recall
int64 0
1
| article_title
stringlengths 5
500
| topic
stringlengths 21
84
| abstract
stringlengths 2
65.8k
|
|---|---|---|---|
0 |
Ultrasound-guided interventional procedures of the wrist and hand
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
This pictorial review will outline the rationale, indications, techniques, controversies and possible complications of ultrasound-guided interventional procedures of the hand and wrist. (copyright) European Society of Radiology 2008
|
0 |
The Radial Nerve in the Brachium: An Anatomic Study in Human Cadavers
|
Distal Radius Fractures
|
Purpose: To explore the course of the radial nerve in the brachium and to identify practical anatomic landmarks that can be used to avoid iatrogenic injury during humerus fracture fixation. Methods: Data were collected from 27 adult cadaveric specimens, including 18 embalmed cadavers and 9 fresh-frozen limbs. Measurements were taken using osseous landmarks to define the relationship of the radial nerve and the posterior and lateral humerus. The extremities were studied further to determine the association of the radial nerve and anatomic landmarks on both longitudinal and cross-sectioned specimens. Results: A 6.3 cm ± 1.7 segment of radial nerve was found to be in direct contact with the posterior humerus from 17.1 cm ± 1.6 to 10.9 cm ± 1.5 proximal to the central aspect of the lateral epicondyle, centered within 0.1 cm ± 0.2 of the level of the most distal aspect of the deltoid tuberosity. The radial nerve lay in direct contact with the periosteum in all specimens, without evidence of a structural groove in the humerus in any specimen. On entering the anterior compartment, the radial nerve had very little mobility as it was interposed between the obliquely oriented lateral intermuscular septum and the lateral aspect of the humerus. As it extended distally, the nerve coursed anterior to the humerus and became protected by brachialis muscle at the level of the proximal aspect of the lateral metaphyseal flare. Conclusions: The radial nerve is at risk of injury with fractures of the humerus and with subsequent operative fixation in 2 areas. The first is along the posterior midshaft region for a distance of 6.3 cm ± 1.7 centered at the distal aspect of the deltoid tuberosity. The second is along the lateral aspect of the humerus in its distal third from 10.9 cm ± 1.5 proximal to the lateral epicondyle to the level of the proximal aspect of the metaphyseal flare. The deltoid tuberosity is a consistent and practical anatomic landmark that can be used to determine the level of the radial nerve along the posterior aspect of the humerus during operative fixation from an anterior approach. © 2007 American Society for Surgery of the Hand.
|
0 |
High Tibial Osteotomy with a Modern Polyetheretherketone (PEEK) System: Mid-Term Results at a Mean of 6 Years Follow-Up
|
Osteochondritis Dissecans 2020 Review
|
The purpose of this study was to determine patient-reported outcomes, hardware removal rates, as well as conversion to arthroplasty at mid-term follow-up following high tibial osteotomy (HTO) with a modern polyetheretherketone (PEEK) system. All PEEK system-based HTOs performed at a single institution between January 2010 and January 2016 with a minimum of 2 years follow-up were reviewed. Rates of postoperative complications, hardware removal and conversion to arthroplasty were calculated. Patient-reported outcomes including visual analog pain scale (VAS), Tegner activity scale, Lysholm, Knee Injury and Osteoarthritis Outcome Score (KOOS), and 36-Item Short Form Survey (SF-36) were obtained. Forty-seven HTOs in 43 patients (mean age: 37.6 ± 10.8 years; 30 M, 13 F) were followed for a mean of 6.0 ± 1.5 years. A total of four postoperative complications occurred in three patients, resulting in an overall complication rate of 6.4%. Hardware removal occurred in three patients at a mean of 0.73 ± 0.53 years after surgery, with overall survival free of hardware removal of 96% (95% confidence interval [CI]: 85-99) at 1 year, 94% (95% CI: 82-98) at 2 years, and 94% (95% CI: 82-98) at 8 years. Conversion to arthroplasty occurred in three patients at a mean of 3.2 ± 1.0 years after surgery, with mean survival of 100% (95% CI: 94-100) at 1 year, 100% (95% CI: 94-100) at 2 years, and 93% (95% CI: 81-98) at 8 years. VAS at rest improved, from 3.1 ± 2.5 preoperatively to 1.1 ± 1.6 postoperatively (p < 0.001). Patients remained active, with a mean Tegner activity scale of 4.4 ± 1.4 at final follow-up and satisfactory Lysholm, KOOS, and SF-36 scores. At mid-term follow-up, medial opening-wedge HTO using a modern PEEK-based system was found to be safe, efficacious, and durable, with satisfactory outcome scores and a low rate of conversion to arthroplasty. PEEK-based implants were found to have low hardware removal rates of 6% at 5 years, which compares favorably to historic metal fixation. This is a Level III study.
|
0 |
Wedge osteotomies of the radius for Kienbock's disease: a biomechanical analysis
|
Distal Radius Fractures
|
We compared changes in lunate cortical strain with an applied physiologic load by altering radial inclination to simulate opening and closing wedge osteotomies of the distal radius. Nineteen fresh-frozen cadaver arms were mounted in neutral position and tested under axial compression at a physiologic load by means of a repeated-measures design. Principal compressive strains were measured with rosette strain gauges mounted on the lunate's palmar and dorsal cortices. Distal radius osteotomy and custom external fixator allowed for altering radial inclination in progressive 3 degrees increments both by increasing and decreasing radial inclination in each specimen. Maximum principal strain was recorded for each inclination increment and compared with control. Comparison of all data showed a 26% decrease on lunate cortical strain for the radial opening wedge osteotomy and a 24% increase for the radial closing wedge osteotomy. This difference was statistically significant. No significant differences were found between individual angular increments (3 degrees to 15 degrees). The radial opening wedge osteotomy was more effective than the radial closing wedge osteotomy at diminishing lunate strain. The results validate the biomechanical effectiveness of this extra-articular osteotomy, which is intended to minimize alteration of ulnar variation.
|
1 |
Mammaplasty with L-incision
|
Reduction Mammoplasty for Female Breast Hypertrophy
|
BACKGROUND: The cutaneous sequelae resulting from mastopexy and reduction mammaplasty are serious drawbacks for patients, particularly young women, and physicians who are dissatisfied with extensive postoperative scarring.
OBJECTIVE: The author reports on an L-incision technique that involves a base resection with an upper transposition of the nipple-areolar complex (NAC) to yield good shape and projection, short scars, and preservation of lactation.
METHODS: Preoperative markings were made to aid estimation of the amount of breast tissue to be excised, to establish anatomic landmarks ensuring breast symmetry, and to position the scars. Breast reduction was performed by means of perpendicular excision of the lower pole and transverse amputation of the base from the pectoral aspect of the breast. In wider breasts, a vertical keel was excised to decrease the circumference of the base. In mastopexy, the lower pole was preserved as a superiorly based flap and used to fill the upper pole. The new site of the NAC was marked bilaterally, slightly lower than the apex of the new mammary cone, with the downward rotation of the breast during the early postoperative period taken into consideration.
RESULTS: The described L-incision procedure was performed in more than 500 patients between 1996 and 2003, with good results and a low rate of complications. Nipple sensitivity was generally preserved unless lesions of the lateral branches of the intercostal nerves were present. No lactation problems were reported by the 9 patients who breastfed babies after undergoing surgery. Twenty-seven patients underwent revision procedures to correct scar hypertrophy, areolar enlargement, asymmetry, persistent ptosis, or correction of "dog-ear."
CONCLUSIONS: The L-incision technique is a safe, reliable procedure that results in good breast shape and projection with inconspicuous scars. It can be used in a wide variety of applications, including correction of breast hypertrophy, ptosis, and asymmetries.
|
0 |
A delta opioid receptor lacking the third cytoplasmic loop is generated by atypical mRNA processing in human malignomas
|
Reconstruction After Skin Cancer
|
delta Opioid receptors were identified in human melanomas by RT-PCR and radioligand binding. In all tumors an additional PCR amplificate was detected in which 144 bp within the third exon were deleted. This fragment corresponded to the third cytoplasmic domain of the receptor protein. The short variant resulted from atypical mRNA processing. There were no common splice recognition sequences around the deleted fragment; instead its excision resembled the removal of a transposon. The deletion was not detected in normal human melanocytes nor in human or rat brain. However, it was present in a human neuroblastoma cell line (SH-SY5Y). Thus, it appears that the occurrence of the short delta opioid receptor is correlated to malignancy.
|
1 |
Injury severity score underpredicts injury severity and resource utilization in combat-related amputations
|
DoD LSA (Limb Salvage vs Amputation)
|
OBJECTIVE: Assess effectiveness of Injury Severity Score (ISS) in predicting injury severity in combat-related amputations. DESIGN: Retrospective evaluation of prospectively collected data. SETTING: Military medical center. PATIENTS: One hundred and nine patients with major extremity amputations sustained in overseas combat. INTERVENTION: Standard combat casualty care. MAIN OUTCOME MEASUREMENTS: Difference in injury severity as measured by ISS, numbers of extremity(s) amputated, number of associated injuries, blood products used, intensive care unit length of stay, hospital length of stay in those with an upper extremity amputation (UEA) compared with those with an isolated lower extremity amputation. RESULTS: Thirteen patients (11.9%) sustained at least one UEA. Patients with an UEA had a greater number of amputations per casualty compared with patients with a lower extremity alone (2.5 vs. 1.5; P < 0.001). The mean hospital length of stay (P = 0.02) and intensive care unit length of stay (P = 0.02) were significantly greater in those with an UEA. Mean blood product utilization was also significantly greater in those with an upper extremity amputation (P < 0.05). There was no difference in ISS between the two groups (P > 0.05). CONCLUSIONS: The presence of an UEA is associated with increased injury severity as evident by increased intensive care unit requirements, blood product utilization, and hospital length of stay. ISS underestimates the severity of injury and therefore resource utilization in patients with multiple combat-related amputations. Recognition of this limitation in addition to the development of a military-specific ISS is required for more effective resource utilization to continue to improve combat casualty care. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
|
0 |
Vitamin D supplementation during infancy is associated with higher bone mineral mass in prepubertal girls
|
Management of Hip Fractures in the Elderly
|
The objective of this study was to determine whether vitamin D supplementation of breast-fed infants during the first year of life is associated with greater bone mineral content and/or areal bone mineral density (aBMD) in later childhood. The design was a retrospective cohort study. One hundred and six healthy prepubertal Caucasian girls (median age, 8 yr; range, 7-9 yr) were classified as vitamin D supplemented or unsupplemented during the first year of life on the basis of a questionnaire sent to participating families and their pediatricians. Bone area (square centimeters) and bone mineral content (grams) were determined by dual energy x-ray absorptiometry at six skeletal sites. Vitamin D receptor (VDR) 3'-gene polymorphisms (BsmI) were also determined. The supplemented (n = 91) and unsupplemented (n = 15) groups were similar in terms of season of birth, growth in the first year of life, age, anthropometric parameters, and calcium intake at time of dual energy x-ray absorptiometry. The supplemented group had higher aBMD at the level of radial metaphysis (mean +/- SEM, 0.301+/-0.003 vs. 0.283+/-0.008; P = 0.03), femoral neck (0.638+/-0.007 vs. 0.584+/-0.021; P = 0.01), and femoral trochanter (0.508+/-0.006 vs. 0.474+/-0.016; P = 0.04). At the lumbar spine level aBMD values were similar (0.626+/-0.006 vs. 0.598+/-0.019; P = 0.1). In a multiple regression model taking into account the effects of vitamin D supplementation, height, and VDR genotype on aBMD (dependent variable), femoral neck aBMD remained higher by 0.045 g/cm2 in the supplemented group (P = 0.02). Vitamin D supplementation in infancy was found to be associated with increased aBMD at specific skeletal sites later in childhood in prepubertal Caucasian girls
|
0 |
Disseminated Mycobacterium kansasii Disease in Complete DiGeorge Syndrome
|
Patrick’s pharmacoepidemiology project
|
Purpose: Complete DiGeorge syndrome (cDGS) describes a subset of patients with DiGeorge syndrome that have thymic aplasia, and thus are at risk for severe opportunistic infections. Patients with cDGS and mycobacterial infection have not previously been described. We present this case to illustrate that patients with cDGS are at risk for nontuberculous mycobacterial infections and to discuss further antimicrobial prophylaxis prior to thymic transplantation. Methods: A 13-month old male was identified as T cell deficient by the T cell receptor excision circle (TREC) assay on newborn screening, and was subsequently confirmed to have cDGS. He presented with fever and cough, and was treated for chronic aspiration pneumonia as well as Pneumocystis jirovecii infection without significant improvement. It was only after biopsy of mediastinal lymph nodes seen on CT that the diagnosis of disseminated Mycobacterium kansasii was made. We reviewed the literature regarding atypical mycobacterial infections and prophylaxis used in other immunocompromised patients, as well as the current data regarding cDGS detection through TREC newborn screening. Results: Multiple cases of cDGS have been diagnosed via TREC newborn screening, however this is the first patient with cDGS and disseminated mycobacterial infection to be reported in literature. Thymic transplantation is the definitive treatment of choice for cDGS. Prophylaxis with either clarithromycin or azithromycin has been shown to reduce mycobacterial infections in children with advanced human immunodeficiency virus infection. Conclusions: Children with cDGS should receive thymic transplantion as soon as possible, but prior to this are at risk for nontuberculous mycobacterial infections. Severe, opportunistic infections may require invasive testing for diagnosis in patients with cDGS. Antimicrobial prophylaxis should be considered to prevent disseminated mycobacterial infection in these patients
|
0 |
A study of hand injury and emergency management in a developing country
|
DoD SSI (Surgical Site Infections)
|
BACKGROUND: Injury to the underlying structures of the hand carries the potential for serious handicap. To reduce this risk, even the smallest hand injuries require proper medical care.
AIMS: To assess wound healing, mobility, and the ability to perform normal essential function post-operatively in open hand injuries associated with fracture.
MATERIALS AND METHODS: Thirty patients with 45 metacarpal and phalangeal fractures of the hand were divided into three groups: Group 1 (n = 13) cases with single fractures of hand, excluding thumb; Group 2 (n = 9) cases with multiple fracture of hand, excluding thumb; Group 3 (n = 8) cases with fractures involving thumb and first metacarpal. Tendon injuries were repaired. For fractures, Kirschner wire fixation was done. In two cases with multiple fractures, Joshi's external support system (JESS) fixator was applied. Patients were followed up for 12 weeks.
RESULTS: One patient with proximal phalangeal fracture developed extension lag. No stiffness was observed in any of the cases treated by intramedullary Kirschner wire fixation. No non-union or delayed union was observed following cross-wire fixation with two Kirschner wires. Two case of open fracture developed superficial infection. Two patients with multiple fractures developed angulation at fracture site after the Kirschner wires were removed 4 weeks postoperatively, and two cases of multiple fractures developed hypertrophic non-union.
CONCLUSIONS: Delicate handling of tissues, preservation of gliding planes for tendons, prevention of infection, accurate reduction and fixation, and early and appropriate physiotherapy affect prognosis in case of hand injuries.
|
0 |
Cathepsin K is present in invasive oral tongue squamous cell carcinoma in vivo and in vitro
|
MSTS 2018 - Femur Mets and MM
|
OBJECTIVES: Cathepsin K, a lysosomal cysteine protease, is expressed in the tumor microenvironment (TME) of skin carcinoma, but nothing is known about cathepsin K in oral tongue squamous cell carcinoma (OTSCC). Our aim was to describe the expression of cathepsin K in invasive OTSCC in vitro and in a series of clinical cancer specimens.
MATERIALS AND METHODS: OTSCC invasion in vitro was studied using invasive HSC-3 tongue carcinoma cells in 3D organotypic models. In total, 121 mobile tongue OTSCCs and 10 lymph node metastases were analyzed for cathepsin K expression. The association between cathepsin K expression and clinicopathological factors was evaluated.
RESULTS: Cysteine protease inhibitor E64 and cathepsin K silencing significantly (p<0.0001) reduced HSC-3 cell invasion in the 3D models. Cathepsin K was expressed in a majority of carcinoma and metastatic cells, but the expression pattern in carcinoma cells did not correlate with clinical parameters. Instead, the weak expression of cathepsin K in the invasive TME front correlated with increased overall recurrence (p<0.05), and in early-stage tumors this pattern predicted both cancer recurrence and cancer-specific mortality (p<0.05 and p<0.005, respectively).
CONCLUSIONS: Cathepsin K is expressed in OTSCC tissue in both carcinoma and TME cells. Although the diminished activity and expression in aggressive tongue HSC-3 cells reduced 3D invasion in vitro, the amount of cathepsin K in carcinoma cells was not associated with the outcome of cancer patients. Instead, cathepsin K in the invasive TME front seems to have a protective role in the complex progression of tongue cancer.
|
0 |
Ad hoc Committee of the Croatian Society for Neurovascular Disorders, Croatian Medical Association: Recommendations for neuropathic pain treatment
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
Damage to the somatosensory nervous system poses a risk for the development of neuropathic pain. Such an injury to the nervous system results in a series of neurobiological events resulting in sensitization of both the peripheral and central nervous system. The symptoms include continuous background pain (often burning or crushing in nature) and spasmodic pain (shooting, stabbing or "electrical"). The diagnosis of neuropathic pain is based primarily on the history and physical examination finding. Although monotherapy is the ideal approach, rational polypharmacy is often pragmatically used. Several classes of drugs are moderately effective, but complete or near-complete relief is unlikely. Antidepressants and anticonvulsants are most commonly used. Opioid analgesics can provide some relief but are less effective than for nociceptive pain; adverse effects may prevent adequate analgesia. Topical drugs and a lidocaine-containing patch may be effective for peripheral syndromes. Sympathetic blockade is usually ineffective except for some patients with complex regional pain syndrome
|
0 |
Acute cognitive and neurobehavioural intervention for individuals with acquired brain injury: Preliminary outcome data
|
DoD PRF (Psychosocial RF)
|
The present study provides a rationale for and detailed description of a structured curriculum for a cognitive and neurobehavioural group intervention for patients in an acute inpatient brain injury rehabilitation setting. Preliminary outcome data are provided for 29 patients with acquired brain injuries who attended the group during inpatient rehabilitation. The group was held during three 30-minute sessions per week. Prior to discharge, patients completed a Learning Assessment, which assessed their level of knowledge about the material covered during the course. Patients received a mean score of 85.54 on the Learning Assessment. High scores on the Learning Assessment correlated significantly with discharge Disability Rating Scale total and Social Interaction FIM scores. Age, level of education, race, sex, and length of stay did not significantly impact these results. Results suggest that patients with acquired brain injuries benefit from acute cognitive and neurobehavioural intervention and are capable of learning compensatory strategies, even in the acute stages of recovery. This learning may help improve functional status, especially skills needed for psychosocial adjustment. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
|
0 |
Fracture prevention service to bridge the osteoporosis care gap
|
Hip Fx in the Elderly 2019
|
BACKGROUND: A care gap exists between the health care needs of older persons with fragility fractures and the therapeutic answers they receive. The Fracture Prevention Service (FPS), a tailored in-hospital model of care, may effectively bridge the osteoporosis care gap for hip-fractured older persons. The purpose of this study was to evaluate the efficacy of the FPS in targeting persons at high risk of future fracture and to improve their adherence to treatment.
