Motor Strength Measurements Obtained Using an Inexpensive Spring Tensiometer and a Clinical Dynamometer Correlated Well: A Prospective Cohort Study.

OBJECTIVE: Manual muscle strength testing is the primary method for testing muscle strength in clinical settings but is highly subjective. An objective measure of muscle strength can be obtained using a handheld dynamometer, but its cost inhibits its widespread usage. We hypothesized that a spring tensiometer (ST) could be an objective tool that can be used as a viable alternative to a dynamometer. METHODS: Twenty-six outpatients were included, and the strengths of several muscle groups were measured using tensiometers and dynamometers. A paired t-test and Pearson's correlation coefficient and Bland-Altman plot analyses were used to estimate the reliability and measurement accuracy of both tools. Multiple regression analysis was performed to identify the factors contributing to the measurement gap between the two instruments. RESULTS: A total of 260 muscle force values were evaluated. Pearson's correlation coefficient and Bland-Altman analyses indicated that the measurements of the two instruments were strongly correlated and highly accurate. In the multiple regression analysis, the gap between the two instruments was significantly related to the original muscle strength and muscle part but was not significantly related to sex, age, body mass index, or laterality. For biceps and triceps muscle groups, the correlations were particularly strong and accurate, indicating that a tensiometer could be well substituted for a dynamometer. CONCLUSIONS: Our data show that a ST is similar to a dynamometer in terms of precision. A ST is an inexpensive alternative to a dynamometer and more accessible for clinical use than a dynamometer.

Preoperative Depression is Associated With Increased Complications Following Ankle Fracture Surgery.

BACKGROUND: The effects of preoperative depression following ankle fracture surgery remains unknown. The purpose of this study is to investigate the relationship between preoperative depression and outcomes following ankle fracture surgery. METHODS: This retrospective study used the Truven MarketScan database to identify patients who underwent ankle fracture surgery from January 2009 to December 2018. Patients with and without a diagnosis of preoperative depression were identified based on International Classification of Diseases (ICD) codes. Chi-squared and multivariate analyses were performed to determine the association between preoperative depression and postoperative complications following ankle fracture surgery. RESULTS: In total, 107,897 patients were identified for analysis, 13,981 of whom were diagnosed with depression (13%). Preoperative depression was associated with the increased odds for postoperative infection (odds ratio [OR]: 1.33, confidence interval [CI]: 1.20-1.46), wound complications (OR: 1.13, CI: 1.00-1.28), pain-related postoperative emergency department visits (OR: 1.58, CI: 1.30-19.1), 30-day and 90-day readmissions (OR: 1.08, CI: 1.03-1.21 and OR: 1.13, CI: 1.07-1.18), sepsis (OR: 1.39, CI: 1.12-1.72), and postoperative development of complex regional pain syndrome (OR: 1.46, CI: 1.18-1.81). CONCLUSION: Preoperative depression is associated with increased complications following ankle fracture surgery. Further studies are warranted to investigate the degree to which depression is a modifiable risk factor. LEVEL OF EVIDENCE: 3.

Depressive Disorders Lead to Increased Complications After Geriatric Hip Fractures.

INTRODUCTION: Intertrochanteric hip fractures are a common injury treated by orthopedic surgeons and the incidence rate is rising. Preoperative depression is a known risk factor for postoperative complications in orthopaedic surgery, however its effects on outcomes after geriatric hip fractures is relatively unknown. The purpose of this study was to investigate the relationship between preoperative depression and potential complications following open reduction internal fixation (ORIF) and intramedullary nailing (IMN) of geriatric hip fractures. METHODS: In this retrospective study, the Truven Marketscan claims database was used to identify patients over age 65 who underwent ORIF or IMN for a hip fracture from January 2009 to December 2019. Patient characteristics, such as medical comorbidities, were collected and from that 2 cohorts were established (one with and one without depression). Chi-squared and multivariate analysis was performed to investigate the association between preoperative depression and common postoperative complications following intertrochanteric hip fracture surgery. RESULTS: In total, 78,435 patients were identified for analysis. In those patients with preoperative depression, the complications associated with the greatest increased odds after undergoing ORIF were surgical site infections (OR 1.32; CI 1.23-1.44), ED visit for pain (OR 1.27; CI 1.16-1.39), wound complications (OR 1.26; CI 1.14-1.35), and non-union (OR 1.25; CI 1.17-1.33). In the patients with preoperative depression undergoing IMN, the complications associated with the greatest increased odds after were surgical site infections (OR 1.37; CI 1.31- 1.45), ED visit for pain (OR 1.31; CI 1.19-1.44), wound complications (OR 1.23; CI 1.10-1.39), and pneumonia (OR 1.22; CI 1.10-1.31). CONCLUSIONS: Preoperative depression in patients undergoing hip fracture surgery is associated with increased complications. Recognizing a patients' preoperative depression diagnosis can allow physicians to adapt perioperative and postoperative surveillance protocols for these higher risk patients. Further studies are warranted to investigate the degree to which depression is a modifiable risk factor.