RESUMO
PURPOSE: To compare complication rates for distal radius fractures treated operatively versus nonsurgical in patients older than 65 years. We hypothesized that surgical intervention would improve fracture alignment, but it would be associated with more complications and equivalent functional outcomes when compared with the nonsurgical group. METHODS: Patients (operative, n = 129) and controls (nonsurgical, n = 129) were identified from a prospective clinical and operating room database. They were matched on fracture severity (AO-A/B/C1 vs AO-C2/C3), sex, age, and energy of injury. Data on complications were extracted from medical charts using a validated complications checklist, and radiologic data were collected for all patients. Functional outcomes (Patient-Related Wrist Evaluation) at 1 year were available in only a subset of patients. We determined differences in complication and reoperation rates using a chi-square test. RESULTS: A significant number of patients experienced complications in the operative group (operative = 37 of 129; nonsurgical = 22 of 129). The most common complication was median neuropathy (n = 8 operative; n = 14 nonsurgical), followed by surgical site infections (n = 16 operative; 12 of 16 were pin site infections) and complex regional pain syndrome (n = 4 operative; 3 nonsurgical). The complication rate in patients treated with volar plate was 22% (16 of 74), for dorsal plate it was 50% (2 of 4), for external fixation it was 42% (16 of 38), and for percutaneous pinning it was 23% (3 of 13). The number of patients requiring reoperations was similar in both groups (11 [9%] operative; 7 [5%] nonsurgical). Our secondary radiologic and functional outcomes demonstrate that despite a higher incidence of malunion in nonsurgical patients (nonsurgical: 69% vs operative: 29%), a subset of patients from both groups (n = 140) had minimal pain and disability at 1 year (Patient-Related Wrist Evaluation operative: 16.9 ± 23.2; nonsurgical: 15.7 ± 17.5). CONCLUSIONS: In a study matching fracture severity, sex, age, and energy of injury, we found that elderly patients with distal radius fractures who underwent surgery had higher complication rates than those treated nonsurgically. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
Assuntos
Fixação Interna de Fraturas/efeitos adversos , Fraturas Intra-Articulares/cirurgia , Fraturas do Rádio/reabilitação , Fraturas do Rádio/cirurgia , Amplitude de Movimento Articular/fisiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Placas Ósseas , Distribuição de Qui-Quadrado , Estudos Transversais , Bases de Dados Factuais , Feminino , Seguimentos , Fixação Interna de Fraturas/métodos , Consolidação da Fratura/fisiologia , Humanos , Escala de Gravidade do Ferimento , Fraturas Intra-Articulares/diagnóstico por imagem , Masculino , Medição da Dor , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , Articulação do Punho/fisiopatologia , Articulação do Punho/cirurgiaRESUMO
PURPOSE: The purpose was to review the literature on the outcomes of elbow arthroscopy and to make evidence-based recommendations for or against elbow arthroscopy for the treatment of various conditions. Our hypothesis was that the evidence would support the use of elbow arthroscopy in the management of common elbow conditions. METHODS: A literature search was performed by use of the PubMed database in October 2010. All therapeutic studies investigating the results of treatment with elbow arthroscopy were analyzed for outcomes and complications. The literature specific to common elbow arthroscopy indications was summarized and was assigned a grade of recommendation based on the available evidence. RESULTS: There is fair-quality evidence for elbow arthroscopy in the treatment of rheumatoid arthritis of the elbow and lateral epicondylitis (grade B recommendation). There is poor-quality evidence for, rather than against, the arthroscopic treatment of degenerative arthritis, osteochondritis dissecans, radial head resection, loose bodies, post-traumatic arthrofibrosis, posteromedial impingement, excision of a plica, and fractures of the capitellum, coronoid process, and radial head (grade C(f) recommendation). There is insufficient evidence to give a recommendation for or against the arthroscopic treatment of posterolateral rotatory instability and septic arthritis (grade I recommendation). CONCLUSIONS: The available evidence supports the use of elbow arthroscopy in the management of the majority of conditions where it is currently used. The quality of the evidence, however, is generally fair to poor. LEVEL OF EVIDENCE: Level IV, systematic review of Level II-IV studies.
Assuntos
Artroscopia , Articulação do Cotovelo/cirurgia , Medicina Baseada em Evidências , Artropatias/cirurgia , HumanosRESUMO
Many studies have shown that computer navigation in total knee arthroplasty aids the surgeon to place the prosthesis in a more accurate overall alignment. Bony resection creates the flexion and extension gaps; important in balancing the knee and implant selection in TKR. The computer plans the bone cuts but has variables that it cannot control: the surgeon, the saw blade thickness and oscillation, the accuracy of the jigs, movement of the pins, and the quality of initial mapping data inputted by the surgeon. The accuracy of computer navigated bone resections are validated on cadavers, but this is the first study to compare the predicted bone cuts to that physically resected during TKR. For 89 patients undergoing primary TKR, the bone cut from the distal femur and proximal tibia was measured using Vernier callipers and compared to the computer calculation of the same. Results show that computer measurement of the physical space left by the resected bone is accurate.