METHODS: This was a prospective observational study conducted in a teaching hospital with traumatology and geriatric units, and had a pre-intervention and post-intervention phase. The records of 172 participants were evaluated in the pre-intervention phase, while data from 210 participants were gathered in the post-intervention phase. All participants underwent telephone follow-up at 12 months after hospital discharge. The participants were patients aged >=65 years admitted to the orthopedic acute ward who underwent surgical repair of a proximal femoral fracture. A multidisciplinary integrated model of care was established. Dedicated pathways were implemented in clinical practice to optimize the identification of high-risk persons, improve their evaluation through bone mineral density testing and blood examinations, and initiate an appropriate treatment for secondary prevention of falls and fragility fractures.
RESULTS: Compared with the pre-intervention phase, more hip-fractured persons received bone mineral density testing (47.62% versus 14.53%, P<0.0001), specific pharmacological treatments (48.51% versus 17.16%, P<0.0001), and an appointment for evaluation at a fall and fracture clinic (52.48% versus 2.37%, P<0.0001) in the post-intervention phase. Independent of some confounders, implementation of the FPS was positively associated with recommendations for secondary fracture prevention at discharge (P<0.0001) and with 1-year adherence to pharmacological treatment (P<0.0001).
CONCLUSION: The FPS is an effective multidisciplinary integrated model of care to optimize identification of older persons at highest risk for fragility fracture, to improve their clinical management, and to increase adherence to prescriptions.
|
0 |
Toxic oil syndrome. A long-term follow-up of a cohort of 332 patients
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
Toxic oil syndrome is a multisystemic, epidemic disease that appeared in Spain in 1981, related to the intake of rapeseed cooking oil sold in bulk. It affected 19,748 people, of whom 457 died. The toxic substance was never identified. We report the 8-year follow-up of a cohort of 332 patients. The disease was usually severe and disabling during the first 2 years, but the clinical condition of most of the patients improved thereafter. The acute phase lasted 2 months, and was characterized by pulmonary edema, rash, eosinophilia, and myalgia. During the intermediate phase (second to fourth months), severe myalgia, skin tenderness, subcutaneous edema, altered liver function, and pulmonary hypertension developed. Later on, an early chronic phase developed, from the fourth month to the end of the second year. It was marked by scleroderma, sicca syndrome, polyneuropathy, joint contractures, weight loss, and functional limitations. The clinical manifestations improved during the late chronic phase. Its most prominent clinical features were muscle cramps, chronic musculoskeletal pain, chronic lung disease, Raynaud phenomenon, carpal tunnel syndrome, and psychologic disturbances. Only 9% of the patients achieved remission after the acute phase, the rest developing late clinical manifestations of the disease. The severity of the chronic manifestations was rather variable. At the end of the 8-year follow-up, there were 10 TOS-related deaths (3%), 47% of the patients had some kind of complaint, albeit subtle in most cases, and 16% showed organic involvement related to TOS. The most important pathologic features of TOS were widespread interstitial infiltrates, non-necrotizing angiitis, endothelial proliferation, and tissue fibrosis. Toxic oil syndrome is a dramatic example of an induced scleroderma-like syndrome, similar to the eosinophilia-myalgia syndrome. Patients with EMS may develop some of the late clinical features of TOS in the years to come
|
0 |
Evolving role of bone biomarkers in castration-resistant prostate cancer
|
MSTS 2018 - Femur Mets and MM
|
The preferential metastasis of prostate cancer cells to bone disrupts the process of bone remodeling and results in lesions that cause significant pain and patient morbidity. Although prostate-specific antigen (PSA) is an established biomarker in prostate cancer, it provides only limited information relating to bone metastases and the treatment of metastatic bone disease with bisphosphonates or novel noncytotoxic targeted or biological agents that may provide clinical benefits without affecting PSA levels. As bone metastases develop, factors derived from bone metabolism are released into blood and urine, including N- and C-terminal peptide fragments of type 1 collagen and bone-specific alkaline phosphatase, which represent potentially useful biomarkers for monitoring metastatic bone disease. A number of clinical trials have investigated these bone biomarkers with respect to their diagnostic, prognostic, and predictive values. Results suggest that higher levels of bone biomarkers are associated with an increased risk of skeletal-related events and/or death. As a result of these findings, bone biomarkers are now being increasingly used as study end points, particularly in studies investigating novel agents with putative bone effects. Data from prospective clinical trials are needed to validate the use of bone biomarkers and to confirm that marker levels provide additional information beyond traditional methods of response evaluation for patients with metastatic prostate cancer.
|
1 |
Decision making and results in subtotal and total lower leg amputations: reconstruction versus amputation
|
DoD LSA (Limb Salvage vs Amputation)
|
As a result of modern therapeutic and technological advances, the surgeon has the ability to salvage even the most severely injured lower limbs. However, the success of replantation nowadays is no longer measured simply on the basis of restoration of viability but also on functional outcome compared with primary amputation with early prosthetic fitting, the risk to the patient during and after replantation and the overall time of treatment which should not exceed 2 years. Although every major limb replantation has to be considered individually, the decision-making process for reconstruction (replantation/revascularisation) versus amputation with subsequent early prosthetic fitting should be determined by objective criteria. Based on personal experience and an extensive literature search, an algorithm for treatment of amputation or amputation-like injuries to the lower leg has been developed and tested in a clinical study. A 100% viability success rate was achieved. There was not only a significant increase in the percentage of "functional extremities" but also a doubling in grade I results. Moreover, there was a 50% reduction in patients presenting a "non-functional extremity", and no patient required a secondary re-amputation. The replantation risk (e.g., risk of severe systemic disturbance during and/or after replantation) was about 16.6% (2/12) in our study. There was a significant decrease in the postoperative complication rate and no patient died during or after replantation. Based on our experience, if reconstruction in subtotal or total lower leg amputation is done for a well-selected patient group, good functional results with a reasonable replantation risk and a reasonable time for social re-integration can be achieved.
|
0 |
Growth and nutrition in children with trichothiodystrophy
|
Developmental Dysplasia of the Hip 2020 Review
|
Objectives: Trichothiodystrophy (TTD) is a rare autosomal recessive disorder of DNA repair and transcription. Patients have multisystem abnormalities, including alterations in growth and development. This report characterizes the growth and nutritional status of a cohort of children with TTD. Methods: Twenty-five patients with TTD were evaluated through a natural history study of patients with DNA repair diseases at the National Institutes of Health. Mean length of follow-up was 2.7 years. Retrospective and prospective data on nutritional status and height/weight were collected. Results: In general, patients with TTD had considerable abnormalities in growth, with a mean height-for-age z score of -2.75 and a mean weightfor-age z score of -2.60 at baseline clinical evaluation. The median weightfor-length at baseline was, however, 50th percentile and indicators of adequate nutrition such as serum albumin, hemoglobin, and vitamins D and B12 were largely within normal limits. Changes in growth parameters as children aged were characterized by further separation from standard growth curves (change height-for-age z score/year [-0.18± 0.42] and weight-for-age z score/year [-0.36± 0.51]). Patients who died during follow-up (n=5) had significantly lower standardized height (P=0.03) and weight (P=0.006), weight-for-length (< 0.0001), and higher heart rates (P=0.02) compared with the remainder of the cohort. Conclusions: Children with TTD have markedly diminished weight-for-age and height-for-age relative to reference populations. The cause for this stunted growth remains unclear but does not appear to be related to poor nutrient absorption or malnutrition.
|
0 |
Vibroarthrography in the evaluation of musculoskeletal system - a pilot study
|
OAK 3 - Non-arthroplasty tx of OAK
|
BACKGROUND. Disorders of the articular surfaces are associated with impaired quality of joint motion and joint play. Crepitations are the hallmark clinical sign. This paper aims to present the possibilities of using vibroacoustic signal analysis in assessing the function of articular surfaces in the course of disorders of the knee and shoulder. MATERIAL AND METHODS. The study involved 30 people, 10 for each of the following disorders: patellar chondromalacia (Ch), meniscal tears (Mc), and degenerative changes of the glenohumeral joint (GH). A control group (K1-K3) was matched to each dysfunctional group. 6-second vibroacoustic signals (VAG) were recorded during motion in particular joints. The resulting time series were filtered (50-1000 Hz) and the following parameters were calculated: variance-mean-square (VMS), the mean of the four lowest and four highest values (R4) and the total spectral power density in the 50-250 Hz (P1) and 250-450 Hz (P2) ranges. RESULTS. Depending on the type of disorder, VAG signals in the dysfunctional groups were characterized by higher variability, amplitude and frequency than was the case in the control groups. This is reflected in the values of all parameters (VMS, R4, P1, P2), which were significantly higher in the Ch, Mc and GH groups compared to K1-K3. CONCLUSIONS. 1. Vibroarthrography can be a useful tool for accurate and objective assessment of the quality of joint motion. 2. The non-invasive nature of vibroarthrography allows the use of this method to monitor the effects of the treatment of joint structures.
|
1 |
Previous fracture surgery is a major risk factor of infection after total knee arthroplasty
|
Surgical Management of Osteoarthritis of the Knee CPG
|
PURPOSE: Total knee arthroplasty (TKA) has been proven to be the most effective treatment for patients with severe joint disease. Although infection is not a frequent complication, it is certainly one of the most dreaded. The purpose of this study was to identify factors associated with infection after TKA. METHODS: Between 1995 and 2006, 2,022 primary TKAs in 1,146 patients were evaluated. Flexible Nichidai Knee (FNK) was used as a prothesis in all subjects. Twenty-four patient-specific data items were collected via chart review for each patient. Revision arthroplasty procedures and infected knees were excluded. The medical records were reviewed to extract the following information: age, gender, body mass index (BMI), preoperative C-reactive protein (CRP), preoperative erythrocyte sedimentation rate (ESR), preoperative total protein (TP), duration of surgery, operative blood loss, total blood loss, duration of surgical drain, duration of antibiotic prophylaxis, primary diagnoses, smoking, diabetes mellitus, steroid or disease modifying anti-rheumatic drugs (DMARDs) therapy, previous operation around the knee joint, previous arthroscopic surgery, previous non-arthroscopic surgery, previous high tibial osteotomy (HTO) or open reduction internal fixation (ORIF), remnants of previous internal fixation material, bone graft, patella replacement, and bone cement. RESULTS: The median age of the patients at the time of primary TKA was 72 (range, 26-91) years. The median follow-up period after primary TKA was 42 (range, 6-145) months. During the study period, 17 infected knee arthroplasties in 17 patients were identified. Previous history of ORIF, male gender, remnants of previous internal fixation material, and BMI showed significant correlation with postoperative infection. CONCLUSION: This study identified previous history of fracture and remnants of internal fixation as major risk factors of infection after TKA. For clinical relevance, surgeons should be aware of potential infection when performing TKA in patients with these risk factors and patients should be informed of the potential risks
|
1 |
The effect of care bundle development on surgical site infection after hemiarthroplasty: an 8-year review
|
DoD SSI (Surgical Site Infections)
|
BACKGROUND: Proximal femoral fracture is the most common reason for emergency orthopedic admission in the United Kingdom with an annual cost of 1.7 billion to the National Health Service. Surgical site infection (SSI) after proximal femoral fracture increases patient morbidity and mortality. Methicillin-resistant Staphylococcus aureus (MRSA) poses a particular risk in this patient cohort as a large proportion of these patients are residents of long-term care facilities and are therefore transient or chronic carriers of MRSA. We recorded the effect of three stages of care bundle development on the infection and specifically the MRSA rate after hemiarthroplasty over an 8-year period.
METHODS: Data were collated retrospectively from the surgical site infection surveillance service. These data were prospectively collected and independently collated. The data were analyzed using the chi(2) test and the normal test for differences between two proportions.
RESULTS: Between October 2001 and June 2009, 1,830 hemiarthroplasties were performed. A statistically significant difference (p < 0.05) in SSI and MRSA rate was identified. The most effective care bundle included double skin preparation using alcoholic chlorhexidine, a single dose of intravenous co-amoxiclav (1.2 g) and gentamicin (240 mg) at induction, and implanted gentamicin-impregnated equine collagen at wound closure.
CONCLUSIONS: Adoption of our care bundle approach led to a reduction in SSI rate after hemiarthroplasty. The care bundle we propose is tailored to reduce MRSA infection and minimize risks associated with antibiotic prophylaxis. It is a simple and cost-effective improvement in the clinical care of this vulnerable group.
LEVEL OF EVIDENCE: IV, therapeutic study.
|
0 |
The RANK/RANKL/OPG system in tumorigenesis and metastasis of cancer stem cell: Potential targets for anticancer therapy
|
MSTS 2018 - Femur Mets and MM
|
The molecular triad involving receptor activator of nuclear factor κβ (RANK)/ RANK ligand (RANKL)/osteoprotegerin cytokine system has been well implicated in several physiological and pathological processes including bone metabolism, mammary gland development, regulation of the immune function, tumorigenesis and metastasis of cancer stem cell, thermoregulation, and vascular calcification. However, this review aimed to summarize several original and up-to-date articles focusing on the role of this signaling system in cancer cell development and metastasis as well as potential therapeutic agents targeting any of the three tumor necrotic factor super family proteins and/or their downstream signaling pathways. The RANK/RANKL axis has direct effects on tumor cell development. The system is well involved in the development of several primary and secondary tumors including breast cancer, prostate cancer, bone tumors, and leukemia. The signaling of this triad system has also been linked to tumor invasiveness in the advanced stage. Bone is by far the most common site of cancer metastasis. Several therapeutic agents targeting this system have been developed. Among them, a monoclonal antibody, denosumab, was clinically approved for the treatment of osteoporosis and cancer-related diseases.
|
0 |
Midterm Outcomes of the Recently FDA Approved Ceramic on Ceramic Bearing in Total Hip Arthroplasty Patients Under 65 Years of Age
|
Hip Fx in the Elderly 2019
|
The present study aimed to evaluate the mid-term results of the fourth generation of ceramic on ceramic (CC) bearing. Demographics, surgical technique, complications, clinical and radiologic outcomes were analyzed in a series of 133 consecutive CC total hip arthroplasties (THAs) with a newest generation CC bearings to determine if these provide safe and well performing bearings. At the last follow-up, there were no cases of ceramic fracture or chipping and no revision surgery necessary for bearing related complication. One hip underwent two staged revision for infection and another underwent revision for dislocation, resulting in an overall 98.5% survival rate at a mean of 6 years. The newest generation of CC bearings provides a reliable and safe bearing in young, active patients undergoing THA.
|
1 |
The Oxford unicompartmental knee prosthesis: Midterm follow-up
|
Surgical Management of Osteoarthritis of the Knee CPG
|
Background Unicompartmental knee arthroplasty is a relatively conservative form of replacement arthroplasty in that it preserves all the important stabilizing structures of the knee instead of discarding them. Our long-term results obtained with the Oxford unicompartmental knee prosthesis (OUKP) for medial unicompartmental knee osteoarthrosis are presented. Methods Forty-five prostheses in 43 patients were evaluated using the Hospital for Special Surgery (HSS) knee score after 10 years (mean follow-up, 8 years 9 months). Three patients were lost to follow-up because of death. Results The mean HSS score was 177.6 (80% excellent, 10% good, 5% fair, 5% poor). Conclusions These findings confirm the good results reported in other studies, regarding proper patient selection and a consistent operative technique. (copyright) 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
|
0 |
Assessing In-Hospital Outcomes and Resource Utilization After Primary Total Joint Arthroplasty Among Underweight Patients
|
PJI DX Updated Search
|
BACKGROUND: Poor nutritional status is a preventable condition frequently associated with low body mass index (BMI). The purpose of this study is to comparatively analyze low (</=19 kg/m(2)) and normal (19-24.9 kg/m(2)) BMI cohorts, examining if a correlation between BMI, postoperative outcomes, and resource utilization exists. METHODS: Discharge data from the 2006-2012 National Inpatient Sample were used for this study. A total of 3550 total hip arthroplasty (THA) and 1315 total knee arthroplasty (TKA) patient samples were divided into 2 cohorts, underweight (</=19 kg/m(2)) and normal BMI (19-24.9 kg/m(2)). Using the Elixhauser Comorbidity Index, all cohorts were matched for 27 comorbidities. In-hospital postoperative outcomes and resource utilization among the cohorts was then comparatively analyzed. Multivariate analyses and chi-squared tests were generated using SAS software. Significance was assigned at P < .05. RESULTS: Underweight patients undergoing THA were at higher risk of developing postoperative anemia and sustaining cardiac complications. In addition, underweight patients had a decreased risk of developing postoperative infection. Resource utilization in terms of length of stay and hospital charge were all higher in the underweight THA cohort. Similarly, in the underweight TKA cohort, a greater risk for the development of hematoma/seroma and postoperative anemia was observed. Underweight TKA patients incurred higher hospital charge and were more likely to be discharged to skilled nursing facilities. CONCLUSION: Our results indicate that low-BMI patients were more likely to have postoperative complications and greater resource utilization. This serves a purpose in allowing orthopedic surgeons to better predict patient outcomes and improve treatment pathways designed toward helping various patient demographics
|
0 |
Scars and perforator-based flaps in the abdominal region: A contraindication?
|
Panniculectomy & Abdominoplasty CPG
|
Background: Although multiple strategies for autologous breast reconstruction exist, a vertical midline scar in the abdominal wall as a result of previous laparatomy or abdominoplasty represents a major surgical challenge. To date, little research has been conducted on the regeneration potential of the abdominal wall's superficial vascular, perforator and choke vessel system after surgery using a vertical approache. Methods: We present the cases of 8 patients, of whom 7 underwent autologous breast reconstruction. One patient received a thigh reconstruction. All patients had a vertical abdominal midline scar as a result of a previous surgical intervention. In 3 of the 7 patients, the breast was reconstructed using an MS-2-vertical rectus abdominis myocutaneous (VRAM) free flap. In 4 of these patients, an MS-2-transverse rectus abdominis myocutaneous (TRAM) free flap was performed. The thigh reconstruction used a transverse deep inferior epigastric perforator (DIEP) free flap. Clinical follow- up was done 12 months after operation. Results: All 3 patients who received an MS-2-VRAM had good aesthetic results. Vertical midline scars had no negative effect on surgical outcomes, perfusion and tissue viability of the 4 MS-2-TRAM and transverse DIEP free flaps. Conclusion: These clinical findings indicate that the regeneration potential of the abdominal wall's superficial vascular system in the presence of vertical surgical scars has been greatly underestimated. Use of MS-2-VRAM free flaps in patients with vertical abdominal scars seems to be a suitable and successful alternative in the reconstruction algorithm. © 2010 Canadian Medical Association.
