Publications by authors named "Gerald McGwin"

630 Publications

The Complexity of Integrating Observations Into Observational Research.

JAMA Ophthalmol 2021 Jul 22. Epub 2021 Jul 22.

Department of Ophthalmology & Visual Sciences, School of Medicine, University of Alabama at Birmingham.

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http://dx.doi.org/10.1001/jamaophthalmol.2021.2633DOI Listing
July 2021

An Increase in Respiratory Protection Device Injuries Associated with the COVID-19 Pandemic.

J Am Acad Dermatol 2021 Jul 15. Epub 2021 Jul 15.

Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.

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http://dx.doi.org/10.1016/j.jaad.2021.07.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8282438PMC
July 2021

Do Formulation and Dose of Long-Term Opioid Therapy Contribute to Risk of Adverse Events among Older Adults?

J Gen Intern Med 2021 Jul 13. Epub 2021 Jul 13.

Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS, USA.

Background: Chronic non-cancer pain (CNCP) is highly prevalent in older adults and long-term opioid therapy (LTOT) has been used to manage chronic pain. However, the safety of LTOT among older adults with CNCP is not well-established and there is a need to identify therapy-related risk factors of opioid-related adverse events among older adults.

Objective: To evaluate the relationship between opioid dose and formulation and the risk of opioid-related adverse events among Medicare-eligible older adults on LTOT.

Design: Nested case-control study.

Participants: Older Medicare beneficiaries (N=35,189) who received > 3 opioid prescriptions with a total days-supply of >45 days within a 90-day period for CNCP between 2012 and 2016.

Main Measures: This study utilized Medicare 5% medical and prescription claims data. Outcome measures included opioid-induced respiratory depression (OIRD), opioid overdose, all-cause mortality, and a composite outcome, defined as the first occurrence of any of the previous three events. Key independent variables were opioid formulation and opioid dose (measured in morphine milligram equivalents (MME)) prescribed during LTOT.

Key Results: Seventy-four OIRD, 133 overdose, 982 all-cause mortality, and 1122 composite outcome events were observed during follow-up. In unadjusted analyses, the use of combination opioids (OR: 4.52 [95%CI: 1.51-13.47]) was significantly associated with OIRD compared to short-acting (SA) opioids. In adjusted analyses, opioid-related adverse events were significantly associated with the use of LA (overdose OR: 13.00 [95%CI: 1.30-130.16] and combination opioids (overdose OR: 6.27 [95%CI: 1.91-20.55]; mortality OR: 2.75 [95%CI: 1.87-4.04]; composite OR: 2.82 [95%CI: 2.01-3.96]) when compared to SA opioids. When compared to an average dose of less than 20 MME, outcomes were significantly associated with doses of 20-50 MME (mortality OR: 1.61 [95%CI: 1.24-2.10]; composite OR: 1.59 [95%CI: 1.26-2.01]) and >50 MME (mortality OR: 1.99 [95%CI: 1.28-3.10]; composite OR: 2.09 [95%CI: 1.43-3.04]).

Conclusions: Older adults receiving medically prescribed opioids at higher doses and those using LA and combination of LA and SA opioids are at increased risks for opioid-related adverse events, highlighting the need for close patient supervision.
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http://dx.doi.org/10.1007/s11606-021-06792-8DOI Listing
July 2021

Driving specialist's ratings of on-road performance and naturalistic driving crashes and near-crashes.

J Am Geriatr Soc 2021 Jul 10. Epub 2021 Jul 10.

Department of Ophthalmology & Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.

Background: This study aimed to evaluate the association between a Certified Driving Rehabilitation Specialist's (CDRS) ratings of on-road driving performance by older drivers and at-fault crash and near-crash involvement using naturalistic driving techniques where crashes and near-crashes are recorded in everyday driving through in-vehicle instrumentation.

Methods: This is a cohort study of 144 drivers aged 70 years and over who were recruited due to a recent ophthalmology clinic visit at the University of Alabama at Birmingham. Baseline measurements consisted of demographics, visual status, and other health variables. At-fault crashes and near-crashes over 6 months were identified through instrumentation placed in their personal vehicle that recorded vehicle kinematics and video. After 6 months, a CDRS completed an on-road assessment and provided a composite rating on specific driving behaviors and a global score.

Results: Rate ratios examining the association between older drivers with worse CDRS composite scores and rates of at-fault crashes, at-fault near-crashes, and combined at-fault crashes and near-crashes were significantly higher compared to drivers with better scores. Results were similar for the CDRS global score.

Conclusions: Motor vehicle administrations use CDRS ratings to make decisions about licensure, and in clinical programs such as those based at rehabilitation clinics use them to make recommendations about fitness to drive and rehabilitation. This study suggests that these decisions and recommendations are valid from a safety standpoint.
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http://dx.doi.org/10.1111/jgs.17359DOI Listing
July 2021

Updates to the Current Landscape of Augmented Reality in Medicine.

Cureus 2021 May 16;13(5):e15054. Epub 2021 May 16.

Department of Orthopaedic Surgery, Hughston Clinic, Columbus, USA.

Objective With the introduction of the Google Glass in 2013, the use of augmented reality (AR) and virtual reality (VR) technology has been sharply accelerating in the field of medicine. Despite numerous hurdles and inadequacies identified with the initial devices, current product offering and the need for remote patient care has driven advancements and adoption of the newer generation of devices. This study aims to evaluate the current use of augmented reality devices and the current hurdles to implementation by surveying authors who have recently published on this topic. Design A 22-question survey was shared with authors of 27 recent publications relating to usage of augmented reality in medicine between the years of 2019 and 2020. Results Eighty-two percent of participants were located in North America while the rest were located in Europe. Interestingly, over 65% of respondents were over the age of 40. Almost half of respondents (45%) used the technology for image review while almost a third (27%) used it for capturing and sharing video. Most concerns to implementation were related to privacy (38%) or reimbursement (33%). Conclusion Despite the hurdles reported by respondents, the advancements in AR/VR have come a long way since their introduction and have great potential for continued usage in medicine. Despite this, however, it is important to recognize that cost, security, and battery life continue to serve as hurdles preventing the widespread adoption of this technology to mass markets.
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http://dx.doi.org/10.7759/cureus.15054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8208174PMC
May 2021

Toothpick-related injuries in the United States from 2001 to 2017.

