RESUMO
Background In the case of elderly patients suffering from osteoporosis, the primary objectives of addressing comminuted intertrochanteric fractures are centered upon the recuperation of the patients' pre-fracture levels of activity, the expeditious promotion of full weight-bearing capacity, and the minimization of the likelihood of further surgical interventions. The adoption of hemiarthroplasty as a method for comminuted intertrochanteric fractures is proven as a means of hastening the recovery process, enabling early weight-bearing and mitigating the problems associated with extended bed rest. The outcomes that resulted from the application of this technique will be evaluated and analyzed as part of this study's objectives. Methodology A prospective study was conducted over the course of one year at a tertiary care hospital in the northern part of India. The study comprised a total of 30 individuals; however, unfortunately, one of the patients could not be located for further analysis. Patients of either gender in the age group of over 60 years old and with unstable osteoporotic intertrochanteric fractures were included (AO Foundation/Orthopaedic Trauma Association type 31-A2.2, A2.3, or 31-A3 group). Patients were observed at one, three, and six months after the surgical operation. The Harris Hip Score (HHS) was used for the functional outcome evaluation. Results Throughout the course of our analysis, we saw an increase in the overall HHS that was statistically significant. The HHS exhibited a mean value of 34.33 during the period of discharge, with a range of 32 to 39. It increased to 55.34 (range = 52-59) after one month of follow-up, and it continued to rise to 85.03 (range = 63-89) after three months of follow-up. It is important to note that the mean HHS reached 95.24 (range = 63-98) by the sixth month of follow-up. The study showed a statistically significant upward trend in HHS scores across all time periods (p < 0.001). Conclusions Early postoperative ambulation was made possible with the use of cemented prostheses, which contributed to patients' overall improvements in their functional results. Cemented primary bipolar hemiarthroplasty has emerged as a promising alternative for the treatment of unstable intertrochanteric fractures. The enhanced functional outcomes measured by the HHS provide evidence of this. The transtrochanteric technique has shown advantages in retaining the anatomical integrity of external rotators, minimizing the necessity for their resection, and reducing the danger of sciatic nerve injury. These advantages were displayed by the transtrochanteric approach. Moreover, owing to the implementation of wiring techniques, the larger trochanter could be conserved, resulting in enhanced postoperative recovery and expediting the return to the preoperative condition. When compared with other techniques of internal fixation, the utilization of cemented bipolar hemiarthroplasty demonstrated much-reduced rates of complications, such as the need for further surgery and implant failure.
RESUMO
Introduction Discharge summaries (DS), which are sent from inpatient to outpatient settings, transmit critical clinical information. DS play a crucial role in the discharge process since they provide critical information about the patients that is simple to remember and help with patient follow-up in the community. This audit sought to determine if a quality improvement (QI) program may have an influence on the severity of mistakes at the moment of discharge and to assess the existing degree of inconsistencies on handwritten DS for orthopaedic patients. Methodology From the orthopaedics department at a tertiary care facility in south India, 100 handwritten DS and 100 electronic DS over six months were randomly chosen, and they were retrospectively audited against a predetermined set of criteria. The errors were compiled and compared by three reviewers. Results Some of the criteria, such as the doctor's signature, the speciality of admission, procedural therapy at the hospital, and the date of admission, were contained in all handwritten and electronic DS. Some of the metrics showed that electronic DS performed better than handwritten DS in areas such as hospital complications, which increased from 50% to 100%, contact information, which increased from 34% to 95%, and condition at discharge, which increased from 66% to 96%. Also, understandability increased from 58% to 100%, prognostic details increased from 70% to 96%, allergies increased from 66% to 100%, physical examination findings increased from 88% to 100%, admission diagnosis increased from 80% to 100%, patient/physician details increased from 92% to 100%, the information given to patient increased from 88% to 100%, problem list/issue pending increased from 35% to 92%, investigation increased from 80% to 100%, discharge medications increased from 88% to 100%, follow-up plan increased from 80% to 100%, discharge diagnosis increased from 94% to 100%, International Classification of Diseases, Tenth Revision (ICD-10) code increased from 93% to 100%, and days of admission increased from 92% to 100%. Conclusion Following the deployment of electronic DS, we were able to better care for patients and lessen their discomfort. We advise converting to electronic DS to enhance patient care and better record-keeping since this will become a significant problem if all notes are not accurately filled and are not readable.