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OTA International
Number of Followers: 0  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2574-2167
Published by LWW Wolters Kluwer Homepage  [307 journals]
  • Open reduction and internal fixation (ORIF) versus ORIF and primary
           subtalar arthrodesis for complex displaced intraarticular calcaneus
           fractures: An expected value decision analysis

    • Authors: Eisenstein; Emmanuel David; Kusnezov, Nicholas A.; Waterman, Brian R.; Orr, Justin D.; Blair, James A.
      Abstract: imageObjectives: To determine the optimal patient-oriented treatment between open reduction and internal fixation (ORIF) with or without primary subtalar arthrodesis (PSTA) for patients with displaced intraarticular calcaneus fractures (DIACFs, OTA 82-C3 and C4).Design: Expected value decision analysis.Setting: Academic military treatment facilityParticipants: One hundred randomly selected volunteers.Intervention: Hypothetical clinical scenario involving ORIF versus ORIF with PSTA.Main outcome measurements: Decision analysis was used to elucidate the superior treatment option based on expected patient values, composed of: the product of the average outcome probabilities established by previously published studies and the average ascribed patient utility values for each outcome probability. One-way sensitivity analysis was performed to quantify the amount of change required for the inferior treatment to equal or surpass the superior option.Results: Expected values for ORIF and ORIF with PSTA were 8.96 and 18.06, respectively, favoring ORIF with PSTA. One-way sensitivity analysis was performed by artificially decreasing the rate of secondary fusion following isolated ORIF thus increasing its overall expected value. Adjusting the rate of secondary fusion to 0%, the expected value of ORIF with PSTA nearly doubled that of ORIF (18.06 vs 9.45). Similarly, when adjusting the moderate and severe complication rates following ORIF with PSTA to 100%, the expected value of ORIF with PSTA still exceeded that of ORIF (15.45 vs 8.96, and 13.52 vs 8.96, respectively).Conclusion: Expected value decision analysis favors ORIF with PSTA as the optimal treatment for complex DIACF.
      PubDate: Sat, 01 Sep 2018 00:00:00 GMT-
       
  • Direct visualization of the syndesmosis for evaluation of syndesmotic
           disruption: A cadaveric study

    • Authors: Gosselin-Papadopoulos; Nayla; Hébert-Davies, Jonah; Laflamme, G. Yves; Ménard, Jérémie; Leduc, Stéphane; Rouleau, Dominique M.; Nault, Marie-Lyne
      Abstract: imageObjectives: Radiologic criteria for syndesmosis instability evaluation remain controversial and direct visualization (DV) of the distal tibiofibular articulation is an alternative diagnostic method worthy of further investigation. We speculate that DV is a more accurate way to evaluate syndesmosis instability than fluoroscopy. The purpose of this study is to determine whether syndesmosis instability can accurately be recognized through DV and if this new intraoperative diagnostic method is more sensitive than fluoroscopy in detecting syndesmosis instability.Methods: Ten cadaveric ankles were tested using a sequential iatrogenic syndesmosis injury model. Specimens were tested incrementally with the lateral stress test (LST) and the external rotation stress test (ERT). The resulting instability was measured directly and fluoroscopically with a true mortise view by using medial clear space (MCS) and tibiofibular clear space (TFCS).Results: DV detected a 2-ligaments injury at a mean diastasis of 3.02 mm (P = 0.0077) and 3.19 mm (P = 0.0077) with the LST and ERT, respectively. Fluoroscopically, TFCS showed a significant diastasis only with a complete syndesmosis rupture while MCS did not show any significant differences.Conclusions: DV of the syndesmosis in a cadaver injury model appears to be more sensitive than fluoroscopy in identifying injury, especially incomplete syndesmotic disruption.
      PubDate: Sat, 01 Sep 2018 00:00:00 GMT-
       
  • A salvage strategy for heel pad degloving injury: A case report

    • Authors: Cantrell; William A.; Lawrenz, Joshua M.; Vallier, Heather A.
      Abstract: imageCase: A 50-year-old female experienced a crush injury to the foot resulting in open degloving of her heel pad. This study details a surgical strategy to achieve healing and limb salvage.Conclusion: Heel pad injuries with degloving are difficult to salvage and have a poor prognosis. Amputation is often the only therapeutic option, unless part of the blood supply to the heel pad is intact, rendering limb salvage a possibility.
      PubDate: Sat, 01 Sep 2018 00:00:00 GMT-
       
 
 
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