Int J Inj Contr Saf Promot 2021 Jun 1:1-5. Epub 2021 Jun 1.

Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.

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http://dx.doi.org/10.1080/17457300.2021.1930059DOI Listing
June 2021

Incorporation of a genetics-based information module into standardized diabetes patient education.

Prim Care Diabetes 2021 Aug 14;15(4):706-712. Epub 2021 May 14.

Division of Endocrinology, Diabetes and Metabolism, University of Alabama at Birmingham, Birmingham, AL, United States.

Objective: The purpose of this study is to investigate the effectiveness of a genetics educational module created to improve understanding about the genetics of diabetes, assess motivation to engage in healthy lifestyle behaviors, and gauge interest in genetic testing for diabetes.

Methods: Participants were recruited from the Multidisciplinary Comprehensive Diabetes Clinic at the University of Alabama at Birmingham. Participants completed a pre-survey to assess three domains: (1) knowledge about diabetes etiology and testing, (2) healthy lifestyle behaviors, and (3) interest in genetic testing. Participants viewed a short, recorded educational module, then completed a post-survey to re-assess the domains.

Results: Participants increased knowledge about genetics of diabetes (p < 0.0001) and genetic testing (p = 0.0184), demonstrated motivation to adopt healthy behaviors (p < 0.0001), and decreased interest in genetic testing (p = 0.0833) after viewing the module.

Conclusions: The educational module increased understanding of diabetes and increased motivation to adopt healthy behaviors. The need for patient-friendly educational modules explaining the genetics of diabetes will likely increase with continued discoveries of how genetics contributes to diabetes risk and outcomes. This short, educational module has the potential to provide genetic information in an effective way that is easily adapted in a routine clinic setting.
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http://dx.doi.org/10.1016/j.pcd.2021.04.013DOI Listing
August 2021

Fracture and Patient Characteristics Associated with Early Conversion Total Hip Arthroplasty After Acetabular Fracture Fixation.

J Orthop Trauma 2021 Mar 16. Epub 2021 Mar 16.

Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.

Objectives: To determine risk factors for early conversion THA after operative treatment of acetabular fractures.

Design: Retrospective cohort.

Setting: Level I trauma center.

Patients And Intervention: We reviewed 685 operative acetabular fractures at our institution from 2011-2017, with median follow-up of 12 months (4-105 months).

Main Outcome Measurement: Multivariable regression analysis was performed after univariate analysis to identify independent risk factors for conversion THA. Sensitivity analysis was performed with minimum follow-up set at 6-months and 12-months.

Results: One-hundred eight patients (16%) underwent conversion THA, with 52% of conversions occurring within 1 year, an additional 27% within 2 years, and the remaining 21% within 6 years of the index acetabular ORIF. The median time to conversion THA was 11.5 months (0.5-72 months). The risk of conversion THA by fracture pattern was: 53/196 (27%) transverse posterior wall, 12/52 (23%) T-shaped, 10/68 (15%) posterior column with posterior wall, and 25/207 (12%) posterior wall. Independent risk factors for early conversion included: transverse posterior wall fracture, protrusio, hip dislocation, increased BMI, increased age, infection and dislocation after ORIF. Independent risk factors for early conversion THA specific to patients with transverse posterior wall fractures include only increased age and BMI. Sensitivity analysis showed no change in results using either 6-month or 12-month minimum follow-up.

Conclusion: Transverse posterior wall fractures have a high risk of early conversion THA compared to other acetabular fracture patterns, especially when in combination with other significant risk factors. Consideration for different and novel management options warrants further study in this subset of acetabular fracture patients.

Level Of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.1097/BOT.0000000000002083DOI Listing
March 2021

Established soft contact lens wearers' awareness of and initial experiences with orthokeratology.

Ophthalmic Physiol Opt 2021 Jul 4;41(4):673-682. Epub 2021 May 4.

University of Alabama at Birmingham, Birmingham, Alabama, USA.

Objectives: To understand the initial awareness of and experience with orthokeratology in a group of adult, symptomatic, soft contact lens (CL) wearers.

Methods: This was a prospective, 3-month, open-label study of symptomatic soft CL wearers who were between the ages of 18 and 45 years. Baseline measurements were taken and then all subjects were treated with orthokeratology. A dry eye evaluation was completed at baseline prior to orthokeratology treatment. This same dry eye evaluation was completed 1 week and 1 month after orthokeratology treatment. An investigator-designed questionnaire that aimed to understand the subject's initial awareness of and experience with orthokeratology was also administered at the baseline, 1-week, 1-month and 3-month visits (perceptions, knowledge, tolerance and ability to apply and remove orthokeratology lenses).

Results: Twenty-nine out of 40 subjects completed this study. Completed subjects (age = 24.28 ± 3.75 years) had significant improvements in ocular comfort over the course of the study compared to their soft CLs. Most subjects were unfamiliar with orthokeratology before the study, were able to quickly adapt to the treatment and were likely to recommend orthokeratology to friends or children for myopia management.

Conclusions: This study found that few subjects knew about orthokeratology before learning about it through this investigation, suggesting that patients should be offered this treatment more regularly. This conclusion is supported by the ability of the subjects to learn and adapt to orthokeratology with ease, and their likelihood to recommend it to a friend or child.
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http://dx.doi.org/10.1111/opo.12828DOI Listing
July 2021

COVID-19 Impact on Orthopedic Surgeons: Elective Procedures, Telehealth, and Income.

