Clinical Outcomes Following Open Olecranon Bursa Excision for Septic and Aseptic Olecranon Bursitis: An Observational Study.

Background and objective Olecranon bursitis (aseptic or septic) is caused by inflammation in the bursal tissue. While it is typically managed with conservative measures, refractory cases may indicate surgical intervention. There is currently limited research about outcomes following bursal excision for both septic and aseptic etiologies. In light of this, the purpose of this study was to determine if patients experienced improvement following surgical olecranon bursa excision and to compare outcomes between septic and aseptic forms. Materials and methods A retrospective review was performed involving patients who underwent olecranon bursa excision from 2014 to 2021. Demographic data, patient characteristics, surgical data, and outcome-related data were collected from the medical records. Patients were classified into subgroups based on the type of olecranon bursitis (septic or aseptic). Preoperative and one-year postoperative 12-item short-form survey (SF-12) results and range of motion (ROM) outcomes were evaluated for the entire cohort as well as the subgroups. Results We included 61 patients in our study and found significant improvement in the Physical Component Scale 12 (PCS-12) score for all patients (42.0 vs. 45.5, p=0.010) following surgery. However, based on subgroup analysis, the aseptic group improved in PCS-12 following surgery (41.5 vs. 46.8, p<0.001), but the septic group did not (43.6 vs. 40.5, p=0.277). No improvements were found in the Mental Component Scale 12 (MCS-12) scores following surgery in either group. Eighteen of the 61 patients experienced postoperative complications (29.5%), but only 6.5% required a second surgical procedure. Specifically, 14 of the 18 complications occurred in the aseptic group while two septic and two aseptic patients required additional surgeries. Elbow ROM did not change significantly after surgery but more patients were found to have full ROM postoperatively (83.0% to 91.8%, p=0.228). Conclusion Our findings suggest that patients with refractory olecranon bursitis, particularly if aseptic, tend to gain significant physical health benefits from open bursectomy.

The Impact of Preoperative Symptom Duration on Patient Outcomes After Posterior Cervical Decompression and Fusion.

STUDY DESIGN: Retrospective Cohort Study. OBJECTIVES: To determine if decreased preoperative symptom duration is associated with greater clinical improvement in function and myelopathic symptoms after posterior cervical decompression and fusion (PCDF). METHODS: All patients over age 18 who underwent primary PCDF for cervical myelopathy or myeloradiculopathy at a single institution between 2014 and 2020 were retrospectively identified. Patient demographics, surgical characteristics, duration of symptoms, and preoperative and postoperative patient reported outcomes measures (PROMs) including modified Japanese Orthopaedic Association (mJOA), Neck Disability Index (NDI), Visual Analogue Scale (VAS) Neck, VAS Arm, and SF-12 were collected. Univariate and multivariate analyses were performed to compare change in PROMs and minimum clinically important difference achievement (%MCID) between symptom duration groups (< 6 months, 6 months-2 years, > 2 years). RESULTS: Preoperative symptom duration groups differed significantly by sex and smoking status. Patients with < 6 months of preoperative symptoms improved significantly in all PROMs. Patients with 6 months-2 years of preoperative symptoms did not improve significantly in mJOA, Physical Component Scores (PCS), or NDI. Patients with > 2 years of symptoms failed to demonstrate significant improvement in mJOA, NDI, or Mental Component Scores (MCS). Univariate analysis demonstrated significantly decreased improvement in mJOA with longer symptom durations. Increased preoperative symptom duration trended toward decreased %MCID for mJOA and MCS. Regression analysis demonstrated that preoperative symptom duration of > 2 years relative to < 6 months predicted decreased improvement in mJOA and NDI and decreased MCID achievement for mJOA and MCS. CONCLUSION: Increased duration of preoperative symptoms (> 2 years) before undergoing PCDF was associated with decreased postoperative improvement in myelopathic symptoms.

Depression Increases Posterior Cervical Decompression and Fusion Revision Rates and Diminishes Neck Disability Index Improvement.

STUDY DESIGN: A retrospective cohort study. OBJECTIVE: To determine if depression and/or anxiety significantly affect patient-reported outcome measures (PROMs) after posterior cervical decompression and fusion (PCDF). SUMMARY OF BACKGROUND DATA: Mental health diagnoses are receiving increased recognition for their influence of outcomes after spine surgery. The magnitude that mental health disorders contribute to patient-reported outcomes following PCDF requires increased awareness and understanding. MATERIALS AND METHODS: A review of electronic medical records identified patients who underwent a PCDF at a single institution during the years 2013-2020. Patients were placed into either depression/anxiety or nondepression/anxiety group based on their medical history. A delta score (∆) was calculated for all PROMs by subtracting postoperative from preoperative scores. χ 2 tests and t tests were utilized to analyze categorical and continuous data, respectively. Regression analysis determined independent predictors of change in PROMs. Alpha was set at 0.05. RESULTS: A total of 195 patients met inclusion criteria, with 60 (30.8%) having a prior diagnosis of depression/anxiety. The depression/anxiety group was younger (58.8 vs . 63.0, P =0.012), predominantly female (53.3% vs . 31.9%, P =0.007), and more frequently required revision surgery (11.7% vs . 0.74%, P =0.001). In addition, they had worse baseline mental component (MCS-12) (42.2 vs . 48.6, P <0.001), postoperative MCS-12 (46.5 vs . 52.9, P =0.002), postoperative neck disability index (NDI) (40.7 vs . 28.5, P =0.001), ∆NDI (-1.80 vs . -8.93, P =0.010), NDI minimum clinically important difference improvement (15.0% vs . 29.6%, P =0.046), and postoperative Visual Analog Scale (VAS) Neck scores (3.63 vs . 2.48, P =0.018). Only the nondepression/anxiety group improved in MCS-12 ( P =0.002) and NDI ( P <0.001) postoperatively. Depression and/or anxiety was an independent predictor of decreased magnitude of NDI improvement on regression analysis (ß=7.14, P =0.038). CONCLUSION: Patients with history of depression or anxiety demonstrate less improvement in patient-reported outcomes and a higher revision rate after posterior cervical fusion, highlighting the importance of mental health on clinical outcomes after spine surgery.

Do Mandatory Face Shields Reduce the Number of Craniomaxillofacial Injuries in the National Hockey League?

PURPOSE: The purpose of this study was to analyze the effectiveness of the National Hockey League's (NHL) mandatory visor policy on the number and type of craniomaxillofacial (CMF) injuries. MATERIALS AND METHODS: A cross-sectional study was designed using the 2 databases: the NHL Injury Viz and the Pro Sports Transactions. CMF injuries and player characteristics from the NHL's 2009-2010 through the 2016-2017 seasons were obtained. The study outcomes of games missed and number of injuries were compared before and after the implementation of the league rule. RESULTS: A total of 149 CMF injuries were included in the final sample. Following the mandatory visor rule, there were significant decreases in the total number of CMF injuries per season (14.3 vs 30.7, P = .01) and the number of upper face injuries per season (7.0 vs 16.7, P = .04). Although there was no difference in the ratio of upper facial injuries before and after the rule change, players who wore a face shield did have a lower proportion of upper face injuries among all CMF injuries sustained (42.9 vs 64.6%, P < .01). Ultimately, neither face shield use (P = .49) nor implementing a mandatory face shield rule (P = .62) changed the number of games missed when injury did occur. CONCLUSIONS: Upper facial injuries were observed to be less common among players wearing face shields. After the NHL mandated face shields, there were significant decreases in the mean number of CMF and upper facial injuries per season. Face shields did not appear to influence the severity or downtime from injury that were sustained.