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1.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 66(6): 477-484, Nov-Dic. 2022. tab, graf
Article in English | IBECS | ID: ibc-210659

ABSTRACT

Introduction: Hip replacement is one of the most successful operations in orthopaedic surgery. Periprosthetic hip fractures (PPHF) have very serious consequences for the patient, and they also entail a very important economic impact on healthcare systems. The aim of the study was to provide the first detailed cost analysis of PPHF in a traumatology and orthopaedics service in a third level hospital in Spain. Methods: The study included all patients admitted between 2009 and 2019 with a diagnosis of “PPHF”. We assessed hospital stay cost, total cost of the operating theatre, cost of the implants used, analyses, consultations with other specialists, rehabilitation sessions, radiological tests, microbiology, blood transfusions and other surgical operations during the same admission. Results: 78 patients were included in the study, 49 women and 29 men, with a mean age of 78.74 years (R 45–92). 69 patients received surgical treatment, 75% had open reduction and internal fixation (ORIF), and 25% had revision surgery. The total cost was €1,139,650.17. The average cost was €14,610.90. Significantly higher costs were incurred for revision compared to ORIF treatments, admissions that lasted more than 30 days, and patients who required more than one operation during admission. The most costly factors were the hospital stay (46%), the cost of the surgery itself (35%), and the implants (24%). Conclusions: Revision arthroplasty versus ORIF treatment, admissions lasting more than 30 days, and patients requiring more than one operation on admission incurred significantly higher costs. The average cost, from a hospital perspective, generated by a PPHF was €14,610.90. The most costly factors were, in descending order, the hospital stay, the cost of the surgery itself, and the implants. It is necessary to establish protocols and updated therapeutic algorithms in the perioperative management of PPHF in order to reduce both morbidity rates and associated costs.(AU)


Introducción: La artroplastia de cadera es una de las operaciones con mejores resultados en cirugía ortopédica. Las fracturas periprotésicas de cadera (FPPC) tienen consecuencias muy graves para el paciente y además suponen un impacto económico muy importante para los sistemas sanitarios. El objetivo del estudio es realizar el primer análisis detallado de los costes de las FPPC en un Servicio de Cirugía Ortopédica y Traumatología en un hospital universitario de tercer nivel en España. Métodos: El estudio incluyó a todos los pacientes ingresados entre 2009 y 2019 con el diagnóstico de «FPPC». Se evaluaron el coste de la estancia hospitalaria, el coste total del quirófano, el coste de los implantes utilizados, los análisis de sangre, las consultas con otros especialistas, las sesiones de rehabilitación, las pruebas radiológicas, la microbiología, las transfusiones de sangre y otras intervenciones quirúrgicas durante el mismo ingreso. Resultados: Se incluyó a un total de 78 pacientes, 49 mujeres y 29 hombres, con una edad media de 78,74 años (R 45-92); 69 pacientes recibieron tratamiento quirúrgico, el 75% se sometió a reducción abierta y fijación interna (RAFI) y el 25% a revisión protésica. El coste total fue de 1.139.650,17 €. El coste medio fue de 14.610,90 €. Los costes fueron significativamente más elevados en la revisión protésica que en la RAFI, en los ingresos que duraron más de 30 días y en los pacientes que requirieron más de una intervención quirúrgica durante el ingreso. Los factores que más influyeron en el coste fueron la estancia hospitalaria (46%), el coste de la intervención quirúrgica (35%) y el de los implantes (24%). Conclusiones: La cirugía de revisión protésica frente a RAFI, los ingresos de más de 30 días y los pacientes que requirieron más de una intervención quirúrgica durante el ingreso supusieron costes significativamente mayores. El coste medio, desde el punto de vista hospitalario, generado por una FPPC fue de 14.610,90 €.(AU)


Subject(s)
Humans , Hip Fractures , Periprosthetic Fractures/surgery , Arthroplasty, Replacement, Hip , Surgery Department, Hospital , Cost of Illness , Hospital Costs , Spain , Traumatology , Wounds and Injuries , Orthopedics
2.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 66(6): T59-T66, Nov-Dic. 2022. tab, graf
Article in Spanish | IBECS | ID: ibc-210673

