International orthopaedics
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The aim of this study was to evaluate the outcome of joint arthroplasty in obese and non-obese patients. We reviewed 2,026 consecutive primary total hip and 535 primary total knee arthroplasties performed for osteoarthritis. Patients were separated into two groups according to their body mass index (BMI): non-obese (BMI < 30) and obese (BMI ≥ 30). ⋯ The mid-term survival of total hip and knee arthroplasty is not adversely affected by obesity. Despite lower clinical scores, the obese patients were satisfied with the results of their surgery and have an equivalent mid-term survival rate. It would be unreasonable to deny patients arthroplasty surgery purely on the basis of a BMI indicating obesity.
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The World Health Organisation (WHO) recommends routine use of a surgical safety checklist prior to all surgical operations. The aim of this study was to prospectively audit checklist use in orthopaedic patients before and after implementation of an educational programme designed to increase use and correlate this with early complications, mortality and staff perceptions. Data was collected on 480 patients before the educational program and 485 patients after. ⋯ Seventy-seven percent thought the checklist improved team communication. Checklist use was not associated with a significant reduction in early complications and mortality in patients undergoing orthopaedic surgery. Education programs can significantly increase accurate use and staff perceptions following implementation.
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Fractures of the head and neck of the femur in children are very rare, occurring only after a high-velocity trauma, e.g. a fall from a height. This analysis shows the clinical course of traumatic femoral head and neck fractures in paediatric patients. Predisposing factors for poor outcome or fracture complications, such as non-union or femoral head necrosis, are described. ⋯ A single case was managed by "secondary" surgical treatment, two weeks after the initial trauma resulting in femoral head necrosis that healed without any subjective complaints. This case series confirms the importance of early surgical fixation of proximal femoral fractures in paediatric patients. An operative intervention later then 48 h after the initial trauma may increase the risk of complications such as femoral head necrosis, particularly in Delbet type I fractures (traumatic slipped capital femoral epiphysis).
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Hip fracture, a moderate musculoskeletal trauma, is associated with a high postoperative mortality. Most patients are elderly, with comorbid conditions and often with heart disease. The objective of this study was to find out if clinical parameters and analyses of specific muscle enzymes could predict three month postoperative mortality. ⋯ However, high TnT levels >0.04 μg/l correlated significantly with death (days -1, +1 and +4, p = 0.003, p = 0.005 and p = 0.003, respectively). Multivariate analyses, adjusted for age, sex and ASA category, confirmed this correlation (day +4, p = 0.008). Thus, in elderly patients with comorbidities undergoing hip fracture surgery information on sex, age, ASA category and postoperative laboratory analyses on TnT provide the clinicians with useful information on patients at risk of fatal outcome.
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Comparative Study
Comparison study of two surgical options for distal tibia fracture-minimally invasive plate osteosynthesis vs. open reduction and internal fixation.
The aim of this study was to compare the results between two surgical options for distal tibia fracture, i.e. minimally invasive plate osteosynthesis (MIPO) vs. open reduction and internal fixation (ORIF), and explore the benefits and defects of these two techniques. Thirty cases of distal tibia fracture (15 pairs of ORIF and MIPO) were submitted for pair comparison with consistence of gender, age and AO fracture classification. Indexes for evaluation included operative time, blood loss, healing time, time of recovery to work, implant irritation symptoms, and union status. ⋯ In the MIPO group, ten cases were excellent and five good. Paired t-test found no significant differences between groups on the indexes for analysis. In conclusion, the MIPO technique is not distinctively superior to ORIF in treatment of distal tibia fracture.