Pre-injury Status Research Articles

Pre-injury health status and excess mortality in persons with traumatic brain injury: A decade-long historical cohort study

An increasing number of patients are able to survive traumatic brain injuries (TBIs) with advanced resuscitation. However, the role of their pre-injury health status in mortality in the following years is not known. Here, we followed 77,088 consecutive patients (59% male) who survived the TBI event in Ontario, Canada for more than a decade, and examined the relationships between their pre-injury health status and mortality rates in excess to the expected mortality calculated using sex- and age-specific life tables. There were 5792 deaths over the studied period, 3163 (6.95%) deaths in male and 2629 (8.33%) in female patients. The average excess mortality rate over the follow-up period of 14 years was 1.81 (95% confidence interval = 1.76–1.86). Analyses of follow-up time windows showed different patterns for the average excess rate of mortality following TBI, with the greatest rates observed in year one after injury. Among identified pre-injury comorbidity factors, 33 were associated with excess mortality rates. These rates were comparable between sexes. Additional analyses in the validation dataset confirmed that these findings were unlikely a result of TBI misclassification or unmeasured confounding. Thus, detection and subsequent management of pre-injury health status should be an integral component of any strategy to reduce excess mortality in TBI patients. The complexity of pre-injury comorbidity calls for integration of multidisciplinary health services to meet TBI patients' needs and prevent adverse outcomes.

Workforce Reintegration After Work-Related Permanent Impairment: A Look at the First Year After Workers' Compensation Claim Closure.

Purpose The purpose of this study was to descriptively quantify experiences of injured workers with permanent impairment during their first year of work reintegration. Methods A representative survey was conducted to characterize health, disability, pain, employment, reinjury, and economic outcomes for 598 workers with permanent impairment who had returned to work during the year after workers' compensation claim closure. Survey responses were summarized by degree of whole body impairment (< 10% vs. ≥ 10%). Results Injured workers who had returned to work reported that permanent impairment made it difficult to get a job (47%) and to keep their job (58%). A year after claim closure, 66% reported moderate to very severe pain; 40% reported pain interference with work. About 13% reported new work injuries; over half thought permanent impairment increased their reinjury risk. Asked to compare current to pre-injury work status, workers with a higher degree of impairment more frequently reported working fewer hours (OR 1.60; 95% CI 1.06, 2.42), earning less (OR 1.56; 95% CI 1.04, 2.36), and being at higher risk of losing their current job due to their impairment (OR 1.66; 95% CI 1.01, 2.71). Conclusions Injured workers with permanent impairment face long-term challenges related to health limitations, chronic pain, work reintegration, and economic impacts. Workers with a higher degree of impairment more frequently reported several economic and job security challenges. Developing workplace and workers' compensation-based interventions that reduce return-to-work interruption and reinjury for workers with permanent impairment should be prioritized as an important public health and societal goal.

Comparative study of fixation of intertrochanteric fracture of the femur by proximal femur nail versus dynamic hip screw

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Intertrochanteric fractures are common in old age group, but uncommon in younger age group. The goal of treatment of intertrochanteric fractures is restoration to pre-injury status at the earliest. The purpose of this study is to compare the functional outcome of the two fixation devices proximal femur nail (PFN) and dynamic hip screw available for intertrochanteric fractures in terms of the eventual functional outcome of the patient.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Prospective study of 30 cases of Intertrochanteric fractures admitted and operated in KIMS hospital from November 2017 to May 2019. Follow-up of these patients was done at 6 weeks, 12 weeks and 24 weeks with functional evaluation was done using Harris hip score at the 24th week.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The results at the end of 24 weeks follow-up were calculated by the Harris hip score were better with the PFN. 66.7% of the patients operated with PFN gave excellent results as compared to 60% of patients operated with dynamic hip screw (DHS).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; We conclude that the use of PFN for the fixation of trochanteric fractures against the proven DHS offered better results along with a few advantages. PFN required smaller incision, shorter duration of surgery, less blood loss and faster recovery and better functional outcome at the end of 24 weeks. But still PFN is technically more demanding than the DHS and was found to have longer fluoroscopy exposure.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Data Mining to Understand How Health Status Preceding Traumatic Brain Injury Affects Functional Outcome: A Population-Based Sex-Stratified Study

