1
|
Fisher ND, Driesman AS, Sperling M, Konda SR, Egol KA. Clavicle Nonunion RepairWhat Can Patients Expect? Bull Hosp Jt Dis (2013) 2020; 78:243-249. [PMID: 33207145] [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: 06/11/2023]
Abstract
BACKGROUND The purpose of this study was to compare the long-term functional status of patients treated surgically for a clavicular nonunion using patients treated either op-eratively or non-operatively for an acute clavicle fracture as a comparison group. METHODS Twenty consecutive patients treated by a single surgeon for a clavicle fracture nonunion were identified. For comparison of outcomes, acute clavicle fractures were identified from an electronic medical record (EMR) query of the same orthopedic surgeon. Ninety acute clavicle fracture patients were identified and 27 (30%) patients were available for long-term follow-up. Clavicular nonunions were compared to acute clavicle fracture patients in a univariate analysis then a multivariate analysis to analyze clavicle nonunion patients against operative and non-operative acute clavicle fracture patients. The main outcome measures were time to bony union, postoperative complications, visual analog scale (VAS) pain scores, and Short Musculoskeletal Functional Assessment (SMFA) scores at long-term follow-up. RESULTS There was no difference in time to healing or functional outcomes as assessed by SMFA and VAS pain scores between clavicle nonunion and acute fracture patients. Postoperative complications also did not differ between the groups. CONCLUSIONS Patients who are treated surgically for clavicular nonunions ultimately regain a similar functional status as patients who are treated either operatively or non-operatively for an acute clavicle fracture and heal acutely.
Collapse
|
2
|
Quadlbauer S, Pezzei C, Jurkowitsch J, Rosenauer R, Kolmayr B, Keuchel T, Simon D, Beer T, Hausner T, Leixnering M. Rehabilitation after distal radius fractures: is there a need for immobilization and physiotherapy? Arch Orthop Trauma Surg 2020; 140:651-663. [PMID: 32193679 DOI: 10.1007/s00402-020-03367-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 02/03/2020] [Indexed: 02/07/2023]
Abstract
Although the literature generally agrees that displaced distal radius fractures require surgery, no single consensus exists concerning the length of immobilization and type of post-operative physiotherapeutic rehabilitation program. Palmar locking plate fixation represents a very stable fixation of the distal radius, and was assessed biomechanically in various studies. Surprisingly, most authors report additional immobilization after plate fixation. One reason might be due to the pain caused during active wrist mobilization in the early post-operative stages or secondly to protect the osteosynthesis in the early healing stages preventing secondary loss of reduction. This article addresses the biomechanical principles, current available evidence for early mobilization/immobilization and impact of physiotherapy after operatively treated distal radius fractures.
Collapse
Affiliation(s)
- S Quadlbauer
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.
- Ludwig Boltzmann Institute for Experimental und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria.
- Austrian Cluster for Tissue Regeneration, 1200, Vienna, Austria.
| | - Ch Pezzei
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - J Jurkowitsch
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - R Rosenauer
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
- Ludwig Boltzmann Institute for Experimental und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, 1200, Vienna, Austria
| | - B Kolmayr
- Department of Physiotherapy, AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, 1200, Vienna, Austria
| | - T Keuchel
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - D Simon
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - T Beer
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - T Hausner
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
- Ludwig Boltzmann Institute for Experimental und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, 1200, Vienna, Austria
- Department for Orthopedic Surgery and Traumatology, Paracelsus Medical University, 5020, Salzburg, Austria
| | - M Leixnering
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| |
Collapse
|
3
|
Sarikaya IA, Seker A, Erdal OA, Talmac MA, Inan M. Minimally invasive plate osteosynthesis for tibial derotation osteotomies in children with cerebral palsy. Acta Orthop Traumatol Turc 2018; 52:352-356. [PMID: 29759883 PMCID: PMC6205033 DOI: 10.1016/j.aott.2018.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 11/24/2017] [Accepted: 02/11/2018] [Indexed: 11/29/2022]
Abstract
Objective Tibial derotation osteotomy can be used in the treatment of rotational deformities in case of ineffective conservative management. Our aim was to evaluate the results of the patients who underwent minimal invasive plate osteosynthesis for tibial derotation osteotomies. Methods Total of 16 patients (17 procedures) were included in this study. Mean age was 11.5 (3–25) years. We clinically assessed the tibial torsion by measuring the thigh-foot angle (TFA). No immobilization was used postoperatively and range of motion exercises were begun immediately. The patient was allowed weight-bearing activity, as tolerated, when callus formation was seen on the radiographs, at approximately three to four weeks after surgery. Results The mean follow-up time was 27.5 months. Mean preoperative and follow up TFA were 27° of internal rotation and 3.74° of external rotation, respectively. A mean of 22.3° improvement was achieved postoperatively. There was only one wound detachment, which was accepted as a complication and healed with local wound care. Conclusions The recurrence risk and correction loss can be decreased with plate-screw fixation. Minimal invasive surgery would also decrease the risk of wound complications. Level of evidence Level IV, Therapeutic study.
Collapse
Affiliation(s)
| | - Ali Seker
- Istanbul Medipol University Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | | | - Mehmet Ali Talmac
- Istanbul Sisli Etfal Training and Research Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | | |
Collapse
|
4
|
Roberts JL, Pritchard AW, Williams M, Totton N, Morrison V, Din NU, Williams NH. Mixed methods process evaluation of an enhanced community-based rehabilitation intervention for elderly patients with hip fracture. BMJ Open 2018; 8:e021486. [PMID: 30093516 PMCID: PMC6089270 DOI: 10.1136/bmjopen-2018-021486] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To describe the implementation of an enhanced rehabilitation programme for elderly hip fracture patients with mental capacity, in a randomised feasibility study compared with usual rehabilitation. To compare processes between the two and to collect the views of patients, carers and therapy staff about trial participation. DESIGN Mixed methods process evaluation in a randomised feasibility study. SETTING Patient participants were recruited on orthopaedic and rehabilitation wards; the intervention was delivered in the community following hospital discharge. PARTICIPANTS Sixty-one older adults (aged ≥65 years) recovering from surgical treatment (replacement arthroplasty or internal fixation) following hip fracture, who were living independently prior to fracture and had mental capacity and 31 of their carers. INTERVENTIONS Usual care (control) or usual care plus an enhanced rehabilitation package (intervention). The enhanced rehabilitation consisted of a patient-held information workbook, goal-setting diary and up to six additional therapy sessions. PROCESS EVALUATION COMPONENTS Recruitment of sites and rehabilitation teams, response of rehabilitation teams, recruitment and reach in patient and carer participants, intervention delivery, delivery to individuals, response of individual patients to the enhanced intervention or usual rehabilitation, response of carer participants, unintended consequences and testing intervention theory and context. RESULTS Usual rehabilitation care was very variable. The enhanced rehabilitation group received a mean of five additional therapy sessions. All of the returned goal-setting diaries had inputs from the therapy team, and half had written comments by the patients and carers. Focus group themes: variation of usual care and its impact on delivering the intervention; the importance of goal setting; the role of the therapist in providing reassurance about safe physical activities; and acceptability of the extra therapy sessions. CONCLUSIONS Lessons learnt for a future definitive RCT include how to enhance recruitment and improve training materials, the workbook, delivery of the extra therapy sessions and recording of usual rehabilitation care. TRIAL REGISTRATION NUMBER ISRCTN22464643; Post- results.
Collapse
Affiliation(s)
| | - Aaron W Pritchard
- Research and Development Department, Betsi Cadwaladr University Health Board, Bangor, Gwynedd, UK
| | | | - Nikki Totton
- School of Health and Related Research, Sheffield University, Sheffield, UK
| | - Val Morrison
- School of Psychology, Bangor University, Bangor, UK
| | - Nafees Ud Din
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Nefyn H Williams
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| |
Collapse
|
5
|
Šrám J, Taller S, Harcuba R, Křivohlávek M, Lukáš R, Džupa V. [Osteosynthesis of Anterior Pelvic Segment: New Symphyseal Plate - First Clinical Experience]. Acta Chir Orthop Traumatol Cech 2018; 85:9-16. [PMID: 30257763] [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 aim of this study is to evaluate the first experience gained with the new type of anatomical symphyseal plates intended to stabilise ruptured symphysis and closely located fractures. MATERIAL AND METHODS A retrospective evaluation was performed in 5 patients who had undergone surgery in the period from July 2015 to the end of 2016 using a new anatomical symphysial plate for pelvic ring injury. In four cases a stabilisation of symphyseolysis was carried out and in one case osteosynthesis of bilateral rami fracture near the symphysis was performed. The posterior pelvic segment was fixed 3 times by iliosacral screws and 2 times by a transsacral bar. All the surgeries in symphysis region were performed via a modified anterior suprapubic approach. A total of 3 men and 2 women with the mean age of 54.6 years (range 19-77 years) were operated. The mean follow-up period of five patients was 12.6 months. Also, preliminary evaluation of postoperative clinical and radiological outcomes was conducted on a very heterogenous group of patients. RESULTS The postoperative radiological outcome assessed by Pohlemann score was excellent in all the cases. After 3-6 months, screw loosening was reported in 3 cases, with no impact on the overall result of the surgery, in one case the symphysis widened 2 mm with simultaneous loosening of two screws, with no impact on the clinical result either. Clinical evaluation of the results was conducted in 4 patients using the Majeed score with the mean follow-up of 12.6 months, the score achieved was 98, 86, 72 and 49 points. In one patient the results could not be evaluated due to concurrent spinal cord injury with quadriplegia. Nonetheless, even this patient has no difficulty in sitting in a rehabilitation wheelchair. No serious intraoperative or early postoperative complications were reported. As regards late complications, one female colostomy patient developed deep infection three months after the primary surgery. DISCUSSION The first clinical as well as radiological outcomes in our small group of patients are comparable to the outcomes of larger groups using multi-hole plates to stabilise the anterior segment, or the application of 2 plates. In agreement with other authors, the new plates can be applied through a less invasive operative approach avoiding the necessity to transect rectus abdominis muscles. The results of earlier biomechanical studies suggest that their strength will equal 2 inserted plates, or will be comparable to multi-hole plates. CONCLUSIONS The first experience with the use of new anatomical symphysial plates are promising. The new types of plates intended for anterior pelvic segment facilitate fixation by screws inserted at two levels. They significantly improve the stability of fixation and can replace the commonly used 2 plates. The only limiting factor of our group of patients is its small size. Comparative weight-bearing tests shall be performed in the future. Key words:symphysis pubic disruption, pelvic ring fractures, pelvic instability, new symphyseal plates.
Collapse
Affiliation(s)
- J Šrám
- Traumatologicko-ortopedické centrum se spinální jednotkou Krajské nemocnice Liberec, a.s
| | | | | | | | | | | |
Collapse
|
6
|
Lanier PJ, Speirs J, Koehler L, Bader J, Abdelgawad A, Waterman BR. Predictors of Persistent Pain After Fixation of Distal Clavicle Fractures in an Active Military Population. Orthopedics 2018; 41:e117-e126. [PMID: 29192935 DOI: 10.3928/01477447-20171127-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 04/25/2017] [Accepted: 10/03/2017] [Indexed: 02/03/2023]
Abstract
Patients who undergo open reduction and internal fixation of distal clavicle fractures have a high rate of hardware removal and persistence of symptoms, particularly when attempting to return to high-demand activities. This study evaluated the outcomes of military servicemembers after surgical treatment of distal clavicle fractures. The authors performed a retrospective analysis of active duty servicemembers who underwent open reduction and internal fixation of Neer type II distal clavicle fractures between October 17, 2007, and July 20, 2012, with a minimum of 2-year clinical follow-up. The electronic health record was queried to extract demographic features and clinical outcomes, primarily persistence of pain, removal of hardware, and postoperative return to high-level activity. A total of 48 patients were identified, with mean follow-up of 3.8 years. A total of 44% of patients underwent subsequent hardware removal. All fractures achieved radiographic union, and 35% of patients had persistence of symptoms. Patients who were treated with hook plating had a 3.64-fold higher risk of persistence of pain compared with those treated with conventional plating techniques. A total of 35% of patients successfully returned to full military function and completed a postoperative military deployment. Coracoclavicular reconstruction did not improve outcomes. Persistence of symptoms and requirement for hardware removal were not associated with the rate of postoperative deployment. Achieving excellent functional outcomes with open reduction and internal fixation of distal clavicle fractures remains a challenge. Where possible, conventional plate fixation should be considered over hook plate fixation. However, subsequent hardware removal and continuing shoulder pain do not preclude a return to high-level activity. [Orthopedics. 2018; 41(1):e117-e126.].
