scholarly journals DIAPHYSEAL TIBIAL FRACTURES;

2018 ◽  
Vol 21 (02) ◽  
pp. 395-399
Author(s):  
Allah Nawaz Abbasi ◽  
Karam Ali Shah ◽  
Muhammad Azeem Akhund
Keyword(s):  
Hospital Stay ◽  
Road Traffic ◽  
Tibial Fractures ◽  
University Hospital ◽  
High Rate ◽  
Time Of Arrival ◽  
X Rays ◽  
Non Union ◽  
Early Return

Objective: To determine the outcome and consequences of close intramedullaryinterlocking nailing in diaphyseal tibial fractures and to observe the hospital stay & complicationsin this method of treatment. Place & Duration: The study was conducted in department oforthopaedic unit-I at Liaquat University Hospital Jamshoro/Hyderabad during Jan 2011 to June2012. Patients & Method: The present study constituted on 43 patients, 3 cases were droppedduring follow up and the rest 40 cases completed 1 year post operative follow up. After havingroutine laboratory investigations and necessary x – rays, the stable patients were operated forintramedullary interlocking nailing on routine operating days. The patients were assessedaccording to the criteria mentioned in follow up proforma from date and time of arrival to final visitin review clinic and results were tabulated. Results: Among 40 patients, 38 (95%) were males and02 (5%) females. The age ranges from 17 to 50 years with mean age of 32.23 years. There were 25close fractures (62.5%) 15 open fractures (37.5%), among these 13 (32.5%) were Gustilo type Iand 2 (5%) were of type II. The mode of injury in majority (75%) of cases was road traffic accident.Good union achieved in 39 cases (97.5%) in 17.53 weeks. But only 1 (2.5%) case unfortunatelywent in infected non union and was converted into Illizarove external Fixation. The maincomplication observed after surgery was loosening of screw in 3 (7.5%) cases. Deep infectionwas observed in the medullary cavity in 3(7.5%) cases (table-V). It has been observed inanalyzing the functional outcome of these patients that majority (80%) of cases was able to sit onbed in 12-24 hours and was able to stand in 24-48 hours. In next 24 hours after surgery 75% ofpatients were pain free. The mean hospital stay in these cases was 8.53 days and by the 48thweek all of cases were able to join their job except one case in which non union observed due toinfection. Conclusions: The data from the current study reveals that intramedullary interlockingnailing of closed and open grade I and II fractures is a safe technique. It combines a high rate ofunion with a low complication rate, less hospitalization and early return to job.

EVALUATION OF LONGO’S HEMORRHOIDECTOMY AT HUE UNIVERSITY HOSPITAL

2012 ◽  
pp. 79-85
Author(s):  
Van Lieu Nguyen ◽  
Doan Van Phu Nguyen ◽  
Thanh Phuc Nguyen
Keyword(s):  
Hospital Stay ◽  
Perioperative Complications ◽  
University Hospital ◽  
Anal Pain ◽  
Stapled Hemorrhoidectomy ◽  
Fourth Degree ◽  
Duration Of Hospital Stay ◽  
The Mean ◽  
Good For

Introduction: Since Longo First described it in 1998, Stapled Hemorrhoidectomy has been emerging as the procedure of choice for symtomatic hemorrhoid. Several studies have shown it to be a safe, effective and relative complication free procedure. The aim of this study was to determine the suitability of (SH) as a day cas procedure at Hue University Hospital. Methods: From Decembre 2009 to April 2012, 384 patients with third- degree and fourth-degree hemorrhoids who underwent Stapled Hemorrhoidectomy were included in this study. Parameters recorded included postoperative complications, analegic requirements, duration of hospital stay and patient satisfaction. Follow-up was performed at 1 month and 3 months post-operative. Results: Of the 384 patients that underwent a Stapled Hemorrhoidectomy 252 (65,7%) were male and 132 (34,3%) were female. The mean age was 47,5 years (range 17-76 years. Duration of hospital stay: The mean day was 2,82 ± 1,15 days (range 1-6 days). There were no perioperative complications. There was one case postoperative complication: hemorrhage; Follow-up after surgery: 286 (74,4%) patients had less anal pain, 78 (20,3%) patients had moderate anal pain, 3 (0,8%) patients had urinary retention; Follow-up after one month: good for 325 (84,6%) patients, average for 59 (15,4%) patients; Follow-up after three months: good for 362 (94,3%) patients, average for 22 (5,7%) patients. Conclusion: Our present study shows that Stapled Hemorrhoidectomy is a safe, reduced postoperative pain, shorter hospital stay and a faster return to unrestricted daily activity

