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1.
Knee ; 51: 11-17, 2024 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-39236634

RESUMEN

BACKGROUND: Total knee arthroplasty (TKA) is the most commonly performed joint replacement procedure in North America. Few studies have successfully evaluated the episode-of-care cost (EOCC) of common elective orthopedic procedures using an activity-based costing (ABC) framework. The objective of this study is to compare the EOCC of same-day discharge versus inpatient TKA using an activity-based costing methodology. METHODS: An observational case-control study was conducted comparing the EOCC of 25 consecutive patients who underwent same-day discharge (SDD) TKA and 25 consecutive patients who underwent same-day admission (SDA) TKA at an academic center. The EOCC was generated using an ABC framework. RESULTS: The median total EOCC for outpatient TKA was $7,243.26 CAD (IQR=614.12), while the median EOCC in the inpatient group was $8,303.94 CAD (IQR=1,157.77). The costs incurred secondary to the hospital admission were the main driver of the increased cost for inpatients. The mean length of stay for admitted patients was 2.45 days (SD=1,52). Patients in the outpatient group were younger (p < 0.01) and had a lower mean Charlson Comorbidity Index group (p = 0.01). There was no significant difference in gender, BMI, ASA scores, and complication rates between the two groups. CONCLUSION: Through the application of an ABC framework, this value-based healthcare study demonstrates that outpatient procedures are a cost-effective approach to knee arthroplasty. Our findings demonstrate that the total cost of outpatient TKA was on average 15% ($1,060 CAD) lower than the cost of TKA with the standard inpatient postoperative care protocol.

2.
Injury ; 55(11): 111903, 2024 Sep 17.
Artículo en Inglés | MEDLINE | ID: mdl-39341048

RESUMEN

BACKGROUND: Rotational malalignment after operative fracture treatment of the lower extremity may be associated with increased pain and functional impairment. Despite its clinical relevance, there are no uniform management guidelines. The aim of this scoping review is to provide an overview of all available evidence to diagnose and treat rotational deformities of the lower extremity following operative fracture treatment. METHODS: This scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A literature search was carried out on 22 August 2023 by two independent reviewers in the Pubmed (MEDLINE), Embase, Web of Science, and Cochrane library databases. The search strategy was developed with the assistance of a biomedical information specialist. The main search terms were tibial and femoral malrotations. Disagreements were resolved through discussion with a third reviewer. RESULTS: After screening and quality assessment of 3929 unique identified records, 50 articles were included for qualitative synthesis. Most studies were retrospective case reports or case series. Thirty studies focused on the femur, 11 on the tibia and nine included both femur and tibia. Most of the included studies presented cases where malrotation was associated with other limb deformities. Only 18 studies focused solely on the treatment of malrotation of the lower extremities after operative fracture treatment. Regarding diagnosis, bilateral CT-scans were used in 34 studies. Regarding treatment, external fixation was used in two studies, internal fixation (either intramedullary nail or plate) in 45 studies, and in three studies the authors used both. Overall, revision surgery resulted in good clinical outcomes with low complication rates. CONCLUSION: This scoping review reveals that rotational malalignment following operative treatment of lower extremity fractures remains an important complication. Although it occurs frequently and is associated with severe disability for the patient, standardized guidelines regarding the terminology, diagnosis, indications for intervention and treatment are lacking. CT-scan is the most used diagnostic modality in daily clinical practice. Revision surgery, using diverse operative techniques, demonstrated positive results, significantly alleviating patient complaints with few complications. Nevertheless, an international consensus regarding the optimal management pathway is needed, and future prospective clinical studies seem therefore necessary.

3.
Can J Surg ; 67(3): E243-E246, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38843943

RESUMEN

SummaryLetters of recommendation are increasingly important for the residency match. We assessed whether an artificial intelligence (AI) tool could help in writing letters of recommendation by analyzing recommendation letters written by 3 academic staff and AI duplicate versions for 13 applicants. The preferred letters were selected by 3 blinded orthopedic program directors based on a pre-determined set of criteria. The first orthopedic program director selected the AI letter for 31% of applicants, and the 2 remaining program directors selected the AI letter for 38% of applicants, with the staff-written versions selected more often by all of the program directors (p < 0.05). The first program director recognized only 15% of the AI-written letters, the second was able to identify 92%, and the third director identified 77% of AI-written letters (p < 0.05).