ObjectivesTo understand how health status preceding traumatic brain injury (TBI) affects relative functional gain after inpatient rehabilitation using a data mining approach. DesignPopulation-based, sex-stratified, retrospective cohort study using health administrative data from Ontario, Canada (39% of the Canadian population). SettingInpatient rehabilitation. ParticipantsPatients 14 years or older (N=5802; 63.4% male) admitted to inpatient rehabilitation within 1 year of a TBI-related acute care discharge between April 1, 2008, and March 31, 2015. InterventionsNot applicable. Main Outcome MeasuresRelative functional gain (RFG) in percentage, calculated as ([discharge FIM−admission FIM]/[126−admission FIM]×100). Health status prior to TBI was identified and internally validated using a data mining approach that categorized all International Classification of Diseases, 10th revision, codes for each patient. ResultsThe average RFG was 52.8%±27.6% among male patients and 51.6%±27.1% among female patients. Sex-specific Bonferroni adjusted multivariable linear regressions identified 10 factors of preinjury health status related to neurology, emergency medicine, cardiology, psychiatry, geriatrics, and gastroenterology that were significantly associated with reduced RFG in FIM for male patients. Only 1 preinjury health status category, geriatrics, was significantly associated with RFG in female patients. ConclusionsComorbid health conditions present up to 5 years preceding the TBI event were significantly associated with RFG. These findings should be considered when planning and executing interventions to maximize functional gain and to support an interdisciplinary approach. Best practices guidelines and clinical interventions for older male and female patients with TBI should be developed given the increasingly aging population with TBI.

MP57: Effect of grip strength measured in the emergency department on the risk of functional decline following a minor trauma in robust elderly: a pan-Canadian study

Introduction: The elderly (65 yo and more) increase in Canada is well documented along with a disproportionate use of Emergency Departments after a minor injury. These patients requires specific care given a 16% risk of functional decline following a visit to ED. To prevent functional decline, a multidimensional assessment of the elderly is recommended in the emergency department. Objective: To determine if ED grip strength can predict functional decline at 3 or 6 months post-injury. Methods: A multicentre prospective study in 5 ED across Canada was realized between 2013 and 16. Patients 65 years old and over, autonomous in daily living activities and consulting the emergency department for minor trauma were recruited 7 days a week. Clinical-demographic data, functional status, fear of falling, number of falls in the last month, grip strength measurement were collected in the ED. Functional decline (loss of at least points to functional status) was calculated at 3 and 6 months. Descriptive statistics and linear regression model with repeated measurements were used to determine if the grip strength was predictive of functional decline at 3 or 6 months. Results: 387 patient were recruited. Mean age was 74 ± 7 years old, 52% were male. XXX experienced a fall in the last month. The initial maximum grip strength was (24 ± 10 intervention vs. 28 ± 13 control; p ≤ 0.05). grip strength is associated with pre-injury functional status (p &lt; 0.0001) and fear of falling (p = 0.0001) but does not predict 3 or 6 month functional decline. Conclusion: Given the strong association with fear of falling and functional status at initial ED evaluation, we recommend that grip strength measurement could be included in a multidisciplinary geriatric emergency department assessment as needed.

Cementless total hip arthroplasty after failed internal fixation of acetabular fractures: A single center experience of 25 consecutive patients.

Total hip arthroplasty (THA) is an available surgical option for failed acetabular fracture, previously managed by open reduction and internal fixation. This study aimed to report the postoperative outcomes of cementless THA in patients with this condition. Between November 2000 and September 2016, 25 consecutive cementless THAs for failed internal fixation after acetabular fractures with a minimum follow-up of 2 years were analyzed. The mean age at the time of surgery was 58 years (36-85 years), and the time elapsed between fracture and THA was 70 months (7-213 months). Clinical and radiologic evaluations were performed on all patients. Clinically, the mean Harris hip score at the last follow-up was 88 points. Walking ability recovered to pre-injury status in 92% patients, and activities of daily living recovered in 96% patients. Radiographically, none of the acetabular cups showed evidence of migration and loosening during the mean follow-up of 50 months. All cases showed stable femoral stem fixation at the last follow-up. Dislocation occurred in three cases (12%). Outcomes of cementless THA after failed internal fixation for acetabular fractures were satisfactory. However, a relatively high incidence of postoperative dislocation is still a concern.

