Archives of orthopaedic and trauma surgery
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Documentation is key to quality assurance (QA): Data must be complete, plausible, and comparable, and then analyzed to implement corrective measures. Important factors are: qualification of care-providing staff, equipment and implants available (structural quality), effective scheduling of operations and therapy management (process quality), and patient status monitoring (outcome quality). ⋯ An evaluation profile with the key quality indicators and a QA guideline is presented. A survey conducted in Germany, Austria, and Switzerland revealed: (1) up to 12-month waiting period for surgery in 6%, (2) only 40% written instructions, (3) data mostly written by hand, (4) differences in surgery planning and use of prosthesis passport, (6) inconsistent data analysis, (7) corrective measures rarely implemented.
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Several years ago, low-intensity pulsed ultrasound (frequency 1.5 MHz; signal burst width 200 micros; signal repetition frequency 1 KHz; intensity 30 mW/cm2) was shown to accelerate fresh fracture healing both clinically and experimentally. On the basis of a prescription use registry, this paper reports on the use of low-intensity pulsed ultrasound in the therapy of 951 delayed unions and 366 nonunions. The overall success rate for delayed unions was 91% (average healing time 129+/-2.7 days) and for nonunions 86% (average healing time 152+/-5.3 days). ⋯ Therefore, the results of these two populations support each other. Low-intensity pulsed ultrasound may provide a method of nonoperative treatment of great promise for healing disorders. Determination of ranking of this new method should be done within the near future.
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Arch Orthop Trauma Surg · Jan 2000
Radiographic analysis of lumbar spine for low-back pain in the general population.
We sought to demonstrate a correlation between low-back pain (LBP) and the plain radiographic findings of the lumbar spine in the general population based on an analysis of 838 persons, 387 of whom presented with complaints of low-back pain. The incidence of intervertebral narrowing and irregular ossification of the vertebral end-plate image increased consistently with age and was higher in the presence of LBP in any age or gender group. Multiregression analysis was performed with the imaging factors as multivariates. ⋯ The discrimination analysis was performed using the linear discriminant function, resulting in a true discrimination rate of 65%. Plain radiography of the lumbar spine is thus significant as it provides information which can be evaluated as meaningful findings in the investigation of LBP. In addition, while the significance can be increased by considering multiple factors, it is important to understand the limits of the accuracy of this prediction.
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Arch Orthop Trauma Surg · Jan 2000
Natural history of unreduced congenital dislocation of the hip in adults.
The natural history of 33 patients with 43 unreduced congenital dislocations of the hip was reviewed. The average age at the first consultation was 50 years. Four were men and 29 were women. ⋯ The average dislocation index was increased in the standing more than in the lying position. In unilaterally dislocated hips the average femorotibial angles in the ipsilateral and contralateral knees to the dislocated hip were 172 and 179 deg, respectively. Lumbar degenerative scoliosis of more than 5 deg was observed in 16 patients.
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Arch Orthop Trauma Surg · Jan 2000
Case ReportsA rare case of enthesopathy of the bicipital tuberositas of the radius.
We present a case of a patient with complaints in both elbows, due to a prominent bicipital tuberosity with an enlarged bursa, in which operative resection was successful.