1
|
Eriksson EA, Wijffels MME, Kaye A, Forrester JD, Moutinho M, Majerick S, Bauman ZM, Janowak CF, Patel B, Wullschleger M, Clevenger L, Van Lieshout EMM, Tung J, Woodfall M, Hill TR, White TW, Doben AR. Incidence of surgical rib fixation at chest wall injury society collaborative centers and a guide for expected number of cases (CWIS-CC1). Eur J Trauma Emerg Surg 2024; 50:417-423. [PMID: 37624405 DOI: 10.1007/s00068-023-02343-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE Surgical stabilization of rib fractures (SSRF) improves outcomes in certain patient populations. The Chest Wall Injury Society (CWIS) began a new initiative to recognize centers who epitomize their mission as CWIS Collaborative Centers (CWIS-CC). We sought to describe incidence and epidemiology of SSRF at our institutions. METHODS A retrospective registry evaluation of all patients (age > 15 years) treated at international trauma centers from 1/1/20 to 7/30/2021 was performed. Variables included: age, gender, mechanism of injury, injury severity score, abbreviated injury severity score (AIS), emergency department disposition, length of stay, presence of rib/sternal fractures, and surgical stabilization of rib/sternal fractures. Classification and regression tree analysis (CART) was used for analysis. RESULTS Data were collected from 9 centers, 26,084 patient encounters. Rib fractures were present in 24% (n = 6294). Overall, 2% of all patients underwent SSRF and 8% of patients with rib fractures underwent SSRF. CART analysis of SSRF by AIS-Chest demonstrated a difference in management by age group. AIS-Chest 3 had an SSRF rate of 3.7, 7.3, and 12.9% based on the age ranges (16-19; 80-110), (20-49; 70-79), and (50-69), respectively (p = 0.003). AIS-Chest > 3 demonstrated an SSRF rate of 9.6, 23.3, and 39.3% for age ranges (16-39; 90-99), (40-49; 80-89), and (50-79), respectively (p = 0.001). CONCLUSION Anticipated rate of SSRF can be calculated based on number of rib fractures, AIS-Chest, and age. The disproportionate rate of SSRF in patients age 50-69 with AIS-Chest 3 and age 50-79 with AIS-Chest > 3 should be further investigated, as lower frequency of SSRF in the other age ranges may lead to care inequalities.
Collapse
Affiliation(s)
- Evert Austin Eriksson
- Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas Drive CSB 420, MSC 613, Charleston, SC, 29425, USA.
| | - Mathieu Mathilde Eugene Wijffels
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Adam Kaye
- Department of Trauma, Overland Park Regional Medical Center, 10500 Quivira Rd., Overland Park, KS, 66215, USA
| | - Joseph Derek Forrester
- Department of Surgery, Stanford Healthcare, Chest Wall Injury Center, Stanford Healthcare, Center for Innovation in Global Health (CIGH), Stanford University, Stanford, USA
| | - Manuel Moutinho
- Department of Surgery, Saint Francis Hospital and Medical Center, UConn School of Medicine, Hartford, CT, USA
| | - Sarah Majerick
- Department of Trauma, Intermountain Health, Salt Lake City, USA
| | - Zachary Mitchel Bauman
- Trauma Surgery, Surgical Critical Care, Emergency General Surgery, Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, TraumaOmaha, NE, 68198-3280, USA
| | - Christopher Francis Janowak
- Section of General Surgery, Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267, USA
| | - Bhavik Patel
- Gold Coast University Hospital, Gold Coast, QLD, 4215, Australia
| | - Martin Wullschleger
- Royal Brisbane and Women's Hospital, Brisbane, Australia
- Griffith University, Gold Coast, Australia
| | - Leanna Clevenger
- Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas Drive CSB 420, MSC 613, Charleston, SC, 29425, USA
| | - Esther M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Jamie Tung
- Department of Surgery, Stanford Healthcare, Chest Wall Injury Center, Stanford Healthcare, Center for Innovation in Global Health (CIGH), Stanford University, Stanford, USA
| | - Michelle Woodfall
- Department of Surgery, Stanford Healthcare, Chest Wall Injury Center, Stanford Healthcare, Center for Innovation in Global Health (CIGH), Stanford University, Stanford, USA
| | - Thomas Russell Hill
- Department of Surgery, Saint Francis Hospital and Medical Center, UConn School of Medicine, Hartford, CT, USA
| | | | - Andrew Ross Doben
- Department of Surgery, Saint Francis Hospital and Medical Center, UConn School of Medicine, Hartford, CT, USA
| |
Collapse
|
2
|
Johnson CT, Tran A, Preslar J, Bussey-Jones J, Schenker ML. Racial Disparities in the Operative Management of Orthopedic Trauma: A Systematic Review and Meta-Analysis. Am Surg 2023; 89:4521-4530. [PMID: 35981540 DOI: 10.1177/00031348221121561] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of this study was to investigate if race is associated with the likelihood of operative management of acute fractures. METHODS A systematic review of the literature was performed using the PubMed, EMBASE, and Cochrane databases to identify studies associated with social disparities and acute orthopedic trauma. Peer-reviewed studies commenting on social disparities and the decision to pursue operative or non-operative management of acute fractures were identified for detailed review. Study characteristics and odds ratios were extracted from each article. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed. A quality analysis of the data was also performed. RESULTS In total, 13 studies were identified and 8 were included in the meta-analysis totaling 743,846 fractures. Hip, distal radius, pelvic, tibial plateau, clavicle, femoral neck, and femoral shaft fractures were represented in this patient population. The meta-analysis demonstrated that White race is associated with a higher likelihood of operative intervention compared to all other races pooled together (odds ratio, 1.31; 95% confidence interval 1.16 to 1.47; p < .0001) as well as Black race (odds ratio 1.39; 95% confidence interval 1.12 to 1.72; p = .0025). CONCLUSIONS Non-White race and Black race are associated with a lower likelihood of receiving surgical management of acute orthopedic trauma. Surgeons and health systems should be aware of these inequities and consider strategies to mitigate bias and ensure all patients receive appropriate and timely care regardless of race.
Collapse
Affiliation(s)
| | - Andrew Tran
- Department of Orthopaedics, School of Medicine, Emory University, Atlanta, GA, USA
| | - Jessie Preslar
- Department of Orthopaedics, School of Medicine, Emory University, Atlanta, GA, USA
| | - Jada Bussey-Jones
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Mara L Schenker
- Department of Orthopaedics, School of Medicine, Emory University, Atlanta, GA, USA
| |
Collapse
|
3
|
Costa ML, Achten J, Ooms A, Png ME, Cook JA, Lamb SE, Hedley H, Dias J. Surgical fixation with K-wires versus casting in adults with fracture of distal radius: DRAFFT2 multicentre randomised clinical trial. BMJ 2022; 376:e068041. [PMID: 35045969 PMCID: PMC8767805 DOI: 10.1136/bmj-2021-068041] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess wrist function, quality of life, and complications in adult patients with a dorsally displaced fracture of the distal radius, treated with either a moulded cast or surgical fixation with K-wires. DESIGN Multicentre randomised clinical superiority trial, SETTING: 36 hospitals in the UK National Health Service (NHS). PARTICIPANTS 500 adults aged 16 or over with a dorsally displaced fracture of the distal radius, randomised after manipulation of their fracture (255 to moulded cast; 245 to surgical fixation). INTERVENTIONS Manipulation and moulded cast was compared with manipulation and surgical fixation with K-wires plus cast. Details of the application of the cast and the insertion of the K-wires were at the discretion of the treating surgeon, according to their normal clinical practice. MAIN OUTCOME MEASURES The primary outcome measure was the Patient Rated Wrist Evaluation (PRWE) score at 12 months (five questions about pain and 10 about function and disability; overall score out of 100 (best score=0 and worst score=100)). Secondary outcomes were PRWE score at three and six months, quality of life, and complications, including the need for surgery due to loss of fracture position in the first six weeks. RESULTS The mean age of participants was 60 years and 417 (83%) were women; 395 (79%) completed follow-up. No statistically significant difference in the PRWE score was seen at 12 months (cast group (n=200), mean 21.2 (SD 23.1); K-wire group (n=195), mean 20.7 (22.3); adjusted mean difference -0.34 (95% confidence interval -4.33 to 3.66), P=0.87). No difference was seen at earlier time points. In the cast group, 33 (13%) of participants needed surgical fixation for loss of fracture position in the first six weeks compared with one revision surgery in the K-wire group (odds ratio 0.02, 95% confidence interval 0.001 to 0.10). CONCLUSIONS Among patients with a dorsally displaced distal radius fracture that needed manipulation, surgical fixation with K-wires did not improve patients' wrist function at 12 months compared with a cast. TRIAL REGISTRATION ISRCTN registry ISRCTN11980540.
Collapse
Affiliation(s)
- Matthew L Costa
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Trauma Unit, Kadoorie Centre, John Radcliffe Hospital, Oxford, UK
| | - Juul Achten
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Trauma Unit, Kadoorie Centre, John Radcliffe Hospital, Oxford, UK
| | - Alexander Ooms
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK
| | - May Ee Png
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Oxford, UK
| | - Jonathan A Cook
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK
| | - Sarah E Lamb
- College of Medicine and Health, South Cloisters, University of Exeter, Exeter, UK
| | - Helen Hedley
- Department of Trauma and Orthopaedics, University Hospital Coventry and Warwickshire NHS Trust, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Joseph Dias
- Department of Health Sciences, University of Leicester, George Davies Centre, Leicester, UK
| |
Collapse
|
4
|
DeVoe WB, Abourezk M, Goslin BJ, Saraswat N, Kiel B, Bach JA, Suh KI, Eriksson EA. Surgical stabilization of severe chest wall injury following cardiopulmonary resuscitation. J Trauma Acute Care Surg 2022; 92:98-102. [PMID: 34629459 DOI: 10.1097/ta.0000000000003426] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) contributes to significant chest wall injury similar to blunt trauma. With benefits realized for surgical stabilization of rib fractures (SSRFs) for flail injuries and severely displaced fractures following trauma, SSRF for chest wall injury following CPR could be advantageous, provided good functional and neurologic outlook. Experience is limited. We present a review of patients treated with SSRF at our institution following CPR. METHODS A retrospective analysis of patients undergoing SSRF following CPR was performed between 2019 and 2020. Perioperative inpatient data were collected with outpatient follow-up as able. RESULTS Five patients underwent SSRF over the course of the 2-year interval. All patients required invasive ventilation preoperatively or had impending respiratory. Mean age was 59 ± 12 years, with all patients being male. Inciting events for cardiac arrest included respiratory, ventricular tachycardia, ventricular fibrillation, pulseless electrical activity, and anaphylaxis. Time to operation was 6.6 ± 3 days. Four patients demonstrated anterior flail injury pattern with or without sternal fracture, with one patient having multiple severely displaced fractures. Surgical stabilization of rib fracture was performed appropriately to restore chest wall stability. Mean intensive care unit length of stay was 9.8 ± 6.4 days and overall hospital length of stay 24.6 ± 13.2 days. Median postoperative ventilation was 2 days (range, 1-15 days) with two patients developing pneumonia and one requiring tracheostomy. There were no mortalities at 30 days. One patient expired in hospice after a prolonged hospitalization. Disposition destination was variable. No hardware complications were noted on outpatient follow-up, and all surviving patients were home. CONCLUSION Chest wall injuries are incurred frequently following CPR. Surgical stabilization of these injuries can be considered to promote ventilator liberation and rehabilitation. Careful patient selection is paramount, with surgery offered to those with reversible causes of arrest and good functional and neurologic outcome. Experience is early, with further investigation needed. LEVEL OF EVIDENCE Therapeutic, Level V.
Collapse
Affiliation(s)
- William B DeVoe
- From the Department of Surgery (W.B.D., M.A., B.J.G., N.S., B.K., J.A.B., K.I.S.), Riverside Methodist Hospital, Columbus, Ohio; and Department of Surgery (E.A.E.), Medical University of South Carolina, Charleston, South Carolina
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Prins JTH, Van Lieshout EMM, Overtoom HCG, Tekin YS, Verhofstad MHJ, Wijffels MME. Long-term pulmonary function, thoracic pain, and quality of life in patients with one or more rib fractures. J Trauma Acute Care Surg 2021; 91:923-931. [PMID: 34407007 DOI: 10.1097/ta.0000000000003378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Long-term outcomes after rib fractures and the effect of treatment modality or chest wall injury severity on these outcomes remains uncertain. This retrospective cohort study evaluated the long-term pulmonary function, thoracic pain, and quality of life in patients admitted with rib fractures. METHODS Patients admitted with rib fractures between January 1, 2012, and December 1, 2019, were included. Data on long-term outcomes were collected during one follow-up visit. Patients were stratified by chest wall injury severity (one or two rib fractures, ≥3 rib fractures, or a flail chest) and treatment modality (surgical stabilization of rib fractures [SSRF] or nonoperative management). Multivariable analysis was performed to compare outcomes after SSRF with nonoperative treatment in patients with three or more rib fractures. RESULTS In total, 300 patients were included. The median follow-up was 39 months (P25-P75, 18-65 months). At follow-up, the corrected forced vital capacity returned to 84.7% (P25-P75, 74.3-93.7) and the forced expiratory volume in 1 second to 86.3% (P25-P75, 75.3-97.0) of the predicted reference values. Quality of life was determined using the Short Form-12 version 2 and EuroQoL-5D-5L. The Short Form-12 version 2 physical and mental component summary were 45 (P25-P75, 38-54) and 53 (P25-P75, 43-60), respectively. The EuroQoL-5D-5L utility score was 0.82 (P25-P75 0.66-0.92) and visual analog scale score 75 (P25-P75 70-85). This indicated a quality of life within normal population ranges. Moderate to severe thoracic pain was reported by 64 (21.3%) patients. Long-term outcomes returned to values within population ranges and were similar across chest wall injury severity and for patients treated with SSRF or nonoperatively. CONCLUSION While long-term pulmonary function and quality of life recover to values considered normal, subjective thoracic complaints, such as pain and dyspnea, remain frequently present following rib fractures. No effect of chest wall injury severity or treatment modality on long-term outcomes was demonstrated. LEVEL OF EVIDENCE Therapeutic, level III.
