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  1. Article: Foot and Ankle Outcome Instruments: Missing the Target.

    Al-Mohrej, Omar A / Petrisor, Bradley

    Current reviews in musculoskeletal medicine

    2023  Volume 16, Issue 6, Page(s) 246–254

    Abstract: Purpose of review: Although developing PROMs is arduous and measuring their psychometric characteristics is even more so, the number of available PROMs has grown dramatically in the foot and ankle community over the past few years. The psychometric ... ...

    Abstract Purpose of review: Although developing PROMs is arduous and measuring their psychometric characteristics is even more so, the number of available PROMs has grown dramatically in the foot and ankle community over the past few years. The psychometric properties of foot and ankle PROMs vary considerably, which could explain why there are so many of them used in the literature. This review aims to shed light on the most commonly used PROMs in foot and ankle literature and assess the evidence supporting their use.
    Recent findings: In this study, very limited evidence was found to support the use of most of the commonly used PROMs in foot and ankle literature, and no evidence was found that supports the use of the most common tool, the AOFAS Clinical Rating System. The quality of the studies examining PROMs was also questioned. Prior to making a conclusive determination regarding each instrument, however, additional research on the evidence is necessary. It is extremely challenging to perform systematic reviews comparing data across foot and ankle studies, and it is almost impossible to pool such data into high-quality meta-analyses. So, we need a foot and ankle score for measuring trauma-related outcomes, a score for measuring elective procedure outcomes, and a score for measuring pediatric foot and ankle.
    Language English
    Publishing date 2023-04-04
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2407827-X
    ISSN 1935-9748 ; 1935-973X
    ISSN (online) 1935-9748
    ISSN 1935-973X
    DOI 10.1007/s12178-023-09827-1
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  2. Article ; Online: Cochrane in CORR®: Nutritional Supplementation for Hip Fracture Aftercare in Older People.

    Zeraatkar, Dena / Petrisor, Bradley

    Clinical orthopaedics and related research

    2019  Volume 477, Issue 3, Page(s) 491–493

    MeSH term(s) Aftercare ; Aged ; Aged, 80 and over ; Dietary Supplements ; Hip Fractures ; Humans ; Pelvic Bones
    Language English
    Publishing date 2019-02-11
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 80301-7
    ISSN 1528-1132 ; 0009-921X
    ISSN (online) 1528-1132
    ISSN 0009-921X
    DOI 10.1097/CORR.0000000000000658
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  3. Article ; Online: The Role of Preoperative Opioid Use in Foot and Ankle Surgery: A Systematic Review.

    Selznick, Asher / Kruse, Colin / Al-Mohrej, Omar A / Valente, Giuseppe / Khan, Moin / Al-Asiri, Jamal / Petrisor, Bradley

    The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons

    2023  Volume 63, Issue 2, Page(s) 305–311

    Abstract: Prescription opioids, particularly for treating musculoskeletal pain, are a significant contributor to the opioid epidemic in North America. There is also evidence to suggest that chronic use of opioids is associated with poor outcomes after orthopedic ... ...

    Abstract Prescription opioids, particularly for treating musculoskeletal pain, are a significant contributor to the opioid epidemic in North America. There is also evidence to suggest that chronic use of opioids is associated with poor outcomes after orthopedic surgery. However, whether this association is relevant in foot and ankle surgery is still unclear. Accordingly, a systematic review of the literature was undertaken to assess the impact of preoperative opioid use in patients undergoing foot and ankle surgery concerning postoperative pain, complications, and postoperative opioid dependence. Four databases, including EMBASE, MEDLINE, PubMed, and CINAHL, were searched to March 2022 for studies reporting preoperative opioid use and its effect on postoperative outcomes or opioid use after foot and ankle surgery. A total of 22,092 patients were included in the final synthesis of 8 studies. Most of which were level 3 evidence (5 studies). Around 18% of the patients used opioids preoperatively. Preoperative opioid use was associated with more quantities and prolonged use of opioids postoperatively. Two studies showed an increased risk of complications postoperatively in patients who used opioids preoperatively compared to the nonopioid group. Preoperative opioid use in patients undergoing foot and ankle surgeries is associated with increased and prolonged use of opioids postoperatively and may therefore predict the potential for misuse.
    MeSH term(s) Humans ; Analgesics, Opioid/adverse effects ; Ankle/surgery ; Opioid-Related Disorders/prevention & control ; Opioid-Related Disorders/complications ; Pain, Postoperative/etiology ; Orthopedic Procedures/adverse effects ; Retrospective Studies
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2023-11-02
    Publishing country United States
    Document type Systematic Review ; Journal Article ; Review
    ZDB-ID 1146972-9
    ISSN 1542-2224 ; 1067-2516
    ISSN (online) 1542-2224
    ISSN 1067-2516
    DOI 10.1053/j.jfas.2023.10.003
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    Zs.A 1468: Show issues Location:
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  4. Article: Closed Limb Fractures With Compromised Vascularization: A Narrative Review.

