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1.
Knee Surg Relat Res ; 33(1): 39, 2021 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-34715941

RESUMO

PURPOSE: Patellofemoral pain syndrome (PFPS) is a common pathology usually presenting with anterior or retropatellar pain. It is associated with a relative imbalance between the vastus medialis oblique (VMO) and the vastus lateralis (VL) muscles. This can lead to considerable morbidity and reduced quality of life (QOL). This study aims to assess the long-term functional outcome of PFPS treated with VL muscle botulinum toxin A (BoNT-A) injection. MATERIALS AND METHODS: A retrospective review was performed on 26 consecutive patients (31 knees) with a mean age of 50.1 years (± 19.7 years) who were treated with BoNT-A injections to the VL muscle followed by physiotherapy between 2008 and 2015. Pre- and post-treatment pain levels (numerical rating scale, NRS), QOL (SF-6D), and functional scores (Kujala and Lysholm questionnaires) were measured. Demographics, physical therapy compliance, previous surgeries, perioperative complications, and patient satisfaction levels were collected. RESULTS: The mean follow-up time was 58.8 ± 36.4 months. There were significant improvements in all the examined domains. The average pain score (NRS) decreased from 7.6 to 3.2 (P < 0.01), and the Kujala, Lysholm, and SF-6D scores improved from 58.9 to 82.7 (P < 0.001), 56.2 to 83.2 (P < 0.001), and 0.6 to 0.8 (P < 0.001), respectively. Similar delta improvement was achieved irrespective of gender, age, compliance to post-treatment physical therapy, or coexisting osteoarthritis. Patients who presented with a worse pre-treatment clinical status achieved greater improvement. Prior to BoNT-A intervention, 16 patients (18 knees) were scheduled for surgery, of whom 12 (75%, 13 knees) did not require further surgical intervention at the last follow-up. CONCLUSIONS: A single intervention of BoNT-A injections to the VL muscle combined with physiotherapy is beneficial for the treatment of patients with persistent PFPS. LEVEL III EVIDENCE: Retrospective cohort study.

2.
Isr Med Assoc J ; 23(8): 506-509, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34392628

RESUMO

BACKGROUND: Flexible flatfoot (FF) is a common foot deformity that can often consist of foot pain. Surgical treatment is designed to lengthen the lateral column. OBJECTIVES: To resolve whether radiographic standing feet measurements of normo-plantigrade feet and FF, symptomatic or not, differ and to determine whether the lateral column is shorter. METHODS: The study comprised 72 patients (127 feet) consecutive patients, 18 years of age and older, who were divided into three groups: normal feet (56), asymptomatic FF (29), and symptomatic FF (42). All patients had a standing anterior posterior (AP) and lateral radiographs. AP images were used for the measurement of the talocalcaneal angle, talar-1st metatarsal angle, and talonavicular coverage. Lateral X-rays were used to estimate the talocalcaneal angle, talar-1st metatarsal angle, calcaneal pitch, naviculocuboid overlap, and column ratio. RESULTS: All three of the AP radiograph measurements differed among groups, and higher values were measured in the symptomatic FF group. Post hoc analysis found that the talonavicular coverage and the talocalcaneal angles also differed between symptomatic and asymptomatic FF patients. While some lateral measurements differed within groups, only the lateral talar-1st metatarsal angle distinguished between asymptomatic and symptomatic patients. The lateral column length was not found to be shorter among FF patients, weather symptomatic or not. CONCLUSIONS: Only the talonavicular coverage, the AP talocalcaneal, and the lateral talar-1st metatarsal angles were found to differ between asymptomatic and symptomatic FF patients. The lateral column was not found to be shorter.


Assuntos
Doenças Assintomáticas , Pé Chato , Dor , Radiografia/métodos , Adulto , Antropometria/métodos , Correlação de Dados , Feminino , Pé Chato/diagnóstico por imagem , Pé Chato/fisiopatologia , Pé Chato/cirurgia , Deformidades Congênitas do Pé/diagnóstico por imagem , Humanos , Masculino , Ossos do Metatarso/diagnóstico por imagem , Dor/diagnóstico , Dor/etiologia , Posicionamento do Paciente/métodos , Articulação Talocalcânea/diagnóstico por imagem , Avaliação de Sintomas/métodos , Tálus/anormalidades , Tálus/diagnóstico por imagem
3.
Isr Med Assoc J ; 23(8): 469-474, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34392619

