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1.
BMC Musculoskelet Disord ; 23(1): 429, 2022 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-35524242

RESUMO

BACKGROUND: The reduction in irreducible extracapsular hip fractures has always been controversial. Here, we present a new minimally invasive reduction technique and compare it with limited open reduction (LOR) to treat irreducible extracapsular hip fractures. METHODS: From January 2016 to January 2018, our institution treated 653 patients with extracapsular hip fractures by intramedullary fixation. Among them, 525 cases got a successful closed reduction. The other 128 were irreducible and reduced by percutaneous reduction with double screwdrivers (PRDS) or LOR. There were 66 cases in the PRDS group while 62 in the LOR group. All fractures were classified using the Evans-Jensen classification. In addition, the differences in incision length, blood loss, fluoroscopic number, operation time, inpatient time, weight training time, Harris score, and complications were analyzed. RESULTS: The incision length was 8.4 ± 1.4 cm in the PRDS group and 15.3 ± 3.0 cm in the LOR group, respectively (p < 0.05); blood loss was equal to 151 ± 26 and 319 ± 33 ml, respectively (p < 0.05); fluoroscopic number was 14 ± 3 and 8 ± 2, respectively (p < 0.05); operation time was 44 ± 9 and 73 ± 11 min, respectively (p < 0.05); inpatient time was 6.2 ± 1.7 and 8.4 ± 2.2 days, respectively (p < 0.05); weight training time after the operation was 4.5 ± 1.5 and 10.7 ± 1.8 days, respectively (p < 0.05); and the excellent rate of Harris score was 92.4% and 88.7%, respectively (p > 0.05). There was no significant difference in complication incidence between the two groups (p > 0.05). CONCLUSIONS: The PRDS group presented better clinical effects for managing irreducible extracapsular hip fractures than the LOR. Therefore, the PRDS technique could be the first reduction choice for patients with irreducible fractures.


Assuntos
Fixação Intramedular de Fraturas , Fraturas do Quadril , Pinos Ortopédicos , Fixação Interna de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/métodos , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/cirurgia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
2.
Acta Orthop Belg ; 88(1): 11-16, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35512149

RESUMO

A non-comparative multi-centre and international pilot study have been carried on Y-STRUT® (Hyprevention, France), an implantable medical device meant to reinforce the hip to reduce the risk of a contralateral hip fracture. Objectives of the study were to determine the feasibility and tolerance of the procedure. Methods Patients older than 60 years were recruited when presenting at the emergency departments with a low-energy pertrochanteric fracture on one side and with a fracture risk assessed for the contralateral side with BMD, T-Score or other bone quality evaluation tool, FRAX index, or fall risk assessment. Pain and functional ability were assessed at the different follow-up visits using VAS, WOMAC and OHS-12 scores. Results Twelve patients were included and reached a one-year follow-up. Mean age was 82 years old (65 - 91). The average hospital stay was 13 days (3 - 29). The prophylactic surgery did not delay the hospital discharge for any patient. The procedure did not lead to unresolvable serious adverse events. At 3 weeks, all patients were able to walk 6 meters, half of them in less of 30 seconds. Minimal pain was reported all along the follow-up visits, except at 3 years when one patient presented high pain in both hips. WOMAC and OHS-12 scores showed a moderate to mild hip impairment. Conclusion The good short and medium-term outcomes of this pilot study demonstrate the feasibility and the tolerability of the device. Further studies should focus on the efficacy of this immediate and lasting bone reinforcement technique.


