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Epidemiology of distal radius fractures: Elucidating mechanisms, comorbidities, and fracture classification using the national trauma data bank

Chinta, Sachin R; Cassidy, Michael F; Tran, David L; Brydges, Hilliard T; Ceradini, Daniel J; Bass, Jonathan L; Agrawal, Nikhil A
BACKGROUND:An update on the epidemiology of distal radius fractures in the United States is necessary, particularly as the elderly population grows. Additionally, age and frailty have been associated with complications following surgical fixation of DRFs. Herein, we utilize the National Trauma Data Bank, a robust nationwide resource, to investigate the relationship between demographics, comorbidities, injury and fracture characteristics, and admission details. METHODS:Patients with isolated distal radius fractures were identified from the National Trauma Data Bank (2016-2019) according to ICD-10 codes. Univariate and multivariate regressions were conducted to determine independent risk factors for bilateral fractures, displaced fractures, open fractures, as well as length of hospital stay and adverse discharge disposition for patients undergoing inpatient surgical fixation. RESULTS:The incidence of DRFs was 3.6/1,000 trauma-related emergency department visits and 10.8/1,000 upper extremity traumas. Trauma mechanism was significantly associated with displaced and open fractures. Age (OR 1.01, 95% CI 1.01-1.01), BMI (OR 1.02, 95% CI 1.01-1.02), smoking (OR 1.34, 95% CI 1.15-1.57), and alcohol level (trace: OR 2.18, 95% CI 1.41-3.29; intoxicated: OR 2.20, 95% CI 1.63-2.95) were significantly associated with open fractures. Machinery (β=2.04, 95% CI 1.00-3.08) and MVT (β=0.39, 95% CI 0.08-0.69) mechanisms were independent risk factors for longer length of stay. mFI-5 was an independent risk factor, in a stepwise fashion, for both length of stay and adverse discharge disposition. CONCLUSIONS:High-energy mechanisms and risk factors for poor skin quality were significantly associated with open fractures. mFI-5 was an independent risk factor for longer length of stay and non-routine discharges in patients of all ages, despite controlling for other comorbidities, unrelated complications, and mechanism of injury. Trauma mechanism was an independent risk factor for prolonged length of stay only, particularly in patients younger than 65 years of age.
PMID: 38029683
ISSN: 1879-0267
CID: 5590952

The Use of Peripheral Nerve Stimulation in Conjunction with TMR for Neuropathic Pain [Case Report]

Agrawal, Nikhil A; Gfrerer, Lisa; Heng, Marilyn; Valerio, Ian L; Eberlin, Kyle R
Targeted muscle reinnervation and regenerative peripheral nerve interfaces are increasingly utilized strategies to mitigate phantom and residual limb pain in amputees. These interventions are successful, yet often imperfect in completely ameliorating neuropathic pain following amputation. Implantable peripheral nerve stimulators are another tool in the armamentarium for management of neuropathic pain. These devices have been utilized adjacent to the spinal cord and more recently in the extremities with good results, and there has been additional interest in their utility for nerve regeneration. In this case report, we present the first reported case in the readily available literature of combining contemporary peripheral nerve strategies with an implantable peripheral nerve stimulator for postamputation neuropathic pain. The patient is a 72-year-old man who presented with severe neuropathic pain following prior below knee amputation with an osseointegrated implant and regenerative peripheral nerve interfaces. The authors performed targeted muscle reinnervation with intra-operative placement of a peripheral nerve stimulator. He did well after the procedure, and his pain improved with activation of the device. The most symptomatic nerve is targeted with the nerve stimulator, and it is placed adjacent to the nerve transfer(s). Combining these contemporary techniques may lead to improved prosthetic use and quality of life for these patients.
PMCID:8219250
PMID: 34168944
ISSN: 2169-7574
CID: 5019122

A multidisciplinary approach to the surgical resection of severe heterotopic ossification: A case-report

Economou, George; Wolde-Semait, Henock T; Spentzouris, Georgios; Agrawal, Nikhil A
ORIGINAL:0016752
ISSN: 2666-769x
CID: 5459462

