Surgical treatment of Vancouver type B periprosthetic femoral fractures

2019 ◽  
Vol 101-B (11) ◽  
pp. 1447-1458 ◽  
Author(s):  
Georgios Chatziagorou ◽  
Hans Lindahl ◽  
Johan Kärrholm
Keyword(s):  
Plate Osteosynthesis ◽  
Femoral Fractures ◽  
Patient Characteristics ◽  
Primary Outcome Measure ◽  
Periprosthetic Femoral Fracture ◽  
Type B ◽  
National Patient ◽  
Component Revision ◽  
Two Stages ◽  
Hip Arthroplasties

Aims We investigated patient characteristics and outcomes of Vancouver type B periprosthetic fractures treated with femoral component revision and/or osteosynthesis. Patients and Methods The study utilized data from the Swedish Hip Arthroplasty Register (SHAR) and information from patient records. We included all primary total hip arthroplasties (THAs) performed in Sweden since 1979, and undergoing further surgery due to Vancouver type B periprosthetic femoral fracture between 2001 and 2011. The primary outcome measure was any further reoperation between 2001 and 2013. Cross-referencing with the National Patient Register was performed in two stages, in order to identify all surgical procedures not recorded on the SHAR. Results Out of 1381 Vancouver type B fractures that fulfilled the inclusion criteria, 257 underwent further reoperation by the end of 2013. Interprosthetic and Type B1 fractures had a higher risk for reoperation. For B1 fractures, the rate of reoperation did not differ (p = 0.322) after use of conventional (26%) or locking plate osteosynthesis (19%). No significant differences were observed between cemented, cementless monoblock, and cementless modular revision components for the treatment of type B2 and B3 fractures. Conclusion In this country-specific study, the choice of locking or conventional plates for the treatment of type B1, and cemented or cementless femoral components fixation for B2 and B3 fractures, had no significant influence on risk for reoperation. Interprosthetic fractures adversely affected the outcome of treatment of type B fractures. Differences in the patient characteristics of the compared groups were observed. Cite this article: Bone Joint J 2019;101-B:1447–1458.

scholarly journals Midterm results of consecutive periprosthetic femoral fractures Vancouver type A and B

2016 ◽  
Vol 6 (3) ◽  
Author(s):  
Klemens Trieb ◽  
Rainer Fiala ◽  
Christian Briglauer
Keyword(s):  
Femoral Fractures ◽  
Type A ◽  
Periprosthetic Femoral Fracture ◽  
Type B ◽  
Single Center ◽  
Midterm Results ◽  
Periprosthetic Femoral Fractures ◽  
Multimorbid Patients ◽  
Lost To Follow Up

Surgical treatment of periprosthetic femoral fractures has a high complication and mortality rate of more than 10%. The aim of this study is to report the outcome of a consecutive single center patient group. Thirty-four consecutive patients (mean age 81.2+/-8.5 years, 14 male, 20 female) with a periprosthetic femoral fracture Vancouver type A (n=5) or type B (n=29) were followed-up after 43.2 months, none of the patients were lost to follow- up. Nineteen of the patients were treated through change of the stem and cerclage fixation, five by plates and ten by cerclage cables. One successfully treated infection was observed. No further complications have been reported peri- or postoperatively, therefore resulting in 2.9% overall complication rate. These results demonstrate that precisely selected revision surgery protocol following periprosthetic femoral fractures within elderly multimorbid patients may lead to beneficial outcomes at a low risk of complications.

