Management and outcome of the dislocated hip hemiarthroplasty

2018 ◽  
Vol 100-B (12) ◽  
pp. 1618-1625 ◽  
Author(s):  
J. R. Gill ◽  
B. Kiliyanpilakkill ◽  
M. J. Parker
Keyword(s):  
Closed Reduction ◽  
Case Series ◽  
Revision Arthroplasty ◽  
Post Injury ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Additional Surgery ◽  
Significant Difference ◽  
One Year ◽  
Excision Arthroplasty

Aims This study describes and compares the operative management and outcomes in a consecutive case series of patients with dislocated hemiarthroplasties of the hip, and compares outcomes with those of patients not sustaining a dislocation. Patients and Methods Of 3326 consecutive patients treated with hemiarthroplasty for fractured neck of femur, 46 (1.4%) sustained dislocations. Of the 46 dislocations, there were 37 female patients (80.4%) and nine male patients (19.6%) with a mean age of 83.8 years (66 to 100). Operative intervention for each, and subsequent dislocations, were recorded. The following outcome measures were recorded: dislocation; mortality up to one-year post-injury; additional surgery; residential status; mobility; and pain score at one year. Results Of 43 dislocations, 30 (70%) occurred within one month and 42 (98%) occurred within three months of hip fracture surgery. Seven (16%) of these patients were treated with a single closed reduction and sustained no further dislocations. Four (9%) were treated with open reduction and experienced no further dislocations. Three (7%) hips were left dislocated and the remaining 32 (74%) patients required additional surgery of further closed reduction, revision, or excision arthroplasty. The one-year mortality rates for patients treated with two or fewer reductions (open or closed), successful revision arthroplasty, and excision arthroplasty were 3/14 (21%), 1/7 (14%), and 8/14 (57%) respectively. The only statistically significant difference in mortality was the difference between patients who did not sustain a dislocation and those who did and were treated by excision arthroplasty (p = 0.03). Patients treated by excision arthroplasty had the greatest reduction in mobility scores and highest pain scores. The excision arthroplasty group also included the greatest proportion of patients not able to mobilize and the smallest proportion of patients remaining in their own home. Conclusion Most dislocations of hemiarthroplasties of the hip occur within one month of surgery. Closed reduction is generally unsuccessful. For those patients with unsuccessful closed reduction, revision arthroplasty should be considered when possible, as this results in a better functional outcome with a lower mortality than excision arthroplasty.

Anaesthesia for orthopaedic surgery

2014 ◽  
Author(s):  
Jeremy Prout ◽  
Tanya Jones ◽  
Daniel Martin
Keyword(s):  
Regional Anaesthesia ◽  
Orthopaedic Surgery ◽  
Perioperative Management ◽  
Revision Arthroplasty ◽  
Joint Arthroplasty ◽  
Physiological Changes ◽  
Medical Comorbidity ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Spinal Cord Function

The risks, benefits, and evidence for use of regional anaesthesia techniques are discussed generally and for specific procedures such as joint arthroplasty. Other perioperative considerations for primary and revision arthroplasty are described. The particular challenges of the patients presenting with fractured neck of femur, physiological changes of older age and goals for perioperative management are highlighted. Surgical procedures for scoliosis are performed in specialist centres and are discussed. Associated medical comorbidity, anaesthetic considerations and neurological monitoring for spinal cord function are described.

scholarly journals Close Reduction and Percutaneous K-wire Fixation without Image Intensifier in Supracondylar Fracture of Humerus in Children

2013 ◽  
Vol 3 (1) ◽  
pp. 19-22
Author(s):  
Ruhullah Mohammad ◽  
Sanjay Kumar Ranjan Shah ◽  
HR Singh ◽  
KD Sinha ◽  
Dipan Barua ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Case Series ◽  
Image Intensifier ◽  
Cost Effective ◽  
Percutaneous Pinning ◽  
Supracondylar Fractures ◽  
Gold Standard Method ◽  
Remote Hospital ◽  
Wire Fixation ◽  
One Year

Introduction: Extension Type III supracondyla fractures of the humerus is most common fractures around the elbow in children. Closed reduction and percutaneous pinning under image intensifier guide has been the gold standard method of treatment. However, image intensifier is not readily available in most part of our country. Closed reduction and percutaneous pinning is possible even without image intensifier. we report our case series of 51 cases who underwent closed reduction and percutaneous pinning without image intensifier. Methods: Between November 2009 and April 2011 a total of 51 children with a displaced supracondylar fractures of the humerus were managed by close reduction and percuteneus k-wire fixation without using image intensifier. They were followed for a period of minimum 6 months up to one and a half years (average one year) and the final outcome was assessed using functional and cosmetic criteria used by Flynn and associates. Results: Of these 51 patients, 46 (90%) patients showed an excellent results. Satisfactory results were achieved in 4 (8%) patients, poor in 1(2%) patients. Conclusion: Close reduction and percutaneous K-wire fixation without using image intensifier is radiation free, cost effective and relatively safe method of management of displaced supracondylar fractures of humerus in children. It can be used in a remote hospital where the facilities of image intensifier or portable x-ray are not available. DOI: http://dx.doi.org/10.3126/noaj.v3i1.9321 Nepal Orthopedic Association Journal 2013 Vol.3(1): 19-22

scholarly journals Long-term Outcomes of Coalition Resection in Adult Tarsal Coalition

