RESUMO
STUDY DESIGN: Prospective clinical cohort study (data collection); expert opinion (recommendation development). OBJECTIVES: Treatment options for nonsurgical and surgical management of osteoporotic vertebral body fractures differ widely. Based on the current literature, the knowledge of the experts, and their classification for osteoporotic fractures (OF classification), the Spine Section of the German Society for Orthopaedics and Trauma has now introduced general treatment recommendations. METHODS: A total of 707 clinical cases from 16 hospitals were evaluated. An OF classification-based score was developed for guidance in the option of nonsurgical versus surgical management. For every classification type, differentiated treatment recommendations were deduced. Diagnostic prerequisites for reproducible treatment recommendations were defined: conventional Xrays with consecutive follow-up images (standing position whenever possible), magnetic resonance imaging, and computed tomography scans. OF classification allows for upgrading of fracture severity during the course of radiographic follow-up. The actual classification type is decisive for the score. RESULTS: A score of less than 6 points advocates nonsurgical management; in cases with more than 6 points, surgical management is recommended. The primary goal of treatment is fast and painless mobilization. Because of the expected comorbidities in this age group, minimally invasive procedures are preferred. As a general rule, stability is more important than motion preservation. It is mandatory to restore the physiological loading capacity of the spine. If the patient was in a compensated unbalanced state at the time of fracture, reconstruction of the individual prefracture sagittal profile is sufficient. The instrumentation technique has to account for compromised bone quality. We recommend the use of cement augmentation or high purchase screws. The particular situations of injuries with neurological impairment, the necessity to fuse, multiple level fractures, consecutive and adjacent fractures and fractures in ankylosing spondylitis are addressed separately. CONCLUSIONS: The therapeutic recommendations presented here provide a reliable and reproducible basis to decide for the treatment choices available. However, intermediate clinical situations with a score of 6 points remain, allowing for both nonsurgical and surgical options. As a result, individualized treatment decisions may still be necessary. In the subsequent step, the recommendations presented will be further evaluated in a multicentre controlled clinical trial.
Assuntos
Ortopedia , Fraturas por Osteoporose , Estudos de Coortes , Fraturas por Compressão , Humanos , Estudos Prospectivos , Fraturas da Coluna Vertebral , Resultado do TratamentoRESUMO
BACKGROUND: The hands of medical stuff are the most important vectors for the transmission of pathogens in the hospital. Furthermore a "bare below the elbows dress code" has been introduced in Great Britain. OBJECTIVES: Aim of this study was to investigate whether workwear contamination of the medical stuff by pathogens is similar to the contamination of their hands and whether wearing workwear is associated with increased transmission risk. MATERIAL AND METHODS: In total 54 swabs were collected from nursing stuff, medical doctors, patients and hospital work material. RESULTS: Patients had a statistically significant more dense colonization with bacteria (median = 73 colony-forming units (CFU)), than the sleeves of the doctor's coat (median = 36 CFU, p = 0,005), followed by workwear of the nursing stuff at the end of a shift (median = 23 CFU, p < 0,001) and the hospital work material (median = 15 CFU, p < 0,001). Isolated pathogens were coagulase-negative staphylococci, Staphylococcus aureus, Enterobacter cloacae and Acinetobacter species. CONCLUSIONS: Contaminated work wear presents a relevant risk for the transmission of pathogens. A "bare below the elbow dress-code" or the daily change of the doctor's coat appear both to represent reasonable measures to reduce the transmission risk of pathogens in hospitals.
Assuntos
Bactérias/isolamento & purificação , Vestuário/estatística & dados numéricos , Infecção Hospitalar/prevenção & controle , Contaminação de Equipamentos/prevenção & controle , Mãos/microbiologia , Enfermagem/estatística & dados numéricos , Alemanha , Humanos , Médicos/estatística & dados numéricosRESUMO
Ruptures of extensor tendons after open reduction and internal plate fixation of distal radius fractures are a rare (up to 5%) and avoidable complication. The analysis of postoperative X-rays permits reliable detection of technical mistakes.