Collapse
Affiliation(s)
- Jonne T H Prins
- From the Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | | | | | | | | |
Collapse
|
6
|
Thomas CN, Lindquist TJ, Paull TZ, Tatro JM, Schroder LK, Cole PA. Mapping of common rib fracture patterns and the subscapular flail chest associated with operative scapula fractures. J Trauma Acute Care Surg 2021; 91:940-946. [PMID: 34417408 DOI: 10.1097/ta.0000000000003382] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rib fractures occur in approximately 10% of trauma patients and are associated with more than 50% of patients with scapula fractures. This study investigates the location and patterns of rib fractures and flail chest occurring in patients with operatively treated scapula fractures. Novel frequency mapping techniques of rib fracture patterns in patients who also injure the closely associated scapula can yield insight into surgical approaches and fixation strategies for complex, multiple injuries patients. We hypothesize that rib fractures have locations of common occurrence when presenting with concomitant scapula fracture that requires operative treatment. METHODS Patients with one or more rib fractures and a chest computed tomography scan between 2004 and 2018 were identified from a registry of patients having operatively treated scapula fractures. Unfurled rib images were created using Syngo-CT Bone Reading software (Siemens Inc., Munich, Germany). Rib fracture and flail segment locations were marked and measured for standardized placement on a two-dimensional chest wall template. Location and frequency were then used to create a gradient heat map. RESULTS A total of 1,062 fractures on 686 ribs were identified in 86 operatively treated scapula fracture patients. The mean ± SD number of ribs fractured per patient was 8.0 ± 4.1 and included a mean ± SD of 12.3 ± 7.2 total fractures. Rib fractures ipsilateral to the scapula fracture occurred in 96.5% of patients. The most common fracture and flail segment location was ipsilateral and subscapular; 51.4% of rib fractures and 95.7% of flail segments involved ribs 3 to 6. CONCLUSION Patients indicated for operative treatment of scapula fractures have a substantial number of rib fractures that tend to most commonly occur posteriorly on the rib cage. There is a pattern of subscapular rib fractures and flail chest adjacent to the thick bony borders of the scapula. This study enables clinicians to better evaluate and diagnose scapular fracture patients with concomitant rib fractures. LEVEL OF EVIDENCE Diagnostic test, level IV.
Collapse
Affiliation(s)
- Claire N Thomas
- From the Department of Orthopaedic Surgery (C.N.T., T.Z.P., J.M.T., L.K.S., P.A.C.), University of Minnesota, Minneapolis; Department of Orthopaedic Surgery (C.N.T., J.M.T., L.K.S., P.A.C.), Regions Hospital, University of Minnesota, St. Paul, Minnesota; Department of Biology (T.J.L.), Wheaton College, Wheaton, Illinois; and HealthPartners Orthopaedics and Sports Medicine (P.A.C.), Bloomington, Minnesota
| | | | | | | | | | | |
Collapse
|
7
|
Or O, Saiyed R, Marty E, Boyer A, Jahnwar YS, Niesvizky R, Lane JM. Prediction of Long Bone Fractures in Multiple Myeloma Patients in an Advanced Imaging World. Isr Med Assoc J 2021; 23:501-505. [PMID: 34392626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Multiple myeloma (MM) affects the long bones in 25% of patients. The advent of positron-emission tomography/computed tomography (PET/CT) scanners offers the possibility of both metabolic and radiographic information and may help determine fracture risk. To the best of our knowledge, no published study correlates these two factors with long bone fractures. OBJECTIVES To evaluate the impact of PET/CT on fracture risk assessment in multiple myeloma patients. METHODS We identified all bone marrow biopsy proven multiple myeloma patients from 1 January 2010 to 31 January 2015 at a single institution. We prospectively followed patients with long bone lesions using PET/CT scan images. RESULTS We identified 119 patients (59 males/60 females) with 256 long bone lesions. Mean age at diagnosis was 58 years. The majority of lesions were in the femur (n=150, 59%) and humerus (n=84, 33%); 13 lesions in 10 patients (8%) required surgery for impending (n=4) or actual fracture (n=9). Higher median SUVmax was measured for those with cortical involvement (8.05, range 0-50.8) vs. no involvement (5.0, range 2.1-18.1). SUVmax was found to be a predictor of cortical involvement (odds ratio = 1.17, P = 0.026). No significant correlation was found between SUVmax and pain or fracture (P = 0.43). CONCLUSIONS Improved medical treatment resulted improvement in 8% of patients with an actual or impending fracture. The orthopedic surgeons commonly use the Mirels classification for long bone fracture prediction. Adding PET/CT imaging to study in myeloma long bone lesions did not predict fracture risk directly but suggested it indirectly by cortical erosion.
Collapse
Affiliation(s)
- Omer Or
- Department of Orthopedic Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
- Department of Orthopedic Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Rehan Saiyed
- Department of Orthopedic Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Eric Marty
- Department of Orthopedic Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Angelique Boyer
- Department of Orthopedic Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Yuliya S Jahnwar
- Department of Radiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Rueben Niesvizky
- Department of Hematology and Oncology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Joseph M Lane
- Department of Orthopedic Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| |
Collapse
|
8
|
Lee C, Brodke DJ, Engel J, Schloss MG, Zaidi SMR, O’Toole RV, Gulbrandsen T, Hogue M, Badon J, Bergin PF, Lirette ST, Morellato J. Low-energy Gunshot-induced Tibia Fractures: What Proportion Develop Complications? Clin Orthop Relat Res 2021; 479:1793-1801. [PMID: 33760776 PMCID: PMC8277282 DOI: 10.1097/corr.0000000000001736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 02/23/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Gunshot injuries of the extremities are common in the United States, especially among people with nonfatal gunshot wounds. Controversy persists regarding the proper management for low-energy gunshot-induced fractures, likely stemming from varying reports on the likelihood of complications. There has yet to be published a study on a large cohort of patients with gunshot-induced tibia fractures on which to base our understanding of complications after this injury. QUESTIONS/PURPOSES (1) What percentage of patients with low-energy gunshot-induced tibia fractures developed complications? (2) Was there an association between deep infection and fracture location, injury characteristics, debridement practices, or antibiotic use? METHODS This was a multicenter retrospective study. Between January 2009 and December 2018, we saw 201 patients aged 16 years or older with a gunshot-induced fracture who underwent operative treatment; 2% (4 of 201) of those screened had inadequate clinical records, and 38% (76 of 201) of those screened had inadequate follow-up for inclusion. In all, 121 patients with more than 90 days of follow-up were included in the study. Nonunion was defined as a painful fracture with inadequate healing (fewer than three cortices of bridging bone) at 6 months after injury, resulting in revision surgery to achieve union. Deep infection was defined according to the confirmatory criteria of the Fracture-Related Infection Consensus Group. These results were assessed by a fellowship-trained orthopaedic trauma surgeon involved with the study. Complication proportions were tabulated. A Kaplan-Meier chart demonstrated presentations of deep infection by fracture location (proximal, shaft, or distal). Univariate statistics and multivariate Cox regression were used to examine the association between deep infection and fracture location, entry wound size, vascular injury, intravenous (IV) antibiotics in the emergency department (ED), deep and superficial debridement, the duration of postoperative IV antibiotics, and the use of topical antibiotics, while adjusting for age, race/ethnicity, smoking status, and BMI. A power analysis for the result of deep infection demonstrated that we would have had to observe a hazard ratio of 4.28 or greater for shaft versus proximal locations to detect statistically significant results at 80% power and alpha = 0.05. RESULTS The overall complication proportion was 49% (59 of 121), with proportions of 14% (17 of 121) for infection, 27% (33 of 121) for wound complications, 20% (24 of 121) for nonunion, 9% (11 of 121) for hardware breakage, and 26% (31 of 121) for revision surgery. A positive association was present between deep infection and deep debridement (HR 5.51 [95% confidence interval 1.12 to 27.9]; p = 0.04). With the numbers available, we found no association between deep infection and fracture location, entry wound size, vascular injury, IV antibiotics in the ED, superficial debridement, the duration of postoperative IV antibiotics, and the use of topical antibiotics. CONCLUSION In this multicenter study, we found a higher risk of complications in operative gunshot-induced tibia fractures than prior studies have reported. Infection, in particular, was much more common than expected based on prior studies. Consequently, surgeons might consider adopting the general management principles for nongunshot-induced open tibia fractures with gunshot-induced fractures, such as the use of IV antibiotics both initially and after surgery. Further research is needed to test and validate these approaches. LEVEL OF EVIDENCE Level IV, therapeutic study.
Collapse
Affiliation(s)
- Christopher Lee
- Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Dane J. Brodke
- Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Jamie Engel
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Michael G. Schloss
- Department of Orthopaedic Surgery, R. Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Syed Muhammad R. Zaidi
- Department of Orthopaedic Surgery, R. Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Robert V. O’Toole
- Department of Orthopaedic Surgery, R. Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Trevor Gulbrandsen
- Department of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA
| | - Matthew Hogue
- Department of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA
| | - Justin Badon
- Department of Orthopaedic Surgery, University of Mississippi, Jackson, MS, USA
| | - Patrick F. Bergin
- Department of Orthopaedic Surgery, University of Mississippi, Jackson, MS, USA
| | - Seth T. Lirette
- Department of Data Science, University of Mississippi, Jackson, MS, USA
| | - John Morellato
- Department of Orthopaedic Surgery, University of Mississippi, Jackson, MS, USA
| |
Collapse
|
9
|
Steinfeld Y, Ben Natan M, Yonai Y, Berkovich Y. Hip Fracture Following a Fall among Older Adults during the COVID-19 Pandemic. Isr Med Assoc J 2021; 23:479-483. [PMID: 34392621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Little is known regarding the impact of the coronavirus disease-2019 (COVID-19) pandemic on the incidence of hip fractures among older adults. OBJECTIVES To compare the characteristics of patients with a hip fracture following a fall during the COVID-19 pandemic year and during the preceding year. METHODS We conducted a retrospective cohort study of older patients who had undergone surgery for hip fracture repair in a major 495-bed hospital located in northern central Israel following a fall. Characteristics of patients who had been hospitalized in 2020 (pandemic year, n=136) and in 2019 (non-pandemic year, n=151) were compared. RESULTS During the pandemic year, patients were less likely to have fallen in a nursing facility, to have had muscle or balance problems, and to have had a history of falls and fractures following a fall. Moreover, the average length of stay (LOS) in the hospital was shorter; however, the average time from the injury to hospitalization was longer. Patients were less likely to have acquired a postoperative infection or to have died. During the pandemic year, postoperative infection was only associated with prolonged LOS. CONCLUSIONS The COVID-19 pandemic may have had a positive impact on the behavior of older adults as well as on the management of hip fracture patients. However, healthcare providers should be aware of the possible reluctance to seek care during a pandemic. Moreover, further research on the impact of the change in management during COVID-19 on hip fracture survival is warranted.
Collapse
Affiliation(s)
- Yaniv Steinfeld
- Department of Orthopedics B, Hillel Yaffe Medical Center, Hadera, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Merav Ben Natan
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera, Israel
| | - Yaniv Yonai
- Department of Orthopedics B, Hillel Yaffe Medical Center, Hadera, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yaron Berkovich
- Department of Orthopedics B, Hillel Yaffe Medical Center, Hadera, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
10
|
Pieracci FM, Leasia K, Hernandez MC, Kim B, Cantrell E, Bauman Z, Gardner S, Majercik S, White T, Dieffenbaugher S, Eriksson E, Barns M, Benjamin Christie D, Lasso ET, Schubl S, Sauaia A, Doben AR. Surgical stabilization of rib fractures in octogenarians and beyond-what are the outcomes? J Trauma Acute Care Surg 2021; 90:1014-1021. [PMID: 34016925 DOI: 10.1097/ta.0000000000003140] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prospective studies of surgical stabilization of rib fractures (SSRF) have excluded elderly patients, and no study has exclusively addressed the ≥80-year-old subgroup. We hypothesized that SSRF is associated with decreased mortality in trauma patients 80 years or older. METHODS Multicenter retrospective cohort study involving eight centers. Patients who underwent SSRF from 2015 to 2020 were matched to controls by study center, age, injury severity score, and presence of intracranial hemorrhage. Patients with chest Abbreviated Injury Scale score less than 3, head Abbreviated Injury Scale score greater than 2, death within 24 hours, and desire for no escalation of care were excluded. A subgroup analysis compared early (0-2 days postinjury) to late (3-7 days postinjury) SSRF. Poisson regression accounting for clustered data by center calculated the relative risk (RR) of the primary outcome of mortality for SSRF versus nonoperative management. RESULTS Of 360 patients, 133 (36.9%) underwent SSRF. Compared with nonoperative patients, SSRF patients were more severely injured and more likely to receive locoregional analgesia. There were 31 hospital deaths among the entire sample (8.6%). Multivariable regression demonstrated a decreased risk of mortality for the SSRF group, as compared with the nonoperative group (RR, 0.41; 95% confidence interval, 0.24-0.69; p < 0.01). However, SSRF patients were more likely to develop pneumonia, and had an increased duration of both mechanical ventilation and intensive care unit stay. There were no differences in discharge destination, although the SSRF group was less likely to be discharged on narcotics (RR, 0.66; 95% confidence interval, 0.48-0.90; p = 0.01). There was no difference in adjusted mortality between the early and late SSRF subgroups. CONCLUSION Patients selected for SSRF were substantially more injured versus those managed nonoperatively. Despite this, SSRF was independently associated with decreased mortality. With careful patient selection, SSRF may be considered a viable treatment option in octogenarian/nonagenarians. LEVEL OF EVIDENCE Therapeutic, Level IV.
