Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Aug 2023
Preoperatively elevated HbA1c levels can meaningfully improve following total joint arthroplasty.
Prior literature has demonstrated that diabetic (DM) patients undergoing total joint arthroplasty (TJA) with elevated preoperative HbA1c scores have poorer clinical outcomes. However, no literature has reported the effect of undergoing TJA on laboratory markers of glycemic control. This study sought to evaluate effect of undergoing TJA on postoperative glycemic control and outcomes. ⋯ Patients with higher preoperative HbA1c were more likely to have clinically meaningful decreases in HbA1c postoperatively. A combination of preoperative medical optimization and improvements in mobility after TJA may play a role in these changes. Those with elevated HbA1c can have meaningful improvement in HbA1c after TJA.
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Arch Orthop Trauma Surg · Aug 2023
Correlation of head screw lengths in proximal humerus nailing: a CT-based study on 289 cases.
Nailing of the proximal humerus is an established method for the treatment of proximal humerus fractures. Choice of the correct length for potentially four proximal locking screws is essential for postoperative outcome. Due to positioning of the patient, intraoperative determination of the correct length of the anteroposterior (AP) screw with the x-ray beam is particularly challenging even for experienced surgeons. We hypothesized that there would be a correlation between the projected lengths of the different proximal locking screws and therefore the length of the AP-screw could be determined based on the three lateromedial (LM) screws. ⋯ This study was able to show that the length of the AP-screw could be determined from the intraoperatively measured lengths of the LM-screws. As our findings base on measurements performed in CT scans, clinical studies are needed to support our data.
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Arch Orthop Trauma Surg · Aug 2023
Smokers have increased risk of soft-tissue complications following primary elective TKA.
Smoking has been associated with numerous adverse outcomes following surgical procedures. The purpose of this study was to investigate, whether smoking status at time of surgery influences the outcome of primary TKA. ⋯ Current smoking increases risk of soft-tissue complications and revision after primary TKA, especially due to hematoma and restricted movement. Smoking cessation programs could reduce the risk of revision surgery.
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Arch Orthop Trauma Surg · Aug 2023
The optimal diagnostic cut-off of WBC and PMN counts for joint aspiration in periprosthetic joint infection is 2479/µL and 67%, respectively: ICM criteria thresholds are too high.
Various organizations have published definitions for periprosthetic joint infection (PJI) with significant differences in the cut-offs of white blood cell (WBC) count and polymorphonuclear (PMN) leukocyte cells. Herein, we aim to analyze optimal cut-offs in patients which are planned to undergo a prosthesis revision and compare them with the actual published thresholds of the International Consensus Meeting (ICM) and European Bone and Joint Infection Society (EBJIS). ⋯ II.
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Arch Orthop Trauma Surg · Aug 2023
The effects of hypoalbuminemia in obese patients undergoing total joint arthroplasty.
Total joint arthroplasty (TJA) is a highly effective surgery. However, poor nutritional status has been associated with worse outcomes. In orthopedics, nutrition status is commonly evaluated using serum albumin. When albumin levels fall below 3.0 g/dL, wound healing ability becomes impaired. Typically, malnutrition is associated with low BMI, but malnourished patients can also be obese. The goals of this study were to investigate the relationship between malnourishment represented through albumin levels of obese patients and likelihood of postoperative complications. ⋯ Our results demonstrated the prevalence of malnutrition increases as a patient's BMI increases. Further, hypoalbuminemia was associated with increased resource utilization and increased complication rates in all obese patients. We suggest screening albumin levels in obese patients preoperatively to give surgeons the best opportunity to optimize patient nutrition before undergoing surgery.