|
1 |
Adverse outcomes after total and unicompartmental knee replacement in 101 330 matched patients: a study of data from the National Joint Registry for England and Wales
|
Surgical Management of Osteoarthritis of the Knee CPG
|
BACKGROUND: Total knee replacement (TKR) or unicompartmental knee replacement (UKR) are options for end-stage osteoarthritis. However, comparisons between the two procedures are confounded by differences in baseline characteristics of patients undergoing either procedure and by insufficient reporting of endpoints other than revision. We aimed to compare adverse outcomes for each procedure in matched patients. METHODS: With propensity score techniques, we compared matched patients undergoing TKR and UKR in the National Joint Registry for England and Wales. The National Joint Registry started collecting data in April 1, 2003, and is continuing. The last operation date in the extract of data used in our study was Aug 28, 2012. We linked data for multiple potential confounders from the National Health Service Hospital Episode Statistics database. We used regression models to compare outcomes including rates of revision, revision/reoperation, complications, readmission, mortality, and length of stay. FINDINGS: 25 334 UKRs were matched to 75 996 TKRs on the basis of propensity score. UKRs had worse implant survival both for revision (subhazard ratio [SHR] 2.12, 95% CI 1.99-2.26) and for revision/reoperation (1.38, 1.31-1.44) than TKRs at 8 years. Mortality was significantly higher for TKR at all timepoints than for UKR (30 day: hazard ratio 0.23, 95% CI 0.11-0.50; 8 year: 0.85, 0.79-0.92). Length of stay, complications (including thromboembolism, myocardial infarction, and stroke), and rate of readmission were all higher for TKR than for UKR. INTERPRETATION: In decisions about which procedure to offer, the higher revision/reoperation rate of UKR than of TKR should be balanced against a lower occurrence of complications, readmission, and mortality, together with known benefits for UKR in terms of postoperative function. If 100 patients receiving TKR received UKR instead, the result would be around one fewer death and three more reoperations in the first 4 years after surgery. FUNDING: Royal College of Surgeons of England and Arthritis Research UK
|
0 |
Bacterial endocarditis prophylaxis
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
Bacterial endocarditis (BE) is a disease resulting from the association of morphological alterations of the heart and bacteraemia originating from different sources that at times can be indiscernible (infectious endocarditis). It is classified on the basis of the morphological alteration involved, depending on the clinical manifestations and course of illness, which varies according to the causative microorganism and host conditions (for example, it is characteristic in I.V. drug users). The most common microorganisms involved are: Streptococcus viridans (55%), Staphylococcus aureus (30%), Enterococcus (6%) and HACEK bacteria (corresponding to the initials: Haemophilus, Actinobacillus, Cardiobacterium, Eikenella and Kingella), although on occasions it can also be caused by fungi. The oral microbiological flora plays a very important role in the aetiopathogenesis of BE, given that the condition may be of oral or dental origin. This paper will deal with the prevention of said bacteraemia. Prophylaxis will be undertaken using amoxicillin or clindamycin according to action protocols, with special emphasis placed on oral hygiene in patients with structural defects of the heart
|
1 |
Effects of pre- or postoperative therapeutic exercise on the quality of life, before and after total knee arthroplasty for osteoarthritis
|
Surgical Management of Osteoarthritis of the Knee CPG
|
Objective: To investigate the effects of a preoperative or postoperative rehabilitation program on health related quality of life, for patients affected by final-stage idiopathic knee osteoarthritis, before and after primary total knee arthroplasty. Design: 53 successive patients (aged 68.76 (plus or minus) 5.64 years) were randomly assigned to receive a general strengthening exercise program for 3 weeks preoperatively (PROP, n = 18) or a specific strengthening rehabilitation program for 8 weeks postoperatively (POP, n = 15). The control group followed standard preoperative and postoperative care (CON, n = 20). Measurements: Health status (Short Form-36), functional ability (Iowa Level of Assistance Scale), active range of motion (AROM). Results: PROP group showed improvement in their mental health dimensions preoperatively and better functional readiness at hospital discharge. POP group achieved higher level of functional ability (p < 0.05) after the exercise intervention and realized a substantial increment of AROM (p < 0.05). Conclusions: A preoperative general strengthening exercise program is feasible, seems to be beneficial to patients' mental health affected by final-stage idiopathic knee osteoarthritis and assists in the early return of basic functional abilities during the in-patient rehabilitation period. A postoperative specific strengthening exercise intervention is effective in increasing the active range of motion and restoring rapidly the functional autonomy throughout the out-patient intermediate rehabilitation phase. (copyright) 2008 IOS Press. All rights reserved
|
0 |
Neurologic Injury in Operatively Treated Acetabular Fractures
|
Hip Fx in the Elderly 2019
|
Objectives: The purpose of this study is to evaluate a series of operatively treated acetabular fractures with neurologic injury and to track sensory and motor recovery. Methods: Operatively treated acetabular fractures with neurologic injury from 8 trauma centers were reviewed. Patients were followed for at least 6 months or to neurologic recovery. Functional outcome was documented at 3 months, 6 months, and final follow-up. Outcomes included motor and sensory recovery, brace use, development of chronic regional pain syndrome, and return to work. Results: One hundred thirty-seven patients (101 males and 36 females), average age 42 (17-87) years, met the criteria. Mechanism of injury included MVC (67%), fall (11%), and other (22%). The most common fracture types were transverse + posterior wall (33%), posterior wall (23%), and both-column (23%). Deficits were identified as preoperative in 57%, iatrogenic in 19% (immediately after surgery), and those that developed postoperatively in 24%. A total of 187 nerve deficits associated with the following root levels were identified: 7 in L2-3, 18 in L4, 114 in L5, and 48 in S1. Full recovery occurred in 54 (29%), partial recovery in 69 (37%), and 64 (34%) had no recovery. Forty-three percent of S1 deficits and 29% of L5 deficits had no recovery. Fifty-five percent of iatrogenic injuries did not recover. Forty-eight patients wore a brace at the final follow-up, all for an L5 root level deficit. Although 60% (42/70) returned to work, chronic regional pain syndrome was seen to develop in 19% (18/94). Conclusions: Peripheral neurologic injury in operatively treated acetabular fractures occurs most commonly in the sciatic nerve distribution, with L5 root level deficits having only a 26% chance of full recovery.
|
0 |
Repair of osteochondral defects in the minipig model by OPF hydrogel loaded with adipose-derived mesenchymal stem cells
|
Osteochondritis Dissecans 2020 Review
|
AIM: Critical knee osteochondral defects in seven adult minipigs were treated with oligo(polyethylene glycol)fumarate (OPF) hydrogel combined with autologous or human adipose-derived stem cells (ASCs), and evaluated after 6 months. METHODS: Four defects were made on the peripheral part of right trochleas (n = 28), and treated with OPF scaffold alone or pre-seeded with ASCs. RESULTS: A better quality cartilage tissue characterized by improved biomechanical properties and higher collagen type II expression was observed in the defects treated by autologous or human ASC-loaded OPF; similarly this approach induced the regeneration of more mature bone with upregulation of collagen type I expression. CONCLUSION: This study provides the evidence that both porcine and human adipose-derived stem cells associated to OPF hydrogel allow improving osteochondral defect regeneration in a minipig model.
|
0 |
Evaluation of the acceptability of a sphygmomanometer device in knee extension training following surgical procedures of the knee
|
OAK 3 - Non-arthroplasty tx of OAK
|
BACKGROUND: The postoperative treatment after a standard surgical intervention such as knee arthroplasty, proximal tibial osteotomy or supracondylar osteotomy, can have an important impact on the overall treatment outcome. In most cases, outcomes are positively effected by patients receiving physiotherapy and occupational therapy. Basic movements and range of motion need to be learnt. Self-responsible behaviour, which is similar to exercise programs in sports, needs to be supported. However, in most cases the transfer of training techniques into successful and desired postoperative care is not simple. A training technique needs to be developed which is self-explanatory, effective, encouraging for and accessible to the patient.
OBJECTIVES: The purpose of this study was to describe and evaluate an easy and effective technique to support regular physiotherapy in early postoperative rehabilitation using a sphygmomanometer device. Measurements were undertaken relating to handling, training results and motivation.
DESIGN: This was a descriptive study.
METHODS: Forty one patients were instructed to undertake extension exercises of the knee in the early postoperative phase. A sphygmomanometer cuff was rolled out and placed just below the popliteal fossa, and inflated to 20 mmHg. In this position the patients were prompted to push the knee down with the maximum available power. The quadriceps muscle of the leg is activated when patients extend the knee using two thirds of their maximum power, and then followed by one third of their maximum power. This exercise sequence was carried out three times for 5 seconds. The results were documented by using a patient questionnaire.
RESULTS: Thirteen patients indicated that they felt highly motivated while undertaking the training program. One patient reported poor motivation due to inconvenient handling (preparing the cuff by closing the valve screw or calculating the target value) and six patients reported that the method of handwritten recording of training sessions needed to be improved. There were no technical problems. The training results were rated as being predominantly good. Due to the variation in individual ability in extending the knee, comparison of the overall values obtained could not be done.
CONCLUSION: The use of a sphygmomanometer device is cheap and feasible technique in postoperative independent knee extension training.
|
0 |
Osteoporosis treatment and prevention for postmenopausal women: Current and future therapeutic options
|
Hip Fx in the Elderly 2019
|
Osteoporosis, a "silent disease," is often unrecognized until fracture. Lifestyle modification with nutritional counseling is recommended during menopausal transition. Bone density testing is recommended for women aged 65 years and older, younger postmenopausal women with risk factors, or to follow therapy. Bisphosphonates treat osteoporosis (prevent bone resorption). Raloxifene and hormone therapy prevent bone loss and fracture, with extraskeletal benefits. Denosumab treats osteoporosis, although bone effects reverse rapidly. Teriparatide (anabolic therapy) is considered for women at high risk of fracture. Bazedoxifene with conjugated estrogens, novel delivery of teriparatide, new parathyroid hormone proteins, anti-sclerostin antibodies, cathepsin K inhibitors, and stem cell therapies are in testing. © 2013, Lippincott Williams & Wilkins.
|
1 |
Comparison of bipolar hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures: a concise four-year follow-up of a randomized trial
|
Management of Hip Fractures in the Elderly
|
We performed a four-year follow-up of a randomized controlled trial involving 120 elderly patients with an acute displaced femoral neck fracture who were randomized to treatment with either a bipolar hemiarthroplasty or a total hip arthroplasty. The difference in hip function (as indicated by the Harris hip score) in favor of the total hip arthroplasty group that was previously reported at one year persisted and seemed to increase with time (mean score, 87 compared with 78 at twenty-four months [p < 0.001] and 89 compared with 75 at forty-eight months [p < 0.001]). The health-related quality of life (as indicated by the EuroQol [EQ-5D(index)] score) was better in the total hip arthroplasty group at the time of each follow-up, but the difference was significant only at forty-eight months (p < 0.039). These results confirm the better results in terms of hip function and quality of life after total hip arthroplasty as compared with hemiarthroplasty in elderly, lucid patients with a displaced fracture of the femoral neck
|
0 |
The sitting active and prone passive lag test: An inter-rater reliability study
|
OAK 3 - Non-arthroplasty tx of OAK
|
Background & purpose: To determine inter-rater reliability in identifying a knee extension lag using the sitting active and prone passive lag test (SAPLT). Methods: 56 patients with a diagnosis of knee pain were randomly assigned and independently examined by two physical therapists at a time, to determine the presence of an active or a passive extension lag at the knee. An active lag was determined by the inability of the erectly seated subject to actively extend the involved knee in maximal dorsiflexion of the ankle to the same level as the normal knee held in maximal extension and ankle in maximal dorsiflexion, as seen by the levels of the toes. A passive lag was determined by placing the subject prone with the knees just past the edge of the table and determining the high position of the heel in a fully resting extension position compared to the heel on the normal side. Results: For the sitting active lag test, the inter-rater reliability was 'good' (Kappa 0.792, SE of kappa 0.115, 95% confidence interval). For the prone passive lag test, the inter-rater reliability was 'good' (Kappa 0.636, SE of kappa 0.136, 95% confidence interval). Conclusion: The SAPLT may be incorporated as a simple yet effective test to determine the presence of a knee extension lag. It identifies the type of restraint, active, passive or both, and is suggestive of the most appropriate management. © 2013 Elsevier Ltd.
|
0 |
Fibular nonunion after closed-wedge high tibial osteotomy
|
OAK 3 - Non-arthroplasty tx of OAK
|
UNLABELLED: Closed-wedge valgus high tibial osteotomy (HTO) has been reported to be an effective procedure for the treatment of medial compartment osteoarthritis of the knee. It requires shortening the fibula, for which many techniques have been described. Dislocation of the proximal tibiofibular joint limits the correction angle of the procedure and the osteotomy of the fibular head runs the rare but dramatic risk of common fibular nerve palsy, which is why many surgeons perform the osteotomy more distally at the shaft. However, the potential complications of fibula shaft osteotomy in closed-wedge proximal tibial osteotomy have been poorly reported. The purpose of this study is to accurately define the incidence and risk of fibular complications.
MATERIALS AND METHODS: One hundred and eight patients (59 men, 49 women, 53+/-10years old, preoperative varus: 6.7degree+/-4degree) underwent a closed-wedge HTO with fibular shaft osteotomy between 1999 and 2004. They were followed up prospectively for clinical and radiological evaluation (2years of follow-up). The main evaluation criterion was the presence of fibular nonunion.
RESULTS: Eighteen knees (16.6%) underwent fibular complications: 15 nonunions were indexed (13.9%); 11 of them (10.1%) required surgical revision. Three knees had nerve injury, with spontaneous recovery for two of them.
DISCUSSION: Fibular nonunion is the most frequent complication, which often leads to revision procedures. Nonunion was correlated to the preoperative body mass index, the obliquity of the osteotomy plane, and the fragmentary contact. No nonunion was reported when the obliquity of the osteotomy plane was above 50degree or the fragment contact greater than 50%.
LEVEL OF EVIDENCE: Level IV, therapeutic study.
|
0 |
Transcutaneous electric nerve stimulation: The effect of intensity on local and distal cutaneous blood flow and skin temperature in healthy subjects
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
Objective: To determine what effect transcutaneous electric nerve stimulation (TENS) intensity has on local and distal cutaneous blood flow and skin temperature. Design: Double-blind conditions. Setting: University research laboratory. Participants: Forty subjects (20 men, 20 women) randomly assigned to 1 of 4 groups (10 per group): control, above-motor-threshold TENS, below-motor-threshold TENS, or perception-threshold TENS. Intervention: TENS (4Hz, 200(mu)s) was applied over the median nerve of the right forearm for 15 minutes. Main Outcome Measures: Blood flow measured by laser Doppler flowmeter and skin temperature measured by skin thermistor were recorded during TENS and for 15 minutes after it. Results: Significant differences occurred between groups for forearm (P < .0001; repeated-measures analysis of variance) but not fingertip cutaneous blood flow. Post hoc Fisher tests showed a significant increase in forearm blood flow during TENS application in the above-motor-threshold TENS group compared with the other 3 groups. No significant differences between groups for skin temperature data were observed. Conclusions: The effect of TENS on cutaneous blood flow depends on whether muscle activity is induced. Low-frequency TENS applied above the motor threshold significantly increases local cutaneous blood flow. There were no significant differences between groups for skin temperature. (copyright) 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation
|
0 |
Abdominal compartment syndrome: clinical manifestations and predictive factors
|
DOD - Acute Comp Syndrome CPG
|
PURPOSE OF REVIEW: Abdominal compartment syndrome (ACS) is the end result of sustained, uncorrected intraabdominal hypertension. In clinical and laboratory settings, ACS has been shown to adversely affect all vital organ systems. Although early descriptions emanated from the trauma literature, ACS is now encountered in all intensive care unit populations. In this review, we examine the literature and identify factors that may predict the onset of ACS.
RECENT FINDINGS: The pathogenesis of ACS remains unclear, and few studies have sought to identify predictive clinical variables. Peak airway pressure and net 24-hour fluid gradient are the only variables that have been identified in the available literature as predictive of ACS development in controlled studies.
SUMMARY: The earlier recognition of predictive variables and identification of patients at higher risk will hopefully lead to recognition and avoidance of the sequelae and increased mortality rate associated with ACS.
