recall
int64 0
1
| article_title
stringlengths 5
500
| topic
stringlengths 21
84
| abstract
stringlengths 2
65.8k
|
|---|---|---|---|
0 |
Ketorolac but not morphine exerts inflammatory and metabolic effects in synovial membrane after knee arthroscopy a double-blind randomized prospective study using the microdialysis technique
|
AMP (Acute Meniscal Pathology)
|
Objective: Our aim was to study local synovial metabolism, inflammation, and subjective pain scoring after intra-articular injection of morphine, ketorolac, or placebo in knee arthroscopy. Methods: Sixty patients undergoing knee arthroscopy were randomized into 3 groups receiving morphine, ketorolac, or placebo before surgery. Microdialysis of the synovial membrane was performed in 10 patients in each group 4 hrs postoperatively. Lactate, glucose, glycerol, glutamate, and prostaglandin E2 (PGE2) were monitored regarding biochemical compounds and visual analog scale regarding perceived postoperative pain. Results: Ketorolac effectively attenuated postoperative PGE2 levels. Glycerol increased over time in the ketorolac group. Glutamate showed a decrease over time in both the morphine and ketorolac groups. Differences in PGE2 in the reference tissue indicated a systemic effect of ketorolac. There were no effects on subjective pain scoring (visual analog scale). Conclusions: To our knowledge, this is the first study on the local metabolic and inflammatory effect of intra-articularly administered morphine or ketorolac. For the first time, glutamate was studied in synovial tissue, and our results suggest that local release of glutamate may be important for nociception and inflammation. The effects of ketorolac on PGE2 implicates a local effect on inflammation and possibly, also nociception, but it should be remembered that 60 mg of ketorolac given intra-articularly also has a systemic effect. Release of glycerol after administration of ketorolac may indicate a toxicity of nonsteroidal antiinflammatory drugs that must be further evaluated. Copyright © 2009 by American Society of Regional Anesthesia and Pain Medicine.
|
0 |
Incidence of Carpal Coalition in an Asian Population - Preliminary Findings of a Study on Patients from a Distal Radius Fracture Database
|
Distal Radius Fractures
|
BACKGROUND: Congenital carpal coalition is usually seen as an incidental finding. The incidence of carpal coalition has been reported from 0.1 to 9.5 %; highest incidence has been reported in people of African descent. The purpose of our study is to evaluate the incidence and subtypes of carpal coalition in an Asian population.
METHODS: Review of the radiographs of the patients in our distal radius fracture database from 2009 to 2014 was conducted to determine the incidence and type of carpal coalition.
RESULTS: 4141 patients' wrist radiographs were reviewed. 2 cases of carpal coalition were identified; this leads to an incidence of 0.048%. One was of luno-triquetral type and the other was of capito-hamate type.
CONCLUSIONS: The preliminary results of our study indicate that carpal coalition in the Asian population is less common than that reported in the Western literature. Our results are inconclusive as to the type of carpal coalition that is more common.
|
0 |
Efficacy of a multimodal analgesia protocol in total knee arthroplasty: a randomized, controlled trial
|
AAHKS (2) Corticosteroids
|
A total of 100 osteoarthritis patients undergoing unilateral total knee arthroplasty were randomly assigned to receive either a multimodal analgesia protocol, comprising oral celecoxib and tramadol before and after surgery and intra-articular injection of large doses of morphine, ropivacaine, adrenaline and betamethasone during surgery (trial group), or oral and intra-articular placebo (control group). All patients received patient-controlled analgesia for 48 h after surgery. Morphine consumption up to 48 h after surgery was significantly lower in the trial than in the control group. Compared with the control group, the trial group had significantly lower visual analogue scale (VAS) scores for pain at rest from 6 h to 7 days after surgery and significantly lower VAS scores during activity from 24 h to 7 days after surgery. Active straight leg raise and active 90 degrees knee flexion were achieved sooner and range of knee movement at postoperative days 1 - 15 were significantly greater in the trial group. Postoperative wound healing, infection, blood pressure, heart rate, rash, respiratory depression, urinary retention and deep vein thrombosis were similar in the two groups, but nausea and vomiting were significantly less frequent in the trial group.
|
0 |
Complex pain regional syndrome after distal radius fractures
|
Distal Radius Fractures
|
Complex regional pain syndrome (CPRS) greatly affects the outcomes of distal radius fractures in terms of functional recovery, time away from work and patient satisfaction. The diagnosis is sometimes difficult to make in the immediate post-injury period. The disproportionate nature of the pain in the absence of differential diagnoses and the presence of a pain-free interval should arouse suspicion. The natural history consists of spontaneous improvement except in some refractory forms. The treatment is multidisciplinary combining a physician specializing in pain, therapist and psychologist coordinated by the surgeon who must not abandon the patient. Treatment aims to improve the patient's comfort and quality of life. Recent treatment approaches aimed at improving cortical reorganization have demonstrated their effectiveness. Surgery has to be considered even in the acute phase to address any causes of pain that can be resolved and address secondary stiffness. Significant progress has to be made in our understanding of the pathogenesis of CPRS to improve treatment and shift this condition to a regional pain syndrome.
|
0 |
Comparison of Two Polypropylene Frontalis Suspension Techniques in 92 Patients With Oculopharyngeal Muscular Dystrophy
|
Upper Eyelid and Brow Surgery
|
PURPOSE: To compare the functional outcome of the polypropylene trapezoid frontalis suspension with the polypropylene modified Crawford frontalis suspension in a large cohort of patients with oculopharyngeal muscular dystrophy. METHODS: Retrospective, nonrandomized comparative case series. Patients with oculopharyngeal muscular dystrophy who underwent bilateral polypropylene frontalis suspension were selected for chart review. Main outcome measures were margin reflex distance, duration of surgery, and ptosis recurrence. RESULTS: Ninety-two patients qualified for chart review; 39 patients underwent the trapezoid sling and 53 patients the modified Crawford sling. There was no difference in preoperative margin reflex distance or levator function between the 2 surgical groups. Postoperative improvement in margin reflex distance was 2.95 +/- 1.56 mm in the trapezoid group compared with 2.85 +/- 1.65 mm in the modified Crawford group (p = 0.67). Duration of surgery was 40.49 +/- 13.33 minutes in the trapezoid group compared with 53.77 +/- 16.04 minutes in the modified Crawford group (p < 0.001). Five percent of eyes in the trapezoid group had ptosis recurrence compared with 13% of eyes in the modified Crawford group (p = 0.07). CONCLUSION: Both polypropylene frontalis suspension techniques generated an equivalent increase in margin reflex distance. However, the trapezoid frontalis suspension required less operative time and trended toward a lower rate of ptosis recurrence.
|
0 |
Knee pain in patients with cancer after chemotherapy, radiotherapy, and bone marrow transplantation
|
BMAC (Bone Marrow Aspirate Concentrate)
|
The causes of knee pain in patients with cancer with are different from those without cancer, and the purpose of this study was to evaluate these differences. Thirty-six patients with cancer who had knee pain who had undergone 1 or more modalities of treatment, including chemotherapy, radiotherapy, and bone marrow transplant, for a primary diagnosis of cancer were compared with a cohort of 40 patients without cancer who had knee pain. All patients were evaluated clinically and underwent radiographic examination, and some underwent computed tomography or magnetic resonance imaging examination. Among patients with a primary diagnosis of cancer, the most common diagnosis was lymphoma (n=10), and the most common causes of knee pain were avascular necrosis of bone, osteoarthritis, insufficiency fractures, and septic arthritis. In 5 patients, the classical signs of a septic knee were not present. Other causes of knee pain included meniscus tear and anterior cruciate ligament rupture with instability. The most common diagnosis in patients without cancer was osteoarthritis of the knee. No patient without cancer was diagnosed with avascular necrosis, metastatic lesion, or insufficiency fracture. Two patients without cancer were diagnosed with septic arthritis of the knee. This study showed that the causes of knee pain in patients with cancer are different from those without cancer. Septic arthritis may present without the classical clinical signs in patients with cancer, and a high index of suspicion should be maintained for it.
|
0 |
Arthroscopic shoulder synovectomy in patients with rheumatoid arthritis
|
Glenohumeral Joint OA
|
Purpose: Currently, there is little information available concerning the results of shoulder synovectomy in patients with rheumatoid arthritis. Furthermore, it remains difficult to assess the success of shoulder synovectomy because of a high association of rotator cuff tears in rheumatoid patients. We hypothesized that synovectomy in patients with a functionally intact rotator cuff would provide durable pain relief. Type of Study: Case series. Methods: Sixteen shoulders in 13 patients with rheumatoid arthritis were treated with arthroscopic shoulder synovectomy from 1988 to 2002 with a mean follow-up of 5.5 years. Patients with full-thickness rotator cuff tears or partial tears that required repair were excluded. Two of the 13 patients had been diagnosed with juvenile rheumatoid arthritis and 11 had adult-onset disease. The medical records of the patients were reviewed and patients were assessed clinically and by questionnaire to assess pain, satisfaction, range of motion, radiographic outcomes, and occurrence of complications. Results: There was an improvement in pain at long-term follow-up in 13 of 16 patients (P < .001). Active shoulder elevation improved from a median of 145° to 160° but was not significant (P = .14). External rotation improved significantly (P = .01) from a median of 45° (range, 0° to 90°) to 60° (range, 0° to 100°). According to the Neer rating system, there were 5 excellent, 8 satisfactory, and 3 unsatisfactory results. Seven of 8 shoulders followed-up radiographically for more than 1 year showed radiographic progression of disease. All 3 patients reporting pain that was no better or worse than before surgery had radiographic arthrosis at last follow-up with advancing periarticular erosions and reduction of glenoid articular space. Conclusions: Arthroscopic synovectomy of the shoulder in patients with rheumatoid arthritis with an intact rotator cuff offers a reliable decrease in pain with less predictable improvements in range of motion. Limitations in predicting final results based on preoperative radiographs should be discussed with patients; those with more advanced radiographic changes may not benefit from the procedure. Level of Evidence: Level IV, therapeutic study, case series, no control group. © 2006 by the Arthroscopy Association of North America.
|
1 |
Serotype classification of Streptococcus mutans and its detection outside the oral cavity
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
Streptococcus mutans, generally known as a major pathogen of dental caries, is also a possible causative agent of bacteremia and infective endocarditis. S. mutans is classified into serotypes c, e, f and k based on the chemical composition of serotype-specific polysaccharides, with approximately 70-80% of strains found in the oral cavity classified as serotype c, followed by e (approximately 20%), and f and k (less than 5% each). Serotype k was recently designated as a novel serotype and shown to possess unique features, the most prominent being a defect of the glucose side chain in serotype-specific rhamnose-glucose polymers, which is related to a higher incidence of detection in cardiovascular specimens, owing to phagocytosis resistance. Molecular analyses of cardiovascular specimens showed a high detection frequency for S. mutans DNA, among which the detection rate for serotype k was quite high. These findings suggest that serotype k S. mutans possibly has a high level of virulence for systemic diseases
|
0 |
Surgical outcome of radial osteotomy for Kienbock's disease-minimum 10 years of follow-up
|
Distal Radius Fractures
|
PURPOSE: Long-term results of radial osteotomy for Kienbock's disease seldom are seen in the literature. The purpose of this study was to report the minimum 10-year results and to compare them with the 5-year results to determine whether the favorable intermediate-term results were maintained.
METHODS: Twenty-five patients who underwent radial osteotomy were followed-up for a mean period of 14.5 years. They were examined for pain, grip strength, and wrist range of motion (ROM). Through a review of clinical records, 5-year postoperative results were collected. The carpal height ratio and Stahl's index were measured and the x-rays were inspected for osteoarthritic changes. We devised an original lunate grade to evaluate radiologic improvement of the ischemic lunate. Overall results were evaluated using Cooney's wrist function score and Nakamura's scoring system for Kienbock's disease. The long-term results were compared with both the preoperative status and the 5-year results.
RESULTS: Pain, ROM, and grip strength were improved significantly after surgery, and the results were maintained for a long period. Carpal height ratio and Stahl's index did not show significant improvements but ischemic lunate showed certain radiologic improvements with time by the lunate grade system. Osteoarthritic changes were observed in 54% of patients at 5 years and in 73% of patients at the final follow-up evaluation, but the arthrosis generally was mild and did not affect the clinical results. Cooney's wrist function score was excellent or good in 96% of the patients, and the results with Nakamura's scoring system for Kienbock's disease were excellent or good in 68% of the patients at the final follow-up evaluation. The percentages were the same 5 years after surgery.
CONCLUSIONS: Radial osteotomy for Kienbock's disease is a reasonable treatment option and clinical improvement lasts for a long period of time. Although radiologic improvement was not drastic, the inner structure such as sclerotic change or bone cysts of the lunate improved with time, indicating healing of the ischemic lunate. Severe osteoarthritic change or proximal migration of the capitate can be avoided.
|
0 |
Arthroscopic repair fo the torn triangular fibrocartilage complex
|
AMP (Acute Meniscal Pathology)
|
Triangular fibrocartilage (TFC) tears of the wrist can cause significant pain and functional limitation. Arthroscopic repair of peripheral tears is an appealing option. An inside-out Tuohy needle technique is described for peripheral ulnar-sided TFC tears. A meniscal needle technique is described for radial-sided TFC tears. These two operative techniques provide a minimally invasive approach to a problem which has traditionally been addressed with an open procedure. © 2003 Elsevier Inc. All rights reserved.
|
0 |
Randomised controlled trial of hip protectors for the prevention of second hip fractures [with consumer summary]
|
Management of Hip Fractures in the Elderly
|
Abstract and full text may be available at: http://ageing.oxfordjournals.org/archive/ NO
|
0 |
A study of wrist injuries in children: The incidence of various injuries and of premature closure of the distal radial growth plate
|
Distal Radius Fractures
|
There were 362 wrist injuries in 359 patients under 18 years of age who attended the Accident and Emergency Department, St James's University Hospital, Leeds, over a 1-year period. These included soft tissue injuries (53%), epiphyseal injuries (4%) and fractures of the distal forearm or carpus (43%) which were reviewed 3 years after injury. At re-examination, a repeat X-ray was undertaken and this showed evidence of premature epiphyseal fusion in three of the 281 who returned for review and in these three patients there was a history of persistent symptoms in the affected wrist or forearm. It is suggested that patients with an obvious epiphyseal injury or those who have persistent symptoms following an injury to the wrist should be followed carefully to skeletal maturity in order to detect early partial or total closure of the growth plate.
