Injury Outcome Research Articles

Elevated GDF-15 is associated with stroke severity, myocardial injury and poor clinical outcome in patients after acute ischemic stroke

Abstract Background GDF-15 is emerging as a biomarker of cardiometabolic risk and disease burden. Increased concentrations of circulating GDF-15 are associated with increased mortality in patients with acute coronary syndromes or heart failure. Purpose We aimed to describe relation between GDF-15 elevation with stroke severity, myocardial injury and poor clinical outcome in patients after acute ischemic stroke (AIS). Methods Patients after AIS were enrolled in our study. Blood samples were obtained from patients at the time of admission, 24 and 48 hours later to determine the plasma levels of GDF-15 and high-sensitive troponin I (hs-cTnI). Receiver-operating characteristic (ROC) curve analysis was used to determine the diagnostic accuracy and optimal elevation cut-off values of GDF-15 on day 1 for the severity of acute stroke defined by NIHSS score. The optimal cut off in our group was 1776 pg/ml (Sensitivity 0,8, Specificity 0,52). Myocardial injury was defined by fourth universal definition of myocardial infarction using hs-cTnI. Demographic characteristics, clinical data, functional outcome, and all-cause mortality at 1 year were compared between groups according to GDF-15 levels. National Institutes of Health Stroke Scale (NIHSS) at the time of admission and the modified Rankin Scale (mRS) 90 days following the patient’s discharge from the hospital were used to assess stroke severity and clinical outcome. All analyses were performed with SPSS 29.0 (SPSS Inc). Results Between August 2020 and August 2022, 177 patients after AIS were enrolled. Elevated GDF-15 was observed in 71 patients (40,1%). Most common comorbidities included arterial hypertension, dyslipidemia, type 2 DM and atrial fibrillation. In analysis, we observed a connection between elevated GDF-15 with unfavourable outcome evaluated by mRS at 90 days (HR 2.57, 95% CI 1,44 to 4,57, p=0.001) and with all-cause death at 1 year (HR 4.479, 95% CI 1,81 to 11,09, p=0.001). GDF-15 elevation was associated with myocardial injury (Figure 1C). Moreover, individuals with moderate to severe and severe strokes (NIHSS 16-42) displayed higher GDF-15 levels compared to those with minor to moderate stroke (Figure 1D). The Kaplan-Meier survival curve accentuated a significantly elevated all-cause mortality among patients with increased GDF-15 (p < 0.001) (Figure 2). In multivariate regression analysis elevated GDF-15 was associated with atrial fibrillation and high-sensitive troponin I elevation. Conclusion The conclusions drawn suggest that heightened GDF-15 is associated with increased stroke severity, myocardial injury and unfavourable outcome.

Sleep difficulties as a universal risk factor for injury among adolescents in 46 countries

Abstract Background Poor sleep is common among adolescents and associated with unintentional injuries. The current evidence base is limited by differences in measures of sleep and injury implemented across studies. We examined the potential universality of the relationship between poor sleep and injury cross-nationally using self-reports from 229,589 adolescents in 46 countries that were collected using common procedures and measures. Methods A cross-sectional study was conducted using records from the 2017/18 Health Behaviour in School-aged Children (HBSC): World Health Organization cross-national study. The prevalence of sleep indicators (difficulties in falling asleep, insufficient sleep, social jet lag) and medically treated injuries (overall, multiple) were described across countries and by gender. Multivariable modified Poisson regression analyses were conducted within and across countries to test the consistency of the association between poor adolescent sleep and injuries. Results Overall, indicators of poor sleep were reported by nearly half of adolescents, and varied by gender and across countries. Country-level analyses found consistently positive associations between indicators of poor sleep and injuries. Pooled (multi-country) analyses further demonstrated a universality of these relationships across sleep indicators and injury outcomes. The strength of relationships varied by gender, with more robust associations detected among girls compared to boys. Conclusions Poor sleep is a robust and mainly consistent risk factor for injury among adolescents across countries and regions. Public health officials and policymakers should therefore recognize adolescent sleep as a health priority. The promotion of sleep hygiene may represent a novel target for injury prevention at regional and national levels. Key messages • Poor sleep, in the form of sleep difficulties, insufficient sleep, and social jet lag, were robust and mainly consistent injury risk factors among adolescents across 46 countries. • Public health officials should recognize sleep hygiene as a novel focus for adolescent injury prevention.