South Med J 2021 05;114(5):311-316

From the Department of Orthopaedic Surgery, the University of Alabama at Birmingham, and the Department of Epidemiology, School of Public Health, the University of Alabama at Birmingham, Birmingham.

Objectives: The purpose of this study was to investigate the response in orthopedic surgery to the coronavirus disease 2019 (COVID-19) pandemic across the United States by surveying surgeons about their care setting, timing of restrictions on elective surgery, use of telehealth, and estimated economic impact.

Methods: A survey was distributed via REDCap through state orthopedic organizations between April and July 2020. The 22-question digital survey collected information regarding restrictions on elective procedures, location of care, utilization of telehealth, and estimated reductions in annual income.

Results: In this study, 192 participants responded to the survey (average age 49.9 ± 11.0 years, 92.7% male). Responses primarily originated from Alabama (30.2%), Georgia (30.2%), and Missouri (16.1%). The remainder of the responses were grouped into the category "other." Respondents did not vary significantly by state in operative setting or income type (salary, work relative value units, or collections). Most of the participants documented elective procedure restrictions in hospital and ambulatory settings. The highest frequency of closures occurred between March 18 and 20 (47% in hospital, 51% in ambulatory). Of the participants, financial loss estimates varied across states ( = 0.005), with 50% of physicians claiming >50% losses of income in Alabama (24% Georgia, 10% Missouri, 31% other). Regarding telehealth, practices set up for these services before 2020 varied across states. None of the orthopedic practices in Alabama had telehealth before the COVID-19 pandemic (Missouri 25%, Georgia 9%, other 8%, = 0.06); however, respondents generally were split when considering the anticipation of implementing telehealth into routine practice.

Conclusions: Most practices did implement restrictions for elective clinic visits and procedures early during the pandemic. COVID-19 ultimately will result in a large revenue loss for elective orthopedic practices. Services such as telehealth may help offset these losses and help deliver orthopedic care to patients remotely.
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http://dx.doi.org/10.14423/SMJ.0000000000001249DOI Listing
May 2021

Naturalistic Driving Techniques and Association of Visual Risk Factors With At-Fault Crashes and Near Crashes by Older Drivers With Vision Impairment.

JAMA Ophthalmol 2021 Jun;139(6):639-645

School of Medicine, Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham.

Importance: Government motor vehicle crash reports used in the study of driver safety can be biased and incomplete. Naturalistic driving methods using in-vehicle instrumentation have been developed in recent years to objectively measure crashes and near crashes as they occur on the road using video and vehicle kinematic data.

Objective: To examine visual risk factors associated with at-fault crashes and near crashes among older drivers, most of whom have age-related eye conditions associated with vision impairment.

Design, Setting, And Participants: This prospective cohort study was conducted at an academic ophthalmology clinic from January 1, 2015, to November 10, 2018, among 154 adults 70 years of age or older who were legally licensed in Alabama and who reported currently driving at least 4 days per week; 137 of 151 participants (90.7%) had an age-related eye condition in at least 1 eye. Drivers participated in a baseline visual function assessment followed by installation of a data acquisition system recording multichannel synchronized video and vehicle kinematics in their personal vehicle. Drivers were instructed to drive for 6 months as they normally would during everyday life. Statistical analysis was performed from June 15 to September 15, 2020.

Main Outcomes And Measures: The rate of combined incident at-fault crashes and near crashes, defined by the number of events and the number of miles driven.

Results: The sample consisted of 154 drivers (85 men [55.2%]; mean [SD] age, 79.3 [5.1] years). Visual functions associated with crash and near-crash involvement included impaired contrast sensitivity (rate ratio [RR], 2.7; 95% CI, 1.3-5.5), moderate (RR, 2.3; 95% CI, 1.1-4.9) and severe (RR, 5.0; 95% CI, 2.2-11.7) slowing in visual processing speed, and elevated motion perception thresholds for a drifting grating (RR, 1.9; 95% CI, 1.1-3.5). Those with impaired peripheral visual field sensitivity had increased rates of crashes and near crashes (RR, 1.8; 95% CI, 1.0-3.3); however, this finding was not statistically significant (P = .07).

Conclusions And Relevance: With the use of naturalistic driving methods in which crashes and near crashes involving older drivers are objectively measured as they occur on the road, associations have been identified between impaired contrast sensitivity, slowed visual processing speed, and impaired motion perception and an increased rate of a combined total of at-fault crashes and near crashes.
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http://dx.doi.org/10.1001/jamaophthalmol.2021.0862DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8085760PMC
June 2021

Reply.

Ophthalmology 2021 Jul 8;128(7):e34. Epub 2021 Apr 8.

Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address:

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http://dx.doi.org/10.1016/j.ophtha.2021.03.012DOI Listing
July 2021

Resistance Training Does Not Decrease Placental Blood Flow During Valsalva Maneuver: A Novel Use of 3D Doppler Power Flow Ultrasonography.

Sports Health 2021 Mar 12:19417381211000717. Epub 2021 Mar 12.

Birmingham Veterans Affairs Medical Center, Birmingham, Alabama.

Background: The Valsalva maneuver may increase maternal blood pressure and intra-abdominal pressure, resulting in decreased blood flow to the fetus during resistance training.

Hypothesis: There is no significant reduction in placental blood flow in pregnancy during resistance training in recreational athletes, as documented by a 3-dimensional power flow Doppler ultrasonography.

Study Design: Cohort.

Level Of Evidence: Level 3.

