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While the roots of burn care date back several millennia, recognition and treatment of psychiatric trauma has had a more contemporary journey. Our understanding of burn care has evolved largely separately from our understanding of psychiatry; however, proper care of the burn patient relies on the comprehension of both disciplines. Historically, high burn mortality rates have caused clinicians to focus on the physiological causes of burn mortality. As burn care improved in the 20th century, providers began to focus on the long-term health outcomes of burn patients, including mitigating mental health consequences of trauma. This shift coincided with advances in our understanding of psychological sequelae of trauma. Subsequently, an association between burn trauma and mental illness began to emerge. The current standard of care is the result of thousands of years of evolving practices and theories, yet our understanding of the pathophysiology of depression among survivors of severe burn injury is far from complete. By taking measure of the past, we aim to provide context and evidence for our current standards and emphasize areas for future lines of research.

Category: Ankle Arthritis; Ankle Introduction/Purpose: Total Ankle Replacement (TAR) has rapidly grown in popularity over the last fifteen years as a treatment for ankle arthritis. With this growth, it is imperative to understand risk factors that may predispose patients to complications following the procedure. This information can be valuable in generating treatment plans and facilitating conversation regarding risks and benefits of those plans. Current literature on TAR-related outcomes is limited in timeframe and scope and does not investigate the association of diabetes with common post operative complications. The objective of this study was to perform a retrospective database analysis to quantify the risk of 90-day complications in patients with diabetes undergoing TAR when compared to patients without diabetes undergoing TAR. Methods: The TriNetX database was utilized for this study. Patients who underwent TAR were identified and stratified by those with a history of diabetes mellitus and those without a history of diabetes mellitus of any type. The cohorts were 1:1 propensity matched based on demographic information and medical history. The 90-day complication rates for readmission, inpatient service use, opioid use, anesthesia use, periprosthetic fracture, deep vein thrombosis, and wound dehiscence were calculated using chi-square analysis. Results: n=5,984 TAR patients were identified. 52% were male and 48% female with mean age of 73±10 years. There was a n=1,331 patients in each the patients with diabetes and without diabetes groups after cohort analysis and propensity matching. TAR patients with diabetes had a significantly higher 90-day odds ratio of inpatient service use (OR: 1.675, 95% CI 1.3082-2.144; p< 0.001). There was no significant difference between groups in opioid use (OR: 1.13, 95% CI 0.941-1.357; p=0.1908), anesthesia use (OR: 1.335, 95% CI 0.906-1.965; p=0.1424), and wound dehiscence (OR: 1.313, 95% CI 0.829-2.08; p=0.2445); Table 1. There was insufficient data to determine the role of diabetes on critical care services, periprosthetic fracture, and DVT within 90 days of TAR. Conclusion: TAR is a developing operation for ankle arthritis and little data exists on diabetes related perioperative complications. The results of this study show that although diabetes is significantly associated with a higher rate of inpatient service use, it may not have as large a role in opioid use, anesthesia use, and wound dehiscence in the immediate postoperative period. More information is still needed to address long term outcomes and the role diabetes plays in other postoperative complications.

Studies conflict on the significance of burn-induced coagulopathy. We posit that burn-induced coagulopathy is associated with injury severity in burns. Our purpose was to characterize coagulopathy profiles in burns and determine relationships between % total burn surface area (TBSA) burned and coagulopathy using the International Normalized Ratio (INR). Burned patients with INR values were identified in the TriNetX database and analyzed by %TBSA burned. Patients with history of transfusions, chronic hepatic failure, and those on anticoagulant medications were excluded. Interquartile ranges for INR in the burned study population were 1.2 (1.0–1.4). An INR of ≥ 1.5 was used to represent those with burn-induced coagulopathy as it fell outside the 3rd quartile. The population was stratified into subgroups using INR levels <1.5 or ≥1.5 on the day of injury. Data are average ± SD analyzed using chi-square; p < .05 was considered significant. There were 7,364 burned patients identified with INR <1.5, and 635 had INR ≥1.5. Comparing TBSA burned groups, burn-induced coagulopathy significantly increased in those with ≥20% TBSA; p = .048 at 20–29% TBSA, p = .0005 at 30–39% TBSA, and p < .0001 for 40% TBSA and above. Age played a significant factor with average age for those with burn-induced coagulopathy 59 ± 21.5 years and 46 ± 21.8 for those without (p < .0001). After matching for age, TBSA, and demographics, the risk of 28 day-mortality was higher in those with burn-induced coagulopathy compared to those without (risk difference 20.9%, p < .0001) and the odd ratio with 95% CI is 4.45 (3.399–5.825). Investigation of conditions associated with burn-induced coagulopathy showed the effect of heart diseases to be significant; 53% of patients with burn-induced coagulopathy had hypertension (p < .0001). Burn-induced coagulopathy increases with %TBSA burned. The information gained firmly reflects a link between %TBSA and burn-induced coagulopathy, which could be useful in prognosis and treatment decisions.

