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INTRODUCTION: Purpose of the study was to answer the question, if there are common fracture or injury characteristics, which help to identify patient at risk for a secondary compartment syndrome. MATERIALS AND METHODS: Between 2003 and 2022 all children and adolescents who were treated for a traumatic compartment syndrome in a lower extremity were retrospectively evaluated. Patient's demographics were recorded, the underlying trauma mechanism identified. Fractures were classified, treatment and complications were analyzed. We differentiated two groups of patients (early onset vs. late onset) and compared trauma mechanism, fracture location, classification and treatment between those two entities. RESULTS: Our collective consisted of 56 children and adolescents with 67 compartment syndromes, with an average age of 14.1 years (5-17). 41 (73.2 %) of the patients were male and 15 (26.8 %) female. Most people in our sample had previously been involved in traffic accidents (64.3 %), with the most common mechanism of injury being "motorbike accident" (34.3 %) and "pedestrian/cyclist accident against car" (26.9 %). There was an accumulation of fractures of the lower leg, in particular tibial shaft fractures (AO 42 and 43A; 49.3 %). In our survey, dislocated fractures and fractures of the foot always led to an early onset of compartment syndrome. The tibial shaft fracture and the surgical treatment with intramedullary nailing showed a significant frequency in the late onset group. CONCLUSIONS: Special attention should be paid to pediatric and adolescent patients with tibial shaft fracture and surgical treatment with intramedullary nailing in order to detect and treat a possible late onset of a compartment syndrome at an early stage.
Subject(s)
Compartment Syndromes , Humans , Adolescent , Male , Female , Child , Retrospective Studies , Compartment Syndromes/etiology , Compartment Syndromes/surgery , Child, Preschool , Lower Extremity/injuries , Lower Extremity/surgery , Fractures, Bone/surgery , Fractures, Bone/epidemiology , Leg Injuries/surgery , Tibial Fractures/surgery , Tibial Fractures/complications , Risk Factors , Accidents, Traffic/statistics & numerical dataABSTRACT
BACKGROUND: This study analysed changes in gait and pedobarography and subjective and functional outcomes after isolated Chopart joint injury. METHODS: The results of 14 patients were reviewed. Kinematic 3D gait analysis, comparative bilateral electromyography (EMG) and pedobarography were performed. RESULTS: On the injured side, the 3D gait analysis showed a significantly increased internal rotation and decreased external rotation of the hip and significantly decreased adduction and decreased range of motion (ROM) for the ankle. On the healthy side, the pedobarography revealed a significantly increased mean force in the forefoot, an increased peak maximum force and an increased maximum pressure in the metatarsal. When standing, significantly more weight was placed on the healthy side. The EMG measurements showed no significant differences between the healthy and injured legs. CONCLUSIONS: After isolated Chopart injuries, significant changes in gait and pedobarography can be seen over the long term.
Subject(s)
Gait , Humans , Male , Adult , Biomechanical Phenomena , Female , Gait/physiology , Middle Aged , Young Adult , Electromyography , Range of Motion, Articular , Ankle Injuries/physiopathology , Gait Analysis/methods , Ankle Joint/physiopathologyABSTRACT
Introduction: The possibility of balancing career and family is meanwhile a central concern for most physicians when choosing a job. The aim of this study was to identify current barriers and opportunities for physician education and career planning. Methods: This cross-sectional study was conducted as an online survey between 11/2021 and 02/2022 and targeted physicians at all career levels in Germany who were members of a clinical professional association. Alternative and consent questions were used to assess experiences/attitudes toward various aspects of life and career planning, as well as alternative work and parental leave models, depending on gender, specialty, and hierarchical level. Results: The majority of the 2060 participants were female (69%) and had children (66%). Many childless residents reported that they felt they had to choose between children and a career. The majority of female residents, specialists and attending physicians (Ø 55.5%) stated that they had experienced career losses as a result of taking parental leave, while most men did not share this experience (Ø 53.7%). 92% of all participants agreed with the statement that men and women have different career opportunities. Job-sharing models were considered feasible at all levels of the hierarchy by an average of 55.6% of all medical executives. Conclusion: Parenthood and the use of parental leave and part-time work appear to have a significant impact on the career paths of those surveyed. Although the majority of directors of medical training programs are open to job-sharing models, further measures are needed in order to equalize career opportunities for men and women.
