Surgical Volume and Postoperative Complications of Acromioclavicular Joint Separations: Analysis of the ABOS Part II Examination.

BACKGROUND: High-grade acromioclavicular (AC) joint separations are relatively rare injuries that are often treated surgically, yet more information is needed about the risks of various surgical procedures in terms of considering and counseling patients regarding operative versus nonoperative treatment. PURPOSE: To calculate whether the volume of surgical treatment of AC joint separations increased over a recent 12-year period; to examine the nature and frequency of complications, reoperations, and readmissions associated with these procedures; and to assess whether patient- and surgeon-specific factors or surgical technique affected these rates. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: The American Board of Orthopaedic Surgery (ABOS) database for orthopaedic surgeons taking the Part II examination was reviewed from 2005 to 2016 to identify surgical treatment of AC joint separations. The authors calculated the percentage of all surgical cases in the ABOS database and rates of complications, reoperations, and readmissions. Association of these sequelae with patient- and surgeon-specific factors and surgical techniques was assessed. RESULTS: There was no difference in the number or percentage of cases per year over the study period. There was an overall complication rate of 24.5%, a reoperation rate of 7.3%, and a readmission rate of 1.9%. Patients ≥40 years of age had significantly higher complication, reoperation, and readmission rates as compared with patients <40 years of age. There were significant differences in complication, reoperation, readmission, and displacement rates dependent on the type of surgical procedure performed. The highest complication rates were seen with open suspensory fixation, screw fixation, open reduction internal fixation, and arthroscopic coracoclavicular ligament repair or reconstruction. The highest reoperation rates were seen with screw fixation, open reduction internal fixation, and open suspensory fixation. CONCLUSION: The volume of surgical treatment for AC joint separations did not change significantly over the study period. Complication, reoperation, and readmission rates were dependent on the type of surgical procedure performed and patient age. This information should assist surgeons in discussing risks when considering and counseling patients regarding operative versus nonoperative treatment.

Machine Learning-Based Classification of 38 Years of Spine-Related Literature Into 100 Research Topics.

STUDY DESIGN: Retrospective review. OBJECTIVE: To identify the top 100 spine research topics. SUMMARY OF BACKGROUND DATA: Recent advances in "machine learning," or computers learning without explicit instructions, have yielded broad technological advances. Topic modeling algorithms can be applied to large volumes of text to discover quantifiable themes and trends. METHODS: Abstracts were extracted from the National Library of Medicine PubMed database from five prominent peer-reviewed spine journals (European Spine Journal [ESJ], The Spine Journal [SpineJ], Spine, Journal of Spinal Disorders and Techniques [JSDT], Journal of Neurosurgery: Spine [JNS]). Each abstract was entered into a latent Dirichlet allocation model specified to discover 100 topics, resulting in each abstract being assigned a probability of belonging in a topic. Topics were named using the five most frequently appearing terms within that topic. Significance of increasing ("hot") or decreasing ("cold") topic popularity over time was evaluated with simple linear regression. RESULTS: From 1978 to 2015, 25,805 spine-related research articles were extracted and classified into 100 topics. Top two most published topics included "clinical, surgeons, guidelines, information, care" (n = 496 articles) and "pain, back, low, treatment, chronic" (424). Top two hot trends included "disc, cervical, replacement, level, arthroplasty" (+0.05%/yr, P < 0.001), and "minimally, invasive, approach, technique" (+0.05%/yr, P < 0.001). By journal, the most published topics were ESJ-"operative, surgery, postoperative, underwent, preoperative"; SpineJ-"clinical, surgeons, guidelines, information, care"; Spine-"pain, back, low, treatment, chronic"; JNS- "tumor, lesions, rare, present, diagnosis"; JSDT-"cervical, anterior, plate, fusion, ACDF." CONCLUSION: Topics discovered through latent Dirichlet allocation modeling represent unbiased meaningful themes relevant to spine care. Topic dynamics can provide historical context and direction for future research for aspiring investigators and trainees interested in spine careers. Please explore https://singdc.shinyapps.io/spinetopics. LEVEL OF EVIDENCE: N A.

¿Qué hay nuevo sobre traumatismos en edad pediátrica? / What’s new in children orthopaedic trauma?