scholarly journals Locked intramedullary nailing technique of the femur without brilliance amplifier at the trauma and orthopedics department of the university hospital of peace series on 35 cases during 1 year

2021 ◽  
Vol 13 (5) ◽  
pp. 95-97
Author(s):  
Augustin Delange Hendrick ◽  
Almenord Pharol ◽  
Khawly Clifford PG ◽  
Augustin Delange ◽  
Pierre Marie Woolley
Keyword(s):  
Hospital Stay ◽  
Intramedullary Nailing ◽  
Femoral Fractures ◽  
Length Of Hospital Stay ◽  
University Hospital ◽  
Patient Morbidity ◽  
Duration Of Hospitalization ◽  
The Cost ◽  
The University

Femoral fractures increase the length of hospital stay for our patients for several reasons such as lack of blood, economic resources, and lack of infrastructure. The use of a C-arm has been shown to reduce patient morbidity due to early functional recovery and reduced hospital stay. Objective: To develop an intramedullary nailing technique without c-arm with a closed focus to reduce the duration of hospitalization of its patients as well as the cost related to the equipment used for follow-up. Methodology: prospective study on 35 patients for 1 year August 2020 to August 2021 Results: We followed 35 patients in which the mean age was 37.83 years with extremes of 18 and 78 years. The male sex predominates 21 against 14 women or 60% against 40% respectively. The sex ratio is 1.5. A total of 19 diaphyseal fractures (54.3%) were nailed, 9 supracondylar (25.7%) and 7 subtrochanteric (20%). Twenty-seven were closed fractures (71.1%), and 8 were open fractures (22.9%). The length of hospitalization was less than 3 days for 30 patients (85.7%), and more than 3 days for 5 patients (14.3%). Conclusion: We recommend that we promote this closed-hearth technique because it improves the postoperative follow-up of patients. Additionally, it would reduce exposure to radiation from c-arm in hospitals that have this equipment.

scholarly journals Outcome of tibial diaphyseal fracture fixation with Surgical Implant Generation Network (SIGN) nail

2019 ◽  
Vol 6 (2) ◽  
pp. 5-11
Author(s):  
Balakrishnan M. Acharya ◽  
Rojan Tamrakar ◽  
Pramod Devkota ◽  
Abhishek K. Thakur ◽  
Suman K. Shrestha
Keyword(s):  
Road Traffic ◽  
Bone Fractures ◽  
Long Bone ◽  
Fracture Union ◽  
Surgical Implant ◽  
Non Union ◽  
Generation Network ◽  
Diaphyseal Fractures ◽  
The Mean

Introductions: Fractures of diaphyseal region of the tibial bone are amongst the most commonly seen extremity injuries in the developing countries. The surgical implant generation network (SIGN) intramedullary (IM) nail was designed for the treatment of long bone fractures in the developing nations. Methods: From March 2008 to December 2018, a total of 104 patients with 104 tibial diaphyseal fractures were treated with SIGN IM nail. The follow-up visits were arranged at 6, 12, 24 weeks and one-year post operatively. During follow-up visits, the signs of fracture union clinically as well as radiologically and the presence of complications any were recorded and analyzed. Results: The mean age of the patients was 32.81 (16 – 65) years, male 74 (71.2%) and female 30 (28.8%). Majority of the patients 70 (67.3%) had fractures after road traffic accidents. The mean time of surgery was 13.58 (1 – 463) days. Six (5.8%) patients had delayed union and no non-union was detected. We had 10 cases (9.6%) of mal-alignment but were on acceptable range. Conclusions: In the developing country like Nepal, the SIGN nail is an effective surgical implant for the management of the tibial diaphyseal fractures with good result of fracture union and low rates of nonunion, mal-alignment and manageable complications.