ABSTRACT

Introduction: Hip replacement is one of the most successful operations in orthopaedic surgery. Periprosthetic hip fractures (PPHF) have very serious consequences for the patient, and they also entail a very important economic impact on healthcare systems. The aim of the study was to provide the first detailed cost analysis of PPHF in a traumatology and orthopaedics service in a third level hospital in Spain. Methods: The study included all patients admitted between 2009 and 2019 with a diagnosis of “PPHF”. We assessed hospital stay cost, total cost of the operating theatre, cost of the implants used, analyses, consultations with other specialists, rehabilitation sessions, radiological tests, microbiology, blood transfusions and other surgical operations during the same admission. Results: 78 patients were included in the study, 49 women and 29 men, with a mean age of 78.74 years (R 45–92). 69 patients received surgical treatment, 75% had open reduction and internal fixation (ORIF), and 25% had revision surgery. The total cost was €1,139,650.17. The average cost was €14,610.90. Significantly higher costs were incurred for revision compared to ORIF treatments, admissions that lasted more than 30 days, and patients who required more than one operation during admission. The most costly factors were the hospital stay (46%), the cost of the surgery itself (35%), and the implants (24%). Conclusions: Revision arthroplasty versus ORIF treatment, admissions lasting more than 30 days, and patients requiring more than one operation on admission incurred significantly higher costs. The average cost, from a hospital perspective, generated by a PPHF was €14,610.90. The most costly factors were, in descending order, the hospital stay, the cost of the surgery itself, and the implants. It is necessary to establish protocols and updated therapeutic algorithms in the perioperative management of PPHF in order to reduce both morbidity rates and associated costs.(AU)


Introducción: La artroplastia de cadera es una de las operaciones con mejores resultados en cirugía ortopédica. Las fracturas periprotésicas de cadera (FPPC) tienen consecuencias muy graves para el paciente y además suponen un impacto económico muy importante para los sistemas sanitarios. El objetivo del estudio es realizar el primer análisis detallado de los costes de las FPPC en un Servicio de Cirugía Ortopédica y Traumatología en un hospital universitario de tercer nivel en España. Métodos: El estudio incluyó a todos los pacientes ingresados entre 2009 y 2019 con el diagnóstico de «FPPC». Se evaluaron el coste de la estancia hospitalaria, el coste total del quirófano, el coste de los implantes utilizados, los análisis de sangre, las consultas con otros especialistas, las sesiones de rehabilitación, las pruebas radiológicas, la microbiología, las transfusiones de sangre y otras intervenciones quirúrgicas durante el mismo ingreso. Resultados: Se incluyó a un total de 78 pacientes, 49 mujeres y 29 hombres, con una edad media de 78,74 años (R 45-92); 69 pacientes recibieron tratamiento quirúrgico, el 75% se sometió a reducción abierta y fijación interna (RAFI) y el 25% a revisión protésica. El coste total fue de 1.139.650,17 €. El coste medio fue de 14.610,90 €. Los costes fueron significativamente más elevados en la revisión protésica que en la RAFI, en los ingresos que duraron más de 30 días y en los pacientes que requirieron más de una intervención quirúrgica durante el ingreso. Los factores que más influyeron en el coste fueron la estancia hospitalaria (46%), el coste de la intervención quirúrgica (35%) y el de los implantes (24%). Conclusiones: La cirugía de revisión protésica frente a RAFI, los ingresos de más de 30 días y los pacientes que requirieron más de una intervención quirúrgica durante el ingreso supusieron costes significativamente mayores. El coste medio, desde el punto de vista hospitalario, generado por una FPPC fue de 14.610,90 €.(AU)


Subject(s)
Humans , Hip Fractures , Periprosthetic Fractures/surgery , Arthroplasty, Replacement, Hip , Surgery Department, Hospital , Cost of Illness , Hospital Costs , Spain , Traumatology , Wounds and Injuries , Orthopedics
3.
Rev Esp Cir Ortop Traumatol ; 66(6): T59-T66, 2022.
Article in English, Spanish | MEDLINE | ID: mdl-35853602

