Publications by authors named "Michael S Pinzur"

129 Publications

Risk Reduction and Perioperative Complications in Patients With Diabetes and Multiple Medical Comorbidities Undergoing Charcot Foot Reconstruction.

Foot Ankle Int 2021 Feb 25:1071100721995422. Epub 2021 Feb 25.

Loyola University Health System, Maywood, IL, USA.

Background: Modern patient safety programs focus on medical optimization of patients prior to surgery, regional anesthesia when possible, and hospitalist-orthopedic co-management during the perioperative period.

Methods: Eighty-five consecutive patients with diabetes and multiple medical comorbidities underwent surgical reconstruction for acquired deformities secondary to Charcot foot arthropathy with circular ring fixation between 2016 and 2019. All patients participated in a standardized risk reduction program that included medical optimization prior to surgery, regional anesthesia whenever possible, and hospitalist-orthopedic co-management during the perioperative period. Charts were retrospectively reviewed for medical comorbidities, complications, and length of stay. The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Risk Calculator was used to retrospectively calculate their predicted perioperative risk.

Results: On multivariable analysis, longer lengths of stay were associated with low preoperative hemoglobin values (rate ratio [RR], 1.36; = .01) and congestive heart failure (RR, 1.42; = .02). There were 22 (26%) complications, though only 10 (12%) were serious. These included acute kidney injury ( = 6), sepsis ( = 2), 1 cardiac event, and 1 pulmonary embolism. Overall, the accuracy of predicting a complication using the ACS NSQIP Risk Calculator was 74% (95% CI, 63%-85%), which was comparable to the accuracy of predicting a complication using only patients' congestive heart failure and pin-tract infection statuses ( = 74%, 95% CI, 62%-86%).

Discussion: Medical optimization of patients with diabetes and multiple medical comorbidities prior to elective complex reconstruction orthopedic surgery allows the surgery to be performed with a predictable risk for perioperative complications. Preoperative anemia and congestive heart failure are associated with longer hospitalizations in this patient group. The ACS NSQIP Risk Calculator appears to be a reliable predictor of complications during the perioperative period. This study demonstrates that reconstructive surgery in this complex patient population can be accomplished with a reasonable exposure to perioperative risk.

Level Of Evidence: Level IV, retrospective case series.
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http://dx.doi.org/10.1177/1071100721995422DOI Listing
February 2021

JBJS Pain Management Research Symposium.

Authors:
Michael S Pinzur

Foot Ankle Int 2020 06 9;41(6):759-760. Epub 2019 Dec 9.

Department of Orthopaedic Surgery & Rehabilitation, Loyola University Health System, Maywood, IL, USA.

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http://dx.doi.org/10.1177/1071100719895255DOI Listing
June 2020

Treatment of Ankle and Hindfoot Charcot Arthropathy.

Authors:
Michael S Pinzur

Foot Ankle Clin 2020 Jun;25(2):293-303

Loyola University Health System, 2160 South First Avenue, Maywood, IL 60153, USA. Electronic address:

It is now well accepted that diabetic patients with clinically and radiographically nonplantigrade Charcot foot arthropathy are best managed with correction of the acquired deformity. Several investigations have demonstrated a high probability for a favorable clinical outcome when the deformity is in the midfoot. Unstable deformity at the subtalar or ankle joints portends a far worse clinical outcome. The goal of this discussion was to describe the author's approach to this highly challenging clinical problem.
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http://dx.doi.org/10.1016/j.fcl.2020.02.010DOI Listing
June 2020

Measuring Clinical Outcomes.

Authors:
Michael S Pinzur

Foot Ankle Int 2020 Oct 16;41(10):1316-1317. Epub 2020 Mar 16.

Department of Orthopaedic Surgery & Rehabilitation, Loyola University Health System, Maywood, IL, USA.

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http://dx.doi.org/10.1177/1071100720913931DOI Listing
October 2020

Clinical Use of Stem Cells.

Authors:
Michael S Pinzur

Foot Ankle Int 2020 08 10;41(8):1027. Epub 2020 Feb 10.

