setting Participants between 18 and 65 years with a type B ankle fracture and minimal talar shift were recruited from 22 hospitals in Australia and New Zealand. Participants willing to be randomised were randomly allocated to undergo surgical fixation followed by mobilisation in a walking boot for 6 weeks. Those treated non-surgically were managed in a walking boot for 6 weeks. Participants not willing to be randomised formed the observational cohort. Randomisation stratified by site and using permuted variable blocks was administered centrally. Outcome assessors were blinded for the primary outcomes. Primary outcomes Patient-reported ankle function using the American Academy of Orthopaedic Surgeons Foot and Ankle Outcomes Questionnaire (FAOQ) and the physical component score (PCS) of the SF-12v2 General Health Survey at 12 months postinjury. Primary analysis was intention to treat; the randomised and observational cohorts were analysed separately.ResultsFrom August 2010 to October 2013, 160 people were randomised (80 surgical and 80 non-surgical); 139 (71 surgical and 68 non-surgical) were analysed as intention to treat. 276 formed the observational cohort (19 surgical and 257 non-surgical); 220 (18 surgical and 202 non-surgical) were analysed. The randomised cohort demonstrated that surgery was not superior to non-surgery for the FAOQ (49.8 vs 53.0; mean difference 3.2 (95% CI 0.4 to 5.9), p=0.028), or the PCS (53.7 vs 53.2; mean difference 0.6 (-2.9 to 1.8), p=0.63). 23 (32%) and 10 (14%) participants had an adverse event in the surgical and non-surgical groups, respectively. Similar results were found in the observational cohort.ConclusionsSurgery is not superior to non-surgical management for 44-B1 ankle fractures in the short term, and is associated with increased adverse events.Trial registration numberNCT01134094.
| S-EPMC5372107 | biostudies-literature
Project description:ObjectivesTo determine (1) the prevalence of ankle osteoarthritis (OA) among former professional football and rugby players, (2) assess the association between ankle injuries or ankle surgeries with ankle OA, and (3) compare the mental and physical quality of life (QoL) between former professional football and rugby players with and without OA.MethodsWe conducted a questionnaire-based observational study with a cross-sectional design. Former professional football and rugby players were recruited by the Football Players Worldwide and the International Rugby Players. Information concerning ankle OA, sustained ankle injuries and ankle surgeries was gathered (medical record or most recent medical professional). Health-related QoL was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) physical and mental health scores.ResultsOverall, 553 former professional football (n=401) and rugby (n=152) players were enrolled in the study (response rate of 56%). Ankle OA prevalence among former professional football and rugby players was 9.2% and 4.6%, respectively. Football players were more likely to suffer from ankle OA following every ankle injury and/or surgery. Football and rugby players with ankle OA had similar PROMIS physical and mental health scores to the norm for the general population.ConclusionFormer professional football and rugby players had higher ankle OA prevalence than the general population (3.4%). Football players are more likely to suffer from ankle OA following every ankle injury and/or surgery. No clinically relevant difference was seen for physical or mental health-related QoL among football and rugby players. Preventive measures for ankle injuries are recommended.
| S-EPMC7310999 | biostudies-literature
Project description:Genetic and environmental risk factors contribute to periodontal disease, but the underlying susceptibility pathways are not fully understood. Epigenetic mechanisms are malleable regulators of gene function that can change in response to genetic and environmental stimuli, thereby providing a potential mechanism mediating risk effects in periodontitis. The aim of this study is to identify epigenetic changes across tissues that are associated with periodontal disease.
2018-11-25 | GSE121633 | GEO
Project description:IntroductionAnkle fractures in the osteoporotic patient are challenging injuries to manage, due to a combination of poor soft tissue, peripheral vascular disease and increased bone fragility, often resulting in more complex fracture patterns. I aim to audit current practice and introduce change by producing recommendations to help improve longer-term functional outcomes.Patients and methodsA retrospective 3-week audit was conducted reviewing results of ankle fracture management in 50 patients aged between 50 and 80 years. Patients admitted for either manipulation under anaesthesia (MUA)/application of cast or open-reduction and internal fixation (ORIF) were considered. Medical notes, including discharge summaries, were used for data extraction.ResultsFrom the 50 patients included within the cohort, forty-two patients (84%) underwent surgical intervention, with eight patients (16%) managed non-operatively. Malunion (63%) and failed fracture fixation (25%) were more commonly reported in patients managed non-operatively. Surgery performed by trainee surgeons was unlikely to prolong theatre time with no statistical significance observed with the consultant led cohort (p = 0.380). However, incidence of fracture malunion and failed fixation were significantly higher following surgery without consultant supervision in the junior trainee group (p = 0.043).ConclusionsPoor bone quality and associated co-morbidity can present technical difficulties when managing patients surgically. However, our results have shown considerably improved anatomical reduction rates following internal fixation in eligible patients, irrespective of age or gender.