Asunto(s)
Inteligencia Artificial , Internado y Residencia , Humanos , Escritura/normas , Ortopedia/educación , Ortopedia/normas , Correspondencia como Asunto , Selección de Personal/métodos , Selección de Personal/normas
4.
Artículo en Inglés | MEDLINE | ID: mdl-38723282

RESUMEN

Treatment of patellofemoral instability in skeletally mature patients remains an important area of clinical and research interest. Both nonsurgical and surgical interventions are used to treat the underlying causes. Surgical management is the mainstay of treatment of recurrent PFI that fails nonsurgical treatment, and it is broadly classified into bony and soft-tissue procedures. Proximal bony procedures include femoral trochleoplasty, derotational osteotomies, and coronal alignment correction of the femur. Distal bony procedures include tibial tubercle transfer and derotational (supratubercle and infratubercle) osteotomies. Soft-tissue procedures consist of medial patellofemoral ligament repair or reconstruction and lateral lengthening procedures. This article is the second part of our two-article review on PFI, which focuses on surgical treatment options, their indications, outcomes, and potential complications.

5.
J Foot Ankle Surg ; 63(4): 468-472, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38438103

RESUMEN

Ankle fractures are one of the most resource-consuming traumatic orthopedic injuries. Few studies have successfully evaluated the episode-of-care costs (EOCC) of common traumatic orthopedic injuries. The objective of this study was to determine the EOCC associated with the surgical management of ankle fractures. A retrospective cohort study of 105 consecutive patients who underwent open reduction internal fixation of an isolated ankle fracture at a Canadian Level-1 trauma center was conducted. Episode-of-care costs were generated using an activity-based costing framework. The median global episode-of-care cost for ankle fracture surgeries performed at the studied institution was $3,487 CAD [IQR 880] ($2,685 USD [IQR 616]). Patients aged 60 to 90 years had a significantly higher median EOCC than younger patients (p = .01). Supination-adduction injuries had a significantly higher median EOCC than other injury patterns (p = .01). The median EOCC for patients who underwent surgery within 10 days of their injury ($3,347 CAD [582], $2,577 USD [448]) was significantly lower than the cost for patients who had their surgery delayed 10 days or more after the injury ($3,634 CAD [776], $2,798 USD [598]) (p = .03). Patient sex, anesthesia type, ASA score and surgeon's fellowship training did not affect the EOCC. This study provides valuable data on predictors of EOCC in the surgical management of ankle fractures. Delaying simple ankle fracture cases due to operating time constraints can increase the total cost and burden of these fractures on the healthcare system. In addition, this study provides a framework for future episode-of-care cost analysis studies in orthopedic surgery.


Asunto(s)
Fracturas de Tobillo , Fijación Interna de Fracturas , Humanos , Fracturas de Tobillo/cirugía , Fracturas de Tobillo/economía , Masculino , Persona de Mediana Edad , Femenino , Estudios Retrospectivos , Anciano , Anciano de 80 o más Años , Fijación Interna de Fracturas/economía , Adulto , Episodio de Atención , Costos de la Atención en Salud , Canadá , Reducción Abierta/economía , Estudios de Cohortes , Centros Traumatológicos/economía
6.
J Orthop Trauma ; 38(4S): S1-S8, 2024 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-38502596

RESUMEN

SUMMARY: Limb reconstruction in patients with critical-sized bone defects remains a challenge due to the availability of various technically demanding treatment options and a lack of standardized decision algorithms. Although no consensus exists, it is apparent from the literature that the combination of patient, surgeon, and institutional collaborations is effective in providing the most efficient care pathway for these patients. Success relies on choosing a particular surgical approach that manages infection, soft tissue defects, stability, and alignment. Recent systematic reviews demonstrate high success rates with the following management options: Ilizarov bone transport, Masquelet (induced membrane) technique, cancellous bone grafting, and vascularized bone grafts.


