What the Physician Needs to Know about Charcot Arthropathy and Ankle Fracture Treatment Dilemma: A Case Report and a Possible Medical Approach and Treatment Algorithm.

Introduction: Charcot arthropathy consists of a rapid and destructive complication of the joints following the loss of innervation caused by many complicated etiologies. Diabetic neuropathy has become the most common etiological factor. Case Report: We present a case of a 64-year-old female patient with a history of chronic renal failure on hemodialysis, hypertension, hypothyroidism, and Type 2 diabetes, complicated with neuropathy and Charcot disease, who referred to our department. Initially, the patient was managed with a restraint orthotic device due to a bimalleolar ankle fracture. An unsuccessful treatment and the presence of a pressure ulcer with pus-like drainage on the lateral malleolus 2 months later led to the decision for a below-knee amputation. Conclusion: High clinical suspicion by the attending physician may reduce the risk of complications and lead to proper treatment with better outcomes.

Diffuse Tenosynovial Giant Cell Tumor Encircling the First Metatarsal Bone Remodeling after Resection. A Case Report.

Introduction: The term tenosynovial giant cell tumor encompasses a group of rare soft-tissue tumors. A new classification divides the group in localized and diffuse type, depending on the involvement of the surrounding tissues. Due to the unclear origin and heterogeneity in extend of the diffuse-type giant cell tumors, there is only limited evidence on the tumor-specific treatment. Thus, every case report has an added value toward setting disease-specific guidelines. Case Report: Presentation of a diffuse type tenosynovial giant cell tumor encircling the first metatarsal. The tumor had mechanically eroded the plantar aspect of the distal metaphysis, with no signs of tumor spread. After an open biopsy, resection of the mass was performed without debriding or resecting the first metatarsal. Repeat imaging postoperatively showed no recurrence at 4-year follow-up and a bony remodeling of the lesion. Conclusion: Bone remodeling is possible after complete resection of diffuse tenosynovial giant cell tumor when the erosion is caused by mechanical pressure and no intraosseous expansion of the tumor is present.

The prevalence of polypharmacy and fall-risk-increasing drugs after hospital discharge for hip fracture: A retrospective study.

Objectives: To evaluate the incidence of polypharmacy and the use of fall-risk-increasing drugs (FRIDs) in patients >65 years of age. Methods: 478 patients >65 years old, discharged from an Orthopaedic Department because of hip-fracture surgery, capable of walking before surgery, were included. The baseline characteristics of the patients and the total numbers of drugs and FRIDs were recorded from the electronic hospital registration system. Polypharmacy was defined as the average daily use of five or more drugs. The gender differences in drug prescriptions were calculated. Results: All the patients took medications except for eight (1.7%); 46% of the patients were taking <5 medications, while 386 (80.8%) were taking ≤3 FRIDs. The female patients were taking more drugs (5±2.7) and FRIDs (2.4±1.3) than the male ones (4.5±3 and 1.9±1.3) (both p<0.01). The average numbers of drugs and FRIDs prescribed at discharge were 4.9±2.8 and 2.3±1.3, respectively. The Barthel Index was higher for patients taking <5 drugs, while the length of hospital stay was greater for patients taking ≥5 medications. Increased age was associated with taking ≥5 medications (p<0.05). Conclusions: Polypharmacy and FRID use are prevalent among patients over 65 years old who have been hospitalized and surgically treated because of hip fractures.

The Relationship Between Vitamin D Status and the Clinical Severity of COVID-19 Infection: A Retrospective Single-Center Analysis.

