Background Heterotopic ossification (HO) is a common complication of the operative treatment of acetabular fractures. Although the surgical approach has been shown to correlate with the development of ectopic bone, specific risk factors have not been elucidated. Questions/purposes The purposes of this study were to determine specific risk factors associated with the development of severe HO and the frequency with which patients develop severe HO after acetabular fracture fixation through an isolated Kocher-Langenbeck approach. Methods Using an institutional orthopaedic trauma database at a regional Level I trauma center, patients undergoing open treatment of acetabular fractures during the study period (January 2000 to January 2010) were identified. A review of medical records and imaging studies was performed on 508 patients who were treated by the senior author (MR) through an isolated Kocher-Langenbeck approach. During the study period, the senior author used indomethacin for HO prophylaxis in patients who had ipsilateral femur fracture treated with antegrade reamed medullary nailing or severe local soft tissue injury; 49 (10%) of the patients he treated with the Kocher-Langenbeck approach received prophylaxis, and they were excluded from this study, leaving a total of 459 patients who met inclusion criteria. Of those, 147 (29%) were lost to followup or did not have radiographs both before and at a minimum of 6 weeks (median, 1 week; range, 0-3 weeks), leaving 312 (61% of the patients treated with the Kocher-Langenbeck approach during this time) available for this analysis. Demographic data as well as information related to cause of injury, associated periacetabular findings, other system injuries, and treatment were gathered. Final followup radiographs were assessed for the presence of ectopic bone by two of the authors (TJO, AS) using the modified Brooker classification. Logistic regression was performed to identify possible predictors of development of severe ectopic bone. Results The only predictor we identified for the development of severe HO was the need for prolonged mechanical ventilation (odds ratio, 7
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Objectives: Vascular surgeons are frequently consulted to evaluate hospitalized patients with finger ischemia. We sought to characterized causes and outcomes of finger ischemia in intensive care unit (ICU) patients. Methods: ICU patients who underwent evaluation for finger ischemia from 2008 to 2015 were reviewed. All were evaluated with finger plethysmography (PPG). Patient demographics, comorbidities, ICU care (ventilator status, arterial lines, use of vasoactive medications), finger amputations, and survival were recorded. ICU patients were compared to concurrently evaluated non-ICU inpatients with finger ischemia. Results: We identified 97 ICU patients (54 men, 43 women). Mean age was 57 6 17 years. Forty-three percent were in the surgical and 57% in the medical ICU. Seventy-two percent had abnormal finger PPGs, 69% unilateral and 31% bilateral. Thirty-seven percent had a radial arterial line. Thirteen percent had concomitant toe ischemia. Seventy-eight percent were on vasoactive medications at the time of diagnosis, with the most frequent being phenylephrine (55%), norepinephrine (47%), ephedrine (30%), epinephrine (26%), and vasopressin (25%). Treatment was with therapeutic anticoagulation in 47%, aspirin in 52%, and clopidogrel in 16%. Other frequent associated conditions included mechanical ventilation (37%), diabetes (33%), peripheral arterial disease (32%), dialysis dependence (31%), cancer (24%), and sepsis (20%). Five patients required finger amputation. Survival was 85% at 30 days, 73% at 1 year, and 65% at 2 years. By Cox modelling, cancer (hazard ratio, 6.3; P ¼ .012) and dialysis (hazard ratio, 4.9; P ¼ .026) were independent predictors of mortality. There were 50 concurrent non-ICU patients with finger ischemia. Non-ICU patients were more likely to have connective tissue disorders (26% vs 13%; P ¼ .05), be on antibiotics (38% vs 14%; P ¼ .02), and undergo finger amputations (16% vs 5%; P ¼ .03). Conclusions: Finger ischemia in ICU patients is often associated with the arterial lines and vasoactive medications, with phenylephrine and norepinephrine the most common. While progression to amputation is rare, patients with finger ischemia in the ICU have high mortality, particularly in the presence of cancer or dialysis. Non-ICU patients with finger ischemia more often require amputations, likely due to more frequent connective tissue disorders and finger infections.
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