PIT13 A SYSTEMATIC REVIEW OF STUDIES MEASURING HEALTH-RELATED QUALITY OF LIFE OF GENERAL INJURY POPULATIONS: UPDATE 2010-2018

Studies examining the impact of injury on health-related quality of life (HRQL) over time are necessary to understand the short- and long-term consequences of injury for population health. The aim of this systematic review was to provide an evidence update on studies that have measured HRQL over time in general injury populations using a generic (general) health state measure. Studies conducted between 2010 and 2018 that assessed HRQL at more than one time point among general injury populations were eligible for inclusion. Two reviewers independently extracted information from each study on design, HRQL measure used, method of HRQL measure administration, timing of assessment(s), predictive variables, ability to detect change, and findings. Quality appraisals of each study were also completed by two reviewers using items from the RTI Item Bank on Risk of Bias and Precision of Observational Studies. Twenty-nine studies (43 articles) that met the inclusion criteria were identified. HRQL was measured using fourteen different generic measures; the SF-36, SF-12, and EQ-5D were used most frequently. A varying number of follow-up assessments were undertaken, ranging from one to five. Follow-up often occurred 12 months post-injury. Fewer studies (n = 11) examined outcomes two or more years post-injury, and only one to 10 years post-injury. While most studies documented improvements in HRQL over time since the injury event, study populations had not returned to pre-injury status or reached general population norm HRQL values at post-injury follow-ups. Since 2010 there has been a substantial increase in the number of studies evaluating the HRQL of general injury populations. However, significant variability in study design continues to impede quantification of the impact of injury on population health over time. Variation between studies is particularly evident with respect to timing and number of follow-up assessments, and selection of instruments to evaluate HRQL.

The Center for Trauma Survivorship: Addressing the great unmet need for posttrauma center care.

Returning patients to preinjury status is the goal of a trauma system. Trauma centers (TCs) provide inpatient care, but postdischarge treatment is fragmented with clinic follow-up rates of <30%. Posttraumatic stress disorder (PTSD) and depression are common, but few patients ever obtain necessary behavioral health services. We postulated that a multidisciplinary Center for Trauma Survivorship (CTS) providing comprehensive care would meet patient's needs, improve postdischarge compliance, deliver behavioral health, and decrease unplanned emergency department (ED) visits and readmissions. Focus groups of trauma survivors were conducted to identify issues following TC discharge. Center for Trauma Survivorship eligible patients are aged 18 to 80 years and have intensive care unit stay of >2 days or have a New Injury Severity Score of ≥16. Center for Trauma Survivorship visits were scheduled by a dedicated navigator and included physical and behavioral health care. Patients were screened for PTSD and depression. Patients screening positive were referred for behavioral health services. Patients were provided 24/7 access to the CTS team. Outcomes include compliance with appointments, mental health visits, unplanned ED visits, and readmissions in the year following discharge from the TC. Patients universally felt abandoned by the TC after discharge. Over 1 year, 107 patients had 386 CTS visits. Average time for each appointment was >1 hour. Center for Trauma Survivorship "no show" rate was 17%. Eighty-six percent screening positive for PTSD/depression successfully received behavioral health services. Postdischarge ED and hospital admissions were most often for infections or unrelated conditions. Emergency department utilization was significantly lower than a similarly injured group of patients 1 year before the inception of the CTS. A CTS fills the vast gaps in care following TC discharge leading to improved compliance with appointments and delivery of physical and behavioral health services. Center for Trauma Survivorship also appears to decrease ED visits in the year following discharge. To achieve optimal long-term recovery from injury, trauma care must continue long after patients leave the TC. Therapeutic, Level III.

Clinical outcome of treatment of intra-articular distal humerus fracture with open reduction and internal fixation by orthogonal locking plate: a prospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The aim of the study was to study the clinical outcome and complications of surgical management of intra-articular fractures of distal humerus.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective study included 23 consented patients with intra-articular distal humeral fractures who underwent osteosynthesis by orthogonal locking compression plating using posterior approach with olecranon osteotomy between November 2017 to May 2019 at BLDE(DU’s) Shri BM Patil Medical College, Vijayapura, Karnataka.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study there were 15 male patients and 8 female patients with mean age of 38.5 years. 65.2% of the cases admitted were due to motor vehicle accident, 21.7% due to accidental fall and 13% due to fall from height with right side (73.9%) being the more commonly affected side. The mean operative time was 100 minutes. Mayo Elbow Performance Score was 83.3% post operatively and the mean arc of motion was 117°. 82% of cases fared excellent to good results.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Orthogonal locking plate construct provides stable rigid fixation for allowing early mobilisation and allows predictable healing both clinically and functionally in these complicated fractures. Absence of implant failure and non-union may be attributed to the highly stable construct system achieved by orthogonal locking plating. Majority of our cases had good functional outcome and return to pre injury status.&lt;/p&gt;

