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1.
Sensors (Basel) ; 21(12)2021 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-34200844

RESUMO

Can we recognize intraoperative real-time stress of orthopedic surgeons and which factors affect the stress of intraoperative orthopedic surgeons with EEG and HRV? From June 2018 to November 2018, 265 consecutive records of intraoperative stress measures for orthopedic surgeons were compared. Intraoperative EEG waves and HRV, comprising beats per minute (BPM) and low frequency (LF)/high frequency (HF) ratio were gathered for stress-associated parameters. Differences in stress parameters according to the experience of surgeons, intraoperative blood loss, and operation time depending on whether or not a tourniquet were investigated. Stress-associated EEG signals including beta 3 waves were significantly higher compared to EEG at rest for novice surgeons as the procedure progressed. Among senior surgeons, the LF/HF ratio reflecting the physical demands of stress was higher than that of novice surgeons at all stages. In surgeries including tourniquets, operation time was positively correlated with stress parameters including beta 1, beta 2, beta 3 waves and BPM. In non-tourniquet orthopedic surgeries, intraoperative blood loss was positively correlated with beta 1, beta 2, and beta 3 waves. Among orthopedic surgeons, those with less experience demonstrated relatively higher levels of stress during surgery. Prolonged operation time or excessive intraoperative blood loss appear to be contributing factors that increase stress.


Assuntos
Procedimentos Ortopédicos , Cirurgiões Ortopédicos , Cirurgiões , Eletroencefalografia , Frequência Cardíaca , Humanos
2.
J Am Acad Orthop Surg ; 29(14): 624-633, 2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-34234094

RESUMO

INTRODUCTION: Cognitive biases are known to affect all aspects of human decision-making and reasoning. Examples include misjudgment of probability, preferential attention to evidence that confirms one's beliefs, and preference for certainty. It is not known whether cognitive biases influence orthopaedic surgeon decision-making. This study measured the influence of a few cognitive biases on orthopaedic decision-making in hypothetical vignettes. The questions we addressed were as follows: Do orthopaedic surgeons display the cognitive biases of base rate neglect and confirmation bias in hypothetical vignettes? Can anchoring and framing biases be demonstrated? METHODS: One hundred ninety-six orthopaedic surgeons completed a survey consisting of three vignettes evaluating base rate neglect, five evaluating confirmation bias, and two separate vignettes each randomly exposing half of the group to different anchors and frames. RESULTS: For the three vignettes evaluating base rate neglect, 43% (84 of 196) chose answers consistent with base rate neglect in vignette 1, 88% (173 of 196) in vignette 2, and 35% (69 of 196) in vignette 3. Regarding confirmation bias, 51% (100 of 196) chose an answer consistent with confirmation bias for vignette 1, 11% (22 of 196) for vignette 2, 22% (43 of 196) for vignette 3, 22% (44 of 196) for vignette 4, and 29% (56 of 196) for vignette 5. There was a measurable anchoring heuristic (56% versus 34%; a difference of 22%) and framing effect (77% versus 61%; a difference of 16%). CONCLUSION: The influence of cognitive biases can be documented in patient vignettes presented to orthopaedic surgeons. Strategies can anticipate cognitive bias and develop practice debiasing strategies to limit potential error.


Assuntos
Procedimentos Ortopédicos , Ortopedia , Viés , Cognição , Tomada de Decisões , Humanos
3.
Acta Biomed ; 92(3): e2021280, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34212934

RESUMO

Purpose The purpose of this bibliometric study was to summarize European orthopedic literature produced by EFORT memberships between 2009 and 2019 and to identify the 100 most cited articles, analyzing the characteristics that made them so interesting for the orthopedic scientific world. Method A search of the literature was conducted using Clarivate Analytics Web of Science in the subject category "orthopaedics"; then the results were summarized using Web of Science tools. Results A total of 160.375 articles were found: most of these were produced by England. In particular the most prolific institution was the University of London. Analyzing in detail the 100 most cited publications emerged that most of them were review published in journal with high impact factor (Q1). The University of Oxford was the institution with the greatest number of contributions (13%). The most cited topics were osteoarthritis (24%), followed by orthopedic basic science (22%). Biomaterials was the most common topic by ordering the 100 analyzed articles according to "usage count", a recent indicator of the level of interest in a specific item. Conclusion This bibliometric study can be useful to identify topics of interest for future scientific research and to outline the features that make some publications more interesting than others.


