A Model to Predict Limb Salvage in Severe Combat-related Open Calcaneus Fractures

Bevevino, Adam J.; Dickens, Jonathan; Potter, Benjamin K.; Dworak, Theodora C.; Gordon, Wade T.; Forsberg, Jonathan A.

doi:10.1007/s11999-013-3382-z

Cited by 23 publications

(22 citation statements)

References 29 publications

(56 reference statements)

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“…Previous reports have emphasized the need for health outcomes data to inform and improve treatment and rehabilitation of patients with serious leg injuries [4–9,30,31]. Our previous [5] and present study findings further support the need to investigate and refine existing clinical treatment pathways.…”

Section: Discussionsupporting

confidence: 81%

“…For patients with the most severe leg injuries, treatment required either amputation or leg-threatening injuries without amputation (hereafter referred to as limb salvage) through reconstructive surgeries [3]. Patients with combat-related amputation and limb salvage continue to present new treatment and rehabilitation challenges to healthcare providers at both military and Department of Veterans Affairs (VA) facilities [4–8]. …”

Section: Introductionmentioning

confidence: 99%

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A Comparison of Four-Year Health Outcomes following Combat Amputation and Limb Salvage

et al. 2017

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Little research has described the long-term health outcomes of patients who had combat-related amputations or leg-threatening injuries. We conducted retrospective analysis of Department of Defense and Department of Veterans Affairs health data for lower extremity combat-injured patients with (1) unilateral amputation within 90 days postinjury (early amputation, n = 440), (2) unilateral amputation more than 90 days postinjury (late amputation, n = 78), or (3) leg-threatening injuries without amputation (limb salvage, n = 107). Patient medical records were analyzed for four years postinjury. After adjusting for group differences, early amputation was generally associated with a lower or similar prevalence for adverse physical and psychological diagnoses (e.g., pain, osteoarthritis, posttraumatic stress disorder) versus late amputation and/or limb salvage. By contrast, early amputation was associated with an increased likelihood of osteoporosis during the first year postinjury. The prevalence of posttraumatic stress disorder increased for all patient groups over four years postinjury, particularly in the second year. The different clinical outcomes among combat extremity injured patients treated with early amputation, late amputation, or limb salvage highlight their different healthcare requirements. These findings can inform and optimize the specific treatment pathways that address the physical and psychological healthcare needs of such patients over time.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

A Comparison of Four-Year Health Outcomes following Combat Amputation and Limb Salvage

et al. 2017

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“…also used this model in their study entitled “A Model to Predict Limb Salvage in Severe Combat-related Open Calcaneus Fractures” to examine the possibility of amputation of an injured person in the open bone fractures which is a major challenge in making decision for clinician and patient on limb salvage or amputation. [ 13 ] Moreover, this method has been widely used for comparing different statistical models in predicting clinical results. [ 33 34 35 36 ]…”

Section: Discussionmentioning

confidence: 99%

“…Using DCA, the relative impact of false-positive and false-negative results produced by the prediction model is measured to yield the “net benefit” for the model. [ 13 ]…”

Section: Methodsmentioning

confidence: 99%

Prediction of low birth weight delivery by maternal status and its validation: Decision curve analysis

et al. 2017

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Background:In this study, we evaluated assessed elements connected with low birth weight (LBW) and used decision curve analysis (DCA) to define a scale to anticipate the probability of having a LBW newborn child.Methods:This hospital-based case–control study was led in Arak Hospital in Iran. The study included 470 mothers with LBW neonate and 470 mothers with natural neonates. Information were gathered by meeting moms utilizing preplanned organized questionnaire and from hospital records. The estimated probabilities of detecting LBW were calculated using the logistic regression and DCA to quantify the clinical consequences and its validation.Results:Factors significantly associated with LBW were premature membrane rupture (odds ratio [OR] = 3.18 [1.882–5.384]), former LBW infants (OR = 2.99 [1.510–5.932]), premature pain (OR = 2.70 [1.659–4.415]), hypertension in pregnancy (OR = 2.39 [1.429–4.019]), last trimester of pregnancy bleeding (OR = 2.58 [1.018–6.583]), mother age >30 (OR = 2.17 [1.350–3.498]). However, with DCA, the prediction model made on these 15 variables has a net benefit (NB) of 0.3110 is best predictive with the highest NB. NB has simple clinical interpretation and utilizing the model is what might as well be called a procedure that distinguished what might as well be called 31.1 LBW per 100 cases with no superfluous recognize.Conclusions:It is conceivable to foresee LBW utilizing a prediction model show in light of noteworthy hazard components connected with LBW. The majority of the hazard elements for LBW are preventable, and moms can be alluded amid early pregnancy to a middle which is furnished with facilities for administration of high hazard pregnancy and LBW infant.

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“…Twenty healthy individuals (age 30.7+6.3 years; 10 men: average BMI 24.2, height 179.2 cm, weight 77.6 kg; 10 women: average BMI 23.9, height 165.2 cm, weight 65.3 kg) with no history of major ankle injury or surgery were imaged using computed tomography (CT) from 10 cm above the ankle joint down through the toes after providing informed consent to participate in this IRB-approved study. From these CT scans, 3-dimensional surface models of each distal tibia, talus, and calcaneus were created based on reformatted scans with cubic voxel sizes ranging from 0.59 to 0.72 mm 3 using Mimics software (Materialise, Leuven, Belgium). A previous validation study, using a high-precision laser scanner to obtain the ground truth bone morphology, determined the accuracy of bone models using these methods is +0.63 mm.…”

Section: Methodsmentioning

confidence: 99%

Bilateral Symmetry, Sex Differences, and Primary Shape Factors in Ankle and Hindfoot Bone Morphology

Gabrielli

Gale

Hogan

et al. 2020

Foot & Ankle Orthopaedics

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Background: Ankle injuries and joint degeneration may be related to ankle bone morphology. Little data exist to characterize healthy hindfoot bone morphology. The purpose of this study was to characterize side-to-side symmetry and sex differences in ankle and hindfoot bone morphology, and to identify the primary shape factors that differentiate ankle and hindfoot bone morphology among individuals. Methods: Computed tomography was used to create 3D surface models of the distal tibia, talus, and calcaneus for 40 ankle and hindfoot bones from 20 healthy individuals. Morphologic differences between left and right bones of the same individual and between males and females were determined. Statistical shape modeling was performed to identify primary shape variations among individuals. Results: Side-to-side differences in bone morphology averaged 0.79 mm or less. The average distal tibia in males was larger overall than in females. No significant sex difference was noted in the tali. The average female calcaneus was longer and thinner than the average male calcaneus. Variability in ankle and hindfoot bone morphology is primarily associated with articulating surface shape, overall length and width, and tendon/ligament attachment points. Conclusion: In general, the contralateral ankle can serve as an accurate guide for operative restoration of native ankle morphology; however, specific regions demonstrate higher asymmetry. Clinical Relevance: Knowledge of regions of high and low bilateral symmetry can improve hindfoot and ankle reconstruction. Design of ankle prostheses can be improved by accounting for differences in bone morphology associated with sex and shape differences among individuals.

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A Model to Predict Limb Salvage in Severe Combat-related Open Calcaneus Fractures

Cited by 23 publications

References 29 publications

A Comparison of Four-Year Health Outcomes following Combat Amputation and Limb Salvage

A Comparison of Four-Year Health Outcomes following Combat Amputation and Limb Salvage

Prediction of low birth weight delivery by maternal status and its validation: Decision curve analysis

Bilateral Symmetry, Sex Differences, and Primary Shape Factors in Ankle and Hindfoot Bone Morphology

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