recall
int64 0
1
| article_title
stringlengths 5
500
| topic
stringlengths 21
84
| abstract
stringlengths 2
65.8k
|
|---|---|---|---|
1 |
Outcomes of dynamic hip screw augmented with trochanteric wiring for treatment of unstable type A2 intertrochanteric femur fractures
|
Hip Fx in the Elderly 2019
|
BACKGROUND: Posteromedial and greater trochanteric fragments are a major cause of telescoping and medialization of the femoral shaft in an unstable intertrochanteric fracture. This leads to significant limb shortening, fracture collapse in varus position and implant failure, which can be prevented by trochanteric wiring in addition to dynamic hip screw (DHS) fixation. The purpose of our study is to assess the outcomes of DHS augmented with trochanteric wiring in unstable type A2 intertrochanteric fractures.
MATERIALS AND METHODS: One hundred and two retrospective cases of unstable intertrochanteric fractures treated with DHS between January 2010 and December 2015 with a minimum follow-up period of 12 months were reviewed. Out of 102 cases, 28 were treated with DHS and derotation screw alone (Group A), while in rest 74 cases trochanteric wiring was used as an augmentation to DHS and derotation screw (Group B). Patients were evaluated clinically for range of motion, Harris hip score and Oxford hip score. Radiologically, fracture reduction, change in neck shaft angle and neck length ratio in comparison to opposite hip and union status of greater trochanter were assessed.
RESULTS: The mean age of the patients at the time of surgery was 72 years (range 23-94 years) with 48 males and 54 females. The mean follow-up period was 20 months (range 12-48 months). The Harris hip score, Oxford hip score, shortening, attainment of weight bearing and change in neck shaft angle was not significantly different between the two groups (all p values >0.05). Incidence of greater trochanter nonunion was greater in group A (17.85%) as compared to group B (6.75%). We found significant association between occurrence of limp with varus change in neck shaft angle, decrease in neck length ratio and greater trochanteric non-union (all p values <0.05). We had 7 complications, one superficial infection, one deep vein thrombosis, 4 screw cut out and one deep infection treated with implant removal.
CONCLUSION: DHS augmented with trochanteric wiring in unstable intertrochanteric fractures gives similar result to group without no wiring, although greater trochanter non-union rate was more in the latter group. Limp can be prevented by anatomical or valgus fixation, augmentation of DHS to support posteromedial and greater trochanteric fragments and delayed weight bearing.
|
1 |
Rifampicin in the treatment of osteoarticular infections due to staphylococci
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
Rifampicin is a suitable drug for treating staphylococcal bone and articular infections, because high levels are obtained in the human tissues. The best oral dose is 600 mg 12 hourly. The serum levels range from 10 to 15 mg/l at the peak concentration and from 0.2 to 0.6 mg/l 8 h after oral administration of 600 mg. The ratio for cancellous bone/serum is 0.41 at 3 h and 0.39 at 12 h, and for cortical bone/serum is 0.20 at 3 h after a dose of 600 mg. In every case, tissue levels paralleled serum levels; cancellous bone levels are greater than the MIC of Staphylococcus aureus strains until 12 h after a dose of 600 mg. Rifampicin is always used in combination with another antibacterial substance. Results are excellent in most cases. The average duration of antibiotic treatment is 3 months for osteo-arthritis, 6 months for spondylitis and osteitis
|
1 |
Perioperative, short-, and long-term mortality related to fixation in primary total hip arthroplasty: a study on 79,557 patients in the ÂNorwegian Arthroplasty Register
|
Hip Fx in the Elderly 2019
|
Background and purpose â?? There are reports on perioperative deaths in cemented total hip arthroplasty (THA), and THA revisions are associated with increased mortality. We compared perioperative (intraoperatively or within 3 days of surgery), short-term and long-term mortality after all-cemented, all-uncemented, reverse hybrid (cemented cup and uncemented stem), and hybrid (uncemented cup and cemented stem) THAs. Patients and methods â?? We studied THA patients in the Norwegian Arthroplasty Register from 2005 to 2018, and performed Kaplanâ??Meier and Cox survival analyses with time of death as end-point. Mortality was calculated for all patients, and in 3 defined risk groups: high-risk patients (age â?¥ 75 years and ASA > 2), intermediate-risk patients (age â?¥ 75 years or ASA > 2), low-risk patients (age < 75 years and ASA â?¤ 2). We also calculated mortality in patients with THA due to a hip fracture, and in patients with commonly used, contemporary, well-documented THAs. Adjustement was made for age, sex, ASA class, indication, and year of surgery. Results â?? Among the 79,557 included primary THA patients, 11,693 (15%) died after 5.8 (0â??14) yearsâ?? follow-up. Perioperative deaths were rare (30/105) and found in all fixation groups. Perioperative mortality after THA was 4/105 in low-risk patients, 34/105 in intermediate-risk patients, and 190/105 in high-risk patients. High-risk patients had 9 (CI 1.3â??58) times adjusted risk of perioperative death compared with low-risk patients. All 4 modes of fixation had similar adjusted 3-day, 30-day, 90-day, 3â??30 day, 30â??90 day, 90-dayâ??10-year, and 10-year mortality risk. Interpretation â?? Perioperative, short-term, and long-term mortality after primary THA were similar, regardless of fixation type. Perioperative deaths were rare and associated with age and comorbidity, and not type of fixation.
|
0 |
Mortality after the hospitalization of a spouse
|
HipFx Supplemental Cost Analysis
|
BACKGROUND: The illness of a spouse can affect the health of a caregiving partner. We examined the association between the hospitalization of a spouse and a partner's risk of death among elderly people. METHODS: We studied 518,240 couples who were enrolled in Medicare in 1993. We used Cox regression analysis and fixed-effects (case-time-control) methods to assess hospitalizations and deaths during nine years of follow-up. RESULTS: Overall, 383,480 husbands (74 percent) and 347,269 wives (67 percent) were hospitalized at least once, and 252,557 husbands (49 percent) and 156,004 wives (30 percent) died. Mortality after the hospitalization of a spouse varied according to the spouse's diagnosis. Among men, 6.4 percent died within a year after a spouse's hospitalization for colon cancer, 6.9 percent after a spouse's hospitalization for stroke, 7.5 percent after a spouse's hospitalization for psychiatric disease, and 8.6 percent after a spouse's hospitalization for dementia. Among women, 3.0 percent died within a year after a spouse's hospitalization for colon cancer, 3.7 percent after a spouse's hospitalization for stroke, 5.7 percent after a spouse's hospitalization for psychiatric disease, and 5.0 percent after a spouse's hospitalization for dementia. After adjustment for measured covariates, the risk of death for men was not significantly higher after a spouse's hospitalization for colon cancer (hazard ratio, 1.02; 95 percent confidence interval, 0.95 to 1.09) but was higher after hospitalization for stroke (hazard ratio, 1.06; 95 percent confidence interval, 1.03 to 1.09), congestive heart failure (hazard ratio, 1.12; 95 percent confidence interval, 1.07 to 1.16), hip fracture (hazard ratio, 1.15; 95 percent confidence interval, 1.11 to 1.18), psychiatric disease (hazard ratio, 1.19; 95 percent confidence interval, 1.12 to 1.26), or dementia (hazard ratio, 1.22; 95 percent confidence interval, 1.12 to 1.32). For women, the various risks of death after a spouse's hospitalization were similar. Overall, for men, the risk of death associated with a spouse's hospitalization was 22 percent of that associated with a spouse's death (95 percent confidence interval, 17 to 27 percent); for women, the risk was 16 percent of that associated with death (95 percent confidence interval, 8 to 24 percent). CONCLUSIONS: Among elderly people hospitalization of a spouse is associated with an increased risk of death, and the effect of the illness of a spouse varies among diagnoses. Such interpersonal health effects have clinical and policy implications for the care of patients and their families. Copyright (copyright) 2006 Massachusetts Medical Society
|
1 |
Value of fat-suppressed proton-density-weighted turbo spin-echo sequences in detecting meniscal lesions: comparison with arthroscopy
|
AMP (Acute Meniscal Pathology)
|
PURPOSE: To evaluate fat-suppressed (FS) proton-density-weighted (PDw) turbo spin-echo (TSE) magnetic resonance imaging (MRI) compared to arthroscopy in the detection of meniscal lesions.
MATERIAL AND METHODS: In a prospective study, 31 knee joints were imaged on a 1.5T MR scanner before arthroscopy using the following sequences: (a) coronal and sagittal FS-PDw TSE (TR/TE: 4009/15 ms); (b) coronal T1w SE (TR/TE: 722/20 ms), and sagittal PDw TSE (TR/TE: 3800/15 ms). Other imaging parameters were: slice thickness 3 mm, FOV 160 mm, matrix 256 x 256. A total of 186 meniscal regions (62 menisci; anterior horn, body, posterior horn) were evaluated. Standard of reference was arthroscopy. Sensitivity, specificity, negative predictive value (npv), positive predictive value (ppv), and accuracy were calculated.
RESULTS: Arthroscopically, meniscal lesions were detected in 55/186 segments (35 medial and 20 lateral meniscal lesions). Sensitivity, specificity, npv, ppv, and accuracy for combination of coronal and sagittal FS PDw TSE were 91.4%, 98.3%, 95%, 97%, and 93.5% for the medial meniscus, and 90%, 98.6%, 97.3%, 94.7%, and 96.8% for the lateral. The results were comparable to the combination of coronal T1w SE and sagittal PDw TSE for the medial (88.6%, 98.3%, 93.4%, 96.9%, 91.4%) and the lateral (90%, 95.9%, 97.2%, 85.7%, 92.5%) meniscus.
CONCLUSION: FS PDw TSE-MR sequences are an excellent alternative for the detection of meniscal lesions in comparison with diagnostic arthroscopy.
|
1 |
Radial forearm flap donor-site complications and morbidity: a prospective study
|
DoD SSI (Surgical Site Infections)
|
One-hundred patients undergoing radial forearm flap reconstruction in the head and neck over a 2-year period were followed prospectively to assess complications and morbidity associated with the radial flap donor site. Eighty-six patients were available follow-up at 3 months and 74 at 1 year (49 fasciocutaneous, 25 composite). Partial loss of the donor-site skin graft occurred in 14 patients (16 percent), with exposure of tendons in 11 patients (13 percent). Delay in healing of the split-thickness skin graft at the donor site occurred in 19 patients (22 percent). Fracture of the radius occurred in 6 of 35 patients with composite flaps (17 percent). Superficial radial nerve sensation was reduced in 24 patients (32 percent) at 1 year. Ten patients (14 percent) reported cold intolerance, and 21 patients (28 percent) complained of poor aesthetic result. Function of the donor arm was restricted in 8 patients (16 percent) in the fasciocutaneous group, in 7 patients (36 percent) in the composite group without fracture, and in all patients who had a fracture of the radius following harvesting of composite flaps. Detailed measurements of forearm circumference, grip strength, pinch strength, and wrist movements showed greater reduction in these parameters in patients reporting restricted function compared with those reporting normal function. It is concluded that there is a low incidence of long-term morbidity associated with fasciocutaneous flaps and a higher incidence with composite flaps. Fracture of the radius results in reduced function in all cases.
|
1 |
There are differences in early morbidity after ACL reconstruction when comparing patellar tendon and semitendinosus tendon graft. A prospective randomized study of 107 patients
|
Anterior Cruciate Ligament Injuries CPG
|
The main objective of this study was to study solely early postoperative morbidity following anterior cruciate ligament (ACL) reconstruction by comparing the gold standard procedure, the bone-patellar tendon-bone graft (BTB), and one of the most common alternatives, the semitendinosus tendon graft (ST). The prospective study included 107 randomized patients (50 BTB and 57 ST). The follow-up period was set to 20-35 weeks postoperatively (mean 26.8 +/- 3.5 weeks). One patient suffered early graft rupture and 89 (84%) of the remaining 106 patients were able to attend the follow-up within the given time limit. There were no differences in sick leave between the groups. The Lysholm score, Tegner activity level score and Visual Analog Scales (VAS) with the questions "How does your knee function?" and "How does your knee affect your activity level?" revealed no differences between the groups. Subjective patellofemoral pain, patellofemoral compartment findings and donor site morbidity were more common in the BTB group, P < 0.05. Lachman test grade 1+ was more common in the ST group, P < 0.05, but there was no significant difference in instrumented Lachman side-to-side comparison. The ST group scored better in the one-leg hop test than the BTB group, P < 0.05. No correlations between these clinical and functional findings and subjective knee function scores were found. In conclusion, ACL reconstruction with ST tendon graft presented fewer short-term postoperative problems as compared to reconstruction with BTB
|
0 |
Exercise Alters Gait Pattern but Not Knee Load in Patients with Knee Osteoarthritis
|
OAK 3 - Non-arthroplasty tx of OAK
|
Six female patients with bilateral medial knee OA and 6 healthy controls were recruited. Patients with knee OA received a 6-week physiotherapist-supervised and home-based exercise program. Outcome measures, including the Western Ontario and McMaster Universities Arthritis Index and Short Form-36 Health Survey as well as objective biomechanical indices were obtained at baseline and follow-up. After treatment, no significant difference was observed in the knee abductor moment (KAM), lever arm, and ground reaction force. We, however, observed significantly improved pain and physical function as well as altered gait patterns, including a higher hip flexor moment and hip extension angle with a faster walking speed. Although KAM was unchanged, patients with bilateral knee OA showed an improved walking speed and altered the gait pattern after 6 weeks of supervised exercise. This finding suggests that the exercise intervention improves proximal joint mechanics during walking and can be considered for patients with bilateral knee OA. Non-weight-bearing strengthening without external resistance combined with stretching exercise may be an option to improve pain and function in individuals with OA who cannot perform high resistance exercises owing to pain or other reasons.
|
0 |
Impaired aortic elastic properties in primary osteoarthritis
|
OAK 3 - Non-arthroplasty tx of OAK
|
Osteoarthritis is one of the most common chronic diseases and associated with increased cardiovascular comorbidity and deaths. Elastic properties of aorta are closely associated with cardiovascular mortality and morbidity. In our study, we aimed to evaluate aortic stiffness in primary osteoarthritis patients. A total of 160 patients including 80 patients with primary knee osteoarthritis and 80 controls without osteoarthritis were included in the study. Additionally, osteoarthritis patients were divided into four subgroups according to the severity of the disease. Aortic parameters were evaluated by using transthoracic echocardiography method. While measurements of aortic stiffness of osteoarthritis group were higher compared to the control group (p<0.01), aortic strain and aortic distensibility measurements of osteoarthritis group are lower than the control group (p< 0.01). Additionally, it was determined that as the severity of osteoarthritis increased also aortic stiffness increased highly significantly (p = 0.001). Presence and severity of osteoarthritis are closely associated with elastic properties of aorta, which are correlated with cardiovascular mortality and morbidity.
|
1 |
The Learning Curve Associated with the Administration of Intra-Articular Liposomal Bupivacaine for Total Knee Arthroplasty: A Pilot Study
|
AAHKS (8) Anesthetic Infiltration
|
INTRODUCTION: Liposomal bupivacaine is a long-acting, local, injectable anesthetic that is used to potentially mitigate post-operative pain after total knee arthroplasty (TKA). In addition, it may reduce opioid use in the post-operative period and shorten lengths-of-stay (LOS). There have been mixed results in the literature with regards to its efficacy, which raises questions regarding the injection technique used. Therefore, we evaluated the learning curve associated with injection techniques prior to, and after, formal teaching. Specifically, we compared differences in: 1) opioid use; 2) LOS; 3) pain intensity; and 4) discharge disposition in patients who did not receive liposomal bupivacaine (no infiltration cohort), received liposomal bupivacaine with less optimal technique (subpar infiltration), and received liposomal bupivacaine with appropriate technique (optimal infiltration) during their primary TKA.
MATERIALS AND METHODS: A 1:1:1 ratio of 54 consecutive cases of patients who had no liposomal bupivacaine infiltration, those who had subpar infiltration, and those who had optimal infiltration were included. To evaluate opioid use, the dosages were obtained and converted to their respective morphine milliequivalents (mEq). The total mEq usage was obtained for the day of surgery through post-operative day (POD) 3. LOS was recorded in days. Pain scores were calculated using the visual analogue scale (VAS), obtained from the first post-operative physical therapy note. Discharge status was recorded as discharged to home or rehabilitation. We used an ANOVA test for continuous and X2-square test for categorical variables.
RESULTS: When compared to patients who had no infiltration, patients who had subpar infiltration had significantly lower opioid use on day 0, while patients who had optimal infiltration had lower opioid use on post-operative day (POD) 0 and 3. When comparing techniques, opioid use was lower on day 3 for patients who had optimal, as compared to subpar technique. However, LOS and VAS were not significantly different among the three groups. The rehab discharge rate was lower for patients who had optimal as compared to subpar technique.
CONCLUSION: There is a learning curve associated with liposomal bupivacaine use, and incorporating an appropriate technique can markedly affect post-operative outcomes. This should be taken into account when evaluating the potential benefits of this peri-articular injection. It appears that liposomal bupivacaine may decrease opioid use and pain scores when optimal infiltration techniques are used.
|
0 |
Femoral head fractures: hemiarthroplasty or total hip arthroplasty?
|
PJI DX Updated Search
|
Most femoral neck fractures are osteoporotic fractures in the elderly. The one-year mortality after neck fracture in this group is 24%.For hemiarthroplasty (HA) the bipolar heads have a risk reduction for reoperation due to acetabular erosion compared with monoblock heads. Surprisingly, the bipolar head had an increased reoperation risk for dislocation, infection and for periprosthetic fracture.Total hip arthroplasty (THA) after fracture has a four-fold raised risk for dislocation compared with THA after osteoarthritis. A larger head on the same neck (head to neck ratio) results in a theoretically larger range of movement and hence less risk for dislocation. The dual mobility bearing has, theoretically, the largest range of movement and good clinical results.Functional results are better for THA compared with HA. Arthroplasty for fracture has much better results compared with arthroplasty after a failed internal fixation; the risk for reoperation is more than doubled for the latter.A Swedish hip arthroplasty register study found a 20-fold higher risk for periprosthetic fracture when comparing uncemented HA with matt cemented HA. Also a polished cemented stem had 13(1/2)-fold higher risks compared with a matt.The mortality during the first day after surgery is higher for cemented compared with uncemented arthroplasties, but lower after one week, one month and one year. Analysing the time points together resulted in no difference.A matt cemented THA with a maximum head size, maybe dual mobility, has the best results, and is also for the low-demanding elderly
|
0 |
Identifying yoga-based knee strengthening exercises using the knee adduction moment
|
OAK 3 - Non-arthroplasty tx of OAK
|
BACKGROUND: This study aimed to compare muscle activations, co-contraction indices, and the knee adduction moment between static standing yoga postures to identify appropriate exercises for knee osteoarthritis.