Assuntos
Procedimentos Ortopédicos , Ortopedia , Bibliometria , Inglaterra , Humanos , Publicações
4.
BMJ ; 374: n1511, 2021 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-34233885

RESUMO

OBJECTIVE: To determine the clinical effectiveness of common elective orthopaedic procedures compared with no treatment, placebo, or non-operative care and assess the impact on clinical guidelines. DESIGN: Umbrella review of meta-analyses of randomised controlled trials or other study designs in the absence of meta-analyses of randomised controlled trials. DATA SOURCES: Ten of the most common elective orthopaedic procedures-arthroscopic anterior cruciate ligament reconstruction, arthroscopic meniscal repair of the knee, arthroscopic partial meniscectomy of the knee, arthroscopic rotator cuff repair, arthroscopic subacromial decompression, carpal tunnel decompression, lumbar spine decompression, lumbar spine fusion, total hip replacement, and total knee replacement-were studied. Medline, Embase, Cochrane Library, and bibliographies were searched until September 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Meta-analyses of randomised controlled trials (or in the absence of meta-analysis other study designs) that compared the clinical effectiveness of any of the 10 orthopaedic procedures with no treatment, placebo, or non-operative care. DATA EXTRACTION AND SYNTHESIS: Summary data were extracted by two independent investigators, and a consensus was reached with the involvement of a third. The methodological quality of each meta-analysis was assessed using the Assessment of Multiple Systematic Reviews instrument. The Jadad decision algorithm was used to ascertain which meta-analysis represented the best evidence. The National Institute for Health and Care Excellence Evidence search was used to check whether recommendations for each procedure reflected the body of evidence. MAIN OUTCOME MEASURES: Quality and quantity of evidence behind common elective orthopaedic interventions and comparisons with the strength of recommendations in relevant national clinical guidelines. RESULTS: Randomised controlled trial evidence supports the superiority of carpal tunnel decompression and total knee replacement over non-operative care. No randomised controlled trials specifically compared total hip replacement or meniscal repair with non-operative care. Trial evidence for the other six procedures showed no benefit over non-operative care. CONCLUSIONS: Although they may be effective overall or in certain subgroups, no strong, high quality evidence base shows that many commonly performed elective orthopaedic procedures are more effective than non-operative alternatives. Despite the lack of strong evidence, some of these procedures are still recommended by national guidelines in certain situations. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018115917.


Assuntos
Procedimentos Ortopédicos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Eletivos , Humanos , Resultado do Tratamento
5.
Acta Med Port ; 34(4): 305-311, 2021 Mar 31.
Artigo em Português | MEDLINE | ID: mdl-34214423

RESUMO

This document was prepared by the College of Orthopedics of the Portuguese Medical Association with the aim of developing the guidelines on the resumption of elective surgical activity in Orthopedics during the COVID-19 pandemic. It sets the criteria that allow the prioritization of surgeries according to the severity of the clinical situation, based on existing and published classifications. Moreover, it provides an organizational model for patient preparation and describes the patient pathways in the preoperative, intraoperative and postoperative periods. It also describes safety rules for elective surgery and a model for monitoring patients after discharge according to scientific evidence.


Assuntos
COVID-19/prevenção & controle , Procedimentos Ortopédicos , Ortopedia , Guias de Prática Clínica como Assunto , COVID-19/epidemiologia , Humanos , Saúde do Trabalhador , Procedimentos Ortopédicos/normas , Pandemias/prevenção & controle , Segurança do Paciente , Portugal , SARS-CoV-2 , Sociedades Médicas
6.
Mayo Clin Proc ; 96(7): 2012-2013, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34218874

RESUMO

Stamp Vignettes focus on biographical details and accomplishments related to science and medicine, and not individual views and prejudices except when they had a major impact on the subject's life. The authors of Stamp Vignettes do not intend to imply any endorsement of such views when discussing a Stamp Vignette on Medical Science.


Assuntos
Fixação Interna de Fraturas , Fixadores Internos/história , Ortopedia/história , Bélgica , Fixação Interna de Fraturas/história , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , História do Século XIX , História do Século XX , Humanos , Procedimentos Ortopédicos
7.
Spine (Phila Pa 1976) ; 46(15): E840-E849, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34228696

