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BACKGROUND: Scaphoid fractures account for 90% of carpal fractures and occur predominantly in young men. The use of immediate surgical fixation to manage this type of fracture has increased, despite insufficient evidence of improved outcomes over non-surgical management. The SWIFFT trial compared the clinical effectiveness of surgical fixation with cast immobilisation and early fixation of fractures that fail to unite in adults with scaphoid waist fractures displaced by 2 mm or less. METHODS: This pragmatic, parallel-group, multicentre, open-label, two-arm, randomised superiority trial included adults (aged 16 years or older) who presented to orthopaedic departments of 31 hospitals in England and Wales with a clear bicortical fracture of the scaphoid waist on radiographs. An independent remote randomisation service used a computer-generated allocation sequence with randomly varying block sizes to randomly assign participants (1:1) to receive either early surgical fixation (surgery group) or below-elbow cast immobilisation followed by immediate fixation if non-union of the fracture was confirmed (cast immobilisation group). Randomisation was stratified by whether or not there was displacement of either a step or a gap of 1-2 mm inclusive on any radiographic view. The primary outcome was the total patient-rated wrist evaluation (PRWE) score at 52 weeks after randomisation, and it was analysed on an available case intention-to-treat basis. This trial is registered with the ISRCTN registry, ISRCTN67901257, and is no longer recruiting, but long-term follow-up is ongoing. FINDINGS: Between July 23, 2013, and July 26, 2016, 439 (42%) of 1047 assessed patients (mean age 33 years; 363 [83%] men) were randomly assigned to the surgery group (n=219) or to the cast immobilisation group (n=220). Of these, 408 (93%) participants were included in the primary analysis (203 participants in the surgery group and 205 participants in the cast immobilisation group). 16 participants in the surgery group and 15 participants in the cast immobilisation group were excluded because of either withdrawal, no response, or no follow-up data at 6, 12, 26, or 52 weeks. There was no significant difference in mean PRWE scores at 52 weeks between the surgery group (adjusted mean 11·9 [95% CI 9·2-14·5]) and the cast immobilisation group (14·0 [11·3 to 16·6]; adjusted mean difference -2·1 [95% CI -5·8 to 1·6], p=0·27). More participants in the surgery group (31 [14%] of 219 participants) had a potentially serious complication from surgery than in the cast immobilisation group (three [1%] of 220 participants), but fewer participants in the surgery group (five [2%]) had cast-related complications than in the cast immobilisation group (40 [18%]). The number of participants who had a medical complication was similar between the two groups (four [2%] in the surgery group and five [2%] in the cast immobilisation group). INTERPRETATION: Adult patients with scaphoid waist fractures displaced by 2 mm or less should have initial cast immobilisation, and any suspected non-unions should be confirmed and immediately fixed with surgery. This treatment strategy will help to avoid the risks of surgery and mostly limit the use of surgery to fixing fractures that fail to unite. FUNDING: National Institute for Health Research Health Technology Assessment Programme.
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Moldes Cirúrgicos , Fixação Interna de Fraturas , Fraturas Ósseas/terapia , Osso Escafoide/lesões , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Parafusos Ósseos , Feminino , Fixação de Fratura , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Fraturas não Consolidadas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Osso Escafoide/cirurgia , Tempo para o Tratamento , Adulto JovemRESUMO
OBJECTIVE: The purpose of this study was to identify the external and internal reliability and responsiveness of the validated patient-reported outcome measures (PROMs) of neck pain to a standardized regimen of physiotherapy administered acutely after mild whiplash injury using the clinically significant improvement components of the Patient Global Impression of Change (PGIC) as the outcome measure. METHODS: Eighty-six patients with neck pain alone were referred for physiotherapy within 2 weeks of whiplash injury. They completed the Copenhagen, Northwick Park (NP), and Neck Bournemouth (NBQ) questionnaires and the Neck Disability Index (NDI) before starting and after treatment when they also completed the PGIC. Treatment comprised deep soft tissue massage, myofascial releases, muscle energy techniques, joint articulation and manipulation techniques, and a home exercise program. The duration of treatment was between 3 and 6 weeks. A PGIC of 6 or 7 was considered to be clinically significant improvement. RESULTS: The external reliability of the PROMs was >0.7 and internal >0.87. All components of the PROMs contributed to the final score except headache in the Copenhagen and upper-limb dysesthesia in the NP. The most reliable questionnaire was the NBQ, which was significantly more responsive than the Copenhagen (P = .008). The NBQ was slightly more responsive than the NDI and NP. The NBQ and NDI were successfully completed more frequently than the NP and Copenhagen. CONCLUSION: The NP, NDI, and NBQ are all reliable and responsive measures of change after physiotherapy for neck pain after acute whiplash injury.
