OBJECTIVES: To evaluate the risk of developing a new mental disorder diagnosis within 2 years of lower extremity fracture. METHODS: Design: Retrospective cohort study. Setting: National insurance claims database. Patient Selection Criteria: Patients between 18 and 65 years with lower extremity, pelvis, and acetabular fractures without prior mental disorders as defined using International Classification of Diseases, 9th and 10th revision diagnosis codes were included. Mental disorders evaluated included alcohol use disorder, generalized anxiety disorder, bipolar disorder, major depressive disorder, drug use disorder, panic disorder, posttraumatic stress disorder, and suicide attempt. Outcome Measures and Comparisons: The individual lower extremity fracture cohorts were matched 1:4 with nonfracture controls. The specific groups of interest were pelvis fractures, acetabulum fractures, proximal femur fractures, femoral shaft fractures, distal femur fractures, patella fractures, tibia plateau fractures, tibia shaft fractures, ankle fractures, pilon fractures, calcaneus fractures, and Lisfranc fractures. Rates of mental disorders after primary lower extremity fractures within 2 years were compared using multivariable logistic regression. RESULTS: Overall, the 263,988 patient-fracture group was 57.2% female with an average age of 46.6 years. Compared with controls with no fracture, patients who sustained pelvis, acetabulum, proximal femur, femoral shaft, distal femur, patella, tibia plateau, tibia shaft, pilon, calcaneus, or Lisfranc fracture had a statistically significantly increased risk of being diagnosed with a queried mental disorder within 2 years of fracture. When comparing all fracture patients by location, those suffering from fractures proximal to the knee joint, including pelvis fractures [OR: 1.51, 95% confidence interval (CI): 1.39–1.64] and proximal femur fractures [odds ratio (OR): 1.36, 95% CI: 1.26–1.47], demonstrated greater risk of developing any of the queried mental disorders compared with fractures distal to the knee, including ankle fractures (OR: 0.99, 95% CI: 0.95–1.03) and pilon fractures (OR: 1.05, 95% CI: 0.81–1.36). When comparing specific fracture patients with patients without fracture by mental disorder, patients demonstrated an increased risk of suicide attempt following fracture of the pelvis, acetabulum, femoral shaft, distal femur, and calcaneus, as well as patients sustaining a Lisfranc fracture. CONCLUSIONS: There is an increased risk of being diagnosed with a new mental disorder following lower extremity trauma in patients without prior mental disorder diagnosis compared with matched individuals without a lower extremity fracture. Among the fractures studied, those that were more proximal, such as pelvis and proximal femur fractures, carried greater risk compared with more distal fracture sites, including ankle and pilon fractures. Patients who experienced certain lower extremity fractures had a significantly higher rate of suicide attempt compared with patients without fracture. Physicians should consider increased mental health screening and potential referral for mental health evaluation for patients following lower extremity trauma. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
To review the graft and visual outcomes in a series of patients with rheumatoid arthritis (RA) who underwent Descemet stripping endothelial keratoplasty (DSEK).In this case series, the electronic medical records at Wills Eye Hospital were queried for cases of patients with RA who underwent DSEK between January 1, 2009 and September 1, 2018. Charts were reviewed to obtain demographic data, medical history, ocular history, surgical variables, graft survival, and visual acuity outcomes.During the study period, 22 transplants performed in 18 eyes of 15 patients with RA were eligible for inclusion. The mean age at the time of initial DSEK was 70.5 ± 11.1 years (range 46-87). The mean follow-up time for the included eyes was 4.89 ± 2.71 years (range 1.95-10.39). The overall estimated graft survival was 8.26 ± 0.81 years with a 5-year survival rate of 88.9%. A significant improvement from preoperative best corrected visual acuity (logarithm of the minimum angle of resolution 0.84, approximately 20/140) to the most recent follow-up (logarithm of the minimum angle of resolution 0.29, approximately 20/40) was noted (P < 0.001).In our case series, patients with a history of RA underwent successful DSEK with excellent graft survival rates and visual acuity outcomes. Well-controlled RA should therefore not be considered a deterrent to performing DSEK.