Radiation Exposure of Anaesthetists Visualised by Real-time Dosimetry

2019 ◽  
Vol 15 (2) ◽  
pp. 220-226
Author(s):  
Marcus Christian Müller ◽  
Michael Windemuth ◽  
Sophie Frege ◽  
Eva Nadine Striepens
Keyword(s):  
Radiation Exposure ◽  
Real Time ◽  
Vertebral Fractures ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
Femoral Fractures ◽  
Dose Monitoring ◽  
Osteoporotic Vertebral Fractures ◽  
Radiation Dose Monitoring ◽  
Dosimetry System

Background: Chronic exposure to occupational ionising radiation is seen as one reason for elevated cancer prevalence. </P><P> Objective: The aim of this retrospective study was to evaluate radiation exposure of anaesthetists by real-time dosimetry. Methods: Data of 296 patients were analyzed. Ten types of trauma operation procedures including osteosynthesis of upper and lower extremity fractures and minimally invasive stabilisation of traumatic and osteoporotic vertebral fractures were accomplished. Evaluation was performed by an occupational dosimetry system, which visualises anaesthetists radiation exposure feedback compared to surgeons in real-time. Results: A significantly lower radiation exposure to anaesthetists compared to surgeons was observed in four types of operative procedures: Plate fixation of proximal humerus fractures, osteosynthesis of proximal femoral fractures, stabilisation of traumatic and osteoporotic vertebral fractures. In four types of operations (plate osteosynthesis of proximal humeral, distal radial and tibial fractures and intramedullary nailing of the clavicle), anaesthetists` amount of radiation exceeded one-third of the surgeons' exposure, especially if the C-arm tube was positioned close to the anaesthetists work station at the patients' head. Conclusion: By using the occupational radiation dose monitoring system, radiation exposure to anaesthetists was visualised in real-time during trauma operations. Radiation exposure of anaesthetists depends on the type of operation and the position of the C-arm. The system may help to increase anaesthetists` awareness concerning radiation exposure and to enhance compliance in using radiation protection techniques.

scholarly journals Preliminary Examination of an Appropriate Price Calculation Method and Medical Treatment Costs for Foreign Visitors in Japan

2021 ◽  
Vol 18 (11) ◽  
pp. 5837
Author(s):  
Tomoyuki Takura ◽  
Keyword(s):  
Medical Treatment ◽  
Price Level ◽  
Femoral Fractures ◽  
Japanese Patients ◽  
Insurance Companies ◽  
Public Healthcare ◽  
Preliminary Examination ◽  
Two Stages ◽  
External Injury ◽  
Japanese Tourists

This study proposes a method for calculating the appropriate medical treatment price level for foreign visitors (FVs) in Japan. Hospital management costs and foreign prices were analyzed from a market principles perspective to determine the medical treatment price. The study involved two stages: a preliminary survey and an extended survey, supplemented by an international survey. Relatively frequent diseases were selected, and the costs incurred by hospitals for the treatment of FVs were analyzed though data from three hospitals, covering 24 outpatients and 4 inpatients. Payments made by three insurance companies for overseas medical institution services for Japanese tourists with pharyngitis were analyzed. This study shows that the appropriate medical treatment prices for FVs, considering profits, were 1.22–4.26 times higher compared with prices under Japan’s public health insurance plans. Furthermore, these prices were 1.31–4.26 times higher for outpatients with pharyngitis and external injury and 1.22–3.66 times higher for inpatients with appendicitis and femoral fractures. The price of pharyngitis treatment in 12 countries was USD 20.32–158.75 per patient for Japanese tourists, whereas FVs paid 60.24 dollars (1.13 times higher than Japan’s public healthcare price) in Japan. This study shows it was appropriate to set the ideal price level for FVs higher than that for Japanese patients.

scholarly journals Neuraminidase inhibitors, superinfection and corticosteroids affect survival of influenza patients

2015 ◽  
Vol 45 (6) ◽  
pp. 1642-1652 ◽  
Author(s):  
Nelson Lee ◽  
Yee-Sin Leo ◽  
Bin Cao ◽  
Paul K.S. Chan ◽  
W.M. Kyaw ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Cox Regression ◽  
Management Strategies ◽  
Patient Characteristics ◽  
Primary Outcome Measure ◽  
Time Dependent ◽  
High Morbidity ◽  
Neuraminidase Inhibitors ◽  
Systemic Corticosteroids ◽  
Time Dependent Analysis