scholarly journals Treatment of Zone II and III Fifth Metatarsal Fractures Using a Novel Fixation Technique

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0019
Author(s):  
Stephanie K. Eble ◽  
Oliver B. Hansen ◽  
Martin J. O’Malley ◽  
Mark C. Drakos
Keyword(s):  
Postoperative Complications ◽  
Return To Sport ◽  
Vascular Supply ◽  
X Rays ◽  
Non Union ◽  
Anatomic Reduction ◽  
Metatarsal Fractures ◽  
Zone Ii ◽  
Operative Notes

Category: Sports; Lesser Toes Introduction/Purpose: Zone II and III 5th metatarsal fractures are common injuries which can be addressed surgically with percutaneous fixation following anatomic reduction. Limited vascular supply and the specific anatomy of the 5th metatarsal causes concern for non-union of these fractures. This study evaluated a novel screw designed to optimize 5th metatarsal fixation. The titanium alloy headless screw (Jones Union System, Extremity Medical, Parsippany, NJ) provides compression across the fracture site using variable angle pitch and is designed to minimize the occurrence of painful hardware. In addition, we use an intramedullary reamer to create local autologous bone grafting in conjunction with an osteoplasty of the cuboid to obtain ideal positioning. This study represents the first to evaluate clinical outcomes following fixation with this system. Methods: Patients treated for a 5th metatarsal fracture between 2018 and 2019 by two surgeons fellowship-trained in foot and ankle orthopedics were identified. Operative notes were reviewed to ensure that patients were treated with the headless compression screw. 21 patients (22 fractures) were identified. Postoperative x-rays were reviewed to evaluate osseous bridging and time to union was determined. Retrospective chart review was performed to determine time to return to sport. Postoperative complications, including non-unions, need for revision, and need for hardware removal, were also evaluated. Results: Of the 22 total fractures, 16 were Zone II fractures and 6 were Zone III fractures. Average time to clinical follow-up was 13.60 months (range, 3.91-25.07). Average age at time of surgery was 28.82 years (range, 16 to 66). 16 males and 5 females were represented with average BMI of 27.41 kg/m2. Average time to union was 6.78 weeks (range, 5.13-12.12), and average time to return to sport was 11.38 weeks (range, 5.87-15.12). No patients experienced a non-union or painful hardware, and no other postoperative complications were observed. Conclusion: Fixation of Jones fractures using the Jones Union System produced excellent postoperative outcomes. This system, designed to address the challenges of 5th metatarsal anatomy, demonstrated effectiveness with expeditious times to union and return to sport. Union rates were high, and our cohort did not experience any postoperative complications. Although follow-up in some cases is short, no patient has experienced painful hardware. Our results suggest that this system is an effective approach for fixation of Zone II and III 5th metatarsal fractures.

Prostate specific antigen five years following stereotactic body radiation therapy (SBRT) for low and intermediate risk prostate cancer: An ablative procedure?