|
1 |
Bone grafting for glenoid bone deficiencies in shoulder arthritis: a review
|
Glenohumeral Joint OA
|
Bone loss in the glenoid in the face of shoulder arthritis can be managed in selected cases with bone grafting. This article reviews the literature and uses this clinical experience to make recommendations for the surgical management of glenoid bone loss in cases of osteopenia, dysplasia, bone loss created by the arthritis, and loss that occurs in the glenoid related to failed shoulder arthroplasty. [References: 27]
|
1 |
Cemented, cementless or hybrid fixation options in total knee arthroplasty for osteoarthritis and other non-traumatic diseases
|
Surgical Management of Osteoarthritis of the Knee CPG
|
BACKGROUND: It is not clear which fixation of total knee arthroplasty obtains the best clinical, functional and radiographic results in people with osteoarthritis and other non-traumatic diseases, such as rheumatoid arthritis. OBJECTIVES: To assess the benefits and harms of cemented, cementless and hybrid knee prostheses fixation techniques in participants with primary osteoarthritis (osteoarthritis following trauma was not included) and other non-traumatic diseases, such as rheumatoid arthritis. SEARCH METHODS: We searched CENTRAL (2011, issue 10), MEDLINE via PubMed, EMBASE, Current Controlled Trials, LILACS, The Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, Health Technology Assessment Database and the Database of Abstracts of Reviews of Effectiveness, all from implementation to October 2011, along with handsearches of high-yield journals and reference lists of articles. No language restrictions were applied. SELECTION CRITERIA: Randomized controlled trials (RCTs) evaluating cemented, cementless and hybrid fixation. Participants included patients that were 18 years or older with osteoarthritis and other non-traumatic diseases who were undergoing primary total knee arthroplasty. DATA COLLECTION AND ANALYSIS: Three authors independently selected the eligible trials, assessed the trial quality, risk of bias and extracted data. Researchers were contacted to obtain missing information. MAIN RESULTS: Five RCTs and 297 participants were included in this review. Using meta-analysis on roentgen stereophotogrammetric analysis (RSA) we observed that cemented fixation of the tibial components demonstrated smaller displacement in relation to cementless fixation (with and without hydroxyapatite) after a follow-up of two years (maximum total point-motion, N = 167, two RCTs, mean difference (MD) = 0.52 mm, 95% confidence interval (CI) 0.31 to 0.74). However, the risk of future aseptic loosening with uncemented fixation was approximately half that of cemented fixation according to the arthroplasty instability classification (moderate quality as assessed by GRADE) inferred from RSA (N = 216, three RCTs, risk ratio (RR) = 0.47, 95% CI 0.24 to 0.92) with a 16% absolute risk difference between groups. The number needed to treat for an additional beneficial outcome (NNTB) to prevent future aseptic loosening was 7 (95% CI 5 to 44). There was a low risk of bias for RSA among the studies included. It was not possible to perform meta-analysis on patient-important outcomes, such as the survival rate of the implant (any change of a component), patient global assessments, functional measures, pain, health-related quality of life measures and adverse events. Almost all included studies recorded functional measures of Knee Society and Hospital for Special Surgery knee scores, but the authors of each study found no significant difference between the groups. AUTHORS' CONCLUSIONS: There was a smaller displacement of the cemented tibial component in relation to the cementless fixation in studies with osteoarthritis and rheumatoid arthritis participants who underwent primary total knee prosthesis with a follow-up of two years; however, the cemented fixation presented a greater risk of future aseptic loosening than cementless fixation
|
0 |
Effect of folate and mecobalamin on hip fractures in patients with stroke: a randomized controlled trial
|
Management of Hip Fractures in the Elderly
|
CONTEXT: Stroke increases the risk of subsequent hip fracture by 2 to 4 times. Hyperhomocysteinemia is a risk factor for both ischemic stroke and osteoporotic fractures in elderly men and women. Treatment with folate and mecobalamin (vitamin B12) may improve hyperhomocysteinemia. OBJECTIVE: To investigate whether treatment with folate and vitamin B12 reduces the incidence of hip fractures in patients with hemiplegia following stroke. DESIGN, SETTING, AND PATIENTS: A double-blind, randomized controlled study of 628 consecutive patients aged 65 years or older with residual hemiplegia at least 1 year following first ischemic stroke, who were recruited from a single Japanese hospital from April 1, 2000, to May 31, 2001. Patients were assigned to daily oral treatment with 5 mg of folate and 1500 microg of mecobalamin, or double placebo; 559 completed the 2-year follow-up. MAIN OUTCOME MEASURE: Incidence of hip fractures in the 2 patient groups during the 2-year follow-up. RESULTS: At baseline, patients in both groups had high levels of plasma homocysteine and low levels of serum cobalamin and serum folate. After 2 years, plasma homocysteine levels decreased by 38% in the treatment group and increased by 31% in the placebo group (P<.001). The number of hip fractures per 1000 patient-years was 10 and 43 for the treatment and placebo groups, respectively (P<.001). The adjusted relative risk, absolute risk reduction, and the number needed to treat for hip fractures in the treatment vs placebo groups were 0.20 (95% confidence interval [CI], 0.08-0.50), 7.1% (95% CI, 3.6%-10.8%), and 14 (95% CI, 9-28), respectively. No significant adverse effects were reported. CONCLUSION: In this Japanese population with a high baseline fracture risk, combined treatment with folate and vitamin B12 is safe and effective in reducing the risk of a hip fracture in elderly patients following stroke
|
1 |
Concentration of metal elements in the blood and urine in the patients with cementless total knee arthroplasty
|
Surgical Management of Osteoarthritis of the Knee CPG
|
Titanium (Ti), cobalt (Co) and chromium (Cr) element concentrations in the whole blood and urine specimen in 40 patients with cementless total knee arthroplasty were determined by the electrothermal atomic absorption spectrophotometry. Their ages ranged from 55 to 78 years (mean, 65 years). Twenty of them had loosening of prosthesis and underwent revision surgery, including 4 subjects with Ti-6Al-4V alloy prosthesis and 16 subjects with Co-Cr-Mo alloy prosthesis. The other 20 patients had well-functioning stable prosthesis, including 5 subjects with Ti-6Al-4V alloy prosthesis and 15 subjects with Co-Cr-Mo alloy prosthesis. The mean duration of prostheses implantation in patients with loosened or well-functioning prostheses were 6.5 and 4.0 years, respectively. The control group consisted of 20 age-matched normal subjects who did not undergo any metal implant surgery. Analysis of variance showed that the metal element concentrations in the whole blood, either Co, Cr or Ti, was statistically higher in the patients with loosened prosthesis than the other two groups. However, the metal element concentrations in the urine did not show any difference. The linear regression analysis showed a moderate positive relationship between the metal element concentrations, either Co or Cr elements, in whole blood and urine only in the patients with loosened prostheses. In conclusion, elevated concentration of metal elements may indicate a loosening of prosthesis while the clinical significance of the metal element concentration in the urine needs further investigation
|
0 |
The tumor microenvironment in prostate cancer: Elucidating molecular pathways for therapy development
|
MSTS 2018 - Femur Mets and MM
|
Mechanisms leading to the development of virulent prostate cancer are not confined to the cancer epithelial cell, but also involve the tumor microenvironment. Multiple signaling pathways exist between epithelial cells, stromal cells, and the extracellular matrix to support tumor progression from the primary site to regional lymph nodes and distant metastases. Prostate cancers preferentially metastasize to the skeleton, prompting considerable research effort into understanding the unique interaction between prostate cancer epithelial cells and the bone microenvironment. This effort has led to the discovery that signaling pathways involved in normal prostate and bone development become dysregulated in cancer. These pathways stimulate excessive cell growth and neovascularization, impart more invasive properties to epithelial cells, weaken antitumor immune surveillance, and promote the emergence of castrate-resistant disease. An improved understanding of the complex relationship between cancer epithelial cells and the organ-specific microenvironments with which they interact has created a powerful opportunity to develop novel therapies. © 2012 Tuca et al, publisher and licensee Dove Medical Press Ltd.
|
0 |
Increased energy intake in hip fracture patients affects nutritional biochemical markers
|
PJI DX Updated Search
|
BACKGROUND AND AIMS: We have previously shown that nutritional guidelines decreased the incidence of pressure ulcers in hip fracture patients. In the present study, we evaluate whether the nutritional biochemical markers S-IGF-1 (Insulin-like Growth Factor 1), S-Transthyretin and S-Albumin are affected by patients' energy intake, and whether the markers are useful as predictors of postoperative complications. MATERIAL AND METHODS: Quasi-experimental design, with one intervention and one control group, as well as pre- and post-study measurements. Eighty-eight hip fracture patients were included: 42 in the control group and 46 in the intervention group. The control group received regular nutritional support pre- and postoperatively, while the intervention group received nutritional support that followed new, improved clinical guidelines from admission to five days postoperatively. S-Albumin, S-Transthyretin, C-Reactive Protein (S-CRP) and S-IGF-1 were analysed at admission and five days postoperatively as well as complications like pressure ulcer and infection. RESULTS: The intervention group had a significantly higher energy intake; for example, 1636 kcal versus 852 kcal postoperative day 1. S-IGF-1 levels decreased significantly in the control group, while no decrease in the intervention group. S-Albumin and S-Transthyretin decreased and S-CRP increased significantly in both groups, indicating that those markers were not affected short-term by a high-energy intake. There was no correlation between short-term post-operative complications and S-IGF-1, S-Transthyretin or S-Albumin at admission. CONCLUSION: The results of our study showed that S-IGF-1 can be used as a short-term nutritional biochemical marker, as it was affected by a five-day high-energy regimen. However, neither S-IGF-1, S-Transthyretin or S-Albumin were useful in predicting postoperative complications within five days postoperatively
|
0 |
Ultrashort versus Conventional Anatomic Cementless Femoral Stems in the Same Patients Younger Than 55 Years
|
Developmental Dysplasia of the Hip 2020 Review
|
Background: Because the clinical and radiographic performance of an ultrashort anatomic cementless stem has been investigated in only two randomized controlled studies, wellâ?designed trials should aim for a thorough comparison of the outcomes of ultrashort anatomic cementless and conventional anatomic cementless stems. Questions/purposes: The purposes of this study were to compare (1) the clinical results, including Harris hip score, thigh pain, and WOMAC index score, (2) radiographic results, (3) bone mineral density; and (4) proportions of patients undergoing revision of a THA using an ultrashort anatomic cementless stem versus a conventional anatomic cementless stem in the same patients who underwent bilateral sequential THAs under the same anesthetic. Methods: Two hundred patients (mean age, 53 years; range, 26â?54 years) who underwent bilateral sequential THAs received an ultrashort anatomic cementless stem in one hip and a conventional anatomic cementless stem in the contralateral hip. From January 2004 to December 2005, we performed 524 sameâ?day bilateral short and conventional anatomic cementless THAs in 262 patients, of whom 212 (81%) participated in this study. Five patients were lost to followup before 2 years, five were lost between 2 to 10 years, and two were lost between 10 to 13 years, leaving 200 patients. Patients who had endâ?stage bilateral hip disease and were younger than 55 years were selected for inclusion. The predominant diagnoses were osteonecrosis (118 patients, 59%) and osteoarthritis (44 patients, 22%). One hundred thirtyâ?eight were men and 62 were women. At the time of each followup, the patients were assessed clinically and radiographically. In addition, each patient completed the WOMAC and the University of California Los Angeles (UCLA) activity scores. The minimum followup was 10 years (mean, 11.8 years; range, 10â?13 years). Followups were done in person, with all images and followup clinic notes. Based on the power analysis, we estimated a sample size of 178 hips was needed in each group to detect a 3â?point difference in the Harris hip score with 80% power. Results: At the latest followup, there were no differences between the two groups regarding the mean Harris hip scores (94 versus 94 points; p = 0.189), mean WOMAC scores (17 versus 16 points; p = 0.191), or mean UCLA activity scores (9 versus 9 points; p = 0.381). Two patients in the ultrashort stem group and one patient in the conventional stem group had severe (9 points) thigh pain, and 30 patients (15%) in the conventional stem group had mild thigh pain (2 or 3 points) after vigorous exercise. Bone mineral density in the ultrashort and conventional stem groups, respectively, was greater in the ultrashort stem group than in the conventional stem group. Bone mineral density in Zone 1 at 12 years was 3.29 versus 1.88 g/cm2 (p = 0.021), and 2.97 versus 0.91 g/m2 in Zone 7 (p = 0.001). With the numbers available, there were no differences between the stem designs in terms of the proportion undergoing revision (one hip, 0.5%, in the shortâ?stem group versus one hip, 0.5%, in the conventional group; p = 1.881). Conclusions: At followup into the second decade, ultrashort stems showed no differences from conventional cementless stems in terms of validated outcomes scores or fixation, although less stress shielding was observed. Reduction of stress shielding may reduce the longâ?term risk of periprosthetic fracture, but this was not shown in our study. Level of Evidence: Level I, therapeutic study. Copyright © 2016, The Association of Bone and Joint Surgeons.
|
0 |
T-condylar fractures of the distal humeral condyles during childhood: an analysis of six cases
|
The Treatment of Pediatric Supracondylar Humerus Fractures AUC
|
Six cases of T-condylar fractures in children less than or equal to 14 years of age were reviewed. Satisfactory results were achieved in all cases. Those who were approached surgically with a posterior triceps splitting approach seemed to have uniformly good results. However, other factors such as accuracy of reduction, development of avascular necrosis of the trochlea, and degree of initial displacement may have a bearing on the final outcome. The posterior approach appeared to provide the best visualization for reduction
|
0 |
Individual differences in post-traumatic stress following post-intimate stalking: stalking severity and psychosocial variables
|
DoD PRF (Psychosocial RF)
|
OBJECTIVE: Stalking can have a major psychosocial impact on its victims. Accumulating evidence suggests frequent post-traumatic stress (PTS) reactions. The present study aimed to detail the affective and cognitive responses following post-intimate stalking, and to assess the associations between stalking severity, person-related psychosocial variables and symptoms of PTS.
DESIGN: Female members (N = 131) of a Dutch nation-wide support group were contacted by mail and completed questionnaires pertaining to their stalking history, Big Five personality traits, coping, social support, as well as PTS reactions and symptoms.
METHOD: The Traumatic Constellation Identification Scale was used to elucidate emotional and cognitive responses to post-intimate stalking. To assess the associations between stalking severity indices, person-related psychosocial variables and PTS, a regression analysis was conducted using the Impact of Events Scale as a dependent variable.
RESULTS: Affective reactions included affective liability, fear, shame and loss. Associated maladaptive beliefs included decreased trust, increased alienation and isolation, and attributions of self-blame. Indices of stalking severity accounted for 22% of the PTS variance, with stalking violence being the most potent predictor. Another 8% of PTS variance was associated with a passive coping reaction and (lower) openness to experience.
CONCLUSION: PTS following stalking was associated with both stressor-related and person-related variables. Risk factors for PTS included severe stalking including violence and passive coping. Prolonged post-intimate stalking may lead to personality adaptation (i.e. becoming more closed, cautious and reserved).
|
0 |
Gender, traumatic events, and mental health disorders in a rural Asian setting
|
DoD PRF (Psychosocial RF)
|
Research shows a strong association between traumatic life experience and mental health and important gender differences in that relationship in the western European Diaspora; but much less is known about these relationships in other settings. We investigate these relationships in a poor rural Asian setting that recently experienced a decade-long armed conflict. We use data from 400 adult interviews in rural Nepal. The measures come from World Mental Health survey instruments clinically validated for this study population to measure depression, posttraumatic stress disorder, and intermittent explosive disorder. Our results demonstrate that traumatic life experience significantly increases the likelihood of mental health disorders in this setting, and that these traumatic experiences have a larger effect on the mental health of women than men. These findings offer important clues regarding the potential mechanisms producing gender differences in mental health in many settings.
|
0 |
Reproducibility of the surveillance effect to decrease nosocomial infection rates
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
OBJECTIVE: To investigate whether the reduction effect due to participation in a nosocomial infection surveillance system for laboratory-confirmed central venous catheter (CVC)-associated primary bloodstream infection (BSI), ventilator-associated pneumonia (VAP), and surgical site infection (SSI) is reproducible for different time periods, independent of confounding factors that might occur during a specific time period. METHODS: Data from the German national nosocomial infection surveillance system from the period January 1997 through June 2008 were used. CVC-associated BSI data and SSI data were analyzed for 3 starting periods, and VAP data were analyzed for 2 starting periods. Monthly infection rates were calculated for the following 36 months, and relative risks comparing the first and third surveillance years of each period were calculated. RESULTS: A total of 2,399 CVC-associated BSI cases from 267 intensive care units, 3,637 VAP cases from 150 intensive care units, and 829 SSIs following 3 different procedures from 113 departments were analyzed. A significant reduction in VAP was shown for both starting periods investigated (overall relative risk [RR], 0.80 [95% CI, 0.74-0.86]). A significant reduction in CVC-associated BSI was demonstrated for 2 of 3 starting periods (overall RR, 0.83 [95% CI, 0.75-0.91]). A significant reduction in SSI was found for 2 starting periods for knee prosthesis insertion (overall RR, 0.56 [95% CI, 0.38-0.82]), for all of the 3 starting periods for cesarean delivery (overall RR, 0.75 [95% CI, 0.61-0.93]), and for none of the 3 starting periods for endoscopically performed cholecystectomy (overall RR, 0.89 [95% CI, 0.62-1.27]). CONCLUSIONS: The surveillance effect, manifest as a significant reduction of nosocomial infection rates between the first and third years of participation in a surveillance system, was observed independently from the calendar year in which the surveillance activities started
|
0 |
Real-World Comparison of Classes IC and III Antiarrhythmic Drugs as an Initial Rhythm Control Strategy in Newly Diagnosed Atrial Fibrillation: From the TREAT-AF Study
|
Hip Fx in the Elderly 2019
|
OBJECTIVES: In this study the authors investigated effectiveness and safety of an initial treatment strategy with class IC or class III antiarrhythmic drugs (AAD) for newly diagnosed atrial fibrillation (AF) or atrial flutter (AFL).
BACKGROUND: There is limited evidence to guide optimal AAD selection for rhythm control in newly diagnosed AF/AFL.
METHODS: Using data from TREAT-AF (The Retrospective Evaluation and Assessment of Therapies in AF), the authors performed a retrospective cohort study of patients with AF/AFL from 2004 to 2014 and class IC or class III AAD prescription within 90 days following diagnosis. Patients with prior myocardial infarction, heart failure, or end-stage renal disease were excluded. Inverse probability treatment weighted propensity scores were used to evaluate the association of AAD class on hospitalization and cardiovascular events. To evaluate residual confounding, falsification outcomes were evaluated.
RESULTS: A total of 230,762 patients developed newly diagnosed AF/AFL during the study period. Of those, 3,973 patients (1.7%) were prescribed class IC and 6,909 (3.0%) were prescribed class III AAD. Median follow-up was 4.9 years. After inverse probability treatment weighted adjustment, class IC medications were associated with lower risk of hospitalizations for AF/AFL (hazard ratio [HR]: 0.77; 95% confidence interval [CI]: 0.73 to 0.81), cardiovascular disease (HR: 0.78; 95% CI: 0.75 to 0.81), heart failure (HR: 0.70; 95% CI: 0.64 to 0.76), and lower incidence of ischemic stroke (HR: 0.74; 95% CI: 0.65 to 0.85). Similar results were found in CHADS<sub>2</sub> (Congestive Heart Failure, Hypertension, Age >=75 Years, Diabetes Mellitus, Prior Stroke, Transient Ischemic Attack, or Thromboembolism) 0 or 1 and CHA<sub>2</sub>DS<sub>2</sub>-VASc (Congestive Heart Failure, Hypertension, Age >=75 Years, Diabetes Mellitus, Prior Stroke, Transient Ischemic Attack, or Thromboembolism, Vascular Disease, Age 65 to 74 Years, Sex) 0 or 1 subgroups. Falsification analyses for outcomes of urinary tract infection, pneumonia, and hip fracture were generally nonsignificant.