ABSTRACT

INTRODUCTION: Hip replacement is one of the most successful operations in orthopaedic surgery. Periprosthetic hip fractures (PPHF) have very serious consequences for the patient, and they also entail a very important economic impact on healthcare systems. The aim of the study was to provide the first detailed cost analysis of PPHF in a traumatology and orthopaedics service in a third level hospital in Spain. METHODS: The study included all patients admitted between 2009 and 2019 with a diagnosis of «PPHF¼. We assessed hospital stay cost, total cost of the operating theatre, cost of the implants used, analyses, consultations with other specialists, rehabilitation sessions, radiological tests, microbiology, blood transfusions and other surgical operations during the same admission. RESULTS: Seventy-eight patients were included in the study, 49 women and 29 men, with a mean age of 78.74 years (R 45-92). Sixty-nine patients received surgical treatment, 75% had open reduction and internal fixation (ORIF), and 25% had revision surgery. The total cost was €1 139 650.17. The average cost was €14 610.90. Significantly higher costs were incurred for revision compared to ORIF treatments, admissions that lasted more than 30 days, and patients who required more than one operation during admission. The most costly factors were the hospital stay (46%), the cost of the surgery itself (35%), and the implants (24%). CONCLUSIONS: Revision arthroplasty versus ORIF treatment, admissions lasting more than 30 days, and patients requiring more than one operation on admission incurred significantly higher costs. The average cost, from a hospital perspective, generated by a PPHF was €14 610.90. The most costly factors were, in descending order, the hospital stay, the cost of the surgery itself, and the implants. It is necessary to establish protocols and updated therapeutic algorithms in the perioperative management of PPHF in order to reduce both morbidity rates and associated costs.

4.
Rev Esp Cir Ortop Traumatol ; 66(6): 477-484, 2022.
Article in English, Spanish | MEDLINE | ID: mdl-35466073

ABSTRACT

INTRODUCTION: Hip replacement is one of the most successful operations in orthopaedic surgery. Periprosthetic hip fractures (PPHF) have very serious consequences for the patient, and they also entail a very important economic impact on healthcare systems. The aim of the study was to provide the first detailed cost analysis of PPHF in a traumatology and orthopaedics service in a third level hospital in Spain. METHODS: The study included all patients admitted between 2009 and 2019 with a diagnosis of "PPHF". We assessed hospital stay cost, total cost of the operating theatre, cost of the implants used, analyses, consultations with other specialists, rehabilitation sessions, radiological tests, microbiology, blood transfusions and other surgical operations during the same admission. RESULTS: 78 patients were included in the study, 49 women and 29 men, with a mean age of 78.74 years (R 45-92). 69 patients received surgical treatment, 75% had open reduction and internal fixation (ORIF), and 25% had revision surgery. The total cost was €1,139,650.17. The average cost was €14,610.90. Significantly higher costs were incurred for revision compared to ORIF treatments, admissions that lasted more than 30 days, and patients who required more than one operation during admission. The most costly factors were the hospital stay (46%), the cost of the surgery itself (35%), and the implants (24%). CONCLUSIONS: Revision arthroplasty versus ORIF treatment, admissions lasting more than 30 days, and patients requiring more than one operation on admission incurred significantly higher costs. The average cost, from a hospital perspective, generated by a PPHF was €14,610.90. The most costly factors were, in descending order, the hospital stay, the cost of the surgery itself, and the implants. It is necessary to establish protocols and updated therapeutic algorithms in the perioperative management of PPHF in order to reduce both morbidity rates and associated costs.

