Impact of the Subtle Lisfranc Injury on Foot Structure and Function.

BACKGROUND: The subtle Lisfranc injury is the disruption of the osteoligamentary complex between the first cuneiform and the second metatarsal, resulting in minor widening of this space that is often difficult to detect with plain radiographs. In this study, we assessed the results after treatment of the different stages of subtle Lisfranc injuries, focusing on their impact on foot arch anatomy and functionality at short- to midterm follow-up. METHODS: A retrospective study including patients treated in our center for a subtle Lisfranc injury between 2012 and 2019 was conducted. Demographic, epidemiologic, radiographic, and clinical data were obtained and assessed, focusing on foot arch structure and foot function, which was evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) midfoot score and the Foot Function Index (FFI). RESULTS: A total of 42 patients with a mean age of 49 ± 17.5 years were included, with an average of 4.3 years' follow-up (range, 1-8). Stage I injuries according to Nunley classification represented 19% and were treated conservatively. Stage II (66.7%) and stage III (14.3%) injuries were treated operatively, via osteosynthesis with screws (74%), K-wires (19%), or plates (7%). Flattening of foot arch after treatment was observed in 42.9% of patients, with significant increases in Costa-Bertani (12 ± 7 degrees), Hibbs (7 ± 6 degrees), and Meary (3 ± 1 degrees) angles. Other complications included complex regional pain syndrome (28.6%) and painful hardware (23.8%). Secondary joint arthrodesis was needed in 16.6% of patients. Chronic pain was present in 71.4% of patients with a mean visual analog scale (VAS) pain score at final follow-up of 4 of 10 points. Results in AOFAS midfoot score and FFI were 87.4 ± 8.3 and 15 ± 6.4, respectively. CONCLUSION: The subtle Lisfranc injury shows dissociation between the initial relatively mild radiographic changes and important future complications. Chronic pain and foot arch flattening were not uncommon. Overall foot function in the short- or midterm was found to be modestly diminished in this somewhat heterogenous cohort. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

A clinical review of 11 cases of large-sized well-differentiated liposarcomas.

Well-differentiated liposarcomas of the extremities are one of the most frequent types of malignant soft tissue tumors in adults. These tumors are typically locally aggressive and show a tendency to recurrence after surgical excision even though they do not metastasize and very rarely dedifferentiate. Its clinical presentation is generally a progressively growing mass causing aesthetic, functional, or compressive symptoms depending on the tumor's size and localization. Several authors recommend a wide excision with free margins in order to minimize the risk of recurrence, while others report good results and a low rate of recurrence with more conservative or even marginal excision thereby avoiding complications due to surgical site morbidity. We present a retrospective study of 11 patients with a large-sized well-differentiated liposarcoma of the lower limb with a mean follow-up of 3.2 years. The mean size was 22 × 19 × 17 cm, and a marginal resection was made, respecting the affected neurovascular structures, in all cases. Only one recurrence was found and the functional results were 81.6% according to the MSTS functional scale 1 year after surgery. We believe that the marginal excision is a good alternative when the tumor is located near vascular or nerve structures, and as to our experience, it is not associated with elevated recurrences.

[Hospital management of pancreatic cancer in Spain and assessment of factors associated with in-hospital mortality]. / Manejo hospitalario del cáncer de páncreas en España y estudio de los factores asociados a la mortalidad intrahospitalaria.