Collapse
|
7
|
Roh YH, Noh JH, Gong HS, Baek GH. Effect of low appendicular lean mass, grip strength, and gait speed on the functional outcome after surgery for distal radius fractures. Arch Osteoporos 2017; 12:41. [PMID: 28411349 DOI: 10.1007/s11657-017-0335-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 12/26/2016] [Accepted: 04/10/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED Patients with low appendicular lean mass plus slow gait speed or weak grip strength are at risk for poor functional recovery after surgery for distal radius fracture, even when they have similar radiologic outcomes. INTRODUCTION Loss of skeletal muscle mass and consequent loss in muscle function associate with aging, and this condition negatively impacts the activities of daily living and increases elderly individuals' frailty to falls. Thus, patients with low appendicular lean mass would show different functional recovery compared to those without this condition after surgery for distal radius fracture (DRF). This study compares the functional outcomes after surgery for DRF in patients with or without low appendicular lean mass plus slowness or weakness. METHODS A total of 157 patients older than 50 years of age with a DRF treated via volar plate fixation were enrolled in this prospective study. A definition of low appendicular lean mass with slowness or weakness was based on the consensus of the Asian Working Group for Sarcopenia. The researchers compared functional assessments (wrist range of motion and Michigan Hand Questionnaire [MHQ]) and radiographic assessments (radial inclination, volar tilt, ulnar variance, and articular congruity) 12 months after surgery between patients with and without low appendicular lean mass plus slowness or weakness. Multivariable regression analyses were performed to determine whether appendicular lean mass, grip strength, gait speed, patient demographic, or injury characteristics accounted for the functional outcomes. RESULTS Patients with low appendicular lean mass plus slowness or weakness showed a significantly lower recovery of MHQ score than those in the control group throughout 12 months. There was no significant difference in the range of motion between the groups. The radiologic outcomes showed no significant difference between groups in terms of volar tilt, radial inclination, or ulnar variance. According to multivariable regression analysis, the poor recovery of MHQ score was associated with an increase in age, weak grip strength, and lower appendicular lean mass, and these three factors accounted for 37% of the variation in the MHQ scores. CONCLUSION Patients with low appendicular lean mass plus slowness or weakness are at risk for poor functional recovery after surgery for DRF, even when they have similar radiologic outcomes.
Collapse
Affiliation(s)
- Young Hak Roh
- Department of Orthopaedic Surgery, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Jung Ho Noh
- Department of Orthopaedic Surgery, Kangwon National University Hospital, 156 Baengnyeong-ro, Chuncheon-si, Gangwon-do, 200-722, South Korea.
| | - Hyun Sik Gong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Goo Hyun Baek
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| |
Collapse
|
8
|
Lädermann A, Abrassart S, Denard PJ, Tirefort J, Nowak A, Schwitzguebel AJ. Functional recovery following early mobilization after middle third clavicle osteosynthesis for acute fractures or nonunion: A case-control study. Orthop Traumatol Surg Res 2017; 103:885-889. [PMID: 28552824 DOI: 10.1016/j.otsr.2017.03.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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] [Received: 11/06/2016] [Revised: 03/27/2017] [Accepted: 03/30/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Good outcomes have been reported after surgical treatment for acute or nonunion of displaced midshaft clavicle fractures. However, the postoperative rehabilitation and timeline for a complete functional recovery are poorly documented. The purpose of the current study was to evaluate the efficacy of an immediate motion protocol following plate fixation of a midshaft clavicle fracture and to compare functional recovery between acute and nonunion cases. METHODS Between October 2011 and July 2015, all patients above the age of 18, having either an acute or a nonunion of the midshaft clavicle fracture, were considered as potentially eligible for inclusion in this prospective case-control study. Postoperatively, no immobilization was recommended and patients were to undergo rehabilitation protocol consisting of hourly stretching. RESULTS Forty-two patients were included (31 with acute and 11 with delayed fixation) at a mean follow-up of 33months (range, 12 to 78months). Surgical complications consisted of one transient frozen shoulder, one delayed union, and two superficial infections. All patients returned to work, retrieved full shoulder range of motion (ROM), and returned to heavy sports and activities. Function returned faster in the acute group compared to the nonunion group based on the SANE score at 2weeks (73±21 vs. 45±26 respectively, P=0.01), SANE score at 6weeks (89±15 vs. 66±23 respectively, P=0.01), SANE score at 3months (96±10 vs. 85±14 respectively, P=0.03), and based on return of full ROM (17±25 vs. 44±31 days respectively, P=0.01). A trend was observed for nonunion cases needing more time to return to work and sports activities. CONCLUSION Functional outcome is excellent following the treatment of both acute and non-united clavicle fractures, but recovery occurs earlier following acute treatment. An early mobilization rehab protocol can be safely recommended for both types of conditions and may result in substantial healthcare cost-savings, without increasing complication rate and decreasing patient satisfaction. LEVEL OF EVIDENCE Level III; case-control study; treatment study.
Collapse
Affiliation(s)
- A Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, rue J.-D.-Maillard 3, 1217 Meyrin, Switzerland; Faculty of Medicine, University of Geneva, rue Michel-Servet 1, 1211 Geneva 4, Switzerland; Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
| | - S Abrassart
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, rue J.-D.-Maillard 3, 1217 Meyrin, Switzerland; Faculty of Medicine, University of Geneva, rue Michel-Servet 1, 1211 Geneva 4, Switzerland
| | - P J Denard
- Department of Orthopaedics and Rehabilitation, Southern Oregon Orthopedics, Medford, Oregon, Oregon Health & Science University, Portland, OR, USA
| | - J Tirefort
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, rue J.-D.-Maillard 3, 1217 Meyrin, Switzerland
| | - A Nowak
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, rue J.-D.-Maillard 3, 1217 Meyrin, Switzerland
| | - A J Schwitzguebel
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, rue J.-D.-Maillard 3, 1217 Meyrin, Switzerland
| |
Collapse
|
9
|
Mizrahi EH, Lubart E, Heymann A, Leibovitz A. Impact of the Holocaust on the Rehabilitation Outcome of Older Patients Sustaining a Hip Fracture. Isr Med Assoc J 2017; 19:207-210. [PMID: 28480669] [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: 06/07/2023]
Abstract
BACKGROUND Holocaust survivors report a much higher prevalence of osteoporosis and fracture in the hip joint compared to those who were not Holocaust survivors. OBJECTIVES To evaluate whether being a Holocaust survivor could affect the functional outcome of hip fracture in patients 64 years of age and older undergoing rehabilitation. METHODS A retrospective cohort study compromising 140 consecutive hip fracture patients was conducted in a geriatric and rehabilitation department of a university-affiliated hospital. Being a Holocaust survivor was based on registry data. Functional outcome was assessed by the Functional Independence Measure (FIM)TM at admission and discharge from the rehabilitation ward. Data were analyzed by t-test, chi-square test, and linear regression analysis. RESULTS Total and motor FIM scores at admission (P = 0.004 and P = 0.006, respectively) and total and motor FIM gain scores at discharge (P = 0.008 and P = 0.004 respectively) were significantly higher in non-Holocaust survivors compared with Holocaust survivors. A linear regression analysis showed that being a Holocaust survivor was predictive of lower total FIM scores at discharge (β = -0.17, P = 0.004). CONCLUSIONS Hip fracture in Holocaust survivors showed lower total, motor FIM and gain scores at discharge compared to non-Holocaust survivor patients. These results suggest that being a Holocaust survivor could adversely affect the rehabilitation outcome following fracture of the hip and internal fixation.
Collapse
Affiliation(s)
- Eliyahu H Mizrahi
- Department of Geriatric Medicine and Rehabilitation, Shmuel Harofe Hospital, Beer Yaakov, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emilia Lubart
- Department of Geriatric Medicine and Rehabilitation, Shmuel Harofe Hospital, Beer Yaakov, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anthony Heymann
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arthur Leibovitz
- Department of Geriatric Medicine and Rehabilitation, Shmuel Harofe Hospital, Beer Yaakov, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
10
|
Abstract
BACKGROUND In the hectic environment of a hand therapy clinic, the opportunity to carefully consider the relationships among pathology, pathomechanics, surgical repair techniques, tissue healing, postoperative management, and rehabilitation program development and progression is limited. Clinicians often default to seeking a protocol, a recipe to follow. OBJECTIVES Using the ulnar side of the wrist as an example, relevant anatomy and biomechanics are directly related to several commonly seen pathologies, including fractures, ligament injuries, and instability. CONCLUSION Armed with knowledge of anatomy, biomechanics, and surgical procedures, the need for a protocol disappears. Each patient can be individually managed according to his or her unique set of variables and responses to injury, repair, healing, and recovery of function.
Collapse
Affiliation(s)
- Emily Altman
- Hand Therapy Department, Hospital for Special Surgery, New York, NY, USA.
| |
Collapse
|
11
|
Anand A, Wei R, Patel A, Vedi V, Allardice G, Anand BS. Tightrope fixation of syndesmotic injuries in Weber C ankle fractures: a multicentre case series. Eur J Orthop Surg Traumatol 2017; 27:461-467. [PMID: 28074301 DOI: 10.1007/s00590-016-1882-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 11/03/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND No general consensus has yet been established for the gold standard treatment of ankle syndesmotic complex injuries. Recent literature has documented the success of ankle tightrope fixation for heterogeneous ankle fracture patterns, resulting in syndesmotic complex injuries. We present a multicentre case series assessing the clinical, radiological and functional outcomes of patients with Weber C ankle fractures treated with the Arthrex TightRope® fixation system. METHOD We performed a retrospective analysis of all adult patients with Weber C ankle fractures who were treated with the Arthrex TightRope® fixation system at four centres over a 3-year period. All patients were followed up for a mean of 14 months (range 12-26). Outcomes measures were assessed subjectively using functional scores (AOFAS and Olerud and Molander) and objectively using radiological measurements, complication rates and revision surgery rates. RESULTS Thirty-six patients met our eligibility criteria. The mean age at operation was 31 years (range 18-65). There were 20 males and 16 females. No patients were lost to follow-up. The ankle tightrope maintained satisfactory reduction in the ankle mortise in 97% of cases. Of these 35 successfully treated cases, no evidence of re-displacement on follow-up radiographs of the syndesmotic complex was observed at an average of 10.8 months (range 6-12). Post-operative mean medial clear space was 3.1 mm, and mean tibio-fibular overlap was 10.1 mm. The mean American Orthopaedic Foot and Ankle Society (AOFAS) score was 88.8 (range 67-98) at a mean follow-up of 14 months (range 12-26). The overall complication rate was 6% (one failure requiring revision surgery and one medial sided skin irritation requiring removal of suture button). No infections or wound complications occurred. CONCLUSION Tightrope fixation is a safe alternative to screw fixation for syndesmotic complex injuries in Weber C ankle fractures. We have shown that it has low complication rates and a high patient satisfaction.
