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4. Outcomes and Complications of Wright Medical INVISION Talus for Complex Total Ankle Arthroplasty

Author

Yvonne C. Conway MD, Spenser Cassinelli MD, Scott Whitlow MD, and Gregory A. Lundeen MD, MPH

Subjects
Orthopedic surgery, RD701-811
Abstract

Category: Ankle Arthritis; Ankle Introduction/Purpose: The INVISION Total Ankle Arthroplasty System (Wright Medical Technology/Stryker) is a modular ankle arthroplasty used for patients with limited bone stock. There is limited early survivorship and clinical outcomes data for this device. The aim of this study is to report on early implant survivorship and complications specifically with regards to the talar component of the INVISION Total Ankle System performed in complex and revision total ankle replacements. Methods: This is a single-institution retrospective review of patients who underwent TAA using the INVISION talus implant between 2018 and 2023. INVISION was chosen in cases with significant talar bone loss. Demographics, reoperation, complications, and radiographic data were collected. Immediate postoperative images were used to measure the height of bone remaining underneath the talar tray at the thinnest remaining portion of the posterior talus. A total of 8 components in 7 different patients that underwent INVISION talar component placement met inclusion criteria with a mean follow-up of 105 weeks. Patient demographics consisted of 71% female(n=5), 29% male(n=2) with mean age of 56 years old. The INVISION talar component was used as a primary implant to address severe AVN of the talus (n= 3), and as a revision talar component to address post infection bone loss (n= 3) and failed total ankle arthroplasty due to aseptic loosening/osteolysis/subsidence (n = 2). Results: Talar implant survivorship was 88%. One patient had implant failure resulting in conversion to a total talus due to loss of fixation of the talar component. Another patient developed a stress fracture 2 years postoperatively in the posterior talus (Figure 1.C) that was successfully treated with a subtalar fusion. The average measured minimum posterior talus thickness underneath the tray for all patients was 4.6mm (range 0.5mm – 10.0 mm). This measurement was not able to be obtained for one patient with a prior subtalar fusion due to talar continuity with calcaneus. In the two patients that had either implant failure or required reoperation, the talar thickness measured 0.5mm and 2.9mm, respectively. None of the implants with greater than 3mm had loss of fixation or ingrowth. Conclusion: The INVISION talus tray is a reliable option for addressing severe talar bone loss in TAA. We caution surgeons using this implant if there is < 3 mm of bone height in the posterior talus. Although the pegs of the talar plate are primarily fixated anterior within the talus, the tray appears to rely on the entire length of the talus to distribute the weightbearing forces. If a surgeon measures >3mm posterior talar height underneath the talar plate, alternative treatments such as subtalar fusion in conjunction with the INVISION talar component placement or total talus should be considered.

Published
2024
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5. Decontamination Points: An Antiquated Graphic Control Planning Measure?

Author

Weddington, Spenser C.

Subjects
Decision-making -- Analysis, Chemicals, plastics and rubber industries, Military and naval science
Abstract

While serving in the Protection Directorate, G-34, 8th Army, I participated in my first combined command post training event at Camp Humphreys, Korea. The event simulated the Notional Joint Combat [...]