RESUMO

BACKGROUND: Hip fractures in elderly patients are a major cause of morbidity and mortality. Variability in length of hospital stay (LOS) was evident in this population. The coronavirus disease-2019 (COVID-19) pandemic led to prompt discharge of effected patients in order to reduce contagion risk. LOS and discharge destination in COVID-19 negative patients has not been studied. OBJECTIVES: To evaluate the LOS and discharge destination during the COVID-19 outbreak and compare it with a similar cohort in preceding years. METHODS: A retrospective study was conducted comparing a total of 182 consecutive fragility hip fracture patients operated on during the first COVID-19 outbreak to patients operated on in 2 preceding years. Data regarding demographic, co-morbidities, surgical management, hospitalization, as well as surgical and medical complications were retrieved from electronic charts. RESULTS: During the pandemic 67 fragility hip fracture patients were admitted (COVID group); 55 and 60 patients were admitted during the same time periods in 2017 and 2018, respectively (control groups). All groups were of similar age and gender. Patients in the COVID group had significantly shorter LOS (7.2 ± 3.3 vs. 8.9 ± 4.9 days, P = 0.008) and waiting time for a rehabilitation facility (7.2 ± 3.1 vs. 9.3 ± 4.9 days, P = 0.003), but greater prevalence of delirium (17.9% vs. 7% of patients, P = 0.028). In hospital mortality did not differ among groups. CONCLUSIONS: LOS and time to rehabilitation were significantly shorter in the COVID group. Delirium was more common in this group, possibly due to negative effects of social distancing.


Assuntos
COVID-19 , Delírio , Fixação de Fratura , Fraturas do Quadril , Controle de Infecções , Tempo de Internação/estatística & dados numéricos , Complicações Pós-Operatórias , Idoso , COVID-19/epidemiologia , COVID-19/prevenção & controle , Delírio/diagnóstico , Delírio/epidemiologia , Delírio/etiologia , Feminino , Fixação de Fratura/efeitos adversos , Fixação de Fratura/métodos , Fixação de Fratura/reabilitação , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Israel/epidemiologia , Masculino , Inovação Organizacional , Avaliação de Processos e Resultados em Cuidados de Saúde , Alta do Paciente/tendências , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Gestão de Riscos/organização & administração , SARS-CoV-2/isolamento & purificação
4.
Disabil Rehabil ; : 1-6, 2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-33984250

RESUMO

PURPOSE: To assess whether intracapsular and extracapsular hip fracture patients in a post-acute rehabilitation setting differ in their background characteristics and whether fracture type affects rehabilitation outcome. METHODS: A retrospective cohort study. OUTCOME MEASURES: Functional Independence Measure (FIM), motor FIM (mFIM), mFIM effectiveness, length of stay (LOS), and discharge destination. Various tests assessed associations (the Mann-Whitney U, the chi-square, logistic regression), population differences (t-test), and independent predictors of discharge FIM score (multiple linear regression model). RESULTS: Six hundred and eighty-seven patients completed the rehabilitation program. The intracapsular hip fracture patient group was characterized by significantly higher percentages of males, higher education levels, and living with a caregiver compared with the extracapsular hip fracture patient group. Intracapsular hip fracture patients were younger, had longer latency time from fracture to surgery, exhibited higher functional levels on admission and upon discharge, higher cognitive function and shorter rehabilitation time than extracapsular hip fracture patients. Both study groups possessed similar comorbidities, rehabilitation achievements, and discharge destination. Regression analyses showed that the fracture type was not associated with discharge FIM score, nor with the probability of achieving a favorable functional gain. CONCLUSIONS: Post-acute extracapsular and intracapsular hip fracture patients are demographically and clinically two distinct subpopulations. Nevertheless, given additional time, extracapsular hip fracture patients will attain similar functional achievements as intracapsular hip fracture patients.Implications for rehabilitationPost-acute extracapsular and intracapsular hip fracture patients are demographically and clinically two distinct subpopulations.Given additional time, extracapsular hip fracture patients can attain similar functional achievements as intracapsular hip fracture patients.

5.
Isr Med Assoc J ; 23(5): 279-285, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34024043

RESUMO

BACKGROUND: The collapse of the Syrian healthcare system during the civil war led numerous citizens to cross the Syrian-Israeli border to seek medical care. OBJECTIVES: To describe the epidemiology of peripheral nerve injuries (PNIs) sustained in war, their management, and short-term outcomes. METHODS: A retrospective case series study was conducted on 45 consecutive patients aged 25.7 ± 9.3 years. These patients were referred to the hand surgery unit of the department of orthopedic surgery and traumatology at Galilee Medical Center between December 2014 and June 2018. Median time between injury and presentation was 60 days. Injury pattern, additional injuries, surgical findings and management, complications, and length of hospital stay were extracted from medical records. RESULTS: Most injuries were blast (55.6%) followed by gunshot injuries (37.8%). There were 9 brachial plexus injuries, 9 sciatic nerve injuries, and 38 PNIs distal to the plexus: specifically 20 ulnar, 11 median, and 7 radial nerve injuries. In the latter group, neurotmesis or axonotmesis was found in 29 nerves. Coaptation was possible in 21 nerves necessitating cable grafting in 19. A tendon transfer was performed for 13 peripheral nerves, occasionally supplementing the nerve repair. The patients returned to their country after discharge, average follow-up was 53.6 ± 49.6 days. CONCLUSIONS: For nerve injuries sustained in war, early surgical treatment and providing adequate soft tissue conditions is recommended. Tendon transfers are useful to regain early function.