Collapse
Affiliation(s)
| | - Ran Wei
- Croydon University Hospital, 530 London Road, Surrey, CR7 7YE, UK
| | - Akash Patel
- Imperial College London Hospitals, London, UK
| | - Vikas Vedi
- Hillingdon and Mount Vernon Hospital, London, UK
| | - Garth Allardice
- Northwick Park Hospital, Watford Road, Harrow, Middlesex, HA1 3UJ, UK
| | - Bobby Singh Anand
- Croydon University Hospital, 530 London Road, Surrey, CR7 7YE, UK.
- The Elective Orthopaedic Centre, Dorking Road, Epsom, KT18 7EG, UK.
| |
Collapse
|
12
|
Jančíková V, Opavský J, Dráč P, Krobot A, Čižmář I. [The Effect of Activation of the Shoulder Girdle Muscles on Functional Outcomes of Rehabilitation in Patients with Surgically Treated Distal Radius Fractures]. Acta Chir Orthop Traumatol Cech 2017; 84:114-119. [PMID: 28809628] [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: 06/07/2023]
Abstract
PURPOSE OF THE STUDY The aim of the study was to assess the functional outcomes of rehabilitation in patients with surgically treated distal radius fractures in the early postoperative period. We compared the functional outcomes of patients undergoing standard rehabilitation with the group of patients whose postoperative rehabilitation was extended with shoulder girdle exercises of the affected upper limb while the wrist was immobilized. Several indices and variables were used for the assessment of the functional therapeutic outcomes of the affected wrist. MATERIAL AND METHODS Forty patients (32 females and 8 males, the mean age 60.5 years) with distal radius fractures treated by internal fixation using volar surgical approach were involved in the study between 2013-2016. The tested subjects were randomized and split into two groups according to the selected method of rehabilitation. The tested subjects with standard rehabilitation extended with shoulder girdle muscles activation were labelled as group I. It included patients (n = 20) of the mean age 59.8 (age range 42-73 years) with immobilized wrist (i.e. for 3-4 weeks) performing shoulder girdle muscles exercises at the same time. Furthermore, standard kinesiotherapy continued after their fixation was removed. The other tested group, labelled as group II (n = 20), the mean age 61.3 (variation 40-74 years of age) involved patients with distal radius fractures. Only standard rehabilitation was performed in this group as late as their forearm fixation was removed. The following indices and parameters were assessed in the early postoperative period (i.e. by 8 weeks after the fixation removal): wrist and fingers range of motion (ROM), hand grip strength (dynamometry), local swelling, pain, scores of a nine hole peg test (NHPT), and a DASH score. RESULTS After the fixation had been removed, the group I reported statistically significantly higher values of movement compared to the values of the contralateral limb in the following directions: dorsal flexion, palmar flexion, MP joints flexion, flexion of PIP joints (proximal interphalangeal), and flexion of DIP joints (distal interphalangeal). After eight weeks, the group I manifested significantly higher values in dorsal flexion, palmar flexion and ulnar deviation in the wrist. There were no significant differences in other movement directions. The hand grip strength mean value examined with a dynamometer was significantly higher in the group I in the sixth and eighth week of testing (group I - 58.9% strength of a healthy limb after six weeks, or 66.5% after eight weeks). The results in the group II were 49.9% strength of a healthy limb after six weeks, or 56.6% after eight weeks. The group I showed statistically significantly lower values of wrist swelling and higher finger dexterity in the NHPT in all measured weeks. Lower pain intensity in the group I during the measurements was observed. At the same time, this group showed significantly better results in the DASH score. DISCUSSION The results of this study are useful for clinical practice. They confirm a functional relation between the activity of hand muscles and the shoulder muscle activity. The differences in the functional ability of the hand and the functional state of the injured wrist were detected as early as in the early postoperative period. It could be stated that the tested subjects in the group I showed a greater and faster improvement in the physical function of the injured hand. This was also accompanied by a positive psychological effect. We had not found a study of a similar type in the available literature that we could have compared our submitted results to. CONCLUSIONS Shoulder girdle muscles exercises after a distal radius fracture, while wrist is immobilized, can evidently enhance functional capability and accelerate the hand-function restitution. Early functional outcomes of the injured wrist after the rehabilitation with shoulder girdle muscles exercises support the efficiency of this broadened rehabilitation protocol. Key words: distal radius frac,ture, hand, shoulder, functional treatment, rehabilitation.
Collapse
Affiliation(s)
- V Jančíková
- Ústav fyzioterapie, Fakulta zdravotnických věd, Univerzita Palackého v Olomouci
| | | | | | | | | |
Collapse
|
13
|
Müller-Mai CM, Schulze Raestrup US, Kostuj T, Dahlhoff G, Günster C, Smektala R. [One-year outcomes for proximal femoral fractures: Posthospital analysis of mortality and care levels based on health insurance data]. Unfallchirurg 2016; 118:780-94. [PMID: 24352202 DOI: 10.1007/s00113-013-2534-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [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 Proximal femur fractures are common and treatment is expensive. The aim of the present study was - after matching of hospital and health insurance data - to evaluate the influence of early operation on certain outcome parameters. Data from a German health insurance were used to identify then influence of the day of operation after admittance on the rate of mortality, decubitus, and revision surgery during the hospital stay and on the care level of the patients up to 1 year and in some cases longer after operation. MATERIALS AND METHODS In all, 7905 patients were included. The descriptive data, specifying the given population, described the hospital stay (occurrence, surgical procedures, early complications, secondary diagnoses, length of stay) and the course of patient recovery up to 1 year after the hospital stay (care level, late complications). The calculated data (analytical statistics) give correlations evaluating the influence of the length of the preoperative hospital stay on the outcome parameters mentioned above. Risk adjustment was performed by using secondary diagnoses. RESULTS The study included more women (mean age 81.5 years). Most common was the femoral neck fracture. Of the operations 77% were carried out on the first day after admission; dominating procedures were intramedullary nails and prostheses. Most common secondary diagnoses were diabetes, dementia, ischemic heart disease, and chronic heart insufficiency. Descriptive data revealed 6% early as well as late complications. In all, 50% of patients had a higher care level after operation. Almost 40% of patients changed from outpatient care to inpatient care. The time interval between admission and operation negatively influenced all outcome parameters. The relative risk to die, to develop decubitus, or to receive early revision was increased by approximately one third when patients were operated on later than the first day after admission. A total of 3172 patients died during the study period. Mortality after operation reached 9.9% within 30 days and 26.9% at 1 year. The mortality of patients operated after the first day was increased by more than 6% compared to patients treated within the first 24 h. CONCLUSION The present study clearly presents the importance of analysis of routine records after discharge and it demonstrates that longer periods up to 1 year and more can be evaluated. The data show that a longer time period between hospital admission and operation negatively influences all outcome parameters. The care data give impressive evidence for a significant loss of quality of life and the importance of intense postoperative rehabilitation.
Collapse
Affiliation(s)
- C M Müller-Mai
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Lünen, Altstadtstraße 23, 44534, Lünen, Deutschland,
| | | | | | | | | | | |
Collapse
|
14
|
Abstract
BACKGROUND Acute complex C2 vertebral body fracture specifically does not involve the odontoid process or C2 pars interarticularis. External stabilization can be effective but may prolong healing and increase morbidity. Many traditional surgical techniques can achieve internal stabilization at the expense of normal cervical motion. We describe direct surgical C2 pedicle screw fixation as an option for managing acute complex C2 vertebral body fracture. CASE DESCRIPTION Three patients were treated with direct pedicle screw fixation of acute traumatic complex C2 vertebral body fractures. All fractures were coronally oriented Benzel type 1. None of the patients sustained neurological injury. Stereotactic navigation with intraoperative computed tomography scanning was used for each procedure. Surgery provided immediate internal orthosis and stability, as judged by intraoperative dynamic fluoroscopy. Rigid cervical collar bracing was used for 1 month after surgery when the patients were out of bed. Initial radiographs showed acceptable screw placement and fracture alignment. Dynamic radiographs at 3 months showed structural stability at the fracture site and adjacent levels, and complete bony union was confirmed with late computed tomography scanning (>1 year) in each case. Each patient reported resolution of trauma-related and postsurgical pain at 30-day follow-up. Postoperative Neck Disability Index questionnaires for each patient suggested no significant disability at 1 year. CONCLUSIONS Direct pedicle screw fixation of acute complex C2 vertebral body fracture appeared to be safe and effective in our 3 patients. It may provide a more-efficient and less-morbid treatment than halo brace or cervical collar immobilization in some patients.
Collapse
Affiliation(s)
| | - Joel D MacDonald
- Intermountain Medical Center, Murray, Utah, USA; Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA.
| |
Collapse
|
15
|
Euler SA, Kralinger FS, Hengg C, Wambacher M, Blauth M. Allograft augmentation in proximal humerus fractures. Oper Orthop Traumatol 2016; 28:153-63. [PMID: 27221231 PMCID: PMC4906073 DOI: 10.1007/s00064-016-0446-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 11/26/2015] [Accepted: 11/27/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Achieve stable fixation to initially start full range of motion (ROM) and to prevent secondary displacement in unstable fracture patterns and/or weak and osteoporotic bone. INDICATIONS (Secondarily) displaced proximal humerus fractures (PHF) with an unstable medial hinge and substantial bony deficiency, weak/osteoporotic bone, pre-existing psychiatric illnesses or patient incompliance to obey instructions. CONTRAINDICATIONS Open/contaminated fractures, systemic immunodeficiency, prior graft-versus-host reaction. SURGICAL TECHNIQUE Deltopectoral approach. Identification of the rotator cuff. Disimpaction and reduction of the fracture, preparation of the situs. Graft preparation. Allografting. Fracture closure. Plate attachment. Definitive plate fixation. Radiological documentation. Postoperative shoulder fixation (sling). POSTOPERATIVE MANAGEMENT Cryotherapy, anti-inflammatory medication on demand. Shoulder sling for comfort. Full active physical therapy as tolerated without pain. Postoperative radiographs (anteroposterior, outlet, and axial [as tolerated] views) and clinical follow-up after 6 weeks and 3, 6, and 12 months. RESULTS Bony union and allograft incorporation in 9 of 10 noncompliant, high-risk patients (median age 63 years) after a mean follow-up of 28.5 months. The median Constant-Murley Score was 72.0 (range 45-86). Compared to the uninjured contralateral side, flexion was impaired by 13 %, abduction by 14 %, and external rotation by 15 %. Mean correction of the initial varus displacement was 38° (51° preoperatively to 13° postoperatively).
Collapse
Affiliation(s)
- S A Euler
- Klinik für Unfallchirurgie und Sporttraumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
| | - F S Kralinger
- Unfallchirurgische Abteilung, Wilhelminenspital Wien, Montlearstr. 37, Vienna, 1160, Austria
| | - C Hengg
- Klinik für Unfallchirurgie und Sporttraumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - M Wambacher
- Klinik für Unfallchirurgie und Sporttraumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - M Blauth
- Klinik für Unfallchirurgie und Sporttraumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| |
Collapse
|
16
|
Kutikov SA, Borzunov DY, D’Yachkova GV, Chevardin AY. TREATMENT OF CONGENITAL PSEUDARTHROSIS OF THE TIBIA. Vestn Khir Im I I Grek 2016; 175:53-58. [PMID: 30457265] [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: 06/09/2023]
Abstract
The work is based on an analysis of treatment results of 47 patients with congenital pseudarthrosis of the tibia. The Ilizarov technique of unfree osteoplasty was applied on these patients. The authors considered an application of combined variants of exterior and external osteosynthesis as very perspective in rehabilitation of the patients with congenital pseudarthrosis.