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Avaliação da Deficiência , Cervicalgia/reabilitação , Medidas de Resultados Relatados pelo Paciente , Modalidades de Fisioterapia , Inquéritos e Questionários , Adulto , Inglaterra , Feminino , Humanos , Masculino , Cervicalgia/etiologia , Reprodutibilidade dos Testes , País de Gales , Traumatismos em Chicotada/complicações , Traumatismos em Chicotada/reabilitaçãoRESUMO
BACKGROUND: Rehabilitation protocols after distal biceps repair are highly variable, with many surgeons favoring at least 2 weeks of immobilization. Is this conservative approach necessary to protect the repair? METHODS: This was a consecutive series of 22 distal biceps tendon repairs in which a cortical button system was used. Patients were encouraged to mobilize their elbow actively from the day of surgery. Physiotherapy commenced at 3 weeks, with strengthening exercises when full range of movement (ROM) was achieved. The primary outcome measured was the clinical integrity of the repaired tendon. Secondary outcomes comprised wound or nerve complication, elbow ROM, and patient-reported outcome measures (the 11-item version of the Disabilities of Arm, Shoulder and Hand, Mayo Elbow Performance Index, and Oxford Elbow Score). RESULTS: All patients were male, and the dominant arm was repaired in 60%. Mean age was 40.6 years (range, 27-62 years), and mean time to surgery was 17 days (range, 5-99 days). Mean follow-up was 16.6 months (range, 3.8-29 months). All tendons were clinically intact at time of review. No wound breakdown occurred. Mean extension was -6° (range, -10° to 10°), and flexion was 144° (range, 135°-150°). All patients achieved full pronosupination. ROM was equivalent to the uninjured arm (P = .7). The mean 11-item version of the Disabilities of Arm, Shoulder and Hand score was 2.7 (range, 0-15.9), the Mayo Elbow Performance Index was 97.8 (range, 70-100), and the Oxford Elbow Score was 46.9 (range, 43-48) at the latest follow-up. One-third of patients experienced a transient sensory neurapraxia. CONCLUSION: Immediate mobilization after biceps tendon repair with a cortical button is possible, and in this series was not associated with failure of the repair, wound breakdown, or patient dissatisfaction. However, this series emphasizes the high incidence of nerve complication that can be associated with the single transverse incision technique.
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Lesões no Cotovelo , Cotovelo/cirurgia , Movimento/fisiologia , Modalidades de Fisioterapia , Traumatismos dos Tendões/cirurgia , Adulto , Articulação do Cotovelo/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Doenças do Sistema Nervoso Periférico/etiologia , Modalidades de Fisioterapia/efeitos adversos , Próteses e Implantes , Amplitude de Movimento Articular , Fatores de Risco , Ruptura/fisiopatologia , Ruptura/cirurgia , Deiscência da Ferida Operatória/etiologia , Traumatismos dos Tendões/fisiopatologia , Traumatismos dos Tendões/reabilitação , Falha de TratamentoRESUMO
PURPOSE: To compare the cement mantle characteristics associated with use of a narrow nozzle cement gun versus the use of a 60-mL catheter tip syringe. METHODS: Twelve cadaveric distal humeri were cemented with either a cement gun or a syringe without canal occlusion. The humeri were sectioned and photographed. The corticocancellous junction and the outer margin of the cement mantle were analyzed digitally. The corticocancellous junction defined the available area for cement penetration. The outline of the cement mantle defined the actual area of penetration. The ratio of penetration to the available area was recorded for each slice. The mean ratio for each humerus was multiplied by the number of slices in that sample containing cement to calculate a cement index. RESULTS: The cement penetration ratios observed in cross-sections at the same level and the cement index were significantly greater with the use of the cement gun than with the use of the syringe. There was no difference in the number of slices that contained cement. CONCLUSIONS: The use of a cement gun with a narrow nozzle improved cement mantle characteristics compared with the use of a syringe when measured in a cadaveric model in the absence of canal occlusion. CLINICAL RELEVANCE: Improving cement mantle characteristics may decrease the incidence of aseptic loosening after total elbow arythroplasty.
