Risk factors associated with neonatal brachial plexus palsy in the United States.

Neonatal brachial plexus palsy (NBPP) is a birth injury that can cause severe functional loss in the affected limb. The purpose of this study was to determine the temporal changes in the national incidence of this condition and whether associated risk factors have changed over time. Children born via vaginal delivery were identified in the Kids' Inpatient Database (KID) from 1997 to 2012, and those with NBPP were identified. The trend in incidence and risk factors were assessed through the study period. The nationwide incidence of NBPP decreased during the study period. Infants with shoulder dystocia, fetal macrosomia, and gestational diabetes had the highest risk of developing NBPP, while multiple birth mates during delivery had a protective effect. Multiple risk factors, including shoulder dystocia, macrosomia, and heavy for dates became less predictive of the development of NBPP over time. Several risk factors predispose children to the development of NBPP, and the effect of these risk factors has been changing. This information can guide obstetric treatment to help prevent NBPP. Level of evidence is diagnostic, level 3.

Conical, radiographic, and patient-reported results of surface replacing proximal interphalangeal joint arthroplasty of the hand.

The purpose of this study was to evaluate the one-year clinical, radiologic and patient-reported results of surface-replacing proximal interphalangeal joint arthroplasty (SR-PIP) of the hand. Fifteen patients with 18 joints underwent the procedure, and nine patients with 11 joints had follow-up of at least one year's duration. Of these joints, six had a diagnosis of osteoarthritis with no history of trauma, three had post-traumatic arthritis, one had psoriatic arthritis, and one had erosive arthritis. The mean clinical follow-up was at 3.3 years, and the mean radiographic follow-up was at 3.1 years. The average post-operative gain in range of motion at the PIP joint was 28 degrees and was statistically significant. Six patients completed self-reported questionnaires at a mean of 4.8 years post-operatively. The mean Disabilities of the Arm, Shoulder and Hand (DASH) score post-operatively was 17, and the Michigan Hand Questionnaire (MHQ) score for overall satisfaction was 70. There were three complications but only one reoperation. Seven of 11 joints showed some evidence of subsidence on follow-up radiographic examination. However, no joints were revised secondary to loosening. Longer follow-up is needed to determine if this observable radiologic subsidence leads to symptomatic loosening of the implant.

The impact of diabetes on patient outcomes after ankle fracture.

BACKGROUND: Ankle fracture is one of the most common injuries treated by orthopaedic surgeons, and the presence of diabetes complicates treatment and recovery from this injury. Although a higher prevalence of adverse postoperative events has been found in small series of diabetic patients with an ankle fracture, we are not aware of any large national series with specific documentation of the outcomes following ankle fracture in patients with diabetes. METHODS: We analyzed data from the Nationwide Inpatient Sample database for the years 1988 through 2000. Information regarding the hospitalizations of 160,598 adult patients with an ankle fracture who underwent subsequent surgical procedures was extracted from the database. Multiple linear and logistic regression models were used to ascertain whether patients with diabetes mellitus were more likely than patients without diabetes mellitus to die while in the hospital, to have in-hospital postoperative complications, to stay longer in the hospital, to have a higher incidence of non-routine discharge, and to have a higher total cost associated with the hospital stay. RESULTS: Significant increases in in-hospital mortality, the rate of in-hospital postoperative complications, the length of hospital stay, the rate of non-routine discharge, and the total charges were found in the diabetic patient group (p < 0.001). Specifically, we found that diabetic patients across all levels of fracture severity (closed unimalleolar, closed bimalleolar or trimalleolar, and dislocated or open fractures) stayed in the hospital for about one additional day (mean, 4.7 compared with 3.6 days) and incurred more than dollar 2000 in increased charges (mean, dollar 12,898 compared with dollar 10,794). CONCLUSIONS: This nationally representative study of inpatients in the United States provides evidence that diabetic patients with an operatively treated ankle fracture are likely to have worse results than non-diabetic patients with regard to postoperative complications, mortality, rate of non-routine discharge, length of hospital stay, and total hospital charges.