Sex differences in clinical characteristics, phenotypes, management, and long-term outcomes of myocardial injury: an international cohort study

Abstract Background Several studies have demonstrated sex differences in patients presenting to the emergency department (ED) with myocardial infarction, heart failure or syncope. Whether sex-specific differences in chest pain patients with myocardial injury exist is unknown. Purpose To determine whether sex-specific differences in the clinical characteristics, phenotypes, management, and long-term outcomes of patients with myocardial injury exist. Methods Patients presenting to the ED with chest pain suggestive of MI were consecutively enrolled into a prospective multicenter international diagnostic study. Final diagnoses were centrally adjudicated by two independent cardiologists, applying the fourth universal definition of myocardial infarction, using all available medical records, including serial hs-cTn and cardiac imaging. Follow-ups were performed at 3 months, 1-, 2- and 5-years. The primary outcome was 5-year all-cause mortality. Secondary outcomes included 5-year cardiovascular mortality and non-cardiovascular mortality. Multivariable flexible parametric (Royston-Parmar) models assuming proportional hazards were fitted. Models were adjusted for age, history of coronary artery disease, history of malignancy, diabetes, hypertension, smoking status, history of liver disease, and renal function. Results Among 8046 chest pain patients presenting to the ED, 1158 (14.4%) had myocardial injury, of which 358 (31%) were females and 800 (69%) males. Women were older (79 years, vs. 73 years), had fewer cardiovascular risk factors and comparable non-cardiovascular comorbidities except for lung disease which was more commonly found in men. Myocardial injury phenotypes varied between sexes (Figure). The most common phenotype in both sexes was heart failure, yet it was more common in men (37.2%) than in women (22.3%). The second most common phenotype in women was hypertension (15.4%) and arrhythmia (15.4 %), while in men was myocarditis (17.8 %), followed by arrhythmia (15.8%). Women underwent less invasive coronary angiography (19.8% vs 26.9%) or stress testing (12% vs 21.5%). In the angiographic findings, women presented more often with normal findings (30.4% vs. 19.6%) or mild CAD (20.3% vs. 11.2%) whereas men displayed more frequently 3-vessel disease (14.5% vs. 36.4%), Table. After adjusting for known confounders, women were associated with a lower 5-years risk for all-cause mortality (HR 0.69; 95%CI: 0.56–0.83) and cardiovascular mortality (HR 0.61; 95%CI: 0.46–0.79). No statistically significant difference in non-cardiovascular mortality risk was found (HR 0.79; 95%CI: 0.59-1.04). Conclusions Women presenting with chest pain to the ED and having myocardial injury were less likely than men to undergo coronary angiography or non-invasive cardiac imaging. Long-term risk for all-cause or cardiovascular mortality was lower for women compared to men.Myocardial Injury phenotypesPatient management

Analysis of factors influencing the surgical treatment outcomes of spinal injuries in polytrauma patients

Analysis of factors influencing the surgical treatment outcomes of spinal injuries in polytrauma patients

Effects of platelet-rich plasma combined with exercise therapy for one year on knee osteoarthritis: retrospective cohort study

BackgroundPlatelet-rich plasma (PRP) is a promising treatment for knee osteoarthritis (OA). However, exercise therapy and activities of daily living (ADL) guidance are recommended as core treatments in the Osteoarthritis Research Society International (OARSI) guidelines. However, the effects of PRP combined with exercise therapy are not fully understood. This study aimed to clarify the effectiveness of this treatment.MethodsWe assigned patients diagnosed with knee OA and treated between January 2021 and December 2022 to groups who underwent PRP + exercise (PE), PRP (P), or exercise (E) therapy. Outcomes were evaluated using Knee Injury and Osteoarthritis Outcome Scores (KOOS) before, and 1, 3, and 12 months after treatment. Within-group comparisons according to the time of each score were statistically assessed using a one-way analysis of variance, then differences were analyzed using Bonferroni multiple comparisons p < 0.05). Treatment responses were determined using Outcome Measures in Rheumatology (OMERACT)-OARSI Responder criteria.ResultsPre-treatment KOOS did not significantly differ among the groups. Pain in the PE group improved within 1 month, symptoms, ADL, and quality of life (QOL) improved after 3, months and continued for 12 months. Pain and symptoms improved in the P group within 1 month, but ADLs and the QOL did not significantly change. Pain improved after 3 months in the E group and ADL, and QOL improved by 12 months. The response among the groups was the highest for the PE, with 50.0% at 1 and 3 months, and 65.0% at 12 months.ConclusionsTherapy with PRP immediately relieved pain, whereas exercise conferred late, but enduring effects. Combining PRP with exercise conferred synergistic advantages that persisted for up to 12 months.

Impact of prior knee surgery on change in knee pain, quality of life, and walking speed following supervised education and exercise therapy: an analysis of 30,545 people with knee osteoarthritis.