Introduction : Scheuermann’s disease is a diagnosis of hyperkyphosis commonly encountered in pediatric patients. Studies in animal models suggest an association with vitamin D deficiency, however, extensive studies have not been performed in humans. This study analyzes the role of vitamin D deficiency on unfavorable results in patients with Scheuermann’s disease. Methods : The TriNetX database was utilized to perform a retrospective analysis. Patients in the United States aged 0–18 years with Scheuermann’s disease were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes and categorized into those with and without a diagnosis of vitamin D deficiency. Comparison of patient groups depending on age, sex, ethnic origin, prior diagnosis of fibromyalgia, anxiety disorder, myositis, and major depressive disorder. Statistical analysis was conducted to identify the association between vitamin D levels and unfavorable results including pain, depression, suicide attempt, emergency department (ED) consult, hospitalization, and procedures on the spine or spinal cord. Results : In total, 11,277 patients were identified, 39% of whom had a concurrent diagnosis of scoliosis. A total of 1,024 (9.08%) were deficient in vitamin D. Patients with vitamin D deficiency had greater odds of pain ( P  < 0.0001), depression ( P  < 0.0001), suicide attempt ( P  = 0.0021), ED visits ( P  = 0.0246), and hospital admission ( P  < 0.0015). Conversely, patients with vitamin D deficiency had decreased odds of surgery on the spine or spinal cord ( P  = 0.0009). Conclusion : Vitamin D deficiency is associated with an elevated risk of pain, depression, suicide attempts, ED visits, and hospitalization. Our analysis highlights the need for more research to study the effect of vitamin D on Scheuermann’s disease. Level of evidence : Level III, Prognostic

Category: Ankle; Diabetes; Midfoot/Forefoot Introduction/Purpose: Osteomyelitis is an invasive infection of the bone that commonly afflicts patients with diabetes mellitus. This bacterial infection can lead to the need for amputation of portions of the foot or ankle. While the association between Osteomyelitis and amputation has been studied, little is known about additional underlying health conditions that can predispose diabetic patients to an increased risk of amputation. Understanding these relationships will be useful in early screening to prevent severe effects associated with the loss of the foot or ankle. Thus, a retrospective analysis was performed using EMR data to evaluate the effect of prior Peripheral Vascular Disease (PVD) or Neuropathy on amputations in Type 2 DM patients with Osteomyelitis. Methods: Patients with Type 2 Diabetes Mellitus and Osteomyelitis who had a foot or ankle amputation within 12 weeks of diagnosis, compared to those who also had PVD or neuropathy were identified. This was done in the EMR database using ICD 10 codes for Osteomyelitis (M86), Type 2 Diabetes Mellitus diagnosis (E11), Foot or Ankle amputations (1005524, 1005529, 28810, 1005525, 28805, 1800300006, 371186005, 180040009, 726651003, 723726002, 723731000, 180038004, 78785006, 28800, 180157006, 723312009, 773821000, 773819005, 397218006), Peripheral Vascular Diseases (I73), and Neuropathy (G62). We then stratified these patients by age (18-29, 30-39, 40-49, 50-59, 60-69,70-79, 80-89), gender (male, female), and year by decade (2001, 2010, and 2020). Results: Our search identified 125,741 patients with T2DM and Osteomyelitis, of whom 10,850 had a foot or ankle amputation within 3 months of diagnosis. 28,242 patients with T2DM, Osteomyelitis, and prior PVD were identified. These patients were found to be 2.6 times more likely to receive a foot or ankle amputation. 12,860 patients with prior Neuropathy were identified.. These patients were found to have 1.36 times more likely to receive a foot or ankle amputation. When stratified by gender, Women were found to be at greater risk of Amputation than Men, for both prior PVD and Neuropathy (2.9 vs 2.47 times greater risk, respectively). Age stratification revealed patients aged 50-59 have the highest risk for a foot or ankle amputation (10% higher risk). This was more than triple the risk seen in patients aged 18-29. The above differences were found to be statistically significant at a p-value of <.0001. Conclusion: This analysis provides insight into the pre-disposing risk factors of Foot and Ankle amputations in patients who have Type 2 Diabetes Mellitus and Osteomyelitis. Of the two risk factors analyzed, Peripheral Vascular Disease was associated with the highest risk of amputation. Overall, females and patients aged 50-59 are at the highest risk of amputation with underlying PVD. As comorbidities become more frequent and the number of foot or ankle amputations continues to rise since 2001, more research on associated risk factors will be necessary to more effectively screen these patients.