We aimed to study factors influencing outcomes of adults hospitalised for seasonal and pandemic influenza. Individual-patient data from three Asian cohorts (Hong Kong, Singapore and Beijing; N=2649) were analysed. Adults hospitalised for laboratory-confirmed influenza (prospectively diagnosed) during 2008–2011 were studied. The primary outcome measure was 30-day survival. Multivariate Cox regression models (time-fixed and time-dependent) were used.Patients had high morbidity (respiratory/nonrespiratory complications in 68.4%, respiratory failure in 48.6%, pneumonia in 40.8% and bacterial superinfections in 10.8%) and mortality (5.9% at 30 days and 6.9% at 60 days). 75.2% received neuraminidase inhibitors (NAI) (73.8% received oseltamivir and 1.4% received peramivir/zanamivir; 44.5% of patients received NAI ≤2 days and 65.5% ≤5 days after onset of illness); 23.1% received systemic corticosteroids. There were fewer deaths among NAI-treated patients (5.3% versus 7.6%; p=0.032). NAI treatment was independently associated with survival (adjusted hazard ratio (HR) 0.28, 95% CI 0.19–0.43), adjusted for treatment-propensity score and patient characteristics. Superinfections increased (adjusted HR 2.18, 95% CI 1.52–3.11) and chronic statin use decreased (adjusted HR 0.44, 95% CI 0.23–0.84) death risks. Best survival was shown when treatment started within ≤2 days (adjusted HR 0.20, 95% CI 0.12–0.32), but there was benefit with treatment within 3–5 days (adjusted HR 0.35, 95% CI 0.21–0.58). Time-dependent analysis showed consistent results of NAI treatment (adjusted HR 0.39, 95% CI 0.27–0.57). Corticosteroids increased superinfection (9.7% versus 2.7%) and deaths when controlled for indications (adjusted HR 1.73, 95% CI 1.14–2.62). Early NAI treatment was associated with shorter length of stay in a subanalysis.NAI treatment may improve survival of hospitalised influenza patients; benefit is greatest from, but not limited to, treatment started within 2 days of illness. Superinfections and corticosteroids increase mortality. Antiviral and non-antiviral management strategies should be considered.

A Novel Insight into the Role of Entry Tears in Type B Aortic Dissection: Pressure Measurements in an in Vitro Model

2017 ◽  
Vol 40 (10) ◽  
pp. 563-574 ◽  
Author(s):  
Stefania Marconi ◽  
Ettore Lanzarone ◽  
Hector De Beaufort ◽  
Michele Conti ◽  
Santi Trimarchi ◽  
...  
Keyword(s):  
False Lumen ◽  
Patient Characteristics ◽  
Acute Type ◽  
Type B ◽  
Type B Dissection ◽  
Vitro Model ◽  
Insight Into

Introduction Predicting aortic growth in acute type B dissection is fundamental in planning interventions. Several factors are considered to be growth predictors in the literature and, among them, size and location of entry tears have been recognized to particularly influence the false lumen pressure. In this study, we develop an in vitro setting to analyze the actual impact of size and location of the entry tears on false lumen pressure, in the absence of other confounding factors such as the deformability of the aortic wall. Methods We formalize some indexes that synthetically describe the false lumen pressure with respect to the true lumen pressure. Then, we experimentally derive their values in several configurations of the in vitro setting, and we look for trends in the indexes with respect to the size and location of entry tears. Results: Results show that the tears have a relevant impact on the false lumen pressure, but that their size and location alone are not enough to explain the phenomena observed in vivo. Conclusions To predict the behavior of acute type B dissection, we therefore recommend not limiting to size and location, as many effects may derive from the interactions between these parameters and other patient characteristics.

scholarly journals Dynamic plate osteosynthesis for fracture stabilization: how to do it