Assuntos
Fraturas do Quadril , Fraturas por Osteoporose , Idoso de 80 Anos ou mais , Benzofenonas , Densidade Óssea , Estudos de Viabilidade , Fraturas do Quadril/cirurgia , Humanos , Fraturas por Osteoporose/cirurgia , Dor , Projetos Piloto , Polímeros , Próteses e Implantes , Medição de Risco , Fatores de Risco
3.
Acta Orthop Belg ; 88(1): 211-213, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35512174

RESUMO

The United Kingdom (UK) Covid-19 pandemic has led to unique changes in the operation of the National Health Service (NHS) including within trauma and orthopaedics. This has led to a significant impact on the NHS ability to provide hip fracture care and sustain emergency surgery. This has led to local hip fracture services changing operations to provide more sustainable care and significant impacts on best practice tariffs. Data was collected using the National Hip Fracture Database data submitted by UHL and split into two cohorts - Pre Covid-19 and Post Covid-19. Data has been collected for 67 consecutive patients in April 2019 (Pre Covid-19) and 87 consecutive patients in April 2020 (Post Covid-19) as of 4th May after the introduction of the Covid-19 measures locally. Data has been collected on demographics- age and sex, ASA, admission time, time of operation, 30 day mortality and length of stay. The average time to theatre in the pre Covid-19 cohort was 27.3 hours and in the post Covid-19 cohort was 45.1 hours. This is an increase of 65.2%. All patients in the pre Covid-19 cohort were operated on and 4 in the post Covid-19 were conservatively managed. However, there were no significant effects on 30 day mortality or length of stay. In conclusion, the measures taken due to the Covid-19 pandemic had a profound impact on the care of hip fracture patients with significant delays in time to theatre. As a result, it is clear that the measures influenced practice at UHL and the best practice tariffs were not met.


Assuntos
COVID-19 , Fraturas do Quadril , Fraturas do Quadril/cirurgia , Hospitais Universitários , Humanos , Pandemias , Estudos Retrospectivos , Medicina Estatal
4.
Clin Appl Thromb Hemost ; 28: 10760296221100806, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35538853

RESUMO

PURPOSE: To analyze the relationship between monocyte count and preoperative deep venous thrombosis (DVT) in older patients with hip fracture. METHODS: Consecutive older patients with hip fracture undergoing surgery were included from January 2014 to December 2021. Monocyte count was measured on admission, and Doppler ultrasonography was performed for DVT screening prior to surgery. Univariate and multivariate logistic regression analyses were used to assess the association between monocyte count and DVT. RESULTS: A total of 674 patients were finally included, and 128 patients (19.0%) were diagnosed with preoperative DVT. Patients with DVT exhibited a higher monocyte count than patients without DVT [0.55 (0.43-0.72) × 109/L versus 0.49 (0.38-0.63) × 109/L, P = 0.007]. Multivariate logistic regression analysis showed that a high monocyte count (> 0.6 × 109/L) was independently associated with a higher risk of DVT (OR = 1.705, 95% CI: 1.121-2.593, P = 0.013), and for every 0.1 × 109/L increase in monocyte count, the risk of DVT increased by 8.5% (OR = 1.085, 95% CI: 1.003-1.174, P = 0.041). Other risk factors associated with DVT included intertrochanteric fracture (OR = 1.596, 95% CI: 1.022-2.492, P = 0.040), and elevated fibrinogen level (OR = 1.236, 95% CI: 1.029-1.484, P = 0.023). CONCLUSION: A high monocyte count is associated with an increased risk of DVT in older patients with hip fracture. Future studies should evaluate the potential role of monocyte in the prevention and treatment of thrombosis.


Assuntos
Fraturas do Quadril , Trombose Venosa , Idoso , Fraturas do Quadril/complicações , Fraturas do Quadril/cirurgia , Humanos , Incidência , Monócitos , Estudos Retrospectivos , Fatores de Risco , Trombose Venosa/diagnóstico
5.
J Orthop Surg Res ; 17(1): 255, 2022 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-35526015