To investigate the impact of prior knee surgery on changes in outcomes following an 8-week supervised patient education and exercise therapy program in patients with knee osteoarthritis. Patients were classified according to knee surgery in the most affected knee joint (yes/no) prior to enrolment in the Good Life with osteoArthritis in Denmark (GLA:D®) program. Between-group differences in outcome changes from baseline to 3 months follow-up were evaluated using linear regression stratified by sex. Outcomes were knee pain intensity (VAS, 0-100 mm), joint related quality of life (Knee Injury and Osteoarthritis Outcome Score Quality of Life subscale score (KOOS QOL, 0-100)) and walking speed (40-m fast-paced walk test). To evaluate clinically relevant between-group differences, proportions of patients reaching a threshold of minimal important change in the surgery and non-surgery groups were compared. Among 30,545 patients, 27% (n, 8254) had prior surgery in the most affected knee. The prior surgery and the non-surgery group experienced improvements in all outcomes with minor between-group differences in change in pain intensity (males, 0.03 95% CI - 0.9 to 1.0; females, 1.3 95% CI 0.6 to 2.1); KOOS QOL (males, 0.3 95% CI - 0.4 to 0.9; females 0.02 95% CI - 0.5 to 0.5); and walking speed (males, 0.01 95% CI - 0.01 to 0.02; females 0.01 95% CI 0.003 to 0.02). The responder analysis showed no clinically relevant between-group differences in improvements. Previous knee surgery does not seem to modify the clinical outcome following exercise therapy and patient education in patients with knee osteoarthritis.

AMIC achieves sustained clinical improvement in isolated patellar cartilage defects over 5 years, correlating with MRI.

To evaluate 5-year postoperative clinical outcomes of autologous matrix-induced chondrogenesis (AMIC) for isolated ICRS grade 3-4 patellar cartilage defects and correlate outcomes with magnetic resonance imaging (MRI). The hypothesis was that AMIC would improve clinical symptoms and induce neocartilage formation, visible on MRI, making it a safe and effective option for repairing focal patellar cartilage defects. The cohort comprised 13 focal patellar lesions in 12 patients. Pain visual analogue scale (VAS), Knee Injury and Osteoarthritis Outcome Score (KOOS), Kujala score, EuroQol-5D Health Survey questionnaire and MRI data were assessed preoperatively and at 2 and 5 years postoperatively. All MRI scans were evaluated using the Magnetic Resonance Observation of Cartilage Repair Tissue System. Descriptive statistics were calculated on all data. Inferential analysis comparing outcome scores before and after surgery employed the nonparametric Wilcoxon signed-rank test, with the nonparametric Friedman test used to detect differences across multiple test attempts. p < 0.05 was considered statistically significant. Twelve patients (23-52 years old) with patellofemoral chondral full-thickness defects (2-4 cm2) were treated. At a 5-year follow-up, eleven knees showed MRI improvement. Two were asymptomatic and nine showed clear clinical improvement. Only one knee showed no clinical improvement. MRI revealed a defect filling with newly formed cartilage characterized by a less compact and heterogeneous signal. Cartilage degradation or joint damage was observed in two knees, and bone formation within the plate was identified in four. AMIC significantly improved patients' VAS pain, KOOS, EuroQol-5D and Kujala scores compared to preoperative baseline for up to 5 years postoperatively. Satisfactory clinical outcomes and new cartilage formation, as observed by MRI, are achieved with AMIC at mid-term follow-up for ICRS grade 3-4 in small-to-medium-sized patellar defects in patients under 52 years of age, with improvements maintained for up to 5 years. Level III.

Favorable impact of FFRCT on myocardial revascularization outcomes: results from an observational real-world registry