RESUMO

STUDY DESIGN: Meta-analysis. OBJECTIVE: To compare the clinical, functional, and radiological outcomes of posterior-only versus combined anterior-posterior instrumentation in order to determine the optimal surgical intervention for thoracolumbar burst fractures. SUMMARY OF BACKGROUND DATA: Unstable thoracolumbar burst fractures warrant surgical intervention to prevent neurological deterioration and progressive kyphosis, which can lead to significant pain and functional morbidity. The available literature remains largely inconclusive in determining the optimal instrumentation strategy. METHODS: Electronic searches of MEDLINE (1948-May 2020), EMBASE (1947-May 2020), The Cochrane Library (1991-May 2020), and other databases were conducted. Cochrane Collaboration guidelines were used for data extraction and quality assessment. Outcomes of interest were divided into three categories: radiological (degree of postoperative kyphosis correction; loss of kyphosis correction at final follow-up), functional (visual analogue scale [VAS] pain score; Oswestry Disability Index [ODI] score), and clinical (intraoperative blood loss; length of stay [LOS]; operative time; the number and type of postoperative complications). RESULTS: Four randomized control trials (RCTs) were retrieved, including 145 randomized participants. Seventy-three patients underwent posterior-only instrumentation and 72 underwent combined instrumentation. No significant difference was found in the degree of postoperative kyphosis correction (P = 0.39), VAS (centimeters) at final follow-up (P = 0.67), ODI at final follow-up (P = 0.89) or the number of postoperative complications between the two approaches (P = 0.49). Posterior-only instrumentation was associated with lower blood loss (P < 0.001), operative time (P < 0.001), and LOS (P = 0.01). Combined instrumentation had a lower degree of kyphosis loss at final follow-up (P = 0.001). There was heterogeneity in the duration of follow-up between the included studies (mean follow-up range 24-121 months). CONCLUSION: The available literature remains largely inconclusive. In order to reliably inform practice in this area, there is a need for large, high-quality, multicenter RCTs with standardized reporting of outcomes, with a particular focus on outcomes relating to patient function and severe complications causing long-term morbidity.Level of Evidence: 2.


Assuntos
Fraturas por Compressão/cirurgia , Vértebras Lombares/cirurgia , Procedimentos Ortopédicos , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Humanos , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/instrumentação , Procedimentos Ortopédicos/métodos , Complicações Pós-Operatórias , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
8.
Vet Clin North Am Equine Pract ; 37(2): 275-291, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34243876

RESUMO

For the equine veterinarian, orthopedic emergencies are a common occurrence in clinical practice, with traumatic wounds of the distal limb and penetrating injuries of the hoof being some of the most common medical conditions to affect horses. Intravenous regional limb perfusion is a technique widely used for the treatment of orthopedic infections in horses. The objectives of this review are to discuss some of the clinical applications for this treatment modality in the field and to review the technique for the practitioner.


Assuntos
Doenças do Pé/veterinária , Doenças dos Cavalos/terapia , Administração Intravenosa , Animais , Antibacterianos/administração & dosagem , Doenças do Pé/terapia , Casco e Garras/lesões , Cavalos , Procedimentos Ortopédicos/veterinária , Perfusão/veterinária
9.
Jt Dis Relat Surg ; 32(2): 323-332, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34145807

RESUMO

OBJECTIVES: The aim of this study was to evaluate the impact of novel coronavirus-2019 (COVID-19) on the epidemiological characteristics of orthopedic fractures. PATIENTS AND METHODS: A total of 2,960 patients (1,755 males, 1,205 females; mean age: 39.6 years; range, 1 to 98 years) with orthopedic fractures were included in the study: 552 patients during the pandemic period (March 10th and July 1st, 2020) and 1,158 control patients in the same period 2019 and 1,250 control patients in 2018. Epidemiological characteristics, injury mechanisms, fracture locations and treatment details of the patients were analyzed and compared between 2018, 2019 and 2020 for adult and pediatric populations. RESULTS: Of a total of 552 patients, 485 were adults and 67 were pediatric patients. In the control groups, of 1,158 patients (2019), 770 were adults and 378 were pediatric patients and, of 1,250 patients (2018), 857 were adults and 393 were pediatric patients. The proportion of proximal femur and hand fractures significantly increased during the pandemic period (p=0.025 and p=0.038, respectively). The most frequent surgical indication in the pandemic period was proximal femoral fracture. The proportion of home accidents as an injury mechanism significantly increased in the pandemic period compared to 2018 and 2019 (48.5% vs. 18.6% and 20.6%, respectively; p=0.000). The proportion of female pediatric patients significantly increased during the pandemic period compared to 2018 and 2019 (44.8% vs. 25.4% and 27.2%, respectively, p=0.004). The proportion of forearm fractures (p=0.001) also increased, and the proportion of tibia-fibula fractures (p=0.03) decreased. The most frequent surgical indication in pediatric patients was distal humeral fracture in both groups. CONCLUSION: During the pandemic period, proximal femoral fractures in the elderly remained a concern. In-home preventative strategies may be beneficial to reduce the incidence of hip fractures in the elderly.