Published
2021

6. Colaboradores

Author

Aaronson, Emily L., Abbott, Ethan E., Abraham, Gallane, Abraham, Michael K., Agrait-Gonzalez, Miguel, Akhtar, Saadia, Aks, Steven E., Atchinson, Patricia Ruth, Auerbach, Marc, Aufderheide, Tom P., Bakes, Katie, Banks, Laura L., Barksdale, Aaron N., Barrett, Whitney, Becker, Bruce M., Ma, Zheng Ben, Biese, Kevin, Biros, Michelle H., Bitterman, Robert A., Blackwell, Thomas H., Blum, Frederick C., Blumen, Ira J., Bolgiano, Edward B., Bond, Michael C., Bookman, Kelly, Borhart, Joelle, Boswell, Brittany, Brady, William J., Braithwaite, Sabina A., Brody, Aaron, Brown, Calvin A., III., Brown, David F.M., Brown, James E., Buchanan, Jennie Alison, Bukhman, Alice Kidder, Bullard-Berent, Jeffrey, Bunney, E. Bradshaw, Burton, John H., Caglar, Derya, Cahill, John D., Carlberg, David J., Chang, Andrew K., Chary, Michael A., Chen, Paul, Chumpitazi, Corrie E., Cico, Stephen John, Claudius, Ilene, Coates, Wendy C., Cole, Jon B., Colwell, Christopher B., Corbin, Theodore, Cooper, Robert, Corwell, Brian Niall, Curtis, Amelia M., D’Andrea, Shawn, Danzl, Daniel F., Davenport, Moira, Davis, Alysa S., Davis, Jonathan, Davis, Natalie L., Daya, Mohamud R., DeGeorge, Lindsey M., Derlet, Robert W., Dobiesz, Valerie A., Dupré, Alan A., Duran-Gehring, Petra, Easter, Joshua S., Edwards, Christopher J., Eilbert, Wesley P., Eiting, Erick, Elie-Turenne, Marie-Carmelle, Erickson, Timothy B., Eyre, Andrew J., Fairley, Romeo, Farrell, Susan E., Fath, John J., Fernandez-Frackelton, Madonna, Finnell, John T., Franco, Vanessa, Frazee, Bradley W., Friedman, Benjamin W., Gaddy, Jeremiah D., Ganetsky, Michael, Gausche-Hill, Marianne, Geiderman, Joel M., Germann, Carl A., Glass, George F., III., Glauser, Jonathan M., Godwin, Steven A., Goldberg, Scott A., Goodloe, Jeffrey M., Gorgas, Diane L., Green, Thomas J., Grossman, Shamai A., Guluma, Kama, Guttman, Joshua, Haas, Nathan L., Haines, Elizabeth J., Hajicharalambous, Christina, Hall, Matthew M., Halmo, Laurie Seidel, Hansoti, Bhakti, Harris, N. Stuart, Harrison, Nicholas, Hart, Danielle, Hatten, Benjamin W., Heine, Carlton E., Heiner, Jason D., Henn, Megan C., Hern, H. Gene, Jr., Hess, Jamie M., Hill, Adam D., Himelfarb, Nadine T., Hockberger, Robert S., Hogrefe, Christopher, Holland, Carolyn Kluwe, Holmes, James F., Hoppe, Jason A., Horeczko, Timothy, Hoyte, Christopher, Hsieh, Dennis, Hudson, Korin, Huesgen, Karl, Hwang, Ula, Iserson, Kenneth V., Iwanicki, Janetta L., Jagoda, Andy, James, Thea, Jewell, Corlin, Johnson, Nicholas J., Jones, Alan E., Jones, Emily M., Jouriles, Nicholas J., Kabrhel, Christopher, Kaide, Colin G., Kaji, Amy H., Kaplan, Julius (Jay) A., Kayden, Stephanie, Kearney, Ryan D., Kelly, Matthew P., Kim, Hyung T., Kivlehan, Sean M., Koenig, Kristi L., Kosowsky, Joshua M., Koval, Christine E., Koyfman, Alex, Kurz, Michael C., Lall, Michelle D., Lang, Spenser C., Lee, Jeffrey E., Lei, Charles, Levine, Michael D., Levy, Matthew J., Levy, Phillip D., Lim, Christopher S., Lindberg, Daniel, Lipsky, Ari M., Liu, J. Marc, Long, Brit, Macias-Konstantopoulos, Wendy, Maciel, Carolina Barbosa, Maher, Patrick