Cada vez son más frecuentes la aparición en la bibliografía de artículos relacionados con problemas en edad pediátrica. Con el objetivo de actualizar información hemos realizado una revisión de la bibliografía publicada en las principales revistas relacionadas con la ortopedia y traumatología infantil durante el año 2015 seleccionando aquellos que trataban sobre traumatismos en edad pediátrica. El artículo ha sido divido en bloques por región anatómica y se resume la información más destacada de las publicaciones

Increasingly frequent occurrence in the literature related problems in childhood items. In order to update information we have conducted a review of the literature published in leading journals related to orthopedics and traumatology child during 2015 selecting those that dealt with trauma age pediatric. The article has been divided into blocks by anatomical region and the most important information is summarized publications

The reliability and reproducibility of the Hertel classification for comminuted proximal humeral fractures compared with the Neer classification.

INTRODUCTION: The Neer classification is the most commonly used fracture classification system for proximal humeral fractures. Inter- and intra-observer agreement is limited, especially for comminuted fractures. A possibly more straightforward and reliable classification system is the Hertel classification. The aim of this study was to compare the inter- and intra-observer variability of the Hertel with the Neer classification in comminuted proximal humeral fractures. MATERIALS AND METHODS: Four observers evaluated blinded radiographic images (X-rays, CT-scans, and CT-scans with 3D-reconstructions) of 60 patients. After at least two months classification was repeated. RESULTS: Inter-observer agreement on plain X-rays was fair for both Hertel (κ = 0.39; 95% CI 0.23-0.62) and Neer (κ = 0.29; 0.09-0.42). Inter-observer agreement on CT-scans was substantial (κ = 0.63; 0.56-0.72) for Hertel and moderate for Neer (κ = 0.51; 0.29-0.68). Inter-observer agreement on 3D-reconstructions was moderate for both Hertel (κ = 0.60; 0.53-0.72) and Neer (κ = 0.51; 0.39-0.58). Intra-observer agreement on plain X-rays was fair for both Hertel (κ = 0.38; 0.27-0.59) and Neer (κ = 0.40; 0.15-0.52). Intra-observer agreement on CT-scans was moderate for both Hertel (κ = 0.50; 0.38-0.66) and Neer (κ = 0.42; 0.35-0.52). Intra-observer agreement on 3D-reconstructions was moderate for Hertel (κ = 0.55; 0.45-0.64) and substantial for Neer (κ = 0.63; 0.48-0.79). CONCLUSIONS: The Hertel and Neer classifications showed a fair to substantial inter- and intra-observer agreement on the three diagnostic modalities used. Although inter-observer agreement was highest for Hertel classification on CT-scans, Neer classification had the highest intra-observer agreement on 3D-reconstructions. Data of this study do not confirm superiority of either classification system for the classification of comminuted proximal humeral fractures.

Topical vs. intravenous administration of tranexamic acid in knee arthroplasty and prevalence of deep venous thrombosis: a randomized clinical trial / Uso tópico versus intravenoso de ácido tranexâmico na artroplastia de joelho e prevalência de trombose venosa profunda: estudo clínico randomizado

BACKGROUND: Tranexamic acid (TXA) is widely used in orthopedic surgery to reduce perioperative bleeding. Since TXA inhibits fibrinolysis, there is concern that it may increase the risk of thromboembolic events. OBJECTIVES: To verify the prevalence of deep venous thrombosis (DVT) in patients receiving TXA during total knee arthroplasty and to compare topical with intravenous administration of the drug. METHODS: All patients admitted for total knee arthroplasty due to primary arthrosis between June and November of 2014 were recruited consecutively. Thirty patients were randomized to a "topical group&" (1.5 g TXA diluted in 50ml saline sprayed over the area operated, before tourniquet release), 30 to an intravenous; (20mg/kg TXA in 100 ml of saline, given at the same time as anesthesia), and 30 to a control group (100 ml of saline, given at the same time as anesthesia). All patients had duplex ultrasound scans of the legs on the 15th postoperative day. RESULTS: Deep venous thrombosis events occurred in five of the 90 patients operated (one out of 30 in the topical group [3.3%], four out of 30 in the control group [13.3%], and zero in the intravenous group). All were confirmed by duplex ultrasound scans and all were asymptomatic. Prevalence rates of DVT were similar between groups (p = 0.112 for control vs. intravenous; p = 0.353 for control vs. topical; and p =1.000 for intravenous vs. topical, according to two-sided exact tests). CONCLUSIONS: Both topical and intravenous administration of TXA are safe with regard to occurrence of DVT, since the number of DVT cases in patients given TXA was not different to the number in those given placebo.

