RESUMEN
INTRODUCTION: Cartilage defects of the knee remain a challenging problem in orthopedic surgery despite the ongoing improvements in regenerative procedures such as the autologous chondrocyte transplantation. Due to the lack of donor-site morbidity and the single-stage procedure cell-free scaffolds are an interesting alternative to cell-based procedures. But as currently mid- and long-term data are lacking, the aim of the present study was to present mid-term clinical, radiological and histological results of a cell-free collagen type I scaffolds for cartilage repair. MATERIALS AND METHODS: Twenty-eight patients were followed prospectively. Clinical evaluation using patient-reported outcome measures (KOOS, IKDC; VAS for pain, Tegner score for activity) as well as radiologic evaluation of the repair tissue (MOCART) was performed at 1 year, 2 years and 5 years. Histologic evaluation of the repair tissue was done in case of revision surgery using the ICRS II score for human cartilage repair. RESULTS: In these large cartilage defects with a mean defect size of 3.7 ± 1.9 cm2, clinical failure necessitating revision surgery was seen in 5 of 28 patients (18%). While the remaining patients showed good-to-excellent clinical results (KOOS, IKDC, VAS, Tegner), the radiologic appearance of the repair tissue showed a reduction of the MOCART score between the 2- and 5-year follow-up. Histologic evaluation of the repair tissue showed a cartilage-like appearance with no signs of inflammation or cell death but an overall medium tissue quality according to the ICRS II Score. CONCLUSION: The use of this cell-free collagen type I scaffold for large defects showed increased wear of the repair tissue and clinical failure in 18% of cases at 5-year follow-up.
Asunto(s)
Cartílago Articular , Colágeno Tipo I , Traumatismos de la Rodilla/cirugía , Prótesis de la Rodilla/efectos adversos , Falla de Prótesis , Cartílago Articular/lesiones , Cartílago Articular/cirugía , Sistema Libre de Células , Colágeno Tipo I/efectos adversos , Colágeno Tipo I/uso terapéutico , Humanos , Estudios ProspectivosRESUMEN
INTRODUCTION: MPFL reconstruction is widely and successfully used for treating patella instability, either as a standalone procedure or in combination. Although different techniques allow for MPFL reconstruction, the use of a free tendon graft is one of the most commonly used. The phenomenon of tunnel widening or tunnel enlargement is well described in ACL reconstruction, but so far only little effort has been put into evaluating this phenomenon after MPFL reconstruction. MATERIALS AND METHODS: Patients who received an MPFL reconstruction with a free gracilis tendon graft were identified by review of patient files. Additional clinical examination and magnetic resonance imaging were performed to assess tunnel enlargement and clinical outcome. RESULTS: Fifty-one knees of 49 patients (34 female, 17 male) with a mean follow-up of 3.0 ± 1.4 years were included in this study. Mean age at the time of surgery was 22.6 ± 8.5 years. Mean Tegner score decreased from preoperative 5.3 ± 2.0 to 4.0 ± 1.4 postoperative. Postoperative IKDC and Kujala scores were 74 ± 16 and 80 ± 15, respectively. Twenty-three patients showed a tunnel enlargement at follow-up examination. Of these 23 patients, 20 showed a tunnel that was positioned too proximal, whereas only 13 of the 28 patients showing no enlargement had a tunnel that was positioned too proximal (p = 0.0033). Interestingly, patients showing a tunnel enlargement at follow-up examination also showed significantly better Kujala (84 ± 12 vs. 75 ± 16; p = 0.03) and IKDC scores (80 ± 7 vs. 70 ± 19; p = 0.02) when compared to the non-enlarged group. CONCLUSION: Tunnel enlargement after MPFL reconstruction with a free gracilis tendon graft seems to be connected to mechanical overload due to a proximal malposition of the femoral tunnel. Interestingly, this did not influence clinical outcome as patients with tunnel enlargement showed better Kujala and IKDC scores.