J., Maloney, Gerald E., Jr., Maloney, Patrick J., Marco, Catherine Anna, Marill, Keith A., Martinez, Joseph P., Matlock, Aaron G., Mayersak, Ryanne J., May, Larissa S., McCoin, Nicole S., McCurdy, Michael T., McKinzie, Jeffry, Meaden, Christopher W., Meehan, Timothy J., Mehta, Niyati, Meurer, William J., Mick, Nathan W., Miloslavsky, Eli M., Miner, James R., Mohr, Nicholas M., Moll, Joel, Monas, Jessica, Monte, Andrew A., Montgomery, Martha M., Moore, Malia J., Moran, Gregory J., Mycyk, Mark B., Nable, Jose V., Nagler, Joshua, Nassisi, Denise, Nathan, Joshua B., Nelson, Lewis S., Nelson, Michael E., Newton, Kim, Nguyen, Thomas, Nicholson, Adam M., Nickels, L. Connor, Nikolaides, Jenna Karagianis, Nite, Micah J., Nitzberg, Michael, Norman, Marquita S., Norse, Ashley Booth, Nowak, Richard M., Ogunniyi, Adedamola A., Overbeek, Daniel L., Padlipsky, Patricia, Palmer, Jessica, Papa, Linda, Peak, David A., Pedigo, Ryan Anthony, Perkins, Jack, Jr., Pfaff, James A., Pfennig, Camiron L., Phelan, Michael P., Pierce, Ava E., Platt, Melissa A., Pontius, Elizabeth P.D., Pour, Trevor R., Preston-Suni, Kian, Price, Timothy G., Prince, William B., Probst, Marc, Pulia, Michael, Puskarich, Michael A., Quest, Tammie E., Raja, Ali S., Raukar, Neha P., Reardon, Robert F., Reed, Kevin C., Richards, David B., Rischall, Megan L., Robinson, Daniel W., Rodenberg, Howard, Roginski, Matthew A., Roline, Chad E., Rose, Emily, Rose, Jeremy, Rose, Nicholas G.W., Rosen, Tony, Ross, Weston, Rudy, C. Craig, Ruha, Anne-Michelle, Rybarczyk, Megan M., Sachs, Carolyn Joy, Salzberg, Matthew, Sánchez, León D., Sanders, Arthur B., Miguel, Christopher E. San, Scarfone, Richard J., Schmidt, Andrew, Schmitt, Eric R., Schnapp, Benjamin H., Schoener, Benjamin, Schultz, Carl H., Seethala, Raghu, Seiden, Jeffrey A., Seigel, Todd A., Selby, Sarah Tolford, Self, Wesley H., Sexton, Joseph, Shaikh, Huma, Shapiro, Michael A., Shapiro, Nathan I., Shappell, Eric, Shapshak, Dag, Sharp, Andrea C., She, Trent, Shetty, Pranav, Shewakramani, Sanjay N., Shreves, Ashley, Simon, Barry C., Simon, Leslie V., Singh, Manpreet, Singh, Sonia, Skolnik, Aaron B., Slovis, Corey M., Smereck, Janet, Smith, Clay, Sokolove, Peter E., Soskin, Philippa, Soulek, Jaron, Southerland, Lauren T., Springer, Brian L., Stenson, Bryan A., Stoklosa, Hanni, Tainter, Christopher R., Takhar, Sukhjit S., Tang, Nelson, Taylor, Todd Andrew, Theobald, Jillian L., Thiessen, Molly E.W., Thomas, Anita A., Thomas, Natasha, Thompson, Holly, Thompson, Trevonne M., Thornton, Joseph E., Tyndall, J. Adrian, Torbati, Sam, VanRooyen, Michael, Verbillion, Meagan B., Vohra, Taher T., Vojta, Leslie R., Waasdorp, Christopher P., Jr., Wacker, David A., Wagner, Mary Jo, Walker, Laura E., Wallenstein, Joshua, Walls, Ron M., Wang, George Sam, Wardi, Gabriel, Waxman, Matthew A., Weichenthal, Lori, Welker, Katherine Louise, Wessel, Amanda L., White, Benjamin, White, William, Wilcox, Susan R., Williamson, Craig A., Wolfson, Allan B., Wu, Andrea W., Yealy, Donald M., Young, Henry W., II., Zafren, Ken, Zdradzinski, Michael J., Zink, Brian J., and Zun, Leslie S.