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0012
Author(s):  
Thomas B. Bemenderfer ◽  
Jacob B. Boersma ◽  
Donald R. Bohay ◽  
John G. Anderson ◽  
John D. Maskill
Keyword(s):  
Wound Care ◽  
Adult Population ◽  
Case Series ◽  
Tarsal Coalition ◽  
Vas Score ◽  
Calcaneonavicular Coalition ◽  
Additional Surgery ◽  
Significant Difference ◽  
Orthopaedic Literature

Category: Hindfoot; Other Introduction/Purpose: Although the diagnosis, treatment, and natural history of tarsal coalitions has been well described in the adolescent population, there remains a paucity of orthopaedic literature on outcomes associated with coalition resection with or without interposition in the adult population. This study is the first to evaluate clinical and radiographic outcomes in adult patients with tarsal coalition resection without interposition. Methods: All patients with symptomatic tarsal coalition (subtalar, calcaneonavicular, or talonavicular) who failed conservative management and underwent coalition resection with concomitant procedures as indicated by their pathology between January 2006 and December 2014 were included in our retrospective case series. Demographics, clinical outcomes, patient comorbidity information, visual analogue scale (VAS) pain scores were collected. Advanced imaging (CT or MRI) was reviewed to determine fibrocartilaginous or osseous coalition. The primary outcome was reoperation. Secondary outcomes were change in visual analog score (VAS), and minor complications (local wound care, use of antibiotics, and skin dehiscence). Results: 68 patients (52.9% males, 47.1% females; average age 35.9 years old, range 18 to 70) met inclusion. Calcaneonavicular, subtalar, and talonavicular coalitions were resected in 45.6% (n=31), 54.4% (n=37), and 0% of patients, respectively. At average final clinical follow up of 36 months, there were a total of 33 reoperations in 33.8% of patients (n=23) most commonly including subsequent fusion (n=11), exostectomy (n=10), and removal of hardware (n=15). There was no significant difference in reoperation (42.3% versus 63.1%, p=0.454) or fusion (19.4% versus 19.2%, p=0.99) following subtalar or calcaneonavicular coalition resection. Average VAS score preoperatively and postoperatively was 5.8 to 3.0. Minor complications were present in 16.2% of patients (n=11; 3 local wound care, 10 use of antibiotics, and 0 skin dehiscence). Conclusion: The present study demonstrates overall improvement in VAS score by an average of 2.8 points following subtalar and calcaneonavicular coalition resection. Although 33.8% of patients may anticipate additional surgery, the majority of patients may expect long-term maintenance of improvement in pain without subsequent fusion.

Does achieving the ‘Best Practice Tariff’ criteria for fractured neck of femur patients improve one year outcomes?

Injury ◽  
2019 ◽  
Vol 50 (7) ◽  
pp. 1358-1363 ◽  
Author(s):  
Samuel R. Whitaker ◽  
Sohail Nisar ◽  
Andrew J. Scally ◽  
Graham S. Radcliffe
Keyword(s):  
Best Practice ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
One Year

scholarly journals Preoperative albumin as a predictor of one-year mortality in patients with fractured neck of femur

2013 ◽  
Vol 95 (1) ◽  
pp. 26-28 ◽  
Author(s):  
WKM Kieffer ◽  
CS Rennie ◽  
AJ Gandhe
Keyword(s):  
Serum Albumin ◽  
Statistical Significance ◽  
Postoperative Mortality ◽  
Decision Making Process ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Operative Planning ◽  
Implant Selection ◽  
One Year ◽  
Preoperative Albumin

A simple measure to determine one-year mortality following hip fractures has its benefits. Where there is controversy over implant selection, such a scoring system can facilitate the decision-making process. We undertook a retrospective analysis of one-year postoperative mortality of our hip fracture patients and established their admission serum albumin levels to see if there was any correlation between this and one-year mortality. Our results showed one-year mortality was significantly higher (p=0.0049) for those patients with a serum albumin of <35g/dl. Of the patients with low albumin, we found that there was no statistical significance between one-year mortality and source of admission (p=0.0789). Prefracture serum albumin can be used as a simple predictor of one-year mortality in patients presenting with a fractured neck of femur, thereby aiding operative planning and implant selection with a view to likely survival and possible need for revision.

