Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Aug 2022
Pre-operative resuscitation discussion with patients undergoing fractured neck of femur repair: a service evaluation and discussion of current standards.
The majority of neck of femur (NOF) fracture patients are frail and at a higher risk of cardiac arrest. This makes discussion of treatment escalation vital to informed care. The optimal time for these discussions is prior to admission or trauma. However, when this has not occurred, it is vital that these discussions happen early in the patient's admission when family is often present and before further deterioration in their condition. We undertook a service evaluation to evaluate and discuss the effect of clinician education on improving rates of timely discussion amongst orthopaedic doctors. ⋯ This project demonstrates how a basic education program can prove limited improvements in the rates of timely resuscitation discussions. We discuss a current lack in quality research into educational programs for discussion of treatment escalation for orthopaedic trainees. We suggest there is room to improve national best practice guidelines and training to ensure these discussions are carried out more frequently and to a better standard.
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Arch Orthop Trauma Surg · Aug 2022
"Anterior-shift sign": a novel MRI finding of adult hip dysplasia.
In adult hip dysplasia, methods for direct evaluation of hip instability have not been established. The present study aimed to determine findings suggestive of hip instability on magnetic resonance imaging (MRI) and to evaluate their correlations with clinical and radiological factors. ⋯ This study suggested that hip instability can be observed as the anterior-shift sign on MRI. This sign is useful when considering indications for periacetabular osteotomy in adult hip dysplasia.
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Arch Orthop Trauma Surg · Aug 2022
Review Meta AnalysisSafety and efficacy of outpatient hip and knee arthroplasty: a systematic review with meta-analysis.
This systematic review aimed to assess the safety and efficacy of outpatient joint arthroplasty (OJA) pathways compared to inpatient pathways. ⋯ OJA pathways are as safe and effective as inpatient pathways in selected populations, with a potential reduction of costs. Considerable risk of bias in the majority of studies emphasizes the need for further research.
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Arch Orthop Trauma Surg · Aug 2022
ReviewOutcome measures in total hip arthroplasty: have our metrics changed over 15 years?
Consensus has not been reached regarding ideal outcome measures for total hip arthroplasty (THA) clinical evaluation and research. The goal of this review was to analyze the trends in outcome metrics within the THA literature and to discuss the potential impact of instrument heterogeneity on clinical practice. ⋯ The utilization of outcome-reporting metrics in THA has continued to increase, resulting in added complexity within the literature. The utilization rates of individual instruments have shifted over the past 15 years. Additional study is required to determine which specific instruments are recommended.