CONTEXTO: O ácido tranexâmico é amplamente utilizado em cirurgia ortopédica para reduzir a hemorragia perioperatória. Como o ácido tranexâmico inibe a fibrinólise, há uma preocupação de que ele possa aumentar o risco de eventos tromboembólicos. OBJETIVOS: Verificar se o uso do ácido tranexâmico é seguro em relação à prevalência de trombose venosa profunda em pacientes submetidos a artroplastia total do joelho, e comparar as administrações tópica e intravenosa desse medicamento. MÉTODOS: Todos os pacientes consecutivamente admitidos para artroplastia total do joelho devido a artrose primária entre junho e novembro de 2014 foram recrutados. Os pacientes foram randomizados em um "grupo tópico" (1,5 g de ácido tranexâmico diluído em 50 ml de solução salina cobrindo toda a área operada antes de liberar o torniquete), um "grupo intravenoso" (20 mg/kg de ácido tranexâmico em 100 ml de solução salina no momento da anestesia) e um "grupo controle" (100 ml de solução salina com a anestesia). No 15º dia de pós-operatório, todos os pacientes foram submetidos a ultrassonografia vascular com Doppler de membros inferiores, independentemente de sintomas. RESULTADOS: Dos 90 pacientes operados, apenas cinco apresentaram trombose venosa profunda (um no grupo tópico e quatro no grupo controle). CONCLUSÕES: Tanto a administração tópica quanto a intravenosa de ácido tranexâmico são seguras em termos de ocorrência de trombose venosa profunda, pois o número de casos de trombose venosa profunda foi semelhante quando comparamos os pacientes que receberam ácido tranexâmico e os que receberam placebo. Novos estudos, com amostras maiores, são necessários para confirmar esse achado.

La otorragia. Una complicación de la hemicolectomía laparoscópica / Otorrhagia. A complication of laparoscopic hemicolectomy

El creciente y rápido avance de la tecnología quirúrgica en las últimas décadas ha permitido el desarrollo de la cirugía laparoscópica. La cirugía «mínimamente invasiva» se ha popularizado en los últimos años, y sus fronteras no solo se limitan a los procedimientos ginecológicos, sino que se ha extendido al campo de la cirugía general, la ortopedia, el tórax y la urología. La insuflación de gas en la cavidad peritoneal y la posición del paciente se acompañan de cambios fisiológicos y complicaciones que no se presentan en la cirugía abierta. Presentamos el caso de una paciente que tras hemicolectomía izquierda laparoscópica presentó otorragia bilateral postoperatoria. El neumoperitoneo y la posición de Trendelenburg a más de 35° provocan alteraciones hemodinámicas que condicionan un aumento de la presión arterial y de la presión venosa central. La vascularización del conducto auditivo externo sufre directamente estas modificaciones, pudiendo aparecer otorragia postoperatoria después de una cirugía laparoscópica prolongada (AU)

The fast and increasing advance in surgical technology during the last decades has led to a remarkable development in laparoscopic surgery. «Minimally invasive» surgery has become very popular in the last few years, not only in gynecological procedures but also in general surgery, orthopedics, thoracic and urological procedures. Gas inflation into the abdominal cavity and patient position provokes physiological changes, as well as complications that are not seen in open surgery. Pneumoperitoneum and the Trendelenburg position beyond 35° cause hemodynamic changes, resulting in an increase in arterial and central venous pressure. The external auditory canal vessels are directly affected by these changes, and postoperative otorrhagia after a prolonged laparoscopic surgery may be present. A case is presented of postoperative bilateral otorrhagia after laparoscopic left hemicolectomy (AU)

