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Teixidor-Serra J, Andrés-Peiró JV, García-Sanchez Y, Selga-Marsa J, Garcia-Martínez MC, Carbonell-Rosell C, García-Albó E, Tomás-Hernández J. Outcomes and their predictors in suprapatellar nailing for tibia fractures. Multivariable analysis of 293 consecutive cases. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02476-0. [PMID: 38472386 DOI: 10.1007/s00068-024-02476-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/19/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE Intramedullary nailing of tibial fractures is one of the most common procedures in orthopedic surgery. It can be technically demanding in proximal or distal fractures, which may be facilitated using semi-extended approaches. The aim of this study is to identify outcomes and their predictors using a semi-extended suprapatellar approach for tibial fracture nailing. METHODS This is a retrospective cohort of 293 patients who underwent intramedullary nail fixation of a tibial fracture through a suprapatellar approach, considering a postoperative follow-up of 1 year. Data on patient's baseline characteristics, injuries, treatments, and outcomes regarding alignment, fracture union, and complications were recorded. For multivariable analysis, hierarchical binary (logistic) regression analysis was performed. RESULTS The mean patient age was 47.7 years (SD 18.9), with 42A1 the most frequent fracture pattern (n = 98, 33.5%). Correct or anatomical alignment (≤ 5º in both planes) was achieved in 272 (92.8%) of the patients. On multivariate analysis, surgical delay ≥ 7 days (OR = 1.3, 95% CI = 1.3-8.1) and age over 50 years (OR = 3.2, 95% CI = 1.2-8.3) were found as predictors of fracture malalignment. Fracture healing was achieved in 97.6%, and reoperation rate was 6.14%. Overall complication's predictors were proximal fracture (OR = 2.8, 95% CI = 1.1-7.2), temporary external fixation (OR = 2.4, 95% CI = 1.2-4.9), and fracture malalignment (OR = 2.9, 95% CI = 1.1-7.9). CONCLUSION The suprapatellar approach is a safe and useful technique for treating tibial fractures, leading to no less than correct reduction in almost all patients and achieving a high fracture healing rate, at very low rates of complications. Pre- and postoperative predictors identified must be taken into account to improve outcomes while treating these fractures.
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Affiliation(s)
- Jordi Teixidor-Serra
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - José Vicente Andrés-Peiró
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
| | - Yaiza García-Sanchez
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Jordi Selga-Marsa
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | | | - Carla Carbonell-Rosell
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Enrique García-Albó
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Tomás-Hernández
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
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Jana Neto FC, Martimbianco ALC, de Medeiros DV, Felix FC, Mesquita-Ferrari RA, Bussadori SK, Duran CCG, Motta LJ, Barbosa EC, Fernandes KPS. Cost analysis of photobiomodulation in tibia fracture in the Brazilian public health system. PLoS One 2023; 18:e0294290. [PMID: 38064443 PMCID: PMC10707925 DOI: 10.1371/journal.pone.0294290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/28/2023] [Indexed: 12/18/2023] Open
Abstract
Managing tibial fractures requires substantial health resources, which costs the health system. This study aimed to describe the costs of photobiomodulation (PBM) with LEDs in the healing process of soft tissue lesions associated with tibial fracture compared to a placebo. Economic analysis was performed based on a randomized controlled clinical trial, with a simulation of the cost-effectiveness and incremental cost model. Adults (n = 27) hospitalized with tibia fracture awaiting definitive surgery were randomized into two distinct groups: the PBM Group (n = 13) and the Control Group with simulated phototherapy (n = 14). To simulate the cost-effectiveness and incremental cost model, the outcome was the evolution of wound resolution by the BATES-JENSEN scale and time of wound resolution in days. The total cost of treatment for the Control group was R$21,164.56, and a difference of R$7,527.10 more was observed when compared to the treatment of the PBM group. The proposed intervention did not present incremental cost since the difference in the costs to reduce measures between the groups was smaller for the PBM group. When analyzing the ICER (Incremental cost-effectiveness ratio), it would be possible to save R$3,500.98 with PBM and decrease by 2.15 points in the daily average on the BATES-JENSEN scale. It is concluded, therefore, that PBM can be a supportive therapy of clinical and economic interest in a hospital setting.