Assuntos
Traumatismos por Explosões/cirurgia , Procedimentos Neurocirúrgicos/métodos , Traumatismos dos Nervos Periféricos/cirurgia , Lesões Relacionadas à Guerra/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Adolescente , Adulto , Traumatismos por Explosões/etiologia , Criança , Feminino , Hospitais , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/etiologia , Socorro em Desastres , Estudos Retrospectivos , Síria/etnologia , Transferência Tendinosa/métodos , Ferimentos por Arma de Fogo/etiologia , Adulto Jovem
6.
Arch Orthop Trauma Surg ; 141(1): 39-44, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32361954

RESUMO

INTRODUCTION: Holocaust survivors (HS) were under an immense continues physical and mental stressors in their younger years, putting them at increased risk for both fragility hip fractures and worse medical and functional outcomes. We aimed to evaluate whether being a HS could affect the functional outcomes of fragility hip fractures in patients 80 years of age and older following surgery. MATERIALS AND METHODS: A retrospective study comparing consecutive patients, 80 years and older, who were operated for fragility hip fractures between 2011 and 2016. HS survival status was self-defined by survivors who were born in European and northern African countries that were later occupied by the Nazi regime during World War II and experienced incarceration in concentration camps, forced labor camps and mass transport. Primary outcomes were mortality either within hospital or in the post-operative year. Secondary outcomes were in-hospital complications, recurrent hospitalizations and orthopedic complications within the post-operative year. RESULTS: Two hundred thirty-one HS and 339 controls, ages 86.4 ± 4.4 years who were operated for fragility hip fracture between January 2011 to June of 2016 were included in the study. Patients from both groups were of similar age, Carlson's co-morbidity index score, leaving arrangement and pre-fracture mobility. Among HS there were more women (p = 0.029). HS did not have lower survival rates either within hospital or in the post- operative year. Both length of stay and in-hospital complication rates were similar between groups. In the post-operative year, HS were less likely to be hospitalized than controls (p = 0.021). The rate of orthopedic complications was also similar. CONCLUSIONS: Holocaust survivors patients do not achieve worse outcome following fragility hip fracture surgery and present distinctive resilience.


Assuntos
Fraturas do Quadril , Holocausto , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/mortalidade , Fraturas do Quadril/cirurgia , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Sobreviventes , Resultado do Tratamento
7.
Arch Gerontol Geriatr ; 93: 104297, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33248319

RESUMO

AIMS: Diabetes mellitus (DM) and osteoporosis are both diseases of epidemic proportions with an increasing incidence worldwide. Fragility hip fractures (FHF) are associated with elevated morbidity, mortality, social burden and medical costs. The aim of this study was to determine whether patients with DM have worse medical and surgical outcomes following FHFs and whether the Diabetes Complications Severity Index (DCSI) can predict in-hospital complications and one-year mortality. METHODS: A single centre retrospective cohort study including 1343 patients older than 65 years who underwent surgery for FHFs was conducted. The data collected included length of hospital stay, time-to-surgery, blood loss, complications and mortality during the first post-operative year. RESULTS: 408 patients with a DM diagnosis were compared with 935 without DM. Pre-operatively, patients with DM had lower haemoglobin levels, higher platelet counts and worse renal function. Following surgery, patients with DM were more likely to be transferred to another department or intensive care. One-year mortality was significantly higher in the DM group [23.3% vs. 17.1%, odds ratio 1.36 (CI 1.029-1.799, p = 0.03)]. Higher DCSI scores were related with elevated one-year mortality rates in the DM group. Cerebrovascular events were found to be nearly five times more prevalent in the DM group. Patients with DM were more likely to continue treatment in a rehabilitation centre and had a higher probability to be re-hospitalized in the first post-operative year (p.<0.001). CONCLUSIONS: Our results emphasize the increased vulnerability of this patient population and the importance of specialized care during the peri-operative period of FHFs.