METHODS: Healthy young women (24.4 (5.4) years, 23.1 (3.7) kg/m(2)) participated. Primary outcome variables were electromyographic activations of the vastus lateralis, rectus femoris, vastus medialis, biceps femoris, and semitendinosus; co-contraction between the biceps femoris and rectus femoris, and vastus lateralis and vastus medialis; and knee adduction moments of both legs during six static, standing yoga postures (two squatting postures, two lunging postures, a hamstring stretch, and a single-leg balance posture). A two-factor repeated measures analysis of variance was used to identify differences in muscle amplitudes, co-contractions, and knee adduction moment between postures and legs.
FINDINGS: Quadriceps activations were highest during squat and lunge postures (p<=0.001). Hamstring activations were highest during the hamstring stretch (p<=0.003). Squat and lunge postures produced higher co-contraction indices than other postures (p<=0.011). The wide legged squat (Goddess) and lunge with trunk upright (Warrior) produced the lowest knee adduction moments (p<=0.006), while the single-leg balance posture elicited a higher knee adduction moment than all other postures (p<0.05).
INTERPRETATION: Squatting and lunging postures could improve leg strength while potentially minimizing exposure to high knee adduction moments. Future work should evaluate whether these exercises are useful in people with knee osteoarthritis.
|
0 |
The Efficacy of Intra-articular Infusion of Ropivacaine after Total Knee Arthroplasty
|
AAHKS (8) Anesthetic Infiltration
|
BACKGROUND: Intravenous patient controlled analgesia may not provide complete postoperative analgesia following total knee arthroplasty. The present study was to evaluate whether the addition of local, intraâ?articular ropivacaine improves the quality of the analgesia after total knee arthroplasty. METHODS: In the prospective, doubleâ?blind trial, 17 patients undergoing total knee arthroplasty of both knees with a standard general anesthetic technique had a infusion catheter placed at each knee joint at the end of surgery. The first knee joints were randomly assigned to receive a bolus of 20 ml 0.75% ropivacaine or saline followed by continuous infusion at 2 ml/h for 48 hours. The later knee joints received saline or ropivacaine that was not administered in the first knee joints in same manner. All patients received IV PCA. The difference in pain for each knee was assessed before surgery and at 2, 4, 6, 12, 24, 36 and 48 hours postoperatively. The use of a visual analogue scale (VAS) for each knee was also assessed at 2, 4, 6, 12, 24, 36 and 48 hours postoperatively. RESULTS: The difference in pain between each knee significantly increased at 4, 6, 12, 24, 36, 48 hours. However, the VAS in the ropivacaineâ?infused knee was significantly lower than that in the salineâ?infused knee at 12 and 24 hours. CONCLUSIONS: These results suggest that an intraâ?articular infusion of a bolus of 20 ml followed by continuous infusion at 2 ml/h with 0.75% ropivacaine after total knee arthroplasty has only a marginal analgesic effect. [By kind permission, KoreaMed, Korean Association of Medical Journal Editors.]
|
0 |
Diabetes and fractures: new evidence of atypical femoral fractures?
|
Hip Fx in the Elderly 2019
|
Summary: Patients with diabetes have an increased risk of fractures. In this study, subtrochanteric and femoral shaft fractures were increased in patients with type 1 diabetes compared with the general population. In the light of this, more evidence points towards an association between diabetes and atypical femoral fractures. Introduction: Patients with diabetes have an increased risk of femoral fractures, but little is known about the risk of atypical femoral fractures (AFFs). The aim of this study was to identify the risk of subtrochanteric and femoral shaft (ST/FS) fractures and estimate the risk of AFFs in patients with type 1 (T1D) and type 2 diabetes (T2D). Methods: From the nationwide Danish National Patient Register, we identified patients with T1D (n = 19,896), T2D (n = 312,188), and sex- and aged-matched controls without diabetes (n = 996,252) from the general population and all ST/FS fractures (n = 7509). Data were analyzed using a Cox proportional-hazards model and the incidence rate and rate ratio of ST/FS fractures were estimated. Results: The incidence rate of ST/FS fractures in T1D was 52.14 events per 100,000 person years and 73.21 per 100,000 person years in T2D. T1D was associated with an increased risk of ST/FS (HR 2.07 (95% CI 1.68â??2.56)), whereas T2D was not (HR 0.99 (95% CI 0.94â??1.10)). Previous ST/FS fractures were associated with an increased risk of subsequent ST/FS fractures (HR 6.95 (95% CI 6.00â??8.05)) and the use of bisphosphonates with an increased risk of ST/FS fractures (HR 1.72 (95% CI 1.54â??1.91)). Conclusion: Patients with T1D have a higher risk of ST/FS fractures compared with sex- and age-matched controls. Since a proportion of ST/FS fractures are classified as AFFs, this could point towards the fact that AFFs also are increased in patients with T1D, but not T2D.
|
0 |
Epidemiology of musculoskeletal injuries sustained by Naval Special Forces Operators and students
|
Glenohumeral Joint OA
|
Objectives The aim of this analysis was to describe the incidence and common types of medical chart-reviewed musculoskeletal injuries, among four distinct groups of Naval Special Warfare (NSW) personnel: Sea, Air, and Land (SEAL) Operators, SEAL Qualification Training (SQT) students, Special Warfare Combatant-craft Crewman (SWCC) Operators, and Crewman Qualification Training (CQT) students. Design Descriptive cross-sectional study. Methods Medical records were reviewed for 920 NSW personnel. MSI were described and classified by frequency and incidence; anatomic location; injury type and cause; activity during injury; and potential for prevention. Results The frequency of MSI was 23.1, 46.5, 31.6, and 17.0 per 100 participants per year among SEAL, SQT, SWCC, and CQT, respectively. Upper extremity MSI were the most common in SEAL, lower extremity MSI were common in the other groups. The most frequent MSI anatomic sub-locations varied across groups (SEAL: shoulder, 21.6% of MSI; SQT: foot and toes, 17.0%; SWCC: lumbopelvic spine, 21.7%; and CQT: knee, 30.3%). Pain/spasm/ache were the most common MSI type in SEAL (29.7%) and SWCC (21.7%), tendonitis/tenosynovitis/tendinopathy was the most common MSI type in SQT (21.0%), and tendonitis/tenosynovitis/tendinopathy and fracture were the most common in CQT (15.2% each). A considerable proportion of MSI were classified as potentially preventableâ??SEAL: 35.1%, SQT: 53.0%, SWCC: 36.7%, and CQT: 21.2%. Conclusions MSI cause considerable morbidity among NSW Operators and students, with distinct patterns of distribution by anatomic location and injury type. Since many injuries may be preventable, targeted interventions may be able to mitigate MSI risk.
|
0 |
Influence of education given to type 2 diabetes patients (Based on Conversation Map) on their foot-care behaviors and on diabetic foot risk factors
|
DoD LSA (Limb Salvage vs Amputation)
|
Objective: The most common cause of amputations in diabetes patients is the foot ulcer. The most prevalent factors leading to ulcer include neuropathy, deformity and traumas. Defining the foot risk factors for all diabetes patients and giving related education constitute the most important way of preventing foot ulcer. The purpose of the present study was to examined the influence of education given with the method of Conversation Map (Diabetes conversations) on Typeâ?2 diabetes individuals' diabetic foot behaviors and on the diabetic foot risk factors. Material and Methods: The study was carried out using the descriptive method with the records of diabetes individuals who were all registered to a diabetes education center of a university hospital and who took education with the method of conversation maps. Within the scope of the study, four training sessions based on conversation maps were held with diabetes patients. In the study, the 12thâ?month foot care behaviors of individuals before and after the education process and the diabetic foot risk factors were compared. Results: The results revealed a significant change over timeâ?before and after the education processâ?between the 12thâ?month foot care behaviors of diabetes individuals who took group education with the conversation map method with respect to foot care efficiency, foot care frequency, and with respect to the diabetic foot risk factors of temperature and humidity. Conclusion: The results of the study demonstrated that the mapâ?based program had positive influence on the patients' diabetic foot behaviors. For the purpose of evaluating the effectiveness of the education given based on the conversation map, future studies could be carried out with larger research samples using the randomized controlled design. Copyright © 2018 by Turkiye Klinikleri
|
0 |
Surgical strategy: Matching the patient with the procedure
|
The Treatment of Pediatric Supracondylar Humerus Fractures AUC
|
The general indications, timing, and choice of procedure can be determined by asking and answering the following questions appropriately: 1. Has the patient achieved neurologic, emotional, and social stability? 2. What is the patient's current level of motor and sensory resources and function? The number and strength of muscles remaining under good voluntary control are the most important variables. 3. Are the patient's expectations realistic? 4. Does the patient possess the necessary intelligence and motivation? Some procedures, such as arthrodesis of a specific joint, require little motivation to succeed; however, a complex set of muscle-tendon transfers requires a great deal of motor reeducation for the patient to achieve an optimal result. 5. Does the patient have the necessary time to invest in achieving a good result? The patient must be able to set aside the time necessary for postoperative immobilization in a cast or splint and for therapy and reeducation. 6. Are the necessary support services and personnel available and committed? 7. Have all preoperative obstacles to success been considered and has a plan developed to overcome any remaining obstacles? 8. Does the patient understand the potential complications and benefits'? 9. Can the patient and professional team tolerate a complication, failure, or suboptimal result? Both the medical staff and the patient must be prepared for complications that may lead to a suboptimal outcome or frank failure. 10. Are the patient's current health and well-being ideal? 11. Is the surgical plan consistent with the patient's physical resources, goals, and expectations? 12. Does an alternate plan exist? 13. Does the surgeon understand the scope of the complications and how to salvage an acceptable result should a complication occur?
|
1 |
MRSA knee infection treated successfully with daptomycin after two failed prolonged high-dose courses of vancomycin
|
Surgical Management of Osteoarthritis of the Knee CPG
|
Staphylococcal infections of joints can be difficult to eradicate, and when multidrug resistance is a factor, there are only a handful of treatment options. The following case study describes a patient with a methicillin-resistant Staphylococcus aureus knee infection that was successfully treated with daptomycin after twice failing on vancomycin. Copyright (copyright) 2005 by Lippincott Williams & Wilkins
|
0 |
Effects of treadmill speed on the knee angle and stance time of white rats with knee osteoarthritis according to the treadmill speed
|
OAK 3 - Non-arthroplasty tx of OAK
|
[Purpose] The purpose of this study was to identify whether walking on a treadmill at an adjusted speed is suitable for humans by examining the effects of exercise on the joint functions of white rats with induced knee osteoarthritis. [Subjects and
|
0 |
Liposuction in benign symmetric lipomatosis: sense or senseless?
|
Panniculectomy & Abdominoplasty CPG
|
Benign symmetric lipomatosis is a rare form of typical fat distribution in the shoulders, the arms, and the neck that can compromise the respiratory, nutritional, and psychological status of the patient. Alcoholism, malignant tumors of the upper airways, endocrine tumors, hypothyroidism, diabetes, and hypertriglyceridemia are often associated with its occurrence. Surgical removal via lipectomy or liposuction can give good cosmetic results, although recurrences often occur. Liposuction has become the first choice to treat this disorder in patients with smaller masses. We have operated on four such cases in which liposuction failed and surgical excision had to be performed. We present a summary of the clinical characteristics of all four patients and discuss the different treatment options.
|
0 |
Clinical practice guidelines for rest orthosis, knee sleeves, and unloading knee braces in knee osteoarthritis
|
SR for PM on OA of All Extremities
|
OBJECTIVE: To develop clinical practice guidelines concerning the use of bracing--rest orthosis, knee sleeves and unloading knee braces--for knee osteoarthritis. METHODS: The French Physical Medicine and Rehabilitation Society (SOFMER) methodology, associating a systematic literature review, collection of everyday clinical practice, and external review by multidisciplinary expert panel, was used. RESULTS: Few high-level studies of bracing for knee osteoarthritis were found. No evidence exists for the effectiveness of rest orthosis. Evidence for knee sleeves suggests that they decrease pain in knee osteoarthritis, and their use is associated with subjective improvement. These actions do not appear to depend on a local thermal effect. The effectiveness of knee sleeves for disability is not demonstrated for knee osteoarthritis. Short- and mid-term follow-up indicates that valgus knee bracing decreases pain and disability in medial knee osteoarthritis, appears to be more effective than knee sleeves, and improves quality of life, knee proprioception, quadriceps strength, and gait symmetry, and decreases compressive loads in the medial femoro-tibial compartment. However, results of response to valgus knee bracing remain inconsistent; discomfort and side effects can result. Thrombophlebitis of the lower limbs has been reported with the braces. Braces, whatever kind, are infrequently prescribed in clinical practice for osteoarthritis of the lower limbs. CONCLUSION: Modest evidence exists for the effectiveness of bracing--rest orthosis, knee sleeves and unloading knee braces--for knee osteoarthritis, with only low level recommendations for its use. Braces are prescribed infrequently in French clinical practice for osteoarthritis of the knee. Randomized clinical trials concerning bracing in knee osteoarthritis are still necessary
|
0 |
Symptomatic venous thromboembolism and mortality in orthopaedic surgery - an observational study of 45 968 consecutive procedures
|
Hip Fx in the Elderly 2019
|
BACKGROUND: Little information exists on the presentation of symptomatic venous thromboembolism (VTE) in orthopaedic surgery when a defined protocol for thromboprophylaxis is used. The objective with this study was to establish the VTE rate and mortality rate in orthopaedic surgery.
METHODS: We performed a prospective, single centre observational cohort study of 45 968 consecutive procedures in 36 388 patients over a 10 year period. Follow-up was successful in 99.3%. The primary study outcome was the incidence of symptomatic deep vein thrombosis (DVT), symptomatic pulmonary embolism (PE) and mortality at 6 weeks, specified for different surgical procedures. The secondary outcome was to describe the DVT distribution in proximal and distal veins and the proportion of VTEs diagnosed after hospital discharge. For validation purposes, a retrospective review of VTEs diagnosed 7-12 weeks postoperatively was also performed.
RESULTS: In total, 514 VTEs were diagnosed (1.1%; 95% CI: 1.10-1.14), the majority (84%) after hospital discharge (432 out of 514). With thromboprophylaxis, high incidence of VTE was found after internal fixation (IF) of pelvic fracture (12%; 95% CI: 5-26), knee replacement surgery (3.7%; 95% CI: 2.8-5.0), after internal fixation (IF) of proximal tibia fracture (3.8%; 95% CI: 2.3-6.3) and after IF of ankle fracture (3.6%; 95% CI: 2.9-4.4). Without thromboprophylaxis, high incidence of VTE was found after Achilles tendon repair (7.2%; 95% CI: 5.5-9.4). In total 1094 patients deceased (2.4%; 95% confidence interval (CI): 2.33- 2.44) within 6 weeks of surgery. Highest mortality was seen after lower limb amputation (16.3%, CI: 13.8-19.1) and after hip hemiarthroplasty due to hip fracture (9.6%, CI; 7.6-12.1).
CONCLUSION: The overall incidence of VTE is low after orthopaedic surgery but our study highlights surgical procedures after which the risk for VTE remains high and improved thromboprophylaxis is needed.
|
0 |
Double-blind, placebo-controlled study of the effects of tibolone on bone mineral density in postmenopausal osteoporotic women with and without previous fractures
|
Management of Hip Fractures in the Elderly
|
A 2-year placebo-controlled, randomized, two-center prospective study was carried out to assess the effects of tibolone (Org OD14, Livial) on trabecular and cortical bone mass and bone biochemistry parameters in elderly postmenopausal women with and without previous fractures. In total, 107 subjects, 71 with fractures and 36 without fractures, were randomized to tibolone (n = 64) or placebo (n = 43). Their mean age was 63.1 years. Bone mineral density (BMD) (g/cm2) was assessed at baseline and every 6 months for 2 years by dual-energy X-ray absorptiometry (DXA). Mean baseline values were 0.79 and 0.80 for the lumbar spine in the tibolone and placebo groups, respectively, and for the femoral neck 0.64 in both groups. Serum and urinary bone biochemistry parameters were measured concurrently. An analysis of variance (ANOVA) model including center and group was applied. The completers' group was the primary subset for the analysis; the intention-to-treat (ITT) group was also analyzed. Results are expressed as the percentage change at 24 months and the annual rate of change percentage year. The tibolone group showed an overall mean increase (vs. placebo) in BMD at the lumbar spine of 7.2% (p < 0.001) and for the femoral neck 2.6% (p < 0.001). In subjects with previous fractures increases were 6.0% and 4.0% for the lumbar spine and femoral neck, while in those with no fractures, respective changes were 8.9% and 1.1%. Overall changes in the placebo group were 0.9% and -1.6% for the lumbar spine and femoral neck, respectively. A significant fall in bone biochemistry parameters showed that tibolone inhibits osteoclastic activity. In conclusion we have found that tibolone 2.5 mg induces significant increases of trabecular and cortical bone mass in elderly postmenopausal osteoporotic women with and without previous fractures
|
1 |
Pre-operative traction for fractures of the proximal femur
|
Management of Hip Fractures in the Elderly
|
BACKGROUND: Pre-operative traction following an acute hip fracture remains standard practice in some hospitals. OBJECTIVES: To evaluate the effects of traction applied to the injured limb prior to surgery for a fractured hip. Different methods of applying traction (skin or skeletal) were considered. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group's specialised register (February 2003), the Cochrane Controlled Trials Register (The Cochrane Library Issue 1, 2003), MEDLINE (1966 to February 2003), EMBASE (1988 to 2003 Week 8), CINAHL (1982 to February 2003), the National Research Register Issue 1, 2003, conference proceedings and reference lists of articles. Date of most recent search: February 2003. SELECTION CRITERIA: All randomised or quasi-randomised trials comparing either skin or skeletal traction with no traction, or skin with skeletal traction for patients with an acute hip fracture prior to surgery. DATA COLLECTION AND ANALYSIS: Both reviewers independently assessed trial quality, using a nine item scale, and extracted data. Additional information was sought from all trialists. Wherever appropriate and possible, the data are presented graphically. MAIN RESULTS: Eight randomised trials, mainly of moderate quality, involving a total of 1349 predominantly elderly patients, were identified and included in the review. The inclusion in this review update of a newly available trial resulted in no important change in the results or conclusions. Seven trials compared traction with no traction. Although no data pooling was possible, overall these provided no evidence of benefit from traction, either in the relief of pain, ease of fracture reduction or quality of fracture reduction at time of surgery. One of these trials included both skin and skeletal traction groups. This trial and one other compared skeletal traction with skin traction and found no important differences between these two methods, although the initial application of skeletal traction was noted as being more painful and more costly. REVIEWER'S CONCLUSIONS: From the evidence available, the routine use of traction (either skin or skeletal) prior to surgery for a hip fracture does not appear to have any benefit. However, the evidence is also insufficient to rule out the potential advantages for traction, in particular for specific fracture types, or to confirm additional complications due to traction use. Further, high quality trials would be required to confirm or refute the absence of benefits of traction
|
0 |
Association of systemic lupus erythematosus with a higher risk of cervical but not trochanteric hip fracture: A nationwide population-based study
|
Hip Fx in the Elderly 2019
|
Objective: To determine the incidence rates and risk factors of cervical and trochanteric hip fractures (HFs) among patients with systemic lupus erythematosus (SLE) based on a nationwide population-based data set. Methods: We conducted a cohort study using data from the Taiwan National Health Insurance database. Patients with SLE and their age- and sex-matched counterparts without SLE were identified. The primary end point was the first occurrence of HF. Cox proportional hazards model was used to evaluate the respective risk factors of cervical and trochanteric HFs in the lupus cohort. Results: Among 14,544 patients with SLE (90% women, mean age 38.1 years) with a mean followup of 6 years, 75 developed HF (incidence rate 8.60 per 10,000 person-years). Compared to controls, the incidence rate ratios (IRRs) for developing HF among lupus patients were 3.17 (95% confidence interval [95% CI] 1.92-5.39, P < 0.001) for cervical HF and 1.11 (95% CI 0.58-2.11, P = 0.571) for trochanteric HF. The IRRs for HF were 2.38 (95% CI 1.58-3.63, P < 0.001) for women and 1.06 (95% CI 0.21-4.93, P = 0.922) for men. Lupus patients with cervical HF were younger than controls with cervical HF (mean age 56.7 versus 67.8 years; P = 0.007). Multivariable Cox regression analyses showed that age, use of intravenous cyclophosphamide, higher dose of steroid, and stroke were associated with cervical HF, whereas age was the only associated factor for trochanteric HF. Conclusion: SLE is associated with a higher risk for cervical but not trochanteric HF, and these 2 types of HFs have different risk factors. © 2013, American College of Rheumatology.
