Can early treatment of lisfranc injuries without planned re-intervention be safely performed.

The Lisfranc complex is a unique combination of ligamentous and osseous relationships between the medial cuneiform and second metatarsal base that is often injured by high energy mechanisms. Fixation for these injuries is often operative; however, the optimal timing of surgical treatment has been debated. All patients who underwent operative fixation of a Lisfranc injury at a single urban tertiary care center were reviewed. Patient were split into two groups based on timing to fixation with one group being less than 24 h from presentation and a second group being greater than 24 h. There were 58 patients who underwent what was planned as final operative stabilization of their Lisfranc injury in less than 24 h and 41 patients who underwent fixation after more than 24 h. The early treatment of Lisfranc injuries did not lead to significant increases in follow up time, infections, time to weight bearing, union rates, or time to union compared patients treated with delayed fixation. There was a higher rate of superficial infection in the early intervention group, but it did not reach statistical significance. We believe our findings demonstrate that delayed fixation is not superior to early treatment of Lisfranc injuries. LEVEL OF EVIDENCE: Level 3 Therapeutic retrospective comparative study.

Go with the flow: An experimental analysis with tubing alternative with irrigation.

Background and Aims: Literature regarding alternative tubing for fluid delivery in irrigation and debridement procedures is lacking. The purpose of this study was to compare three different apparatuses with varying quantities of irrigation fluid to assess efficiency of administration and evaluate overall time for fluid administration. Methods: This model was designed to compare available methods of gravity irrigation used in practice. Fluid flow time was measured for three types of tubing: single-lumen cystoscopy tubing, Y-type double-lumen cystoscopy tubing, and nonconductive suction tubing. Irrigation times were assessed for varying volumes of 3, 6, and 9 L to investigate the relationship between bag changes and irrigation time. Bag changes were not conducted for the 3 L trial, but were for 6 and 9 L trials. Dimensions of cystoscopy tubing consisted of 4.95 mm internal diameter and 2.1 m length in both single-lumen and Y-type double-lumen apparatus. Nonconduction suction tubing dimensions were 6.0 mm internal diameter and standard 3.7 m in length. Results: The mean flow time for suction tubing was significantly faster than the cystoscopy tubing for the 3 and 9 L trials (p < 0.001). At 6 L, flow time for the suction tubing and the double lumen cystoscopy tubing were similar, 264 versus 260 s, respectively. At 9 L, the mean flow time for the suction tubing was 80 s faster (410 vs. 491 s) compared with single-lumen cystoscopy and was nearly 30 s faster compared with Y-type cystoscopy tubing. Conclusion: The results of this study provide insight into a faster, widely available, and cost-efficient alternative to commonly used cystoscopy tubing.

Comparative analysis between operative and non-operative acetabular labral tear injuries in division 1 collegiate athletes.

Acetabular labral tears have shown to be difficult to diagnose and manage in an active and competitive athletic population. The goal of this study was to compare NCAA Division 1 collegiate athletes undergoing operative and non-operative management of their labral injuries by assessing ability to return to competition and secondarily evaluate days lost from sport. A retrospective cohort analysis was conducted on Division 1 collegiate athletes from 2005 to 2020, incorporating all varsity university sports. Records showing MRI confirmed diagnosis were included in the cohort, as well as all pertinent clinical data. Data revealed 10/18 (55%) of individuals managed conservatively versus 23/29 (79%) surgically (p-value = 0.0834) were able to return to sport following treatment. Of those athletes, 22 surgical patients experienced a mean of 324 days ± 223 days lost from sport and nine conservatively managed patients experienced a mean of 27 days ± 70 lost days (p-value < 0.001) Seven of nine conservatively managed patients were able to continue competition while undergoing treatment. Findings suggest no statistical significance regarding operative vs non-operative management of acetabular labral tears. The majority of athletes returning to sport and treated conservatively were able to resume competition during treatment. Therefore, treatment of these injuries should be individualized based on athlete's symptoms.

Differences Between Patients With Diabetes Mellitus and Those Without in Cases of Necrotizing Fasciitis.

Purposes This study aims to evaluate further differences between patients with diabetes and those without who have been diagnosed with necrotizing fasciitis (NF) to assist clinicians in improving morbidity and mortality. Methods All patients diagnosed with NF of an extremity were retrospectively reviewed and divided into two groups based on a diagnosis of diabetes. Patient charts were reviewed to obtain multiple variables, which were compared between groups. Results From 2015 to 2021, 115 patients underwent surgical intervention due to concern for NF of an extremity with 92 patients included for data computation. Patients with diabetes had an average Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score of 9.02 compared to 7.24 (p=0.02). Patients with diabetes had a significantly higher rate of undergoing amputation when diagnosed with NF (p<0.0001). The mortality rate for diabetes and non-diabetes cohorts were 30.9% and 18.9%, respectively (p=0.2). Conclusion This study demonstrated that patients with diabetes with confirmed NF of an extremity had a significantly higher LRINEC score were more likely to undergo an amputation primarily, and were more likely to have a polymicrobial infection compared to those without. The overall mortality rate of NF was 26.1%.