Category: Statistics

Acta Orthop Belg. 2022 Jun;88(2):368-371. doi: 10.52628/88.2.8215.

ABSTRACT

To objectively assess wound healing utilizing a novel digital photo planimetry method. 58 wounds mostly of traumatic origin were studied. In method I (control or gold standard), a transparent plastic graph paper sheet with 2.5 mm squares was placed on the wound to trace the wound edges. This was scanned and analyzed in Adobe Photoshop (PS6) to estimate the area. In the novel method (method II), we clicked a photo with one-inch lines marked (on either side of the wound). This photo was similarly assessed in PS6. A two-sample t-test was used for analysis. Photos were clicked every third day. The time taken to calculate the resultant area was also noted. 484 photos and 1936 values were analyzed. The mean areas obtained were 10690 mm 2 and 10859 mm 2 respectively by methods I and II. The mean difference was 0.824%, 95% CI [-0.05, 1.60] and p = 0.923. The inter and intra- observer variation was < 2% for all readings. The time taken by the novel method was much lesser than the time-tested method (mean = 82 sec vs 178 sec; p < 0.01). The difference in area by the two methods is not statistically significant. The accuracy of both methods is therefore comparable. Our novel method is easier, more cost-effective, equally accurate, safer and reproducible in comparison with the transparency squares method, especially for flat or 2-dimensional wounds.

PMID:36001845 | DOI:10.52628/88.2.8215

Acta Orthop Belg. 2022 Jun;88(2):359-367. doi: 10.52628/88.2.8351.

ABSTRACT

The popliteal fossa nerve block (PFNB) technique is one of the most popular anesthesia method in the foot and ankle surgery. The wide awake local anesthesia no tourniquet (WALANT) technique is an local anesthetic method and it has been gaining popularity in orthopedic surgery in recent years. Our aim is to compare the efficacy of the WALANT and the PFNB techniques in pain management. This prospective study included 40 patients with lateral malleolar and medial malleolar fractures. The first group was anesthetized using the WALANT technique; in the second group, PFNB was performed. All patients were evaluated for intrasurgical bleeding amounts, mean arterial pressure, surgery time and VAS scores for presurgical pain, pain during the local anesthetic injection sequence, mean intrasurgical pain, mean postsurgical pain. A total of 40 patients in both groups were successfully operated on with the WALANT and the PFNB techniques. When the two groups were compared, statistically significant differences were observed for mean intrasurgical VAS (p = 0.033), mean postsurgical VAS (p = 0.038) and intrasurgical bleeding (p = 0.006). No significant difference was found in pain scores during anesthetic injection (p = 0.529), mean arterial pressure (p = 0.583) and surgery time (p = 0.277). The PFNB technique is more successful in pain management in the treatment of the unimalleolar fractures. Intrasurgical bleeding amounts were less detected in the WALANT tech- nique. The both techniques are a reliable and suitable anesthetic method in the surgical treatment of uni- malleolar fractures.

PMID:36001844 | DOI:10.52628/88.2.8351

Acta Orthop Belg. 2022 Jun;88(2):355-358. doi: 10.52628/88.2.8982.

ABSTRACT

Partial running whipstitches are commonly used in DT4 SAMBBA (Single Anteromedial Bundle Biological Augmentation) transplant preparation. We wanted to determine whether or not running whipstitches all over the graft affected the risk of iterative rupture and the overall outcome of the procedure. Two groups of 32 patients comparable in terms of sex, age, sport level and type of sport practiced were recruited in this prospective cohort study. DT4 SAMBBA was performed for all patients by a single surgeon. One cohort was treated with a full length running whipstitches during SAMBBA DT4 transplant preparation (F), the other had a classical SAMBBA DT4 graft preparation (NO F). The ACL RSI, subjective IKDC and KOOS scores were established preoperatively and with a 4 years follow-up. Complication rates (iterative rupture, cyclops syndrome) as well as pre and postoperative score variations were calculated. No statistically significant difference in terms of frequency of iterative rupture or complications could be demonstrated (NO F 9.3% vs F 3.1%, p = 0.61). There was no difference either on score variations compared pre and post operatively. Full running whipstitches of the DT4 SAMBBA transplant does not seem to influence the ligamentoplasty outcomes with a 4 years follow-up.

PMID:36001843 | DOI:10.52628/88.2.8982

Acta Orthop Belg. 2022 Jun;88(2):347-354. doi: 10.52628/88.2.7306.