5.
Rev Esp Cir Ortop Traumatol ; 65(5): 374-381, 2021.
Article in Spanish | MEDLINE | ID: mdl-34630777

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has led to the confinement of approximately one third of the world population, causing a drastic change in the activities of daily life with many repercussions at the health, economic and social levels. OBJECTIVES: The objective of the present work is to present the epidemiological variations in the production of fractures in the period of mandatory confinement in our reference population. METHODS: Analytical retrospective comparative study of two groups of patients: Group A: patients admitted before the state of alarm that forced confinement in the period from January 13 to March 13 compared to Group B: patients admitted in the two months of confinement, until the de-escalation period began, March 13-May 13. Epidemiological variables including age, personal history, type of fracture, mechanism of injury, outpatient rate, and hospital stay were recorded. RESULTS: A total of 190 patients were included. 112 in the pre-confinement period and 78 in the confinement (30% decrease). The mean age (p = 0.007) and falls at home (p < 0.001) were higher in the confinement group. The postoperative (p = 0.006) and overall (p < 0.001) hospital stay were significantly less in the confinement group. No differences were found in the anatomical location of the lesion, sex, comorbidities, mechanism of injury, outpatient rate, or death. CONCLUSIONS: Based on the results of our study, the period of forced confinement due to the COVID-19 pandemic has produced a drastic decrease in the total number of fractures admitted to the traumatology service of a third level hospital. On the other hand, osteoporotic hip fractures have not varied in their incidence and a decrease in the average postoperative and overall stay has been observed.

6.
Article in English, Spanish | MEDLINE | ID: mdl-32792284

ABSTRACT

INTRODUCTION: There is currently great controversy about the ideal treatment of intraarticular calcaneal fractures. The objective of this study is to determine the usefulness of postoperative computed tomography (CT). PATIENTS AND METHODS: We conducted a retrospective descriptive study of patients operated on in the period 2007 to 2015 in our center. Epidemiological variables, specific fracture data, surgical intervention as well as results and complications were collected. The radiological evaluation was performed using simple radiology (Böhler angle) and coronal CT (congruence of posterior subtalar joint). For the functional results we use the AOFAS hindfoot scale and the EVA scale for the level of pain. RESULTS: We included 46 fractures in 43 patients (three bilateral). Thirty-five were male and eight female, with an average age of 42 years (18-79) and an average follow-up of 57.39 months (33-129). Preoperative CT was performed in all cases, of which 11 were Sanders ii, 23 type iii and 12 type iv. Postoperative CT was only performed in 17 cases. The subsequent subtalar reduction measured by CT was satisfactory (articular step < 2 mm) in 12 cases. The average presurgical Böhler angle was 6.45 ± 10.21 ([-22]-25) and the post-surgical angle of 20.46 ± 7.09 (4-38). Subtalar osteoarthritis developed in 19 cases (symptomatic in 12) and calcaneo-cuboid osteoarthritis in six cases (only one symptomatic). The AOFAS was 74.28 ± 18.98 (27-100) and the EVA was 4.14 ± 2.98 (2-9). A CT scan with a step of less than 2 mm was statistically significant, with a higher result on the AOFAS scale (77.17 average points) as well as lower EVA on average (2.83) (p = 0.002). Regarding the Böhler, it was statistically significant the relationship of an angle > 20° post-surgical with higher AOFAS (80.82) and lower VAS (3.18) (p = 0.001). The literature search obtained a total of 117 articles that met the search criteria, of which only 29 requested postoperative CT. CONCLUSIONS: The indication of postoperative CT in patients operated by intraarticular calcaneal fracture is the best technique to corroborate the correct reduction of the subtalar joint surface, although it is not universally accepted, according to the literature.


Subject(s)
Calcaneus/injuries , Intra-Articular Fractures/diagnostic imaging , Intra-Articular Fractures/surgery , Subtalar Joint/surgery , Tomography, X-Ray Computed , Adolescent , Adult , Aged , Calcaneus/diagnostic imaging , Female , Fracture Fixation, Internal/methods , Humans , Intra-Articular Fractures/classification , Male , Middle Aged , Postoperative Care , Retrospective Studies , Subtalar Joint/diagnostic imaging , Treatment Outcome , Young Adult
7.
Acta Ortop Mex ; 32(3): 172-181, 2018.
Article in Spanish | MEDLINE | ID: mdl-30521710

ABSTRACT

Calcaneal fractures are the most common tarsal fractures and their treatment is still debated today. We intend in this update to highlight the points of controversy and clarify the consensus, especially in the treatment of intra-articular fractures, as well as to describe the management of major complications.


Las fracturas de calcáneo son las más frecuentes del tarso y su tratamiento sigue siendo hoy en día objeto de debate. Pretendemos en esta actualización destacar los puntos de controversia, así como clarificar los consensos, especialmente en el tratamiento de las fracturas intraarticulares, así como describir el manejo de las principales complicaciones.