Abstract Background Based on excellent clinical outcomes data, coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFRCT) is endorsed by guidelines to diagnose obstructive coronary artery disease (OCAD)(1). Dedicated outcome analyses in revascularized patients are essential to assess the additional value of FFRCT in revascularization. Purpose To assess the impact of FFRCT use on the postprocedural myocardial injury (PMI) and long-term outcomes of patients with OCAD undergoing myocardial revascularization. Methods Patients with suspected OCAD on CCTA (at least one stenosis of &amp;gt;50% in any vessel) were included from a 2013-2021 tertiary hospital registry. Propensity score adjusted Cox- regression and logistic regression analysis were used to assess the impact of FFRCT on the outcomes of OCAD patients post-revascularization. PMI was defined as cardiac troponin (cTn)&amp;gt;5 times the 99th percentile URL for percutaneous coronary intervention (PCI) and cTn&amp;gt;10 times the 99th percentile URL for coronary artery bypass graft (CABG) (2). Major adverse cardiovascular events (MACE) comprised all – cause mortality, acute myocardial infarction (AMI), stroke, hospitalization for heart failure (HHF) and new revascularization. Results From a registry of 7541 patients, suspected CCTA - derived OCAD was reported in 1601 cases. 559 OCAD patients were revascularized: 386(69.05%) by PCI, 166(29.7%) by CABG and 7(1.25%) by PCI and CABG. FFRCT was performed in 252(45.1%) patients. During a follow-up of 4.4±2.2 years, MACE occurred in 137(24.5%) patients: 43(7.7%) died, 21(3.8%) patients were hospitalized for AMI, 14(2.5%) patients had a stroke, 12 (2.1%) patients had HHF and 77(13.8%) patients had a new revascularization. Survival analysis indicated significant differences in MACE and all-cause mortality–rates between FFRCT use and no FFRCT use (log- rank p = 0.033 and 0.004, Fig 1). Multivariable propensity–adjusted Cox–regression analysis showed a non–significant trend towards reduced MACE risk by using FFRCT (HR 0.736, 95% CI 0.513-1.055, P=0.095) and a significant reduction in all-cause mortality risk (HR 0.476, 95% CI 0.230–0.985, P=0.046). Sub-analysis in the PCI and CABG groups showed no significant association between FFRCT and MACE. Among the 477 patients with available cTn values, 203 (42.5%) had PMI. In the CABG group, FFRCT use correlated with low PMI incidence (5.3% vs. 15.6%, p=0.044). However, multivariable Cox regression analysis revealed no significant association between FFRCT use and PMI(Fig 2). Conclusion This observational designed study reveals for the first time that FFRCT reduces post-myocardial revascularization MACE, primarily driven by reduced all-cause mortality. No clear reduction of PMI was observed suggesting that FFRCT value extends beyond procedural enhancements. Although derived from a large real-world registry, these promising observations need to be confirmed by randomized studies.Figure 1Figure 2

Preventing unintentional injuries due to home and leisure time accidents in children: the parents’ beliefs matters (CHILD Vigilance project - CHIVI)

Abstract Background The CHILD Vigilance project is a European study supported by the Injury Prevention section of the European Public Health Association and aims at contributing to the epidemiological knowledge of injuries and accidents in Greece, Portugal and Lithuania, through increasing knowledge on parents’ and caregivers’ safety perceptions. Methods A descriptive, observational, cross-sectional study was developed in these countries between February and April 2023, under the CHILD Vigilance project. Information was collected online via a questionnaire exploring parents’ and/or caregivers’ knowledge, attitudes and risk perception towards prevention of unintentional injuries in children and adolescents. Results A total of 916 valid responses were obtained, involving 1229 children (51.4% male; mean age 7.8 years). Falls were perceived as the most common type of unintentional injuries in pre-schoolers and school-age children (47,8% in Greece; 63,5% in Portugal; 74,8% in Lithuania). Country differences were observed in terms of the most commonly perceived types of injury in adolescents, which were road traffic crashes in Greece and Portugal (41.2% and 39.5% respectively) vs poisonings in Lithuania (38.1%). Some differences were also observed between these countries as to the most common causes of death. In Greece and Lithuania diseases were reported as the main cause of death in pre-schoolers (62.5%; 35.1%) and in children attending primary education (55.1%; 29.7%), while injuries were identified as a cause only in the oldest group of children. In Portugal on the other hand, injuries were identified as the most frequent cause of death in all groups, pre-schoolers (40.5%), children attending primary education (47.1%) and in the oldest (55.1%). Conclusions The study emphasizes the need to address misperceptions, improve safety attitudes and invest more efforts in managing harmonised injury outcomes across global initiatives.

Preventing unintentional injuries in children: the parents’ beliefs matters (CHILD Vigilance)

Abstract The CHILD Vigilance project is a European study supported by the Injury Prevention &amp; Safety Promotion Section of the European Public Health Association (EUPHA INJ) and aims at assessing parenting knowledge and attitudes that are relevant to supervision and risk taking in children. For children the majority of these injuries occur in or around the home when their safety is the responsibility of a parent or other caregiver. The study aims contribute to the epidemiological knowledge of injuries through the study of the perceptions of parents and caregivers of children and adolescents. A descriptive, observational, cross-sectional study was developed under the CHILD Vigilance project, developed at European level within the scope of the Injury Prevention &amp; Safety Promotion Section of the European Public Health Association. The information was collected by survey, from parents’ associations and schools in the EU countries represented in the EUPHA INJ Section. A total of 916 valid responses were obtained, involving 1229 children (51,4% male; mean age 7,8 years). Falls were perceived as the most common type of unintentional injuries in pre-schoolers and school-age children (47,8% in Greece; 63,5% in Portugal; 74,8% in Lithuania). However it was found differences in these countries as to the most common type of injury in adolescents, pointing out road traffic crashes (41.2% in Greece vs 39.5% in Portugal) and poisonings in Lithuania (38,1%). Some differences were also observed between these countries as to the most common causes of death. In Greece and Lithuania diseases were reported the main cause in the pre-schoolers (62,5%; 35,1%) and in primary education (55,1%; 29,7%), being injuries pointed as the most frequent cause only in the oldest. The study emphasizes the need to invest in the identification of appropriate determinants of child unintentional injuries and harmonised injury outcomes across global initiatives. Key messages • The lack of data regarding to parents’ knowledge on injury prevention involving children highlight the need to conduct this type of studies. • The need for adequate epidemiological data on the burden of child injuries and validated tools to accurately measure injuries.