Infection Rates of an Intraoral Versus Extraoral Approach to Mandibular Fracture Repairs are Equal: A Systematic Review and Meta-Analysis

Shah, Alay; Perez-Otero, Sofia; Tran, David; Aponte, Hermes A; Oh, Cheongeun; Agrawal, Nikhil
PURPOSE/OBJECTIVE:The study investigates whether the intraoral approach to mandibular open reduction and internal fixation, through exposure to the oral cavity's microbiome, results in higher infection rates compared to the extraoral approach, thus addressing a critical public health concern, health-care costs, and aiming to guide effective clinical practice. METHODS:statistics). RESULTS: = 84% for intraoral and 56% for extraoral). CONCLUSION/CONCLUSIONS:Our meta-analysis found no significant difference in infection rates between the two approaches. There is opportunity to expand on reporting complication rates comparing the various approaches to mandibular fixation. Until these data are presented, surgeon preference may dictate the operative approach to expose the mandible for reduction and fixation.
PMID: 38336352
ISSN: 1531-5053
CID: 5632082

The Potential of Transexamic Acid Use for Wide Awake Local Anesthesia No Tourniquet [Case Report]

Economou, George; Kunda, Nicholas; Eberlin, Kyle R; Valerio, Ian L; Agrawal, Nikhil A
Tranexamic acid (TXA) is a drug commonly used to decrease intraoperative bleeding. Its use in various types of surgery is well defined; however, its use in plastic surgery and even more so, hand surgery is not as well researched. Concurrently, the use of wide-awake local anesthesia no tourniquet (WALANT) procedures has increased in popularity. As the use of WALANT increases, it comes to question whether TXA could be used as an alternative to epinephrine during WALANT procedures. This case involves a 33-year-old woman status-post motor vehicle collision. On examination, the patient sustained transection of the flexor digitorum profundus on both her left middle and ring fingers along with absent sensation to her left middle finger. Due to the surgical preference for vascular monitoring, TXA was used alternatively to epinephrine to control intraoperative bleeding during the tendon repairs. It was observed that TXA allowed for controlled bleeding, preservation of the surgical visual field, successful tendon repair, and postoperative success. The successful use of TXA in this case prompts further investigation as to whether TXA could be used as an alternative to epinephrine in WALANT procedures.
PMCID:9612953
PMID: 36312906
ISSN: 2169-7574
CID: 5348192

[The characterization and treatment

Bhashyam, Abhiram R; Agrawal, Nikhil; Garg, Rohit; Mudgal, Chaitanya
PMID: 35722922
ISSN: 2043-6289
CID: 5285862

A Novel Algorithm for Defining the Mandibular Border

Rohrich, Rod J; Agrawal, Nikhil A; Avashia, Yash; Savetsky, Ira L
SUMMARY/CONCLUSIONS:Techniques for defining the mandibular angle are a particular focus for patients around the world. Developing the desirable sharp contours is a combination of reducing bulkiness around the mandible while augmenting the border. Invasive techniques (e.g., face lifts and chin augmentation) can help define the mandible; however, younger patients are demanding more affordable and less invasive procedures. The "Nefertiti lift," masseter neurotoxin, buccal fat excision, mandibular border augmentation with filler, and liposuction of the neck can all be done in the office and will produce excellent results. If the loss of definition is due to superior soft tissue, the next step is to determine if this is based on anterior or posterior soft-tissue excess. Posteriorly, it is caused by masseter hypertrophy, and anteriorly, it may be because of an enlarged or full buccal fat pad in the lower cheek area. If the loss of definition is inferior, the next step is to again define if it is anterior or posterior. Anterior excess tissue can be corrected with liposuction of the neck along with energy-based skin tightening technology. Posteriorly, the inferior pull of the platysma can be blunted with neurotoxin. Finally, once the soft tissues are adequate, the mandibular border can be augmented with filler. In this article, the authors propose an algorithm for when to utilize each of these procedures while reviewing proper technique.
PMID: 35196678
ISSN: 1529-4242
CID: 5285852