Subject(s)
Medicine , Physicians , Child , Humans , Male , Female , Cross-Sectional Studies , Career Choice , Gender Identity , Surveys and QuestionnairesABSTRACT
BACKGROUND: Chronic pain after trauma and surgery is a long-term complication. Its relevance for patients within the workers' compensation rehabilitation process has not been adequately investigated. OBJECTIVES: Initial evaluation of frequency of chronic pain after occupational accidents. METHODS: In 2017, surgical inpatients (18-65 y) treated in a tertiary hospital were asked about chronic pain arising from an occupational trauma recognized by statutory occupation insurance (interval 2.8±6.9 years), regardless of care received, first at the time of hospitalization and then by telephone interview 6 months later. The focus was on patients with a work-related trauma (A) within the past month or (B) >6 months. PRIMARY OUTCOME: frequency of work trauma-related chronic pain (>6 months) at the initial interview (point prevalence), secondary outcomes: frequency of chronicity at 6 months (A) and persistence of chronic pain (B). Tertiary outcomes: ability to work, occupational injury classification, burden based on pain intensity, localization, and medication, functional deficits due to the existence of chronic pain, and comorbidity. RESULTS: Out of 415 patients included in the survey, 85% (160/188) reported accident-related chronic pain (predominantly moderate to highly severe in intensity, localized at joints and bones). 90% (131/145) also reported this pain six months later. 67% (64/96) reported chronic pain for the first time. Patients with chronic pain at follow-up (281/369) were less likely to return to work (p=0.003), required analgesics in 60%, were more often comorbid (p<0.002) and had greater functional deficits (p<0.002). CONCLUSION: Despite the preliminary nature of the data, chronic pain seems to be common after occupational trauma and negatively affects the recovery of work ability in the long term. Based on the present observational data, a further differentiated re-evaluation of prospective data considering therapeutic measures is strongly recommended.
Subject(s)
Chronic Pain , Occupational Diseases , Humans , Workers' Compensation , Chronic Pain/epidemiology , Disability Evaluation , Prospective Studies , Occupational Diseases/epidemiology , Germany/epidemiologyABSTRACT
Purpose: Purpose of the study was to report the outcomes after radial head excision in children and adolescents in addition with a review of the current literature. Methods: We report a series of five children and adolescents, who had undergone a post-traumatic radial head excision. Clinical outcomes were evaluated in terms of elbow/wrist range of motion, stability, deformity and discomforts or restrictions at two follow-up points. Radiographic changes were evaluated. Results: Patient's age at time of the radial head excision averaged 14.6 (13-16) years. Mean time from the injury to the radial head excision was 3.6 (0-9) years. Follow-up I averaged 4.4 (1-8) years and follow-up II 8.5 (7-10) years. At follow-up I, patients showed an average elbow range of motion of 0-10-120° Ext/Flex and 90-0-80° Pro/Sup. Two patients reported discomfort or pain at the elbow. Four (80%) patients had a symptomatic wrist with pain or crepitation at the distal radio ulnar joint. In three (60%) of them, an ulna plus at the wrist was present. Two patients required ulna shortening and autograft stabilization of the interosseous membrane. At final follow-up, all patients reported full functioning with daily activities. Restrictions were present with sport activities. Conclusion: Functional results at the elbow joint might be improved and pain syndromes lessen due to the radial head excision. Problems at the wrist are likely secondary to the procedure. A critical analysis of other options should be performed ahead of the procedure and a careless application should be avoided by all means. Level of evidence: IV.