Acellular Particulated Costal Allocartilage Improves Cartilage Regeneration in High Tibial Osteotomy: Data From a Randomized Controlled Trial.

This study aimed to compare short-term arthroscopic and clinical outcomes between microfractures with (treatment group) and without (control group) acellular particulated costal allocartilage in patients undergoing concurrent high tibial osteotomy (HTO). This retrospective cohort study enrolled 19 and 21 patients in the treatment and control groups, respectively, and reviewed them at a minimum 2-year follow-up after HTO. Cartilage regeneration status was evaluated according to the International Cartilage Repair Society-Cartilage Repair Assessment (ICRS-CRA) grading and Koshino's macroscopic staging systems during medial locked plate removal. Patient-reported measures, including the visual analog scale pain score, Knee Injury and Osteoarthritis Outcome Score, and International Knee Documentation Committee score, assessed clinical outcomes. The total points of the ICRS-CRA grading system were significantly higher in the treatment group than in the control group (7.7 ± 3.8 vs 4.2 ± 3.0, respectively; P = 0.007). Likewise, the cartilage status according to Koshino's macroscopic staging system was better in the treatment group (P = 0.022). Patient-reported functional outcomes significantly improved postoperatively but were equivalent between the study groups at the final follow-up. Microfractures augmented with acellular particulated costal allocartilage resulted in better repair quality than microfractures alone at a minimum 2-year follow-up after HTO, but functional outcomes improved similarly for both treatment approaches.

Effect of Iliotibial Band Myofascial Release Combined with Valgus Correction Exercise on Pain, Range of Motion, Balance, and Quality of Life in Patients with Grade II Knee Osteoarthritis: A Randomized Clinical Trial

The objective of this study was to find out the effect of the myofascial release technique combined with valgus correction exercise on the pain, range of motion, balance, and quality of life in participants with grade II knee osteoarthritis. Forty participants with grade II knee osteoarthritis were randomly assigned into two treatment groups in the present clinical trial; group A was the myofascial release group, and group B was the myofascial release with valgus correction exercises group. Measurement included pain, balance, range of motion, and quality of life, as measured through the visual analog scale (VAS), Berg balance scale (BBS), goniometer, and knee injury and osteoarthritis outcome score (KOOS), respectively. The data were collected at the baseline and 3rd and 6th weeks. The between-groups comparison at the end of the 6th week showed significant results in the iliotibial band myofascial release with the valgus correction exercise group (p &lt; 0.001). The within-group difference showed improvement in both groups individually, with more significant values in group B. The current study showed that the myofascial release combined with valgus correction exercises can effectively improve the pain, range of motion, balance, and quality of life in participants with grade II knee osteoarthritis. Trial Registration: IRCT20230216057434N3.

The Effect of Blood Flow Restriction Exercise Prior to Total Knee Arthroplasty on Postoperative Physical Function, Lower Limb Strength and Patient-Reported Outcomes: ARandomized Controlled Trial.

30-s sit to stand (30STS). Timed Up&Go, 40-m walk test (40mWT), knee range of motion (ROM) 1-repetition maximum (1RM) leg press and knee extensor strength, maximal isometric contraction (MVIC) for the knee extensors and flexors, Knee injury and Osteoarthritis Outcome Score (KOOS), and Euroqol 5-dimensions (EQ-5D-L5) questionnaire. Data were collected at baseline (12 weeks pre-surgery), ~3 days pre-surgery, 3 and 12 months postoperatively. Intention-to-treat analysis revealed no significant between-group differences in the change from baseline to 3 and 12 months postoperatively on 30STS, TUG, or 40mFWT. Significant between-group differences were observed at 3 but not 12 months postoperatively for the corresponding changes in 1RM leg press strength, 1RM knee extensor strength, and MVIC knee extensor favoring BFR-RT. No between-group differences were observed for the delta changes from baseline in knee ROM, KOOS subscales or EQ-5D-L5 at any postoperative time points. These findings suggest that preoperative BFR-RT offered no superior effects compared with usual preoperative care on postoperative physical function or patient-reported outcomes. Preoperative BFR-RT produced amplified gains in lower limb muscle strength at 3 months postoperatively. NCT04081493.

