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Surgical treatment of fibula fractures associated with unstable ankle injuries traditionally involves an extensile exposure, direct reduction of the fracture, and fixation with a plate and screw construct. Some patient populations may benefit from less invasive approaches and indirect reduction associated with fibular rods. The aim of this report is to demonstrate successful treatment of an unstable ankle injury in a geriatric patient with insulin dependent diabetes using a fibular rod.OBJECTIVE To determine whether the practice of overlapping surgery influenced patient safety following open reduction internal fixation (ORIF) for ankle fractures. DESIGN Retrospective case-control SETTING Level 1 Academic Midwest trauma center PATIENTS All patients who underwent ankle fracture ORIF by a single surgeon were eligible for our study, with 478 total patients. INTERVENTION Cases that were overlapping were compared against cases that were not overlapping. Cases were defined as overlapping if there was greater than 30 minutes of overlap between procedural times. Patient complications were recorded up to a year from the index surgery. MAIN OUTCOME MEASURE Unexpected return to surgery. RESULTS There were 478 ankle fracture ORIF patients, 238 with at least 3 months follow-up; 124 (52%) in the overlapping group and 114 (48%) in the non-overlapping group. There was no difference in the rate of unexpected return to surgery (p=0.76), infection (p = 0.52), readmission (p = 0.96), painful hardware (p = 0.62), malunion (p = 0.27), nonunion (p = 0.52), or arthritis (p = 0.39) between the overlapping and non-overlapping groups. There were 467 isolated ankle fractures used for time analysis. Average procedure time was 26 minutes longer for the overlapping group than the non-overlapping group (p less then 0.01). CONCLUSION Overlapping surgery causes increased operative time for ankle ORIF, but there was no apparent increased risk to the patients for short term complications. The need for graduated resident responsibility required by ACGME guidelines need to be weighed against the decreased efficiency of operating room time.Level of Evidence-3.BACKGROUND Bilateral THAs performed in the same patient should not be considered independent observations, neither biologically nor statistically. As a result, when surgical results are reviewed, it is common to analyze only the first of the two hips, assuming that the first, and not the second hip of a staged bilateral THA, better resembles unilateral THAs. This assumption has not been empirically justified.Question/purposes (1) In patients with staged bilateral THA, is the first or second hip more similar to a unilateral THA in terms of age at surgery, presence of any preoperative Charlson comorbidity, and risk of postoperative reoperation? (2) Should the date of a first or second hip surgery of a staged bilateral THA be used as a starting point for patient survival to better resemble patients with unilateral THA? METHODS We identified 68,357 THAs due to osteoarthritis in 63,613 patients from the Swedish Hip Arthroplasty Register (SHAR) in 1999-2015. selleck compound Of those THAs, 14,780 concerned the first hip of a staged (95% CI 108.8 to 109.5) for patients with a first hip of a staged bilateral THA. Patients with only a first hip of a planned staged bilateral THA who did not survive long enough to undergo their second THA were classified as unilaterals. The rank-order of survival curves are therefore by design ("immortal time bias"). We conclude, however, that survival for patients with unilateral THA more closely resembles the survival of patients with a second hip of a staged bilateral THA, compared with the first. CONCLUSIONS Our findings, which are based on observational register data, challenge the common practice in epidemiologic studies of analyzing only the first hip of a staged bilateral THA. We recommend analyzing the second THA in a patient who has undergone staged bilateral THA rather than the first because the second procedure better resembles unilateral THA. LEVEL OF EVIDENCE Level III, therapeutic study.BACKGROUND Future projections for both TKA and THA in the United States and other countries forecast a further increase of already high numbers of joint replacements. The consensus is that in industrialized countries, this increase is driven by demographic changes with more elderly people being less willing to accept activity limitations. Unlike the United States, Germany and many other countries face a population decline driven by low fertility rates, longer life expectancy, and immigration rates that cannot compensate for population aging. Many developing countries are likely to follow that example in the short or medium term amid global aging. Due to growing healthcare expenditures in a declining and aging population with a smaller available work force, reliable predictions of procedure volume by age groups are requisite for health and fiscal policy makers to maintain high standards in arthroplasty for the future population.Questions/purposes (1) By how much is the usage of primary TKA and THA in Germany ee projected increase in Germany will be from the use of TKA in younger patients and from the use of THA in elderly patients. Knowledge of these trends may help planning by surgeons, hospitals, stakeholders, and policy makers in countries similar to Germany, where high incidence rates of arthroplasty, aging populations, and overall decreasing populations are present. LEVEL OF EVIDENCE Level III, economic and decision analysis.OBJECTIVES The instantaneous wave-free ratio cutoff value of 0.93 had a negative predictive value of 100%. Acute instantaneous wave-free ratio less then 0.86 and less then 0.83 had positive predictive values of 71 and 77%. Using acute instantaneous wave-free ratio less then 0.90 as cutoff for hemodynamic significance yielded the highest degree of classification agreement between acute and follow-up instantaneous wave-free ratio. CONCLUSIONS In patients with ST-segment elevation myocardial infarction, acute instantaneous wave-free ratio with the cutoff values less then 0.90 for hemodynamic significance appears optimal in the evaluation of nonculprit stenoses and has a high negative predictive value and a moderate positive predictive value.
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