RESUMO

BACKGROUND: Since Mohamed et al. analyzed 2326 orthopedic cases in 2002 and believed that the POSSUM formula can be directly used to predict postoperative morbidity and mortality in orthopedic patients, applications of POSSUM and P-POSSUM scores in the hip fracture surgery have been mostly reported in the field of orthopedics, but there are still some inconsistencies in the related reports. METHODS: The electronic library was searched for all literature that met the purpose from its inception to 2021. Relative risk (RR) was selected to evaluate whether the model could be used to assess the risk of surgery in patients with elderly hip fractures. Finally, sensitivity analyses and subgroup analyses were performed. RESULTS: Thirteen studies were finally included, including 9 retrospective and 4 prospective studies.The morbidity analysis includes 11 studies, and the result was RR = 1.07 (95% CI 0.93-1.24), The mortality analysis includes 11 studies on POSSUM and 5 studies on P-POSSUM. The results of mortality by POSSUM and by P-POSSUM were RR = 1.93 (95% CI 1.21-3.08) and RR = 1.15 (95% CI 0.89-1.50), respectively. POSSUM had more accuracy to predict mortality for sample < 200 subgroup(RR = 2.45; 95% CI 0.71-8.42) than sample > 200 subgroup(RR = 1.59; 95% CI 1.06-2.40), and in the subgroup of hip fractures that did not distinguish between specific fracture types(RR = 1.69, 95% CI 0.87-3.32) than intertrochanteric neck fracture subgroup(RR = 5.04, 95% CI 1.07-23.75) and femoral femoral fracture subgroup(RR = 1.43,95% CI 1.10-1.84). CONCLUSION: POSSUM can be used to predict morbidity in elderly hip fractures. The P-POSSUM was more accurate in predicting mortality in elderly hip fracture patients compared to the POSSUM, whose predictive value for mortality was influenced by the sample size and type of fracture studied. In addition, we believe that appropriate improvements to the POSSUM system are needed to address the characteristics of orthopedic surgery.


Assuntos
Fraturas do Quadril , Idoso , Fraturas do Quadril/cirurgia , Humanos , Morbidade , Estudos Prospectivos , Estudos Retrospectivos , Medição de Risco
6.
Zhongguo Gu Shang ; 35(5): 460-3, 2022 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-35535535

RESUMO

OBJECTIVE: To explore the incidence and risk factors of readmission of elderly patients with hip fracture after hip hemiarthroplasty. METHODS: A retrospective analysis of 237 elderly hip fracture patients who underwent hip hemiarthroplasty from February 2015 to October 2020 were performed. According to the readmission status of the patients at 3 months postoperatively, the patients were divided into readmission group (39 cases)and non-readmission group(198 cases). In readmission group, there were 7 males and 32 females with an average age of(84.59±4.34) years old, respectively, there were 34 males and 164 females with average age of (84.65±4.17) years old in non-readmission group. The general information, surgical status, hip Harris score and complications of patients in two groups were included in univariate analysis, and multivariate Logistic regression was used to analyze independent risk factors of patients' readmission. RESULTS: The proportion of complications(cerebral infarction and coronary heart disease) in readmission group was significantly higher than that of non-readmission group (P<0.05), and intraoperative blood loss in readmission group was significantly higher than that of non-readmission group(P<0.05). Harris score of hip joint was significantly lower than that of non-readmission group(P<0.05). The proportion of infection, delirium, joint dislocation, anemia and venous thrombosis in readmission group were significantly higher than that of non-readmission group (all P<0.05). Multivariate Logistic regression analysis showed that the risk factors for readmission of elderly patients with hip fracture after hip hemiarthroplasty included cerebral infarction, infection, delirium, dislocation, anemia and venous thrombosis (all P<0.05). CONCLUSION: The complications of the elderly patients who were readmission after hip hemiarthroplasty for hip fractures were significantly higher than those who were non-readmission. Cerebral infarction, infection, delirium, dislocation, anemia and venous thrombosis are risk factors that lead to patient readmission. Corresponding intervention measures can be taken clinically based on these risk factors to reduce the incidence of patient readmissions.