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Affiliation(s)
- Frederico Carlos Jana Neto
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
- Orthopedics and Traumatology Group Conjunto Hospitalar do Mandaqui, São Paulo, SP, Brazil
- Medicine School Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Ana Luiza Cabrera Martimbianco
- Postgraduate Program in Health and Environment. Universidade Metropolitana de Santos (UNIMES), Santos, SP, Brazil
- Health Technology Assessment Center, Hospital Sírio-Libanês (NATS-HSL), São Paulo, SP, Brazil
| | | | | | - Raquel Agnelli Mesquita-Ferrari
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Sandra Kalil Bussadori
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Cinthya Cosme Gutierrez Duran
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
- Postgraduate Program in Medicine, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Lara Jansiski Motta
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Estela Capelas Barbosa
- Population Health Sciences, Bristol Medical School, Bristol University, Bristol, United Kingdom
| | - Kristianne Porta Santos Fernandes
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
- Postgraduate Program in Medicine, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
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Abstract
Aims To report the outcomes of patients with a fracture of the distal tibia who were treated with intramedullary nail versus locking plate in the five years after participating in the Fixation of Distal Tibia fracture (FixDT) trial. Methods The FixDT trial reported the results for 321 patients randomized to nail or locking plate fixation in the first 12 months after their injury. In this follow-up study, we report the results of 170 of the original participants who agreed to be followed up until five years. Participants reported their Disability Rating Index (DRI) and health-related quality of life (EuroQol five-dimension three-level questionnaire) annually by self-reported questionnaire. Further surgical interventions related to the fracture were also recorded. Results There was no evidence of a difference in patient-reported disability, health-related quality of life, or the need for further surgery between participants treated with either type of fixation at five years. Considering the combined results for all participants, there was no significant change in DRI scores after the first 12 months of follow-up (difference between 12 and 24 months, 3.3 (95% confidence interval -1.8 to 8.5); p = 0.203), with patients reporting around 20% disability at five years. Conclusion This study shows that the moderate levels of disability and reduced quality of life reported by participants 12 months after a fracture of the distal tibia persist in the medium term, with little evidence of improvement after the first year.
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Affiliation(s)
- Nick Parsons
- Statistics and Epidemiology, Warwick Medical School, University of Warwick, Coventry, UK
| | - Juul Achten
- Oxford Trauma and Emergency Care, University of Oxford, Oxford, UK
| | - Matt L Costa
- Oxford Trauma and Emergency Care, University of Oxford, Oxford, UK
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Group sequential designs in pragmatic trials: feasibility and assessment of utility using data from a number of recent surgical RCTs. BMC Med Res Methodol 2022; 22:256. [PMID: 36183085 PMCID: PMC9526271 DOI: 10.1186/s12874-022-01734-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/16/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Assessing the long term effects of many surgical interventions tested in pragmatic RCTs may require extended periods of participant follow-up to assess effectiveness and use patient-reported outcomes that require large sample sizes. Consequently the RCTs are often perceived as being expensive and time-consuming, particularly if the results show the test intervention is not effective. Adaptive, and particularly group sequential, designs have great potential to improve the efficiency and cost of testing new and existing surgical interventions. As a means to assess the potential utility of group sequential designs, we re-analyse data from a number of recent high-profile RCTs and assess whether using such a design would have caused the trial to stop early. METHODS Many pragmatic RCTs monitor participants at a number of occasions (e.g. at 6, 12 and 24 months after surgery) during follow-up as a means to assess recovery and also to keep participants engaged with the trial process. Conventionally one of the outcomes is selected as the primary (final) outcome, for clinical reasons, with others designated as either early or late outcomes. In such settings, novel group sequential designs that use data from not only the final outcome but also from early outcomes at interim analyses can be used to inform stopping decisions. We describe data from seven recent surgical RCTs (WAT, DRAFFT, WOLLF, FASHION, CSAW, FIXDT, TOPKAT), and outline possible group sequential designs that could plausibly have been proposed at the design stage. We then simulate how these group sequential designs could have proceeded, by using the observed data and dates to replicate how