Simultaneous Total Hip Arthroplasty for Delayed Management of Bilateral Acetabular Fractures due to Alcohol-Withdrawal Seizures.

Bilateral acetabular fractures after seizure activity are rare, as most of these injuries are associated with high-energy trauma. It is hypothesized that rapid forceful contracture of hip musculature during a seizure can lead to the femoral head fracturing the medial wall and driving in proximal and medial directions. Absence of standardized surgical treatment algorithms and literature-reported outcomes makes this fracture pattern challenging to orthopedic surgeons. To the best of our knowledge, no published data describe delayed simultaneous total hip arthroplasty for treating seizure-induced bilateral acetabular fractures with protrusio. We present a patient that sustained bilateral acetabular fractures after an alcohol-withdrawal seizure. The patient underwent delayed simultaneous total hip arthroplasty 3 months later with excellent functional outcomes at the 6-month follow-up.

Factores con valor predictivo de ingreso en cirugía laparoscópica ambulatoria / Predictive Factors of Admission in Outpatient Laparoscopic Surgery

INTRODUCCIÓN: El objetivo del estudio fue evaluar la tasa de ingreso no planificado tras cirugía laparoscópica ambulatoria e identificar factores relacionados con el fracaso de la ambulatorización en este tipo de pacientes. MÉTODOS: Estudio observacional prospectivo de 297 pacientes adultos intervenidos mediante cirugía laparoscópica en régimen ambulatorio en el Hospital Universitari I Politècnic La Fe de Valencia durante 18 meses. Como variable principal se consideró la necesidad de ingreso hospitalario el mismo día de la intervención. Como variables independientes se registraron factores preoperatorios, intraoperatorios y postoperatorios. Mediante regresión múltiple se comprobó la asociación de ingreso postoperatorio con sus factores condicionantes, realizando un ajuste estadístico por las posibles variables de confusión. RESULTADOS: Tras la cirugía laparoscópica el 8,1% de los pacientes precisó ingreso hospitalario. Esta proporción fue significativamente superior en las pacientes intervenidas de cirugía ginecológica, en los que habían presentado complicaciones en cirugías previas, en pacientes con un ASA superior y en fumadores, así como en quienes se prolongó el tiempo de neumoperitoneo por encima de 45 minutos. También lo fue entre los pacientes que presentaron complicaciones anestésicas o quirúrgicas intraoperatorias. Por último, la proporción de pacientes ingresados fue significativamente superior cuando presentaron NVPO. CONCLUSIÓN: La proporción de pacientes que ingresaron tras cirugía laparoscópica ambulatoria fue del 8,1%, correspondiendo al 5,5% de los sometidos a cirugía general y al 12,1% de las sometidas a cirugía ginecológica. Los factores más relacionados con el fracaso ambulatorio fueron la presencia de complicaciones quirúrgicas, el tiempo de neumoperitoneo superior a 100 minutos y la aparición de náuseas postoperatorias

INTRODUCTION: The aim of the study is to analyze the rate of no planificated hospitalization after ambulatory surgical procedures by laparoscopy, and identify associated risk factors to failure in the ambulatory manage of this patients. METHODS: A prospective observational study was performed during 18 months and included 297 patients treated with ambulatory laparoscopies performed at University Hospital La Fe of Valencia. The need for hospital admission, same day after surgery, was considered the main variable. Variables were recorded for preoperatives, intraoperatives o postoperatives factors. To identify risk factors and variables associated with complications, statistical analyses were calculated with logistic regression models. RESULTS: After laparoscopic surgery, the 8.1% of patients required hospitalization. This rate was significantly superior in gynecologic surgery, patients with previous surgery complications, superior ASA classified (II and III) and smokers. Likewise, patients with pneumoperitoneum time over 45 minutes presented a higher hospitalization rate; also founded in patients with anesthetic or surgery complications (including conversion to laparotomy). At least, the rate of hospitalization was significantly superior in relation with postoperative nausea and vomiting (PONV). CONCLUSION: The rate of patients who need hospitalization after ambulatory laparoscopic surgery was 8.1%, of which 5.5% were general surgeries and 12.1% were gynecologic surgeries. The mots relationated factors with ambulatory manage failure, analyzed with multiple regression, were the appearance of surgery complications, the pneumoperitoneum time over 100 minutes and the PONV

Predictive Factors of Admission in Outpatient Laparoscopic Surgery. / Factores con valor predictivo de ingreso en cirugía laparoscópica ambulatoria.