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 123-123
Author(s):  
Shaan Kataria ◽  
Harsha Koneru ◽  
Shan Guleria ◽  
Malika Danner ◽  
Marilyn Ayoob ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Specific Antigen ◽  
University Hospital ◽  
High Rate ◽  
Total Testosterone ◽  
Intermediate Risk ◽  
Biochemical Relapse ◽  
Risk Prostate Cancer ◽  
Psa Nadir

123 Background: Our previous work on early PSA kinetics following prostate SBRT showed that an initial rapid and then slow PSA decline may result in very low PSA nadirs. This retrospective study sought to evaluate the PSA nadir 5 years following SBRT for low and intermediate risk prostate cancer (PCa). Methods: 65 low and 80 intermediate risk PCa patients were treated definitively with SBRT at Georgetown University Hospital between January 2008 and October 2011. All patients were treated to 35-37.5 Gy in 5 fractions delivered via the CyberKnife Radiosurgical System. Patients who received androgen deprivation therapy were excluded from this study. Pre- and post-treatment PSA and total testosterone levels were obtained during routine follow up visits. Biochemical relapse was defined as a PSA rise > 2 ng/mL above the nadir and analyzed using the Kaplan Meier method. The PSA nadir was defined as the lowest PSA value prior to biochemical relapse or as the lowest value recorded during follow up. Prostate ablation was defined as a PSA nadir < 0.2 ng/mL. Univariate logistic regression analysis was used to evaluate relevant variables on the likelihood of achieving a PSA nadir < 0.2 ng/mL. Results: The median age at the start of SBRT was 72 years. These patients had a median prostate volume of 36 cc with a median 25% of total cores involved. At a median follow up of 5.8 years, 84% and 37% of patients achieved a PSA nadir ≤ 0.5 ng/mL and < 0.2 ng/mL, respectively. Five low and 8 intermediate risk patients experienced a biochemical relapse; those who did not experience a biochemical relapse, achieved a median PSA nadir of 0.2 ng/mL. There was no difference between the 5-year bRFS rate for low (96.6%) and intermediate risk (97.4%) patients and the median time to PSA nadir was 36 months. Initial PSA (p = 0.024) and a lower testosterone at the time of the PSA nadir (p = 0.049) were found to be significant predictors of achieving a PSA nadir < 0.2 ng/mL. Conclusions: SBRT for low and intermediate risk PCa is a convenient treatment option with low PSA nadirs and a high rate of early bRFS. Less than 40% of patients achieved an ablative PSA nadir. Thus, the role of further dose escalation is an area of active investigation.

Contrast-Enhanced Ultrasound (CEUS) Identifies Perfusion Differences Between Tibial Fracture Unions and Non-Unions

2018 ◽  
Vol 41 (01) ◽  
pp. 44-51 ◽  
Author(s):  
Christian Fischer ◽  
Tabea Haug ◽  
Marc-Andre Weber ◽  
Hans-Ulrich Kauczor ◽  
Thomas Bruckner ◽  
...  
Keyword(s):  
Tibial Fracture ◽  
Tibial Fractures ◽  
Contrast Enhanced Ultrasound ◽  
Inclusion Criteria ◽  
Feasible Method ◽  
Non Union ◽  
Peak Enhancement ◽  
Contrast Enhanced ◽  
Osseous Regeneration

Abstract Purpose To assess the value of CEUS in the evaluation of tibial fracture perfusion and its ability to differentiate between physiologic and abnormal fracture healing. Materials and Methods From 2014 to 2017, 107 patients with tibial fractures or tibial non-unions underwent CEUS examination. CEUS was performed at the regular follow-up examination 26 weeks after osteosynthesis or before non-union surgery. Time-intensity curves (TICs) of the contrast enhancement in the fracture gap were generated, and volume parameters such as wash-in rate (WiR), peak enhancement (PE) and wash-in perfusion index (WiPI) were quantified. Results A total of 34 patients met the inclusion criteria of this study, including 14 consolidated fractures, 12 aseptic non-unions and 8 infected non-unions. WiR, PE and WiPI showed significantly lower values in aseptic non-unions compared to unions (p = 0.009, 0.009, 0.012, resp.). In contrast, infected non-unions showed higher values of WiR, PE and WiPI when compared to unions (p = 0.034, 0.056, 0.029, resp.). Conclusion CEUS represents a feasible method in the assessment of tibial fracture perfusion. Perfusion differences between aseptic and infected tibial non-unions as well as healing tibial fractures could be detected. The deviation of physiologic fracture perfusion seems to be associated with disturbed osseous regeneration leading to non-union.