information could have accumulated and decisions been made for each RCT. RESULTS The results of the simulated group sequential designs showed that for two of the RCTs it was highly likely that they would have stopped for futility at interim analyses, potentially saving considerable time (15 and 23 months) and costs and avoiding patients being exposed to interventions that were either ineffective or no better than standard care. We discuss the characteristics of RCTs that are important in order to use the methodology we describe, particularly the value of early outcomes and the window of opportunity when early stopping decisions can be made and how it is related to the length of recruitment period and follow-up. CONCLUSIONS The results for five of the RCTs tested showed that group sequential designs using early outcome data would have been feasible and likely to provide designs that were at least as efficient, and possibly more efficient, than the original fixed sample size designs. In general, the amount of information provided by the early outcomes was surprisingly large, due to the strength of correlations with the primary outcome. This suggests that the methods described here are likely to provide benefits more generally across the range of surgical trials and more widely in other application areas where trial designs, outcomes and follow-up patterns are structured and behave similarly.
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John M, Mir HR. Extreme nailing and immediate weight bearing constructs in fractures of the distal tibia. OTA Int 2022; 5:e180. [PMID: 37781481 PMCID: PMC10538524 DOI: 10.1097/oi9.0000000000000180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/18/2021] [Indexed: 10/03/2023]
Abstract
Extraarticular fractures of the distal tibia can present as difficult but manageable lower extremity injuries. Historically, these injuries have been fixed in a myriad of ways. Early management with intramedullary nailing had higher complication rates due to the unique anatomical and biomechanical features of the distal tibia. Modern improvements in intramedullary nailing surgical techniques and implant design have significantly decreased complication rates and led to improvement in patient outcomes. Many surgeons protect weight bearing postoperatively, but recent literature suggests that patients may safely weight bear immediately following intramedullary fixation. This article reviews technique and implant design changes that have facilitated immediate safe weight bearing following intramedullary nailing of extraarticular distal tibia fractures.
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Affiliation(s)
- Mitchell John
- University of South Florida, Department of Orthopaedic Surgery
| | - Hassan R Mir
- University of South Florida, Department of Orthopaedic Surgery
- Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL
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Conombo B, Guertin JR, Tardif PA, Gagnon MA, Duval C, Archambault P, Berthelot S, Lauzier F, Turgeon AF, Stelfox HT, Chassé M, Hoch JS, Gabbe B, Champion H, Lecky F, Cameron P, Moore L. Economic Evaluation of In-Hospital Clinical Practices in Acute Injury Care: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:844-854. [PMID: 35500953 DOI: 10.1016/j.jval.2021.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/27/2021] [Accepted: 10/31/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Underuse of high-value clinical practices and overuse of low-value practices are major sources of inefficiencies in modern healthcare systems. To achieve value-based care, guidelines and recommendations should target both underuse and overuse and be supported by evidence from economic evaluations. We aimed to conduct a systematic review of the economic value of in-hospital clinical practices in acute injury care to advance knowledge on value-based care in this patient population. METHODS Pairs of independent reviewers systematically searched MEDLINE, Embase, Web of Science, and Cochrane Central Register for full economic evaluations of in-hospital clinical practices in acute trauma care published from 2009 to 2019 (last updated on June 17, 2020). Results were converted into incremental net monetary benefit and were summarized with forest plots. The protocol was registered with PROSPERO (CRD42020164494). RESULTS Of 33 910 unique citations, 75 studies met our inclusion criteria. We identified 62 cost-utility, 8 cost-effectiveness, and 5 cost-minimization studies. Values of incremental net monetary benefit ranged from international dollars -467 000 to international dollars 194 000. Of 114 clinical interventions evaluated (vs comparators), 56 were cost-effective. We identified 15 cost-effective interventions in emergency medicine, 6 in critical care medicine, and 35 in orthopedic medicine. A total of 58 studies were classified as high quality and 17 as moderate quality. From studies with a high level of evidence (randomized controlled trials), 4 interventions were clearly dominant and 8 were dominated. CONCLUSIONS This research advances knowledge on value-based care for injury admissions. Results suggest that almost half of clinical interventions in acute injury care that have been studied may not be cost-effective.