|
1 |
Quality and content analysis of clinical practice guidelines which include nonpharmacological interventions for knee osteoarthritis
|
OAK 3 - Non-arthroplasty tx of OAK
|
Rationale, Aims, and Objectives: Clinical practice guidelines (CPGs) for knee osteoarthritis (OA) guide the provision of high-quality healthcare for people with knee OA, which may improve outcomes. Our aim was to evaluate the quality of and content within recently published CPGs for people with knee OA. Methods: CPGs (2014-2019) that described recommendations for nonpharmacological interventions for knee OA were included in the analysis. Two pairs of evaluators used the Appraisal of Guidelines Research and Evaluation II instrument (AGREE II) to assess the quality of guideline development. CPG content was reviewed and summarized for comparison. Results: Ten CPGs were identified for inclusion in the quality and content analysis (seven newly developed and three recently updated). Overall CPG scores ranged between 42% and 100%. Six CPGs were found to be high-quality. Exercise was the only intervention recommended by all CPGs that we appraised. Weight-management and education were the next most frequently recommended interventions. Inter-rater reliability scores were high in domain 1: scope and purpose, (P-value =.001, intraclass correlation coefficient [ICC] = 0.90, 95% confidence interval [CI] = 0.62-0.98), domain 3: rigor of development (P-value =.000, ICC = 0.95, 95% CI = 0.80-0.99) and domain 5: applicability (P-value =.001, ICC = 0.91, 95% CI = 0.64-0.98). Conclusion: Several CPGs have been developed or recently updated since 2014. Over half of the ten CPGs we appraised were deemed to be high-quality. Exercise, education, and weight-management advice are interventions that were most commonly recommended by CPGs.
|
0 |
Penile Amputation: Cosmetic and Functional Results
|
Panniculectomy & Abdominoplasty CPG
|
Introduction: Penile amputation is a rare type of external genital trauma. It may arise from accidental trauma, assault or self-inflicted mutilation. As with all trauma, initial management focuses on assessment and resuscitation of the patient. When available, hypothermic preservation of the detached penis should be undertaken. Aim: This review serves to compile the current available information on etiology and management of penile amputation injuries, with focus on functional and cosmetic results. Main Outcome Measures: Main outcome measures were penile cosmetics, viability, and sensation; urethral patency and graft survival, functionality. Methods: A literature search using Medline, PubMed (U.S. National Library of Medicine and the National Institutes of Health), and abstracts from scientific meetings was performed from 1980-2013. Results: Due to the rarity of penile amputation injuries, no randomized trials exist. Likewise, available published series on management of this condition are comprised of a small number of patients. Conclusions: Penile amputation is rare but challenging. Current microreplantation procedures have a uniformly good result with a minimum number of post-operative complications. When microreplantation cannot be performed, older corporal reattachment techniques may be offered. When phallic reconstruction is required, a microsurgical free forearm flap phalloplasty may be performed to restore the patient with an acceptable cosmetic and functional phallus.
|
0 |
Randomized trial of aminoglutethimide versus tamoxifen in metastatic breast cancer
|
MSTS 2018 - Femur Mets and MM
|
We compared antiestrogen therapy (tamoxifen) with an estrogen suppression regimen (aminoglutethimide-hydrocortisone) in postmenopausal women with metastatic breast carcinoma. Fifteen of 39 patients (38%) who received tamoxifen experienced an objective tumor regression (3 complete, 12 partial remissions), whereas 13 of 36 women (36%) receiving aminoglutethimide responded (one complete remission, 12 partial remissions). The median duration of response was similar. The site of tumor involvement appears to be important in choosing between these hormonal treatments. Aminoglutethimide appears to offer a greater chance of response in patients with bone involvement.
|
1 |
Predictors of reoperation following operative management of fractures of the tibial shaft
|
DoD SSI (Surgical Site Infections)
|
BACKGROUND: Accurate prediction of likelihood of reoperation in patients with tibial shaft fractures would facilitate optimal management. Previous studies were limited by small sample sizes and noncomprehensive examination of possible risk factors.
OBJECTIVE: We conducted an observational study to determine which prognostic factors were associated with an increased risk of reoperation following operative treatment in a heterogeneous population of patients with tibial shaft fractures.
DESIGN: Retrospective observational study.
SETTING: Level 1 trauma center.
METHODS: We identified 200 patients with tibial shaft fractures from two university-affiliated centers. Two reviewers independently abstracted data regarding 20 possible prognostic variables, reviewed preoperative and postoperative radiographs, and documented reoperations (defined as any surgical procedure </=1 year after the initial surgery that was aimed specifically at achieving bony union of the fracture, including bone grafts, implant exchanges, or debridement for infections). We chose a Cox proportion hazards model to conduct a survival analysis for time to reoperation and constructed a multivariable model to estimate the relative risk of reoperation and associated 95%confidence interval (CI) for each predictor variable.
MAIN OUTCOME MEASURES: Time to reoperation following the initial surgery.
RESULTS: Complete follow-up information was available for 192 of 200 (96%) patients. Three variables predicted reoperation: the presence of an open fracture wound (relative risk 4.32, 95% CI 1.76 to 11.26), lack of cortical continuity between the fracture ends following fixation (relative risk 8.33, 95% CI 3.03 to 25.0), and the presence of a transverse fracture (relative risk 20.0, 95% CI 4.34 to 142.86).
CONCLUSIONS: We identified a set of three simple prognostic variables (open fracture, transverse fracture, and postoperative fracture gap) that can assist surgeons in predicting reoperation following operative treatment of tibial shaft fractures.
|
0 |
Complexity of cancer protease biology: Cathepsin K expression and function in cancer progression
|
MSTS 2018 - Femur Mets and MM
|
Proteases, including lysosomal cathepsins, are functionally involved in many processes in cancer progression from its initiation to invasion and metastatic spread. Only recently, cathepsin K (CatK), the cysteine protease originally reported as a collagenolytic protease produced by osteoclasts, appeared to be overexpressed as well in various types of cancers. In this review, the physiological functions of CatK are presented and compared to its potential role in pathobiolology of processes associated with tumour growth, invasion and metastasis of cancer cells and their interactions with the tumour microenvironment. CatK activity is either indirectly affecting signalling pathways, or directly degrading extracellular matrix (ECM) proteins, for example in bone metastases. Recently, CatK was also found in glioma, possibly regulating cancer stem-like cell mobilisation and modulating recently found physiological CatK substrates, including chemokines and growth factors. Moreover, CatK may be useful in differential diagnosis and may have prognostic value. Finally, the application of CatK inhibitors, which are already in clinical trials for treatment of osteoporosis, has a potential to attenuate cancer aggressiveness.
|
0 |
Past and current surgical treatment of giant omphalocele: outcome of a questionnaire sent to authors
|
Acellular Dermal Matrix
|
PURPOSE: Operative treatment of giant omphalocele (OC) is still a challenge for pediatric surgeons. We were interested to ascertain whether published operative techniques for giant OC once advocated by their authors were still being used by these authors and whether the techniques had been modified or even abandoned for other techniques. METHODS: Relevant studies concerning the treatment of giant OC were identified by an electronic search. Publication date of the articles was from 1967 to 2009. A questionnaire was sent to the first author or coauthor, unless contact details were unavailable. The described surgical techniques were categorized into primary closure, staged closure, and delayed closure. RESULTS: Almost half of the authors (42%), independent of the initial technique used (primary, staged, or delayed closure), changed or stopped using their technique after the publication of the article. The change was not to one particular proven better technique. Herniation rate was lower in delayed closure (9% delayed vs 18% staged vs 58% primary). CONCLUSIONS: The results of the questionnaire did not show a generally accepted method of treatment after more than 30 years of innovations in managing patients with a giant OC. There are generally 2 main treatment modalities: staged closure and delayed closure. Because of the lack of large patient numbers and late follow-up, long-term results of the published techniques are needed, and randomized multicenter trials based on these outcomes are recommended. Until then, we remain dependent on expert opinions.
|
0 |
Are there gender differences in coping with neck pain following acute whiplash trauma? A 12-month follow-up study
|
DoD PRF (Psychosocial RF)
|
BACKGROUND: Little is known about gender differences in coping after whiplash, and to date possible interaction of gender and coping on recovery has not been investigated.
AIMS: To examine if gender differences in coping are associated with long-lasting neck pain after acute whiplash. Seven hundred and forty participants referred from emergency departments or general practitioners after car accidents in Denmark. Within a median of five days, post-collision participants completed questionnaires on collision characteristics, psychological distress, and socio-demographics. After 3 months they completed the Coping Strategies Questionnaire, and after 12 months a VAS scale on neck pain intensity.
RESULTS: The odds for long-lasting neck pain were more than twice as high for women than for men (OR=2.17 (95% CI: 1.40; 3.37). However, no gender difference in coping and no interaction between gender and the five coping subscales on neck pain after 12 months were found. 'Distraction' increased the odds for considerable neck pain for both men and women (OR=1.03 (95% CI: 1.01; 1.05), 'reinterpreting' (OR=1.03 (95% CI: 1.01; 1.06), 'catastrophizing' (OR=1.14 (95% CI: 1.10; 1.18), and 'praying and hoping' (OR=1.10 (95% CI: 1.05; 1.13) for each point on these scales.
CONCLUSIONS: No interaction between coping and gender on neck pain was found, thus different coping strategies 3 months post-collision did not explain the different prognosis observed in men and women. Clinically relevant influence of 'catastrophizing' and 'praying and hoping' to prognosis was found, therefore we should identify patients predominantly using these strategies.
|
0 |
Six-month post-surgical elevations in cartilage T1rho relaxation times are associated with functional performance 2 years after ACL reconstruction
|
OAK 3 - Non-arthroplasty tx of OAK
|
The current study looks to: (i) investigate postural stability following anterior cruciate ligament (ACL) reconstruction, as assessed by Y-Balance Test, by comparing single-leg balance of the injured limb against those of controls and the uninjured limb; (ii) analyze the relationship between postural stability symmetry with localized cartilage matrix changes and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Bilateral knee MRI of 36 patients who underwent ACL reconstruction were performed before surgery, 6 months, 1 year, and 2 years, postoperatively. Postural stability was evaluated based on Y-Balance Test at 1 and 2 years. ACL patients were also split into three groups based on postural stability symmetry at 2 years and symmetry thresholds associated with elevated risks of lower extremity injury. Voxel-based relaxometry employing analysis of covariance was used to analyze localized differences in cartilage composition at all time-points (using quantitative magnetic resonance [MR] T1Ï and T2 mapping) between the three groups. The ACL patients displayed no significant deficits in postural stability. Compared with symmetric patients, those with asymmetric postural stability at 2 years had significantly prolonged cartilage T1Ïâ??indicating deterioration of the cartilage matrixâ??specifically in the injured knee's medial tibia as early as 6-month post-reconstruction. Prolonged T1Ï in asymmetric patients persisted up to 2 years, where the group also reported worse KOOS. Our results demonstrate an association between early stages of cartilage matrix deterioration and postural stability symmetry that may manifest in elevated lower extremity injury risk and worse patient-reported outcomes. Quantitative MR, in combination with local analysis performed with voxel-based relaxometry, is a tool to further study this relationship. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:1132-1140, 2020.
|
0 |
The effect of balanced analgesia on early convalescence after major orthopaedic surgery
|
AAHKS (4) Acetaminophen
|
Forty-two patients scheduled for total knee arthroplasty (n = 20) or hip arthroplasty (n = 22) were randomly allocated to receive either continuous epidural bupivacaine/morphine for 48 h postoperatively plus oral piroxicam, or general anaesthesia followed by a conventional intramuscular opioid and acetaminophen regimen. Patients undergoing knee- or hip arthroplasty treated with epidural analgesia had significantly lower pain scores during mobilization under the 48 h epidural infusion compared with patients receiving conventional treatment, while no important differences were observed after cessation of the epidural regimen. However, the achieved pain relief had no impact on postoperative convalescence parameters, such as ambulation, patient activity including need for nursing care, fatigue or hospital stay. Late postoperative pain, fatigue and conservative attitudes and routines in the postoperative care, were the most important reasons limiting mobilization and activity. We conclude that effective early (48 h) postoperative pain relief with balanced analgesia does not per se lead to important improvements in convalescence and hospital stay.
|
1 |
MRI diagnosis of ACL bundle tears: value of oblique axial imaging
|
Anterior Cruciate Ligament Injuries CPG
|
OBJECTIVE: To investigate the diagnostic accuracy of oblique axial intermediate weighting MR imaging in detecting partial thickness anterior cruciate ligament (ACL) bundle tears. MATERIALS AND METHODS: The study protocol was approved by the institutional ethics committee. Sixty-one subjects (43 male, 18 female; mean age 27.4 years; range 9 to 57 years) with clinically suspected ACL tear or meniscal tear between September 2009 and January 2011 were studied with MRI and arthroscopy. Detection of partial tear for the ACL as a whole and for each ACL bundle by protocol A (standard orthogonal sequences) and protocol B (standard orthogonal sequences plus oblique axial intermediate weighted imaging) was compared in a blinded fashion. Performance characteristics for protocol A and protocol B were compared using sensitivity, specificity, accuracy and ROC curves. A two-tailed p value of <0.05 indicated statistical significance. RESULTS: Fifteen (24.6%) normal, 15 (24.6%) partial and 31 complete tears were diagnosed by arthroscopy. Sensitivity, specificity and accuracy of protocol A for the diagnosis of partial tear of the ACL was 33%, 87% and 74%, while for protocol B the values were 87%, 87% and 87% respectively. The area under the curve (AUC) for the diagnosis of partial ACL tear and individual bundle tear was higher for protocol B, although this difference did not reach statistical significance (p > 0.05). CONCLUSION: The addition of oblique axial imaging to standard MR imaging improves diagnostic accuracy for detecting partial tears of the ACL as well as individual bundle tears of the ACL
|
0 |
Six-year course and prognosis of nontraumatic knee symptoms in adults in general practice: a prospective cohort study
|
Surgical Management of Osteoarthritis of the Knee CPG
|
OBJECTIVE: To examine the 6-year course of nontraumatic knee symptoms in adults in general practice, to identify prognostic factors for unfavorable outcome, and to develop a clinical prediction rule. METHODS: Adults (ages >35 years) with incident nontraumatic knee symptoms (n = 549) were followed for 6 years. Multivariable logistic regression analysis was used to identify prognostic factors associated with an unfavorable outcome, the area under the receiver operating curve (AUC) was calculated to determine discriminative ability, and a clinical prediction rule was developed. Unfavorable outcome is defined as persistent knee symptoms at 6-year followup or having undergone knee replacement surgery during followup. RESULTS: At 6-year followup, 42.1% of patients had an unfavorable outcome. Having persistent knee symptoms (odds ratio [OR] 5.31, 95% confidence interval [95% CI] 3.27-8.61) and fulfilling the clinical American College of Rheumatology (ACR) criteria for osteoarthritis (OA; OR 2.65, 95% CI 1.48-4.73) at 1-year followup were significantly associated with unfavorable outcome, while fulfilling the clinical ACR criteria for OA at baseline was not. Baseline factors independently associated with an unfavorable outcome were low/middle education level, comorbidity of the skeletal system, duration of knee symptoms of >3 months, bilateral knee symptoms, self-reported warm knee, history of nontraumatic knee symptoms, valgus alignment, pain at passive knee flexion/extension, and bony enlargement of the knee joint (AUC 0.80). CONCLUSION: Nontraumatic knee symptoms in adults in general practice appear to become a chronic disorder in nearly half of the patients. The developed clinical prediction rule with 10 baseline prognostic factors can be used to select high-risk patients for an unfavorable outcome at long-term followup
|
1 |
Cutaneous nasal malignancies: is primary reconstruction safe?
|
Reconstruction After Skin Cancer
|
BACKGROUND: The nose is particularly vulnerable to cutaneous malignancies, making it the most common location for presentation. Recurrence of these cutaneous lesions is not uncommon, often compromising the timing of nasal restoration. It is the purpose of this report to reexamine the safety of primary nasal reconstruction in selected patients. METHODS: Seventy-one patients who underwent nasal reconstruction at The University of Texas M. D. Anderson Cancer Center between 1987 and 1995 were retrospectively reviewed. There were 35 men and 36 women with an average age of 60 years. All nasal reconstructions were performed for defects secondary to malignancies. Basal cell carcinoma was the most common lesion (n = 49), followed by squamous cell carcinoma (n = 10) and melanoma (n = 7), with five additional variable malignancies. The most common location of the cutaneous lesions was the nasal dorsum, and the forehead flap was the most common adjacent tissue used for reconstruction. Immediate reconstruction was performed for 42 of the basal cell carcinomas, 6 of the squamous cell carcinomas, 6 melanomas, and 3 other lesions. Delayed restoration was performed for 7 basal cell carcinomas, 4 squamous cell carcinomas, 1 melanoma, and 2 additional lesions. The average time between surgical extirpation and the start of nasal reconstruction was 8.2 months for basal cell carcinoma, 29 months for squamous cell carcinoma, and 10 months for melanoma. RESULTS: Twenty-six recurrent lesions were identified at an average of 36 months after extirpation. Despite these numbers, only three recurred after nasal reconstruction at our institution. Follow-up averaged 41 months, with none less than 1 year. Seventy patients are still alive with no evidence of disease. CONCLUSION: Primary reconstruction is safe in selected patients. Surgical delay in reconstruction should be considered if margins are questionable, the pathology is determined to be aggressive, if there is perineural or deep bony invasion, or if postoperative radiotherapy is to be initiated. Nasal reconstruction ultimately is based upon a complex series of issues but can be performed with few complications in an effort to restore self-image.
