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1.
Acute Med Surg ; 9(1): e751, 2022.
Article in English | MEDLINE | ID: mdl-35462684

ABSTRACT

Aim: Emergency physicians (EPs) often treat anterior shoulder dislocation, but epidemiology of anterior shoulder dislocation in the emergency department of Japan remains unclear. In this study, we clarified the success rate of anterior shoulder reduction performed by EPs. Methods: This single-center cohort study included patients with anterior shoulder dislocation for whom the EP performed initial reduction. The period was from January 2006 to March 2021 and we used the electronic medical record data of the tertiary care hospital. Our primary outcome was the success rate of the shoulder reduction performed by EP. The secondary outcome was to compare the success of reduction with the failure of the reduction. Results: In total, 293 eligible patients were identified. Of these patients, 244 were included in this study. The success rate of the shoulder reduction performed by EP was 92.2% (225/244). EPs failed in successfully performing reduction in 19 (7.8%) cases of anterior shoulder dislocations. The failure group was older (P = 0.017), had a higher frequency of fall down in the mechanism of dislocation (P = 0.019), used intravenous analgesics more frequently (P = 0.004), used peripheral nerve blocks more frequently (P = 0.006), and had fewer patients who did not use drugs (P = 0.002). We could not perform statical adjustment because the sample size was small. Conclusion: The success rate of the shoulder reduction performed by EPs was 92.2%. Older age might be associated with failure of shoulder reduction.

2.
Pediatr Surg Int ; 34(11): 1225-1231, 2018 Nov.
Article in English | MEDLINE | ID: mdl-30151752

ABSTRACT

OBJECTIVE: To investigate the safety and effectiveness of ultrasound-guided saline enema to treat intussusception and to analyze the risk factors affecting short-term recurrence and reduction failure. MATERIALS AND METHODS: We selected patients who had undergone intussusception reduction via ultrasound-guided saline enema from January 2010 to December 2017. The overall success rate, overall pathologic intussusception rate, and pathologic intussusception rate were calculated in each group. All the patients were divided into two groups: the successfully reduced group and the failed reduction group. Then, the successfully reduced patients were divided into two groups: the short-term recurrence group and the short-term non-recurrence group. The differences between each of the two sets of groups were analyzed, and the risk factors affecting short-term recurrence and failure of intussusception were analyzed. RESULTS: During the 8-year study period, a total of 1793 patients with intussusception were treated with ultrasound-guided saline enema reduction in our hospital. Among these patients, 1743 (97.2%) experienced successful reduction, 29 (1.6%) had pathologic intussusception, and 1 experienced perforation. After applying the univariate analysis and logistic regressive multivariate analysis, we found that age above 2 years and the absence of fever were risk factors for the early recurrence of intussusception. Pathologic intussusception was a risk factor for reduction failure. CONCLUSION: The overall success rate of ultrasound-guided saline enemas was 97.2%, and the pathologic intussusception rate was 1.6%. Age above 2 years and the absence of fever were risk factors for short-term recurrence, and pathologic intussusception was a risk factor for the failure of reduction.


Subject(s)
Enema , Intussusception/therapy , Age Factors , Child, Preschool , Female , Humans , Infant , Male , Multivariate Analysis , Recurrence , Retrospective Studies , Risk Factors , Saline Solution , Ultrasonography, Interventional
3.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-129448

ABSTRACT

PURPOSE: A rapid and accurate reduction is important for hip dislocated patients to avoid various potential complications, including avascular necrosis of the femoral head. We analyzed hip dislocation cases, ones that particularly failed during the primary reduction trial. MATERIALS AND METHODS: Eighty-seven patients with hip dislocation, who visited the emergency department between January 2007 and September 2015, were retrospectively analyzed. Of them, 68 patients were successfully treated in the first closed reduction trial, and the remaining 19 patients were unsuccessful. Of the 19 unsuccessful first trial, 12 patients were successfully treated in the second closed reduction; however, in the remaining 7 patients, open reduction was performed in the operation room with general anesthesia. Every closed reduction was practiced by at least 2 orthopedic doctors, and open reduction was performed by a single senior author. RESULTS: The rate of first reduction failure was higher, with statistical significance, in patients aged under 50 years, male gender, and those with combined around hip fractures, including femoral head and acetabular fracture (p0.05). CONCLUSION: To evaluate the patients with hip dislocation, realizing the type of dislocation, presence of accompanied fracture, location and size of fracture fragment, age, as well as gender of patients is important. If the fracture fragment is impacted in the hip joint and the size of the fragment is large, then the operative treatment is considered, rather than the repetitive trial of closed reduction by constraint.