Longitudinal analysis of health status the first year after trauma in severely injured patients

PurposeWhile survival rates after a trauma are increasing a considerable part of the trauma population are still at risk for both short and long term disabilities. Little is known about prognostic factors over time after a severe trauma. The aim of the present prospective cohort study was to examine trauma and patient related prognostic factors for a lower health status over time after a severe trauma.MethodsA multicentre prospective observational cohort study was conducted. Adult trauma patients with severe injuries (ISS ≥ 16) were included from August 2015 until November 2016 if admitted to one of the hospitals in Noord-Brabant (the Netherlands). Outcome measure was health status, measured by the EuroQol-5D (EQ-5D utility and EQ-Visual analogue scale) and the Health Utilities Index (HUI2 and HUI3) one week and one, three, six, and twelve months after injury. Patient and trauma characteristics were analysed as prognostic factors with linear mixed models. The effect of each prognostic factor over time was analysed by adding the interaction term between the prognostic factor and time point in a multivariable linear mixed model, adjusted for confounders. Additionally, the risk factors for problems in the EQ-5 dimensions of HS and cognition were analysed.ResultsIn total 239 severely injured patients participated. Pre-injury health status, hospital length of stay, ISS and comorbidities were significant prognostic factors for a lower health status. A younger age and extremity injury were prognostic factors for a lower health status until one month after trauma and unemployment before trauma and comorbidities six until twelve months after trauma. In the EQ-5 dimensions 44.1% remained problems in mobility, 15.3% in self-care, 46.4% in activity, 53.3% in pain, 32.5% in anxiety and 35.7% in cognition.ConclusionsLower pre-injury health status, longer hospital length of stay, higher ISS, and comorbidities were significant prognostic factors for a lower health status during one year after a severe injury. A younger age and an extremity injury were short-term prognostic factors and unemployment before trauma and comorbidities were long-term prognostic factors. Even after twelve months patients in our population reported more problems in all EQ-5D dimensions when compared to the Dutch reference population.

Prognostic factors for medical and productivity costs, and return to work after trauma.

AimThe aim of this study was to determine prognostic factors for medical and productivity costs, and return to work (RTW) during the first two years after trauma in a clinical trauma population.MethodsThis prospective multicentre observational study followed all adult trauma patients (≥18 years) admitted to a hospital in Noord-Brabant, the Netherlands from August 2015 through November 2016. Health care consumption, productivity loss and return to work were measured in questionnaires at 1 week, 1, 3, 6, 12 and 24 months after injury. Data was linked with hospital registries. Prognostic factors for medical costs and productivity costs were analysed with log-linked gamma generalized linear models. Prognostic factors for RTW were assessed with Cox proportional hazards model. The predictive ability of the models was assessed with McFadden R2 (explained variance) and c-statistics (discrimination).ResultsA total of 3785 trauma patients (39% of total study population) responded to at least one follow-up questionnaire. Mean medical costs per patient (€9,710) and mean productivity costs per patient (€9,000) varied widely. Prognostic factors for high medical costs were higher age, female gender, spine injury, lower extremity injury, severe head injury, high injury severity, comorbidities, and pre-injury health status. Productivity costs were highest in males, and in patients with spinal cord injury, high injury severity, longer length of stay at the hospital and patients admitted to the ICU. Prognostic factors for RTW were high educational level, male gender, low injury severity, shorter length of stay at the hospital and absence of comorbidity.ConclusionsProductivity costs and RTW should be considered when assessing the economic impact of injury in addition to medical costs. Prognostic factors may assist in identifying high cost groups with potentially modifiable factors for targeted preventive interventions, hence reducing costs and increasing RTW rates.