CONCLUSIONS: Prescription of class IC AAD as initial treatment for newly diagnosed AF/AFL, compared with prescription of class III AAD, may be associated with lower risk of hospitalization and cardiovascular events.
|
0 |
Electromyographic data differentiate patients with the carpal tunnel syndrome when double blindly treated with pyridoxine and placebo
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
Six typical patients with the carpal tunnel syndrome in a neurological practice were double blindly treated with pyridoxine and placebo to determine whether electromyographic data alone could identify without mistake those patients receiving pyridoxine or placebo. All six patients had a significant deficiency of vitamin B6 by the data on the erythrocyte glutamic oxaloacetic transaminase. Multiple measurements for statistical significance of EMG functions were made on temperature-controlled hands over periods of 15 to 27 days for control and final evaluation. There were significant changes in criteria of amplitude on placebo which ruled out these criteria for a double blind trial. There was no statistically significant change in any criterion of latency and conduction velocity for patients on placebo, indicating these criteria could serve for differentiation. Criteria of latency and conduction velocity showed significant changes for three patients on pyridoxine, and the extent of changes indicated a relationship to compliance. By data on latency and conduction velocity, no mistake was made in blindly identifying patients receiving pyridoxine or placebo; p less than 0.0156
|
0 |
Complex regional pain syndrome type i of the knee: A systematic literature review
|
AAHKS (8) Anesthetic Infiltration
|
In our Center for Pain Medicine, a group of patients reported to have symptoms possibly attributable to complex regional pain syndrome (CRPS) of only the knee(s). Therefore, this study aimed to investigate whether the literature reports on patients with CRPS type I in the knee(s) alone and, if so, to summarize the reported diagnostics, aetiology and treatment strategies of CRPS of the knee(s). Medline, Embase, Cochrane Library, PubMed and Web of Science were searched for articles focusing on a painful disorder of the knee, most likely CRPS type I. Screening on title and abstract was followed by full-text reading and searching of reference lists to determine the final set of relevant articles. Of the 513 articles identified, 31 met the inclusion criteria. These articles reported on a total of 368 patients diagnosed with CRPS of the knee(s) based on the diagnostic criteria used at the time of publication. Knee surgery, especially arthroscopic surgery, was the most common inciting event in developing CRPS of the knee(s). Various treatment strategies were applied with variable outcomes. In conclusion, the scientific literature does report cases of CRPS type I of only the knee(s). This applies when using the diagnostic criteria prevailing at the time of publication and, obviously for a smaller number of cases, also when using the current Budapest criteria set. Arthroscopic knee surgery is described multiple times as the inciting event. We recommend to include CRPS of the knee in future research on the aetiological mechanisms of and optimal treatment for CRPS. © 2013 European Pain Federation - EFIC ®.
|
0 |
Multimodal Clinical Pathway With Adductor Canal Block Decreases Hospital Length of Stay, Improves Pain Control, and Reduces Opioid Consumption in Total Knee Arthroplasty Patients: A Retrospective Review
|
AAHKS (4) Acetaminophen
|
BACKGROUND: Total knee arthroplasty volume is increasing significantly in the United States. Reducing hospital length of stay may represent the best method for accommodating expanding volume and reducing costs. We hypothesized that tailoring a clinical pathway to facilitate early ambulation would decrease costs and resource utilization.
METHODS: We conducted a sequential before-and-after study of total knee arthroplasty patients after a phased implementation of a clinical pathway that includes multimodal oral analgesic protocols, adductor canal nerve block, and standardized day of surgery ambulation protocols. Primary outcomes measured were hospital length of stay, total opioid consumption, total antiemetic use, and perioperative pain scores.
RESULTS: Two hundred ninety-five patients were divided into 3 sequential cohorts. Cohort 1 received spinal anesthesia, femoral nerve block, and was not placed into postop day 0 ambulation therapy. Cohort 2 received spinal anesthesia, adductor canal block, and postop day 0 ambulation therapy. Cohort 3 received spinal anesthesia, adductor canal block, postop day 0 ambulation therapy, and standardized oral multimodal analgesic protocol. Cohort 3 had significantly reduced hospital length of stay. Cohorts 2 and 3 had significantly less opioid consumption. Cohort 3 had significantly less total ondansetron consumption compared with cohort 1. Cohort 3 had significantly reduced average pain scores compared with cohort 1.
CONCLUSION: The data demonstrate that tailored clinical pathways designed to facilitate early ambulation can reduce hospital length of stay, reduce opioid consumption, reduce antiemetic use, and improve pain control. The results establish that refined clinical pathways can assist in improving care while increasing value to patients, providers, and systems.
|
1 |
Dorsal and volar 2.4-mm titanium locking plate fixation for AO type C3 dorsally comminuted distal radius fractures
|
Distal Radius Fractures
|
PURPOSE: In this retrospective, nonrandomized, single-surgeon study, we evaluated the clinical outcomes of dorsal and volar locking plate fixation for AO type C3 dorsally comminuted distal radius fractures.
METHODS: We treated 41 consecutive patients who had sustained AO C3 dorsally comminuted fractures of the distal radius with 2.4-mm titanium locking plates between 2006 and 2008. Patients in group 1 (n = 22) were treated with dorsal locking plates, and those in group 2 (n = 19) with volar locking plates. We evaluated clinical outcomes at an average of 37 months and performed statistical analysis using the Mann-Whitney U test and Fisher's exact test.
RESULTS: No significant difference was noted between the 2 groups in terms of radial inclination, volar tilt, and ulnar variance. At the 3- and 6-month follow-up, group 1 showed better clinical results with respect to wrist extension, grip strength, and Gartland and Werley score, whereas group 2 showed better wrist flexion during this period. The range of motion and grip strength progressively leveled out between the 2 groups, and no significant differences were observed at the 9- and 12-month assessments. One patient in group 1 had short-term complex regional pain syndrome, and 4 patients in group 2 had temporary median nerve numbness.
CONCLUSIONS: Treatment with dorsal or volar locking plates can provide satisfactory radiographic and functional outcomes for AO type C3 dorsal comminuted distal radius fractures. The dorsal plate group showed an earlier recovery of wrist extension, grip strength, and functional score at the 3- and 6-month follow-up owing to direct reduction as well as fragmental-specific fixation of the dorsal fracture fragments.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
|
1 |
Objective Effects of Breast Reduction Surgery on Physical Fitness
|
Reduction Mammoplasty for Female Breast Hypertrophy
|
BACKGROUND: Reduction mammaplasty is known for excellent outcomes and patient satisfaction. Although patients report improvements in pain, weight loss, and exercise levels, objective data on physical fitness benefits are limited.
METHODS: Using the Stanford Military Data Repository, we identified 89 US Army active duty women with at least 1 pre- and postoperative Army Physical Fitness Test (APFT) who underwent reduction mammaplasty during 2011 to 2014. We used paired t tests to compare pre- and postoperative APFT score means and raw values for push-ups, sit-ups, and the 2-mile run.
RESULTS: There were 56 subjects (62.9%) who improved in total APFT scores. Total score means increased from 235.9 preoperatively to 243.4 postoperatively (P = 0.0065). Of 28 subjects with at least 2 APFT scores before and after surgery, 20 (71.4%) improved in total scores. The subgroup's mean total score increased from 237.8 to 251.3 (P = 0.0009). Comparing individual pre- and postprocedure APFTs, all subjects demonstrated a mean 3.9% (SD, 0.1) improvement in total scores, and the subpopulation of 28 improved by 6.3% (SD, 0.1). In all events, mean performance values trended toward better postoperative scores. Differences were statistically significant for the total population for the number of sit-ups (P = 0.035), and, for the subgroup of 28, differences were statistically significant for the total score (P = 0.0009), sit-ups (P = 0.0002), and push-ups (P = 0.0134).
CONCLUSIONS: Reduction mammaplasty was associated with postoperative physical fitness improvements among US Army active duty women. Soldier data are useful for objectively assessing physical fitness effects of breast reduction surgery.
|
0 |
Endoscopic full facelift
|
Panniculectomy & Abdominoplasty CPG
|
This article demonstrates the efficacy of endoscopic techniques in total facial rejuvenation. The author has introduced the total subperiosteal dissection to the endoscopic forehead lift. This concept has been extended to the rejuvenation of the central and lower third of the face. Patients up to the late 40s can have a total facelift without skin excisions. In older patients, the introduction of endoscopic techniques helps to minimize some of the undesirable sequelae of the traditional open procedures such as alopecia, scalp paresthesias, and facial edema of the subperiosteal lift. The author also introduces a new, more efficacious method of midface suspension.
|
0 |
Successful treatment of Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ) patients with sitafloxacin: New strategies for the treatment of BRONJ
|
MSTS 2018 - Femur Mets and MM
|
BRONJ has become a well-known, occasionally severe side effect of bisphosphonate therapy, as well as a clinical problem. Although treatment recommendations exist, no standard therapy has yet been established for BRONJ. Also, these recommendations identify several limitations that prevent clinicians from confidently diagnosing BRONJ. The aim of the present study was to establish a treatment approach in which all patients with exposed, infected bone or intraoral/extraoral fistulas were treated with sitafloxacin (STFX). We examined 20 BRONJ patients, fourteen with cancer and six with osteoporosis. We used the current updated definition of BRONJ (12), except that we included patients who had shown symptoms for a minimum of only one month, rather than two months. Thus half of our patients had infection with no exposed, necrotic bone in the oral cavity. We purposely excluded all patients exhibiting no signs of infection (current Stages 0 and 1). In addition, each potentially causative organism was isolated from pus collected from an intraoral or extraoral fistula in ten patients on their first visit to our department. 90% of the patients had received a course of treatment with common antibiotics. STFX was administered to all patients. We then re-evaluated the lesion every other week, to determine whether epithelialization was present. We recommended surgical treatment for cases without epithelialization within 4. weeks after the onset of administration of STFX even if bone was not exposed at the lesion. 19 of our 20 cases of Stages 2-3 BRONJ responded to 2-10. weeks of STFX treatment by entering either a remission or healed phase. While surgery was done on thirteen cases, seven others reached such phases without surgery. Every patient had at least one bacterial species that showed resistance to common antibiotics. All species in all patients were susceptible to STFX. Our results indicate that STFX, with or without minor surgery, gives a high probability of controlling infection in BRONJ patients with persistent infection after use of common antibiotics, leading to remission and/or complete healing in 95% of patients.
|
0 |
Radiological evolution of the rheumatoid wrist after radio-lunate arthrodesis
|
Distal Radius Fractures
|
Radio-lunate arthrodesis of the rheumatoid wrist is an established technique which has been in use for more than 12 years. The evolution of 26 operated wrists and 20 non-operated wrists has been studied with a mean follow-up of 5 years. The results show that although radio-lunate arthrodesis can prevent dislocation of an unstable wrist, it cannot prevent deterioration. Collapse, ulnar translation, tilt of the lunate, and the inter-carpal instability continued with time, whether the wrists were operated on or not. The speed of deterioration was dependent on the type of rheumatoid arthritis and is faster in the disintegration type than in the osteoarthritis or the ankylosis type. The technique is applicable to the osteoarthritis type of rheumatoid arthritis, in the middle stage (2 to 4a according to the Larsen-Alnot classification). At that stage, the ankylosis type and the disintegration type, and the osteoarthritis type at an advanced stage, are better treated by total arthrodesis or total prosthetic arthroplasty.
|
0 |
Treatment of spinal metastases in renal cell carcinoma: A critical review
|
MSTS 2018 - Femur Mets and MM
|
Kidney cancer is the 9th most common cancer in men and the 14th most common in women worldwide. Renal cell carcinoma (RCC) constitutes 90% of all malignancies of the kidney. RCC, is known to be highly vascular and relatively radioresistant. Bone metastases are one of the most common metastatic sites and occur in around 30% of RCCs. They significantly impact the quality of life of patients causing pain and pathological fractures. Spinal metastases represent a particular case with regard to symptoms and treatment. Indeed, neurological pain is often added to the nociceptive pain caused by metastases. More importantly, neurological impairment can be seen, caused by spinal cord or nerve root compression (MSCC). Due to close contact with the spinal cord, the treatment of spinal bone metastases is challenging and requires a multidisciplinary approach. Specific treatment is currently focused on 4 main avenues which are surgery, radiotherapy, interventional radiology and systemic treatment. In June 2017 we carried out an extensive search on PubMed, Web of Science, and Cochrane Library to review the various treatment options and to establish a treatment strategy. This article presents the result of our critical review of the literature, given our expertise in the field.
|
1 |
Obesity is associated with increased health care charges in patients undergoing outpatient plastic surgery
|
Panniculectomy & Abdominoplasty CPG
|
BACKGROUND: Obesity is associated with greater rates of surgical complications. To address these complications after outpatient plastic surgery, obese patients may seek care in the emergency department and potentially require admission to the hospital, which could result in greater health care charges. The purpose of this study was to determine the relationship of obesity, postdischarge hospital-based acute care, and hospital charges within 30 days of outpatient plastic surgery. METHODS: From state ambulatory surgery center databases in four states, all discharges for adult patients who underwent liposuction, abdominoplasty, breast reduction, and blepharoplasty were identified. Patients were grouped by the presence or absence of obesity. Multivariable regression models were used to compare the frequency of hospital-based acute care, serious adverse events, and hospital charges within 30 days between groups while controlling for confounding variables. RESULTS: The final sample included 47,741 discharges, with 2052 of these discharges (4.3 percent) being obese. Obese patients more frequently had a hospital-based acute care encounter [7.3 percent versus 3.9 percent; adjusted OR, 1.35 (95% CI,1.13 to 1.61)] or serious adverse event [3.2 percent versus 0.9 percent; adjusted OR, 1.73 (95% CI, 1.30 to 2.29)] within 30 days of surgery. Obese patients had adjusted hospital charges that were, on average, $3917, $7412, and $7059 greater (p < 0.01) than those of nonobese patients after liposuction, abdominoplasty, and breast reduction, respectively. CONCLUSION: Obese patients who undergo common outpatient plastic surgery procedures incur substantially greater health care charges, in part attributable to more frequent adverse events and hospital-based health care within 30 days of surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
|
0 |
Use of a bone block graft from the iliac crest with rigid fixation to correct diaphyseal defects of the radius and ulna
|
DoD SSI (Surgical Site Infections)
|
We report our experience with the use of a bone block graft from the iliac crest to correct diaphyseal defects of the forearm bones. The technique was used in 12 patients (ten men and two women, average age 29 years) for defects resulting mainly from either closed or compound fractures, which later developed infection and bone tissue loss. The average dimensions of the graft required to correct the defect was 3.5 x 1.8 cm. The graft application was combined with rigid fixation with an AO 3.5 mm DCP plate, permitting early active motion. The graft incorporated without any additional grafting procedure in ten cases within 17.2 weeks on average. The most frequent complication was infection (four cases), controlled by means of debridement, cleansing and antibiotics. A comparative analysis of the immediate and final radiographs of the graft showed an average 30% loss of bone mass despite integration. We conclude that the technique of bone block grafting to correct diaphyseal defects of the radius or ulna is relatively easy to carry out and has a high success rate.
|
1 |
Preoperative Use of Clopidogrel Does Not Affect Outcomes for Femoral Neck Fractures Treated With Hemiarthroplasty
|
Hip Fx in the Elderly 2019
|
BACKGROUND: The antiplatelet effect of clopidogrel on blood loss and perioperative complications after surgical intervention remains ambiguous. The purpose of this study was to determine if patients on clopidogrel before hemiarthroplasty for femoral neck fracture are predisposed to greater surgical bleeding and perioperative complications compared with those not taking clopidogrel before surgery.
METHODS: We conducted a review of our electronic medical record from 2006-2013 and identified 602 patients who underwent 623 hemiarthroplasty procedures for displaced femoral neck fracture, of which 54 cases (9%) were taking clopidogrel before hospital admission. Patient demographics and comorbidities, operative and surgical variables, and perioperative complications at 90 days were compared between the clopidogrel and nonclopidogrel user groups.
RESULTS: The 2 groups of patients had similar baseline characteristics, but patients taking clopidogrel preoperatively were sicker with higher American Society of Anesthesiologists scores (P = .049) and age-adjusted Charlson index (P = .001). They also had a greater incidence of cerebrovascular disease (P = .01), chronic obstructive pulmonary disease (P = .03), diabetes (0.03), and malignancy (P < .001). There was no significant difference between the 2 patient groups with respect to 90-day postoperative medical readmissions (P = .85), surgical readmissions (P = .26), infection (P = .99), and mortality (P = .89).