    Vannabouathong, Christopher / Schemitsch, Emil / Petrisor, Bradley / Bhandari, Mohit

    Clinical medicine insights. Arthritis and musculoskeletal disorders

    2019  Volume 12, Page(s) 1179544119836742

    Abstract: Vascular compromised fractures typically result in a high rate of healing complications, such as avascular necrosis, nonunion, delayed union, and arthritis, which severely affect a patient's function and quality of life. The purpose of this review was to ...

    Abstract Vascular compromised fractures typically result in a high rate of healing complications, such as avascular necrosis, nonunion, delayed union, and arthritis, which severely affect a patient's function and quality of life. The purpose of this review was to identify and describe the epidemiology and available treatment options for the most well-known vascular compromised closed fractures. The injuries discussed in detail in this review were scaphoid, lunate, femoral neck, and talar fractures. Current evidence suggests that optimal treatment for vascular compromised fractures is dependent on the degree of fracture displacement and comminution, and the patient's post-injury functional demands, age, and bone quality. Conservative efforts generally include casting or splinting with a period of immobilization. Surgery is indicated for substantially displaced fractures, patients who require higher functional demands and an earlier return to activity, or if complications occur following nonoperative treatment; however, operative intervention is typically performed for femoral neck fractures regardless of the amount of displacement. Various surgical techniques exist, though internal fixation with screws is a common procedure among these injuries and can be used in combination with other implants, such as plating or Kirschner wires (k-wires), when needed. Severe fracture comminution, poor bone quality, or arthritis can contraindicate the use of screws and more invasive intervention will be required. Bone grafting is done in some cases to enhance vascularity. Salvage procedures exist for patients who develop severe complications, but these will permanently alter the anatomy of the injured area and should be considered a last resort.
    Language English
    Publishing date 2019-03-18
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2590933-2
    ISSN 1179-5441
    ISSN 1179-5441
    DOI 10.1177/1179544119836742
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  5. Article ; Online: Posterior-Based Approaches to Open Reduction Internal Fixation of Bimalleolar and Trimalleolar Fractures: A Systematic Review and Meta-analysis.

    Carr, Deborah / Vannabouathong, Christopher / Petrisor, Bradley A / Parekh, Selene G / Bhandari, Mohit

    The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons

    2020  Volume 59, Issue 2, Page(s) 373–378

    Abstract: Although there is growing evidence supporting posterior-based surgical approaches to open reduction internal fixation (ORIF) of malleolar fractures, the lateral approach still remains the standard of care for this injury. The purpose of this review was ... ...

    Abstract Although there is growing evidence supporting posterior-based surgical approaches to open reduction internal fixation (ORIF) of malleolar fractures, the lateral approach still remains the standard of care for this injury. The purpose of this review was to integrate the results of several studies investigating outcomes following posterior-based approaches to the ORIF of malleolar fractures. The literature search was undertaken using PubMed, the Cochrane Library, and Embase. Crude event rates for fracture healing and postoperative complications were calculated. When possible, meta-analyses were conducted to estimate the relative risk of these outcomes between patients treated by posterior-based approaches versus other approaches to ORIF of malleolar fractures. Twenty-two studies were eligible, and 4 studies were included in the meta-analyses. The healing rate was 100% in all patients, regardless of the surgical approach. Overall, 1.26% of patients developed an infection, 0.63% required reoperation, 1.13% experienced aseptic loosening, 5.53% experienced pain after treatment, and 2.52% experienced symptomatic hardware. No malunion or heterotopic ossification was reported in any study. Among patients treated with a posterior-based approach, the most frequently reported complication was infection (2.50%), with lower rates of reoperation and postoperative pain. Patients with trimalleolar fractures experienced slightly poorer outcomes. Patients treated by posterior-based approaches had a significantly increased risk of infection (p = .010) relative to those treated by the lateral approach; patients treated by the lateral approach had a significantly increased risk of pain after surgery (p = .004) and symptomatic hardware (p = .007). This study brought together evidence that posterior-based surgical approaches and non-posterior-based approaches to ORIF are effective in healing malleolar fractures, with significant differences in specific postoperative complications that need to be further explored.
    MeSH term(s) Ankle Fractures/surgery ; Fracture Healing ; Humans ; Open Fracture Reduction/methods ; Treatment Outcome
    Language English
    Publishing date 2020-03-04
    Publishing country United States
    Document type Journal Article ; Meta-Analysis ; Systematic Review
    ZDB-ID 1146972-9
    ISSN 1542-2224 ; 1067-2516
    ISSN (online) 1542-2224
    ISSN 1067-2516
    DOI 10.1053/j.jfas.2019.09.004
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    Zs.A 1468: Show issues Location:
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  6. Article ; Online: A Survey for End-Stage Ankle Arthritis Treatment: Ankle Arthrodesis Versus Ankle Arthroplasty.