Category: Ankle; Hindfoot; Midfoot/Forefoot Introduction/Purpose: Antibiotic resistance has quickly become one of the most pressing current public health challenges. Many studies have analyzed general prescription trends, but little information exists about how antibiotic therapy is utilized in orthopedic practice- particularly in patients with Osteomyelitis of the Ankle and Foot. Thus, a retrospective analysis was performed using EMR data to understand temporal tends in antibiotic use, as well as the impact of patient-specific factors on antibiotic use. Methods: Patients with Osteomyelitis of the Ankle and Foot who were given antibiotics within 12 weeks of their diagnosis were identified in the EMR database using ICD 10 codes (M86.17, M86.67, M86.8X7, M86.171, M86.172, M86.27, M86.679, M86.279, M86.671, M86.672, M86.07, M86.271, M86.37) for foot and ankle Osteomyelitis and the VA Drug Classification Code (AM000) for antibiotics. We then stratified these patients by age (0-9, 10-19, 20-29, 30-39, 40-49, 50-59, 60-69,70-79, 80-89, 90-99), gender (male, female), and year by decade (2001, 2010, 2020). In addition, pre-disposing risk factors of Osteomyelitis, such as Diabetes, Hypertension, and Chronic Ischemic Heart Disease, were analyzed for association with antibiotic use. Results: Our search identified 85,767 patients, of whom 50,043 (58.35%) received antibiotics within 12 weeks of Osteomyelitis diagnosis. Overall, Males (60.01%) were slightly more likely than Females (54.88%) to use antibiotics. Stratification by age revealed a skewed distribution with the highest incidence of antibiotic use seen in 50-59 year-olds (61.93%). This was more than double the incidence of antibiotic use seen among 20-29 year-olds (30.63%). Additionally, we discovered notable increases in antibiotic usage over time. The most substantial increases occurred from 2001 to 2010 (14.08% to 33.71%, respectively) and 2010 to 2020 (33.71% to 60.51%, respectively). Lastly, patients with pre-existing co-morbidities were found to have a higher usage of antibiotics, when compared to patients without the co-morbidity. Specifically, prior Hypertension increased use by 11.73%, followed by Chronic Ischemic Heart Disease (10.50% increase) and Diabetes (8.40% increase). The above differences were found to be statistically significant at a p-value of <.0001. Conclusion: This analysis provides insight into present and past antibiotic usage in patients with Foot and Ankle Osteomyelitis. Overall, patients aged 50-59, males, and with Chronic Ischemic Heart Disease are the most likely to take antibiotics within 12 weeks of their diagnosis. This is all against the background of rising antibiotic use, with notable increases since 2001. The data necessitates a deeper look into antibiotic use in patients with foot and ankle injuries as a whole.

Abstract Purpose: To compare T1DM as a risk factor for various complications of arthroscopic hip surgery, including infection, wound dehiscence, septic arthritis, heterotopic ossification, deep vein thrombosis (DVT), emergency department (ED) visits, readmission, need for a total hip replacement, and mortality. Methods: Utilizing deidentified patient records from the TriNetX database, this retrospective study analyzed 67,493 patients who underwent hip arthroscopy from January 1, 2018, to January 1, 2023. Patients were categorized into cohorts based on T1DM status, and propensity score matching was employed for age, gender, ethnicity, race, and comorbidities. Chi-square analysis and logistic regression were used to assess the relationship between T1DM and complications within 90 days post-surgery, as well as 1 and 2-year outcomes. Results: Patients with T1DM (n=5,997) exhibited significantly higher odds of infection, wound dehiscence, septic arthritis, DVT, ED visits, readmissions, and mortality within 90 days post-hip arthroscopy compared to those without T1DM (p<0.05). Similar trends were observed at 1 and 2 years, with increased odds of total hip replacement and mortality (p<0.05). Notably, T1DM patients had decreased odds of heterotopic ossification (p= 0.0003). Conclusion: Patients with T1DM demonstrated significantly elevated rates of postoperative complications, including infections, wound issues, and mortality, following hip arthroscopy.