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OBJECTIVES: To assess patients' opioid prescription usage and pain management satisfaction after fracture surgery. METHODS: Design: An IRB-approved prospective prognostic cohort study for postoperative fracture patients was conducted. Patients were evaluated by an independent observer at two weeks, six weeks, three months, and six months postoperatively where they were given Detroit Interventional Pain Assessment (DIPA) questionnaires regarding their postoperative pain and opioid usage. Opioid prescriptions were verified by Michigan Automated Prescription System. All patients were divided into major fractures (tibia, femur, acetabulum, pelvis, calcaneus, talus, and polytrauma) and minor fractures (scapula, clavicle, humerus, radius, ulna, scaphoid, carpal/metacarpal, patella, fibula, ankle, and metarsal) and were followed for two years. SETTING: Single-Center Level One Trauma Center. PATIENT SELECTION CRITERIA: Patients presenting to clinic over a six month period were invited to participate in this study. Patients who did not consent were excluded. OUTCOME MEASURES AND COMPARISONS: Outcome measures were the amount of prescribed opioids in daily Milligram Morphine equivalents (MMEs), opioid usage, DIPA pain scores, pain management efficiency (percentage of patients reporting no pain or tolerable pain with their regimen). Prescribed MMEs, pain management efficiency scores, and the percentage of patients using opioids were compared across all postoperative periods. RESULTS: For 201 fracture patients, the average age was 47.8 ± 16.3 SD (18-87 years) and there were 116 males (57.8%) and 85 females (42.2%). The percentage of patients using opioids and their daily prescribed MMEs significantly decreased from two weeks (48.2%, 21.6 MMEs) to six months (10.3%, 8.13 MMEs) (P < 0.001). Fifty-one percent of patients were off opioids at two weeks, 64.5% at six weeks, 84.2% at three months, and 89.7% at six months. All opioid prescriptions at six months and two years were prescribed to polytrauma patients who underwent sequential surgeries and these prescriptions originated from outside prescribers. Pain management efficiency scores were worst at two weeks (67.2%) but improved at three months (82.6%). CONCLUSIONS: As patients transitioned further from their surgical date, there was a decrease in opioid prescriptions and patient reported opioid usage. Despite the opioid tapering practices by surgeons, polytrauma patients still received prescriptions from outside prescribers for orthopaedic aftercare after three months, signaling the necessity for patients to see outside prescribers for their pain management after this time. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Background and objective Sizing on digital films is important for implants and planning deformity correction. CT is the most accurate digital measurement method. We use a 1-inch ball bearing (cost: $1) to size our long-leg standing films (LLSFs) when planning deformity correction. In this study, we aimed to assess the accuracy of digital measurements calibrated by this method. Methods We conducted An IRB-approved study involving 25 patients having both an LLSF with a 1-inch ball bearing taped to the inner mid-thigh and a CT scanogram. The longest distance in the axial cut of the bilateral ankle, knee, and femoral heads of the CT images were compared to the same anatomic locations on LLSFs calibrated with the ball bearing using the online digital planning software DetroitBonesetter (DBS) and measurements from our Picture Archiving Communication Software (PACS). Five observers performed each measurement. Results The average measurement differences between the gold standard CT scan and LLSFs calibrated with DBS were as follows: 0.110 ± 0.432 mm (femoral head); 2.173 ± 0.0619 mm (knee); and 3.671 ± 0.30 mm (ankle). In PACS, they were as follows: 5.470 ± 0.381 mm (femoral head); 6.248 ± 0.712 mm (knee); and 1.806 ± 0.548 mm (ankle). The intraclass correlation coefficient for 600 measurements by five observers was 0.972. Conclusions The $1 ball-bearing sizing on DBS using LLSFs provides accuracy to <1 mm for the femoral head, 2 mm at the knee, and 3.7 mm at the ankle. It was significantly better than the PACS system for both the femoral head and knee (<0.001), while PACS was better at the ankle (<0.001).
