Background: There are few validated instruments that serve as a proxy for fracture-healing after lower-extremity trauma in low-resource settings. The squat-and-smile test (S&S) has been under development by SIGN (Surgical Implant Generation Network) Fracture Care International to monitor outcomes of lower-extremity long-bone fractures after intramedullary nailing in resource-limited settings. The goals of this study were to develop and identify domains of the S&S test.
Methods: The S&S domains were developed through an iterative process, and consensus was achieved regarding 3: squat depth, support needed to squat, and facial expression. Adult patients with an OTA/AO type-32 femoral shaft fracture were included in this retrospective study and had the S&S administered at 6 weeks and 3, 6, and 12 months postoperatively. Two authors independently assessed photographs of the patients performing the S&S. S&S domains were correlated with the EuroQol 5-Dimensions (EQ-5D) index score, and comparisons were made between S&S domains and reoperation status. Interrater and test-retest reliability was assessed using the kappa statistic. Sensitivity and specificity analyses were performed.
Results: Six hundred and nine S&S images were evaluated for 231 patients. Each domain improved over time and correlated positively with EQ-5D scores (p < 0.05). Squat depth and support needed to squat correlated with the need for a reoperation (p ≤ 0.01), and both had high specificity (0.95 and 0.97, respectively) for ruling out the need for a reoperation at 1 year. All 3 domains had high test-retest reliability (κ = 0.95, 0.92, and 0.96). Squat depth and need for support also had strong interrater reliability (κ = 0.75 and 0.78).
Conclusions: The S&S is a potential tool for monitoring clinical and functional outcome of femoral shaft fractures in low-resource settings. Our data support the binary assessment of squat depth and need for support, but not facial expression, as a proxy for fracture-healing. Future prospective studies in external populations are warranted to evaluate the validity, reliability, and responsiveness of the S&S.
Clinical Relevance: The S&S provides a valuable proxy for femoral shaft fracture assessment for middle to low-income countries because it is locally relevant (based on squatting), it is easy to administer, and assessment can be performed remotely via mobile telephone or text messaging.
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http://dx.doi.org/10.2106/JBJS.18.00387 | DOI Listing |
Medicina (Kaunas)
January 2025
Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", 80131 Naples, Italy.
The anatomy of the sciatic nerve allows it to be blocked at different levels using various anesthetic approaches. However, for several reasons, performing these approaches may be challenging or disadvantageous in specific categories of patients, particularly in obese patients. The objective of this brief technical report is to describe a new technical approach to sciatic nerve block, designed to simplify the procedure for certain categories of patients and less experienced practitioners.
View Article and Find Full Text PDFAnimals (Basel)
January 2025
Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Basseterre P.O. Box 334, Saint Kitts and Nevis.
The paper presents a detailed gross anatomical description of the elements of the pelvic limb in the African green monkey and provides comparative and differential elements on pelvic limb monkey osteology. The osteometric investigation adds value to the gross morphological and radiological investigation, adjoining metric data to the gross descriptive data set. The main methodology used was the gross morphological investigation, doubled by regular osteometrical and radiographical assessments.
View Article and Find Full Text PDFEur J Trauma Emerg Surg
January 2025
Department of Trauma Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Purpose: The aim of this study was to evaluate the feasibility of using patient-specific implants (PSI) for complex shaft corrective osteotomies in multiplanar deformities of long bones in the lower extremities. Additionally, it aimed to investigate the added value of these implants by quantifying surgical accuracy on postoperative CT, comparing their outcomes to two commonly used techniques: 3D virtual visualizations and 3D-printed surgical guides.
Methods: Six tibial and femoral shaft corrective osteotomies were planned and performed on three Thiel embalmed human specimen.
J Anat
January 2025
Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
The primary weight-bearing structure of the proximal femur, trabecular bone, has a complex three-dimensional architecture that was previously difficult to comprehensively display. This study examined the spatial architecture of trabecular struts in the coronal, sagittal, and horizontal sections of the proximal femur using 21 cases prepared with P45 sectional plasticization. The primary compressive strut (PCS) exhibited a "mushroom-like" shape with upper and lower parts.
View Article and Find Full Text PDFActa Radiol
January 2025
Department of Orthopedics and Experimental and Clinical Medicine, Faculty of Health Science, Linköping University, Linköping, Sweden.
Background: Bisphosphonate-associated stress fractures, atypical femur fractures (AFF), are a rare subgroup of femoral stress fractures. Their correct and early diagnosis is imperative for appropriate treatment.
Purpose: To investigate the sensitivity of written radiology reports to mention radiographic features of AFF, depending on the time period and academic level of the hospital.
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