ABSTRACT

Recently there has been growing interest in the quadriceps tendon (QUAD) as a valid option for reconstruction of the anterior cruciate ligament (ACLR). The aims of the study is to compare the outcomes achieved in anatomic ACLR involving QUAD vs. Hamstring (HT) autografts. A total of 52 consecutive patients underwent an ACLR, 25 patients with QUAD graft and 27 with HT graft. The same surgical technique, fixation method and postoperative protocol were used in both groups. The following parameters were evaluated: functional status (Lysholm, Tegner, subjective IKDC scores), joint stability (Lachman and pivot shift tests), surgical reoperation rate, complications, degree of satisfaction and return to previous level of activity. Descriptive statistics were analysed using the Student’s t-test. Forty four patients were evaluated (20 QUAD, 24 HT), with a mean follow-up of 27.4 months. Two patients were re-operated in the QUAD group (including one ACL revision), and one patient in the HT group required an ACL revision. There were no significant differences between the two groups in postoperative scores: Lysholm (96.05 vs. 96.05), IKDC (86.2 vs. 91.2) and Tegner (6 vs. 5) scales. The percentage of negative Lachman and pivot shift tests was similar in the two groups (45% vs. 50% and 40% vs. 45.8%, respectively). There were no significant differences between the groups in the degree of satisfaction (95.8% vs. 80%, p = .16) or in the percentage who returned to their previous level of activity (62.5% vs. 45%, p = .17). The use of a QUAD graft in ACL reconstruction leads to similar clinical and functional outcomes to those obtained with HT.

PMID:36001842 | DOI:10.52628/88.2.7306

Acta Orthop Belg. 2022 Jun;88(2):335-341. doi: 10.52628/88.2.8383.

ABSTRACT

Perioperative intravenous (IV) TA has become routine in knee and hip arthroplasty. Less evidence exists on the administration of oral TA in the post- operative period. Our study aims to identify the efficacy and safety of combined perioperative IV and post-operative oral TA on blood loss and Hemoglobin (Hb) drop compared to perioperative IV TA alone. Patients undergoing primary elective knee arthro- plasty at our institution were invited to participate in the study (n=50). A computer-generated randomisation sequence was created online (www.randomization. org), with an allocation ratio of 1:1 and a block size of 50. Group A received perioperative IV TA alone and post-operative oral TA (n= 26) and Group B received perioperative IV TA plus 48 hours additional oral placebo (n= 24). Day 3 total blood loss and Hb drop was calculated. Continuous, normally distributed data (total blood loss) was compared utilising using one-way analysis of variance with post hoc Tukey test. Continuous skewed data (Hb drop) was compared using the Kruskal-Wallis test. P <0.05 was considered statistically significant. Group A demonstrated a trend in decreased total blood loss that was close to statistical significance ( p = 0.072). No difference in Hb drop was identified between the 2 groups. Increased nausea was also observed in Group A. The administration of oral TA to post-operative knee arthroplasty patients does not improve further blood loss compared to patients receiving perioperative IV TA pre-operatively and at wound closure.

PMID:36001840 | DOI:10.52628/88.2.8383

Acta Orthop Belg. 2022 Jun;88(2):329-334. doi: 10.52628/88.2.10276.

ABSTRACT

Fixed flexion deformity also called flexion contracture is relatively rare, but a very demanding functional limitation that both surgeons and patients may have to deal with. The purpose of the present study was to evaluate the functional outcomes after posteromedial capsular release in case of fixed flexed deformity > 15 o . Between June 2011 and November 2018, 15 patients (6 males and 9 females) were treated with open posterior capsular release through medial approach for fixed flexion deformity of the knee > 15 o and prospectively followed with a minimum follow-up of 2 years. Primary outcome was knee extension measured with a manual goniometer and secondary outcome treatment related complications. All patients reported inability to walk and clinical semiology of pain and swelling. The mean age of the study population at surgery was 61.7 years with a mean BMI of 30.9 kg/m2. Complete data were recorded for all patients. Statistically significant improvement was found in clinical and functional assessment tools analyzed from baseline to the latest follow-up (p<0.05). More precisely, the mean postoperative fixed flexion deformity was decreased from 23.57 o to 2.86 o . No adverse effect or major complications were recorded during follow-up. Posterior open release via posteromedial was shown to be an efficient and safe salvage procedure to deal with persistent fixed flexion deformity of more than 15 o following TKA at two years follow-up. However, future studies with a higher number of participants and longer follow-up should be conducted to validate our data.

PMID:36001839 | DOI:10.52628/88.2.10276

Acta Orthop Belg. 2022 Jun;88(2):319-327. doi: 10.52628/88.2.9002.

ABSTRACT

In older patients with highly comminuted intra- articular tibial plateau fractures (TPFs), primary total knee arthroplasty (TKA) may be a treatment option. Our aim was to report and rank decisional factors considered by Dutch orthopaedic trauma and knee surgeons that may lead to the decision for TKA as treatment for TPFs. A survey was distributed among 141 experts on traumatology and arthroplasty of the knee. The survey assessed the likelihood of TKA surgery after TPF in various patient and radiological characteristics. The level of experience with this of each responder was also noted. Descriptive statistics were calculated for all items. 141 participants were approached and 68 responded (48.2%). Responders were not more likely to proceed with TKA based on fracture types, impaired mobility, multiple incisions for ORIF, body mass index and ASA classification. However, in patients with pre-existing osteoarthritis (OA) and age ≥ 80 a majority would be more likely to proceed with TKA, with respectively 69.1% and 50.0%. The most strongly considered factors were the presence of pre-existing OA, the age of the patient and the type of fracture, with respectively 55.9%, 51.4% and 42.6% of responders ranking it in their top three most important factors. The study showed that the presence of pre-existing symptomatic OA and age of the patient were valued highest and increased the probability of a TKA in acute TPFs.