CONCLUSION: Patients taking clopidogrel who present with a displaced femoral neck fracture can safely undergo a hemiarthroplasty while actively on clopidogrel without an increase in medical or surgical complications and mortality. We do not recommend delaying surgical intervention until the antiplatelet effects of clopidogrel subside.
|
0 |
Pre-surgery planning of lower limbs major joints arthroplasty
|
OAK 3 - Non-arthroplasty tx of OAK
|
BACKGROUND: Knee and hip joints endoprosthetics are the main surgical method of arthrosis treatment. The epidemiological incidence rate of the disease is growing steadily every year, affecting younger and younger people. Despite the proven tactics of joint endoprosthetics, an important issue is quality planning of surgery. AIM: The aim of this research is to develop a device and a method that would contribute to solving the existing challenges of pre-surgery planning of hip endoprosthetics in patients with related pathologies, which have caused compensatory deformation, and making long vertebrarium-pelvis-lower limbs scout images with the patient lying on his back with an axial load in a computer tomography. METHODS: Analog X-ray photographs of the pelvis made on film, digital DICOM images, and special planning programs are used for planning. However, according to numerous studies, the disease of the hip joint is not an independently isolated pathology. In most cases, this pathology is accompanied by changes in the lumbar spine. Often, patients prepared for endoprosthetics have a congenital deformity of tarsus or hip segment, which, during the knee, joint endoprosthetics surgery causes difficulties with the installation of an intramedullary guide. RESULTS: The results after total knee arthroplasty according to the method modified at the Department showed a reduction of the WOMAC index slightly more than twice down to 37.26 ± 7.92. The number of revision surgeries after endoprosthetics decreased from 5 (5.7%) to 1 (1.1%) for the hip joint, and from 7 (4.3%) to 2 (1.3%) for the knee joint, respectively. CONCLUSION: To form a proper guide entry point, it is necessary to assess the segment at the stage of surgery planning and examination of patients, which can be done using the proposed method. To remove the complications during the pre-surgery planning of hip joint endoprosthetics in patients with related pathologies, a device and methods have been developed for obtaining long topograms of the vertebrarium-pelvis-lower limbs complex with the patient lying on his back with the axial load in computer tomography.
|
0 |
Articular cartilage of the knee: Evaluation with fluctuating equilibrium MR imaging - Initial experience in healthy volunteers
|
AMP (Acute Meniscal Pathology)
|
Institutional review board approval and informed consent were obtained for this HIPPAA-compliant study, whose purpose was to prospectively compare three magnetic resonance (MR) imaging techniques-fluctuating equilibrium, three-dimensional (3D) spoiled gradient-recalled acquisition in the steady state (SPGR), and two-dimensional (2D) fast spin echo (SE)-for evaluating articular cartilage in the knee. The study cohort consisted of 10 healthy volunteers (four men, six women; age range, 26-42 years). Cartilage signal-to-noise ratio (SNR), SNR efficiency, cartilage-fluid contrast-to-noise ratio (CNR), CNR efficiency, image quality, cartilage visibility, and fat suppression were compared. Cartilage volume was compared for the fluctuating equilibrium and 3D SPGR techniques. Compared with 3D SPGR and 2D fast SE, fluctuating equilibrium yielded the highest cartilage SNR efficiency and cartilage-fluid CNR efficiency (P < .01 for both). Image quality was similar with all sequences. Fluctuating equilibrium imaging yielded higher cartilage visibility than did 2D fast SE imaging (P < .01) but worse fat suppression than did 3D SPGR and 2D fast SE imaging (P < .04). Cartilage volume measurements with fluctuating equilibrium and 3D SPGR were similar. Fluctuating equilibrium MR imaging is a promising method for evaluating articular cartilage in the knee. © RSNA, 2006.
|
0 |
The effects of a FRAX revision for the USA
|
Management of Hip Fractures in the Elderly
|
A revision (version 3.0) of the fracture risk assessment tool (FRAX) is developed based on an update of epidemiological information for the USA. With the revised tool, there were strong correlations (r > 0.99) between versions 2.0 and 3.0 for FRAX estimates of fracture probability, but the revised models gave lower probability estimates. INTRODUCTION: The aim of this study was to determine the effects of a revision of the epidemiological data used to compute fracture probabilities in the USA with FRAX. METHODS: Models were constructed to compute fracture probabilities based on updated fracture incidence and mortality rates in the USA. The models comprised the ten-year probability of hip fracture and the ten-year probability of a major osteoporotic fracture, both including femoral neck bone mineral density (BMD). For each model, fracture and death hazards were computed as continuous functions. The effect of the revised rates on fracture probability was examined by piecewise linear regression using multiple combinations of clinical risk factors and BMD. RESULTS: At all ages, there was a strong correlation (r > 0.99) between version 2.0 and revised FRAX estimates of fracture probability. For a major osteoporotic fracture, the revised model gave lower median probabilities by 13% to 24% in men, depending on age, and by 19% to 24% in women. For hip fracture probability, the revised model gave lower median fracture probabilities by 40% and 27% at the ages of 50 and 60 years in men and by 43% and 30%, respectively, in women. At the ages of 70 years and older the revised model gave similar hip fracture probabilities as version 2.0 in both men and women. CONCLUSION: The revised FRAX model for the USA (version 3.0) does not alter the ranking of fracture probabilities but provides lower probability estimates than version 2.0, particularly, in younger women and men
|
0 |
Volkmann's ischaemic contracture of the forearm
|
DOD - Acute Comp Syndrome CPG
|
Twenty-three patients with established contractures of the forearm, which were treated by excision of all irreparably damaged muscles, lengthening of the tendons and neurolysis of the median and ulnar nerves, are reported. Fourteen patients were children. Supracondylar fractures of the humerus, all treated by plaster-of-Paris, were associated with 10 contractures. Twelve patients achieved good or normal function of the hand after treatment; 5 had obvious functional disability, 4 achieved only a support function and 2 required forearm amputations. Early treatment improved the functional result. Treatment of displaced supracondylar fractures by traction seemed to be an important prophylactic procedure.
|
0 |
Computed Tomographic Angiography-Based Characterization of Source Blood Vessels for Nipple-Areola Complex Perfusion in Hypertrophic Breasts
|
Reduction Mammoplasty for Female Breast Hypertrophy
|
BACKGROUND: Current knowledge about the blood supply of the nipple-areola complex (NAC) has largely been derived from studies on cadavers or persons with breasts of normal size. The aim of this study was to identify and classify the NAC blood supply by computed tomographic angiography (CTA) examination in female volunteers with breast hypertrophy.
METHODS: CTA examination was performed on hypertrophic breasts of 23 female subjects. The main blood supplies were revealed through image data analyses. The dominant blood supply of the NAC and its vascular sources were identified and sorted. The detectable diameter threshold of blood vessels was set beyond 1.0 mm.
RESULTS: A total of 61 dominant blood vessels were identified. The source arteries were traced as the internal thoracic artery (ITA, 50.8%), lateral thoracic artery (LTA, 27.8%), thoracoacromial artery (TA, 14.8%), brachial artery (BA, 3.3%), and axillary artery (AA, 3.3%), and the corresponding reproducibility of these source vessels was 31, 37, 9, 4.3, and 4.3%, in all breasts. The intercostal artery (IA) was not identified as a dominant NAC supplying vessel in any CTA scan image. Twenty-six breasts had only one dominant artery, whereas 17 breasts showed multiple dominant blood supplies. Three breasts showed no dominant blood vessels of the NAC, with diameters greater than the detectable threshold of 1.0 mm, and 52.2% of the breasts demonstrated anatomically symmetrical patterns of blood supply for the NAC.
CONCLUSIONS: The ITA, LTA, and TA are likely to be the main vessel sources, whereas the IA is unlikely to be the dominant vessel for NAC perfusion, on the basis of the studied breasts. An asymmetrical pattern of bilateral breast blood supply was demonstrated in a considerable portion of the females with breast hypertrophy in this study.
LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
|
0 |
Reconstruction after external hemipelvectomy using tibia-hindfoot rotationplasty with calcaneo-sacral fixation
|
Management of Hip Fractures in the Elderly
|
Background: External hemipelvectomy is associated with high post operative morbidity and a poor functional outcome. We aim to explore a reconstruction technique to improve function and post operative appearance for patients who undergo external hemipelvectomy. Case presentation: We present a Case where extensive cancer involvement of pelvis and femur was managed with a novel surgical technique, which involved a calf sparing modified anterior flap hemipelvectomy combined with rotationplasty of the spared calf and fixation of calcaneus to the sacrum, thereby recreating a new thigh stump. Conclusion: Tibia-hindfoot rotationplasty result in good functional outcome and appearance for selected patients undergoing external hemipelvectomy with unaffected external iliac and femoral vessels. (copyright) 2008 Kong et al; licensee BioMed Central Ltd
|
0 |
Surgical Strategies in the Treatment of Gynecomastia Grade I-II: The Combination of Liposuction and Subcutaneous Mastectomy Provides Excellent Patient Outcome and Satisfaction
|
Panniculectomy & Abdominoplasty CPG
|
Background: Gynecomastia (GM) is a benign condition with glandular tissue enlargement of the male breast. GM is classified into 4 grades of increasing severity. We describe a series of GM grade I-II, diagnosed, treated surgically and analyzed regarding feasibility, complication rate, and satisfaction. Methods: From 2005 to 2012, a chart review was performed for 53 patients. Preoperative examination included endocrine and urological examination and exclusion of other pathological conditions. The surgical technique consisted of liposuction through an inframammarian-fold incision and excision of the glandular tissue by a minimal periareolar approach. Results: A total number of 53 male patients with 104 breasts were available for analysis. By liposuction, a median of 300 ml (range: 10-1000 ml) was aspirated from each breast and 25.1 g (range: 3-233 g) gland tissue was resected. Surgery lasted between 25 and 164 min per patient (median: 72 min). 2 postoperative hemorrhages occurred (n = 2, 3.8%). 2 patients underwent re-operation due to cosmetic reasons (n = 2, 3.8%). Conclusions: This analysis demonstrates that treatment of GM grade I-II can easily be performed by liposuction combined with subcutaneous resection of the glandular tissue as a minimally invasive and low-impact surgical treatment with a low rate of complications and excellent patient satisfaction. Preoperative workup is important to rule out specific diseases or malignancy causing the GM.
|
0 |
Update on the role of autologous hematopoietic stem cell transplantation in multiple myeloma
|
MSTS 2018 - Femur Mets and MM
|
Autologous stem cell transplantation is considered the standard of care for multiple myeloma patients aged < 65 years with no relevant comorbidities. The addition of drugs acting both on bone marrow microenvironment and on neoplastic plasma cells has significantly increased the proportion of patients achieving a complete remission after induction therapy, and these results are mantained after high-dose melphalan, leading to a prolonged disease control. Studies are being carried out in order to evaluate whether short term consolidation or long-term maintenance therapy can result into disease eradication at the molecular level thus increasing also patients survival. The efficacy of these new drugs has raised the issue of deferring the transplant after achiving a second response upon relapse. Another controversial point is the optimal treatment strategy for high-risk patients, that do not benefit from autologous stem cell transplantation and for whom the efficacy of new drugs is still matter of debate.
|
0 |
Visual Acuity, Contrast Sensitivity, and Mortality in Older Women: Study of Osteoporotic Fractures
|
DoD PRF (Psychosocial RF)
|
Objectives: To determine whether poorer visual acuity and contrast sensitivity are independent risk factors for all-cause and traumatic mortality in older women. Design: Twelve-year prospective cohort study (1986-2003). Setting: Four U.S. clinical centers. Participants: Nine thousand seven hundred four postmenopausal white women aged 65 and older. Measurements: Habitually corrected binocular visual acuity and low- and high-frequency contrast sensitivity were measured at baseline using a standard protocol. A study physician adjudicated the primary cause of death from death certificates and medical record review. Results: During an average of 12.2 years of follow-up, 3,427 women died (35%), 72 (0.7%) from traumatic events. In multivariate models adjusted for age, chronic medical problems, and smoking, all-cause mortality risk was 19% greater for persons in the worst quartile of visual acuity than for those in the best (hazard ratio (HR) = 1.19, P = .008) and 39% greater for persons with the worst contrast sensitivity (HR = 1.39, P < .001) than for those with the best. Traumatic mortality risk was 2.4 times greater for women with the worst contrast sensitivity than for those with the best (HR = 2.44, P = .03). Conclusion: Poorer visual acuity and contrast sensitivity are associated with greater risk of traumatic and all-cause mortality in older women, even after controlling for demographic and clinical characteristics. Although further research is necessary to determine how treating reversible causes of visual impairment or improving current refraction affects mortality in older women, clinical detection and follow-up of these visual impairments holds promise for identifying those who are at risk of mortality from other systemic conditions. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
|
0 |
The Contribution of Genes to Osteoarthritis
|
Surgical Management of Osteoarthritis of the Knee CPG
|
Osteoarthritis (OA) is the most prevalent form of arthritis in the elderly. A large body of evidence, including familial aggregation and classic twin studies, indicates that primary OA has a strong hereditary component that is likely polygenic in nature. Furthermore, traits related to OA, such as longitudinal changes in cartilage volume and progression of radiographic features, are also under genetic control. In recent years, several linkage analysis and candidate gene studies have been performed and have unveiled some of the specific genes involved in disease risk, such as FRZB and GDF5. The authors discuss the impact that future genome-wide association scans can have on our understanding of the pathogenesis of OA and on identifying individuals at high risk for developing severe OA. (copyright) 2008 Elsevier Inc. All rights reserved
|
0 |
Aluminium in antacids and cooking pots and the risk of hip fractures in elderly people
|
Management of Hip Fractures in the Elderly
|
The relationship between hip fractures and aluminium in antacids and cooking pots was examined in an epidemiological study in Sydney, Australia. A population-based case-control study was conducted and 416 men and women aged 65 years and over were recruited (209 cases and 207 controls). There was a significantly (p < 0.05) increased risk of hip fracture associated with use of aluminium cooking pots at age 20 years: the age- and sex-adjusted odds ratio was 1.9 [95% confidence interval (CI) 1.1-3.2]. No association was detected between risk of hip fracture and current use of aluminium cooking pots or use at age 50. There was some suggestion that long-term use of aluminium-containing antacids might increase the risk of hip fracture: the adjusted odds ratio comparing those who had used aluminium-containing antacids for more than 10 years with those who had never used them was 1.8 (95% CI 0.8-4.1). The findings of this study support the need for further research on the association between oral ingestion of aluminium and risk of hip fracture
|
1 |
Anterior levator resection in congenital genuine blepharoptosis. A follow-up of 55 operated eyelids
|
Upper Eyelid and Brow Surgery
|
Fifty-five eyelids operated on for congenital blepharoptosis over a 10-year period were followed up, with a mean observation time of seven years. Ptosis was on the right side in 12 patients, the left side in 20, and bilateral in 12. Ptosis was regarded as being slight in 32 eyelids, moderate in 10 and severe in 14. The operative procedure was resection of the levator muscle and its aponeurosis through an anterior approach. Fifty-five percent of the patients with slight ptosis were improved, with the eyelid having a normal position. All the patients with moderate ptosis were improved - half to a normal eyelid position, and half with a residual slight ptosis. All but one patient with severe ptosis were improved, and half of these to a normal eyelid position. It is concluded that this operation can be used for all types of congenital ptosis, and especially in severe cases, where it produces better results than e.g. the frontalis sling procedure.
|
1 |
PTSD and depression construct: prevalence and predictors of co-occurrence in a South Lebanese civilian sample
|
DoD PRF (Psychosocial RF)
|
BACKGROUND: Armed conflict, occupation, and political and economic instability that are particularly experienced by the civilian Lebanese population of South Lebanon would almost inevitably affect these individuals psychologically. Therefore, identifying predictors of co-occurring mental disorders is paramount to sound assessment and intervention planning.
OBJECTIVE: This study aims to determine the prevalence and predictors of co-occurring posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) in a post-war population from South Lebanon.
METHOD: A total of 991 citizens from 10 villages were interviewed using a cross-sectional design through random sampling. The prevalence of PTSD, MDD, or both was 23.4%. To identify predictors of PTSD and depression co-occurrence, multinomial logistic regression was used. Participants were divided into four groups (participants with no PTSD or depression, participants with PTSD only, participants with depression only, and participants with PTSD-depression comorbidity).
RESULTS: Among the significant predictors of PTSD-depression co-occurrence, female gender, health problems, social life events, and witnessed traumatic events were most consistently found. Additionally, employment and educational status, as well as social support, were found to significantly predict co-occurrence.
CONCLUSIONS: Results reveal the distinct risk and protective factors that characterize the PTSD-depression profile. These findings will hopefully assist in the development of interventions that are sensitive to individuals' psychosocial milieu.
|
0 |
Age and visual impairment decrease driving performance as measured on a closed-road circuit
|
Upper Eyelid and Brow Surgery
|
In this study the effects of visual impairment and age on driving were investigated and related to visual function. Participants were 139 licensed drivers (young, middle-aged, and older participants with normal vision, and older participants with ocular disease). Driving performance was assessed during the daytime on a closed-road driving circuit. Visual performance was assessed using a vision testing battery. Age and visual impairment had a significant detrimental effect on recognition tasks (detection and recognition of signs and hazards), time to complete driving tasks (overall course time, reversing, and maneuvering), maneuvering ability, divided attention, and an overall driving performance index. All vision measures were significantly affected by group membership. A combination of motion sensitivity, useful field of view (UFOV), Pelli-Robson letter contrast sensitivity, and dynamic acuity could predict 50% of the variance in overall driving scores. These results indicate that older drivers with either normal vision or visual impairment had poorer driving performance compared with younger or middle-aged drivers with normal vision. The inclusion of tests such as motion sensitivity and the UFOV significantly improve the predictive power of vision tests for driving performance. Although such measures may not be practical for widespread screening, their application in selected cases should be considered.
|
0 |
Role of subcutaneous abdominal fat on cardiac function and proinflammatory cytokines in premenopausal obese women
|
Panniculectomy & Abdominoplasty CPG
|
The role of surgically removing subcutaneous fat by abdominoplasty on circulating inflammatory markers and myocardial dysfunction, evaluated by myocardial performance index (MPI), were investigated. Twenty volunteers submitted to the abdominoplasty (abdominoplasty group), and other 28 women treated by hypocaloric diet (diet group) were evaluated. Echocardiographic parameters of MPI, circulating levels of tumor necrosis factor (TNF)-alpha and interleukin (IL)-6, were performed at baseline and 2 months later. Compared with nonobese women, obese women had increased concentrations of TNF-alpha (P < 0.01), IL-6 (P < 0.01), and higher MPI (P < 0.02), indicating ventricular dysfunction. Subcutaneous fat concentrations of TNF-alpha and IL-6 were related to MPI impairment. After 60 days, waist-to hip ratio was significantly reduced in the abdominoplasty group. Anthropometric changes were accompanied by a significant decline in plasma concentrations of TNF-alpha and IL-6 levels as well as by significant improvements of MPI in abdominoplasty group compared with diet group. Abdominoplasty may represent a safe method for ameliorating cardiac function in obese women.
|
0 |
Surgical treatment of metastatic long bone disease
|
MSTS 2018 - Femur Mets and MM
|
A retrospective study of the results of operative treatment of 60 long bones secondaries in 46 patients was carried out. The mean period of follow-up was 10 months. The most common primary in this study was carcinoma of the breast (28.2%), followed by carcinoma of the lung (21.7%) and unknown primary (10.9%). Three groups of patients were studied--pathological fracture group, prophylactic fixation group and a mixed group. In the pathological fracture group, 70% of patients achieved good to excellent pain relief and 60.9% was able to walk with or without walking aids. In the prophylactic group, all the patients achieved good to excellent pain relief and 60% were able to ambulate with or without walking aids. In the mixed group, all the patients achieved good to excellent pain relief and 66.6% of the patients were able to walk with aids. The operative mortality in both the pathological fracture group and prophylactic fixation group was 10% and 33.3% in the mixed group. Multiple internal fixation performed at one operative session was associated with high operative mortality (50%).
|
0 |
Acute carpal tunnel syndrome in a diver: evidence of peripheral nervous system involvement in decompression illness
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
Conclusive evidence for involvement of the peripheral nervous system in decompression illness is lacking. We report a case of decompression illness associated with shoulder pain and the clinical features of median nerve injury at the wrist. Initial recompression and hyperbaric oxygen treatment produced prompt relief of all symptoms and signs, but carpal tunnel syndrome subsequently recurred. Nerve conduction studies confirmed median nerve conduction delay at the wrist. Repeat measurements after treatment with hyperbaric oxygen showed electrophysiologic improvement that was consistent with improvement in symptoms. We believe this is the first objectively substantiated case of injury to the peripheral nervous system caused by decompression illness
|
0 |
Alpine Skiing With total knee ArthroPlasty (ASWAP): impact on molecular and architectural features of musculo-skeletal ageing
|
OAK 3 - Non-arthroplasty tx of OAK
|
This study investigated features of skeletal muscle ageing in elderly individuals having previously undergone unilateral total knee arthroplasty (TKA) and whether markers of sarcopenia could be mitigated by a 12-week alpine skiing intervention. Novel biomarkers agrin, indicative of neuromuscular junction (NMJ) degeneration, tumor suppressor protein p53, associated with muscle atrophy, and a new ultrasound-based muscle architecture biomarker were used to characterize sarcopenia. Participant details and study design are presented by Kösters etâ??al. (2015). The results of this study show that NMJ degeneration is widespread among active septuagenarians previously subjected to TKA: all participants showed elevated agrin levels upon recruitment. At least 50% of individuals were identified as sarcopenic based on their muscle architecture, supporting the hypothesis that NMJ alterations precede sarcopenia. Notably, sarcopenia was strongly associated with the expression of p53, which seems to confirm its validity as a biomarker of muscle atrophy. Training did not significantly modify any of these biomarkers. In view of the lack of accretion of muscle mass in response to the alpine skiing intervention, we hypothesize that local muscle inflammation and oxidative stress may have blunted the anabolic response to training and promoted muscle breakdown in this elderly post-TKA population.
|
0 |
Clinical profile of Filipino patients with osteoarthritis seen at two arthritis clinics
|
OAK 3 - Non-arthroplasty tx of OAK
|
AIM: To describe a cohort of Filipinos with primary osteoarthritis (OA).