Department of Orthopaedic Surgery & Rehabilitation, Loyola University Health System, Maywood, IL, USA.

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http://dx.doi.org/10.1177/1071100720906413DOI Listing
August 2020

Risk of Complications With the Total Contact Cast in Diabetic Foot Disorders.

Foot Ankle Spec 2021 Feb 31;14(1):25-31. Epub 2019 Dec 31.

Loyola University Medical School, Maywood, Illinois (AR, RL, MW).

The custom-fabricated total contact cast is commonly used in the treatment of diabetic foot disorders. This resource-consuming treatment option has been associated with iatrogenic morbidity as well as the need for urgent cast removal and inspection of the underlying limb when potential problems arise. Over a 10-year period, 381 diabetic patients had 2265 total contact cast applications by certified orthopaedic technologists, in a university orthopaedic practice, under the supervision of university faculty. Patients were stratified by glycemic control based on hemoglobin A1c levels, and obesity based on body mass index (BMI). Complications were grouped as (1) development of a new ulcer or wound, (2) new or increasing odor or drainage, (3) wound infection, (4) gangrene, (5) newly identified osteomyelitis, and (6) pain or discomfort necessitating cast change or removal. At least 1 complication was observed in 159 of 381 patients. The odds of experiencing a cast-related event for patients with a BMI greater than 30 kg/m was 1.55 times greater than patients with a BMI less than 25 kg/m. As compared to patients with good glycemic control, the odds of experiencing a cast-associated complication was 1.27 times greater in patients with moderate glycemic control and 1.48 times greater in patients with poor glycemic control. The total contact cast is commonly used in the treatment of diabetic foot morbidity. Treatment-associated morbidity may well be greater than previously appreciated. Complications are more likely in patients who have poor glycemic control and are morbidly obese. This information will hopefully stimulate interest in developing commercially available nonrigid alternatives that retain the attributes of the resource-consuming rigid device, with the potential advantage of avoiding the associated morbidity.: Level IV, retrospective chart review.
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http://dx.doi.org/10.1177/1938640019895920DOI Listing
February 2021

Superiority Versus Noninferiority.

Foot Ankle Int 2020 05 11;41(5):624-625. Epub 2019 Nov 11.

Public Health Sciences, Loyola University Chicago, Maywood, IL, USA.

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http://dx.doi.org/10.1177/1071100719886571DOI Listing
May 2020

Unproven Billion-Dollar Interventions.

Authors:
Michael S Pinzur

Foot Ankle Int 2020 03 27;41(3):373. Epub 2019 Sep 27.

Department of Orthopaedic Surgery & Rehabilitation, Loyola University Health System, Maywood, IL, USA.

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http://dx.doi.org/10.1177/1071100719879710DOI Listing
March 2020

Pain Management and the Opioid Crisis 2019.

Authors:
Michael S Pinzur

Foot Ankle Int 2019 Sep 1;40(9):1110. Epub 2019 Aug 1.

1 Department of Orthopaedic Surgery & Rehabilitation, Loyola University Health System, Maywood, IL, USA.

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http://dx.doi.org/10.1177/1071100719866197DOI Listing
September 2019

CORR Insights®: What are the Optimal Cutoff Values for ESR and CRP to Diagnose Osteomyelitis in Patients with Diabetes-related Foot Infections?

Authors:
Michael S Pinzur

Clin Orthop Relat Res 2019 07;477(7):1603-1604

M. S. Pinzur, Professor of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Department of Orthopaedics & Rehabilitation, Maywood, IL, USA.

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http://dx.doi.org/10.1097/CORR.0000000000000778DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6999973PMC
July 2019

Bias in Medical Education.

Authors:
Michael S Pinzur

Foot Ankle Int 2020 01 21;41(1):121. Epub 2019 May 21.

Department of Orthopaedic Surgery & Rehabilitation, Loyola University, Health System, Maywood, IL, USA.

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http://dx.doi.org/10.1177/1071100719851795DOI Listing
January 2020

Case-Based Adult Learning.

Authors:
Michael S Pinzur

Foot Ankle Int 2019 Nov 16;40(11):1346-1347. Epub 2019 May 16.

