Browsing by Author "Davis, Justin Joe"
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Item Risk Factors for Surgical Site Infection in Distal Radius Fracture Surgery(2020-05-01T05:00:00.000Z) Davis, Justin Joe; Zhang, Andrew; Sammer, Douglas; Koehler, DanielPURPOSE: Surgical site infections (SSI) after distal radius surgery can introduce substantial morbidity and additional direct and indirect costs. The clearest risk factors for SSI are the use of externalized Kirschner wires (K-wires) or external fixation (ex-fix). The roles of other potential risk factors such as open injuries, diabetes mellitus, and tobacco use are less clear. The purpose of this study was to identify independent risk factors for SSI in distal radius surgery. METHODS: A retrospective study of 541 operative distal radius fractures over a 5-year period was performed. Potential risk factors for infection included surgery duration, externalized K-wires or ex-fix, diabetes mellitus, uncontrolled diabetes defined as a HgBA1c >7 documented within a 90-day perioperative period, open fracture, tobacco use, osteoporosis, gender, and age. A screening bivariate logistic regression was performed, followed by a multiple logistic regression of the selected independent variables, with SSI as the dependent variable. A p-value of <0.05 was considered statistically significant. RESULTS: Twenty fractures (3.7%) were complicated by post-operative SSI, and 521 (96.3%) were not. Uncontrolled diabetes with HgA1c >7 (OR = 7.83, p=0.002), the presence of an ex-fix or k-wires (OR =3.73, p=0.007), and tobacco use (OR=3.79, p=0.007) were significant independent predictors of SSI. Of note, while uncontrolled diabetes was an independent risk factor, the diagnosis of diabetes alone was not. CONCLUSIONS: Previously identified risk factors for SSI after distal radius surgery including the presence of externalized K-wires or ex-fix were confirmed in this study. Additionally, this study demonstrates that tobacco use and uncontrolled diabetes (HgA1c >7) are both independent risks factors for SSI. Notably, the presence of diabetes alone was not an independent risk factor, highlighting the importance of glycemic control. LEVEL OF EVIDENCE: Level IIIItem Rodeo Thumb: To Replant or Not(2020-05-01T05:00:00.000Z) Davis, Justin Joe; Zhang, Andrew; Sammer, Douglas; Koehler, DanielOBJECTIVE: To investigate patient reported outcomes after surgical treatment of Rodeo Thumb to help guide clinical decision making at the time of injury. METHODS: A retrospective review was performed for all rodeo thumb amputations from 2009-2019. Outcomes measured included daily functionality determined by QuickDASH scores, roping ability, and overall satisfaction. These were then compared between different levels of injury and definitive treatment. Outcomes between older and younger patients were also compared. Two-sided t-tests were used for QuickDASH scores and Pearson's Chi square test for categorical data. RESULTS: Thirty-seven patients underwent replantation or amputation as definitive treatment. IP level injury patients treated with replantation had a lower average QuickDASH than those treated with amputation (1.36 vs. 8.11; p=0.07), but fewer were roping at the same level or better (40% vs 78.6%; p=0.262). Patients with MCP level injury treated with replantation also had an average QuickDASH less than those treated with amputation (7.32 vs 10.4; p=0.52) and were roping at same level or better (66.6% vs 55.6%; p=1.00). Younger patients had lower QuickDASH scores than older patients (5.53 vs. 8.19; p=0.42), more who were roping at the same level or better (100% vs. 53%; p=0.02), and more who were satisfied with their treatment decision (88.9% vs. 60.7%; p=0.22.). CONCLUSIONS: For IP level injury, amputation seems to result in the same or better roping abilities as replantation. Replantation is the preferred treatment for MCP level injury. Younger patients tend to have better outcomes, possibly due to increased adaptation to injury. LEVEL OF EVIDENCE: IV