Asunto(s)
Trasplante Óseo , Hueso Esponjoso , Humanos , Trasplante Óseo/métodos
7.
OTA Int ; 6(4): e295, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-38053755

RESUMEN

Background: Despite the large impact of hip fracture care on hospital budgets, accurate episode-of-care costs (EOCC) calculations for this injury remains a challenge. The objective of this article was to assess EOCC for geriatric patients with hip fractures using an activity-based costing methodology and identify intraoperative, perioperative, and patient-specific factors associated with higher EOCC. Material and Methods: This is a retrospective cohort study involving a total of 109 consecutive patients with hip fracture treated surgically at a Canadian level-1 trauma center from April 2018 to February 2019. Clinical and demographic data were extracted through the institution's centralized data warehouse. Data acquisition also included direct and indirect costs per episode of care, adverse events, and precise temporal data. Results: The median total EOCC was $13,113 (interquartile range 6658), excluding physician fees. Out of the total cost, 75% was attributed to direct costs, which represented a median expenditure of $9941. The median indirect cost of the EOCC was $3322. Based on the multivariate analysis, patients not operated within the 48 hours guidelines had an increased length of stay by 5.7 days (P = 0.003), representing an increase in EOCC of close to 5000$. Higher American Society of Anesthesiology (ASA) scores were associated with elevated EOCC. Conclusion: The cost of managing a patient with geriatric hip fracture from arrival in the emergency department to discharge from surgical ward represented $13,113. Main factors influencing the EOCC included adherence to the 48-hour benchmark surgical delay and ASA score. High-quality costing data are vital in assessing health care spending, conducting cost effectiveness analyses, and ultimately in guiding policy decisions. Level of Evidence: Level III (3), retrospective cohort study.

8.
J Orthop Trauma ; 37(11): 581-585, 2023 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-37491711

RESUMEN

OBJECTIVE: Acute compartment syndrome (ACS) is a true emergency. Even with urgent fasciotomy, there is often muscle damage and need for further surgery. Although ACS is not uncommon, no validated classification system exists to aid in efficient and clear communication. The aim of this study was to establish and validate a classification system for the consequences of ACS treated with fasciotomy. METHODS: Using a modified Delphi method, an international panel of ACS experts was assembled to establish a grading scheme for the disease and then validate the classification system. The goal was to articulate discrete grades of ACS related to fasciotomy findings and associated costs. A pilot analysis was used to determine questions that were clear to the respondents. Discussion of this analysis resulted in another round of cases used for 24 other raters. The 24 individuals implemented the classification system 2 separate times to compare outcomes for 32 clinical cases. The accuracy and reproducibility of the classification system were subsequently calculated based on the providers' responses. RESULTS: The Fleiss Kappa of all raters was at 0.711, showing a strong agreement between the 24 raters. Secondary validation was performed for paired 276 raters and correlation was tested using the Kendall coefficient. The median correlation coefficient was 0.855. All 276 pairs had statistically significant correlation. Correlation coefficient between the first and second rating sessions was strong with the median pair scoring at 0.867. All surgeons had statistically significant internal consistency. CONCLUSION: This new ACS classification system may be applied to better understand the impact of ACS on patient outcomes and economic costs for leg ACS.

9.
J Am Acad Orthop Surg ; 31(18): e685-e693, 2023 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-37384878

RESUMEN

Multiple successful strategies exist for the management of critical-sized bone defects. Depending on the location and etiology of an osseous defect, there are nuances that must be considered by the treating surgeon. The induced membrane technique and various modifications of the Ilizarov method (bone transport by distraction osteogenesis) have been the most common methods for biologic reconstruction. Despite the versatility and high union rates reported, they may not be practical for every patient. The rapid expansion of three-dimensional printing of medical devices has led to an increase in their use within orthopaedic surgery, specifically in the definitive treatment of critical bone defects. This article proposes indications and contraindications for implementation of this technology and reviews the available clinical evidence on the use of custom nonresorbable implants for the treatment of traumatic bone loss. Clinical cases are presented to illustrate the scenarios in which this approach is viable.


