Risk Factors for Nonunion in Pediatric Lateral Column Lengthening (Mosca) Procedures

Category: Hindfoot Introduction/Purpose: The Evans/Mosca procedure remains the most utilized extra-articular osteotomies for correction of pes planus. This desired lengthening is created by inserting a graft in the anterior aspect of the calcaneus through a complete transverse osteotomy. Failure of conservative methods, particularly for rigid pes planus, is a primary consideration for surgical management. Complications of the Evans procedure include delayed union, nonunion, malunion, subluxation of the calcaneocuboid joint, and persistent lateral column pain. Our study analyzes risk factors for development of non-union. Methods: After IRB approval 120 patients charts and 157 feet were analyzed for incidence of non-union which was defined by clinical and radiographic evidence of absence of union &gt;6 months. Delayed union was diagnosed if there was clinical evidence of healing without complete union at &gt;6 months. Exclusion criteria included age &gt;18 and revision lateral column lengthening. Patients' medical records were reviewed for basic demographics, complications, and surgical technique. Results: The cohort consisted of 75 females (47.8%) and 82 males (52.2%). The median age was 12 with an interquartile range (IQR) of 3. A total of 6 patients (3.7%) had wound complications or nerve injury. Nonunion occurred in 7 of 157 feet (4.5%) with 2 of 157 feet (1.3%) experiencing delayed union. The median age for patients with nonunion was significantly higher than those who achieved union (13.2 (IQR 2.75) vs. 11.2 (IQR 3) respectively). The fixation construct used was associated with increased risk of nonunion. Patients with screw fixation had the highest rate of nonunion at 50% (2/2) compared to pin and/or staple fixation at 6.8% (5/73), no fixation at 4% (3/75), and plate fixation at 0% (0/2). Both delayed union patients were treated with ultrasound bone stimulation, both patients were able to achieve complete union. Revision was attempted in 5/7 nonunions with all operative patients achieving union. Conclusion: Our study analyzed risk factors for developing non-union in patients undergoing calcaneal lengthening osteotomy for pediatric pes planus. We found age at time of surgery and graft fixation method to be significant risk factors for development of non-union. Our study highlighted that those patients who had non-union was on average &gt;2yrs older at time of surgery. Overall, lateral column lengthening is a well-tolerated procedure with a complication rate, including non-and delayed union, of 10.8%. Surgeons should be aware, in the largest cohort of pediatric Evans/Mosca procedures to date, patient age and type of fixation were associated with nonunion. </jats:sec

Outcomes of Tibiocalcaneal Arthrodesis in High Risk Patients: An Institutional Cohort of 18 Patients

Category: Hindfoot Introduction/Purpose: Tibiocalcaneal (TC) arthrodesis is commonly performed in patients with severe hindfoot disease. These include severe Charcot deformities, ankle malformations, chronic osteomyelitis (COM), and avascular necrosis (AVN). The talar vasculature becomes disrupted to the point that the bone can no longer be salvaged. The procedure involves performing a talectomy and fusing the tibia to the calcaneus. This helps in preserving the remaining hindfoot anatomy while allowing the patient to regain function and mobility. Our study highlights certain risk factors that influence the rate of postoperative complication after tibiocalcaneal surgery. Methods: We retrospectively reviewed the charts of 18 patients from a single institution who underwent tibiocalcaneal arthrodesis between the years of 2011 and 2019. Preoperative diagnoses, comorbidities, post-operative outcomes were noted among all patients. Then, the rates of non-union, below-knee amputations, revision surgeries, postoperative infections, and hardware failure were recorded. This data was then analyzed to determine which preoperative and perioperative factors affected postoperative outcomes for patients after tibiocalcaneal arthrodesis surgery. Results: Nonunion was the most commonly reported complication in this series. Eight of the eighteen patients were documented to have nonunion including three patients with stable pseudarthrosis. Diabetic patients had a slightly higher incidence of nonunion (4 of 7 patients) compared to those without diabetes (4 of 11 patients). Of the 9 patients diagnosed with Charcot arthropathy, 5 had nonunion. Three of five individuals with a BMI ranging from 25-30, and four of six individuals with a BMI of greater than 30 had a nonunion. Infection was a post-operative complication for four of the eighteen patients. Two of the four patients had multiple comorbidities in addition to chronic infections in the joint which were recurrent after surgery. Conclusion: In conclusion, TC arthrodesis provides a viable option for high risk patients with complicated ankle pathology who have not had successful outcomes from previous treatment. It is not without complications considering the comorbidities the patients present with before requiring this procedure. Further studies are necessary in order to validate the trends of outcomes and comorbidities of patients with TC arthrodesis. [Table: see text] </jats:sec

Incidence and Risk Factors of Preoperative and Postoperative Falls for Patients with Chronic Foot Pathologies: An Institutional Prospective Study

