Spartan medical research journal最新文献

{"title":"Quality Improvement Intervention associated with Improved Lung Protective Ventilation Settings in an Emergency Department","authors":"David H. Heimberg, Zachary Illg, W. Corser","doi":"10.51894/001c.29603","DOIUrl":"https://doi.org/10.51894/001c.29603","url":null,"abstract":"INTRODUCTION Patients requiring endotracheal intubation and mechanical ventilation in the emergency department (ED) are critically ill, and their ventilator management is crucial for their subsequent clinical outcomes. Lung-protective ventilation (LPV) setting strategies are key considerations for this care. The objectives of this 2019-2020 community-based quality improvement project were to: a) identify patients at greater risk of not receiving LPV, and b) evaluate the effectiveness of a series of brief quality improvement educational sessions to improve LPV setting protocol adherence rates. METHODS A 15-month retrospective chart review of ventilator settings and subject characteristics (N = 200) was conducted before and after a series of 10-15-minute educational sessions were delivered to improve LPV adherence. This information was presented at a series of four educational sessions for 25 attending physicians (n = two sessions) and 27 residents at conferences (n = two sessions). Two additional materials (e.g., LPV reference charts, tape measures to gauge patients’ heights) were also posted in three ED resuscitation rooms and on cabinets containing emergency airway equipment. The pre and post-intervention occurrence rates of LPV setting orders were inferentially compared before and after educational sessions. RESULTS Patients ventilated using LPV increased from 70% to 82% after the educational sessions (p = 0.04). All patients who were 67 inches or greater in height were ventilated appropriately before and after sessions. For patients under 65 inches in height, post-session LPV adherence increased from 13% to 53% (p = 0.01). CONCLUSIONS Based on these results, a brief ED provider educational intervention can significantly improve the utilization of LPV guideline-based settings. Patients under 65 inches in height may also be especially at risk of receiving non-LPV ventilator setting orders.","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48867429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial Variations in Emergency Department Management of Chest Pain in a Community-based Setting.","authors":"Elisabeth Greenberg, Elle Schultz, Emily Cobb, Shelia Philpott, Megan Schrader, Jessi Parker","doi":"10.51894/001c.32582","DOIUrl":"10.51894/001c.32582","url":null,"abstract":"<p><strong>Introduction: </strong>Chest pain is one of the most common chief presenting complaints occurring in most Emergency Departments. The HEART score is a validated risk stratification tool commonly used to evaluate chest pain. Prior research has demonstrated the existence of complex racial variations in health care, specifically in what tests are ordered (or accepted by patients) during evaluation and treatment of cardiac disease. The authors hypothesized that chest pain management (i.e., disposition to hospital/observation unit and rates of stress testing) patterns and longitudinal outcomes (i.e., death and 30-day readmission) would occur differently in African Americans despite systematic use of the HEART score.</p><p><strong>Methods: </strong>Funded by the Statewide Campus System, this study was comprised of a retrospective chart review of a sample of eligible patients presenting with chest pain to the authors' 345-bed community-based Michigan hospital.</p><p><strong>Results: </strong>Of the 1,412 eligible sample patients, 886 (63%) reported their racial affiliation as White, 473 (33%) African-American, and 53 (4%) \"Other\". The average HEART score in Whites was 3.92 (SD = 1.89) compared to 3.31 (SD = 1.79) in African-Americans, (p < 0.01, 95% CI: 0.40-0.82). However, White patients' odds of admission to observation or inpatient was 1.49 times higher (95% CI: 1.04 - 2.15), with every unit increase in HEART score increasing the odds ratio of admission by 3.24 times (95% CI: 2.79 - 3.76). White patients were also 2.37 times more likely to receive (or accept) stress tests than African American patients (95% CI: 1.41 - 3.88). Only five (0.01%) of 458 White patients with HEART score between 4 and 6 experienced 30-day readmission or death whereas seven (0.04%) of 193 African-American patients experienced these outcomes (p = 0.04 with OR 3.40, 95% CI: 1.07 - 10.9).</p><p><strong>Conclusions: </strong>Although the authors were unable to precisely distinguish the provider (e.g., desire to order testing) and patient-driven (e.g., desire to accept testing) factors likely to contribute to measured differences, these results suggest continued complex racial variations concerning hospital admission and stress testing in chest pain patients. Further studies are needed to analyze potential systems or subject-level factors influencing the multi-dimensional phenomenon of chest pain management across racial affiliation.