METHOD: Charts with diagnosis of OA from two arthritis clinics (Philippine General Hospital and a private clinic) from January 2008 to May 2011, were reviewed for demographics, clinical presentation, risk factors and management. Descriptive statistics were applied.
RESULTS: Eight hundred and fifty-nine (859) patients had primary OA. Female-to-male ratio was 3 : 1. Mean age at diagnosis was 63 years, onset at 59 years. Men consulted 10 months later. Mean body mass index was 27.1 kg/m(2). Women were overweight, men, obese. Co-morbid conditions included hypertension (53%), dyslipidemia (16%) and diabetes (13%). Women (94.7%) developed symptoms 12 years after menopause. One-third of patients were of low socioeconomic status. Chief complaint was pain in 92.8%. Joint findings included crepitus (70.8%) and Heberden's nodes (13.0%) for knees and hands, respectively. Commonly involved joints were knees (62.5%), knees and hands (14.3%), and generalized joint involvement (13.5%). The hip was involved in 2.9% of cases. Radiographs showed Kellgren-Lawrence score of 2 in 56.6%. Less than 25% received physical therapy. Most prescribed drugs were glucosamine sulfate (45.5%), paracetamol (42.8%) and coxibs (40.6%). Less than 8% received intra-articular treatment, or were referred for surgery.
CONCLUSION: We described a large cohort of Filipino OA patients. Clinical characteristics show more women than men, with knees as the most common and hips as the least involved joints. Medical management was based on a local practice guideline. Compared to the literature, this cohort had more overweight than obese subjects and low surgical referral. A coordinated registry with orthopedics and physiatry departments is currently underway.
|
0 |
Assessment of Bone and Muscle Measurements by Peripheral Quantitative Computed Tomography in Geriatric Patients
|
Hip Fx in the Elderly 2019
|
The loss of bone and muscle mass increases the risk of osteoporotic fractures. Dual energy X-ray absorptiometry (DXA) loses sensitivity in older age. The purpose of this study was to evaluate bone and muscle measurements of peripheral quantitative computed tomography (pQCT) in a geriatric cohort with osteoporosis. Bone mineral density and muscle area of 168 patients aged 65 years and older (76.3 ± 6.5) were measured with pQCT at distal forearm additionally to an osteoporosis assessment consisting of anamnesis, blood test and DXA of lumbar spine and hip. Prior fractures were categorized in minor and major osteoporotic fractures. Logistic regression was used to show the association of bone mineral density and muscle area with major fractures. 54.8% of the participants had at least one major fracture. Bone mineral density measured with pQCT and muscle area were significantly associated with these fractures (total and trabecular bone mineral density OR 2.243 and 2.195, p < 0.01; muscle area OR 2.378, p < 0.05), whereas DXA bone mineral density showed no significant association. These associations remained after adjustment for age, sex, BMI, physical activity and other factors. In all models for patients >75 years only muscle area was significantly associated (OR 5.354, p < 0.05) with major fractures. Measurement of bone mineral density and muscle area with pQCT seems to have advantage over DXA in fracture association in geriatric patients. Measuring muscle area also adds useful information to estimate the presence of osteosarcopenia.
|
1 |
The fate of lower extremities with failed free flaps: a single institution's experience over 25 years
|
DoD LSA (Limb Salvage vs Amputation)
|
BACKGROUND: Lower-extremity reconstruction with microvascular free flap coverage is often the only option for limb salvage. Flap failure rates, however, continue to have higher complication rates than those to other anatomic sites; a significant number of flaps that fail result in amputation. This study retrospectively analyzed patients treated at a single institution who underwent attempted lower-extremity limb salvage with microsurgical techniques over a 25-year period. Of particular interest are the outcome data for patients who had initial free flap failure. PATIENTS AND METHODS: A prospectively maintained database was used to identify patients who satisfy criteria. Every patient who was treated with a microvascular free flap to their lower extremities was identified and included in this analysis. All records were reviewed from 1980 through 2004. Patients who had free flaps to the lower extremity fail after the initial operation were identified and selected for further analysis. RESULTS: Five hundred eighty-eight patients who underwent microsurgical reconstruction of lower extremity wounds had a failure rate of 8.5%. Trauma patients (83%) had a failure rate of 9%. On subset analysis, the failure rate for trauma patients decreased from 11% (1980-1992) to 3.7% (1993-2004). Of patients who had a failed free flap, 18% went on to limb amputation; the remainder was salvaged with secondary free flaps, local flaps, or skin grafting. CONCLUSION: This single institutional experience spanning 25 years represents the longest continual series of lower-extremity free flaps reported in the literature. The improved success rate seen in the second half of the study period is attributed to a more critical selection of free-flap candidates, improved understanding of the physiology surrounding acute trauma and a more sophisticated multidisciplinary team organization.
|
1 |
Factors Associated With Early Opioid Prescription Among Workers With Low Back Injuries
|
DoD PRF (Psychosocial RF)
|
Prescription of opioids for nonmalignant musculoskeletal pain has increased substantially in recent years, but there is little information on the incidence of, or factors associated with, such prescription for work-related back pain. In a prospective cohort study (N = 1067), we examined associations between worker sociodemographic and other characteristics and opioid prescription within six weeks of the first medical visit for workers' compensation claims for work loss due to back injury. We examined administrative, pharmacy, and worker-reported data. In bivariate logistic regression models, Hispanics were less likely than non-Hispanic whites to receive opioid prescriptions, and very high body mass index, daily tobacco use, greater pain and physical disability, pain radiating below the knee, injury severity categorizations (from medical records) of major sprain and radiculopathy, and worse mental health were associated with opioid prescription. Adjusting for demographics, pain intensity, and physical disability, opiate prescription was significantly associated with daily tobacco use, pain radiating below the knee, and injury severity categories (major sprain and radiculopathy). Knowledge of worker characteristics associated with early opioid prescription may be useful in future studies of the role of early pain treatment in influencing subsequent course of pain and disability among workers with back injuries. Perspective: Little is known about patient characteristics that may influence physicians' decisions concerning prescription of opioids for acute back pain. Not surprisingly, workers with more severe back injuries are more likely to be prescribed opioids, but reasons for prescription disparities based on ethnicity and tobacco use warrant further study. © 2006 American Pain Society.
|
0 |
Hemophilic arthropathy
|
DOD - Acute Comp Syndrome CPG
|
The musculoskeletal manifestations of hemophilia A and B are some of the most common presenting symptoms and continue to be challenging to practitioners. Hemophilic arthropathy, if not initially adequately treated and managed, may lead to debilitating disease and eventually require the consideration of major surgery, including total joint arthroplasty. Thorough comprehension of the pathophysiology, diagnosis, and both medical and surgical interventions is critical in establishing an appropriate treatment regimen for these patients. Furthermore, a true multidisciplinary approach involving hematology, orthopedics, and physical therapy is essential for a patient with hemophilic arthropathy. The authors present a comprehensive review of hemophilic arthropathy from an orthopedist's perspective.
|
0 |
Observation on the effect of manipulation treatment in children with supracondylar fracture of the humerus
|
Pediatric Supracondylar Humerus Fracture 2020 Review
|
Objective: To investigate the clinical effects of manipulation treatment in children with supracondylar fracture of the humerus. Methods: 160 children with supracondylar fracture of humerus were selected from January 2012 to June 2014. They were randomly divided into the observation group and the control group with 80 cases in each. The control group was given the treatment of conventional open reduction and pin internal fixation combined with small splint external fixation, while the observation group implemented the practices of Chinese medicine treatment of external fixation combined with Kirschner wire internal fixation combined with small splint, then we compared the clinical treatment effect and the clinical complications in children of two groups. Results: In the observation group, 54 patients were cured (67.5%), 22 cases were effective (27.5%), the total efficiency was 95%; in the control group there 42 cases were cured (52.5%), 24 cases were effective (30%), the total efficiency was 82.5%; so the clinical therapeutic effect of the observation group was obviously better than that of the control group, and the difference was statistically significant between two groups (P<0.05). The total incidence of complications in the observation group was 7.5%, and significantly lower than the control group of 27.5%, there was significant difference between two groups (P<0.05). Conclusion: Application of traditional manipulation treatment in children with supracondylar fracture of humerus can effectively promote the fracture reduction and fracture healing of children, promote the recovery of elbow function, shorten the recovery time, and reduce the pain of patients. It has the advantages of high clinical effective rate, low complication rate and rapid recovery, so it is an effective method for clinical treatment of humeral supracondylar fracture in children, and worthy of clinical application.
|
0 |
Health-related quality of life after total knee or hip replacement for osteoarthritis: a 7-year prospective study
|
Surgical Management of Osteoarthritis of the Knee CPG
|
OBJECTIVE: To assess health-related quality of life (HRQOL) in a prospective study with 7 years of follow-up in 49 consecutive patients who underwent a total joint replacement because of osteoarthritis. METHODS: Generic HRQOL was assessed with the short-form 36 (SF-36) and specific HRQOL with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS: Out of the 39 subjects who have completed the 7 years of follow-up of this study, 22 (56.4 %) underwent a hip replacement surgery and the other 17 (43.6 %) a knee replacement. Six months after surgery, a significant improvement, compared to preoperative scores, was observed in two of the eight dimensions of the SF-36 (i.e. physical function and pain). The same dimensions, pain and physical function, at the same time, 6 months after surgery, measured by the WOMAC, showed a significant improvement as well, but there was no significant change in the stiffness score. From 6 months to the end of follow-up, changes in SF-36 scores showed a significant improvement in physical function (p = 0.008), role-physical (p = 0.004) and role-emotional (p = 0.01) while all scores of the WOMAC improved (p < 0.001 for pain, p < 0.001 for stiffness and p < 0.01 for physical function). CONCLUSION: The improvements observed in HRQOL at short term after surgery, are at least maintained over a 7-year follow-up period
|
0 |
Attenuation of glucan-binding protein C reduces the cariogenicity of Streptococcus mutans: analysis of strains isolated from human blood
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
A blood isolate of Streptococcus mutans strain TW871 shows relatively low homology with MT8148, a reference oral isolate strain, and lacks the serotype-specific polysaccharide antigen, suggesting that other cell-surface structures correlate with cariogenicity. We compared cariogenicity of TW871 with MT8148 (serotype c) and blood isolate TW964 (serotype f) in rats. Strain TW871 showed significantly lower cariogenicity than MT8148 or TW964 and expressed significantly lower sucrose-independent cellular adhesion to saliva-coated hydroxyapatite and dextran-binding activity than strain MT8148. Strains TW871 and TW964 showed a defect in the gbpA gene by Southern hybridization analysis, while sequencing analysis revealed gbpC variation in TW871. These results suggest that variation in GbpC may alter cellular adherence properties and can be correlated with the cariogenicity of S. mutans in this strain
|
0 |
Wrist deformities after fracture
|
Distal Radius Fractures
|
Wrist deformities can occur after fracture because of malunion of the fracture or injury to the growth plate leading to imbalance of growth. Prevention of malunion is paramount by early recognition with proper reduction and casting or fixation with casting. If a malunion occurs, an osteotomy may be necessary if anticipated growth will not correct the deformity. Injury of the growth plate may lead to wrist deformity in two ways: angular growth or growth arrest. Angular growth deformities are corrected most commonly by osteotomy. Growth arrest of the radius or the ulna leads to an ulnar-positive or an ulnar-negative variance at the wrist. If the ulnar variance is symptomatic, treatment is centered on achieving a level joint. Options for joint leveling procedures include epiphysiodesis or physeal stapling of the longer bone, lengthening osteotomy of the shorter bone, or shortening osteotomy of the longer bone. © 2006 Elsevier Inc. All rights reserved.
|
0 |
Endoscope-assisted suction extraction of lipomas
|
Panniculectomy & Abdominoplasty CPG
|
The blunt technique of suction-assisted lipectomy partially evolved while proving to be an efficient, albeit blind, method for the removal of lipomas. Larger or poorly encapsulated tumors were acknowledged to be at a greater risk for recurrence probably because of an unrecognized residua. Just as liposuction has enhanced body-contour surgery because of the potential for smaller and fewer scars hidden in strategically camouflaged locations, the identical advantages are possible for liposuction extraction of lipomas, with a greater assurance for their entire removal via direct visualization using a surgical endoscope.
|
0 |
Serum insulin-like growth factor-1 in centenarians: implications of IGF-1 as a rapid turnover protein
|
Management of Hip Fractures in the Elderly
|
BACKGROUND: It is well documented that serum insulin-like growth factor 1 (IGF-1) levels as well as growth hormone secretion decline with advancing age. Low levels of IGF-1 are shown to be associated with low activity of growth hormone, low lean mass, and high body fat mass; however, in the elderly, the relationship has not been confirmed. METHODS: We studied serum IGF-1 levels in 49 centenarians, who are at the ultimate stage of physiological senescence, and investigated the possible relationship between IGF-1 and body mass index, lipid parameters, nutritional indices, physical and cognitive function, and frequency of hip fracture. As nutritional indices, serum levels of albumin, prealbumin, transferrin, and retinol binding protein were measured. Cognitive function of the centenarians was assessed by clinical dementia rating. RESULTS: In the centenarians, the mean levels of IGF-1 were relatively low, indicating that there is an age-associated decline in IGF-1 even in the extremely old age. We demonstrated a strong association of IGF-1 with prealbumin and retinol binding protein (r2 = .192, .195, respectively); however, there was no association with albumin, transferrin, or body mass index. Interestingly, centenarians with lower IGF-1 levels had a higher prevalence of definitive dementia. CONCLUSIONS: These data suggest that serum IGF-1 levels in the centenarians appeared to reflect their short-term nutritional status as a rapid turnover protein. It is also suggested that low levels of serum IGF-1 may be involved in the progression of dementia in the oldest old
|
0 |
Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. Surgical technique
|
DoD SSI (Surgical Site Infections)
|
BACKGROUND: The results of elbow dislocations with associated radial head and coronoid fractures are often poor because of recurrent instability and stiffness from prolonged immobilization. We managed these injuries with a standard surgical protocol, postulating that early intervention, stable fixation, and repair would provide sufficient stability to allow motion at seven to ten days postoperatively and enhance functional outcome.
METHODS: We retrospectively reviewed the results of this treatment performed, at two university-affiliated teaching hospitals, in thirty-six consecutive patients (thirty-six elbows) with an elbow dislocation and an associated fracture of both the radial head and the coronoid process. Our surgical protocol included fixation or replacement of the radial head, fixation of the coronoid fracture if possible, repair of associated capsular and lateral ligamentous injuries, and in selected cases repair of the medial collateral ligament and/or adjuvant-hinged external fixation. Patients were evaluated both radiographically and with a clinical examination at the time of the latest follow-up.
RESULTS: At a mean of thirty-four months postoperatively, the flexion-extension arc of the elbow averaged 112 degrees +/- 11 degrees and forearm rotation averaged 136 degrees +/- 16 degrees . The mean Mayo Elbow Performance Score was 88 points (range, 45 to 100 points), which corresponded to fifteen excellent results, thirteen good results, seven fair results, and one poor result. Concentric stability was restored to thirty-four elbows. Eight patients had complications requiring a reoperation: two had a synostosis; one, recurrent instability; four, hardware removal and elbow release; and one, a wound infection.