Assuntos
COVID-19 , Fraturas Ósseas , Procedimentos Ortopédicos , Adulto , Fatores Etários , Idoso , COVID-19/epidemiologia , COVID-19/prevenção & controle , Criança , Feminino , Fraturas Ósseas/classificação , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/prevenção & controle , Fraturas Ósseas/cirurgia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/estatística & dados numéricos , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos Retrospectivos , SARS-CoV-2 , Fatores Sexuais , Turquia/epidemiologia
10.
Jt Dis Relat Surg ; 32(2): 333-339, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34145808

RESUMO

OBJECTIVES: The aim of this study is to investigate the effect of the novel coronavirus-2019 (COVID-19) pandemic on the operational trends in the orthopedic surgery department of a tertiary referral center. PATIENTS AND METHODS: A total of 305 orthopedic surgical procedures in 245 patients (136 males, 109 females; mean age: 34±26.6 years; range, 0 to 91 years) between March 16th and June 27th, 2020 were retrospectively analyzed. The same period of the year before including 860 procedures in 783 patients (364 males, 419 females; mean age: 33.6±25.8 years; range, 0 to 95 years) was also reviewed as a pre-pandemic control group. Patient demographics, surgical indications, COVID-19 polymerase chain reaction (PCR) test status, method of anesthesia, surgical subspecialties (trauma, sports, etc.), trauma mechanisms, and surgical priorities were evaluated. The pandemic and the pre-pandemic periods were compared. RESULTS: The rate of elective surgeries decreased compared to the previous year, and priority C type surgeries had the highest frequency (42.5%). Orthopedic trauma was the leading subspecialty with 91 (29.8%) cases and had a higher share, compared to the pre-pandemic period (17.0%). Hip fractures (18.7%) were the most common cause of trauma surgery, and simple falls (42.3%) composed the largest group of trauma mechanisms, which was similar to the pre-pandemic period (hip fractures, 13.6%; simple falls, 42.5%). The distribution of surgical urgency levels and subspecialties differed significantly between the pre-pandemic and pandemic periods (p<0.001). Post-hoc analysis of subspecialty distribution revealed a significant decrease in arthroplasty (p=0.002) and hand surgery (p<0.001), and a significant increase in trauma (p<0.001) and the "other" category (p<0.001). CONCLUSION: Our experience in a tertiary referral center illustrated a shift toward performing emergent and urgent surgeries, when the severity of the outbreak increased. Prioritizing surgical urgencies during the outbreak changed the orthopedic surgery practice with an emphasis on trauma and oncology surgeries. Hip fractures were the most common cause of trauma surgery, and simple falls composed the largest group of trauma mechanisms.


Assuntos
Anestesia/métodos , COVID-19 , Procedimentos Cirúrgicos Eletivos , Fraturas do Quadril , Doenças Musculoesqueléticas , Procedimentos Ortopédicos , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Humanos , Masculino , Doenças Musculoesqueléticas/epidemiologia , Doenças Musculoesqueléticas/etiologia , Doenças Musculoesqueléticas/cirurgia , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/estatística & dados numéricos , Estudos Retrospectivos , SARS-CoV-2 , Centros de Atenção Terciária/estatística & dados numéricos , Turquia/epidemiologia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/cirurgia
11.
Pan Afr Med J ; 38: 291, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34178210

RESUMO

The refusal and abandonment of treatment is a behavior frequently observed in our daily practice. The purpose of this study was to describe the epidemiology and to identify the reasons for refusals and abandonment of treatment. We conducted a prospective study in the emergency surgery at the University Hospital Center of Bouake from 1st January 2018 to 31st December 2018. It involved all patients admitted with traumatic lesions who had refused or abandoned treatment. Data from 106 cases (16%) of refusal and abandonment of treatment out of 662 cases admitted with limb traumas were examined over this period. The average age of patients was 37 years. The study enrolled 77 men (72.6%). Tertiary sector workers accounted for 56.6% (n= 60) of cases. Lesions were dominated by closed fractures (82.1%; n= 87) and pelvic limbs were the most achieved (78.3%; n=83). Treatment was based on surgery (n=85; 80.2% ) and orthopaedic treatment (n=21; 19.8%). The cost of orthopedic treatment was estimated at 26 500 CFA francs (40 euros) while at 250 000 FCFA (380 euros) for surgical treatment. These costs varied as a function of implant prescribed and its location. Refusal of tratment was expressed by patients (n=30; 28.3%) and by parents (n=76; 71.7%). Reported reasons were dominated by financial problems (n=62; 58.5%), trust in traditional medicine (n=42; 39.6%), religious belief (n=2; 1.9%). The average time of refusal was 22 hours. Eighty eight point seven percent (n=94) of patients signed discharge while 11.3% (n=12) escaped. Refusal of care is a recurrent theme in our context and is due to inadequate health care management of people with limited financial resources.