BackgroundOrthopaedic surgeons who are fellowship-trained in adult reconstruction (AR) specialize specifically in total joint arthroplasty, including total knee arthroplasty (TKA). However, TKA procedures are not only performed by AR surgeons. The purpose of this study was to compare the patient demographics and postoperative outcomes of patients who had a TKA procedure performed by an AR surgeon vs a sports medicine (SM) surgeon.MethodsA retrospective cohort study was conducted using a national insurance database. Patients who underwent a primary elective TKA procedure by an AR surgeon (n = 56,570) and an SM surgeon (n = 72,888) were identified. Patient demographics, rates of joint complications within 2 years, and medical complications within 90 days postoperatively were compared using multivariable logistic regression.ResultsCompared to the cohort of patients undergoing TKA by SM surgeons, the patient cohort of AR surgeons had a higher mean Elixhauser comorbidity index (4.2 vs 4.0, P < .001), and had significantly higher rates of several comorbidities. Within 90 days, patients of AR surgeons demonstrated significantly lower rates of acute kidney injury and transfusions. When compared to patients of SM surgeons, patients of AR surgeons demonstrated significantly lower rate of manipulation under anesthesia or lysis of adhesions within 2 years. Rates of all other joint-related complications were statistically comparable between the 2 cohorts.ConclusionsAs a cohort, AR surgeons perform TKA on a higher-risk cohort of patients compared to sports medicine surgeons. Despite the higher-risk patient population, outcomes of TKA by AR surgeons appear equivalent compared to their SM colleagues.
To evaluate the clinical outcomes and biomechanical performance of transosseous tunnels compared with suture anchors for quadriceps tendon repair.In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search was performed in April 2021 in the following databases: Cochrane Database of Systematic Reviews, PubMed (1980-2021), MEDLINE (1980-2021), Embase (1980-2021), and CINAHL (1980-2021). Level I-IV studies were included if they provided outcome data for surgical repair of the quadriceps tendon using transosseous tunnels or suture anchors with minimum 1-year follow-up. Biomechanical studies comparing transosseous tunnels and suture anchors were separately analyzed.The systematic search yielded 1,837 citations, 23 of which met inclusion criteria (18 clinical, 5 biomechanical). In total, 13 studies reported results for transosseous repair and 7 studies reported results for repair with suture anchors. There were results for 508 patients from clinical studies. The average postoperative Lysholm score ranged from 88 to 92 for suture anchor repairs and 72.8 to 94 for transosseous repairs with range of motion ranging from 117° to 138° and 116° to 135°, respectively. Synthesis of the biomechanical data revealed the mean difference in load to failure was not significant between constructs (137.21; 95% confidence interval -10.14 to 284.57 N; P = .068).Transosseous and suture anchor techniques for quadriceps tendon repair result in similar biomechanical and postoperative outcomes. No difference between techniques in regard to ultimate load to failure among comparative biomechanical studies were observed.Level IV, systematic review level III-IV studies.
Fragility fractures can be substantially life-altering with notable effects on patient well-being and mental health. The purpose of this study was to evaluate the risk of developing a new mental disorder diagnosis within 2 years following osteoporotic fragility fracture. A retrospective cohort study was conducted using a large national insurance claims database. Patients with proximal humerus, wrist, pelvis, hip, and spine fractures were matched in a 1:4 ratio with nonfracture control patients. Rates of mental disorders after primary fragility fractures were compared using multivariable logistic regression. Mental disorders evaluated included alcohol use disorder, generalized anxiety disorder, bipolar disorder, major depressive disorder, drug use disorder, panic disorder, posttraumatic stress disorder, and suicide attempt. Elderly patients who sustained fragility fractures had a statistically significant increased risk of being diagnosed with many of the queried mental disorders within 2 years following fracture compared with control patients with no fracture. Comparing each individual fragility fracture demonstrated that hip fractures had the greatest risk of developing any of the queried mental disorders (OR:1.88, CI: 1.74-2.03). There is an increased risk of being diagnosed with a new mental disorder following fragility fracture in patients older than 65 years. Mental health screening and potential psychiatric evaluation should be considered for patients following fragility fracture. Original Research (Level III).