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Affiliation(s)
- Blanchard Conombo
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada; Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada
| | - Jason R Guertin
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada
| | - Pier-Alexandre Tardif
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada
| | - Marc-Aurèle Gagnon
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada; Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada
| | - Cécile Duval
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada; Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Québec, Canada; VITAM-Centre de recherche en santé durable, Université Laval, Québec City, Québec, Canada; Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Université Laval, Québec City, Québec, Canada
| | - Simon Berthelot
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Québec, Canada
| | - François Lauzier
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Alexis F Turgeon
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Medicine and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Michaël Chassé
- Department of Medicine, Université de Montréal, Québec City, Québec, Canada
| | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Davis, CA, USA
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine at Monash University, Melbourne, Victoria, Australia
| | - Howard Champion
- Uniformed Services University of the Health Sciences Annapolis, Bethesda, MD, USA
| | - Fiona Lecky
- School of Health and Related Research, Sheffield, England, UK
| | - Peter Cameron
- School of Public Health and Preventive Medicine at Monash University, Melbourne, Victoria, Australia
| | - Lynne Moore
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada; Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada.
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Abstract
AIMS The aim of this study was to determine the immediate post-fixation stability of a distal tibial fracture fixed with an intramedullary nail using a biomechanical model. This was used as a surrogate for immediate weight-bearing postoperatively. The goal was to help inform postoperative protocols. METHODS A biomechanical model of distal metaphyseal tibial fractures was created using a fourth-generation composite bone model. Three fracture patterns were tested: spiral, oblique, and multifragmented. Each fracture extended to within 4 cm to 5 cm of the plafond. The models were nearly-anatomically reduced and stabilized with an intramedullary nail and three distal locking screws. Cyclic loading was performed to simulate normal gait. Loading was completed in compression at 3,000 N at 1 Hz for a total of 70,000 cycles. Displacement (shortening, coronal and sagittal angulation) was measured at regular intervals. RESULTS The spiral and oblique fracture patterns withstood simulated weight-bearing with minimal displacement. The multifragmented model had early implant failure with breaking of the distal locking screws. The spiral fracture model shortened by a mean of 0.3 mm (SD 0.2), and developed a mean coronal angulation of 2.0° (SD 1.9°) and a mean sagittal angulation of 1.2° (SD 1.1°). On average, 88% of the shortening, 74% of the change in coronal alignment, and 75% of the change in sagittal alignment occurred in the first 2,500 cycles. No late acceleration of displacement was noted. The oblique fracture model shortened by a mean of 0.2 mm (SD 0.1) and developed a mean coronal angulation of 2.4° (SD 1.6°) and a mean sagittal angulation of 2.6° (SD 1.4°). On average, 44% of the shortening, 39% of the change in coronal alignment, and 79% of the change in sagittal alignment occurred in the first 2,500 cycles. No late acceleration of displacement was noted. CONCLUSION For spiral and oblique fracture patterns, simulated weight-bearing resulted in a clinically acceptable degree of displacement. Most displacement occurred early in the test period, and the rate of displacement decreased over time. Based on this model, we offer evidence that early weight-bearing appears safe for well reduced oblique and spiral fractures, but not in multifragmented patterns that have poor bone contact. Cite this article: Bone Joint J 2021;103-B(2):294-298.