Assuntos
Placas Ósseas/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Erros Médicos/prevenção & controle , Traumatismos dos Tendões/diagnóstico por imagem , Traumatismos dos Tendões/etiologia , Traumatismos do Punho/complicações , Traumatismos do Punho/cirurgia , Fixação Interna de Fraturas/instrumentação , Humanos , Radiografia , Ruptura/diagnóstico por imagem , Ruptura/etiologia , Traumatismos do Punho/diagnóstico por imagemRESUMO
STUDY DESIGN: Multicenter prospective cohort study. OBJECTIVES: Anxiety in combination with osteoporotic vertebral compression fractures (OVCFs) of the spine remains understudied. The purpose of this study was to analyze whether anxiety has an impact on the short-term functional outcome of patients with an OVCF. Furthermore, a direct impact of the fracture on the patient's anxiety during hospitalization should be recognized. METHODS: All inpatients with an OVCF of the thoracolumbar spine from 2017 to 2020 were included. Trauma mechanism, analgetic medication, anti-osteoporotic therapy, timed-up-and-go test (TuG), mobility, Barthel index, Oswestry-Disability Index (ODI) and EQ5D-5L were documented.For statistical analysis, the U test, chi-square independence test, Spearman correlation, General Linear Model for repeated measures, Bonferroni analysis and Wilcoxon test were used. The item anxiety/depression of the EQ5D-5L was analyzed to describe the patients' anxiousness. RESULTS: Data from 518 patients from 17 different hospitals were evaluated. Fracture severity showed a significant correlation (r = .087, P = .0496) with anxiety. During the hospital stay, pain medication (P < .001), anti-osteoporotic medication (P < .001), and initiation of surgical therapy (P < .001) were associated with less anxiety. The anxiety of a patient at discharge was negatively related to the functional outcomes at the individual follow-up: TuG (P < .001), Barthel index (P < .001), ODI (P < .001) and EQ5D-5L (P < .001). CONCLUSIONS: Higher anxiety is associated with lower functional outcome after OVCF. The item anxiety/depression of the EQ5D-5L provides an easily accessible, quick and simple tool that can be used to screen for poor outcomes and may also offer the opportunity for a specific anxiety intervention.
RESUMO
One third of all lawsuits against doctors include statements of insufficient or lacking informed consent. The objectives of this prospective study in 104 patients were to elucidate the actual clinical routine of obtaining informed consent (process quality), collect information on active and passive recall 3 to 7 days p.op., and to investigate whether patient age, sex, education, profession, and cognitive function using the Mini Mental State Test, the time from obtaining consent to interview, acuity (emergency vs elective cases), and quantity of patient/doctor interaction would influence the patient's recall capabilities. In clinical routine, obtaining informed consent is a very variable procedure, and between two and 18 items were documented by the physician. Of the patients, 12.6% recalled actively and 43.5% passively. They named between 1.1 and 3.7 items on average, with "infection" as the leading complication, followed by "pain" and "lesion of nerves". Of all parameters investigated, only the number of initially documented items exhibit a significant effect on the patients' recall. The quantity of patient/physician interaction not only guarantees an increased effect on recall but also means improves patient interaction, thereby reducing the probability of imminent accusations.
Assuntos
Consentimento Livre e Esclarecido/legislação & jurisprudência , Imperícia/legislação & jurisprudência , Procedimentos Ortopédicos/legislação & jurisprudência , Educação de Pacientes como Assunto/legislação & jurisprudência , Complicações Pós-Operatórias/etiologia , Ferimentos e Lesões/cirurgia , Adolescente , Adulto , Escolaridade , Feminino , Humanos , Consentimento Livre e Esclarecido/psicologia , Masculino , Competência Mental/legislação & jurisprudência , Rememoração Mental , Entrevista Psiquiátrica Padronizada , Pessoa de Meia-Idade , Relações Médico-Paciente , Estudos Prospectivos , Retenção Psicológica , Fatores de Risco , Fatores SocioeconômicosRESUMO
Osteoarthritis (OA) influences the levels of free intraarticular glucosaminoglycans (GAG). Little is known about the direction--decrease/increase--of these changes, and information on the correlation between GAG levels and the degree of OA is sparse. Objectives of this study were to investigate the correlation between intraarticular levels of sulphated and unsulphated GAG and the degree of experimental OA, the time course of these changes and whether GAG might be useful as a marker for OA. Twenty-one sheep were randomly assigned to three groups: (1) transsection of the posterolateral bundle of the anterior cruciate ligament, ACL (TD), (2) medial meniscectomy (ME), and (3) meniscectomy and resection of the ACL (MV). During follow-up clinical and radiological examinations were done. After screening for intraarticular effusions, a joint tab was performed and the levels of hyaluronic acid and chondroitin sulphate were measured. The radiological scores differ significantly between group TD and groups ME and MV (P < 0.01). Hyaluronic acid levels in ME and MV are significantly higher than in the controls. Significantly increased levels (P < 0.01) of chondroitin sulphate are found 6 months after ME and 1 year following TD. Clinical consequences: Hyaluronic acid levels--at least in the experimental setting--correspond to a certain degree with osteoarthrotic changes: increasing levels were found along with increasing postoperative interval and increasing grade of OA. Chondroitin sulphate, on the other hand seems, to lend itself as a marker for chondromalacia, in other words for prearthrotic deformities and early stages of OA.