Asunto(s)
Técnica de Ilizarov , Procedimientos Ortopédicos , Ortopedia , Osteogénesis por Distracción , Humanos , Osteogénesis por Distracción/métodos , Huesos , Resultado del Tratamiento
10.
JMIR Res Protoc ; 12: e47524, 2023 Jun 23.
Artículo en Inglés | MEDLINE | ID: mdl-37351933

RESUMEN

BACKGROUND: Innovative approaches are needed to address the self-management needs of youths with osteogenesis imperfecta (OI) transitioning into adult-oriented health care systems. Using a sequentially phased research approach, the goal is to design, develop, and test the usability of an innovative eHealth program called "Teens Taking Charge: Managing OI Online," hereafter named "Teens OI." This program seeks to optimize self-management, facilitate a successful transition to adult care, and address a critical gap in the quality of care for youths with OI. OBJECTIVE: The study objectives are to (1) design and develop an English and French version of the Teens OI and (2) test the usability of the Teens OI in terms of efficiency, effectiveness, and satisfaction from the perspectives of youths with OI and their parents. METHODS: A user-centered design is presently in progress to design and develop Teens OI. A "Website Design and Development Council" (ie, Council) has been convened, with 20 youths and parent dyads recruited and global experts surveyed at an international meeting. With unanimous support from the Council, usability testing of the Teens OI will ensue in 4 iterative cycles with 32 youth-parent dyads. All sociodemographic and usability metrics will be descriptively analyzed. All recorded interview and focus group data are analyzed using content analysis techniques involving an iterative process of data reduction, data display, conclusion drawing, and verification. RESULTS: As of December 2022, an 8-person, interdisciplinary Teens OI council, comprising 4 health care professionals, 3 youths and young adults with OI, and 1 parent, has been convened to oversee the design and development of Teens OI. Two cycles of interviews have been conducted with 10 youths with OI with or without their parents (n=6) from December 2021 to September 2022. Data analysis has been in progress since April 2022. Aim 2 is ethically approved and will commence following the completion of content development, expected by late July 2023. Preliminary analysis indicates that the following topics need to be prioritized for the youths: mental health, pain, accessibility, medical care, education, community, and parental care. CONCLUSIONS: The proposed study will design and develop a self-management and transitional care program for youths with OI in partnership with patients, caregivers, and health care professionals. This study leverages youths' openness to adopt eHealth technologies to meet their needs and has the potential to actively engage them to autonomously manage their lifelong conditions, and facilitate a successful transition to adult health care. Finally, the proposed study will also address a critical gap in the quality of care and the growing concern that the OI population transitioning from pediatric to adult care is at risk of various adverse events associated with the transition. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/47524.

11.
JBJS Rev ; 11(6)2023 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-37276266

RESUMEN

BACKGROUND: In the past decade, distal femur anterior hemiepiphysiodesis for fixed knee flexion deformity has gained popularity. In this study, we aim to systematically review the literature on this technique as a treatment for fixed knee flexion deformity in patients with neuromuscular disorders. METHODS: A systematic review was performed in the following databases: PubMed, Embase, and Medline. The inclusion criteria included anterior hemiepiphysiodesis of the distal femur for patients with neuromuscular disorders and fixed knee flexion deformities. RESULTS: Our search yielded 419 titles. A total of 12 articles were qualified for final review based on the inclusion and exclusion criteria. The total number of patients was 279, with 483 knees corrected. The male to female ratio was 2.1:1, and the mean age of the patients was 11.3 ± 1.4 years (range 4-17 years). The mean preoperative flexion deformity was 23.1° ± 10.0° (range 10°-90°). The mean residual flexion deformity at the final follow-up was 8.6° ± 9.0° (range 0°-32.5°), which corresponds to a statistically significant decrease compared with the preoperative deformity (p < 0.05). CONCLUSION: Anterior hemiepiphysiodesis for fixed knee flexion deformity provides favourable outcomes with low complication rates in patients with neuromuscular disorders. Future studies should focus on comparing the long-term outcomes of the different metal implants used for these operations. LEVEL OF EVIDENCE: Level III. See Instructions for Authors for a complete description of levels of evidence.