Asunto(s)
Fémur/cirugía , Inestabilidad de la Articulación/cirugía , Ligamentos Articulares/cirugía , Procedimientos Ortopédicos/efectos adversos , Procedimientos Ortopédicos/métodos , Articulación Patelofemoral/cirugía , Tendones/trasplante , Adolescente , Adulto , Femenino , Fémur/diagnóstico por imagen , Humanos , Inestabilidad de la Articulación/diagnóstico por imagen , Ligamentos Articulares/diagnóstico por imagen , Masculino , Articulación Patelofemoral/diagnóstico por imagen , Complicaciones Posoperatorias , Adulto JovenRESUMEN
Posterior cruciate ligament (PCL) injuries are still often overlooked and treatment of a ruptured PCL is inherently different in comparison to anterior cruciate ligaments (ACL). Conservative treatment is the first-line therapy for acute isolated PCL injuries leading to good clinical and biomechanical results. Injuries to the PCL combined with rupture of other stabilizing ligaments, such as the collateral ligaments or the posterolateral corner of the knee joint are treated surgically. The same is true for high grade chronic PCL insufficiency. Meticulous classification of PCL injuries taking all stabilizing factors of the knee joint as well as the time from injury into account are essential for successful treatment of PCL injuries.
Asunto(s)
Artroplastia/métodos , Terapia por Ejercicio/métodos , Inmovilización/métodos , Traumatismos de la Rodilla/diagnóstico , Traumatismos de la Rodilla/terapia , Ligamento Cruzado Posterior/lesiones , Terapia Combinada/métodos , Medicina Basada en la Evidencia , Humanos , Ligamento Cruzado Posterior/diagnóstico por imagen , Ligamento Cruzado Posterior/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: The intraoperative application of focused transthoracic echocardiography (TTE) is often considered to be restricted. Echocardiography with pocket-sized hand held ultrasound systems has been shown to be feasible in various settings. OBJECTIVE: The aim of this study was to investigate the feasibility of the intraoperative application of pocket-sized echocardiography and the comparison of its imaging quality and diagnostic reliability and variability with a standard ultrasound system. METHODS: After written informed consent, TTE was performed on 40 anaesthetised general, vascular, visceral, thoracic surgical and orthopaedic patients according to the FATE protocol: first, with a pocket-sized and second, with a high-end ultrasound system randomly by two anaesthetists. Imaging quality of four basic and three additional FATE views was rated on an established scale from 1 (impossible) to 5 (perfect). Successful TTE was defined, if one basic FATE views would be rated as grade 4 or 5 or alternatively two views as grade 3. Pathologic findings by both ultrasound devices were documented and imaging quality and pathologic findings were compared. RESULTS: All 40 patients presented acceptable imaging quality, resulting in a success rate of 1.0 (97.5%-CI 0.91-1, p= 0.015). The individual imaging ratings of each view were significantly lower with the pocket-sized system, but still showed acceptable imaging quality. With the high-end device more pathologic findings were detected (107 vs. 87), but none of the relevant or severe pathologies were overseen with the hand-held device. CONCLUSION: The application of a pocket-sized echocardiography device for focused intraoperative TTE is feasible and can appropriate be used for the initial evaluation of relevant pathologies in the operating theatre.
Asunto(s)
Anestesiólogos , Ecocardiografía/instrumentación , Sistemas de Atención de Punto , Anciano , Anciano de 80 o más Años , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Reconstruction of the medial patellofemoral ligament (MPFL) using free tendon grafts has become a widespread treatment option for patellofemoral instability. As the numbers of cases gradually grow, so do the reports of possible peri- and postoperative complications following this procedure. OBJECTIVE: The present review summarizes all known complications of MPFL reconstruction with regard to postoperative outcome and seeks to highlight possible pitfalls that may occur during treatment. CONCLUSIONS: MPFL reconstruction generally has to be regarded as a safe procedure today due to low patellar re-dislocation rates. Complication rates however are not trivial owing to the complexity of the underlying pathology. Complications can arise from graft fixation or femoral tunnel placement. Postoperative flexion deficits and medial knee pain have been described as predominant complaints. Anatomical preconditions as the grade of trochlear dysplasia, axis or torsion of the lower extremity have to be considered in search of causes for possible graft failure as well as in the thorough preoperative planning of the procedure.