Assuntos
Artroplastia de Quadril , Delírio , Fraturas do Colo Femoral , Hemiartroplastia , Fraturas do Quadril , Luxações Articulares , Idoso , Idoso de 80 Anos ou mais , Infarto Cerebral/etiologia , Infarto Cerebral/cirurgia , Feminino , Fraturas do Colo Femoral/cirurgia , Hemiartroplastia/efeitos adversos , Fraturas do Quadril/etiologia , Fraturas do Quadril/cirurgia , Humanos , Luxações Articulares/cirurgia , Masculino , Readmissão do Paciente , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
12.
Isr Med Assoc J ; 24(5): 293-298, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35598052

RESUMO

BACKGROUND: The influence of the coronavirus disease 2019 (COVID-19) pandemic caused countries worldwide to implement lockdowns. Elective surgeries were temporarily suspended, with surgeries being performed only for emergent/urgent medical conditions such as hip fractures where early surgical intervention has shown decreased rates of morbidity/mortality. OBJECTIVES: To assess the indirect influence of the COVID-19 pandemic and associated lockdown on hip fracture patients, considering factors such as time to surgery, early postoperative complications, and ambulation status. METHODS: A comparative retrospective study was conducted on consecutive patients presenting to our emergency department (ED) with hip fractures that were treated surgically (N=29) during a 1-month period during the government lockdown due to the COVID-19 pandemic. The treatments were compared to consecutive patients who presented with hip fractures and were treated surgically (N=44) during the same timeframe in the previous year (control). Comparisons were made using t-test, ANOVA test, Fisher's exact test, and chi-square test. RESULTS: The COVID-19 group was operated on sooner (20.34 vs. 34.87 hours), had fewer early postoperative complications (10.3% vs. 31.8%), had better ambulatory status at discharge, and experienced a shorter hospital stay (5.93 vs. 8.13 days) with more patients being discharged home (72.4% vs. 22.7%). CONCLUSIONS: Patients presenting with hip fractures to our ED during the COVID-19 pandemic lockdown indirectly benefited from this situation by undergoing earlier surgical treatment, thus experiencing fewer early postoperative complications, faster ambulation, and sooner discharge.


Assuntos
COVID-19 , Fraturas do Quadril , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Humanos , Pandemias , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , SARS-CoV-2 , Caminhada
13.
J Orthop Traumatol ; 23(1): 24, 2022 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-35538323

RESUMO

INTRODUCTION: Posterior hip dislocation is the commonest type of hip dislocation. It is associated with femoral head fracture in 7% of cases. Urgent and congruent hip reduction is mandatory to improve clinical outcomes and avoid irreversible complications. The purpose of this study is to assess the safety and functional and radiological outcomes of surgical hip dislocation by Ganz technique for treatment of femoral head fracture. PATIENTS AND METHODS: In this retrospective study, 18 cases of femoral head fracture were included. Six cases had Pipkin type I and 12 had Pipkin type II fracture. They were treated through surgical hip dislocation. All cases were followed up for at least 24 months. Matta's criteria were used for radiological evaluation (plain radiographs). Functional evaluation was done using Harris Hip Score and modified Merle d'Aubigne and Postel score at final follow-up. RESULTS: No patients were lost during the follow-up period. No signs of infection or wound dehiscence were noted in this study. There was one case of osteonecrosis. All cases had labral injury, which was debrided. None of our cases needed suture anchor repair of the labrum. Radiographical evaluation according to Matta's criteria yielded anatomic fracture reduction in 17 patients but imperfect in 1 patient. According to Harris Hip Score, four Pipkin type I cases were rated as excellent and two as good. Among cases of Pipkin type II fracture, six were rated as excellent, four as good, one as fair, and one as poor. According to modified Merle d'Aubigne and Postel score, 11 cases had excellent results, 5 cases were rated as good, one as fair, while one case had poor results. CONCLUSION: Open reduction and internal fixation of femoral head fracture using surgical hip dislocation through Ganz approach is a viable treatment option and provides satisfactory results with low complication rate.