Asunto(s)
Contractura , Enfermedades Neuromusculares , Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Estudios de Seguimiento , Resultado del Tratamiento , Articulación de la Rodilla/cirugía , Fémur/cirugía , Contractura/etiología , Enfermedades Neuromusculares/complicaciones
12.
Can J Surg ; 66(1): E59-E65, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36731911

RESUMEN

BACKGROUND: Although day surgery (DS) total hip arthroplasty (THA) has good patient satisfaction and a good safety profile, accurate episode-of-care cost (EOCC) calculations for this procedure compared to standard same-day admission (SDA) THA are not well known. We determined the EOCCs for patients who underwent THA, comparing DS and SDA pathways. METHODS: We evaluated the EOCCs for consecutive patients who underwent DS or SDA THA for osteoarthritis or osteonecrosis performed by a single surgeon at 1 academic centre from July 2018 to January 2020. Patient demographic and clinical data were recorded, as were preoperative diagnosis, type of anesthesia, type of implant used, surgical time and estimated blood loss. We determined direct and indirect costs from time of arrival at the presurgical unit to hospital discharge. We determined the EOCCs using an ABC method. RESULTS: The study included 50 patients who underwent THA (25 DS, 25 SDA). The mean length of stay in the SDA group was 45.1 (standard deviation [SD] 21.4) hours. Differences were observed between the 2 groups in mean age, mean Charlson Comorbidity Index score, surgical technique and mean surgical time (p ≤ 0.001). The mean total EOCC for SDA THA was $10 911 (SD $706.12, range $9944.07-$12 871.95), compared to $9672 (SD $546.55, range $8838.30-$11 058.07) for DS THA, a difference of 11.4%, mostly attributable to hospital resources such as laboratory tests, radiologic studies and cost of the surgical admission. CONCLUSION: Day surgery THA is cost-effective in selected patient populations. With the savings identified in this study, every 10 additional DS THA procedures would save sufficient resources to perform an additional THA operation.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Humanos , Artroplastia de Reemplazo de Cadera/métodos , Procedimientos Quirúrgicos Ambulatorios , Tiempo de Internación , Alta del Paciente , Costos y Análisis de Costo , Estudios Retrospectivos , Complicaciones Posoperatorias
13.
Clin Biomech (Bristol, Avon) ; 102: 105892, 2023 02.
Artículo en Inglés | MEDLINE | ID: mdl-36652877

RESUMEN

BACKGROUND: Supratubercle tibial rotational osteotomies are useful in patellar stabilizing procedures with high tibial-tuberosity to trochlear-groove distance caused by excessive external tibial torsion. An investigation determined one degree of internal tibial rotation results in 0.68 mm reduction of tibial-tuberosity to trochlear-groove distance, but did not account for anatomical variability. METHODS: This is a radiographic proof of concept for equation validation. We compared two different derived equations, a complex four-variable and simplified two-variable equation, to the literature relationship and true measured value from CT imaging. Bilateral pre-operative CTs of 37 patients, evaluated for malalignment, were reviewed retrospectively. We virtually simulated derotations of five, ten and fifteen degrees, and compared the reduction in tibial-tuberosity to trochlear-groove distance measured radiologically from CTs to the one predicted by our equation. FINDINGS: The difference between the true change in tibial-tuberosity to trochlear-groove distance and that obtained using our four-variable was statistically insignificant for all derotation angles (p > 0.05), and the two-variable equation it was statistically insignificant for five and fifteen degrees of derotation (p > 0.05). Conversely, the true values were statistically different from those found using the published relationship (p < 0.05 for all). INTERPRETATION: This new equation accounts for individual patient anatomy, for a more accurate relationship between internal rotation of the distal segment of the tibia and the subsequent decrease in the tibial-tuberosity to trochlear-groove distance. The change was overestimated using the linear relationship, which may result in under correction. Future studies will assess true post-operative distance change following osteotomy.