Asunto(s)
Ligamentos Articulares/cirugía , Articulación Patelofemoral/cirugía , Procedimientos de Cirugía Plástica/efectos adversos , Procedimientos de Cirugía Plástica/métodos , Tendones/trasplante , Humanos , Dolor/epidemiología , Complicaciones Posoperatorias/epidemiología , Rango del Movimiento ArticularRESUMEN
INTRODUCTION: Muscular recovery of structural integrity after arthroscopic Bankart repair using the para- and trans-musculotendinous three-portal technique has not been investigated. MATERIALS AND METHODS: Twenty-seven athletes [mean age 26.9 years, (group 1; G1)] were prospectively and longitudinally monitored after arthroscopic Bankart repair using the three-portal technique by magnetic resonance imaging (MRI) and specific clinical muscular testing. The muscular integrity was assessed at the subscapularis (SSC) for the para-tendinous anteroinferior portal, the supraspinatus (SSP) for the trans-tendinous suprabicipital portal, and the infraspinatus (ISP) for the trans-tendinous posterior portal. Muscular atrophy was assessed by standardized ratios of transverse and vertical diameters for the SSC and ISP, as defined by cross-sectional area ratios for the SSP. Fatty infiltration was assessed by signal intensity analysis for the upper and lower SSC, SSP, and upper ISP as a ratio with the lower ISP. These parameters were analyzed for pre-operative (T0), 1-year (T1), and 2-year status (T2), and compared to 27 healthy volunteers [mean age 29.4 years, (group 2, G2)]. RESULTS: The structural integrity assessments were performed after 14.8 (T1) and 32.0 months (T2). The SSC analysis revealed no muscular impairments in the upper and lower portions between T0 and T2 or compared to G2. MRI analysis for SSP and ISP showed full muscular recovery without any changes between T0 and T2 or deficits compared to G2. The number of pre-operative dislocations had no influence on the muscular integrity. MR analysis detected signs of overuse syndrome in 15 % at T0, 41 % at T1, and 63 % at T2; 77, 22, and 26 % of patients at T0, T1, and T2, respectively, were symptomatic. CONCLUSIONS: Arthroscopic Bankart repair using the three-portal technique prevents full muscular integrity for para-tendinous anteroinferior portals at the SSC, the trans-tendinous suprabicipital portal through the SSP, and the trans-tendinous portal through the ISP.
Asunto(s)
Artroscopía/métodos , Traumatismos en Atletas/cirugía , Manguito de los Rotadores/cirugía , Luxación del Hombro/cirugía , Adolescente , Adulto , Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/patología , Traumatismos en Atletas/rehabilitación , Femenino , Humanos , Estudios Longitudinales , Imagen por Resonancia Magnética , Masculino , Atrofia Muscular/diagnóstico , Estudios Prospectivos , Manguito de los Rotadores/patología , Lesiones del Manguito de los Rotadores , Luxación del Hombro/diagnóstico , Luxación del Hombro/patología , Luxación del Hombro/rehabilitación , Adulto JovenRESUMEN
PURPOSE: The restoration of joint congruency and labrum slope and height after arthroscopic revision Bankart repair (RB) compared to the primary arthroscopic Bankart repair (PB) remain unclear. METHODS: Twenty-three consecutive patients after RB with minor glenoid deficits were matched to 23 patients after PB and retrospectively followed by a score system and native 1.5 T magnetic resonance imaging (MRI) assessment. Bankart repair surgeries were performed using double-loaded knotless suture anchors. The glenoidal (GAA) and labral articulation arc (LAA), labrum slope, height index and morphology were assessed separately for the anterior and inferior glenoid and compared to 23 healthy volunteers [radiologic control group (RC)]. RESULTS: Arthroscopic revision Bankart repair showed 28.0 months post-operative equivalent anterior labral congruency (LAA, 9.3°/PB 9.9°/RC 10.1°) and inferior (LAA 9.9°/PB 9.6°/RC 10.5°). The anterior GAA remain decreased (54.6°/PB 55.7°/RC 58.0°) with an original inferior GAA (85.1°/PB 83.2°/RC 83.8°). The RB labrum was slightly decreased anteriorly (slope 22.9°/PB 23.9°/RC 24.6°; height index 2.4/PB 3.0/RC 3.2). The inferior portion had an equivalent labrum slope (23.8°/PB 24.7°/RC 25.1°), but a decreased height index (2.1/PB 2.2/RC 2.3). Morphologic labrum analysis revealed significant changes between all three groups. The clinical outcome after revision surgery was good-to-excellent, but inferior to the primary stabilization and without influence of joint congruency and labrum morphology to the clinical outcome. CONCLUSION: A properly applied arthroscopic revision of a Bankart repair generates sufficient restoration of the anteroinferior labral joint congruency and good clinical results. STUDY DESIGN: Case series.