Methods: A cohort of healthy women who participated in recreational athletics was enrolled in a prospective study to assess placental blood flow during a resistance exercise. A 1 repetition maximum (1RM, up to 50 lb) was determined through a modified chest press as a marker of heavy resistance training. Three-dimensional volume measurements and power Doppler flow were determined at the rest phase and during the 1RM lift phase. The vascular flow index (VFI) was calculated to determine placental perfusion during each phase.

Results: A total of 22 women participated. The mean age of participants was 31 years. Gestational age ranged from 13 to 28 weeks. Average 1RM weight lifted was 30 lb. Four women (18%) were able to lift 50 lb, the maximum weight that the study allowed. The remaining 18 women (82%) lifted their true 1RM. Mean VFI during lift phase was 2.185 compared with 2.071 at rest ( = 0.03). There was a slight mean increase in VFI during lift phase, 0.114 (95% CI 0.009-0.182) from 2.071 to 2.185 with lifting ( = 0.03). The 15 women who participated in structured exercise had a mean VFI at rest and during the lift phase of 2.031 and 2.203, respectively ( = 0.01).

Conclusion: Three-dimensional power flow Doppler imaging can guide resistance training during pregnancy to prevent fetal injury due to hypoperfusion. Resistance training up to an RM1 of 50 lb did not result in a significant reduction of placental blood flow from resting state in the study population.

Clinical Relevance: This technique may be used to guide training parameters among pregnant athletes.
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http://dx.doi.org/10.1177/19417381211000717DOI Listing
March 2021

MRI evaluation of axillary neurovascular bundle: Implications for minimally invasive proximal humerus fracture fixation.

JSES Int 2021 Mar 9;5(2):205-211. Epub 2021 Jan 9.

Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.

Background: Percutaneous fixation of proximal humeral fractures places the axillary nerve and posterior humeral circumflex artery at risk for injury. Safe operative zones for the axillary nerve are described based on external measurements from anatomic landmarks, but no study to date has incorporated advanced imaging to help guide surgical procedures in the region of the axillary neurovascular bundle (ANVB). We sought to define the location and trajectory of the ANVB in relation to osseous landmarks using magnetic resonance imaging (MRI) measurements.

Methods: Retrospective review of 750 consecutive MRI studies was performed with 55 imaging studies meeting inclusion criteria for patient positioning, image alignment, and quality. Five measurements were performed including the distance from mid-lateral acromion to lateral ANVB, mid-lateral acromion to medial ANVB, greater tuberosity to lateral ANVB, vertical distance between inferior anatomic neck and lateral ANVB, and angle the ANVB crosses the humerus. Height, gender, and age were recorded. Analysis was performed using ANOVA and Pearson correlation tests.

Results: The lateral ANVB was below the inferior articular margin of the humeral head by an average of 12.9 ± 3.9 mm and within a 22 mm window. It was an average of 57.4 ± 5.1 mm from the lateral mid-acromion, and 34.7 ± 4.3 mm below the greater tuberosity. The angle formed by the ANVB crossing the humerus averaged 19.5 ± 3.9 degrees upward from medial to lateral. Height and gender directly impacted measurements.

Conclusions: The use of the inferior humeral head articular margin provides a radiographic landmark to aid intraoperative lateral ANVB assessment which may be helpful during percutaneous fracture fixation.
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http://dx.doi.org/10.1016/j.jseint.2020.11.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910741PMC
March 2021

Is outpatient shoulder arthroplasty safe? A systematic review and meta-analysis.

J Shoulder Elbow Surg 2021 Aug 4;30(8):1968-1976. Epub 2021 Mar 4.

Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address:

Background: Amid rising health care costs and recent advances in surgical and anesthetic protocols, the rate of outpatient joint arthroplasty has risen steadily in recent years. Although the safety of outpatient total knee arthroplasty and total hip arthroplasty has been well established, outpatient shoulder arthroplasty is still in its infancy. The purpose of this study was to synthesize the current literature and provide further data regarding the outcomes and safety of outpatient shoulder arthroplasty.

Methods: A systematic review was conducted following the standard PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included were studies that evaluated the outcomes of patients undergoing outpatient total shoulder arthroplasty (TSA) or reverse TSA. Meta-analysis was conducted using Mantel-Haenszel statistics to generate odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) comparing outpatient and inpatient shoulder arthroplasty.

Results: Twelve studies were included, with a total of 194,513 patients, of whom 7162 were outpatients. Of the studies, 8 were level III and 4 were level IV. The average age of the outpatients was 66.6 years, and the average age of the inpatients was 70.1 years. The overall OR for complications was significantly lower in outpatients (OR, 0.40; 95% CI, 0.35-0.45) than in inpatients. There was no significant difference in rates of 90-day readmission (OR, 0.88; 95% CI, 0.75-1.03), revision (OR, 0.96; 95% CI, 0.65-1.41), and infection (OR, 0.93; 95% CI, 0.64-1.35) when comparing outpatients with inpatients.

Conclusion: Outpatient TSA, in an appropriately selected patient population, is safe and results in comparable patient outcomes to those of inpatient shoulder arthroplasty. Given the expected increase in the number of patients requiring TSA, surgeons, hospital administrators, and insurance carriers should strongly consider the merits of a cost- and care-efficient approach to total shoulder replacement.
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http://dx.doi.org/10.1016/j.jse.2021.02.007DOI Listing
August 2021

Publication Characteristics of Foot and Ankle Trauma Publications: A Review of Articles From 1997 to 2017.

Cureus 2021 Jan 10;13(1):e12607. Epub 2021 Jan 10.

Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA.