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Artroplastia de Substituição do Cotovelo/instrumentação , Cimentos Ósseos/uso terapêutico , Cimentação/instrumentação , Complicações Pós-Operatórias/prevenção & controle , Falha de Prótese , Seringas , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Feminino , Humanos , Técnicas In Vitro , MasculinoRESUMO
BACKGROUND: Arthroscopic triple fusion has several advantages over open techniques, but its use has yet to become widespread. Preliminary published techniques use five portals with neurovascular risk. Our aim was to assess the safety and efficacy of an alternative lateral two portal technique. METHODS: Four cadaveric hindfeet were arthroscopically prepared for a triple fusion using two lateral portals. The distance to relevant subcutaneous nerves was measured as well as the prepared joint surface percentage. RESULTS: Mean distance from mid-lateral portal to the nearest sural nerve branch was 22.3mm (range 20-24mm) and from the dorsolateral portal to the intermediate branch of the superficial peroneal nerve was 7.8mm (range 4-11mm). Mean percentages of joint preparation were 63% (talar head), 62% (navicular), 75% (calcaneum) and 74% (cuboid). CONCLUSIONS: Two lateral arthroscopic portals allow adequate joint preparation for triple fusion procedures. The proximity of subcutaneous nerves is important to appreciate when using these portals.
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Artrodese/métodos , Articulações do Pé/cirurgia , Idoso , Artrodese/instrumentação , Cadáver , Feminino , Pé/inervação , Humanos , Masculino , Nervo Fibular/anatomia & histologia , Nervo Sural/anatomia & histologia , Resultado do TratamentoRESUMO
Background: The aim of this study is to compare the surgical and non-operative management of displaced radial head fractures via a network meta-analysis of randomised controlled trials (RCTs). Methods: RCTs comparing management of isolated, displaced radial head fractures in adults were included in our review and statistical analysis. A systematic review of electronic databases (Medline, Embase and Cochrane Library) were screened for comparative RCTs reporting on the management of displaced radial head fractures in August 2021. Two investigators independently reviewed studies for eligibility and an assessment of bias was performed for each study. A Bayesian network meta-analysis of the included RCTs was performed. Results: Five RCTs (326 patients) were included in our meta-analysis. Treatment methods included radial head arthroplasty (RHA), open reduction internal fixation (ORIF) with metal implants (ORIF-M), ORIF with biodegradable implants (ORIF-B) and non-operative management. In our network meta-analysis of 'good' or 'excellent' patient-reported outcome measures (PROMs), RHA was significantly favourable to ORIF-M (OR: 0.04, CrI: 0.0011, 0.87), ORIF-B (OR: 0.1 CrI: 0.00076, 6.37). Nonoperative treatment was not shown to be significantly worse than RHA (OR: 0.01 CrI: 2.5e-0.5, 3.61). Conclusions: This network meta-analysis shows that in displaced radial head fractures, RHA is associated with significantly superior functional PROMs than ORIF-M based on the evidence available. Nonoperative management has not been shown to be significantly worse. Level of Evidence: Level III (Therapeutic).