Department of Orthopaedic Surgery & Rehabilitation, Loyola University Health System, Maywood, IL, USA.

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http://dx.doi.org/10.1177/1071100719850101DOI Listing
November 2019

The Board Certification Process.

Authors:
Michael S Pinzur

Foot Ankle Int 2019 Jul 17;40(7):866-867. Epub 2019 Mar 17.

1 Department of Orthopaedic Surgery & Rehabilitation, Loyola University Health System, Maywood, IL, USA.

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http://dx.doi.org/10.1177/1071100719838489DOI Listing
July 2019

Ankle fusion following failed initial treatment of complex ankle fractures in neuropathic diabetics.

Foot Ankle Surg 2020 Feb 5;26(2):189-192. Epub 2019 Feb 5.

The Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, 2160 South First Avenue, Maywood, IL 60153, United States. Electronic address:

Background: Unstable ankle fractures in diabetics with peripheral neuropathy have an increased risk of postoperative complications, often leading to amputation. Primary ankle arthrodesis has been suggested as an alternative when acceptable reduction and mechanical stabilization cannot be obtained.

Methods: Over a fourteen year period, thirteen diabetic patients with peripheral neuropathy underwent an attempt at primary ankle arthrodesis following the early post-fracture development of acute neuropathic (Charcot) deformity of the ankle after sustaining a low energy unstable ankle fracture. Eight patients with open wounds and osteomyelitis underwent single stage debridement of the osteomyelitis and primary ankle fusion with an ankle fusion construct circular external fixator. Five patients without evidence of infection underwent primary arthrodesis with a retrograde locked intramedullary nail used for fixation. A successful clinical outcome was achieved with either successful radiographic arthrodesis or stable pseudarthrosis, when community ambulation was achieved with commercially-available therapeutic footwear and a short ankle orthosis.

Results: Eight of the thirteen patients achieved a successful clinical outcome at a mean follow-up of 48 (range 12-136) months following the initial surgery. Three achieved clinical stability following a second surgery and one following a third. One patient with radiographic nonunion expired due to unrelated causes. One patient underwent transtibial amputation due to persistent infection. Of the five patients with failure of radiographic union, three successfully ambulated in the community with a short ankle orthosis. Postoperative complications included wound and pin-site infection, infected nonunion, chronic wounds, and tibial stress fracture.

Conclusion: In spite of the high risk for complications and initial failure, primary ankle fusion is a reasonable option for diabetic neuropathic patients who develop acute neuropathic arthropathy following ankle fracture.

Level Of Evidence: Level IV retrospective case series.
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http://dx.doi.org/10.1016/j.fas.2019.01.010DOI Listing
February 2020

Ethics and Disclosure.

Authors:
Michael S Pinzur

Foot Ankle Int 2019 Mar 30;40(3):364. Epub 2019 Jan 30.

1 Department of Orthopaedic Surgery & Rehabilitation, Loyola University Health System, Maywood, IL, USA.

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http://dx.doi.org/10.1177/1071100719826957DOI Listing
March 2019

Evaluation of a Simplified Risk Stratification Twice-Daily Aspirin Protocol for Venous Thromboembolism Prophylaxis After Total Joint Replacement.

J Pharm Pract 2020 Aug 20;33(4):443-448. Epub 2018 Dec 20.

Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL, USA.

Objective: To determine using a simplified risk-stratified protocol to select candidates for aspirin therapy have similar death and postoperative complications as universal warfarin therapy in patients undergoing total joint replacement (TJR).

Methods: Retrospective cohort study comparing 30-day postoperative outcomes 6 months before and after the implementation of the aspirin protocol (January 1, 2015) in patients undergoing TJR. The control group was comprised of patients using warfarin for VTE prophylaxis. The protocol group included patients who used aspirin 325 mg twice-daily or warfarin if deemed high thrombotic risk or aspirin intolerant by the criteria set forth by the aspirin protocol.