Assuntos
Glicosaminoglicanos/análise , Traumatismos do Joelho/diagnóstico , Articulação do Joelho , Osteoartrite/diagnóstico , Animais , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior , Biomarcadores/análise , Sulfatos de Condroitina/análise , Feminino , Ácido Hialurônico/análise , Traumatismos do Joelho/cirurgia , Articulação do Joelho/química , Meniscos Tibiais/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Sensibilidade e Especificidade , Ovinos , Lesões do Menisco TibialRESUMO
The aim of the study was to investigate the biomechanical properties of segmental cortical autografts subjected to extracorporeal treatment. For this purpose, 12 beagle dogs were submitted to tibial osteotomy, when 25 mm-long diaphyseal segments of bone were removed and treated outside the body by autoclaving or gamma radiation (Co, 5 kGy). Subsequently, osteosynthesis involving the use of medullary nailing was performed. After 36 weeks, the dogs were killed painlessly and, after removing the nails, the tibias were tested for the biomechanical properties. In comparison with the contralateral tibia, a mean stiffness of 47% and 32% was measured for tibia treated by irradiation and autoclaving, respectively, while bending showed an increase of up to 590%. These results show the need to allow plenty of time for healing in the case of weightbearing transplants. When bealing is undisturbed, no biomechanical differences are found between proximal and distal osteotomies, although in the X-ray image the osteotomy gap (fracture line) remains visible, and scintigraphic activity persists for a longer period. This means that the radiological aspect of the former does not necessarily reflect actual biomechanical strength.
Assuntos
Transplante Ósseo/fisiologia , Fixação Intramedular de Fraturas , Consolidação da Fratura/fisiologia , Suporte de Carga/fisiologia , Animais , Fenômenos Biomecânicos , Cães , Elasticidade , Feminino , Masculino , Lesões Experimentais por Radiação/fisiopatologia , Resistência à Tração , Tíbia/fisiopatologia , Tíbia/efeitos da radiação , Tíbia/cirurgiaRESUMO
Since locked intramedullary nailing of the tibia in dogs was followed by material failure of the conventional slotted hollow nails within days, special solid nails were developed and tested with respect to their mechanical properties. There was a clear advantage of the solid nails over the hollow nails in terms of bending resistance and yield force. In animal experiments--even in long-term experiments over nine months--no case of material failure occurred with the solid nails. The high torsional and bending resistance of the solid nails suggests the use of a mechanical device which, as our experience shows, permits reliable interlocking without the need for an image intensifier, that is to say, without radiation exposure.
Assuntos
Fixação Intramedular de Fraturas/instrumentação , Animais , Fenômenos Biomecânicos , Cães , Desenho de Equipamento , Ovinos , Resistência à Tração , Suporte de CargaRESUMO
The Garmisch-Partenkirchen experience--15,513 skiing injuries between 1972 and 1990--was compared to the results of an inquiry into the skiing injuries among 565 persons of the medical profession, that were active skiers over an average of 18 years. The parameter injuries per 1000 skiing days was calculated from the outpatient clinic data as well as from all skiing injuries that had happened in the interview group and those that required surgical treatment. The mean value of 2.7 injuries/1000 skiing days--corrected for the number of patients--from the literature and the clinical data with 2.1 is comparable to the 1.8 injuries/1000 skiing days (injuries that required surgical treatment) but stands sharply against the 4.2 arising from the total number of injuries in the inquiry group.--Thus, every epidemiological study clearly underestimates the actual rate of skiing injuries. This fact may be defined as the "bypass-effect". The comparison between clinical setting and inquiry allowed for a quantification: Depending on the type of injury and the study design, a true prevalence of skiing injuries that is between 10% and 200% higher than the published data has to be expected.--Descriptive, not controlled epidemiologic studies on skiing injuries are justified and give valid trends on which therapeutic and prophylactic measures can be based--but exclusively under the following prerequisite conditions: 1. a standardized study protocol; 2. an observation.
