Long-term analysis of chronic pain associated with lower extremity injuries

INTRODUCTION The main objective of this study is to examine chronic pain and limping in relation to lower extremity and pelvic fracture location in addition to fracture combinations if multiple fractures are present on the same leg that have not been previously reported. We hypothesize that fracture pattern and location of lower extremity and pelvis fractures of multiple injured patients influence their long-term pain outcome. MATERIALS AND METHODS Retrospective cohort study. Patients with treated multiple lower limb and pelvic fractures at a level 1 trauma center and followed up for at least 10 years postinjury were assessed. Lower leg pain subdivided into persistent, load-dependent and intermittent pain, as well as limping were recorded by using self-administered patient questionnaires and standardized physical examinations performed by a trauma surgeon. Descriptive statistics were used to present comparative measurements between groups. RESULTS Fifty-seven percent of patients (n = 301) showed chronic lower limb pain 10 years postinjury. Ten percent of all patients with chronic pain displayed persistent pain, and here the most common fracture combination was tibial shaft fractures in combination with femoral shaft or proximal tibial fractures (13%). One hundred fifty-one patients reported load-dependent pain, with the most common fracture combinations being fractures of the foot in combination with femoral shaft fractures or distal tibial fractures (11%). One hundred twenty patients reported intermittent pain, with the most common fracture combinations involving the shaft of the tibia with either the femoral shaft or distal tibia (9%). Two hundred fifteen patients showed a persistent limp, and here the most common fractures were fractures of the femoral shaft (19%), tibial shaft (17%), and pelvis (15%). CONCLUSIONS In multiple injured patients with lower extremity injuries, the combination of fractures and their location are critical factors in long-term outcome. Patients with chronic persistent or load-dependent pain often had underlying femoral shaft fractures in combination with joint fractures

The local soft tissue status and the prediction of local complications following fractures of the ankle region

INTRODUCTION Well-known risk factors (RF) for soft tissue complications following surgical treatment of fracture of the ankle region include diabetes, smoking, and the local soft tissue status. A weighted analysis might provide a risk profile that guides the surgical treatment strategy. The aim of this meta-analysis was to provide a risk profile for soft tissue complications following closed fractures of the ankle region. METHODS This review provides a meta-analysis of studies that investigate potential risk factors for complications in fractures of the ankle region. INCLUSION CRITERIA Original articles that were published between 2000 and 2020 in English or German language that calculated odds ratios (OR) of RF for soft tissue complications. Further, this study only includes articles that investigated fractures of the ankle region including pilon fracture, calcaneal fractures, and fractures of the malleoli. This study excluded articles that provide exploratory analyses, narrative reviews, and case reports. RF were stratified as patient specific systemic RF (PSS), patient specific local RF (PSL), and non-patient specific RF (NPS). PSS RF includes comorbidities, American society of anaesthesiology (ASA), requirement of medication, additional injuries, and smoking or substance abuse. PSL RF includes soft tissue status, wounds, and associated complications. NPS RF includes duration of surgery, staged procedure, or time to definitive surgery. Random effect (RE) models were utilized to summarize the effect measure (OR) for each group or specific RF. RESULTS Out of 1352 unique articles, 34 were included for quantitative analyses. Out of 370 complications, the most commonly assessed RF were comorbidities (34.6%). Local soft tissue status accounted for 7.5% of all complications. The overall rate for complication was 10.9% (standard deviation, SD 8.7%). PSS RF had an OR of 1.04 (95%CI 1.01 to 1.06, p = 0.006), PSL an OR of 1.79 (95% 1.28 to 2.49, p = 0.0006), and NPS RF an OR of 1.01 (95%CI 0.97 to 1.05, p = 0.595). Additional injuries did not predict complications (OR 1.23, 95%CI 0.44 to 3.45, p = 0.516). The most predictive RF were open fracture (OR 3.47, 95%CI 1.64 to 7.34, p < 0.001), followed by local tissue damage (OR 3.05, 95%CI 1.23 to 40.92, p = 0.04), and diabetes (OR 2.3, 95%CI 1.1 to 4.79, p = 0.26). CONCLUSION Among all RFs for regional soft tissue complications, the most predictive is the local soft tissue status, while additional injuries or NPS RF were less predictive. The soft tissue damage can be quantified and outweighs the cofactors described in previous publications. The soft tissue status appears to have a more important role in the decision making of the treatment strategy when compared with comorbidities such as diabetes

Genie: A Generator of Natural Language Semantic Parsers for Virtual Assistant Commands

To understand diverse natural language commands, virtual assistants today are trained with numerous labor-intensive, manually annotated sentences. This paper presents a methodology and the Genie toolkit that can handle new compound commands with significantly less manual effort. We advocate formalizing the capability of virtual assistants with a Virtual Assistant Programming Language (VAPL) and using a neural semantic parser to translate natural language into VAPL code. Genie needs only a small realistic set of input sentences for validating the neural model. Developers write templates to synthesize data; Genie uses crowdsourced paraphrases and data augmentation, along with the synthesized data, to train a semantic parser. We also propose design principles that make VAPL languages amenable to natural language translation. We apply these principles to revise ThingTalk, the language used by the Almond virtual assistant. We use Genie to build the first semantic parser that can support compound virtual assistants commands with unquoted free-form parameters. Genie achieves a 62% accuracy on realistic user inputs. We demonstrate Genie's generality by showing a 19% and 31% improvement over the previous state of the art on a music skill, aggregate functions, and access control.Comment: To appear in PLDI 201

Long-term outcome in 324 polytrauma patients: what factors are associated with posttraumatic stress disorder and depressive disorder symptoms?

