Cirugía de Columna y Articulaciones: agosto 2014

domingo, 31 de agosto de 2014

Risk factors for early mortality following modern total hip arthroplasty.

Authors

Aynardi M, et al. Show all

Journal

J Arthroplasty. 2013 Mar;28(3):517-20. doi: 10.1016/j.arth.2012.06.040. Epub 2012 Nov 8.

Affiliation

Abstract

The aim of this study was to evaluate the incidence of early mortality and identify risk factors for early death following modern uncemented THA. Between 2000 and 2006, we identified patients who died within 90days of THA. Demographics, comorbidities, laboratory studies, and complications were analyzed as risk factors for mortality. 38 of 8261 patients undergoing THA (0.46%) died within 90days postoperatively. Of these, 26% were due to myocardial infarction. Multivariate analysis revealed Charlson index >3, peripheral vascular disease, elevated postoperative glucose, and abnormal postoperative cardiac studies as independent predictors of early mortality following THA. Caution should be taken in patients with increased comorbidities, PVD, perioperative hyperglycemia, and impaired renal function in order to reduce mortality following THA.

PMID

23142452 [PubMed - indexed for MEDLINE]

sábado, 30 de agosto de 2014

Nonsurgical or Surgical Treatment of ACL Injuries: Knee Function, Sports Participation, and Knee Reinjury

http://jbjs.org/content/96/15/1233.abstract

Nonsurgical or Surgical Treatment of ACL Injuries: Knee Function, Sports Participation, and Knee Reinjury

The Delaware-Oslo ACL Cohort Study

; ; ; ;

J Bone Joint Surg Am, 2014 Aug 06;96(15):1233-1241. http://dx.doi.org/10.2106/JBJS.M.01054

ABSTRACT

Background: While there are many opinions about the expected knee function, sports participation, and risk of knee reinjury following nonsurgical treatment of injuries of the anterior cruciate ligament (ACL), there is a lack of knowledge about the clinical course following nonsurgical treatment compared with that after surgical treatment.

RESUMEN

Antecedentes: Si bien hay muchas opiniones sobre la función de espera de la rodilla, la participación deportiva, y el riesgo de una nueva lesión de rodilla después del tratamiento no quirúrgico de las lesiones del ligamento cruzado anterior (ACL), hay una falta de conocimiento sobre la evolución clínica tras el tratamiento no quirúrgico en comparación con el que después del tratamiento quirúrgico.

lunes, 25 de agosto de 2014

Discusión entre pares / Case was 35 yrs old male , fresh # ,due to hard blunt injury

Indian-Orthopaedic Research-Group

Ramit Gunjan

4 days ago I had posted this case n asked for your valuable suggestions. Case was 35 yrs old male , fresh # ,due to hard blunt injury.
Thanks or your valuable suggestions - finally we did ORIF of Fibula, CRIL OF Tibia with il nail n through the same incision as was made for Fibula we grafted Tibia .

Me gusta

P Rajasekhar Rao pls post proper xrays with proper distal tip visualisation

22 de agosto a la(s) 20:26 · Me gusta
Bhuwan Singh Wt bearing avoided till callus forms.nice fixation

22 de agosto a la(s) 21:04 · Me gusta · 2
Indra Agrawal Better than distal tibial plate

22 de agosto a la(s) 21:38 · Me gusta · 3
Bansal Ajay What is the harm in fibula rush nail with tibia iln?...and allow full we bearing at 6 we. I have never faced problem in such cases

22 de agosto a la(s) 21:44 · Editado · Me gusta · 3
Sunil Patil transverse fibula # should have been fixed with cr and rush nail

22 de agosto a la(s) 21:53 · Me gusta · 2
Ehab Ragab Nice work
Thanks for 1ry graft
Nailing of fibula is better

22 de agosto a la(s) 21:54 · Me gusta · 1
Rishi Sanghavi Nice done.. i have done similar thing but now found that primary graftin is not req and another is never leave empty hole in indian implants as it bcomes wk spot and if patient is non co operative and starts to walk implant may break. And proximal do only dynamic lock.

22 de agosto a la(s) 21:56 · Me gusta · 4
Ramit Gunjan Thanks to all for the wonderful comments n words of encouragement... We'll surely try to improve . Regarding Fibular plating preference over Rush nail - 1) vascularity at this site is precarious as such 2) wished to do primary BG for Tibia to fill the gap if any after Fibular fixation . ORIF of Fibula avoided separate Tibial incision - this addresses both the issues 1) and 2) . We've been preferring IM fixation of Fibula otherwise , but this being an injury inflicted by HARD BLUNT TRAUMA viability of skin was an issue I preferred to address.