Collapse
|
17
|
Iryanov YM, Kiryanov NA. [Reparative Osteogenesis and Angiogenesis in Low Intensity Electromagnetic Radiation of Ultra-High Frequency]. ACTA ACUST UNITED AC 2015:334-40. [PMID: 26495722 DOI: 10.15690/vramn.v70i3.1330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Non-drug correction of reparative bone tissue regeneration in different pathological states - one of the most actual problems of modern medicine. OBJECTIVE Our aim was to conduct morphological analysis of the influence of electromagnetic radiation of ultra-high frequency and low intensity on reparative osteogenesis and angiogenesis in fracture treatment under transosseous osteosynthesis. METHODS A controlled nonrandomized study was carried out. In the experiment conducted on rats we modeled tibial fracture with reposition and fixation of the bone fragments both in control and experimental groups. In the animals of the experimental group the fracture zone was exposed to low intensity electromagnetic radiation of ultra-high frequency. Exposure simulation was performed in the control group. The operated bones were examined using radiography, light and electronic microscopy, X-ray electronic probe microanalysis. RESULTS It has been established that electromagnetic radiation of ultra-high frequency sessions in fracture treatment stimulate secretory activity and degranulation of mast cells, produce microcirculatory bed vascular permeability increase, endotheliocyte migration phenotype expression, provide endovascular endothelial outgrowth formation, activate reparative osteogenesis and angiogenesis while fracture reparation becomes the one of the primary type. The full periosteal, intermediary and intraosteal bone union was defined in 28 days. CONCLUSION Among the therapeutic benefits of electromagnetic radiation of ultra-high frequency in fracture treatment we can detect mast cell secretorv activity stimulation and endovascular anziozenesis activation.
Collapse
|
18
|
Lin T, Liu J, Xiao B, Fu D, Yang S. Comparison of the outcomes of cannulated screws vs. modified tension band wiring fixation techniques in the management of mildly displaced patellar fractures. BMC Musculoskelet Disord 2015; 16:282. [PMID: 26445425 PMCID: PMC4596291 DOI: 10.1186/s12891-015-0719-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 09/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND K wire fixation with tension band wiring has conventionally been used for the open reduction and internal fixation of the patella. However, it suffers from distinct disadvantages such as implant irritation, need for open reduction, incidence of palpable implants, and need for subsequent implant removal. A smaller incision with percutaneous fixation may be an alternative to this established conventional technique. Thus, the purpose of this trial was to compare the treatment outcomes of patients with mildly displaced patellar fractures treated with closed reduction and percutaneous cannulated screw fixation (CRCF) as compared to open reduction and tension band wiring fixation (ORTF). Specifically, we aimed to determine whether cannulated screw fixation was associated with improved clinical outcomes at 12 months as measured using the Lysholm score, pain scores, degree of flexion, range of motion, time to radiographic union, radiographic outcomes, and complication rates. METHODS Sixty-three patients with transverse patellar fractures displaced less than 8 mm were included in this prospective, randomized, controlled trial, with 52 patients in the final data analysis. Thirty-two patients were operatively treated by CRCF with either two or three cannulated screws. Thirty-one patients were operatively treated by conventional ORTF using the modified tension band technique. At postoperative intervals of 3, 6, and 12 months, knee function was evaluated using the Lysholm score, pain was assessed using the visual analog scale (VAS) score, and active knee extensions and flexion were measured in degrees by goniometry. RESULTS The CRCF group had average Lysholm scores of 84.4 ± 5.8, 86.7 ± 6.4, and 93.2 ± 5.3 after 3, 6, and 12 months, respectively, which were significantly greater than those of the ORTF group (79.0 ± 5.3, p = 0.001; 81.5 ± 4.6, p = 0.002; and 89.8 ± 6.2, p = 0.039, respectively). Lower pain and squatting scores were the main reasons for the poorer Lysholm scores in the ORTF group. The VAS scores showed that the CRCF group had lower pain scores and better flexion and total range of motion (ROM) compared with the ORTF group after 3 and 6 months, although both groups had similar outcomes after 12 months. The mean fracture healing time of 2.65 months was similar in the CRCF groups (2.77 months; p = 0.440). Complication rates were 3/26 (11.5 %) in the CRCF group and 14/26 (53.4 %) in the ORTF group. Two patients in the CRCF group and eight patients in the ORTF group experienced skin irritation. In addition, two (7.7 %) patients in the CRCF group and 11 (42.3 %) patients in the ORTF group required implant removal because of symptoms due to the presence of the implants. CONCLUSION Surgical treatment of mild displaced (less than 8 mm) transverse patellar fractures by the CRCF technique provides satisfactory clinical results and excellent knee function, with little pain and a low incidence of complications at early follow-up (up to 6 months). These results suggest that the CRCF technique may be a superior alternative to conventional ORTF. Registration Trial (Chinese Clinical Trial Register): Current Controlled Trials ChiCTR-PRCH-14005017, registration dates 2014-06-14.
Collapse
Affiliation(s)
- Tao Lin
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
| | - Junbin Liu
- Department of Traumatic Surgery, Jining No. 1 Peoples Hospital, Jining, Shandong, China.
| | - Baojun Xiao
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
| | - Dehao Fu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
| | - Shuhua Yang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
| |
Collapse
|
19
|
Arduini M, Saturnino L, Piperno A, Iundusi R, Tarantino U. Fragility fractures of the pelvis: treatment and preliminary results. Aging Clin Exp Res 2015; 27 Suppl 1:S61-7. [PMID: 26264247 DOI: 10.1007/s40520-015-0430-4] [Citation(s) in RCA: 23] [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] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/14/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND With increasing life expectancy, fragility fractures of the pelvic ring (FFP) are becoming frequent. In elderly, osteoporosis leads to a decrease of bone strength and resistance to the ligament's traction; this represents the most important difference between FFP and fractures in young patients. Usually, these fractures are underestimated and treatment is often conservative. AIMS To evaluate clinical and surgical outcomes of surgically treated patients with FFP. METHODS We retrospectively enrolled 14 patients, in our Trauma Center, underwent surgery procedures for FFP between 2012 and 2014. All patients attended clinical and radiological investigation at 1, 3, and 6 months postoperatively and every year after surgery with a mean follow-up of 22 months. RESULTS At 6-month follow-up, 11 patients resulted asymptomatic: able to maintain standing position and walk without crunches. Two patients were able to walk with one crunch. The patient with history of previous acetabular fracture walks with two crunches and is still waiting for total hip arthroplasty. DISCUSSION The compromised health status and the diminished bone-healing capacity, in elderly, decrease chances for a good clinical outcome. In literature, many authors suggest that mortality rate in patients with FFP is similar to those with hip fracture. Diagnosis of FFP is very important: these fractures are highly disabling in elderly and can lead to displacement and instability. For these reasons, correct diagnosis and well-conduct preoperative plan are necessary to improve stability of fractures and support bone healing. After diagnosis, an anti-osteoporotic treatment is indicated to improve bone quality and bone healing. CONCLUSIONS Our study shows encouraging results and demonstrates that minimally or less invasive osteosynthesis technique could lead to good outcome in these patients.
Collapse
Affiliation(s)
- M Arduini
- Department of Orthopaedics and Traumatology, University of Rome Tor Vergata, "Policlinico Tor Vergata" Foundation, Rome, Italy.
| | - L Saturnino
- Department of Orthopaedics and Traumatology, University of Rome Tor Vergata, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - A Piperno
- Department of Orthopaedics and Traumatology, University of Rome Tor Vergata, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - R Iundusi
- Department of Orthopaedics and Traumatology, University of Rome Tor Vergata, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - U Tarantino
- Department of Orthopaedics and Traumatology, University of Rome Tor Vergata, "Policlinico Tor Vergata" Foundation, Rome, Italy
| |
Collapse
|
20
|
Cankaya D, Balci M, Deveci A, Yoldas B, Tuncel A, Tabak Y. Better life quality and sexual function in men and their female partners with short-segment posterior fixation in the treatment of thoracolumbar junction burst fractures. Eur Spine J 2015. [PMID: 26202101 DOI: 10.1007/s00586-015-4145-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Thoracolumbar junction burst fractures remain a challenging problem due to controversy over the treatment choice of short- or long-segment posterior fixation. The aim of the present study was to compare life quality and sexual function of patients after short- and long-segment posterior fixations in the treatment of thoracolumbar junction burst fractures. METHODS In this prospective, randomized study, 24 sexually active male patients diagnosed with thoracolumbar junction burst fractures were randomly assigned to either the short-segment posterior fixation (SSPF) group or the long-segment posterior fixation group (LLPF). The exclusion criteria were rheumatological disease and spinal surgery history. There were no significant differences in age, body mass index or smoking habits between the groups. The life quality score of EQ-5D and the International Index of erectile function (IIEF-5) score of male patients and the Female Sexual Function Index (FSFI) score of female partners were recorded preoperatively and 1 year after surgery. RESULTS The mean age of patients in the SSPF and LSPF groups was 44.58 and 42.92 years, respectively. There were no statistically significant differences between the groups in the preoperative EQ-5D and IIEF-5 scores of male patients and the FSFI score of their partners. Postoperatively, the EQ-5D scores (p = 0.011) and IIEF-5 scores (p = 0.000) of male patients and the FSFI score of their partners (p = 0.001) were better in the short-segment group. CONCLUSIONS Patients treated with SSPF have better sexual function and life quality with their partners compared to those treated with LSPF. The main clinical relevance of this study is that the impact of the choice of short or long-segment treatment on postoperative sexual function and life quality should be considered by surgeons when performing posterior fixation after thoracolumbar junction burst fractures.
Collapse
Affiliation(s)
- Deniz Cankaya
- Department of Orthopaedic and Traumatology, Ankara Numune Training and Research Hospital, 06100, Altindag, Ankara, Turkey.
| | - Melih Balci
- Department of Urology, Ankara Numune Training and Research Hospital, 06100, Altindag, Ankara, Turkey
| | - Alper Deveci
- Department of Orthopaedic and Traumatology, Ankara Numune Training and Research Hospital, 06100, Altindag, Ankara, Turkey
| | - Burak Yoldas
- Department of Orthopaedic and Traumatology, Ankara Numune Training and Research Hospital, 06100, Altindag, Ankara, Turkey
| | - Altug Tuncel
- Department of Urology, Ankara Numune Training and Research Hospital, 06100, Altindag, Ankara, Turkey
| | - Yalcin Tabak
- Department of Orthopaedic and Traumatology, Ankara Numune Training and Research Hospital, 06100, Altindag, Ankara, Turkey
| |
Collapse
|
21
|
Oberreiter B, Kilgus M, Bodmer E, Platz A. [Osteosynthesis of metacarpal fractures with 2.0 mm LCP system and functional postoperative treatment]. Unfallchirurg 2015; 120:40-45. [PMID: 26070731 DOI: 10.1007/s00113-015-0023-x] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND Locking head systems are an additional option in the surgical treatment of metacarpal fractures. In this clinic 2.0 mm locking compression plates (LCP) are used, which provide the possibility of functional postoperative treatment even for complex and osteoporotic metacarpal fractures. For simple fractures and good bone quality the LCP system is used as a compression or neutralization plate. Depending on the type and localization of the fracture, different osteosynthesis techniques are used in order to achieve a functional postoperative treatment in as many patients as possible. MATERIAL AND METHODS Between July 2009 and December 2010 a total of 49 patients were enrolled in a prospective trial. All patients underwent surgical treatment with a 2.0 mm LCP system. Postoperative functionality of the hand was restored without immobilization. Clinical and radiological examinations were performed after 6 and 12 weeks and after 6 and 12 months with documentation of the range of motion (ROM), grip strength, fingertip to palm distance and the disabilities of the arm, shoulder and hand (DASH) score. RESULTS After 6 months a good functional result was achieved in all patients with no cases of malrotation. Radiographs showed a completely consolidated bone healing. CONCLUSION After osteosynthesis with 2.0 mm LCPs all types of metacarpal fractures can be treated without immobilization.
