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1.
Isr Med Assoc J ; 23(8): 475-478, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34392620

RESUMO

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic had enormous impact on many aspects of our society, including huge medical, social, and economic challenges. OBJECTIVES: To evaluate the impact of the first wave of the COVID-19 pandemic and the related movement restrictions on the incidence of hip fractures in different age groups. METHODS: This single center retrospective observational study included all patients over 60 years old admitted to our hospital with the diagnosis of hip fracture during March and April 2020. Exclusion criteria were periprosthetic or pathologic fractures and multitrauma. We collected the same data on all patients with hip fractures admitted during March and April of 2018 and 2019. RESULTS: Mean patient age increased from 81.7 to 85.0 years. Only two of 49 patients tested positive for COVID-19. The data show a decrease of 38% in fracture load, but a striking decrease of 85% and 59% among sexagenarians and septuagenarian, respectively. There was no decrease among nonagenarians. Early mortality, both at 30 days and 90 days, was twice as common during the pandemic. However, stratification by age group demonstrated that the risks of early mortality were the same as previous years. Mean waiting time for surgery decreased from 27.5 to 18.9 hours. Patient discharge to home over a rehabilitation facility increased from 9% to 17. CONCLUSIONS: The COVID-19 pandemic affected the epidemiology of hip fractures in the elderly. The incidence of fractures and age distribution were significantly different from other years. Discharge destinations were also affected. The management of hip fracture patients was not compromised.


Assuntos
COVID-19 , Fraturas do Quadril , Administração dos Cuidados ao Paciente , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , COVID-19/prevenção & controle , Feminino , Fraturas do Quadril/mortalidade , Fraturas do Quadril/reabilitação , Fraturas do Quadril/terapia , Humanos , Incidência , Controle de Infecções/métodos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Mortalidade , Avaliação de Processos e Resultados em Cuidados de Saúde , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/tendências , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , SARS-CoV-2/isolamento & purificação
2.
Injury ; 2021 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-34253355
3.
Harefuah ; 159(11): 797-803, 2020 Nov.
Artigo em Hebraico | MEDLINE | ID: mdl-33210849

RESUMO

BACKGROUND: Several demographic and medical factors have an established effect on mortality and function after hip fractures, however varying fracture characteristics and surgical factors have been less thoroughly investigated. The study assessed the impact of specific fracture patterns on mortality and mobility one year post hip fracture. Other surgical factors including the type of intervention, major complications and sequential fractures were assessed as well. METHODS: An institutional hip fracture registry was reviewed. Mobility status scores were calculated one year post-operatively. RESULTS: Thirty days mortality was 4.6% and one year mortality was 19.9%. There was no significant effect of fracture type on mortality. However, patients receiving hemiarthroplasty had a significantly higher mortality (28.1%) than other patients receiving internal fixation (18.6%) or total hip arthroplasty (4%). An increased mobility status after intra-capsular fractures over extracapsular fractures was demonstrated. Patients receiving total hip arthroplasty had significantly better mobility at one year than patients with fracture fixation or hemiarthroplasty. Major complications and sequential fractures had no significant effect on outcome. CONCLUSIONS: Critical factors that influence decision making for orthopedic surgeons are revealed to have a lesser effect on the patient's ultimate outcome.


Assuntos
Artroplastia de Quadril , Hemiartroplastia , Fraturas do Quadril , Artroplastia de Quadril/efeitos adversos , Fixação Interna de Fraturas , Fraturas do Quadril/cirurgia , Humanos , Amplitude de Movimento Articular
4.
Isr Med Assoc J ; 20(9): 553-556, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30221868