Copyright 2003 Lippincott Williams & Wilkins [References: 24]
|
1 |
Phase III clinical trial of thalidomide plus dexamethasone compared with dexamethasone alone in newly diagnosed multiple myeloma: A clinical trial coordinated by the eastern cooperative oncology group
|
MSTS 2018 - Femur Mets and MM
|
Purpose: To determine if thalidomide plus dexamethasone yields superior response rates compared with dexamethasone alone as induction therapy for newly diagnosed multiple myeloma. Patients and Methods: Patients were randomly assigned to receive thalidomide plus dexamethasone or dexamethasone alone. Patients in arm A received thalidomide 200 mg orally for 4 weeks; dexamethasone was administered at a dose of 40 mg orally on days 1 to 4, 9 to 12, and 17 to 20. Cycles were repeated every 4 weeks. Patients in arm B received dexamethasone alone at the same schedule as in arm A. Results: Two hundred seven patients were enrolled: 103 were randomly assigned to thalidomide plus dexamethasone and 104 were randomly assigned to dexamethasone alone; eight patients were ineligible. The response rate with thalidomide plus dexamethasone was significantly higher than with dexamethasone alone (63% v 41 %, respectively; P = .0017). The response rate allowing for use of serum monoclonal protein levels when a measurable urine monoclonal protein was unavailable at follow-up was 72% v 50%, respectively. The incidence rates of grade 3 or higher deep vein thrombosis (DVT), rash, bradycardia, neuropathy, and any grade 4 to 5 toxicity in the first 4 months were significantly higher with thalidomide plus dexamethasone compared with dexamethasone alone (45% v 21%, respectively; P < .001). DVT was more frequent in arm A than in arm B (17% v 3%); grade 3 or higher peripheral neuropathy was also more frequent (7% v 4%, respectively). Conclusion: Thalidomide plus dexamethasone demonstrates significantly superior response rates in newly diagnosed myeloma compared with dexamethasone alone. However, this must be balanced against the greater toxicity seen with the combination. © 2006 by American Society of Clinical Oncology.
|
0 |
Nationwide survey for bisphosphonate-related osteonecrosis of the jaws in Japan
|
MSTS 2018 - Femur Mets and MM
|
Purpose: A nationwide retrospective cohort study was conducted by the Japanese Society of Oral and Maxillofacial Surgeons to assess the occurrence of bisphosphonate (BP)-related osteonecrosis of the jaws (BRONJ) during 2006 to 2008 and to elucidate the outcome and factors associated with remission of BRONJ. Materials and Methods: A written questionnaire, including the clinical characteristics, management, and outcome of patients with BRONJ, was sent to 248 institutions certified as training facilities by the Japanese Society of Oral and Maxillofacial Surgeons in 2008. Results: A total of 568 patients with BRONJ, including suspicious cases, were registered. Of these 568 patients, 263, including the maxilla in 81, the mandible in 160, and both in 22, met the working definition of BRONJ proposed by the American Association of Oral and Maxillofacial Surgeons. The patients included 219 women (83.3%) and 44 men (16.7%). Of these patients, 152 (57.8%) had received intravenous BPs, 104 (39.5%) had received oral BPs, and 7 (2.7%) had received both. The mean duration of administration until onset of BRONJ was 23.6 months for intravenous BPs and 33.2 months for oral BPs. BRONJ was stage 1 in 42 patients (16.0%), stage 2 in 187 (71.1%), stage 3 in 32 (12.2%), and unknown in 2. Of these patients, 34.2% had remission of BRONJ, 46.0% had persistent or progressive disease, and 19.7% died of malignancy or were lost to follow-up. Statistical analysis revealed that surgical treatment, including tooth extraction, sequestrectomy, and segmental mandibulectomy, contributed to the remission of BRONJ. In contrast, conservative treatment, concurrent anticancer drugs, poor oral hygiene, and the use of intravenous BPs did not. Conclusions: The relative ratio of BRONJ related to the use of oral BPs was greater in Japan than in the United States and European Union. Surgical treatment contributed to remission of BRONJ, and conservative treatment, concurrent anticancer drugs, poor oral hygiene, and intravenous BPs did not. © 2011 American Association of Oral and Maxillofacial Surgeons.
|
1 |
Dental bacteremia and its relationship to bacterial endocarditis: preventive measures
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
This article indicates that using local degerming agents in conjunction with traditional antibiotics prevents dental bacteremia more effectively than either procedure alone. In many patients at risk for endocarditis who practice home-care procedures than can produce bacteremia from gingival bleeding, daily antibiotic prophylaxis is impractical and contraindicated. This article discusses an effective method to control daily bacteremia with 0.2% chlorhexidine mouthwash. The article also attempts to identify patients at risk, determine the degree that they are exposed to potentially bacteremic situations, and encourage an aggressive team approach of physician and dentist to protect such patients adequately. Recommendations to prevent bacteremia are offered to supplement traditional antibiotic regimens
|
0 |
Upper tibial osteotomy for secondary osteoarthritis of the knee
|
AMP (Acute Meniscal Pathology)
|
Of 34 consecutive proximal tibial osteotomies for secondary degenerative arthritis in patients under 40 years of age, 33 were evaluated at least three years (mean 7.5 years) after operation. In all 73% were satisfactory, with four failures in 21 procedures in men and five failures in 12 procedures in women. The primary abnormalities were medial meniscectomy (11), medial and lateral meniscectomy (4), osteochondritis dissecans (3), osteochondritis dissecans with medial meniscectomy (4) and fracture (11). All four knees with both medial and lateral meniscectomy had unsatisfactory results despite obtaining anatomical alignment. Eight patients needed subsequent surgery; five of them had total knee replacement, four within four years of the osteotomy. Proximal tibial osteotomy in younger patients with secondary arthritis gives similar results to those for older patients with primary osteoarthritis. If it fails, this is generally within the first four years after the operation.
|
0 |
Percutaneous cannulated screw fixation of acute scaphoid fractures
|
Distal Radius Fractures
|
Percutaneous cannulated screw fixation (PCSF) of acute scaphoid fractures has been shown to consistently produce good results. It is less invasive and avoids damage to the radiocarpal ligaments. The scar is good. The procedure could be performed under Bier's block anaesthesia. No cast is required after the operation and the range of wrist motion is regained early. Most recently reported series achieved more than 95% primary radiological fracture union. The functional results were good. The surgical technique of PCSF is described in detail and special tricks for difficult problems are highlighted. [References: 28]
|
1 |
Serum ropivacaine levels after local infiltration analgesia during total knee arthroplasty with and without adductor canal block
|
AAHKS (9/10) Regional Nerve Blocks
|
BACKGROUND AND OBJECTIVES: A common analgesic technique for total knee arthroplasty (TKA) is to inject local anesthetic into the periarticular tissue during surgery, known as local infiltration analgesia (LIA). Since the solution used typically contains a large amount of local anesthetic, concerns arise about exceeding the maximum dosage when adding a peripheral nerve block. Little research exists that addresses serum ropivacaine concentrations following LIA combined with peripheral nerve block. We hypothesized that after combining LIA and adductor canal blockade (ACB), serum ropivacaine concentrations would remain below levels associated with local anesthetic toxicity.
METHODS: This was a prospective observational study that included 14 subjects undergoing TKA with intraoperative LIA containing 270 mg ropivacaine with epinephrine. Patients weighing less than 80 kg were excluded due to standardized dosing by our pharmacy. Seven patients were assigned consecutively to receive LIA alone (Group LIA) and seven were assigned to receive LIA plus ACB with 100 mg ropivacaine with epinephrine (Group LIA+ACB). Venous serum ropivacaine concentrations were measured over 24 hours.
RESULTS: Peak serum concentrations (Cmax) in Group LIA ranged from 0.23 to 0.75 micro g/mL and occurred at times from 4 to 24 hours. Cmax in Group LIA+ACB ranged from 0.46 to 1.00 micro g/mL and occurred at times from 4 to 8 hours. No participants demonstrated signs or symptoms of local anesthetic toxicity.
CONCLUSIONS: Total serum concentration of ropivacaine after LIA using 270 mg ropivacaine with and without an additional 100 mg perineural ropivacaine remained well below the toxicity threshold of 3.0 micro g/mL at all time points. Additional studies are needed to ascertain the safety of combining LIA with peripheral nerve blockade.
|
0 |
American Society of Anesthesiologist Physical Status score may be used as a comorbidity index in hip fracture surgery
|
Management of Hip Fractures in the Elderly
|
Comorbidities affect outcome, but there is no consensus which comorbidity instrument is best in orthopedic surgery. We assessed whether the American Society of Anesthesiologists Physical Status score (ASA) predicts long-term mortality after hip fracture. We followed 1635 patients for 5 to 10 years after operative treatment of hip fracture. Unadjusted Kaplan-Meyer statistics indicated that the overall survival of the patients was 4.7 (95% confidence interval [CI], 4.5-4.9) years, but survival varied significantly between the ASA groups. Survival for ASA 1 was 8.5 years (95% CI, 7.8-9.2); for ASA 2, it was 5.6 years (95% CI, 5.3-5.9); for ASA 3, it was 3.5 years (95% CI, 3.2-3.7); and for ASA 4, survival was 1.6 years (95% CI, 1.0-2.1). The ASA predicts long-term mortality after hip fracture treatment
|
0 |
Load-Sharing at the Wrist Following Radial Head Replacement with a Metal Implant: A Cadaveric Study
|
Distal Radius Fractures
|
Background: Surgical excision of the radial head is frequently required after a comminuted fracture of the radial head. The outcome of this procedure is often unpredictable, with some patients experiencing ulna-sided pain in the wrist secondary to proximal migration of the radius. Insertion of a radial head prosthesis could prevent proximal radial migration and restore normal load-sharing at the wrist. The thickness of the radial head implant is an important variable in restoring anatomical radial length; however, the effects of varying the length of implants that were used to reconstruct the radius on load-sharing at the wrist have not been studied biomechanically, to our knowledge. Methods: A miniature load cell was attached to fifteen fresh-frozen cadaveric forearms to record force in the distal part of the ulna as the wrist was axially loaded to 134 N of compression force. Proximal displacement of the radius relative to the capitellum was also recorded. Loading tests on intact forearms were performed with the elbow in valgus and varus alignment and with three positions of wrist rotation (neutral, 45° of pronation, and 45° of supination). Loading tests were then repeated, with the same positions of varus and valgus elbow alignment and wrist rotation as had been used in the tests of the intact forearm, after radial head excision and subsequent insertion of metal radial head implants that restored anatomical length, implants that produced a radial length that was longer than the anatomical length, and implants that produced a radial length that was shorter than the anatomical length. Testing of these different implant thicknesses was repeated after sectioning of the interosseous membrane. Results: The mean distal ulnar forces and mean proximal radial displacements following insertion of an implant that restored anatomical length were not significantly different from the corresponding values for the intact forearm. At neutral wrist rotation, replacing that implant with an implant that increased the radial length by 4 mm (after sectioning of the interosseous membrane) decreased the mean distal ulnar force from 13.4% to 3.3% of the applied wrist force with the elbow in valgus alignment and from 29.1% to 8.6% with the elbow in varus alignment. Replacing the implant that restored anatomical length with one that decreased the length by 4 mm (after sectioning of the interosseous membrane) significantly increased the mean distal ulnar force from 13.4% of the applied wrist load to 33.3% with the elbow in valgus alignment and from 29.1% to 51.6% with it in varus alignment. The mean distal ulnar forces were not significantly affected by the position of wrist rotation when the elbow was in valgus alignment. However, when the elbow was in varus alignment, the mean distal ulnar forces associated with all reconstructed radial lengths were significantly higher when the wrist was placed in 45° of supination. Conclusions: In this cadaveric model, insertion of a metal implant maintained distal ulnar forces at normal levels, at all three positions of wrist rotation, when the radius had been restored to its original anatomical length. Distal ulnar forces and proximal radial displacements were significantly affected by the reconstructed length of the radius. Clinical Relevance: Radial head implants are utilized to prevent proximal migration of the radius as the wrist is loaded; this is especially important when the interosseous membrane has been ruptured and thus cannot help to limit radial displacement. At the time of surgery, comminution and displacement of a radial head fracture may make estimation of the original radial length difficult. Our results demonstrate that, in terms of distal ulnar loading, it is preferable to insert an implant that is too thick rather than too thin.
|
0 |
Fractures of the distal radius and ulna
|
Distal Radius Fractures
|
Associated fractures of the distal ulnar metaphysis were present in 19 of 320 distal radial fractures requiring either closed manipulation or surgical treatment over a 2-year period. Four morphological patterns of ulnar fracture were encountered, the commonest being the type 1 simple extra-articular fracture of the distal end of ulna with minimal comminution (eight out of 19). 15 patients were treated conservatively and two each were treated by internal and external fixation. 15 patients were reviewed after a mean follow-up of 23.8 months and there were four excellent, five good, five fair clinical results and one poor result. Radiographically the distal radio-ulnar joint (DRUJ) was normal in eight wrists, but longitudinal or horizontal disruption of the DRUJ was present in seven wrists. Fracture callus encroached on the DRUJ in three patients, who also had limitation of forearm rotation. Two comminuted ulnar fractures (type 4) developed non-union, but both patients had full forearm rotation, in contrast to restriction of forearm rotation in four out of five patients with type 1 fractures.
|
0 |
Safety of osseointegrated implants for transfemoral amputees: A two-center prospective cohort study
|
DoD LSA (Limb Salvage vs Amputation)
|
Background: Osseointegrated implants are an alternative for prosthetic attachment for individuals unable to wear a socket following an amputation. The concept of an integrated metal implant communicating with the external environment raises substantial concern about the risk of ascending infection. We report on the safety of press-fit osseointegrated implants currently used in Australia and the Netherlands. Methods: We prospectively recorded all adverse events in all patients with transfemoral amputation who were managed with an osseointegration implant system between 2009 and 2013 at two centers. The procedure was performed in two stages. A customized porous-coated implant was placed in the first stage, and a stoma was created in the second. Adverse events were categorized according to type (infection or "other") and severity. Infections were classified according to four grades of severity based on clinical and radiographic findings: (1) low-grade soft-tissue infection, (2) high-grade softtissue infection, (3) bone infection, and (4) septic implant failure. Results: Eighty-six patients (ninety-one implants), twenty-five to eighty-one years of age, were included in the study and followed for a median of thirty-four months (range, twenty-four to seventy-one months). Thirty-one patients had an uneventful course with no complications; twenty-nine developed infection (all grade 1 or 2); and twenty-six did not develop infection but had one or more other complications requiring intervention, including stoma hypergranulation (seventeen patients), soft-tissue redundancy (fourteen), proximal femoral fracture (three), inadequate osseointegration leading to implant replacement (one), implant breakage (two), and breakage of the pin used as a fail-safe mechanism (twenty-five). Conclusions: Mild infection and irritation of the soft tissue in the skin-penetration area are common in transfemoral amputees who have an osseointegrated implant. These complications were successfully managed with simple measures. Severe infections resulting in septic implant loosening are rare.
|
0 |
DTI parameters of axonal integrity and demyelination of the optic radiation correlate with glaucoma indices
|
Upper Eyelid and Brow Surgery
|
BACKGROUND: In glaucoma, damage of retinal ganglion cells may continue to the linked optic radiations. This study investigates the correlation of glaucoma severity indicators with parameters of axonal and myelin integrity of the optic radiations. METHODS: In this observational case-control study, 13 patients with normal-tension glaucoma, 13 patients with primary open-angle glaucoma, and seven control subjects (mean age, 57.6 +/- 12.5 years) were randomly selected for diffusion tensor imaging (DTI) of the optic radiations. The results of the frequency doubling test (FDT) and the HRT-based linear discriminant functions of Burk (BLDF) and Mikelberg (MLDF) were correlated with the mean of the fractional anisotropy (FA), apparent diffusion coefficient (ADC), and radial diffusivity (RD) of the optic radiations. Multiple correlation analysis, corrected for age, stage of cerebral microangiopathy, diagnosis group, and gender was conducted at increasing thresholds of linear anisotropy (C(L)) to reduce mismeasurements because of complex fiber situations. RESULTS: The best correlations were found for BLDF with FA at C(L) threshold 0.3 (0.594, p = 0.001), with ADC at C(L) 0.4 (-0.511, p = 0.005), and with RD at C(L) 0.4 (-0.585, p = 0.001). MLDF correlated with FA at C(L) 0.4 (0.393, p = 0.035). The FDT score correlated with FA at C(L) 0 (-0.491, p = 0.007) and with RD at C(L) 0 (-0.375, p = 0.045). CONCLUSIONS: In glaucoma, DTI-derived parameters of the axonal integrity (FA, ADC) and demyelination (RD) of the optic radiation are linked to HRT-based indices of glaucoma severity and to impairment of the spatial-temporal contrast sensitivity.
|
0 |
Cementless fixation in high performance knee design
|
PJI DX Updated Search
|
Although cemented fixation in total knee arthroplasty remains the gold standard, new interest in cementless fixation has returned. Earlier implant designs for use in cementless fixation have been associated with high failure rates but newer implants have achieved similar results to their cemented counterparts. This is in part due to advances in the technique and the introduction of new porous materials and design modifications. Cementless techniques can achieve better bony fixation, have less potential for backside wear, and may result in better bone stock. We report excellent results on 177 trabecular metal (TM) (porous tantalum) monoblock tibial components using a minimal invasive technique. Although our experience with cementless TM tibia and fiber metal femur has been excellent, the high failure rate of the TM monoblock patella led us to abandon the implant in favor of an all-polyethylene component. Therefore, excellent results are possible with cementless tibial and femoral fixation but the ideal method for patellar fixation remains to be determined. Copyright é 2011 by Lippincott Williams & Wilkins
|
1 |
Simultaneous cemented and cementless total knee replacement in the same patients: a prospective comparison of long-term outcomes using an identical design of NexGen prosthesis
|
Surgical Management of Osteoarthritis of the Knee CPG
|
The purpose of this prospective, randomised study was to evaluate the clinical and radiological results comparing the identical cemented or cementless NexGen total knee prostheses implanted bilaterally in the same patient. Sequential simultaneous bilateral total knee replacements were performed in 50 patients (100 knees). There were 39 women and 11 men with a mean age of 58.4 years (51 to 67) who received a cemented prosthesis in one knee and a cementless prosthesis in the other. The mean follow-up was 13.6 years (13 to 14). At final review, the mean Knee Society scores (96.2 (82 to 100) versus 97.7 (90 to 100)), the mean Western Ontario and McMaster Universities osteoarthritis index (34.5 (4 to 59) versus 35.6 (5 to 51)), the mean ranges of knee movement (124 degrees (100 degrees to 140 degrees ) versus 128 degrees (110 degrees to 140 degrees )), mean patient satisfaction (8.1 (SD 1.9) versus 8.3 (SD 1.7)), and radiological results were similar in both groups. The rate of survival of the femoral components was 100% in both groups at 14 years. The rate of survival of the cemented tibial component was 100% and 98% in the cementless tibial component. No osteolysis was identified in either group. Our data have shown no advantage of cementless over cemented components in total knee replacement
|
0 |
Rehospitalization after hip fracture: predictors and prognosis from a national veterans study
|
Hip Fx Time to Surgery
|
OBJECTIVES: To estimate the risk and long-term prognostic significance of 30-day readmission postdischarge of a 4-year cohort of elderly veterans first admitted to Medicare hospitals for treatment of hip fractures (HFx), controlling for comorbidities. DESIGN: Retrospective, national secondary data analysis. SETTING: National Medicare and Veterans Health Administration (VHA) facilities. PARTICIPANTS: The study cohort was 41,331 veterans with a HFx first admitted to a Medicare eligible facility during 1999 to 2002. MEASUREMENTS: HFxs were linked with all other Medicare and VHA inpatient discharge files to capture dual inpatient use. Logistic regression was used to examine the relationship between 30-day readmission and age, sex, inpatient length of stay, and selected Elixhauser comorbidities. RESULTS: Approximately 18.3% (7,579/41,331) of HFx patients were readmitted within 30 days. Of those with 30-day readmissions, 48.5% (3,675/7,579) died within 1 year, compared with 24.9% (8,388/33,752) of those without 30-day readmissions. Readmission risk was significantly greater in the presence of specific comorbidities, ranging from 11% greater risk for patients with fluid and electrolyte disorders (95% confidence interval (CI)=1.04-1.20) to 43% for renal failure (95% CI=1.29-1.60). For this cohort, cardiac arrhythmias (24%), chronic pulmonary disease (28%), and congestive heart failure (16%) were common comorbidities, and all affected the risk of 30-day readmission. CONCLUSION: Patients with HFx with 30-day readmissions were nearly twice as likely to die within 1 year. Identification of several predictive comorbidities at discharge and examination of reasons for subsequent readmission suggests that readmission was largely due to active comorbid clinical problems. These comorbidity findings have implications for the current Centers for Medicare and Medicaid Services (CMS) pay-for-performance initiatives, especially those related to better coordination of care for patients with chronic illnesses. These comorbidity findings for elderly patients with HFx may also provide data to enable CMS and healthcare providers to more accurately differentiate between comorbidities and hospital-acquired complications under the current CMS initiative related to nonpayment for certain types of medical conditions and hospital acquired infections.
|
1 |
Treatment of periprosthetic femoral fractures with the Bicontact revision stem
|
MSTS 2018 - Femur Mets and MM
|
PURPOSE: Periprosthetic fractures in cases without prior loosening of the stem can be treated with open reduction and internal fixation, but cases with preexisting loosening and/or bone defects present specific challenges to the surgeon. The keys to the success of intramedullary stabilization of femoral fractures--reconstruction of length, axis and rotation rather than meticulous reduction of the fragments and minimal impact on fragment vascularization by the surgical approach--can be transferred to the treatment of periprosthetic fractures.