Assuntos
Complicações do Diabetes , Diabetes Mellitus , Fraturas do Quadril , Osteoporose , Idoso , Diabetes Mellitus/epidemiologia , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Humanos , Osteoporose/complicações , Osteoporose/epidemiologia , Estudos Retrospectivos
8.
J Knee Surg ; 2020 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-33167053

RESUMO

For patients with advanced osteoarthritis of the knee, total knee arthroplasty (TKA) has been shown to provide significant pain relief and improved function with consistent, reproducible results. Post-operative physical therapy (PT) plays an important role is restoring muscle strength and range of motion (ROM). Yet, the impact of earlier physical therapy initiation after TKA has not been well defined. We assessed 205 patients that underwent primary TKA including 136 patients who started PT on the first post-operative day (POD1) and a second group that started PT 3 days after surgery (POD3), or later. Length of hospital stay (LOS), opioid use during hospital stay, complications, re-admissions, knee ROM and the need for subsequent hospitalized rehabilitation were recorded. LOS was not significantly shorter in the early PT group, compared with the delayed PT group (6.4 ± 2.2 days vs. 6.8 ± 2 days, respectively, P = .217). Patients in the delayed PT group consumed more opioids during their inpatient stay compared with the early PT group on both POD 3 (89% vs 82%, p = 0.013) and POD 4 (81% vs 66%, p = 0.005). There was no significant difference in the incidence of Immediate post-operative complications or final knee ROM between the two groups. While early postoperative PT did not impact hospital LOS or final knee ROM, it was associated with an earlier reduction in postoperative opioid consumption after primary TKA.

9.
Artigo em Inglês | MEDLINE | ID: mdl-33216182

RESUMO

INTRODUCTION: Fragility hip fractures are associated with increased morbidity, mortality, and costs. To improve patient care, quality indicator programs were introduced. Yet, the efficacy of these programs and specific quality indicators are questioned. We aimed to determine whether defining prophylactic pre-surgical antibiotic treatment as a quality indicator affected hip fracture outcomes. MATERIALS AND METHODS: A retrospective study comparing consecutive patients, 65 years and older, who were operated for fragility hip fractures between 01/01/2011 and 30/06/2016, before and after the prophylactic pre-surgical antibiotic treatment quality indicator, which was introduced in 01/2014. Primary outcomes were 1-year surgical site infections (SSI). Secondary outcomes were meeting the quality index and mortality rates, either within a hospital or during the first post-operative year. RESULTS: 904 patients, ages 82.5 ± 7.2 years were operated for fragility hip fractures. 403 patients presented before the antibiotic prophylaxis quality indicator, and 501 following its administration. Patients demographics were comparable. In the pre-quality indicator period, documentation of prophylactic antibiotic treatment was lacking. Only 19.6% had a record for antibiotic administration in their surgical records and for merely 10.4% the type of antibiotic was stated. However, in the post-quality indicator period, 97.0% of patients had a registered prophylactic antibiotic regimen in the hour preceding the surgical incision (p < 0.001). Post-operative SSI rates were equivalent, and as were in-hospital infections, mortality and recurrent hospitalizations CONCLUSIONS: The introduction of the pre-operative antibiotic treatment quality indicator increased the documentation of antibiotic administration yet failed to influence the incidence of post-operative orthopaedic and medical infections in fragility hip fracture patients.

10.
Arch Orthop Trauma Surg ; 140(6): 777-783, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32372239

RESUMO

PURPOSE: Patellar dislocation is a serious complication leading to patient morbidity following total knee arthroplasty (TKA). The cause can be multifactorial. Extensor mechanism imbalance may be present and result from technical errors such as malrotation of the implants. We sought to understand the reasons for post-arthroplasty patellar dislocation and the clinical outcomes of patients in whom it occurs. METHODS: This is a retrospective cohort study assessing the outcomes of revision surgery for patellar dislocation in patients with component malrotation in both primary and revision TKAs. Patient demographics, dislocation etiology, presurgical deformity, intraoperation component position, complications, reoperation, and Knee Society Scores (KSS) were collected. RESULTS: Twenty patients (21 knees) were identified. The average time from primary arthroplasty to onset of dislocation was 33.6 months (SD 44.4), and the average time from dislocation to revision was 3.38 months (SD 2.81). Seventeen knees (80.9%) had internal rotation of the tibial component and seven knees (33.3%) had combined internal rotation of both the femoral and tibial components. Fifteen knees (71.4%) were treated with a condylar constrained implant at the time of revision, and five knees were converted to a hinged prosthesis. The average follow-up time was 56 months. During this time, one patient (4.54%) had a recurrent dislocation episode, requiring further surgery. At final follow up, the mean KSS was 86.2. CONCLUSION: Revision TKA following patellar dislocation for patients with malrotated components was associated with high success rates. After revision surgery, patients had a low recurrence of patellar dislocation, low complication rates, and excellent functional outcomes.