|
1 |
Early Complications following Articular Calcaneus Fracture Repair: Evaluation of Open Versus Percutaneous Techniques
|
DoD SSI (Surgical Site Infections)
|
Objectives:To assess complications and secondary operations in patients treated with either open reduction and internal fixation (ORIF) versus percutaneous fixation of displaced intra-articular calcaneus fractures.Design:Retrospective comparative study.Setting:Level 1 trauma center.Patients/Participants:Ninety-three adult patients with 111 fractures treated by a single orthopaedic traumatologist between 2001 and 2014.Intervention:ORIF through an extensile lateral approach or percutaneous reduction and internal fixation.Main Outcome Measurements:Wound-healing complications, infections, posttraumatic arthrosis (PTOA), and secondary procedures.Results:Fifty patients with 58 fractures underwent ORIF, and 43 patients with 53 fractures had percutaneous fixation. Mean age was 43 years, and 80% were male. Open fractures and two-part fractures were more often treated percutaneously (26% vs 8%, P = 0.03) and (49% vs 31%, P = 0.02), respectively. Patients undergoing percutaneous fixation were more often tobacco users (58% vs 36%, P = 0.04) and with history of alcohol and other substance abuse. Twenty-seven patients (29%) had 28 complications, including 21% with PTOA, with no differences based on type of treatment. Six patients had secondary procedures, with no difference based on type of treatment. Patients with open fractures (P = 0.001) or tobacco abuse (P = 0.005) were more likely to experience complications.Conclusions:No differences in complication rates were found for ORIF versus percutaneous fixation. Regardless of fixation technique, patients with open fractures or history of tobacco abuse were more likely to develop complications. Percutaneous reduction and fixation represents an alternative to extensile ORIF in terms of similar early and late complications, particularly in high risk patients.Level of Evidence:Therapeutic Level III.
|
1 |
Sonographic measurement of cross-sectional area of the median nerve in the diagnosis of carpal tunnel syndrome: correlation with nerve conduction studies
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
PURPOSE: To assess the usefulness of sonographic measurement of the median nerve cross-sectional area (CSA) in the diagnosis of carpal tunnel syndrome (CTS) and grading of its severity using nerve conduction (NC) studies as the standard. METHOD: The CSA of the median nerve was measured at the tunnel inlet and outlet using the ellipse formula and automatic tracing in 72 hands with suspicion of CTS. RESULT: The lack of inter-reader reliability led to excluding CSA measurements obtained at the tunnel outlet. Based on the receiver operating characteristic curves, the following cut-off points for the CSA of the median nerve at the tunnel inlet was selected: 9.8 mm and 12.3 mm(2) for the ellipse formula and 11 and 13 mm(2) for automatic tracing. For the ellipse formula, a CSA less than or equal to 9.8 mm(2) excluded CTS whereas a CSA greater than or equal to 12.3 mm(2) was diagnostic of CTS with measurements between 9.8 and 12.3 mm(2) being indeterminate and requiring NC studies. For automatic tracing, the cutoff value of 11 mm(2) was excluded because of the high percentage of false negatives, whereas CSAs greater than or equal to 13 mm(2) were diagnostic of CTS. There were no statistically significant differences in CSA measurements between the various degrees of CTS severity determined by NC studies. CONCLUSION: Sonographic measurement of median nerve CSA at the tunnel inlet is a good alternative to NC studies as the initial diagnostic test for CTS, but it cannot grade the severity of CTS as well as NC studies
|
0 |
Carpal tunnel: Normal anatomy, anatomical variants and ultrasound technique
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
The carpal tunnel is an osteofibrous canal situated in the volar wrist. The boundaries are the carpal bones and the flexor retinaculum. In addition to the medial nerve, the carpal tunnel contains nine tendons: the flexor pollicis longus, the four flexor digitorum superficialis and the four flexor digitorum profundus. Ultrasound (US) study of the carpal tunnel generally involves short-axis imaging of the tendons, and in the presence of disease, long-axis imaging and dynamic maneuvers are added. There are numerous reports of anatomical variants of the wrist involving vessels, nerves, tendons and muscles, and they can all be studied by US. Some are particularly relevant from a clinical point of view and will therefore be accurately described. The anatomy is complex, and the US operator should therefore be thoroughly familiar with the normal anatomy as well as the anatomical variants that may have a role in the pathogenesis of carpal tunnel syndrome or influence treatment
|
0 |
The intercellular adhesin locus ica is present in clinical isolates of Staphyloccus aureus from bacteremic patients with infected and uninfected prosthetic joints
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
Although polysaccharide intercellular adhesin (PIA) is thought to be crucial in the pathogenesis of prosthetic device infections caused by Staphylococcus epidermidis, its role in prosthetic device infections caused by Staphylococcus aureus is unknown. To assess the clinical impact of PIA production, isolates from 15 prospectively identified cases of S. aureus bacteremia in patients with prosthetic joints (8 infected, 7 uninfected) were characterized for biofilm production, hemagglutination, and the presence of a 419-bp amplification product within icaA. Although icaA was present in all 15 isolates, none of the isolates produced hemagglutination and only one isolate (from a patient with an uninfected prosthetic device) weakly produced biofilm in vitro. These results support the observation that the ica locus is conserved between S. epidermidis and S. aureus and that PIA may be expressed only under in vivo conditions. Future investigations should include animal models to approximate the complex milieu surrounding implanted prosthetic medical devices
|
0 |
Complications after patello-femoral versus total knee replacement in the treatment of isolated patello-femoral osteoarthritis. A meta-analysis
|
Surgical Management of Osteoarthritis of the Knee CPG
|
PURPOSE: Both patellofemoral arthroplasty (PFA) and total knee arthroplasty (TKA) are successful in treating isolated patellofemoral osteoarthritis, but the complication rates after PFA are concerning. We performed a meta-analysis to compare the incidence of complications, re-operations, and revision following PFA and TKA for patellofemoral osteoarthritis. METHODS: We systematically identified publications with patients who underwent PFA or TKA for patellofemoral osteoarthritis with minimum 1.5 year follow-up. Demographics, implant (TKA, first [1G] or second-generation [2G] PFA), complications, and cause of re-operations were extracted. Random-effects meta-analysis was used to pool incidence data, which was compared between groups using logistic regression to adjust for length of follow-up. RESULTS: Twenty-eight observational studies and no randomized trials were included in this meta-analysis, which limits its generalizability. There was a higher likelihood of any re-operation (odds ratio 8.06) and revision (OR 8.11) in PFA compared to TKA. Re-operation (OR 4.33) and revision (OR 4.93) were more likely in 1G-PFA than 2G-PFA. When comparing 2G-PFA to TKA, there was no significant difference in re-operation, revision, pain, or mechanical complications. CONCLUSIONS: Patients who undergo PFA rather than TKA are more likely to experience complications and require re-operation or revision, but subgroup analysis suggests a relation to implant design. There is no significant difference in re-operation, revision, pain, or mechanical complications between 2G-PFA and TKA. LEVEL OF EVIDENCE: Systematic review of Level III therapeutic studies, Level III
|
0 |
Serum undercarboxylated osteocalcin is a marker of the risk of hip fracture: a three year follow-up study
|
Management of Hip Fractures in the Elderly
|
We have previously shown that elderly women with an increased serum undercarboxylated osteocalcin (ucOC) level have an increased risk of sustaining a hip fracture as compared to those with normal serum ucOC. We reassessed our findings on a larger number of hip fractures that occurred over 3 years in 183 institutionalized women (aged 70-97 years) belonging to a large prospective clinical trial. Total OC, carboxylated OC, ucOC, and alkaline phosphatase were significantly higher at baseline in those who sustained a hip fracture during the follow-up. The age-adjusted odds ratio for hip fracture was three times higher in women with increased ucOC at baseline (odds ratio = 3.1, 99.9% C.I. = 1.7-6.0, p < 0.001). In the logistic regression, ucOC was still predictive of the hip fracture when age and parathyroid hormone concentration were included into the model (odds ratio = 2.6, 95% C.I. = 1.05-6.4). These data confirm that ucOC is a marker of the increased risk of hip fracture in elderly institutionalized women. Serum ucOC may reflect some nutritional deficiency associated with increased bone fragility
|
0 |
Treating Severe Knee Osteoarthritis with Combination of Intra-Osseous and Intra-Articular Infiltrations of Platelet-Rich Plasma: An Observational Study
|
PRP (Platelet-Rich Plasma)
|
OBJECTIVE: Assessing the therapeutic effects of a combination of intra-articular and intra-osseous infiltrations of platelet-rich plasma (PRP) to treat severe knee osteoarthritis (KOA) using intra-articular injections of PRP as the control group.
DESIGN: In this observational study, 60 patients suffering from severe KOA were treated with intra-articular infiltrations of PRP (IA group) or with a combination of intra-osseous and intra-articular infiltrations of PRP (IO group). Both groups were matched for sex, age, body mass index, and radiographic severity (III and IV degree according to Ahlback scale). Clinical outcome was evaluated at 2, 6, and 12 months, using the Knee injury and Osteoarthritis Outcome Score (KOOS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaires.
RESULTS: At 2, 6 and 12 months after treatment, IO group had a significant improvement in all KOOS and WOMAC subscales ( P < 0.05). On the contrary, patients of the IA group did not improve in any of the scores. Sixteen out of 30 IO group patients showed minimal clinically important improvement (MCII) whereas 8 out of 30 IA group patients showed this response at 6 months (26.7%; 95% CI -0.4 to 49.9; P = 0.037). At 12 months, 14 patients of IO group and 5 patients of the IA group showed MCII (30%; 95% CI 4.3 to 51.9; P = 0.013). No differences between groups were observed at 2 months.
CONCLUSIONS: PRP intra-articular injections in severe KOA were not effective and did not provide any benefit. Combination of intra-articular and intra-osseous infiltrations of PRP was not clinically superior at 2 months, but it showed superior clinical outcomes at 6 and 12 months when compared with intra-articular injections of PRP.
|
0 |
Nipple-areola complex cutaneous sensitivity: a systematic approach to classification and breast volume
|
Reduction Mammoplasty for Female Breast Hypertrophy
|
INTRODUCTION: The aim of our study was to develop a systematic approach to provide a data bank on normative cutaneous pressure thresholds of the nipple-areola complex (NAC) in different breast volumes and a classification of the NAC sensitivity function.
PATIENTS AND METHODS: A population of 150 Caucasian women stratified in five groups of 30 subjects according to the Lalardie-Jouglard classification of breast volume was enrolled in our study. A single evaluator (B.L.) performed breast volume assessments using the BREAST-V and sensory testing on NACs with Pressure-Specified Sensory Device; static and moving one- and two-point discriminations of nipple and areola were collected from each group. Statistical analysis using mixed effects model was performed with significant p-values <0.05.
RESULTS: Nipple was found to be more sensitive than areola for both static and moving one-point tests. From our analyses emerged an inverse relationship between skin pressure thresholds and breast volume, with NACs from small breasts (group A) statistically more sensitive than NACs from macromastia women (group E). Properly, the group A women were found to be 0.42, 1.89, 4.98, and 9.55 times progressively more sensitive (p < 0.001) than groups B, C, D, and E, respectively, for quickly adapting fibers of nipple, and 0.58, 1.97, 4.97, and 8.67 times more sensitive (p < 0.001) than groups B, C, D, and E, respectively, for quickly adapting fibers of areola. The sensitivity function of the nipple and areola was classified as high (first degree), medium (second degree), and low (third degree) according to mean +/- standard deviation of the overall values.
CONCLUSION: Our study first provides a complete data bank of normative NAC sensitivity in a wide range of breast volumes, and gives three degrees of classification of NAC sensitivity function.
|
0 |
Acute Shoulder Injuries in Adults
|
Hip Fx in the Elderly 2019
|
Acute shoulder injuries in adults are often initially managed by family physicians. Common acute shoulder injuries include acromioclavicular joint injuries, clavicle fractures, glenohumeral dislocations, proximal humerus fractures, and rotator cuff tears. Acromioclavicular joint injuries and clavicle fractures mostly occur in young adults as the result of a sports injury or direct trauma. Most nondisplaced or minimally displaced injuries can be treated conservatively. Treatment includes pain management, short-term use of a sling for comfort, and physical therapy as needed. Glenohumeral dislocations can result from contact sports, falls, bicycle accidents, and similar high-impact trauma. Patients will usually hold the affected arm in their contralateral hand and have pain with motion and decreased motion at the shoulder. Physical findings may include a palpable humeral head in the axilla or a dimple inferior to the acromion laterally. Reduction maneuvers usually require intra-articular lidocaine or intravenous analgesia. Proximal humerus fractures often occur in older patients after a low-energy fall. Radiography of the shoulder should include a true anteroposterior view of the glenoid, scapular Y view, and axillary view. Most of these fractures can be managed nonoperatively, using a sling, early range-of-motion exercises, and strength training. Rotator cuff tears can cause difficulty with overhead activities or pain that awakens the patient from sleep. On physical examination, patients may be unable to hold the affected arm in an elevated position. It is important to recognize the sometimes subtle signs and symptoms of acute shoulder injuries to ensure proper management and timely referral if necessary.
|
0 |
When is hemiarthroplasty preferable to intramedullary prophylactic fixation of malignant lesions of the proximal femur?
|
Hip Fx in the Elderly 2019
|
BACKGROUND: Malignant hip lesions can be managed operatively by intramedullary (IM) nail fixation and hemiarthroplasty.
METHODS: A retrospective review was performed on 86 patients who underwent hemiarthroplasty (n = 22) or IM nail fixation (n = 64) for prophylactic treatment of impending pathologic fracture due to malignant lesions of the hip. Cox proportional hazards and logistic regression modeling were performed to determine risk of death, fixation failure, pain relief, and return to ambulation without gait aids.
RESULTS: Median survival time after surgery was 8.8 months (with no difference in survival between hemiarthroplasty and IM nail [adjusted Hazard Ratio 1.40, CI 0.72, 2.53; P = 0.31]). Hemiarthroplasty was associated with lower risk of pathologic fracture, fixation failure, or reoperation (adjusted HR 0.02, CI < 0.001, 0.48; P = 0.01). Hemiarthroplasty did not increase odds of unassisted ambulation compared to IM nail fixation (adjusted Odds Ratio [OR] 2.23, CI 0.56, 9.71; P = 0.26). The strongest predictor of postoperative ambulation was preoperative ambulation without aids (adjusted OR 28.9, CI 7.37, 161; P < 0.001).
CONCLUSIONS: There is no difference in survival or likelihood of unassisted ambulation after prophylactic femoral fixation with IM nails versus hemiarthroplasty in patients with metastatic disease of proximal femur.
|
1 |
Reduction of lipoplasty risks and mortality: an ASAPS survey
|
Panniculectomy & Abdominoplasty CPG
|
BACKGROUND: Previously published articles presenting rates for lipoplasty morbidity and mortality have reported on procedures performed before mid 1998. OBJECTIVE: The present survey reports on morbidity and mortality for lipoplasty procedures performed by members of the American Society for Aesthetic Plastic Surgery (ASAPS) from September 1, 1998, through August 31, 2000. It assesses whether ASAPS-member surgeons have modified their lipoplasty practices in accordance with the 1998 recommendations of the Lipoplasty Task Force. METHODS: In September 2000, ASAPS sent out a 4-page questionnaire to 1432 Active Members, all of whom were board-certified plastic surgeons. The survey included questions about complications and fatal outcomes associated with lipoplasty procedures, performance of combination procedures, patient selection, changes in lipoplasty and anesthesia techniques, and surgical facility accreditation. Completed surveys were anonymous and were mailed by respondents directly to an independent research firm for collation. Further data analysis was conducted by an independent statistician. RESULTS: A total of 754 questionnaires were returned, for a response rate of 53%. ASAPS members reported on 94,159 lipoplasty procedures. In all, 66% of the procedures were lipoplasty only, 20% were lipoplasty without abdominoplasty but with one or more additional procedures, and 14% were lipoplasty with abdominoplasty, with or without any other procedures. The most frequently reported postoperative event was nausea/vomiting (1.02%, or 1 per 98 procedures). The most frequently reported major complication was skin slough (0.0903%, or 1 per 1107 procedures). In all, there were 245 major complications, for a rate of 0.2602%. Death associated with lipoplasty performed as an isolated procedure was rare; the mortality rate was 0.0021%, or 1 per 47,415 procedures. Stated positively, the estimated non-mortality probability is 99.98%. When lipoplasty was performed with other procedures, excluding abdominoplasty, the rate was 0.0137%, or 1 per 7314 procedures. When lipoplasty was combined with abdominoplasty, with or without other procedures, the rate was 0.0305%, or 1 per 3281 procedures[mdash ]a rate 14 times greater than that for lipoplasty only. Nearly 33% of respondents said that they had modified their approach to lipoplasty and/or their approach to patient selection within the last 24 months in accordance with published recommendations of the Lipoplasty Task Force. CONCLUSIONS: The ASAPS survey documents the current safety of lipoplasty when it is performed as an isolated procedure by properly trained surgical specialists adhering to recommended standards of clinical practice. Further studies are needed to examine the factors that increase the risk in combined procedures as well as the effectiveness of prophylactic measures in avoiding complications.
|
0 |
Inter-hospital variations in length of hospital stay following hip fracture
|
Hip Fx in the Elderly 2019
|
Objective: to investigate differences in length of hospital stay after hip fracture. Design: prospective survey of a consecutive series of patients admitted with an acute hip fracture and followed-up for 90 days after admission. Setting: eight hospitals in the East Anglian region, Subjects: 580 patients admitted with a hip fracture. Main outcome measures: mortality length of hospital stay place of discharge and transfer of patients between hospitals. Results: there was a significant difference in the median lengths of hospital stay between centres (range 13-28 days). A prolonged hospital stay was associated with increased age, decreased activities of daily living score and delay from surgery to mobilization. Hospitals which had a policy of transferring patients to other wards prior to discharge tended to have a longer length of hospital stay. Conclusions: large differences in the duration of inpatient stay exist between hospitals. Centres which transferred a high proportion of patients before discharge had a longer length of stay.