METHOD: The Bicontact revision stem can be regarded as a combination of an interlocking nail in its distal part and a proximally coated femoral stem in its proximal part. The transfemoral approach respects the vascularization of the bone, although it is not minimally invasive. Forty-one patients with a mean age of 72.3 years and a periprosthetic fracture were included in this study. According to the Vancouver classification there were 2 type A fractures of the trochanteric region, 14 were B1, 8 were B2 with prior loosening, 13 were B3 with significant bone loss, and 2 fractures were distal to the tip of the prosthesis (type C).
RESULTS: In all patients, intramedullary stabilization with a Bicontact revision stem was performed. All but three fractures healed (pathologic fracture with multiple myeloma in one case, impaired bone healing in two cases). In 7 patients, further procedures had to be undertaken (new periprosthetic fracture in 2, loosening and revision with a standard prosthesis in 2, revision with a long stem prosthesis together with bone grafting in 3 cases). At follow-up, after a mean of 4.3 years, all patients were able to walk, and the mean Harris Hip Score was 71.1 points.
CONCLUSION: In conclusion, combined application of the principles of intramedullary nailing and of uncemented total hip replacement by use of the distally interlocked Bicontact revision stem enables successful treatment of periprosthetic femoral fractures.
|
0 |
Prediction functional independence measure in hip fracture patients
|
Hip Fx in the Elderly 2019
|
The importance of early inclusion in rehabilitation program and exercise of older people after the hip fracture could be explained by the fact that physical activity influences the muscle strength, balance and eventually degree of hip pain [11]. Such determinants are very important particularly for individuals quality of life and could prevent further risks of comorbidities and falls later in life. It has been often hypothesized that the success of recovery is extremely dependent on the timeliness and adequacy of the treatment. While it is desirable to provide the best possible care as soon as possible the actual limitations that may exist in health-care systems due to a limited number of medical staff as well as limited capacity in rehabilitation programs may create need for appropriate planning and/or scheduling.
|
1 |
Association of hospital and surgeon procedure volume with patient-centered outcomes of total knee replacement in a population-based cohort of patients age 65 years and older
|
Surgical Management of Osteoarthritis of the Knee CPG
|
OBJECTIVE: To study the association between procedure volume and patient-centered outcomes such as functional status. METHODS: We performed an observational study of a stratified random sample of Medicare beneficiaries who underwent primary total knee replacement (TKR) in 2000. Low-volume surgeons were defined as surgeons performing < or =6 TKRs per year in the Medicare population, and low-volume centers were defined as those in which < or =25 TKRs per year were performed. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) functional status score (0-100 scale; 100 = best) 2 years after TKR. We defined a WOMAC functional status score of <60 as a poor functional outcome. Analyses were adjusted for sociodemographic factors, preoperative functional status, and comorbidities. RESULTS: Fifty-eight percent of 1,597 eligible patients agreed to participate. Twelve percent of participating patients had a WOMAC score <60 2 years following TKR. Patients operated upon by low-volume surgeons in low-volume hospitals were twice as likely to have a poor WOMAC functional status score as patients operated upon by higher volume surgeons and in higher volume hospitals (odds ratio 2.1, 95% confidence interval 1.1-4.2). CONCLUSION: Patients operated upon in low-volume hospitals by low-volume surgeons had worse functional outcomes 2 years after TKR. These findings add a new and important dimension to the discussion of whether to promote selective referral of procedures such as TKR to high-volume centers
|
0 |
Colles' fracture associated with reduced bone mineral content. Photon densitometry in 74 patients with matched controls
|
Distal Radius Fractures
|
In a prospective population-based investigation, we measured bone mineral density (BMD) of the forearm using single-photon absorptiometry at both a distal and a more proximal site in 74 Colles'-fracture patients who were compared with controls matched for age, sex, and years after menopause. For both groups there was a marked inverse relationship between age and bone mass. However, over the entire age range, the probands had 11 percent reduced BMD when compared with the controls. Our findings confirm that patients with fracture of the distal forearm have reduced BMD. They constitute an appropriate group for studies aimed at prevention of fracture in the elderly.
|
0 |
The abdominal compartment syndrome in patients with burn injury
|
DOD - Acute Comp Syndrome CPG
|
INTRODUCTION: Intra-abdominal hypertension (IAH) and subsequent abdominal compartment syndrome (ACS) in burned patients is common. This sequence of events typically occurs in patients with larger burns receiving high volume fluid resuscitation.
METHODS: A review of the literature was performed. The National Library of Medicine (PUBMED) was queried for "Burn" and "Abdominal Compartment Syndrome". Twenty-nine articles were retained for study.
RESULTS: Abdominal pressure monitoring is appropriate in all patients with burns that require significant volume resuscitation (>30% total burned surface area-TBSA). Prevention of ACS in burns includes limiting fluid resuscitation, burn escharotomy, and percutaneous drainage when abdominal pressures are reaching perilous levels. Treatment includes all of the above and in addition, decompressive laparotomy when needed. However, despite decompressive laparotomy, mortality rates among burn victims with ACS remain unacceptably high.
CONCLUSION: Increasing amounts of volume delivery are associated with an increased risk of IAH. Therefore, intra-abdominal pressure should be monitored in all burn patients requiring massive fluid resuscitation. Escharotomy, paracentesis, and decompressive laparotomy may all be needed to counter the side effects of appropriate fluid resuscitation in the severely burned patient. Nevertheless, the prognosis in burn patients developing ACS is grim. [References: 26]
|
0 |
Prospective study of the effect on gait of a two-component total ankle replacement
|
OAK 3 - Non-arthroplasty tx of OAK
|
BACKGROUND: The purpose of this study was to evaluate the functional outcome as measured by prospective gait analysis of patients undergoing total ankle arthroplasty using a 2-component Salto Talaris total ankle prostheses with a fixed polyethylene bearing.
METHODS: Twenty-one patients with severe ankle arthritis who underwent unilateral total ankle arthroplasty using a 2-component Salto Talaris device with a fixed polyethylene bearing were studied prospectively. Mean age was 69 years in 16 female and 5 male patients, and mean follow-up was 37.2 (range, 24-50) months. Three-dimensional gait analysis was performed using a 12-camera digital-motion capture system preoperatively and repeated at a minimum of 2 years postoperatively. Temporospatial measurements included velocity, cadence, step length, and support times. Measured kinematic parameters included sagittal plane range of motion of the ankle, knee, and hip. Kinetic parameters included sagittal plane ankle power and ankle plantarflexion moment.
RESULTS: There was significant improvement in temporospatial parameters, including step length (P = .014) and walking velocity, which increased from 0.9 to 1 m/s (P = .01). Kinematic results showed sagittal plane range of motion of the ankle increased significantly from a mean of 15.8 degrees preoperatively to 20.6 degrees (P = .00005) postoperatively with the increase occurring primarily in dorsiflexion. Kinetic results showed ankle peak power increased from a mean of 0.7 Nm/kg to 1.1 Nm/kg (P = .004).
CONCLUSIONS: A prospective study of gait in patients undergoing total ankle arthroplasty using a 2-component Salto Talaris device with a fixed polyethylene bearing showed, at midterm follow-up, significant improvements in multiple parameters of gait when compared to the patients' own preoperative function.
LEVEL OF EVIDENCE: Level IV, prospective case series.
|
0 |
The bone-vacuum cementing technique for the fixation of the stem in total hip arthroplasty
|
Management of Hip Fractures in the Elderly
|
The bone-vacuum cementing technique is a promising method developed to obtain reliable fixation of the femoral component. Previous studies showed that intraoperative embolic complications, cardiopulmonary impairment, and deep venous thrombosis can be prevented when this technique is used. The specific aims of the present investigation were to provide additional treatment outcome information, to identify risk factors for poor results, and to define the need of surgical technique improvement by risk factor analysis. The first 118 consecutive patients (121 hips) who had primary total hip arthroplasty using the bone-vacuum cementing technique and an anatomical stem were followed-up for a mean of 2.5 years (1 to 4 years). The mean age of patients at index operation was 73 years. Current criteria were used for clinical and radiological assessment. At the time of the latest follow-up, 3 patients (3 hips, 2.5%) had been lost, and 9 patients (9 hips, 7.5%) had died. However, the status of the hip joint at the time of death could be verified in all patients. Thus, the clinical outcome of 115 patients (118 hips, 97.5%) was known. Radiographs were available for 102 patients (104 hips) who were alive for the entire follow-up period. The mean preoperative Harris Hip Score was rated 51, and it had improved to 92 at the time of follow-up. The score was good for 70 hips and excellent for 42 hips, so the rate of clinical success was 95%. Six patients (6 hips, 5%) had a fair result. Two of them had a fracture of the greater trochanter after the index operation, requiring internal fixation. Four hips with severe acetabular dysplasia had persistent limp and limited motion. The quality of the cement mantle was rated good (grade A and B) in 108 of 121 hips (89.5%). Nineteen of the 108 hips presented at least one small void in the cement mantle (grade C1). Insufficient thickness of the cement mantle (grade C2) was present in 10 hips (8%). Failure of cement to extend below the tip of the stem (grade D) was observed in the remaining 3 hips (2.5%). In the present series no femoral component required revision because of aseptic loosening, and there was no radiographic evidence of aseptic loosening at follow-up. Radiolucencies without progression were found in Gruen zone 1 in 11 of 104 hips (10.6%), and in zone 7 in 7 hips (6.7%). In one hip (0.9%) ballooning osteolysis was observed in zone 7. Seventy-five hips (72%) had either no change in femoral bone density or only patchy loss of bone density isolated to Gruen zones 1 and 7. Twenty-nine hips (28%) had some reduction of bone density isolated to zones 1 and 7. A slight cortical hypertrophy was seen in 4 hips (3.8%). Of the whole series, one hip required revision surgery because of septic loosening 2 years after the index operation. At an average of 2.5 years postoperatively, the femoral component inserted using the bone-vacuum technique functioned well overall, and patient satisfaction was high. Clinical and radiological results do not contrast with those achieved using contemporary cementing techniques
|
0 |
Paediatric fracture clinic referrals: What does it consist of?
|
Distal Radius Fractures
|
Aim: To assess the pattern of new cases referred to fracture clinic at a large paediatric university teaching hospital. Materials and Methods: The study was carried out over a four-week period in May and June of 2010. A total of 864 patients were seen during this period, which included 310 new cases and 554 follow up cases. The radiographs and reports were analysed to collect the data. Results: Two hundred and ninety two new cases were analysed as 18 cases did not have radiographs available. One hundred and one (34%) cases did not have any fractures and 14 (5%) were suspected fractures. Fractures of the distal radius and ulna were the predominant cases (23%) followed by hand fractures (15%). Conclusion: Significant number of patients (34%) did not have fractures. Considerable amount of time can be saved especially in a busy fracture clinic ifprotocols are developed to manage new referrals.
|
1 |
Bone injury associated with anterior cruciate ligament and meniscal tears: assessment with bone single photon emission computed tomography
|
Anterior Cruciate Ligament Injuries CPG
|
RATIONALE AND OBJECTIVES: Acute injury of the menisci and ligaments about the knee joint is often associated with accompanying bone injury. The role of bone single photon emission computed tomography (SPECT) was assessed in this clinical setting. MATERIALS AND METHODS: Knee SPECT was performed in 94 patients with suspected ACL, meniscal tear, or both and was correlated with arthroscopy (n = 74), magnetic resonance imaging (MRI) (n = 37), or both. Scintigraphic findings were categorized based on their anatomic location and on uptake intensity (0-3 grade scale). RESULTS: Correlation with arthroscopy: Eleven patients had a normal arthroscopy of which in 10, SPECT images detected no abnormality. Sixty-three patients had abnormal arthroscopic findings, whereas all had abnormal SPECT studies. Thirty-eight patients had an anterior cruciate ligament (ACL) tear on arthroscopy. In this type of injury SPECT images detected increased uptake in the posterior aspect of the lateral tibial plateau (LTPp) with a positive predictive value (PPV) of 93% and a negative predictive value (NPV) of 97%. In 55% of the patients, increased uptake was also detected in the region of the middle sulcus of the lateral femoral condyle (LFCm): a "kissing" pattern. Tear of the medial meniscus was diagnosed by arthroscopy in 43 patients. SPECT images detected increased uptake in the medial tibial plateau (MTP) with a PPV of 78% and a NPV of 83%. Correlation with MRI: all seven cortical fractures seen on MRI were detected on SPECT. Twenty-eight patients had MRI findings suggestive of an ACL injury. Accompanying bone bruises were seen in 18 of them (64%). On SPECT images, all 28 patients with an ACL tear had increased uptake in the LTPp. Intensity of uptake in patients with associated bone bruise, however, was significantly higher; mean intensity grade 2.4 +/- 0.7 in case of accompanying bone bruise compared with 1.4 +/- 0.8 in case of an ACL tear without associated bone injury, P< 0.01. CONCLUSION: Results of the study suggest that bone SPECT is valuable in acute knee trauma for assessment of ACL, meniscal tears, or both and for detection of associated bone injury
|
1 |
Comparison of splinting, splinting plus local steroid injection and open carpal tunnel release outcomes in idiopathic carpal tunnel syndrome
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
The objective of this study was to compare the short- and long-term efficacies of splinting (S), splinting plus local steroid injection (SLSI), and open carpal tunnel release (OCTR) in mild or moderate idiopathic carpal tunnel syndrome (CTS). Patients with mild or moderate idiopathic CTS who experienced symptoms for over 6 months were included in the study. The patients were evaluated for the baseline and the third and sixth month scores after treatment. Follow-up criteria were ENMG parameters, Boston Questionnaire, and patient satisfaction. Fifty-seven hands completed the study. Twenty-three hands had been splinted for 3 months. Twenty-three hands were given a single steroid injection and splinted for 3 months, and 11 hands were operated. In the first 3 months, all treatment methods provided significant improvements in both clinical and EMG parameters in which OCTR had better outcomes on median sensorial nerve velocity at palm wrist segment. In the second 3 months, while the clinical and EMG parameters began to deteriorate in S and SLSI group, OCTR group continued to improve, and BQ functional capacity score of OCTR group was statistically better than that in conservative methods (P = 0.03). S and SLSI treatments improved clinical and EMG parameters comparable to OCTR in short term. However, these beneficial effects were transient in the sixth month follow-up and OCTR was superior to conservative treatments
|
0 |
Comparison of xenon with propofol for supplementary general anaesthesia for knee replacement: A randomized study
|
AAHKS (8) Anesthetic Infiltration
|
Background. Xenon anaesthesia is associated with rapid recovery and may also offer protection against neuronal damage. The aim of this study was to compare xenon with propofol for supplementary general anaesthesia in patients undergoing knee replacement in spinal anaesthesia. Methods. In total, 39 patients aged 60 or over were randomized to xenon 50-70% or propofol 3-5 mg kg-1 h-1. Vital signs and emergence time were recorded and cognitive function was assessed before operation, at discharge between the third and the fifth day and at 3 months using four neuropsychological tests. Results. Propofol supplementation was necessary in six xenon patients (29%) because of detectable movement of the upper body. Emergence time was significantly shorter with xenon (260 s for xenon and 590 s for propofol, P=0.001). There was no significant difference between the groups in blood pressure, heart rate, ventilatory frequency or end-tidal carbon dioxide concentration. No difference could be detected in cognitive function, which may be attributed to insufficient sample-size rather than the absence of a true difference. Conclusions. Xenon was well tolerated for supplementary general anaesthesia in elderly spontaneously breathing patients but supplementation may be necessary. Compared with propofol, emergence was faster with xenon. A larger sample-size is needed if cognitive function is to be addressed. © 2006 Oxford University Press.
|
0 |
Shock waves do more than just crush stones: Extracorporeal shock wave therapy in plantar fasciitis
|
The Treatment of Pediatric Supracondylar Humerus Fractures AUC
|
Heel pain is a common orthopaedic problem, The cause of this clinical entity remains an enigma. The overall prognosis is good, however, and the symptoms generally settle well with time. There appears to be little evidence of the effectiveness of local steroid injections and dorsiflexion night splints. Extracorporeal shock wave therapy (ECSW) has been used in orthopaedics since the 1980s. With this, a new tool has become available for the treatment of plantar fasciitis, achillis tendinitis, shoulder pain and tendinosis of the elbow. In our pilot study we found good results with the use of ECSW therapy in resistant plantar fasciitis. Additional controlled studies are required to define the precise role of this new modality in the treatment of chronic plantar fasciitis
|
1 |
British Oculoplastic Surgery Society (BOPSS) National Ptosis Survey
|
Upper Eyelid and Brow Surgery
|
AIM: To assess the results of primary aponeurotic ptosis surgery among UK ophthalmic oculoplastic surgeons, from both the surgeon's and patient's perspective; also to inform and encourage good clinical practice by generating outcomes for individual surgeons, units and for benchmarking purposes. METHODS: A prospective, web-based, non-comparative, interventional study was conducted over a period of 1 year commencing January 2005 and ending December 2005. The data-entry sheet for the preoperative, operative and postoperative data was completed and submitted online via the British Oculoplastic Surgery Society website. Surgical results were assessed objectively (by the surgeon) by measuring the upper lid margin reflex distance (uMRD) and the interlid difference in: MRD, lid show, skin crease and lid contour with the outcome graded as: success, partial success or failed. Surgical results were also assessed subjectively (by the patient) with the outcome graded as: completely satisfied, significantly improved, no change or worse than before the operation. RESULTS: Three hundred and sixty-five patients undergoing primary aponeurotic ptosis repair, from 40 different consultant-led teams with a declared oculoplastic interest and expertise, originating from 27 units across the UK were entered into the study. Using objective criteria, success was achieved in 128/223 (57%) cases, with significantly greater degrees of success seen in patients with mild ptosis and for surgeons who performed ptosis surgery more frequently. Using subjective criteria, 184/282 (65%) of patients were completely satisfied, with a further 89/282 (32%) judging themselves significantly improved. The patients' assessment of the surgery was less critical than that of the surgeons: 46/138 (33%) of patients who were completely satisfied and 37/72 (51%) of those who were significantly improved did not meet the criteria for a successful surgical outcome. The re-operation rate was 8/313 (2.6%). CONCLUSIONS: The authors have generated a valid series of surgical outcomes both for individuals, units and the UK as a whole, expressed in both objective and subjective terms for what we regard as the signature procedure for an oculoplastic surgeon: aponeurotic ptosis surgery. Individual results have been communicated to our members, which will allow them to compare their results with true peer-group-generated figures and will aid appraisal and ultimately revalidation.