Subject(s)
Humans , Male , Acetabulum , Anesthesia, General , Classification , Joint Dislocations , Emergency Service, Hospital , Head , Hip Dislocation , Hip Fractures , Hip Joint , Hip , Methods , Necrosis , Orthopedics , Retrospective Studies
4.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-129433

ABSTRACT

PURPOSE: A rapid and accurate reduction is important for hip dislocated patients to avoid various potential complications, including avascular necrosis of the femoral head. We analyzed hip dislocation cases, ones that particularly failed during the primary reduction trial. MATERIALS AND METHODS: Eighty-seven patients with hip dislocation, who visited the emergency department between January 2007 and September 2015, were retrospectively analyzed. Of them, 68 patients were successfully treated in the first closed reduction trial, and the remaining 19 patients were unsuccessful. Of the 19 unsuccessful first trial, 12 patients were successfully treated in the second closed reduction; however, in the remaining 7 patients, open reduction was performed in the operation room with general anesthesia. Every closed reduction was practiced by at least 2 orthopedic doctors, and open reduction was performed by a single senior author. RESULTS: The rate of first reduction failure was higher, with statistical significance, in patients aged under 50 years, male gender, and those with combined around hip fractures, including femoral head and acetabular fracture (p0.05). CONCLUSION: To evaluate the patients with hip dislocation, realizing the type of dislocation, presence of accompanied fracture, location and size of fracture fragment, age, as well as gender of patients is important. If the fracture fragment is impacted in the hip joint and the size of the fragment is large, then the operative treatment is considered, rather than the repetitive trial of closed reduction by constraint.


Subject(s)
Humans , Male , Acetabulum , Anesthesia, General , Classification , Joint Dislocations , Emergency Service, Hospital , Head , Hip Dislocation , Hip Fractures , Hip Joint , Hip , Methods , Necrosis , Orthopedics , Retrospective Studies
5.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-106820

ABSTRACT

PURPOSE: Intussusceptions are one of the most common causes of intestinal obstruction in infants and young children. Although it is easily treated by non-operative reduction using barium, water or air, this treatment is very stressful for young patients and may cause bowel perforation, peritonitis and shock. In this study, we identified the risk factors associated with the failure of non-operative reduction, to identify a group of children that would benefit from the procedure and those who would not. METHODS: We reviewed the medical records of patients with intussusception who were treated at the Korea University Medical Center Ansan hospital from March 1998 to July 2006. Three hundred fourteen children with intussusception were identified. Among them, non-operative reductions were performed in three hundred. Clinical and radiological variables were compared according to the failure or success of the non-operative reduction. RESULTS: Non-operative reductions were successful in 243 (81%) and failed in 57 (19%). The group that had failed procedures had a younger age (12.3+/-17.2 months vs. 18.0+/-15.8 months, p=0.03), longer symptom duration before reduction (33.6+/-29.0 hr vs. 21.5+/-20.3 hr, p<0.01), more vomiting and lethargy (p<0.01), but less abdominal pain and irritability (p<0.01), compared with the group that had a successful procedure. Logistic regression analysis showed that the factors associated with the failure of non-operative reductions were a younger age, less than 6 months of age (odds ratio: 2.5, 95% confidence interval: 1.2~5.2, p=0.01), duration of symptoms, longer than 24 hrs before reduction (odds ratio: 2.1, 95% confidence interval: 1.2~4.2, p=0.03), bloody stool (odds ratio: 4.8, 95% confidence interval: 1.9~12.2, p<0.01), lethargy (odds ratio: 3.4, 95% confidence interval: 1.1~10.4, p=0.04), and abdominal pain or irritability (odds ratio: 0.2, 95% confidence interval: 0.1~0.4, p<0.01). CONCLUSION: For children with intussusception, an age younger than 6 months, and duration of symptoms more than 24 hrs before reduction, as well as the presence of bloody stools, lethargy and abdominal pain or irritability were variables associated with failure of a non-operative reduction. Knowledge of these variables should be considered in making clinical decisions for therapeutic interventions.


Subject(s)
Child , Humans , Infant , Abdominal Pain , Academic Medical Centers , Barium , Intestinal Obstruction , Intussusception , Korea , Lethargy , Logistic Models , Medical Records , Peritonitis , Risk Factors , Shock , Vomiting
6.
Article in Korean | WPRIM (Western Pacific) | ID: wpr-175807

ABSTRACT

PURPOSE: Intussusception is one of the most common cause of childhood intestinal obstructions. Early diagnosis is essential to avoid treatment delays, which can increase morbidity and mortality. METHODS: In order to evaluate the factors contributing to air-reduction failure, we reviewed cases of childhood intussusception admitted via the ER and managed by air enema reduction from 1994 to 1998. They were divided into two groups and compared retrospectively by using medical records. Group I was the operation group after air-reduction failure, and group II was the air-reduction group. RESULTS: In 319 cases (279 patients), group I consisted of 112 cases (110 patients), and group II consisted of 207 cases (169 patients). No differences in age, sex, body weight, location of intussusception, laboratory findings (leukocytosis and thrombocytosis), presence of bloody stool, and body temperature were noted between the two groups. Factors significantly contributing to air-reduction failure were duration of symptoms, type of intussusception and a few physical findings (abdominal distension, palpable mass, lethargy, and vomiting). The recurrence rate of group I was significantly lower than that of group II, and most recurrences developed in the first postoperative month. CONCLUSION: Childhood intussusceptions of a non-ileocolic type with longer durations of symptoms and severe clinical findings have a higher chance of air-reduction failure.


Subject(s)
Body Temperature , Body Weight , Early Diagnosis , Enema , Intestinal Obstruction , Intussusception , Lethargy , Medical Records , Mortality , Recurrence , Retrospective Studies
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