|
0 |
Silicone ring tourniquet versus pneumatic cuff tourniquet in total knee arthroplasty surgery: A randomised comparative study
|
OAK 3 - Non-arthroplasty tx of OAK
|
Introduction: The aim of the present study was to compare a silicone ring tourniquet (SRT) and a classic pneumatic cuff tourniquet (PT) in patients undergoing total knee replacement. We have compared the impact on the glycolytic activity caused by the ischaemia applied to the limb during the surgery. Material and methods: 140 patients that underwent total knee arthroplasty (TKA) were randomised in two groups. Serum lactate determination was made by reactive strips of enzymatic-amperometric detection, 5 min before tourniquet application and 5 min after tourniquet removal. Results: The mean tourniquet time was similar for both groups (p 0.13). Postoperative serum lactate levels were higher with statistical significance than the preoperative levels and with a positive Pearson´s correlation in the overall cases. The postoperative serum lactate levels where higher in the PT group (4.097 ± 2.248 mmol/L) than the SRT group (3.499 ± 1.566 mmol/L). There was no significant difference (p 0.07) to be able to affirm that there was a difference of the anaerobic metabolism according to the tourniquet system used. Discussion: Ischaemia applied to the lower extremity during knee replacement surgery can produce tissue injury. Serum lactate determination allows comparison of the ischaemic changes during TKA surgery caused by two different tourniquet systems. Conclusions: SRT may be not disadvantageous compared to the classic PT from the impact on the glycolytic activity caused by the ischaemia. Level of evidence II.
|
0 |
Effect of repeated local minocycline administration on periodontal healing following guided tissue regeneration
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
BACKGROUND: Infection after a periodontal surgical site has been prepared for guided tissue regeneration (GTR) is one of the common complications that can compromise healing. The purpose of this study was to assess the effect of repeated local antimicrobial therapy following GTR for improving clinical attachment gains, and to histologically evaluate the various cell populations and bacterial contamination of the retrieved expanded polytetrafluoroethylene membrane (ePTFE). METHODS: Forty periodontal intrabony defects in 40 patients were treated by a flap procedure that included the use of ePTFE membranes to allow GTR. Patients were randomly assigned to 2 treatment groups: 20 patients were treated with the ePTFE alone (control group), and the other 20 were treated with the ePTFE combined with the administration of a weekly repeated local application of minocycline ointment for 8 weeks after membrane placement (test group). The membranes were retrieved 6 weeks after the initial surgery and sectioned serially in a coronal-apical plane. The sections were then divided into 9 fields and examined by light microscopy for the presence of inflammatory cells and oral bacteria. Clinical measurements were taken at the time of baseline examination and at a 6-month follow-up examination after removal of the ePTFE. RESULTS: At the 6-month follow-up examination, control and test groups showed significant improvement; i.e., reduction in the probing depth and increased clinical attachment gain compared with the values at the baseline examination. However, the mean clinical attachment gain of the test group (3.0+/-0.3 mm) was significantly (P = 0.03) greater than that of the control group (2.0+/-0.5 mm). Histologically, the total number of the cells of both groups was similar. In both groups, mononuclear cells were dominant and fibroblasts, neutrophils, and plasma cells were rarely encountered. There was a tendency for the number of macrophages to be somewhat higher in the control group. The total number of bacteria in the test group was significantly less than that in the control group. The number of bacteria in both control and test groups decreased toward the apical portion. CONCLUSIONS: In the present study, clinical attachment gain of intrabony defects following GTR was favorable with repeated local administration of minocycline ointment. However, a complete microbial eradication was not achieved
|
0 |
What are the patterns of injury and displacement seen in lateral compression pelvic fractures?
|
Management of Hip Fractures in the Elderly
|
BACKGROUND: Lateral compression (LC)-type pelvic fractures encompass a wide spectrum of injuries. Current classification systems are poorly suited to help guide treatment and do not adequately describe the wide range of injuries seen in clinical practice. QUESTIONS/PURPOSES: We therefore (1) defined the spectrum of injuries that compose LC fractures with respect to both anterior and posterior ring injuries, with particular focus on the morphology of sacral fractures, and (2) identified fracture patterns associated with displacement at presentation. METHODS: We retrospectively reviewed 318 LC pelvic fractures. Displacement of the anterior pelvic ring was identified and measured on plain radiographs and posterior displacement was identified by CT. RESULTS: All 318 patients had an anterior injury and all but 13 (4%) had a posterior injury; 263 of the 318 fractures (87%) included a sacral fracture, with 162 of 318 (51%) having an anterior incomplete sacral fracture, 53 (17%) a complete simple fracture, and 48 (15%) a complete comminuted fracture. Forty-two of 318 (13%) had a crescent fracture. One hundred six of 318 (33%) were displaced at presentation. There was a higher incidence of initial displacement observed in fractures including bilateral rami fractures, a comminuted sacral fracture, or a crescent fracture. CONCLUSIONS: LC pelvic fractures represent a heterogeneous group of injuries with a wide range of associated fracture patterns. In particular, there is a wide range of fracture types represented by injuries classified as LC1 (involving any sacral fracture). Fractures with more complex sacral fractures, crescent fractures, or bilateral pubic rami fractures tend to have higher degrees of initial displacement. LEVEL OF EVIDENCE: Level IV, diagnostic study. See Instructions for Authors for a complete description of levels of evidence
|
1 |
Lomefloxacin concentrations in bone after a single oral dose
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
We studied the penetration characteristics of lomefloxacin in bone in 30 patients with osteoarthritis undergoing total hip replacement. Patients were given a single oral 400 mg dose at various times from 1 to 12 hours prior to removal of bone samples. The peak plasma and bone (subchondral bone from femoral head) concentrations reached approximately 4.0 micrograms/mL at 2 hours post-dose and 3.0 micrograms/mL at 3 hours post-dose, respectively. At 12 hours post-dose both plasma and bone concentrations were still greater than 1.0 microgram/mL. Two hours after dosing the average bone-to-plasma ratio was greater than 0.6. These data indicate that a single 400 mg oral dose of lomefloxacin attains bone concentrations that are above its usual minimum inhibitory concentrations for susceptible organisms
|
0 |
Cultural Insensitivity Pervasive in Spanish Online Cosmetic Surgery Resources: A Call to Action
|
Panniculectomy & Abdominoplasty CPG
|
BACKGROUND: Hispanics are the second largest demographic that underwent cosmetic surgery in 2017. The popularity of cosmetic surgeries among this group has increased significantly within the past decade and is projected to continue rising. Patient-directed websites that provide educational materials addressing these procedures should include information that is accurate, comprehensible, and sensitive to the demographic's diverse cultural and ethnic needs. Online health resources have been shown to vary significantly in their quality and reliability. This can be inimical for patients, as misinformation has been associated with poor health outcomes. The aim of this study is to evaluate online Spanish patient-directed materials for the top 5 cosmetic surgeries performed in 2017 using validated metrics. METHODS: The top 5 cosmetic surgeries performed in 2017 according to the American Society of Plastic Surgeons were identified, and a Google search was performed using the following terms: "breast augmentation," "liposuction," "rhinoplasty," "blepharoplasty," and "abdominoplasty." The top 10 websites providing relevant information in Spanish were identified for each procedure. Fifty unique web links were analyzed by 2 independent bilingual raters using the Cultural Sensitivity Assessment Tool, and mean reading grade level was determined. Interrater reliability was computed using a Cohen kappa. RESULTS: Online information in Spanish was difficult to encounter, with an average of 130 websites evaluated to identify 10 websites for each surgery. The mean reading grade level of all evaluated pages was 10.19, appropriate for a high school sophomore. There were no statistically significant differences between cosmetic surgery procedures (P = 0.69). The mean cultural sensitivity score was 2.20 (2.08-2.38). No subgroup met the threshold score for acceptable cultural sensitivity of >2.5. CONCLUSION: This study demonstrates that US websites do not offer appropriate-level Spanish materials for patients seeking information on cosmetic surgeries. Websites providing information in Spanish were often inaccurate automatic translations and further compromised reader understanding. In our search, we frequently encountered organizational statements expressing a commitment to diversity. Increased awareness and development of more culturally appropriate materials is paramount to effectively communicate with patients and begin to close the gap in cultural disparities in health literacy.
|
0 |
Effect of immobilization of metacarpophalangeal joint in thumb carpometacarpal osteoarthritis on pain and function. A quasi-experimental trial
|
Glenohumeral Joint OA
|
STUDY DESIGN: A quasi-experimental trial.
INTRODUCTION: Orthoses are effective to decrease pain and improve function in patients with carpometacarpal osteoarthritis (CMC OA). However, current research does not support one design of an orthosis as more effective and/or more favorable than another.
PURPOSE OF THE STUDY: The aim of this study was to compare the effectiveness of 2 different static orthosis on pain and functional abilities on CMC OA.
METHODS: Eighty-four patients, 91.7% females (mean +/- standard deviation age, 60.1 +/- 9.6 years), with thumb CMC OA were randomized into 1 of 2 groups. For group A, a Ballena orthotic was constructed, and for group B, a Colditz orthotic was constructed. Both static orthoses were worn for 3 months. The outcome measures included pain with activity measured with the visual analog scale and functional abilities assessed with the Disabilities of the Arm, Shoulder and Hand.
RESULTS: Both orthoses improved pain level and functional abilities (F<sub>[1.0]</sub> = 413.327 and F<sub>[1.0]</sub> = 211.742; both P < .001). There was no statistically significant difference between 2 groups regarding to pain recovery and functional improvement (F<sub>[1.0]</sub> = 0.075 and F<sub>[1.0]</sub> = 7.248; both P > .05).
DISCUSSION: The main purpose was to compare the effect of 2 different thermoplastic thumb orthoses. Previous studies support the use of CMC orthoses to decrease hand pain and improve hand function, but different orthoses have been described and in most cases, orthotic interventions were accompanied by other medical treatments.
CONCLUSIONS: A clinically significant reduction in pain intensity and improvement in functional abilities was achieved with both orthoses in patients with thumb CMC OA.
Level of evidence: 2.
TRIAL REGISTRATION: ClinicalTrials.gov registration number: NCT02780999.
|
0 |
Single portal endoscopic carpal tunnel release: Modification of Menon's technique and data from 65 cases
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
The purpose of our study is to make a follow-up evaluation of endoscopic carpal tunnel release under focal anesthesia using the Wolf single portal system. A total of 65 patients with a mean age of 50 years undergoing 79 procedures were retrospectively studied. Preoperative complaints, intraoperative findings, and postoperative results of all the patients were recorded. Follow-up was conducted at 1, 5, 12, and 24 weeks and at 1 year postoperatively. Wound pain, analysis of satisfaction, Levine functional status scales, and surgical complications were included. No patients sustained iatrogenic neurovascular injury or hematoma formation. The average Levine functional severity score decreased from 2.82 points preoperatively to 1.2 points at the most recent survey. One case recurred at 1 year after the surgery and subsequently underwent open release. Surgery using the Wolf single portal system under focal anesthesia is a safe and efficacious option for endoscopic carpal tunnel release. (copyright) 2010 Springer-Verlag
|
0 |
Microbiological basis of oral infections and sensitivity to antibiotics
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
Because oral infections are common, the physician must understand the underlying etiology, pathogeny, and other variables that determine how these processes evolve in order to choose the most appropriate antibiotic drug. The special characteristics of the oral cavity determine the make-up of the microflora that lives there. Different anaerobic species belonging to the Peptostreptococcus, Prevotella, Fusobacterium, Gemella, and Porphyromonas genera are of particular interest, as are the aerobic species Streptococcus, Staphylococcus, and Corynebacterium. Each of these microorganisms occupies a different microniche within the oral cavity, and the prevailing balance is upset when conditions become modified as a result of illness or due to dental interventions such as tooth extraction or tooth scaling and polishing. Pathogenic or opportunistic bacteria (Actinomyces, Prevotella intermedia species, etc.) can develop in these conditions, as can yeasts (Candida sp., Histoplasma capsulatum), virus (herpes simplex, papilomavirus), and parasites (Entamoeba gingivalis, Trichomonas tenax). When infection occurs, the patients s immune system reacts by means of inborn immunity (non-specific) and acquired immunity (specific). Empirical treatment is administered that should be based on etiological data and on the antimicrobial sensitivity of the pathogen that is causing the infection. However, oral microflora sensitivity to different antibiotics is currently declining and there is a noticeable trend towards resistances. As a consequence of all this, the treatment of oral infections must also aim to restore the ecological balance of the oral cavity and to minimize the emergence of resistance in the microorganisms present in the mouth. Hence, epidemiological oral pathogen sensitivity studies must be conducted, fostering the administration of appropriate antibiotics at proper doses and keeping specialists abreast of the latest trends. In recent decades, oral infections comprise one of the most common pathologies in the general population, due in large part to infectious complications associated with poor oral hygiene. This in turn, translates into an increased need and demand for dental care, while at the same time, it requires that the professional accurately understand the etiological factors involved, as well as the pathogeny and different variables that determine the specificity of these kinds of infections, so as to be able to choose the appropriate antimicrobial drugs for proper treatment
|
0 |
Complications of syndesmotic screw removal
|
DoD SSI (Surgical Site Infections)
|
BACKGROUND: Currently, the metallic syndesmotic screw is the gold standard in the treatment of syndesmotic disruption. Whether or not this screw needs to be removed remains debatable. The aim of the current study was to determine the complications which occur following routine removal of the syndesmotic screw following operative treatment of unstable ankle fractures.
METHODS: This was a retrospective study with consecutive cases in a Level-2 Trauma center. All patients with routine removal of a syndesmotic screw, following the treatment of an unstable ankle fracture, between January 1, 2004 and November 30, 2010 were included. Complications recorded were: 1) minor or major wound infection following removal of the syndesmotic screw, 2) recurrent syndesmotic diastasis, and 3) unnecessary removal of a broken screw, not recognized during preoperative planning prior to surgery.
RESULTS: A total of 76 patients were included. A wound infection occurred in 9.2% (N = 7) of which 2.6% (N = 2) were deep infections requiring reoperation. Recurrent syndesmotic diastasis was found in 6.6% (N = 5) of patients, and in 6.6% (N = 5) screws were broken at the time of implant removal. In the group with recurrent diastasis the screws were removed significantly earlier compared with the group without recurrent diastasis (Mann-Whitney U-test; p = 0.011) and the group with screw breakage had their screws significantly longer in place compared with the group without breakage (p = 0.038).
CONCLUSION: A total of 22.4% complications occurred upon routine removal of the syndesmotic screw. Removal might therefore be considered only in selected cases with complaints, after a minimum of eight to twelve weeks and using antibiotic prophylaxis during removal.
|
0 |
Transfer of hip arthroplasty patients leads to increased cost and resource utilization in the receiving hospital
|
Hip Fx in the Elderly 2019
|
Factors other than complexity of care often drive the transfer of orthopedic patients to tertiary centers. We sought to compare the demographics, diagnoses, insurance data, peri-operative outcomes and institutional costs of total hip arthroplasty patients transferred from outside facilities with those of patients derived from our clinics. We analyzed 419 consecutive patients as part of a prospective risk study. Transferred patients were older (P=0.01), less likely to have private insurance (P<0.0001), and more likely to be admitted on weekends (P=0.04). Both dislocation and fracture were more prevalent in transferred patients (P=0.04; P=0.003). Across all key metrics - including length of stay, mortality scoring, peri-operative complications, and direct and total costs - transferred patients more significantly strained the resources of our arthroplasty center.
|
0 |
Epidemiology of osteoporotic fractures
|
HipFx Supplemental Cost Analysis
|
Osteoporosis constitutes a major public health problem through its association with age-related fractures. These fractures typically occur at the hip, spine and distal forearm. It has been estimated that the lifetime risk of a hip fracture in white women is 17.5%, with a comparable risk in men of 6%. Hip fractures lead to an overall reduction in survival of about 15% (relative or observed/expected survival at 5 years of 0.83), and the majority of excess deaths occur within the first 6 months following the fracture. Such fractures are also associated with considerable morbidity. Although all vertebral deformities do not come to clinical attention, the lifetime risk of clinically diagnosed vertebral fractures is about 15% in white women. Vertebral fractures tend to be associated with back pain and kyphosis, and also with an impairment of survival, though this is likely to be due to clustering of comorbidity. About one-quarter of clinically diagnosed vertebral deformities result in hospitalization
|
1 |
Short-term outcomes of platelet-rich plasma injection for treatment of osteoarthritis of the knee
|
OAK 3 - Non-arthroplasty tx of OAK
|
PURPOSE: To compare the clinical outcomes of osteoarthritis indices (WOMAC and Lequesne scores) and adverse events in the treatment of osteoarthritis (OA) of the knee with platelet-rich plasma (PRP) versus hyaluronic acid (HA) or placebo.
METHODS: A systematic review and meta-regression were performed to compare outcomes between PRP injections versus HA or placebo. Relevant randomized control trials were identified from Medline and Scopus from date of inception to 13 August 2015.
RESULTS: Nine of 551 studies were eligible; 6, 5, 5, 5, 2, 2, 2 and 7 studies were included in pooling of WOMAC total, pain, stiffness and function scores, Lequesne score, IKDC score, EQ-VAS score and adverse events in OA knee patients, respectively. The PRP injections had -15.4 (95 % CI -28.6, -2.3, p = 0.021), lower mean WOMAC total scores, and 8.83 (95 % CI 5.88, 11.78, p < 0.001), 7.37 (95 % CI 4.33, 10.05, p = 0.021) higher mean IKDC and EQ-VAS scores when compared to HA injections. However, PRP injections had no significant differences in WOMAC pain, stiffness and function scores, as well as Lequesne score and adverse events when compared to HA or placebo.
CONCLUSION: In short-term outcomes (<=1 year), PRP injection has improved functional outcomes (WOMAC total scores, IKDC score and EQ-VAS) when compared to HA and placebo, but has no statistically significant difference in adverse events when compared to HA and placebo. This study suggests that PRP injection is more efficacious than HA injection and placebo in reducing symptoms and improving function and quality of life. It has the potential to be the treatment of choice in patients with mild-to-moderate OA of the knee who have not responded to conventional treatment.