RESUMO

BACKGROUND: Mortality and decrease in function after hip fracture are significantly related to patient factors including age, gender, co-morbidities, and mental status. Several studies demonstrated ethnic disparities in incidence, mortality, and functional outcome after hip fractures in the United States. OBJECTIVES: To assess the relationship between ethnicity and hip fracture incidence and outcomes of mortality, functional change, and perioperative complications in the Israeli population. METHODS: We reviewed our institutional hip fracture registry for all patients from 2014-2015. Patients with incomplete data, < 60 years of age, or pathologic and periprosthetic fractures were excluded. Our study comprised 693 patients. Ethnicity was based on country of birth. Specifically, for those born in Israel, the nationality of either Jewish or Arab was further dichotomized. Perioperative complications, mortality, and mobility status at 1 year follow-up were recorded. The ethnicities of 27,130 patients admitted to the medicine and surgical wards during the same time interval served as a control group for the hip fracture cohort. RESULTS: Immigrants from Europe and America had the highest incidence of hip fractures. Fracture types varied in incidence in groups with 70% of extracapsular hip fractures occurring in Arabs and immigrants from Eastern countries, compared to 60% in immigrants from Western countries and the former Soviet Union. Mortality, perioperative complications, and mobility at 1 year were similar in all ethnic groups. CONCLUSIONS: Our study demonstrated significant differences in incidence and fracture characteristic among ethnicities, but no difference in patient outcome. These findings differed from the available North American studies.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Fraturas do Quadril/etnologia , Fraturas do Quadril/mortalidade , Recuperação de Função Fisiológica , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos
5.
Indian J Orthop ; 52(3): 239-243, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29887625

RESUMO

Background: Conventionally, the extended lateral approach (ELA) served as the standard extensile approach for intraarticular calcaneal fracture fixation. However, this approach has a high rate of wound complications. The purpose of this study was to describe an alternative approach, the posteriorlateral approach (PLA) and compare it to the ELA regarding soft tissue complications and functional outcome. Materials and Methods: 32 patients operated through PLA and 66 patients treated through ELA were included in this retrospective study. Major and minor soft tissue complications up to 3 months postoperatively were recorded. Eighteen patients of the PLA group and 32 patients of the ELA group were available for 1-year functional outcome assessment with the American Foot and Ankle Score (AOFAS) score. Results: The PLA group had no major complications requiring surgical intervention. Six patients (19%) had minor wound complications. The ELA group had 8 (12%) major complications and 9 (14%) minor complications. There were no significant differences in AOFAS scores at 1-year followup. PLA is a safe and efficient approach for open reduction and internal fixation of displaced intraarticular calcaneal fractures. Conclusion: In selected cases when fracture comminution and displacement may not be adequately treated through a less invasive approach, it is a good alternative with less concern about wound complications as in ELA.

6.
BMC Musculoskelet Disord ; 19(1): 188, 2018 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-29879934

RESUMO

BACKGROUND: Total hip arthroplasty (THA) is considered a successful surgical procedure. It can be performed by several surgical approaches. Although the posterior and anterolateral approaches are the most common, there has been increased interest in the direct anterior approach. The goal of the present study is to compare postoperative leg length discrepancy and acetabular cup orientation among patients who underwent total hip arthroplasty through a direct anterior (DAA) and anterolateral (ALA) approaches. METHODS: The study included 172 patients undergoing an elective THA by a single surgeon at our institution within the study period. Ninety-eight arthroplasties were performed through the ALA and 74 arthroplasties through the DAA. Preoperative planning was performed for all patients. Assessment of the two groups included the following postoperative parameters: abduction angle, cup anteversion angle and leg length discrepancy (LLD). Additional analysis was done to evaluate component positioning by comparing deviation from the Lewinnek zone of safety in both approaches. RESULTS: For the DAA the absolute LLD was 11 mm, ranging from -6 mm to 5 mm. For the ALA, the absolute LLD was 36 mm, ranging from -22 mm to 14 mm. None of the DAA patients had an absolute LLD greater than 6 mm. Comparatively, 7.4% of the ALA group exceeded 6 mm of LLD in addition to 2.1% with LLD greater than 10 mm. 15% of the ALA group resided out of the Lewinnek abduction zone compared to 3% of the DAA group (P = 0.016). 17% of the ALA group were out of the Lewinnek anteversion zone as opposed to 8% of the DAA group (P = 0.094). CONCLUSION: Our study demonstrates good component positioning outcomes and LLD values in patients following THA through the DAA compared to the ALA.