Subject(s)
Calcaneus , Fractures, Bone , Calcaneus/injuries , Consensus , Fracture Fixation, Internal , Fractures, Bone/surgery , Humans , Treatment Outcome
8.
Article in English, Spanish | MEDLINE | ID: mdl-29572077

ABSTRACT

OBJECTIVE: The indiscriminate practice of radiographs for foot and ankle injuries is not justified and numerous studies have corroborated the usefulness of clinical screening tests such as the Ottawa Ankle Rules. The aim of our study is to clinically validate the so-called Shetty Test in our area. MATERIAL AND METHOD: A cross-sectional observational study by applying the Shetty test to patients seen in the Emergency Department. RESULTS: We enrolled 100 patients with an average age of 39.25 (16-86). The Shetty test was positive on 14 occasions. Subsequent radiography revealed a fracture in 10 cases: 4 were false positives. The test was negative in the remaining 86 patients and radiography confirmed the absence of fracture (with sensitivity of 100% and specificity of 95.56%, positive predictive value of 71.40%, and negative predictive value of 100%). CONCLUSIONS: The Shetty test is a valid clinical screening tool to decide whether simple radiography is indicated for foot and ankle injuries. It is a simple, quick and reproducible test.


Subject(s)
Ankle Fractures/diagnosis , Emergency Service, Hospital , Foot Bones/injuries , Physical Examination/methods , Adolescent , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Foot Bones/diagnostic imaging , Humans , Male , Middle Aged , Radiography , Sensitivity and Specificity , Young Adult
9.
Rev Esp Cir Ortop Traumatol ; 61(6): 441-445, 2017.
Article in English, Spanish | MEDLINE | ID: mdl-28684112

ABSTRACT

Tibiotalocalcaneal arthrodesis is an effective salvage procedure in cases of combined ankle and subtalar osteoarthritis as well as severe multiplanar deformities and severe joint destruction of the hindfoot. Special mention should be made of this procedure in cases of bone loss, especially from the talus, secondary to failed previous surgeries or bone infection, often being the only way to achieve a stable and painless foot and ankle. We present a case of ankle fracture in a patient with associated morbidity and multiple complications following osteosynthesis, in which tibiotalocalcaneal arthrodesis with cemented with antibiotic coated retrograde nail has achieved a satisfactory final result.


Subject(s)
Ankle Fractures/surgery , Arthrodesis/methods , Bone Nails , Calcaneus/surgery , Reoperation/methods , Salvage Therapy/methods , Tibia/surgery , Aged , Ankle Joint/surgery , Arthrodesis/instrumentation , Bone Cements , Female , Humans , Reoperation/instrumentation , Salvage Therapy/instrumentation , Subtalar Joint/surgery
10.
Rev Esp Cir Ortop Traumatol ; 59(4): 266-74, 2015.
Article in English, Spanish | MEDLINE | ID: mdl-25572819

ABSTRACT

INTRODUCTION: Intraoperative neurophysiological monitoring has experienced a spectacular development in the past 20 years, particularly in the fields of neurosurgery and spine surgery. it has become a useful, almost indispensable, tool in preventing nerve damage during surgery. The aim of this article is to describe the intraoperative technique and analyze its results in the field of peripheral nerve surgery. OBJECTIVE: To describe the usefulness of a technique in peripheral nerve surgery, the technique used and the experience in a centre. PATIENTS AND METHODS: A retrospective study was conducted on 30 cases of peripheral nerve surgery performed in this centre from 2009 to 2013, using the intraoperative monitoring technique. RESULTS: Of the total of 13 peripheral nerve tumors recorded, there were 11 excellent results and 2 good results, one temporary hypoesthesia and one with almost complete sensory, except for motor, recovery. Traumatic injury was recorded in 17 cases, of which 6 required performing a graft, and the remaining 11 cases only neurolysis was performed, with complete motor and sensory recovery. CONCLUSIONS: Intraoperative neurophysiological monitoring is a useful tool in the secondary surgery of peripheral nerve injury and the intraneural tumor pathology.