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Fixação Interna de Fraturas , Metanálise em Rede , Fraturas do Rádio , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Fraturas do Rádio/terapia , Fraturas do Rádio/cirurgia , Fixação Interna de Fraturas/métodos , Redução Aberta/métodos , Artroplastia/métodos , Medidas de Resultados Relatados pelo Paciente , Fraturas da Cabeça e do Colo do RádioRESUMO
Aims: The aims of this study were to describe the epidemiology of metacarpal shaft fractures (MSFs), assess variation in treatment and complications following standard care, document hospital resource use, and explore factors associated with treatment modality. Methods: A multicentre, cross-sectional retrospective study of MSFs at six centres in the UK. We collected and analyzed healthcare records, operative notes, and radiographs of adults presenting within ten days of a MSF affecting the second to fifth metacarpal between 1 August 2016 and 31 July 2017. Total emergency department (ED) attendances were used to estimate prevalence. Results: A total of 793 patients (75% male, 25% female) with 897 MSFs were included, comprising 0.1% of 837,212 ED attendances. The annual incidence of MSF was 40 per 100,000. The median age was 27 years (IQR 21 to 41); the highest incidence was in men aged 16 to 24 years. Transverse fractures were the most common. Over 80% of all fractures were treated non-surgically, with variation across centres. Overall, 12 types of non-surgical and six types of surgical treatment were used. Fracture pattern, complexity, displacement, and age determined choice of treatment. Patients who were treated surgically required more radiographs and longer radiological and outpatient follow-up, and were more likely to be referred for therapy. Complications occurred in 5% of patients (39/793). Most patients attended planned follow-up, with 20% (160/783) failing to attend at least one or more clinic appointments. Conclusion: MSFs are common hand injuries among young, working (economically active) men, but there is considerable heterogeneity in treatment, rehabilitation, and resource use. They are a burden on healthcare resources and society, thus further research is needed to optimize treatment.
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BACKGROUND: We assessed distal humeral column preservation effects on clinical, radiographic and patient reported outcomes following distal humerus hemiarthroplasty for acute unreconstructable fractures. METHODS: Thirty-seven consecutive patients (mean age, 75; range, 29-93 years) with an average follow-up of 61 months (range, 24-105 months) after distal humerus hemiarthroplasty using a triceps preserving approach were studied. QuickDASH and Oxford Elbow Score assessed patient reported outcomes. Clinical and radiographic assessments comprised range of motion, grip strength, instability, implant loosening, chondral wear, heterotopic ossification and condylar union. RESULTS: Average QuickDASH was 14.9 (range, 0-63) and Oxford Elbow Score 40.35 (range, 25-48). Mean flexion arc was 108°, extension deficit 17° and pronosupination arc 155°. Average operative sided grip strength was 31.05 kg versus 31.13 kg contralaterally. Column preservation had no statistically significant effect on QuickDASH (p = 0.75), Oxford Elbow Score (p = 0.78), flexion-extension (p = 0.87), pronosupination (p = 0.78) or grip strength (p = 0.87). No progressive radiographic loosening or symptomatic chondral wear occurred. All fixed columns united. Three cases of immediate post-operative laxity fully resolved on elbow mobilisation. Four post-operative complications required further surgery: one ulnar neuropathy, one heterotopic ossification, one wound breakdown and one traumatic dislocation. CONCLUSION: Medium-term outcome of distal humerus hemiarthroplasty for acute unreconstructable distal humeral fractures is reliable irrespective of condylar preservation.
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Background: Distal biceps rupture presents with an increasing incidence and evidence suggests that although a surgical repair is not mandatory, it results in superior functional outcomes when compared to non-operative management. As implant technology has advanced, several devices have been utilised and studied in managing this pathology. We present our single-centre experience with the use of the ToggleLoc Ziploop reattachment device, a knotless cortical button implant, using a single-incision technique. Methods: Retrospective series of 70 consecutive distal biceps tendon repairs, at a mean follow-up of 45.6 months after surgery, using a standardised single implant, single-incision technique, and post-operative rehabilitation programme. Results: There was one (1.4%) re-rupture in our patient cohort. The range of motion was complete in all patients except for one patient who had symptomatic heterotopic ossification, causing limitation in pronation. Complications were minor with the commonest being transient neuropraxia of the lateral cutaneous nerve of the forearm. The mean Oxford elbow score was 46.9 out of 48, and the patient global impression of change scale was 7 out of 7 in 77% of cases. Conclusion: Our data support this technique and implant combination when dealing with acute and chronic distal biceps tendon rupture.