|
0 |
Olecranon osteotomy for exposure of fractures and nonunions of the distal humerus
|
The Treatment of Pediatric Supracondylar Humerus Fractures AUC
|
Although olecranon osteotomy provides excellent exposure of the distal humerus, enthusiasm for this approach has been limited by reports suggesting numerous complications. It has been suggested that specific techniques for creating and repairing an olecranon osteotomy may help limit complications. This paper describes a technique for olecranon osteotomy using an apex, distal, chevron-shaped osteotomy, Kirschner wires directed out the anterior ulnar cortex distal to the coronoid process and bent 180degrees and impacted into the olecranon proximally, and two 22- gauge, figure-of-eight, stainless steel tension wires. A single surgeon used this technique for exposure of a fracture (16 patients) or nonunion (29 patients) of the distal humerus in 45 consecutive patients. One patient returned to activity too soon, had loosening of the wire fixation, and required a second operation for plate fixation of the ulna. The remaining 44 osteotomies (98%) healed with good alignment within 6 months. There were no broken or migrated wires prior to healing. Twelve patients (27%) had removal of the wires used to repair the olecranon: in 6 patients, this was for symptoms related to the wires (13%); 1 for septic olecranon bursitis, and 5 at the time of another procedure (elbow capsular release in 4 patients and submuscular ulnar nerve transposition in 1). Olecranon osteotomy can be used for exposure of the distal humerus with a low rate of complications when specific techniques are used
|
0 |
Preventive effect of comprehensive rehabilitation nursing on early complications of total hip arthroplasty
|
Management of Hip Fractures in the Elderly
|
BACKGROUND: Although the early postoperative functional rehabilitation can effectively guarantee the results of operations, incidence rate of complications following total hip replacement is still high. OBJECTIVE: To evaluate preventive effect of comprehensive rehabilitation care of early complications of total hip arthroplasty. METHODS: Totally 90 total hip arthroplasty patients were randomly divided into control group and study groups equally. Both groups were given conventional treatment and care, of which the study group underwent comprehensive postoperative rehabilitation care. The control group received general procedure of rehabilitation care
|
0 |
Long-term cadmium exposure and the association with bone mineral density and fractures in a population-based study among women
|
Management of Hip Fractures in the Elderly
|
All people are exposed to cadmium (Cd) via food; smokers are additionally exposed. High Cd exposure is associated with severe bone damage, but the public health impact in relation to osteoporosis and fractures at low environmental exposure remains to be clarified. Within the population-based Swedish Mammography Cohort, we assessed urinary Cd [U-Cd, microg/g of creatinine (cr)] as a marker of lifetime exposure and bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA) among 2688 women. Register-based information on fractures was retrieved from 1997 to 2009. Associations were evaluated by multivariable regression analyses. In linear regression, U-Cd was inversely associated with BMD at the total body (p < .001), femoral neck (p = .025), total hip (p = .004), lumbar spine (p = .088), and volumetric femoral neck (p = .013). In comparison with women with U-Cd < 0.50 microg/g of cr, those with U-Cd >/= 0.75 microg/g of cr had odds ratios (ORs) of 2.45 [95% confidence interval (CI) 1.51-3.97] and 1.97 (95% CI 1.24-3.14) for osteoporosis at the femoral neck and lumbar spine, respectively. Among never-smokers, the corresponding ORs were 3.47 (95% CI 1.46-8.23) and 3.26 (95% CI 1.44-7.38). For any first fracture (n = 395), the OR was 1.16 (95% CI 0.89-1.50) comparing U-Cd >/= 0.50 microg/g of cr with lower levels. Among never-smokers, the ORs (95% CIs) were 2.03 (1.33-3.09) for any first fracture, 2.06 (1.28-3.32) for first osteoporotic fracture, 2.18 (1.20-3.94) for first distal forearm fracture, and 1.89 (1.25-2.85) for multiple incident fractures. U-Cd at low environmental exposure from food in a general population of women showed modest but significant association with both BMD and fractures, especially in never-smokers, indicating a larger concern than previously known
|
0 |
Effect of low-dose alendronate treatment on bone mineral density and bone turnover markers in Chinese postmenopausal women with osteopenia and osteoporosis
|
Management of Hip Fractures in the Elderly
|
Objective: The aim of this study was to evaluate the effect of low-dose alendronate (ALN) treatment on bone mineral density (BMD) and bone turnover markers in Chinese postmenopausal women with osteopenia and osteoporosis. Methods: This study was a large-sample, randomized, open-label, prospective, multicenter, clinical trial with a 12-month follow-up. A total of 639 postmenopausal women (aged 62.2 (plus or minus) 7.0 y) with osteopenia or osteoporosis were randomized into two groups: low-dose ALN (70 mg every two weeks) and standard-dose ALN (70 mg weekly). All patients were also supplemented with calcium (600 mg) and vitamin D3 (125 IU) daily. BMD (measured by dual-energy X-ray absorptiometry; Hologic and Lunar) and levels of serum bone turnover markers (bone resorption marker, carboxy-telopeptide of type I collagen; bone formation marker, alkaline phosphatase) were assessed at baseline and at 3, 6, and 12 months of treatment. BMD and bone turnover markers were compared between the baseline and the end of treatment, and the changes in BMD and bone turnover markers were also compared between the low-dose ALN group and the standard-dose ALN group. Results: No significant differences in age, years since menopause, body mass index, BMD, 25-hydroxy vitamin D level, and serum biochemical markers were found at baseline between the two dose groups. A total of 558 (87.3%) and 540 (84.5%) women completed the treatment at the 6th and 12th months, respectively. After the 12-month treatment, lumbar spine and hip BMD increased and serum bone turnover markers decreased significantly in both of the treatment groups (P < 0.01), and no differences in percentage changes in BMD at the lumbar spine, femoral neck, and hip were found between the low-dose group (5.60%, 3.87%, and 3.28%, respectively) and the standard-dose group (5.07%, 2.93%, and 3.80%, respectively; P > 0.05). However, levels of serum alkaline phosphatase and carboxy-telopeptide of type I collagen in the standard-dose group decreased moderately compared with those in the low-dose group (P < 0.05 and P < 0.01). The women tolerated the two doses of ALN quite well. Adverse effects were similar in the two groups. Conclusions: Treatment with low-dose ALN (70 mg every two weeks) in women with postmenopausal osteopenia or osteoporosis effectively increases lumbar spine and hip BMD, similar to treatment with standard-dose ALN. Low-dose ALN may be a cost-effective and safe protocol for treating osteopenia or osteoporosis in Chinese women. (copyright) 2013 by The North American Menopause Society
|
0 |
nullHealthcare Cost, Quality, and Policy: Driving Stakeholder Innovation in Process and Practicenull
|
SR for PM on OA of All Extremities
|
The proceedings contain 62 papers. The special focus in this conference is on Stakeholders Innovation in Process and Practice. The topics include: Psychotropic medication use and 10-year incident fracture risk in men and women ages 50 and older in the population-based Canadian multicentre osteoporosis study (CaMoS); the impact of recent generic drug price policies on pharmaceutical innovation; a qualitative assessment of patientsnull beliefs about adherence to oral anti-diabetes drug treatment; current management and associated cost of metastatic castration-resistant prostate cancer in Canada; glucocorticoid-induced osteoporosis management among seniors; time series methods applied in drug utilization research; methods for survival extrapolation within costeffectiveness analyses that address concerns raised in pCODR reviews; use of product listing agreements by Canadian provincial drug benefit plans; development and validation of severity criteria for drug-related problems in chronic kidney disease patients; population-level costs and resource utilization of homecare for persons with Alzheimernulls disease; appraisal of non-inferiority margins in assessing study quality; safety and effectiveness of dabigatran versus warfarin in economic evaluations; comparative gastrointestinal safety of bisphosphonates; cost effectiveness of a systematic guidelines-based approach to the prevention and management of vascular disease in a primary care setting; hospitalization for hemorrhage among warfarin recipients prescribed amiodarone; creation of a reference set of the health preference values in oncology; systematic review of cost-of-illness studies in chronic ulcer population; the health care resource utilization of recently spinal cord injured; implementation and evaluation of pharmacy services through a practice-based research network (PBRN); consistencies in cancer therapy reimbursement recommendations made in Canada, Australia, Sweden, and United Kingdom; cost-sharing for health care services; economic evaluation of collagenase clostridium histolyticum injection for the treatment of dupuytrennulls contracture in Canada; the impact of ProFiL program on the progression of chronic kidney disease (CKD) and its risk factors; the impact of ProFiL program on the community pharmacistsnull knowledge and competencies and the quality of pharmacotherapy of their chronic kidney disease (CKD) patients; a self-management program for osteoarthritis patients and primary care clinicians supported by a group of interdisciplinary regional team of clinicians; socio-economic status and non-adherence to antihypertensive medications; antimalarial drug use during pregnancy and the risk of low birth weight (LBW); validation of the telephone-administered Age and stage questionnaire and the revised pre-screening Denver questionnaire; long-term oral anticoagulant management associated with routine medical care (RMC) in patients with Non-Valvular Atrial Fibrillation (NVAF) in Canada; estimation of outpatient versus inpatient adverse drug reactions (ADRS) reporting using ecology of medical care data; Cost-effectiveness analysis of apixaban compared to warfarin for stroke prevention in atrial fibrillation (SPAF) in Canada; Preliminary results of the impact of the use of pillbox on the stabilization of the INR among patients initiating warfarin treatment from a prospective cohort; Validity of self-reported regimen of dose by patient initiating warfarin treatment from a prospective cohort; Cost-effectiveness of insulin glargine versus sitagliptin in insulin naive patients with type 2 diabetes mellitus; Transfusion-related costs before and after treatment with azacitidine in higher-risk myelodysplastic syndrome; targeting postprandial glucose (PPG) with the addition of a rapid acting meal time insulin is more efficient to lower A1C after 12 weeks than optimization of basal insulin in patients with type 2 diabetes (T2D); targeting breakfast for type 2 diabetes (T2D) therapy appears more likely to succeed based on a subanalysis of START and
|
0 |
A localized scleroderma case with atypical presentation
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
Scleroderma is a connective tissue disorder characterized by excessive accumulation of collagen in the skin and internal organs. It is classified according to the skin and organ involvement. Skin changes together with organ involvement is known as systemic scleroderma, while only skin and subcutaneous involvement, and sometimes with muscle involvement is called localized form of scleroderma. Localized scleroderma is subdivided into localized morphea, generalized morphea and linear scleroderma. Half body involvement is described in none of these subtypes. However, in the literature, rare scleroderma cases were reported with hemiatrophy in half of the body presented in pediatric age. We aimed to report a case with a skin involvement in half of the body like a hemiscleroderma. A 53-year- old woman was presented with stiffness and pain in her left side of the body. She claimed that this stiffness had started after her pregnancy 30 years ago. The stiffness first appeared in her left buttock and progressed in time. From then on she had been complaint free until 4 years ago when she had burning pain in her left arm and leg, and consulted to the orthopedist. The orthopedist performed a muscle biopsy and the result was normal. Pronator teres syndrome and carpal tunnel syndrome of the left arm were reported in EMG. She had had no diagnosis and relevant therapy after the tests performed, and hospitalized in our clinic for further evaluation. There was no history of dysphagia, gastroesophageal reflux, raynaud phenomenon, constipation or diarrhea. On physical examination, sclerotic skin changes were observed in left half of the body including face and trunk. Interestingly, sclerosis in hands and foots was hardly noticeable. Neurological examination was normal. Laboratory results were within normal limits. EMG revealed no myopathic involvement. Patient was diagnosed with localized scleroderma. Atypical manifestation of the disease is aimed to be focused on
|
0 |
Minimal invasive long PHILOS®-plate osteosynthesis in metadiaphyseal fractures of the proximal humerus
|
Pediatric Supracondylar Humerus Fracture 2020 Review
|
Minimal invasive plate osteosynthesis (MIPO) not only meets the criteria of a "biological" osteosynthesis by minimising invasivity as well as iatrogenic soft tissue damage, but can also provide adequate stability for fracture healing and early functional aftertreatment. Up to date, only few publications report on MIPO of humeral shaft fractures mainly using the anterolateral deltopectoral approach for proximal plate insertion. Objective of the present study was to assess the feasibility and clinical outcome of MIPO for metadiaphyseal fractures of the proximal humerus through a lateral approach using angular stable long PHILOS®-plates. We retrospectively evaluated 29 patients (mean age 77 years, range 48-95 years) with displaced metadiaphyseal fractures of the proximal humerus treated with MIPO technique. For the first time, an angular stable long PHILOS®-plate through a lateral deltoid-split approach proximally and a brachialis/brachioradialis intermuscular approach with exposure of the radial nerve distally, were used. There were no infections and no iatrogenic injuries to the axillary and radial nerve. One patient showed subacromial impingement and one patient had to be reoperated for redislocation of the distal fragment with screw breakage, which was most likely due to incorrect screw placement. This patient was successfully operated using the same method and implant. Besides one patient who refused further follow-up, 28 patients could be followed up to a mean of 8 months (range 3-12 months) each with an entirely healed fracture. Furthermore, patient's quality of life was documented using the SF-36 questionnaire. Comparison with published United States normative data showed no significant deficits in the physical as well as in the mental domains 8 months after MIPO. Minimal invasive long PHILOS®-plate osteosynthesis using a combined lateral deltoid-split and brachialis/brachioradialis intermuscular approach proved to be a safe procedure for the treatment of metadiaphyseal fractures of the proximal humerus with low morbidity and full restoration of quality of life in these elderly patients. © 2010 Elsevier Ltd. All rights reserved.
|
1 |
Preoperative screening/decolonization for Staphylococcus aureus to prevent orthopedic surgical site infection: prospective cohort study with 2-year follow-up
|
Surgical Management of Osteoarthritis of the Knee CPG
|
We quantified surgical site infections (SSIs) after preoperative screening/selective decolonization before elective total joint arthroplasty (TJA) with 2-year follow-up and 2 controls. Concurrent controls (n = 2284) were patients of surgeons not participating in screening/decolonization. Preintervention controls (n = 741) were patients of participating surgeons who underwent TJA the previous year. Staphylococcus aureus nasal carriers (321/1285 [25%]) used intranasal mupirocin and chlorhexidine baths as outpatients. Staphylococcal SSIs occurred in no intervention patients (0/321) and 19 concurrent controls. If all SSIs occurred in carriers and 25% of controls were carriers, staphylococcal SSI rate would have been 3.3% in controls (19/571; P = .001). Overall SSI rate decreased from 2.7% (20/741) in preintervention controls to 1.2% (17/1440) in intervention patients (P = .009). Preoperative screening/selective decolonization was associated with fewer SSIs after elective TJA
|
0 |
Effects of low-level laser irradiation on cartilage injury in animal models: A systematic review
|
SR for PM on OA of All Extremities
|
This systematic review was performed to identify animal research defining the effects of low-level laser irradiation on experimental models of cartilage injury and the impact of dosage. EMBASE, PubMed, and CINAHL were searched for studies in the areas of laser and cartilage repair, published from January 2001 to January 2012. Included studies had to investigate cartilage repair in any animal model using any type of low-level laser irradiation and at least 1 quantitative measure of repair. Seventeen studies from 155 original articles related to laser irradiation and cartilage met our inclusion criteria and were critically appraised by 2 raters independently, using a structured tool designed for rating the quality of animal research studies. Although conclusions are limited by the small number of studies, the scientific literature indicates that low-level laser irradiation can be an effective short-term approach for reducing pain levels, loss of function, and inflammation and for increasing cell proliferation and synthesis of extracellular matrix elements such as elastic collagen fibers and reticular fibers. However, there was lack of uniformity in the terminology used to describe the parameters and dose used for low-level laser treatment. (copyright) Med Sci Tech, 2013
|
1 |
Effect of periarticular corticosteroid injections during total knee arthroplasty. A double-blind randomized trial
|
AAHKS (2) Corticosteroids
|
BACKGROUND: Multimodal pain-control protocols that include periarticular injections have been reported to decrease pain and improve early outcomes following total knee arthroplasty. While injections containing a corticosteroid have been demonstrated to be safe and effective, we are not aware of any randomized trials in which the specific effect of the corticosteroid on early postoperative outcomes has been evaluated. The purpose of this double-blind study was to compare the clinical efficacy of periarticular injections consisting of bupivacaine, morphine, epinephrine, clonidine, and cefuroxime as well as a corticosteroid (methylprednisolone acetate) with the efficacy of periarticular injections consisting of the same agents but without the inclusion of a corticosteroid.
METHODS: Seventy-six patients were randomized to either the no-steroid group (thirty-seven patients) or the steroid group (thirty-nine patients). Pain and narcotic consumption during the inpatient stay and the length of the hospital stay were recorded. Knee Society scores, the range of motion, and the occurrence of any complications were recorded preoperatively and at six and twelve weeks after the surgery.
RESULTS: The hospital stay was significantly shorter for patients in the steroid group (2.6 days compared with 3.5 days in the no-steroid group; p = 0.01). No significant group differences in terms of pain, narcotic consumption, outcome scores, or motion were identified. There were three complications in the steroid group: two patients required a manipulation under anesthesia, and the knee joint became infected in another patient, leading to numerous complications and ultimately death.