Assuntos
Traumatismos em Atletas/epidemiologia , Esqui/lesões , Adulto , Traumatismos em Atletas/etiologia , Traumatismos em Atletas/prevenção & controle , Estudos Transversais , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Fatores de RiscoRESUMO
The reconstruction of the anterior cruciate ligament deficient knee with the patellar tendon is the "gold standard". Dislocation of the patella, rupture of the patellar tendon and fracture of the patella were reported to occur. In this biomechanical investigation on the changes of the patellar tendon following harvesting of a graft, 51 sheep knee underwent destructive testing at t0 (n = 11), 4 weeks p.op. (n = 5), 3 months p.op. (n = 14), 6 months p.op. (n = 15), and 12 months p.op. (n = 6). Harvesting of a graft produces a stiffness and strength of the patellar tendon of 50-70% of normal. There was no significant change of free patellar tendon length up to 12 months p.op. The cross-sectional area is definitely increased (p < 0.05). The tensile stress is always above normal, nevertheless the strength shows a massive decline until 6 months p.op. and does not regain normal strength by one year p.op. Stiffness shows comparable biomechanical pattern like tensile stress. There are time-dependent changes, the structural weakness is compensated by an increase of cross-sectional area. There is no restitution of the patellar tendon ad integrum, the remainder is a defect with scar tissue and alterated biomechanical properties. Revision surgery using the same host patellar tendon cannot be recommended.
Assuntos
Lesões do Ligamento Cruzado Anterior , Traumatismos do Joelho/cirurgia , Transferência Tendinosa/métodos , Animais , Ligamento Cruzado Anterior/fisiopatologia , Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Feminino , Traumatismos do Joelho/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Ovinos , Técnicas de Sutura , Tendões/fisiopatologiaRESUMO
BACKGROUND: The optimal time to perform endoprosthesis of hip fractures in the elderly is still under discussion. CRP as an objective marker of postoperative inflammatory reaction should give an indication if early or late surgery is favored. METHODS: CRP values from 122 patients with no complications after hip arthroplasty of femoral neck fractures were analyzed in context with the time between the trauma and the operation. RESULTS: In early surgery within 24 h after trauma the CRP values were significantly lower than in delayed surgery. CONCLUSION: The lower postoperative inflammatory reaction after early surgery of hip fractures provides a better outcome when treated with arthroplasty.
Assuntos
Artroplastia de Quadril , Proteína C-Reativa/análise , Fraturas do Colo Femoral/imunologia , Fraturas do Colo Femoral/cirurgia , Complicações Pós-Operatórias/imunologia , Síndrome de Resposta Inflamatória Sistêmica/imunologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Reoperação , Prevenção Secundária , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Fatores de TempoAssuntos
Distrofia Simpática Reflexa/terapia , Fraturas Ósseas/cirurgia , Humanos , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Distrofia Simpática Reflexa/classificação , Distrofia Simpática Reflexa/diagnóstico , Fatores de Risco , Resultado do TratamentoAssuntos
Lesões do Ligamento Cruzado Anterior , Traumatismos em Atletas/cirurgia , Traumatismos do Joelho/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Adulto , Ligamento Cruzado Anterior/diagnóstico por imagem , Ligamento Cruzado Anterior/cirurgia , Artroscopia , Traumatismos em Atletas/diagnóstico por imagem , Seguimentos , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Masculino , Meniscos Tibiais/diagnóstico por imagem , Meniscos Tibiais/cirurgia , Pessoa de Meia-Idade , Radiografia , Ruptura , Técnicas de Sutura , Lesões do Menisco TibialRESUMO
In general, dislocations of the long head of the biceps tendon are associated with partial or complete rotator cuff rupture on the side of the affected shoulder. We report about a patient with bilateral fixed and painless dislocation of the tendon of the long biceps head. By using functional ultrasound, correct diagnosis was facilitated and accelerated.