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BACKGROUND: The aim of this retrospective study was to analyze gait kinematicsandoutcome parameters after knee arthrodesis. METHODS: Fifteenpatients with a mean follow-up of 5.9 (range0.8-36) years after unilateral knee arthrodesis were included. A 3D gait analysis was performed and compared to a healthy control group of14patients. Comparative electromyography was performed bilaterally at the rectus femoris, vastuslateralis/medialisand tibialis anterior muscles. The assessment further included standardized outcome scores- Lower Extremity Functional Scale (LEFS) andShort Form Health Survey (SF-36). RESULTS: The 3D analysis showed a significantly shortened stance phase (p = 0.000), an extended swing phase (p = 0.000), and an increased time per step (p = 0.009) for the operated side compared with thenonoperatedside. There were statistically significant differences in the extent of movement of the hips, knees and ankles among the operated andnonoperatedsides and the control group. For the mean EMG measurement, no significant difference was found between the healthy control group and the patients with arthrodesis.The average LEFSscorewas 27.5 ± 10.6out of a maximum of 80 points,and the mean physical total scale and mean emotional total scale scores for the SF-36 were 27.9 ± 8.5and 52.9 ± 9.9, respectively. CONCLUSIONS: Arthrodesis of the knee joint causes significant kinematic changes in gait pattern,and patients achieve poor results in subjective and functional outcomes(SF- 36, LEFS).Arthrodesis ensures that the extremities are preserved and can enable walking, but it must be viewed as a severe handicap for the patient.
Subject(s)
Gait , Knee Joint , Humans , Biomechanical Phenomena , Retrospective Studies , Gait/physiology , Knee Joint/surgery , Muscle, Skeletal , Arthrodesis , Patient Reported Outcome Measures , Range of Motion, Articular/physiologyABSTRACT
The development of increasingly more complex computer and electromotor technologies enables the increasing use and expansion of robot-assisted systems in trauma surgery rehabilitation; however, the currently available devices are rarely comprehensively applied but are often used within pilot projects and studies. Different technological approaches, such as exoskeletal systems, functional electrical stimulation, soft robotics, neurorobotics and brain-machine interfaces are used and combined to read and process the communication between, e.g., residual musculature or brain waves, to transfer them to the executing device and to enable the desired execution.Currently, the greatest amount of evidence exists for the use of exoskeletal systems with different modes of action in the context of gait and stance rehabilitation in paraplegic patients; however, their use also plays a role in the rehabilitation of fractures close to the hip joint and endoprosthetic care. So-called single joint systems are also being tested in the rehabilitation of functionally impaired extremities, e.g., after knee prosthesis implantation. At this point, however, the current data situation is still too limited to be able to make a clear statement about the use of these technologies in the trauma surgery "core business" of rehabilitation after fractures and other joint injuries.For rehabilitation after limb amputation, in addition to the further development of myoelectric prostheses, the current development of "sentient" prostheses is of great interest. The use of 3D printing also plays a role in the production of individualized devices.Due to the current progress of artificial intelligence in all fields, ground-breaking further developments and widespread application possibilities in the rehabilitation of trauma patients are to be expected.
Subject(s)
Exoskeleton Device , Robotics , Humans , Artificial Intelligence , Gait/physiology , ParaplegiaABSTRACT
INTRODUCTION: There is not much data on traumatic spinal cord injuries sustained during sports in Germany. This study aims to present the frequency of traumatic spinal cord injuries with neurological involvement within various sports over the past 22 years. METHODS: This study is a retrospective evaluation of traumatic spinal cord injuries (tSCI) in sports sustained in the past 22 years. The study was performed by a German level 1 trauma centre with a department for spinal cord injuries. The files of inpatients treated in the years 1998 to 2020 were evaluated with regard to patients' histories and traumatic spinal cord injuries. In addition, injury location and gender distribution were recorded. RESULTS: A total of 1630 patients with traumatic spinal cord injuries with neurological involvement were recorded. Of the 1630 patients, N=116 (7.1%) had had sports accidents. The age of this subpopulation was significantly younger at 41 years (p=0.05) than the age of the total group of tSCI at 50 years. A more detailed analysis of the sports injuries showed that in descending order equestrian sports (N=22), winter (N=18), air (N=16), motor sports (N=16) and cycling (N=15) were the most common causal factors for these particularly serious spinal injuries. As regards the distribution of the location of the spinal cord injury with a view to the type of sports practiced, a significant result was shown in aerial sports, with patients from this group mainly having had lumbar spine injuries (p <0.01), and in diving with cervical spine injuries (p=0). Gender distribution in the individual sports shows a significant difference in equestrian sports (male < female, p <0.01) as well as a significant difference in air sports (male > female, p = 0.05) and cycling (male > female, p=0.07). CONCLUSION: In summary, equestrian sports is the most common cause of spinal cord injuries with neurological involvement in the sports sector with a higher proportion of female participants, although the proportion of female patients is smaller compared with male patients in the section of traumatic spinal cord injuries. Winter (N=18), air (N=16), motor sports (N=15) and cycling (N=15) come next in descending order.Patients with traumatic spinal cord injuries caused by sports accidents are significantly younger than the entirety of patients with traumatic spinal cord injuries.
