issued a statement warning that rates of widespread intimate partner violence (IPV) will increase owing to the coronavirus disease 2019 (COVID-19) pandemic, including intimate partner femicides. 1 Measures to minimize the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinforce environments that facilitate behaviours used by one person within an intimate relationship to exert power over and inflict physical, psychological or sexual harm on another. 2 The stress of confinement, financial uncertainty, attitudes about gender roles and a desire for control during disasters all contribute to an increased risk of IPV. 3,4 During their recent lockdowns, China, Italy and Spain reported a substantial increase in calls to IPV emergency support lines. 5 Areas of the United Kingdom and France have seen increases of 20% and 30%, respectively, in police reports regarding IPV. In Canada, calls to the Vancouver Battered Women's Support Services have tripled, 6 while in Alberta, specialized crisis lines for IPV have seen a 30%-50% increase in calls. In Ontario, the York and Durham Regional Police Departments reported a 22% increase in domestic incidents and sexual assault reports. 7 Health care providers, although facing the need to learn many new skills related to COVID-19, must also maintain awareness of IPV, seek opportunities for self-education, develop strategies for discussing IPV and become familiar with currently available local resources for patient referral.Intimate partner violence is already the most common cause of nonfatal injury to women worldwide. 3 Even in the absence of a public health emergency, women have a 30% estimated lifetime prevalence of physical and sexual IPV. 2 Worldwide, a woman is killed by their intimate partner every 6 days. 7 Health care professionals frequently encounter victims of IPV. One in 3 women presenting to the emergency department after a trauma have been injured by their partner, and 1 in 6 women presenting to an orthopedic fracture clinic have experienced IPV in the previous 12 months. 8 Of women murdered by their intimate partner, 45% presented to a health care professional for treatment of an IPV injury in the 2 years before their death. 3 Identified risk indicators for IPV include lower socioeconomic status, inadequate social supports, low education level, substance abuse, mental illness, younger age, unintended pregnancy, financial dependency and employment status. 4,9 However, IPV affects all races, ethnicities, socioeconomic strata, ages and relationship statuses. 8 Because of discrimination or prejudgment, individuals who have experienced IPV may be overlooked. 2 Head and neck trauma and upper extremity injuries are the most common physical health care presentations related to IPV. 3 Unfortunately, only 14% of patients presenting to health care practitioners with IPV-related injuries are asked questions to identify IPV and initiate support. 9 For patients in whom the health care practitioner suspects IPV, best evidence supports direct questioning about I...
Purpose The aim of the study was to assess the use of the centre-edge (CE) angle in the assessment of pincer femoroacetabular impingement (FAI) for reliability and predictability in the diagnosis. Methods Between 2004 and 2008, 55 patients underwent surgical treatment for FAI. A control group of 30 was identified among patients attending the emergency department with normal radiographs. Radiographs were assessed by two independent observers both before and after the operation. Nine patients with trauma were excluded. The magnetic resonance arthrogram reports of the remaining 46 patients were assessed for pincer FAI. Nineteen patients were identified and underwent repeat radiographic assessment. All underwent surgical dislocation of hip (SDH), acetabular, with/without femoral osteochondroplasty. Acetabular depth and version were also assessed. The intraclass correlation (ICC) was used to assess reliability of the CE angle. The paired t test and independent groups t test were used to assess the difference between the pincer FAI group, both pre-op and post-op and against controls. Results The control and pincer groups were similar in demographics (p=0.1769). Coxa profunda was present in 14 patients with eight also having retroverted acetabuli. Of the rest two had retroverted acetabuli and one protrusio. The mean CE angle in the control group was 31.4°, in the pre-op pincer group 46.2°and in the post-op pincer group 38.3°. The ICC for intra-observer correlation was 0.977 and 0.992 pre-op and 0.986 and 0.974 post-op. The ICC for inter-observer correlation was 0.960 and 0.957 pre-op and 0.979 and 0.967 post-op.The p value was <0.001 between the controls, the pre-op and post-op pincer groups. The test characteristics using the CE angle ≥ 40 is a reasonably good predictor of FAI, with a sensitivity of 84.2% and a specificity of 100%. Conclusions The pincer FAI can be reliably assessed with the CE angle and can be predicted in patients presenting with FAI.
Objective: To compare the rate of malreduction after high fibular fractures associated with syndesmosis injury treated with open reduction and internal fixation, with either 2 screws or 1 knotless TightRope device. Design: Prospective randomized controlled multicenter trial. Setting: Eleven academic and community hospitals including Level 1 and Level 2 trauma centers across Canada. Patients/Participants: One hundred three patients with OTA/AO 44-C injuries with demonstrated radiographic syndesmosis diastasis or instability after malleolar bony fixation were followed for 12 months after treatment. Methods: Open reduction of the syndesmosis was performed in all cases. Fixation was randomized to either TightRope (1 knotless TightRope, group T) or screw fixation (two 3.5-mm cortical positional screws placed across 3 cortices, group S). Surgical techniques and rehabilitation were standardized. All surgeons were trained or experienced in the use of the TightRope device. Follow-up was performed at 2 and 6 weeks, 3, 6, and 12 months. Main Outcome Measure: Rate of malreduction based on bilateral ankle computed tomography scan results at 3 months after fixation. Secondary outcome measures included adverse events, reoperation, and validated functional outcomes including the EQ-5D, the Olerud–Molander Ankle Score, the Foot and Ankle Disability Index, and the Work Productivity Activity Impairment Questionnaire. The estimated sample size required to detect a difference in reduction rate was 72 patients, but the estimated sample size required to detect a difference in functional outcome scores was 240 patients, suggesting the study was adequately powered for radiographic results only. Results: Overall, the rate of malreduction using screw fixation was 39% compared with 15% using TightRope fixation (P = 0.028, χ2). Analysis of computed tomography results was performed using a 2-mm translation or 10-degree rotation threshold for malreduction and included fibular translation (anterior, posterior); syndesmosis distance (anterior, posterior, and mid); medial compression; and rotation (fibular and articular). Patients in group T had greater anterior translation (5.4 ± 1.8 mm) compared with the contralateral limb (4.3 ± 1.3 mm, P < 0.01) or group S (4.6 ± 1.5 mm, P = 0.05). Group T syndesmoses also had greater diastasis compared with control limb (4.1 ± 1.3 vs. 3.3 ± 1.4 mm, P < 0.01) and less fibular medialization compared with group S (1.04 ± 1.8 vs. 0.3 ± 1.8 mm, P = 0.05). Functional outcome measures demonstrated significant improvements over time, but no differences between fixation groups. Foot and Ankle Disability Index scores at each time interval were 44 ± 22 (T) versus 45 ± 24 (S) (6 weeks), 76 ± 14 versus 73 ± 17 (3 months), 89 ± 10 versus 86 ± 13 (6 months), and 93 ± 9 versus 90 ± 14 (12 months) (all P > 0.2). The reoperation rate was higher in the screw group compared with TightRope (30% vs. 4%, P = 0.02) with the difference driven by the rate of implant removal. Conclusions: Based on our results, the TightRope device seems to compare favorably with two, 3.5-mm, 3-cortex screw fixation for syndesmosis injuries. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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