Senior Managed Care System for Hip Fracture in the United States

BACKGROUND: It is debatable whether a managed care model would affect the quality of care and length of hospital stay in the treatment of hip fractures in elderly patients. METHODS: This prospective study was undertaken to determine whether or not a managed care critical pathway tool shortened hospital stay in a group of 102 senior patients with fractures of the hip during follow-up. We compared our study findings with two equivalent populations of senior hip fracture patients not treated using a critical care pathway concerning specific markers of quality. RESULTS: The managed care group had a 9% mortality rate, 95% return to prefracture living and 63% return to ambulatory status. The rates compared favorably with previous studies. The quality of care provided before and after the critical pathway was equivalent, while the post-pathway length of stay dropped 30%. CONCLUSIONS: The proposed care protocol is recommended to shorten hospital stay in elderly patients with hip fractures.

Comparison of different methods of femoral fixation anterior cruciate ligament reconstruction

The aim of this study is to compare three modes of femoral fixation, namely Aperfix, Rigidfix and Endobutton, in anterior cruciate ligament [ACL] reconstruction. 120 patients were randomly assigned to three groups, each consisting of 40 patients, and each group was treated by one of the above mentioned methods of femoral fixation. All patients were examined prior to and 24 months after surgery, and they were compared for anterior tibial displacement using the Lysholm score and KT-1000. The three modes of femoral fixation were not significantly different in terms of time of surgery. In the Endobutton group, the Lysholm score rose from 63.21 +/- 18.59 prior to ACL reconstruction to 90.64 +/- 9.47 after the surgery, while it rose from 65.72 +/- 18.74 to 96.22 +/- 5.35 in the Aperfix group and from 69.21 +/- 17.45 to 90.64 +/- 9.47 in the Rigidfix group. Anterior tibial displacement was 3.96 +/- 1.58 mm for Endobutton, 4.28 +/- 1.48 mm for Rigidfix and 4.03 +/- 1.79 mm for Aperfix. Aperfix was indicated to yield a better outcome in terms of instant stability and general results

Reliability of the center of pressure parameters after ACL reconstruction surgery

The elicited parameters from the center of pressure [COP] of patients after surgery of the anterior cruciate ligament are proper indications for estimating balance after surgery and rehabilitation. Thus, making sure about repeatability of COP parameters which can determine the knee joint after the knee reconstruction surgery is very important. This study measures repeatability rate of some COP parameters after reconstructing anterior cruciate ligament in various positions. In this study, 15 athlete men [mean age: 27 +/- 5] after 4-6 months since repair of their anterior cruciate ligament were included; they have been selected through simple non-probability sampling method. The study was conducted in biomechanics lab of Tarbiat Modares University in 2010. Assessment of balance was done with open/closed eyes, with/without foam using force platform in two sessions with 48 hours interval. The external-internal amplitude [0.86], external-internal standard deviation [0.86], phase plane [0.82] and area oscillation [0.81] were among parameters which showed the most repeatability. The average oscillation of anterior - posterior frequency [0.6] showed the lowest repeatability. A number of parameters caused by oscillation of COP show high rate of repeatability after reconstructing anterior cruciate ligament which can be used as an assessment of patients condition after reconstruction of the anterior cruciate ligament

[Intra-articular hyaluronic acid injections Vs. dextrose prolotherapy in the treatment of osteoarthritic knee pain]

Conservative treatment needs to be tried prior to surgical treatment of knee osteoarthritis. This study was designed to evaluate the short-term effects of dextrose prolotherapy on pain relief and functional improvement in knee osteoarthritis in comparison with intra-articular hyaluronic acid injections. In this double blind clinical trial, 100 patients, aged 40-70 years, with complaints of knee pain lasting >3 months were recruited in Akhtar hospital during the years 2010 to 2011. The patients met the criteria proposed by the American College of Rheumatology [ACR] for knee osteoarthritis. 50 patients in hyaluronic acid group received five 2 ml injections of hyaluronic acid [Synocrom Forte[R] 1%] weekly and 50 patients in dextrose prolotherapy group received three 2 ml bimonthly injections of 25% dextrose. The patients were evaluated before and after treatment in terms of pain and functionality using the Knee injury and Osteoarthritis Outcome Score [KOOS] self-questionnaire. The patients were followed up for 12 weeks and were examined 12 weeks after the injections by an observer unaware of group assignments. The data were recorded for statistical analysis. The mean age of the patients was 60.6 +/- 8.2 years. No significant differences were found between the two groups with respect to pre- and post-treatment KOOS scores. The scores showed significant improvements in all items following treatment in both groups [P<0.001]. It seems that intra-articular injections of 25% dextrose prolotherapy could be as effective as hyaluronic acid injections for the treatment of knee pain due to OA