Subject(s)
Spinal Cord Injuries , Spinal Injuries , Humans , Male , Female , Adult , Middle Aged , Trauma Centers , Retrospective Studies , Spinal Cord Injuries/diagnosis , Spinal Cord Injuries/epidemiology , Spinal Cord Injuries/etiology , Spinal Injuries/diagnosis , Spinal Injuries/epidemiology , Spinal Injuries/complications , AccidentsABSTRACT
BACKGROUND: Fractures of the anterior process of the calcaneus are often missed, and their treatments and results receive little attention in the current literature. The aim of this study was to specify treatment algorithms through a modification of the Degan classification. METHODS: Between 2009 and 2019, patients with APC fractures were retrospectively analyzed. The Degan classification was used and modified. Type III fractures were further divided into subgroups A (not displaced) and B (displaced). The type of treatment and complications were recorded. Return to work and posttraumatic osteoarthritis were determined as primary and secondary outcome parameters, respectively. RESULTS: Forty-one patients with 43 fractures were included. Follow-up averaged 35,5 months (range 1,5-152 months). Fractures were eight type I, six type II, 15 type IIIA and 14 type IIIB. The fracture was initially recognized in 29 (70,7%) patients, and missed in 12 (29,3%) patients, respectively. Overall, the delayed diagnosed fractures had a significantly higher complication rate (p < 0,000) than the initially diagnosed fractures and received surgical treatment significantly (p < 0,009) more often. After surgical treatment of 13 type IIIB, one nonunion occurred. Six missed type IIIA fractures were treated surgically after delayed diagnosis because of persistent symptoms. Two type I fractures required arthrodesis of the Chopart joint. Four patients did not return to work during the follow-up (3 missed type IIIA fractures, 1 type II fracture). CONCLUSION: Missed APC type IIIA fractures are at risk to develop complications, which is why computed tomography diagnostics should be performed if there is any clinical suspicion.
Subject(s)
Calcaneus , Fractures, Bone , Humans , Calcaneus/diagnostic imaging , Calcaneus/surgery , Retrospective Studies , Fractures, Bone/diagnostic imaging , Fractures, Bone/surgery , Fracture Fixation, Internal/methods , Algorithms , Treatment OutcomeABSTRACT
INTRODUCTION: Open and closed fractures of the tibial shaft or distal tibia can be challenging for surgeons to treat if the fractures are accompanied by aggravating conditions, such as various accompanying diseases, pronounced soft tissue injuries, osteomyelitis, and/or noncompliance. The aim of this retrospective study was to present our approach and results with the Ilizarov fixator as a treatment option for such individually complex cases. MATERIALS AND METHODS: Between 2005 and 2018, 20 patients were treated with the Ilizarov fixator for fractures of the tibial shaft/distal tibia. The indication for this was a 2nd- to 3rd-degree open fracture in 10 patients, a 1st-degree open fracture in one patient, and closed fractures in 9 patients. Aggravating conditions included soft tissue injuries, osteomyelitis, leg deformities, multiple traumas, smoking, alcohol/drug abuse, and obesity (BMI > 60). In addition to demographic data, the time of fixator treatment, complications, and the endpoint of consolidation were evaluated retrospectively. RESULTS: The mean time of fixator treatment was 29 (range 15-65) weeks. Complete fracture consolidation was achieved in 13 patients (65%) with the Ilizarov fixator. The mean follow-up period after fixator removal was 36 (range 2-186) months in 14 patients. Five patients with complete consolidation were lost to further follow-up. One patient was amputated. In six patients without union, internal osteosynthesis was carried out. CONCLUSION: The use of the Ilizarov fixator is a treatment option for individual high-risk patients with complicating courses but should be seen as a salvage procedure due to the high complication rate and long treatment process.