Background and objective Some studies have suggested a potential protective role of vitamin D in coronavirus disease 2019 (COVID-19) patients, and this has led to a debate on the topic in the medical community. However, the reported data on the number of hospitalized patients who were vitamin D-deficient is not convincing. In light of this, the aim of the present study was to explore if vitamin D deficiency is correlated with severity and mortality rates of COVID-19 infection in hospitalized COVID-19 patients at a tertiary care hospital in Greece. Methods We conducted a single-center retrospective study involving 71 patients hospitalized with COVID-19 from August to October 2020. Serum 25-hydroxyvitamin D (25(OH)D) level was assessed in all patients within 48 hours of hospital admission. Serum 25(OH)D level ≤20 ng/ml was defined as a deficiency, while that >20 ng/ml as repletion. The primary outcomes of the infection were classified as partial/complete recovery and mortality during hospitalization. The secondary outcomes were blood markers of inflammation and thrombosis. Results Among the 71 COVID-19-positive patients [mean age: 63 years, range: 20-97; male (n=47; 66.2%): female (n=24; 33.8%)] who were enrolled in the study, 46 (64.8%) patients had 25(OH)D levels ≤20 ng/ml and 25 (35.2%) had a level >20 ng/ml. According to the patients' medical history, 55 patients (77.5%) had comorbidities. It appears that vitamin D deficiency (<20 ng/ml) significantly correlated with elevated biochemical markers such as procalcitonin and troponin (p<0.001). Moreover, male gender, advanced age (>60 years), and comorbidities were positively associated with more severe COVID-19 infection (elevated inflammation markers, radiographic findings on X-rays, and increased length of hospital stay). Conclusion These preliminary findings show that vitamin D status among the patients was not related to the severity of COVID-19 infection.

Plantar Injuries in Runners: Is There an Association With Weekly Running Volume?

Running is an athletic activity that is increasingly gaining popularity. Despite its benefits, there are many suspected risk factors for running-related overuse injuries. The objective of this study is to describe injuries and clinical symptoms observed on the sole of the foot in runners, giving special attention to the weekly running volume. The literature presented in this narrative review is based on a non-systematic search of the Medline, Google Scholar, and ResearchGate databases and focuses on foot injuries (the full spectrum of the foot pathology from bones to tendons and plantar fascia, nerve, and joint disorders) in runners, which represents an important topic for both professional and recreational runners. The weekly running distance appeared to be one of the strongest predictors for future overuse injuries. Marathon training and average weekly running of over 20 km are possible predictive factors in the development of plantar foot injuries. The plantar medial aspect of the foot is the anatomic area of the foot that most frequently experiences pain, with numerous pathologic conditions. As a result, diagnosis is always a challenging task. The ability to obtain an accurate medical history and carefully perform a physical examination, together with good knowledge of the foot anatomy and kinesiology, are also proven to be key players in ensuring proper diagnosis.

Arthroscopic os trigonum en-bloc removal outcomes at 6-month follow-up are better compared to Stieda's process resection in patients with posterior ankle impingement syndrome: a prospective comparative study.

OBJECTIVE: To evaluate the potential differences in American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and Foot Function Index (FFI) at 6-month and 12-month postoperative follow-up of arthroscopic treatment for posterior ankle impingement (PAIS) between os trigonum (OT) and Stieda's process (SP) patients. METHODS: Thirty consecutive patients (32 ankles) treated in our Institution for PAIS with posterior arthroscopy were prospectively enrolled in the study from December 2012 to July 2019. Indications were patients with PAIS with persistent symptoms following conservative management. Exclusion criteria were the coexistence of concomitant pathologies and patients who underwent additional surgical procedures. An independent investigator interviewed and evaluated the patients according to the AOFAS hindfoot score and FFI preoperatively, at 6-month and 12-month follow-up. RESULTS: Except for AOFAS scores in the SP group (MD (mean difference) 11.28, p=0.08), patients undergoing arthroscopic treatment for bony PAIS had an overall significant improvement in AOFAS score (OT MD 22.29, p<0.05) and FFI (OT MD -70.07, p<0.05; SP MD -50.96, p<0.05) from their preoperative scores at 6-month follow-up. Similarly, a significant improvement in AOFAS score (OT MD 5.78, p=0.01; SP MD 12.14, p<0.05) and FFI (OT MD -9.36, p=0.04; SP MD -26.43, p<0.05) was observed from the 6-month to 12-month follow-up in all groups. At 6-month follow-up, the OT group had significantly better FFI outcomes (MD -33.57, p=0.04) compared with the SP group. No differences were found by group when comparing AOFAS score and FFI score at 12-month follow-up. CONCLUSIONS: When comparing patients undergoing OT excision or SP resection, better FFI outcomes were observed in the OT group at 6-month follow-up. LEVEL OF EVIDENCE: Prospective comparative study. Level II.