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Affiliation(s)
- Michael M Hadeed
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Hans Prakash
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Seth R Yarboro
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - David B Weiss
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
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Nicholson JA, Jones R, MacDonald DJ, Brown I, McBirnie J. Cost-effectiveness of the reverse total shoulder arthroplasty. Does indication affect outcome? Shoulder Elbow 2021; 13:90-97. [PMID: 33717222 PMCID: PMC7905516 DOI: 10.1177/1758573219897860] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/16/2019] [Accepted: 12/08/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND The primary aim of this study was to determine the cost-effectiveness of the reverse total shoulder arthroplasty in a prospective cohort of patients over a two-year post-operative period. METHODS Patients who underwent reverse total shoulder arthroplasty were prospectively monitored for 24 months post-operatively using the Oxford Shoulder Score, Disabilities of the Arm, Shoulder and Hand questionnaire and EuroQol 5-dimensional questionnaire. Any complications or use of health care resources were recorded. The incremental cost-effectiveness ratio was used to express the cost per quality-adjusted life year gained. RESULTS Sixty-seven patients were analysed, 46 primary reverse total shoulder arthroplasty for cuff arthropathy and 21 revisions from previous arthroplasty. Both indications had comparable peri-operative shoulder scores without significant difference. Using the mean change of EuroQol 5-dimensional questionnaire at one year, the incremental cost-effectiveness ratio was calculated at £16,827.43 per quality-adjusted life year, decreasing to £8313.48 per quality-adjusted life year at two years. Primary was associated with a lower incremental cost-effectiveness ratio at two years (primary £7596.76 vs. revision £11,748.51). The estimated post-operative life expectancy of the cohort was 6.9 years with a projected cost per quality-adjusted life year of £2438.78. CONCLUSIONS Reverse total shoulder arthroplasty provides a cost-effective intervention with excellent patient outcomes at two years post-operatively.
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Affiliation(s)
- Jamie A Nicholson
- Jamie A Nicholson, Department of Orthopaedic Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SA, UK.
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Fang R, Ji A, Zhao Z, Long D, Chen C. A regression orthogonal biomechanical analysis of internal fixation for femoral shaft fracture. Biocybern Biomed Eng 2020. [DOI: 10.1016/j.bbe.2020.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Interlocking screw configuration influences distal tibial fracture stability in torsional loading after intramedullary nailing. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1205-1213. [PMID: 32367222 DOI: 10.1007/s00590-020-02686-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study evaluated the influence of fracture obliquity and locking screw configuration on interfragmentary motion during torsional loading of distal metaphyseal tibial fractures fixed by intramedullary (IM) nailing. METHODS The stability of six IM nail locking screw configurations used to fix distal metaphyseal tibial fractures of various obliquities was evaluated. A coronal osteotomy from proximal lateral to distal medial was made in sawbone tibiae at different obliquities from 0° to 60°. After fixation, motion at the fracture was assessed during internal and external rotation tests to 7 Nm under two compressive loading conditions: 20 N and 500 N. RESULTS With results organized by interlocking configuration, significant differences in interfragmentary rotation between fracture obliquities are observed when the number of interlocking screws is decreased to one distal static and one proximal dynamic during internal rotation. During external rotation testing, significant rotational differences between fracture obliquities are encountered with two distal static screws and one proximal dynamic. No significant differences were seen between different distal interlocking screw orientations (two parallel versus perpendicular distal screws) for all fracture obliquity patterns tested. CONCLUSION Fracture obliquity influences rotational stability which can be mitigated by interlocking screw configurations when nailing distal tibia fractures. At least two distal and one proximal interlocking screw in a static mode is recommended to resist torsional loading of distal tibia fractures undergoing intramedullary nailing. The addition of more interlocking screws than this did not significantly alter control of torsional displacement with load.