| S-EPMC4777982 | biostudies-literature
Project description:ObjectiveTo investigate whether the prices of new anticancer drugs correlated with their relative benefit despite negotiation.DesignRetrospective cross-sectional study correlating new anticancer drugs prices with clinical outcomes.SettingWe did a retrospective cross-sectional study including all new anticancer drugs approved by the European Medicines Agency (EMA) (2010-2016) and reimbursed in Italy.Main outcomes and measuresInformation on clinical outcomes-in terms of median overall survival (OS), median progression-free survival (PFS) and objective response rate (ORR)-was extracted from pivotal trials as reported in the European Public Assessment Reports available on the EMA website. Cost of a full course treatment was estimated on negotiated official and discounted prices. Regression coefficients β, their levels of significance p and the coefficients of determination R2 were estimated adjusting by tumour type.ResultsOverall, 30 new anticancer drugs (with 35 indications) were available for analysis. Where data on OS were available, we observed no correlation between the improvement in median OS (in weeks) and negotiated price (R2=0.067, n=16 drugs for 17 indications). When the clinical outcomes were expressed as improvements in the median PFS or ORR, 25 drugs (29 indications) were available for the analysis, and again, there was no correlation with prices (R2=0.004 and 0.006, respectively).Conclusions and relevanceOur results suggest that the prices of anticancer drugs in Italy do not reflect their therapeutic benefit. Drug price negotiations, which is mandatory by law in Italy, do not seem to ensure that prices correlate with clinical benefits provided by the cancer drugs. These results call for further efforts to establish the standard determinants of drug prices available at the time of negotiation. These findings need to be confirmed in other countries where price negotiations are in place. Moreover, further investigations may verify whether outcome data obtained after drug marketing would improve the correlation between prices and therapeutic benefit.
| S-EPMC6924817 | biostudies-literature
Project description:BackgroundSince the COVID-19 pandemic onset, telemedicine has increased exponentially across numerous outpatient departments and specialties. Qualitative studies examining clinician telemedicine perspectives during the pandemic identified challenges with physical examination, workflow concerns, burnout, and reduced personal connection with patients. However, these studies only included a relatively small number of physicians or were limited to a single specialty, and few assessed perspectives on integrating trainees into workflows, an important area to address to support the clinical learning environment. As telemedicine use continues, it is necessary to understand a range of clinician perspectives.ObjectiveThis study aims to survey pediatric and adult medicine clinicians at the University of Chicago Medical Center to understand their telemedicine benefits and barriers, workflow impacts, and training and support needs.MethodsIn July 2020, we conducted an observational cross-sectional study of University of Chicago Medical Center faculty and advanced practice providers in the Department of Medicine (DOM) and Department of Pediatrics (DOP).ResultsThe overall response rate was 39% (200/517; DOM: 135/325, 42%; DOP: 65/192, 34%); most respondents were physicians (DOM: 100/135, 74%; DOP: 51/65, 79%). One-third took longer to prepare for (65/200, 33%) and conduct (62/200, 32%) video visits compared to in-person visits. Male clinicians reported conducting a higher percentage of telemedicine visits by video than their female counterparts (P=.02), with no differences in the number of half-days per week providing direct outpatient care or supervising trainees. Further, clinicians who conducted a higher percentage of their telemedicine by video were less likely to feel overwhelmed (P=.02), with no difference in reported burnout. Female clinicians were "more overwhelmed" with video visits compared to males (41/130, 32% vs 12/64, 19%; P=.05). Clinicians 50 years or older were "less overwhelmed" than those younger than 50 years (30/85, 35% vs 23/113, 20%; P=.02). Those who received more video visit training modalities (eg, a document and webinar on technical issues) were less likely to feel overwhelmed by the conversion to video visits (P=.007) or burnt out (P=.009). In addition, those reporting a higher ability to technically navigate a video visit were also less likely to feel overwhelmed by video visits (P=.02) or burnt out (P=.001). The top telemedicine barriers were patient-related: lack of technology access, lack of skill, and reluctance. Training needs to be focused on integrating learners into workflows. Open-ended responses highlighted a need for increased support staff. Overall, more than half "enjoyed conducting video visits" (119/200, 60%) and wanted to continue using video visits in the future (150/200, 75%).ConclusionsDespite positive telemedicine experiences, more support to facilitate video visits for patients and clinicians is needed. Further, clinicians need additional training on trainee education and integration into workflows. Further work is needed to better understand why gender and age differences exist. In conclusion, interventions to address clinician and patient barriers, and enhance clinician training are needed to support telemedicine's durability.
| S-EPMC8274680 | biostudies-literature
Project description:Joint angle data from healthy subjects are necessary as baseline information.To analyze the problems of patients who struggle with activities of daily living (ADL) due to restricted range of motion and to provide ADL guidance based on objective data.An electromagnetic three-dimensional tracking system (FASTRAK) was used to quantify the hip, knee, and ankle angles of the dominant leg of 26 healthy adults as they performed 22 ADLs related to dressing, using the toilet, bathing, picking up objects, and crouching. For each ADL, the maximum angle was averaged across the 26 subjects. Mean angles of adduction/abduction and internal/external rotation during maximum hip flexion were also measured.The largest mean maximum angle was 101° for hip flexion (trunk rotation during crouching), 17° for hip adduction (putting on shoes), and 149° for knee flexion (trunk rotation during crouching). Analysis of adduction/abduction and internal/external rotation angles during maximum hip flexion showed the largest angle of adduction when putting on shoes, and the largest angle of internal rotation with trunk rotation during crouching.ADLs such as crouching and putting on pants showed larger joint angles than walking, climbing stairs, and standing up. Results obtained from this study can provide important objective data for ADL guidance for total hip arthroplasty and femoroacetabular impingement patients.
| S-EPMC5537477 | biostudies-other