Collapse
Affiliation(s)
- Fredric M Pieracci
- From the Department of Surgery (F.M.P., K.L.), Denver Health Medical Center, Denver, Colorado; Department of Surgery (M.C.H., B.K.), Mayo Clinic, Rochester, Minnesota; Department of Surgery (E.C., Z.B.), University of Nebraska Medical Center, Omaha, Nebraska; Department of Surgery (S.G., S.M., T.W.), Intermountain Medical Center, Murray, Utah; Department of Surgery (S.D., E.E.), Medical University of South Carolina, Charleston, South Carolina; Department of Surgery (M.B., D.B.C.), The Medical Center, Navicent Health, Macon, Georgia; Department of Surgery (E.T.L., S.S.), University of California, Irvine, California; Department of Surgery (A.S.), University of Colorado School of Medicine, Aurora, Colorado; and Department of Surgery (A.R.D.), St. Francis Medical Center, Hartford, Connecticut
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Spraul AMS, Schönbach AM, Müller N, Müller UA, Koller A, Spraul M. Long-term outcome of persons with diabetic and non-diabetic neuro-osteoarthropathy after foot correction using external fixation. Diabet Med 2021; 38:e14404. [PMID: 32949070 DOI: 10.1111/dme.14404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/28/2020] [Accepted: 09/10/2020] [Indexed: 11/29/2022]
Abstract
AIM Diabetic neuro-osteoarthropathy (Charcot foot) is a serious form of diabetic foot syndrome, often leading to severe deformity of the foot and subsequently to ulcers and osteomyelitis. The aim of this retrospective study was to determine the success rate and long-term outcomes for a Charcot foot operation using external fixation in 115 individuals who underwent surgery between July 2008 and December 2012. METHODS Some 115 consecutive persons, 78 (68%) men and 37 (32%) women, were enrolled in this study. The eligibility criterion for this retrospective study was reconstructive foot surgery using a Hoffmann II external fixator in diabetic and non-diabetic neuro-osteoarthropathy. The main examination parameters in the follow-up were walking ability, amputation and mortality. Average follow-up was 5.7 (± 3.2) years. RESULTS Ninety-seven per cent of people were able to walk after the operation with bespoke shoes or an orthosis. At follow-up, 77% were able to walk and 51% were fully mobile even outside the home. Subsequent amputations were performed in 29 individuals (26%), with 17 (15%) minor and 12 (11%) major amputations. Forty-seven individuals died before follow-up, the majority (53%) from cardiovascular events. Average survival time post surgery was 4.5 (± 2.9) years. CONCLUSION Reconstruction surgery using external fixation is a very useful method for maintaining walking ability in the case of conservatively non-treatable diabetic and non-diabetic neuro-osteoarthropathy. Individuals with severe Charcot foot disease had a low rate of major amputations. Osteomyelitis was the main reason for major amputations.
Collapse
Affiliation(s)
- A M S Spraul
- Department for Internal Medicine III, Mathias-Spital Rheine, Rheine, Germany
| | - A M Schönbach
- Department for Internal Medicine III, Mathias-Spital Rheine, Rheine, Germany
| | - N Müller
- Department for Internal Medicine III, Jena University Hospital, Jena, Germany
| | - U A Müller
- Practice for Endocrinology and Diabetology, Dr. Kielstein Ambulante Medizinische Betreuung GmbH, Jena, Germany
| | - A Koller
- Department of Foot Surgery, Klinik Dr Guth, Hamburg, Germany
| | - M Spraul
- Department for Internal Medicine III, Mathias-Spital Rheine, Rheine, Germany
| |
Collapse
|
12
|
van der Zwaard BC, Stein CE, Bootsma JEM, van Geffen HJAA, Douw CM, Keijsers CJPW. Fewer patients undergo surgery when adding a comprehensive geriatric assessment in older patients with a hip fracture. Arch Orthop Trauma Surg 2020; 140:487-492. [PMID: 31664575 DOI: 10.1007/s00402-019-03294-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Geriatricians have been increasingly involved in the pre-operative process in frail elderly patients with a hip fracture which can benefit re-hospitalization, post-operative functional performance, and mortality. The objective of this study was to compare the number of older patients with hip fractures who opted for non-surgical management after the addition of pre-operative comprehensive geriatric assessment (CGA) with shared decision making by a geriatrician to usual care. Secondary objectives were: reasons for non-surgical management, duration of life, and location of death. MATERIALS AND METHODS A single-center, with a level 2 trauma center, retrospective study comparing care before and after introducing pre-operative CGA with shared decision making in September 2014. Patients ≥ 70 years with a hip fracture, admitted from January 2014 to September 2015, were included. The percentages of patients elected for non-surgical management and palliative care without or with CGA were compared. Differences in secondary objectives (age, sex, medical history, medication use, functional, and social status) were compared descriptively and qualitatively. RESULTS With pre-operative CGA significantly more patients (or representatives) elected the non-surgical management option after hip fracture (respectively, 9.1% vs 2.7%, p = 0.008). Patient characteristics were comparable. Reported reasons not to undergo surgery include aversion to be more dependent on others, and severe dementia. CONCLUSION The geriatrician can have an important role in decisions for non-surgical management by shared decision making in the pre-operative period in patients ≥ 70 years with a hip fracture in the emergency room.
Collapse
Affiliation(s)
- Babette C van der Zwaard
- Department of Orthopedic Surgery, Jeroen Bosch Hospital, PO Box 90153, 5200 ME, 's-Hertogenbosch, The Netherlands.
| | - Charlotte E Stein
- Department of Geriatric Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Janet E M Bootsma
- Department of Geriatric Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | | | - Conny M Douw
- Department of Orthopedic Surgery, Jeroen Bosch Hospital, PO Box 90153, 5200 ME, 's-Hertogenbosch, The Netherlands
| | | |
Collapse
|
13
|
Abstract
PURPOSE This study evaluated a series of geriatric femoral neck fracture treated with closed reduction percutaneous pinning (CRPP) at a single level-1 trauma center to determine if there are any simple, reliable, radiographic characteristics that can be used to predict increased risk of post-operative failure in nondisplaced and valgus impacted fracture patterns. METHODS We conducted a retrospective cohort study of all patients with femoral neck fractures (AO/OTA 31B) who underwent CRPP over a 12-year period at a single Level 1 trauma center. Failure was defined as radiographic failure within the first year after the index operation requiring revision surgery. Common patterns identified on initial review were the presence of a visible medial transcervical line (MTL) felt to indicate a tension-sided failure, a straight inferior calcar (SIC) indicating severe valgus impaction, and quality of intra-operative screw positioning. X-rays of patients were then reviewed for these characteristics in a blinded manner by three different trauma-fellowship trained orthopedic surgeons. Inter-rater reliability was calculated using Fleiss' Kappa Coefficient. Comparisons of failure rates between groups were made using a Fisher's Exact test. RESULTS 139 patients who underwent CRPP for a femoral neck fracture and follow-up for at least 90 days were identified and reviewed. There were a total of 19 failures (13.6%) within one year. The patients with a varus fracture had a failure rate of 9/24 (37.5%). Of the valgus/nondisplaced fractures, MTL was identified in 42/115 (36%) patients. Inter-rater agreement was high for the presence of an MTL (84%, Kappa 0.69). Patients with an MTL had a fourfold increase in risk of failure (7/42=17% with an MTL vs. 3/73=4% without, p 0.03). The presence of a SIC and quality of screw placement were not predictive of failure. CONCLUSION Varus femoral neck fractures fixed with CRPP have a high rate of failure (37.5%). Nondisplaced or valgus impacted fractures with the presence of a visible medial transcervical line on pre-operative radiographic imaging resulted in a fourfold increase in the risk of failure after CRPP. Identification of the MTL will help treating surgeons better council patients when making pre-operative decisions between arthroplasty and CRPP.
Collapse
Affiliation(s)
- Christina Kane
- University of Massachusetts, Department of Orthopaedic Surgery, Worcester, MA, United States
| | - Jacob Jo
- University of Massachusetts, Department of Orthopaedic Surgery, Worcester, MA, United States
| | - Jodi Siegel
- University of Massachusetts, Department of Orthopaedic Surgery, Worcester, MA, United States
| | - Paul E Matuszewski
- University of Kentucky School of Medicine, Department of Orthopaedic Surgery and Sports Medicine, Lexington, KY, United States
| | - Eric Swart
- University of Massachusetts, Department of Orthopaedic Surgery, Worcester, MA, United States
| |
Collapse
|
14
|
Margalit A, Peddada KV, Dunham AM, Remenapp CM, Lee RJ. Salter-Harris type II fractures of the distal tibia: Residual postreduction displacement and outcomes-a STROBE compliant study. Medicine (Baltimore) 2020; 99:e19328. [PMID: 32118764 PMCID: PMC7478605 DOI: 10.1097/md.0000000000019328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We assessed factors associated with premature physeal closure (PPC) and outcomes after closed reduction of Salter-Harris type II (SH-II) fractures of the distal tibia. We reviewed patients with SH-II fractures of the distal tibia treated at our center from 2010 to 2015 with closed reduction and a non-weightbearing long-leg cast. Patients were categorized by immediate postreduction displacement: minimal, <2 mm; moderate, 2 to 4 mm; or severe, >4 mm. Demographic data, radiographic data, and Lower Extremity Functional Scale (LEFS) scores were recorded.Fifty-nine patients (27 girls, 31 right ankles, 26 concomitant fibula fractures) were included, with a mean (±SD) age at injury of 12.0 ± 2.2 years. Mean maximum fracture displacements were 6.6 ± 6.5 mm initially, 2.7 ± 2.0 mm postreduction, and 0.4 ± 0.7 mm at final follow-up. After reduction, displacement was minimal in 23 patients, moderate in 21, and severe in 15. Fourteen patients developed PPC, with no significant differences between postreduction displacement groups. Patients with high-grade injury mechanisms and/or initial displacement ≥4 mm had 12-fold and 14-fold greater odds, respectively, of PPC. Eighteen patients responded to the LEFS survey (mean 4.0 ± 2.1 years after injury). LEFS scores did not differ significantly between postreduction displacement groups (P = .61).The PPC rate in this series of SH-II distal tibia fractures was 24% and did not differ by postreduction displacement. Initial fracture displacement and high-grade mechanisms of injury were associated with PPC. LEFS scores did not differ significantly by postreduction displacement.Level of Evidence: Level IV, case series.
Collapse
|
15
|
Sáez-López P, Ojeda-Thies C, Alarcón T, Muñoz Pascual A, Mora-Fernández J, González de Villaumbrosia C, Molina Hernández MJ, Montero-Fernández N, Cancio Trujillo JM, Díez Pérez A, Prieto Alhambra D, Caeiro Rey JR, Etxebarria Foronda Í, Gómez Campelo P, Pareja Sierra T, Tarazona-Santabalbina FJ, López-Giménez R, Otero Puime Á, Navarro-Castellanos L, Queipo Matas R, Jiménez Mola S, López-Peña T, Cassinello Ogea C, González-Montalvo JI. [Spanish National Hip Fracture Registry (RNFC): First-year results and comparison with other registries and prospective multi-centric studies from Spain]. Rev Esp Salud Publica 2019; 93:e201910072. [PMID: 31625534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/23/2019] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE The Spanish National Hip Fracture Registry (Registro Nacional de Fracturas de Cadera or RNFC) is a Spanish, prospective, multi- centric registry, commenced in 2017. The goal of this paper is to present the data from the first annual report and to compare them with autonomic registries and recent prospective multi-centric studies performed in Spain. METHODS We included persons 75 years or older treated for fragility hip fractures in any of the centers participating in the RNFC between January and October 2017. The descriptive statistics of each variable used the mean (and standard deviation) or the median (and interquartile ranges) for the ordinal variables and the percentage for the categoric variables. A descriptive analysis of the casemix was performed and compared with available data from the aforementioned studies. RESULTS The RNFC included 7.208 patients from 54 hospitals, with a mean age of 86.7 (SD 5.6) years; 75.4% were women, and 36.4% showed cognitive decline. Mean surgical delay was 75.7 (SD 63.6) hours, and length of stay averaged 10.9 (SD 6.7) days. Of the patients who lived at home (75.4%), less than half (37.0%) returned home at discharge. One-month mortality was 7.1%. Comparison with other studies showed important differences, especially regarding patients newly sent to nursing homes (7.7-29.4%) and with antiosteoporotic treatment at discharge (14.5-36.7%). CONCLUSIONS The RNFC is the largest prospective database to date that offers data regarding the characteristics of patients hospitalized for hip fractures in Spain. Comparison with recent studies showed some important differences.