Assuntos
Procedimentos Ortopédicos/estatística & dados numéricos , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Ferimentos e Lesões/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Costa do Marfim , Feminino , Fraturas Ósseas/terapia , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
12.
Biomed Res Int ; 2021: 8875643, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34189140

RESUMO

Background: Almost every sector in the health care is affected by the COVID-19 pandemic. Many studies already investigated the effect on different aspects in orthopedic and trauma care. However, the current literature lacks data regarding the consequence on daily surgical business. Thus, the aim of the present study was to analyze the development of knee-related pathologies and surgical procedures in a German university level-one trauma center during the lockdown phase and early lockdown phase to investigate the impact of the COVID-19 lockdown on orthopedic and trauma knee surgery. Material and Methods. The amount of knee joint surgeries performed during the high-peak COVID-19 crisis in the period of January to May 2020 was evaluated retrospectively and compared to the corresponding time periods of the previous years (2017-2019). Results: The COVID-19 lockdown led to a significant decrease in the number of knee injuries in March and April 2020 by 83.3%. Surgical procedures were reduced by 84.8% during the same period. In May 2020, the number of knee joint procedures returned to an almost prepandemic level. The distribution of urgent and elective knee surgery changed to predominantly acute trauma care at the beginning of the COVID-19 lockdown and persisted through to May 2020. Conclusion: The COVID-19 pandemic had a high impact on emergency and elective knee surgery in a level-one trauma center in Germany during the lockdown phase. It also showed that a level-one trauma center in the German healthcare system is able to handle urgent trauma and orthopedic operations during a worldwide medical crisis and to return to a prepandemic level within a short phase.


Assuntos
COVID-19 , Traumatismos do Joelho , Procedimentos Ortopédicos , Quarentena , SARS-CoV-2 , Centros de Traumatologia , Adulto , Idoso , COVID-19/epidemiologia , COVID-19/prevenção & controle , Feminino , Alemanha/epidemiologia , Humanos , Traumatismos do Joelho/epidemiologia , Traumatismos do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
J Pediatr Orthop ; 41(6): e417-e421, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34096548

RESUMO

BACKGROUND: Tension band plating for temporary hemiepiphysiodesis has been reported by several authors as simple and effective for treating angular deformities of the lower limb. Anecdotally, patients have reported higher pain levels than expected given the small size of incision and relatively minimal amount of dissection, and we sought to investigate this further. METHODS: Patients 16 years old or less with lower extremity angular deformities or limb length inequality were prospectively enrolled before tension band plating from 2 pediatric institutions from July 2016 to December 2018. Participants completed postoperative questionnaires regarding their pain and activity level. Pain was assessed using the FACES Pain Scale. Patients were included if they completed the 1 month survey. RESULTS: Of the 48 patients that met inclusion criteria (mean age at surgery: 13.1 y; range: 7 to 16 y), 39 patients completed the survey at 3 months postoperatively. There was a significant change in pain level between 1 week and 1 month postoperatively (P<0.001). Eighty-three percent (34/41) of patients were still taking pain medication at 1 week, which decreased to 38% (18/48) at 1 month. At 3 months, 21% (8/39) patients reported they were still using pain medication. At 1 month, 65% of patients (31/48) had not returned to their prior activity level. Of the 39 patients who played sports, 59% (23/39) still had not fully returned to sports at 1 month. CONCLUSION: At 1 month following tension band plating, 65% of patients had not returned to their preoperative activity level, and 38% were taking pain medications. Although the tension band plate and surgical incision is small in size, patients and parents should be counseled that there are significant activity limitations and pain levels for a month or longer in many patients. LEVEL OF EVIDENCE: Level II.


Assuntos
Desigualdade de Membros Inferiores/cirurgia , Procedimentos Ortopédicos/efeitos adversos , Dor Pós-Operatória/etiologia , Recuperação de Função Fisiológica , Adolescente , Analgésicos/efeitos adversos , Placas Ósseas , Criança , Feminino , Humanos , Masculino , Procedimentos Ortopédicos/reabilitação , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Estudos Prospectivos
14.
Spine (Phila Pa 1976) ; 46(13): 901-906, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34100843

RESUMO

STUDY DESIGN: Retrospective cohort study with propensity matched cohorts. OBJECTIVE: The purpose of this study was to evaluate the association of anticoagulation with VTE and hematoma complications after spine surgery. SUMMARY OF BACKGROUND DATA: One of the major complications of surgery is VTE which can range in presentation. Spine surgery is an especially complex balance between minimizing the risk of a VTE event and also the increased risk of a hematoma which can lead to devastating neurological outcomes. METHODS: The elective spine surgery cases at a single academic center between 2015 and 2017 were identified. A total of 3790 patients were initially identified. Two hundred sixty patients were excluded. The cohort was then matched using a propensity score. This matched a single patient who did not receive anticoagulation to a single patient who did within the institution. This left a total of 1776 patients with 888 patients in each arm. RESULTS: The incidence of VTE, PE, and unplanned reoperation for hematoma in this cohort was 0.96%, 0.34%, and 1.13%, respectively. Predicted odds of VTE and PE were not significantly different; however, the odds of an unplanned reoperation for hematoma (odds ratio [OR] = 7.535, 95% confidence interval [CI]: 2.004-28.340, P = 0.002) were greater for those who received pharmacological anticoagulation in our institutional cohort. CONCLUSION: In this study, anticoagulation does not lead to lower rates of VTE events, but it increases the risk of symptomatic hematomas which require a return trip to the OR. While this was not a randomized controlled trial, we attempted to correct for this with propensity matching. Future randomized control trials would be needed.Level of Evidence: 3.