Caracterización de la enfermedad de Legg-Calvé-Perthes en población pediátrica en tres Hospitales de Bogotá DC, Colombia / Characterization of Legg-Calvé-Perthes disease in the pediatric population of three hospitals in Bogotá DC, Colombia

Estudio observacional, descriptivo longitudinal (nivel III). Objetivo: describir las características clínicas, demográficas y posibles factores de riesgo en pacientes con enfermedad de Legg-Calvé-Perthes (LCP) en tres hospitales de Bogotá DC, Colombia entre 2003 y 2013. Materiales y métodos: historias clínicas ortopédicas de pacientes con LCP en rangos de edad entre 4 y 14 años. Resultados: el total de la población fue de 83 pacientes con 89 caderas comprometidas; 88% fueron hombres. Los factores de riesgo encontrados fueron: en 24 casos (29%) trastorno de déficit de atención e hiperactividad (TDAH), 23 (28%) evidenciaron exposición pasiva a humo de cigarrillo de la madre durante el embarazo y 4.8% tenían discrasias sanguíneas. Conclusiones: teniendo en cuenta los resultados no se demostró que la enfermedad de LCP en pacientes pediátricos tuviera relación con madres añosas (>35 años) al momento del parto; 29% cursó con TDAH y 28% con exposición pasiva a humo de cigarrillo durante el embarazo...

Longitudinal, observational, descriptive (level III) study. Objective: to describe the clinical features, demographics and possible risk factors of Legg-Calvé-Perthes disease (LCPD) in patients of three hospitals in Bogotá DC, Colombia between 2003 and 2013. Materials and Methods: review of orthopedic clinical records of patients with LCPD aged 4 to 14 years. Results: a total population of 83 patients with 89 compromised hips were included, 88% were males. Risk factors found were: attention deficit hyperactivity disorder (ADHD) in 24 cases (29%), passive exposure to cigarette smoke of the mother during pregnancy in 23 (28%) and coagulation disorders in 4.8%. Conclusions: the results did not demonstrate that LCPD in pediatric patients had relation to advanced maternal age (>35 years) at delivery; 29% were associated to ADHD and 28% with passive exposure to cigarette smoke of the mother during pregnancy...

Spinal surgery and neurosurgeon: quo vadis?

The aim of this review was to point out some critical points in spinal surgery. We present a good idea dealing with the subspecialisation in neurosurgery. Spine surgery is a good and especially timely example for it. The technical progress in the discipline of spinal surgery since the catalytic advances of diagnostic imaging, our understanding of spinal biomechanics and bone growth physiology, and the development of spinal fixation instrumentation have allowed exponential growth in this field. As a result, there is an increasing interest in spinal surgery. In this paper, a Medline review of the literature was performed from 2000 to the present regarding spinal surgery. Today, there is an emerging field of "spine surgery" that incorporates both neurosurgery and orthopedic surgery. In the future, it is possible that there may be a well-defined medical specialty of "spine specialists" defined by its own board certification. This is not currently the case. In this paper, it was concluded that productive collegiality between neurosurgeon and orthopedic surgeon is necessary for the advancement of spine care. This could be to build an own specialisation of spinal surgery. But for that this speciality needs his own and common research, not a part done by neurosurgeons and one by orthopedic surgeons.

Practice patterns for subacromial decompression and rotator cuff repair: an analysis of the American Board of Orthopaedic Surgery database.