Category: Other; Hindfoot; Lesser Toes; Midfoot/Forefoot Introduction/Purpose: Individuals with chronic foot pathologies often have an increased fall risk due to decreased power, deformity, or neuropathy. If patients do fall they can suffer injuries leading to emergency room visits, hospital admission, and surgery. Additionally, falls can increase the severity of their existing condition. This leads to an increase cost burden on the healthcare field and can ultimately decrease the quality of life for the patient. It is important to identify which foot pathologies are associated with the highest fall risk preoperatively and postoperatively. This study analyzes preoperative and postoperative fall data for patients with a variety of common forefoot, midfoot, and hindfoot pathologies. Methods: Over the course of 2019 70 patients had preoperative and 2-week and 6-week postoperative fall data collected in clinic prior to and after surgery. These patients were subdivided into three cohorts based on the location of foot pathology. This included 25 patients for forefoot, 20 patients for midfoot and 20 patients for hindfoot. We had patients complete several surveys that pertained to previous fall history, fall risks, fall history after surgery, current medical status, and use of an assistant device. The John’s Hopkins Fall Risk Assessment tool and the survey pertaining to fall risk from the national council on aging were validated surveys that were completed. Results: Patients that suffered from a hindfoot pathology had the highest risk of suffering a fall preoperatively. Of the 25 patients in the hindfoot cohort 36% experienced at least one fall in the 12 months prior to surgery. Patients with forefoot and hindfoot pathologies experienced the most falls prior to surgery (0.64 and 0.60 respectively). Postoperatively patients with midfoot pathologies had the highest frequency of falls with 35% experiencing at least one fall within the 2-week period after surgery. The midfoot cohort also experience the most falls postoperatively averaging 0.50 falls. Preoperatively all patients completed a John’s Hopkins fall risk assessment and the scores for forefoot midfoot and hindfoot were 6.32, 4.70, 6.96 respectively. With a score of over 6 indicating moderate fall risk. Conclusion: This information can help to identify which patients undergoing surgery for chronic foot pathologies are at the highest risk for preoperative and postoperative falls. Our study suggests that individuals with hindfoot pathologies are at greatest risk for preoperative falls and patients with midfoot pathologies have the greatest risk for postoperative falls. This study can help to guide patient management and decrease fall risk by understanding which patients are most susceptible. We are currently undertaking a prospective study looking at how preoperative mobility device training can reduce postoperative fall risk. [Table: see text] </jats:sec

Diagnostic yield of nontuberculous mycobacteria in patients booked for endoscopy at the University Teaching Hospital, Lusaka.

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.BACKGROUND: The intestinal carriage of nontuberculous mycobacteria (NTM) is associated with disease, especially in severely immunocompromised individuals. These organisms, although often considered contaminants, have been known to cause various types of illnesses. We aimed to determine the prevalence of and associated factors for NTM among patients booked for colonoscopy at the University Teaching Hospital (UTH) in Lusaka. METHODS: We randomly recruited 97 patients attending routine endoscopy procedures between November 2012 and October 2013 and after consent, administered a structured questionnaire. We collected stool and intestinal lavage samples, as well as biopsy samples from the descending colon and the caecal area during the endoscopy procedure. Samples were cultured using the mycobacteria growth indicator tube (MGIT) method followed by the GenoType Mycobacterium CM/AS assay for identification of NTM. Results were expressed as means and standard deviations; proportions were expressed as percentages with corresponding 95% confidence intervals. We used Fisher's exact Chi square test for cross-tabulations where appropriate. All statistical tests were two-sided, with a significance level set at p < 0.05. RESULTS: Out of the 97 patients, 45 (46.4%) were female and 52 (53.6%) were males with mean ages 49.1 (±16.7, range 24-85) and 44.4 (±15.0, range 18-80) years respectively. The prevalence of NTM was 7.2% (95% CI 1.9-12.4), while that of Mycobacterium tuberculosis (MTB) was 6.2% (95% CI 2.3-13.0). Carriage of NTM was not significantly associated with age, sex or presenting symptoms such as diarrhoea, abdominal pain, weight loss as well as HIV status. There were no identifiable predictors of NTM carriage. CONCLUSION: The results have shown that NTM and MTB are present in the intestines of the patients booked for colonoscopy at the University Teaching Hospital in Lusaka, but their presence is not related to presenting symptoms. Given that this may be an indicator of a bigger burden of NTM in this population, there is a need to explore this burden and the contribution it could have on abdominal disease in general as well as examine potential factors that might be important predictors.Financial support for this study was provided by the Research Support Centre at the University of Zambia School of Medicine (UNZA-SOM), through the Southern African Consortium for Research Excellence (SACORE), which is part of the African Institutions Initiative Grant of the Wellcome Trust (Company Number 2711000), a charity (No. 210183) registered in Englan

Nontuberculous mycobacteria in milk from positive cows in the intradermal comparative cervical tuberculin test: implications for human tuberculosis infections

ABSTRACT Although the tuberculin test represents the main in vivo diagnostic method used in the control and eradication of bovine tuberculosis, few studies have focused on the identification of mycobacteria in the milk from cows positive to the tuberculin test. The aim of this study was to identify Mycobacterium species in milk samples from cows positive to the comparative intradermal test. Milk samples from 142 cows positive to the comparative intradermal test carried out in 4,766 animals were aseptically collected, cultivated on Lowenstein-Jensen and Stonebrink media and incubated for up to 90 days. Colonies compatible with mycobacteria were stained by Ziehl-Neelsen to detect acid-fast bacilli, while to confirm the Mycobacterium genus, conventional PCR was performed. Fourteen mycobacterial strains were isolated from 12 cows (8.4%). The hsp65 gene sequencing identified M. engbaekii (n=5), M. arupense (n=4), M. nonchromogenicum (n=3), and M. heraklionense (n=2) species belong to the Mycobacterium terrae complex. Despite the absence of M. tuberculosis complex species in the milk samples, identification of these mycobacteria highlights the risk of pathogen transmission from bovines to humans throughout milk or dairy products, since many of mycobacterial species described here have been reported in pulmonary and extrapulmonary diseases both in immunocompetent and immunocompromised people