Asunto(s)
Artroscopía/métodos , Inestabilidad de la Articulación/cirugía , Luxación del Hombro/cirugía , Articulación del Hombro/cirugía , Adulto , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Análisis por Apareamiento , Reoperación , Estudios Retrospectivos , Escápula , Anclas para SuturaRESUMEN
BACKGROUND: The aim of this study was to compare the results of the single (STR) versus double TightRope™ (DTR) technique for stabilisation of acute separations of the AC joint with the hypothesis that DTR achieves lower CC distance. PATIENTS AND METHODS: A total of 29 consecutive patients treated operatively with the TR technique (mean age 38.1 years, n=26 male) were analysed in a cohort study with a mean follow-up of 13.3 months (12.0-21.7). Acute AC joint separations types III and V according to Rockwood (R) were included; R types I, II, IV and VI were excluded. The prospective scores determined pre-op and 3, 6 and 12 months post-op and X-rays were evaluated. RESULTS: Of the patients 12 suffered an R type III and 17 an R V separation; 14 were treated with STR and 15 with DTR. With STR, 8 R III and 6 R V injuries and with DTR 4 R III and 11 R V injuries were treated arthroscopically. STR achieved an increased CC distance >125% compared to the contralateral AC joint in five cases (36%). Two of them occurred as R V and three as R III injury. DTR achieved a CC distance >125% in two cases of an R V injury (13%). CONCLUSION: The DTR technique provides lower CC distance compared to the STR technique, without a significant difference of CC distance and scores.
Asunto(s)
Articulación Acromioclavicular/lesiones , Articulación Acromioclavicular/cirugía , Artroscopía/instrumentación , Luxaciones Articulares/diagnóstico , Luxaciones Articulares/cirugía , Procedimientos de Cirugía Plástica/instrumentación , Técnicas de Sutura/instrumentación , Enfermedad Aguda , Adolescente , Adulto , Artroscopía/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Rango del Movimiento Articular , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: The aim of this study is the presentation of the polyaxial locking NCB-plate in the treatment of femoral fractures, especially in elderly patients and in proximity of a prosthetic implant. The reduction and fixation of these fractures is a challenging surgical procedure with high complication rates reported up to 40%. PATIENTS AND METHODS: A total of 72 patients with femoral fractures had polyaxial locking plate osteosynthesis. Indications included fractures of the shaft and around an implant. Concerning surgical procedures, three different standardized techniques were performed: (1) minimally invasive with percutaneous distal insertion using a targeting device; (2) mini-open with additional cerclage wire via the same approach and (3) a conventional open reduction and internal fixation. Data collection included intraoperative data and early complications at 6, 24 and 52 weeks. Fifty-two patients had an implant or prosthesis in situ. Thirty-three patients were treated by technique (1), 32 patients had mini-open surgery and seven patients conventional open surgery. RESULTS: Thirty-nine patients attended clinical follow-up after 52 weeks. Twenty-two patients were interviewed by telephone, two were untraceable and nine patients had died. Bony consolidation without secondary loss of reduction was confirmed after 52 weeks in all patients but two. Plate breakage occurred in these two at 25 and 31 weeks after surgery due to non-union. Implant related complications (17% in total) lead to surgical revision in five other cases: two deep wound infections as well as three minor revisions. When itemizing complications according to surgical technique used, most major complications occurred following open surgery. CONCLUSION: The availability of polyaxial locking implants widened the range of indications for plate fixation in femoral fractures. The advantages of the polyaxial locking implant combined with minimally invasive surgical technique contribute to successful management of this population category. Early revision rate is noticeably lower compared to similar procedures. LEVEL OF EVIDENCE: IV retrospective series.