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AIM: The aim of the current study was to assess the amount of the distal humerus articular surface exposed through the Newcastle approach, a posterior triceps preserving exposure of the elbow joint. METHOD: Twenty-four cadaveric elbows (12 pairs) were randomized to receive one of the four posterior surgical approaches: triceps reflecting, triceps splitting, olecranon osteotomy and Newcastle approach. The ratio of the articular surface exposed for each elbow was calculated and compared. RESULTS: The highest ratio observed was for Newcastle approach (0.75 ± 0.12) followed by olecranon osteotomy (0.51 ± 0.1), triceps reflecting (0.37 ± 0.08) and triceps splitting (0.35 ± 0.07). The differences between Newcastle approach and other approaches were statistically significant (p = 0.003 vs. osteotomy and <0.0001 vs. triceps reflecting and splitting). CONCLUSION: The Newcastle approach sufficiently exposes the distal humerus for arthroplasty or fracture fixation purposes. Its use is supported by the current study.
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Articulação do Cotovelo/cirurgia , Procedimentos Ortopédicos/métodos , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Masculino , Osteotomia/métodos , Distribuição AleatóriaRESUMO
INTRODUCTION: A study conducted to establish the most accurate combination of questionnaire and physical signs for the diagnosis of carpal tunnel syndrome. METHOD: Nerve conduction studies confirmed 70 patients with having carpal tunnel syndrome who were enrolled along with 70 age- and sex-matched controls. Patients were assessed using a symptom questionnaire, Phalen's test, Hoffmann-Tinel's sign, hand elevation test, carpal compression test, tourniquet test, pressure aesthesiometry and two-point discrimination. RESULTS: Through multivariate analysis, the best combination of tests was tourniquet, carpal compression and Phalen's tests but the difference between these and hand elevation test alone was negligible. CONCLUSION: The hand elevation test may be used in isolation and is superior to questionnaires and other physical signs in the clinical diagnosis of carpal tunnel syndrome.
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Síndrome do Túnel Carpal/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Síndrome do Túnel Carpal/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Condução Nervosa , Exame Físico , Curva ROC , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: The soft cervical collar has been prescribed for whiplash injury but has been shown to be clinically ineffective. As some authors report superior results for managing whiplash injury with a cervical brace, we were interested in comparing the mechanical effectiveness of the soft collar with a rigid cervical brace. Therefore, the purpose of this study was to measure ranges of motion in subjects without neck pain using a soft cervical collar and a rigid brace compared with no orthosis. METHODS: Fifty healthy subjects (no neck or shoulder pain) aged 22 to 67 years were recruited for this study. Neck movement was measured using a cervical range of motion goniometer. Active flexion, extension, right and left lateral flexion, and right and left rotation were assessed in each subject under 3 conditions: no collar, a soft collar, and a rigid cervical brace. RESULTS: The soft collar and rigid brace reduced neck movement compared with no brace or collar, but the cervical brace was more effective at reducing motion. The soft collar reduced movement on average by 17.4%; and the cervical brace, by 62.9%. The effect of the orthoses was not affected by age, although older subjects had stiffer necks. CONCLUSION: Based on the data of the 50 subjects presented in this study, the soft cervical collar did not adequately immobilize the cervical spine.