Assuntos
Acetábulo/diagnóstico por imagem , Artroplastia de Quadril/tendências , Procedimentos Cirúrgicos Eletivos/tendências , Desigualdade de Membros Inferiores/diagnóstico por imagem , Posicionamento do Paciente/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Acetábulo/cirurgia , Idoso , Artroplastia de Quadril/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Humanos , Desigualdade de Membros Inferiores/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia
7.
J Shoulder Elbow Surg ; 27(7): 1263-1267, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29398398

RESUMO

BACKGROUND AND HYPOTHESIS: The diagnostic workup of the painful shoulder after rotator cuff repair (RCR) can be quite challenging. The aim of this study was to assess the reliability of ultrasonography (US) for the detection of recurrent rotator cuff tears in patients with shoulder pain after RCR. We hypothesized that US for the diagnosis of recurrent rotator cuff tear after RCR would not prove to be reliable when compared with surgical arthroscopic confirmation (gold standard). METHODS: In this cohort study (diagnosis), we retrospectively analyzed the data of 39 patients with shoulder pain after arthroscopic RCR who had subsequently undergone US, followed by revision arthroscopy. The rotator cuff was evaluated first using US for the presence of retears. Thereafter, revision arthroscopy was performed, and the diagnosis was either established or disproved. The sensitivity and specificity of US were assessed in reference to revision arthroscopy (gold standard). RESULTS: A rotator cuff retear was indicated by US in 21 patients (54%) and by revision arthroscopy in 26 patients (67%). US showed a sensitivity of 80.8% and specificity of 100% in the diagnosis of rotator cuff retears. Omission of partial rotator cuff retears resulted in a spike in sensitivity to 94.7%, with 100% specificity remaining. CONCLUSION: US imaging is a highly sensitive and specific test for the detection of recurrent rotator cuff tears, as confirmed by revision arthroscopy, in patients with a painful shoulder after primary RCR.


Assuntos
Artroscopia , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/cirurgia , Ultrassonografia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Humanos , Pessoa de Meia-Idade , Recidiva , Reprodutibilidade dos Testes , Estudos Retrospectivos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/complicações , Sensibilidade e Especificidade , Dor de Ombro/etiologia
8.
Best Pract Res Clin Rheumatol ; 32(5): 662-668, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-31203924

RESUMO

The aim of the present study was to evaluate whether circulating serum ferritin and adiponectin (ADP) in the serum and synovial fluid correlate with cartilage damage severity assessed by arthroscopy in patients with knee osteoarthritis. The 40 subjects with symptomatic knee osteoarthritis were divided into four groups according to arthroscopy assessed cartilage damage, using Outerbridge (OB) grading. Group I included minor damage while Group IV included severe damage. Metabolic parameters, bone homeostasis, and insulin resistance markers were determined. Synovial fluid of the affected knee joint was obtained and assessed for synovial adiponectin levels. Parameters of bone homeostasis in the serum including levels of PTH, alkaline phosphatase, 25OH vitamin D, serum calcium and phosphorus were similar in the four groups. A significant difference in the level of serum ferritin was found: ferritin levels increased from Group 1 to Group 4 in a continuous fashion (p < 0.035). In General linear model (GLM) analysis significant by-group differences in circulating ferritin persisted even after adjustment (p = 0.030). Although all groups were similar in terms of serum ADP levels, between groups difference in synovial fluid ADP was found (p < 0.037). However, after controlling for the age, there was no between-group difference in terms of synovial ADP levels. Serum ferritin levels were associated with cartilage damage severity assessed by arthroscopy. This association was independent of age, sex, BMI, and CRP levels suggesting that ferritin may be actively involved in the progression of cartilage damage in patients with symptomatic knee OA.


