scholarly journals 88 The Truth Behind the Pubic Rami Fracture: Identification of Pelvic Fragility Fractures at A University Teaching Hospital

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i28-i29
Author(s):  
D van Berkel ◽  
O Herschkovich ◽  
R Taylor ◽  
T Ong ◽  
O Sahota
Keyword(s):  
Older People ◽  
Pelvic Fracture ◽  
Plain Radiograph ◽  
Fragility Fractures ◽  
University Teaching ◽  
Acetabular Fractures ◽  
Sacral Fractures ◽  
Pubic Rami ◽  
Number Of Patients ◽  
Pelvic Imaging

Abstract Introduction Older patients presenting with pelvic fragility fractures (PFF) is an increasing epidemic. The most common pelvic fracture identified by plain radiograph is pubic rami fracture. These fractures are painful and often require admission to hospital. However, despite optimal analgesia, many of these patients struggle to mobilise and may have fractures of the posterior pelvic ring, which are overlooked and not visible on plain radiograph imaging. We aimed to quantify the number of patients progressing to further pelvic imaging in the form of computed tomography (CT) or magnetic resonance imaging (MRI) and the presence of concurrent fractures. Methods Prospective screening of pelvic imaging in patients aged over 70 years was undertaken at Nottingham University Hospitals NHS Trust over an 8-month period from October 2018. Results 103 predominantly female (83%) patients were confirmed to have an acute fragility fracture of the pubic rami on plain radiograph. 19% of patients were discharged direct from the Emergency Department, 45% were admitted to Health Care of Older People (HCOP) teams, 30% to Trauma and Orthopaedic (T&O) teams and 6% to other specialities. 25% of the patients admitted underwent further pelvic imaging, which confirmed fragility fractures of the pubic rami in 88%, with 40% showing acetabular fractures and 68% showing sacral fractures of all types. A further 10 patients were diagnosed with pubic rami insufficiency fractures on further imaging, having had a normal initial radiograph, but had been admitted with poor mobility due to groin pain. In these 10 patients, 20% also had an acetabular fracture and 60% sacral fractures. Overall, 59% of patients with pubic rami fractures had an ipsilateral sacral fracture; a Type 1 Lateral Compression pelvic fracture by AO classification. Conclusions Pubic rami fractures are a significant problem in older people and often require admission to hospital. Further imaging confirms these fractures are complex, with co-existing fractures of the acetabulum and sacrum common. However despite this, only a quarter of patients admitted had further imaging. Where pelvic fractures are missed or severity not appreciated, appropriate pain control can be more difficult to achieve. With the potential for minimally invasive surgical options to aid pain management in sacral fractures, it may be prudent for all patients hospitalised with suspected or confirmed pelvic fracture to undergo further imaging.

scholarly journals The truth behind the pubic rami fracture: identification of pelvic fragility fractures at a university teaching hospital

2020 ◽  
Vol 20 (Suppl 2) ◽  
pp. s113-s113
Author(s):  
Dawn van Berkel ◽  
Orly Herschkovich ◽  
Rachael Taylor ◽  
Terence Ong ◽  
Opinder Sahota
Keyword(s):  
Teaching Hospital ◽  
Fragility Fractures ◽  
University Teaching ◽  
Pubic Rami ◽  
Fracture Identification

scholarly journals Management of Complex Pelvic Fracture with Associated Both Column Acetabular Fracture Judet-Letournel Type and a Coccygeal Fracture in a Severe Polytrauma Patient

2021 ◽  
pp. 192-201
Author(s):  
Jessica Fiolin ◽  
Ludwig Andre Powantia Pontoh ◽  
Ismail Hadisoebroto Dilogo
Keyword(s):  
Pelvic Fracture ◽  
Hypovolemic Shock ◽  
Stable Condition ◽  
Acetabular Fractures ◽  
Advanced Technique ◽  
Operative Strategy ◽  
Ilioinguinal Approach ◽  
Outcome Score ◽  
Satisfactory Outcome ◽  
Sacroiliac Joint Disruption