Collapse
Affiliation(s)
- Pilar Sáez-López
- Unidad de Geriatría. Hospital Universitario Fundación Alcorcón. Alcorcón. España
- Instituto de Investigación del Hospital Universitario La Paz, "IdiPaz". Madrid. España
| | - Cristina Ojeda-Thies
- Servicio de Traumatología y Cirugía Ortopédica. Hospital Universitario 12 de Octubre. Madrid. España
| | - Teresa Alarcón
- Instituto de Investigación del Hospital Universitario La Paz, "IdiPaz". Madrid. España
- Servicio de Geriatría. Hospital Universitario La Paz. Madrid. España
| | | | - Jesús Mora-Fernández
- Servicio de Geriatría, IdISSC. Hospital Universitario Clínico San Carlos. Madrid. España
| | | | | | - Nuria Montero-Fernández
- Servicio de Geriatría. Instituto de Investigación Sanitaria Gregorio Marañón. Hospital Universitario Gregorio Marañón. Madrid. España
| | - José Manuel Cancio Trujillo
- Centro Sociosanitario El Carme. Servicio de Geriatría y Cuidados Paliativos de BSA (Badalona Servicios Asistenciales). Badalona.España
| | - Adolfo Díez Pérez
- Hospital del Mar y Universidad Autónoma de Barcelona. Barcelona. España
- CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES). Instituto Carlos III. Madrid. España
| | - Daniel Prieto Alhambra
- NDORMS, Grupo de Investigación GREMPAL, Idiap Jordi Gol y CIBERFes. University of Oxford. Oxford. Reino Unido
- Universitat Autònoma de Barcelona e Instituto de Salud Carlos III. Barcelona. España
| | - José Ramón Caeiro Rey
- Servicio de Cirugía Ortopédica y Traumatología. Complejo Hospitalario Universitario de Santiago. Departamento de Cirugía. Universidad de Santiago de Compostela. Santiago de Compostela. España
| | | | - Paloma Gómez Campelo
- Instituto de Investigación del Hospital Universitario La Paz, "IdiPaz". Madrid. España
- Centro de Ciencias de la Salud San Rafael. Universidad Antonio de Nebrija. Madrid. España
| | - Teresa Pareja Sierra
- Servicio de Geriatría. Hospital Universitario de Guadalajara. Guadalajara. España
| | | | - Rosario López-Giménez
- Departamento de Medicina Preventiva y Salud Pública. Universidad Autónoma de Madrid. Madrid. España
| | - Ángel Otero Puime
- Departamento de Medicina Preventiva y Salud Pública. Universidad Autónoma de Madrid. Madrid. España
| | | | | | - Sonia Jiménez Mola
- Servicio de Geriatría. Complejo Asistencial Universitario de León. León. España
| | - Tomás López-Peña
- Subdirección General de Programas Internacionales de Investigación y Relaciones Institucionales. Instituto de Salud Carlos III. Madrid. España
| | | | - Juan I González-Montalvo
- Instituto de Investigación del Hospital Universitario La Paz, "IdiPaz". Madrid. España
- Servicio de Geriatría. Hospital Universitario La Paz. Madrid. España
| |
Collapse
|
16
|
Perkins C, Buck JS, Karunakar MA. Outcomes in the Treatment of Femur Fractures in Patients with Pre-Existing Spinal Cord Injury. Bull Hosp Jt Dis (2013) 2019; 77:211-215. [PMID: 31487488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Spinal cord injured patients have an estimated 25% to 34% lifetime incidence of sustaining an extremity fracture. The objective of this study is to describe the outcomes of femur fractures treated in patients with pre-existing spinal cord injury (SCI) and lower extremity paraplegia. MATERIALS AND METHODS An IRB approved retrospective review of patients 18 years of age and older who sustained a femur fracture a minimum of 2 years following spinal cord injury and received treatment at a regional academic level 1 trauma center over a 10-year period was performed. Patients were divided into two groups based on whether they received operative or nonoperative management of the femoral shaft fracture. The primary outcome assessed was re-operation. Additional outcomes including union, infection, implant failure, and mortality were recorded. RESULTS Twenty-one patients sustaining a total of 25 femur fractures were identified. The most common mechanism of injury was fall during transfer. Sixteen fractures were treated non-operatively and nine were treated operatively. At a mean of 4.1 years of follow-up (range: 1.1 to 12.1 years) six out of nine (66.7%) patients in the operative group required an unplanned secondary surgery compared to two patients (12.5%) in the non-operative group (p = 0.006). Overall, the rate of fracture union was 48%, and there was no difference seen between treatment groups (56.3% in nonoperative group versus 33.3% in operative group, p = 0.28). Six operative patients (66.7%) developed an infection as compared to one patient (6.3%) in the non-operative group (p = 0.002). Three operative patients (33.3%) had failure of fixation with implant cutout. One patient died within 2 years of fracture in the non-operative group (6.3%) as did one patient in the operative group (11.1%), (p = 1.0). CONCLUSIONS Surgical treatment of femur fractures in patients with a pre-existing SCI and lower extremity paraplegia had a higher rate of complications than nonoperative management in our series. Based on our experience, we recommend non-operative treatment of femur fractures in patients with pre-existing spinal cord injury and lower extremity paraplegia.
Collapse
|
17
|
Boylan MR, Suchman KI, Bosco JA, Tejwani NC. Tibial Shaft Fractures in Workers Compensation and No-Fault Insurance Is There a Difference in Resource Utilization? Bull Hosp Jt Dis (2013) 2019; 77:200-205. [PMID: 31487486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Workers Compensation claims have been previously associated with inferior clinical outcomes. However, variation in inpatient stays for orthopedic trauma injuries according to insurance type has not been previously examined. METHODS We investigated the differences according to insurance for tibial shaft fractures in regard to length of stay and disposition. Using the New York SPARCS database, we identified 1,856 adult non-elderly patients with an isolated tibial shaft fracture who underwent surgery. Patients were stratified by insurance type, including private, Medicaid, Workers Compensation, and no-fault, which covers medical expenses related to automobile or pedestrian accidents. RESULTS Compared to private insurance (mean: 2.7 days), length of stay was longer for no-fault (mean: 3.9 days; adjusted difference +33%, p < 0.001) and Medicaid (mean: 3.5 days; adjusted difference +22%, p < 0.001), but not significantly different for Workers Compensation (mean: 3.5 days; adjusted difference +4%, p = 0.474). Compared to private insurance (rate: 3.5%), disposition to a facility was significantly higher for no-fault (rate: 10.1%; adjusted odds ratio [OR] = 3.3, p < 0.001) and Medicaid (rate: 7.6%; OR = 2.2, p = 0.003), but was not significantly different for Workers Compensation (rate: 6.3%; OR = 1.8, p = 0.129). CONCLUSIONS Patients with no-fault insurance, but not Workers Compensation, are subject to longer hospital stays and are more likely to be discharged to a facility following operative fixation of an isolated tibial shaft fracture. These findings suggest that financial, social, and legal factors influence medical care for patients involved in automobile accidents with no-fault insurance.
Collapse
|
18
|
Abstract
PURPOSE This study looks to compare patient outcomes in those with pilon fractures fixed with the anterolateral approach versus those with the posterolateral approach. METHODS 135 patient charts of those with surgically treated pilon fractures over a 7-year period were retrospectively reviewed, recording demographic information, fracture description, surgical intervention timeline, operative outcomes, patient outcomes, and complication rates. RESULTS Of the 44 included patients (32 anterolateral and 12 posterolateral), most were older than 40 years of age (65.9%) and male (63.6%). There was no difference seen between anterolateral approach and posterolateral approach tourniquet times (p = 0.80), operating room time (p = 0.40), or estimated blood loss (p = 0.73). There was also no reported difference in decrease in Numerical Rating Scale pain scores (p = 0.38), FOTO (Focus on Therapeutic Outcomes) percent increase (p = 0.13), active flexion-extension axis range of motion (p = 0.35), or inversion-eversion axis (p = 0.25) range of motion after an anterolateral approach versus a posterolateral approach. Finally, statistically similar complication rates (p = 0.75) were seen between anterolateral and posterolateral approaches, but patients who underwent a posterolateral approach surgical fixation were trending towards significantly using more post-operative outpatient opioid medications for pain control compared to those who underwent surgical fixation with an anterolateral approach (p = 0.09). CONCLUSIONS Pilon injuries that lend themselves to anterolateral fixation have similar outcomes peri-operatively and post-operatively compared to injuries lending to posterolateral fixation. Both approaches can be used as dictated by the injury not fearing poorer outcomes or increased complication rates. However, surgeons must be wary of high complication rates associated with all pilon injury patterns. LEVEL OF EVIDENCE Therapeutic Level IV.
Collapse
Affiliation(s)
- Ajith Malige
- Department of Orthopaedic Surgery, St. Luke's University Health Network, 801 Ostrum Street Bethlehem, Fountain Hill, PA, 18015, USA.
| | - Shawn Yeazell
- Department of Orthopaedic Surgery, St. Luke's University Health Network, 801 Ostrum Street Bethlehem, Fountain Hill, PA, 18015, USA
| | - Chinenye Nwachuku
- Department of Orthopaedic Surgery, St. Luke's University Health Network, 801 Ostrum Street Bethlehem, Fountain Hill, PA, 18015, USA
| |
Collapse
|
19
|
Baroni M, Serra R, Boccardi V, Ercolani S, Zengarini E, Casucci P, Valecchi R, Rinonapoli G, Caraffa A, Mecocci P, Ruggiero C. The orthogeriatric comanagement improves clinical outcomes of hip fracture in older adults. Osteoporos Int 2019; 30:907-916. [PMID: 30715561 DOI: 10.1007/s00198-019-04858-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 01/15/2019] [Indexed: 01/23/2023]
Abstract
UNLABELLED Treatment of older adults with hip fracture is a healthcare challenge. Orthogeriatric comanagement that is an integrated model of care with shared responsibility improves time to surgery and reduces the length of hospital stay and mortality compared with orthopedic care with geriatric consultation service and usual orthopedic care, respectively. INTRODUCTION Treatment of fractures in older adults is a clinical challenge due partly to the presence of comorbidity and polypharmacy. The goal of orthogeriatric models of care is to improve clinical outcomes among older people with hip fractures. We compare clinical outcomes of persons with hip fracture cared according to orthogeriatric comanagement (OGC), orthopedic team with the support of a geriatric consultant service (GCS), and usual orthopedic care (UOC). METHODS This is a single-center, pre-post intervention observational study with two parallel arms, OGC and GCS, and a retrospective control arm. Hip fracture patients admitted to the trauma ward were assigned by the orthopedic surgeon to the OGC (n = 112) or GCS (n = 108) group. The intervention groups were compared each with others and both with the retrospective control group (n = 210) of older adults with hip fracture. Several clinical indicators are considered, including time to surgery, length of stay, in-hospital, and 1-year mortality. RESULTS Patients in the OGC (OR 2.62; CI 95% 1.40-4.91) but not those in the GCS (OR 0.74; CI 95% 0.38-1.47) showed a higher probability of undergoing surgery within 48 h compared with those in the UOC. Moreover, the OGC (β, - 1.08; SE, 0.54, p = 0.045) but not the GCS (β, - 0.79; SE, 0.53, p = 0.148) was inversely associated with LOS. Ultimately, patients in the OGC (OR 0.31; CI 95 % 0.10-0.96) but not those in the GCS (OR 0.37; CI 95% 0.10-1.38) experienced a significantly lower 1-year mortality rate compared with those in the UOC. All analyses were independent of several confounders. CONCLUSIONS Older adults with hip fracture taken in care by the OGC showed better clinical indicators, including time to surgery, length of stay and mortality, than those managed by geriatric consultant service or usual orthopedic care.
Collapse
Affiliation(s)
- M Baroni
- Orthogeriatric Service, Geriatric Unit, Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - R Serra
- Orthogeriatric Service, Geriatric Unit, Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - V Boccardi
- Orthogeriatric Service, Geriatric Unit, Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - S Ercolani
- Orthogeriatric Service, Geriatric Unit, Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - E Zengarini
- Orthogeriatric Service, Geriatric Unit, Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - P Casucci
- Regional Direction for Health and Welfare Umbria Region, Perugia, Italy
| | - R Valecchi
- Medical Direction, Hospital S. Maria della Misericordia, Perugia, Italy
| | - G Rinonapoli
- Orthopedic and Traumatologic Unit, Department of Surgery, Hospital S. Maria della Misericordia, University of Perugia, Perugia, Italy
| | - A Caraffa
- Orthopedic and Traumatologic Unit, Department of Surgery, Hospital S. Maria della Misericordia, University of Perugia, Perugia, Italy
| | - P Mecocci
- Orthogeriatric Service, Geriatric Unit, Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - C Ruggiero
- Orthogeriatric Service, Geriatric Unit, Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy.
| |
Collapse
|
20
|
Kirk RJ, Lawes CM, Farrington W, Misur P, Walker ML, Kluger M, Seow MY, Andrew P. Post-operative mortality rates for neck of femur fracture at Waitemata District Health Board. N Z Med J 2019; 132:17-25. [PMID: 30789885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIM Mortality rates of up to 38% at one year have been reported following surgery for neck of femur fractures. The aim of this review is to evaluate the post-operative mortality rates and trends over time for patients with fractured neck of femur at Waitemata District Health Board. METHOD A retrospective cohort study of all patients who received surgery following a neck of femur fracture at Waitemata District Health Board between 2009 and 2016. Inpatient data was retrieved from electronic hospital records and mortality rates from the Ministry of Health, New Zealand. Analyses included crude mortality rates and trends over time, and time-to-theatre from presentation with neck of femur fracture. RESULTS A total of 2,822 patients were included in the study; mean age 81.9 years, 70.4% female and 29.6% male. Overall post-operative crude rates for inpatient, 30-day and one-year mortality were 3.7%, 7.2% and 23.8% respectively. Adjusted analyses showed a statistically significant decrease in mortality rates between 2009 and 2016 at inpatient (p=0.001), 30 days (p=<0.001) and one year (p=<0.001) time periods. There was also a significant association between time-to-theatre and mortality at inpatient (p=0.002), 30 days (p=0.0001), and one year (p=0.0002) time periods. CONCLUSION Mortality rates following surgery for fractured NOF have significantly improved over recent years at Waitemata District Health Board. Reduced time-to-theatre is associated with decreased inpatient, 30-day and one-year mortality.
Collapse
Affiliation(s)
- Reuben J Kirk
- House Surgeon, Department of Orthopaedics, Waitemata District Health Board, Auckland
| | - Carlene Mm Lawes
- Public Health Physician, Institute for Innovation and Improvement, Waitemata District Health Board, Auckland
| | - William Farrington
- Orthopaedic Surgeon, Department of Orthopaedics, Waitemata District Health Board, Auckland
| | - Peter Misur
- Orthopaedic Surgeon, Department of Orthopaedics, Waitemata District Health Board, Auckland
| | - Matthew L Walker
- Clinical Director of Orthopaedics, Waitemata District Health Board, Auckland
| | - Michal Kluger
- Anaesthetist, Department of Anaesthesiology and Perioperative Medicine, Waitemata District Health Board, Auckland
| | - Min Yee Seow
- Orthogeriatrician, Department of Orthopaedics, Waitemata District Health Board, Auckland
| | - Penny Andrew
- Director of the Institute of Innovation and Improvement, Waitemata District Health Board, Auckland
| |
Collapse
|
21
|
Saving J, Ponzer S, Enocson A, Mellstrand Navarro C. Distal radius fractures-Regional variation in treatment regimens. PLoS One 2018; 13:e0207702. [PMID: 30444926 PMCID: PMC6239340 DOI: 10.1371/journal.pone.0207702] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 11/04/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES After recent technical innovations of fracture surgery implants, treatment traditions are changing for distal radius fractures, the most common orthopaedic injury. The aim of this study was to determine if the choice of surgical method for treatment of distal radius fractures differ between healthcare regions in Sweden. METHOD The study was based on all (n = 22 378) adult patients who were registered with a surgical procedure due to a distal radius fracture during 2010-2013 in Sweden. Consecutive data was collected from the Swedish National Patient Registry. RESULTS The proportions of use of surgical method varied among the 21 healthcare regions between 41% and 95% for internal fixation, between 2.3% and 44% for percutaneous fixation and between 0.6% and 19% for external fixation. Differences between regions were statistically significant in all but 6 comparisons when controlled for age and gender. Incidence rates of surgical treatment of a distal radius fracture varied between 4.2 and 9.2/10 000 person-years. CONCLUSION We conclude that there is a large variation in operative management of distal radius fractures between Swedish healthcare regions.