Collapse
Affiliation(s)
- B Oberreiter
- Klinik für Allgemein-, Hand- und Unfallchirurgie, Stadtspital Triemli, Birmensdorferstrasse 497, 8063, Zürich, Schweiz.
| | - M Kilgus
- Klinik für Allgemein-, Hand- und Unfallchirurgie, Stadtspital Triemli, Birmensdorferstrasse 497, 8063, Zürich, Schweiz
| | - E Bodmer
- Klinik für Allgemein-, Hand- und Unfallchirurgie, Stadtspital Triemli, Birmensdorferstrasse 497, 8063, Zürich, Schweiz
| | - A Platz
- Klinik für Allgemein-, Hand- und Unfallchirurgie, Stadtspital Triemli, Birmensdorferstrasse 497, 8063, Zürich, Schweiz
| |
Collapse
|
22
|
Kronborg L, Bandholm T, Kehlet H, Kristensen MT. Municipality-based physical rehabilitation after acute hip fracture surgery in Denmark. Dan Med J 2015; 62:A5023. [PMID: 25872545] [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: 06/04/2023]
Abstract
INTRODUCTION Patients who are surgically treated for an acute hip fracture in Denmark commence early in-hospital physical rehabilitation (PR) with more than 95% of patients referred to further PR following discharge. However, the specifics of the PR services after discharge are unknown. Thus, the aim of the present paper was to describe the specifics of PR provided to patients following discharge after hip fracture (HF) surgery in Denmark to evaluate the need for future interventions or guidelines. METHODS This was a national, cross-sectional questionnaire survey including 56 randomly selected municipalities out of 98. Information was gathered on PR and categorised into outpatient PR (including one-to-one and group), home-based PR, 24-hour in-patient PR units and nursing homes. RESULTS Sixty PR centres (97%) within 51 municipalities (91%) participated. The PR was initiated within 1-2 weeks after the municipality had received a referral from the hospital in 97% of the participating centres. The duration of PR was 8-12 weeks or 4-7 weeks in 85% of the centres, and most often comprised 1-2 training sessions per week. In all, 72% out of 56 municipalities returned a specific PR programme of which only 14% provided specific information regarding the intensity and the progression of training. CONCLUSION PR after hip fracture in Denmark is initiated shortly after referral, for a variable duration of time and with poorly described exercise intensity and progression. This calls for a national description and implementation of an optimised PR programme according to the best available evidence. FUNDING The study was supported by grants from The IMK Foundation, The Research Foundation of the Capital Region, The Research Foundation of the Danish Physical Therapy Organization, The Research Foundation of Hvidovre Hospital and The UCSF Lundbeck Foundation. The funding agencies had no influence on the study design, methods, subjects, data collection, analyses or on the manuscript. TRIAL REGISTRATION not relevant.
Collapse
Affiliation(s)
- Lise Kronborg
- Fysio- og Ergoterapien 236, Hvidovre Hospital, Kettegård Allé 30, 2650 Hvidovre, Denmark.
| | | | | | | |
Collapse
|
23
|
Milewski MD, Booker JL. Tibial Spine Avulsion Fractures: A Focus on Arthroscopic Treatment and Rehabilitation. Conn Med 2015; 79:139-148. [PMID: 26244219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
24
|
Abstract
BACKGROUND Fracture sequelae of proximal humeral fractures arise following nonoperative and operative forms of treatment. Due to a painful restricted range of motion, in most cases shoulder prostheses are implanted. There is a need for joint-preserving alternatives especially for younger patients. OBJECTIVES The aim of this study was to evaluate the surgical techniques and prospective results of fracture sequelae of proximal humeral fractures following corrective osteosynthesis. MATERIAL AND METHODS A total of 11 patients (4 female) with an average age of 53 years (range 29-71 years) and a mean follow-up of 19.5 months were included prospectively. The preoperative and postoperative ranges of motion of the affected shoulder were compared by statistical means. At the time of follow-up the constant score (CS), the simple shoulder test (SST) and the simple shoulder value (SSV) were assessed. RESULTS Fracture sequelae were classified as type II in four patients, as type III in two and as type IV in five patients using the Boileau classification. Shoulder flexion (p = 0.006), abduction (p = 0.003) and external rotation (p = 0.02) improved significantly in the postoperative course. The mean age and gender-adapted CS was 74.8 ± 19.9 % at the time of follow-up, 10.1 out of 12 points were reached in the SST and the mean SSV was 77 %. CONCLUSION Corrective osteosynthesis of fracture sequelae (Boileau types II-IV) of proximal humeral fractures appears to be a good alternative to implantation of shoulder prostheses, especially in younger patients (< 60 years of age).
Collapse
Affiliation(s)
- H Lill
- Klinik für Unfall- und Wiederherstellungschirurgie, Diakoniekrankenhaus Friederikenstift gGmbH, Humboldtstr. 5, 30169, Hannover, Deutschland,
| | | | | | | | | |
Collapse
|
25
|
Klein SM, Prantl L, Koller M, Vykoukal J, Dolderer JH, Graf S, Nerlich M, Loibl M, Geis S. Evidence based postoperative treatment of distal radius fractures following internal locking plate fixation. Acta Chir Orthop Traumatol Cech 2015; 82:33-40. [PMID: 25748659] [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: 06/04/2023]
Abstract
Originally, the treatment method of choice for distal radial fractures (DRF) has been a non-operative approach with six to eight weeks of plaster casting. The introduction of volar locking plate systems at the beginning of the 21 st century has pushed trends towards open reduction and internal fixation (ORIF). While the introduction of fixed angle locking plates together with the increasing knowledge on wrist function and related variable outcomes has led to consensus that operative fixation in instable DRF is the treatment method of choice, there is no agreement on a postoperative care of these injuries. The authors will discuss the available evidence for current concepts of postoperative treatment of DRFs following fixed angle fixation under socioeconomical, biomechanical and burden of disease aspects. Further, relevant randomized controlled trials are evaluated with regard to applied postoperative treatment regimes and related risks for complications.
Collapse
Affiliation(s)
- S M Klein
- Center of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Griffin D, Parsons N, Shaw E, Kulikov Y, Hutchinson C, Thorogood M, Lamb SE. Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial. BMJ 2014; 349:g4483. [PMID: 25059747 PMCID: PMC4109620 DOI: 10.1136/bmj.g4483] [Citation(s) in RCA: 175] [Impact Index Per Article: 17.5] [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: 01/10/2023]
Abstract
OBJECTIVE To investigate whether surgery by open reduction and internal fixation provides benefit compared with non-operative treatment for displaced, intra-articular calcaneal fractures. DESIGN Pragmatic, multicentre, two arm, parallel group, assessor blinded randomised controlled trial (UK Heel Fracture Trial). SETTING 22 tertiary referral hospitals, United Kingdom. PARTICIPANTS 151 patients with acute displaced intra-articular calcaneal fractures randomly allocated to operative (n=73) or non-operative (n=78) treatment. MAIN OUTCOME MEASURES The primary outcome measure was patient reported Kerr-Atkins score for pain and function (scale 0-100, 100 being the best possible score) at two years after injury. Secondary outcomes were complications; hindfoot pain and function (American Orthopaedic Foot and Ankle Society score); general health (SF-36); quality of life (EQ-5D); clinical examination; walking speed; and gait symmetry. Analysis was by intention to treat. RESULTS 95% follow-up was achieved for the primary outcome (69 in operative group and 74 in non-operative group), and a complete set of secondary outcomes were available for 75% of participants. There was no significant difference in the primary outcome (mean Kerr-Atkins score 69.8 in operative group v 65.7 in non-operative group; adjusted 95% confidence interval of difference -7.1 to 7.0) or in any of the secondary outcomes between treatment groups. Complications and reoperations were more common in those who received operative care (estimated odds ratio 7.5, 95% confidence interval 2.0 to 41.8). CONCLUSIONS Operative treatment compared with non-operative care showed no symptomatic or functional advantage after two years in patients with typical displaced intra-articular fractures of the calcaneus, and the risk of complications was higher after surgery. Based on these findings, operative treatment by open reduction and internal fixation is not recommended for these fractures.Trial registration Current Controlled Trials ISRCTN37188541.
Collapse
MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Calcaneus/injuries
- Female
- Fracture Fixation/methods
- Fracture Fixation/rehabilitation
- Fracture Fixation, Internal/methods
- Fracture Fixation, Internal/rehabilitation
- Fractures, Bone/physiopathology
- Fractures, Bone/rehabilitation
- Fractures, Bone/therapy
- Fractures, Closed/physiopathology
- Fractures, Closed/rehabilitation
- Fractures, Closed/therapy
- Humans
- Intra-Articular Fractures/physiopathology
- Intra-Articular Fractures/rehabilitation
- Intra-Articular Fractures/therapy
- Male
- Middle Aged
- Pain, Postoperative/etiology
- Patient Compliance
- Physical Therapy Modalities
- Pilot Projects
- Range of Motion, Articular
- Recovery of Function/physiology
- Reoperation/psychology
- Treatment Outcome
- Young Adult
Collapse
Affiliation(s)
- Damian Griffin
- Warwick Medical School and Department of Statistics, University of Warwick, and University Hospital of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Nick Parsons
- Warwick Medical School and Department of Statistics, University of Warwick, and University Hospital of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Ewart Shaw
- Warwick Medical School and Department of Statistics, University of Warwick, and University Hospital of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Yuri Kulikov
- Warwick Medical School and Department of Statistics, University of Warwick, and University Hospital of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Charles Hutchinson
- Warwick Medical School and Department of Statistics, University of Warwick, and University Hospital of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Margaret Thorogood
- Warwick Medical School and Department of Statistics, University of Warwick, and University Hospital of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Sarah E Lamb
- Warwick Medical School and Department of Statistics, University of Warwick, and University Hospital of Coventry and Warwickshire NHS Trust, Coventry, UK
| |
Collapse
|
27
|
Seppel G, Lenich A, Imhoff AB. [Distal clavicle fracture]. Oper Orthop Traumatol 2014; 26:254-62. [PMID: 24924506 DOI: 10.1007/s00064-013-0280-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 03/13/2014] [Accepted: 04/30/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Reposition and fixation of unstable distal clavicle fractures with a low profile locking plate (Acumed, Hempshire, UK) in conjunction with a button/suture augmentation cerclage (DogBone/FibreTape, Arthrex, Naples, FL, USA). INDICATIONS Unstable fractures of the distal clavicle (Jäger and Breitner IIA) in adults. Unstable fractures of the distal clavicle (Jäger and Breitner IV) in children. Distal clavicle fractures (Jäger and Breitner I, IIB or III) with marked dislocation, injury of nerves and vessels, or high functional demand. CONTRAINDICATIONS Patients in poor general condition. Fractures of the distal clavicle (Jäger and Breitner I, IIB or III) without marked dislocation or vertical instability. Local soft-tissue infection. SURGICAL TECHNIQUE Combination procedure: Initially the lateral part of the clavicle is exposed by a 4 cm skin incision. After reduction of the fracture, stabilization is performed with a low profile locking distal clavicle plate. Using a special guiding device, a transclavicular-transcoracoidal hole is drilled under arthroscopic view. Additional vertical stabilization is arthroscopically achieved by shuttling the DogBone/FibreTape cerclage from the lateral portal cranially through the clavicular plate. The two ends of the FibreTape cerclage are brought cranially via adjacent holes of the locking plate while the DogBone button is placed under the coracoid process. Thus, plate bridging is achieved. Finally reduction is performed and the cerclage is secured by surgical knotting. POSTOPERATIVE MANAGEMENT Use of an arm sling for 6 weeks. RESULTS Due to the fact that the described technique is a relatively new procedure, long-term results are lacking. In the short term, patients postoperatively report high subjective satisfaction without persistent pain.