Asunto(s)
Inestabilidad de la Articulación , Articulación Patelofemoral , Humanos , Tibia/cirugía , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Rótula , Osteotomía/métodos , Inestabilidad de la Articulación/cirugía , Articulación Patelofemoral/cirugía , Articulación de la Rodilla
14.
OTA Int ; 5(3): e208, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36425093

RESUMEN

Case: The American Academy of Orthopaedic Surgeons has recently identified continuous intracompartmental pressure monitoring as 1 of the few means to assist in ruling out acute compartment syndrome (ACS). There are very few methods that allow this measurement. This manuscript describes the use of a new digital monitoring system for ACS in 3 patients. This minimally invasive device, the MY01 (NXTSENS, Montreal, Canada) is capable of continuously and precisely measuring variations in intracompartmental pressure. Conclusion: MY01 detected the occurrence of ACS at early-stage and expedited the timing of surgery for 2 patients. This tool also objectively excluded a suspected diagnosis of ACS in a medically comorbid patient, obviating the need for unnecessary fasciotomies and potential complications.

15.
Clin Biomech (Bristol, Avon) ; 100: 105795, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-36252452

RESUMEN

BACKGROUND: The goal was to determine the effect of addition of oblique trajectory distal interlock screws to a retrograde intramedullary femoral nail on implant stability (stiffness), cycles to failure and mode of failure. The hypothesis was that addition of oblique screws would increase implant stability and number of loading cycles to failure. METHODS: Eight matched pairs were tested; one femur implanted with a femoral nail with only transverse distal interlock screws and the other with transverse and oblique interlock screws. Axial compressive load was applied to the femoral head and the gluteal tendon was tensioned vertically to simulate standing or at 45° to the sagittal plane to simulate stair climbing. Loads were cycled to increasing amplitude until failure of fixation (10 mm displacement or 10° rotation). FINDINGS: In simulated standing, oblique screw specimen had greater sagittal bending (bowing) than transverse only specimen. Transverse (axial) plane motion was higher in simulated stair climbing in oblique screw specimen. Oblique screw specimen had higher sagittal plane translation at 600 N of load. At 300 N, oblique screw specimen had lower internal-external rotation than transverse only specimen. A larger number of cycles to failure were observed in four oblique screw of seven paired specimen. Failure (10 mm or 10 degrees of motion) was only achieved during simulated stair climbing. INTERPRETATION: Our hypothesis that adding oblique screws improves fixation was rejected. Activities of daily living other than standing may constitute a challenge to fracture fixation; fixation failure occurred at lower loads in simulated stair climbing than standing.


Asunto(s)
Actividades Cotidianas , Humanos
16.
Medicina (Kaunas) ; 58(8)2022 Aug 10.
Artículo en Inglés | MEDLINE | ID: mdl-36013547

RESUMEN

Background and objectives: Alignment of the lower extremity is important when treating congenital deformities, fractures, and joint replacement. During the COVID-19 pandemic, AO North America offered an online course on deformity measurement and planning. The Bonesetter app is a deformity planning tool that is freely available online. The purpose of this study was to see how effective an online course was in teaching axial alignment measurement and to assess that skill using an online digital planning tool, the Bonesetter app. Materials and Methods: An online module on axial alignment was provided during the AONA osteotomy course as well as a tutorial on how to use an online digital planning tool (Bonesetter app). The tools within the Bonesetter app allow users to draw digital lines directly on the CT images and measure the exact angle between two planes. Participants in this study were directed to perform these measurements in four different cases that tested different variations of deformity. Results: The measurements were completed correctly in case 1 = 56%, case 2 = 61%, case 3 = 84%, and case 4 = 76%. The standard deviation of angular digital measurements between individuals was ±4.26 degrees. Measuring the angle directly vs. drawing angles to a horizontal line had smaller standard deviations per case (p < 0.005) and less incidents outside 1 standard deviation for each measurement. Errors in adding and subtracting were the most common errors, particularly in relation to femoral anteversion or retroversion. Conclusions: The online course successfully instructed a group of orthopedic surgeons to measure alignment and malalignment of lower limb axial deformities. The Bonesetter app helped participants to learn this skill and identify errors in measurement. The inability to differentiate between anteversion and retroversion of the femur is a common source of error when it occurs and should be a focus of instruction.