BACKGROUND: Recently there have been several evolving trends in the practice of shoulder surgery. Arthroscopic subacromial decompression has been performed with greater frequency by orthopaedic surgeons, and there has been considerable recent interest in arthroscopic rotator cuff repair. The purpose of this study was to identify trends in practice patterns for subacromial decompression and rotator cuff repair over time and in relation to the location of practice, fellowship training, and declared subspecialty of the surgeon. METHODS: We reviewed the American Board of Orthopaedic Surgery Part II database to identify patterns in the utilization of open and arthroscopic subacromial decompression and rotator cuff repair among candidates for board certification. All procedures involving only arthroscopic or open subacromial decompression and/or rotator cuff repair from 2004 to 2009 were identified. The rates of arthroscopic and open subacromial decompression and/or rotator cuff repair were compared in terms of year, geographic region, fellowship training, and declared subspecialty of the surgeon. RESULTS: Between 2004 and 2009, 12,136 surgical procedures involving only arthroscopic or open subacromial decompression and/or rotator cuff repair were performed. There were significant differences in treatment with respect to year, geographic region of practice, declared subspecialty, and fellowship training (p < 0.001). There was a significant increase over time in the utilization of arthroscopy among all candidates (p < 0.001). Surgeons with sports medicine fellowship training or a sports-medicine-declared subspecialty performed significantly more subacromial decompressions and rotator cuff repairs arthroscopically than all other candidates (p < 0.001). During this time period, there was a significant decrease in the rate of arthroscopic subacromial decompression, both as an isolated procedure and combined with arthroscopic rotator cuff repair (p < 0.001). CONCLUSIONS: From 2004 to 2009, there was a significant shift throughout the United States toward arthroscopic rotator cuff repair and subacromial decompression among young orthopaedic surgeons, with sports medicine fellowship-trained surgeons performing more of their procedures arthroscopically than surgeons with other training. However, there was an increasing frequency of arthroscopic rotator cuff repair performed without subacromial decompression, and, overall, there was a decrease in the frequency of isolated arthroscopic subacromial decompression over time.

The postoperative COFAS end-stage ankle arthritis classification system: interobserver and intraobserver reliability.

End-stage ankle arthritis is operatively treated with numerous designs of total ankle replacement and different techniques for ankle fusion. For superior comparison of these procedures, outcome research requires a classification system to stratify patients appropriately. A postoperative 4-type classification system was designed by 6 fellowship-trained foot and ankle surgeons. Four surgeons reviewed blinded patient profiles and radiographs on 2 occasions to determine the interobserver and intraobserver reliability of the classification. Excellent interobserver reliability (κ = .89) and intraobserver reproducibility (κ = .87) were demonstrated for the postoperative classification system. In conclusion, the postoperative Canadian Orthopaedic Foot and Ankle Society (COFAS) end-stage ankle arthritis classification system appears to be a valid tool to evaluate the outcome of patients operated for end-stage ankle arthritis.

Estudo da reprodutibilidade e compreensão da classificação de Judet e Letournel / Comprehension and reproducibility of the Judet and Letournel classification

OBJETIVO: Avaliar a eficácia do método de interpretação radiográfica das fraturas de acetábulo, segundo a classificação de Judet e Letournel, por um grupo de médicos residentes de Ortopedia de um hospital universitário. MÉTODO: Foram selecionados aleatoriamente 10 residentes de ortopedia e divididos em dois grupos, um deles recebeu treinamento de uma metodologia para a classificação de fraturas do acetábulo, que consiste em transpor as imagens radiográficas para uma representação gráfica em duas dimensões. Foram classificados 50 casos de fratura acetábulo em dois momentos distintos e verificada a concordância intra e interobservador. RESULTADO: O índice de acerto médio no grupo treinado foi de 16,2% (10-26%), no grupo não treinado foi de 22,8% (10-36%). O coeficiente kappa médio intraobservador e interobservador do grupo treinado foi respectivamente de 0,08 e 0,12, e o do grupo não treinado foi de 0,14 e 0,29. CONCLUSÃO: O treinamento do método de interpretação radiográfica das fraturas do acetábulo não foi efetivo para auxiliar na classificação das fraturas do acetábulo. Nível de evidência II, Teste de critérios diagnósticos desenvolvimento anteriormente em pacientes consecutivos (com padrão de referência "ouro" aplicado).

OBJECTIVE: To evaluate the effectiveness of the method of radiographic interpretation of acetabular fractures, according to the classification of Judet and Letournel, used by a group of residents of Orthopedics at a university hospital. METHODS: We selected ten orthopedic residents, who were divided into two groups; one group received training in a methodology for the classification of acetabular fractures, which involves transposing the radiographic images to a graphic two-dimensional representation. We classified fifty cases of acetabular fracture on two separate occasions, and determined the intraobserver and interobserver agreement. RESULT: The success rate was 16.2% (10-26%) for the trained group and 22.8% (10-36%) for the untrained group. The mean kappa coefficients for interobserver and intraobserver agreement in the trained group were 0.08 and 0.12, respectively, and for the untrained group, 0.14 and 0.29. CONCLUSION: Training in the method of radiographic interpretation of acetabular fractures was not effective for assisting in the classification of acetabular fractures. Level of evidence I, Testing of previously developed diagnostic criteria on consecutive patients (with universally applied reference "gold" standard).