Comprehensive emergency managements and early stabilization are pivotal upon treating complex pelvic and acetabular fractures. A thorough operative strategy is required to determine the best operative approach based on the patient’s general condition, available facilities, and surgeon preferences in such complex fracture configuration. Advanced technique of the fixation is necessary during a skillful execution of surgery in order to achieve good treatment results. An 18-years-old female crushed by a bus upon crossing street, presented with hypovolemic shock with ISS polytrauma score 50 consisting of right acetabular associated both column fracture, bilateral pelvic fracture anteroposterior compression type 3, and coccygeal fracture with bilateral drop foot. She underwent emergency laparotomy, had her ovary, bladder, and intestine primarily sutured, and then we immobilized the pelvic using anterior frame external fixator, which was maintained for 6 days. Upon stable condition, we performed right ilioinguinal approach and modified Stoppa with lateral window for the left side, while Kocher-Langenbeck technique was used to approach the posterior acetabular column. Postoperative radiology showed an adequate internal fixation in both right acetabular columns, successful reconstruction of pelvic ring which was fixated the left ischium, left superior and inferior pubic rami, and full restoration of left sacroiliac joint disruption. Majeed pelvic outcome score was 54, while Hannover pelvic outcome score was good and the patient was able to sit without pain 2 months postoperative. Management of complex pelvic-acetabular-coccygeal fracture requires a holistic chain of treatment by emphasizing the prompt emergency management, accurate preoperative planning, and excellent execution of reconstructive surgical strategy to achieve satisfactory outcome.

151 Optimising Bone Health on Sheffield Frailty Unit Through Quality Improvement

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
C M Orton ◽  
N E Sinson ◽  
R Blythe ◽  
J Hogan ◽  
N A Vethanayagam ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Fracture Risk ◽  
Fragility Fracture ◽  
Bone Health ◽  
Assessment Tool ◽  
Health Assessment ◽  
Fragility Fractures ◽  
Improvement Project ◽  
Number Of Patients ◽  
Fracture Risk Assessment Tool

Abstract Introduction NICE and the National Osteoporosis Guidance Group (NOGG) advise on evaluation of fracture risk and osteoporosis treatment1,2, with evidence suggesting that screening and treatment reduces the risk of fragility fractures 3,4,5. However, it is often overlooked in the management of older patients within secondary care. Audit data from Sheffield Frailty Unit (SFU) in 2018 showed that national guidance was not routinely followed. Fracture Risk Assessment Tool (FRAX®) scores were not calculated and bone health was poorly managed. Therefore, we undertook a quality improvement project aiming to optimise bone health in patients presenting to SFU. Method & Intervention In January 2019 we collaborated with Sheffield Metabolic Bone Centre (MBC) to develop a pathway aiming to improve bone health assessment and management in patients presenting to SFU with a fall or fragility fracture. This included a user-friendly flow chart with accompanying guidelines, alongside education for staff. Performance was re-evaluated in May 2019, following which a tick box prompt was added to post take ward round documentation. A re-audit was performed in March 2020. Results In March 2018 0% of patients presenting with a fall had a FRAX® score calculated and only 40% of those with a new fragility fracture were managed according to guidelines. In May 2019, this had improved to 18% and 100% respectively. In March 2020 86% of patients had a FRAX® score calculated appropriately and 100% of fragility fractures were managed according to guidelines. In both re-audits 100% of FRAX® scores were acted on appropriately. Conclusions There has been a significant increase in the number of patients who have their bone health appropriately assessed and managed after presenting to SFU. However, achieving optimum care is under constant review with the aim to deliver more treatment on SFU, thereby reducing the need for repeat visits to the MBC.

Impact of a Vancomycin Restriction Policy on Use and Cost of Vancomycin and Incidence of Vancomycin-Resistant Enterococcus

1997 ◽  
Vol 31 (9) ◽  
pp. 970-973 ◽  
Author(s):  
Amy S Morgan ◽  
Patrick J Brennan ◽  
Neil O Fishman
Keyword(s):  
Policy Implementation ◽  
University Teaching ◽  
Vancomycin Resistant Enterococcus ◽  
Vancomycin Therapy ◽  
Billing Data ◽  
Restriction Policy ◽  
Number Of Patients ◽  
Before And After ◽  
Vancomycin Resistant ◽  
Prophylactic Use

