ABSTRACT
Introducción Este trabajo propone el concepto de criterio apropiado en el tratamiento quirúrgico de las fracturas de platillos tibiales compuesto por 10 elementos. Dentro de estos se incluye el abordaje, la calidad de la reducción, la estabilidad de la fijación y el tiempo para la fijación, entre otros. El estudio busca correlacionar el puntaje de esta escala propuesta con la escala funcional descrita por Rasmussen. Materiales y métodos Estudio tipo cohorte retrospectiva que incluye los pacientes con fracturas de platillos tibiales tratadas quirúrgicamente entre enero de 2013 y junio de 2017. Se registraron variables demográficas, las variables de interés para establecer el criterio apropiado y el resultado funcional con la escala de Rasmussen. Resultados 75 pacientes fueron incluidos, logrando seguimiento mínimo de 6 meses en 89% (n=67). La mediana para edad fue 39 años y el predominio masculino (56.7%). La etiología principal fue accidente de tránsito en moto (67%). En 78% se presentó compromiso de alguna columna posterior. El tratamiento fue apropiado en 61% de los casos, mientras 89% tuvieron resultado bueno o excelente en la escala de Rasmussen. La correlación fue lineal y estadísticamente significativa entre el criterio apropiado y la escala funcional de Rasmussen, correlación Pearson: 0.6279 (p<0.001). Discusión El concepto de criterio apropiado puede ser aplicado en la toma de decisiones y planeamiento quirúrgico de las fracturas de platillos tibiales. Sus buenos resultados se asocian con mejores resultados en la escala de Rasmussen y mayor satisfacción para el paciente.
Background This study presents the use of benchmark criteria for the surgical treatment of tibial plateau fractures. It has 10 elements, including: quality of fracture reduction, fixation stability, time elapsed to fixation, among others. The purpose of the study is to correlate the benchmark criteria used with Rasmussen's functional score system. Materials and methods A retrospective cohort study that included patients with a tibial plateau fracture that required surgical treatment between January 2013 and June 2017. Baseline characteristics, outcomes related with the benchmark criteria, and Rasmussen's score variables, were registered. Results A total of 75 patients were included, with a 6-months minimum follow-up for 89% (n=67). The median age was 39 years old, and the majority (56.7%) were men. The first cause of fracture was motorcycle accident (67%). There was compromise of a posterior column in 78% of the cases. Treatment was considered appropriate in 61%, and 89% had a good/excellent result in Rasmussen's functional score. There was a significant linear correlation between the benchmark criteria and Rasmussen's score, with a Pearson correlation coefficient of 0.6279 (P<.001). Discussion Benchmarking criteria may be useful in the evaluation and planning of surgical treatment of tibial plateau fractures. They are associated with better functional results and satisfaction in the Rasmussen's score.
Subject(s)
Humans , Tibia , Prognosis , Quality of Life , Therapeutics , Fractures, BoneABSTRACT
Objective: To investigate the effect of accuracy of phase 3 Oxford prosthesis positioning on short-term effectiveness of unicompartmental knee arthroplasty (UKA). Methods: The clinical data of 26 patients (26 knees) who were treated with UKA between September 2015 and November 2015 was retrospectively analyzed. The single-peg Oxford prosthesis was implanted in 15 patients (single-peg group), and twin-peg Oxford prosthesis was implanted in 11 patients (twin-peg group). There was no significant difference in gender, age, body mass index, Kellgren-Lawrence grading, and preoperative Hospital for Special Surgery (HSS) scores between 2 groups ( P>0.05). HSS, knee society score (KSS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and Oxford knee score (OKS) were used to evaluate the knee function. Radiographic criteria for Oxford UKA was used to evaluate the prosthesis position. The reason and treatment of bearing dislocations were recorded. Results: All patients were followed up with mean follow-up time of 26.2 months in single-peg group (range, 24-27 months) and 25.2 months in twin-peg group (range, 24-26 months). The bearing dislocation occurred in 2 cases of twin-peg group during follow-up. At last follow-up, there was no significant difference in HSS, WOMAC, OKS, and KSS scores between 2 groups ( P>0.05). There was no significant difference in radiographic scores of femoral component, tibial component, and overall components between 2 groups ( P>0.05). No significant correlation was found between radiographic scores and postoperative functional outcome in 2 groups ( P>0.05). Conclusion: Within a safe range, the accuracy of phase 3 Oxford prosthesis positioning has limited influence on the short-term functional outcome.
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Objective: Rehabilitation after anterior cruciate ligament (ACL) reconstruction has focused over the past decade on early mobility and exercises in the recent years, due to advancements in the surgical techniques, presumably less strain on the graft. Thus it was necessary to investigate the effect of early mobilization with the single elbow crutch with conventional methods and its outcome responses. Materials and Methods: Totally, 40 subjects of day 1 post-ACL oblique repair with mean age of 25 ± 5.3 years participated in the study. Subjects were divided into experimental and control groups for rehabilitation with single elbow crutch and walker, respectively, along with conventional exercises for 6 weeks. After 4 th week elbow crutch and walker were discarded for both groups. Interventional outcomes were assessed by static, dynamic stability, and knee functional score at 4 th and 6 th weeks post-operatively for both groups. Results: Both groups showed statistically significant difference in static and dynamic stability at 4 th and 6 th weeks. Whereas compared with experimental group, in control group Lysholm functional score was low in at 4 th and 6 th weeks. It was found that outcomes were improved within each group from 4 th to 6 th week. Conclusion: Study concluded that knee stability and Lysholm functional Knee Score were significantly improved by early mobilization although functional score was more significant in single elbow crutch group than walker and also recommended early weaning off walking aids for faster outcomes during rehabilitation of post-ACL repair.
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PURPOSE: To analyze the surgical results of AO type C distal femoral fractures using locking compression plate. MATERIALS AND METHODS: From February 2006 to June 2008, 14 patients 15 cases were included. Injury mechanisms, combined injuries, radiologic and clinical results and postoperative complications were analyzed. RESULTS: The mean age was 59.6 (30~77) years. The mean follow up period was 25 (12~40) months. AO types were 3 of C1, 5 of C2 and 7 of C3. Injury mechanisms were 9 of traffic accident, 5 of slip down and 1 of fall from a height. Four cases were combined with other extremity injuries or fractures. The mean radiologic union was obtained at postoperative 15 (13~20) weeks. The mean Neer's functional score was 74.2 (58~97); 3 of excellent, 5 of satisfactory and 7 of unsatisfactory. Postoperative complications were 2 of infection and 1 of nonunion. There were no mechanical failures or fixation loss with locking compression plate at the final follow up. CONCLUSION: Internal fixation using locking compression plate for AO type C distal femoral fractures provided excellent fixations. At the final follow up, the clinical results were variable. The affecting factors on the final results seemed to be joint congruencies after anatomical reduction and active rehabilitation.