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Braquetes , Movimento , Pescoço/fisiologia , Aparelhos Ortopédicos , Amplitude de Movimento Articular , Adulto , Fatores Etários , Idoso , Artrometria Articular , Fenômenos Biomecânicos , Vértebras Cervicais , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Restrição Física/instrumentação , Rotação , Adulto JovemRESUMO
We present a case of volar rotatory subluxation of index finger proximal interphalangeal joint (PIPJ) following a skiing accident. The injury was initially perceived to be a central slip rupture and treatment was directed as such. After the initial delay in the diagnosis, the patient underwent surgery during which his radial collateral ligament was found to be avulsed from the proximal origin, the radial lateral band palmarly subluxed and was interposed in the joint space. This structure was also adhered to the uninjured volar plate.PIPJ volar rotatory subluxation could be readily missed in the acute setting. Without surgery, the functional outcome could be mediocre and to the patient's detriment.
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Ligamentos Colaterais/lesões , Traumatismos dos Dedos/diagnóstico , Luxações Articulares/diagnóstico , Esqui/lesões , Adulto , Ligamentos Colaterais/diagnóstico por imagem , Ligamentos Colaterais/patologia , Ligamentos Colaterais/cirurgia , Diagnóstico Tardio , Traumatismos dos Dedos/etiologia , Traumatismos dos Dedos/cirurgia , Articulações dos Dedos/diagnóstico por imagem , Articulações dos Dedos/patologia , Articulações dos Dedos/cirurgia , Humanos , Período Intraoperatório , Luxações Articulares/etiologia , Luxações Articulares/cirurgia , Masculino , Diagnóstico Ausente , Placa Palmar/diagnóstico por imagem , Placa Palmar/patologia , Placa Palmar/cirurgia , Amplitude de Movimento Articular , Fatores de Tempo , Aderências Teciduais/diagnóstico , Aderências Teciduais/etiologia , Aderências Teciduais/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
PURPOSE: The porosity of the femoral head prepared for hip resurfacing has not been previously described. This is important as greater pore size increases the penetration of bone cement and excessive cement penetration can cause osteonecrosis. METHODS: 96 osteoarthritic femoral heads were harvested at total hip arthroplasty and prepared for hip resurfacing. The porosity of the bone cement interface in hip resurfacing was calculated from digitised black and white photographs using MatLab software. RESULTS: The mean porosity was 0.63. Increased porosity was associated with larger femoral heads in both the coronal and sagittal dimensions and cysts in the femoral head. It was not associated with gender, age, body mass index (BMI), smoking, alcohol or corticosteroid consumption. CONCLUSION: The porosity of the femoral head has been shown to be 0.63. Future studies of cementing techniques in hip resurfacing should include this porosity in their designs. The surgeon prior to hip resurfacing should consider altering his cementing technique when cysts are present on the preoperative radiographs.
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Artroplastia de Quadril , Prótese de Quadril , Artroplastia de Quadril/efeitos adversos , Cimentos Ósseos , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/cirurgia , Humanos , PorosidadeRESUMO
BACKGROUND: Malunited proximal radius fractures causing dislocation of the radio-capitellar joint are rare. We present a case of a two-year-old female patient with such an injury who was treated with a proximal radius osteotomy with good long-term outcomes. METHOD/RESULTS: Case study of a single patient with a malunited proximal radius fracture which was identified as causing radio-capitellar dislocation who underwent corrective osteotomy with a good result. CONCLUSION: Our opinion is that a corrective osteotomy for a malunited proximal radius fracture causing radio-capitellar dislocation is a sound treatment option and that no supplementary soft tissue reconstruction such as annular ligament exploration/reconstruction is necessary.