Evaluation and Monitoring of the Clinical Pathway for Thyroidectomy

2008 ◽  
Vol 74 (1) ◽  
pp. 29-36 ◽  
Author(s):  
VÍCtor Soria-Aledo ◽  
Benito Flores-Pastor ◽  
Mari Fe Candel-Arenas ◽  
AndrÉS Carrillo-Alcaraz ◽  
ÁLvaro Campillo-Soto ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Clinical Pathway ◽  
Length Of Hospital Stay ◽  
University Hospital ◽  
Before And After ◽  
Clinical Variation ◽  
Evaluation And Monitoring ◽  
Surgery Department ◽  
Mean Cost

The aim of this study is to present the evaluation and monitoring of a clinical pathway for thyroidectomy 1 year after its implementation and after 4 years’ follow up. We compare the results of an evaluation and monitoring indicators series before and after the establishment of the clinical pathway for thyroidectomy in the Surgery Department of Morales Meseguer Hospital, a general university hospital in Murcia, Spain. Implementation of the clinical pathway led to a reduction in length of hospital stay for all the surgery patients (4.8 ± 2.1 and 3.6 ± 1.9 days before and after pathway implementation, respectively; P < 0.001). Implementation of the clinical pathway led to a reduction in cost in all the operated patients (3357 ± 966 and 2695 ± 970 US$ before and after implementing the clinical pathway, respectively; P < 0.001). Evolution of the mean hospital cost according to year of study shows a reduction from 2000 (3400 ± 1056 US$) to 2004 (2404 ± 666 US$) with a slight increase during 2005 (2721 ± 1335 US$) (P < 0.001). Implementation of the clinical pathway for thyroidectomy has successfully reduced clinical variation and therefore the length of hospital stay and mean cost of the process. In subsequent years, no such major improvements have been made with regard to hospital stay, although they are still clearly better than those before pathway implementation.

High rate of infection eradication following cementless one-stage revision hip arthroplasty with an antibacterial hydrogel coating

2021 ◽  
pp. 039139882199550
Author(s):  
Antonio Pellegrini ◽  
Claudio Legnani
Keyword(s):  
Hip Arthroplasty ◽  
Soft Tissues ◽  
High Rate ◽  
Revision Hip Arthroplasty ◽  
Harris Hip Score ◽  
X Rays ◽  
One Stage ◽  
Infection Eradication ◽  
Hydrogel Coating

Purpose: We conducted a retrospective study to evaluate the outcomes of one-stage revision total hip arthroplasty (THA) following periprosthetic joint infection (PJI) in terms of eradication of the infection, improvement of pain and joint function. We hypothesized that this treatment strategy could lead to satisfying results in selected patients after preoperative microorganism isolation. Methods: Ten patients underwent cementless one-stage revision hip arthroplasty with antibacterial hydrogel coating for the treatment of an infected THA. Inclusion criteria were: the presence of a known organism with known sensitivity, patients non-immunocompromised with healthy soft tissues with minimal or moderate bone loss. Mean age at surgery was 69.4 years. Assessment included objective examination, Harris hip score, visual analog scale pain score, standard X-rays. Results: At a mean follow-up of 3.1 years (range, 2–5 years), none of the patients had clinical or radiographic signs suggesting recurrent infection. Follow-up examination showed significant improvement of all variables compared to pre-operative values ( p < 0.05). Radiographs did not show progressive radiolucent lines or change in the position of the implant. Conclusions: One-stage revision THA with antibacterial hydrogel coated implants represents a safe and effective procedure providing infection eradication and satisfying subjective functional outcomes in selected patients.