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":"7 1","pages":"32582"},"PeriodicalIF":0.0,"publicationDate":"2022-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8873438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10144046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality and Implementation of Diabetic Care at a Free Clinic.","authors":"Noumi Chowdhury, Mark Trottier, Ghufraan Akram","doi":"10.51894/001c.30026","DOIUrl":"10.51894/001c.30026","url":null,"abstract":"<p><strong>Introduction: </strong>Although typically receiving little government funding, free clinics help ensure access to affordable quality health care to the medically underserved. Established in 2004, the authors' metropolitan Detroit Health Unit on Davison Avenue (HUDA) Clinic delivers primary care and specialized services to uninsured populations. The authors compared proportionate changes in A1c levels compared to prior national averages to evaluate the significance of care a free diabetes clinic can provide to uninsured populations.</p><p><strong>Methods: </strong>Retrospective data from 2017-2019 were reviewed of adult patients who have been diagnosed with Type 2 Diabetes. From HUDA Clinic medical records, data were collected concerning patient demographics, insurance status, pregnancy, major comorbidities and several factors related to diabetes standards of care.</p><p><strong>Results: </strong>There were a total of 2,231 patient visits to HUDA Clinic in 2019, of which 125 patients (5.6%) received care for their Type 2 diabetes. Forty (32%) clinic patients who had a visit in 2019 had an HbA1c <7.0 and 29 (23%) had an HbA1c > 9.5. This is comparable to the 2020 National Diabetes Statistics Report in which approximately 50% (n = 15.6 million) of Americans had an HbA1c < 7.0 and 14% (n = 5.1 million) had an HbA1c > 9.5.</p><p><strong>Conclusions: </strong>Huda Clinic's diabetes care percentages were quite comparable to state and national data and CDC parameters, although these comparative results need to be considered in terms of the authors' smaller sample size. These overall results indicate that health care providers can meet major recommended diabetic care at inner-city free clinics in metropolitan communities. Future provider and patient study studies regarding free clinic care patterns are clearly required to identify gaps in healthcare access and formulate and test specific strategies to improve diabetes-related outcomes.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":"30026"},"PeriodicalIF":0.0,"publicationDate":"2022-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8873429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43904022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Efficacy of External Nasal Dilator Strips with N95 Respirator Masks by Emergency Department Personnel.","authors":"Ariel Hawley, Mitchell Rozman, Matthew Hysell","doi":"10.51894/001c.30215","DOIUrl":"10.51894/001c.30215","url":null,"abstract":"<p><strong>Introduction: </strong>The coronavirus disease 2019 (COVID-19) pandemic has prompted increased use of personal protective equipment (PPE) to maintain the health and safety of caregivers. This study was conducted in 2020 to evaluate the safety and efficacy of external nasal dilator strips (ENDS) coupled with N95 respirators in a sample of community hospital emergency department personnel.</p><p><strong>Methods: </strong>After obtaining written consent, the authors tested participants' response to exercise (i.e., walking up 10 flights of stairs) while wearing an N95 respirator, both with and without an ENDS. The authors measured participants' heart rate and respiratory effort responses over four minutes following their exercise trial. A convenience sample of these personnel also repeated their respirator fit testing while wearing an ENDS with the N95 style they had previously been fitted for.</p><p><strong>Results: </strong>A total of N = 50 participants were enrolled. Peak heart rate while wearing an ENDS was 125 beats per minute (BPM) with the ENDS versus 130 BPM without (p = 0.21). The Borg Exertion Score while wearing an ENDS peaked at 13 with the ENDS versus 14 without (p = 0.08). However, when subjects were surveyed before and after the trial upon whether they would consider using an ENDS beneath their N95 using a scale of 1-5, their interest in this significantly increased (p = 0.004). Four of the 13 (31%) participants who completed repeated fit testing while wearing the ENDS beneath their N95 respirator failed the repeat testing.</p><p><strong>Conclusions: </strong>These results first suggest that a sizable proportion of ED personnel may fail N95 fit testing while wearing an ENDS beneath the N95 mask for which they had been previously fitted. Although providers' subjective interest in use of ENDS increased, these results also demonstrate that use of an ENDS beneath an N95 respirator may not significantly increase exercise tolerance.