Level of evidence: I.
|
0 |
Does the Robotic Arm and Preoperative CT Planning Help with 3D Intraoperative Total Knee Arthroplasty Planning?
|
OAK 3 - Non-arthroplasty tx of OAK
|
Although several studies highlight the advantages of robotic arm-assisted total knee arthroplasty (RA-TKA), few investigate its intraoperative outcome. Therefore, the purpose of this study was to analyze the RA-TKA's ability to assist with intraoperative correction of: (1) flexion and (2) extension gaps, as well as its ability to (3) accurately predict implant sizes. Additionally, in this RA-TKA cohort, length of stay, complications, and readmissions were assessed. A total of 335 patients who underwent RA-TKA were included. The robotic software virtually measured the intraoperative prebone cut extension and flexion gaps. Differences in medial versus lateral prebone cut extension and flexion gaps were calculated. A total of 155 patients (46%) had an extension gap difference of between -2 and 2 mm (mean, -0.3 mm), while 119 patients (36%) had a flexion gap difference of between -2 and 2 mm (mean, -0.6 mm). Postbone cut differences in medial versus lateral flexion and extension gaps were measured. Balanced knees were considered to have a medial and lateral flexion gap difference within 2 mm. The robot-predicted implant size was also compared with the final implant size. Additionally, lengths of stay, complications, and readmissions were assessed. All patients achieved a postbone cut extension gap difference between -1 and 1 mm (mean, -0.1 mm). A total of 332 patients (99%) achieved a postbone cut flexion gap difference of between -2 and 2 mm (mean, 0 mm). For 98% of prostheses, the robotic software predicted within 1 implant size the actual tibial or femoral implant size used. The mean length of stay was found to be 2 days. No patients suffered from superficial skin infection, pin site infections or fractures, soft tissue damage, and no robotic cases were converted to manual TKA due to intraoperative complications. A total of 8 patients (2.2%) were readmitted; however, none were directly related to robotic use. The robotic software and use of a preoperative computed tomography (CT) substantially helped with intraoperative planning and accurate prediction of implant sizes. Therefore, based on the results of this study, the RA-TKA device does, in fact, provide considerable intraoperative assistance.
|
0 |
Treatment of closed femoral diaphyseal fractures with external fixators in children
|
DoD SSI (Surgical Site Infections)
|
From August 1992 to July 1996, 57 patients with closed femoral fractures were treated by external fixator in the Orthopaedic and Traumatology Clinics, School of Medicine, Dicle University. The technique was applied to children with closed femoral fractures. Their mean age was 6 (range 4-12) years old. The mean hospitalisation period was 8 (range 5-15) days. Fixators were removed on an average of 55 (range 38-79) days. The mean follow-up period was 18 (range 9-36) months. Pintract infection was observed in 3 and refracture in 1 patient. Infection was controlled with oral antibiotics and local dressing. An external fixator was applied to a patient in whom refracture developed. No patient had malunion, nonunion, or leg length discrepancy. We propose that external fixation in closed femoral shaft fractures of children could be a rational alternative mode of therapy, since it has some advantages and can be easily removed without undergoing a second round of anaesthesia.
|
0 |
The clinical potential of chemokine receptor antagonists
|
MSTS 2018 - Femur Mets and MM
|
Chemokines belong to a family of chemotactic cytokines that direct the migration of immune cells towards sites of inflammation. They mediate their biological effects by binding to cell surface receptors, which belong to the G protein-coupled receptor superfamily. Since chemokines and their receptors have been implicated in the pathophysiology of a number of autoinflammatory diseases, chemokine receptor antagonists could prove to be useful therapeutics to target these diseases. Here, we review the role of chemokines in autoimmunity, concentrating mainly on the chemokine receptors CCR1 and CCR5, and discuss the potential utility of antagonists that target these 2 receptors as they progress through the clinic. [References: 126]
|
0 |
Common cutaneous disorders in athletes
|
Reconstruction After Skin Cancer
|
Athletic activity may cause or aggravate skin disorders, which in turn may diminish athletic performance. Since many sporting activities necessitate prolonged exposure to the sun, athletes must avoid painful sunburn which will adversely affect their performance. Drugs and chemicals also may cause photoallergic and/or phototoxic reactions, including polymorphous light eruption and athletes should thus avoid photosensitising drugs and chemicals. The effects of chronic ultraviolet exposure include ageing, pigmentation and skin cancers. The most effective protection against excessive exposure to sunlight is the use of sunscreens, although inadequate application and poor protection in the UVA spectrum may diminish their effectiveness and contact allergies may create other problems. Viral, bacterial and fungal infections are common in athletes due to heat, friction and contact with others. Herpes simplex may be treated with any drying agents (e.g. alcohol) as they are as effective as more expensive topical agents such as acyclovir. Molluscum contagiosum may be spread by close contact or water contact and is treated by superficial incision, cryotherapy or standard wart varnishes. Plantar wart infection is transmitted by swimming pool decks, changing rooms and hand-to-hand from weights in gymnasiums. Plantar warts presenting with pain may be aggressively treated, by blunt dissection, but painless ones are best treated conservatively. Impetigo and folliculitis often develop after trauma. Antibiotics are effective against mild infections while abrasions and lacerations should be cleansed and dressed with occlusive dressings. Diphtheroid bacteria in moist footwear may produce pitted keratolysis and erythrasma. Tinea pedis is common in athletes and probably originates in swimming pools, gymnasium floors and locker rooms. Interdigital, dry-moccasin and pustular-midsole forms can be distinguished. The latter two forms respond to topical antifungal agents, while the interdigital form, a mixed fungal/bacterial infection, is treated with debridement, antibiotics and drying routine similar to the therapy of otitis externa. Nail infections by a variety of organisms may appear as onycholysis with or without paronychia and should be treated with the appropriate antibiotics. Tinea versicolor occurs in heat and humidity. Since Pityrosporum orbiculare is part of the normal flora it often recurs, necessitating regular treatment. Acute trauma injuries include contusions, black heel or petichiae of the heel, black toe (bleeding under the nail), 'jogger's nipple' caused by chafing, and foot blisters. Chronic trauma may result in calluses, corns and paronychia. Plantar corns can be disabling and may be caused by overly tight shoes or abnormalities in biomechanics; treatment includes restoring normal foot function and minimal surgical procedures. Paronychia is treated best by wedge resection.(ABSTRACT TRUNCATED AT 400 WORDS)
|
0 |
Bisphosphonates Can Prevent Skeletal Complications of Malignant Bone Disease from Prostate Cancer and Renal Cell Carcinoma
|
MSTS 2018 - Femur Mets and MM
|
Objectives: The majority of patients with hormone-refractory prostate cancer (HRPC) develop bone metastases, which are also common in patients with other genitourinary malignancies. Bone metastases can lead to debilitating skeletal complications and reduced quality of life (QoL). Therefore, the goal of therapy for patients with malignant bone disease is preservation of functional independence and QoL by delaying onset of skeletal-related events (SREs) and by palliating bone pain. Bisphosphonates have become integral in achieving treatment goals for these patients. Methods: Data from two phase 3, placebo-controlled trials in patients with malignant bone disease from HRPC or solid tumors including renal cell carcinoma (RCC) were reviewed to determine the efficacy of zoledronic acid in reducing the incidence and delaying the onset of SREs. Results: In patients with metastatic HRPC (n = 422), 4 mg zoledronic acid every 3 wk significantly reduced all types of SREs, delayed time to first SRE by >5 mo, and reduced ongoing risk of SREs by 36% compared with placebo. Moreover, zoledronic acid reduced the risk of experiencing a second SRE compared with placebo and appeared to be more beneficial in patients with no pain at baseline. In a separate trial in patients with solid tumors, zoledronic acid reduced the proportion of patients who experienced any SRE compared with placebo in the RCC subset (n = 46). Furthermore, zoledronic acid demonstrated trends for longer overall survival in these patient populations. Conclusions: Zoledronic acid significantly delays the onset and reduces the incidence of SREs in patients with bone metastases secondary to HRPC and RCC. © 2007 European Association of Urology.
|
1 |
Risk factors for failing to achieve improvement after anatomic total shoulder arthroplasty for glenohumeral osteoarthritis
|
Trial Systematic Review Project
|
Background: Although anatomic total shoulder arthroplasty (TSA) successfully improves pain and function, not all patients improve clinically. This study was conducted to determine patient-related factors for failure to achieve improvement after primary TSA for osteoarthritis at 2 years postoperatively. Methods: This prospective study reviewed an institutional shoulder registry for consecutive patients who underwent primary TSA for osteoarthritis from 2007 to 2013 with baseline and 2-year postoperative American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form scores. A failed outcome was defined as (1) a failure to reach the ASES minimal clinically important difference of 16.1 points or (2) revision surgery within 2 years of the index procedure, or both. Univariate and multivariable analyses of clinical and demographic patient factors were performed using logistic regression. Results: Of 459 arthroplasties that met inclusion criteria, 411 were deemed successful by the aforementioned criteria, and 48 (10.5%) failed to achieve a desirable outcome. Clinical risk factors associated with failure included previous surgery to the shoulder (P =.047), presence of a torn rotator cuff (P =.025), and presence of diabetes (P =.036), after adjusting for age, sex, race, and body mass index. A higher preoperative ASES score at baseline was associated with failure (P <.001). Conclusion: Previous shoulder surgery, a rotator cuff tear requiring repair during TSA, presence of diabetes, surgery on the nondominant arm, and a higher baseline ASES score were associated with a higher risk of failing to achieve improvement after anatomic TSA.
|
0 |
Abl kinases are required for invadopodia formation and chemokine-induced invasion
|
MSTS 2018 - Femur Mets and MM
|
The Abl tyrosine kinases, Abl and Arg, play a role in the regulation of the actin cytoskeleton by modulating cell-cell adhesion and cell motility. Deregulation of both the actin cytoskeleton and Abl kinases have been implicated in cancers. Abl kinase activity is elevated in a number of metastatic cancers and these kinases are activated downstream of several oncogenic growth factor receptor signaling pathways. However, the role of Abl kinases in regulation of the actin cytoskeleton during tumor progression and invasion remains elusive. Here we identify the Abl kinases as essential regulators of invadopodia assembly and function. We show that Abl kinases are activated downstream of the chemokine receptor, CXCR4, and are required for cancer cell invasion and matrix degradation induced by SDF1alpha, serum growth factors, and activated Src kinase. Moreover, Abl kinases are readily detected at invadopodia assembly sites and their inhibition prevents the assembly of actin and cortactin into organized invadopodia structures. We show that active Abl kinases form complexes with membrane type-1 matrix metalloproteinase (MT1-MMP), a critical invadopodia component required for matrix degradation. Further, loss of Abl kinase signaling induces internalization of MT1-MMP from the cell surface, promotes its accumulation in the perinuclear compartment and inhibits MT1-MMP tyrosine phosphorylation. Our findings reveal that Abl kinase signaling plays a critical role in invadopodia formation and function, and have far-reaching implications for the treatment of metastatic carcinomas.
|
1 |
Antibiotic prophylaxis in operations on trochanteric femoral fractures
|
Management of Hip Fractures in the Elderly
|
Short-term prophylaxis against infection using cephalothin and cephalexin was studied in 140 patients operated on for trochanteric fractures of the femur. The group given the drug during preparation for anesthesia, intraoperatively, and for two days postoperatively had an infection rate of 1.8 per cent (one patient), whereas the group without prophylaxis had a rate of 16.9 per cent (twelve patients). The two groups were similar with regard to factors that may have influenced the infection rate, for example, age, time required for surgery, and blood loss. Staphylococcus aureus was the most common infecting organism, but several patients had mixed infections with intestinal bacteria
|
0 |
Effects of repetitive transcranial magnetic stimulation on motor functions in patients with stroke: A meta-analysis
|
Pediatric Supracondylar Humerus Fracture 2020 Review
|
Background and Purpose-The purpose of this study was to perform a meta-analysis of studies that investigated the effects of repetitive transcranial magnetic stimulation (rTMS) on upper limb motor function in patients with stroke. Methods-We searched for randomized controlled trials published between January 1990 and October 2011 in PubMed, Medline, Cochrane, and CINAHL using the following key words: stroke, cerebrovascular accident, and repetitive transcranial magnetic stimulation. The mean effect size and a 95% CI were estimated for the motor outcome and motor threshold using fixed and random effect models. Results-Eighteen of the 34 candidate articles were included in this analysis. The selected studies involved a total of 392 patients. A significant effect size of 0.55 was found for motor outcome (95% CI, 0.37-0.72). Further subgroup analyses demonstrated more prominent effects for subcortical stroke (mean effect size, 0.73; 95% CI, 0.44-1.02) or studies applying low-frequency rTMS (mean effect size, 0.69; 95% CI, 0.42-0.95). Only 4 patients of the 18 articles included in this analysis reported adverse effects from rTMS. Conclusions-rTMS has a positive effect on motor recovery in patients with stroke, especially for those with subcortical stroke. Low-frequency rTMS over the unaffected hemisphere may be more beneficial than high-frequency rTMS over the affected hemisphere. Recent limited data suggest that intermittent theta-burst stimulation over the affected hemisphere might be a useful intervention. Further well-designed studies in a larger population are required to better elucidate the differential roles of various rTMS protocols in stroke treatment. © 2012 American Heart Association, Inc.
|
1 |
Late presentation of congenital dislocation of the hip: an audit
|
Developmental Dysplasia of the Hip CPG
|
Despite the widespread introduction of neonatal screening programmes, the late presentation of congenital dislocation of the hip remains a considerable problem. Important gaps in our understanding of the natural history of this condition make it difficult to assess the effectiveness of screening. An audit of late presenting cases of congenital dislocation of the hip in south Bedfordshire between 1980 and 1988 suggests that improved liaison between hospital doctors and general practitioners and closer scrutiny as children start walking could make screening more effective
|
0 |
A novel hybrid fixation (percutaneous anterior pelvic bridge with K-wire) for the treatment of traumatic pelvic ring injury: A prospective study
|
DoD SSI (Surgical Site Infections)
|
Background: The aim of the study was to introduce a novel percutaneous technique for the treatment of pelvic ring injuries using a percutaneous anterior pelvic bridge (PAPB) with K-wire. Methods: From December 2010 to November 2016, a prospective study of 86 patients with anterior pelvic ring fracture (42 utilizing PAPB with K-wire and 44 utilizing PAPB). Patient data was retrieved from electronic charts. Radiological results were assessed based on the Matta criteria system to evaluate the quality of the reduction and time to union. Functional outcomes were evaluated using the Majeed scoring system. Postoperative complications were also recorded. Results: Age, sex, cause of injury, type of fracture, functional recovery, American Society of Anesthesiologists classification, union time, Majeed scoring and complications did not differ significantly between the two groups. The quality of the reduction and pain scoring differed between groups (all p-values < 0.05). Group A got better reduction and less pain scoring. Conclusions: The novel percutaneous technique with hybrid fixation using PAPB with K-wire is a successful alternative for the treatment of pelvic ring injuries, which results in better quality of reduction and less pain scoring outcomes comparing to PAPB. May the PAPB + K-wire could provide more stability.
|
1 |
The effect of postoperative pain on postoperative blood loss after sequential bilateral total knee arthroplasty
|
Surgical Management of Osteoarthritis of the Knee CPG
|
BACKGROUND: Bilateral total knee arthroplasty is generally accompanied by a significant amount of blood loss. We investigated the relationship between the intensity of pain and the amount of blood loss in the early postoperative period after bilateral total knee arthroplasty. METHODS: A prospective study was conducted on 91 patients who underwent elective sequential bilateral total knee arthroplasty for osteoarthritis. All patients received combined spinal and epidural anesthesia. Patients were divided into three groups based on their scores on the verbal numerical rating scale (VNRS) for pain at 6 hours postoperatively. The VNRS was classified as follows; mild pain (n = 34, VNRS score 0-4), moderate pain (n = 24, VNRS score 5-6), and severe pain (n = 33, VNRS score 7-10). We compared the mean arterial pressures and the amount of blood loss during the first 24 postoperative hours in the three groups. Factors influencing postoperative blood loss were analyzed. RESULTS: Postoperative mean arterial pressures and blood loss were not different among the groups. Of the factors examined, the amount of postoperative blood loss was only dependent on the amount of intraoperative blood loss (P = 0.001). CONCLUSIONS: Early postoperative pain has no effect on postoperative blood pressure and the amount of blood loss after bilateral total knee arthroplasty. For postoperative blood loss, intraoperative blood loss is the main determinant
|
0 |
Patterns of Extrathoracic Metastases in Different Histological Types of Lung Cancer
|
MSTS 2022 - Metastatic Disease of the Humerus
|
Lung cancer is the leading cause of cancer-related deaths mainly attributable to metastasis, especially extrathoracic metastasis. This large-cohort research is aimed to explore metastatic profiles in different histological types of lung cancer, as well as to assess clinicopathological and survival significance of diverse metastatic lesions. Lung cancer cases were extracted and enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. ?2-tests were conducted to make comparisons of metastatic distribution among different histological types and odds ratios were calculated to analyze co-occurrence relationships between different metastatic lesions. Kaplan–Meier methods were performed to analyze survival outcomes according to different metastatic sites and Cox regression models were conducted to identify independent prognostic factors. In total, we included 159,241 lung cancer cases with detailed metastatic status and complete follow-up information. In order to understand their metastatic patterns, we elucidated the following points in this research: (1) Comparing the frequencies of different metastatic lesions in different histological types. The frequency of bone metastasis was highest in adenocarcinoma, squamous cell carcinoma, LCLC and NSCLC/NOS, while liver was the most common metastatic site in SCLC. (2) Elaborating the tendency of combined metastases. Bi-site metastases occurred more common than tri-site and tetra-site metastases. And several metastatic sites, such as bone and liver, intended to co-metastasize preferentially. (3) Clarifying the prognostic significance of single-site and bi-site metastases. All single-site metastases were independent prognostic factors and co-metastases ended up with even worse survival outcomes. Thus, our findings would be beneficial for research design and clinical practice.
|
1 |
Long-term complications of open carpal tunnel release
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
Fifty patients who underwent open carpal tunnel release (OCTR) surgery at least 12 months earlier for carpal tunnel syndrome were reviewed, focusing on scar tenderness, pillar pain, and symptoms of neuroma. A total of 55 hands were studied. At an average of 20.2 months of follow-up, 5.5% had Tinel's sign, 7.3% had scar tenderness, 12.7% had pillar pain, and 18% had burning discomfort. Pillar pain was elicited in a much higher fraction of patients by using the "table test" (provocation of pillar pain by having the patient lean with his/her weight on the hands placed on the edge of a table), even when traditional tests were negative. Symptoms and signs are present in a substantial number of patients after OCTR, even after almost 2 years of follow-up. Patients should be informed of the incidence of long-term symptoms and signs after OCTR surgery
|
1 |
Quality assessment of randomized controlled trials reporting on knee osteoarthritis treated with warming needle moxibustion
|
OAK 3 - Non-arthroplasty tx of OAK
|
OBJECTIVE: To evaluate the quality of randomized controlled trials (RCTs) testing the efficacy of warming needle moxibustion on knee osteoarthritis (KOA).
METHODS: Nine databases were searched systematically including: the Cochrane Library (1/1993-10/2012), PubMed (1/1980-10/2012), EMBASE (1/1990-10/12012), SCI Expanded (1/1986-10/2012), Science Direct (1/1979-10/2012), Chinese Biomedical Literature Database disc (1/1978-10/2012), China National Knowledge Infrastructure Database (1/1979-10/2012), China Science and Technology Journal Database (a full text issue database of China, 1/1989-10/2012), and Wanfang Database (a full text issue database of China, 1/1990-10/12012). Traditional reference retrieval was also conducted. Language was limited to Chinese and English. We identified 37 RCTs that used warming needle moxibustion as an intervention and they were assessed with the Consolidated Standards for Reporting of Trials Statement 2010 (CONSORT 2010) and Standards for Reporting Interventions Controlled Trials of Acupuncture 2010 (STRICT A 2010).
