Margaret D. Bs Fisher

Objectives: Assess mortality and complications in patients with chronic kidney disease (CKD) after fixation of lower extremity fractures. Design: Retrospective cohort. Setting: Single academic level 1 trauma center. Patients: Four hundred seventy-six patients with CKD and operative lower extremity fractures (pelvis to ankle). Intervention: Patients were grouped according to preoperative glomerular filtration rate (GFR) per the National Kidney Foundation Guidelines. Patients with moderate-to-severe CKD and end stage renal disease (ESRD) were compared with those with predisease state CKD. Outcome Measurements: Mortality and complication rates at time points up to 2 years or until death. Results: Patients with predisease state CKD were significantly less likely to have a complication within 2 years than patients with ESRD but not patients with moderate-to-severe CKD. One-year and 2-year mortality rate were significantly higher in the moderate-to-severe CKD (36.1%) and ESRD (49.0%) groups than in the predisease state CKD group. Compared to the patients with predisease state CKD, patients with moderate-to-severe CKD and ESRD both had increased odds of 1-year mortality, 2-year mortality, and a complication at 2 years after operative fixation of a lower extremity fracture. Patients with ESRD also had increased odds of 30-day and 90-day mortality compared with patients with predisease state CKD. Conclusions: Compared to patients with predisease state CKD, patients with moderate-to-severe CKD and ESRD had increased odds of 1-year mortality and 2-year mortality, as well as a complication at 2 years. Patients with ESRD had increased odds of 30-day and 90-day mortality compared with patients with predisease state CKD. Two-year mortality rate was 49% in the ESRD group. Level of Evidence: Therapeutic level III.

Background: Radial sensory nerve (RSN) injuries occur during common surgical procedures or injuries to the wrist and often result in the formation of painful neuromas. Management strategies of primary repair or secondary reconstruction are limited by poor patient satisfaction. We present a targeted muscle reinnervation (TMR) technique, its clinical outcomes, and a novel classification system for the treatment of recalcitrant RSN neuromas with transfer of the RSN to the anterior interosseous nerve (AIN). Methods: Cadaveric specimens were used to devise a classification system for transfer. RSN to AIN transfer was performed after simulated injury at three levels: proximal, at, and distal to the bifurcation. Transfer was performed in five patients with symptomatic recalcitrant RSN neuromas. Clinical and patient-reported outcomes were prospectively collected for one year. Results: A cadaveric classification system was devised to guide nerve transfer. Five patients underwent RSN to AINN transfer for symptomatic recalcitrant RSN neuromas. The mean visual analog scale (VAS) pain score significantly improved by 6 ± 2 points. The mean Quick Disabilities of Arm, Shoulder, & Hand (DASH) scores significantly improved by 37 ± 11 points. The wrist flexion/extension arc significantly improved by 30 ± 14 °, and the radial/ulnar deviation arc significantly improved by 10 ± 3 degrees. Conclusions: Our classification system can guide intraoperative decision-making for RSN to AIN transfer based on the zone of RSN injury. RSN to AIN transfer resulted in significant improvement in QuickDASH and VAS Pain scores that exceeded the established thresholds for substantial clinical benefit.