Background Septic arthritis of the temporomandibular (TM) joint is rare, but it is associated with high risk for significant morbidity. Objective We reviewed the available literature regarding the presentation, evaluation, treatment, and clinical course of TM joint septic arthritis, focusing on elements relevant to emergency medicine physicians. Case Reports In the first case, a healthy 6-year-old boy presented with fever and trismus; computed tomography with contrast revealed a TM joint effusion. After empiric intravenous antibiotics, intraoperative arthrocentesis of the TM joint returned one milliliter of flocculent fluid, which was cultured and grew pan-sensitive Streptococcus pyogenes. He was discharge home with amoxicillin/clavulanate and experienced complete resolution of his symptoms. In the second case, more than three weeks after extraction of her third molars, an 18-year-old woman presented with facial pain, swelling, and trismus and was found to have a loculated abscess involving the left masseteric and pterygomandibular spaces with extension to the left deep temporal region and the skull base. She experienced a complicated postoperative course and required multiple procedures and intravenous antibiotics for growth of multiple bacteria. More than a month later underwent TM joint arthrotomy for TM joint septic arthritis, and she was found to have acute osteomyelitis. She continued to require multiple treatment modalities; twenty months after her initial presentation, she underwent left total TM joint arthroplasty for fibrous ankylosis of the TM joint. Conclusion Septic arthritis of the TM joint may be caused by hematogenous spread of distant infection or local spread of deep masticator space infections. Patients may present with TM joint septic arthritis acutely or sub-acutely. Septic arthritis of the TM joint should be considered in the differential diagnosis of patients who present with trismus and pain or fever.

Background: No study has examined the incidence of risk factors for postoperative falls following foot and ankle surgery. We investigated the incidence and risk factors for postoperative falls in foot and ankle surgery using inpatient and outpatient population. Methods: A single fellowship-trained foot and ankle surgeon instituted collection of a postoperative fall questionnaire at 2 and 6 weeks postoperatively. A retrospective review of 135 patients with complete prospectively collected fall questionnaire data was performed. Patient demographic information, injury characteristics, comorbidities, baseline medications, length of hospital stay, visual analog scale (VAS) pain scores were collected. After univariable analysis, a multivariable binary logistic regression was conducted to assess independent risk factors for postoperative falls. Results: The median (interquartile range) age was 52 (21) and body mass index was 32.7 (11.1). A total of 108 patients (80%) underwent outpatient procedures. Thirty-nine of the 135 patients (28.9%) reported experiencing a fall in the first 6 weeks after surgery. In multivariable analysis, antidepressant use (adjusted odds ratio 3.41, 95% CI 1.19-9.81) and higher VAS pain scores at 2 weeks postoperatively (adjusted odds ratio 1.27, 95% CI 1.08-1.50) were found to be independent risk factors for postoperative falls. Conclusion: This study found a high incidence of postoperative falls in the first 6 weeks after foot and ankle surgery. Baseline antidepressant use and higher 2-week VAS pain scores were associated with postoperative falls. Foot and ankle surgeons should discuss the risk of falling with patients especially those with risk factors. Level of Evidence: Level III, retrospective cohort study at a single institution.

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Resilience is a dynamic construct defined as the ability to recover from stress. There is no literature examining the impact of resilience on outcomes following foot and ankle surgery. Retrospective analysis of patients who underwent first MTP arthrodesis from September 2011 to May 2020 were reviewed for patient characteristics and union status. PROMIS Physical Function (PF), Pain Interference (PI), Depression (D), and Foot Function Index (FFI) were collected. Resilience was measured using the Brief Resilience Scale. A multivariable linear regression analysis examining the impact of resilience on patient reported was conducted. At an average of 3.4 years postoperatively, resilience was found to independently affect patient reported outcomes across all instruments, except the FFI pain subscale. In the first study examining the impact of resilience following foot and ankle surgery, we found that resilience has an independent positive effect on overall physical function, disability, pain, and mental health following MTP arthrodesis. Preoperative resilience scores could be used to predict postoperative functional outcomes following MTP arthrodesis and guide postoperative rehabilitation. These findings help establish the role of early positive psychosocial characteristics within orthopaedic foot and ankle population.

Category: Bunion; Other Introduction/Purpose: Hallux valgus is a common deformity the foot and ankle surgeon will encounter that tends to have a progressive nature with a predilection for females. There are many operative techniques to appropriately treat HV however, there is limited literature focused on patient-reported outcomes for these procedures. In particular, we intend to compare patient- reported outcomes for those who had early (2 weeks postoperatively) vs standard weight-bearing (SWB) (6 weeks postoperatively) postoperative protocols after hallux valgus correction via the Lapidus procedure. Methods: A retrospective analysis of patients that underwent hallux valgus correction at our facility from 2010-2021 was conducted. Patients were selected if they underwent this correction via the Lapidus procedure. Basic patient demographics, preoperative and post-operative hallux valgus angles and intermetatarsal angles were recorded, type of hardware used for fixation, postoperative weight bearing protocol, complication rate, deformity recurrence, duration of symptoms, and any adjunctive procedures were all recorded utilizing the electronic medical record. Early weight-bearing (EWB) was defined as beginning a protected weight-bearing protocol at the two week visit. To evaluate outcomes, we utilized the Foot and Ankle Ability Measure (FAAM) survey as well as the Patient Reported Outcomes Measurement Information System (PROMIS) survey. Results: A total of 77 patients met criteria for this study with 20 patients having completed both the FAAM and PROMIS score surveys. The average time point at which the outcomes were collected was 5.65 years postoperatively ranging from 2.43 to 11.5 years. There were 35 patients in the EWB cohort and 42 in the SWB protocol. The average PROMIS physical function, pain interference, and depression scores for the EWB population was 45.96, 54.66, and 47.48 respectively vs 47.10, 48.34, and 50.21 in the SWB group. Patients in the EWB group reported their average activities of daily living (ADLs) via the FAAM subscale to be at 57% vs 62% in the SWB group. For the FAAM Sports Subscale, both groups reported fairly low numbers at 44% and 36% respectively. In this study, 1 patient experienced wound infection, 3 patients experienced nonunion (2 EWB, 1 SWB), and 1 patient experienced deformity recurrence. Conclusion: Preliminary results suggest equivalent results for EWB and SWB postoperative protocol for patients undering the Lapidus procedure. We plan to increase the power of our study for a more thorough investigation as well as conduct a more intensive statistical analysis to gain more insight on patient related factors and their effect on outcomes. We expect a higher number of patients to complete the PROMIS and FAAM surveys as we continue to reach out to these patients.