RESULTS: Of the 37 reports, only seventeen (45.95%) mentioned the random allocation of sequence methods, nine used unacceptable methods, and only one (2.70%) gave the description of the mechanism of allocation concealment. One study (2.70%) mentioned blinding, one (2.70%) had a sample size calculation, and twenty-three (62.16%) used reasonable statistical methods. Thirteen (35.14%) described the background and reason for the RCTs, three (8.11%) gave a description of lost or eliminated patients, and two (5.41%) reported accidental situations. Only three (8.11%) gave analysis of the RCT limitations. No report mentioned intentional analysis.
CONCLUSION: The quality of the RCTs assessed in this study was from moderate to low. The design of RCTs, the methods of statistical analysis, and the description of reports information needs to be improved. CONSORT 2010 and STRICT A 2010 should be used to standardize the reporting of acupuncture RCTs in the future.
|
0 |
Acute carpal tunnel syndrome resulting from haemorrhage into the carpal tunnel in a patient on warfarin
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
A case of acute compression neuropathy of the median nerve associated with haemorrhage into the carpal tunnel is presented. The condition occurred spontaneously in a patient on Warfarin for previous deep venous thrombosis. The signs and symptoms were those of acute tenosynovitis originating in the common flexor synovial sheath at the wrist with associated paraesthesia in the distribution area of the median nerve in the hand. The patient was afebrile and blood tests were normal
|
1 |
Deficits in shoulder function and general health associated with sixteen common shoulder diagnoses: A study of 2674 patients
|
Glenohumeral Joint OA
|
The purpose of this study is to define the self-assessed deficits in function and general health perceived by a large cohort of patients with common shoulder diagnoses. For a 10-year period, all new shoulder patients presenting to the senior author were characterized by diagnosis, age, gender, and self-assessed shoulder function and general health status. This report concerns the 2674 patients having 1 of the 16 most prevalent diagnoses. The deficits in shoulder function and health status were correlated with diagnosis, age, and gender, as well as with each other. Patient self-assessment provided a standardized method for collecting data on shoulder function and health status. These assessments revealed substantial deficits; for example, 81% of patients were unable to sleep on the affected side, and 71% were unable to wash the back of the opposite shoulder. The magnitude of these deficits correlated significantly with gender and diagnosis but not with age. Copyright © 2006 by Journal of Shoulder and Elbow Surgery Board of Trustees.
|
0 |
Chondroitin sulphate for symptomatic osteoarthritis: critical appraisal of meta-analyses
|
SR for PM on OA of All Extremities
|
BACKGROUND: Chondroitin sulphate (CS) is an important structural component of cartilage and is approved and regulated as a symptomatic slow-acting drug for osteoarthritis (OA) (SYSADOA) in Europe and some other countries. Although numerous studies have shown the clinical benefits of CS to decrease pain, improve functional disability, reduce non-steroidal anti-inflammatory drug (NSAID) or acetaminophen consumption, and good tolerability with an additional carry-over effect, there are still some concerns regarding its effectiveness in treating OA. PURPOSE: To examine the data provided by meta-analyses to clarify the effectiveness of CS as a symptomatic treatment for OA. METHODS: A MEDLINE database search was conducted for appropriate meta-analyses published between 1997 and 2007. Five meta-analyses that limited their analysis to randomised controlled trials (RCTs) comparing CS with placebo or no-treatment control arms were retrieved. RESULTS: Four meta-analyses showed significant clinical effects of CS compared with placebo for pain and function measures and one demonstrated greater reduction of analgesic co-medication in patients assigned to the active treatment. In one meta-analysis, the 20 trials included in the study showed a high degree of heterogeneity and the conclusion that CS showed minimal symptomatic benefits was based on the analysis of only three trials. One meta-analysis showed that pain relief after CS treatment steadily increased between 4 and 12 weeks of treatment, whereas the time course of pain relief after treatment with NSAIDs decreased. Two meta-analyses reported consistently higher frequencies of side effects in the placebo group than in patients treated with CS. CONCLUSION: Data provided by these meta-analyses indicate that CS has a slight to moderate efficacy in the symptomatic treatment of OA, with an excellent safety profile
|
0 |
Change in patient concerns following total knee arthroplasty described with the International Classification of Functioning, Disability and Health: A repeated measures design
|
Surgical Management of Osteoarthritis of the Knee CPG
|
Background: There is no published evidence of how patient concerns change during the first six weeks following total knee arthroplasty (TKA). An understanding of the recovery process from the patient's perspective will inform clinicians on how to best educate patients about their post-operative concerns. Our objectives were to (1) quantify the level of importance for each of 32 previously identified concerns pre-operatively, and across the first six weeks following primary TKA and, (2) convey this change in importance post-operatively using the components of the International Classification of Functioning, Disability and Health (ICF). Methods: The objectives were achieved using a repeated measures design. Convenience sampling was used to recruit 54 consecutive patients undergoing primary TKA at a hospital in Ontario, Canada. Pre-operatively and at two, four and six weeks post-operatively subjects rated the level of importance for each of the 32 previously identified patient concerns Results: The importance rating of patient concerns in all four ICF components changed from before surgery to two weeks after surgery. Patient concerns in the Participation component became increasingly important after the first two weeks following surgery. Post-operatively from week two to week four, changes in importance ratings were also found in the Body Function and Activity components, but not in the Environmental Factors component. Conclusion: Changes in patient concerns mirror their early recovery from TKA surgery. Consistent with this, Participation restrictions become increasingly important to patients after discharge from acute care suggesting that clinicians should think of managing patient expectations for return to societal roles early in post-operative rehabilitation. (copyright) 2008 Rastogi et al; licensee BioMed Central Ltd
|
1 |
Hospital Transfer of Open Tibial Fractures Requiring Microsurgical Reconstruction Negatively Impacts Clinical Outcomes
|
DoD SSI (Surgical Site Infections)
|
INTRODUCTION: Open tibial fractures are orthopedic emergencies that may present with severe soft tissue damage. Free tissue transfer is often required when local tissues are insufficient and patients may require hospital transfer to tertiary care centers for this purpose. Although the negative impact of inter-facility transfer has been well demonstrated in trauma patients, less is known regarding transfers for lower extremity injury patients. This study investigates differences in outcomes based on transfer status after open tibial fracture.
METHODS: Thirty-four consecutive open tibial fractures requiring free tissue transfer over a 13-year period (2001-2014) were retrospectively reviewed. Patients transferred from outside facilities were compared to non-transferred patients in regards to demographics, injury, surgical characteristics, and outcomes (mean follow-up of 2.5 years). Student t tests and chi square analysis were used to compare means and proportions, respectively.
RESULTS: One-half of patients were transferred from an outside hospital. Transferred and nontransferred patients were not significantly different in regard to age, sex, comorbidities, mechanism of injury, and Gustilo grade. There was no significant difference in the method of bony fixation or free flap used for soft tissue coverage. The time to wound vacuum-assisted closure placement was longer in transferred patients, though this difference was not found to be significant (2.4 vs 3.3 days, P = 0.55). Time to definitive bony fixation was delayed in the transfer group by 9 days (5.2 vs 14.1 days, P = 0.05) and to tissue coverage by 7 days (14.2 vs 20.9 days, P = 0.13). Rates of flap loss and amputation did not differ between the groups. However, transferred patients were more likely to develop osteomyelitis (risk ratio [RR], 3.0; P = 0.03), nonunion (RR, 5.0; P = 0.09), and require hardware removal (RR, 3.3; P = 0.01).
CONCLUSIONS: Transferred and nontransferred patients were not significantly different in their demographics or presentation. However, an analysis of clinical outcomes showed that transfer was associated with increased rates of osteomyelitis, nonunion, and hardware removal. Although likely multifactorial, this study suggests that a delay to definitive fixation and soft tissue coverage contributes to the increased rate of complications and poorer prognosis.
|
0 |
Integrated nutritional intervention in the elderly after hip fracture. A process evaluation
|
Management of Hip Fractures in the Elderly
|
BACKGROUND & AIMS: Within a multicentre randomized controlled trial aimed at improving the nutritional status and increase the speed of recovery of elderly hip fracture patients, we performed a process evaluation to investigate the feasibility of the intervention within the present Dutch health care system. METHODS: Patients in the intervention group received nutritional counseling during 10 contacts. Oral nutritional supplements were advised as needed until three months after hip fracture surgery. The intervention was evaluated with respect to dieticians' adherence to the study protocol, content of nutritional counseling, and patients' adherence to recommendations given. RESULTS: We included 66 patients (mean age of 76, range 55-92 years); 74% women. Eighty-three percent of patients received all 10 contacts as planned, but in 62% of the patients one or more telephone calls had to be replaced by face to face contacts. Nutritional counseling was complete in 91% of contacts. Oral nutritional supplementation was needed for a median period of 76 days; 75% of the patients took the oral nutritional supplements as recommended. CONCLUSIONS: Nutritional counseling in elderly hip fracture patients through face to face contacts and telephone calls is feasible. However, individual tailoring of the intervention is recommended. The majority of hip fracture patients needed >2 months oral nutritional supplements to meet their nutritional requirements. The trial was registered at clincialtrails.gov as NCT00523575
|
0 |
Effects of lateral wedge insole application on medial compartment knee osteoarthritis severity evaluated by ultrasound
|
AMP (Acute Meniscal Pathology)
|
BACKGROUND: It is known that a lateral wedge insole (LWI) decreases medial loading stress in the knee. Medial meniscus pathology, such as a degenerative tear or a root tear, leading to malfunction and medial meniscus extrusion (MME), is a critical condition that leads to severe osteoarthritis (OA). However, the effect of LWI on MME is still unknown. The objective of this study was to investigate the effect of LWI use on MME in knee OA using ultrasonography.
METHODS: Thirty-one knees from 18 patients with knee OA diagnosed radiographically were allocated to the OA group (mean age, 73.6years; sex M:F, 2:16). Twenty-two knees from 11 volunteers without knee OA were also enrolled as an age-matched control group. MME was evaluated using ultrasonography with the patients in three positions: supine, standing without LWI, and standing with LWI.
RESULTS: In both groups, the mean values of the MME increased significantly when patients were in the standing position compared to the supine position. In the OA group, MME significantly decreased with LWI use. There was no significant difference in MME between use and non-use of an LWI in the control group.
CONCLUSIONS: The LWI could significantly decrease MME in patients with knee OA.
|
0 |
Does the Surgical Correction of Tibial Torsion with Genu Varum Produce Outcomes Similar to Those in Varus Correction Alone?
|
AMP (Acute Meniscal Pathology)
|
The aim of this article is to study the relationship between tibia vara and external tibial torsion in adults. The following questions were asked: (1) what is the incidence of rotational deformity in patients with genu varum and (2) do patients who undergo correction of tibial torsion with genu varum have similar outcomes to those who undergo simple tibia vara correction? In this study, 69 patients (138 limbs) underwent bilateral proximal tibial osteotomy for the correction of genu varum. Patients with simple coronal plane deformity (varus alone) were treated with either a monolateral external fixator or a hexapod frame. Those with concomitant external tibial torsion were treated with circular external fixation. The primary outcome was the ability to achieve the desired correction of alignment in the coronal, sagittal, and axial planes. Secondary outcomes included a postoperative Knee Injury and Osteoarthritis Outcome Score (KOOS) and a routine patient satisfaction questionnaire. The incidence of tibial torsion among the entire group of patients with bilateral tibia vara was 46% and overwhelmingly external in direction. The two groups had some significant differences in demographics with torsion patients tending to be younger and thinner. The final mechanical axis deviation and medial proximal tibial angle values for both groups did not differ significantly (p = 0.956). The postcorrection thigh-foot axis was not significantly different between the two groups (p = 0.666). Time to union was not significant (p > 0.999). KOOS was not different between the two groups in symptoms, pain, activities of daily living, and return to sport. There was a difference in the quality of life score between the two groups (p = 0.044). There was no difference between the two groups regarding the patient questionnaire. Based on the finding of this analysis, the incidence of rotational malalignment with genu varum is close to 50%. The recognition of this close association with external tibial torsion deformity may allow for further insights into the role of rotation in varus deformity-related knee pathology and treatment. Patients can expect nearly identical outcomes from this surgery.
|
0 |
Arterial occlusion after total knee arthroplasty: Successful management of an uncommon complication by percutaneous thrombus aspiration
|
Surgical Management of Osteoarthritis of the Knee CPG
|
Management of arterial occlusion after total knee arthroplasty is controversal in the literature, in part because of the relatively small number of reported cases. We report a case of perioperative popliteal artery thrombosis after total knee arthroplasty that was treated successfully with percutaneous thrombus aspiration and balloon dilation. Immediate intervention prevented ischemic muscular necrosis, resulting in full recovery of the limb
|
0 |
Prophylactic intramedullary fixation for bisphosphonate-related subtrochanteric stress fracture
|
Management of Hip Fractures in the Elderly
|
Bisphosphonates are the most widely used medication to treat osteoporosis. Recent reports have documented an association between chronic bisphosphonate use and femoral insufficiency fractures. This article describes an 84-year-old woman with a diagnosis of osteoporosis treated with bisphosphonate medications for 9 years. She presented with left groin pain, and magnetic resonance imaging revealed a subtrochanteric femoral stress fracture. Operative and nonoperative management was discussed with the patient, and she chose to undergo prophylactic intramedullary nailing of the left femur. Six months postoperatively, she was asymptomatic and ambulating without assistive devices.This article describes successful management of a bisphosphonate-related femoral insufficiency fracture. The presence of groin or thigh pain in a patient taking bisphosphonates should alert the physician to the possibility of insufficiency fracture of the proximal femur, and plain radiographs should be obtained. If these radiographs show lateral cortical thickening, consideration should be given to prophylactic intramedullary femoral nailing. The risks and benefits of prophylactic fixation vs conservative management should be discussed with the patient. A recent series showed a high failure rate with conservative treatment of these fractures. A dialogue with the primary care physician should be initiated to determine the necessity of bisphosphonate therapy, and, if deemed necessary, an alternative class of medications should be considered
|
0 |
Open reduction internal fixation versus percutaneous iliosacral screw fixation for unstable posterior pelvic ring disruptions
|
DoD SSI (Surgical Site Infections)
|
BACKGROUND: Surgical stabilization of posterior pelvic ring fractures can be achieved by either open or closed methods. They all provide a comparable biomechanical stability. The aim of the present study is to compare the clinical results of both techniques for treating posterior pelvic ring injuries.
MATERIAL AND METHODS: Seventy patients operated for unstable posterior pelvic ring disruptions were retrospectively reviewed. We compared 35 patients treated by open reduction internal fixation (ORIF group) versus 35 patients stabilized by using closed reduction and percutaneous iliosacral screw fixation (CRIF group) under fluoroscopic guidance.
RESULTS: According to pelvic outcome scoring system of Pohlemann et al., 28 patients out of the ORIF group obtained good or excellent results (20 excellent and 8 good), five fair and two poor. In the CRIF group, 30 patients obtained good or excellent results (25 excellent and 5 good), four fair and one poor (P=0.64). The average intraoperative blood loss in the ORIF group was 500cc with average blood transfusion of 2units (1000cc) compared to blood loss 150cc in the CRIF group, with average blood transfusion of 1unit (500cc) (P=0.002). No intraoperative complications were reported in the ORIF group while operative guide wires were broken in two cases in the CRIF group (P=0.16). There were no neurological complications observed in the ORIF group, but one radiculopathy (L5 root palsy) occurred in the CRIF group (P=0.317). In the ORIF group, three patients had superficial wound infection and one patient had deep infection while in the CRIF group, we noted only one case of deep infection (P=0.083).
CONCLUSION: No difference was noticed between ORIF and CRIF. The technical decision is variable according to time of surgery, fracture types, patient general condition, skin condition, presence of ipsilateral fractures of the acetabulum and feasibility of the closed reduction. More studies are needed to identify prognostic factors related to quality of the reduction. We need for creation of decisional algorithm for ORIF versus CRIF.
LEVEL OF EVIDENCE: Level 4.
|
1 |
Periarticular multimodal drug injection in total knee arthroplasty
|
AAHKS (8) Anesthetic Infiltration
|
PURPOSE: A systematic review and meta-analysis based on randomized controlled trials (RCTs) were conducted to evaluate the efficiency and safety of periarticular multimodal drug injection in total knee arthroplasty (TKA).
METHODS: Periarticular injection with the use of multimodal drugs is an efficient alternative for postoperative analgesia in TKA. A systematical electronic search was performed to identify the eligible RCTs in the databases of PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science and the Chinese Biomedical Literature Database. Two independent reviewers completed data collection and assessment of methodological quality. The quality of evidence of outcomes was judged using GRADE criteria. Meta-analysis was performed for the outcomes of pain, straight leg raise, operating time, hospital stay and complications.
RESULTS: Ten RCTs including eight studies with 1,216 TKAs in 835 patients met the inclusion criteria. Periarticular injection with multimodal drugs in TKA was associated with short-term benefits in terms of pain relief, straight leg raise, narcotic consumption, and the rates of nausea, vomiting, rash and pruritus. There were no statistically significant differences in operating time, hospital stay, wound complications and deep vein thrombosis between both groups.
CONCLUSIONS: The current evidence suggests that periarticular multimodal drug injection in TKA provides short-term advantages in pain relief, straight leg raise and postoperative complications.
|
0 |
The Koolen-de Vries syndrome: A phenotypic comparison of patients with a 17q21.31 microdeletion versus a KANSL1 sequence variant
|
Developmental Dysplasia of the Hip 2020 Review
|
The Koolen-de Vries syndrome (KdVS; OMIM #610443), also known as the 17q21.31 microdeletion syndrome, is a clinically heterogeneous disorder characterised by (neonatal) hypotonia, developmental delay, moderate intellectual disability, and characteristic facial dysmorphism. Expressive language development is particularly impaired compared with receptive language or motor skills. Other frequently reported features include social and friendly behaviour, epilepsy, musculoskeletal anomalies, congenital heart defects, urogenital malformations, and ectodermal anomalies. The syndrome is caused by a truncating variant in the KAT8 regulatory NSL complex unit 1 (KANSL1) gene or by a 17q21.31 microdeletion encompassing KANSL1. Herein we describe a novel cohort of 45 individuals with KdVS of whom 33 have a 17q21.31 microdeletion and 12 a single-nucleotide variant (SNV) in KANSL1 (19 males, 26 females; age range 7 months to 50 years). We provide guidance about the potential pitfalls in the laboratory testing and emphasise the challenges of KANSL1 variant calling and DNA copy number analysis in the complex 17q21.31 region. Moreover, we present detailed phenotypic information, including neuropsychological features, that contribute to the broad phenotypic spectrum of the syndrome. Comparison of the phenotype of both the microdeletion and SNV patients does not show differences of clinical importance, stressing that haploinsufficiency of KANSL1 is sufficient to cause the full KdVS phenotype.
|
1 |
Comparative Efficacy and Safety of Nonsurgical Treatment Options for Enthesopathy of the Extensor Carpi Radialis Brevis: A Systematic Review and Meta-analysis of Randomized Placebo-Controlled Trials
|
PRPs for Lateral Epicondylitis/Elbow Tendinopathies
|
BACKGROUND: Numerous treatment options have been proposed for enthesopathy of the extensor carpi radialis brevis (eECRB).
