ABSTRACT
Fracture-related infection (FRI) is a common complication following open tibia fracture (OTF), especially in patients with high-energy trauma or comorbidities. The use of gentamicin-coated nail (GCN) has been proposed as a local adjuvant to prevent FRI in high-risk patients. HYPOTHESIS: The incidence of FRI is expected to be lower in OTF treated with a GCN, alongside with no detrimental effects on fracture healing time. OBJECTIVES: This study aimed to evaluate the effectiveness of GCNs as a definitive fixation method and prophylaxis for FRI in OTFs. Secondary outcomes included non-union rates and time to healing. METHODS: The study design was a mixed cohort, including a prospective group of patients treated with GCN (Expert Tibial Nail PROtect™, Depuy Synthes, Johnson&Johnson Company Inc, New Jersey, USA) and a retrospectively evaluated group treated with non-gentamicin-coated nail (NGCN). Patients with at least 12 months of follow-up were included. The treatment protocol consisted of timely administration of antibiotics, surgical debridement, and early soft-tissue coverage. Exclusion criteria included protocol infringement, traumatic amputation, and loss of follow-up. Statistical analysis was performed using Stata v14.0, with a significance level of p < 0.05. RESULTS: The study included 243 patients, 104 in GCN group and 139 NGCN group. External Fixator use was higher in the NGCN group, but this did not significantly affect the FRI rate. GCN use was associated with a significantly lower incidence of FRI (2.88% GCN group vs. 15.83% NGCN group, OR 0.16, p < 0.01). Furthermore, GCN use was found to be a protective factor against tibial non-union (OR 0.41, p = 0.03). There were no adverse effects attributed to locally administered gentamycin. The NGCN cohort had a higher incidence of polytrauma, although the difference was not statistically significant. A longer time to heal as well as more FRI and Non-union according to the progression in Gustilo-Anderson classification was observed in the GCN group. CONCLUSION: Our findings suggest that GCN is an effective prophylactic method to reduce the risk of FRI in open tibial fractures at 12-month follow-up, as well as, probably derived from this protective effect, leading to lower fracture consolidation times when compared with cases treated without GCN.
Subject(s)
Fractures, Open , Tibial Fractures , Humans , Tibia , Retrospective Studies , Treatment Outcome , Surgical Wound Infection/therapy , Tibial Fractures/complications , Tibial Fractures/surgery , Fractures, Open/complications , Fractures, Open/surgery , Gentamicins , Fracture HealingABSTRACT
OBJETIVO Describir el resultado funcional informado por el paciente de una cohorte de pacientes sometidos a artroplastia unicompartimental de rodilla (AUR) en un hospital universitario chileno. MÉTODOS Se diseñó un estudio de cohorte histórica. Se incluyeron todos los pacientes que se sometieron a AUR de platillo fijo entre 2003 y 2019. Un evaluador independiente se puso en contacto con los pacientes en junio de 2020. Se utilizó el índice de artritis de las universidades de Western Ontario y McMaster (WOMAC) para comparar los procedimientos de AUR (medial o lateral), la edad (mayor o menor de 70 años), y el seguimiento (más o menos de 5 años). RESULTADOS Se incluyeron 78 pacientes, en un total de 94 AURs. La mediana de edad fue de 64 años (rango: 43 a 85 años). Hubo 72 (76,6%) casos de AUR medial. Un paciente necesitó revisión para artroplastia total de rodilla (ATR). Un total de 60 pacientes (76,9%), correspondientes a 72 AURs (76,7%), fueron contactados con éxito por teléfono para el seguimiento final. La mediana del puntaje en los dominios del WOMAC fue: dolor 1 (rango: 0 a 12); rigidez 0 (rango: 0 a 4); y función física 2 (rango: 0 a 29). La mediana del puntaje total en el WOMAC fue de 4 (rango: 0 a 44). Los pacientes sometidos a AUR lateral lograron mejores puntuaciones funcionales (p » 0,0432), y el puntaje total en el WOMAC fue similar en pacientes mayores o menores de 70 años (p » 0,3706). CONCLUSIONES La AUR es un tratamiento eficaz y reproducible para pacientes con artrosis de rodilla unicompartimental. La edad parece no afectar los resultados funcionales, y la AUR es un tratamiento eficaz en pacientes mayores de 70 años. Estos resultados deberían animar a los cirujanos de rodilla a aprender esta técnica y a los responsables de las políticas de salud pública a considerar la AUR para la osteoartritis de rodilla.