PMID:36001838 | DOI:10.52628/88.2.9002

Acta Orthop Belg. 2022 Jun;88(2):285-291. doi: 10.52628/88.2.7727.

ABSTRACT

The aim of this retrospective study is to evaluate and compare the clinical and radiological results of the use of Zero-P implant and the integrated cage-plate implant in surgical treatment of single level cervical disc disease. It includes 54 consecutive patients who underwent single level anterior cervical discectomy and fusion. The patients were divided into 2 groups. Group (A) including 28 patients operated with zero- profile implant and group (B) including 26 patients operated with integrated cage-plate implant. Mean operative time, blood loss, incidence of dysphagia and any other complications related to the procedure were recorded and compared. Patients were assessed radiologically by measuring cervical lordosis using the Cobb angle and the segmental angle. Patients were assessed clinically by the Japanese orthopedic association score and the neck disability index. These values were also compared. The mean age of the patients in group (A) was 49.5±11 years, and in group (B) it was 49.8±11.6 years. Mean blood loss and operative time in group (A) were 77.3±9.4 ml and 72.1±7.9 minutes, while in group B, they were 80.7±9.5 ml and 74.8±8.4 minutes with no statistically significant difference between both groups. There were also no statistically significant difference between both groups as regards incidence of dysphagia, clinical scores nor radiological parameters. In conclusion, both zero-profile implant and integrated cage-plate implant have comparable satisfactory clinical and radiological results in treatment of single level cervical disc diseases with little complications.

PMID:36001834 | DOI:10.52628/88.2.7727

Acta Orthop Belg. 2022 Jun;88(2):217-221. doi: 10.52628/88.2.8784.

ABSTRACT

The aim of the study is to find the correlation between vitamin D level and the severity of slippage and bilateral development in slipped capital femoral epiphysis (SCFE) cases if any. Thirty-nine patients with moderate-severe stable SCFE were evaluated regarding their vitamin D level and to which extent the severity of vitamin D deficiency, if present, can be correlated with the severity and bilaterality of the slip. Vitamin D serum level was assessed pre- operatively for all patients. In case of deficiency, the patient underwent in situ pinning unless performed before his/her presentation. Alongside, he/she received a vitamin D course until correction prior to the definitive surgery (Imhäuser osteotomy with osteochondroplasty) 6-12 weeks after. Thereafter, osteotomy healing and physis closure were monitored radiologically. Results show that all patients but one had vitamin D deficiency, with an average of 14.39 ng/mL, necessitating vitamin D therapy before proceeding to the definitive surgery. No correlation existed between vitamin D level and Southwick angle severity with a p-value of 0.85. A negative correlation existed between vitamin D level and bilaterality, but not statistically significant (p-value 0.192). Patients’ osteotomy healing was uneventful, and physeal closure was achieved in all the cases that had in situ pinning. We conclude that the severity of Vitamin D deficiency could be linked to the bilateral development of SCFE but not the severity of slippage. Treatment of Vitamin D deficiency facilitates physeal closure.

PMID:36001825 | DOI:10.52628/88.2.8784

Am J Audiol. 2022 Aug 24:1-6. doi: 10.1044/2022_AJA-21-00241. Online ahead of print.

ABSTRACT

PURPOSE: Military service personnel are at increased risk for developing tinnitus due to heightened exposure to acoustic trauma. The auditory disorder is the leading service-connected disability among veterans and is highly comorbidly diagnosed with posttraumatic stress disorder (PTSD). The biopsychosocial model illustrates that chronic health conditions are exacerbated or maintained by psychiatric distress. Therefore, alleviation of such psychiatric distress can have beneficial impacts on health conditions, such as tinnitus. The aim of this study was to determine whether individuals with both disorders who receive evidence-based therapy for PTSD will experience decreases in both PTSD and tinnitus-related distress.

METHOD: Veterans with comorbid bothersome tinnitus and PTSD received cognitive processing therapy and were assessed for PTSD, tinnitus-related distress, and depression at baseline and 1 month posttreatment follow-up.

RESULTS: At posttreatment follow-up, participants demonstrated significant decreases in PTSD symptoms compared to their baseline scores. Participants also demonstrated decreased tinnitus-related distress and depression, with high effect sizes.

CONCLUSIONS: This pilot study demonstrated that clinical management addressing psychiatric distress, as associated with PTSD, may simultaneously provide benefit for patients with bothersome tinnitus. Although not statistically significant due to the small sample size, large effect sizes indicate that tinnitus-related distress decreased as a function of receiving evidence-based therapy for PTSD. Future clinical trials should increase sample sizes and compare effects to control conditions.

PMID:36001823 | DOI:10.1044/2022_AJA-21-00241