Open pronation abduction ankle fractures associated with increased complications and patient BMI.

INTRODUCTION: Pronation abduction (PA) ankle fractures are often associated with a medial tension failure wound. Though this injury pattern was defined based on the mechanism of injury, there is a paucity of literature evaluating risk factors for understanding which patients will sustain an open PA fracture. Furthermore, how patients with these types of fractures perform relative to other open ankle fractures has not been established. We hypothesized that open PA fractures are associated with obesity and increased number of reoperations. METHODS: All patients at a single level one trauma center who received operative treatment for an ankle fracture between February 2012 to January 2019 were retrospectively identified using Current Procedural Terminology (CPT) codes. Patients with open PA ankle fractures were identified. Demographic data, body mass index, medical comorbidities, time to surgery, and reoperations were compared between open PA ankle fractures and other open ankle fracture subtypes. RESULTS: There were 22 open PA ankle fractures and 35 other open ankle fracture subtypes. The open PA fracture group had a significantly higher median and average BMI and percentage of patients with obesity. There was no difference in number of patients requiring reoperation between the two groups. When reoperation was required, patients with open PA ankle fractures were found to undergo significantly more reoperations and were significantly more likely to require arthrodesis or below knee amputation. CONCLUSIONS: Open PA ankle fractures are more often associated with obesity (BMI > 30 kg/m2) than are other open ankle fractures caused by a different mechanism. When reoperation does occur, patients with open PA ankle fractures require more reoperations and are more likely to require arthrodesis or below knee amputation that patients with other open ankle fracture subtypes. Early identification of those patients or injuries at increased risk of complications can help ensure optimal outcomes.

Telerehabilitation for Total Hip and Knee Arthroplasty Patients: A Pilot Series with High Patient Satisfaction.

BACKGROUND: The demand for total hip and total knee arthroplasty in the USA is projected to increase significantly. Traditionally, face-to-face physical therapy has been an essential component of recovery in patients after total joint arthroplasty. Emerging technology allows telerehabilitation, or virtual physical therapy, which may reduce costs and increase standardization, but its effects on outcomes are not known. QUESTIONS/PURPOSE: We sought to review our initial experience using a telerehabilitation protocol for patients after primary total hip or total knee arthroplasty. METHODS: In this pilot study, we retrospectively compared our first 40 telerehabilitation patients after a primary total hip or knee arthroplasty with a historical cohort or literature referenced values and evaluated (1) readmission rates at 90 days, (2) emergency department visits, (3) patient-reported outcome scores, (4) incidence of closed knee manipulation within 90 days of primary total knee arthroplasty, and (5) patient satisfaction surveys. RESULTS: We observed no increase in the telerehabilitation group at 90 days in readmissions, emergency department visits, or closed knee manipulations. Accuracy of telerehabilitation exercises performed was 92%. Patient-reported outcome scores showed improvements comparable with traditional therapy. Extremely high patient satisfaction scores were reported with the telerehabilitation protocol. CONCLUSION: Our early experience demonstrates the feasibility of implementing a telerehabilitation program following primary total hip or knee arthroplasty without compromising clinical quality and with high patient satisfaction.

Outcomes of Total Shoulder Arthroplasty With Posterior Capsular Plication.

BACKGROUND: Glenoid loosening and instability are among the most common complications after anatomic total shoulder arthroplasty (TSA), resulting in poor function. Posterior instability is one contributing factor. The purpose of this study is to report the clinical and radiographic outcomes of a series of patients treated with posterior capsule plication for intraoperative posterior instability during TSA. It is hypothesized that patients undergoing this procedure will have improvement in posterior stability intraoperatively while not limiting their ROM postoperatively. METHODS: Patients of the senior author were identified who had undergone TSA with posterior capsule plication from 2014 to 2015 based on Current Procedural Terminology (CPT) codes. Their records and preoperative radiographs were retrospectively reviewed for demographic data and preoperative range of motion (ROM) which was documented in the clinic notes. Patients were then evaluated postoperatively to determine the outcomes after TSA with posterior capsule plication. Final follow-up was conducted via telephone survey. RESULTS: Nineteen patients were identified for review; however, only 14 had all imaging available. The mean age at the time of surgery was 63 years. There were 2 A1, 6 B1, and 6 B2 Walch-type glenoids based on preoperative imaging. All but one had equivalent or better ROM for active forward elevation and external rotation postoperatively. One patient required return to operating room at 5 months after developing adhesive capsulitis. CONCLUSION: This study indicates that the use of posterior capsule plication during TSA is a safe method to address posterior subluxation, while still allowing for improved ROM postoperatively.

Macrophages and mesenchymal stromal cells support survival and proliferation of multiple myeloma cells.

Multiple myeloma (MM) is characterized by almost exclusive tropism of malignant cells for the bone marrow (BM) milieu. The survival and proliferation of malignant plasma cells have been shown to rely on interactions with nonmalignant stromal cells, in particular mesenchymal stromal cells (MSCs), in the BM microenvironment. However, the BM microenvironment is composed of a diverse array of cell types. This study examined the role of macrophages, an abundant component of BM stroma, as a potential niche component that supports malignant plasma cells. We investigated the proliferation of MM tumour cell lines when cultured alone or together with MSCs, macrophages, or a combination of MSCs and macrophages, using the carboxyfluorescein succinimidyl ester assay. Consistently, we observed increased proliferation of MM cell lines in the presence of either MSCs or macrophages compared to cell line-only control. Furthermore, the combined co-culture of MSCs plus macrophages induced the greatest degree of proliferation of myeloma cells. In addition to increased proliferation, MSCs and macrophages decreased the rate of apoptosis of myeloma cells. Our in vitro studies provide evidence that highlights the role of macrophages as a key component of the BM microenvironment facilitating the growth of malignant plasma cells in MM.