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":"7 1","pages":"30215"},"PeriodicalIF":0.0,"publicationDate":"2022-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8873432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41161327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Omitted Radiological finding in the Pediatric Age Group: Physiological Sacroiliac Joint Vacuum Normal Variant.","authors":"Emrah Doğan,&nbsp;Hüseyin Aydoğmuş,&nbsp;Sinem Aydoğmuş","doi":"10.51894/001c.27361","DOIUrl":"https://doi.org/10.51894/001c.27361","url":null,"abstract":"<p><strong>Introduction: </strong>Gas accumulation in human joint spaces has been generally described as the vacuum phenomenon (VP). To date, the sacroiliac joint VP has been associated mostly with pathological, particularly degenerative conditions (e.g., arthritis, obesity, discal degenerations, fractures, dislocations, avascular necrosis).</p><p><strong>Objective: </strong>The study aimed to examine the characteristics of the physiological form of VP and its radiological patterns in a sample of pediatric patients.</p><p><strong>Methods: </strong>A sample of seventy patients between 0 and 17 years old (mean age, 11.4 ± 5.54) were included in the study. Sample VP cases was evaluated according to types, age group, anatomic localization, gender, and sides. RESULTS: Two (2.9%) of sample children had degenerative VP, with 24 (34.2%) of patients demonstrating physiological VP in the sacroiliac joints. VP rates significantly increased after nine years of age (p < 0.01) and 83% of physiological VP cases were determined to be bilateral.</p><p><strong>Conclusions: </strong>Although degenerative VP is a rare entity in children, non-pathological VP can be a more common aspect of sacroiliac anatomy. Although sacroiliac VP is frequently an underreported or omitted finding in imaging studies, this condition may be clinically important as a clue for other degenerative diagnoses. Normal variants of VP may be clinically important in children since they may mimic inflammatory and infectious pathologies during magnetic resonance imaging and computed tomography images.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":"27361"},"PeriodicalIF":0.0,"publicationDate":"2021-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8405278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39427124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Care Transitions: An Initiative between the Emergency Department and Senior Care Facilities.","authors":"Michelle Joan Moccia, Daniel Keyes","doi":"10.51894/001c.26862","DOIUrl":"10.51894/001c.26862","url":null,"abstract":"<p><strong>Introduction: </strong>The transfer of individuals (i.e., residents) between senior care facilities (SCF) and the emergency department (ED) remains an ongoing healthcare quality gap as communication of key resident information is often lost. For this study, a sample of SCF representatives were invited to join a collaborative group termed Safe Transition of All Residents For yoU and Me (STARForUM, STAR-F) to improve SCF resident transitions of care.</p><p><strong>Study purpose: </strong>The purpose of this pilot study was to invite a convenience sample of SCF facilities to join a collaborative intervention named <i>Safe Transition of All Residents For yoU and Me</i> (STARForUM, STAR-F) to improve information exchange during SCF residents' transitions of care. The potential influence of a hospital-SCF collaboration program to improve transfer of essential SCF resident information sent to the hospital ED was used as an evaluation measure.</p><p><strong>Methods: </strong>This study project enrolled a total of 120 residents (i.e., patients) with 40 (33%) transferred from participating STAR-F facilities.</p><p><strong>Results: </strong>Following the authors' development of a transfer checklist, STAR-F facilities sent a significantly greater number of essential elements comprised of the resident's medical history information to the ED compared to non-STAR-F facilities. Controlling for the standard classification of skill level of the individual facility, STAR-F residents had significantly higher essential information transmission composite scores (10.5 + 2.9 for STAR-F patients vs. 7.75 + 3.1 for non-STAR-Fs p = < 0.01) that may have served to reduce number of associated transition errors.</p><p><strong>Conclusions: </strong>The findings of this study suggest that a collaborative hospital-SCF initiative can significantly improve transfer of information for elderly residents during ED visits, help guide clinical decision-making and optimize care coordination.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":"26862"},"PeriodicalIF":0.0,"publicationDate":"2021-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8405283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39424805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review: Cardiac Metastasis of Lingual Squamous Cell Carcinoma.","authors":"Connor C Kerndt, Trevor A Nessel, John A Bills, Zaid J Shareef, Alexander M Balinski, Devin T Mistry","doi":"10.51894/001c.27297","DOIUrl":"10.51894/001c.27297","url":null,"abstract":"<p><strong>Introduction: </strong>Lingual squamous cell carcinoma (LSCC) is an aggressive malignancy that carries significant mortality risk and the potential for cardiac metastasis. The authors performed a systematic review designed to characterize disease progression of LSCC cardiac metastasis by evaluating patient demographics, characteristics, management, and clinical outcomes.