Background The purpose of this study is to evaluate and compare publishing characteristics in foot and ankle trauma articles published in two subspecialty journals and two general orthopedic journals. Methods All trauma articles related to foot and ankle surgery published from five different time intervals over a 20-year period were collected and the following was analyzed: authorship, level of evidence, type of study, citations, and geographic region. Results Foot and Ankle International (FAI) had the highest percentage of last and corresponding authors that were fellowship-trained in foot and ankle. The Journal of Bone and Joint Surgery American and British volumes (JBJS(A) and JBJS(B), respectively) and the Journal of Orthopaedic Trauma (JOT) articles had a higher percentage of last and corresponding authors that were fellowship-trained in trauma. Conclusion Foot and ankle-trained authors are currently under-represented in foot and ankle trauma literature. As the field of foot and ankle continues to grow, it is important that the experts in the field are well represented in the literature.
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http://dx.doi.org/10.7759/cureus.12607DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872493PMC
January 2021

Alabama Screening and Intervention for Glaucoma and Eye Health Through Telemedicine (AL-SIGHT): Study Design and Methodology.

J Glaucoma 2021 05;30(5):371-379

Departments of Ophthalmology and Visual Sciences.

Prcis: This paper presents the methods and protocol of a community-based telemedicine program to identify glaucoma and other eye diseases.

Purpose: To describe the study rationale and design of the Alabama Screening and Intervention for Glaucoma and eye Health through Telemedicine project.

Methods: The study will implement and evaluate a telemedicine-based detection strategy for glaucoma, diabetic retinopathy, and other eye diseases in at-risk patients seen at federally qualified health centers located in rural Alabama. The study will compare the effectiveness of the remote use of structural and functional ocular imaging devices to an in-person examination. Study participants will receive a remote ocular assessment consisting of visual acuity, intraocular pressure, visual field testing, and imaging of the retina and optic nerve with spectral-domain optical coherence tomography, and the data will be reviewed by an ophthalmologist and optometrist. It will also compare the effectiveness of financial incentives along with a validated patient education program versus a validated patient education program alone in improving follow-up adherence. Finally, cost and cost-effectiveness analyses will be performed on the telemedicine program compared with standard in-person care using effectiveness measured in numbers of detected eye disease cases.

Conclusions: The study aims to develop a model eye health system using telemedicine to prevent vision loss and address eye health among underserved and at-risk populations.
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http://dx.doi.org/10.1097/IJG.0000000000001794DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8084961PMC
May 2021

An Exploratory Analysis of Tamsulosin for Overactive Bladder (OAB) in Men With Varying Voiding Symptom Burden.

Urology 2021 Jul 20;153:42-48. Epub 2021 Jan 20.

Birmingham/Atlanta Department of Veterans Affairs Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL, and Decatur, GA; University of Alabama at Birmingham, Birmingham, AL.

Objective: To evaluate tamsulosin (α-blocker therapy) for male overactive bladder (OAB) and to examine if indicators of concomitant benign prostatic hyperplasia are associated with OAB symptom improvement.

Materials And Methods: This was a planned, exploratory analysis of a 4-week, α-blocker (tamsulosin 0.4 mg) run-in phase of the Male Overactive Bladder Trial in Veterans (MOTIVE). Participants with urinary urgency and urinary frequency (> 8 voids/24 hours) completed bladder diaries, answered symptom questionnaires (AUA-7 SI), and had post-void residual and noninvasive uroflowmetry measurement.

Results: A total of 116 male Veterans aged 42-88 years with OAB participated. There were statistically significant reductions in voiding frequency (11.3 > 10.0 voids/24 hours, P < .0001), urgency scores (mean 2.5-2.2 points, P < .0001), and nightly nocturia (2.1 > 1.8, P < .001). Only baseline AUA-7 SI total and voiding subscale categories (mild, moderate, severe) were associated with significant reduction in AUA-7 SI total score. For continuous variables, only AUA-7 SI baseline total score was associated with AUA-7 SI storage symptom changes. No other baseline measures were associated with changes in urgency, frequency, or nocturia.

Conclusion: Initiation of short course tamsulosin therapy in men was associated with statistical reduction in OAB symptoms. Baseline post-void residual, uroflow rate, and the voiding symptom subscore of the AUA-7 SI were not predictive of OAB symptom improvement with tamsulosin. These findings merits further exploration.
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http://dx.doi.org/10.1016/j.urology.2021.01.022DOI Listing
July 2021

Motion perception as a risk factor for motor vehicle collision involvement in drivers ≥ 70 years.

Accid Anal Prev 2021 Mar 11;151:105956. Epub 2021 Jan 11.

Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.

Purpose: To evaluate the relationship between visual function and a five-year history of motor vehicle collision rates in older adults. Motion perception impairment was explored as a risk factor for motor vehicle collisions for the first time in this study.

Materials And Methods: Participants were licensed drivers ≥70 years old enrolled in the Alabama VIP Older Driver Study who underwent functional assessments for motion perception, distance visual acuity, contrast sensitivity, visual field sensitivity, and visual processing speed. Participants were recruited based on their being patients in an ophthalmology clinic in the year prior to enrollment or had participated in an earlier driving study. Crash reports were obtained from the Alabama Law Enforcement Agency for the 5 years prior to enrollment and mileage estimated using the Driving Habits Questionnaire. Crude and age-adjusted rate ratios (RRs) and 95 % confidence intervals (95 % CIs) were calculated using Poisson regression.

Results: 159 participants enrolled with a mean age of 79 years. The age-adjusted crash rate was higher among those with worse motion perception (RR: 2.7, 95 % CI: 1.4-5.2), severe slowing in visual processing speed (RR: 3.6, 95 % CI: 1.5-8.5), and impaired peripheral visual field sensitivity (RR: 2.4, 95 % CI: 1.3-4.4).

Conclusions: Among a sample of older drivers, crash rates were higher for those with impaired motion perception, severely slowed visual processing speed, and impaired peripheral visual field sensitivity. The association between motion perception and crash risk in older drivers has not been previously reported. Prospective analysis of the Alabama VIP Older Driver Study will examine these risk factors for future collision involvement based on naturalistic driving data.
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http://dx.doi.org/10.1016/j.aap.2020.105956DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7878317PMC
March 2021

The United States Eye Injury Registry: Past and Future Directions.