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Objectives: Despite the high proportion of female medical students, the leading positions in almost all medical departments are still considerably less often held by female clinicians than by male. The aim of this project report is to introduce a career mentoring curriculum for female clinician scientists at Ruhr-University of Bochum in Germany. Methods: The career mentoring program was developed for young female clinician scientists who aim for a leading position in academic medicine. We describe and discuss herein its planning and implementation over two years (11/2020-11/2022) focusing on the needs of the target group. Results: The mentoring program is based on an agile twin-track strategy. It includes peer mentoring, content-related input and interdisciplinary three-to-one mentoring by the coordinators. Additionally, the mentees develop and conduct a scientific project to practice their acquired skills in a protected environment. The quality assurance system of the mentoring program includes a continuous evaluation of the mentees' satisfaction with the content and organisation of the program, whose results serve as the basis of the prompt adjustment of the latter. It also includes an evaluation of the sustainable impact of the program on the mentees' career development based on an adapted role matrix. The role matrix addresses the mentees to acquire the competencies required for them to become a successful clinician, scientist and academic teacher. Conclusions: A 2-year innovative and unique career mentoring program for female clinician scientists was developed and already successfully launched. Making use of different mentoring strategies, the program has the potential to promote gender equality and encourage female physicians to pursue a career in academic medicine.
Subject(s)
Mentoring , Physicians , Curriculum , Female , Humans , Male , Mentors , Peer GroupABSTRACT
Introduction: Purpose of the study is to present and discuss the femoral neck osteotomy as a salvage procedure for unstable, locked geriatric acetabular fractures in selected frail patients. When disadvantages and possible risks of other treatments exceed the benefits, this method may relieve pain and allow for early wheelchair mobilization in frail patients with limited mobility. Materials and Methods: We report nine patients from 2008 to 2020, which were treated with an osteotomy of the femoral neck for an unstable acetabular fracture. Indications, ASA-Score, Frailty Index, operative procedure, length of hospital stay, complications and outcomes will be discussed. Results: Patient's age averaged 86 years (range 81-92). Acetabular fractures were classified as six both column fractures, two anterior column posterior hemitransversal fractures and one destruction of the acetabulum by multiple metastases. Fracture dislocation with medialization plus locking of the femoral head and a superomedial dome impaction were present in all patients. All patients were classified as ASA III/ IV and the average value on the CSHA Frailty index was 7 (range 6-7). The operation time averaged 52 min (range 34-62). Immediate wheelchair mobilization in seven out of nine patients was started postoperatively. Conclusion: The osteotomy of the femoral neck may be discussed as a salvage procedure in low functional demanding, multimorbid, frail geriatric patients with unstable acetabular fractures and impairment of mobilisation due to a locked femoral head. The procedure has the advantages of a short operation time and immediate mobilization of the patients. However, this procedure only applies as a salvage solution in selected individual cases.
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STUDY DESIGN: Retrospective study. OBJECTIVES: To analyze factors associated with major complications (MC) in patients with ankylosing spondylitis (AS) undergoing surgical management for a spine fracture. METHODS: Included were all persons with spine fractures and AS in a teriary health care center between 2003 and 2019. Clinical data and MC were characterized with descriptive characteristics. Multivariable analyses were used to find factors associated with MC. RESULTS: In total, 174 traumatic fracture incidents in 166 patients with AS were included, with a mean patient age of 70.7 ± 13.1 years. The main reason for spine fracture was minor trauma (79.9%). Spinal cord injuries (SCI) were described in 36.7% of cases. The majority of patients (54.6%) showed more than one fracture of the spine, with cervical fractures being the most common (50.5%). Overall, the incidences of surgical site infection, implant failure, nosocomial pneumonia (NP), and mortality were 17.2%, 9.2%, 31%, and 14.9%, respectively. ICU stay > 48 hours was associated with MC (including death). Posterior approach for spondylodesis, ICU stay > 48 hours and cervical SCI were related to MC (excluding death). Age > 70 years, NP and Charlson comorbidity index > 5 points were associated with in-hospital mortality. CONCLUSIONS: Patients with AS and surgical treatment of spine fractures are at high risk for MC. Therefore, our results might give physicians better insight into the incidence and sequelae of major complications and therefore might improve patient and family expectations.