Assuntos
Luxações Articulares/complicações , Tendinopatia/diagnóstico por imagem , Traumatismos dos Tendões/etiologia , Adulto , Humanos , Luxações Articulares/diagnóstico por imagem , Masculino , Articulação do Ombro/diagnóstico por imagem , Traumatismos dos Tendões/diagnóstico por imagem , UltrassonografiaRESUMO
BACKGROUND: The worldwide rise of MRSA is equivalent to an increase of nasal colonization with MRSA. The objectives of this study were to investigate the rate of occult nasal MRSA colonization in trauma patients, to elucidate the role of MRSA carriers for endogenous infection (nose --> wound) and to check the efficiency of mupirocin therapy. PATIENTS AND METHODS: A total of 643 consecutive trauma patients underwent MRSA screening (nasal swabs) on admission. At the same time all MRSA wound infections were registered and all isolates were analysed with PFGE (pulsed-field gel electrophoresis) to detect cross-infection between individuals. RESULTS: In 13 patients (2.0%) we found MRSA in the nose and limited isolation as well as therapy with mupirocin were performed. No endogenous transmission of MRSA from the nose to the wound could be seen, and no cross-infection to other patients could be detected. CONCLUSION: Our findings suggest that in our patients with nasal colonization the risk of intra- and interindividual transmission of MRSA is very small. Therefore, in trauma patients screening on admission does not seem to be absolutely necessary either for clinical or for epidemiological reasons.
Assuntos
Antibacterianos/farmacologia , Infecção Hospitalar/prevenção & controle , Programas de Rastreamento , Resistência a Meticilina , Mupirocina/farmacologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Infecção Hospitalar/microbiologia , Seguimentos , Humanos , Unidades de Terapia Intensiva , Pessoa de Meia-Idade , Mupirocina/administração & dosagem , Nariz/microbiologia , Pomadas , Fatores de Tempo , Infecção dos Ferimentos/microbiologiaRESUMO
Under established jurisdiction,burn damage to the skin in connection with the use of coagulating current is not regarded as unavoidable. On the contrary, a breach of duty by the surgeon will be assumed.He is responsible for acquainting himself with the techniques and the risks of the high-frequency surgical devices he is using.He has to prevent injuries on the basis of controllable risks, even those which only appear as a result of cooperation with other specialist. The evaluation of judicial decisions, the literature, damage reports and expert opinions confirms that most injuries could have been avoided by compliance with the recommended precautions.
Assuntos
Queimaduras/etiologia , Eletrocoagulação/efeitos adversos , Complicações Intraoperatórias/etiologia , Imperícia/legislação & jurisprudência , Pele/lesões , Eletrocoagulação/instrumentação , Prova Pericial/legislação & jurisprudência , Alemanha , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Fatores de RiscoRESUMO
At present no established therapy for the complete loss of meniscus is available. An attempt is made to create a transplant out of autogeneic tissue resembling the meniscus in its morphological and functional aspects. The middle third of the patellar tendon with proximal and distal bone blocks serves as a basis and is coated with a fascia lata strip. After temporary subcutaneous transfer, the meniscus substitute is intended for later transplantation. The theoretical ideas for the imitation of a meniscus in view of fibre architecture and biomechanical validity were tested in 14 sheep. In principal this model succeeds in imitating the fibre architecture of the menisci. After a conditioning period of 8-10 weeks in the subcutaneous tissue, the neomeniscus seems to be suitable for transplantation. The tensile strength of the grafts decreases slightly but the bone blocks stay viable.
Assuntos
Fascia Lata/transplante , Traumatismos do Joelho/cirurgia , Transferência Tendinosa/métodos , Lesões do Menisco Tibial , Animais , Fenômenos Biomecânicos , Fascia Lata/patologia , Humanos , Traumatismos do Joelho/patologia , Meniscos Tibiais/patologia , Meniscos Tibiais/cirurgia , Microscopia Eletrônica de Varredura , Ovinos , Resultado do TratamentoRESUMO
Segments of the tibial diaphysis from 24 adult dogs were reimplanted after extracorporeal autoclaving or gamma-irradiation. Fixation was by interlocking intramedullary nailing, or plating. The dogs were killed after 36 weeks and the tibias examined. Bony union was seen in 46 of the 48 contact areas. Microangiography and Tc-perfusion scans demonstrated complete revascularisation of all the grafts. Biomechanical tests showed defective union with increased bending and decreased stiffness compared to normal controls. Fluorescent microscopy confirmed restitution of Haversian systems and slow replacement of the graft by lamellar bone containing viable osteocytes.