Assuntos
Anticoagulantes , Procedimentos Cirúrgicos Eletivos , Hematoma , Procedimentos Ortopédicos , Coluna Vertebral/cirurgia , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/métodos , Hematoma/epidemiologia , Hematoma/etiologia , Humanos , Incidência , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Reoperação , Estudos Retrospectivos
15.
J Orthop Traumatol ; 22(1): 22, 2021 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-34128114

RESUMO

BACKGROUND: Periprosthetic fractures (PPFs) are a growing matter for orthopaedic surgeons, and patients with PPFs may represent a frail target in the case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The purpose of this study is to investigate whether hospital reorganisations during the most severe phase of the SARS-CoV-2 pandemic affected standards of care and early outcomes of patients treated for PPFs in Northern Italy. MATERIALS AND METHODS: Data were retrieved from a multicentre retrospective orthopaedics and traumatology database, including 14 hospitals. The following parameters were studied: demographics, results of nasopharyngeal swabs, prevalence of coronavirus disease 2019 (COVID-19), comorbidities, general health status (EQ-5D-5L Score), frailty (Clinical Frailty Scale, CFS), pain (visual analogue scale, VAS), anaesthesiologic risk (American Society of Anaesthesiology Score, ASA Score), classification (unified classification system, UCS), type of operation and anaesthesia, in-hospital and early complications (Clavien-Dindo Classification, CDC), and length of stay (LOS). Data were analysed by means of descriptive statistics. Out of 1390 patients treated for any reason, 38 PPFs were included. RESULTS: Median age was 81 years (range 70-96 years). Twenty-three patients (60.5%) were swabbed on admission, and two of them (5.3%) tested positive; in three patients (7.9%), the diagnosis of COVID-19 was established on a clinical and radiological basis. Two more patients tested positive post-operatively, and one of them died due to COVID-19. Thirty-three patients (86.8%) presented a proximal femoral PPF. Median ASA Score was 3 (range, 1-4), median VAS score on admission was 3 (range, 0-6), median CFS was 4 (range, 1-8), median EQ-5D-5L Score was 3 in each one of the categories (range, 1-5). Twenty-three patients (60.5%) developed post-operative complications, and median CDC grade was 3 (range, 1-5). The median LOS was 12.8 days (range 2-36 days), and 21 patients (55.3%) were discharged home. CONCLUSIONS: The incidence of PPFs did not seem to change during the lockdown. Patients were mainly elderly with comorbidities, and complications were frequently recorded post-operatively. Despite the difficult period for the healthcare system, hospitals were able to provide effective conventional surgical treatments for PPFs, which were not negatively influenced by the reorganisation. Continued efforts are required to optimise the treatment of these frail patients in the period of the pandemic, minimising the risk of contamination, and to limit the incidence of PPFs in the future. LEVEL OF EVIDENCE: IV.


Assuntos
COVID-19 , Reestruturação Hospitalar , Controle de Infecções , Pandemias , Fraturas Periprotéticas , Padrão de Cuidado , Idoso , Idoso de 80 Anos ou mais , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/normas , Controle de Doenças Transmissíveis/estatística & dados numéricos , Comorbidade , Feminino , Fragilidade/epidemiologia , Reestruturação Hospitalar/organização & administração , Reestruturação Hospitalar/normas , Reestruturação Hospitalar/estatística & dados numéricos , Humanos , Incidência , Controle de Infecções/métodos , Controle de Infecções/normas , Controle de Infecções/estatística & dados numéricos , Itália/epidemiologia , Masculino , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/normas , Procedimentos Ortopédicos/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Fraturas Periprotéticas/complicações , Fraturas Periprotéticas/epidemiologia , Fraturas Periprotéticas/cirurgia , Fraturas Periprotéticas/terapia , Estudos Retrospectivos , SARS-CoV-2 , Padrão de Cuidado/normas , Padrão de Cuidado/estatística & dados numéricos
16.
J Pediatr Orthop ; 41(6): 379-384, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34096555

