Both groups showed comparable good to excellent clinical and radiologic outcomes at final follow-up. However, the PECA group had significantly less pain in the first 6 weeks following surgery. Level of Evidence Level II, prospective comparative study.

Given the low survivorship of this frail group of patients the main objectives are achieving early mobilisation whilst maintaining good fracture position. In our experience, tibiotalocalcaneal nailing is a very useful and successful way of treating fragility fractures of the ankle because it has a low risk of complications and restores function with impressive patient satisfaction. The potential benefits of this technique, we believe, outweigh the disability ensued from subtalar joint fusion.

Background While successful subtalar joint arthrodesis provides pain relief, resultant alterations in ankle biomechanics need to be considered, as this procedure may predispose the remaining hindfoot and tibiotalar joint to accelerated degenerative changes. However, the biomechanical consequences of isolated subtalar joint arthrodesis and additive fusions of the Chopart's joints on tibiotalar joint biomechanics remain poorly understood. Questions/purposes We asked: What is the effect of isolated subtalar fusion and sequential Chopart's joint fusions of the talonavicular and calcaneocuboid joints on tibiotalar joint (1) mechanics and (2) kinematics during loading for neutral, inverted, and everted orientations of the foot? Methods We evaluated the total force, contact area, and the magnitude and distribution of the contact stress on the articular surface of the talar dome, while simultaneously tracking the position of the talus relative to the tibia during loading in seven fresh-frozen cadaver feet. Each foot was loaded in the unfused, intact control condition followed by three randomized simulated hindfoot arthrodesis modalities: subtalar, double (subtalar and talonavicular), and triple (subtalar, talonavicular, and calcaneocuboid) arthrodesis. The intact and arthrodesis conditions were tested in three alignments using a metallic wedge insert: neutral (flat), 10°i nverted, and 10°everted. Results Tibiotalar mechanics (total force and contact area) and kinematics (external rotation) differed owing to hindfoot arthrodeses. After subtalar arthrodesis, there were Each author certifies that he or she, or a member of their immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Clinical Orthopaedics and Related Research ®A Publication of The Association of Bone and Joint Surgeons® decreases in total force (445 ± 142 N, 95% CI, 340-550 N, versus 588 ± 118 N, 95% CI, 500-676 N; p \ 0.001) and contact area (282 mm 2 , 95% CI, 222-342 mm 2 , versus 336 ± 96 mm 2 , 95% CI, 265-407 mm 2 ; p \ 0.026) detected during loading in the neutral position; these changes also were seen in the everted foot position. Hindfoot arthrodesis also was associated with increased external rotation of the tibiotalar joint during loading: subtalar arthrodesis in the neutral loading position (3.3°± 1.6°; 95% CI, 2°-4.6°; p = 0.004) and everted loading position (4.8°± 2.6°; 95% CI, 2.7°-6.8°; p = 0.043); double arthrodesis in neutral (4.4°± 2°; 95% CI, 2.8°-6°; p = 0.003) and inverted positions (5.8°± 2.6°; 95% CI, 3.7°-7.9°; p = 0.002), and triple arthrodesis in all loaded orientations including neutral (4.5°±1.8°; 95% CI, 3.1°-5.9°; p = 0.002), inverted (6.4°± 3.5°; 95% CI, 3.6°-9.2°; p = 0.009), and everted (3.6°± 2°; 95% CI, 2°-5.2°; p = 0.053) positions. Finally, after subtalar arthrodesis, additive fusions at Chopart's joints did not appear to result in additional observe...

Most patients who sustained a Lisfranc injury could return to sport and physical activity after ORIF. Patients should be counseled preoperatively that about 1 in 3 might experience continued pain at the injury site Level of Evidence: Level IV, retrospective case series.

Employee Assistance Programs (EAPs) are employer-sponsored benefits that provide mental health and behavioral support to employees experiencing personal or work-related difficulty. Traditionally, EAPs have been offered as an internally or externally delivered stand-alone benefit that offers a limited or fixed number of free services to employees. However, even though most employers provide the benefit, employee utilization of EAPs has been historically low. The COVID-19 pandemic and the resulting impact on employees has elevated the issue of mental health in the workplace. This accelerates the need to understand the factors associated with EAP utilization in order to more effectively meet the increasing mental health needs of employees. Consequently, the purpose of the study was to examine EAP utilization as a result of the pandemic, including demographic factors influencing employee use of EAPs. Findings suggest that employees are experiencing higher levels of mental health issues as a result of the COVID-19 pandemic, which affects their overall mental well-being; however, EAP utilization results were mixed. Moreover, demographic differences were found to influence the type of support resource utilized, including EAPs. The implications of these findings as they relate to practice, as well as the strengths and limitations of the study, are also discussed. In addition, due to the evolving nature of EAP services, a brief review of state and federal regulatory compliance considerations and limitations is presented.