INTRODUCTION: The aim of the study is to analyze the rate of no planificated hospitalization after ambulatory surgical procedures by laparoscopy, and identify associated risk factors to failure in the ambulatory manage of this patients. METHODS: A prospective observational study was performed during 18 months and included 297 patients treated with ambulatory laparoscopies performed at University Hospital La Fe of Valencia. The need for hospital admission, same day after surgery, was considered the main variable. Variables were recorded for preoperatives, intraoperatives o postoperatives factors. To identify risk factors and variables associated with complications, statistical analyses were calculated with logistic regression models. RESULTS: After laparoscopic surgery, the 8.1% of patients required hospitalization. This rate was significantly superior in gynecologic surgery, patients with previous surgery complications, superior ASA classified (II and III) and smokers. Likewise, patients with pneumoperitoneum time over 45minutes presented a higher hospitalization rate; also founded in patients with anesthetic or surgery complications (including conversion to laparotomy). At least, the rate of hospitalization was significantly superior in relation with postoperative nausea and vomiting (PONV). CONCLUSION: The rate of patients who need hospitalization after ambulatory laparoscopic surgery was 8.1%, of which 5.5% were general surgeries and 12.1% were gynecologic surgeries. The mots relationated factors with ambulatory manage failure, analyzed with multiple regression, were the appearance of surgery complications, the pneumoperitoneum time over 100minutes and the PONV.

Biomechanical strength comparison of pedicle screw augmentation using poly-dicalcium phosphate dihydrate (P-DCPD) and polymethylmethacrylate (PMMA) cements.

STUDY DESIGN: A basic science, hypothesis-driven experimental study of the biomechanics of two bone cements in their ability to augment pedicle screws in bone foam. OBJECTIVE: The purpose of our study was to compare the pullout and torque resistance of conventional pedicle screws (CPS) augmented with either polymethylmethacrylate (PMMA) or poly-dicalcium phosphate dihydrate (P-DCPD) cement in polyurethane foam blocks mimicking osteoporotic bone. P-DCPD cement has attractive safety characteristics such as non-exothermic curing and drug-eluting capacity. PMMA cement lacks these safety features yet is the current standard in pedicle screw augmentation. METHODS: Standardized low-density polyurethane open-cell foam blocks were instrumented with conventional pedicle screws and categorized into three groups of six each. Group 1 was the control group and no cement was used. Groups 2 and 3 were augmented with PMMA and P-DCPD, respectively. An Instron machine applied an axial load to failure at a rate of 2 mm/min for 3 min and a torsional load to failure at a rate of 1°/s. Failure was defined by an evident drop in the load after maximum value. RESULTS: Maximal pullout load for PMMA and P-DCPD was significantly greater than control (p < 0.0001). Interestingly, there was no significant difference in the pullout load to failure for the PMMA and P-DCPD groups. Analysis showed significant difference in torsional resistance between PMMA and P-DCPD, with PMMA having greater resistance (p = 0.00436). CONCLUSIONS: No difference was observed between PMMA and P-DCPD in pullout load to failure conducted in low-density open-cell, rigid foam blocks. Although a significant difference did exist in our torque analysis, the clinical significance of such a load on a native spine is questionable. Further investigation is warranted for this promising compound that seems to be comparable in pullout resistance to PMMA and offers attractive safety features. LEVEL OF EVIDENCE: Basic science, not applicable.

Professional Formation of Physicians Focused on Improving Care: How Do We Get There?

As the Accreditation Council for Graduate Medical Education (ACGME) and National Academy of Medicine (NAM) increase emphasis on quality improvement (QI), continuing medical education must also adapt to meet these increasing demands. In fellowship programs and for attending physicians, QI initiatives exist but are more rare compared with initiatives during residency programs, and they are even more rare for orthopedic surgery residents, fellows, and attending physicians. A QI curriculum should be in place at all stages of continuing medical education, as they help meet the criteria of the ACGME and NAM and promote better clinical practice and minimize errors.