scholarly journals Similar results for revision ACL with and without a lateral extra-articular reconstruction. A prospective evaluation

2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0019
Author(s):  
Juan Pablo Zicaro ◽  
Carlos Yacuzzi ◽  
Ignacio Garcia-Mansilla ◽  
Matias Costa-Paz
Keyword(s):  
Case Series ◽  
Lysholm Score ◽  
Consecutive Series ◽  
Return To Sports ◽  
Mri Imaging ◽  
Significant Difference ◽  
Group 2 ◽  
One Year ◽  
Group 1

Objectives Lateral extra-articular augmentation procedure (LEAP) has been proposed as an additional technique in the setting of revision ACL Reconstruction (ACLR). Few case series have been reported. The purpose of this study was to compare the clinical results and return to sports of a consecutive series of patients treated for revision ACLR with and without a LEAP. Methods We prospectively evaluated a series of patients treated for isolated revision ACL between 2014 and 2015 (group 1) and revision ACL associated with a LEAP from 2015 to 2016 (group 2). We analyzed the surgical technique and graft used for primary and revision ACL and for the LEAP. All patients were evaluated at one-year follow-up with Lysholm score and IKDC evaluation, return to sports and MRI evaluation. Results Thirty-six patients were evaluated, eighteen patients in each group. For the revision ACL procedures, 14 autografts and 4 allografts were used in group 1 and 16 autografts and 2 allografts in group 2. For the LEAP, in 13 cases we performed a lateral tenodesis using ilio-tibial band and in 5 patients we used allograft. The mean age was 32 years (SD 8,5) for group 1 and 28,4 (SD 6,5) for group 2. In group 1, the median Lysholm and IKDC scale was 90 (IQR 27) and 80 (IQR 40) respectively, and in group 2 the median was 90 (IQR 48) and 67,5 (IQR 33) respectively. The difference for IKDC was statistically significant (p=0,000). Eight patients return to sports in group 1 and seven in group 2. The MRI shown and homogeneous neoligament in 66% of patients in group 1 and 61% in group 2. Conclusion Despite there was a statistically significant difference in IKDC results in favor of group 2, we found no differences in return to sports, Lysholm score and MRI imaging when a LEAP was associated at one year follow-up.

scholarly journals Comparison of Using One Trabecular Microbypass Stent versus Two during Cataract Surgery at Two Sites: One-Year Follow-Up

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Shuo Yang ◽  
Mantapond Ittarat ◽  
Elaine Tran ◽  
Patricia Ferrell ◽  
Gloria Wang ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Open Angle Glaucoma ◽  
Case Series ◽  
Palo Alto ◽  
Stent Group ◽  
Retrospective Case ◽  
Significant Difference ◽  
Stanford Versus ◽  
One Year

Purpose. To compare IOP and ocular hypotensive medication reduction of using one trabecular microbypass stent versus two in patients with open-angle glaucoma. Setting. Palo Alto Veterans Affairs (VA) Hospital and the Byers Eye Institute at Stanford University, Palo Alto, California, USA. Design. Retrospective case series. Methods. A chart review included patients who underwent trabecular microbypass implantation with cataract surgery in 2015-2017, with at least one-year follow-up. Subjects were divided into two groups by location (always one stent at Stanford versus two stents at the VA). Primary outcome measures included IOP and medication reduction at baseline and 12-month follow-up. Results. 132 subjects (166 eyes) were included. The preoperative IOP was 16.3±3.4 mmHg on 2.6±1.1 medications in the one-stent group (N=85) and 17.5±3.1 mmHg on 2.7±0.6 medications in the two-stent group (N=81). There was no significant difference between the two groups (p=0.06). At the 12-month visit, there was a 13.37%±2.93 reduction in IOP in the 1-stent group (p≤0.001) and 13.49%±2.69 in the 2-stent group (p≤0.001); both were not significantly different from each other (p=0.074). At 12 months, there was also a 14.5% reduction in medication use for the 1-stent group and 15.3% reduction in the 2-stent group, both statistically significant from baseline, (p=0.022 and p=0.037, respectively). Conclusions. Implantation with either one or two stents during cataract surgery in patients with glaucoma demonstrated similar IOP and med reduction in both groups between the two sites.