Assuntos
Artroplastia do Joelho , Luxação Patelar/cirurgia , Complicações Pós-Operatórias/cirurgia , Reoperação , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Humanos , Articulação do Joelho/cirurgia , Prótese do Joelho/efeitos adversos , Estudos Retrospectivos
11.
J Plast Surg Hand Surg ; 54(1): 14-18, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31453741

RESUMO

Pyogenic flexor tenosynovitis (PFT) of the hand is a common infection which is clinically diagnosed using Kanavel's signs. Delay in diagnosis and treatment may lead to devastating outcomes, including reduced range of motion (ROM), deformities, tendon impairment or even amputation. While the gold standard for treatment is irrigation and debridement of the flexor sheath, little is known about the outcomes of conservative treatment with intravenous (IV) antibiotics. Patients treated conservatively for PFT between 2000 and 2013 were included. Demographic information, co-morbidities and clinical features at presentation such as Kanavel's signs and inflammatory markers levels were gathered. Treatment course, length of stay (LOS), functional outcomes and complications were collected. Fifty-four (54) patients presented with PFT in the study period. Forty-six (46) patients, ages 19-84 years old, who were treated conservatively were included. Average time from symptoms onset to presentation was 4.6 ± 7.1 days. Fourteen (14) patients failed to improve with course of oral antibiotics prior to presentation. The average number of Kanavel's signs was 3 ± 0.7. Inflammatory markers were elevated in 82.2% of patients. The mean LOS was 4.7 ± 2 days. Forty-four (44) patients continued follow-up for 55 ± 45 months. Final flexion ROM was full or minimally limited in 69% of patients. Three patients were eventually operated. Complication rate for the entire cohort was 4.3% and no fingers were lost. This retrospective case series indicate that inpatient empirical IV antibiotic therapy can be considered for patients presenting with uncomplicated PFT, provided it is practiced under a hand specialist's surveillance.


Assuntos
Antibacterianos/uso terapêutico , Tratamento Conservador , Dedos , Tenossinovite/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Biomarcadores/sangue , Proteína C-Reativa/análise , Cefazolina/uso terapêutico , Diabetes Mellitus , Feminino , Dedos/cirurgia , Humanos , Tempo de Internação/estatística & dados numéricos , Leucocitose/etiologia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Tenossinovite/cirurgia , Adulto Jovem
12.
Eur J Trauma Emerg Surg ; 46(5): 939-946, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30167740

RESUMO

PURPOSE: To define risk factors for rehospitalization following fragility hip fractures and to create a predictive model. METHODS: A retrospective cohort study of patients 65 years and older, who were treated operatively following fragility hip fractures between 01.2011 and 06.2016. Patients were allocated into two study groups based on the occurrence of recurrent hospitalizations in the year following surgery. Demographic information, comorbidities, and in-hospital characteristics were collected, as was information regarding 1-year readmissions. Multivariate analysis of factors predictive of rehospitalizations was performed, followed by a logistic regression using all predictors with p < 0.05. A stepwise backwards elimination method was used to create the predictive model. RESULTS: Eight hundred and fifty-one patients were included; 369 (43.4%) had recurrent hospitalizations within the first post-operative year. Patients who were rehospitalized were more likely to be males, to use a walking aid and to live dependently. They had a higher age-adjusted Charlson's comorbidity index (ACCI) score, a higher perveance of atrial fibrillation, lower hemoglobin, worse renal function, less platelets, and longer time to surgery. Prevalence of in-hospital complications was similar. Six variables were found to independently influence the chance for readmissions: male gender, the use of a walking aid, higher ACCI score, lower hemoglobin, atrial fibrillation, and a longer surgical delay. Only the first four were found to be adequate predictors and were added to the prediction formula. CONCLUSION: High 1-year readmission rates are seen following discharge in patients with fragility hip fractures. Addressing risk factors might aid to better rehabilitate patients and reduce morbidity.


Assuntos
Fraturas do Quadril/cirurgia , Fraturas por Osteoporose/cirurgia , Readmissão do Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Fixação de Fratura/métodos , Hospitalização , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais
13.
Isr Med Assoc J ; 21(8): 532-537, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31474015

RESUMO

BACKGROUND: Implant-related spinal infections are a surgical complication associated with high morbidity. Due to infection, hardware removal may be necessary, which could lead to pseudarthrosis and the loss of stability and alignment. OBJECTIVES: To evaluate the accuracy and diagnostic value of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) in the workup of patients with suspected implant-related infections of the spine and to assess the clinical impact of PET/CT results on the management of these infections. METHODS: The study included nine consecutive patients with a history of spinal surgery who underwent PET/CT for evaluation of suspected spinal implant related infection. All imaging studies were performed between January 2011 and December 2013. All 18F-FDG PET/CT scans were performed on an 8 slice PET/CT following an 18F-FDG injection. Images were scored both visually and semi-quantitatively by a radiology expert. Results were compared to additional imaging studies when available, which were correlated to clinical and bacteriological findings allowing calculation of sensitivity, specificity and accuracy. RESULTS: Among the patients, five experienced hardware-related spinal infection. 18F-FDG PET/CT sensitivity was 80%, specificity 100%, and accuracy 88.9%. One scan produced a false negative; however, a second PET/CT scan revealed an infection. CONCLUSIONS: PET/CT was found to be valuable for the diagnosis of postoperative hardware-related spinal infection, especially when other imaging modalities were uninformative or inconclusive. As such, PET/CT could be useful for management of infection treatment.


