ABSTRACT
Background: In total hip arthroplasty, it is necessary to evaluate the diameter of the acetabulum as a part of the preoperative planning. However, usually the measurement of the acetabular diameter in the anteroposterior view of the pelvic radiograph gives an inaccurate value. Objective: To determine the accuracy of acetabular diameter measurement from various pelvic radiographs when compared to direct measurement. Methods: The study was performed in 10 cadavers; 5 males and 5 females with a mean age of 69.7 years. 20 hips were studied by taking radiographs at 3 positions: anteroposterior, 45° iliac oblique and 45° obturator oblique views. The acetabular diameters were directly measured from the cadaver and in all views of pelvic radiographs. Intraobserver and interobserver reliability of all the methods were evaluated by measuring 3 times by 3 doctors. Results: The mean diameter of the acetabulum measured directly from the cadaver was 46.13± 3.05 mm., while when measured from the pelvic radiographs in anteroposterior, iliac oblique and obturator oblique view was 54.29 ± 3.67, 47.63 ± 2.85, and 57.29 ± 4.34 mm. respectively. The iliac oblique view gave the most accurate value with a magnification of 3.36%, while the magnification in the anteroposterior and the obturator oblique view was 17.81% and 24.30%, respectively. The diameter measured from the iliac oblique view was not statistically different from the direct measurement, while the diameter measured from the anteroposterior and obturator oblique view was statistically different (p < 0.001).The intraobserver and interobserver reliability of the 3 observers showed excellent correlations (p < 0.0001). Conclusion: The iliac oblique view of the pelvic radiograph provided the most accurate value compared with the direct measurement. The iliac oblique view is the best view of the pelvic radiograph used to measure the acetabular diameter for operative planning for hip arthroplasty as a guide to choosing the proper prosthetic size.
ABSTRACT
Objective: Utilization review is very important especially in universal coverage policy. In Siriraj Hospital the utilization review began in 2002, and the Department of Orthopaedic Surgery developed the indicators “ORTHOPAEDICS” to assess the appropriateness of medical utilization. This study is designed to study the effectiveness of medical utilization review by using indicators “ORTHOPAEDICS” in orthopaedics, public inpatients under universal coverage policy in terms of expenses, the appropriateness, length of hospital stay and the satisfaction of the patients. Methods: 301 orthopaedic inpatients were divided in 2 groups: Group A included 149 patients, 100 men and 49 women. Their average age was 32.7 years old. From June 1, 2003 – May 31, 2004, each patient was prospectively reviewed regarding their daily utilization in terms of expenses, appropriateness of medical utilization by using indicators “ORTHOPAEDICS”. Their length of hospitalization was measured, as well as and their satisfaction evaluated. Group B was the control which included 152 patients, 98 men and 54 women. Their average age was 34.8 years old. No intervention was performed and the data was collected only in expenses and the length of hospital stay for each patient retrospectively from June 1, 2002– May 31, 2003. The expenses and the length of hospital stay of both groups were compared and analyzed. The appropriateness in Group A was studied by using indicators “ORTHOPAEDICS” which were: O = Operation; R = Relative weight rate; T = Type of treatment; H = Hospital stay; O = Occurrence of complication; P = procedures; A = admission; E = expenses; D = drugs; I = Investigation; C = Care map according to CPG of 12 diseases; S = Satisfactions score from 0-10 minimum to maximum, by asking the patients about the satisfaction in term of results of treatment. Results: The total expenses per patient in group A was 24,566.74 baht but in group B was 30,484.53 baht. The expense in group A was 5,917.79 baht reduction which was statistically significant difference (P<0.05). The average length of hospital stay in group A was 8.24 days, whereas in group B was 10.93 days. It reduced 2.69 days after utilization review was implemented. The appropriateness of utilization was found in the procedures, drugs and investigation without inappropriateness (0%). The inappropriateness in admission was 26.9% because the physician forgot to take blood examination and laboratory investigation before admission and it was done in the ward without any effect the treatment. And the average satisfaction score in group A was 9.6. Conclusion: “ORTHOPAEDICS” was useful and helpful indicator to significantly reduce the expense per patient and the length of hospitalization without reducing patient satisfaction and quality of treatment.
ABSTRACT
Hypovolemic shock in severe pelvic injury, such as open-book pelvic injury is a life-threatening condilion. Increased intrapelvic volume causes loss of temponade effect for bleeding control. Most of the bleeding is confine in the false pelvis and lower abdomen. Therefore, this study is carried out to measure intrapelvic volume from the pelvic floor to the level of the pelvic brim and to the horizontal level of the iliac crest. Ten embalmed cadaver pelvic ring in which the pelvic floor, pubic symphysis and sacroiliac joints were preserved, were dissected. Open-book pelvic ring disruption was created by separation of the pubic symphysis and left sacroiliac joints at 2.5,3,5 and 8 cm separation. Intrapelvic volume was measured at two levels. Level 1 was measured from the pelvic floor to the level of pelvic brim (V1) and level 2 from the pelvic floor to the horizontal level of the iliac crest with reconstruction of anterior lower abdominal wall. V1 and V2 before separation of pubic symphysis were 701.00 ml (SD 69.72) and 1,591.40 ml (Sd215.23) respectively. Percentage of increment of V1 at 2.5,3,5 and 8 cm separation were 3.68 ml (SD 1.29), 6.69 ml (SD 2.08), 9.25 ml (SD 2.63) and 31.28 ml (SD 6.47 respectively and of V2 were 26.08 ml (SD 11.19), 31.36 ml (SD 9.51), 37.06 ml (SD 9.31) and 74.08 ml (SD 18.51) respectively. The increment of V1 at less than 5 cm pelvic ring disruption is minimal when compared with V2 The increment of both V1 and V2 is large when the pelvic ring is disrupted over 5 cm. Obviously, V2 increases much more than V1. The increment of intrapelvic volume in open-book pelvic ring disruption is much greater at the level of the false pelvis and lower abdomen especially when the disruption is more than 5 cm, so that there is loss of the temponade effect of the intrapelvic cavity for the control of bleeding, one of the possible causes of hemodynamic instabiliy.