2010 ◽  
Vol 2 (1) ◽  
pp. 4 ◽  
Author(s):  
Juerg Sonderegger ◽  
Karl R. Grob ◽  
Markus S. Kuster
Keyword(s):  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
Femoral Fractures ◽  
Fracture Site ◽  
Fixation Strength ◽  
Safe Procedure ◽  
Font Size ◽  
Biological Fixation ◽  
Fracture Stabilization ◽  
Anterior Knee

<!--StartFragment--> <p class="MsoNormal"><span style="font-family: 'Times New Roman', Arial, Helvetica, sans-serif; font-size: medium;"><span style="font-size: 16px;"><span style="font-family: Verdana, Arial, Helvetica, sans-serif; font-size: x-small;"><span style="font-size: 10px;"><p class="MsoNormal">Plate osteosynthesis is one treatment option for the stabilization of long bones. It is widely accepted to achieve bone healing with a dynamic and biological fixation where the perfusion of the bone is left intact and micromotion at the fracture gap is allowed. The indications for a dynamic plate osteosynthesis include distal tibial and femoral fractures, some midshaft fractures, and adolescent tibial and femoral fractures with not fully closed growth plates. Although many lower limb shaft fractures are managed successfully with intramedullary nails, there are some important advantages of open-reduction-and-plate fixation: the risk of malalignment, anterior knee pain, or nonunion seems to be lower. The surgeon performing a plate osteosynthesis has the possibility to influence fixation strength and micromotion at the fracture gap. Long plates and oblique screws at the plate ends increase fixation strength. However, the number of screws does influence stiffness and stability. Lag screws and screws close to the fracture site reduce micromotion dramatically. </p><p class="MsoNormal">Dynamic plate osteosynthesis can be achieved by applying some simple rules: long plates with only a few screws should be used. Oblique screws at the plate ends increase the pullout strength. Two or three holes at the fracture site should be omitted. Lag screws, especially through the plate, must be avoided whenever possible. Compression is not required. Locking plates are recommended only in fractures close to the joint. When respecting these basic concepts, dynamic plate osteosynthesis is a safe procedure with a high healing and a low complication rate. </p></span></span></span></span></p>

scholarly journals The national incidence of PML in Sweden, 1988–2013

Neurology ◽  
2018 ◽  
Vol 90 (6) ◽  
pp. e498-e506 ◽  
Author(s):  
Ellen Iacobaeus ◽  
Sarah Burkill ◽  
Shahram Bahmanyar ◽  
Ramil Hakim ◽  
Camilla Byström ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Patient Characteristics ◽  
Hematologic Malignancies ◽  
Antibody Treatment ◽  
Monoclonal Antibody Treatment ◽  
National Patient ◽  
Notable Increase ◽  
High Level ◽  
Underlying Diseases ◽  
Record Review

ObjectiveTo investigate the incidence of progressive multifocal leukoencephalopathy (PML) and patient characteristics in Sweden between 1988 and 2013.MethodsAll PML diagnoses in Sweden between 1988 and 2013 were identified in the National Patient Register. Information to validate the diagnosis and patient characteristics was obtained from medical records.ResultsMedical record review classified 108 out of 250 patients (43%) as definite (n = 84), probable (n = 4), or possible (n = 20) PML according to diagnostic criteria. Accurate diagnoses were more common in records obtained from neurology departments (82% of patients seen in neurology departments) compared with other departments (31%) (p < 0.001). The incidence of PML increased from a largely stable level at 0.026 (95% confidence interval [CI] 0.021–0.031) per 100,000 individuals per year during 1988–2010 to 0.11 (95% CI 083–0.137) during 2011–2013, during which time there was a notable increase (p < 0.001). Hematologic malignancies (n = 34), HIV/AIDS (n = 33), and autoimmune disease (n = 23) were the most common underlying diseases. Treatment with a monoclonal antibody prior to PML diagnosis was identified in 26 patients.ConclusionAn increased incidence of PML in Sweden was observed and coincided with the prior use of monoclonal antibody treatment. The high level of misdiagnosis emphasizes the importance of immediate contact with a neurology center upon suspicion of PML.

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