A Review of Venous Thromboembolism Risk Assessment and Prophylaxis in Plastic Surgery

Agrawal, Nikhil A; Hillier, Kirsty; Kumar, Riten; Izaddoost, Shayan; Rohrich, Rod J
BACKGROUND:Venous thromboembolism is a significant cause of postoperative death and morbidity. While prophylactic and treatment regimens exist, they usually come with some risk of clinically relevant bleeding and, thus, must be considered carefully for each individual patient. METHODS:This special topic article represents a review of current evidence regarding venous thromboembolism risk, biology, and prevention in plastic surgery patients. The specific types and duration of available prophylaxis are also reviewed. The balance of venous thromboembolism risk must be weighed against the risk of hemorrhage. RESULTS:Though alternatives exist, the most validated risk assessment tool is the 2005 modification of the Caprini Risk Assessment Model. Controversies remain regarding recommendations for outpatient and low risk cosmetic patients. The authors additionally make recommendations for high-risk patients regarding the use of tranexamic acid, estrogen therapy, anesthesia, and prophylaxis regimens. CONCLUSION/CONCLUSIONS:The authors have made great strides in understanding the science behind venous thromboembolism, risk stratification for patients, and prophylactic regimens; yet, continued studies and definitive data are needed.
PMID: 34851883
ISSN: 1529-4242
CID: 5069132

The Role of the Buccal Fat Pad in Facial Aesthetic Surgery

Rohrich, Rod J; Stuzin, James M; Savetsky, Ira L; Avashia, Yash J; Agrawal, Nikhil A; Prada, Margarita
SUMMARY/CONCLUSIONS:Social media have triggered a buccal fat pad excision frenzy. Not surprisingly, there is tremendous appeal of having a slimmer lower face and more defined jawline after undergoing a small intraoral procedure under local anesthesia. Although this procedure is great for social media and seemingly beneficial for jawline aesthetics, the evidence remains limited as to whether or not this is an effective long-term solution. How much the buccal fat pad persists or diminishes as we age is an area of debate. However, the possibility of causing premature aging and midface distortion in the long run is disconcerting.
PMID: 34398085
ISSN: 1529-4242
CID: 5019132

A Systematic Review of Wellness in Plastic Surgery Training

Grome, Luke J; Reul, Ross M; Agrawal, Nikhil; Abu-Ghname, Amjed; Winocour, Sebastian; Buchanan, Edward P; Maricevich, Renata S; Reece, Edward M
BACKGROUND:Physician and resident wellness has been increasingly emphasized as a means of improving patient outcomes and preventing physician burnout. Few studies have been performed with a focus on wellness in plastic surgery training. OBJECTIVES:The aim of this study was to systematically review what literature exists on the topic of wellness in plastic surgery training and critically appraise it. METHODS:A PubMed search was performed to identify journal articles related to wellness in plastic surgery residency. Seventeen studies (6 cohort and 11 cross-sectional) met inclusion criteria and were appraised with the Newcastle-Ottawa Quality Assessment Scale (NOQAS) to determine the quality of the studies based on selection, comparability, and outcome metrics. RESULTS:Critical assessment showed that the studies were highly variable in focus. Overall, the quality of the data was low, with an average NOQAS score of 4.1. Only 2 studies focused on plastic surgery residents, examining work hours and social wellness, respectively; they were awarded NOQAS scores of 3 and 4 out of 10. CONCLUSIONS:The results of this systematic review suggest that little research has been devoted to wellness in surgery training, especially in regard to plastic surgery residents, and what research that has been performed is of relatively low quality. The available research suggests a relatively high prevalence of burnout among plastic surgery residents. Evidence suggests some organization-level interventions to improve trainee wellness. Because outcomes-based data on the effects of such interventions are particularly lacking, further investigation is warranted.
PMID: 32596712
ISSN: 1527-330x
CID: 5018982