Incidence and Risk Factors of Postoperative Acute Kidney Injury in Non-Cardiovascular Surgery: A Retrospective Cohort Study

Objective: To identify the incidence, risk factors, and outcome of postoperative acute kidney injury (AKI) in non-cardiovascular surgery. Materials and Methods: A single-center retrospective cohort study included patients who underwent non-cardiovascular surgeries such as general, orthopedics, gynecology, neurosurgery, ENT, plastic, and endoscopy, between January 1, 2019 and December 31, 2020. The primary outcome was the incidence of AKI within seven days after surgery, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The secondary outcomes were risk factors and the outcome of AKI. Results: From 2,898 cases, the incidence of postoperative AKI was 2% (57 cases). Twenty-two out of 57 cases (38.6%) had diagnosis of acute renal failure in the discharge summary. Independent risk factors of postoperative AKI by multivariate logistic regression analysis were the American Society of Anesthesiologists (ASA) classification of 3 or greater, emergency surgery, atrial fibrillation, preoperative use of a mechanical ventilator, eGFR of less than 60 mL/minute/1.73 m², hypoalbuminemia, intraoperative urine output of less than 0.5 mL/kg/hour, vasopressor infusion, and intraoperative blood transfusion. Patients with postoperative AKI had higher mortality rates and postoperative complications included pneumonia, surgical site infection, sepsis, respiratory failure, and severe arrhythmia. Conclusion: Postoperative renal function should be monitored in patients with risk factors associated with postoperative AKI to improve patient outcomes.

Study of clinical and functional outcome of malleoli fracture

Background: Ankle fractures are a common orthopedic injury, accounting for 9% of all fractures, with an increasing incidence among both young and elderly populations. These fractures often result from road traffic accidents, falls, and sports injuries. Malleolar fractures, involving the bony prominences of the ankle, are particularly prevalent and necessitate accurate reduction and stable internal fixation to prevent complications such as post-traumatic arthritis and restricted motion. This study aims to assess the functional outcomes and results of surgical treatment of malleolar fractures. Methods: The study utilized Lauge-Hansen’s classification to analyze the mechanism of injury in 32 patients with ankle fractures. Surgical techniques included the fixation of syndesmotic injuries with anatomical fibular plates, (AFP) posterior malleolus fractures with percutaneous screws or Ellis plates, and medial malleolus fractures with tension band wiring (TBW). The outcomes were measured in terms of union time, range of motion, and stability. Results: The most common injury mechanism was supination external rotation (SER) in 14 patients, followed by pronation external rotation (PER) in 7 patients, pronation abduction (PAB) in 6 patients, and supination adduction (SAD) in 5 patients. Syndesmotic injuries were found in 7 patients, all treated surgically except one. Posterior malleolus fractures were present in 3 patients and treated with screws or plates. Fixation of medial malleolus fractures with TBW showed better union rates and improved range of motion compared to screw fixation. Lateral malleolar fractures treated with AFP provided additional stability. The average union time was 6 to 8 weeks. Conclusions: Anatomical reduction and stable internal fixation are crucial for the successful treatment of malleolar fractures. TBW for medial malleolus fractures and AFP for lateral malleolar fractures provide favorable outcomes. However, a larger sample size and longer follow-up duration are required to further evaluate the outcomes of ankle injuries, particularly in older patients with osteoporosis and comorbidities.

Comparative analysis of treatment outcomes in osteoarthritis knee: integrating physiotherapy and medication versus mono-therapies

Background: Osteoarthritis (OA) of the knee is a prevalent degenerative joint disorder that significantly impacts patients' mobility and quality of life. Effective management of knee OA is crucial to alleviate symptoms and improve daily functioning. This study aims to conduct a comparative analysis of treatment outcomes for knee OA by evaluating three distinct therapeutic approaches: a combination of physiotherapy and medication, physiotherapy alone and medication alone, all supplemented with routine daily activities. Methods: The research involves a cohort of patients diagnosed with knee OA, divided into three groups, each receiving one of the specified treatments. Outcome measures include pain reduction, assessed through the Visual Analog Scale (VAS); functional mobility, evaluated using the Timed Up and Go (TUG) test; and overall quality of life, measured by the Knee Injury and Osteoarthritis Outcome Score (KOOS). Results: Preliminary findings suggest that patients receiving the integrated treatment of physiotherapy and medication show significantly greater improvements in pain relief and functional mobility compared to those undergoing mono-therapies. The combination approach appears to leverage the synergistic effects of both modalities, offering a more comprehensive management strategy. Physiotherapy alone also demonstrates notable benefits in enhancing mobility and reducing pain, while medication primarily provides symptomatic relief. Conclusions: This study underscores the importance of a multidisciplinary approach in treating knee OA, highlighting that integrated treatment plans may offer superior outcomes. These findings aim to inform clinical practice, suggesting that combining physiotherapy with medication can optimize therapeutic efficacy, improve patient quality of life and potentially alter the standard care protocols for knee OA. Further research is warranted to substantiate these results and explore long-term benefits.

