The treatment of metatarsalgia by minimally invasive surgery: A cross-sectional study

Introduction: Minimally invasive surgery (MIS) is one of the most innovative approaches for the treatment of metatarsalgia. This cross-sectional study aims to analyse the clinical and radiological outcomes of patients treated for metatarsalgia by this technique and to evaluate their results in relation to the Maestro formula. Methods: Patients between 18 and 80 years, affected by metatarsalgia and treated by percutaneous oblique osteotomies, were included in this study. All patients were assessed radiographically and clinically with internationally validated scales: SF-36, AOFAS, 17-FFI, MOXFQ and VAS. Both outcomes were evaluated in relation to the restoration of the Maestro formula. Statistical analysis was performed and its significance was set at p < 0.05. Results: A total of 91 patients (mean age 51.6 years, M:F = 13:78) with a mean follow-up of 3.9 years (range 2 to 7 years) were evaluated. MIS bone osteotomies were completely healed at a mean time of 3.3 months. We observed significant functional improvement after surgery of all parameters considered in our analysis: AOFAS (84.1 vs. 48.6); 17-FFI (43.2 vs. 7.8); MOXFQ-Pain (11.4 vs. 2.1); MOXFQ-Walking (15.7 vs. 3.9) and MOXFQ-Social (4.8 vs. 0.8). However, the Maestro formula did not improve significantly at last follow-up. Complications occurred in 17 cases and 3 patients required a second operation. Mean VAS satisfaction was 7.785 at last follow-up. Conclusions: MIS has significantly improved the clinical-functional outcomes of patients with metatarsalgia, even if the Maestro formula did not improve significantly.

Understanding Factors Associated With Psychomotor Subtypes of Delirium in Older Inpatients With Dementia

Objectives: Few studies have analyzed factors associated with delirium subtypes. In this study, we investigate factors associated with subtypes of delirium only in patients with dementia to provide insights on the possible prevention and treatments. Design: This is a cross-sectional study nested in the “Delirium Day” study, a nationwide Italian point-prevalence study. Setting and Participants: Older patients admitted to 205 acute and 92 rehabilitation hospital wards. Measures: Delirium was evaluated with the 4-AT and the motor subtypes with the Delirium Motor Subtype Scale. Dementia was defined by the presence of a documented diagnosis in the medical records and/or prescription of acetylcholinesterase inhibitors or memantine prior to admission. Results: Of the 1057 patients with dementia, 35% had delirium, with 25.6% hyperactive, 33.1% hypoactive, 34.5% mixed, and 6.7% nonmotor subtype. There were higher odds of having venous catheters in the hypoactive (OR 1.82, 95% CI 1.18-2.81) and mixed type of delirium (OR 2.23, CI 1.43-3.46), whereas higher odds of urinary catheters in the hypoactive (OR 2.91, CI 1.92-4.39), hyperactive (OR 1.99, CI 1.23-3.21), and mixed types of delirium (OR 2.05, CI 1.36-3.07). We found higher odds of antipsychotics both in the hyperactive (OR 2.87, CI 1.81-4.54) and mixed subtype (OR 1.84, CI 1.24-2.75), whereas higher odds of antibiotics was present only in the mixed subtype (OR 1.91, CI 1.26-2.87). Conclusions and Implications: In patients with dementia, the mixed delirium subtype is the most prevalent followed by the hypoactive, hyperactive, and nonmotor subtype. Motor subtypes of delirium may be triggered by clinical factors, including the use of venous and urinary catheters, and the use of antipsychotics. Future studies are necessary to provide further insights on the possible pathophysiology of delirium in patients with dementia and to address the optimization of the management of potential risk factors