CONCLUSIONS: Use of our surgical protocol for elbow dislocations with associated radial head and coronoid fractures restored sufficient elbow stability to allow early motion postoperatively, enhancing the functional outcome. We recommend early operative repair with a standard protocol for these injuries. [References: 12]
|
0 |
Femur shaft fracture at a young age and the risk of subsequent severe injuries during childhood: a cohort study
|
Pediatric Diaphyseal Femur Fractures 2020 Review
|
BACKGROUND: A child who suffers a fracture or a soft-tissue injury at a young age faces an increased risk of subsequent injuries during childhood. This risk could be related to personal and family characteristics or to lower-than-average bone-mineral density. The purpose of this nationwide cohort study was to estimate the association between a femur shaft fracture at a young age and the subsequent risk of hospitalization for injuries during childhood. METHODS: We compared the subsequent risk of hospitalization for injuries during childhood among 1,404 children (exposed) who were one to three years of age when they suffered a femur shaft fracture with the risk among 13,814 randomly selected, gender- and age-matched femur fracture-free children (unexposed). Hazard ratios (HRs) and 95% confidence intervals (CIs) for severe injuries defined as fractures or soft-tissue injuries requiring hospital admission were estimated in a Cox proportional hazards model. RESULTS: Exposed children exhibited no significantly increased risk of upper-extremity fractures or soft-tissue injuries during childhood, regardless of sex and follow-up time. Boys exhibited a 162% increased risk of suffering a lower leg fracture requiring hospital admission (HR?=?2.62, 95% CI: 1.45-4.71), but the refracture risk was not significant for girls 2.02 (0.58-6.97). CONCLUSIONS: We found an increased risk for subsequent fractures in the lower leg that requires inpatient care during childhood for boys, but not for girls, who were one to three years of age when they first suffered a femur shaft fracture. This increased fracture risk is probably not simply the result of greater risk-taking among boys. The explanation might relate to factors affecting the bone quality of the lower leg.
|
0 |
Trends in surgical management of femoral neck fractures in the United States
|
Management of Hip Fractures in the Elderly
|
We examined trends in utilization of open reduction and internal fixation (ORIF), THA, and hemiarthroplasty (HA) for femoral neck fractures. Closed femoral neck fractures managed with ORIF or hip arthroplasty (n = 162,257) were extracted from 1990 to 2001 Nationwide Inpatient Samples. Trends were examined during three periods (1990-1993 [Period I], 1994-1997 [Period II], and 1998-2001 [Period III]). Utilization of HA increased from 67.8% in Period I to 75.3% in Period III. In the same period, utilization of THA decreased from 11.6% to 6.6%. The trend of decreased use of THA was consistent regardless of age, hospital, or surgeon volume. In Period III, 28.7% of patients were managed at urban teaching hospitals as compared with 19.6% in Period I. Increased utilization of HA conforms with recent evidence that arthroplasty has better outcomes than ORIF. However, the decrease in THA is contrary to what was expected, and its impact on patient outcomes needs to be evaluated. The increase in the proportion of femoral fractures managed at urban teaching hospitals may reflect a change in the organization of trauma systems during the last decade. Level of Evidence: Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence
|
0 |
Ultrasound-aided unilateral epidural block for single lower-extremity pain
|
Surgical Management of Osteoarthritis of the Knee CPG
|
We report an ultrasound-aided unilateral epidural block, employed in two patients, to provide better analgesia and motor function for lower-extremity pain. The patient in case 1 was a 72-year-old woman who suffered pain arising from Herpes zoster rash on the left leg (the second lumbar nerve area). A left-dominant continuous unilateral epidural block was performed to reduce her pain. After confirming the L2/3 epidural space and needle direction using ultrasound imaging, epidural cannulation was performed. Continuous infusion of 4 ml h(-1) of 1% lidocaine through the epidural catheter eliminated the herpetic pain in the left leg, maintaining motor function and normal sensation in her right leg. The patient in case 2 was a 35-year-old man whose complaint was postoperative pain in his left knee during passive movement. Dependent-side (left-side) dominant ultrasound-aided continuous unilateral epidural block, the same procedure as that used in case 1, was performed at the L3/4 intervertebral space. His left knee pain was clearly reduced, with partial paralysis, but motor function in his right leg was completely normal during the continuous epidural block with 4 ml h(-1) of 0.2% ropivacaine. Ultrasound imaging around the epidural space facilitated effective unilateral epidural block for single lower-extremity pain in both patients. This technique could decrease possible side effects and improve patient satisfaction during continuous nerve block by maintaining motor function and sensation in the nondependent side
|
1 |
Retrospective Study Of Internal Derangements Of Knee Joints With MRI
|
AMP (Acute Meniscal Pathology)
|
Background: Knee injury is the second most common problem in the musculoskeletal system for which patients consult their general physician or an orthopaedician. Since its introduction to musculoskeletal imaging in the early 1990`s and then onwards, MRI has revolutionized diagnostic imaging of the knee joints. Magnetic resonance imaging has an advantage in diagnosis of menisci, ligaments and cartilages of the knee joints along with their pathologies and injuries, particularly in the early detection of grade I and grade II lesions. The ‘knee joint’, also known as the tibio-femoral joint, is one of the largest and a complex joint of the human body, and of one of the most frequently injured joints as the bony articular surface alone is inherently unstable. Therefore, it is imperative to study internal derangements in traumatic and degenerative knees. Objectives and Aims: To evaluate the internal derangements of knee joints with MRI ". Materials and Methods: This study was carried out in the Department of Radiology, MGM Medical College & Research Institute, Puducherry and SGRR Institute of Medical & Health Sciences and SMI Hospital, Dehradun, Uttarakhand, India. Study period was from June 2022 to December 2022. 102 patients, 76 males and 26 females, aged 14-72, mean age 36.7 years, who were suspected to have meniscal, ligamentous and intra-articular pathologies and were referred by the orthopaedic department were studied using GE Signa 1.5 T MR machine. Images were obtained in sagittal, axial and coronal planes using T1, T2 and PD sequences. Slice thickness of 4mm, FOV of 19 x 19 and NEX of 4 were used. Observations and Results: Anterior cruciate ligament (ACL) tears accounted for the majority of cases (63%) followed by Medial meniscal tears (57%), Lateral meniscal tear (36%), PCL tears (15%), MCL tears (10%) and least common were LCL tears (7%). Hyperintensity, discontinuity and non-visualisation were primary signs of ACL tear. Meniscal tears seen commonly are grade II in both medial and lateral meniscus Conclusion: Thus, MRI is a useful non-invasive modality having high sensitivity, specificity and accuracy in the diagnosis of meniscal and cruciate ligament injuries. Because of its better soft tissue delineation, non-invasiveness and radiation free imaging, MRI is the best investigation for the assessment of ligamentous, meniscal and intra-articular knee pathologies. It provides an accurate preoperative anatomic assessment, thus aids clinical examination and arthroscopy.
|
0 |
Radiofrequency ablation of genicular nerves prior to total knee replacement has no effect on postoperative pain outcomes: A prospective randomized sham-controlled trial with 6-month follow-up
|
OAK 3 - Non-arthroplasty tx of OAK
|
Background and objectives Refractory chronic knee pain from osteoarthritis (OA) is commonly treated with total knee arthroplasty (TKA). TKA can be associated with severe postoperative pain and persistent postsurgical knee pain. Poorly controlled postoperative pain can negatively effect functional outcomes following TKA, and effective opioid-sparing analgesia is key to the ideal recovery. Genicular nerve radiofrequency ablation (GN-RFA) has been shown in several trials to be clinically effective in patients with severe refractory knee pain from OA. We aimed to assess if preoperative GN-RFA would improve postoperative pain outcomes following TKA. Methods This was a sham-control prospective clinical trial in which blinded participants were randomized to image-guided GN-RFA or a simulated sham procedure 2-6 weeks prior to elective TKA. Outcomes were assessed at 48 hours and 1, 3 and 6 months following TKA. Results Seventy participants enrolled in this study. As compared with sham controls, GN-RFA had no treatment effect on postoperative opioid consumption, pain or functional measures at any time point. Conclusions Cooled RFA of the superior lateral, superior medial and inferomedial genicular nerves, when performed 2-6 weeks prior to elective TKA as part of a multimodal postoperative pain management regime, had no measurable effect on postoperative opioid use, analgesia use or function in the 48 hours following surgery. In addition, we found no longer term effect on outcome measures 1, 3 and 6 months after TKA. Trial registration number NCT02746874.
|
0 |
Osteochondral and Meniscal Allograft Transplantation in the Football (Soccer) Player
|
Surgical Management of Osteoarthritis of the Knee CPG
|
Knee injuries are common in football, frequently involving damage to the meniscus and articular cartilage. These injuries can cause significant disability, result in loss of playing time, and predispose players to osteoarthritis. Osteochondral allografting is an increasingly popular treatment option for osteoarticular lesions in athletes. Osteochondral allografts provide mature, orthotopic hyaline cartilage on an osseous scaffold that serves as an attachment vehicle, which is rapidly replaced via creeping substitution, leading to reliable graft integration that allows for simplified rehabilitation and accelerated return to sport. The indications for meniscal replacement in football players are currently still evolving. Meniscus allografts offer potential functional, analgesic, and chondroprotective benefits in the meniscectomized knee. In the player at the end of his or her professional/competitive career, meniscal allografts can play a role in averting progression of chondropenia and facilitating knee function and an active lifestyle. This article is intended to present a concise overview of the limited published results for osteochondral and meniscal allografting in the athletic population and to provide a practical treatment algorithm that is of relevance to the clinician as well as the patient/football player, based on current consensus of opinion. (copyright) SAGE Publications 2012
|
1 |
Patients with pertrochanteric hip fracture may benefit from preoperative intravenous iron therapy: a pilot study
|
Management of Hip Fractures in the Elderly
|
BACKGROUND: Patients undergoing pertrochanteric hip fracture (PHF) repair surgery often receive perioperative allogeneic blood transfusions (ABTs) to avoid the deleterious effects of anemia. Nevertheless, concerns about adverse effects of ABTs have prompted the review of transfusion practice and the search for a safer treatment of perioperative anemia. MATERIAL AND METHODS: The effect of preoperative 200 to 300 mg of intravenous (IV; Group 2; n = 55) iron sucrose administration on transfusion requirements and postoperative morbidity-mortality in patients with PHF has been prospectively investigated. A previous series of 102 PHF patients served as the control group (Group 1). All patients were older than 65 years and were operated on at the third day after admission to the hospital, by the same medical team and with the same implant. RESULTS: Iron sucrose was well tolerated and reduced the transfusion rate in patients with admission hemoglobin levels of greater than 120 g per L (p < 0.05) who also received fewer units of red blood cells (p < 0.05). In addition, iron sucrose reduced postoperative infection rate (p < 0.05), but not 30-day mortality rate or mean length of hospital stay. CONCLUSION: The administration of IV iron sucrose seems to reduce ABT requirements in patients with PHF and is associated to lower postoperative morbidity. The possible mechanisms involved in these effects are discussed
|
0 |
Abdominal strength after breast reconstruction using a free abdominal flap
|
Reduction Mammoplasty for Female Breast Hypertrophy
|
BACKGROUND: Today, breast reconstruction with autologous tissue is most commonly done either as a free muscle sparring TRAM flap or as a DIEP flap. Studies of donor site morbidity have shown an advantage in using the DIEP flap. However, this procedure might also be associated with an increased risk of flow related complications and it is also thought to be more demanding and time consuming. A few studies have evaluated the abdominal wall strength after dissection of a TRAM flap or a DIEP flap. However, these studies do not distinguish between the various types of free TRAM flaps and they also compare TRAM procedures preformed in an early period to DIEP procedures done in a later period.
METHODS: We used an isokinetic dynamometer to measure concentric, eccentric and isometric abdominal muscle strength in 32 patients who had had a unilateral breast reconstruction with a free MS-2 (15) or a DIEP (17) flap in the year 2003.
RESULTS: No significant reduction in muscle strength was observed for concentric or isometric muscle strength. However, significant lower eccentric muscle strength was found in the TRAM compared to the DIEP group (p=0.05). There was no significant difference in abdominal strength between the two flap groups at low to moderate work intensity (isometric/concentric). At the greatest work intensity (eccentric muscle strength) the patients reconstructed with a DIEP flap had a clinical small, but significant advantage over the patients reconstructed with a MS-2 TRAM flap.
|
0 |
Ethical aspects of genetic testing in the workplace
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
The European Group on Ethics and New Technologies, which advises the European Commission, has published an opinion paper on ethical aspects of genetic testing in the workplace. The paper goes well beyond the usual ethical issues, presenting a summary of genetic testing in the workplace in the United States and Europe and criteria for appropriate testing. Unlike many other documents on ethics, it pays close attention to the problem of false-positive and false-negative test results. Although no genetic tests are currently appropriate for screening workers or applicants for jobs in which occupational hazards exist, inappropriate testing has occurred and regulations are needed to ensure that only appropriate testing is used in the future. Workers or their representatives should be involved in deciding when and how genetic testing in the workplace is done. Copyright (copyright) 2003 S. Karger AG, Basel
|
0 |
Matrix-Assisted Autologous Chondrocyte Transplantation in the Knee: A Systematic Review of Mid- to Long-Term Clinical Outcomes
|
OAK 3 - Non-arthroplasty tx of OAK
|
Background: Matrix-assisted autologous chondrocyte transplantation (MACT) is a surgical treatment option for articular cartilage lesions of the knee joint. Purpose: To investigate mid- to long-term clinical outcomes of MACT in the patellofemoral (PF) and tibiofemoral (TF) joints. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed by searching PubMed, Embase, and the Cochrane Library to find studies evaluating minimum 5-year clinical outcomes of patients undergoing MACT in the knee joint. Search terms used were knee, matrix, and autologous chondrocyte. Patients were evaluated based on treatment failure rates, magnetic resonance imaging, and subjective outcome scores. Study methodology was assessed using the Modified Coleman Methodology Score (MCMS). Results: Ten studies (two level 1, one level 2, one level 3, and six level 4 evidence) were identified that met inclusion and exclusion criteria, for a total of 442 TF patients and 136 PF patients. Treatment failure occurred in 9.7% of all patients, including 4.7% of PF patients and 12.4% of TF patients (P =.037). Weighted averages of subjective outcome scores, including Knee injury and Osteoarthritis Outcome Score, Short Formâ??36 Health Survey, and Tegner scores, improved from baseline to latest follow-up in both TF and PF patients. The mean MCMS was found to be 57.4, with a standard deviation of 18.5. Conclusion: Patients undergoing MACT in the knee show favorable mid- to long-term clinical outcomes. A significantly higher treatment failure rate was found in patients undergoing MACT in the TF joint compared with the PF joint.
|
0 |
Single Shot vs 24hr vs 48hr Continuous Adductor Canal Block After TKA
|
AAHKS (2) Corticosteroids
|
If the patient is willing to participate and signs the consent, he/she will be randomized to one of the three treatment groups: 1. Single shot block 2. 24 hour catheter 3. 48 hour catheter The choice of anesthetic technique will be at the discretion of the anesthesiologist. In our institution we usually advocate for spinal anesthesia for total knee arthroplasty. All patients will receive their multimodal perioperative pain protocol (MP3) medication as per protocol in the patient receiving area (400 mg of gabapentin, 200 mg of Celecoxib, and 1gm of acetaminophen). Patients will be monitored during block performance with standard ASA monitors. All patients will be receiving 2 L of oxygen via a nasal cannula. Sedatives will be titrated to effect. Midazolam 1â?2 mg, and fentanyl 50â?100 mcg will be used for sedation. Block time out will be preformed according to standard operating procedure. All blocks will be done under ultrasound guidance. Sonosite S nerve machine will be used with a high frequency linear (HFL) US probe with 6â?13 MHZ frequency. Both single shot and continuous adductor canal block will be performed according to the standard operating practices in our department 4. Ultrasound survey at the medial part of the thigh will take place, halfway between the superior anterior iliac spine and the patella. In a short axis view, the femoral artery will be identified underneath the sartorius muscle, with the vein just inferior and the saphenous nerve just lateral to the artery. The needle will be introduced inâ?plane and 2 to 3 mL of local anesthesia bolus will be used to verify correct placement of the needle in the vicinity of the saphenous nerve in the adductor canal. For single shot blocks: A bolus of total volume of 20 ml of ropivicaine 0.5% will be injected through the needle. For the continuous block: The catheter will be introduced and advanced 2â?3 cm beyond the tip of the needle under ultrasound visualization. The needle was withdrawn over the catheter. Injection of a bolus of 5 ml of ropivacaine 0.5% will take place through the catheter while observing the spread of local anesthetic under ultrasound. The catheter hub will be affixed to the upper lateral thigh with sterile occlusive dressings and an anchoring device. Block success will be defined as a change in cutaneous sensation to touch with an alcohol pad in the saphenous nerve distribution over the medial leg within 30min after injection. Subjects with successful catheter placement per protocol and nerve block onset were retained in the study. Subjects with a failed catheter insertion or misplaced catheter indicated by a lack of sensory changes had their catheter replaced or were withdrawn from the study. At the conclusion of surgery, the catheters will be connected to a pump that will infuse local anesthetic. Ropivicaine 0.2% at 8 ml/hour. In the postoperative anesthesia care unit, intermittent boluses of hydromorphone will be used as needed. Postoperative analgesia will follow the MP3 protocol. Drugs that are used for the multimodal analgesia protocol include acetaminophen (1 gm every 8 hours for 72 hours), celecoxib (200 mg every 8 hours for 72 hours), Gabapentin (300 mg every 8 hours for one week if the patient is opioid naïve and for two weeks if patients are opioid tolerant), and oxycodone (5â?10â?15 mg oral as needed every 4 hours for pain based on patient reported pain score). All patients will receive prophylaxis for postoperative nausea and vomiting (PONV) during surgery. The protocol for prophylaxis against PONV include administration of 4 mg of dexamethasone after induction of anesthesia and 4 mg of ondansetron 20 minutes before recovery from anesthesia. Dexamethasone is withheld if the patient has poorly controlled diabetes mellitus (DM). Uncontrolled DM will be defined as random blood glucose above 250 mg/dl.