New perspectives and recommendations for anticoagulant therapy post orthopedic surgery

Anticoagulant therapy is essential for the prevention of risks associated with the formation of thrombus in patients after surgery, especially in orthopedics. Recently, new oral anticoagulants were introduced in the therapeutic arsenal. This fact is important, because the current drug of choice in clinical practice is enoxaparin, a low molecular weight heparin. As all injecting drugs, enoxaparin may reduce patients' adherence to treatment by dissatisfaction with and resistance to the administration. This article reviews the available literature on the overall utility of these innovative medicines, approaching the pharmacology, the compared efficacy in relation to current agents, and the potential targets for new agents, as well as points to new trends in research and development. The article also contributes with a practical guide for use and recommendations to health professionals, especially focusing on the reversibility of hemorrhagic events, and discusses the importance of convenience/satisfaction of use, the cost of treatment, and the risk-benefit profile for patients.

A terapia anticoagulante é fundamental para a prevenção de riscos associados à formação de trombos em pacientes pós-cirúrgicos, principalmente em ortopedia. Recentemente, novos anticoagulantes orais foram introduzidos no arsenal terapêutico. Tal fato é importantíssimo, visto que o atual medicamento de primeira escolha na prática clínica é a enoxaparina, uma heparina de baixo peso molecular. Por ser de uso injetável, a enoxaparina pode diminuir a adesão do paciente ao tratamento, devido à insatisfação e à resistência quanto à via de administração. Este artigo revisa a literatura disponível sobre a utilidade total desses medicamentos inovadores ao abordar a farmacologia, a eficácia em comparação com os agentes atuais e os alvos potenciais para novos agentes, bem como aponta as novas tendências em pesquisa e desenvolvimento. O artigo também contribui com um guia prático de uso e recomendações aos profissionais de saúde, com um enfoque especial sobre a reversibilidade de eventos hemorrágicos e, finalmente, discute a importância da conveniência/satisfação de uso, o custo de tratamento e o perfil risco-benefício para o paciente.

Orthopaedic procedure coding. Does accuracy matter?

PURPOSE: Coding clinical work should allow accurate and precise methods of assessing individual or department activity. The NHS financial reforms have increased correct diagnostic coding importance by introducing "payment by results" so that funding is directly linked to patient activity. The aim of this study is to assess the accuracy of procedure codes (OPCS 4.4), and its effect on Healthcare Resource Group tariff codes that directly affect revenue. DESIGN/METHODOLOGY/APPROACH: A total of ten procedures from ten consultants were randomly selected over one month. Each consultant coded his or her own procedures. From these codes, Healthcare Resource Group tariff codes were assigned to each patient. These were compared with procedure and Healthcare Resource Group tariff codes generated by coding department staff. FINDINGS: Of 100 procedures, four were un-coded by coding department staff. There was concordance in 35 per cent of cases. Coders only gave one code for each procedure, whereas 35 per cent of procedures coded by consultants were assigned multiple codes. This resulted in 27 per cent of cases generating a different Healthcare Resource Group tariff code. Of the cases, five resulted in a difference of pound 4,000 or more; however, the overall difference was a pound 3,367 revenue loss if coder's codes were used. RESEARCH LIMITATIONS/IMPLICATIONS: Study numbers were limited to 100 with five cases showing excessive financial gain or loss significantly influencing the overall result. PRACTICAL IMPLICATIONS: Present procedure coding practice is inaccurate and results in Healthcare Resource Group tariff codes that do not accurately represent clinical activity and productivity. Under payment by results, this can result in a significant revenue loss and possibly ultimately future referrals. Therefore, coding practice needs to be improved as a matter of urgency. Arguably, this could be achieved by closer communication between coders and clinicians. ORIGINALITY/VALUE: The paper identifies a flaw in the way clinical activity and productivity is assessed at present. This is fundamental to the process on which "payment by results" is based, and therefore must be addressed if trusts are to be financially successful.

