Rates of Lapidus Procedures in the US Military Before and After the Advent of and Advocacy for Tri-Plane Lapidus Corrective Surgery.

Tri-plane corrective Lapidus surgery has been described as advantageous with respect to its anatomic basis and outcomes. Because the procedure has been broadly publicized, changes in overall Lapidus procedure rates due to increased numbers of patients opting for the tri-plane approach could have occurred. Data supporting this possibility appears lacking. We employed official personnel and health records of the total active-duty US military to conduct a retrospective cohort study of Lapidus surgery rates before and after the advent of the tri-plane corrective Lapidus procedure. Least-squares and locally-weighted scatterplot smoother regression functions were used to confirm time trends. Sociodemographic and occupational traits of Lapidus patients were compared using 2-sided t tests and chi square tests. Lapidus surgery rates among hallux valgus patients decreased during 2014 to 2016 and increased during 2017 to 2021. While multiple factors might explain these trends, they coincide with the advent of and advocacy for tri-plane Lapidus surgery. The results support the possibility that its rise influenced overall Lapidus rates in this population. As these findings represent limited evidence of such an influence, further research is required to confirm a causal link. If such a link is found, and if the ongoing research suggests that superior outcomes are associated with tri-plane Lapidus surgery, substantial implications could exist for this population. Benefits might include enhanced medical readiness due to the importance of lower extremity function during military duties. Additional research is needed to confirm the impact of the procedure and to determine whether Lapidus surgery rate patterns in civilian populations mirror these findings.

Fasciotomy and Occupational Separation among US Service Members with Lower Extremity Chronic Exertional Compartment Syndrome.

PURPOSE: Lower extremity chronic exertional compartment syndrome (LE-CECS) can limit rigorous physical activity, particularly in the US military, and fasciotomy is a potential treatment. Associations between LE-CECS, fasciotomy, and occupational outcomes appear understudied. We studied active-duty US service members to identify whether LE-CECS diagnoses and fasciotomy for LE-CECS predict military service separation. METHODS: We conducted a retrospective cohort study of 1,103,417 individuals who entered service during 2011 to 2017. Distributions of separation statuses and independent variables were tabulated, and sex-specific multivariable regression models were computed for separation outcomes. RESULTS: LE-CECS was associated with a 474% medical service separation risk in men (95% confidence interval (CI) for adjusted risk ratio: 5.21 to 6.33) and a 282% increase in women (CI: 2.99 to 4.88). Among 1947 patients with LE-CECS, men saw a 57% nonmedical separation risk increase (CI: 1.27 to 1.93) and women had a 119% increase (CI: 1.10 to 4.35) when anterior and/or lateral compartment procedures occurred. Men with LE-CECS and any posterior procedures saw a 47% nonmedical separation risk increase (CI: 1.17 to 1.86). Men with anterior and/or lateral procedures and any posterior procedures experienced 36% (CI: 1.09 to 1.71) and 78% (CI: 1.40 to 2.26) medical separation risk increases, respectively. No statistically significant risk increases for the outcomes were otherwise seen for women. CONCLUSIONS: LE-CECS was associated with increased military service discharge risks. Among the affected patients, positive effects on career longevity were not seen in association with fasciotomy. However, fasciotomy could simply serve as a marker of the most refractory cases that are least likely to continue service. More study is needed to clarify causal pathways and identify patients who may derive career benefits from surgical treatment.

An investigation of sickle cell trait, body mass index, and fitness in relation to venous thromboembolism among African American adults.

BACKGROUND: The relationships of sickle cell trait (SCT), body mass index (BMI), and physical fitness to venous thromboembolism (VTE) in young adults have received little attention. OBJECTIVES: To test for associations among SCT, BMI, fitness, and VTE. PATIENTS/METHODS: We conducted a retrospective cohort study of 48,316 SCT-tested, African American individuals in the US Army during 2011-14. We used Cox proportional hazards models to compute adjusted hazards of deep vein thrombosis (DVT) and pulmonary embolism (PE) associated with selected factors. RESULTS: Incidence rates of DVT and PE were 1.09 and 0.91 cases per 1000 person-years, respectively. Adjusted hazard ratios (aHRs) for DVT for men and women with SCT were 0.9 (95% confidence interval [CI]: 0.4-2.0; P = .711) and 1.51 (CI: 0.7-3.2; P = .274), respectively. aHRs for PE for SCT+ men and women were 1.1 (CI: 0.5-2.4; P = .773) and 1.2 (CI: 0.5-3.1; P = .650), respectively. Low physical fitness was associated with DVT and PE in women (DVT aHR =3.1; CI: 1.4-6.5; P = .004; PE aHR =4.6; CI: 2.1-9.9; P < .001) and DVT in men (aHR =2.2; CI: 1.0-4.6; P = .048). Recent weight gain of 1 or more BMI points was associated with DVT in men (aHR =1.8; CI: 1.1-2.8; P = .017). CONCLUSIONS: We found no evidence of increased VTE risk associated with SCT in this population. However, lower fitness levels and BMI increases were so associated.