Assuntos
Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Infecções Relacionadas à Prótese/diagnóstico por imagem , Compostos Radiofarmacêuticos , Coluna Vertebral/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/patologia , Infecções Relacionadas à Prótese/patologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Coluna Vertebral/patologia
14.
J Orthop Trauma ; 33(10): 518-524, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31094939

RESUMO

OBJECTIVES: Surgical site infection (SSI) is a devastating complication of proximal femoral fracture surgery, related with an increased morbidity and mortality. As warfarin treatment has been described as a risk factor for SSI, we aimed to compare patient and SSI characteristics in warfarin and nonanticoagulated patients. DESIGN: Retrospective cohort study. SETTING: Level-1 trauma center. PATIENTS: Individuals 65 years of age and older with fragility hip fractures. INTERVENTION: Patients were divided into 2 cohorts: warfarin treated (n = 85) or nonanticoagulated (n = 771). Demographics, in-hospital characteristics, laboratory data, prior hospitalizations, recent antibiotic use, and 1-year incidence of SSIs and their characteristics were gathered. MAIN OUTCOME MEASURES: Postoperative SSIs. RESULTS: Twelve patients (14.1%) from the warfarin group and 21 patients (2.7%) from the noncoagulated group had SSI (P < 0.001). Both groups were comparable in terms of demographics and Charlson comorbidity score. Warfarin-treated patients had reduced white blood and neutrophils counts (10.1 ± 3.2 vs. 11.6 ± 4.0 cells/mm and 8.1 ± 3.2 vs. 9.6 ± 3.9 cells/mm for both comparisons respectively; P < 0.001 for both). They were more likely to be admitted to a geriatric ward than to orthopedics ward and were delayed to theater (58.5 ± 44.5 vs. 30.6 ± 27.4 hours; P < 0.001). Following surgery, there was no difference in blood transfusions required, in-hospital complications, or time to infection. Rates of prior hospitalizations, antibiotic use, or type of bacteria did not differ. CONCLUSIONS: Warfarin treatment in fragility hip fracture surgery is correlated with an increased risk for SSI, regardless of in-hospital complications, and hospitalizations before surgery or to the infection itself. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Anticoagulantes/uso terapêutico , Fraturas Espontâneas/cirurgia , Fraturas do Quadril/cirurgia , Procedimentos Ortopédicos , Infecção da Ferida Cirúrgica/epidemiologia , Varfarina/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Estudos de Coortes , Feminino , Humanos , Masculino , Estudos Retrospectivos , Varfarina/efeitos adversos
15.
Injury ; 50(7): 1347-1352, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31142435

RESUMO

INTRODUCTION: With the aging of the population the rate of fragility hip fractures increases. While medical recommendations are for hasten surgical treatment, for some older patients burdened with severe comorbidities, this might be risky. AIMS: To compare the outcomes of patients treated non-surgically to those of the most fragile patients treated surgically. PATIENTS AND METHODS: A retrospective cohort study, of individuals aged ≥65 years who presented with fragility hip fractures between 01.01.2011-30.06.2016, to a primary trauma center. Patients treated surgically were stratified according to their age-adjusted Charlsons' comorbidity index (ACCI) score. Patients in the upper third of ACCI score, representing the more fragile population, were compared to patients treated non-surgically. RESULTS: 847 patients presented with fragility fractures. 94 (11%) were treated non-surgically and 753 (89%) underwent surgery. Medical reasons were the leading cause for non-surgical treatment (61.7%). Surgically-treated patients were stratified according to their ACCI and 114 patients with ACCI > 9 were chosen for comparison. While both groups were comparable in terms of age, the non-surgical treatment group had more female patients (p. = 0.026) and a smaller proportion of independent walkers (p < 0.001). The ACCI was higher for the surgical treatment group (p < 0.001). In-hospital mortality was similar (14.9% and 18.1% for the operative and non-surgical groups respectively, P. = 0.575). However, one-year mortality was significantly higher for the non-surgical group (48.2% vs. 67.0%, P. = 0.005). The rates of in-hospital complications and 1-year readmissions were similar. CONCLUSIONS: Operative treatment for fragility hip fracture reduces long-term mortality rates even in the more fragile patients, compared to non-surgical treatment.