Ophthalmology 2021 May 30;128(5):647-648. Epub 2020 Dec 30.

Baltimore, Maryland. Electronic address:

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http://dx.doi.org/10.1016/j.ophtha.2020.11.026DOI Listing
May 2021

Repeatability and Validity of MNREAD Test in Children With Vision Impairment.

Transl Vis Sci Technol 2020 12 16;9(13):25. Epub 2020 Dec 16.

Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.

Purpose: To evaluate the test-retest reliability and validity of the MNREAD test for use in children with vision impairment (VI) and to compare their performance on the test to that of normally sighted children.

Methods: Children with VI ( = 62) and without VI ( = 40) were administered the MNREAD test and the Basic Reading Inventory (BRI) on two study visits, 1 to 3 weeks apart. The maximum reading rate, critical print size, and reading acuity were determined for the MNREAD test, and test-retest reliability was evaluated. The reading rate for the MNREAD test was compared to the BRI results.

Results: Strong correlations between visits were found for all MNREAD parameters (0.68-0.99). Older, but not younger, children with VI read significantly more slowly on both the MNREAD and the BRI than children with normal vision ( < 0.05). Reading rates between the two tests were strongly correlated ( = 0.88). For the MNREAD test, the reading rate increased 4.4 words per minute (wpm) per year for VI and 10.6 wpm/y for those with normal vision. For the BRI, the reading rate increased by 5.9 wpm/y for VI and 9.7 wpm/y for those with normal vision. Poorer visual acuity was associated with slower reading rates on the MNREAD test but not on the BRI, as the MNREAD relies largely on visual factors but the BRI also relies on linguistic and grammar skills.

Conclusions: The MNREAD test are reliable and valid for use in children with vision impairment.

Translational Relevance: The MNREAD test can be utilized by clinicians, as they are a quick, easy-to-administer method for evaluating reading vision in children with VI.
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http://dx.doi.org/10.1167/tvst.9.13.25DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7757625PMC
December 2020

The Association between Ranitidine Use and Gastrointestinal Cancers.

Authors:
Gerald McGwin

Cancers (Basel) 2020 Dec 23;13(1). Epub 2020 Dec 23.

Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35223, USA.

N-nitrosodimethylamine (NDMA) is a carcinogen in experimental animals. It has been classified a probable human carcinogen and has been found in ranitidine. This study sought to evaluate the association between ranitidine use and cancer of the gastrointestinal system. Events reported to the FDA Adverse Events Reporting System that were associated with the use of proton pump inhibitors (PPIs) and H antagonists were selected. Proportionate reporting ratios (PRRs) and associated 95% confidence intervals (CIs) were calculated to compare the proportion of all reported adverse events that were for gastrointestinal system cancers among adverse event reports for ranitidine to adverse event reports for other H antagonists. The proportion of adverse events for any gastrointestinal system cancer relative to all other events was elevated for ranitidine compared to PPIs and other H antagonists (PRR 3.66, 95% CI 3.19-4.20). Elevated and significant PRRs were observed for pharyngeal (PRR 9.24), esophageal (PRR 3.56), stomach (PRR 1.48), colorectal (PRR 16.31), liver (PRR 2.64), and pancreatic (PRR 2.18) cancers. The PRRs for anal (PRR 4.62) and gallbladder (PRR 4.62) cancer were also elevated though not statistically significant. In conjunction with a large body of epidemiologic and human and animal basic science research, the study results support the hypothesis that NDMA-contaminated ranitidine increases the risk of cancer and supports the withdrawal of these medications from the market.
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http://dx.doi.org/10.3390/cancers13010024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7793066PMC
December 2020

Application of systane complete for the treatment of contact lens discomfort.

Cont Lens Anterior Eye 2021 Aug 13;44(4):101399. Epub 2020 Dec 13.

Southern College of Optometry, Memphis, TN, United States.

Purpose: To understand the safety of treating contact lens (CL) discomfort with a new artificial tear when it is directly applied to a CL-wearing eye.

Methods: This was a two-week, two-visit, double-masked study that randomized participants with CL discomfort to use Systane Complete (artificial tear), Sensitive Eyes (rewetting drop), or no treatment. Drops were applied before, twice during, and after CL use each day. Corneal staining served as the primary safety metric. Conjunctival staining, tear break-up time, Schirmer's test, CL comfort (Contact Lens Dry Eye Questionnaire-8 [CLDEQ-8]), and dry eye symptoms (Standardized Patient Evaluation of Eye Dryness [SPEED]) were also evaluated.

Results: This study recruited 73 participants with a mean age of 30.3 ± 11.5 years; 18 % of the participants were male. There were no significant changes in ocular surface signs from baseline or between the artificial tear and rewetting drop groups after two weeks (p ≥ 0.05). Participants in the artificial tear and rewetting drop groups had significant improvements in CLDEQ-8 scores after two weeks of treatment compared with baseline (p < 0.0001), though scores for this test were not significantly different between these groups after two weeks (p = 0.94). CLDEQ-8 scores were significantly better in the artificial tear and rewetting drop groups compared with no treatment after two weeks (p < 0.0001).

Conclusions: Both drops were found to be safe for use with CLs while also significantly improving ocular symptoms compared to no treatment after two weeks of use.
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http://dx.doi.org/10.1016/j.clae.2020.12.004DOI Listing
August 2021

Questioning the association between ABO type and outcomes in patients with COVID-19.

Ann Hematol 2020 Nov 17. Epub 2020 Nov 17.

Division of Laboratory Medicine, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA.