Subject(s)
Intraoperative Complications/prevention & control , Intraoperative Neurophysiological Monitoring/methods , Neurilemmoma/surgery , Neurosurgical Procedures/adverse effects , Peripheral Nerve Injuries/prevention & control , Peripheral Nervous System Neoplasms/surgery , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Intraoperative Complications/diagnosis , Male , Middle Aged , Neurosurgical Procedures/methods , Peripheral Nerve Injuries/diagnosis , Peripheral Nerve Injuries/etiology , Retrospective Studies , Treatment Outcome , Young Adult
11.
Acta Ortop Mex ; 28(4): 253-7, 2014.
Article in Spanish | MEDLINE | ID: mdl-26021108

ABSTRACT

Hallux rigidus is the most frequent arthrosis of the foot and ankle and the second most important condition involving the first metatarsophalangeal joint after hallux valgus. If left untreated, it may cause important alterations in gait, mobility and activities of daily living. The purpose of this review article is to describe a complete treatment algorithm for all grades of this condition, after a thorough bibliographic review.


Subject(s)
Algorithms , Hallux Rigidus/surgery , Humans
12.
Rev Esp Cir Ortop Traumatol ; 57(6): 409-16, 2013.
Article in Spanish | MEDLINE | ID: mdl-24126145

ABSTRACT

INTRODUCTION: The most common cause of osteoarthritis of the ankle is post-traumatic, and although tibiotalar arthrodesis remains the surgical gold standard, a number of techniques have been described to preserve joint mobility, such as joint distraction arthroplasty or arthrodiastasis. OBJECTIVE: To evaluate the functional outcome and changes in Visual Analogue Scale (VAS) for pain after the application of the distraction arthroplasty for post-traumatic ankle osteoarthritis. PATIENTS AND METHODS: A prospective comparative study of a group of 10 young patients with post-traumatic ankle osteoarthritis treated by synovectomy and arthrodiastasis, compared to a control group of 10 patients treated by isolated synovectomy. Results were calculated using the AOFAS scale and the VAS for pain before and after treatment. RESULTS: As regards the pain measured by VAS, no difference was observed between the two groups before surgery (P=.99), but there was a difference at 3 months (P<.001), 6 months (P=.005), and 12 months (P=.006). No differences were observed in the AOFAS scale between the two groups before surgery (P=.99), or at 3 months (P<.99), but there was a difference at 6 months (P<.001). CONCLUSIONS: Ankle arthrodiastasis is effective in reducing pain in post-traumatic ankle arthropathy, and is superior to isolated synovectomy.


Subject(s)
Ankle Joint/surgery , Osteoarthritis/surgery , Adult , Ankle Injuries/complications , Female , Humans , Male , Middle Aged , Orthopedic Procedures/methods , Osteoarthritis/etiology , Prospective Studies , Treatment Outcome , Young Adult
13.
Acta Ortop Mex ; 27(2): 71-7, 2013.
Article in Spanish | MEDLINE | ID: mdl-24701756

ABSTRACT

High-energy tibial pylon fractures represent some of the most severe injuries of the ankle joint and currently represent a challenge for the orthopedic surgeon. These are usually polytraumatized patients and before admitting them into the traumatology unit, spinal cord, pelvic or thoracoabdominal injuries should be ruled out. Due to the special anatomy of the area, its thin skin cover and subcutaneous location, soft tissues are usually severely affected and this is key when choosing the time for a surgical intervention. Although the definitive treatment of these injuries is controversial, the so called two-stage treatment seems to predominate in order to minimize soft tissue iatrogenic injuries applying the concept of orthopedic damage control of the limb. We present the preliminary results of 10 patients operated with this method at our center.


Subject(s)
Ankle Injuries/therapy , Fracture Fixation/methods , Fractures, Closed/therapy , Tibial Fractures/therapy , Time Factors , Ankle Injuries/etiology , Ankle Injuries/surgery , Bone Screws , External Fixators , Fibula/injuries , Fracture Fixation, Internal , Fractures, Bone/surgery , Fractures, Closed/classification , Fractures, Closed/etiology , Fractures, Closed/surgery , Humans , Immobilization , Internal Fixators , Multiple Trauma , Retrospective Studies , Soft Tissue Injuries/etiology , Soft Tissue Injuries/surgery , Soft Tissue Injuries/therapy , Tibial Fractures/classification , Tibial Fractures/etiology , Tibial Fractures/surgery , Wound Healing
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