22 de agosto a la(s) 22:17 · Me gusta · 1
Bansal Ajay Empty hole ? Have similar chances of implant breakage even you locked then also

22 de agosto a la(s) 22:53 · Me gusta · 1
Srinivas Daravathu no good not good case for nailing,u wud hav fixed fibula percutaneously with flex nail ,done DTLP BY MIPO FOR TIBIA,by leaving a hole distally it acts as stress riser leading to nail breakage

22 de agosto a la(s) 23:52 · Me gusta · 1
Srinivas Daravathu for such a low fracture,nailing is not an option

22 de agosto a la(s) 23:55 · Me gusta · 1
Bibek Rai Done nicely. primary bone grafting is appreciable. Yes, it a very low fracture for nailing. DTLCP/MIPPO would have been better. For fibula rush nail. Implant hole at fracture site is an stress riser issue.

23 de agosto a la(s) 0:42 · Me gusta · 1
Randhir Patil Well done... Pt shud do well with standard protocols for wt bearing

23 de agosto a la(s) 1:03 · Me gusta · 1
Drsrinivasa Mahendra Parasuraman Excellent job done

23 de agosto a la(s) 1:16 · Me gusta · 1
Prabodh Kotwal WELL DONE EXCELLENT.

23 de agosto a la(s) 1:32 · Me gusta · 1
Manpal Narula Nice surgery. As already suggested ,you could have pushed the nail a little deeper and locked that empty hole too. . Not a criticism but just an advice. Avoid leaving empty hole esp in such fractures. I wudnt have primarily grafted it but thats ok . Keep it protected

23 de agosto a la(s) 1:33 · Me gusta · 1
DrShamsul Hoda Nice fixation, I rather prefer leave traumatised area virgin untouched, either expert nail with fibula nail, or dtlp with mippo.. Congrats

23 de agosto a la(s) 1:34 · Me gusta · 1
Jitendra Kolhe Excellent

23 de agosto a la(s) 1:48 · Me gusta · 1
Onkar Singh With such lower fr of tibia ... fibular plating is a wiser option as I have seen ankle going into valgus in many cases with early or late weight bearing

This wud require long protection by a brace

23 de agosto a la(s) 2:02 · Me gusta · 4
Rajeev Jaiswal Nicely done

23 de agosto a la(s) 4:04 · Me gusta · 1
Lokesh Bhatia Well Done Keep Protected in PTB Cast for 6 Weeks,after staples removed and wounds healed well.

23 de agosto a la(s) 4:21 · Me gusta · 1
Ujagar Singh Well done Sir...

23 de agosto a la(s) 5:18 · Me gusta · 1
DrVinod Chahar Excellent

23 de agosto a la(s) 6:16 · Me gusta · 1
Natraj Hm Which was done first; tibia nailing or fibula plating?

23 de agosto a la(s) 6:35 · Me gusta · 1
Ragab Abo Jana objection . you change closed # to open # skin complication common at this site . i prefer closed reduction and ex fixator (ilizaroove)

23 de agosto a la(s) 6:56 · Me gusta
Ramit Gunjan Thanks to all for your kind words. BG was done through Fibular incision only to avoid skin complications. Obviously Fibula was fixed first ... Anticipated a considerable gap after maintaining length by Fib fixation , so primary BG was always on the cards. X-Ray doesn't reveal the skin condition n it's my mistake not to have posted the clinical pic. Skin had developed blisters which were not present initially . Earlier we had planned n posted 4days ago that I'd prefer Plate but skin condition allowed only nailing for this rather distal fracture .

23 de agosto a la(s) 7:15 · Me gusta · 1
Ashwini Sood Any role of fibular shortening to approximate the tibial # ends ?

23 de agosto a la(s) 7:19 · Me gusta · 1
Ramit Gunjan Thanks to all for your kind words. BG was done through Fibular incision only to avoid skin complications. Obviously Fibula was fixed first ... Anticipated a considerable gap after maintaining length by Fib fixation , so primary BG was always on the cards. X-Ray doesn't reveal the skin condition n it's my mistake not to have posted the clinical pic. Skin had developed blisters which were not present initially . Earlier we had planned n posted 4days ago that I'd prefer Plate but skin condition allowed only nailing for this rather distal fracture .

23 de agosto a la(s) 7:22 · Me gusta · 1
Kishore Panda Nice ly done

23 de agosto a la(s) 7:39 · Me gusta · 1
Siddhartha V Paluvadi Good job.

23 de agosto a la(s) 7:53 · Me gusta · 1
Abhishek Patil Good job under circumstances. I would primarily apply a distract or till skin heals then go for MIPPO plating thereafter

Ayer a las 4:40 · Me gusta · 1
Sameer Haveri Sir u did fibula first?

Ayer a las 5:09 · Me gusta
Natraj Hm I personally feel doing illizarov is overkill for this particular case

Ayer a las 5:45 · Me gusta · 1
Mehboob Nadaf Excellent

16 horas · Me gusta
Rehan Azmi Good job,nicely done.

1 hora · Me gusta