Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Dec 2008
Comparative StudyEvaluation of estimation of physiologic ability and surgical stress (E-PASS) to predict the postoperative risk for hip fracture in elder patients.
The Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system is comprised of a preoperative risk score (PRS), a surgical stress score (SSS), and a comprehensive risk score (CRS) determined by both the PRS and SSS. E-PASS predicts the postoperative risk by quantifying the patient's reserve and surgical stress in general surgery. This study aims to evaluate the usefulness of this scoring system for the hospitalization outcomes in hip fracture. ⋯ These results suggest that E-PASS may be useful for predicting postoperative risk and estimating medical expense for surgical cases with hip fracture.
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Arch Orthop Trauma Surg · Dec 2008
Multicenter Study Comparative StudyFinancing in knee arthroplasty: a benchmarking analysis.
Flat rate payment and "diagnosis related groups" (DRG) in knee arthroplasty offer incentives to save expenses. A cost-benefit analysis exactly compares all expenses to revenues. This requires patient-related assessment of treatment costs in terms of cost-unit accounting. This study compared expenses of knee arthroplasty in Austrian, German and Swiss clinics. ⋯ The proportion for personnel costs (medical, nursing, med.-tech.) of total costs was higher in Germany (41%) than Austria (26.6%) and Switzerland (39.9%). Implant costs were proportionally nearly the same in Austria (29.5%) than Germany (28%) and Switzerland (28.7%). Administration was proportionally higher in Austria (26.8%) than Germany (19.1%) and Switzerland (11.3%). To lower the costs, the expenses for personnel and implants must be reduced. Ultimately, the potential for hospitals to save costs can be found here.
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Arch Orthop Trauma Surg · Dec 2008
Case ReportsAxillary nerve palsy after retrograde humeral nailing: clinical confirmation of an anatomical fear.
Locked antegrade or retrograde nailing of humeral shaft and proximal humerus fractures is a well established treatment option. Anatomic-morphological studies revealed a potential high risk of axillary nerve injury within proximal interlocking screw insertion. However, clinical experiences do not seem to confirm this, as there is a lack of interlocking screw insertion associated axillary lesions in literature. ⋯ Even for clinical practise proximal interlocking screw insertion is associated with a substantial risk of axillary nerve injury. Particularly for posterior-to-anterior screw insertion anatomic conditions should be considered. In spite of axillary nerve lesion, recovery of almost full shoulder function is possible by compensating the loss of deltoid function by rotator cuff muscles.
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Arch Orthop Trauma Surg · Dec 2008
Mismatch between PFNa and medullary canal causing difficulty in nailing of the pertrochanteric fractures.
The proximal femoral nail (PFN) and the proximal femoral nail anti-rotation (PFNA) have been successfully used in the management of osteoporotic pertrochanteric fractures. Although many studies have described the geometrical mismatch between the antecurvation of the femur and the contemporary intramedullay nails, technical difficulties related to the mismatch between the femoral bowing and the PFN/PFNA at the time of nailing have rarely been discussed in the literature. We have experienced a technical difficulty related to the mismatch between the medullary canal and the PFN/PFNA. We describe the complications related with the mismatch and the technical pitfalls and some technical tips to avoid this problem are also described.
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Arch Orthop Trauma Surg · Dec 2008
Comparative StudyDoes intraoperative fluoroscopic 3D imaging provide extra information for fracture surgery?
Fracture surgery of the extremities using 2D fluoroscopy frequently fails to detect the suboptimal positioning of implants and joint incongruities. The use of intraoperative 3D-rotational X-ray (3D-RX) imaging with a new X-ray device potentially reveals these failures. We compared 50 intraoperative (2D) results of surgery and certainty about the effectiveness of different aspects of fracture reduction as interpreted from conventional (2D) methods versus intraoperative 3D-RX in 42 distal extremity fractures by means of a surgery questionnaire. ⋯ None of the 81 patients in whom 3D-RX was performed needed surgical revision based on postoperative radiological examinations. Intraoperative 3D-RX with this new device scanning offers additional information about extremity fracture reduction as compared to conventional intraoperative 2D imaging, and may reduce the need for revision surgery. The value of 3D-RX on functional outcomes still needs to be assessed.