Grant Medical Center

Venothromboembolic (VTE) events are considered rare complications following foot and ankle surgery. Most instances of VTE following surgical procedures occur in particularly high-risk patient populations; therefore, VTE prophylactic anticoagulation is initiated based on risk/benefit stratification for each individual patient undergoing foot and ankle surgery. We present a case report on a 40-year-old male who underwent isolated Lisfranc ligament repair and subsequently developed an acute saddle pulmonary embolism and deep vein thrombosis 1 month postoperatively. The patient was on prophylactic Lovenox, yet still developed a life-threatening complication. The patient was found to be on a selective estrogen receptor modulator for the off-label treatment of male infertility. This medication, surgical intervention, and a period of non-weight bearing are believed to be contributory to the patient's relatively increased hypercoagulable state. This case depicts a rare complication of foot and ankle surgery and highlights the importance of VTE prophylaxis during the postoperative period.

BACKGROUND:Periprosthetic femoral fractures account for up to 16% of all revision total hip arthroplasties with one- and two-year mortality rates of 23.4 and 29.2%, respectively. Given the substantial clinical and financial burden, accurate preoperative risk assessment is essential. This study evaluated the predictive performance of the Five-Item Modified Frailty Index (mFI-5) and Risk Analysis Index (RAI) in patients undergoing surgery for PFs, aiming to improve preoperative assessment, inform surgical decision-making, and facilitate postoperative planning. METHODS:A total of 824 patients at least 18 years old who underwent revision total hip arthroplasty and/or open reduction internal fixation for periprosthetic femoral fractures were identified in a national surgical database. The RAI and mFI-5 were calculated for each patient. Outcomes were major and minor complications, readmission, reoperation, nonhome discharge, wound complications, venous thromboembolisms, and mortalities. Multivariable logistic regression models for each index-outcome were fitted, controlling for body mass index, operative time, procedure type, and smoking status. The ability of RAI and mFI-5 to predict postoperative outcomes was assessed using the area under the receiver operating curve (AUC) with DeLong's test used to compare differences between correlated AUCs. RESULTS:The RAI demonstrated significantly better predictive ability for mortality (AUC: 0.69 versus 0.53; P = 0.033) and nonhome discharge (AUC: 0.71 versus 0.57; P < 0.001) compared with mFI-5. In adjusted models, RAI was significantly associated with mortality (odds ratio: 1.08; 95% confidence interval: 1.00 to 1.17; P = 0.040) and nonhome discharge (odds ratio: 1.16; 95% confidence interval: 1.12 to 1.20; P < 0.001). CONCLUSIONS:The RAI was superior to the mFI-5 in predicting mortality and nonhome discharge for patients undergoing surgical management of PPFs. Our findings support the implementation of RAI as a tool for preoperative risk stratification and may be impactful in surgical planning and counseling of geriatric orthopaedic patients and their families.

As the global population ages, fractures among elderly individuals are increasing, with humeral shaft fractures (HSFs) comprising 3

Intertrochanteric hip fractures are commonly treated with cephalomedullary nailing. One time-consuming aspect of the procedure is intraoperatively measuring the helical blade length. This investigation sought to determine if preoperative imaging can be reliably used to predict helical blade length and therefore reduce operative time accurately. This was a single-center, single-surgeon retrospective chart review. All subjects were operated on by the senior author at a single urban level-1 trauma center. Each patient underwent cephalomedullary nailing using a helical blade. The medical records were reviewed for demographic, imaging, and operative data. Two raters preoperatively recorded head element length, subsequently estimated helical blade implant sizes, and actual implant length used intraoperatively. In total, 134 patients were analyzed. The results demonstrated that radiographs (R2 = 0.337, p < 0.001) and computed tomography (CT) imaging (R2 ≥ 0.435, p < 0.001) could not reliably predict helical blade length, and that radiographs were more accurate than CT scans in predicting actual implant size (p < 0.001). Preoperative imaging modalities predicted the exact size only 23.8% of the time using radiographs and 17.2% of the time using CT. Preoperative helical blade implant size was estimated accurately 24% of the time. However, raters were successful in estimating the length of the helical blade within three sizes. We demonstrate that preoperative imaging modalities are unable to accurately predict helical blade length.

The Annals of Family Medicine encourages readers to develop a learning community to improve health and health care through enhanced primary care. With the Annals Journal Club, we [encourage][1] diverse participants—particularly among students, trainees, residents, and interns—to think critically