Published
2024
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7. Contributors

Author

Aaronson, Emily L., Abbott, Ethan E., Abraham, Gallane, Abraham, Michael K., Agrait-Gonzalez, Miguel, Akhtar, Saadia, Aks, Steven E., Atchinson, Patricia Ruth, Auerbach, Marc, Aufderheide, Tom P., Banks, Laura L., Barksdale, Aaron N., Barrett, Whitney, Becker, Bruce M., Ben Ma, Zheng, Biese, Kevin, Biros, Michelle H., Bitterman, Robert A., Blackwell, Thomas H., Blum, Frederick C., Blumen, Ira J., Bolgiano, Edward B., Bond, Michael C., Bookman, Kelly, Borhart, Joelle, Boswell, Brittany, Brady, William J., Braithwaite, Sabina A., Brody, Aaron, Brown, Calvin A., III, Brown, David F.M., Brown, James E., Buchanan, Jennie Alison, Bukhman, Alice Kidder, Bullard-Berent, Jeffrey, Bunney, E. Bradshaw, Burton, John H., Caglar, Derya, Cahill, John D., Carlberg, David J., Chang, Andrew K., Chary, Michael A., Chen, Paul, Chumpitazi, Corrie E., Cico, Stephen John, Claudius, Ilene, Coates, Wendy C., Cole, Jon B., Colwell, Christopher B., Corbin, Theodore, Cooper, Robert, Corwell, Brian Niall, Curtis, Amelia M., D’Andrea, Shawn, Danzl, Daniel F., Davenport, Moira, Davis, Alysa S., Davis, Jonathan, Davis, Natalie L., Daya, Mohamud R., DeGeorge, Lindsey M., Derlet, Robert W., Dobiesz, Valerie A., Dupré, Alan A., Duran-Gehring, Petra, Easter, Joshua S., Edwards, Christopher J., Eilbert, Wesley P., Eiting, Erick, Elie-Turenne, Marie-Carmelle, Erickson, Timothy B., Eyre, Andrew J., Fairley, Romeo, Farrell, Susan E., Fath, John J., Fernandez-Frackelton, Madonna, Finnell, John T., Franco, Vanessa, Frazee, Bradley W., Friedman, Benjamin W., Gaddy, Jeremiah D., Ganetsky, Michael, Gausche-Hill, Marianne, Geiderman, Joel M., Germann, Carl A., Glass, George F., III, Glauser, Jonathan M., Godwin, Steven A., Goldberg, Scott A., Goodloe, Jeffrey M., Gorgas, Diane L., Green, Thomas J., Grossman, Shamai A., Guluma, Kama, Guttman, Joshua, Haas, Nathan L., Haines, Elizabeth J., Hajicharalambous, Christina, Hall, Matthew M., Halmo, Laurie Seidel, Hansoti, Bhakti, Harris, N. Stuart, Harrison, Nicholas, Hart, Danielle, Hatten, Benjamin W., Heine, Carlton E., Heiner, Jason D., Henn, Megan C., Hern, H. Gene, Jr., Hess, Jamie M., Hill, Adam D., Himelfarb, Nadine T., Hockberger, Robert S., Hogrefe, Christopher, Holland, Carolyn Kluwe, Holmes, James F., Hoppe, Jason A., Horeczko, Timothy, Hoyte, Christopher, Hsieh, Dennis, Hudson, Korin, Huesgen, Karl, Hwang, Ula, Iserson, Kenneth V., Iwanicki, Janetta L., Jagoda, Andy, James, Thea, Jewell, Corlin, Johnson, Nicholas J., Jones, Alan E., Jones, Emily M., Jouriles, Nicholas J., Kabrhel, Christopher, Kaide, Colin G., Kaji, Amy H., Kaplan, Julius (Jay) A., Kayden, Stephanie, Kearney, Ryan D., Kelly, Matthew P., Kim, Hyung T., Kivlehan, Sean M., Koenig, Kristi L., Kosowsky, Joshua M., Koval, Christine E., Koyfman, Alex, Kurz, Michael C., Lall, Michelle D., Lang, Spenser C., Lee, Jeffrey E., Lei, Charles, Levine, Michael D., Levy, Matthew J., Levy, Phillip D., Lim, Christopher S., Lindberg, Daniel, Lipsky, Ari M., Liu, J. Marc, Long, Brit, Macias-Konstantopoulos, Wendy, Maciel, Carolina