PURPOSE: To (1) compare the efficacy and safety of nonsurgical treatment options for eECRB described in randomized placebo-controlled trials at short-term, midterm, and long-term follow-up and (2) evaluate outcomes in patients receiving placebo.
STUDY DESIGN: Systematic review and meta-analysis.
METHODS: Following PRISMA guidelines, 4 electronic databases were searched for randomized placebo-controlled trials for eECRB. Studies reporting visual analog scale (VAS) for pain scores and/or grip strength were included. Random- or fixed-effects meta-analysis was employed to compare treatments with at least 2 eligible studies using the standardized mean difference and odds ratio. The study protocol was registered at PROSPERO (ID: CRD42018075009).
RESULTS: Thirty-six randomized placebo-controlled trials, evaluating 11 different treatment modalities, with a total of 2746 patients were included. At short-term follow-up, only local corticosteroid injection improved pain; however, it was associated with pain worse than placebo at long-term follow-up. At midterm follow-up, laser therapy and local botulinum toxin injection improved pain. At long-term follow-up, extracorporeal shock wave therapy provided pain relief. With regard to grip strength, only laser therapy showed better outcomes in comparison with placebo. While there was no difference among various treatments in the odds ratio of an adverse event, they all increased adverse events compared with placebo. In placebo-receiving patients, a sharp increase in the percentage of patients reporting mild pain or less was observed from 2% at short-term follow-up to 92% at midterm follow-up.
CONCLUSION: Most patients experienced pain resolution after receiving placebo within 4 weeks of follow-up. At best, all treatments provided only small pain relief while increasing the odds of adverse events. Therefore, if clinicians are inclined to provide a treatment for particular patients, they may consider a pain relief regimen for the first 4 weeks of symptom duration. Patient-specific factors should be considered when deciding on treatment or watchful waiting.
|
0 |
A method to estimate the depth of the sciatic nerve during subgluteal block by using thigh diameter as a guide
|
Surgical Management of Osteoarthritis of the Knee CPG
|
BACKGROUND AND OBJECTIVE: The subgluteal approach is common for sciatic nerve block. Although the surface landmarks are clear, the depth of this nerve at this level is difficult to judge. The purpose of this study is to establish a method of estimating the sciatic nerve depth using the anteroposterior (AP) diameter of the thigh as a marker. METHODS: The study was undertaken in 2 phases. Phase 1 entailed review of 100 magnetic resonance images (MRIs) of the pelvis and proximal lower extremity of patients. Measurements were taken of the AP diameter of the thigh at the midpoint of the lesser trochanter and then compared with distances of the sciatic nerves from the skin of the posterior aspect of the thigh at the same level. Phase 2 involved enrolling 40 patients undergoing lower-extremity surgery for whom subgluteal sciatic nerve blocks were indicated. The AP diameters of the thighs were measured from the subgluteal groove to the inguinal groove with the patient in the supine position. Placing the patient in the lateral position, the subgluteal sciatic block was then performed by using a stimulating needle. The distances from the skin at which the sciatic nerves were actually found, as estimated by maximum motor response to stimulus, were noted. RESULTS: Phase 1 showed a mean AP diameter of 18.94 cm +/- 2.61 cm (mean +/- standard deviation [SD]), mean nerve depth of 6.51 cm +/- 1.46 cm (mean +/- SD), and a linear regression slope of 0.48. Phase 2 showed a mean AP diameter of 16.28 cm +/- 2.73 cm (mean +/- SD), a mean nerve depth of 6.99 cm +/- 1.39 cm (mean +/- SD), and a linear regression slope of 0.43. The thigh diameters differed (P < .001) between the groups, but there was no difference in the depth to the sciatic nerve between the 2 groups (P = .07). CONCLUSIONS: Comparing phase 1 and phase 2 datasets shows the slopes of linear regression lines are nearly parallel. The clinical data from phase 2 verify the anatomical data collected in phase 1 and show that the sciatic nerve depth to AP diameter ratio is 0.43 or the depth of the sciatic nerve is approximately 43% of thigh diameter if the patient is positioned in the lateral decubitus position
|
0 |
Randomized, Placebo-Controlled Analysis of the Knee Synovial Environment Following Platelet-Rich Plasma Treatment for Knee Osteoarthritis
|
PRP (Platelet-Rich Plasma)
|
BACKGROUND: Platelet-rich-plasma (PRP) is used to treat knee osteoarthritis; however, mechanistic evidence of PRP effectiveness for pain relief is limited.
OBJECTIVE: To assess molecular biomarkers and mesenchymal stem cells (MSCs) in synovial fluid during PRP treatment of the osteoarthritic knee joint.
DESIGN: Single blinded, randomized, placebo controlled pilot study.
SETTING: Veterans Affairs Medical Center.
PARTICIPANTS: Seventeen participants with mild to moderate knee osteoarthritis were randomized in a 2:1 placebo-controlled ratio, receiving PRP or saline (placebo) intra-articular injection into the knee joint.
METHODS: Knee synovial fluid was analyzed before the respective injections and again 10 days following injection. Participants were followed up to 12 months completing visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaires at intervals over that period.
MAIN OUTCOME MEASURES: The effects of PRP on synovial protein and MSC gene expression levels were measured by multiplex enzyme-linked immunosorbent assay and quantitative polymerase chain reaction.
RESULTS: Novel biomarkers including levels of interleukin (IL)-5, IL-6, IL-10, and tumor necrosis factor-alpha were measured in synovial fluid 10 days after PRP treatment. Altered gene expression profiles in MSCs from patients treated with PRP were observed for matrix metalloproteinases and inflammatory markers (IL-6, IL-8, CCL2, TNF-alpha). A2M protease was significantly increased following PRP treatment (P = .005). WOMAC scores declined for up to 3 months from baseline levels and remained low at 6 and 12 months in the PRP group. In contrast, WOMAC scores for patients receiving the saline injection were relatively unchanged for up to 12 months.
CONCLUSIONS: We report significant changes for the biomarker A2M (P = .005) as well as differences in expression of cellular markers and postulate that PRP modulates the local knee synovial environment by altering the inflammatory milieu, matrix degradation, and angiogenic growth factors. The PRP treatment group had less pain and stiffness and improved function scores.
|
0 |
Expression of TGF-beta1 and miRNA-145 in patients with diabetic foot ulcers
|
DoD LSA (Limb Salvage vs Amputation)
|
The aim of the present study was to investigate the expression levels of transforming growth factor (TGF)-beta1 and microRNA (miRNA)-145 in patients with diabetic foot ulcers (DFUs). A total of 26 patients with DFUs requiring amputation were enrolled in the study between January 2013 and August 2014. In addition, 15 trauma patients undergoing amputation over the same time period were included as a control group. Samples were collected from the blood, the dorsalis pedis arteries and muscles of the amputated limbs. The expression levels of TGF-beta1 mRNA and miRNA-145 in these samples was detected using reverse transcription-quantitative polymerase chain reaction. The expression levels of TGF-beta1 protein were evaluated using western blot analysis. In comparison with the control, the protein and mRNA expression levels of TGF-beta1 in the DFU patients was significantly higher in the serum and the dorsalis pedis arteries, and significantly lower in the muscles with ulcers. In contrast, the expression levels of miRNA-145 was significantly lower in the blood and the dorsalis pedis arteries, and significantly higher in the muscles with ulcers in DFU patients compared with the control. The results of the present study suggested that there exists an inverse correlation between the expression levels of miRNA-145 and TGF-beta1 in patients with DFU; thus suggesting that miRNA-145 may regulate the expression of TGF-beta1 in patients with DFUs.
|
0 |
The role of bone graft and alternatives in unstable distal radius fracture treatment
|
Distal Radius Fractures
|
The increased prevalence of unstable fractures of the distal radius has stimulated the development of new technologies and new surgical techniques for treating these complex injuries. New developments also contribute to the expectation that orthopedic surgeons should be able to treat the fractured distal radius more successfully by achieving early stability, early function, and better outcomes. The continuous introduction of commercial bone graft substitutes and graft extenders has provided a large array of implantable materials. Rigorous comparison of the commercially available bone graft substitutes is difficult not only because of their diversity but also because uniformly accepted preclinical assays and comparable clinical studies have not been performed. Despite the lack of complete data, however, available data and collective experience suggest that bone graft substitutes can provide improved treatment methods and outcomes. [References: 28]
|
0 |
Correlation of fractalkine concentrations in serum and synovial fluid with the radiographic severity of knee osteoarthritis
|
OAK 3 - Non-arthroplasty tx of OAK
|
BACKGROUND: Fractalkine has been detected in synovial fluid (SF) from osteoarthritis (OA) patients. This study aims to examine the relation of fractalkine concentrations in serum and SF with the radiographic severity of OA.
METHODS: Fractalkine concentrations of serum and SF were measured using an enzyme-linked immunosorbent assay method in 223 patients with knee OA and 165 healthy controls. The progression of OA was classified according to the Kellgren-Lawrence grading system.
RESULTS: Elevated concentrations of fractalkine in serum were found in knee OA patients compared with healthy controls [all results median (interquartile range) 226.25 (183.19-259.91) vs. 127.42 (99.54-154.98) pg/mL, P < 0.001]. The case group included 71 knee OA patients with grade 2, 98 with grade 3, and 54 with grade 4. Knee OA patients with KL grade 4 had significantly higher fractalkine concentrations in serum and SF compared with those with KL grade 2 and 3 [serum: 247.68 (215.05-278.64) vs. 212.45 (169.19-247.96) pg/mL, P < 0.001, and 247.68 (215.05-278.64) vs. 222.00 (179.80-254.98) pg/mL, P = 0.005, respectively; SF: 94.95 (76.46-106.68) vs. 74.31 (63.64-84.79) pg/mL, P < 0.001, and 94.95 (76.46-106.68) vs. 80.34 (68.84-96.39) pg/mL, P = 0.001, respectively]. Knee OA patients with KL grade 3 showed significantly elevated concentrations of fractalkine in SF compared with those with KL grade 2 [80.34 (68.84-96.39) vs. 74.31 (63.64-84.79) pg/mL, P = 0.004]. Fractalkine concentrations in serum and SF of knee OA patients were both significantly associated with the disease severity evaluated by KL grading criteria (r = 0.261, P < 0.001 and r = 0.366, P < 0.001, respectively).
CONCLUSION: The fractalkine concentrations in serum and SF may serve as an effective biomarker for the severity of OA.
|
1 |
Free tissue transfer to the traumatized upper extremity: Risk factors for postoperative complications in 282 cases
|
DoD SSI (Surgical Site Infections)
|
Background: Complex traumatic upper extremity injuries frequently possess compromised local vasculature or extensive defects that are not amenable to local flap reconstruction. Free tissue transfer is required to provide adequate soft tissue coverage. The present study aimed to evaluate risk factors that contribute to postoperative complications and flap loss in complex upper extremity reconstruction. Methods: Retrospective chart review was performed for all patients undergoing free tissue transfer for upper extremity reconstruction from 1976 to 2001. Data collected included patient demographic characteristics, timing of reconstruction, location of injury, fracture characteristics, operative interventions, and postoperative complications. Statistical analysis was performed using ?2 and Fisher exact tests. Results: In total, 238 patients underwent 285 free tissue transfers and met inclusion criteria, from which 3 were excluded because of inadequate information (n = 282). Extremities were repaired within 24 h (75 cases; 27%), in days 2-7 (32 cases; 12%), or after day 7 (172 cases; 62%). Timing of reconstruction did not significantly affect postoperative outcomes. Proximal location of injury was significantly associated with superficial (relative risk [RR], 6.5; P <.01) and deep infection (RR, 5.3; P <.01), and osteomyelitis (RR, 4.0; P <.01), although not with flap failure (P =.30). Presence of an open fracture was significantly associated with developing superficial (RR, 3.1; P =.01) and deep (RR, 1.9; P <.01) infection, as well as osteomyelitis (RR, 1.6; P <.01). Having a closed fracture did not negatively influence postoperative outcomes. Conclusions: This study supports the safety of early free tissue transfer for reconstruction of traumatized upper extremities. Injuries proximal to the elbow and open fracture were associated with a significantly higher infection rate. Gustilo grade IIIC fractures, need for interpositional vein grafts, and anastomotic revision at index operation resulted in significantly higher risk of flap loss, whereas the presence of fracture, fracture fixation, and injury location were not predictors of flap failure.
|
0 |
Two-stage treatment protocol for isolated septic acetabular cup loosening
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
The aim of this study was to evaluate the treatment of isolated septic acetabular cup loosening without involvement of the prosthesis stem by insertion of an antibiotic-loaded spacer head and stem retention. Between 1999 and 2008, 13 patients (5 men, 8 women, mean age 69 years) were treated according to this regimen. S. epidermidis and S. aureus were the two most commonly identified pathogens. In 12 cases the polymethylmethacrylate spacers were impregnated with 0.5 g gentamicin + 2 g vancomycin per 40 g bone cement, except in one patient with vancomycin allergy, in whom 0.5 g gentamicin + 0.4 g teicoplanin were used. The spacers acted as hemiarthroplasties. The mean spacer head implantation time was 88 (35-270) days. At a mean follow-up of 55 (12-83) months, infection eradication was achieved in 11 out of 12 cases (91.6%). Complications included a draining sinus, and one spacer and one definitive prosthesis dislocation. One patient died after reimplantation due to cardiopulmonary decompensation. (copyright) 2010 Wichtig Editore
|
0 |
Non-reducible knee dislocation with interposition of the vastus medialis muscle
|
AMP (Acute Meniscal Pathology)
|
Irreducibility of the knee following complete dislocation is a rare event determined by the interposition of various capsulo-ligamentous structures in the joint space. Such cases often require urgent surgical treatment. We report the case of a healthy 70-year-old man with a sprain of the left knee that occurred after a sports trauma. The patient showed knee dislocation with multiple ligamentous injuries and articular block due to interposition of a portion of the vastus medialis muscle. After arthroscopic evaluation, we performed surgical treatment to free the muscle, regularize the medial meniscus and suture the posterior and medial capsule and ligaments; the cruciate ligaments were not treated. The most interesting aspect of the articular damage in this case was a wide detachment of the vastus medialis muscle with intra-articular dislocation. The decision to treat only the posterior lesions and allow the healing of the front ones by rehabilitation treatment was supported by full functional recovery and return to sports activity. © 2011 The Author(s).
|
0 |
Effect of postoperative epidural analgesia on morbidity and mortality following surgery in medicare patients
|
Surgical Management of Osteoarthritis of the Knee CPG
|
BACKGROUND: Because of the uncertainty and limitations in available randomized controlled trials, we performed an analysis of the Medicare claims database to determine whether an association exists between postoperative epidural analgesia and mortality. METHODS: A 5% nationally random sample of Medicare beneficiaries from 1997 to 2001 was analyzed to identify patients undergoing segmental excision of the lung (International Statistical Classification of Diseases, Ninth Revision, Clinical Modification codes 32.3 and 32.4), complete pneumonectomy (code 32.5), partial excision of large intestine (codes 45.73 and 45.76), anastomosis of the esophagus (codes 42.5 and 42.6), total knee replacement/revision (codes 81.54 and 81.55), total/radical abdominal hysterectomy (codes 68.4 and 68.6), partial/radical pancreaticoduodenectomy (codes 52.5 and 52.7), partial/complete nephrectomy (codes 55.4 and 55.5), partial/complete cystectomy (codes 57.6 and 57.7), hepatotomy/lobectomy of the liver (codes 50.0 and 50.3), partial/total gastrectomy (codes 43.5 to 43.9), and radical retropubic prostatectomy (codes 60.4 and 60.5). Patients were divided into 2 groups, depending on the presence or absence of postoperative epidural analgesia. The rate of major morbidity and death at 7 and 30 days after surgery were compared. Multivariate regression analyses incorporating race, gender, age, comorbidities, hospital size, hospital teaching status, and hospital technology status were performed. RESULTS: The presence of epidural analgesia was associated with a significantly lower odds of death at 7 days (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.38 to 0.73; P = .0001) and 30 days (OR, 0.74; 95% CI, 0.63 to 0.89; P = .0005) after surgery; however, no difference was seen between the groups with regard to overall major morbidity, with the exception of an increase in pneumonia at 30 days for the epidural group (OR, 1.91;[95% CI, 1.09 to 3.34; P = .02). CONCLUSIONS: Postoperative epidural analgesia may contribute to lower odds of death after surgery
|
0 |
Maximum standardised uptake value of quantitative bone SPECT/CT in patients with medial compartment osteoarthritis of the knee
|
OAK 3 - Non-arthroplasty tx of OAK
|
Aim To evaluate the correlation between the maximum standardised uptake value (SUVmax) from bone single-photon-emission computed tomography/computed tomography (SPECT/CT) and other imaging parameters for medial compartment osteoarthritis (OA) of the knee. Materials and methods Patients (n=26; male:female=2:24; age, 55.3±5.8 years) underwent quantitative knee SPECT/CT using technetium-99m (Tc-99m) hydroxymethylene diphosphonate (HDP) before surgical operation for medial OA of the knee. SUVmax was calculated using dedicated quantitative software. Visual grades of tracer uptake on bone SPECT/CT and Kellgrenâ??Lawrence (KL) OA scores on plain radiographs were assessed using a five-point scale. Magnetic resonance imaging (MRI) scores (n=22) and patient symptom scores were also assessed. Results The operated knees (n=34) had a greater SUVmax than the non-operated knees (n=18) in the medial compartment (14.1±6.1 versus 5.3±4.4, p<0.0001). In the medial compartment, the SUVmax was significantly correlated with SPECT/CT visual grades (rho=0.794, p<0.0001), KL scores (rho=0.703, p<0.0001), and MRI scores (rho=0.714â??0.808, pâ?¤0.0002); however, SUVmax and other imaging parameters were not correlated with patient symptom scores (p>0.05). Conclusions The SUVmax of quantitative bone SPECT/CT was highly correlated with traditional imaging parameters for medial compartment OA severity of the knee. Quantitative bone SPECT/CT is a promising imaging technique for the objective assessment of knee OA.
|
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.