PURPOSE To describe the patient-reported functional outcome of a cohort of patients undergoing unicompartmental knee arthroplasty (UKA) in a Chilean university hospital. METHODS A historical cohort study was designed. All patients who underwent fixedbearing UKA between 2003 and 2019 were included. An independent evaluator contacted the patients in June 2020. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) was used to compare UKA procedures (medial or lateral), age (over or under 70 years), and follow up (longer or shorter than 5 years). RESULTS A total of 78 patients, corresponding to 94 UKAs, were included. The median age was 64 years (range: 43 to 85 years). There were 72 (76.6%) cases of medial UKA. One patient needed revision to total knee arthoplasty (TKA). A total of 60 patients (76.9%), corresponding to 72 UKAs, were successfully contacted by phone for the final follow-up. The median scores on the WOMAC domains were: pain 1 (range: 0 to 12); stiffness 0 (range: 0 to 4); and physical function 2 (range: 0 to 29). The median total score on the WOMAC was 4 (range: 0 to 44). Patients submitted to lateral UKA had better functional scores (p » 0.0432), and the total WOMAC score was similar among patients older or younger than 70 years of age (p » 0.3706). CONCLUSIONS For patients with unicompartmental knee osteoarthritis, UKA is an effective and reproducible treatment. Age does not seem to affect the functional results, and UKA is an effective treatment in patients over 70 years old. These results should encourage knee surgeons to learn this technique and those responsible for public health policies to consider UKA for knee osteoarthritis
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Arthroplasty, Replacement, Knee/methods , Magnetic Resonance Imaging , Chile/epidemiology , Osteoarthritis, Knee/surgery , Osteoarthritis, Knee/epidemiology , Osteoarthritis, Knee/diagnostic imaging , Patient Outcome AssessmentABSTRACT
OBJETIVOS: Estimar un modelo predictivo para la no-unión en pacientes que presentan fractura de tibia. MATERIALES Y MÉTODOS: Estudio de cohorte retrospectivo, en pacientes con fractura de tibia operadas entre 2012 y 2018, con un mínimo de 12 meses de seguimiento, excluyendo amputaciones traumáticas. Realizamos un modelo de regresión logística con 13 variables descritas en la literatura. Se descartaron las variables estadísticamente no significativas y las que no causaban efecto de confusión. Se evaluó la bondad de ajuste mediante el test de Hosmer-Lemeshow y la discriminación del modelo con la curva ROC. RESULTADOS: Se incluyeron 411 fracturas de tibia, las variables estadísticamente significativas fueron: exposición ósea OR » 2,57(IC:1,155,75, p » 0,022), diabetes OR » 3,29 (IC:1,377,91, p » 0,008) y uso de tutor externo OR » 1,77(IC:0,813,85), el que tuvo efecto de confusión. La bondad de ajuste demostró que los datos se ajustan adecuadamente al modelo (p » 0,35). La curva ROC demuestra un 70,91% de poder discriminatorio. Al evaluar aisladamente las fracturas expuestas, no hubo asociación estadísticamente significativa con ninguna variable. DISCUSIÓN: Al evaluar el modelo, obtuvimos una asociación estadísticamente significativa entre: no unión, exposición ósea, diabetes y uso de tutor externo, información concordante con la literatura. Al estudiar el subgrupo de fracturas expuestas, las demás variables son estadísticamente no significativas. Eso refleja que la exposición ósea es la variable que confiere mayor riesgo. El seguimiento adecuado de esos pacientes es fundamental dado este alto riesgo de evolucionar con no-unión. CONCLUSIÓN: En nuestra serie, la exposición ósea es el factor de riesgo más importante para presentar no unión de tibia.
OBJECTIVES: Estimate a predictive model for non-union in patients presenting with a tibial fracture. MATERIALS AND METHODS: Retrospective cohort study in patients with tibia fractures operated between 2012 and 2018, with a minimum follow-up of 12 months, excluding traumatic amputations. We performed a multivariate logistic regression model with 13 variables described in the literature. The variables that were statistically non-significant and those variables that do not cause confusion, were discarded. Goodness of fit was evaluated using the Hosmer-Lemeshow test and the discrimination of the model with the ROC curve. RESULTS: 411 tibial fractures were included, the statistically significant variables were: bone exposure OR » 2.57(CI:1.155.75, p » 0.022), diabetes OR » 3.29(CI:1.377.91, p » 0.008) and use of external fixation OR » 1.77(CI:0.813.85), being included in the model because of its confounding effect. Goodness of fit demonstrates that the data fit the model adequately(p » 0.35). The ROC curve demonstrates 70.91% discriminatory power. When evaluating the exposed fractures in isolation, there was no statistically significant association with any variable. DISCUSSION: When evaluating the model, we obtained a statistically significant association between non-union, bone exposure, diabetes and use of external fixation, being consistent with the literature. When studying the subset of exposed fractures, the other variables are statistically non-significant. This reflects that bone exposure is the variable that confers the greatest risk. Proper follow-up of these patients is essential given this high risk of evolving with non-union. CONCLUSION: In our series, bone exposure is the most important risk factor for presenting tibial non-union.