Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Feb 2014
Co-morbidities in elderly patients with hip fracture: recommendations of the ISFR-IOF hip fracture outcomes working group.
Hip fractures are the second leading cause of hospitalization in the aged and by 2041, epidemiologists forecast an increase in economic cost to $2.4 billion. The hip patient population often presents with comorbidities causing these patients to receive less aggressive medical treatment and have a low quality of life. We believe that physical function is a patient-important outcome for many medical and surgical interventions. The functional co-morbidity index (FCI), unlike prior co-morbidity indices, was developed with physical function as an outcome instead of being designed for administrative purposes or to predict mortality. Our objective was to evaluate the perceptions of practitioners in hip fracture care about the impact of comorbidities on physical function as primary outcome. ⋯ The FCI may provide a useful instrument to predict functional outcome after hip fracture; however, the index may need to be modified for this specific population.
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Arch Orthop Trauma Surg · Feb 2014
Lateral ligament reconstruction with allograft in patients with severe chronic ankle instability.
Chronic ankle instability is a condition of perception of giving way and persistent pain usually following multiple ankle sprains. In case of severe joint laxity, surgical treatment with reconstruction of the lateral ligamental complex is recommended. The aim of this study was to evaluate the functional outcome of patients treated with lateral ligament reconstruction with allograft for severe chronic lateral ankle instability. ⋯ Lateral ligament reconstruction with allograft represents a valid treatment option in patients with severe chronic lateral ankle instability.
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Arch Orthop Trauma Surg · Feb 2014
Meta Analysis Comparative StudyArtificial total disc replacement versus fusion for lumbar degenerative disc disease: a meta-analysis of randomized controlled trials.
The purpose of this study is to compare the effectiveness and safety of artificial total disc replacement (TDR) with fusion for the treatment of lumbar degenerative disc disease (DDD). Spinal fusion is the conventional surgical treatment for lumbar DDD. Recently, TDR has been developed to avoid the negative effects of the fusion by preserving function of the motion segment. Controversy still surrounds regarding whether TDR is better. ⋯ TDR showed significant safety and efficacy comparable to lumbar fusion at 2 year follow-up. TDR demonstrated superiorities in improved physical function, reduced pain and shortened duration of hospitalization. The benefits of operating time, blood loss, motion preservation and the long-term complications are still unable to be proved.
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Arch Orthop Trauma Surg · Feb 2014
ReviewKey outcomes are usually not reported in published fracture secondary prevention programs: results of a systematic review.
A secondary analysis of a systematic review on interventions to improve osteoporosis (OP) investigation and treatment was conducted to examine reported key outcomes: (1) the cost of the intervention; (2) the proportion of patients taking OP medication beyond 6 months of the intervention; and (3) the proportion of patients who re-fractured. ⋯ Most interventions did not report key outcomes. In addition, authors used varying time frames for re-fracture and medication use, making direct comparisons impossible. Authors should consider including intervention costs, medication use beyond 6 months of the intervention, and re-fracture data in future fracture secondary prevention programs.
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Arch Orthop Trauma Surg · Feb 2014
ReviewLiterature review of outcome parameters used in studies of Geriatric Fracture Centers.
A variety of multidisciplinary treatment models have been described to improve outcome after osteoporotic hip fractures. There is a tendency toward better outcomes after implementation of the most sophisticated model with a shared leadership for orthopedic surgeons and geriatricians; the Geriatric Fracture Center. The purpose of this review is to evaluate the use of outcome parameters in published literature on the Geriatric Fracture Center evaluation studies. ⋯ In-hospital mortality, length of stay, time to surgery, place of residence and complication rate are the most frequently used outcome parameters. The patient-reported outcomes included activities of daily living and mobility scores. There is a need for generally agreed upon outcome measures to facilitate comparison of different care models.