Barbosa, Maher, Patrick J., Maloney, Gerald E., Jr, Maloney, Patrick J., Marco, Catherine Anna, Marill, Keith A., Martinez, Joseph P., Matlock, Aaron G., Mayersak, Ryanne J., May, Larissa S., McCoin, Nicole S., McCurdy, Michael T., McKinzie, Jeffry, Meaden, Christopher W., Meehan, Timothy J., Mehta, Niyati, Meurer, William J., Mick, Nathan W., Miloslavsky, Eli M., Miner, James R., Mohr, Nicholas M., Moll, Joel, Monas, Jessica, Monte, Andrew A., Montgomery, Martha M., Moore, Malia J., Moran, Gregory J., Mycyk, Mark B., Nable, Jose V., Nagler, Joshua, Nassisi, Denise, Nathan, Joshua B., Nelson, Lewis S., Nelson, Michael E., Newton, Kim, Nguyen, Thomas, Nicholson, Adam M., Nickels, L. Connor, Nikolaides, Jenna Karagianis, Nite, Micah J., Nitzberg, Michael, Norman, Marquita S., Norse, Ashley Booth, Nowak, Richard M., Ogunniyi, Adedamola A., Overbeek, Daniel L., Padlipsky, Patricia, Palmer, Jessica, Papa, Linda, Peak, David A., Pedigo, Ryan Anthony, Perkins, Jack, Jr, Pfaff, James A., Pfennig, Camiron L., Phelan, Michael P., Pierce, Ava E., Platt, Melissa A., Pontius, Elizabeth P.D., Pour, Trevor R., Preston-Suni, Kian, Price, Timothy G., Prince, William B., Probst, Marc, Pulia, Michael, Puskarich, Michael A., Quest, Tammie E., Raja, Ali S., Raukar, Neha P., Reardon, Robert F., Reed, Kevin C., Richards, David B., Rischall, Megan L., Robinson, Daniel W., Rodenberg, Howard, Roginski, Matthew A., Roline, Chad E., Rose, Emily, Rose, Jeremy, Rose, Nicholas G.W., Rosen, Tony, Ross, Weston, Rudy, C. Craig, Ruha, Anne-Michelle, Rybarczyk, Megan M., Sachs, Carolyn Joy, Salzberg, Matthew, Sánchez, León D., Sanders, Arthur B., San Miguel, Christopher E., Scarfone, Richard J., Schmidt, Andrew, Schmitt, Eric R., Schnapp, Benjamin H., Schoener, Benjamin, Schultz, Carl H., Seethala, Raghu, Seiden, Jeffrey A., Seigel, Todd A., Selby, Sarah Tolford, Self, Wesley H., Sexton, Joseph, Shaikh, Huma, Shapiro, Michael A., Shapiro, Nathan I., Shappell, Eric, Shapshak, Dag, Sharp, Andrea C., She, Trent, Shetty, Pranav, Shewakramani, Sanjay N., Shreves, Ashley, Simon, Barry C., Simon, Leslie V., Singh, Manpreet, Singh, Sonia, Skolnik, Aaron B., Slovis, Corey M., Smereck, Janet, Smith, Clay, Sokolove, Peter E., Soskin, Philippa, Soulek, Jaron, Southerland, Lauren T., Springer, Brian L., Stenson, Bryan A., Stoklosa, Hanni, Tainter, Christopher R., Takhar, Sukhjit S., Tang, Nelson, Taylor, Todd Andrew, Theobald, Jillian L., Thiessen, Molly E.W., Thomas, Anita A., Thomas, Natasha, Thompson, Holly, Thompson, Trevonne M., Thornton, Joseph E., Tyndall, J. Adrian, VanRooyen, Michael, Verbillion, Meagan B., Vohra, Taher T., Vojta, Leslie R., Waasdorp, Christopher P., Jr, Wacker, David A., Wagner, Mary Jo, Walker, Laura E., Wallenstein, Joshua, Walls, Ron M., Wang, George Sam, Wardi, Gabriel, Waxman, Matthew A., Weichenthal, Lori, Welker, Katherine Louise, Wessel, Amanda L., White, Benjamin, White, William, Wilcox, Susan R., Williamson, Craig A., Wolfson, Allan B., Wu, Andrea W., Yealy, Donald M., Young, Henry W., II, Zafren, Ken, Zdradzinski, Michael J., Zink, Brian J., and Zun, Leslie S.