</p><p><strong>Methods: </strong>Two authors independently screened articles in Embase, PubMed, and Cochrane Database of Systematic Reviews up until December 2019 for study eligibility. Demographic data, patient symptomatology, imaging findings, management strategies, and patient outcomes were obtained and analyzed. The Oxford Centre for Evidence Based Medicine (OCEBM) Levels of Evidence categorization was implemented to determine the quality of studies selected in this review.</p><p><strong>Results: </strong>From this review, a total of 28 studies met inclusion criteria and received an OCEBM Level 4 evidence designation. Thirty-one patients were identified with cardiac metastasis from LSCC. Shortness of breath (29.0%) and chest pain (29.0%) were the most common presenting symptoms, and pericardial effusion (29.2%) and right ventricular outflow tract obstruction (25.0%) were the predominant echocardiogram findings. Cardiac metastases most often presented in the right ventricle (56.7%), followed by the left ventricle (43.3%). Palliative intervention (68.2%) or chemotherapy (40.9%) were typically implemented as treatments. All sample patients expired within one year of metastatic cancer diagnosis in cases that reported mortality outcomes.</p><p><strong>Conclusions: </strong>Patients presenting with shortness of breath, tachycardia, and a history of squamous cell carcinoma of the tongue may indicate evaluation for LSCC cardiac metastasis. Although LSCC cardiac metastases typically favor the right and left ventricles, they are not exclusive to these sites. Palliative care may be indicated as treatment due to high mortality and overall poor outcomes from current interventions.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":"6 2","pages":"27297"},"PeriodicalIF":0.0,"publicationDate":"2021-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8405280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9649998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Carpal Tunnel Syndrome be Appropriately Diagnosed in a Cold Hand?","authors":"Michael T Andary, Drew B Parkhurst, Maurice R Bernaiche, Jose S Figueroa, Lata Kumaraswamy, Suzanne M Manzi, Ryan A O'Connor, Ingrid P Parrington, Jim R Sylvain","doi":"10.51894/001c.25941","DOIUrl":"10.51894/001c.25941","url":null,"abstract":"<p><strong>Introduction: </strong>The diagnosis of carpal tunnel syndrome (CTS) with nerve conduction studies traditionally involves warming the hand to avoid misleading prolongation of distal latency (DL). Comparing the median nerve DL to the ulnar and radial nerves using the combined sensory index (CSI) has been reported to improve the accuracy of CTS diagnosis. During this study, the authors examined the effect of hand temperature on the CSI and diagnosis of CTS.</p><p><strong>Methods: </strong>The authors conducted a prospective, controlled, cohort study with 20 asymptomatic control patients and 21 symptomatic patients with confirmed CTS. Symptomatic patients underwent nerve conduction studies with the CSI calculated under both cold and warm conditions.</p><p><strong>Results: </strong>Control subjects with warm hands had an average CSI of 0.0 milliseconds (ms), and -0.3ms with cold hands. CTS subjects with warm hands had an average CSI of 3.2ms, and 3.7ms with cold hands. Although hand temperature was shown to slow sample latencies, differences calculated with the CSI did not misclassify any of the 41 sample subjects.</p><p><strong>Conclusions: </strong>During this study, cold temperature did not result in misclassification of either control patients or CTS patients when CSI was diagnostically used. Based on these results, peak latency comparisons in cold hands can be considered as diagnostically reliable as under standard hand temperature ranges for the diagnosis of CTS, with caution warranted in borderline cases. This diagnostic technique can save time for the patient, physician, and care team without compromising quality of care. Future larger sample blinded studies at multiple electrodiagnostic sites are indicated.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":"25941"},"PeriodicalIF":0.0,"publicationDate":"2021-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8405284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39424803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of COVID-19 on the Orthopaedic Surgery Residency Experience.","authors":"Devan O Higginbotham, Abdul K Zalikha, Steven K Stoker, Bryan E Little","doi":"10.51894/001c.25963","DOIUrl":"10.51894/001c.25963","url":null,"abstract":"<p><strong>Introduction: </strong>The rapid spread of the COVID-19 virus led to dramatic changes in graduate medical education and surgical practice. The purpose of this study was to evaluate the effects of the COVID-19 pandemic on Orthopaedic Surgery residency education in the United States.</p><p><strong>Methods: </strong>A survey sent to all residents of the 201 ACGME-accredited Orthopaedic Surgery programs in the United States.