Examination of Reaction Time Deficits Following Concussion: A Systematic Review and Meta-analysis

Reaction time (RT) deficits are reported following concussion, but it is unknown when these deficits normalize to pre-injury status. It is also unclear how factors such as RT measurement technique and participant characteristics influence post-concussion RT. The purpose of this systematic review and meta-analysis was to (1) characterize acute post-concussion (0-3days) RT impairments, (2) examine RT recovery over time, and (3) explore moderating factors related to acute RT impairment following concussion. Database searches (PubMed, CINAHL, EBSCOhost) were conducted according to PRISMA guidelines for articles published in English from January 2002 to March 2019. Studies compared baseline-to-post-injury RT within individuals (within-subject) and/or RT in concussed individuals to non-concussed controls (between-subject). Sixty studies met inclusion criteria, reporting on a total of 9688 participants with 214 discrete RT effects (Hedges' d; between-subject: N = 29, k = 129; within-subject: N = 42, k = 85). Of the 214 effects, 93 occurred in the acute (0-3days) post-injury timeframe (k = 47 between-subject). Numerous demographic [sex, age, concussion history, population type (athlete, military, and general population), athlete level (high school, college), and sport], and method-based (RT test and measure type, computerized neurocognitive testing platform, concussion definition, and time post-injury) moderators were examined for mean effect influence. Mixed-effects multi-level modeling with restricted-maximum-likelihood estimation was used to account for nested effects and high heterogeneity for the pooled effect size (D+). Significant medium-magnitude RT deficits were observed acutely for between- (D+ = -0.7279, 95% CI -0.9919, -0.4639, I2 = 88.66, p < 0.0001) and within-subject (D+ = -0.7472, 95% CI -0.9089, -0.5855, I2 = 89.21, p < 0.0001) effect models. RT deficits were present at the sub-acute and intermediate-term timeframes for between-subject effects (sub-acute: D+ = -0.5655, 95% CI -0.6958, -0.4352, p < 0.0001; intermediate-term: D+ = -0.3219, 95% CI -0.5988, -0.0450, p = 0.0245). No significant RT mean effect was observed for the between-subject model at the long-term timeframe, indicating RT recovery among concussed participants relative to controls (D+ = 0.3505, 95% CI -0.4787, 1.1797, p = 0.3639). Sex was a significant moderator for between-subject effects, with every 1% male sample size increase demonstrating -0.0171 (95% CI -0.0312, -0.0029, p = 0.0193) larger RT deficits. Within-subject effect models resulted in RT measure type (simple: [D+ = -0.9826] vs. mixed: [D+ = -0.6557], p = 0.0438) and computerized neurocognitive testing platforms (ANAM: [D+ = -0.3735] vs. HeadMinder CRI: [D+ = -1.4799] vs. ImPACT: [D+ = -0.6749], p = 0.0004) having significantly different RT-deficit magnitudes. No other moderators produced significantly different RT-deficit magnitudes (between-subject: [p ≥ 0.0763], within-subject: [p ≥ 0.1723]). Robust RT deficits were observed acutely following concussion. Minimal magnitude differences were noted when comparing between- and within-subject effects, suggesting that pre-injury baselines may not add clinical value in determining post-injury RT impairment. RT deficits persisted up till the intermediate-term (21-59days post-injury) timeframe and indicate lingering deficits exist. Mean effect size differences were observed between RT measure types and computerized neurocognitive testing platforms; however, all categories displayed negative effects consistent with impaired RT following concussion. Clinical interpretation suggests that measuring RT post-concussion is more important than considering the RT method employed so long as reliable and valid tools are used. PROSPERO Registration #CRD42019119323.

Return to Productivity Projections for Individuals With Moderate to Severe TBI Following Inpatient Rehabilitation: A NIDILRR TBIMS and CDC Interagency Collaboration.

Return to work and school following traumatic brain injury (TBI) is an outcome of central importance both to TBI survivors and to society. The current study estimates the probability of returning to productivity over 5 years following moderate to severe brain injury. A secondary longitudinal analysis using random effects modeling, that is, individual growth curve analysis based on a sample of 2542 population-weighted individuals from a multicenter cohort study. Acute inpatient rehabilitation facilities. Individuals 16 years and older with a primary diagnosis of TBI who were engaged in school or work at the time of injury. Participation in productive activity, defined as employment or school, as reported during follow-up telephone interviews at 1, 2, and 5 years postinjury. Baseline variables, age of injury, race, level of education and occupational category at the time of injury, disability rating at hospital discharge, substance abuse status, and rehabilitation length of stay, are significantly associated with probability of return to productivity. Individual-level productivity trajectories generally indicate that the probability of returning to productivity increases over time. Results of this study highlight the importance of preinjury occupational status and level of education in returning to productive activity following moderate to severe TBI.