Published
2023
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8. Measuring the Correlation Between Emergency Medicine Resident and Attending Physician Patient Satisfaction Scores Using Press Ganey

Author

Paul Logan Weygandt, Stephanie J. Gravenor, Michael J. Schmidt, Tiffani A. Darling, Michael A. Gisondi, Juliet J. Evans, and Spenser C. Lang

Subjects
medicine.medical_specialty, business.industry, 030208 emergency & critical care medicine, Original Contribution, Emergency Nursing, University hospital, Education, Correlation, 03 medical and health sciences, 0302 clinical medicine, Patient satisfaction, Family medicine, Emergency medicine, Emergency Medicine, medicine, 030212 general & internal medicine, Physician patient, Response rate, business
Abstract

Objective The purpose of this study was to assess the relationship between emergency medicine (EM) resident and attending physician patient satisfaction scores. Methods We added four resident questions to the standard Press Ganey survey used at a large, urban, university hospital with a PGY-1 to -4 EM residency. The resident questions were identical to the traditional attending questions. Press Ganey distributed the modified survey to a random sample of 30% of discharged patients. We assessed the correlation between resident and attending top-box Press Ganey scores using Pearson's coefficients. Two-tailed two-sample comparisons of proportions were used to compare top-box responses between residents and attendings. Results From September 1, 2012, to August 31, 2015, a total of 66,216 patients received surveys, and 7,968 responded, resulting in a 12.03% response rate, similar to Press Ganey survey response rate at comparable peer institutions. Patients were able to discriminate between residents and attendings; however, 751 surveys did not contain responses for residents, resulting in a total number of 6,957. All 64 of the EM residents had a minimum of 5 or more surveys returned. There was a high degree of correlation between resident and attending top-box scores with correlation coefficients ranging from 0.75 to 0.80. However, the proportion of top-box scores was consistently higher for residents (p

Published
2017
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9. Controversial uses of the 'clawback' remedy in the current financial crisis.

Author

Barasch, Spenser C. and Chestnut, Sara J.

Subjects
Fraudulent conveyances -- Research, Securities fraud -- Remedies, Executives -- Compensation and benefits, Executives -- Laws, regulations and rules, Government regulation, Emergency Economic Stabilization Act of 2008, Sarbanes-Oxley Act of 2002
Published
2009

10. A case of too many crunches

Author

Spenser C. Lang and Michael J. Schmidt

Subjects
Abdominal pain, medicine.medical_specialty, business.industry, General surgery, Emergency Medicine, medicine, medicine.symptom, business, medicine.disease, Rhabdomyolysis
Published
2017
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13. Drawing on your knowledge with VisiRule.

Author

Spenser, C.

Abstract

The decision charts provide an excellent medium for storing and communicating the knowledge associated with making decisions. It helps to overcome many of the problems associated with text-based rules and decision tables. It can be accessed and used by a wide range of people directly involved with the business processes. VisiRule provides a drawing environment, which helps to draw decision charts, and it can be immediately executed and verified, or exported as graphical objects or as program text for embedding within larger computer processes and/or applications [ABSTRACT FROM PUBLISHER]

Published
2007
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14. Comparison of Fixation Stability of the Novel Lisfranc Plate to Transarticular Screws

Author

Stephen Shymon MD, Thomas Harris MD, Spenser Cassinelli MD, Edward Ebramzadeh PhD, John Fleming MD, Virat Agrawal BS, and Sophia Sangiorgio PhD

Subjects
Orthopedic surgery, RD701-811
Abstract

Category: Midfoot/Forefoot, Trauma Introduction/Purpose: The objective of this study was to compare the stability of fixation of ligamentous Lisfranc injuries stabilized using two devices: a novel Lisfranc plate and conventional transarticular screws. Methods: A biomechanical cadaver model was developed to compare the fixation stability of a novel Lisfranc plate to that of traditional fixation, using transarticular screws. Thirteen pairs of cadaveric specimens were tested intact, after a simulated injury, and after implant fixation. Optical motion tracking was used to measure the three dimensional (3D) motion between each of the following four bones: first metatarsal, second metatarsal, first cuneiform, and second cuneiform. Testing included both cyclic abduction loading and cyclic axial loading. Results: Both the Lisfranc plate and screw fixation method provided stability such that the average 3D motions across the Lisfranc joint (between the second metatarsal and the first cuneiform), were between 0.2 and 0.4 mm under cyclic abduction loading and between 0.4 and 0.5 mm under cyclic axial loading. Comparing the stability of fixation between the Lisfranc plate and the screws, the differences in motion were all 0.3 mm or lower, with no significant differences (p > 0.16). Conclusion: Average 3D motions of the Lisfranc joint were 0.5 mm or below, whether fixed with the Lisfranc plate or the screws. Therefore, the Lisfranc plate provided comparable stability to the transarticular screws, which have been established as the gold standard for arthrodesis in Lisfranc injuries. Due to its anatomical placement, the Lisfranc plate may provide adequate support without risk of iatrogenic injury to the articular cartilage.