Assuntos
Fraturas do Fêmur , Luxação do Quadril , Fraturas do Quadril , Fraturas do Fêmur/cirurgia , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/lesões , Cabeça do Fêmur/cirurgia , Fixação Interna de Fraturas/métodos , Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/etiologia , Luxação do Quadril/cirurgia , Fraturas do Quadril/complicações , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/cirurgia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
14.
BMC Surg ; 22(1): 165, 2022 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-35538455

RESUMO

BACKGROUND: In clinical practice, acetabular posterior wall fracture combined with femoral head fracture is rare. However, with the increasing number of engineering and traffic accidents, such fractures, have increased significantly in recent years. This paper aims to explore the clinical efficiency of the Kocher-Langenbeck (K-L) and Smith-Petersen (S-P) combined approaches for open reduction and internal fixation (ORIF) of acetabular posterior wall fractures accompanied by femoral head fractures (Pipkin type IV fractures). METHODS: A retrospective study was conducted on 8 patients who underwent open reduction and internal fixation (ORIF) of Pipkin type IV fractures through the K-L combined with S-P approach in our hospital from January 2015 to January 2020. All 8 patients were successfully operated on without serious complications, such as important blood vessel and nerve damage, with an operation time of 143.8 ± 44.38 min and intraoperative blood loss of 225 ± 70.71 ml. Perioperative data were recorded. The Harris score was used to evaluate the clinical effect. Fracture reduction quality was evaluated according to the Matta radiological standard. The grade of ectopic ossification was evaluated by the Brooker grading method, and the stage of femoral head necrosis was evaluated by Ficat-Arlet staging. RESULTS: The Harris score increased significantly from 57.38 ± 4.779 at 3 months, to 76.13 ± 3.682 at 6 months, 88.25 ± 3.495 at 12 months, and 92.13 ± 2.232 at 36 months postoperatively. After statistical analysis, compared with the previous observation time point, the data comparison differences between the groups were statistically significant. P < 0.001, P < 0.001, P < 0.05). By the time of the latest follow-up, 6 of the 8 patients had recovered to the level of pre-injury sports capacity. In contrast, the other 2 patients remained below the level of pre-injury sports capacity. In terms of imaging evaluation, the quality of fracture reduction on radiographs was graded as excellent in 6 patients and good in 2 patients according to Matta's criteria. At the last follow-up, no heterotopic ossification or femoral head necrosis was found in of all the images. In addition, the hip joint space was normal in 6 cases, mildly narrowed in 1 case, and clearly narrowed in 1 case. CONCLUSIONS: The K-L combined with S-P approach provides effective exposure for the reduction and fixation of Pipkin type IV fractures and achieves satisfactory clinical outcomes.


Assuntos
Fraturas do Fêmur , Necrose da Cabeça do Fêmur , Fraturas Ósseas , Fraturas do Quadril , Fraturas da Coluna Vertebral , Cabeça do Fêmur/cirurgia , Necrose da Cabeça do Fêmur/etiologia , Necrose da Cabeça do Fêmur/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Fraturas do Quadril/cirurgia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
15.
BMC Musculoskelet Disord ; 23(1): 417, 2022 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-35509097

RESUMO

BACKGROUND: This study aimed to investigate the prevalence of preoperative deep venous thrombosis (DVT) following intertrochanteric fractures in the elderly and identify the associated factors, based on which a risk prediction model was developed. METHOD: This was a retrospective single-center study of elderly patients presenting with intertrochanteric fractures between our institution between January 2017 and December 2020. Patients' duplex ultrasound (DUS) or venography results were retrieved to evaluate whether they had a preoperative deep venous thrombosis (DVT) of bilateral extremities, whereby patients were dichotomized. Various variables of interest on demographics, comorbidities, injury and biomarkers were extracted and their relationship between DVT were investigated. Statistically significant variables tested in multivariate logistics regression analyses were used to develop a risk prediction model. RESULTS: There were 855 patients eligible to be included in this study, and 105 were found to have preoperative DVT, with a prevalence rate of 12.3%. Ten factors were tested as significantly different and 2 marginally significant between DVT and non-DVT groups in the univariate analyses, but only 6 demonstrated the independent effect on DVT occurrence, including history of a VTE event (OR, 4.43; 95%CI, 2.04 to 9.62), time from injury to DVT screening (OR, 1.19; 95%CI, 1.13 to 1.25), BMI (OR, 1.11; 95%CI, 1.04-1.18), peripheral vascular disease (OR, 2.66; 95%CI, 1.10 to 6.40), reduced albumin (2.35; 95%CI, 1.48 to 3.71) and D-Dimer > 1.0 mg/L(OR, 1.90; 95%CI, 1.13 to 3.20). The DVT risk model showed an AUC of 0.780 (95%CI, 0.731 to 0.829), with a sensitivity of 0.667 and a specificity of 0.777. CONCLUSION: Despite without a so high prevalence rate of DVT in a general population with intertrochanteric fracture, particular attention should be paid to those involved in the associated risk factors above. The risk prediction model exhibited the improved specificity, but its validity required further studies to verify.