|
1 |
Decision-making on the use of antimicrobial prophylaxis for dental procedures: a survey of infectious disease consultants and review
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
There is debate concerning use of antibiotic prophylaxis before invasive dental procedures for patients at risk of acquiring distant site infection (DSI). We determined the opinions and practices of infectious disease consultants (IDCs) regarding antimicrobial prophylaxis to prevent DSIs that result from invasive dental procedures by conducting a survey of the 797 members of the Infectious Diseases Society of America Emerging Infections Network (477 members [60%] responded). Ninety percent of respondents closely follow the American Heart Association guidelines for antibiotic prophylaxis for patients with valvular heart disease who undergo invasive dental procedures. In contrast, few IDCs recommend prophylaxis for patients with lupus erythematosus, poorly controlled diabetes mellitus, dialysis catheters or shunts, cardiac pacemakers, or ventriculoperitoneal shunts. Twenty-five percent to forty percent of respondents recommended prophylaxis for prosthetic vascular grafts, orthopedic implants, or chemotherapy-induced neutropenia. We conclude that IDCs differ considerably in their assessment of the need for prophylaxis for patients who have noncardiac risk factors for DSI. These differences underscore the need for definitive studies to delineate appropriate candidates for antimicrobial prophylaxis in dental practice
|
0 |
External Fixation Versus Open Reduction With Locked Volar Plating for Geriatric Distal Radius Fractures
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
The optimal management of displaced dorsal radius fractures (DRFs) in older patients remains an issue of debate. Bridging external fixation is a well-accepted treatment modality for severely comminuted DRFs, while open reduction and internal fixation with locked volar plating has emerged as a promising alternative in recent years. The current body of randomized trials supports the trend toward locked volar plating, as it allows for quicker improvement in subjective and functional outcomes. There is no clear evidence to suggest that one technique carries significantly less complications than the other. Locked volar plating should be considered in patients for whom an accelerated functional recovery would be advantageous. Otherwise, both external fixation and locked volar plating provide good long-term clinical outcomes. (copyright) The Author(s) 2014
|
0 |
Acute exacerbation of carpal tunnel syndrome after radial artery cannulation
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
Acute carpal tunnel syndrome that follows radial artery cannulation has been described. To determine the incidence and predisposing factors, we prospectively studied 151 patients who had perioperative radial artery cannulation. Postoperatively 9 of the 151 patients had symptoms of carpal tunnel syndrome with positive Phalen and Tinel signs on the side on which the radial artery catheter had been inserted. Eight of 12 patients with a prior history of carpal tunnel syndrome had acute exacerbation of symptoms postoperatively. By contrast, only 1 of 139 patients with no prior history of the disorder had symptoms. Fourteen patients had multiple arterial artery punctures or perforations of the posterior wall of the radial artery. In three of these, postoperative symptoms of carpal tunnel syndrome developed but did not reach statistical significance. The only patient with postoperative acute carpal tunnel syndrome but no prior history of the syndrome had multiple arterial punctures. The use of perioperative anticoagulation, the use of wrist-extension splints, and the duration of radial artery cannulation did not influence acute exacerbation of carpal tunnel syndrome. Patients with a prior history of carpal tunnel syndrome are at increased risk of recurrent symptoms after radial artery cannulation. We found no statistically significant relationship between traumatic cannulations and the development of symptoms of carpal tunnel syndrome
|
0 |
Evaluation of physical performance level as a fall risk factor in women with a distal radial fracture
|
Hip Fx in the Elderly 2019
|
Background: Decreased physical performance has been associated with an increased risk of falls and fragility hip fractures. The purpose of our study was to compare physical performance measures and fall risk factors in middle-aged and elderly patients with recent distal radial fractures relative to age-matched control patients. Methods: We prospectively recruited forty postmenopausal women over fifty years of age who sustained a distal radial fracture due to a fall and forty age-matched controls without a recent history of falls. We excluded those patients with cognitive impairment, neuromuscular diseases, or other chronic conditions affecting muscle function. We compared the two groups for the level of physical performance and other risk factors of a fall. Other known risk factors assessed were low body mass index; osteoarthritis; arrhythmia; depression; visual disturbance; hypotension; use of antihypertensive drugs, sedatives, hypnotics, or antidepressants; and use of four or more medications. Results: There was no significant difference in the Short Physical Performance Battery summary score between the two groups. However, when patients with distal radial fracture were compared with control patients, significantly lower scores were observed for chair stand (p = 0.034) and grip strength (adjusted for hand dominance) (p = 0.038). Conclusions: This study suggests that overall physical performance level is not different between women with a distal radial fracture and those without a distal radial fracture. Differences in chair stand test scores and grip strength may imply an early subtle decrease in physical performance level in patients with distal radial fracture. Copyright © 2014 By The Journal of Bone and Joint Surgery, Incorporated.
|
0 |
Evidence-based guidelines for fixing broken hips: An update
|
DoD SSI (Surgical Site Infections)
|
Objective: To update evidence-based guidelines for the treatment of proximal femoral fractures published in the Journal in 1999. Data sources: Systematic literature search of MEDLINE, CINAHL and EMBASE from January 1996 to September 2001 and the Cochrane Database of Systematic Reviews (most recent issue searched - Issue 2, 2002). Study selection: Randomised controlled trials and meta-analyses of all aspects of acute-care hospital treatment and rehabilitation of proximal femoral fractures among subjects aged 50 years and over with proximal femoral fractures not associated with metastatic disease or multiple trauma. Data extraction: All studies were read independently by two reviewers. Reviewers recorded individual study results, and an assessment of study quality and treatment conclusions according to Cochrane Collaboration protocols. If necessary, a third review was performed to reach consensus. Results: 93 new studies were identified and 82 met our inclusion criteria. Recommendations for thromboprophylaxis, anaesthesia, surgical fixation of fractures and nutritional status have been altered to incorporate new evidence. Recommendations have been added regarding postoperative blood transfusion, the management of subtrochanteric fractures, and the type of surgical swabs which should be used. Conclusions: Although there have been few significant changes to the previous recommendations, updating the guidelines has required substantial effort. The common clinical problem of hip fracture should be treated according to the most up-to-date evidence to achieve the best possible outcomes and optimal utilisation of limited resources. Guideline updates also require resourcing.
|
0 |
Effects of single or combined administration of salmon calcitonin and omega-3 fatty acids vs. diclofenac sodium in sodium monoiodoacetate-induced knee osteoarthritis in male Wistar rats
|
OAK 3 - Non-arthroplasty tx of OAK
|
There is a continuous search for a better therapy in osteoarthritis (OA) management. Therefore, this study investigated the effects of salmon calcitonin (Sct) and/or omega-3 fatty acids (N-3) relative to diclofenac sodium (DF) in induced knee osteoarthritic male Wistar rats. The 40 rats that were used in this study were divided into 8 groups (n=5 rats), viz: Normal control; OA control; OA+N-3; OA+Low dose of Sct (Sct.Lw); OA+High dose of Sct (Sct.Hi); OA+N-3+SCt.Lw; OA+N-3+Sct.Hi; and, OA+DF. OA was induced with 4 mg of sodium monoiodoacetate in 40 μL of saline. The solution was injected into the left knee joint space of anaesthetised rats. Sct was administered at 2.5 and 5.0 IU/kg b.w. (im), whereas N-3 and DF were administered at 200 and 1 mg/kg b.w. (p.o.), respectively. Treatments commenced 9 days after the induction of OA, and they lasted for 28 days. Sct and/or N-3 significantly reduced c-telopeptide of type 1 collagen (CTX-1), collagen type 2 α-1 (C2M), malondialdehyde (MDA), uric acid (UA), and interleukin-6 (IL-6), but, significantly increased superoxide dismutase (SOD) after OA induction. Both therapies had additive effects on C2M, MDA, SOD, and catalase (CAT), but, non-additive actions on UA, IL-6, and CTX-1. Like the Sct and N-3, DF significantly reduced CTX-1, C2M, UA, and IL-6. However, it had no significant effect on SOD and MDA, even though it significantly reduced CAT activity. None of the therapies had significant effect on total alkaline phosphatase activity, except N-3+Sct.Lw. The combined, and sometimes the single administration of Sct and N-3 proved to be better therapies in OA management than DF.
|
0 |
Economic aspects of carpal tunnel syndrome
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
CTS is very costly to the national genomy. Cost figures vary from different locations around the United States. The average cost per case is about $12,000, but individual cases can cost much more. The most cost- effective measure is prevention
|
0 |
The efficacy of intravenous tranexamic acid administration at induction in definitive hip fracture surgery: Is there a role?
|
Hip Fx in the Elderly 2019
|
Tranexamic acid (TXA) is a cheap and powerful drug that has several uses in surgery and is well established in elective orthopaedic surgery. At present, limited small studies have looked into its role in the acute hip fracture. Transfusion in the geriatric population presents risks and increased costs to healthcare systems around the world. Our retrospective study looks at the role of TXA administration at induction for both intracapsular fracture requiring hemiarthroplasty and our preferred method of fixation of extracapsular fracture by intramedullary nail (IM nail). We show a statistically significant reduction in the number of patients requiring transfusion as well as mean haemoglobin (Hb) drop in those undergoing hemiarthroplasty. This was not replicated in those undergoing IM nail fixation. Both groups showed no increase in 1-year mortality or thromboembolic events following TXA administration. These results support the use of TXA for hemiarthroplasty for intracapsular hip fractures over the age of 60.
OBJECTIVES: The aim of this pre and post interventional study looks at the effects of intravenous administration of tranexamic acid on induction for elderly patients undergoing hemiarthroplasty or intramedullary nail fixation for hip fractures.
DESIGN: Pre and post interventional, randomised observational study SETTING: Large hip fracture unit, Level 2 Trauma Centre, single centre PATIENTS: Two arms of the study looking at those aged above the age of 60 undergoing hemiarthroplasty and intramedullary nail fixation without and with tranexamic acid on induction.
RESULTS: 12.1% of hemiarthroplasties required post-operative transfusion without tranexamic acid compared to 2.6% of those with tranexamic acid (n=15 vs n=3 respectively, p=0.006). Equally, the mean Hb drop in g/L is reduced in those with tranexamic acid compared to those without (mean Hb = 14.6 vs 17.7 respectively, p=0.034). This was not replicated in the IM nail group between those without and those with tranexamic acid (n=31 vs n=20 respectively, p= 0.16). The mean Hb drop in g/L was not statistically significant in the tranexamic acid arm compared to without (mean Hb = 19.2 vs mean Hb = 21.9, p=0.11). Gross reporting of thromboembolic events did not demonstrate an increase in the number of those with DVT, PE, MI or stroke. 1-year mortality was not statistically significant in either hemiarthroplasty or IM nail fixation following tranexamic acid administration.
CONCLUSIONS: Tranexamic acid both statistically significantly reduces the number of patients requiring transfusion post hemiarthroplasty and also the value of mean Hb drop without appearing to increase in thromboembolic events or 1 year mortality rates. This does not appear to be emulated in the IM nail fixation although both thrombotic events and 1-year mortality rates are also not affected by administration of TXA. We propose that TXA has a role in hemiarthroplasty surgery in reducing post-operative transfusions.
LEVEL OF EVIDENCE: Level 3 - retrospective cohort study.
|
0 |
Acid-induced molten globule state of a fully active mutant of human interleukin-6
|
MSTS 2018 - Femur Mets and MM
|
Interleukin-6 (IL-6), a four-helix bundle protein, is a multifunctional cytokine which plays an important role in the regulation of the immune system, hematopoiesis, and inflammatory response, as well as in the pathogenesis of multiple myeloma. We have previously shown that a single-disulfide variant of human IL-6, lacking 22 N-terminal amino acids and the disulfide bond connecting Cys-45 and Cys-51 in the 185-residue chain of the wild-type protein, fully retains the conformational, stability, and functional properties of the full-length human IL-6 [Breton et al. (1995) Eur. J. Biochem. 227, 573-581]. In this study, we have investigated the conformational and stability properties of mutant IL-6 at acidic pH (A-state). Using far- and near-ultraviolet (UV) circular dichroism (CD), fluorescence emission, and second-derivative absorption spectroscopy, we have established that mutant IL-6 at pH 2.0 fully retains the helical secondary structure of the native protein at pH 7.5, while the tertiary interactions are much weaker. At variance from the native species, mutant IL-6 in the A-state binds 1-anilinonaphthalene-8-sulfonic acid (ANS), a property considered most typical of a protein in the molten globule state. The pH-induced conformational change from the native to the A-state, monitored either by near-UV CD or by ANS-binding measurements, shows a transition midpoint at pH approximately 4.5, thus indicating that the partial unfolding of the protein is mediated by the titration of glutamic and/or aspartic acid residues. At pH 2.0, the thermal denaturation of mutant IL-6 occurs as a broad process of low cooperativity with a transition at 50-60 degrees C, whereas at pH 7.5 the thermal unfolding is cooperative and characterized by a transition midpoint at 65 degrees C. Of interest, the unfolding of the A-state is not complete even up to approximately 85 degrees C. The urea-mediated unfolding profile of mutant IL-6, measured by far-UV CD, is essentially identical at both pH 7.5 and 2.0, with a midpoint of the cooperative unfolding transition at 5.5 +/- 0.1 M denaturant. Both thermal and urea denaturations of the A-state are complex and cannot fit to a two-state model for unfolding. The unusual stability of mutant IL-6 in acid is also reflected by the resistance to proteolysis at pH 3.6-4.0 by Staphylococcus aureus V8 protease or cathepsin D, an acid protease released by machrophages upon inflammatory stimulation. It is suggested that the molten globule state of IL-6 at acidic pH can play a role in the biological activity of this cytokine, which can exert its activity also at mildly acidic pH, as in inflammation sites.
|
0 |
Long-term survival of semi-constrained total knee arthroplasty for revision surgery
|
PJI DX Updated Search
|
Semi-constrained implants provide stability in the setting of soft-tissue deficiency in revision total knee arthroplasty (TKA). This study evaluated our institution's long-term survival results with a semi-constrained implant used in the revision TKA setting. 234 semi-constrained revision total knee arthroplasties were performed in 209 patients. The average follow-up was 9. years. Forty repeat revisions were performed. 5-year survival was 91% and 10-year survival was 81%. Male gender significantly increased the risk of revision. At 10. years the average range of motion, pain level, and Knee Society score improved significantly (P<. 0.001). Ninety percent of patients reported an improvement in their knee. The semi-constrained implant used in revision knee arthroplasty has acceptable implant survival and functional outcomes in the long-term follow-up period. é 2014 Elsevier Inc
|
0 |
Fracture risk in patients treated with loop diuretics
|
Management of Hip Fractures in the Elderly
|
BACKGROUND: Loop diuretics (LD) increase renal calcium excretion. Discrepant results on associations between LD and fracture risk have been reported. OBJECTIVE: To assess the fracture risk in users of LD. DESIGN AND SUBJECTS: A population-based pharmaco-epidemiological case-control design with fracture in year 2000 as outcome and use of LD during the previous 5 years as exposure variable. We used nationwide computerized registers to assess individual use of LD and related these data to individual fracture data and information on potential confounders. We compared 64,699 cases aged 40 years or more who sustained a fracture during year 2000 with 194,111 age- and gender-matched controls. RESULTS: A total of 44,001 subjects used LD. Ever use of LD was associated with a crude 51% (OR 1.51; 95% CI 1.48-1.55) increased risk of any fracture and a 72% (OR 1.72; 95% CI 1.64-1.81) increased risk of hip fracture. The risk estimates were reduced after confounder adjustment, i.e. adjusted risk of any fracture was increased by 4% (OR 1.04; 95% CI 1.01-1.07) and risk of hip fracture by 16% (OR 1.16; 95% CI 1.10-1.23). In current users, a tendency towards a decreased fracture risk with increased dose was observed, whereas in former users risk of fracture increased with increased dose. Use of furosemide was associated with higher risk estimates than use of bumetanide. CONCLUSION: Treatment with LD affects fracture risk. Special attention should be paid to patients in whom treatment with LD is initiated or stopped, as they may be at an increased risk of fracture
|
1 |
Complications of elastic stable intramedullary nailing of femoral shaft fractures in children weighing fifty kilograms (one hundred and ten pounds) and more
|
Pediatric Diaphyseal Femur Fractures 2020 Review
|
AIM: The purpose of this study was to assess treatment outcomes in children weighing 50 kg (110 pounds) or more with displaced femur shaft fractures treated by elastic stable intramedullary nailing (ESIN) and to identify potential correlations between nail size/medullary canal diameter ratio and outcome. METHODS: Twenty out of 117 consecutive children surgically treated by ESIN for displaced fractures of the femoral shaft with no associated neurovascular injury weighed 50 kg (110 pounds) or more. All patients underwent regular clinical and radiographic follow-up for at least one year after their index surgery. RESULTS: The average patient age at the time of injury was 13.1 years (25th and 75th interquartile range [IQR]â??=â??11.7-14.5). The mean follow-up was 27.4 months (IQRâ??=â??18.4-36.8). Overall, nine (45 %) adverse events were observed. The rate of complications was higher among children weighting 55 kg and over (67 %) than in children weighing less than 55 kg (35 %) and among children aged 13 years old or older (72 %) than among children younger than 13 years old (11 %). DISCUSSION: Femoral shaft fractures in children and adolescents weighing 50 kg (110 pounds) and over and older than ten years of age have an increased rate of complications. CONCLUSION: Heavier patients have a greater chance of complications. In particular, patients younger than 13 years old and weighing less than 55 kg can be safely managed with ESIN, but older and heavier patients should preferably be treated with rigid fixation systems due to a greater complication rate. However, further studies are needed to consolidate the conclusions.
|
1 |
The accuracy of magnetic resonance imaging scanning and its influence on management decisions in knee surgery
|
AMP (Acute Meniscal Pathology)
|
PURPOSE: The purpose of our study was to evaluate the impact of preoperative magnetic resonance imaging (MRI) assessment of articular knee pathology on the clinical management of patients presenting with joint line pain.