Lumbar Spine Orientation Affects Compressive Fracture Outcome.

Understanding how spinal orientation affects injury outcome is essential to understand lumbar injury biomechanics associated with high-rate vertical loading. Whole-column human lumbar spines (T12-L5) were dynamically loaded using a drop tower to simulate peak axial forces associated with high-speed aircraft ejections and helicopter crashes. Spines were allowed to maintain natural lordotic curvature for loading, resulting in a range of orientations. Pre-test X-rays were used to quantify specimen orientation at the time of loading. Primary fracture types were identified (wedge, n = 6; burst, n = 4; hyperextension, n = 4) and compared for loading parameters and lumbar orientation. Fracture type was dependent on peak acceleration, bending moment, Cobb angle, sagittal spinal tilt, and location of the applied load. Lumbar spine orientation under high-rate axial acceleration affected the resulting fracture type. Analysis of pre-test X-rays revealed that spines that sustained wedge and burst fractures were oriented straighter at the time of loading. The load was applied centrally to T12 in spines with burst fractures, and anteriorly to T12 in spines with wedge fractures. Spines that sustained hyperextension fracture had lower peak accelerations, larger Cobb angles at the time of loading, and sustained larger extension moments. Fracture presentation is an important and understudied factor that influences biomechanical stability, clinical course, and long-term patient outcomes.

Comparative Analysis of Burn Injuries in Toddler and Preschool Children: Implications for Triage and Outcome Assessment.

This study aims to compare the demographic, clinical characteristics, and outcomes of burn injuries in toddler and preschool children, and to validate the American Burn Association (ABA) Burn Triage Decision Matrix in the Turkish pediatric population. A retrospective analysis was conducted on 684 pediatric burn patients (494 toddlers, 190 preschoolers) admitted to our burn center over a 5-year period. Variables including gender, burn etiology, burn area, depth, treatment modalities, complications, length of hospital stay, and mortality were analyzed. The performance of the ABA Burn Triage Decision Matrix was evaluated in both groups. Scalding was the predominant cause of burns in both groups, with a significant difference in the involvement of anterior trunk (p = 0.027). The mean Total Body Surface Area (TBSA) was comparable between the groups (p = 0.286). There was no significant difference in mortality rates (p = 0.385), treatment modalities, and complications. The ABA Burn Triage Decision Matrix demonstrated consistency in triaging the severity of burn injuries, with a notable discrepancy observed in the moderate risk category of toddler group. This study highlights the distinct characteristics and outcomes of burn injuries in different pediatric age groups. The ABA Burn Triage Decision Matrix's validation suggests its utility in enhancing triage accuracy and resource allocation in pediatric populations, especially in disaster-prone regions.

Hyperbaric Oxygen Therapy (HBOT) in Moderate Traumatic Brain Injury (TBI): A Randomized Controlled Trial

