'Absolute' inter-observer classifications agreement for proximal humeral fractures with a single shoulder anteroposterior X-ray.

PURPOSE: Several studies have been carried out, and there is no classification for proximal humeral fractures (PHF) exempted from variability in interpretation and with questioned reliability. In the present study, we investigated the 'absolute diagnostic reliability' of the most currently used classifications for PHFs on a single anterior-posterior X-ray shoulder image. METHODS: Six orthopaedic surgeons, with varying levels of experience in shoulder pathology, evaluated radiographs from 30 proximal humeral fractures, according to the 'absolute reliability' criteria. Each of the observers rated each fracture according to Neer, Müller/AO and Codman-Hertel's classification systems. RESULTS: The overall inter-observer agreement (κ) has been 0.297 (CI95% 0.280 to 0.314) for the Neer's classification system, 0.206 (CI95% 0.193 to 0.218) for the Müller/AO classification system, and 0.315 (CI95% 0.334 to 0.368) for the Codman-Hertel classification system. We found loss of agreement in Neer's classification as the study progressed, low agreement in the AO classification, and stable values in the different evaluations with the best degree of agreement for Codman-Hertel classification, with a moderate agreement in the second evaluation among the six evaluators. CONCLUSION: The Neer, AO, and Hertel-Codman classification systems for PHF with a single radiographic projection have a difficult interpretation for orthopaedic surgeons of varying levels of experience, and therefore substantial agreements are not obtained.

Venous thromboembolism in nonagenarians. Findings from the RIETE Registry.

The balance between the efficacy and safety of anticoagulant therapy in patients aged >/=90 years with venous thromboembolism (VTE) is uncertain. RIETE is an ongoing, prospective registry of consecutive patients with acute, objectively confirmed, symptomatic VTE. We evaluated the efficacy and safety of anticoagulant therapy during the first three months in all patients aged >/=90 years. In addition, we tried to identify those at a higher risk for VTE. Of 21,873 patients enrolled from March 2001 to February 2008, 610 (2.8%) were aged >/=90 years. Of these, 307 (50%) presented with pulmonary embolism (PE), 240 (39%) had immobility >/=4 days, and 271 (44%) had abnormal creatinine levels. During the first three months of therapy, 140 patients aged >/=90 years (23%) died. Of these, 45 (32%) died of PE (34 of the initial episode, 11 of recurrent PE), 18 (13%) had fatal bleeding. Recent immobility >/=4 days was the most common risk factor for VTE (240 of 610 patients, 39%), but only 54 of them (22%) had received thromboprophylaxis. The most frequent causes for immobility were senile dementia, acute infection, trauma or decompensated heart failure. The duration of immobility was <4 weeks in 126 patients (52%), and most of them were bedridden at home. In conclusion, one in every four VTE patients aged >/=90 years died during the first three months of therapy. Of these, one in every three died of PE, one in every eight had fatal bleeding. Identifying at-risk patients may help to prevent some of these deaths.

Elaboração de protocolo de investigação de neuropatia periférica em pacientes diabéticos / Elaboration of a protocol for peripheral neuropathy investigation in diabetic patients / Elaboración de protocolo de investigación de neuropatía periférica en pacientes diabéticos

Introdução: A neuropatia distal diabética é uma das principais complicações do diabetes mellitus, acometendo metade dos pacientes com diabetes, e pode ser a causa de deformidades, úlceras e amputações. Mais de 70% dos pacientes com pé diabético apresentam neuropatias. A investigação e o reconhecimento precoce da presença da neuropatia distal diabética são importantes, pois permitem detectar pacientes que apresentam neuropatia distal diabética, que podem evoluir para úlcera e/ou amputação...(AU)

Introduction: Diabetic distal neuropathy is one of the main complications of diabetes mellitus, affecting half of diabetes patients, and may be the cause of deformities, ulcers and amputations. More than 70% of diabetic foot patients have neuropathies. Investigation and early recognition of the presence of diabetic distal neuropathy is important because it allows the detection of patients with diabetic distal neuropathy, which may progress to ulcer and / or amputation ... (AU)

Introducción: la neuropatía distal diabética es una de las principales complicaciones de la diabetes mellitus, afecta a la mitad de los pacientes con diabetes y puede ser la causa de deformidades, úlceras y amputaciones. Más del 70% de los pacientes con pie diabético tienen neuropatías. La investigación y el reconocimiento temprano de la presencia de neuropatía distal diabética es importante porque permite la detección de pacientes con neuropatía distal diabética, que puede progresar a úlcera y / o amputación ... (AU)