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http://dx.doi.org/10.1007/s00277-020-04348-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7671666PMC
November 2020

Measuring the Contributions of Basal Laminar Deposit and Bruch's Membrane in Age-Related Macular Degeneration.

Invest Ophthalmol Vis Sci 2020 11;61(13):19

Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States.

Purpose: Basal laminar deposit (BLamD) is a consistent finding in age-related macular degeneration (AMD). We quantified BLamD thickness, appearance, and topography in eyes of aged donors with and without AMD and evaluated its relationship to other components of the retinal pigment epithelium-basal lamina/Bruch's membrane (RPE-BL-BrM) complex.

Methods: Donor eyes (n = 132) were classified as normal (n = 54), early to intermediate AMD (n = 24), geographic atrophy (GA; n = 13), and neovascular AMD (NV; n = 41). In high-resolution histology, we assessed RPE, BLamD, and BrM thicknesses and phenotypes at 3309 predefined locations in the central (foveal and perifovea) and superior (perifoveal) sections. Pre-mortem optical coherence tomography (OCT) imaging of a 90-year-old woman was compared to postmortem histopathology.

Results: In non-atrophic areas of AMD eyes, the RPE-BLamD is thick (normal = 13.7 µm, early-intermediate = 16.8 µm, GA = 17.4 µm, NV = 18.7 µm), because the BLamD is thick (normal = 0.3 µm, early-intermediate = 5.5 µm, GA = 4.1 µm, NV = 5.3 µm). RPE layer thickness is similar across these stages. Disease-associated variants of BLamD (thick, late, basal mounds) cluster subfoveally. A thick BLamD is visible on OCT as a hyporeflective split in the RPE-BL-BrM complex. BrM is thin (3.5 µm) in NV (normal = 4.2 µm, early to intermediate = 4.4 µm, and GA = 4.2 µm).

Conclusions: The RPE-BL-BrM complex is thick in AMD, driven by the accumulation and expansion of BLamD rather than expansion of either three-layer BrM, RPE-BL, or RPE. BLamD is clinically appreciable by OCT in some patients as a non-neovascular "split RPE-BL-BrM complex" or "double-layer sign." BLamD may contribute toward the formation and progression of high-risk drusen yet also exhibit protective properties.
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http://dx.doi.org/10.1167/iovs.61.13.19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7671869PMC
November 2020

Publishing Characteristics of Foot and Ankle Research Over a 15-Year Time Interval: A Review of The Journal of Bone & Joint Surgery from 2004 to 2018.

J Bone Joint Surg Am 2020 Oct;102(20):e117

Departments of Orthopaedic Surgery (B.K.A., J.W.H., A.A., B.B.C., S.F.S., A.J.J., G.M., and A.S.) and Epidemiology (G.M.), University of Alabama at Birmingham, Birmingham, Alabama.

Background: As the foot and ankle subspecialty continues to grow in orthopaedics, trends in published literature provide valuable insights to help understand and strengthen the field. The current study evaluates the changes in the characteristics of foot and ankle articles in The Journal of Bone & Joint Surgery (American Volume) (JBJS-A) from 2004 to 2018.

Methods: Foot and ankle-related articles in JBJS-A from 2004 to 2018 were identified and categorized by type of study, level of evidence, number of authors, academic degree(s) of the first and last authors, male and female authorship, number of citations, number of references, region of publication, and use of patient-reported outcomes (PROs).

Results: A total of 336 foot and ankle articles from 2004 to 2018 were reviewed. The type of study published has changed over time, with more clinical therapeutic evidence and less case reports. The level of evidence grades, as rated by JBJS-A and objective evaluators, have increased over the past 15 years. The total number of authors per article has increased, and female authorship has increased significantly. The number of references per article has increased, and the number of citations per year has decreased. The field of foot and ankle surgery has seen an increase in global publications.

Conclusions: The results of this study suggest that the foot and ankle literature that has been published in JBJS-A has continued to increase in quality and diversity over the past 15 years.
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http://dx.doi.org/10.2106/JBJS.20.00367DOI Listing
October 2020

Extended Antibiotic Coverage in the Management of Type II Open Fractures.

Surg Infect (Larchmt) 2020 Oct 16. Epub 2020 Oct 16.

Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.

Responsible antibiotic stewardship requires surgeons treating open fractures to use the narrowest appropriate antibiotic coverage possible to prevent infection. Because inter-observer agreement about the application of the Gustilo-Anderson open fracture classification is moderate at best, antibiotic selection can be overly aggressive. The purpose of this study was to evaluate the outcomes of Type II open fractures treated with gram-positive coverage only (GP) versus broad-spectrum antibiotic coverage (BS) with piperacillin-tazobactam (PT). A retrospective review of all Type II open fractures was performed at a single Level one trauma center over a 5-year period (2013-2017). All patients received prophylactic antibiotics on arrival on the basis of the best judgment of classification by the house officer on call. The final Gustilo-Anderson open fracture classification was assigned intra-operatively by the operating surgeon. Two groups were created, a GP antibiotic group (cefazolin and/or clindamycin) and a BS group (PT). A minimum of 3-month follow-up was required for inclusion. Patient demographics, cost of treatment, fracture-related infection (FRI) rates, and infecting bacteria were assessed. The GP group contained 70 open fractures and the BS group contained 74 open fractures. Between the groups, there were no differences in age, sex, race, Body Mass Index, American Society of Anesthesiologists Class, or smoking status. There were no statistical differences in Injury Severity Score (ISS), fracture location, fixation method, or rates of staged management with external fixation. There was no difference in FRI rate between the GP and BS groups (8.6% versus 10.8%; p = 0.78). The bacteria responsible for FRI were similar in the GP and BS groups. The hospital charge for PT was 4.39 × the cost of cefazolin. The use of BS coverage in Type II open fractures does not result in a lower infection rate and adds significant cost to patient care. These data support the use of a GP-only antibiotic regimen for Type II open fractures.
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http://dx.doi.org/10.1089/sur.2020.300DOI Listing
October 2020

Intrawound Antibiotic Powder in Acetabular Fracture Open Reduction Internal Fixation Does Not Reduce Surgical Site Infections.