Collapse
Affiliation(s)
- G Seppel
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81657, München, Deutschland
| | | | | |
Collapse
|
28
|
Zielinski SM, Bouwmans CAM, Heetveld MJ, Bhandari M, Patka P, Van Lieshout EMM. The societal costs of femoral neck fracture patients treated with internal fixation. Osteoporos Int 2014; 25:875-85. [PMID: 24072404 DOI: 10.1007/s00198-013-2487-2] [Citation(s) in RCA: 30] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 08/02/2013] [Indexed: 11/26/2022]
Abstract
SUMMARY The study rationale was to provide a detailed overview of the costs for femoral neck fracture treatment with internal fixation in the Netherlands. Mean total costs per patient at 2-years follow-up were <euro>19,425. Costs were higher for older, less healthy patients. Results are comparable to internationally published costs. INTRODUCTION The aim of this study was to provide a detailed overview of the cost and healthcare consumption of patients treated for a hip fracture with internal fixation. A secondary aim was to compare costs of patients who underwent a revision surgery with patients who did not. METHODS The study was performed alongside the Dutch sample of an international randomized controlled trial, concerning femoral neck fracture patients treated with internal fixation. Patient characteristics and healthcare consumption were collected. Total follow-up was 2 years. A societal perspective was adopted. Costs included hospital costs during primary stay and follow-up, and costs related to rehabilitation and changes in living situation. Costs were compared between non-revision surgery patients, implant removal patients, and revision arthroplasty patients. RESULTS A total of 248 patients were included (mean age 71 years). Mean total costs per patient at 2-years follow-up were <euro>19,425. In the non-revision surgery patients total costs were <euro>17,405 (N = 137), in the implant removal patients <euro>10,066 (N = 38), and in the revision arthroplasty patients <euro>26,733 (N = 67). The main contributing costs were related to the primary surgery, admission days, physical therapy, and revision surgeries. CONCLUSIONS The main determinant was the costs of admission to a rehabilitation center/nursing home. Costs were specifically high in elderly with comorbidity, who were less independent pre-fracture, and have a longer admission to the hospital and/or a nursing home. Costs were also higher in revision surgery patients. The 2-years follow-up costs in our study were comparable to published costs in other Western societies.
Collapse
Affiliation(s)
- S M Zielinski
- Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
29
|
Buecking B, Struewer J, Waldermann A, Horstmann K, Schubert N, Balzer-Geldsetzer M, Dodel R, Bohl K, Ruchholtz S, Bliemel C. What determines health-related quality of life in hip fracture patients at the end of acute care?--a prospective observational study. Osteoporos Int 2014; 25:475-84. [PMID: 23783644 DOI: 10.1007/s00198-013-2415-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [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: 10/08/2012] [Accepted: 06/03/2013] [Indexed: 12/30/2022]
Abstract
UNLABELLED Hip fractures are associated with reduced health-related quality of life (HrQoL). We found pre-existing need of care or limited function, cognitive impairment, and depression to be independent factors associated with lower HrQoL during the postsurgical period. In contrast, joint replacement was associated with better HrQoL compared to internal fixation. Patients' treatment should be focused on functional recovery and treatment of depression. INTRODUCTION The aim of the study was to identify independent factors that were correlated with health-related quality of life (HrQoL) after hip fracture. METHODS A total of 402 patients with a mean age of 81 years suffering from a hip fracture were included in this prospective, observational cohort study. HrQoL (determined by the EuroQol instrument) was measured at admission and at discharge from an acute care hospital. Independent factors correlated with HrQoL at discharge and changes from pre-fracture to discharge were determined using multivariate analyses. The influence of antidepressants was evaluated by an ANOVA with repeated measurements. RESULTS Need of care prior to fracture was the most important determinant of EQ-5D index at discharge (ß = -0.359, p = 0.003). Additionally, low Mini Mental Status Examination (MMSE) was associated with a lower EQ-5D index at discharge (MMSE 0-9: ß = -0.238, p <0.001; MMSE 10-19: ß = -0.294, p <0.001) and a greater decrease in EQ-5D during hospitalisation (MMSE 10-19: ß = 0.281, p <0.001), while joint replacement (compared to internal fixation) was associated with a higher EQ-5D index (ß = 0.188, p = 0.002) and a lower decrease in the index (ß = -0.216, p = 0.003). EQ VAS values at discharge were correlated with pre-fracture Barthel Index (ß = 0.253, p <0.001) and Geriatric Depression Scale scores (ß = -0.135, p = 0.026). Depressive patients on antidepressants demonstrated less of a decrease in the EQ-5D index compared to patients not receiving medication (F = 2.907, p = 0.090). CONCLUSIONS Acute care of hip fracture patients should be focused on functional recovery and treatment of depression. When the preferred surgical strategy is unclear, joint replacement should be considered.
Collapse
Affiliation(s)
- B Buecking
- Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg GmbH, Baldingerstrasse, 35043, Marburg, Germany,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Egol KA, Forman J, Ong C, Rosenberg A, Karia R, Zuckerman JD. Regional anesthesia improves outcome in patients undergoing proximal humerus fracture repair. Bull Hosp Jt Dis (2013) 2014; 72:231-236. [PMID: 25429392] [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: 06/04/2023]
Abstract
BACKGROUND The purpose of this study was to examine functional outcomes following ORIF of displaced proximal humerus fractures in patients who received brachial plexus blocks compared to those who underwent general anesthesia. METHODS We retrospectively reviewed prospectively collected data on 92 patients. Patients were grouped according to anesthesia type: regional interscalene brachial plexus block, with or without general anesthesia, or general anesthesia alone. Patients were asked to complete the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and range of motion assessments at a minimum of 6-month follow-up. Plain radiographic films were obtained to assess fracture healing. RESULTS Forty-five (48.9%) patients with 45 proximal humerus fractures received a regional anesthetic, while 47 (51.1%) patients with 48 proximal humerus fractures had general anesthesia. No significant differences existed in demographic information or fracture type. DASH scores at the most recent follow-up were significantly better in the regional block group (38.6) compared to the general anesthesia group (53.1) (p = 0.003). The regional block group had significantly better passive and active forward elevation and external rotation range and equivalent internal rotation (p = 0.002, 0.005, 0.002, and 0.507, respectively). CONCLUSION Patients who received regional anesthetic via a brachial plexus interscalene blocks had better functional outcomes and range of motion at the most recent clinical follow-up. Regional anesthesia provides patients with prolonged postoperative pain relief, which may allow for early mobilization, increasing the likelihood that the patient's function and range of motion will return to baseline.
Collapse
|
31
|
Gorodnichenko AI, Guseĭnov TS, Uskov ON. [Surgical treatment of humerus condylar fracture]. Khirurgiia (Mosk) 2014:53-57. [PMID: 25042192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
55 patients with intra-articular condyles fractures of humerus were operated in terms 1998 to 2013 year in the Clinic of Traumatology and Orthopedics of the Presidential Administration. All patients were operated by using of perosseous osteosynthesis method with external fixing device design A.I. Gorodnichenko. Indications for osteosynthesis were open and closed fractures of C1,2,3 types accordingly to AO Classification. Closed, atraumatic and reliable fixation of bone fragments intensifies patients faster, improves their life quality, decreases time of hospitalization and minimizes complications rate. Fractures consolidation was achieved in all cases. It was observed such complications as soft tissue inflammatory around shafts in 4 (7.3%) observations. Long-term results were studied in 51 (92.7%) patients including 9 (17.6%) patients with excellent results, 24 (47.1%) patients with good results and 18 (35.3%) patients with satisfactory results. It was not detected unsatisfactory results. The method permits early reconstructive treatment of patients and improves functional results in case of condyles fractures. This preserves active moving function of damaged elbow from the first day after operation and during all period of treatment.
Collapse
|
32
|
Ferrand M, Beaufils P. [Prosthesis and osteosynthesis]. Rev Prat 2013; 63:1459-1468. [PMID: 24579353] [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: 06/03/2023]
Affiliation(s)
- Mathieu Ferrand
- Service de chirurgie orthopédique et traumatologique de I'hôpital André-Mignot, Versailles, France.
| | - Philippe Beaufils
- Service de chirurgie orthopédique et traumatologique de I'hôpital André-Mignot, Versailles, France
| |
Collapse
|
33
|
Tosti R, Ilyas AM. Prospective evaluation of pronator quadratus repair following volar plate fixation of distal radius fractures. J Hand Surg Am 2013; 38:1678-84. [PMID: 23916193 DOI: 10.1016/j.jhsa.2013.06.006] [Citation(s) in RCA: 53] [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: 03/07/2013] [Revised: 06/03/2013] [Accepted: 06/04/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the efficacy of pronator quadratus (PQ) repair after volar plating of distal radius fractures. METHODS All consecutive distal radius fractures treated operatively with a volar plate during a 1-year period were assigned to receive a repair of the PQ versus no repair. Surgical exposure, reduction, and postoperative rehabilitation were equivalent in both groups. Clinical outcomes with a minimum follow-up of 12 months were assessed via range of motion; grip strength; Disabilities of the Arm, Shoulder, and Hand (DASH) scores; and visual analog scale (VAS) scores. RESULTS A total of 60 consecutive distal radius fractures were treated operatively with a locking volar plate. Full follow-up data were available for 33 patients in the PQ repair group and 24 patients in the control group. At 12 months, the mean DASH score was 8 for the repair group and 5 for the control group. Range of motion at the wrist, grip strength, and VAS scores were also not significantly different between groups. In addition, we found no significant differences in any of the parameters at the 2-, 6-, or 12-week intervals, although we observed greater grip strength and wrist flexion in the repair group at 6 weeks. Reoperation was required for 4 patients in the repair group and 1 in the control group. CONCLUSIONS Pronator quadratus repair after volar plating of a distal radius fractures did not significantly improve postoperative range of motion, grip strength, or DASH and VAS scores at 1 year. The rates of reoperation between groups were not significantly different.
Collapse
Affiliation(s)
- Rick Tosti
- Department of Orthopaedic Surgery and Sports Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA.
| | | |
Collapse
|
34
|
Bauer AS, Singh AK, Amanatullah D, Lerman J, James MA. Free vascularized fibular transfer with langenskiöld procedure for the treatment of congenital pseudarthrosis of the forearm. Tech Hand Up Extrem Surg 2013; 17:144-150. [PMID: 23970196 DOI: 10.1097/bth.0b013e318295238b] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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: 06/02/2023]
Abstract
Congenital pseudarthrosis of the radius or ulna is a rare entity. It is associated with neurofibromatosis, but occurs much less commonly than congenital pseudarthrosis of the tibia. Pseudarthrosis of the forearm can lead to pain, deformity, and limited forearm rotation. Nonsurgical management leads to poor results, as do surgical treatments such as open reduction internal fixation and conventional bone grafting. The transfer of a free vascularized fibula to the forearm pseudarthrosis has been more successful, and it is our preferred method of treatment for children with this condition. Because the transfer is often performed in young children, there is the potential for valgus deformity at the ankle after the fibula is removed. We describe here our technique for the transfer, including the technique for distal tibiofibular fusion (Langenskiöld procedure) after removal of the fibular graft. In addition, we present the results of 5 patients who have undergone this combination of procedures for pseudarthrosis of the forearm at our institution.