Assuntos
Adiponectina/metabolismo , Biomarcadores/metabolismo , Ferritinas/metabolismo , Osteoartrite do Joelho/patologia , Adiponectina/análise , Adulto , Artroscopia , Cartilagem Articular/metabolismo , Cartilagem Articular/patologia , Progressão da Doença , Ensaio de Imunoadsorção Enzimática , Feminino , Ferritinas/análise , Humanos , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/metabolismo , Líquido Sinovial/química
9.
Injury ; 48(7): 1589-1593, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28477993

RESUMO

BACKGROUND: The objective of this study was to evaluate the correlation between specific joint biomechanical parameters and 1year functional outcome scores in elderly patients receiving hemiarthroplasty in the setting of intracapsular hip fractures. METHODS: This is a retrospective, institutional registry based study. 168 hip hemarthroplasties were captured from October 2013 to June 2015. Patients were excluded based on contralateral hip surgery, perioperative complications or inadequate radiographs. 84 patients were alive at one year follow up. We compared mobility and pain scores to radiographically determined variations of leg lengths and femoral offset. We also compared the performance of fellowship trained arthroplasty surgeons to their non-fellowship trained counterparts. RESULTS: The operated leg was a mean of 1.12±6.8mm longer than the contralateral. leg length discrepancy (LLD) was less than 10mm in 72 patients. Mean difference in offset between limbs was 0.25±3.3mm. The difference was within 5mm in 79 patients (94%). We found no statistically significant correlation between mobility or pain scores and variations in leg length or offset. We found significantly better performance of the arthroplasty surgeons in restoring leg length but no difference in offset reconstruction or functional benefit for the patient. CONCLUSIONS: Our study was unable to demonstrate a significant relationship between leg length or femoral offset restoration and the patient's ultimate functional recovery. Arthroplasty surgeons performed better in restoring leg length, but no associated functional advantage was seen.


Assuntos
Fraturas do Colo Femoral/cirurgia , Fêmur/diagnóstico por imagem , Hemiartroplastia , Desigualdade de Membros Inferiores/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Radiografia , Centros de Traumatologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Colo Femoral/diagnóstico por imagem , Fraturas do Colo Femoral/fisiopatologia , Seguimentos , Hemiartroplastia/normas , Humanos , Desigualdade de Membros Inferiores/diagnóstico por imagem , Desigualdade de Membros Inferiores/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Recuperação de Função Fisiológica , Sistema de Registros , Estudos Retrospectivos
11.
Int Orthop ; 41(4): 831-836, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27271723

RESUMO

PURPOSE: The purpose of this study was to evaluate the use of pre-operative digital templating to minimize complications including limb length discrepancy (LLD), intraoperative fractures and early dislocations in patients with intracapsular femoral neck fractures. METHODS: We retrospectively compared 23 patients undergoing total hip arthroplasty (THA) for intracapsular femoral fractures with pre-operative digital templating and 48 patients without templating. RESULTS: The mean post-operative LLD was significantly lower in patients who had pre-operative templating than in the control group (6.7 vs. 11.5 mm, p = 0.023). Only three patients (13 %) with templating had LLD greater than 1.5 cm, compared to the 15 patients (31 %) without templating (p = 0.17). In eight cases the final femoral stem size matched the templated size, while 19 patients were within two size increments. Complications included one dislocation and one intra-operative fracture in the control group. CONCLUSION: The present study demonstrated that careful pre-operative planning may reduce LLD in patients undergoing THA due to intracapsular hip fractures.