Bipolar Hemiarthroplasty by Using Cemented Calcar Replacement Stem for Unstable Inter-trochanteric Fractures in Old Age

Background: Internal fixation of unstable inter-trochanteric is challenging and most of the morbidity is associated with prolonged immobilization and implant cut outs. Aim of this study is to evaluate clinical outcomes of bipolar hemiarthroplasty in old age patients with unstable inter-trochanteric fractures by using cemented calcar replacement stem. Methods: 80 hips of inter-trochanteric fractures (AO/OTA type 31-A2.2 and 31-A2.3) in 80 patients, 49 females and 31 male patients from Aug 2016 to Sept 2019. All the patients were operated by posterolateral approach, and hemi-replacement done using cemented modular calcar replacement stem, greater trochanter also reconstructed in all the patients. Patients were followed at 6 wks, 3 months, 6 months and 1 year. Primary outcome included Harris hip score and secondary outcome includes functional walking ability (kovals), thigh pain, dislocation, trendelenberg test and infection, mortality. Results: No dislocation, No e/o infection, only two patients complained of anterior thigh pain. One patient developed pulmonary embolism treated and recovered, limb length discrepancy seen in 4 patients (lengthening 4, no shortening) range 0-20 mm, Perioperative mortality during hospitalization is seen in two patients due to cardiac complications. 5 patients died from discharge to within one year. 3 patients lost to follow up. Fifty five patients (78.57%) regained preinjury ambulation status at final follow up. At final follow up, Average Harris hip score (HSS) was 80 (Range 70 to 95) , poor (&lt;70)-3, fair(70-79)-12, Good (80-89)-50, Excellent (90-100)-5. Conclusion: Hemiarthroplasty using calcar replacement stem in unstable inter-trochanteric fracture in old age patients helps in early mobilization of patients and early regaining of preinjury ambulation status. keyword: Unstable inter-tochanteric fracture; Cemented bipolar; Calcar stem bipolar. Level of evidence: Therapeutic level II.

Analysis of factors affecting the radiological and functional outcome of proximal femoral nailing in unstable intertrochanteric fractures

Introduction: The incidence of hip fracture continues to increase as the elderly population increases, as a result of the extension of the average life span. Intertrochanteric fractures have been treated successfully by various methods, and now we are in an era where functional rehabilitation of patients to their preinjury levels is of prime importance. Reconstruction-type proximal femoral nailing is one of the surgical techniques used to treat intertrochanteric fractures. This implant faces less criticism than the previous ones, but it also has its own disadvantages. Aim: To analyze the factors that affect the functional and radiological outcomes of unstable intertrochanteric fractures treated by proximal femoral nailing and to identify the factors responsible for an abnormal gait pattern after union in some patients. Materials and Method: Forty-two patients treated in our facility who were categorized as having unstable intertrochanteric fractures were followed up until radiological union was achieved and 16 patients who had abnormal gait patterns were further studied to find the factor responsible. Tip­ Apex Distance, lateral screw sliding/collapse, screw position in the neck, initial and final neck-shaft angles, quality of reduction by the modified Fogagnolo et al. criteria and functional outcomes based on Harris Hip Score were analyzed. Results: The average Harris Hip Score in our study was 83.8. Thirty-eight patients did not have any complications, but 16 our patients had abnormal gait patterns at the final follow-up. The reason for the abnormal gait pattern was secondary varus collapse caused by excessive lag screw sliding. Conclusion: The initial quality of reduction as recommended by Fogagnolo is the key factor to achieve a favorable outcome. Proximal femoral nail helps in early return to their preinjury status in most of the patients. It also prevents the varus collapse in unstable intertrochanteric fractures, given the screws are positioned ideally.

The Effect of Pre-Operative Medical Co-Morbidities on Rehabilitation Outcomes Following Surgery for Hip Fracture Management in Geriatric Populations.