Asunto(s)
COVID-19 , Aplicaciones Móviles , Fémur , Humanos , Osteotomía/métodos , Pandemias
17.
J Am Acad Orthop Surg ; 30(22): e1431-e1442, 2022 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-36037281

RESUMEN

Patellofemoral instability (PFI) is a prevalent cause of knee pain and disability. It affects mostly young females with an incidence reported as high as 1 in 1,000. Risk factors for instability include trochlear dysplasia, patella alta, increased tibial tubercle-to-trochlear groove distance, abnormal patella lateral tilt, and coronal and torsional malalignment. Nonsurgical and surgical options for PFI can treat the underlying causes with varied success rates. The goal of this review series was to synthesize the current best practices into a concise, algorithmic approach. This article is the first in a two-part review on PFI, which focuses on the clinical and radiological evaluation, followed by nonsurgical management. The orthopaedic surgeon should be aware of the latest diagnostic protocol for PFI and its nonsurgical treatment options, their indications, and outcomes.


Asunto(s)
Inestabilidad de la Articulación , Articulación Patelofemoral , Femenino , Humanos , Articulación Patelofemoral/cirugía , Inestabilidad de la Articulación/terapia , Inestabilidad de la Articulación/cirugía , Rótula/cirugía , Tibia/cirugía , Articulación de la Rodilla/cirugía
18.
Can J Surg ; 65(3): E382-E387, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35701005

RESUMEN

BACKGROUND: Day-of surgery cancellation (DOSC) is considered to be a very inefficient use of hospital resources and results in emotional stress for the patient. To examine opportunities to minimize the incidence of preventable cancellations - an indicator of quality of care - we assessed the incidence of and reasons for DOSCs over 3 months among inpatients and outpatients at a trauma orthopedic service. METHODS: This was a prospective study of 2 cohorts of patients, inpatients and outpatients, scheduled for emergent orthopedic surgery at a Canadian tertiary level 1 trauma centre from Jan. 1 to Mar. 31, 2020. Patient demographic characteristics, injury characteristics, delays until surgery and reasons for DOSCs were recorded. RESULTS: A total of 185 patients (100 males and 85 females with a mean age of 54 yr) were included in the study. There were 98 outpatients and 87 inpatients. Seventy-five (40%) of the scheduled procedures in the outpatient group and 34 (30%) of those in the inpatient group were cancelled. In both groups, more than 85% of the cancellations were because of prioritization of a more urgent orthopedic or nonorthopedic surgical case. The average operative delay for the outpatient group was 11.4 days, compared to 3.8 days for the inpatient group (p < 0.001). CONCLUSION: High DOSC rates were observed among both outpatients and inpatients. The main reason for delaying surgery was prioritization of a more urgent surgical case. Providing the orthopedic trauma service with a dedicated OR opened 6 days per week, along with extended hours of OR services to 1700 daily, might be effective at minimizing DOSCs.