Collapse
Affiliation(s)
- Andrea S Bauer
- Shriners Hospital for Children Northern California, Sacramento, CA 95817, USA.
| | | | | | | | | |
Collapse
|
35
|
Alanís-Blancas LM, Zamora-Muñoz PM, Cruz-Miranda A. [Arthroplasty for distal femur fracture in elderly adults. Case report and literature review]. Acta Ortop Mex 2013; 27:47-50. [PMID: 24701751] [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: 06/03/2023]
Abstract
In the treatment of distal femur fractures in osteoporotic elderly people with complex fracture patterns and articular compromise, results of internal fixation are not always satisfactory because they frequently require delaying weight bearing for long periods of time thus delaying the rehabilitation process. We report the case of a 70 year-old patient with supra- and intercondylar femur fracture treated with unconventional total knee prosthesis. We review the factors that decrease the success of internal fixation and the results that turn total knee arthroplasty into an appealing treatment for these patients, as they do not need long-term rest, they start rehabilitation early on and quickly return to the activity level they had prior to the injury.
Collapse
MESH Headings
- Accidental Falls
- Aged
- Arthroplasty, Replacement, Knee/methods
- Arthroplasty, Replacement, Knee/rehabilitation
- Female
- Femoral Fractures/diagnostic imaging
- Femoral Fractures/etiology
- Femoral Fractures/rehabilitation
- Femoral Fractures/surgery
- Fracture Fixation, Internal/methods
- Fracture Fixation, Internal/rehabilitation
- Fractures, Comminuted/diagnostic imaging
- Fractures, Comminuted/rehabilitation
- Fractures, Comminuted/surgery
- Humans
- Osteoporosis, Postmenopausal/complications
- Radiography
- Recovery of Function
Collapse
|
36
|
Kubota M, Uchida K, Kokubo Y, Shimada S, Matsuo H, Yayama T, Miyazaki T, Takeura N, Yoshida A, Baba H. Changes in gait pattern and hip muscle strength after open reduction and internal fixation of acetabular fracture. Arch Phys Med Rehabil 2012; 93:2015-21. [PMID: 22475054 DOI: 10.1016/j.apmr.2012.01.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [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: 08/19/2011] [Revised: 01/17/2012] [Accepted: 01/17/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To characterize changes in the gait pattern at 3 and 12 months after surgery for acetabular fracture, to assess the relationship between various gait parameters and hip muscle strength, and to determine the factors associated with gait disorders that correlate with gait parameters measured at 12 months after surgery. DESIGN Prospective cohort study. SETTING University hospital. PARTICIPANTS Patients (N=19) with acetabular fractures were treated by open reduction and internal fixation (ORIF) and examined at 3 and 12 months postoperatively. The study also included a similar number of sex- and age-matched control subjects. INTERVENTIONS Postoperative rehabilitation program. MAIN OUTCOME MEASURES Spatiotemporal, kinematic, and kinetic variables of gait and strength of hip flexor, adductor, and abductor muscles at 3 and 12 months after ORIF. RESULTS Walking velocity at 3 months after ORIF was slower in the patients than in the control subjects; however, walking velocity at 12 months was similar in the 2 groups. Although most of the kinematic and kinetic variables showed recovery to control levels at 3 and 12 months after ORIF, recovery was incomplete for pelvic forward tilt and hip abduction moment even at 12 months after ORIF. The greatest loss of muscle strength was noted in the hip abductors, where the average deficit was 35.4% at 3 months and 24.6% at 12 months. There was a significant relationship between hip abductor muscle strength and hip abduction moment at 3 months (R(2)=.63); however, this relationship diminished at 12 months (R(2)=.14). The presence of associated injuries correlated with lack of recovery of the peak hip abduction moment. CONCLUSIONS Pelvic forward tilt and peak hip abduction moment showed incomplete recovery at 12 months after ORIF with subsequent conventional and home exercise rehabilitation programs. Our results suggest that improvement of hip abductor muscle strength in the early postoperative period could improve the peak hip abduction moment.
Collapse
Affiliation(s)
- Masafumi Kubota
- Gait Analysis Laboratory, Division of Physical Therapy and Rehabilitation, Fukui University Hospital, Fukui, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Zabari A, Lubart E, Ganz FD, Leibovitz A. The effect of a pain management program on the rehabilitation of elderly patients following hip fracture surgery. Isr Med Assoc J 2012; 14:104-106. [PMID: 22693791] [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: 06/01/2023]
Abstract
BACKGROUND Pain following hip fracture and internal fixation is a major factor during the treatment of elderly patients on rehabilitation programs. A proactive pain management program was instituted in our geriatric rehabilitation ward in 2005. OBJECTIVES To compare retrospectively two groups of patients, one before and one after implementation of the proactive pain management program. METHODS The study group comprised 67 patients and the control group 77 patients. Pain in the study group was evaluated daily by the visual analogue scale (VAS) and the outcome of the rehabilitation process by the Functional Independence Measure (FIM). During the study period (2003-2006) no changes were made in the rehabilitation team, methods or facilities other than introduction of the pain control program. We compared the FIM scores between admission and discharge in both groups. RESULTS Improvement in FIM scores between admission and discharge was significantly higher in the study group than in the control group (11.07 +/- 7.9 vs. 8.4 +/- 7.3, P < 0.03). There was no significant difference between the average lengths of stay. CONCLUSIONS These data support the view that the proactive monitoring of pain in surgical hip fracture patients is associated with a better outcome of the rehabilitation process.
Collapse
Affiliation(s)
- Ahuva Zabari
- Geriatric Medical Center, Shmuel Harofe Hospital, Beer Yaakov, Israel
| | | | | | | |
Collapse
|
38
|
Lareau C, Sawyer G. Hip fracture surgical treatment and rehabilitation. Med Health R I 2010; 93:108-111. [PMID: 20486521] [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: 05/29/2023]
Affiliation(s)
- Craig Lareau
- The Warren Alpert Medical School, Brown University/Rhode Island Hospital, Providence, RI 02903, USA.
| | | |
Collapse
|
39
|
Liu M, Yang Z, Pei F, Huang F, Chen S, Xiang Z. A meta-analysis of the Gamma nail and dynamic hip screw in treating peritrochanteric fractures. Int Orthop 2010; 34:323-8. [PMID: 19401825 PMCID: PMC2899291 DOI: 10.1007/s00264-009-0783-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2009] [Revised: 04/01/2009] [Accepted: 04/01/2009] [Indexed: 02/05/2023]
Abstract
The objective of this meta-analysis was to compare the fixation outcome of the Gamma nail and dynamic hip screw (DHS) in treating peritrochanteric fractures. Relevant randomised controlled studies were included, and the search strategy followed the requirements of the Cochrane Library Handbook. Methodological quality was assessed and data were extracted independently. Seven studies involving 1,257 fractures were included which compared the effect of the Gamma nail and DHS. The results showed a higher rate of postoperative femoral shaft fracture with the Gamma nail compared to the DHS [relative risk (RR): 7.27, 95% confidence interval (CI): 2.83-18.70, P < 0.0001] but no statistical differences in wound infection (RR: 1.02, 95% CI: 0.56-1.86), mortality (RR: 1.00, 95% CI: 0.81-1.24), re-operation (RR: 1.64, 95% CI: 0.91-2.95) and walking independently after rehabilitation (RR: 0.89, 95% CI: 0.60-1.33). It seemed that there were no obvious advantages of the Gamma nail over the DHS in treating peritrochanteric fractures.
Collapse
Affiliation(s)
- Ming Liu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Zhiming Yang
- Institute of Stem Cells and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Fuxing Pei
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Fuguo Huang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Shiqiang Chen
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan Province People’s Republic of China
| | - Zhou Xiang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan Province People’s Republic of China
- Institute of Stem Cells and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan Province People’s Republic of China
| |
Collapse
|
40
|
Gwinn DE, O'Toole RV, Eglseder WA. Early motion protocol for select Galeazzi fractures after radial shaft fixation. J Surg Orthop Adv 2010; 19:104-108. [PMID: 20727306] [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: 05/29/2023]
Abstract
Galeazzi fractures traditionally are treated in long arm casts with the wrist fully supinated for 6 weeks after open reduction and internal fixation. Recent literature suggests that early motion can be permitted for a subset of Galeazzi fractures. Defining a safe postoperative protocol that allows immediate elbow motion, immediate platform weight bearing, and early wrist motion might decrease elbow morbidity, increase range of motion, and improve outcomes. A retrospective review of a prospectively collected database of 26 patients at a level I trauma center was conducted. Early motion protocol was assigned to patients who were radiographically and clinically stable after plate and screw fixation. Elbow flexion and platform weight bearing were allowed immediately; increased wrist rotation was allowed at 2-week intervals. Early motion of elbow and wrist seems to be safe during postoperative rehabilitation of repaired Galeazzi fractures. The postoperative protocol might maximize elbow and wrist range of motion.
Collapse
Affiliation(s)
- David E Gwinn
- Department of Orthopaedics, National Naval Medical Center, Bethesda, MD 21201, USA
| | | | | |
Collapse
|
41
|
Eldzarov PE, Zelianin AS, Filippov VV. [Surgical treatment of consequences of humeral [correction of femoral] fractures]. Khirurgiia (Mosk) 2010:47-52. [PMID: 21164422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
55 patients, aged 19 to 77 years, with consequences of humeral [correction of femoral] fractures were surgically treated. 1st group consisted of 17 patients with slow fracture consolidation, 2nd group contained 31 patients with uninfected false joints and the 3rd group consisted of 7 patients with infected false joints. Surgical tactics of treatment in each group was thoroughly described. Long-term results were analyzed in 38 patients. Good results were achieved in 27 cases, satisfactory--in 7 cases and unsatisfactory results were registered in 4 patients. Cases of nonconsolidation of bone fragments, requiring repeated operations, were assessed as unsatisfactory.
Collapse
|
42
|
Laflamme† GY, Delisle† J, Leduc† S, Uzel PA. Isolated quadrilateral plate fracture: an unusual acetabular fracture. Can J Surg 2009; 52:E217-E219. [PMID: 19865567 PMCID: PMC2769100] [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: 05/28/2023] Open
Affiliation(s)
- G. Yves Laflamme†
- Divisions of Orthopedic Surgery Université de Montréal and Hôpital du Sacré-Cœur de Montréal, Montréal, Que. and the
| | | | - Stephane Leduc†
- Divisions of Orthopedic Surgery Université de Montréal and Hôpital du Sacré-Cœur de Montréal, Montréal, Que. and the
| | - Pierre-Andre Uzel
- Service d’Orthopedie Traumatologie, CHU Pointe-a-Pitre, Pointe-a-Pitre, Guadeloupe (France)
| |
Collapse
|
43
|
Palm H, Foss NB, Kristensen MT. [Reconvalescence after surgery for proximal femoral fractures]. Ugeskr Laeger 2009; 171:2896-2899. [PMID: 19814935] [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: 05/28/2023]
Abstract
In Denmark, 10,000 patients with hip fractures are annually admitted to hospital. These patients are generally old with a high degree of comorbidities. Current treatment strategies for peri- and postoperative treatment are presented in relation to patient reconvalescence. Overall expected hospitalization is 5-25 days with 1-3 months of analgesic treatment and physiotherapy. The 30-day mortality is 10% and the reoperation rate is 10-20%. The use of specialized centres and accelerated clinical programmes in Denmark is recommended.