CONCLUSIONS: The periarticular injection of a corticosteroid may reduce the length of the hospital stay following total knee arthroplasty, but it does not appear to improve pain relief, motion, or function in the early postoperative period. While we cannot definitively state that the corticosteroid was a causative factor in the development of the infection at the site of the prosthetic joint, we cannot rule it out either, which raises concern regarding the role of corticosteroids in perioperative pain management following total knee arthroplasty.
|
0 |
MRI for the evaluation of knee pain: comparison of ordering practices of primary care physicians and orthopaedic surgeons
|
PJI DX Updated Search
|
BACKGROUND: Knee pain is one of the most common reasons for outpatient visits in the U.S. The great majority of such cases can be effectively evaluated through physical examination and judicious use of radiography. Despite this, an increasing number of magnetic resonance images (MRIs) of the knee are being ordered for patients with incomplete work-ups or for inappropriate indications. We hypothesized that MRIs ordered by orthopaedic providers were more likely to result in changes in diagnoses and/or plans for care than those ordered by non-orthopaedic providers. METHODS: We reviewed the charts of all consecutive new patients seen at our orthopaedic outpatient office between January 1, 2010, and December 31, 2011, with International Classification of Diseases, Ninth Revision (ICD-9) codes for meniscal or unspecific sprains and strains of the knee. A total of 1592 patients met our inclusion criteria and were divided into two groups: those initially evaluated and referred by their primary care physician (PCP) (n = 747) and those initially evaluated by one of our staff orthopaedic surgeons (n = 845). RESULTS: MRI-ordering rates were nearly identical between orthopaedic surgeons and PCPs (25.0% versus 24.8%; p = 0.945). MRIs ordered by orthopaedic surgeons, however, resulted in significantly more arthroscopic interventions than those ordered by PCPs (41.2% versus 31.4%; p = 0.042). Orthopaedic surgeons ordered MRIs for patients who were more likely to benefit from arthroscopic intervention, including patients who were younger (mean age, 45.1 years versus 56.5 years for those with PCP-ordered MRIs; p < 0.001), patients with acute symptoms (39.3% versus 22.2%; p < 0.001), and patients with a history of trauma (49.3% versus 36.2%; p = 0.019). Finally, orthopaedic surgeons were less likely than PCPs to order MRIs for patients with substantial osteoarthritis who subsequently underwent total knee arthroplasty (4.3% versus 9.2%; p = 0.048). CONCLUSIONS: MRI utilization by orthopaedic surgeons results in more appropriate interventions for patients with symptoms and findings most amenable to surgical intervention
|
0 |
2018 Frank Stinchfield Award: Spinopelvic Hypermobility Is Associated With an Inferior Outcome After THA: Examining the Effect of Spinal Arthrodesis
|
Hip Fx in the Elderly 2019
|
BACKGROUND: Many patients undergo both THA and spinal arthrodesis, and those patients may not fare as well as those who undergo one procedure but not the other. The mechanisms of how spinal arthrodesis affects patient function after THA remain unclear.
QUESTIONS/PURPOSES: The aims of our study were to (1) determine how patient-reported outcome measures (PROMs), including the Oxford hip score as well as dislocations and complications compare after THA between patients with and without spinal arthrodesis; (2) characterize sagittal pelvic changes in these patients that occur when moving between different functional positions and test for differences between patients with and without spinal arthrodesis; and (3) assess whether differences in sagittal pelvic dynamics are associated with PROMs, complications, and dislocations after THA.
METHODS: In this case-control study, we identified 42 patients (60 hips) who had undergone both THA and spinal arthrodesis between 2002 and 2016 and who were available for followup at a minimum of 12 months (mean, 6 +/- 5 years) after the later of the two procedures. These cases were case-control-matched for age, gender, and body mass index with 42 patients (60 hips) who underwent only THA and had no known spinal pathology. All patients completed PROMs, including the Oxford hip score, and underwent four radiographs of the pelvis and spinopelvic complex in three positions (supine, standing, and deep-seated). Cup orientation and various spinopelvic parameters, including pelvic tilt and pelvic-femoral angle, were measured. The difference in pelvic tilt between standing and seated allowed for patient classification based on spinopelvic mobility into normal (+/- 10degree-30degree), stiff (< +/- 10degree) or hypermobile (> +/- 30degree) groups.
RESULTS: Compared with the THA-only group, the THA-spinal arthrodesis group had inferior PROMs (Oxford hip score, 33 +/- 10 versus 43 +/- 6; p < 0.001) and more surgery-related complications (such as dislocation, loosening, periprosthetic fracture or infection, psoas irritation) (12 versus 3; p = 0.013), especially dislocation (5 versus 0; p = 0.023). We detected no difference in change of pelvic tilt between supine and standing positions between the groups. When standing, patients undergoing THA-spinal arthrodesis had greater pelvic tilt (25degree +/- 11degree versus 17degree +/- 8degree; p < 0.001) and the hip was more extended (193degree +/- 22degree versus 185degree +/- 30degree; p = 0.012). We found that patients undergoing THA-spinal arthrodesis were more likely to have spinopelvic hypermobility (12 of 42 versus three of 42; odds ratio, 5.2; p = 0.02) with anterior tilting of the pelvis. Of all biomechanical parameters, only spinopelvic hypermobility was associated with inferior PROMs (Oxford hip score, 35 +/- 9 versus 40 +/- 7 in normal mobility; p = 0.049) and was also present in dislocating hips that underwent revision despite acceptable cup orientation.
CONCLUSIONS: In patients with spinal arthrodesis who have undergone THA, spinopelvic hypermobility is associated with inferior outcomes, including hip instability. Spinopelvic hypermobility should be routinely assessed because these patients may have a narrow zone of optimum cup orientation that would require new technology to define and assist the surgeon in obtaining it.Level of Evidence Level III, therapeutic study.
|
1 |
Evolving role of bone biomarkers in castration-resistant prostate cancer
|
MSTS 2018 - Femur Mets and MM
|
The preferential metastasis of prostate cancer cells to bone disrupts the process of bone remodeling and results in lesions that cause significant pain and patient morbidity. Although prostate-specific antigen (PSA) is an established biomarker in prostate cancer, it provides only limited information relating to bone metastases and the treatment of metastatic bone disease with bisphosphonates or novel noncytotoxic targeted or biological agents that may provide clinical benefits without affecting PSA levels. As bone metastases develop, factors derived from bone metabolism are released into blood and urine, including N- and C-terminal peptide fragments of type 1 collagen and bone-specific alkaline phosphatase, which represent potentially useful biomarkers for monitoring metastatic bone disease. A number of clinical trials have investigated these bone biomarkers with respect to their diagnostic, prognostic, and predictive values. Results suggest that higher levels of bone biomarkers are associated with an increased risk of skeletal-related events and/or death. As a result of these findings, bone biomarkers are now being increasingly used as study end points, particularly in studies investigating novel agents with putative bone effects. Data from prospective clinical trials are needed to validate the use of bone biomarkers and to confirm that marker levels provide additional information beyond traditional methods of response evaluation for patients with metastatic prostate cancer.
|
1 |
Osteochondritis dissecans of the hip
|
Developmental Dysplasia of the Hip CPG
|
PURPOSE: To investigate the clinical and radiological characteristics of osteochondritis dissecans (OD) of the hip and the outcome of this condition after treatment. MATERIAL AND METHODS: Twelve male and 3 female patients with OD were retrospectively studied. Six patients had a history of Legg-Calve-Perthes disease (LCPD) and among them 2 also had had a trauma to the hip. A further 5 had had trauma and 1 a developmental dislocation of the hip (DDH). The remaining 3 patients had no history of previous hip disease or trauma. All patients were examined with plain radiography, 7 with MR, 3 with CT and 2 with hip arthrography. RESULTS: All OD lesions were detected at plain radiography, and most of them were located near the fovea. At MR the lesions had low signal intensity at T1-weighted sequences, and 6/7 had edema or fluid collection in or adjacent to the lesion on T2-weighted sequences. The early treatment in 7 patients was surgery, 2 had had conservative treatment and 6 no treatment. At follow-up 12 years after radiological diagnosis, 5 patients had hip arthrosis, 4 of whom were treated with arthroplasty. All but 3 had reduced hip rotation and all but 2 (with arthroplasty) had load pain. Three of the patients with earlier surgery had not developed arthrosis. CONCLUSIONS: OD lesions are usually well seen with plain radiography. There is a great risk of developing early arthrosis and it seems that early surgery is connected with arthrosis development. Thus only symptomatic treatment is recommended
|
0 |
Carpal tunnel syndrome and vitamin B6
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
We reviewed 1075 patients presenting over a 12-year period with symptoms of carpal tunnel syndrome. A total of 994 had a final diagnosis of carpal tunnel syndrome. There were 444 male and 550 female patients with a mean age of 42 years. Three-hundred and ninety-five related symptoms to their job. Surgery was performed in 27 percent of the total diagnosed cases with approximately 97 percent relief of symptoms. Satisfactory alleviation of symptoms was obtained in 14.3 percent of patients treated conservatively prior to 1980, with one or a combination of splinting anti-inflammatory agents, job or activity change, and steroid injections. In 1980, vitamin B6 (pyridoxine) was added as a method of conservative treatment. Satisfactory improvement was obtained in 68 percent of 494 patients treated with a controlled dosage (100 mg b.i.d.). While our findings were not the result of a controlled scientific study, we feel they suggest that regulated use of vitamin B6 may be helpful in treating many cases of carpal tunnel syndrome
|
0 |
Obesity, diabetes, and preoperative hyperglycemia as predictors of periprosthetic joint infection: a single-center analysis of 7181 primary hip and knee replacements for osteoarthritis
|
PJI DX Updated Search
|
BACKGROUND: Diabetes and obesity are common in patients undergoing joint replacement. Studies analyzing the effects of diabetes and obesity on the occurrence of periprosthetic joint infection have yielded contradictory results, and the combined effects of these conditions are not known. METHODS: The one-year incidence of periprosthetic joint infections was analyzed in a single-center series of 7181 primary hip and knee replacements (unilateral and simultaneous bilateral) performed between 2002 and 2008 to treat osteoarthritis. The data regarding periprosthetic joint infection (defined according to Centers for Disease Control and Prevention criteria) were collected from the hospital infection register and were based on prospective, active surveillance. Patients diagnosed with diabetes were identified from the registers of the Social Insurance Institution of Finland. The odds ratios (ORs) for infection and the accompanying 95% confidence intervals (CIs) were calculated with use of binary logistic regression with adjustment for age, sex, American Society of Anesthesiologists risk score, arthroplasty site, body mass index, and diabetic status. RESULTS: Fifty-two periprosthetic joint infections occurred during the first postoperative year (0.72%; 95% CI, 0.55% to 0.95%). The infection rate increased from 0.37% (95% CI, 0.15% to 0.96%) in patients with a normal body mass index to 4.66% (95% CI, 2.47% to 8.62%) in the morbidly obese group (adjusted OR, 6.4; 95% CI, 1.7 to 24.6). Diabetes more than doubled the periprosthetic joint infection risk independent of obesity (adjusted OR, 2.3; 95% CI, 1.1 to 4.7). The infection rate was highest in morbidly obese patients with diabetes; this group contained fifty-one patients and periprosthetic infection developed in five (9.8%; 95% CI, 4.26% to 20.98%). In patients without a diagnosis of diabetes at the time of the surgery, there was a trend toward a higher infection rate in association with a preoperative glucose level of >/=6.9 mmol/L (124 mg/dL) compared with <6.9 mmol/L. The infection rate was 1.15% (95% CI, 0.56% to 2.35%) in the former group compared with 0.28% (95% CI, 0.15% to 0.53%) in the latter, and the adjusted OR was 3.3 (95% CI, 0.96 to 11.0). The type of diabetes medication was not associated with the infection rate. CONCLUSIONS: Diabetes and morbid obesity increased the risk of periprosthetic joint infection following primary hip and knee replacement. The benefits of joint replacement should be carefully weighed against the incidence of postoperative infection, especially in morbidly obese patients. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence
|
1 |
Quality of life assessment of patients with posttraumatic fracture nonunion, chronic refractory osteomyelitis, and lower-extremity amputation
|
DoD PRF (Psychosocial RF)
|
One hundred nine patients with long-bone fracture nonunion, chronic refractory osteomyelitis, and posttraumatic amputation were evaluated to assess the impact of chronic disability on the quality of life. The quality of life parameters were defined by a functional assessment instrument, the Arthritis Impact Measurement Scale (AIMS), and a Psychosocial Adjustment to Illness Scale (PAIS). A spouse PAIS self-report instrument was administered to assess the psychosocial adjustment of spouses or significant others. A final questionnaire was developed to determine the reasons, in order of their importance, for either continuing medical therapy or accepting amputation. The PAIS scores differed significantly between osteomyelitis patients and nonunion or amputation patients. The presence or absence of pain produced significant differences in AIMS and PAIS scores of nonunion and osteomyelitis patients. Subscale analysis of AIMS scores showed significant differences among the three groups with respect to health perception and scale of orthopaedic problem. The osteomyelitis patients were more severely affected than the nonunion or amputation patients. The PAIS was unable to detect any statistically significant differences in psychosocial adjustment of the spouses of patients in each of the three population groups. The most frequent reason for continuing medical and surgical management of nonunion and osteomyelitis was hopeful expectation for cure. The group who chose amputation did so in an attempt to put an end to the need for medical and surgical treatment. Differences in psychosocial and functional ability were related to disease diagnosis, pain, status of fracture healing, and timing of amputation. This study provides further insight into the quality of life experience for patients with long-term orthopaedic problems.
|
0 |
Elderly with knee osteoarthritis should perform nutritional assessment: integrative literature review
|
OAK 3 - Non-arthroplasty tx of OAK
|
To review scientific literature to assess nutritional status of elderly patients with osteoarthritis in the last 16 years. This is an integrative literature review that included articles published in national and international journals indexed in PubMed, SciELO and BIREME. We selected 14 articles, and English language was predominant. The year of publication of articles ranged from 2006 to 2016, and most of papers were cross-sectional studies. To gather papers and for posterior evaluate, we used a validated data collection instrument and the included studies were critical analyzed by reading, gathering and analysis of articles. Studies suggested that there is a positive correlation between obesity and knee osteoarthritis. Obesity is one of the most important modifiable factors in worsening of osteoarthritis symptoms. RESUMO O objetivo da pesquisa foi revisar a produção cientÃfica referente à avaliação do estado nutricional de idosos com osteoartrite nos últimos 16 anos. Assim, o estudo foi uma revisão integrativa da literatura, realizada com a busca de artigos publicados em periódicos nacionais e internacionais indexados no PubMed, na SciELO e na BIREME. Foram selecionados 14 artigos, e o idioma inglês foi preponderante. O perÃodo de publicação dos artigos variou de 2006 a 2016, com predominância de estudos do tipo transversais. Para reunir os artigos e para posterior avaliação, foi utilizado um instrumento de coleta de dados validado, e as análises crÃticas dos estudos incluÃdos foram realizadas por meio da leitura, do agrupamento e da análise dos artigos. As pesquisas sugeriram que existe correlação positiva entre obesidade e osteoartrite de joelhos. Além disto, a obesidade é um dos fatores mais significativos e modificáveis no agravamento dos sintomas da osteoartrite.
|
0 |
Infections in implantology: from prophylaxis to treatment
|
Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures
|
Since the introduction of osseointegrated implant treatment, odontology, and in particular the area of prosthodontic replacement of lost teeth, has evolved in an unimaginable way, to the extent that the age-old idea of "restitutio ad integrum" has almost become possible. Implant treatment has a high success rate that has been rated as high as 95 to 99%, according to different casuists, but there is another group of cases in which implants fail, and in fact it is hard to know the causes of such failures. The microbiological component plays an important role in encouraging and facilitating implant infection during implant placement, and also later when the implant is in function in the mouth, which is a septic medium. In this paper we will study infections in implantology, classified according to the treatment phase: Infection prior to the implant; Peri-surgical infection; Severe post-surgical infection; Peri-implant disease
|
0 |
Lengthening strategies for Peyronie's disease
|
Panniculectomy & Abdominoplasty CPG
|
Loss of penile length is a common complaint of men with Peyronie's disease (PD), both before and after corrective intervention, which has a significant negative effect on patient quality of life. We sought to identify and describe the methods by which penile length can be preserved or increased. We conducted an extensive, systematic literature review, based on a search of the PUBMED database for articles published between 1990 and 2015. Articles with the key words "Peyronie's disease", "penile length" and/or "penile lengthening" were reviewed if they contained subjective or objective penile length outcomes. Only English-language articles that were related to PD and penile size were included. We found no evidence in the literature that medical therapy alone increases penile length. Classic inflatable penile prosthesis (IPP) placement, plication procedures, and the Nesbit procedure appear likely to maintain or decrease penile length. Plaque incision (PI) and grafting appears likely to maintain or increase penile length, but is complicated by risk of post-operative erectile dysfunction (ED). There are several surgical procedures performed concomitantly with IPP placement that may be suitable treatment options for men with comorbid ED, and consistently increase penile length with otherwise good outcomes concerning sexual function. These include the subcoronal penile prosthesis (scIPP), Egydio circumferential technique, the sliding technique, the modified sliding technique (MoST), and the multiple slice technique (MuST). In addition, adjuvant therapies such as penile traction therapy (PTT), post-operative inflation protocols, suspensory ligament relaxation, lipectomy, and adjuvant medical therapy for glans engorgement appear to increase subjective and/or objective penile length for men at high risk of decreased penile length after PD surgery. Considering the psychological burden of length loss in men with PD, providers with adequate volume and expertise should attempt, if possible, to maintain or increase penile length for men undergoing surgical intervention. There are several evidence-based, safe, and effective ways to increase penile length for these men and multiple emerging adjuvant therapies that may help ensure adequate length.
|
0 |
Serial Improvement of Medial Meniscus Extrusion Following Medial Open-Wedge High Tibial Osteotomy Does Not Correlate With Clinical Outcomes and Arthroscopic Articular Cartilage Improvement
|
AMP (Acute Meniscal Pathology)
|
PURPOSE: To assess serial change up to 2 years in medial meniscus extrusion (MME) following medial open-wedge high tibial osteotomy (MOWHTO) and to determine whether postoperative changes in MME correlated with clinical outcomes and arthroscopic articular cartilage status.
METHODS: This study included 26 patients from December 2016 to March 2018 who underwent MOWHTO for primary medial osteoarthritis with varus malalignment. Second-look arthroscopy with plate removal was performed at postoperative 2 years. MME was consecutively measured using coronal magnetic resonance imaging at preoperative and postoperative 3 months, 6 months, 1.5 years, and 2 years. We also assessed which preoperative parameters could reflect the postoperative changes in MME and evaluated whether postoperative clinical outcomes and arthroscopic articular cartilage improvement would be influenced by the MME changes.
RESULTS: Regarding the postoperative serial changes in MME values, significant improvement in MME was noted from postoperative 6 months (P = .003), and thereafter, mean MME was further improved with time until postoperative 2 years (P < .001). Regarding the correlation between preoperative parameters and MME changes, preoperative medial proximal tibial angle (MPTA) showed significant correlations in univariate and multivariate analysis (P = .004 and P = .004, respectively). Meanwhile, changes in MME were not correlated with postoperative clinical outcomes or arthroscopic articular cartilage improvement.