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Anquilose/cirurgia , Moldes Cirúrgicos , Lesões no Cotovelo , Articulação do Cotovelo/cirurgia , Liberação da Cápsula Articular , Luxações Articulares/terapia , Terapia Passiva Contínua de Movimento , Cuidados Pós-Operatórios , Adulto , Anquilose/fisiopatologia , Articulação do Cotovelo/fisiopatologia , Medicina Baseada em Evidências , Feminino , Humanos , Luxações Articulares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Reoperação , Estudos RetrospectivosRESUMO
This study investigated the relationship of bone porosity and bone-cement interface shear strength. One hundred forty-six samples were taken from the distal metaphysis of 20 bovine femora. After cementation, the shear strength of the bone-cement interface was tested. According to the porosity, the samples were divided into four groups. Group I (porosity <80%) had a median interface shear strength of 4.03 MPa, group II (80%
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Cimentos Ósseos , Cimentação/métodos , Teste de Materiais/métodos , Resistência ao Cisalhamento , Animais , Bovinos , Fêmur/cirurgia , Processamento de Imagem Assistida por Computador , Porosidade , Falha de Prótese , Estresse MecânicoRESUMO
This article presents a prospective longitudinal study to determine the cut-off values for change scores of DASH, Levine, and Kamath questionnaires to distinguish clinical improvement following carpal tunnel surgery. Fifty-four patients (40 female, 14 male), with positive nerve conduction studies, were prospectively followed up. Three questionnaires (DASH, Levine, and Kamath) were posted to patients at four and two weeks prior to their operation and then six weeks following surgery. A patient global impression of change (PGIC) score was completed for patients to rate the overall change in their symptoms. According to the PGIC, 93% of patients improved. The cut-off values for raw change scores that best define clinically significant improvement following carpal tunnel release were 20.9 for DASH, 0.47 for Levine, and 1.97 for the Kamath questionnaire. This study provides a methodological framework for identifying clinically significant changes following treatment. A questionnaire follow-up of patients is now possible using the data provided.
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Síndrome do Túnel Carpal/fisiopatologia , Síndrome do Túnel Carpal/cirurgia , Avaliação da Deficiência , Procedimentos Ortopédicos/métodos , Avaliação de Resultados em Cuidados de Saúde/métodos , Feminino , Seguimentos , Inquéritos Epidemiológicos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Condução Nervosa/fisiologia , Estudos Prospectivos , Sensibilidade e Especificidade , Resultado do TratamentoRESUMO
INTRODUCTION: We reviewed the mid-term outcome of GSB-III semi-constrained total elbow arthroplasty (TEA) and compared the results of patients with rheumatoid arthritis (RA) and those suffering from post-traumatic arthritis (PTA). PATIENTS: Forty-five patients with 54 replaced elbows, with an average age of 69 (range 49-84) were clinically [using Mayo Clinical Performance Index (MCPI) and Liverpool Elbow Score (LES)] and radiographically assessed. The average follow-up was 54 (range 20-103) months. RESULTS: Based on MCPI 82% of patients had excellent or good outcome. This figure was 88% for RA and 64% for PTA group (P = 0.22). Overall MCPI was 83.7(+/- 19) and LES 7.5 (+/- 1.8). Neither the MCPI (P = 0.39) nor the LES (P = 0.95) were statistically different between the RA and PTA groups. The mid-term outcome of GSB-III TEA is satisfactory. CONCLUSION: The recommendation of TEA, including in patients with PTA, is supported.
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Artrite Reumatoide/cirurgia , Artroplastia de Substituição/métodos , Articulação do Cotovelo/cirurgia , Osteoartrite/cirurgia , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Feminino , Humanos , Prótese Articular , Masculino , Pessoa de Meia-Idade , Osteoartrite/etiologia , Resultado do Tratamento , Lesões no CotoveloRESUMO
OBJECTIVES: Prospective longitudinal study to evaluate the effect of physiotherapy on whiplash associated disorders (WAD). MATERIALS AND METHODS: A total of 141 patients suffering from grades I-III WAD after a road traffic accident were employed. Validated neck Bournemouth Questionnaire was used in order to look at the effect of treatment on the symptoms. RESULTS: The mean age was 40 (+/-14) years. The mean length of the treatment was 6 (+/-3.4) weeks. The mean individual effect size was 0.97 (95% CI 0.8-1.2). A total of 67% of the patients who started their treatment in the first 3 months post-injury improved compared to 48% in those who started physiotherapy after 3 months (P = 0.025). In both groups the applied treatment almost halved the number of patients taken sick leave. CONCLUSION: Physiotherapy is effective in the treatment of whiplash injury, especially in order to get the patients fit to go back to their previous employment.