Objective To review the appropriateness of vancomycin therapy, changes in vancomycin use, and the incidence of vancomycin-resistant Enterococcus (VRE) after implementation of a limited restriction policy requiring approval from the Infectious Diseases Approval service to continue vancomycin therapy beyond 72 hours. Design A prospective chart review was conducted in April 1995. Pharmacy billing data and infection control data were compared before and after policy implementation. Setting A 725-bed university teaching institution. Patients All patients receiving vancomycin during April 1995. Main outcome Measures Appropriateness of use was based on the Centers for Disease Control and Prevention (CDC) recommendations for prudent vancomycin use. Results A total of 333 courses of vancomycin therapy were reviewed. Vancomycin use was appropriate in 219 (66%) courses. Of the 114 courses that did not meet the CDC guidelines, 76 (67%) were for empiric use, 35 (31%) were for prophylactic use, and 3 (3%) were for therapeutic use. Overall, the total number of grams used decreased 9%, grams per 1000 patient-days decreased by 10, and the total number of patients exposed to vancomycin decreased 0.5%. Several services had large decreases in vancomycin use. Vancomycin expenditures decreased by $15 788 for the 7-month time period. The incidence of VRE remained unchanged, at 30% of all enterococcal isolates 2 years after policy implementation. Conclusions The limited restriction policy was effective in decreasing the total grams of vancomycin used. However, one-third of vancomycin therapy was inappropriate and the incidence of VRE was unchanged. A more stringent restriction policy could potentially increase appropriate use, further decrease the amount of vancomycin used, and decrease the incidence of VRE.

scholarly journals A Review on 3D-Printed Templates for Precontouring Fixation Plates in Orthopedic Surgery

2020 ◽  
Vol 9 (9) ◽  
pp. 2908
Author(s):  
Rodica Marinescu ◽  
Diana Popescu ◽  
Dan Laptoiu
Keyword(s):  
3D Printing ◽  
Orthopedic Surgery ◽  
Acetabular Fractures ◽  
Anatomical Location ◽  
Case Control Studies ◽  
Virtual Planning ◽  
Number Of Patients ◽  
3D Printed ◽  
Virtual Modeling ◽  
Blood Loss Reduction

This paper is a systematic review of the literature on 3D-printed anatomical replicas used as templates for precontouring the fixation plates in orthopedic surgery. Embase, PubMed, Cochrane, Scopus and Springer databases were consulted for information on design study, fracture anatomical location, number of patients, surgical technique, virtual modeling approach and 3D printing process. The initial search provided a total of 496 records. After removing the duplicates, the title and abstract screening, and applying exclusion criteria and citations searching, 30 papers were declared eligible and included in the final synthesis. Seven studies were identified as focusing on retrospective non-randomized series of clinical cases, while two papers presented randomized case control studies. Two main approaches were highlighted in developing 3D-printed anatomical models for precontouring fixation plates: (a.) medical reconstruction, virtual planning and fracture reduction followed by 3D printing the model; (b.) medical reconstruction followed by 3D printing the model of the mirrored uninjured side. Revised studies reported advantages such as surgical time and blood loss reduction, while the reduction quality is similar with that of the conventional surgery. During the last couple of years there was an increase in the number of studies focused on precontouring orthopedic plates using 3D printing technology. Three-dimensionally-printed templates for plate precontouring were mostly used for acetabular fractures. Knowledge on medical virtual modeling and reconstruction is mandatory.

Clinical Profile of Critically Ill Patients Presenting to Emergency Department of Tertiary Level Hospital of Nepal

2019 ◽  
Vol 41 (1) ◽  
pp. 67-74
Author(s):  
Shubha K Shrestha ◽  
Bishwas Pradhan ◽  
Yogendra M Shakya ◽  
Hem R Paneru
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
University Teaching ◽  
Chronic Obstructive ◽  
Optimal Care ◽  
Obstructive Pulmonary Disease ◽  
Number Of Patients ◽  
Common Diagnosis ◽  
The Common ◽  
A Prospective Study

Introduction: Among critically ill patients presenting to Emergency Room (ER) of Tribhuwan University Teaching Hospital (TUTH), a number of patients have to either remain in ER or have to be referred outside due to unavailability of critical care beds. Studies have shown significant association between delayed admission and mortality rates along with increased length of stay and higher cost. This study aimed to present an audit of critically ill patients presenting to ER of TUTH. Methods: This was a prospective study conducted over a period of one month. All patients presenting to ER of TUTH were triaged and critically ill patients were shifted to Red area of the ER. All patients ≥16 years of age shifted to Red area during the study period were enrolled in our study. Results: Out of 3718 patients presenting to ER during the study period, the number of critically ill patients ≥16 years of age was 526 i.e. 14.14% of total patients. Among them, the common diagnosis were Cerebrovascular Accidents (CVA) followed by Intoxication, Acute Exacerbation (AE) of Chronic Obstructive Pulmonary Disease (COPD), Pneumonia and Chronic Kidney Disease (CKD) respectively. Almost 20% of these patients were admitted, 31% were referred and 40% were shifted for observation. The median length of ER stay was 6 hours (Mean: 8.5 hrs; Range: 20 min to 70 hr 15 min). Conclusion: Among critically ill patients presenting to our ER, almost 1/5th of the patients were admitted whereas more than 2/3rd were either referred or remained in our ER. This data highlights the need for solutions to provide optimal care for the acute phase management of the critically ill patients.