Results: This study included 449 patients. No difference was found in the rates of 30-day postoperative bleeding, VTE, death, composite end point of VTE and death, and length of stay between the control and the protocol groups (all > .05). Thirty-day postoperative surgical site infections (SSIs; 5.8% vs 1.2%; = .02) and return to operative room (OR; 3.9% vs 0.4%; = .03) were less frequent in the protocol group.

Conclusion: A simplified risk-stratified protocol used to choose patients for aspirin 325 mg twice-daily therapy is safe and effective in patients undergoing TJR, and SSI and return to OR rates may be lower when compared to universal warfarin therapy.
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http://dx.doi.org/10.1177/0897190018815050DOI Listing
August 2020

The Medical Optimization Clinic.

Authors:
Michael S Pinzur

Foot Ankle Int 2019 May 19;40(5):611-612. Epub 2018 Dec 19.

1 Department of Orthopaedic Surgery & Rehabilitation, Loyola University Health System, Maywood, IL, USA.

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http://dx.doi.org/10.1177/1071100718816069DOI Listing
May 2019

Deformity and Clinical Outcomes Following Operative Correction of Charcot Ankle.

Foot Ankle Int 2019 Feb 10;40(2):145-151. Epub 2018 Dec 10.

1 Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, Maywood, IL, USA.

Background:: Deformity associated with Charcot foot arthropathy leads to a poor quality of life in affected individuals. Deformity in the midfoot appears to be predictive of clinical outcomes following operative correction. The goal of this retrospective study was to determine if that same methodology could be applied to patients treated for Charcot foot arthropathy involving the ankle joint.

Methods:: Fifty-six consecutive patients underwent operative reconstruction of Charcot foot deformity involving the ankle joint by a single surgeon over a 14-year period. Preoperative patient characteristics and tibiotalar alignment, were recorded. Surgical treatment included single-stage debridement of active infection and ankle arthrodesis with application of a circular external fixator when infection was present (39 of 56, 69.6%) or retrograde locked intramedullary nailing in the absence of infection (17 of 56, 30.3%). Clinical outcomes were graded based on limb salvage, resolution of infection and chronic wounds, and the ability to ambulate with therapeutic footwear or accommodative orthoses. The average follow-up was 7.5 (range 1.1-14.0) years.

Results:: One patient died at 134.3 weeks following surgery of unrelated causes and 8 underwent amputation. Twenty-eight of 56 patients (50.0%) achieved a favorable (excellent or good) clinical outcome. There was no significant association between pre- or postoperative alignment and clinical outcomes. Insulin-dependent diabetics were approximately 3 times more likely to have a poor clinical outcome.

Conclusions:: Operative correction of Charcot deformity involving the ankle joint was associated with a high complication rate and risk for failure. The lessons learned from this highly comorbid patient population with complex deformities can be used as a benchmark for applying modern surgical techniques.

Level Of Evidence:: Level IV, case series.
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http://dx.doi.org/10.1177/1071100718805076DOI Listing
February 2019

High Tech Solutions.

Authors:
Michael S Pinzur

Foot Ankle Int 2019 Jan 11;40(1):120. Epub 2018 Sep 11.

1 Department of Orthopaedic Surgery & Rehabilitation, Loyola University Health System, Maywood, IL, USA.

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http://dx.doi.org/10.1177/1071100718797615DOI Listing
January 2019

The Peer Review Process.

Authors:
Michael S Pinzur

Foot Ankle Int 2018 11 11;39(11):1383-1384. Epub 2018 Sep 11.

1 Department of Orthopaedic Surgery & Rehabilitation, Loyola University Health System, Maywood, IL, USA.

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http://dx.doi.org/10.1177/1071100718797614DOI Listing
November 2018

Best Available Evidence.

Authors:
Michael S Pinzur

Foot Ankle Int 2018 09 21;39(9):1133. Epub 2018 Jun 21.

1 Department of Orthopaedic Surgery & Rehabilitation, Loyola University Health System, Maywood, IL, USA.

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http://dx.doi.org/10.1177/1071100718782464DOI Listing
September 2018

The Numbers Game.

Authors:
Michael S Pinzur

Foot Ankle Int 2018 07 22;39(7):880. Epub 2018 May 22.