Assuntos
Artroplastia de Quadril/métodos , Fraturas do Colo Femoral/diagnóstico por imagem , Fraturas do Colo Femoral/cirurgia , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Colo do Fêmur/diagnóstico por imagem , Colo do Fêmur/cirurgia , Fraturas Ósseas/etiologia , Luxação do Quadril/etiologia , Humanos , Desigualdade de Membros Inferiores/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
Knee Surg Sports Traumatol Arthrosc ; 25(6): 1736-1742, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27017213

RESUMO

PURPOSE: The objective of this study was to quantify the amount of ensuing internal rotation of the tibial component when positioned along the medial border of the tibial tubercle, thus establishing a reproducible intraoperative reference for tibial component rotational alignment during total knee arthroplasty (TKA). METHODS: The angle formed from the tibial geometric centre to the intersection of both lines from the middle of the tibial tuberosity and its medial border was measured in 50 patients. The geometric centre was determined on an axial CT slice at 10 mm below the lateral tibial plateau and transposed to a slice at the level of the most prominent part of the tibial tuberosity. Similar measurements were taken in 25 patients after TKA, in order to simulate the intraoperative appearance of the tibia after making its proximal resection. RESULTS: This angle was found to be similar (n.s.) in normal and post-TKA tibiae [median 20.4° (range 15°-24°) vs. 20.7° (range 16°-25°), respectively]. In 89.3 % of the patients, the angle ranged from 17° to 24°. No statistical difference (p n.s.) was found between women and men in both normal [median -20.7° (range 16°-25°) vs. 19.9° (range 15°-24°)] and post-TKA tibiae [median 21.4° (range 19°-24°) vs. 20° (range 16°-25°)]. CONCLUSION: This study found that in 90 % of the patients, the medial border of the tibial tuberosity is internally rotated 17°-24° in relation to the line connecting the middle of the tuberosity to the tibial geometric centre. Since this anatomical landmark may be more easily identifiable intraoperatively than the commonly used "medial 1/3", it can provide a better quantitative reference point and help surgeons achieve a more accurate tibial implant rotational position. LEVEL OF EVIDENCE: Cohort and case control studies, Level III.


Assuntos
Artroplastia do Joelho/métodos , Tíbia/cirurgia , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Rotação
13.
Hip Int ; 27(1): 55-59, 2017 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-27791237

RESUMO

BACKGROUND: When performing total hip arthroplasty (THA) on a dysplastic hip, proper positioning of the acetabular component may not allow for more than 70% coverage. Structural support in the form of an autograft or a high porosity metal augment may be necessary. The purpose of the study was to investigate the value of preoperative templating and deformity classification in predicting cup coverage and the need for structural support. METHODS: 65 cases of THA for DDH were retrospectively analysed. 2 observers independently classified each dysplastic hip according to Hartofilakidis and determined the extent of cup coverage via templating software on preoperative digital AP pelvic radiographs. RESULTS: Weighted kappa interobserver agreement was 0.68 for cup coverage and 0.76 for Hartofilakidis type. Structural support was necessary in 10 hips. No structural support was necessary in Hartofilakidis type 1, dysplasia cases. However, 27-30% of cases with type 2 or type 3 dysplasia required structural support. All cases with templated cup coverage of 65% or less required structural support. Templated coverage within 65-75% and over 75% resulted in 20% and 10% of patients receiving structural augmentation, respectively. CONCLUSIONS: Preoperative planning for THA in the setting of hip dysplasia is crucial and can provide valuable insight to the need for column augmentation. However, the 3-D severity of the deformity may be underestimated in the 2-D radiographs.


Assuntos
Artroplastia de Quadril/métodos , Luxação Congênita de Quadril/diagnóstico por imagem , Prótese de Quadril , Osteoartrite do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/cirurgia , Desenho de Prótese/métodos , Adulto , Idoso , Artroplastia de Quadril/efeitos adversos , Estudos de Coortes , Feminino , Seguimentos , Luxação Congênita de Quadril/complicações , Luxação Congênita de Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Osteoartrite do Quadril/etiologia , Medição da Dor , Cuidados Pré-Operatórios/métodos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
14.
J Am Podiatr Med Assoc ; 104(4): 383-6, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25076082