Asunto(s)
Placas Óseas , Hilos Ortopédicos , Fracturas del Fémur/cirugía , Fijación de Fractura/instrumentación , Fracturas Periprotésicas/cirugía , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Fracturas del Fémur/diagnóstico por imagen , Humanos , Prótesis Articulares , Masculino , Persona de Mediana Edad , Fracturas Periprotésicas/diagnóstico por imagen , Radiografía , Reoperación , Resultado del TratamientoRESUMEN
BACKGROUND: Periprosthetic femur fractures in elderly patients are a challenging surgical procedure. The aim of this study was a prospective evaluation of minimally invasive implantation of non-contact bridging (NCB-DF®) plates. PATIENTS AND METHODS: A total of 30 osteosynthesis procedures in 29 patients (average age 76 years and mean ASA 2.9) with complex femur fractures were registered, 19 fractures were periprosthetic and osteoporosis was present in 17 bones. In 25 patients a minimally invasive percutaneous procedure was performed using a standardized technique. An x-ray examination and clinical follow-up were performed after 6, 12 and 24 weeks. RESULTS: The early complications (14% in total) included 1 plate breakage after 16 weeks as well as 3 minor revisions for screw length correction. The x-ray follow-up after 24 weeks showed a secondary extension deficit of 10° and 15° in the knee joint in 2 patients, respectively. CONCLUSION: The NCB-DF® implantation using a standardized minimally invasive technique in periprosthetic femur fractures is a safe alternative in elderly patients. In this very sensitive population the early revision rate within the first 24 weeks is noticeable lower compared to similar procedures.
Asunto(s)
Placas Óseas , Fracturas del Fémur/cirugía , Prótesis de Cadera , Prótesis de la Rodilla , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Fracturas Osteoporóticas/cirugía , Fracturas Periprotésicas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Tornillos Óseos , Evaluación de la Discapacidad , Diseño de Equipo , Femenino , Fracturas del Fémur/diagnóstico por imagen , Estudios de Seguimiento , Alemania , Escala de Consecuencias de Glasgow , Humanos , Masculino , Persona de Mediana Edad , Fracturas Osteoporóticas/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Estudios Prospectivos , Radiografía , ReoperaciónRESUMEN
PURPOSE: Conventionally, radiography studies revealed prolonged glenoidal drill hole visibilities with an unclear influence to the clinical outcome after arthroscopic Bankart repair using Poly-Laevo-Lactic-Acid (PLLA) anchors. The primary aim of the present study was the separated assessment of drill hole consolidation (DHC) and the concomitant osseous reaction (OR) of the glenoidal bio-degradation process in new specific magnetic resonance grading systems. In accordance with the specific DHC and the OR graduation, the clinical relevance was the secondary focus. METHODS: Twenty-eight patients with arthroscopic Bankart repair using knotless PLLA anchors were prospectively followed and analyzed using a clinical scoring system (3, 6, 15 and 32 months). The T2-weighted OR and T1-weighted DHC were assessed using specific magnetic resonance imaging grading protocols (15 and 32 months). RESULTS: Longitudinal assessments revealed successive clinical status improvements over time (32 months: Rowe 95.7 ± 3.8; Walch-Duplay 93.8 ± 6.6; Constant 93.9 ± 4.5; ASES 93.8 ± 6.9; DASH 28.6 ± 7.2; NAS(pain) 1.1 ± 1.3; NAS(function) 1.3 ± 1.4). The initial OR level regressed over the 15-32 month period while the DHC showed significant drill hole reductions (P < 0.05). The inferior glenoid revealed a significantly increased bio-degradation capacity (P < 0.05) with drill hole enlargements in 14.3%. Neither the OR nor the drill hole enlargements influenced the clinical status. In no case were clinical or radiologic signs for a foreign body reaction. CONCLUSION: Knotless bio-anchors provide secure glenoidal fixation for Bankart repair without any specific clinical or MR evidence of an inflammatory response. The clinical status remained unaffected by the bio-degradation process. LEVEL OF EVIDENCE: IV.