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Background Walking is an everyday activity but also complex in nature. Gait disorders have the potential to drastically affect an individual's quality of life and their ability to be independent. The causes of gait disorders are numerous. To identify abnormal gait, clinicians utilize gait analysis. The aim of this study is to assess how well individuals can identify limps in postoperative traumatized individuals with lower extremity deformities. Methods Participants observed a video compiled of individuals with various gait abnormalities and severities of limps. In the video, there were nine abnormal gait presentations, four obvious limps, and five subtle limps, while the other 10 gait presentations were normal gaits. Classifications for gait presentations were assigned by the research team. Participants assigned a classification to each limp case presented in the video on a survey. The participants were separated into two groups: those with healthcare experience and lay individuals. A Mann-Whitney U-test was used to compare healthcare experience and lay individuals' ability to identify limps correctly. In addition, the observers were evaluated on their ability to perform a screening diagnosis of a limp. Results A total of 100 participants were included in the study, 46 with healthcare experience and 54 individuals without. All tests, identification of limp and subtle limp, using the Mann-Whitney U-test yielded non-significant differences between healthcare and nonhealthcare experience. Overall lowest correctness between both groups came when attempting to identify subtle limp (healthcare = 57.39%, nonhealthcare = 56.67%) while the highest correctness yield was when identifying limp (healthcare = 96.74%, nonhealthcare = 95.37%). Analysis of the observers' ability to perform a screening diagnosis of limp provided close to gold standard results (sensitivity = 96.0%, specificity = 98.7%, positive predictive value = 99.2%, negative predictive value = 98.4%). Conclusion This study showed that nonhealthcare individuals can accurately perform gait analysis from a video, particularly in identifying the presence of a limp, to a similar extent as individuals with healthcare experience. The implementation of two-dimensional catwalk videos taken from a smartphone is beneficial due to accessibility and cost-effectiveness. It also suggested that limp diagnosis can be done as a screening test, using individuals as the screener.
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Background and Objectives: Orthopedic surgeons commonly prescribe opioids, surpassing all medical specialties. Our objective was to develop a pain management scale that captures medication use, patient-reported pain scores, and helps orthopedic surgeons evaluate their post-operative prescribing practice. Materials and Methods: An IRB-approved prospective study followed 502 post-operative orthopedic surgery patients over a six-month period. All patients were surveyed in an orthopedic clinic at a Level 1 US Trauma Center, during a routine follow-up. Patient pain satisfaction was assessed using the validated Interventional Pain Assessment (IPA) scale, which uses three categories: 0 (no pain), 1 (tolerable pain), and 2 (intolerable pain). Daily narcotic use was translated to morphine milligram equivalents (MMEs) using the Michigan Automated Prescription System (MAPS) narcotics registry. When patient pain satisfaction and narcotic usage were combined, this scale was called the Detroit Interventional Pain Assessment (DIPA) scale. Results: The five classes based on common prescription and usage of narcotics in this cohort include the following: A (no pain medication), B (over-the-counter medication), C (occasional use of short-acting narcotics 1-30 MMEs), D (consistent/regular use of short-acting narcotics 31-79 MMEs), and E (long-duration or stronger short-acting narcotics 80+ MMEs). Patients were most satisfied with their pain management at six weeks (80.5%) and three months (75.65%), and least satisfied at two weeks (62.5%) and six months (60.9%). Additional information displayed on the DIPA graph revealed there was a significant decrease in the percentage of patients on narcotics at two weeks (65.2%) to six months (32.6%) at p < 0.001. Conclusions: The DIPA pain scale shows the relationship between patient pain perception and opioid prescription/usage, while also tracking prescriber tendencies. Providers were able to visualize their post-operative pain management progression at each designated clinic visit with corresponding alphabetical daily MME categories. In this study, results suggest that surgeons were not effective at managing the pain of patients at two weeks post-operative, which is attributed to an inadequate number of pain pills prescribed upon discharge. Overall, the DIPA graph signaled that better pain management interventions are necessitated in periods with lower efficiency scores.