    Tai, Kerry / Vannabouathong, Christopher / Mulla, Sohail M / Goldstein, Christina L / Smith, Christopher / Sales, Brendan / Yeardley, Darryl / Bhandari, Mohit / Petrisor, Bradley A

    The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons

    2020  Volume 59, Issue 2, Page(s) 330–336

    Abstract: With promising technological advances, ankle arthroplasty has become an alternative to arthrodesis, traditionally the gold standard, for treating end-stage ankle arthritis. We collected knowledge and perceptions on both procedures to determine the need ... ...

    Abstract With promising technological advances, ankle arthroplasty has become an alternative to arthrodesis, traditionally the gold standard, for treating end-stage ankle arthritis. We collected knowledge and perceptions on both procedures to determine the need for a patient decision aid for these patients by administering a cross-sectional survey to 103 orthopaedic surgeons. Respondents were predominantly male and 41 to 50 years old. Half of those who stated that they do not perform arthroplasty said this was because they do not have adequate training. Additionally, certain variables were associated with the surgeon's choice of intervention: patient gender, age, body mass index, postoperative activity level, employment type, perceived risk of infection, neurovascular injury or wound complication, risk of developing or pre-existing adjacent arthritis, deformity, malalignment, bone loss or abnormal bone quality, number of prior ankle operations, cause of arthritis, and desire for motion preservation. The majority agreed that they always incorporate patient preferences into their decisions and that a decision aid would be beneficial. This survey revealed that several patient characteristics are influential in the surgeon's preference for either arthroplasty or arthrodesis for end-stage ankle arthritis. Because the majority of surgeons incorporate patient preferences in their decisions and report that a decision aid would be beneficial for informed decision-making in this clinical scenario, this survey identified an unmet need supporting the development of such a tool for these patients.
    MeSH term(s) Adult ; Ankle Joint/surgery ; Arthritis/surgery ; Arthrodesis/methods ; Arthroplasty, Replacement, Ankle/methods ; Cross-Sectional Studies ; Decision Making ; Female ; Humans ; Male ; Middle Aged ; Surveys and Questionnaires ; Treatment Outcome
    Language English
    Publishing date 2020-03-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1146972-9
    ISSN 1542-2224 ; 1067-2516
    ISSN (online) 1542-2224
    ISSN 1067-2516
    DOI 10.1053/j.jfas.2019.09.007
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  7. Article ; Online: The Role of Deltoid Ligament Repair in Ankle Fractures With Syndesmotic Instability: A Systematic Review.

    Wang, Julian / Stride, Devon / Horner, Nolan S / Petrisor, Bradley / Johal, Herman / Khan, Moin / Alolabi, Bashar

    The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons

    2020  Volume 60, Issue 1, Page(s) 132–139

    Abstract: Ankle fractures are the fourth most common fracture requiring surgical management. The deltoid ligament is a primary ankle stabilizer against valgus forces. It is frequently ruptured in ankle fractures; however, there is currently no consensus regarding ... ...