A prospective study of prevalence and characterization of headache following mild traumatic brain injury

Cephalalgia ◽  
2013 ◽  
Vol 34 (2) ◽  
pp. 93-102 ◽  
Author(s):  
Sylvia Lucas ◽  
Jeanne M Hoffman ◽  
Kathleen R Bell ◽  
Sureyya Dikmen
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Post Injury ◽  
Persistent Symptoms ◽  
Primary Headache Disorders ◽  
Significant Difference ◽  
Probable Migraine ◽  
One Year ◽  
Tension Type Headaches

Background Headache is one of the most common and persistent symptoms following traumatic brain injury (TBI). The current study examines the prevalence and characteristics of headache following mild TBI (mTBI). Methods We prospectively enrolled 212 subjects within one week of mTBI who were hospitalized for observation or other system injuries in a single level 1 US trauma center and followed by telephone at three, six, and 12 months after injury for evaluation of headache. Headaches were classified according to ICHD-2 criteria as migraine, probable migraine, tension-type, cervicogenic, or unclassifiable headache. Results Subjects were 76% male and 75% white, and 58% were injured in vehicle-related crashes. A follow-up rate of 90% (190/212) occurred at 12 months post-injury. Eighteen percent (38/212) of subjects reported having a problem with headaches pre-injury while 54% (114/210) of subjects reported new or worse headaches compared to pre-injury immediately after injury, 62% (126/203) at three months, 69% (139/201) at six months, and 58% (109/189) at one year. Cumulative incidence was 91% (172/189) over one year. Up to 49% of headaches met criteria for migraine and probable migraine, followed by tension-type headaches (up to 40%). Age (≤ 60) was found to be a risk factor, but no significant difference was found in persistence of new or worse headache compared to pre-injury between males and females. More than one-third of the subjects reported persistent headache across all three follow-up time periods. Conclusions Headache after mTBI is very common and persistent across the first year after injury. Assertive, early treatment may be warranted to avoid chronicity and disability. Further research is needed to determine whether post-traumatic headache (PTH) responds to headache treatment used in the primary headache disorders and whether chronic PTH is preventable.

scholarly journals Combining Baerveldt Implant with Trabectome Negates Tube Fenestration: A Coarsened-matched Comparison

2020 ◽  
Author(s):  
Hamed Esfandiari ◽  
Kiana Hassanpour ◽  
Peter Knowlton ◽  
Tarek Shazly ◽  
Mehdi Yaseri ◽  
...  
Keyword(s):  
Case Series ◽  
Glaucoma Surgery ◽  
Secondary Outcome ◽  
Cumulative Probability ◽  
Eye Drops ◽  
Exact Matching ◽  
Significant Difference ◽  
Baerveldt Glaucoma Implant ◽  
One Year

Purpose: To assess the efficacy and survival rate of the Trabectome-mediated ab interno trabeculectomy combined with non-fenestrated Baerveldt glaucoma implant compared with the Baerveldt glaucoma implant alone. Method: In this retrospective comparative case series, 175 eyes undergoing primary glaucoma surgery (Baerveldt–Trabectome [BT] group: 60 eyes and Baerveldt [B] group: 115 eyes) were included. Participants were identified using the procedural terminology codes. Groups were then matched by Coarsened Exact Matching that resulted in the inclusion of 51 eyes in each group. The primary outcome measure was surgical success defined as 5 mmHg < intraocular pressure (IOP) ≤ 21 mmHg, and IOP reduction ≥ 20% from baseline, and no need to reoperation for glaucoma. Secondary outcome measures were IOP, number of glaucoma medications, and best-corrected visual acuity (BCVA). Results: The cumulative probability of success at one year was 61% in the BT group and 50% in the B group. IOP decreased from 23.5 ± 2.4 mmHg at baseline to 14.1 ± 2.7 mmHg at the final follow-up in the BT group (P = 0.001). The corresponding values for the B group were 23.2 ± 2.0 mmHg and 13.9 ± 1.6 mmHg, respectively (P = 0.001). There was no significant difference between the groups in terms of IOP at the final follow-up (P = 0.56). The number of medications at baseline was 2.3 ± 0.3 in both groups. However, the BT group needed fewer drops at all postoperative time intervals and used 1.1 ± 0.3 versus 2.0 ± 0.4 eye drops (group B) at the final follow-up visit (P = 0.004). Eyes in B with phacoemulsification had a significantly higher IOP on day 1 compared to B (23.2 ± 14.3 versus 17.9 ± 11.4, P = 0.041). During the one-year follow-up, 7 (13.7%) patients in BT group and 18 (35.2%) in B group experienced hypotony (P = 0.04). No dangerous hypotony or hypertension occurred in BT group. The mean BCVA at baseline was 0.64 ± 0.85 logMAR and changed to 0.55 ± 0.75 logMAR in BT and B groups, respectively (P = 0.663). The corresponding numbers for the final follow-up visit was 0.72 ± 1.07 and 0.63 ± 0.97 logMAR, respectively (P = 0.668). Conclusion: We observed similar rates of success and IOP reduction using BT and B techniques. BT group needed fewer glaucoma medications. Tube fenestration was unnecessary in BT group resulting in less postoperative ocular hypotony and hypertension. The results of our study indicate that additional trabectome procedure makes Baerveldt glaucoma implant safer, easier to handle, and more predictable in the most vulnerable patients with advanced glaucoma.

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