ABSTRACT
The paper described the basic theory and methods of tracer methodology. By means of case study, case tracing and system tracing, the authors applied this methodology in review or appraisal work in such aspects as priority focus process, priority focus content, clinical service team, appraisal process, and tracing pathways. All these aim at promoting continuous improvement of the quality of care.
ABSTRACT
Objective To evaluate the results of total knee replacement (TKR) in treating post traumatic degenerative arthritis. Methods A retrospective study was carried out on the results of TKR that performed in 11 patients with post traumatic degenerative arthritis due to a previous fracture around knee from 1997 to 2002. There were one female and 10 males with an average age of 59 years (31 76 years). The time from fracture to TKR averaged 8.7 years (2 27 years). Internal fixation was performed in seven cases, among which the removal of the hardware at one stage at the time of TKR was performed in four and TKR in three. Lateral retinacular release was done in four cases, extensor mechanism realignment in one and collateral ligament reconstruction in two at the time of TKR. Fracture malunion appeared in two cases during operation. Results All the cases were followed up for average 36 months (12 72 months). The mean pre operative Knee Society Scores for 37 scores (10 69 scores) for knee and 42 (0 60) for function were improved significantly to mean post operative 85 (10 100) and 75 (20 100), respectively. The mean knee arc of motion improved from pre operative 83?to post operative 93?. Post operative manipulation under anesthesia for poor motion was carried out in four knees. No knee had aseptic loosening that required subsequent revisions. One knee developed superficial infection treated with debridement and retention of components. Conclusions Significant improvement in function and relief in pain is seen in the patients with previous fractures following subsequent TKR. However, special efforts to restore limb alignment, ensure correct component position and manage soft tissue balance may improve outcome of TKA.
ABSTRACT
Objective To provide the anatomical basis for treatment of comminuted fractures of the radial head with bending steel miniplates by observations of the proximal end of the radius (PEOTR) in adults and to investigate the effect of its application. Methods The PEOTR and the dynamic relationship between the articular circumference of the radial head and the ulnar radial notch were studied with 32 pairs of specimen of the dried radii and ulnae in adults. From Jan 1988 to Mar 1998, eleven cases of comminuted fractures of the radial head were treated with bending steel miniplates procedure; there were seven males and four females, with an average age of 35 years. According to Mason's grading, 9 cases were classified as Type Ⅲ radial head fractures, 2 cases as Type Ⅳ radial head fractures. Results The average length of the PEOTR was 41.6 mm. The radial neck deviated from the radial shaft at an angle of 164?. Then at the neutral position, the greatest range of pronation and supination of the forearm, the range of contact of radians and the range of non contact radian between the articular circumference of the radial head and the ulnar radial notch were 69?,108?,45? and 138?, respectively. The period of follow up in all cases was 20-38 months. All had bony union, with an average healing time of 8.5 months. Evaluation was done according to the criterion made by Broberg and Morrey. The result was excellent in 6 cases, good in 4 cases, and fair in 1 case. Conclusion The treatment of comminuted fractures of the radial head with bending steel miniplates is a safe and effective method.