    Abstract Ankle fractures are the fourth most common fracture requiring surgical management. The deltoid ligament is a primary ankle stabilizer against valgus forces. It is frequently ruptured in ankle fractures; however, there is currently no consensus regarding repair. A systematic database search was conducted with Medline, PubMed, and Embase for relevant studies discussing patients with ankle fractures involving deltoid ligament rupture and repair. Screening, quality assessment, and data extraction were performed independently and in duplicate. Data extracted included pain, range of motion (ROM), function, medial clear space (MCS), syndesmotic malreduction, and complications. After screening, 9 eligible studies from 1990 to 2018 were included (N = 508). Compared to nonrepair groups, deltoid ligament repair patients had lower syndesmotic malreduction rates (0%-9% vs 20%-35%, p ≤ .05), fewer implant removals (5.8% vs 41% p ≤ .05), and longer operating time by 16-20 minutes (p ≤ .05). There was no significant difference for pain, function, ROM, MCS, and complication rate (p ≤ .05). In conclusion, deltoid ligament repair offers lower syndesmotic malreduction rates and reduced re-operation rates for hardware removal in comparison to trans-syndesmotic screws. Repair groups demonstrated equivalent or better outcomes for pain, function, ROM, MCS, and complication rates. Other newer syndesmotic fixation methods such as suture-button fixation require further evaluation when compared to the outcomes of deltoid ligament repair. A randomized control trial is required to further examine the outcomes of ankle fracture patients who undergo deltoid ligament repair versus trans-syndesmotic screw fixation.
    MeSH term(s) Ankle ; Ankle Fractures/diagnostic imaging ; Ankle Fractures/surgery ; Ankle Joint/surgery ; Bone Screws ; Fracture Fixation, Internal ; Humans ; Ligaments ; Treatment Outcome
    Language English
    Publishing date 2020-11-04
    Publishing country United States
    Document type Journal Article ; Review ; Systematic Review
    ZDB-ID 1146972-9
    ISSN 1542-2224 ; 1067-2516
    ISSN (online) 1542-2224
    ISSN 1067-2516
    DOI 10.1053/j.jfas.2020.02.014
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  8. Article ; Online: Intra-articular Injections in the Treatment of Symptoms from Ankle Arthritis: A Systematic Review.

    Vannabouathong, Christopher / Del Fabbro, Gina / Sales, Brendan / Smith, Christopher / Li, Chuan Silvia / Yardley, Darryl / Bhandari, Mohit / Petrisor, Bradley A

    Foot & ankle international

    2018  Volume 39, Issue 10, Page(s) 1141–1150

    Abstract: Background: Intra-articular (IA) injections are commonly used to treat knee arthritis pain; however, whether their efficacy generalizes to ankle arthritis remains debatable. We aimed to evaluate the evidence for IA therapies in the management of this ... ...

    Abstract Background: Intra-articular (IA) injections are commonly used to treat knee arthritis pain; however, whether their efficacy generalizes to ankle arthritis remains debatable. We aimed to evaluate the evidence for IA therapies in the management of this patient population.
    Methods: We performed a literature search for observational and randomized controlled trials (RCTs). Treatments included corticosteroids (CS), hyaluronic acid (HA), platelet-rich plasma (PRP), and mesenchymal stem cells (MSC). We extracted study details, patient demographics, treatment characteristics, efficacy outcomes, and safety. When feasible, data from RCTs were meta-analyzed using a random-effects model and 95% confidence intervals (CIs) were calculated. A P value <.05 was considered statistically significant.
    Results: We identified 27 studies (1085 patients). Ankle OA, rheumatoid arthritis (RA), and hemophilic arthropathy populations were examined. The majority of studies were observational (20 studies); the only RCTs were those evaluating HA. Case series demonstrated favorable results in terms of symptomatic relief with CS, HA, PRP, and MSC injections; however, the effects of CS may only be short term and the evidence on MSCs was limited to 1 study with 6 ankle OA patients. Pooled results (3 RCTs, 109 patients) suggested significantly improved Ankle Osteoarthritis Scale scores with HA over saline at 6 months, with a mean difference of 12.47 points (95% CI 1.18-23.77, P = .03).
    Conclusion: Evidence from small trials favors HA and PRP injections for the treatment of pain associated with ankle osteoarthritis. However, the relative efficacy of all injectable therapies is far from definitive and warrants further high-quality comparative trials.
    Level of evidence: Level III, systematic review.
    MeSH term(s) Adrenal Cortex Hormones/therapeutic use ; Ankle Joint/pathology ; Humans ; Hyaluronic Acid/therapeutic use ; Injections, Intra-Articular/methods ; Mesenchymal Stem Cell Transplantation ; Osteoarthritis/drug therapy ; Osteoarthritis/therapy ; Pain ; Pain Measurement ; Platelet-Rich Plasma ; Treatment Outcome ; Viscosupplements/therapeutic use
    Chemical Substances Adrenal Cortex Hormones ; Viscosupplements ; Hyaluronic Acid (9004-61-9)
    Language English
    Publishing date 2018-06-18
    Publishing country United States
    Document type Journal Article ; Systematic Review
    ZDB-ID 1183283-6
    ISSN 1944-7876 ; 1071-1007
    ISSN (online) 1944-7876
    ISSN 1071-1007
    DOI 10.1177/1071100718779375
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  9. Article ; Online: A survey of current practices and preferences for internal fixation of displaced olecranon fractures.