Collapse
Affiliation(s)
- Henrik Palm
- Ortopaedkirurgisk Afdeling, Hvidovre Hospital, DK-2650 Hvidovre, Denmark.
| | | | | |
Collapse
|
44
|
Wong TC, Chiu Y, Tsang WL, Leung WY, Yeung SH. A double-blind, prospective, randomised, controlled clinical trial of minimally invasive dynamic hip screw fixation of intertrochanteric fractures. Injury 2009; 40:422-7. [PMID: 19309606 DOI: 10.1016/j.injury.2008.09.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [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: 07/24/2008] [Accepted: 09/09/2008] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare minimally invasive dynamic hip screw (MIDHS) fixation with conventional dynamic hip screw (CDHS) fixation for treatment of intertrochanteric femoral fracture. METHODS Of the 66 participants in this double-blind study, 35 were randomised to MIDHS and 31 to CDHS fixation. Main outcome measurements were wound size, haemoglobin decrease, blood transfusion rate, pain score, analgesic consumption, Elderly Mobility Scale score, hip screw position, tip-apex distance, union rate, time to healing and complication rate. RESULTS The groups had similar preoperative clinical data. Postoperatively the MIDHS group had significantly smaller wound size, less blood loss, lower blood transfusion rates, pain scores and rates of analgesic consumption, and higher early Elderly Mobility Scale scores. There were no significant differences in fracture alignment, hip screw position, tip-apex distance, union rate, time to healing or complication rate. CONCLUSION MIDHS fixation of intertrochanteric fractures is effective and safe and significantly reduces blood loss, pain and rehabilitation period, without sacrificing reduction alignment, screw position, fixation stability or bone healing.
Collapse
Affiliation(s)
- Tak-Chuen Wong
- Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong, China.
| | | | | | | | | |
Collapse
|
45
|
Kayali C, Oztürk H, Altay T, Reisoglu A, Agus H. Arthroscopically assisted percutaneous osteosynthesis of lateral tibial plateau fractures. Can J Surg 2008; 51:378-382. [PMID: 18841234 PMCID: PMC2556545] [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: 05/26/2023] Open
Abstract
BACKGROUND The aim of our study was to evaluate the results of lateral tibial plateau fractures treated with arthroscopically assisted percutaneous osteosynthesis (AAPO). METHODS Twenty-one patients (14 men and 7 women) with a mean age of 41 years underwent AAPO to repair low-energy Schatzker I-III tibial plateau fractures. Under pneumatic tourniquet, we reduced and fixed the fracture with 1 or 2 subchondral cannulated screws. Accompanying lesions included 10 meniscus tears, which we partially excised in 9 patients and repaired in 1 patient. On the second postoperative day, patients began range-of-motion exercises. We encouraged partial and full weight-bearing by the sixth and tenth weeks, respectively. The mean follow-up period was 38 (range 12-96) months, and we evaluated the patients using Rasmussen's clinical and radiologic criteria. We used a t test for statistical analysis. RESULTS There were 13 excellent (62%), 6 good (28%) and 2 fair (10%) clinical results, and 11 excellent (52%), 7 good (33%) and 3 fair (14%) radiologic results. We observed mild or moderate arthritic changes in 5 patients (24%). There were no infection or wound problems, but we removed hardware in 4 patients. CONCLUSION Arthroscopically assisted treatment of lateral tibial plateau fractures yields satisfactory results and can be accepted as an alternative and effective method for the treatment of low-energy tibial plateau fractures.
Collapse
Affiliation(s)
- Cemil Kayali
- 2nd Clinic of Orthopaedics and Traumatology, Tepecik Education and Research Hospital, Izmir, Turkey.
| | | | | | | | | |
Collapse
|
46
|
Abstract
Distraction bone-block arthrodesis has been advocated for the treatment of the late sequelae of fracture of the os calcis. Between 1997 and 2003 we studied a consecutive series of 17 patients who had in situ arthrodesis for subtalar arthritis after fracture of the os calcis with marked loss of talocalcaneal height. None had undergone any previous attempts at reconstruction. We assessed the range of dorsiflexion and plantar flexion and measured the talocalcaneal height, talocalcaneal angle and talar declination angle on standing lateral radiographs, comparing them with the normal foot. The mean follow-up was for 78.7 months (48 to 94). The mean American Orthopaedic Foot and Ankle Society hindfoot score improved from 29.8 (13 to 48) to 77.8 (48 to 94) (Student's t-test, p < 0.001). The mean loss of talocalcaneal height was 10.3 mm (2 to 17) and the mean talar declination angle was 6.7 degrees (0 degrees to 16 degrees) which was 36% of the normal side. One patient suffered anterior ankle pain but none had anterior impingement. Two patients complained of difficulty in ascending slopes and stairs and four in descending. The mean ankle dorsiflexion on the arthrodesed side was 11.6 degrees (0 degrees to 24 degrees) compared with 14.7 degrees (0 degrees to 24 degrees) on the normal side, representing a reduction of 21.1%. The mean plantar flexion on the arthrodesed side was 35.5 degrees (24 degrees to 60 degrees) compared with 44.6 degrees (30 degrees to 60 degrees ) on the normal side, a reduction of 20.4%. These results suggest that anterior impingement need not to be a significant problem after subtalar arthrodesis for fracture of the os calcis, even when the loss of talocalcaneal height is marked. We recommend in situ arthrodesis combined with lateral-wall ostectomy for all cases of subtalar arthritis following a fracture of the os calcis, without marked coronal deformity, regardless of the degree of talocalcaneal height loss.
Collapse
Affiliation(s)
- N Savva
- Brisbane Foot and Ankle Centre, 259 Wickham Terrace, Brisbane 4000, Australia
| | | |
Collapse
|
47
|
Einsiedel T, Becker C, Stengel D, Schmelz A, Kramer M, Däxle M, Lechner F, Kinzl L, Gebhard F. [Do injuries of the upper extremity in geriatric patients end up in helplessness? A prospective study for the outcome of distal radius and proximal humerus fractures in individuals over 65]. Z Gerontol Geriatr 2007; 39:451-61. [PMID: 17160740 DOI: 10.1007/s00391-006-0378-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [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: 08/03/2005] [Accepted: 03/17/2006] [Indexed: 11/26/2022]
Abstract
In a prospective study 104 patients >or=65 years with distal radius fractures (DRF; n=52) and proximal forearm fractures (PHF; n=52) were followed up for a period of 4 months after injury. As an inception- cohort study, influence on treatment pattern was not part of the examination. A total of 53% of the DRF and 74% of the PHF patients underwent surgery. There were no significant changes in the ability of daily living management (IADL) with either fracture form. Functional outcome was better in PHF than DRF patients. PHF patients showed a high incidence in "fear of falling" throughout the whole study, whereas fear of falling rose significantly in DRF patients. 4% of DRF and 9.6% of PHF patients died during the observation period, while 6% of DRF and even 17% of PHF patients had to give up their own housekeeping. One third of both patient groups did not receive physiotherapy. In only 12% of DRF and 6% of PHF patients was osteoporosis treated. In both groups of patients there was a significant worsening in the ability of walking after injury, leading to two or more new falls in 24% of DRF and 28% of PHF patients.
Collapse
Affiliation(s)
- T Einsiedel
- Abteilung für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Steinhövelstrasse 9, 89075, Ulm, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Kaya A, Altay T, Ozturk H, Karapinar L. Open reduction and internal fixation in displaced juvenile Tillaux fractures. Injury 2007; 38:201-5. [PMID: 17054954 DOI: 10.1016/j.injury.2006.07.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [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: 05/10/2006] [Revised: 05/10/2006] [Accepted: 07/18/2006] [Indexed: 02/02/2023]
Abstract
BACKGROUND Juvenile Tillaux fracture is relatively an uncommon injury for which there appears no established treatment protocol. MATERIALS AND METHODS Ten patients with juvenile Tillaux fractures were treated by open reduction and internal fixation and the results were evaluated by an objective scoring system. RESULTS At the latest follow-up (32-75 months) mean score was 99.3 (97-100) by the score of American Orthopaedic Foot and Ankle Society. Radiographically all fractures had healed in anatomical position. CONCLUSION Treatment of juvenile Tillaux fractures with 2mm or more displacement by internal fixation without any attempt of closed reduction gives excellent results.
Collapse
Affiliation(s)
- Ahmet Kaya
- Department of Orthopaedics and Traumatology, Izmir-Tepecik Training and Research Hospital, 35100 Izmir, Turkey.
| | | | | | | |
Collapse
|
49
|
Carmeli E, Sheklow SL, Coleman R. A comparative study of organized class-based exercise programs versus individual home-based exercise programs for elderly patients following hip surgery. Disabil Rehabil 2006; 28:997-1005. [PMID: 16882639 DOI: 10.1080/09638280500476154] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [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: 10/25/2022]
Abstract
PURPOSE To evaluate and compare the effectiveness of supervised and non-supervised exercise programs for improving health and rehabilitation outcomes for elderly persons following hip surgery. METHOD Prospective, descriptive and quantitative study involving two groups: The class-based program (group A, n = 34: 21 females, 13 males, mean age 79.2 years +/- 5.23) was directed and administered in the outpatient clinic, and a home-based program (group B, n = 29, 17 females, 12 males, mean age 80.3 years +/- 5.74) which administered in the patient's home. Sixty three elderly patients began at a period of 2 weeks post hip surgery for open reduction with internal fixation. The training period took place for 14 consecutive weeks. The main outcome measures include results from physical performance test, functional reach test and short form-36 health survey questionnaire. RESULTS Fifty five patients completed the exercise program. No significant difference according to gender or Body Mass Index was found between the groups. At the conclusion of 14 weeks of exercise training both groups demonstrated improvement in physical function. However, only 4 of 6 total tasks of a physical performance test were improved in the home-based group compared to improvement in all 6 tasks for the class-based group. The SF-36 scores and the functional reach test indicated that the class-based subjects also presented significant gains in contrast to no significant changes in the home exercise group. CONCLUSIONS Both groups demonstrated improvement in a number of issues. However, there appears to be more positive health outcomes presented by the participants in the supervised/class-based group when compared to the non-supervised/home-based group. And therefore, patients may select to participate to either a home-based or class-based regime. The clinical relevance is the significant of the necessity for close supervision by a professional therapist. In addition, the results could have some political and economical implications on the healthcare system.
Collapse
Affiliation(s)
- Eli Carmeli
- Department of Physical Therapy, Sackler Faculty of Medicine, Stanley Steyer School of Health Professions, Tel Aviv University, Ramat Aviv, Israel.
| | | | | |
Collapse
|
50
|
Abstract
BACKGROUND Hip fracture is a significant health problem for men and women; between 25 and 30 percent of all hip fractures are sustained by men. Relatively little is known about gender differences in functional outcomes after hip fracture. The purpose of the current study is to compare post-hip fracture functional recovery of men and women. METHODS A sample of 674 patients age 65 or older were recruited as part of the Baltimore Hip Studies and were followed longitudinally for 1 year following fracture. Information on prefracture status and hospital course of treatment was collected as well as functional data at baseline, 2, 6, and 12 months postfracture. Data were analyzed longitudinally using Generalized Estimating Equations (GEEs). RESULTS Men in the study were generally younger and suffered greater comorbidity at time of fracture. Men further suffered higher mortality in the year following fracture. Among survivors, little difference between men and women was seen in patterns of recovery of function following fracture. CONCLUSIONS Hip fracture is not a problem affecting just women. Recovery following fracture for men is probably no better than that for women, even after mortality differentially eliminates the frailest male participants. However, psychosocial factors, greater comorbidity, and higher rates of certain complications among men may require adjustments to interventions designed to restore function. Further research into the consequences of hip fracture for men and women is needed.
Collapse
Affiliation(s)
- William G Hawkes
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Division of Gerontology, 660 W. Redwood Street, Suite 200, Baltimore, MD 21201, USA.
| | | | | | | | | |
Collapse
|