J Orthop Trauma 2021 04;35(4):198-204

Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and.

Objectives: To compare the risks of surgical site infection (SSI) and postoperative complications after acetabular fracture open reduction internal fixation (ORIF) in patients receiving topical intrawound antibiotic powder compared with those not receiving antibiotic powder (control group).

Design: Retrospective cohort.

Setting: Level I trauma center.

Patients And Intervention: We reviewed 789 acetabular fracture ORIF cases from 2010 to 2019 at our institution, with mean follow-up of 18 months (3-112 months). Overall, 326 patients comprised the control group and 463 received topical antibiotic powder (294 vancomycin and 169 vancomycin/tobramycin).

Main Outcome Measurement: The study groups were compared for risk of SSI, seroma formation, wound dehiscence, acute kidney injury (AKI), and other postoperative complications.

Results: There were 63 total SSI (8.0%), 50 (6.3%) deep SSI and 13 suprafascial SSI (1.6%) cases. There was no difference in the risk of total SSI (8.3% vs. 7.8%, P = 0.80) or deep SSI (6.1% vs. 6.5%, P = 0.64). This was confirmed by multivariate analysis adjusting for covariates (odds ratio = 0.93; 95% confidence interval, 0.52-1.67; P = 0.80). Similar results were demonstrated when comparing the control group with the vancomycin and vancomycin/tobramycin subgroups. The control group and antibiotic powder groups had similar risks of all outcomes of interest, including seroma formation (1.8% vs. 1.7%, P = 1.00), wound dehiscence (1.2% vs. 2.2%, P = 0.42), total AKI (5.2% vs. 8.2%, P = 0.12), and RIFLE classification AKI (injury; 0.9% vs. 2.2%, P = 0.50).

Conclusions: The addition of topical intrawound antibiotic powder, whether vancomycin alone or vancomycin/tobramycin before closure, does not reduce the risk of SSI after acetabular fracture ORIF compared with standard normal saline irrigation alone.

Level Of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.1097/BOT.0000000000001943DOI Listing
April 2021

Elective spine surgery with continuation of clopidogrel anti-platelet therapy: Experiences from the community.

J Clin Orthop Trauma 2020 Sep-Oct;11(5):928-931. Epub 2020 Jun 7.

University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL, 35205, USA.

Purpose: This retrospective study aimed to assess the feasibility of continuing clopidogrel therapy during the perioperative period in elective cervical and thoracolumbar surgery.

Methods: After IRB approval, medical records of patients requiring one or two-level surgery over a two-year period (2015-2017) while receiving clopidogrel were reviewed for relevant outcomes. Over the same period, a control group of patients not receiving clopidogrel perioperatively was formed.

Result: In total, 136 patients were included: 37 clopidogrel and 99 control, with a mean age of 64.8 years. Between clopidogrel and control respectively, operative time was 86.7 min and 86.7 min (p = 0.620); blood loss was 127.0 cc and 117.5 cc (p = 0.480); drain output was 171.2 cc and 190.7 cc (p = 0.354); length of stay was 1.8 days and 1.5 days (p = 0.103). Two clopidogrel patients and 1 control patient had complications. Two clopidogrel patients and 1 control patient were readmitted within 30 days.

Conclusions: Remaining on clopidogrel therapy during elective spine surgery results in no difference in operative time, blood loss, drain output, length of stay, or readmission. Precaution should be taken in cervical procedures as the drain output in clopidogrel patients was increased and complications in this region can be severe.
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http://dx.doi.org/10.1016/j.jcot.2020.06.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7452213PMC
June 2020

Do Indomethacin or Radiation for Heterotopic Ossification Prophylaxis Increase the Rates of Infection or Wound Complications After Acetabular Fracture Surgery?

J Orthop Trauma 2020 09;34(9):455-461

Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and.

Objectives: To compare the rates of infection and wound complications in patients undergoing operative fixation (ORIF) of acetabular fractures receiving heterotopic ossification (HO) prophylaxis using indomethacin or external beam radiation therapy (XRT) versus no prophylaxis.

Design: Retrospective cohort.

Setting: Level I trauma center.

Patients: We reviewed 473 patients undergoing ORIF of acetabular fractures through posterior, combined, or extensile surgical approaches from 2012 to 2017, with a median follow-up of 13 months (0.5-77 months).

Main Outcome Measurement: Rates of infection and wound complications were stratified according to their HO prophylaxis method into three groups as indomethacin, XRT, and no prophylaxis.

Results: Overall, 167 patients (35.3%) received indomethacin, 104 patients (22.0%) received postoperative XRT, and 202 patients (42.7%) received no prophylactic treatment. There was no difference between the 3 groups for the risk of surgical site infection (P = 0.280). The XRT group had a significantly increased risk of noninfectious wound complications (20.2%) compared with the indomethacin group (6.6%, P = 0.002) and the no prophylaxis group (5.0%, P < 0.0001). Multivariate analysis revealed XRT remained a significant risk factor for noninfectious wound complications compared with no prophylaxis (odds ratio 5.39; 95% confidence interval 2.37-12.22; P < 0.0001).

Conclusions: Although there is no difference between XRT, indomethacin, and no HO prophylaxis for the risk of surgical site infection, the use of XRT results in more than 5 times increased risk of noninfectious wound complications compared with no prophylaxis. This increased risk should be considered when contemplating XRT for HO prophylaxis in acetabular fracture patients.

Level Of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.1097/BOT.0000000000001775DOI Listing
September 2020
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