Introduction:As a result of increasing longevity, we are seeing more elderly patients with complex medical co-morbidities who sustain hip fractures requiring surgical management. The aim of this study is to understand and analyze the effect of preoperative medical comorbidities and associated low physiological reserve status on functional rehabilitation outcomes following surgical management of hip fractures.Materials and methods:This study conducted a retrospective analysis of 73 patients who fulfilled the inclusion criteria .We utilized the de Morton Mobility Index (DEMMI) scores pre surgery and at the time of discharge from hospital following a period of rehabilitation as a measure of their pre and post-surgery functional status. The Physiological and Operative Score (POSSUM) was used as our tool to objectively quantify medical co-morbidities including but not limited to cardiovascular and pulmonary conditions.Results:The median age of our study population was 83 years of which 55(75%) were female. Time to surgery was a median of 21.0 hours, IQR (15.0-29.0), with a median physiological score of 21.0, IQR (19.0-26.0), the median pre surgery DEMMI was 85.0, IQR (55.5- 100.0) and the median DEMMI at discharge was 33.0, IQR (30.0-41.0).There is a moderate correlation between DEMMI pre and DEMMI at 3 months, 0.38 that is statistically significant, p = 0.001.Discussion:The effect of medical co- morbidities which causes the patient to have a poor physiological reserve even when coupled with the effect of the operative stress have no significant negative impact on the 90-day functional outcome of these patients.Conclusion:This study demonstrated that the presence of medical comorbidities in patients who require surgical management of hip fractures would not adversely affect their rehabilitation outcomes. The preinjury functional status of a patient is a significant factor in predicting functional rehabilitation outcomes.

Pre-injury health status of major trauma patients with orthopaedic injuries

BackgroundPre-injury health status is an important determining factor of long-term outcomes after orthopaedic major trauma. Determining pre-injury health status of major trauma patients with orthopaedic injuries is also important for evaluating the change from pre to post-injury health status. ObjectivesDescribe pre-injury health statuses reported at three different time points (6, 12 and 24 months) after injury and compare these with Australian normative values; determine the agreement between pre-injury health status collected at multiple time points post-injury; and identify factors associated with reporting better pre-injury health status. Materials and MethodsA registry-based cohort study was conducted. Major trauma patients with orthopaedic injuries captured by the Victorian State Trauma Registry with a date of injury from January 2009 to December 2016 were included. Pre-injury health status (measured using the EuroQol-Visual Analogue Scale (EQ-VAS)), reported 6, 12 and 24 months post-injury, was compared against Australian population normative values. The Bland-Altman method of comparison was used to determine the agreement between pre-injury EQ-VAS scores reported 6 to 12 and 6 to 24 months post-injury. Mixed effects ordinal logistic regression was used to determine factors associated with reporting better pre-injury health status. ResultsA total of 3,371 patients were eligible for the study. The median (IQR) pre-injury EQ-VAS score reported 6, 12 and 24 months post-injury was 90 (85–100) out of 100. Participants’ pre-injury EQ-VAS scores reported 6, 12 and 24 months post-injury were significantly higher than Australian population normative values. Pre-injury EQ-VAS scores reported 6 months post-injury agreed with pre-injury EQ-VAS scores reported 12 and 24 months post-injury. A significant association exists between pre-injury health status and age, comorbidities, injury characteristics, socioeconomic status and pre-injury work status. ConclusionsPeople with orthopaedic major trauma have better pre-injury health compared to the general Australian population. Therefore, population-specific values should be used as baseline measures to evaluate orthopaedic trauma outcomes. Pre-injury health status values reported at three different post-injury time points were comparable. If conducting a retrospective pre-injury health evaluation, researchers need be aware of factors that influence self-reporting of pre-injury health status and the response shift that may happen due to encountering injury.