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Immediate weightbearing after intramedullary fixation of extra-articular distal tibial fractures reduces the nonunion rate compared with traditional weight-bearing protocol: A cohort study. Int J Surg 2020; 76:132-135. [DOI: 10.1016/j.ijsu.2020.02.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 02/02/2020] [Accepted: 02/28/2020] [Indexed: 01/01/2023]
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Lowenberg DW, DeBaun MR, Sox-Harris A, Behn A. Influence of fracture obliquity and interlocking nail screw configuration on interfragmentary motion in distal metaphyseal tibia fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:343-350. [DOI: 10.1007/s00590-019-02553-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/11/2019] [Indexed: 11/24/2022]
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Affiliation(s)
- F S Haddad
- The Bone & Joint Journal, Professor of Orthopaedic Surgery, University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
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Affiliation(s)
- B J Ollivere
- Trauma and Orthopaedics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - B A Marson
- Trauma and Orthopaedics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - F S Haddad
- The Bone & Joint Journal, Professor of Orthopaedic Surgery, University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
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Treatment of distal tibial fractures: prospective comparative study evaluating two surgical procedures with investigation for predictive factors of unfavourable outcome. INTERNATIONAL ORTHOPAEDICS 2018; 43:201-207. [PMID: 30135986 DOI: 10.1007/s00264-018-4121-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/15/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE The aim of this study is to compare clinical and radiological outcome of intramedullary nailing (IMN) and locked plate (LP) in patients affected by fracture of the distal tibia (DTF). We performed also an analysis to identify predictive factors of unfavourable outcome. METHODS Data about patients with DTF treated at our first level trauma centre between 2008 and 2017 were collected. Patients were divided in group 1 (IMN) and group 2 (LP). The inclusion criteria were age at least 18 years at the time of diagnosis and unilateral DTF (closed or Gustilo 1). Demographic variables and data related to surgical procedure and hospitalization were registered. X-ray at follow-up was reviewed to identify malunions and nonunions. Clinical outcome was evaluated using scores and registering any complication. RESULTS One hundred two patients were included in group 1 and 81 in group 2. In group 2 were documented higher operating time and hospitalization. The mean union time was 20.2 weeks for IMN and 24.8 weeks for LP group (p = 0.271). The rate of infections and wound complications was higher in group 2 while malunion and anterior knee pain were more frequent in group 1. No difference in scores for clinical outcome was documented after six months. The full-weight bearing time was significantly longer in the LP group (p = 0.019). At multivariate analysis, no variables showed a predictive power for unfavourable outcome. CONCLUSIONS Clinical and radiological results of LP and IMN appear similar. No predictive factors of unfavourable outcome were identified.
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Maredza M, Petrou S, Dritsaki M, Achten J, Griffin J, Lamb SE, Parsons NR, Costa ML. Infographic: Economic justification for intramedullary nail fixation over locking plate fixation for extra-articular distal tibial fractures. Bone Joint J 2018; 100-B:622-623. [DOI: 10.1302/0301-620x.100b5.bjj-2017-0393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- M. Maredza
- Clinical Trials Unit, Warwick Medical
School, The University of Warwick, Coventry, UK
| | - S. Petrou
- Clinical Trials Unit, Warwick Medical
School, The University of Warwick, Coventry, UK
| | - M. Dritsaki
- Oxford Trauma,Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J. Achten
- Oxford Trauma,Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J. Griffin
- Clinical Trials Unit, Warwick Medical
School, The University of Warwick, Gibbet
Hill Campus, Coventry, UK
| | - S. E. Lamb
- Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - N. R. Parsons
- Clinical Trials Unit, Warwick Medical
School, The University of Warwick, Coventry, UK
| | - M. L. Costa
- Oxford Trauma,Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, University of Oxford, and Clinical
Trials Unit, Warwick Medical School, The
University of Warwick, Coventry, UK
and University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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