Assuntos
Fraturas do Quadril , Trombose Venosa , Idoso , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Humanos , Incidência , Prevalência , Estudos Retrospectivos , Fatores de Risco , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/epidemiologia
16.
Clin Lab ; 68(4)2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35443580

RESUMO

BACKGROUND: Heparin-induced thrombocytopenia (HIT) is a severe complication caused by heparin. It is characterized by occult onset and missed diagnosis. Misdiagnosis easily occurs. METHODS: This paper reported an 85-year-old woman with an intertrochanteric fracture of the femur which was treated with low molecular weight heparin (LMWH) and fondaparinux sodium to prevent venous thrombosis. Then, the patient developed HIT. This is the first case report of HIT induced by LMWH and fondaparinux in a patient with a hip fracture. This case highlights the severity of HIT in elderly patients with hip fractures using LMWH and fondaparinux and the need for platelet monitoring in these patients. RESULTS: LMWH was ceased in this HIT-confirmed patient, and non-heparin treatment was begun instead. Apixaban was given twice daily for therapeutic anticoagulation therapy. In the end, the platelet levels gradually returned to normal. CONCLUSIONS: We should pay more attention to HIT and platelets during the perioperative period of orthopedic surgery, especially in elderly patients. Once the disease is confirmed, it is necessary to stop heparin-related drugs immediately and administer oral anticoagulants instead.


Assuntos
Fraturas do Quadril , Trombocitopenia , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Feminino , Fêmur , Fondaparinux/efeitos adversos , Heparina/efeitos adversos , Heparina de Baixo Peso Molecular/efeitos adversos , Fraturas do Quadril/complicações , Fraturas do Quadril/tratamento farmacológico , Fraturas do Quadril/cirurgia , Humanos , Trombocitopenia/induzido quimicamente , Trombocitopenia/diagnóstico
17.
BMC Musculoskelet Disord ; 23(1): 370, 2022 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-35443641

RESUMO

BACKGROUND: The surgical treatment of complex acetabular fractures is one of the most challenging procedures for orthopedic surgeons. The Pararectus approach, as a reasonable alternative to the existing surgical procedures, was performed for the treatment of acetabular fractures involving the anterior column. This study aimed to evaluate outcome using the Pararectus approach for acetabular fractures involving anterior columns. METHODS: Thirty-seven with displaced acetabular fractures involving anterior columns were treated between July 2016 and October 2019 using the Pararectus approach. The functional outcomes (using the Merle d Aubigné and Postel scoring system, WOMAC and modified Harris scoring), the quality of surgical reduction (using the Matta criteria), and postoperative complications were assessed during approximately 26 months follow-up period. RESULTS: Thirty-seven patients (mean age 53 years, range: 30-71; 28 male) underwent surgery. Mean intraoperative blood loss was 840 ml (rang: 400-2000 ml) and mean operating time was 210 min (rang: 140-500 min). The modified Merle d Aubigné score was excellent and good in 27 cases (73%), fair in 6 cases (16%), and poor in 3 cases (11%). The mean score was 88.5 (range:77-96) for the modified Harris Hip scores, and 22 (range:7-35) for the WOMAC scores after operation. Postoperative functional outcomes were significantly improved compared with preoperative outcomes (P < 0.0001). The quality of reduction was anatomical in 21 cases (57%), satisfactory in 9 cases (24%), and unsatisfactory in 7 cases (19%). At follow-up, four patients developed a DVT, and heterotopic bone formation was observed in one patient. The hip osteoarthritis was not observed. CONCLUSION: The Pararectus approach achieved good functional outcomes and anatomical reduction in the treatment of acetabular fractures involving anterior column with minimal access morbidity.