CONCLUSION: After MOWHTO, MME improved with time and was significantly correlated with preoperative MPTA. However, the changes in MME after MOWHTO did not reflect postoperative clinical and arthroscopic articular cartilage improvement.
LEVEL OF EVIDENCE: IV, case series.
|
0 |
Osteoporosis. Pathogenesis, diagnosis, and treatment in older adults
|
Management of Hip Fractures in the Elderly
|
Osteoporosis is a major cause of disability and excess mortality in older men and women. Hip fracture incidence accelerates approximately 10 years after menopause in women and after age 70 in men. Approximately 1 million Americans suffer fragility fractures each year at a cost of over 14 billion dollars. The disability, mortality, and cost of hip and vertebral fractures are substantial in the rapidly growing, aging population so that prevention of osteoporosis is a major public health concern. BMD is used to make the diagnosis of osteoporosis before incident fracture and predict fracture risk. Recommendations for treatment and prevention of osteoporosis based on BMD score have been published by the World Health Organization and the National Osteoporosis Foundation. In a process that continues throughout life, bone repairs itself by the coupled action of bone resorption followed by bone formation, sometimes referred to as bone turnover. Osteoblasts and osteoclasts are the primary cells involved in bone formation and resorption, respectively. The process of bone turnover is regulated by hormones, such as PIH and local factors such as IL-1 and prostaglandins. Following attainment of peak bone mass at age 25, bone loss begins, accelerates in women at menopause and slows again but continues into advanced years at a rate of 1% to 2% per year, similar to premenopausal bone loss rate. The leading theories of the mechanism of bone loss in older individuals is calcium deficiency leading to secondary hyperparathyroidism and sex hormone deficiency. Risk factors such as age, gender, ethnic background, smoking, exercise, and nutrition, and medical conditions associated with osteoporosis should be evaluated and modified when possible to prevent further bone loss. Osteoporosis treatment and prevention include weight-bearing exercise, calcium and vitamin D supplementation, estrogen replacement, bisphosphonates, selective estrogen receptor antagonists, and calcitonin. Although there is no currently approved treatment for osteoporosis in men, many of the treatments approved for osteoporosis in women hold promise to be beneficial in men
|
0 |
Diffusion MR imaging for monitoring of treatment response
|
MSTS 2018 - Femur Mets and MM
|
Functional imaging techniques are increasingly being used to monitor response to therapies, often predicting the success of therapy before conventional measurements are changed. This review focuses on magnetic resonance imaging (MRI) depicted water diffusivity as a tumor response parameter. Response assessments are undertaken by noting changes in signal intensity on high b-value images or by using measurements of apparent diffusion coefficient values. The different diffusion-weighted (DW)-MRI appearances in response to treatment of soft tissue disease and bone metastases are discussed. DW-MRI changes observed in response to cytotoxics, radiotherapy, antiangiogenics, embolization, and thermocoagulation are detailed. © 2011 Elsevier Inc.
|
0 |
Expression of CXCL12 and CXCR4 in pT3-stage gastric cancer does not correlate with peritoneal metastasis
|
MSTS 2018 - Femur Mets and MM
|
CXCR4, a chemokine receptor, is considered to be involved in the metastastic formation of various types of cancer and could influence survival. More recently, CXCR4 was reported to be associated with peritoneal metastasis in gastric cancer, and CXCL12, its ligand, as a prognostic determinant among gastric cancer of various stages. In order to more specifically delineate the relevance of CXCR4 in peritoneal metastasis, 98 patients with pT3-stage gastric cancer who underwent gastrectomy and detection of intra-abdominal free cancer cells in the peritoneal washing samples were evaluated. Immunostaining with anti-CXCL12 and anti-CXCR4 antibodies were performed for the primary tumor specimens, and correlation of the immunoreactivities with various clinicopathologic factors was evaluated. CXCR4 was detected in 61 specimens and CXCL12 in 76 specimens. No significant correlation was observed between presence of free cancer cells in the peritoneal cavity or development of clinical peritoneal carcinomatosis and expression of either the chemokine or the receptor. On the other hand, there was a trend towards correlation of expression of these molecules with recurrences to the distant lymph nodes or to the liver, although the number of events in these categories were insufficient to reach a statistical significance. In gastric cancer, CXCL12/ CXCR4 axis seems to be more strongly associated with lymphatic or hematogenous metastasis than the establishment of peritoneal deposits.
|
1 |
Neutral glenoid alignment in reverse shoulder arthroplasty does not guarantee decreased risk of impingement
|
Trial Systematic Review Project
|
Reverse Shoulder Arthroplasty (RSA) has gained popularity over the recent years, but impingement concerns are still present. Surgeons aim to correct pre-operative glenoid deformities to reduce impingement but it can be challenging without assistance like patient specific guides. However, it is unclear how accurate glenoid correction affects the impingement. The main objective of this study was to determine whether accurate glenoid correction to neutral version and tilt can reduce the risk of impingement. Two types of virtual surgeries were performed on 22 pre-operative arthritic shoulders: (i) “Interactive,” the glenoid baseplate could be placed with accuracy, and (ii) “Blind,” surgeons placed the RSA baseplate while they could only visualize the glenoid. The virtual models were then used in an RSA biomechanical model which recorded impingement for (i) four Range of Motion (ROM) tasks, (ii) ten Activities of Daily Living (ADL). The “Blind” method resulted in more variable glenoid placement (version and tilt) than the “Interactive” method (p = 0.001). However, both methods showed similar ROM and impingement occurrence in ADLs. The results suggest it is challenging for surgeons to accurately correct version and tilt on arthritic glenoids when only referencing off of the face of the glenoid. However, the variable glenosphere placement observed in the “Blind” method did not result in worse impingement compared to the accurate “Interactive” method. This was because both methods had similar inferior baseplate positioning which is more important than correcting version or tilt. Implantation accuracy remains important in RSA, but pre-operative planning should not just target at correcting version and tilt. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1213–1219, 2018.
|
0 |
Immunotherapy of multiple myeloma: The start of a long and tortuous journey
|
MSTS 2018 - Femur Mets and MM
|
The field of tumor immunotherapy is still in its infancy. It is becoming clear that the human immune response is the result of highly complex, continuously evolving interactions between cells of the adaptive and innate arms of the immune system, the internal and external environments, and normal and abnormal cells (e.g., myeloma plasma cells). Despite the considerable advances in our knowledge over the past 30 years, we have still only scratched the surface of the immune system's interaction with malignant diseases such as myeloma and to date, this has not translated into significantly better outcomes for patients with this disease. This review will summarize our current knowledge of the fundamental immunology of myeloma, review immunotherapy trials reported to date and discuss whether, in light of the current information, immunotherapy of multiple myeloma is an achievable goal. © 2006 Future Drugs Ltd.
|
1 |
Outcomes of arthroscopic revision rotator cuff repair with acellular human dermal matrix allograft augmentation
|
Trial Systematic Review Project
|
Background: The purpose was to assess the minimum 2-year patient-reported outcomes and failure rate of patients who underwent revision arthroscopic rotator cuff repair augmented with acellular human dermal matrix (AHDM) allograft for repairable retears. Methods: From 2008-2014, patients who underwent revision rotator cuff repair augmented with AHDM with greater than 2 years’ follow-up by a single surgeon were retrospectively reviewed. Data regarding surgical history, demographic characteristics, and medical comorbidities were collected. Outcome data included American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores, as well as rotator cuff healing on magnetic resonance imaging or ultrasound. Retears and subsequent surgical procedures were characterized. Results: A total of 28 patients met our inclusion criteria, and 23 (82%) were available for follow-up at 2 years. The mean age was 60.1 ± 9.3 years (range, 43-79 years), with a mean follow-up period of 48 ± 23 months. All patients had at least 1 prior rotator cuff repair. Of the 23 patients, 13 (56%) underwent postoperative imaging, and 4 of these 13 (31%) had a retear. A reoperation was performed in 3 of 23 patients (13%). Among the 6 patients with both preoperative and postoperative outcome scores, we saw improvement in the ASES score from 56 to 85 (P =.03) and in the SANE score from 42 to 76 (P =.03). The full cohort's mean postoperative ASES and SANE scores were 77 and 69, respectively. Conclusion: AHDM allograft augmentation is a safe and effective treatment method for patients with full-thickness rotator cuff retears. Further research is needed with larger studies to confirm these findings from our small cohort of patients.
|
1 |
Early diagnosis of congenital dislocation of the hip
|
Developmental Dysplasia of the Hip CPG
|
In this prospective study, 35,550 neonates were examined shortly after birth by a team of orthopaedic surgeons. They diagnosed 775 unstable or dislocated hips in 656 babies; there were two teratological dislocations. Treatment was first with a Frejka pillow and, if this failed to give a normal hip, a Pavlik harness at three months. Early clinical examination did not identify 21 infants who were found to have subluxation or dislocation of the hip at the three-month review. The number of missed cases declined during the study, however, reflecting the increasing experience of the examiners. One case of avascular necrosis occurred in the group treated from birth and one in the late-diagnosed group. Open reduction was necessary only in the two teratological dislocations. Experienced examiners are needed for accurate clinical diagnosis; and treatment should be started before the baby is discharged from the maternity ward
|
0 |
Inferior pole length and long-term aesthetic outcome after superior and inferior pedicled reduction mammaplasty
|
Reduction Mammoplasty for Female Breast Hypertrophy
|
BACKGROUND: Long-term aesthetic results after reduction mammaplasty remain an important issue for evaluating the success of different techniques. Superior pedicled techniques are reported to maintain a better breast projection with less bottoming-out of the inferior mammary pole than inferior pedicled techniques.
METHODS: The outcomes of 18 patients who had undergone the superior pedicled technique described by Pitanguy and 16 patients operated on using the inferior pedicled technique by Robbins were compared.
RESULTS: The mean follow-up period was 49 months in the Pitanguy group and 35 months in the Robbins group. The distance between the inframammary crease and the inferior margin of the nipple-areola complex (NAC) showed a mean elongation of 3.3 cm (80.5 %) after the superior pedicled Pitanguy technique and 3.9 cm (92.9 %) after the inferior pedicled Robbins technique (p = 0.077). Using postoperative photographs, the overall aesthetic result after Pitanguy's technique was judged significantly better than the result after Robbins' technique (p = 0.002).
CONCLUSIONS: Distinct postoperative elongation of the inferior mammary pole length must be considered in the preoperative marking for inferior and superior pedicled reduction mammaplasty. Guide values for the elongation can be used for planning unilateral adjustment reduction mammaplasty. To avoid bottoming-out of the inferior mammary pole, the NAC should be located at the level of the inframammary crease and the distance between the inframammary crease and the inferior border of the NAC should not exceed 4-4.5 cm. The definite position of the NAC should be decided after final shaping of the reduced breast toward the end of the operation.
LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article.
|
0 |
Wild-type transthyretin-derived amyloidosis in various ligaments and tendons
|
Diagnosis and Treatment of Carpal Tunnel Syndrome CPG
|
Transthyretin-derived amyloid deposition is commonly found in intercarpal ligaments of patients with senile systemic amyloidosis. However, the frequency of transthyretin-derived amyloid deposits in ligaments of other tissues remains to be elucidated. This study aimed to determine the frequency of amyloid deposition and the precursor proteins of amyloid found in orthopedic disorders. We studied 111 specimens from patients with carpal tunnel syndrome (flexor tenosynovium specimens), rotator cuff tears (rotator cuff tendon specimens), and lumbar canal stenosis (yellow ligament specimens). To identify amyloid precursor proteins, we used immunohistochemical staining with antibodies that react with transthyretin, immunoglobulin light chain, amyloid A protein, and beta(2)-microglobulin. By means of Congo red staining, we identified 47 (42.3%) amyloid-positive samples, 39 of which contained transthyretin-derived amyloid (18 flexor tenosynovium specimens, 5 rotator cuff tendon specimens, and 16 yellow ligament specimens). Genetic testing and/or clinical findings suggested that all patients with transthyretin amyloid deposits did not have familial amyloidotic polyneuropathy. The occurrence of amyloid deposition in those tissues depended on age. These results suggest that transthyretin-derived amyloid deposits may occur more frequently in various ligaments and tendons than originally expected. In the future, such amyloid deposits may aid determination of the pathogenesis of ligament and tendon disorders in older patients
|
0 |
MicroRNA-320 regulates matrix metalloproteinase-13 expression in chondrogenesis and interleukin-1beta-induced chondrocyte responses
|
OAK 3 - Non-arthroplasty tx of OAK
|
OBJECTIVE: Metalloproteinases (MMPs) are key regulators of osteoarthritis (OA) and collagen degradation and have been shown to participate in endochondral ossification. The aim of this study was to determine whether microRNA-320 (miR-320) regulates the expression of MMP-13 in chondrogenesis and inflammation.
EXPERIMENTAL DESIGN: miR-320 expression was assessed in vitro, in the ATDC5 cell model of chondrogenesis and in interleukin-1beta (IL-1beta)-treated primary mouse chondrocytes (PMCs), and in vivo, in normal and OA human cartilage by in situ hybridization. ATDC5 and PMCs were transfected with miR-320 or its antisense inhibitor (anti-miR-320), respectively. The roles of activated MAP kinases (MAPK) and NF-kappaB were evaluated by using specific inhibitors. Direct interaction between miR-320 and its putative binding site in the 3'-untranslated region (3'-UTR) of Mmp-13 mRNA was confirmed by the luciferase reporter assay.
RESULTS: miR-320 expression was elevated in chondrogenic and hypertrophic ATDC5, while significantly reduced in OA cartilage compared with normal cartilage. Stimulation with IL-1beta led to a significant reduction in miR-320 expression in PMCs. Upregulation of MMP-13 expression was correlated with downregulation of miR-320 expression in both PMCs and ATDC5. Overexpression of miR-320 suppressed the activity of a reporter construct containing the 3'-UTR and inhibited MMP-13 expression in both ATDC5 and IL-1beta-treated PMCs, while treatment with anti-miR-320 enhanced MMP-13 expression. NF-kappaB and MAPK activation downregulated miR-320 expression.
CONCLUSION: Cartilage development and homeostasis are influenced by miR-320, which directly targets MMP-13 and regulates chondrogenesis and the IL-1beta-stimulated catabolic effect in mouse chondrocytes.
|
0 |
Ulnar shortening osteotomy in posttraumatic ulnar impaction syndrome
|
Distal Radius Fractures
|
Twenty-eight patients (average age 45 years) with posttraumatic ulnar impaction syndrome underwent ulnar shortening osteotomy of 3-15 mm. Contributing factors were malunited fractures of the distal radius in 20, diaphyseal fractures of the ulna and radius in 6, resection of the radial head and a traumatic tear of the triangular fibrocartilage in 1 patient each. Evaluation at an average follow-up of 20 months showed a high rate of satisfied patients (89%), but according to Chun's modification of the Gartland-Werley score there were 1 excellent (3.5%), 11 good (39.5%), 11 fair (39.5%) and 5 poor (17.5%) results. Degenerative changes of the distal radioulnar joint were associated with fair and poor results, and ulnar shortening osteotomy is only recommended in ulnocarpal impaction with an intact distal radioulnar joint. Osteotomy fixation with 3.5 mm dynamic compression plates enabled immediate postoperative mobilisation and resulted in a low complication rate. There was no advantage for the technically more demanding oblique as compared with a transverse osteotomy.
|
0 |
Results of using Ilizarov distraction osteogenesis technique for the treatment of cubitus varus deformities in adults
|
The Treatment of Pediatric Supracondylar Humerus Fractures AUC
|
INTRODUCTION: Five adult patients, with posttraumatic cubitus varus deformity underwent corrective surgery by the Ilizarov method of distraction osteogenesis. METHOD: A standard technique was applied in all patients. The average follow-up was 28 (range, 24-38) months. Preoperative carrying angle ranged from 12 degrees to 22 degrees of varus (average 16.6 degrees ) and postoperative carrying angle ranged from 10 degrees to 14 degrees of valgus (average, 11.6 degrees ) equalized to the contralateral side. RESULT: The outcome was rated as excellent in all patients. No complication was observed, except a grade-2 pin-tract infection in two patients. CONCLUSION: Rigid fixation, early rehabilitation, precise correction, satisfactory cosmetic scars and functionally excellent results can be obtained with this method
|
0 |
Influence of coronavirus disease 2019 pandemic state of emergency in orthopaedic fracture surgical treatment
|
Coronavirus Disease 2019 (COVID-19)
|
PURPOSE: After the appearance of first COVID-19 cases in Serbia, state of emergency was declared on 15 March 2020 and lasted for 54Â days. The aim of this report is to compare orthopaedic fracture frequencies in this period, when the walk was limited at the home mostly, with those during the same part in the previous year with regular state, thus to examine staying at home as a factor influencing the frequency of different fracture types. METHODS: There were 86 patients during the state of emergency in year 2020 and 106 patients during the same part of year 2019 with a regular state, having orthopaedic trauma surgery. Number of fractures, gender distribution, and age of patients have been compared between these periods. RESULTS: Total number of fractures decreased for about 19% during the state of emergency. There was nonsignificant difference in fracture frequency for all skeletal areas (pâ??>â??0.05), except for distal femoral fractures which occurred more often during the state of emergency (pâ??<â??0.05). Female ratio was higher during state of emergency than in regular state for femoral neck fractures. CONCLUSION: Restricted going outside the home for 54Â days has the influence in total number of fractures and gender distribution in femoral neck fractures. The method of external fixation used could be assumed as a reducing factor of intraoperative virus pandemic propagation among medical staff.
|
0 |
Safe zone for placement of anterior distal femoral half pins
|
OAK 3 - Non-arthroplasty tx of OAK
|
Background: Anterior external fixator half pins are commonly used to secure a knee spanning external fixator. Knee joint penetration by the pins is a serious complication. Objective: To determine the safe zone for the insertion of anterior half pins at the distal femur to avoid suprapatellar pouch penetration using fixed anatomical landmarks. Materials and Methods: The distance from the medial and lateral epicondyle along the femoral axis to the perpendicular line of the superior reflection of suprapatellar pouch was measured in MRI images of 100 knees. Results: The average distance from the superior pole of the patella to the superior reflection of the suprapatellar pouch was 26.5±7.2 mm (95% CI 25.1 to 27.9). The average distance from superior reflection of the suprapatellar pouch to the medial epicondyle was 47.5±6.3 mm (95% CI 46.2 to 48.7) and to lateral epicondyle was 53.0±6.6 mm (95% CI 51.7 to 54.3). Conclusion: Insertion of anterior external fixator half pins into the distal femur should begin at least 5.0 cm above the medial epicondyle or 5.5 cm above the lateral epicondyle to avoid knee joint penetration.
|
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.