Asunto(s)
Citas y Horarios , Procedimientos Ortopédicos , Canadá , Femenino , Humanos , Masculino , Persona de Mediana Edad , Quirófanos , Estudios Prospectivos , Centros Traumatológicos
19.
Can Geriatr J ; 25(1): 57-65, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-35310476

RESUMEN

Background: Surgical intervention within 48 hours is recommended for hip fractures in the elderly in order to reduce post-operative complications and lower mortality rates. The purpose of this retrospective study is to explore the causes of surgical delays for acute geriatric hip fractures. Methods: This is a retrospective cohort study involving a total of 109 consecutive geriatric patients who sustained proximal femur fractures ("hip fractures"), who subsequently underwent definitive fixation. Clinical, demographic, and direct costing data were extracted via a modern system and electronic medical records on a centralized data warehouse. Surgical delays and length of stay were analyzed according to clinical variables. Results: The established benchmark of a time-to-surgery of less than 48 hours was respected for 63 (57.8%) patients. Patients on oral anticoagulant (ACO) waited significantly longer, on average 58 hours compared to 44 for non-anticoagulated patients (p = .007). Patients with higher ASA scores waited significantly longer (p = .0018). More importantly, patients treated within 48 hours were discharged significantly earlier, on average after 10 days compared to 16 days for patients who waited more than 48 hours before receiving surgical treatment (p = .003), regardless of the pre-operative waiting time. Conclusion: Fewer than 60% of patients received surgery within the 48-hour benchmark after being admitted for an acute hip fracture in a Level-1 trauma centre. Patients with more comorbidities waited longer and stayed longer in the hospital after surgery. Implementing strategic, evidence-based changes should be done using this data to improve care of this vulnerable population.

20.
Injury ; 53(7): 2557-2561, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-35249740

RESUMEN

BACKGROUND: There remain gaps in knowledge regarding the pathophysiology, initial diagnosis, treatment, and outcome of acute compartment syndrome (ACS). Most reported clinical outcomes are from smaller studies of heterogeneous patients. For a disease associated with a financial burden to society that represents billions of dollars worldwide the literature does not currently establish baseline diagnostic parameters and risk factors that may serve to predict treatment and outcomes. METHODS: This study looks at a very large cohort of trauma patients obtained from four recent years of the Trauma Quality Programs data from the American College of Surgeons. From 3,924,127 trauma cases - 203,500 patients with tibial fractures were identified and their records examined for demographic information, potential risk factors for compartment syndrome, an associated coded diagnosis of muscle necrosis, and presence of other outcomes associated with compartment syndrome. A recurrent multiple logistic regression model was used to identify factors predictive of fasciotomy. The results were compared to the reported results from the literature to validate the findings. RESULTS: The rate of fasciotomy treatment for ACS was 4.3% in the cohort of identified patients. The analysis identified several clinical predictors of fasciotomy. Proximal and midshaft tibial fractures (P <0.0001) showed highest increases in the likelihood of ACS. Open fractures were twice (O.R [2.20-2.42]) as likely to have ACS. Having a complex fracture (P<0.0001), substance abuse disorder (P<0.0002), cirrhosis (P = 0.002) or smoking (P<0.0051) all increased the likelihood of ACS. Age decreased the likelihood by 1% per year (OR= [0.99-0.993]). Crush and penetrating injuries showed an important increase in the likelihood of ACS (O.R of 1.83 and 1.37 respectively). Additionally, sex, BMI, cirrhosis, tobacco smoking and fracture pattern as defined by OTA group and OTA subgroup had predictive value on actual myonecrosis. Fasciotomies for open tibial fractures were more likely to uncover significant muscle necrosis compared to closed fractures. Amputation resulted after 5.4% of fasciotomies. CONCLUSION: This big data approach shows us that ACS is primarily linked to the extent of soft tissue damage. However, newfound effect of some comorbidities like cirrhosis and hypertension on the risk of ACS imply other mechanisms.


Asunto(s)
Síndromes Compartimentales , Fracturas Abiertas , Fracturas de la Tibia , Macrodatos , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/epidemiología , Síndromes Compartimentales/etiología , Fasciotomía/métodos , Fracturas Abiertas/complicaciones , Fracturas Abiertas/cirugía , Humanos , Cirrosis Hepática/complicaciones , Necrosis , Estudios Retrospectivos , Fracturas de la Tibia/complicaciones , Fracturas de la Tibia/cirugía
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