Collapse
Affiliation(s)
- Jenny Saving
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedic Surgery, Södersjukhuset Hospital, Stockholm, Sweden
- * E-mail:
| | - Sari Ponzer
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedic Surgery, Södersjukhuset Hospital, Stockholm, Sweden
| | - Anders Enocson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Mellstrand Navarro
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Hand Surgery Södersjukhuset Hospital, Stockholm, Sweden
| |
Collapse
|
22
|
Peter L, Hong CC, Daniel P, Aoyama R, Murphy D, Kuan WS. Bicycle-Related Injuries in Paediatric Patients. Ann Acad Med Singap 2018; 47:424-428. [PMID: 30460970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Luke Peter
- University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | | | | | | | | | | |
Collapse
|
23
|
Kyriakedes JC, Tsai EY, Weinberg DS, Yu CC, Hoyen HA, Malone K, Bafus BT. Distal Radius Fractures: AAOS Appropriate Use Criteria Versus Actual Management at a Level I Trauma Center. Hand (N Y) 2018; 13:209-214. [PMID: 28720040 PMCID: PMC5950960 DOI: 10.1177/1558944717691133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this study is to determine whether the American Academy of Orthopaedic Surgeons' (AAOS) Appropriate Use Criteria (AUC) for distal radius fractures correlates with actual treatment by orthopedic hand surgeons at a level I trauma center. METHODS ICD-9 codes were used to retrospectively identify patients who presented with wrist fractures over 1 year. Patients with isolated distal radius fractures were evaluated using the AAOS AUC application for distal radius fractures. Actual treatment was then compared with treatment recommended by the AUC. RESULTS Of the 112 patients, 64 (57%) received treatment that matched the AAOS AUC recommendation as an "appropriate treatment." Actual management matched the AUC recommendation 100%, 7%, and 50% of the time, for Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) type A, B, and C fractures, respectively. Surgery was performed for type A, B, and C fractures 30%, 7%, and 50% of the time, respectively. For type B fractures, only the 2 cases that were managed operatively were in agreement with the AUC. For type C fractures, increased patient age (57 years and older) was significantly associated with nonoperative treatment decisions. Surgeon decisions for nonoperative treatment were in agreement with the AUC recommendations 40% of the time, whereas surgeon decisions for surgery matched the AUC recommendations 97% of the time. CONCLUSIONS We found low agreement between actual treatment decisions and the AUC-recommended "appropriate" treatments, especially for the type B and C fractures that were managed nonoperatively. The AUC favors surgery for all intra-articular fractures, while we emphasized age and fracture displacement in our decision-making process.
Collapse
Affiliation(s)
- James C. Kyriakedes
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Eugene Y. Tsai
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Douglas S. Weinberg
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Charles C. Yu
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Harry A. Hoyen
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Kevin Malone
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Blaine T. Bafus
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
24
|
Hendrych J, Pešl T, Havránek P. [Triplane Fractures of the Distal Tibial Epiphysis - Contributions of CT Scans to Indication and Planning of Osteosynthesis]. Acta Chir Orthop Traumatol Cech 2018; 85:336-342. [PMID: 30383530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE OF THE STUDY The triplane fracture of the distal tibial epiphysis is characterised by the fracture line in typical three planes which can, however, differ case by case. The authors use the CT imaging as the perfect examination method to determine the nature of the fracture to plan the osteosynthesis. MATERIAL AND METHODS In the five-year retrospective study of a group of patients treated at their own department in the period 2011-2015 the authors assess a total of 55 patients with a triplane fracture. The radiograph, the CT scan and the specific therapeutic process are evaluated. Regarding the imaging methods, they focus on the fracture line, the number of fragments and the size of the dorsal metaphyseal fragment. As concerns the method of treatment, they zero in on the indication for osteosynthesis and the number and location of used implants. RESULTS The authors present a total of nine different treatment options of the triplane fracture of distal tibial epiphysis. Of 55 followedup patients, in seventeen cases (30.9%) conservative treatment was opted for, in seven cases (12.7%) a reduction under general anaesthesia was an adequate option, whereas in the remaining thirty-one cases (56.4%) an osteosynthesis had to be performed. In the group with osteosynthesis, in altogether twenty cases (64.5%) only a single implant was used: of which in twelve cases it was transepiphyseal, in eight cases transmetaphyseal. In the other eight cases (25.8%) two implants were used, one metaphyseal and one epiphyseal. In three remaining patients (9.7%) two implants were introduced, both into the metaphysis. DISCUSSION The world literature has been referring to the importance of CT scan in relation to the triplane fracture of the distal tibial epiphysis since 1980s. Some papers have only highlighted the necessity of the CT scan for the examination of a complex ankle injury, covering also the triplane fracture, while in majority of injuries involving the distal tibia region a common X-ray examination suffices;also mentioned has been its importance for determining the number of fragments, or in some papers also for preoperative planning. At our department, in correlation with the majority of authors, we routinely use two basic projections (AP view and lateral view) to examine the ankle. In the case of suspected intraarticular fracture, both the mortise views (internal and external) are added. The CT scan is a standard procedure used at our department for confirmed triplane fractures. In severely displaced fractures we recommend to perform a CT scan only after the closed reduction of fragments under general anaesthesia. CONCLUSIONS An X-ray obtained from 4 views is a standard examination in diagnosing a triplane fracture. A CT scan than makes it possible to precisely locate the fracture line, to determine the size of fragments and to plan the optimal placement of osteosynthetic material. Key words: tibial fractures, distal tibia fractures, paediatric fractures, triplane fracture, physeal fracture, CT imaging, minimally invasive osteosynthesis, treatment of distal tibia, osteosynthesis planning.
Collapse
Affiliation(s)
- J Hendrych
- Klinika dětské chirurgie a traumatologie 3. lékařské fakulty Univerzity Karlovy a Thomayerovy nemocnice, Praha
| | | | | |
Collapse
|
25
|
Nicolay RW, Tawari AA, Kempegowda H, Suk M, Mullis B. How Often Are Protocols Followed at Level I Trauma Centers? J Surg Orthop Adv 2018; 27:109-112. [PMID: 30084817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study analyzes adherence to an evidence-based protocol established at two level I trauma centers to determine its effect on clinical decision making. The centers' trauma databases were retrospectively studied and 51 patients with long bone fractures were identified who required revascularization and orthopaedic intervention and survived long enough to receive an index intervention. An arterial shunt was the protocol's first step; the preprotocol rate of shunting was 9.5%, while the postprotocol rate of shunting was 3.3%. The protocol's next step was external fixation; among the cases managed without a shunt, external fixation was the index intervention in 63.2% of the preprotocol cases and 31.0% of the postprotocol cases. Definitive vascular surgery was routinely performed before external fixation in 28.6% of the preprotocol cases and 56.7% of the postprotocol cases. This study demonstrates that this evidence-based protocol had no effect on the management of patients with combined orthopaedic and vascular injuries. Protocols should never supersede clinical judgment, but poor protocol adherence may represent a need for trauma centers to routinely review their protocols' compliance and efficacy. (Journal of Surgical Orthopaedic Advances 27(2):109-112, 2018).
Collapse
Affiliation(s)
- Richard W Nicolay
- Indiana University School of Medicine and Department of Orthopaedic Surgery, Eskenazi Health, Indianapolis, Indiana
| | - Akhil A Tawari
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Harish Kempegowda
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Michael Suk
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Brian Mullis
- Indiana University School of Medicine and Department of Orthopaedic Surgery, Eskenazi Health, Indianapolis, Indiana e-mail:
| |
Collapse
|
26
|
Haapasalo H, Laine HJ, Mäenpää H, Wretenberg P, Kannus P, Mattila VM. Epidemiology of calcaneal fractures in Finland. Foot Ankle Surg 2017; 23:321-324. [PMID: 29202996 DOI: 10.1016/j.fas.2016.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 07/15/2016] [Accepted: 10/21/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to assess the nationwide incidence (per 100,000 person-years) of operative treatment and hospitalization due to calcaneal fractures (CF) in Finland. METHODS The study was based on the Finnish National Hospital Discharge Register. All patients aged 18-years or older admitted to Finnish hospitals for primary treatment of CF in 1987-2012 were included. RESULTS During the 26-year study period 5977 patients were hospitalized with main or secondary diagnosis of a CF. The incidence of hospitalization due to CF remained relatively stable: (12.5)/100,000 in men and 3.9/100,000 in women. The men were younger (median 43 years) than the women (median 61 years). CONCLUSIONS The incidence of the hospitalization due to CF in Finland has remained at steady level during the past 26 years. The incidence of CF is three times higher in men. In 2012 22% of the fractures were operatively treated.
Collapse
Affiliation(s)
- Heidi Haapasalo
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Finland.
| | - Heikki-Jussi Laine
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Finland
| | - Heikki Mäenpää
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Finland
| | - Per Wretenberg
- Department of Molecular Medicine and Surgery, Section of Orthopaedics Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Pekka Kannus
- Injury & Osteoporosis Research Center, UKK Institute for Health Promotion Research, Tampere, Finland
| | - Ville M Mattila
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Finland; The School of Medicine, University of Tampere, Finland; Department of Clinical Science, Intervention and Technology, Karolinska Institute, Division of Orthopedics and Biotechnology, Karolinska Institute and Department of Orthopedics at Karolinska University Hospital Solna and Huddinge, Sweden
| |
Collapse
|
27
|
Abstract
BACKGROUND The purpose of the study was to conduct a systematic analysis based on data from the Norwegian Patient Registry and describe the incidence and treatment of wrist fractures among adults, at national level and in the catchment areas of the various regional health authorities. MATERIAL AND METHOD A search was conducted in the Norwegian Patient Registry for all patients aged ≥ 18 years with diagnosis codes for wrist fractures in the period 2009–2014. Age, sex and type of treatment were recorded. The results are presented as rates adjusted for age and sex for the catchment areas of Norway’s 21 regional health authorities. RESULTS In the period 2009–2014, a total of 75 132 patients aged ≥ 18 years were registered as having a wrist fracture. Almost 1/3 of these patients received operative treatment. During this period, the age- and sex-adjusted rate of wrist fractures in Norway averaged 244 per 100 000 inhabitants per year. Operation rates varied across catchment areas by a factor of three, and the use of plates by a factor of nine. INTERPRETATION We found great variation in clinical practice, which is reflected in differences in operation rates and choice of surgical method across the catchment areas to which the patients belong.
Collapse
|
28
|
Holloway KL, Yousif D, Bucki-Smith G, Hosking S, Betson AG, Williams LJ, Brennan-Olsen SL, Kotowicz MA, Sepetavc A, Pasco JA. Lower limb fracture presentations at a regional hospital. Arch Osteoporos 2017; 12:75. [PMID: 28849404 DOI: 10.1007/s11657-017-0369-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/14/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED We found that lower limb fractures, which were largely the result of minimal trauma, had high levels of hospitalisation, length of stay and surgery. It is therefore important to prevent fractures at all sites to avoid the associated morbidity and mortality. PURPOSE Hip fractures are a major cause of morbidity and mortality, particularly in older women. In comparison, less is known about the epidemiology and burden of other lower limb fractures. The study aimed to investigate the epidemiology and burden of these fractures. METHODS Incident fractures of the hip, femur, tibia/fibula, ankle and foot in women (≥ 20 years) managed through the University Hospital Geelong, Australia, were ascertained from 1 Jan. 2014 to 31 Dec. 2014 from radiology reports. Age, cause of fracture, post-fracture hospitalisation, surgery, length of stay and discharge location were ascertained from medical records. RESULTS We identified 585 fractures of the lower limb (209 hip, 42 femur, 41 tibia/fibula, 162 ankle, 131 foot). Most fractures were sustained by women aged ≥ 50 years. Fractures were largely a result of minimal trauma. Most women with hip or femur fractures were hospitalised; fewer were hospitalised for fractures at other sites. Surgery for fracture followed the same pattern as hospitalisations. Length of stay was the highest for hip and femur fractures and the lowest for foot fractures. Women with hip or femur fractures were discharged to rehabilitation more often than home. Fractures at other sites were most commonly discharged home. CONCLUSIONS Fractures of the lower limb occurred frequently in older women. Hospitalisation and subsequent surgery were common in cases of hip and femur fractures. It is important for prevention strategies to target fractures at a range of skeletal sites to reduce costs, hospitalisations, loss of independence and reduced quality of life.