METHODS: A preliminary study on 100 patients was performed to assess the accuracy of specific MRI sequences, using arthroscopy as a gold standard. Six hundred and eighteen consecutive patients with knee symptoms presenting to 2 specialist knee surgeons were then recruited. A clinical diagnosis of an arthroscopically treatable lesion was made in all cases. Clinical assessment data were correlated to subsequent MRI findings, recording any discrepancy and in particular whether or not MRI findings influenced management decisions.
RESULTS: In the preliminary study, MRI sequences had an overall sensitivity of 83.2% and a specificity of 94.3% for the detection of chondral lesions. However, when considering arthroscopic grade III and IV lesions, MRI sensitivity and specificity were improved to 84.5% and 97.1%. In the second phase of the study, 141 (22.8%) of the 618 patients presenting with knee symptoms had an altered clinical management subsequent to MRI. The presence of unexpected chondral lesions was found in 77 of these patients. Conversely, 22 patients with clinical symptoms suspicious for simple chondral degeneration had unstable meniscal tears.
CONCLUSIONS: We suggest that preoperative MRI scanning identifies a group of patients who have more advanced degenerative joint disease than the clinical assessment and the plain radiographs suggest. This would expedite definitive surgery in patients with advanced osteoarthritis on MRI scans.
LEVEL OF EVIDENCE: Level II, development of diagnostic criteria on basis of consecutive patients with universally applied gold standard.
|
0 |
Removal of oral debris and bacteria during supervised tooth brushing
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
OBJECTIVE: To investigate foam generation during brushing, and the oral debris and bacteria removal efficacy of an experimental gel-to-foam dentifrice compared to a commercially-available dentifrice after brushing. METHODS: Thirty-four subjects participated in this blinded, crossover study. After a wash-out period prior to each session of product use, subjects reported to the site having abstained from oral hygiene, eating and drinking from 22:00 h on the evening prior to treatment visits. The subjects brushed with a weighed dose of assigned paste and were asked to expectorate their toothpaste slurry into a collection vessel at 30 and 60 seconds during supervised brushing. The expectorated foam was measured immediately, after which subjects rinsed with 10 ml of sterile water and expectorated into the same vessel. Samples were placed on ice and immediately transported to the laboratory for analysis. Bacteria (total anaerobes and VSC-producing bacteria) were enumerated using appropriate selective media. To calculate the amount of debris, a measured portion of the sample was deposited onto a pre-weighed dish and weighed. Dishes were dried thoroughly and weighed again after cooling. RESULTS: Use of the gel-to-foam dentifrice resulted in 105% greater foam volume compared with use of the control dentifrice (p < 0.0001). Further, the gel-to-foam dentifrice removed 15.77% more debris than the control dentifrice (p-value = 0.0342). There was greater removal of total anaerobes and VSC-producing bacteria by the gel-to-foam dentifrice versus the control dentifrice (p-value < 0.0001). CONCLUSION: Single use of a gel-to-foam dentifrice generated a greater volume of foam and removed a greater amount of oral debris and bacteria during brushing than a standard dentifrice
|
0 |
Intraoperative platelet-rich plasma does not improve outcomes of total knee arthroplasty
|
OAK 3 - Non-arthroplasty tx of OAK
|
This randomized controlled study was conducted to assess the effects of platelet-rich plasma (PRP) on outcomes of total knee arthroplasty (TKA). Forty patients who underwent unilateral TKA were evaluated prospectively; 20 received intraoperative PRP and 20 served as control subjects. The results showed no significant differences in reduction of bleeding, range of motion, swelling around the knee joint, muscle power recovery, pain, Knee Society Scores, and Knee Injury and Osteoarthritis Outcome Score between the 2 groups. Additionally, no distinct clinical characteristics were found in patients who received intraoperative PRP. Therefore, we conclude that intraoperative PRP does not improve outcomes of TKA.
|
0 |
Predictors of Exercise Adherence in Patients With Meniscal Tear and Osteoarthritis
|
AMP (Acute Meniscal Pathology)
|
OBJECTIVE: To identify predictors of poor exercise adherence in patients with osteoarthritis (OA) and meniscal tear.
DESIGN: Secondary analysis of data gathered over the first 12 weeks in the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial, a multicenter, randomized controlled trial.
SETTING: Seven referral centers.
PARTICIPANTS: Most of the patients in the MeTeOR trial (N=325 of 351) were included in the analysis, each of whom was aged >=45 years and had a meniscal tear and osteoarthritic changes on imaging studies; 26 were excluded because of missing data from which to derive the primary outcome variable.
INTERVENTIONS: All patients received a structured, supervised exercise program focused on strengthening, along with prescribed home exercises; half were randomly assigned to also receive arthroscopic partial meniscectomy.
MAIN OUTCOME MEASURE: Poor exercise adherence through 12 weeks, defined as performing <50% of prescribed exercise.
RESULTS: Thirty-eight percent of the MeTeOR cohort showed poor exercise adherence. In the multivariate model, adjusting for treatment group, those who earned <=$29,000 per year had 1.64 times the risk of nonadherence (95% confidence interval [CI], 1.10-2.43) than those who earned >$100,000 per year; and those without baseline pain with pivoting and twisting had 1.60 times greater risk of nonadherence than those with these symptoms (95% CI, 1.14-2.25).
CONCLUSIONS: Low income was associated with poor exercise adherence among patients aged >=45 years with OA and a meniscal tear, as was absence of pain with pivoting and twisting. Our findings highlight the need for further research into exercise adherence and for interventions to enhance adherence among those with low incomes.
|
0 |
The pathoanatomy of lateral ligamentous disruption in complex elbow instability
|
Distal Radius Fractures
|
We sought to determine the lateral soft-tissue injury pattern in a consecutive series of patients with elbow dislocation (10 cases) or fracture-dislocation (52 cases) that required open operative repair. Patients who were seen more than 3 months after injury or those in whom previous operative intervention had obscured the anatomy were excluded. There were 42 men and 19 women (mean age, 43 years; range, 13-82 years). One patient had bilateral injuries. The mean time to surgery was 15 days after injury, with a range from 1 to 76 days. There were associated fractures in 52 elbows: coronoid (39), radial head (36), proximal ulna (14), and distal humerus (6). Disruption of the lateral collateral ligament (LCL) complex was seen in all 62 elbows in one of six patterns of injury: proximal avulsion in 32, bony avulsion of the lateral epicondyle in 5, midsubstance rupture in 18, ulnar detachment of the LCL in 3, ulnar bony avulsion in 1, and combined patterns in 3. We found concomitant rupture of the common extensor origin in 41 cases (66%). Operative tactics included anatomic fixation of associated fractures, fixation or replacement of the radial head, and lateral soft-tissue repair. Disruption of the LCL was a universal finding in our patients. Avulsion from the distal humerus was the most common pattern, followed by midsubstance rupture; ulnar detachment or bony avulsion was rare. Disruption of the common extensor origin (a secondary constraint) was seen in 66% of cases. Repair of these lateral soft-tissue structures should be an integral part of the surgical strategy for elbow dislocations and fracture-dislocations that require operative treatment.
|
0 |
Too much, too little, too late to start again? Assessing the efficacy of bisphosphonates in patients with bone metastases from breast cancer
|
MSTS 2018 - Femur Mets and MM
|
The diagnosis of bone metastases can be a devastating occurrence for any woman with breast cancer. In this setting, bone metastases can result in skeletal-related events (SREs) such as pathologic fracture, spinal cord compression, and hypercalcemia. Several trials have confirmed the ability of bisphosphonates to reduce or delay these skeletal complications, and they should now be considered standard care for these women. The analysis of SREs is the typical primary end point in bisphosphonate studies. While not undermining their importance, the definition of SREs does not include complications important to patients, such as pain and immobility. It is these symptoms that are most frequently reported by patients, and bone pain and quality of life (QoL) are often measured as secondary end points in these trials. Bone pain and QoL measures are not standardized and are difficult to compare among patient populations. We do not yet know the true efficacy of bisphosphonates as analgesics or how they impact QoL. This paper reviews the current efficacy measures used in recent bisphosphonate trials and discusses their benefits and limitations. It also explores the role of bone biomarkers and their potential use in monitoring treatment response. ©AlphaMed Press.
|
1 |
Synovialization on second-look arthroscopy after anterior cruciate ligament reconstruction using Achilles allograft in active young men
|
Anterior Cruciate Ligament Injuries CPG
|
PURPOSE: This study is to assess the relationship between clinical outcomes and the extent of synovialization through second-look arthroscopy for anterior cruciate ligament (ACL) reconstruction using Achilles allograft in active young men. METHODS: Ninety-five subjects were diagnosed with ACL rupture and underwent reconstruction with Achilles allograft. Median age was 22 years old (range, 17-40). Mean period from injury to operation was 15.1 +/- 18.2 weeks. Lysholm score, IKDC classification, range of motion (ROM) of knee, and side-to-side difference (SSD) in anterior instability were evaluated preoperatively and at the last follow-up. Tegner activity scale was evaluated before injury and at the final follow-up. The extent of synovialization of the graft was evaluated under second-look arthroscopy at least 1 year after surgery. Formation of the synovial membrane was divided into four groups-group 1 for 25% or less, group 2 for 25-50%, group 3 for 50-75%, and group 4 for more than 75%. Outcomes were compared between each group. RESULTS: Lysholm score and IKDC classification were improved after surgery (P < 0.05). Most subjects had full ROM at the final follow-up except three subjects that showed flexion deficit of 5 degrees or less. Mean SSD in anterior instability was 9.0 +/- 2.1 mm preoperatively and 1.6 +/- 2.0 mm at the final follow-up (P < 0.001). Median Tegner activity scale was 7 before injury and 7 at the final follow-up (P < 0.001). Twelve subjects were in group 1, 10 in group 2, 14 in group 3, and 59 in group 4. Clinical outcomes depending on the extent of synovialization of the grafts were different between each group (P < 0.05). The average period from injury to reconstruction in each group was significantly different (P < 0.001). Correlation coefficient between the period from injury to reconstruction and the extent of synovialization was -0.411 (P < 0.001). CONCLUSION: The extent of the synovialization is positively correlated with clinical outcomes and is negatively correlated with the period from injury to reconstruction
|
0 |
Anatomical feature of the blood supply in the repair of the meniscus of knee joint
|
DoD LSA (Limb Salvage vs Amputation)
|
Background: The blood supply is essential for the repair of the meniscus after the suture of it in the injured knee joint. According to the condition of blood supply, the meniscus was divided into three zones by Arnoczk in 1982. The absolute vascularization zone, in which the distance to the combination part of meniscus and synovial membrane is inferior to 3 mm, is called the red zone. The absolute devascularization zone, in which the above-mentioned distance is superior to 5 mm, is called the white zone. And the relative vascularization zone with the distance between 3 mm to 5 mm is called red-white zone. Objective: To observe and discuss the anatomical features of the blood supply of the meniscus. Design: Single sample observation. Setting: Department of Orthopaedics, Huaxi Hospital of Sichuan University. Participants: The study was conducted in Huaxi Hospital of Sichuan University during the period from September 2000 to March 2001. Nineteen cases were collected, including 19 knees (38 menisci) from the subjects, 17 male and 2 female, whose age varied from 21 to 43 years old. All the samples were obtained in the amputation operation, the isolated limbs were without the change of re-transplantation and the voluntary donations from the non-minorities living in Sichuan. Methods: 1 The observation of the blood supply of the transparent meniscus samples: 7 knees (14 menisci) were taken. After the femoral artery intubation and infusion of the heparinized normal saline, the vascular bed had no blood and then was infused with the normal saline and ink of 0.5 volume fraction and the infusion pressure was 13 kPa. The infused meniscus samples underwent the dehydration of gradient ethanol, the transparency of dimethylbenzene, and preservation with ilex pedunculosa, and then the blood supply of the menisci was observed and described under the microscope. 2 The observation of the blood supply distribution of the meniscus section: 6 knees (12 menisci) with fresh and uninfused menisci were taken. The sections obtained at the sagittal plane, the coronal plane and the horizontal plane underwent hematoxylin-eosin staining.Then the tissues structure and blood supply of the meniscus samples were observed with light microscope. Another 6 knees (12 meniscus) underwent the specific CD34 antibody immunohistochemical staining. Then the tissue structure and blood supply distribution of the meniscus samples were observed with the light microscope. Main outcome measures: 1 Sources of the blood supply. 2 Feature of the blood supply in the body of the meniscus. 3 Feature of the blood supply in the angular parts of the meniscus. 4 The nutrition supply in the devascularization zone of the meniscus. Results: Nineteen cases with 38 menisci all went into the final result analysis. 1 The blood supply of the meniscus: The blood supply is resourced from the medial and lateral genicular arteries and the middle genicular artery. The small vessels from them form the peripheral capillary vessel plexus and annular vessel meshwork in the synovium and joint capsule and then go into the menisci for the nutrition of the lateral part of the meniscus. 2 The blood supply in the body of the meniscus: The apparent lunar artery is sent by the vessel plexus around the meniscus into the body of the meniscus and arranges in the inferior, middle and superior layers and dominates 25%-30% of the zone around the meniscus. 3 The blood supply in the angular part of the meniscus: The vessels of the angular part of the semilunar plate cover the whole zone. 4 The nutrition of the devascularized body and the surface of the meniscus. The nutrition is supplied by the membranous synovium on the surface of the meniscus. Conclusion: 1 The result of the blood supply in the study was identical to that of the Arnoczky Red-White zoning of the meniscus. 2 Rich blood supply was observed in the anterior and posterior angular parts and the peripheral tissues of the meniscus. 3 The feature of the laminated blood supply in the body of the meniscus was newly suggested. 4 The evidence to ensure that the nutrition of the devascularization zone of the meniscus is supplied from the joint synovial fluid is explicit.
|
0 |
Galeazzi fractures in adults
|
Distal Radius Fractures
|
Galeazzi fractures are not uncommon. They frequently result from falls with forced hyperpronation of the forearm. They are potentially unstable because of certain destabilizing factors at the wrist. Early recognition is essential, as is early operative fixation of the radius in adults. This paper reviews the English language literature and current knowledge of Galeazzi fractures in adult. © Arnold 2004.
|
0 |
Multi-vendor multi-site T1? and T2 quantification of knee cartilage
|
AMP (Acute Meniscal Pathology)
|
Objective: To develop 3D T1? and T2 imaging based on the same sequence structure on MR systems from multiple vendors, and to evaluate intra-site repeatability and inter-site inter-vendor reproducibility of T1? and T2 measurements of knee cartilage. Methods: 3D magnetization-prepared angle-modulated partitioned k-space spoiled gradient echo snapshots (3D MAPSS) were implemented on MR systems from Siemens, GE and Philips. Phantom and human subject data were collected at four sites using 3T MR systems from the three vendors with harmonized protocols. Phantom data were collected by means of different positioning of the coil. Volunteers were scanned and rescanned after repositioning. Two traveling volunteers were scanned at all sites. Data were transferred to one site for centralized processing. Results: Intra-site average coefficient of variations (CVs) ranged from 1.09% to 3.05% for T1? and 1.78–3.30% for T2 in phantoms, and 1.60–3.93% for T1? and 1.44–4.08% for T2 in volunteers. Inter-site average CVs were 5.23% and 6.45% for MAPSS T1? and T2, respectively in phantoms, and 8.14% and 10.06% for MAPSS T1? and T2, respectively, In volunteers. Conclusion: This study showed promising results of multi-site, multi-vendor reproducibility of T1? and T2 values in knee cartilage. These quantitative measures may be applied in large-scale multi-site, multi-vendor trials with controlled sequence structure and scan parameters and centralized data processing.
|
0 |
Teriparatide use during an economic crisis: Baseline data from the Greek cohort of the Extended Forsteo Observational Study (ExFOS) Epidemiology of musculoskeletal disorders
|
HipFx Supplemental Cost Analysis
|
Background: The Extended Forsteo Observational Study (ExFOS) is a multinational, non-interventional, prospective, observational study that aims to provide real-life data on patients with osteoporosis treated with teriparatide for up to 24 months. It includes the new indications of osteoporosis in men and glucocorticoid-induced osteoporosis (GIOP). We describe the Greek subpopulation enrolled in this study and compare it with a similar cohort from the previous European Forsteo Observational Study (EFOS). Methods: Baseline data were collected from the Greek cohort of ExFOS. Data included demographic characteristics, medical and osteoporosis history, disease status, prior use of medications, back pain and quality of life. Results: Baseline data for 439 patients, enrolled at 31 sites, indicated the majority of patients were females (92.3 %), elderly [mean (standard deviation; SD) age 70.1 (9.8) years] and slightly overweight [mean (SD) body mass index 26.7 (4.3) kg/m<sup>2</sup>], with very low bone mineral density (mean T-score(element of)<-3 in lumbar spine or total hip) and at least one previous fracture (55.1 % of patients). Of the 439 patients, 19.8 % were osteoporosis treatment naive, 88.4 % had experienced back pain during the previous 12 months, 68.1 % had experienced back pain at least fairly often during the previous month and 50.9 % reported moderate to severe limitation of activities due to back pain, with a mean (SD) of 4.2 (7.7) days spent in bed because of back pain during the previous month. Most baseline characteristics were numerically similar between the female ExFOS and EFOS cohorts; however, the rate of enrolment was faster in ExFOS (by approximately 45 %) and a history of fracture was recorded in 53.8 % of female patients in ExFOS versus 74.5 % in EFOS. Conclusions: Greek patients prescribed teriparatide in ExFOS had severe osteoporosis with a high risk of fractures and back pain. Female patients shared similarities with EFOS counterparts, reflecting a constant prescribing profile for use of teriparatide, although a noticeable difference in fracture history between the two study cohorts may indicate a change towards prescribing in less severely affected patients. The economic crisis in Greece did not appear to affect patient enrolment. Data are interpreted in the context of an observational setting
|
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.