RESUMO
INTRODUCTION: Surgery for proximal femoral fractures in the Netherlands is performed by trauma surgeons, general surgeons and orthopaedic surgeons. The aim of this study was to assess whether there is a difference in outcome for patients with proximal femoral fractures operated by trauma surgeons versus general surgeons. Secondly, the relation between hospital and surgeon volume and postoperative complications was explored. METHODS: Patients of 18 years and older were included if operated for a proximal femoral fracture by a trauma surgeon or a general surgeon in two academic, eight teaching and two non-teaching hospitals in the Netherlands from January 2010 until December 2013. The combined endpoint was defined as reoperation or surgical site infection. Multivariate analysis was used to adjust for patient and fracture characteristics and hospital and surgeon volume. Categories for hospital volume were>170/year (high volume), 96-170/year (medium volume) and <96/year (low volume). RESULTS: In 4552 included patients 2382 (52.3%) had surgery by a trauma surgeon. Postoperative complications occurred in 276 (11.6%) patients operated by a trauma surgeon and in 258 (11.9%) operated by a general surgeon (p=0.751). When considering confounders in a multivariate analysis, surgery by trauma surgeons was associated with less postoperative complications (OR 0.746; 95%CI 0.580-0.958; p=0.022). Surgery in high volume hospitals was also associated with less complications (OR 0.997; 95%CI 0.995-0.999; p=0.012). Surgeon volume was not associated with complications (OR 1.008; 95%CI 0.997-1.018; p=0.175). CONCLUSION: Surgery by trauma surgeons and high hospital volume are associated with less reoperations and surgical site infections for patients with proximal femoral fractures.
Assuntos
Competência Clínica/normas , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas , Reoperação/estatística & dados numéricos , Cirurgiões , Infecção da Ferida Cirúrgica/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Fêmur/epidemiologia , Fixação Interna de Fraturas/métodos , Fixação Interna de Fraturas/normas , Cirurgia Geral , Humanos , Masculino , Países Baixos/epidemiologia , Procedimentos Ortopédicos , Seleção de Pacientes , Complicações Pós-Operatórias , Índices de Gravidade do Trauma , Resultado do TratamentoRESUMO
A 41-year-old woman presented to our emergency department after she tripped over a doorstep. Physical examination showed swelling and a stepladder deformity of the left little finger. Radiographs confirmed dorsal dislocation in both interphalangeal joints. Closed manual reduction under local anaesthesia restored position and function of the finger.
Assuntos
Acidentes por Quedas , Traumatismos dos Dedos/diagnóstico , Articulações dos Dedos/patologia , Luxações Articulares/diagnóstico , Adulto , Serviço Hospitalar de Emergência , Feminino , Traumatismos dos Dedos/terapia , Humanos , Luxações Articulares/terapia , Exame FísicoRESUMO
BACKGROUND: The condition of pneumatosis intestinalis is characterized by gas in the intestinal wall, with a variety of causes. CASE: A septic patient with intestinal pneumatosis, locally advanced ovarian cancer, and Sister Joseph's Nodule. CONCLUSION: The clinical significance of this rare combination of symptoms and signs is discussed.