1 Department of Orthopaedic Surgery & Rehabilitation, Loyola University Health System, Maywood, IL, USA.

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http://dx.doi.org/10.1177/1071100718778541DOI Listing
July 2018

Improvement in Quality of Life Following Operative Correction of Midtarsal Charcot Foot Deformity.

Foot Ankle Int 2018 07 2;39(7):808-811. Epub 2018 Apr 2.

1 Department of Orthopaedic Surgery & Rehabilitation, Loyola University Health System, Maywood, IL, USA.

Background: Patients with Charcot foot arthropathy report a poor quality of life following the development of deformity. Their quality of life is often not improved with "successful" historic accommodative treatment. There is increased current interest in operative correction of the acquired deformity with the stated goals of achieving both the traditional goals of resolution of infection and limb salvage as well as the desire to improve quality of life. The Short Musculoskeletal Functional Assessment (SMFA) outcomes instrument appears to be a valid tool for evaluating this complex patient population.

Methods: Twenty-five consecutive patients undergoing operative reconstruction for nonplantigrade midtarsal Charcot foot arthropathy completed the SMFA patient-reported outcomes instrument prior to surgery, with 24 completing it at 1 year following the surgery. One patient died during the year following surgery from unrelated causes.

Results: There was an 11.5-point (95% confidence interval [CI]: -19.7 to -3.2) decrease in the standardized functional index ( P = .01). Similarly, there was a 12.4-point (95% CI: -22.5 to -2.3) decrease in the standardized bother index ( P = .02). The standardized daily activity index demonstrated a 19.6-point decrease (95% CI: -30.5 to -8.6, P = .002), and there was a 14.7-point (95% CI: -24.1 to -5.3) decrease in the standardized emotion index ( P = .004). There was no meaningful change in the standardized arm/hand index ( P = .81).

Conclusion: The results of this investigation demonstrate that successful operative reconstruction of midtarsal Charcot foot arthropathy improved quality of life. This supports the modern paradigm shift from immobilization during the active phase of the disease process followed by simple accommodation of the acquired deformity to the modern interest in operative correction to allow the use of commercially available therapeutic footwear.

Level Of Evidence: Level IV, case series.
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http://dx.doi.org/10.1177/1071100718762138DOI Listing
July 2018

CORR Insights®: Are Gait Parameters for Through-knee Amputees Different From Matched Transfemoral Amputees?

Authors:
Michael S Pinzur

Clin Orthop Relat Res 2019 04;477(4):826-828

M. S. Pinzur, Professor of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL, USA.

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http://dx.doi.org/10.1007/s11999.0000000000000266DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6437363PMC
April 2019

University-Based Residency Training.

Authors:
Michael S Pinzur

Foot Ankle Int 2018 05 12;39(5):636. Epub 2018 Mar 12.

1 Department of Orthopaedic Surgery & Rehabilitation, Loyola University Health System, Maywood, IL, USA.

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http://dx.doi.org/10.1177/1071100718762779DOI Listing
May 2018

Surgical Management of Charcot Arthropathy.

Instr Course Lect 2018 Feb;67:255-267

Orthopaedic Surgeon, OrthoCarolina Foot & Ankle Institute, Clinical Faculty and Fellowship Director, Carolinas Medical Center, Charlotte, North Carolina.

The historic management of Charcot foot arthropathy has consisted of immobilization until the active phase of the disease resolves, followed by longitudinal accomodative bracing of the acquired deformity. This historic management of Charcot foot arthropathy has not resulted in improved quality of life and has fostered interest in the surgical correction of the acquired deformity. Orthopaedic surgeons should understand the current indications for the surgical management of and the specific surgical techniques to correct acquired deformities in patients with Charcot foot and ankle disorders.
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February 2018

Burden of Disease.

Authors:
Michael S Pinzur

Foot Ankle Int 2018 03 6;39(3):387. Epub 2018 Feb 6.

1 Department of Orthopaedic Surgery & Rehabilitation, Loyola University Health System, Maywood, IL, USA.

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http://dx.doi.org/10.1177/1071100718756009DOI Listing
March 2018