Factors associated with physical, psychological and functional outcomes in adult trauma patients following Road Traffic Crash: A scoping literature review

ObjectiveRoad Traffic Crashes (RTCs) are a major cause of disability globally, with millions of people being injured or disabled each year. This study aims to identify the factors reported in the literature that are associated with physical, psychological and functional outcomes of adult trauma patients following an RTC. MethodsA scoping literature review was conducted. Peer-reviewed articles were retrieved from MEDLINE, EMBASE, and CINAHL. These databases were chosen as the MeSH and Emtree thesauri allow for high specificity searches. Moreover, these databases index the major biomedical/health journals in the field. ResultsThirty-one studies from 10 countries are reported in a PRISMA chart and summarized in a matrix. This review identified a number of factors that are clustered into six categories; (i.) injury characteristics and hospital predictive factors; (ii.) demographic factors; (iii.) family and social support; (iv.); compensation system process and fault in the RTC (v.); pre-injury health status. A final category was used to represent the range of (vi.) psychological and functional outcomes. ConclusionThese findings highlight the multiple and diverse contributors that influence a person's outcomes following an RTC. These factors are intrinsic and extrinsic and commence from the time of injury as well as highlighting the importance for ongoing support after acute care discharge to enable a quick return to optimal wellbeing. Research examining RTC outcomes must integrate information about the crash response and health care system while simultaneously measuring other factors to appropriately quantify the relative contribution of each variable to psychological and functional outcomes.

Return to Sport and Work After High Tibial Osteotomy With Concomitant Medial Meniscal Allograft Transplant

(1) To examine the timeline of return to sport (RTS) and return to work (RTW) after high tibial osteotomy (HTO) with concomitant medial meniscal allograft transplant (MAT), (2) to evaluate the degree of function on RTS and RTW, and (3) to identify reasons patients do not return to sport- or work-related activity. Patients undergoing HTO plus MAT were reviewed retrospectively at a minimum of 2years postoperatively. The exclusion criterion was any concomitant procedure except cartilage restoration for focal full-thickness medial femoral condylar defects. Patients completed a subjective sport and work questionnaire, a visual analog scale for pain, the Single Assessment Numeric Evaluation, and a satisfaction questionnaire. Twenty-two patients (aged 35.1 ± 8.1years) were included at 9.3 ± 3.7years postoperatively. Sixteen patients participated in sports within 3years before surgery, and 14 patients (87.5%) returned to sport by 9.7 ± 3.8months postoperatively. Only 7 patients (43.8%) returned to their preinjury status. Eighteen patients were employed within 3years before surgery, and all patients returned to work; however, only 16 patients (88.9%) returned at the same occupational intensity by 3.1 ± 2.4months. The rates of RTW for light-, medium-, and heavy-intensity occupations were 100%, 75.0%, and 85.7%, respectively, whereas the duration of RTW was 2.1months, 2.3months, and 4.8months, respectively. Of the patients, 20 (90.9%) reported at least 1 complaint postoperatively, with 13 patients (59.1%) returning to the operating room for recurrent symptoms, including 1 patient who received a knee replacement at 7.75years postoperatively. In patients with medial meniscal deficiency and varus deformity, HTO plus MAT provided high rates of RTS (87.5%) and RTW (100%) by 9.7months and 3.1months, respectively. It is imperative that clinicians manage expectations because patients may RTS and RTW after HTO plus MAT; however, return to high-intensity activities or occupations may be unlikely or delayed. Level IV, retrospective case series.

Valuing the Recovery Priorities of Orthopaedic Trauma Patients After Injury: Evidence From a Discrete Choice Experiment Within 6 Weeks of Injury.

To determine the recovery priorities of extremity fracture patients during the subacute phase and the patient factors associated with variation in recovery priorities. Discrete choice experiment. Academic trauma center. One hundred ninety-eight patients with a fracture to the appendicular skeleton. Patients with severe traumatic brain injuries, spinal cord injuries, and non-English-speaking patients were excluded. The relative importance of clinical recovery, work-related recovery, and obtaining disability benefits after injury. In the subacute period, clinical recovery was the main priority for fracture patients (mean: 62%, SD: 5.3). Work-related recovery (mean: 27%, SD: 3.9) and the receipt of other disability benefits (mean: 11%, SD: 6.4) were each of significantly less importance. Heterogeneity was observed across these estimates based on the physical demands of preinjury employment, preinjury physical health, preinjury work status, health insurance type, and the severity of the fracture. Clinical recovery was of paramount importance for fracture patients during the subacute recovery phase. However, patients also valued resuming work and access to disability benefits. Understanding a patient's recovery priorities early in the clinical care pathway will enable the development of multidisciplinary care plans that are responsive to these priorities and, hence, deliver value-based health care. Level V. See Instructions for Authors for a complete description of levels of evidence.