RESUMO

BACKGROUND: Toe amputation is the most common partial foot amputation. Controversy exists regarding whether to primarily close toe amputations or to leave them open for secondary healing. The purpose of this study was to evaluate the results of closed toe amputations in diabetic patients, with respect to wound healing, complications, and the need for further higher level amputation. METHODS: We retrospectively reviewed the results of 40 elective or semi-elective toe amputations with primary closure performed in 35 patients treated in a specialized diabetic foot unit. Patients with abscesses or necrotizing fasciitis were treated emergently and were excluded. Patients in whom clean margins could not be achieved due to extensive cellulitis or tenosynovitis and patients requiring vascular intervention were excluded as well. Outcome endpoints included wound healing at 3 weeks, delayed wound healing, or subsequent higher level amputation. RESULTS: Out of 40 amputations, 38 healed well. Thirty amputations healed by the time of stitch removal at 3 weeks and eight had delayed healing. In two patients the wounds did not heal and subsequent higher level amputation was eventually required. CONCLUSIONS: In carefully selected diabetic foot patients, primary closure of toe amputations is a safe surgical option. We do not recommend primary closure when infection control is not achieved or in patients requiring vascular reconstruction. Careful patient selection, skillful assessment of debridement margins and meticulous technique are required and may be offered by experienced designated surgeons in a specialized diabetic foot unit.


Assuntos
Amputação , Pé Diabético/cirurgia , Procedimentos Cirúrgicos Eletivos , Dedos do Pé/cirurgia , Cicatrização , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
J Arthroplasty ; 29(11): 2146-9, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25064018

RESUMO

This study presents the selective use of partial patellar lateral facetectomy for maltracking during primary TKA, as an alternative to lateral release. Twenty three partial facetectomies were performed out of 191 TKAs (12%). Balanced tracking was achieved in 22 knees. At follow-up 2 patients had persistent anterior knee pain. Mean Knee Society score (KSS) was 94 and mean functional KSS was 86. Mean patellar score was 28. Patellar tilt angles were within 2 degrees in all but one knee. Patellar translation was within 2 mm in all cases. No complications were recorded. A control group of 46 matched patients had similar functional and radiographic results. If tracking is not satisfactory at the conclusion of TKA, our method of choice would be partial lateral facetectomy.


Assuntos
Artrite/cirurgia , Artroplastia do Joelho/métodos , Articulação do Joelho/cirurgia , Patela/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
Artigo em Inglês | MEDLINE | ID: mdl-24963683

RESUMO

Abstract BACKGROUND: METHODS: RESULTS: CONCLUSIONS:

17.
Can J Surg ; 57(2): E15-8, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24666453

RESUMO

BACKGROUND: Dislocation may complicate revision total hip arthroplasty (THA). We examined the correlation between the components revised during hip arthroplasty (femur only, acetabulum only and both components) to the rates of dislocation in the first and multiple revision THA. METHODS: We obtained data from consecutive revision THAs performed between January 1982 and December 2005. Patients were grouped into femur-only revision, acetabulum-only revision and revision THA for both components. RESULTS: A total of 749 revision THAs performed during the study period met our inclusion criteria: 369 first-time revisions and 380 repeated revisions. Dislocation rates in patients undergoing first-time revisions (5.69%) were significantly lower than in those undergoing repeated revisions (10.47%; p = 0.022). Within the group of first-time revisions, dislocation rates for acetabulum-only revisions (10.28%) were significantly higher than those for both components (4.61%) and femur-only (0%) reconstructions (p = 0.025). CONCLUSION: Although patients undergoing first-time revisions had lower rates of dislocations than those undergoing repeated revisions, acetabulum-only reconstructions performed at first-time revision arthroplasty entailed an increased risk for instability.


