RESUMO
Clinical governance is the structured approach to maintaining and improving the quality of patient care and is a vital part of global surgery. BFIRST and BSSH closely collaborate with local doctors on a number of overseas projects, seeking to strengthen and develop local knowledge and skills, aiming for an independent local practice in reconstructive and upper limb surgery. Thoughts on essential requirements, improvements and pitfalls in the ethical approach to global collaboratives are presented.
Assuntos
Missões Médicas/organização & administração , Procedimentos de Cirurgia Plástica/normas , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Assistência ao Convalescente , Fortalecimento Institucional/organização & administração , Saúde Global , Humanos , Consentimento Livre e Esclarecido , Garantia da Qualidade dos Cuidados de Saúde/métodosRESUMO
Isolated lesser trochanter fractures are a rare presentation of hip fractures in the elderly. Classically, lesser trochanter fractures in adults are associated with tumours and result from little or no trauma. We present three elderly osteoporotic ladies who sustained isolated fractures of the lesser trochanter secondary to a definite history of trauma. Radiologically, none of them showed any evidence of pathological lesions or intertrochanteric fracture at presentation. Two patients subsequently developed displaced intertrochanteric fractures, which necessitated internal fixation. In the third patient, a dynamic hip screw (DHS) was inserted before mobilisation. Based on this experience, we recommend careful observation and follow-up of such cases and suggest that isolated lesser trochanteric fractures in the elderly osteoporotic population may be an indication for prophylactic DHS fixation.
Assuntos
Parafusos Ósseos , Fraturas do Quadril/cirurgia , Acidentes Domésticos , Idoso , Idoso de 80 Anos ou mais , Evolução Fatal , Feminino , Fixação Interna de Fraturas , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/etiologia , Humanos , Osteoporose/complicações , Osteoporose/cirurgia , Complicações Pós-Operatórias/cirurgia , RadiografiaAssuntos
Síndromes Compartimentais/etiologia , Exercício Físico , Antebraço , Doença Crônica , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/fisiopatologia , Síndromes Compartimentais/cirurgia , Edema/diagnóstico , Edema/etiologia , Edema/fisiopatologia , Edema/cirurgia , Exercício Físico/fisiologia , Teste de Esforço , Fáscia/patologia , Fasciotomia , Fibrose , Antebraço/patologia , Antebraço/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/patologia , Músculo Esquelético/cirurgia , Necrose , Transdutores de PressãoRESUMO
A clinical algorithm was developed to help to establish a diagnosis in patients with chronic wrist pain. The accuracy of the algorithm was examined in a prospective blind study of 40 patients presenting to the Hand Unit with undiagnosed wrist pain and compared with the later findings at arthroscopy, which were believed to be as accurate as currently possible. Using simple examination techniques and conventional radiographs, an accurate diagnosis was made in 80% of cases. Examination techniques including the scapholunate shear test and the presence of local tenderness or pseudostability were found to be particularly accurate.
Assuntos
Algoritmos , Artralgia/diagnóstico , Articulação do Punho , Adolescente , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
A clinical algorithm was developed to help establish a diagnosis in patients with chronic wrist pain. The accuracy of the algorithm was examined in a prospective blind study of 40 patients presenting to the Hand Unit with undiagnosed wrist pain and compared with the later findings at arthroscopy, which were believed to be as accurate as currently possible. Using simple examination techniques and conventional radiographs, an accurate diagnosis was made in 80% of cases. Examination techniques including the scapho-lunate shear test and the presence of local tenderness or pseudostability were found to be particularly accurate.
Assuntos
Algoritmos , Dor/diagnóstico , Articulação do Punho/patologia , Adolescente , Adulto , Idoso , Artroscopia , Ossos do Carpo/diagnóstico por imagem , Ossos do Carpo/patologia , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/patologia , Doença Crônica , Árvores de Decisões , Feminino , Humanos , Artropatias/diagnóstico , Artropatias/diagnóstico por imagem , Luxações Articulares/diagnóstico , Luxações Articulares/diagnóstico por imagem , Osso Semilunar/diagnóstico por imagem , Osso Semilunar/patologia , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico por imagem , Estudos Prospectivos , Radiografia , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/patologia , Amplitude de Movimento Articular , Método Simples-Cego , Ulna/diagnóstico por imagem , Ulna/patologia , Articulação do Punho/diagnóstico por imagemRESUMO
In all, 23 capitellocondylar total elbow replacements were performed in 18 patients with rheumatoid arthritis. Follow-up was for a mean (range) of 3 (1.5-5) years. Pain relief was achieved in all patients and the postoperative range of movement showed an improvement in all directions. No evidence of radiological loosening has been seen. Complications consisted of a transient ulnar nerve palsy in 15 elbows (65%) and a permanent ulnar nerve palsy in one elbow (4%). In two elbows there was delayed wound healing.
Assuntos
Artrite Reumatoide/cirurgia , Articulação do Cotovelo/cirurgia , Prótese Articular , Desenho de Prótese , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We reviewed 37 consecutive patients who have had Moore's pins removed from the hip as an elective procedure. Ten cases were bilateral giving a total of 47 hips from which pins were removed. Complications were encountered in 19 hips (40%). The most common complication was pin breakage.
Assuntos
Pinos Ortopédicos , Epifise Deslocada/cirurgia , Fraturas do Quadril/cirurgia , Pré-Escolar , Epifise Deslocada/diagnóstico por imagem , Feminino , Fraturas do Quadril/diagnóstico por imagem , Humanos , Lactente , Masculino , Metais , Complicações Pós-Operatórias , Radiografia , Estudos Retrospectivos , Fatores de Risco , Fatores de TempoRESUMO
A retrospective review of 70 cases of bone and joint tuberculosis seen between 1978 and 1987 is reported. Forty-nine of the cases were patients of Indian subcontinent ethnic origin. There was a wide range of sites affected. Pain, swelling or sinus formation were the commonest presenting features. Delay in diagnosis from the first hospital visit was significantly longer in the Caucasian population (mean delay; Caucasian 17.6 weeks, Indian subcontinent 2.8 weeks). Drug treatment was used in all cases, combined with biopsy in 21 cases and more radical surgery in 28 cases. The results of treatment were good with low morbidity and mortality, long-term problems have been few, and no relapses have occurred. Nine months of chemotherapy and the joint system of orthopaedic and medical management employed locally are strongly recommended.
Assuntos
Tuberculose Osteoarticular , Adolescente , Adulto , Idoso , Criança , Inglaterra , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tuberculose Osteoarticular/mortalidade , Tuberculose Osteoarticular/terapiaAssuntos
Tuberculose Osteoarticular/diagnóstico , Adulto , Idoso , Bursite/etiologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Sinovite/etiologiaRESUMO
We have reviewed the pre-operative radiological appearances, the type of operation performed and the results of surgery of 234 wrists in 179 patients with rheumatoid arthritis. Based on this, a classification of X-rays of the rheumatoid wrist is described. It is designed to provide practical guidance to the surgeon who is planning surgery in a patient with rheumatoid disease. The surgical choices at each stage of the disease are briefly discussed.