Collapse
Affiliation(s)
- K L Holloway
- Epi-Centre for Healthy Ageing (ECHA), IMPACT Strategic Research Centre, School of Medicine, Deakin University, PO Box 281, (Barwon Health), Geelong, VIC, 3220, Australia.
| | - D Yousif
- Epi-Centre for Healthy Ageing (ECHA), IMPACT Strategic Research Centre, School of Medicine, Deakin University, PO Box 281, (Barwon Health), Geelong, VIC, 3220, Australia
| | - G Bucki-Smith
- Epi-Centre for Healthy Ageing (ECHA), IMPACT Strategic Research Centre, School of Medicine, Deakin University, PO Box 281, (Barwon Health), Geelong, VIC, 3220, Australia
| | - S Hosking
- Epi-Centre for Healthy Ageing (ECHA), IMPACT Strategic Research Centre, School of Medicine, Deakin University, PO Box 281, (Barwon Health), Geelong, VIC, 3220, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne, Parkville, Australia
| | - A G Betson
- Epi-Centre for Healthy Ageing (ECHA), IMPACT Strategic Research Centre, School of Medicine, Deakin University, PO Box 281, (Barwon Health), Geelong, VIC, 3220, Australia
| | - L J Williams
- Epi-Centre for Healthy Ageing (ECHA), IMPACT Strategic Research Centre, School of Medicine, Deakin University, PO Box 281, (Barwon Health), Geelong, VIC, 3220, Australia
| | - S L Brennan-Olsen
- Epi-Centre for Healthy Ageing (ECHA), IMPACT Strategic Research Centre, School of Medicine, Deakin University, PO Box 281, (Barwon Health), Geelong, VIC, 3220, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne, Parkville, Australia
- The Institute for Health and Ageing, Australian Catholic University, Melbourne, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia
| | - M A Kotowicz
- Epi-Centre for Healthy Ageing (ECHA), IMPACT Strategic Research Centre, School of Medicine, Deakin University, PO Box 281, (Barwon Health), Geelong, VIC, 3220, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia
- Barwon Health, Ryrie Street, Geelong, VIC, Australia
| | - A Sepetavc
- Epi-Centre for Healthy Ageing (ECHA), IMPACT Strategic Research Centre, School of Medicine, Deakin University, PO Box 281, (Barwon Health), Geelong, VIC, 3220, Australia
| | - J A Pasco
- Epi-Centre for Healthy Ageing (ECHA), IMPACT Strategic Research Centre, School of Medicine, Deakin University, PO Box 281, (Barwon Health), Geelong, VIC, 3220, Australia
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia
- Barwon Health, Ryrie Street, Geelong, VIC, Australia
| |
Collapse
|
29
|
Byrne JP, Nathens AB, Gomez D, Pincus D, Jenkinson RJ. Timing of femoral shaft fracture fixation following major trauma: A retrospective cohort study of United States trauma centers. PLoS Med 2017; 14:e1002336. [PMID: 28678793 PMCID: PMC5497944 DOI: 10.1371/journal.pmed.1002336] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/25/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Femoral shaft fractures are common in major trauma. Early definitive fixation, within 24 hours, is feasible in most patients and is associated with improved outcomes. Nonetheless, variability might exist between trauma centers in timeliness of fixation. Such variability could impact outcomes and would therefore represent a target for quality improvement. We evaluated variability in delayed fixation (≥24 hours) between trauma centers participating in the American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP) and measured the resultant association with important clinical outcomes at the hospital level. METHODS AND FINDINGS A retrospective cohort study was performed using data derived from the ACS TQIP database. Adults with severe injury who underwent definitive fixation of a femoral shaft fracture at a level I or II trauma center participating in ACS TQIP (2012-2015) were included. Patient baseline and injury characteristics that might affect timing of fixation were considered. A hierarchical logistic regression model was used to identify predictors of delayed fixation. Hospital variability in delayed fixation was measured using 2 approaches. First, the random effects output of the hierarchical model was used to identify outlier hospitals where the odds of delayed fixation were significantly higher or lower than average. Second, the median odds ratio (MOR) was calculated to quantify heterogeneity in delayed fixation between hospitals. Finally, complications (pulmonary embolism, deep vein thrombosis, acute respiratory distress syndrome, pneumonia, decubitus ulcer, and death) and hospital length of stay were compared across quartiles of risk-adjusted delayed fixation. We identified 17,993 patients who underwent definitive fixation at 216 trauma centers. The median injury severity score (ISS) was 13 (interquartile range [IQR] 9-22). Median time to fixation was 15 hours (IQR 7-24 hours) and delayed fixation was performed in 26% of patients. After adjusting for patient characteristics, 57 hospitals (26%) were identified as outliers, reflecting significant practice variation unexplained by patient case mix. The MOR was 1.84, reflecting heterogeneity in delayed fixation across centers. Compared to hospitals in the lowest quartile of delayed fixation, patients treated at hospitals in the highest quartile of delayed fixation suffered 2-fold higher rates of pulmonary embolism (2.6% versus 1.3%; rate ratio [RR] 2.0; 95% CI 1.2-3.2; P = 0.005) and required greater length of stay (7 versus 6 days; RR 1.15; 95% CI 1.1-1.19; P < 0.001). There was no significant difference with respect to mortality (1.3% versus 0.8%; RR 1.6; 95% CI 1.0-2.8; P = 0.066). The main limitations of this study include the inability to classify fractures by severity, challenges related to the heterogeneity of the study population, and the potential for residual confounding due to unmeasured factors. CONCLUSIONS In this large cohort study of 216 trauma centers, significant practice variability was observed in delayed fixation of femoral shaft fractures, which could not be explained by differences in patient case mix. Patients treated at centers where delayed fixation was most common were at significantly greater risk of pulmonary embolism and required longer hospital stay. Trauma centers should strive to minimize delays in fixation, and quality improvement initiatives should emphasize this recommendation in best practice guidelines.
Collapse
Affiliation(s)
- James P. Byrne
- Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
- Clinical Epidemiology Program, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of General Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Avery B. Nathens
- Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
- Clinical Epidemiology Program, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of General Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
- Trauma Quality Improvement Program, American College of Surgeons, Chicago, Illinois, United States of America
| | - David Gomez
- Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Daniel Pincus
- Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
- Clinical Epidemiology Program, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, University of Toronto, Ontario, Canada
| | - Richard J. Jenkinson
- Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
- Department of Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
- Division of Orthopaedic Surgery, University of Toronto, Ontario, Canada
| |
Collapse
|
30
|
Sanz-Reig J, Salvador Marín J, Ferrández Martínez J, Orozco Beltrán D, Martínez López JF. Risk-factors for surgical delay following hip fracture. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 61:162-169. [PMID: 28373089 DOI: 10.1016/j.recot.2017.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 01/18/2017] [Accepted: 02/04/2017] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To identify pre-operative risk factors for surgical delay of more than 2 days after admission in patients older than 65 years with a hip fracture. MATERIAL AND METHODS A prospective observational study was conducted on 180 hip fractures in patients older than 65 years of age admitted to our hospital from January 2015 to April 2016. The data recorded included, patient demographics, day of admission, pre-fracture comorbidities, mental state, level of mobility and physical function, type of fracture, antiaggregant and anticoagulant medication, pre-operative haemoglobin value, type of treatment, and surgical delay. RESULTS The mean age of the patients was 83.7 years. The mean Charlson Index was 2.8. The pre-fracture baseline co-morbidities were equal or greater than 2 in 70% of cases. Mean timing of surgery was 3.1 days. At the time of admission, 122 (67.7%) patients were fit for surgery, of which 80 (44.4%) underwent surgery within 2 days. A Charlson index greater than 2, anticoagulant therapy, and admission on Thursday to Saturday, were independently associated with a surgical delay greater than 2 days. CONCLUSIONS The rate of hip fracture patients undergoing surgery within 2 days is low. Risk factors associated to surgical delay are non-modifiable. However, their knowledge should allow the development of protocols that can reduce surgical delay in this group of patients.
Collapse
Affiliation(s)
- J Sanz-Reig
- Servicio de Cirugía Ortopédica, Hospital Universitario Sant Joan d' Alacant, Sant Joan d'Alacant, Alicante, España.
| | - J Salvador Marín
- Servicio de Cirugía Ortopédica, Hospital Universitario Sant Joan d' Alacant, Sant Joan d'Alacant, Alicante, España
| | - J Ferrández Martínez
- Servicio de Cirugía Ortopédica, Hospital Universitario Sant Joan d' Alacant, Sant Joan d'Alacant, Alicante, España
| | - D Orozco Beltrán
- Departamento de Medicina, Universidad Miguel Hernández, Elche, Alicante, España
| | - J F Martínez López
- Servicio de Cirugía Ortopédica, Hospital Universitario Sant Joan d' Alacant, Sant Joan d'Alacant, Alicante, España
| |
Collapse
|
31
|
Sumrein BO, Huttunen TT, Launonen AP, Berg HE, Felländer-Tsai L, Mattila VM. Proximal humeral fractures in Sweden-a registry-based study. Osteoporos Int 2017; 28:901-907. [PMID: 27787593 DOI: 10.1007/s00198-016-3808-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 10/10/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED Proximal humeral fracture is the third most common osteoporotic fracture. To our knowledge, this is the first nationwide population-based registry study in adults that includes both inpatient and outpatient visits. Thus, we were able to report the true incidence rates and trends in the treatment of proximal humeral fractures. INTRODUCTION Proximal humeral fractures are among the most common osteoporotic fractures. Valid epidemiologic population-based data, including both inpatient and outpatient visits, however, are lacking. METHODS To investigate the Swedish national incidence rates and treatment trends of proximal humeral fractures, we obtained data from the Swedish Hospital Discharge Register between 2001 and 2012. All adult patients (≥18 years of age) in the Swedish Hospital Discharge Register were included. Outpatient visits have been included in the register since 2001. RESULTS We identified 98,770 patients (women n = 72,063; 73 %) with proximal humeral fractures between 2001 and 2012. In 2001, the sex-specific incidence of proximal humeral fractures was 134.5 per 100,000 person-years for women and 49.2 for men. In 2012, the corresponding values were 174.6 for women and 68.1 for men, increasing 30 % in women and 39 % in men. A total of 17,013 surgical procedures were conducted between 2001 and 2012. Open reduction and internal fixation with a plate was the most common procedure (n = 5050, 30 %), followed by endoprosthetic implantation (n = 3962, 23 %) and intramedullary nailing (n = 3376, 20 %). The proportion of surgically treated patients increased from 12.1 % in 2001 to 16.8 % in 2012 for women and from 15.1 % in 2001 to 17.1 % in 2012 for men. CONCLUSION The Swedish national incidence of proximal humeral fractures has been increasing, although it seems to have peaked in the elderly population during 2008-2010. The rate of surgical treatment has increased substantially, particularly open reduction and internal fixation with a plate. To our knowledge, this is the first nationwide epidemiologic study for Sweden reporting the incidence of proximal humeral fractures and including all inpatient and outpatient visits.
Collapse
Affiliation(s)
- B O Sumrein
- Division of Orthopedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland.
| | - T T Huttunen
- School of Medicine, University of Tampere, Tampere, Finland
- Department of Anesthesia, Tampere University Hospital, Tampere, Finland
| | - A P Launonen
- Division of Orthopedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - H E Berg
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Division of Orthopedics and Biotechnology, Karolinska Institutet and Department of Orthopedics, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - L Felländer-Tsai
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Division of Orthopedics and Biotechnology, Karolinska Institutet and Department of Orthopedics, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - V M Mattila
- Division of Orthopedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Division of Orthopedics and Biotechnology, Karolinska Institutet and Department of Orthopedics, Karolinska University Hospital Huddinge, Stockholm, Sweden
| |
Collapse
|
32
|
Fernández-Ibáñez JM, Morales-Ballesteros MC, Crespo-Romero E, Gómez-Gómez S, Fraga-Fuentes MD, Cruz-Tejado J, Hernández-Zegarra PA, Arias-Arias Á, García-Baltasar MM. Orthogeriatric activity in a general hospital of Castilla-La Mancha, Spain. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 61:88-95. [PMID: 28214194 DOI: 10.1016/j.recot.2016.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 11/16/2016] [Accepted: 11/27/2016] [Indexed: 01/09/2023] Open
Abstract
AIM To describe the orthogeriatric activity in the elderly with hip fractures in the Hospital Mancha Centro, based on the recommendations of the main guidelines. MATERIAL AND METHOD Observational prospective study, comprising all patients over 65 years of age admitted to the Traumatology Unit with a hip fracture between April 2015 and December 2015. Patients were admitted under the care of the Traumatology Unit with cross-consultation carried out with the Geriatrics Department, which then carried out a pre-operative geriatric assessment and the post-operative follow-ups. RESULTS The mean pre-surgery waiting time was 48h and the overall time in hospital was 10.3±8.2 days. Patients who suffered from delirium (42.1%) did not improve as well, and were referred to nursing homes. Blood transfusions were received by 54.7% of the patients, despite 53.5% of them having received intravenous and/or oral iron after the surgery. Treatment with calcium and vitamin D was prescribed in 79% of the patients on discharge. The Rehabilitation Unit assessed 36% of the patients, with 4.8% fully, and 16.7% partially recovering their prior functional status. Upon discharge, 55% of the patients returned to their homes, and 22% were referred to short-term assisted living facilities. DISCUSSION This article describes how the main clinical problems are handled in the elderly with hip fractures in our hospital, based on recommendations of the main guidelines and publications. CONCLUSIONS Our hospital follows the recommended guidelines. Aspects for improvement include the management of anaemia during admission and rehabilitation.
Collapse
Affiliation(s)
- J M Fernández-Ibáñez
- Sección de Geriatría, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España.
| | - M C Morales-Ballesteros
- Sección de Geriatría, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - E Crespo-Romero
- Servicio de Traumatología, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - S Gómez-Gómez
- Servicio de Traumatología, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - M D Fraga-Fuentes
- Servicio de Farmacia, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - J Cruz-Tejado
- Servicio de Anestesia, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - P A Hernández-Zegarra
- Sección de Geriatría, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - Á Arias-Arias
- Unidad de Investigación, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - M M García-Baltasar
- Servicio de Trabajo Social, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| |
Collapse
|
33
|
Antabak A, Andabak M, Barišić B, Papeš D, Romić I, Fuchs N, Luetić T. FRACTURE OF THE HUMERUS IN CHILDREN – CAUSES AND MECHANISMS OF INJURY. Lijec Vjesn 2016; 138:74-78. [PMID: 30146852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Due to hyperactivity, children are often exposed to injuries of the upper arm and fractures of the humerus can leave permanent damage even after the surgical treatment. The high incidence of fractures justifi es questioning the possible prevention of this injury. Preventive actions are possible only with the knowledge of the causes and circumstances of the fracture. Aim is to analyze the circumstances of the injury, critical places and activities engaged in at the time of the humeral fracture by age groups. The paper analyzed 102 children that were treated at the University Hospital Centre in Zagreb due to fractures of the humerus in the period from 2010 to 2014. In this study, we analyzed 45 girls (44%) and 57 boys (56%). The average age of children was 8.3 years. Fractures of the distal third of the humerus accounted for 4/5 of all analyzed fractures. The right hand was affected more frequently. Nearly 80% of fractures were unstable, which generally require surgical treatment. The injury occurred most often among the 5-9 year-olds. Most injuries took place at the recreational facilities (47%), followed by injuries at home (31%), on streets or roads (15%) and at school or kindergarten (7%). Mechanism of the injury was mainly a fall onto the arm (94%) and the rest of the injuries were due to a direct blow. Almost half of the children got injured in sports or recreational activities. Due to close physical contact and engagement in games, children in preschool and early school age are by far the most susceptible to injuries. To reduce the incidence of such injuries, preventive actions should be taken during daily activities under the supervision of parents towards the most vulnerable age group (5-9 years), along with increasing the supervision in preschools and schools. Of all the activities, the most dangerous to cause fractures of the humerus occur in sports grounds and recreational facilities of preschool children and children in the lower grades of elementary school.