Published
2017
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15. Risk Factors for Prolonged Opioid Use After Ankle Fracture Surgery.

Author

Broggi MS, Oladeji PO, Spenser C, Kadakia RJ, and Bariteau JT

Subjects
Humans, Analgesics, Opioid adverse effects, Retrospective Studies, Risk Factors, Pain, Postoperative drug therapy, Ankle Fractures surgery, Opioid-Related Disorders epidemiology
Abstract

Background: The incidence of ankle fractures is increasing, and risk factors for prolonged opioid use after ankle fracture fixation are unknown. Accordingly, the purpose of this study was to investigate risk factors that lead to prolonged opioid use after surgery., Methods: The Truven MarketScan database was used to identify patients who underwent ankle fracture surgery from January 2009 to December 2018 based on CPT codes. Patient characteristics were collected, and patients separated into 3 cohorts based on postoperative opioid use (no refills, refills within 6 months postoperative, and refills within 1 year postoperatively). The χ 2 test and multivariate analysis were performed to assess the association between risk factors and prolonged use., Results: In total, 34 691 patients were analyzed. Comorbidities most highly associated with prolonged opioid use include 2+ preoperative opioid prescriptions (odds ratio [OR] = 11.92; P < .001), tobacco use (OR = 2.03; P < .001), low back pain (OR = 1.81; P < .001), depression (OR = 1.48; P < .001), diabetes (OR = 1.34; P < .001), and alcohol abuse (OR = 1.32; P < .001)., Conclusion: Opioid use after ankle fracture surgery is common and may be necessary; however, prolonged opioid use and development of dependence carries significant risk. Identifying those patients at an increased risk for prolonged opioid use can aid providers in tailoring their postoperative pain regimen., Levels of Evidence: Prognostic, Level III., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Published
2023
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16. Allergenius, an expert system for the interpretation of allergen microarray results.

Author

Melioli G, Spenser C, Reggiardo G, Passalacqua G, Compalati E, Rogkakou A, Riccio AM, Di Leo E, Nettis E, and Canonica GW

Abstract

Background: An in vitro procedure based on a microarray containing many different allergen components has recently been introduced for use in allergy diagnosis. Recombinant and highly purified allergens belonging to different allergenic sources (inhalants, food, latex and hymenoptera) are present in the array. These components can either be genuine or cross-reactive, resistant or susceptible to heat and low pH, and innocuous or potentially dangerous. A large number of complex and heterogeneous relationships among these components has emerged, such that sometimes these interactions cannot be effectively managed by the allergist. In the 1960s, specialized languages and environments were developed to support the replacement of human experts with dedicated decision-making information systems. Currently, expert systems (ES) are advanced informatics tools that are widely used in medicine, engineering, finance and trading., Methods: We developed an ES, named Allergenius ®, to support the interpretation of allergy tests based on microarray technology (ImmunoCAP ISAC ®). The ES was implemented using Flex, a LPA Win-Prolog shell. Rules representing the knowledge base (KB) were derived from the literature and specialized databases. The input data included the patient's ID and disease(s), the results of either a skin prick test or specific IgE assays and ISAC results. The output was a medical report., Results: The ES was first validated using artificial and real life cases and passed all in silico validations. Then, the opinions of allergists with experience in molecular diagnostics were compared with the ES reports. The Allergenius reports included all of the allergists' opinions and considerations, as well as any additional information., Conclusions: Allergenius is a trustable ES dedicated to molecular tests for allergy. In the present version, it provides a powerful method to understand ISAC results and to obtain a comprehensive interpretation of the patient's IgE profiling.

Published
2014
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