ABSTRACT
Fifty shoulders in 46 patients underwent stabilization surgery for multidirectional instability. Univariate analysis showed no significant differences (P>0.05) for age, gender, or workers' compensation in patient satisfaction or American Shoulder and Elbow Surgeons (ASES) score. Only the ASES score was lower with prior surgery (P=0.001). There was a significantly increased ASES score (P<0.05) for arthroscopic versus open treatment. Subjective variable analysis showed that satisfaction and ASES score were significantly associated with questions regarding pain, instability, and upper extremity use (P<0.01). Increased range of motion showed a trend toward higher ASES scores (P<0.074). Patient satisfaction (P=0.013) was associated with greater forward elevation and greater external rotation (P=0.056). Multivariate analysis (P<0.05) showed that independent determinants of patient satisfaction with outcome included change in instability symptoms and ASES score. Subjective variables of symptoms and motion had the greatest correlation with patient satisfaction and ASES score following surgery for multidirectional shoulder instability. To improve patient satisfaction, an expanded focus on these subjective points may be beneficial.
Subject(s)
Joint Instability/epidemiology , Joint Instability/surgery , Outcome Assessment, Health Care/methods , Patient Satisfaction/statistics & numerical data , Shoulder Joint/surgery , Adolescent , Adult , Age Distribution , Colorado/epidemiology , Employment , Female , Humans , Male , Middle Aged , Sex Distribution , Treatment Outcome , Young AdultABSTRACT
Patients admitted to the authors' institution with tibial osteomyelitis between 1978 and 1998 were reviewed. The purpose of this study was to determine the incidence, etiology, treatment, and outcome in chronic pediatric tibial osteomyelitis. The authors describe their treatment of chronic osteomyelitis in children resistant to previous therapeutic modalities. Thirty patients were identified with a mean age of 8.5 years at diagnosis. Mean age at admission was 9.6 years, indicating more than a 1-year duration of disease. Follow-up averaged 2.3 years. Patients underwent 97 procedures, averaging 3.2 procedures per patient. Hospital stay ranged from 2 weeks to 18 months, with an average stay of 4.7 months. Seventy-seven percent of patients were culture-positive, and 78% of positive cultures identified Staphylococcus aureus as the causative pathogen. Eighty percent of patients had a good outcome, 13% had a fair outcome, and there were no poor results. Patients with large tibial defects obtained good results with both tibiofibular synostosis and Ilizarov distraction osteogenesis. The authors describe the only reported group of pediatric patients successfully treated using Ilizarov bone transport for bony tibial defects due to osteomyelitis.
Subject(s)
Ilizarov Technique , Osteomyelitis/therapy , Bone Transplantation , Child , Child, Preschool , Chronic Disease , Female , Humans , Male , Osteomyelitis/microbiology , Retrospective Studies , Tibia , Treatment OutcomeABSTRACT
A retrospective review of 10 patients admitted to 4 regional hospitals between 1987 and 1997 in whom acute septic hip arthritis was diagnosed was performed to compare presentation, laboratory and radiographic findings, treatment, and outcome. Patients presented with fever, hip or groin pain, and an inability to bear weight. Most patients manifested a leukocytosis, and all patients had an elevated erythrocyte sedimentation rate. Hematogenous septic hip arthritis is rare. The consequences of a missed diagnosis are serious and include death. Clinical examination combined with appropriate laboratory and radiographic studies leads to prompt diagnosis and treatment.