scholarly journals Access to Breast Cancer Care in Jos, North Central

2020 ◽  
pp. 1-7
Author(s):  
Alexander Femi Ale ◽  
Mercy Wakili Isichei ◽  
Michael Ayedima Misauno
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Cancer Care ◽  
Demographic Data ◽  
Descriptive Statistics ◽  
University Teaching ◽  
Treatment Modalities ◽  
Breast Cancer Care ◽  
Number Of Patients ◽  
Health Care Centers

Aims: This paper seeks to evaluate the extent to which breast cancer patients from two tertiary health care centers in Jos were able to access the different components of breast cancer care. Background: Breast cancer in low- and middle-income countries is associated with poor outcomes when compared with high-income countries. Numerous studies have identified factors responsible for this, one of them being a lack of access to the various components of breast cancer care. Breast cancer care requires a multimodal approach involving prevention, early detection, diagnosis and treatment, rehabilitation and palliative care. Access to the various modalities of care is key to a good outcome. Study Design: This study is a retrospective study. Place and Duration of the Study: The study was carried out at Jos University Teaching Hospital, and FOMAS Hospital which are both tertiary health care centers located in the city of Jos, Plateau State, Nigeria. The study spanned January 2016 to June 2019.We applied descriptive statistics for data analysis. Methodology: We included all patients who were diagnosed with breast cancer between January 2016 and December 2017. Patients were followed up for a minimum of one and a half years (from January 2018 to June 2019). The project team performed a review of medical records and charts for data elements which included; sex, age, site of tumor, stage of tumor at presentation, and access to the different treatment modalities. Data was entered into a pre-designed proforma and analyzed on the SPSS 20 Chicago, Illinois. We applied descriptive statistics to the demographic data and clinical information of patients. Results: The total number of patients was 110. Forty-four (40%) patients had access to immunohistochemistry (IHC). Eighty-nine (81%) patients were eligible for chemotherapy. Twenty-one (19%) patients were not fit for chemotherapy. Ten (9%) patients received radiotherapy.  A total of 73 (66%) patients had different forms of breast surgeries. Three (3%) patients declined surgery, while 34 (31%) were not fit for surgery. Thirty-four (31%) patients were treated with hormonal therapy. Conclusion: This study examined access to the various components of breast cancer care within two tertiary health centers. It shows that in our environment, there is limited access to immunohistochemistry, chemotherapy, radiotherapy and targeted therapy.

scholarly journals Prevalence of Skin Diseases in Kavre District, Nepal

1970 ◽  
Vol 9 (1) ◽  
pp. 7-9
Author(s):  
D Karn ◽  
R Khatri ◽  
M Timalsina
Keyword(s):  
General Population ◽  
Skin Diseases ◽  
Public Health Problem ◽  
University Teaching ◽  
Major Public Health Problem ◽  
Dermatology Department ◽  
Total Study Population ◽  
Pigmentary Disorders ◽  
Number Of Patients ◽  
Prevalent Disease

Background Skin is the major interface of human to the environment . It is the major susceptible organ for any disease. Wide prevalence of skin diseases in the community is a well established fact. Objectve The aim of this study is to determine the prevalence of skin diseases among the general population of Kavre District,Nepal . Methods This is a hospital based, retrospective study done among all the patients visiting Dhulikhel Hospital, Kathmandu University Teaching Hospital, in Dhulikhel, Kavre during the year 2007-2008 AD. Data were obtained from the hospital out-patient records and analyzed. The total number of patients who visited the hospital were 74,279 (male-30,809 female- 43,470), out of which 7374 (9 .92 %), male 4155, female 3219, visited the Dermatology Department. Among this total study population now comparative study of the prevalence of skin diseases was performed based on sex, age and type of dermatological condition. Results The overall prevalence of skin diseases were 9.92% with slight higher rates seen among males ( 56.34 %) than females (43.65 %).Non-infective conditions , 6063 ( 82.22% ) outweighed infective conditions 1311 (17.78 %), commonest one being the pigmentary disorders (32.56 %) and in the age group 16-35 years old (31.23% ). Conclusion This study demonstrates that skin diseases are one of the most prevalent disease condition among the general population, representing a major public health problem. Keywords Prevalence; infective diseases; non-infective diseases. DOI: http://dx.doi.org/10.3126/njdvl.v9i1.5761 NJDVL 2010; 9(1): 7-9

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