Assuntos
Tratamento Conservador , Idoso Fragilizado , Fraturas do Quadril/terapia , Fraturas por Osteoporose/terapia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Fraturas do Quadril/mortalidade , Fraturas do Quadril/fisiopatologia , Humanos , Masculino , Fraturas por Osteoporose/mortalidade , Fraturas por Osteoporose/fisiopatologia , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
16.
Clin Biomech (Bristol, Avon) ; 65: 87-91, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31005694

RESUMO

BACKGROUND: Functional scores and radiographs are often used to assess function and predict development of osteoarthritis in patients with multi-fragmentary tibial plateau fractures (TPFs). Locomotion, which is the primary goal of fracture treatment, is rarely assessed. The objective of this study was to assess functional ability of patients after TPF fixation using spatio-temporal gait analysis (STGA), and to compare STGA variables with self-reported functional scores and preoperative fracture characteristics. METHODS: Preoperative CT scans of 21 patients with complete articular multi-fragmentary TPFs were evaluated for number of fragments, maximum gap between the fragments and maximum articular depression. All patients underwent STGA (velocity, cadence, step length of the affected and the unaffected leg, single-limb support by the affected and the unaffected leg, and double-leg support) and filled the Knee Society Score and the Short Form-12 questionnaires on average 3 years (SD = 1.56, range, 2-5.8) post-injury. FINDINGS: Step length and single-limb support time of the affected leg were shorter compared to the unaffected leg (p = 0.02 and p = 0.007, respectively). Number of fracture fragments correlated with cadence (R = -0.461, p = 0.04) and velocity (R = -0.447, p = 0.04). INTERPRETATION: Given that both higher fracture comminution and deformity on the one hand and the above gait parameter alterations on the other hand are associated with knee osteoarthritis, STGA may be used for routine postoperative evaluation of patients after TPF fixation.


Assuntos
Fixação Interna de Fraturas , Marcha/fisiologia , Fraturas da Tíbia , Adulto , Fenômenos Biomecânicos , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Radiografia , Estudos Retrospectivos , Inquéritos e Questionários , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/fisiopatologia , Fraturas da Tíbia/cirurgia , Tomografia Computadorizada por Raios X
17.
Drugs Aging ; 36(7): 667-674, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30949984

RESUMO

BACKGROUND: The use of renin-angiotensin-aldosterone system inhibitors has increased over the past few years. There are conflicting data as to their relationship with acute kidney injury following surgery. OBJECTIVES: The objective of the article was to evaluate the risk of acute kidney injury in diabetic older patients treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and their medical outcomes following fragility hip fracture surgery. METHODS: Consecutive diabetic patients presenting with fragility hip fractures to our primary trauma center between January 2012 and June 2016 were included. Demographic and clinical data, including co-morbidities, medication use, and laboratory results, were collected from the electronic medical records. The primary outcome was the incidence of acute kidney injury; the secondary outcome was 1-year mortality. RESULTS: Two hundred and seventeen patients were included; 125 were receiving treatment with medications targeting the renin-angiotensin-aldosterone system. Demographic and clinical characteristics were similar between groups. No association was found between the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and the risk of acute kidney injury, which occurred in 25% of the cohort. Univariate analysis revealed that diuretic use, particularly furosemide, increased the risk of acute kidney injury during hospitalization (p = 0.003). However, in a multivariate analysis, only age and estimated glomerular filtration rates were associated with an increased risk of acute kidney injury. Patients with acute kidney injury were found to have increased mortality during the first post-operative year (p < 0.001). CONCLUSIONS: Acute kidney injury is a frequent complication after hip fracture surgery in elderly diabetic patients and is associated with increased 1-year mortality; however, it was not found to be associated with angiotensin-converting enzyme inhibitor/angiotensin receptor blocker pre-fracture treatment.


Assuntos
Injúria Renal Aguda/etiologia , Antagonistas de Receptores de Angiotensina/administração & dosagem , Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Diabetes Mellitus/tratamento farmacológico , Fraturas do Quadril/cirurgia , Injúria Renal Aguda/induzido quimicamente , Fatores Etários , Idoso de 80 Anos ou mais , Antagonistas de Receptores de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Angiotensinogênio , Estudos de Coortes , Diabetes Mellitus/fisiopatologia , Feminino , Taxa de Filtração Glomerular , Humanos , Incidência , Masculino , Sistema Renina-Angiotensina/efeitos dos fármacos , Estudos Retrospectivos
18.
Arch Orthop Trauma Surg ; 138(11): 1519-1524, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30054813