Assuntos
Artroplastia de Quadril , Luxação do Quadril/epidemiologia , Prótese de Quadril , Artropatias/cirurgia , Desenho de Prótese , Falha de Prótese , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Artropatias/etiologia , Artropatias/patologia , Masculino , Pessoa de Meia-Idade , Reoperação , Adulto Jovem
18.
Isr Med Assoc J ; 16(1): 20-5, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24575500

RESUMO

BACKGROUND: Surgical adverse events are errors that emerge during perioperative patient care. The World Health Organization recently published "Guidelines for Safe Surgery." OBJECTIVES: To estimate the effect of implementation of a safety checklist in an orthopedic surgical department. METHODS: We conducted a single-center cross-sectional study to compare the incidence of complications prior to and following implementation of the Guidelines for Safe Surgery checklist. The medical records of all consecutive adult patients admitted to the orthopedics department at Wolfson Medical Center during the period 1 July 2008 to 1 January 2009 (control group) and from 1 January 2009 to 1 July 2009 (study group) were reviewed. The occurrences of all complications were compared between the two groups. RESULTS: The records of 760 patients (380 in each group) hospitalized during this 12 month period were analyzed. Postoperative fever occurred in 5.3% versus 10.6% of patients with and without the checklist respectively (P = 0.008). Significantly more patients received only postoperative prophylactic antibiotics rather than both pre-and postoperative antibiotic treatment prior to implementation of the checklist (3.2% versus 0%, P = 0.004). In addition, a statistically non-significant 34% decrease in the rate of surgical wound infection was also detected in the checklist group. In a logistic regression model of postoperative fever, the checklist emerged as a significant independent predictor of this outcome: odds ratio 0.53, 95% confidence interval 0.29-0.96, P = 0.037. CONCLUSION: A significant reduction in postoperative fever after the implementation of the surgical safety checklist occurred. It is possible that the improved usage of preoperative prophylactic antibiotics may explain the reduction in postoperative fever.


Assuntos
Antibioticoprofilaxia/métodos , Lista de Checagem , Procedimentos Ortopédicos/métodos , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Febre/etiologia , Febre/prevenção & controle , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/efeitos adversos , Segurança do Paciente , Complicações Pós-Operatórias/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle
19.
Foot Ankle Surg ; 19(1): 62-4, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23337280

RESUMO

Proximal interphalangeal joint (PIP) arthrodesis is a very common procedure in the practice of foot and ankle surgeons. The standard technique recommends using a Kirschner wire (KW) with double sharp ends. Using this technique there are some complication that can be eliminated by small modification. The technique of proximal interphalangeal joint arthrodesis using a simple blunt KW on one side with an accurate placement and avoidance of metatarsophalangeal joint (MTPJ) penetration without the need for fluoroscopy is described. This technique is simple, reproducible, very economical and avoiding most of the complications attributed to the KW.


Assuntos
Artrodese/métodos , Síndrome do Dedo do Pé em Martelo/cirurgia , Articulação do Dedo do Pé/cirurgia , Fios Ortopédicos , Humanos
20.
J Arthroplasty ; 28(2): 279-285.e2, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22854347

RESUMO

We examined the influence of acetabular cup alignment on the primary arc of motion (PAOM) for minus (-3.5), skirtless (+3.5), and skirted (+10.5) neck lengths with 28-, 32-, 36-, and 40-mm femoral heads. Total hip arthroplasty was performed in a pelvic saw bone model. The acetabulum was positioned in 30°/45°/60° abduction and 0°/15°/30° anteversion, respectively. The PAOM was determined using a digital inclinometer for each of the acetabular positions and 12 femoral heads mentioned above. Best PAOM was found in 45° abduction and 15° to 30° anteversion as well as 60° abduction and 0° anteversion. Combinations of excessive abduction and anteversion as well as horizontalization and retroversion resulted in the worst PAOM. Primary arc of motion is mainly determined by cup alignment even when using larger femoral heads.


Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril/métodos , Cabeça do Fêmur/cirurgia , Prótese de Quadril , Luxação do Quadril/prevenção & controle , Humanos , Modelos Anatômicos , Desenho de Prótese , Amplitude de Movimento Articular
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