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INTRODUCTION: The use of forklift trucks during work has a high accident potential. The aim of this study is to describe injury patterns, treatment and outcome after forklift truck accidents in the context of the employers' liability insurance association. METHODS: Retrospective data collection of all cases between 2004 and 2019. Excluded were patients < 18 years, without follow-up or with definitive external treatment. Trauma mechanism, injury patterns and distribution, treatment, complications, time of incapacity for work, return to work and impairment of earning capacity were recorded. RESULTS: Of 109 patients with 110 injuries, 52.7% showed isolated injuries and 47.3% combined injuries, which affected the lower extremity in 95 cases. There were fractures in 85.5%, including 32.7% in open form. The mean length of stay was 29.1 days (range 1â-â129); an indication for surgery was seen in 80.9%. Surgical treatment required an average of 3 interventions, with significantly more operations for soft tissue closure than for the fractures (p ≤ 0.023). Amputations were necessary in 8 cases; complications occurred in 29.1%. Return to work was possible in 90%, after a mean period of incapacity for work of 33.6 weeks. A total of 40% showed a pensionable impairment of earning capacity. CONCLUSION: Accidents with forklift trucks result in complex lower extremities injuries with the need of multi-stage treatment and show relatively high complication rates. A return to work is often possible after a long period of convalescence, and a pensionable impairment of earning capacity often persists.
Subject(s)
Fractures, Bone , Insurance, Accident , Accidents , Fractures, Bone/epidemiology , Fractures, Bone/surgery , Humans , Motor Vehicles , Retrospective StudiesABSTRACT
The aim of this study was to assess the functional outcome after lumbopelvic fixation (LPF) using the SMFA (short musculoskeletal functional assessment) score and discuss the results in the context of the existing literature. The last consecutive 50 patients who underwent a LPF from January 1st 2011 to December 31st 2014 were identified and administered the SMFA-questionnaire. Inclusion criteria were: (1) patient underwent LPF at our institution, (2) complete medical records, (3) minimum follow-up of 12 months. Out of the 50 recipients, 22 questionnaires were returned. Five questionnaires were incomplete and therefore seventeen were included for analysis. The mean age was 60.3 years (32-86 years; 9m/8f) and the follow-up averaged 26.9 months (14-48 months). Six patients (35.3%) suffered from a low-energy trauma and 11 patients (64.7%) suffered a high-energy trauma. Patients in the low-energy group were significantly older compared to patients in the high-energy group (72.2 vs. 53.8 years; p = 0.030). Five patients (29.4%) suffered from multiple injuries. Compared to patients with low-energy trauma, patients suffering from high-energy trauma showed significantly lower scores in "daily activities" (89.6 vs. 57.1; p = 0.031), "mobility" (84.7 vs. 45.5; p = 0.015) and "function" (74.9 vs. 43.4; p = 0.020). Our results suggest that patients with older age and those with concomitant injuries show a greater impairment according to the SMFA score. Even though mostly favorable functional outcomes were reported throughout the literature, patients still show some level of impairment and do not reach normative data at final follow-up.
Subject(s)
Fracture Fixation, Internal/methods , Joint Instability/surgery , Lumbosacral Region/surgery , Pelvis/injuries , Pelvis/surgery , Spinal Cord Injuries/surgery , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prognosis , Recovery of Function , Retrospective Studies , Review Literature as TopicABSTRACT
BACKGROUND AND AIMS: Radical surgical intervention is necessary to save patients' lives in cases of necrotizing fasciitis. This leads to persistent disabilities and most likely to a deteriorated quality of life. The purpose of this study was to evaluate the midterm outcomes after survival of necrotizing fasciitis. MATERIALS AND METHODS: A retrospective analysis of 69 patients, treated for necrotizing fasciitis between 2003 and 2012. The patients were identified using the International Classification of Diseases (10th Revision) code M 72.6. Of the 50 survivors, 22 patients completed the Short Form 36 and Short Musculoskeletal Function Assessment questionnaires as a postal survey. The follow-up averaged 59 months (range: 6-128 months). RESULTS: The average age at the time of necrotizing fasciitis was 60.0 years. The body mass index average was 29.7. The patients had a significantly decreased physical component summary score of 33.3 compared to a normative group (p < 0.001) (Short Form 36). They further showed a significantly decreased dysfunction and bother indices (Short Musculoskeletal Function Assessment) (p < 0.001). An increased age (⩾70 years) was associated with an inferior role emotional (p = 0.048) and physical functioning (p = 0.011) as well as social functioning (p = 0.038) (Short Form 36). The majority of patients (16, 72.7%) complained of pain at the final follow-up and 50% of patients required an assistive device on a regular basis. CONCLUSION: Patients who survived necrotizing fasciitis suffer from functional impairment and changed body appearance. Assistive devices or pain medication are often required, and the patients present with significantly decreased physical, social, and emotional functioning at the midterm follow-up. The patient's age is a critical factor regarding functional or mental outcome parameters. Further research on the post-hospital course and long-term multidisciplinary care is required to improve the outcomes of these patients.