Collapse
|
34
|
Çabuk H, Dedeoğlu SS, Adaş M, Tekin AÇ, Seyran M, Ayanoğlu S. Medial Spike and Obesity Associate with Open Reduction in Type III Supracondylar Humeral Fracture. Acta Chir Orthop Traumatol Cech 2016; 83:102-105. [PMID: 27167414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED PURPOSE OF THE STUDY Although supracondylar humeral fractures represent a major part of the pediatric fractures, no classification system or radiological characteristics describes which supracondylar fractures require open reduction. We aim to evaluate the factors that lead us to perform open reduction during operation. MATERIAL AND METHODS We retrospectively evaluated 57 patients who underwent operation for type III supracondylar fracture, and divided them into two groups; those with open reduction and internal fixation, and those with closed reduction and percutaneous fixation. The two groups were compared based on age, gender, BMI by age, medial spike angle of the fracture, medial spike-skin distance and rotation angle between the fractured fragments. RESULTS Of all patients, 46 (81.71%) underwent closed reduction and percutaneous fixation (CRPF) and 11 (19.29%) were treated with open reduction and internal fixation (ORIF). BMI by age was remarkably higher in the ORIF group (p = 0.00). And medial spike angle was smaller in the ORIF group (p = 0.014). DISCUSSION Closed reduction and percutanous fixation is the main treatment of supracondylar humeral fractuers. Open reduction in supracondylar humeral fractures could be associate with complications and cosmetic lesions. Many studies indicates that obesity is high risk factor for complex fractures as well as preoperative and postoperative complications. A prominant medial spike could associate with muscle entrapment, and obliquity of the fracture line. It could be also an indirect finding of instablity of the fracture. CONCLUSION We suggest that a smaller medial spike angle and a higher BMI in children with Type III supracondylar humeral fractures may require open reduction, and it is unreasonable to avoid open reduction in cases where closed reduction is not achieved. KEY WORDS supracondylar humerus, open reduction, obesity, medial spike angle.
Collapse
Affiliation(s)
- H Çabuk
- Okmeydanı Training and Research Hospital, Department of Orthopedics and Traumatology, İstanbul, Türkiye
| | | | | | | | | | | |
Collapse
|
35
|
Pazour J, Křivohlávek M, Lukáš R. [Positions of Sustentacular Screw in Osteosynthesis of Calcaneal Fractures: Clinical and Radiographic Study]. Acta Chir Orthop Traumatol Cech 2016; 83:182-185. [PMID: 27484076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED PURPOSE OF THE STUDY The aim of the study was to analyse the options for sustentacular screw placement in osteosynthesis of intra-articular fractures of the heel bone and to assess the effect of various screw positions on failure to maintain the reduction in the postoperative period. In addition, problems related to screw-end protrusion over the medial cortical bone or to screw penetration into the talocalcaneal joint were assessed. MATERIAL AND METHODS The group comprised 23 patients with a total of 25 intra-articular fractures of the heel bone treated by surgery. The procedure involved insertion of a sustentacular screw under fluoroscopic guidance. Post-operatively, screw position in the sustentacular fragment was evaluated on CT scans. During follow-up, attention was focused on the effect of screw placement on maintenance of fracture reduction, and clinical symptoms potentially associated with screw malposition were recorded. RESULTS All sustentacular screws were fixed sustentacular fragments. Seven screws (28%) were inserted in the talar shelf, seven (28%) were placed under and nine (36%) over the sustentaculum tali. Two screws penetrated into the talocalcaneal joint (8%). The end of a screw projecting by 2 mm over the medial wall of the calcaneus was found in 11 cases (44%). Two patients with screws penetrating into the talocalcaneal joint had problems. On the other hand, no clinical effect of a screw extending over the medial wall of the calcaneus was recorded. No significant association of screw position with late //delayed failure of fracture reduction was detected. DISCUSSION Although the ideal trajectory for a sustentacular screw have been defined using a model of the calcaneus, it is not easy to achieve optimal screw placement due to the complex anatomy of the calcaneus and limited possibilities of intra-operative control of screw insertion. Any sustentacular screw malposition is a potential risk factor, particularly if the screw has penetrated into the talocalcaneal joint. Therefore, it will be useful to seek methods allowing for safer screw insertion and elimination of risks associated with screw misplacement. The technique of sustentacular screw insertion by means of a compression-based device, described by the authors, designated to allow for screw placement in distal humerus fractures is one of the options. CONCLUSIONS Optimisation of techniques for sustentacular screw insertion in the osteosynthesis of calcaneal fractures should contribute to reduction of risks related to screw malposition. The assessment of effects which the position of a screw may have on delayed failure of fracture reduction should be based on a thorough biomechanical study. KEY WORDS sustentacular screw, calcaneal fracture, insertion, malposition.
Collapse
Affiliation(s)
- J Pazour
- Traumatologicko-ortopedické centrum, Krajská nemocnice Liberec, a.s., Liberec
| | | | | |
Collapse
|
36
|
Abrahamsen B, Jørgensen NR, Schwarz P. Epidemiology of forearm fractures in adults in Denmark: national age- and gender-specific incidence rates, ratio of forearm to hip fractures, and extent of surgical fracture repair in inpatients and outpatients. Osteoporos Int 2015; 26:67-76. [PMID: 25138260 DOI: 10.1007/s00198-014-2831-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/28/2014] [Indexed: 02/03/2023]
Abstract
UNLABELLED National epidemiological studies of forearm fractures are scarce. We examined in- and outpatient rates in Denmark, including anatomical location, surgery, hospitalization ratio, recurrent fractures, and ratio of forearm to hip fractures. This may be useful for triangulation in countries with less detailed information. Rates were higher than previously estimated. INTRODUCTION Despite a significant contribution to the overall burden of osteoporotic, nonvertebral fractures, relatively little information is available about age- and gender-specific incidence rates for many countries including Denmark. METHODS We used national individual patient data on inpatient and outpatient treatment to calculate rates of forearm fractures, taking readmissions into account, with subtables for distal and proximal fractures. We also calculated ratios of forearm to hip fractures that may be useful when imputing forearm fracture rates from other administrative sources. In addition, we report the rates of hospital admission and the rates of surgical treatment, allowing readers to extrapolate from the number of admissions or surgical procedures to incidence rates, should their data sources be less comprehensive. RESULTS Forearm fracture rates were 278 per 100,000 patient years in men aged 50+ and 1,110 per 100,000 in women aged 50+. The female to male incidence rate ratio was 4.0 for the age group 50+ but close to unity in persons aged 40 or under. Two thirds of patients were treated on an outpatient basis with little difference across age and gender strata. Four out of five fractures were treated conservatively. The rate of forearm fractures in Denmark was somewhat higher in both genders than recently imputed from hip fracture rates and were close to the rates previously reported in studies from Norway and Sweden. CONCLUSION The rates of forearm fracture in Denmark are higher than previously estimated and very similar to the high risk reported from studies in Norway and Sweden.
Collapse
Affiliation(s)
- B Abrahamsen
- Odense Patient Data Explorative Network (OPEN), Institute of Clinical Research, University of Southern Denmark, Odense, Denmark,
| | | | | |
Collapse
|
37
|
Farner S, Malkani A, Lau E, Day J, Ochoa J, Ong K. Outcomes and cost of care for patients with distal radius fractures. Orthopedics 2014; 37:e866-78. [PMID: 25275973 DOI: 10.3928/01477447-20140924-52] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 02/20/2014] [Indexed: 02/03/2023]
Abstract
This study was designed to evaluate treatment patterns in open treatment and percutaneous fixation of distal radius fractures, compare morbidity rates for the 2 types of treatment, and compare costs associated with the procedure and treatment of complications up to 1 year after surgery. From a 5% sample of nationwide Medicare claims records (1997-2009), patients with distal radius fractures were identified with International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM), codes. Patients who underwent percutaneous fixation and open treatment were tracked with appropriate Current Procedural Terminology codes. Complications were identified at 3 and 12 months. Medicare charges and payments associated with the treatment groups were compiled from the claims data. The rate of surgical treatment increased from 44.7 to 82.0 surgeries per 100,000 persons (+83.0%) over the study period. A total of 9343 procedures met the inclusion criteria between 1998 and 2008. The proportion of open treatment procedures increased from 25.5% in 1998 to 73.4% in 2008. Percutaneous fixation was associated with lower adjusted risk of carpal tunnel syndrome and release and mononeuritis at 3 and 12 months. The percutaneous fixation group had lower adjusted risk of malunion/nonunion at 3 months and tendon rupture at 12 months. Average charges were lower in the percutaneous fixation group for the index operation as well as for treatment of morbidities at 3 and 12 months. The operative fixation rate for distal radius fractures in the Medicare population continues to rise, with a significant trend toward open fixation. Charges and payments associated with open treatment are significantly higher than those for percutaneous fixation.
Collapse
|
38
|
Testerman GM, West MR, Hensley S. Full-time orthopedic traumatologists enhance value and increase pelvic fracture caseloads at a rural Level I trauma center. Am Surg 2013; 79:549-550. [PMID: 23635597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- George M Testerman
- Department of Trauma and Critical Care, Holston Valley Hospital Trauma Center, Kingsport, TN 37660, USA.
| | | | | |
Collapse
|
39
|
Oransky M, Martinelli N, Sanzarello I, Papapietro N. Fractures of the femoral head: a long-term follow-up study. Musculoskelet Surg 2012; 96:95-9. [PMID: 22389008 DOI: 10.1007/s12306-012-0182-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 02/14/2012] [Indexed: 05/05/2023]
Abstract
The femoral head fracture has become an increasingly frequent injury, usually sustained by individuals during high-energy trauma. Regardless of the type of treatment, long-term consequences, as avascular necrosis, post-traumatic arthritis, and heterotopic ossification, may complicate the clinical outcome leading to variable degree of disability. The aim of this study was to review the clinical and radiological long-term follow-up of patients with a fracture of the femoral head. Between January 1985 and January 2002, twenty-one patients with mean age 42.0 ± 15.9 years (range, 21-70 years) with a fracture of the femoral head were evaluated retrospectively. According to Pipkin's classification, there were four type I, nine type II, and eight type IV fractures. Functional outcomes were measured using the Merle d'Aubigné-Postel and Thompson-Epstein scoring scale. Heterotopic calcifications was graded according to the Brooker classification. All patients were followed up from 12 to 210 months, with an average of 81.19 ± 37.4 months. The average Merle d'Aubigné-Postel score was 12.9 ± 4.5. According to the Thompson-Epstein criteria, eight patients had excellent results, eight patients good, two patients fair, and three patients poor results. Overall, almost all (95. 2%) patients were determined to have radiographic criteria of post-traumatic arthritis (PA). Ten patients (47.6%) had a mild PA, seven patients (33.3%) had a moderate PA, and three patients (14.2%) had a severe PA. Open reduction and internal fixation of the fragments provided better results in comparison to excision. Although degenerative changes of the hip were observed in almost all patients, most severe case occurred in the excision group.
Collapse
Affiliation(s)
- M Oransky
- Department of Orthopaedic and Trauma Surgery, Aurelia Hospital, Rome, Italy
| | | | | | | |
Collapse
|
40
|
Ozçelik D, Toplu G, Unveren T, Kaçağan F, Senyuva CGT. Long-term objective results of proximal phalanx fracture treatment. ULUS TRAVMA ACIL CER 2011; 17:253-260. [PMID: 21935805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Proximal phalanx fractures are common. In this study, our preferred methods regarding the treatment of proximal phalanx fractures and their long-term objective results are presented. METHODS Between October 2001 and March 2010, in the Plastic Reconstructive and Aesthetic Surgery Department of Düzce Medical Faculty, we treated 23 patients with 32 proximal phalanx fractures. Stable fractures (n=5) were treated with splints, while unstable fractures (n=27) were stabilized with 1.0 mm percutaneous intramedullary Kirschner wires following open reduction. RESULTS At follow-ups, ranging from 3 months to 9 years, patients were evaluated with radiologic efficiency, range of motion (ROM), total active movements (TAM), and grip power of the digit. TAM scores of 20 fingers were perfect (≥220° for D2-5, ≥150° for D1), for 7 fingers were good (180- 220° for D2-5, 120-150° for D1), and for 5 fingers were either moderate or poor. No difference was observed between grip strength of broken fingers and that of healthy fingers. As a major complication, non-union occurred in one finger. CONCLUSION We concluded that Kirschner wire fixation is a reliable and simple method of treating unstable proximal phalangeal fractures, and excellent long-term results can be obtained in suitable cases. In stable proximal phalanx fractures, splints provide sufficient treatment.
Collapse
Affiliation(s)
- Derya Ozçelik
- Department of Plastic, Reconstructive and Aesthetic Surgery, Düzce University Faculty of Medicine, Düzce, Turkey.
| | | | | | | | | |
Collapse
|
41
|
Ayvaz M, Cağlar O, Yılmaz G, Güvendik GI, Acaroğlu RE. Long-term outcome and quality of life of patients with unstable pelvic fractures treated by closed reduction and percutaneous fixation. ULUS TRAVMA ACIL CER 2011; 17:261-266. [PMID: 21935806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Treatment of unstable pelvic fractures has evolved recently, and percutaneous treatment has become the choice of treatment in most cases. The aim of this study was to evaluate the outcome of percutaneous treatment in patients with unstable pelvic fractures. METHODS Twenty patients (11 females, 9 males; mean age, 32 years, range, 11-66 years) who had unstable pelvic fractures and were treated percutaneously were enrolled in the study. Short Form-36 (SF-36) scores, Majeed scores, Iowa Pelvic Scores, and Pelvic Outcome Scores were determined for the outcome assessment. RESULTS The minimum duration of follow-up was 2 years, (range, 24-48 months). The mean Injury Severity Score (ISS) was 31 (range, 16-50). The average SF-36 scores were comparable with the general population in terms of bodily pain, general health and social function. The mean Majeed functional pelvic score was 93.3 (range, 72-100; 19 excellent and 1 good clinical grades) and the mean Iowa Pelvic Score was 86 (range, 82-90). The mean Pelvic Outcome Score was 33 (range, 24-37; maximum score, 40). CONCLUSION We have demonstrated better outcomes in patients with pelvic fractures treated with percutaneous fixation. The technique may be advantageous as it avoids the use of extensive approaches, bleeding, wound complications, and prolonged surgeries.