BACKGROUND: Pancreatic cancer is becoming an increasingly important health problem in Spain. This study aimed to analyze the hospital management of this process and the factors associated with mortality by using an administrative data base. MATERIAL AND METHOD: We performed a descriptive study. Socio-demographic, clinical, diagnostic, and therapeutic variables of episodes registered in the national Hospital Discharge Minimum Data Set for 2004 were gathered. Comorbidity was assessed with the Charlson index. A logistic regression model was built to explain the individual influence of variables on in-hospital mortality. Mortality in the 17 autonomous regions of Spain was analyzed by using standardized mortality rates, through predicted mortality obtained from the multivariate model. RESULTS: The mean age was 68 years and men represented 56%. Readmissions accounted for 80% of the cases. The most frequent localization was in the pancreatic head and the most frequently employed procedures were computed tomography and surgery. In-hospital mortality was 25%, was higher in men, and increased with age. Mortality was higher in new admissions than in readmissions. Factors associated with higher mortality in the multivariate analysis were male sex, age, unspecified location or location in the tail, emergency admission, hospital stay, and comorbidity. Observed mortality was higher than expected in the Canary Islands and Madrid and was lower than expected in Catalonia and the Valencian Community. DISCUSSION: Future studies with more detailed information should be performed to allow the factors associated with in-hospital mortality from pancreatic cancer to be confirmed and to clarify the reasons for the geographical differences identified.

Manejo hospitalario del cáncer de páncreas en España y estudio de los factores asociados a la mortalidad intrahospitalaria / Hospital management of pancreatic cancer in Spain and assessment of factors associated with in-hospital mortality

Introducción: El cáncer de páncreas es un proceso de salud de importancia creciente en España. El objetivo de este estudio es explorar su manejo y los factores asociados a su mortalidad en el hospital mediante una base de datos administrativa. Material y método: Se realiza un estudio descriptivo con variables sociodemográficas y clínicas, y procedimientos diagnósticos y terapéuticos de episodios contenidos en el Conjunto Mínimo Básico de Datos al alta hospitalaria nacional del año 2004. La comorbilidad se valora mediante el índice de Charlson. Se construye un modelo de regresión logística para explicar la influencia individual de las variables de interés en la mortalidad intrahospitalaria. Mediante razones de mortalidad estandarizadas, a través de las predicciones de mortalidad del modelo multivariante, se estudian las 17 comunidades autónomas españolas. Resultados: La edad media es de 68 años y los varones representan el 56%. Los reingresos representan el 80%. La localización predominante es la cabeza del páncreas, y los procedimientos más empleados, la tomografía computarizada y la cirugía. La mortalidad intrahospitalaria es del 25%, superior en varones, y aumenta con la edad. La mortalidad es mayor en los nuevos ingresos que en los reingresos. Los factores asociados a mayor mortalidad en el análisis multivariante son: sexo masculino, edad, localización en la cola del páncreas o no especificada, ingreso urgente, estancia y comorbilidad. Canarias y Madrid presentan una mortalidad observada superior a la esperada; en cambio, en Cataluña y la Comunidad Valenciana sucede lo contrario. Discusión: Es necesario abordar futuros estudios con información más detallada que permitan confirmar los factores involucrados en la mortalidad intrahospitalaria del cáncer de páncreas y clarificar las razones de las diferencias geográficas encontradas

Background: Pancreatic cancer is becoming an increasingly important health problem in Spain. This study aimed to analyze the hospital management of this process and the factors associated with mortality by using an administrative data base. Material and method: We performed a descriptive study. Socio-demographic, clinical, diagnostic, and therapeutic variables of episodes registered in the national Hospital Discharge Minimum Data Set for 2004 were gathered. Comorbidity was assessed with the Charlson index. A logistic regression model was built to explain the individual influence of variables on in-hospital mortality. Mortality in the 17 autonomous regions of Spain was analyzed by using standardized mortality rates, through predicted mortality obtained from the multivariate model. Results: The mean age was 68 years and men represented 56%. Readmissions accounted for 80% of the cases. The most frequent localization was in the pancreatic head and the most frequently employed procedures were computed tomography and surgery. In-hospital mortality was 25%, was higher in men, and increased with age. Mortality was higher in new admissions than in readmissions. Factors associated with higher mortality in the multivariate analysis were male sex, age, unspecified location or location in the tail, emergency admission, hospital stay, and comorbidity. Observed mortality was higher than expected in the Canary Islands and Madrid and was lower than expected in Catalonia and the Valencian Community. Discussion: Future studies with more detailed information should be performed to allow the factors associated with in-hospital mortality from pancreatic cancer to be confirmed and to clarify the reasons for the geographical differences identified