Asunto(s)
Implantes Absorbibles , Artroscopía/instrumentación , Oseointegración , Osteítis/patología , Articulación del Hombro/cirugía , Anclas para Sutura/efectos adversos , Artroscopía/métodos , Humanos , Ácido Láctico/análogos & derivados , Imagen por Resonancia Magnética , Osteítis/clasificación , Dimensión del Dolor , Polímeros , Estudios Prospectivos , Lesiones del Hombro , Articulación del Hombro/patologíaRESUMEN
PURPOSE: Adequate labral restorations after Bankart repair have been demonstrated in cadaver models for knot-tying and knotless anchors and in vivo by magnetic resonance imaging for knot tying. The influence of glenoidal bio-degradation on clinical outcome, and conclusions regarding drill hole enlargement and foreign body reactions remain controversial. METHODS: The labrum was analyzed in magnetic resonance images for 37 consecutive patients with Bankart repair using knotless PLLA anchors and for 31 volunteers as radiologic controls. The labrum was assessed regarding slope, height index (quotient between labral height to the glenoid height), and labrum morphology in axial and coronal T2 images. Glenoidal bio-degradation was graded in terms of the drill hole configuration in T1 images and the corresponding osseous reaction in T2 images. Constant-Murley, Walch-Duplay, and Rowe scoring were carried out preoperatively and at follow-up. RESULTS: At 15 months after arthroscopy, the anterior slope (24.8°), height index (3.0), inferior slope (25.4°), and height index (2.5) were not significantly different from control values. Morphologic analysis revealed significant changes in the Bankart group (P < 0.05) that were influenced by the number of preoperative dislocations. Bio-degradation proceeded slowly with no evidence of drill hole enlargement. Osseous reactions were significantly greater in inferior compared to superior implants. The clinical scores were excellent and were not influenced by bio-degradation. CONCLUSIONS: Knotless anchors facilitate labral restoration that is comparable to the knot-tying approach. Bio-degradation proceeds slowly without clinical or radiologic evidence of foreign body reactions. LEVEL OF EVIDENCE: III.
Asunto(s)
Artroplastia/métodos , Inestabilidad de la Articulación/cirugía , Imagen por Resonancia Magnética , Luxación del Hombro/cirugía , Articulación del Hombro/cirugía , Anclas para Sutura , Técnicas de Sutura/instrumentación , Adulto , Artroplastia/instrumentación , Artroscopía , Femenino , Cavidad Glenoidea , Humanos , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/etiología , Masculino , Estudios Prospectivos , Luxación del Hombro/complicaciones , Lesiones del Hombro , Resultado del TratamientoRESUMEN
BACKGROUND: The aim of the present study is to analyse the increased surgical time required due to supervised surgery as an element of costs of education. MATERIAL AND METHODS: Incision to closure times of 353 primary hip and knee prostheses were evaluated according to educational level. Differences between planned and real operation times were recorded, and the mean DRG proceeds per minute of surgical time were determined. RESULTS: The difference between incision to closure times of the board certified surgeons for the respective surgical interventions and that of the supervised surgery is statistically significant (p<0.01) and clinically relevant (+15 min for THA, +13 min for TKA). The correlation between planned and real operation time was significantly lower in the category of supervised surgery. CONCLUSION: There is an increased surgical time required for surgical training. It is the responsibility of health care policy to ensure an appropriate financial compensation.