[Orthopedic and trauma surgery in the German-DRG-System 2009]. / Orthopädie und Unfallchirurgie im G-DRG-System 2009.

BACKGROUND: The German DRG-System was advanced into version 2009. For orthopedic and trauma surgery significant changes concerning coding of diagnoses, medical procedures and concerning the DRG-structure were made. METHODS: Analysis of relevant diagnoses, medical procedures and G-DRGs in the versions 2008 and 2009 based on the publications of the German DRG-institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). RESULTS: Changes for 2009 focussed on the development of DRG-structure, DRG-validation and codes for medical procedures to be used for very complex cases. The outcome of these changes for German hospitals may vary depending in the range of activities. CONCLUSION: G-DRG-System gained complexity again. High demands are made on correct and complete coding of complex orthopedic and trauma surgery cases. Quality of case-allocation within the G-DRG-System was improved. Nevertheless, further adjustments of the G-DRG-System especially for cases with severe injuries are necessary.

[Complex surgical procedures in orthopedics and trauma surgery. A contribution to the proposal procedure for the DRG system in 2009]. / Komplexe operative Prozeduren in der Orthopädie und Unfallchirurgie. Ein Beitrag zum Vorschlagsverfahren für das DRG-System 2009.

Since the DRG system was introduced in 2003/2004 the system for remuneration has been continually modified in conjunction with input from specialized medical associations. As part of this development of the payment system, the criteria for classification of a diagnosis-related group were further expanded and new functions were added. This contribution addresses the importance of the complex surgical procedures as criteria for subdivision of the DRG case-based lump sums in orthopedics and trauma surgery.

Fractura acetabulares. El reto técnico / Acetabular fractures: a technical challenge

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Anillos de reconstrucción en la cirugía de revisión de las artroplastias de cadera / Acetabular rings in revision total hip replacement

Objetivo. Evaluar los resultados radiográficos de los anillos de reconstrucción utilizados en la cirugía de revisión de grandes defectos acetabulares. Material y método. Se ha estudiado la evolución radiológica de 13 anillos de reconstrucción utilizados en grados 3 y 4, con un seguimiento mínimo de 25 meses y máximo de 60 (media de seguimiento: 37 meses). En todos los casos se utilizaron aloinjertos debajo del anillo y cúpula cementada. Las mediciones radiológicas usadas tomaban como referencia la posición, altura y profundidad del anillo, así como la evolución del centro de la cabeza protésica. También se registró la presencia de complicaciones y la recuperación de la dismetría de extremidades. Resultados. Se presentaron tres complicaciones, una lesión vascular intraoperatoria, una luxación posterior y una infección superficial. El descenso medio del centro de rotación fue de 4 cm. En ningún caso fue necesario reintervenir a los pacientes. La dismetría de extremidades disminuyó de 6,3 cm en el preoperatorio a 3,1 cm en el postoperatorio inmediato. Después no se encontraron modificaciones en las mediciones radiográficas. Conclusiones. La utilización de un anillo de reconstrucción en la cirugía de revisión acetabular permite descender el centro de rotación de la cadera y recuperar precozmente la estructura y depósito óseo sin complicaciones graves (AU)

Purpose. To assess the radiographic results of reconstruction rings used in surgical procedures conducted to revise large acetabular defects. Materials and methods. A study was carried out to analyze the radiological evolution of 13 acetabular rings used in grade 3 and 4 patients, with a follow-up between 25 and 60 months (mean: 37 months). In all cases, allografts were placed underneath the ring and the cemented cup. The radiological measurements taken used as their landmarks the position, height and depth of the ring as well as the evolution of the center of the prosthetic head. The appearance of complications was also recorded, as was the restoration of limb dysmetry. Results. There were three complications, an intraoperative vascular lesion, a posterior dislocation as well as a superficial infection. The average downward migration of the center of rotation was 4 cm. In no case was it necessary to reoperate. Limb dysmetry went down from a preop value of 6.3 cm to 3.1 at the immediate postop. Alter this, no changes were found in the radiographical measurements. Conclusions. The use of an acetabular ring in revision THR enables the bringing down of the hip's center of rotation as well as an early restoration of both the structure of the area an the bone stock without any serious complications (AU)