</p><p><strong>Results: </strong>A total of 309 Orthopaedic surgery residents responded to our survey. A subset of 283 (91.6%) residents surveyed reported decreased Orthopaedic-related clinical duty hours due to the COVID-19 pandemic, and 300/309 (97.1%) reported a decrease in surgical case volume. 298 (96.4%) residents reported that their program had scheduled activities or made changes to supplement their education, most common being virtual and video conferences 296/309 (95.5%), required practice questions 132/309 (42.7%), required reading or pre-recorded lectures 122/309 (39.5%), in-person small group meetings or lectures 24/309 (7.77%), and surgical simulation activities 17/309 (5.50%). Almost half (152/309 (48.9%)) of respondents reported their overall resident education was somewhat or much worse due to the impact of COVID-19. Over a quarter (81 (26.2%)) of residents reported their well-being was negatively impacted by residency-related changes due to COVID-19.</p><p><strong>Conclusions: </strong>Based on these results, the COVID-19 pandemic has brought about significant changes to the training experience of Orthopaedic surgery residents in the United States. Although the majority of residents in this sample had favorable opinions of the educational changes their programs have instituted in light of the pandemic, clinical duty hours and case volume were reported to have substantially decreased, with a large portion of residents viewing their overall resident education as worsened and reporting negative impacts on their overall well-being.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":"25963"},"PeriodicalIF":0.0,"publicationDate":"2021-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8405282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39424804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Postoperative Leg Length Discrepancy and Femoral Offset Using Two Different Surgical Approaches for Hemiarthroplasty of the Hip.","authors":"James T Layson, Matthew S Coon, Rajan Sharma, Benjamin Diedring, Alan Afsari, Benjamin Best","doi":"10.51894/001c.25096","DOIUrl":"10.51894/001c.25096","url":null,"abstract":"<p><strong>Introduction: </strong>The direct anterior approach (DAA) and anterolateral approach (ALA) may be used for hip hemiarthroplasty (HHA) as a treatment for femoral neck fractures. The DAA often utilizes intraoperative fluoroscopy to determine leg length and offset, while the ALA traditionally utilizes an intraoperative clinical exam to determine offset and leg length. This study will evaluate two techniques: the \"grid fluoroscopy [GF] technique\" and the \"intraoperative exam [IE] technique,\" each performed by one of two separate surgeons, and compare each technique's accuracy to restore leg length and femoral offset in a patient population that underwent HHA.</p><p><strong>Methods: </strong>Two investigators retrospectively reviewed charts of 208 randomly selected patients who had an HHA from either a DAA or ALA performed by two different surgeons for the treatment of femoral neck fractures. Postoperative AP pelvis radiographs were measured to determine offset and leg length compared with the non-operative extremity. Non-normal continuous variables were provided by median and interquartile range. Data were analyzed with the Mann-Whitney U test and Student's t-test.</p><p><strong>Results: </strong>After inclusion and exclusion criteria, data were reviewed on 173 hemiarthroplasties. The mean age was 80.3 years (± 11.2 years). Of the surgical patients, 65.9% were female, and 70.9% identified their ethnicity as white. The DAA was used in 93 patients and ALA in 80 patients. Analysis comparing the two techniques demonstrated no statistically significant differences in median leg length between GF technique (1.02 IQR -0.1, 2.0 mm) and IE technique (1.25 IQR -2.4, 1.3 mm,) (p=0.67). There was also no statistically significant difference in offset between GF technique (1.3 IQR 0.2, 2.1 mm) and IE technique (0.6 IQR -2.7 mm, 3.2 mm) (p=0.13). However, a difference was found in mean length of surgery that was statistically significant. We found that the mean length of surgery for the IE technique was 74.8 ± 24.7 minutes versus the GF technique, which was 95.1 ± 23.0 minutes, (p<0.0001).</p><p><strong>Discussion: </strong>There was no significant difference between leg length and offset with the use of intraoperative fluoroscopy with DAA compared to no intraoperative imaging with ALA. Our study suggests that DAA and ALA are equally effective approaches for re-establishing symmetric leg length and offset in HHA for femoral neck fractures. In this study, the ALA had a shorter surgical time compared to DAA, potentially due to the utilization of intraoperative fluoroscopy for this particular technique during the DAA.</p>","PeriodicalId":74853,"journal":{"name":"Spartan medical research journal","volume":" ","pages":"25096"},"PeriodicalIF":0.0,"publicationDate":"2021-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8405281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39424801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}