scholarly journals Early osteoporosis diagnosis improves post-hip fracture outcome

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
G Lavranos ◽  
P P Manolopoulos ◽  
P Xenophontos ◽  
P Vogazianos ◽  
K Tsioutis ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Osteoporosis Treatment ◽  
The Elderly ◽  
University Hospital ◽  
High Rate ◽  
Osteoporosis Screening ◽  
Fracture Outcome ◽  
Overall Mortality

Abstract Background Hip fracture is associated with mortality and high rate of hospital re-admission after discharge. Osteoporosis screening and treatment have been shown to lower the risk of hip fractures. The aim of this study was to assess whether osteoporosis treatment also improves the post-hip fracture overall outcome. Methods All patients over the age of 65 that sustained a hip fracture at a tertiary University Hospital were approached to enroll in the study. The patients were informed of the context of the study, all queries were answered and an informed consent was signed by the patients in the presence of one of the investigators. The data were collected over an 8 month period from October 2017 to June 2018 and the cohort was followed up until February 2019. Recorded outcomes included mortality, re-admission and unscheduled hospital visit. Results The overall mortality rate of elderly patients after a hip fracture was 12.3% (n = 24) after a 6 month follow-up period. The overall event rate of elderly patients after a hip fracture was 29.7% (n = 58) after a 6 month follow-up period. Only 3% of patients were already on osteoporosis treatment. However, patients on treatment for osteoporosis had a favorable outcome with no deaths and significantly less overall events (p &lt; 0.0001). Conclusions Early osteoporosis screening and treatment in the elderly can not only prevent falls and fractures, but also improve outcome in case a hip fracture does occur. Key messages Osteoporosis treatment improves outcome after a hip fracture. Despite relevant guidance, osteoporosis screening in the elderly remains suboptimal.

Non-Vascularized Tri-Cortical Iliac Crest Graft–A Reliable Option in the Management of Scaphoid Waist Non-Unions

2021 ◽  
Vol 26 (03) ◽  
pp. 383-389
Author(s):  
Vivek Singh ◽  
Nagaraj Manju Moger ◽  
Pragadeeshwaran Jaisankar ◽  
Surjala Rajkumar ◽  
Sunny Chaudhary ◽  
...  
Keyword(s):  
Iliac Crest ◽  
Wrist Joint ◽  
Successful Outcome ◽  
Iliac Crest Bone Graft ◽  
Bony Union ◽  
X Rays ◽  
Iliac Crest Graft ◽  
Non Union ◽  
Functional Scores

Background: Scaphoid non-union often leads to a change in biomechanics of the wrist joint. Various types of bone grafts and different sites of harvest have been described in the literature for scaphoid reconstruction. This study was conducted to assess the clinical and radiological outcome after non-vascularised tri-cortical iliac crest bone graft for non-union of scaphoid waist fractures. Methods: 12 adult patients who underwent reconstruction of scaphoid waist non-union with tricortical iliac crest grafting and internal fixation with headless compression screws (11 cases) and k-wires (1 case) were prospectively analysed. There were 11 males and 1 female (mean age 23.9 years). The mean duration of presentation was 5.7 months following injury. Outcome following surgery were analyzed clinically by range of movements (ROM) and functional scores like DASH and modified Mayo wrist score and radiologically by X-rays and Non contrast CT of the wrist. Radiological assessment included scaphoid length, radio-lunate (RL) angle and scapho-lunate (SL) angle at latest 6 months follow up. Results: Bony union was achieved in 10 cases (union rate 83%). All the cases which achieved union had a significant improvement in radiological and clinical outcome criterias at 6-month follow-up interval. 1 patient had persistent non-union and 1 had k-wire back out with fixation failure. Conclusions: It is important to restore scaphoid length and to correct flexion deformity for a successful outcome. This can reliably be acheived by a carefully planned wedge-shaped iliac crest graft along with secure fixation with a headless compression screw.

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