RESUMO

BACKGROUND: The prevalence of venous thromboembolism (VTE) may be increasing in children; however, scarce literature exists comparing incidence rates between pediatric orthopaedic patients and other pediatric patients. The purpose of this study was to compare the incidence, anatomic locations, and risk factors of VTEs between orthopaedic and nonorthopaedic pediatric related patients to determine if important differences exist. METHODS: Computed tomography and ultrasound data were reviewed for children (below 19 y old) with a diagnosed VTE between January 1, 2009 and December 31, 2016. Demographic and clinical data, including VTE anatomic location and risk factors, were recorded. Two major cohorts were identified: orthopaedic-related (ORTH) and nonorthopaedic-related (NORTH) VTEs. Incidence rates were estimated and risk factors were compared using χ2 testing. RESULTS: There were 373 children diagnosed with a VTE (average age 10.3 y) of a total of 810,097 treated as in-patients for an incidence rate of 4.60 per 10,000 cases (95% confidence interval=4.15 to 5.10 per 10,000 cases). The rate of ORTH VTEs (28 of 188,669 orthopaedic patients, 1.48 per 10,000 cases) was significantly lower than that of NORTH VTEs (345 of 621,428 nonorthopaedic patients, 5.55 per 10,000 cases; P<0.001). For the ORTH cohort, there was a significant difference in the proportion of deep vein thrombosis in the lower extremity (91%) compared with the upper extremity (9%) (P<0.001), while a more even distribution of NORTH deep vein thrombosis in the upper (50%) and lower (41%) extremities was appreciated. The primary risk factors for ORTH VTEs included surgery (93%; P<0.001), change in ambulatory status (61%; P<0.001), and trauma (18%; P<0.001), while the primary risk factors for NORTH VTEs included intravenous peripheral inserted central catheter/central line (61%; P<0.001) and cancer (27%; P=0.001). CONCLUSIONS: Pediatric ORTH VTEs have a significantly lower incidence rate and different primary risk factors than those of NORTH VTEs. This information is useful for health care providers when making decisions regarding risk and prophylaxis in pediatric patients with orthopaedic and nonorthopaedic conditions. LEVEL OF EVIDENCE: Level III.


Assuntos
Procedimentos Ortopédicos/estatística & dados numéricos , Tromboembolia Venosa/epidemiologia , Trombose Venosa/epidemiologia , Adolescente , Cateteres Venosos Centrais/estatística & dados numéricos , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Incidência , Extremidade Inferior , Masculino , Ortopedia/estatística & dados numéricos , Fatores de Risco , Extremidade Superior , Tromboembolia Venosa/diagnóstico por imagem , Caminhada , Ferimentos e Lesões/epidemiologia
17.
J Surg Orthop Adv ; 30(2): 116-119, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34181530

RESUMO

Military orthopaedic surgeons are faced with hardship and decreased morale. Surgeons have frequent deployments and practice inefficiencies resulting in poor retention rates. The purpose of this analysis is to report demographics and factors effecting military retention. A survey was sent to all members of the Society of Military Orthopedic Surgeons. The survey obtained demographic information, as well as factors affecting retention and termination of service. Data was compared between subset groups within the total respondent population. Of active-duty personnel, 38.5% plan on staying in the military until retirement. Most surgeons entered into the military due to a desire to serve their country, while most people leave service due to higher pay as a civilian. A minority of military orthopaedic surgeons achieve military retirement; however, increased pay, increased control over practice, and decreased frequency of deployments are factors that could improve retention rates. (Journal of Surgical Orthopaedic Advances 30(2):116-119, 2021).


Assuntos
Militares , Procedimentos Ortopédicos , Cirurgiões Ortopédicos , Ortopedia , Cirurgiões , Humanos
18.
Ann R Coll Surg Engl ; 103(7): e209-e211, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34192493

RESUMO

A 75-year-old man presents to his general practitioner (GP) with dyspnoea, and dysphagia to liquids and solids, with regurgitation causing recurrent episodes of dyspnoea. He had a background of osteoarthritis, was an ex heavy smoker and had undergone coronary artery bypass graft five years previously. After several emergency admissions, initial investigation by the GP, and referral to ear, nose and throat specialists with no cause for dysphagia found, he underwent computed tomography imaging of the neck and thorax which demonstrated large cervical osteophytes at the level of C3-C4. He was referred to spinal orthopaedics and after multidisciplinary team discussion the cervical osteophytes were removed via an anterior approach, resulting in complete resolution of his symptoms.


Assuntos
Vértebras Cervicais/cirurgia , Transtornos de Deglutição/etiologia , Dispneia/etiologia , Procedimentos Ortopédicos , Osteófito/diagnóstico , Idoso , Vértebras Cervicais/diagnóstico por imagem , Transtornos de Deglutição/cirurgia , Dispneia/cirurgia , Humanos , Masculino , Osteófito/complicações , Osteófito/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
Medicine (Baltimore) ; 100(23): e26322, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115046