Abstract Introduction Hyperbaric oxygen therapy (HBOT) is a novel technique recently under investigation with intention to improve outcomes in traumatic brain injury (TBI). It increases the partial pressure of oxygen in the blood and tissues by inhaling pure oxygen in an environment pressurized to at least 1.4 times normal atmospheric pressure (ATM) at sea level. The rationale behind the use of HBOT in TBI is its potential to mitigate the secondary brain injury cascade initiated by the primary mechanical trauma. Tissue damage and neuroinflammation secondary to intricate and complex cellular biochemical processes are expected to be counteracted by increased oxygen availability during HBOT, which reduces oxidative stress and improves neuroplasticity. Materials and Methods All patients, except whose legal guardians denied informed consent, with moderate TBI presenting to the neurotrauma center, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India, were included within the study period of June 2022 to July 2023. Patient allocation was randomized into two arms: namely, treatment and control arm. Simple randomization was done using randomization mobile app, RRApp. Each patient received standard of care per the Brain Trauma Foundation guidelines. Patients randomized under the treatment arm additionally received adjuvant HBOT sessions. One session daily for 10 consecutive days. Session duration was for 60 minutes each at 1.4 ATM. The primary objective of the study was to compare the Glasgow Coma Score (GCS) at discharge and 3-month post-TBI Glasgow Outcome Scale-Extended (GOS-E) among patients in the treatment arm (those who received adjuvant HBOT) with those in the control arm (those who received only standard of care). Results The mean GCS (±standard deviation [SD]) at discharge in the treatment arm was 14.37 (±00.51) with a median of 14 and a range of 14 to 15. Comparatively, the mean GCS (±SD) at discharge in the control arm was 13.40 (±00.84) with a median of 13 and a range of 12 to 15. The difference between the two arms was statistically significant (p &lt; 0.001). GOS-E at 3 months postinjury for the treatment arm was 7.62 ± 00.51 (mean ± SD) with a median of 8 (range: 7–8). For the control arm, GOS-E at 3 months postinjury was 6.40 ± 1.50 (mean ± SD) with a median of 7 (range: 4–8). The difference between the two arms was statistically significant (p &lt; 0.001). Conclusion The current study concludes that early adjuvant HBOT using 1.4 ATM with one session of one-hour daily for 10 days among adults sustaining moderate TBI significantly improves GCS at 10 days. Early adjuvant HBOT is also associated with significantly improved GOS-E at 3 months postinjury compared to standard of care alone.

Physiologic Preoperative Knee Hyperextension Is Not Associated With Postoperative Laxity, Subjective Knee Function, or Revision Surgery After ACL Reconstruction With Hamstring Tendon Autografts.

There is concern that physiologic knee hyperextension may be associated with inferior outcomes after anterior cruciate ligament reconstruction (ACLR) using hamstring tendon (HT) autografts. To assess whether there is an association between contralateral passive preoperative knee hyperextension (≤-5°) and postoperative anterior knee laxity, subjective knee function, or revision surgery after ACLR using HT autografts. Cohort study; Level of evidence, 3. Patients without concomitant ligament injuries who underwent primary ACLR using an HT autograft at Capio Artro Clinic, Stockholm, Sweden, between January 1, 2005, and December 31, 2018, were identified. The cohort was dichotomized into the hyperextension group (≤-5°) and the no hyperextension group (>-5°) depending on preoperative contralateral passive knee extension degree. Anterior knee laxity (KT-1000 arthrometer; 134 N) was assessed preoperatively and at 6 months postoperatively. The Knee injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and at 1, 2, and 5 years postoperatively. Patients who underwent revision ACLR at any institution in Sweden within 5 years of the primary surgery were identified in the Swedish National Knee Ligament Registry. A total of 6104 patients (53.5% male) for whom knee range of motion measurements were available were identified (hyperextension group [≤-5°]: 2350 [38.5%]; mean extension, -6.1°± 2.3° [range, -20° to -5°]; no hyperextension group [>-5°]: 3754 [61.5%]; mean extension, 0°± 1.4° [range, -4° to 15°]). There were no intergroup differences in anterior knee laxity preoperatively (hyperextension group, 3.6 ± 2.8 mm; no hyperextension group, 3.7 ± 2.7 mm; P = .24) or postoperatively (hyperextension group, 1.8 ± 2.3 mm; no hyperextension group, 1.8 ± 2.2 mm; P = .41). The only significant but nonclinically relevant intergroup differences were seen in the KOOS Symptoms subscale at the 1-year follow-up (hyperextension group, 81.4 ± 16.0; no hyperextension group, 80.3 ± 16.5; P = .03) and in the Sport and Recreation subscale at the 5-year follow-up (hyperextension group, 73.0 ± 25.6; no hyperextension group, 75.7 ± 24.3; P = .02). No other significant intergroup differences were noted preoperatively or at 1, 2, or 5 years postoperatively in any of the KOOS subscales. The overall revision ACLR rate at ≤5 years after the primary surgery was 4.9% (302 of 6104 patients). The hazard for revision ACLR in the no hyperextension group (4.5%; 170 of 3754 patients) was not significantly different from that in the hyperextension group (5.6%; 132 of 2350 patients) (hazard ratio, 0.89; 95% CI, 0.71 to -1.12; P = .34). A subsequent subanalysis showed that the hazard of revision ACLR in patients with no hyperextension was not significantly different from that of patients with ≤-10° of extension (5.8%; 27 of 467 patients) (hazard ratio, 0.91; 95% CI, 0.61 to 1.36; P = .65). Preoperative passive contralateral knee hyperextension (≤-5°) was not associated with postoperative anterior knee laxity, subjective knee function, or revision surgery ≤5 years after ACLR using HT autografts. Therefore, the presence of knee hyperextension alone should not be considered a contraindication per se for the use of HT autografts in ACLR.