Asunto(s)
Artroplastia de Reemplazo de Cadera/educación , Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Artroplastia de Reemplazo de Rodilla/educación , Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Evaluación Educacional , Competencia Profesional/estadística & datos numéricos , Carga de Trabajo/estadística & datos numéricos , Alemania/epidemiología , Humanos , Médicos/estadística & datos numéricos , Factores de Tiempo , Estudios de Tiempo y MovimientoRESUMEN
The causative factors and ocular complications of Stevens-Johnson syndrome and toxic epidermal necrolysis are reported here. Six out of seven patients developed the syndrome secondary to ingestion of sulphadoxine/pyrimethamine while one developed it as a complication of HAART (highly active antiretroviral therapy). The ocular complications were ankyloblepharon, symblepharon, chronic conjunctivitis, corneal vascularization and conjunctivalization, and blindness. One patient died. A shift to the WHO-recommened artemisin-based combination therapy for the treatment of malaria is advised. Early referral to the ophthalmologist will help to reduce the complications.
Asunto(s)
Terapia Antirretroviral Altamente Activa/efectos adversos , Oftalmopatías/etiología , Síndrome de Stevens-Johnson/complicaciones , Síndrome de Stevens-Johnson/etiología , Combinación Trimetoprim y Sulfametoxazol/efectos adversos , Adolescente , Adulto , Antibacterianos/administración & dosificación , Preescolar , Oftalmopatías/tratamiento farmacológico , Femenino , Hospitales Universitarios , Humanos , Masculino , Nigeria , Soluciones Oftálmicas , Síndrome de Stevens-Johnson/terapiaRESUMEN
AIM: The aim of the study was to survey the current state of the conservative and operative treatment of anterior shoulder instability and its rehabilitation in German hospitals. METHODS: A previously evaluated online questionnaire was sent out to all German hospitals with orthopaedic or trauma surgery departments. The Federal Statistical Office's hospital list was the basis for the selection of hospitals. The questions referred to the year 2007. The survey, including 3 reminders, was conducted over 3 months. The questionnaire consisted of 6 response categories: always (100%), almost always (99-81%), predominantly (80-51%), rarely (50-21%), almost never (20-1%) and never (0%). RESULTS: The response rate was 41% and 67% of these had carried out shoulder stabilisations. In total, 99.2% of the 67% were evaluable. The proportion of shoulder surgery was 8.4% of the total number of operations. Shoulder stabilisations represented 10.6% of these operations. A specialised shoulder department existed in 22.9%. Conservative treatment was carried out with an immobilisation of the arm "predominantly", "almost always" and "always" for internal rotation in 70.8% and in 23.4% for external rotation. The shoulders were "predominantly", "almost always" and "always" stabilised in an arthroscopic technique in 68.2% and in an open one in 31.8% of the clinics. With 92.9%, the Bankart repair was the most common operation. Shoulder instability was principally treated with the arthroscopic technique, regardless of the care level and department and is considered the best surgical technique. Physiotherapy was prescribed "always" and "almost always" in 99.3%. The rate of reluxation after conservative treatment was estimated at 35.5%, after operative open anterior shoulder stabilisation at 9.1% and after arthroscopic shoulder stabilization at 10.6%. Nevertheless, 49.4% of respondents expected the best results after arthroscopic treatment. Participants, who mainly applied the arthroscopic technique, expected a lower rate of reluxation in comparison to other techniques (p<0.001). CONCLUSION: The operative shoulder stabilisation is most frequently carried out as arthroscopic Bankart repair. A standardised, subsequent treatment is well established.