RESUMO

INTRODUCTION: Post-operative physiotherapy (PT) following fragility hip fractures is intended to improve balance, gait, and muscle strength for enhanced functional outcomes. This study aims to assess whether postponing initiation of PT effects patients' outcomes during hospitalization and in the first 3 months following discharge. MATERIALS AND METHODS: A retrospective study comparing consecutive patients, 65 years and older, who were operated for fragility hip fractures between 2011 and 2016, within 48 h from admission, and started PT treatment either in the first post-operative day (POD1) or later (POD2-5). Patients were operated upon as soon as medically possible and in accordance with theater availability. All surgeries were performed outside of workday hours (either in the afternoon or during the weekend). Group allocation was established corresponding with the surgical day, as PT services are unavailable during weekends and holidays, and surgeries were performed daily. Primary outcomes were mortality either within hospital or in the post-operative year. Secondary outcomes were in-hospital complications, recurrent hospitalizations, and orthopedic complications within 3 months. RESULTS: 747 patients were included in the study; 525 patients started PT at POD1 and 222 had delayed PT. Patients' demographics, living arrangements, age-adjusted Charlsons' co-morbidity index, mobility, hemoglobin levels, and implant type were comparable. In-hospital mortality was significantly higher for the delayed PT group, 6.8 vs. 3.2% (OR 2.2, 95% CI 1.06-4.42, p value 0.034). One-year mortality, in-hospital complications, and the average number of 3 months' recurrent hospitalizations did not differ between groups. A trend for more orthopedic complications was noted in the delayed PT group (p = 0.099), and patients from this group were readmitted more often due to orthopedic surgery-related reasons (p = 0.031). CONCLUSIONS: Post-operative delay in PT following fragility hip fracture surgery was related to increased risk for in-hospital mortality.


Assuntos
Terapia por Exercício/métodos , Fraturas do Quadril/reabilitação , Tempo para o Tratamento/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Quadril/mortalidade , Fraturas do Quadril/cirurgia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Alta do Paciente , Modalidades de Fisioterapia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
19.
Thromb Res ; 166: 106-112, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29727737

RESUMO

INTRODUCTION: Early surgical treatment is recommended to reduce morbidity and mortality in patients with fragility hip fractures. Anticoagulation treatment poses a surgical challenge. While the action of vitamin K antagonists (VKAs) can be reversed, for direct oral anticoagulants (DOACs) antidote is only available for dabigatran. We aimed to assess the outcomes of patients treated with VKAs or DOACs undergoing surgical treatment for fragility hip fractures. MATERIALS AND METHODS: A retrospective study of patients presenting with proximal femoral fractures between January 2012 and June 2016. Patients with VKAs received vitamin-K. Primary outcomes were 1-year and in-hospital mortality. Secondary outcomes were time to surgery, in-hospital complications, need for blood transfusions and 1-year readmissions. RESULTS: Seven-hundred seventy-nine patients (796 hips) were included; 103 received VKAs, 47 DOACs and 646 no-anticoagulation. No difference between the 3 groups was noted with respect to patients' demographics or surgery type. Charlson's comorbidity index was higher for the DOACs group. Patients under anticoagulation were delayed to theater (Surgery < 48 h in 51% DOACs and 59% VKAs patients vs. 92% of no-anticoagulation, p < 0.001). Neither in-hospital nor 1-year mortality differed between groups. No other outcome measures differed, except for more wound infections in VKAs patients. CONCLUSIONS: While preoperative anticoagulation delays surgery following fragility hip fractures, this delay was not found to be related to increased morbidity or mortality. DOACs-treated patients did not have adverse outcomes compared to VKAs-treated patients despite the irreversibility of their treatment.


Assuntos
Anticoagulantes/uso terapêutico , Fraturas do Quadril/cirurgia , Vitamina K/antagonistas & inibidores , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Quadril/mortalidade , Humanos , Masculino , Estudos Retrospectivos , Taxa de Sobrevida
20.
Isr Med Assoc J ; 20(3): 147-150, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29527851

RESUMO

BACKGROUND: Accurate pulse oximetry reading at hospital admission is of utmost importance, mainly for patients presenting with hypoxemia. Nevertheless, there is no accepted or evidence-based protocol for such structured measuring. OBJECTIVES: To devise and assess a structured protocol intended to increase the accuracy of pulse oximetry measurement at hospital admission. METHODS: The authors performed a prospective comparison of protocol-based pulse-oximetry measurement with non-protocol based readings in consecutive patients at hospital admission. They also calculated the relative percentage of improvement for each patient (before and after protocol implementation) as a fraction of the change in peripheral capillary oxygen saturation (SpO2) from 100%. RESULTS: A total of 460 patients were recruited during a 6 month period. Implementation of a structured measurement protocol significantly changed saturation values. The SpO2 values of 24.7% of all study participants increased after protocol implementation (ranging from 1% to 21% increase in SpO2 values). Among hypoxemic patients (initial SpO2 < 90%), protocol implementation had a greater impact on final SpO2 measurements, increasing their median SpO2 readings by 4% (3-8% interquartile range; P < 0.05). Among this study population, 50% of the cohort improved by 17% of their overall potential and 25% improved by 50% of their overall improvement potential. As for patients presenting with hypoxemia, the median improvement was 31% of their overall SpO2 potential. CONCLUSIONS: Structured, protocol based pulse-oximetry may improve measurement accuracy and reliability. The authors suggest that implementation of such protocols may improve the management of hypoxemic patients.


Assuntos
Hospitalização , Hipóxia/diagnóstico , Oximetria/métodos , Oxigênio/metabolismo , Admissão do Paciente , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hipóxia/terapia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes
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