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We report the case of a 13-year-old boy, who suffered a posterior hip dislocation from playing soccer. Closed reduction was performed urgently. Because of a nonconcentric hip after closed reduction, further imaging was done. An intra-articular bony fragment was identified. Arthroscopic treatment was performed. Through an anterior portal we were able to locate the intra-articular bony fragment, which was located within the region of the fovea. After lifting of the caudal enfolded labral complex, we were able to remove the fragment. Evidence of a grade 3 cartilage defect was present at the femoral head. We were able to reduce the enfolded posterior labral complex, which was stable afterwards without the necessity of additional suture fixations. The concentric hip reduction was confirmed on an anteroposterior view of the hip postoperatively. The patient was instructed to toe tip weight-bearing for 6 weeks with limited range of motion to 60° of hip flexion. Eight weeks after surgery, he was free of pain and discomforts. From our experience, the arthroscopic intervention after pediatric hip dislocation associated with intra-articular bony fragments or posterior labral complex injuries, represents to be a preferred minimally invasive method in contrast to open surgical procedures.
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INTRODUCTION: Pediatric pelvic injuries are rare. Due to anatomic differences of the immature pelvis, different injury patterns may occur as compared to adults. The purpose was to analyze the effect of skeletal maturity on pediatric pelvic injury pattern, associated injuries, and treatment intervention. PATIENTS AND METHODS: Ninety children with a pelvic injury receiving treatment at a private orthopaedic practice in association with a Level One Teaching Trauma Center, between March 2002 and June 2011, were retrospectively analyzed. Skeletal maturity was determined as closed triradiate cartilage. Forty-one (46%) were skeletally immature and 49 (54%) were skeletally mature. Mean age was 11.5 years (2-16). Fractures were 23 A2, 1 A3, 4 B1, 44 B2, 16 B3, and 2 C2 according to OTA/AO classification. OTA B and C fractures were 26 LC1 (lateral-compression), 20 LC2, 10 LC3, 4 APC1 (anterior-posterior-compression), 5 APC2, and 1 VS (vertical-shear) injury according to Young and Burgess. Treatment of the pelvic injury was operative in 28 (31%) and non-operative in 62 (69%) of children. Mechanism of injury, Injury Severity Score (ISS), deaths, and associated injuries were recorded. RESULTS: More complex and unstable injuries occurred in skeletally mature vs. immature children (pâ¯=â¯0.014). Skeletally mature children had a significantly higher rate of operative intervention (pâ¯=â¯0.009). The ISS in skeletally mature children was higher 25 (1-66) than in skeletally immature children 17 (4-43) (pâ¯=â¯0.013). 84% (41) skeletally mature and 78% (32) skeletally immature children sustained associated injuries. Twenty-two% (11) of all skeletally mature children sustained urinary tract injuries, but only 7% (3) of all skeletally immature children (pâ¯=â¯0.049). DISCUSSION: Skeletally mature children are more likely to sustain more complex injury patterns with a higher rate of operative treatment, to have a higher rate of associated injuries, and to have a higher ISS than immature patients. LEVEL OF EVIDENCE: Retrospective comparative study, Level III.