Asunto(s)
Artroscopía/estadística & datos numéricos , Inestabilidad de la Articulación/cirugía , Complicaciones Posoperatorias/rehabilitación , Luxación del Hombro/cirugía , Terapia Combinada , Recolección de Datos , Alemania , Tamaño de las Instituciones de Salud , Capacidad de Camas en Hospitales/estadística & datos numéricos , Humanos , Inestabilidad de la Articulación/diagnóstico , Evaluación de Procesos y Resultados en Atención de Salud/estadística & datos numéricos , Reoperación/estadística & datos numéricos , Prevención Secundaria , Luxación del Hombro/diagnóstico , Servicio de Cirugía en Hospital/estadística & datos numéricos , Encuestas y Cuestionarios , Revisión de Utilización de Recursos/estadística & datos numéricosRESUMEN
BACKGROUND: In most cases, loosening of a prosthesis stem is accompanied by periprosthetic osteolysis. This article presents the short-term clinical and radiological results after revision of total hip arthroplasty (THA) with bone substance deficiencies using a modular noncemented femoral stem system (LINK MP). PATIENTS AND METHODS: Between March 2003 and November 2005, 91 LINK MP modular revision stems were implanted in 90 patients. Eighty-one patients (51 stem revisions, 24 revisions of stem and shell, and six reimplantations after a Girdlestone situation) were available for prospective clinical and radiological evaluation at an average follow-up time of 16.7+/-6.5 (6-36) months. The average patient age at revision was 67.2+/-10.5 (31-87) years. RESULTS: Bone defects in the proximal femur were evaluated according to the Paprosky classification and showed type 2 in five cases, type 3A in 73 cases, and type 3B in three cases. The Merle d'Aubigné score increased significantly from 10.4+/-2.3 (4-15) preoperatively to 14.7+/-2.2 (9-18) at the latest follow-up (p<0.001). Migration analysis in conventional radiographs revealed an average stem subsidence of 3.4 mm. Thirty-one intraoperative and postoperative complications were noted in 28 (34.5%) patients. CONCLUSION: After a short-term follow-up, the modular noncemented femoral stem system LINK MP was shown to be a reliable tool for revision of THA with bony defects of the proximal femur. Our results are comparable to those for other modular noncemented revision stems. As expected, complication rates were higher than with primary THA.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Complicaciones Posoperatorias/cirugía , Diseño de Prótesis , Falla de Prótesis , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteólisis/diagnóstico por imagen , Osteólisis/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Estudios Prospectivos , Radiografía , ReoperaciónRESUMEN
INTRODUCTION: The introduction of the German Diagnostic Related Groups (D-DRG) system requires redesigning administrative patient management strategies. Wrong coding leads to inaccurate grouping and endangers the reimbursement of treatment costs. This situation emphasizes the roles of documentation and coding as factors of economical success. PURPOSE: The aims of this study were to assess the quantity and quality of initial documentation and coding (ICD-10 and OPS-301) and find operative strategies to improve efficiency and strategic means to ensure optimal documentation and coding quality. METHODS: In a prospective study, documentation and coding quality were evaluated in a standardized way by weekly assessment. RESULTS: Clinical data from 1385 inpatients were processed for initial correctness and quality of documentation and coding. Principal diagnoses were found to be accurate in 82.7% of cases, inexact in 7.1%, and wrong in 10.1%. Effects on financial returns occurred in 16%. Based on these findings, an optimized, interdisciplinary, and multiprofessional workflow on medical documentation, coding, and data control was developed. CONCLUSIONS: Workflow incorporating regular assessment of documentation and coding quality is required by the DRG system to ensure efficient accounting of hospital services. Interdisciplinary and multiprofessional cooperation is recognized to be an important factor in establishing an efficient workflow in medical documentation and coding.