Assuntos
Fraturas Ósseas , Fraturas do Quadril , Lesões do Pescoço , Fraturas da Coluna Vertebral , Acetábulo/diagnóstico por imagem , Acetábulo/lesões , Acetábulo/cirurgia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Fraturas do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
19.
Jt Dis Relat Surg ; 33(1): 17-23, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35361076

RESUMO

OBJECTIVES: In this study, we aimed to analyze patient mortality rate after non-operative treatment of hip fractures to determine the distribution of causes of death and to compare factors affecting mortality. PATIENTS AND METHODS: Between January 2013 and March 2019, a total of 93 patients (17 males, 76 females; mean age: 86.0±7.4 years; range, 64 to 98 years) who had hip fractures and were treated non-operatively were analyzed retrospectively. Survival, date of death, and cause of death were collected and analyzed. Baseline demographics, pre-trauma ambulation, pre- and post-trauma residence status, American Society of Anesthesiologists Physical Status (ASA PS) classification, and Parker's mobility score were compared with one-year mortality rates. RESULTS: The mean follow-up of survivors was 16.1±11.9 (range, 6.3 to 79.6) months. The mean survival of non-survivors was 4.9±6.1 (range, 0.007 to 27.3) months. The 3-, 6-, 12-, and 24-month mortality rates were 40.9%, 53.3%, 74.4%, and 87.5%, respectively. Respiratory diseases (33.3%) and cardiovascular diseases (13.6%) were the main causes of death among the patients. There was no statistically significant difference between the patients' age, sex, fracture site, pre-trauma ambulation, pre- and post-trauma residence status, ASA PS classification, Parker's mobility score, and one-year mortality. CONCLUSION: A significant number of patients are still treated non-operatively after hip fractures, and they have a high mortality rate. Efforts and research are needed to reduce mortality and improve the quality of life.


Assuntos
Fraturas do Quadril , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Feminino , Fixação Interna de Fraturas , Fraturas do Quadril/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Caminhada
20.
Jt Dis Relat Surg ; 33(1): 187-192, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35361094

RESUMO

OBJECTIVES: This study aims to evaluate the effect of surgical experience on reliability for Boyd-Griffin, Evans/Jensen, Evans, Orthopaedic Trauma Association (main and subgroups), and Tronzo classification systems. PATIENTS AND METHODS: Between January 2013 and December 2014, radiological images of a total of 60 patients (13 males, 47 females; mean age: 78.9±21.9 years; range, 61 to 96 years) with the diagnosis of intertrochanteric femur fracture were analyzed. Radiographs were evaluated and classified by five residents and five orthopedics and traumatology surgeons according to the Evans, Boyd-Griffin, Evans/Jensen, OTA, and Tronzo classification systems. Intra- and interobserver reliability were calculated using the kappa statistics. RESULTS: The worst intraobserver compatibility among the residents was the classification system with OTA subgroups (κ=0.516), while the classification system with the best intraobserver fit was found to be OTA main groups (κ=0.744). The worst agreement among surgeons was in the Evans classification system (κ=0.456). However, the best intraobserver agreement was in the OTA main groups (κ=0.741). The best interobserver agreement was observed regarding the OTA main groups (κ=0.699). CONCLUSION: The classification that has the best harmony both among residents and surgeons, and between residents and surgeons is the OTA main group classification.


Assuntos
Fraturas do Quadril , Traumatologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Fêmur , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes
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