RESUMO

RATIONALE: Severe tension pneumocephalus can lead to drowsiness, coma, and even brain hernia and death. The occurrence of delayed pneumocephalus after spinal surgery is rarely reported and often ignored. Herein, we report a case of delayed pneumocephalus after repeated percutaneous aspiration following spinal surgery. PATIENT CONCERNS: A 55-year-old man was admitted in October 2020 because of aggravation in bilateral lower limb weakness and dysuria for seven days. He was diagnosed with liver cancer a year ago, and he underwent several operations because of tumor recurrence. The patient underwent thoracic vertebrae tumor excision on this admission, and no cerebrospinal fluid leakage was discovered during surgery. After the third drainage by percutaneous aspiration, the patient complained of severe headache and vomiting on postoperative day 16. DIAGNOSIS: Emergency brain computed tomography revealed massive pneumocephalus. INTERVENTIONS: Thereafter, suction drainage was discontinued, and he was placed on bed rest and administered intravenous mannitol. OUTCOMES: Repeated computed tomography showed complete resolution of the pneumocephalus after five days. LESSONS: Wound exudates and cystic fluid after spinal surgery should be differentiated from cerebrospinal fluid leakage. Reckless percutaneous aspirations can form pneumocephalus in patients with an occult dural injury, and pneumocephalus can occur up to 16 days after surgery. Early diagnosis of pneumocephalus is crucial to avoid severe consequences.


Assuntos
Neoplasias Ósseas , Descompressão Cirúrgica/efeitos adversos , Drenagem/efeitos adversos , Procedimentos Ortopédicos , Complicações Pós-Operatórias , Vértebras Torácicas , Neoplasias Ósseas/patologia , Neoplasias Ósseas/secundário , Neoplasias Ósseas/cirurgia , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Descompressão Cirúrgica/métodos , Diuréticos Osmóticos/administração & dosagem , Drenagem/métodos , Humanos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Masculino , Manitol/administração & dosagem , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neuroimagem/métodos , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Pneumocefalia/diagnóstico , Pneumocefalia/etiologia , Pneumocefalia/fisiopatologia , Pneumocefalia/terapia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Reoperação/efeitos adversos , Reoperação/métodos , Vértebras Torácicas/patologia , Vértebras Torácicas/cirurgia , Resultado do Tratamento
20.
Medicine (Baltimore) ; 100(23): e26333, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115049

RESUMO

ABSTRACT: Subacromial impingement syndrome (SIS) after hook plate fixation for acromioclavicular joint (AC) dislocation was the most common complication. However, the researches on its' influential factors were rare. The purpose of this study was to identify the risk factors by analyzing the influencing factors of postoperative SIS and minimize the incidence of SIS in clinical surgery.We retrospectively analyzed the prospectively collected data from 330 consecutive patients with AC joint dislocation between August 2014 and August 2017 at our institute. The SIS was presented as the dependent variable at the last follow-up when the internal fixation was removed. The independent variables included age, gender, body-mass index (BMI), smoking status, alcohol consumption, type of injury, Rockwood Classification, site of injury, operation time, injury-to-surgery, the distance between the hook body and the acromion (DBA), the depth of hook tip (DHT), the distance between the hook plate and the humeral head (DHH), the distance between the acromion and the humeral head (DAH), the hook plate angle (AHP) and acromial shape. Logistic regression analysis was performed to identify independent influential factors of SIS.A total of 312 cases were included and 18 cases were lost. The follow-up rate was 94.5%. In without SIS group, there were 225 cases (123 males and 102 females). In with SIS group, a total of 87 cases were included (56 males and 31 females). The incidence of SIS was 27.8%. DHT (OR = 9.385, 95% CI = 4.883 to 18.040, P < .001) and DBA (OR = 2.444, 95% CI = 1.591 to 3.755, P < .001) were the significant independent risk factor for SIS of AC dislocation treat with hook plate. DAH (OR = 0.597, 95% CI = 0.396 to 0.900, P = .014) and acromial shape with flat and straight (OR = 0.325, 95% CI = 0.135 to 0.785, P = .012) were also independent factors of SIS, but they were all protective.The SIS had a high incidence in fixation of clavicular hook plate for AC dislocation. DHT and DBA were two independent risk factors, DAH and acromial shape with flat and straight were two independent protective factors for SIS. In clinical surgery, we should avoid risk factors to reduce the incidence of SIS.


Assuntos
Articulação Acromioclavicular , Placas Ósseas , Fixadores Internos , Luxações Articulares , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias , Síndrome de Colisão do Ombro , Articulação Acromioclavicular/diagnóstico por imagem , Articulação Acromioclavicular/lesões , Articulação Acromioclavicular/cirurgia , China/epidemiologia , Feminino , Humanos , Luxações Articulares/diagnóstico , Luxações Articulares/epidemiologia , Luxações Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/instrumentação , Procedimentos Ortopédicos/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Risco Ajustado/métodos , Fatores de Risco , Síndrome de Colisão do Ombro/diagnóstico , Síndrome de Colisão do Ombro/epidemiologia , Síndrome de Colisão do Ombro/etiologia , Síndrome de Colisão do Ombro/prevenção & controle
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