Collapse
Affiliation(s)
- Mehmet Ayvaz
- Department of Orthopedics and Traumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | | | | | | | | |
Collapse
|
42
|
Punjabi SK, Ali Z, Ahmed S. Causes and management of zygomatic bone fractures at Abbasi Shaheed Hospital Karachi (analysis of 82 patients). J PAK MED ASSOC 2011; 61:36-39. [PMID: 22368900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To assess the causes and management of Zygomatic bone fractures at Abbasi Shaheed Hospital, Karachi. METHODS This study was carried out at Department of Oral & Maxillofacial surgery Abbasi Shaheed Hospital, Karachi. A total of 82 cases were studied. A detailed history was taken, clinical examination was performed and fractures were confirmed by radiography. Management of fractures was done by using different proposed modalities, suitable for every case. A number of factors, like age of patients, causes of trauma and gender were assessed. RESULTS The commonest cause of Zygomatic bone fracture was found to be road traffic accident (RTA) 50% (n = 41), followed by assault 23.17% (n = 19), fall 20.73% (n = 17), sports injuries 3.65% (n = 3), and others 2.43% (n = 2) respectively. Right side (55%) was involved a little more than the left side (45%). Zygomatic bone fracture was more prevalent in age group between 21-30 years, while male to female ratio was 5.30:1. Remote reduction using Gillie's Temporal Approach with and without fixation using bone plates were the commonest management modalities used in this center. CONCLUSION The commonest cause of Zygomatic bone fracture was found to be road traffic accident, with the right side fractures being more common. It reveals poor road traffic sense in road users, lack of road safety measures and legislation in our population.
Collapse
|
43
|
Dai ZY, Li Y, Lu MP, Chen L, Jiang DM. Clinical profile of musculoskeletal injuries associated with the 2008 Wenchuan earthquake in China. ULUS TRAVMA ACIL CER 2010; 16:503-507. [PMID: 21153941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND The Wenchuan earthquake was an enormous devastating disaster and caused mass casualties. The descriptive analysis presented here serves as a reference not only for present injury intervention but also for future earthquake disaster response. METHODS A total of 205 patients with a musculoskeletal injury were admitted in two teaching hospitals. We conducted a retrospective review of medical records to document the injury profile, chief complaints, damage locations and types, subsequent treatment, and prognosis. RESULTS Of the 205 patients, fracture was the major type of injury (78.0%). Forty patients were determined to have crush injuries and 19 patients had crush syndromes. Open fractures, multiple fractures and comminuted fractures were common. Fracture-associated neural injuries and trauma-associated infections were also common. Surgical treatments included debridement, bone traction, external fixation, open reduction and internal fixation, and spinal fixation. All the patients were effectively treated with few complications, a low deformity rate and no death. CONCLUSION For emergency conditions after a major earthquake, pre-hospital emergency care is highly important. After the patients are transported to the hospital, we should plan individualized treatment according to the patients' respective clinical features, and at the same time, prevent and cure the related complications in a timely manner in order to reduce mortality and disability rates.
Collapse
Affiliation(s)
- Zhen-Yu Dai
- Department of Orthopedics, First Affiliated Hospital, Chongqing Medical University, Chongqing, PRC
| | | | | | | | | |
Collapse
|
44
|
Geoghegan JM, Longdon EJ, Hassan K, Hahn DM, Calthorpe D. Acetabular surgical units: a directory for the United Kingdom. Injury 2010; 41:677-9. [PMID: 19616776 DOI: 10.1016/j.injury.2008.06.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Revised: 05/09/2008] [Accepted: 06/12/2008] [Indexed: 02/02/2023]
Abstract
We present the first directory of the specialist acetabular surgical units throughout the United Kingdom. Previously there has not been any directory of acetabular surgeons in the UK as held by any governmental or healthcare agency. We have established that acetabular fracture fixation cases were performed at 33 NHS hospitals in the UK in 2003-2004. The total number of cases performed at each centre per year varied greatly (range 2-98). Twenty-one units performed greater than 10 cases per annum, comprising 92% of all operative cases in the UK in 2003-2004. We encourage trauma and orthopaedic units to communicate directly with their local units and familiarise themselves with those units' preferred referral processes. We publish this directory to assist in future research in this field, to help in resource planning in the field of major trauma, to aid training and continued development in this complex area and help with the timely referral of injured patients to these specialist units for this significant injury.
Collapse
Affiliation(s)
- J M Geoghegan
- Department of Trauma and Orthopaedics, Nottingham University Hospitals, Queens Medical Centre Campus, Clifton Boulevard, Nottingham NG7 2UH, United Kingdom.
| | | | | | | | | |
Collapse
|
45
|
Zieńczuk W, Cetnar T, Kawik Ł, Kotela I. [Problems with treatment of trochanteric femur fractures at elderly patients]. Przegl Lek 2010; 67:368-372. [PMID: 20684339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Authors analyzed patients complications with trochanteric fractures of femur treated in Department Orthopedic and Casualty of St. Lukas Hospital in Tarnów from 01.01.2008 to 31.12.2009 in this study. During this period were treated 167 patients. In most of cases operative treatment such as: Dynamic Hip Screw fixation, Gamma nailing, Ender's method and angle plate with screws were used. Prosthetic replacement was also used and 9 patients weren't operated because of coexisting pathological states. Basing on a done analyze of clinical material it was pronounced that independently from used surgical procedure regional and general complications are being occurred.
Collapse
Affiliation(s)
- Witold Zieńczuk
- Oddział Ortopedyczno-Urazowego, Szpitala Wojewódzkiego im. Sw. Łukasza w Tamowie
| | | | | | | |
Collapse
|
46
|
Cheecharern S. Factors affecting the redisplacement of the conservatively treated extra articular fractures of distal radius. J Med Assoc Thai 2009; 92 Suppl 6:S239-S243. [PMID: 20120693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND The objective of the study was to predict the amount of radiographic dorsal tilt angulation of extra articular fracture of distal radius with the size of dorsal cortical bone defect, radioulna index difference, age and gender of the patient. MATERIAL AND METHOD Sixty two patients with close fracture of Colles type were treated by close reduction and short arm cast. They were evaluated radiographically for initial dorsal tilt angulation, initial radioulna index, radioulna index after reduction, dorsal cortical defect after reduction and dorsal tilt angulation at the end of immobilization at 4 to 6 weeks. Using the method of multiple regression analysis, The author tried to construct the equation to predict quantitatively the changing amount of dorsal tilt angulation of extra articular fracture of distal radius from the independent variables of dorsal cortical bone defect size, radioulna index difference, age and gender of the patients. RESULTS The presence of dorsal cortical bone defect,age and sex of the patient were found to be the predictors of the increased dorsal tilt angulation of distal radius. For the estimation of dorsal tilt angulation, the correlation coefficient for dorsal cortical bone defect size was 0.177, for age was 0.201, and female gender was -8.206. The radioulna index difference was not found to have correlation with increased dorsal tilt angulation of distal radius. CONCLUSION The increased dorsal tilt angulation of extra articular fracture of distal radius at 4-6 week after reduction can be predicted from the initial data on size of dorsal cortical bone defect, age and gender of the patients. The radioulna index difference did not show the significant correlation with increased dorsal tilt angulation of extra articular fracture of distal radius treated conservatively.
Collapse
Affiliation(s)
- Sukrom Cheecharern
- Department of Orthopaedic Surgery, Rajavithi Hospital, College ofMedicine, Rangsit University, Bangkok, Thailand
| |
Collapse
|
47
|
Ostiak W, Koczewski P. [Pain intensity in patients treated by the external fixation]. Chir Narzadow Ruchu Ortop Pol 2009; 74:228-232. [PMID: 19999618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
One of the inherent features of the external fixation is pain occurring during the whole treatment process. The aim of this paper is evaluation of the level of pain intensity during particular stages of treatment and defining the correlation between pain intensity and type and also localization of fixator, etiology, type of treatment and patient's life activity. We analyzed 64 patients treated by external fixation of the lower limb in the age between 13 to 72 (mean 23.7). The pain intensity was evaluated four times by the NRS protocol (Numeric Rating Scale) in active and passive situation. It is stated that there is a different pain pattern in time depending on the type of treatment and personal life activity. Lengthened and patients in full time education are characterized by rapid increase in pain level in the first period of treatment. Patients with stabilization of non-union or fracture and professionally inactive had lower fluctuations of pain intensity. Localization of apparatus has influence on pain intensity level- greater pain was noted in the tibial group. Etiology influences on pain intensity. Increase of pain intensity in patients with non-union is lower in comparison to patients treated for the other indications.
Collapse
Affiliation(s)
- Wioleta Ostiak
- Katedra i Klinika Ortopedii i Traumatologii Dzieciecej, Uniwersytet Medyczny, Poznaniu.
| | | |
Collapse
|
48
|
Kubilius R, Keizeris T. Epidemiology of mandibular fractures treated at Kaunas University of Medicine Hospital, Lithuania. Stomatologija 2009; 11:73-76. [PMID: 19996672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Fractures of the mandible are one of the most common maxillofacial injuries. Because the pattern and incidence of mandibular fractures vary in different countries, there is a need to evaluate aspects of mandibular trauma in Lithuania's population. In this retrospective study hospital files of Oral and maxillofacial surgery unit of Kaunas University of Medicine Hospital were examined. The data that we collected included age, gender, hospitalization time, trauma mechanism, site of fracture, associated injuries, diagnostic and treatment methods. 87.1% of patients were male and they predominated in all age groups with a male to female ratio of 6.8:1. The highest incidence of mandibular fractures in male patients was in the 16-30 year age group and 31-45 year group for females. Interpersonal violence was the main cause of mandibular fractures, followed by falls and road traffic accidents. The incidence of falls in the <16 year age group was higher than expected. The angle was the most common fracture site (34.8%) and 51.7% patients experienced multiple fractures. The mean hospitalization time was 7.34+/-9.02 days. 55% of patients required Kirschner wire osteosynthesis, open reduction with miniplate osteosynthesis or a combination of both methods.
Collapse
Affiliation(s)
- Ricardas Kubilius
- Department of Maxillofacial Surgery, Kaunas University of Medicine, Kaunas, Lithuania
| | | |
Collapse
|
49
|
Pieske O, Dang M, Zaspel J, Beyer B, Löffler T, Piltz S. [Midshaft clavicle fractures--classification and therapy. Results of a survey at German trauma departments]. Unfallchirurg 2008; 111:387-94. [PMID: 18351312 DOI: 10.1007/s00113-008-1430-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The therapy of the midshaft clavicle fracture, in particular dislocated midshaft fractures, remains controversial. Therefore the objective of this study was to obtain data about the current treatment for midshaft clavicle fractures. METHODS In a countrywide anonymous survey 240 German orthopaedic trauma departments were asked about their diagnostic and therapeutic procedures for midshaft clavicle fractures. A total of 142 questionnaires (59%) were returned and evaluated. RESULTS More than 80% of the hospitals dispense with a standardised fracture classification for midshaft fractures. Simple fractures are generally conservatively treated, in the majority using a figure-of-eight bandage (88%). On average 26% of all clavicle fractures are operatively stabilized, independent of whether the treatment was performed at a trauma centre or any other hospital (p=0.45). Indications for operative treatment of midshaft fractures include severe additional injuries in the shoulder region (81-95%), young and active adults (52-64%) and dislocated midshaft fractures (56-75%). All departments use plate fixation for midshaft fractures; in particular the reconstruction plate (56%) is most frequently applied. Alternatively, if the fracture pattern is considered suitable for intramedullary fixation, this procedure is performed by 43% of the clinics, although this operative technique is used significantly more often in trauma centres (55%) than in other hospitals (31%) (p=0.01). CONCLUSION This survey demonstrates a high rate (26%) of German trauma hospitals operating clavicular midshaft fractures. This result is consistent with recently published studies showing better results for operative treatment of dislocated midshaft clavicular fractures compared to conservative therapy.
Collapse
Affiliation(s)
- O Pieske
- Klinikum der Universität München, Chirurgische Klinik und Poliklinik - Grosshadern, Marchioninistr. 15, 81377, München.
| | | | | | | | | | | |
Collapse
|
50
|
Feehan LM, Sheps SS. Treating hand fractures: population-based study of acute health care use in British Columbia. Can Fam Physician 2008; 54:1001-1007. [PMID: 18625825 PMCID: PMC2464804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To examine trends in use of acute health care services for hand fractures in a large diverse population across a range of medical settings. DESIGN Retrospective review of data from the British Columbia Linked Health Dataset on patients who had been treated for hand fractures between May 1, 1996, and April 30, 2001. SETTING British Columbia. PARTICIPANTS A total of 72 481 British Columbia residents identified from the British Columbia Linked Health Dataset as having received treatment for hand fractures. MAIN OUTCOME MEASURES Initial treatment for fractures (who had provided treatment and where had the treatment taken place) and hospital use (type of hospital, physician responsible, wait time, length of stay,geographic variation). RESULTS Almost all patients (97%) with hand fractures received initial treatment as outpatients. Just over half these patients (54%) received initial care in nonhospital settings, and more than two-thirds (70%) received initial care from primary care physicians. By far most patients (90%) were treated conservatively without surgical intervention. The few patients with more complicated hand fractures (10%) were most commonly treated in day surgery settings by specialist surgeons within 2 days of first presentation. Patients in the more rural, isolated,northern region of British Columbia had higher hospital admission rates (relative risk 2.1) for hand fractures than patients in other regions did. CONCLUSION In contrast to other common fracture injuries that are routinely managed by specialist surgeons,most hand fractures in BC were managed initially as nonemergency medical problems by primary care physicians. Almost all patients were treated conservatively without surgical intervention. The few patients with more complicated hand fractures were referred to and treated quickly by specialist surgeons. Focused training and continuing education opportunities for primary care physicians on new approaches to management of acute hand fractures will ensure that patients with hand fractures in British Columbia and the whole of Canada continue to benefit from appropriate management by primary care physicians.
Collapse
|