Survival and prognostic factors of salivary gland malignant mixed tumor-not otherwise specified: A population-based analysis.

OBJECTIVE: Malignant mixed tumors of the salivary gland are a group of neoplasms comprised of carcinoma-ex-pleomorphic adenoma, carcinosarcoma, and metastasizing pleomorphic adenoma. An alternative classification, malignant mixed tumor-not otherwise (MMT-NOS), is a diagnosis of exclusion for neoplasms that do not fit the previous histologically profiled subtypes. The objective was to provide a comprehensive assessment of MMT-NOS and determine prognostic factors. METHODS: This retrospective cohort study queried the Surveillance, Epidemiology, and End Results database for patient and tumor characteristics of US patients with MMT-NOS of the major salivary glands from 1973 to 2016. Kaplan-Meier and Cox regression analysis were performed to determine 5-year survival and prognostic factors. RESULTS: 434 patients were identified with a mean age at diagnosis of 61.5 years. The majority of neoplasms were high grade and stage (70.8% grade III/IV; 63.8% stage III/IV). Extraparenchymal extension (40.6%) and lymph node involvement (28.5%) were common; distant metastases (2.4%) were rare. Treatment included surgery (93.0%), radiation (51.6%), and chemotherapy (10.4%). Facial nerve sacrifice was common (50.8%). Median survival was 66.5 months. 5-year overall and disease-specific survival were 65.7% and 83.0%, respectively. In multivariate analysis, nodal involvement (HR 7.0; P < 0.001), surgery-radiation-chemotherapy (HR 6.1; P = 0.02), extraparenchymal extension (HR 2.50; P = 0.04), and tumor size >4 cm (HR 1.3; P = 0.03) were prognostic factors. CONCLUSION: Despite high stage and grade at diagnosis, MMT-NOS portends a good 5-year prognosis and low rate of distant metastasis. Prognostic factors were nodal involvement, tumor size, and extraparenchymal extension.

Prospective Study of Military Special Operations Medical Personnel and Lower Extremity Fracture Immobilization in an Austere Environment.

BACKGROUND: Austere fracture immobilization equipment and techniques are often overlooked, with few studies critically evaluating the process. The purpose of this study was to evaluate current austere splinting techniques and equipment used for lower extremity fractures while field testing a new 1-step spray-on foam splint. METHODS: This is a prospective analysis of austere splinting techniques. A cadaveric model with a distal third tibia-fibula fracture was used for testing. The specimens were placed in an austere environment and participants immobilized the injury with standard equipment (structural aluminum malleable [SAM] splint, 6-in. ACE wrap) while being critically evaluated. The specimens were also immobilized with a 1-step in-situ foam splint. RESULTS: Twenty-one military Special Operations medical personnel participated. Each participant was observed and scored by a single orthopedic foot and ankle surgeon using a Likert scale based on 10 splinting criteria. Standard splinting resulted in an average score of 32.2 (range, 5-50), with significant deficiencies in fracture traction (1/5), fracture motion (2.9/5), protection of neurovascular structures (3/5), and soft tissue manipulation (3/5). The average time to completion was 203 seconds, with 1 splint failure. The spray-on foam splinting technique yielded a significantly higher score of 48.5 while completing the task significantly faster (68 seconds), with no failures. CONCLUSION: Special Operations medical personnel demonstrated success in immobilizing a complex fracture with standard techniques in a cadaveric model. However, testing demonstrated the inherent inability of the SAM splint to provide longitudinal traction while simultaneously allowing excessive fracture motion and potential injury to the soft tissues. In comparison, our spray-on foam proof of concept technique eliminated motion by allowing an in situ application with adequate rigidity. CLINICAL RELEVANCE: This experiment included a likert scale to critically evaluate splinting techniques and equipment. It reliably tested standard splinting equipment and a 1-step in-situ foam splint for distal third tibia-fibula fractures.

Implementing an Electronic Patient-Based Orthopaedic Outcomes System: Factors Affecting Patient Participation Compliance.

INTRODUCTION: Few studies have reported on the optimization of patient compliance within outcome registries and no studies exist on orthopaedic outcome registries in the military to date. Our aim is to report on the compliance rate of an electronic, web-based, patient-reported outcomes program, with particular emphasis on the effect of variables in data acquisition on survey compliance at a single military installation. METHODS: 1,814 patients were entered into the database allowing patients to complete subjective preoperative validated scores. Patient compliance and completeness was calculated. Furthermore, we compared compliance rates for paper vs. electronic platforms and length of survey. RESULTS: 40% complied without staff intervention. This increased to 73% with staff intervention. The electronic platform had a higher compliance rate (67%) and lower incompletion rate (3%) than paper (59%, p = 0.044). Short form compliance was 89% compared to standard form of 70% (p = 0.006). CONCLUSIONS: This is the first report of an orthopaedic registry in a U.S. military population. Self-prompted compliance occurred in 40% of patients and can be increased to over 70% with staff intervention. Electronic platforms are logistically simpler, and result in higher patient compliance, as do shorter survey lengths. Further study on longer term compliance is warranted.