Double Interphalangeal Joint Dislocation of the Finger in Adolescent Athletes: A Review of Two Cases and the Relevant Literature.

Double interphalangeal joint dislocation of the same finger is a rare condition. We report two cases of adolescent athletes with distal and proximal interphalangeal joint dislocation. The diagnosis was confirmed with plain radiograph, while anatomical reduction was easily obtained with gentle longitudinal traction. A simple immobilization of the injured finger was applied by buddy taping for two weeks. Early mobilization as tolerated was recommended, and they have made a full return to their previous status of activities within 5 months. We also provide a review of the literature detailing demographic characteristics, cause and mechanism of injury with associated injuries, treatment options, and functional outcomes in this population.

Non-Respiratory Symptoms of Patients Infected with SARS-CoV-2 (Coronavirus Disease 2019): Lessons from Their Initial Presentation at the Hospital.

Background and objectives: As the COVID-19 pandemic spreads, it is becoming increasingly evident that this coronavirus is not limited to the respiratory system and that the musculoskeletal system can also be affected. The purpose of the present study was to describe non-respiratory symptoms of laboratory-confirmed COVID-19 cases. Materials and Methods: All patients with SARS-CoV-2 admitted to our hospital, between 1 August and 30 September 2020, were included in this retrospective study. Data were extracted from medical records. Epidemiological, clinical, laboratory and radiological characteristics at the initial presentation at the hospital were collected and analyzed. Results: A total of 79 COVID-19 patients were enrolled. The mean age of the patients was 44.08 years (age range, 18-87 years) and 59.5% were male. The most common symptoms were fatigue in 60 (75.9%) patients, followed by fever (73.4%), myalgia (51.9%), cough (41.8%), anosmia (38%) and arthralgia (36.7%). The muscles of the upper back and the knee joint were the most painful anatomic region and joint, respectively. The laboratory findings on admission showed that D-dimer, CRP and procalcitonin levels were increased, without significant gender differences (p > 0.05). Chest imaging demonstrated pneumonia in 20 (25.3%) patients. Conclusions: Our results indicate that from the onset of the symptoms of COVID-19 patients, musculoskeletal symptoms, such as fatigue, myalgia and arthralgia, were present in three-quarters of all patients. These findings could help elaborate updated triage and admission protocols for suspect COVID-19 patients at the hospital and Emergency Department presentation.

The Financial Burden of Delayed Hip Fracture Surgery: A Single-Center Experience.

Fragility hip fractures have become a worldwide epidemic with serious socioeconomic implications. The projected number of hip fractures by 2050 is estimated to reach 4.5 million cases. The aim of this study was to calculate the in-hospital financial burden on public health insurance funds related to the delayed treatment of hip fractures. This research took place in a tertiary university hospital that is a major trauma center in Thessaloniki, which is second largest city in Greece . A retrospective search was conducted in the electronic hospital database for patients older than 65 years, with low energy hip fractures that were surgically treated between November 18, 2018, and October 20, 2019. Age, length of stay (LOS), days to surgery, postoperative LOS, anticoagulation medication, major and minor complications, and the reimbursement that the hospital received from public health insurance funds were recorded. Cost deviation from the standard tariff for the treatment of these fractures was also calculated. Of a total of 145 patients, 32.4% had early surgery as opposed to 67.6% who were operated after 48 hours from admission. The excess financial burden from the baseline reimbursement for those operated within 48 hours from admission was 4,074.64€, while for the group that received delayed surgery it was 45,654.14€. Patients under any form of anticoagulation therapy were seven times more probable to have delayed surgery [OR=6.8; 95% confidence interval (CI): 2.97-18.18; p<0.01] and were 3.5 times more probable to have minor complications (OR: 3.6; 95% CI: 1.19-11.23; p<0.017). Early surgery is beneficial to the patient and reduces the economic burden on healthcare public funds. Every effort should be made to manage these patients in a timely manner.