Background: Physical impairment is well-known to last for many years after a severe injury, and there is a high impact on the quality of the survivor's life. The purpose of this study was to examine if this is also true for psychological impairment with symptoms of posttraumatic stress disorder or depression after polytrauma. Design: Retrospective cohort outcome study. Setting: Level I trauma centre. Population: 637 polytrauma trauma patients who were treated at our Level I trauma centre between 1973 and 1990. Minimum follow-up was 10 years after the injury. Methods: Patients were asked to fill in a questionnaire, including parts of the Posttraumatic Stress Diagnostic Scale, the Impact of Event Scale-Revised and the German Hospital Anxiety and Depression Scale, to evaluate mental health. Clinical outcome was assessed before by standardised scores. Results: Three hundred and twenty-four questionnaires were evaluated. One hundred and forty-nine (45.9%) patients presented with symptoms of mental impairment. Quality of life was significantly higher in the mentally healthy group, while the impaired group achieved a lower rehabilitation status. Conclusions: Mental impairment can be found in multiple trauma victims, even after 10 years or more. Treating physicians should not only focus on early physical rehabilitation but also focus on early mental rehabilitation to prevent long-term problems in both physical and mental disability

Surgical treatment options for femoral neck fractures in the elderly

This review paper on femoral neck fractures in the elderly provides updated information from the most recent literature and examines the advantages and disadvantages of different surgical treatment options. Femoral neck fractures are a common injury that many orthopaedic surgeons will encounter within their practice. These injuries are associated with significant morbidity, and the economic impact of surgically fixing these fractures is notable. Contemporary treatment options include internal fixation, hemiarthroplasty, and total hip arthroplasty. For non-displaced fractures, both internal fixation and hemiarthroplasty remain feasible options. Hemiarthroplasty decreases re-operation rate, while internal fixation decreases operative time, blood loss, and infection risk. Newly designed fixation constructs require further investigation. For displaced fractures, the literature strongly supports arthroplasty. Most elderly patients with displaced femoral neck fractures should be managed with a hemiarthroplasty. In select active elderly patients, total hip arthroplasty may achieve favourable early functional outcomes as compared to a hemiarthroplasty. Finally, cemented arthroplasty decreases periprosthetic fracture risk as compared to cementless arthroplasty. However, experienced arthroplasty surgeons with significant expertise in press-fitting techniques may achieve similar outcomes with cementless arthroplasty

Ethnic differences in patients’ perceptions towards isolated orthopedic injuries: a pilot study

Abstract Background Patients’ perceptions of their healthcare have been reported to influence clinical outcomes following orthopedic trauma. Findings across clinical outcomes have demonstrated significant differences in perceptions towards healthcare between Hispanics and non-Hispanic whites. However, ethnic disparities in perceptions towards orthopedic injuries have not been examined in the literature. Aim of study The aim of this pilot study is to explore whether Hispanic patients with isolated orthopedic injuries will demonstrate different perceptions towards their injury as compared to non-Hispanic white patients. The pilot data will be used to inform a subsequent larger clinical investigation and interventional study. Methods A total of 43 patients (31 Hispanics and 12 non-Hispanic whites) with isolated orthopedic injuries requiring surgical treatment were enrolled in this cross-sectional observational pilot study. Outcome measures included the Questionnaire of Perceived Injustice (QPI), Short-Form 36 Health Survey (SF-36v2), Pain Catastrophizing Scale, and Consumer Assessment of Healthcare Providers and Systems (CAHPS) Cultural Competence (CC) item set. Results The CAHPS was completed by 34 patients, and the remaining scoring systems were completed by all 43 subjects enrolled in this study. Hispanic patients trended towards higher QPI scores indicating poorer outcomes than non-Hispanic whites (mean difference [MD] 5.4, 95%; confidence interval [CI] − 4.4, 15.2). The mental component summary score of the SF-36 trended lower in Hispanics as compared to non-Hispanic white (MD − 6.8, 95%; CI − 15.0, 1.4). Hispanic patients also expressed less trust in their doctor on a scale from 0 to 10 (MD − 1.0, 95%; CI − 1.9, − 0.1). Conclusions Our study suggests ethnic differences in patients’ perceptions towards isolated orthopedic injuries. These results must be interpreted cautiously given the limited number of subjects in this pilot examination. We collected sufficient data to allow a sample size calculation for a subsequent larger clinical investigation. Future clinical investigations may determine the influence of ethnic differences in patients’ perceptions towards orthopedic injuries, identify their impact on the functional outcomes, and establish intervention strategies