Subject(s)
Bone Development/physiology , Elasticity/physiology , Fractures, Bone/physiopathology , Orthopedic Procedures/statistics & numerical data , Pelvic Bones/physiology , Adolescent , Age Factors , Child , Child, Preschool , Female , Fractures, Bone/surgery , Humans , Injury Severity Score , Male , Pelvic Bones/injuries , Retrospective Studies , Trauma Centers , Trauma Severity Indices , Treatment OutcomeABSTRACT
BACKGROUND: The role of illicit drug abuse in total joint arthroplasty is largely unknown and is likely underestimated. Patients with drug addictions often suffer from septic osteoarthritis or a necrosis of the femoral head. Purpose of the study was to evaluate the operative management and clinical outcome of total hip replacement in patients with a history of intravenous drug abuse. METHODS: This retrospective study included 15 patients with a history of intravenous drug abuse who underwent total hip arthroplasty. A total of 6 females and 9 males with an average age of 34.3 years were identified. Ten patients presented an acute bacterial coxitis (Coxitis-group) and five an aseptic osteonecrosis of the femoral head (Osteonecrosis-group). RESULTS: Ten patients with a bacterial coxitis underwent a two-staged total hip arthroplasty (THA), with temporary insertion of a drug-eluting spacer. Five patients with a necrosis of the femoral head were primarily treated with THA. All patients developed multiple re-infections after insertion of a drug-eluting spacer or THA. Only two patients finally achieved a THA without infection in the period of 3.9 years follow-up. The other 13 patients underwent a Girdlestone arthroplasty (7 patients) or total joint replacement with a chronic fistula (6 patients). CONCLUSION: THA in patients with illicit drug abuse shows a low success rate. Following septic osteoarthritis or osteonecrosis in drug-addicted patients, we recommend a two-stage procedure with temporary insertion of a drug-eluting spacer. THA might follow only under strict premises.
Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Substance Abuse, Intravenous/complications , Adult , Female , Femur Head Necrosis/surgery , Follow-Up Studies , Hip Joint/microbiology , Hip Joint/surgery , Hip Prosthesis/microbiology , Humans , Male , Osteomyelitis/surgery , Patient Compliance , Postoperative Complications , Prosthesis-Related Infections/etiology , Recurrence , Reoperation/statistics & numerical data , Retrospective StudiesABSTRACT
The outcomes of pediatric talus fractures have been minimally reported in published studies. The purpose of the present retrospective study was to determine the clinical and radiographic outcomes after talus fractures in pediatric and adolescent patients and to define the differences among the different age groups in this population. A total of 52 children and adolescents (54 fractures) with 24 type 1 (44.44%), 13 type 2 (24.07%), 8 type 3 (14.81%), and 9 type 4 (16.67%) Marti-Weber fractures were considered. Of the 52 patients, 19 (35.19%; 21 talus fractures) with follow-up data available for >12 months were included in the final study population. Of the 21 fractures, 9 (42.86 %) were type 1, 4 (19.05%) were type 2, 1 (4.76%) was type 3, and 7 (33.33%) were type 4. The mean patient age was 14.7 (range 4 to 18) years. The patients were divided into 3 age groups: group 1, age ≤11.9 years; group 2, age 12.0 to 15.8 years; and group 3, age 16.1 to 18.0 years. Of the 21 fractures, 3 (14.29%) were treated nonoperatively and 18 (85.71%) operatively. The overall mean follow-up duration was 40.3 (range 14 to 95) months. The outcomes of interest included fracture nonunion, talar avascular necrosis, ankle range of motion, pain, arthrosis, and arthrodesis. After treatment, the mean ankle range of motion was 20° (range 0° to 35°) of dorsiflexion and 40° (range 0° to 45°) of plantarflexion. Complications included persistent pain in 10 fractures (47.62%), 3 cases of nonunion (14.29%), 3 cases of avascular necrosis (14.29%; of which, 1 [4.76%] required ankle and subtalar fusion), and arthrosis developing in ≥1 surrounding joint in 12 fractures (57.14%). Of the 12 fractures in group 3, 9 (75.00%) developed arthrosis and 2 (16.67%) subsequently required arthrodesis. Our observations suggest that the incidence of displaced talus fractures, as well as complications, increases with patient age.