    Wood, Thomas / Thomas, Katie / Farrokhyar, Forough / Ristevski, Bill / Bhandari, Mohit / Petrisor, Bradley

    Canadian journal of surgery. Journal canadien de chirurgie

    2015  Volume 58, Issue 4, Page(s) 250–256

    Abstract: Background: Olecranon fractures represent 10% of upper extremity fractures. There is a growing body of literature to support the use of plate fixation for displaced olecranon fractures. The purpose of this survey was to gauge Canadian surgeons' ... ...

    Abstract Background: Olecranon fractures represent 10% of upper extremity fractures. There is a growing body of literature to support the use of plate fixation for displaced olecranon fractures. The purpose of this survey was to gauge Canadian surgeons' practices and preferences for internal fixation methods for displaced olecranon fractures.
    Methods: Using an online survey tool, we administered a cross-sectional survey to examine current practice for fixation of displaced olecranon fractures.
    Results: We received 256 completed surveys for a response rate of 31% (95% confidence interval [CI] 30.5-37.5%). The preferred treatment was tension band wiring (78.5%, 95% CI 73-83%) for simple displaced olecranon fractures (Mayo IIA) and plating (81%, 95% CI 75.5-85%) for displaced comminuted olecranon fractures (Mayo IIB). Fracture morphology with a mean impact of 3.31 (95% CI 3.17-3.45) and comminution with a mean impact of 3.34 (95% CI 3.21-3.46) were the 2 factors influencing surgeons' choice of fixation method the most. The major deterrent to using tension band wiring for displaced comminuted fractures (Mayo IIB) was increased stability obtained with other methods described by 75% (95% CI 69-80%) of respondents. The major deterrent for using plating constructs for simple displaced fractures (Mayo IIA) was better outcomes with other methods. Hardware prominence was the most commonly perceived complication using either method of fixation: 77% (95% CI 71.4-81.7%) and 76.2% (95% CI 70.6-81.0%) for tension band wiring and plating, respectively.
    Conclusion: Divergence exists with current literature and surgeon preference for fixation of displaced olecranon fractures.
    MeSH term(s) Canada ; Fracture Fixation, Internal/methods ; Fracture Fixation, Internal/statistics & numerical data ; Fractures, Comminuted/surgery ; Health Care Surveys/statistics & numerical data ; Humans ; Olecranon Process/injuries ; Olecranon Process/surgery ; Orthopedics/methods ; Surveys and Questionnaires ; Ulna Fractures/surgery
    Language English
    Publishing date 2015-07-22
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 410651-9
    ISSN 1488-2310 ; 0008-428X
    ISSN (online) 1488-2310
    ISSN 0008-428X
    DOI 10.1503/cjs.014614
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  10. Article ; Online: Electrical stimulation for fracture healing: current evidence.

    Goldstein, Christina / Sprague, Sheila / Petrisor, Bradley A

    Journal of orthopaedic trauma

    2010  Volume 24 Suppl 1, Page(s) S62–5

    Abstract: This article provides an overview of the biology behind the use of electrical stimulation in fracture healing and discusses the current methods of electrical bone growth stimulation. In addition, we review the best available clinical evidence for the use ...

    Abstract This article provides an overview of the biology behind the use of electrical stimulation in fracture healing and discusses the current methods of electrical bone growth stimulation. In addition, we review the best available clinical evidence for the use of electrical stimulation in the treatment of delayed and nonunions of fractures. Our search identified 4 meta-analyses on the use of electrical stimulation on fracture healing. The most methodologically rigorous and recent meta-analysis suggests that the current evidence is insufficient to conclude a benefit of electromagnetic stimulation in improving the rate of union in patients with a fresh fracture, osteotomy, delayed union, or nonunion. The other 3 meta-analyses that we identified suggested a more significant treatment effect from electrical stimulation. Although the evidence supporting electrical stimulation does trend in favor of its use to help achieve bony union, further large, multicenter, randomized, controlled trials are required to resolve the current uncertainty surrounding the use of electrical stimulation and fracture healing.
    MeSH term(s) Bone and Bones/physiopathology ; Bone and Bones/radiation effects ; Electric Stimulation Therapy/methods ; Electric Stimulation Therapy/trends ; Evidence-Based Medicine/trends ; Fracture Healing/physiology ; Fracture Healing/radiation effects ; Fractures, Bone/physiopathology ; Fractures, Bone/therapy ; Humans
    Language English
    Publishing date 2010-03
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639099-7
    ISSN 1531-2291 ; 0890-5339
    ISSN (online) 1531-2291
    ISSN 0890-5339
    DOI 10.1097/BOT.0b013e3181cdde1b
    Database MEDical Literature Analysis and Retrieval System OnLINE

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