Mortalidad al año en fracturas de cadera y demora quirúrgica / Relationship between one-year mortality in hip fractures and surgical delay

Objetivo: Analizar la relación entre el retraso en la cirugía de fractura de cadera por causas administrativo organizativas y el índice de mortalidad. Material y método: Estudio retrospectivo de 634 fracturas de cadera intervenidas durante 5 años que incluían a pacientes que retrasaron su cirugía por motivos administrativo organizativos y preparados para cirugía desde el momento de su ingreso. Se excluyó a pacientes con enfermedad previa o agudizada, a menores de 65 años, con fracturas patológicas, politraumatizados, con anticoagulación o con demencia. Se comparó la mortalidad de los pacientes intervenidos el día de su ingreso o al siguiente día con los pacientes intervenidos el segundo o el tercer día y con los pacientes intervenidos más tarde. Se efectuó un análisis univariado y multivariado para estudiar la relación del retraso quirúrgico con diversas variables. Resultados: El 18,6% de los pacientes incluidos falleció al año. La edad, el sexo masculino y el riesgo quirúrgico se asociaron a una mayor mortalidad. El tipo de fractura, la cirugía y la anestesia no influyeron en el pronóstico vital. Los pacientes intervenidos el día del ingreso o al día siguiente tuvieron menor mortalidad que los intervenidos más tarde, independientemente de la edad, el sexo o el riesgo quirúrgico. Conclusiones: El índice de mortalidad en pacientes autónomos, sin enfermedad aguda al ingreso e intervenidos por fractura de cadera durante el primer día desde su ingreso hospitalario o al siguiente es significativamente menor al de los pacientes intervenidos más tarde (AU)

Purpose: To analyze the relationship between surgical delay for hip fractures due to administrative-organizational reasons and the mortality index. Materials and methods: We present a retrospective study of 634 hip fractures operated over a 5-year period. These also included patients whose surgery was postponed for organizational-administrative reasons but who were ready for surgery from the moment they were admitted. We excluded from the study patients who had a prior or an acute condition, patients under 65, patients with pathological fractures, multiple-trauma patients, and patients with anti coagulation or dementia. A comparison was made between the mortality rate of patients operated the same or the following day they were admitted with those operated the second or third days and with those operated after that. Uni- and multivariate analyses were performed to analyze the relationship between surgical delay and several variables. Results About 18.6% of patients included in the study died at one year. Age, male gender and surgical risk were associated to higher mortality. The type of fracture, surgery or anesthesia did not influence final prognosis. Patients operated the same or the following day they were admitted had a lower mortality rate than those operated subsequently, regardless of age, gender or surgical risk. Conclusions: The mortality index in autonomous patients, who did not present with an acute condition on admission and who were operated for a hip fracture the same or the following day they were admitted is significantly lower than that for patients operated at a later date (AU)

[The contribution made by neurophysiological and ultrasound imaging studies to the diagnosis of carpal tunnel syndrome. Surgical correlation]. / Aportación de los estudios neurofisiológico y ecográfico al diagnóstico del síndrome del túnel carpiano. Correlación quirúrgica.

INTRODUCTION: Electrophysiological study has been for long time the elected approach for the diagnosis and clinical evaluation of carpal tunnel syndrome (CTS). More recently, echography and other imaging techniques have been introduced in current medicine for their potential in the anatomical evaluation of the neural compression. To asses the usefulness of both diagnostic procedures we have compared the findings obtained by electrophysiological and echographic approaches in a group of 60 CTS patients with different degrees of the disease. PATIENTS AND METHODS: In all patients the conduction velocity was evaluated in the median and cubital nerves using surface electrodes. For echography lineal transductors of 5-10 Hz and 5-12.5 MHz were employed. RESULTS: The patients were distributed for each test on a scale depending of the severity of the alterations detected by the corresponding technique and both files were subsequently compared by regression analysis, Pearson test and paired-test. No correlation was detected in any of the statistical test. CONCLUSIONS: The lack of correlation between the results of both proofs emphasizes the usefulness of the two diagnostic approaches in CTS. While electrophysiological study provides information about nerve function, ecography unravels the morphological alterations accounting for the syndrome, therefore being non-excluding complementary approaches.

Aportación de los estudios neurofisiológico y ecográfico al diagnóstico del síndrome del túnel carpiano. Correlación quirúrgica / The contribution made by neurophysiological and ultrasound imaging studies to the diagnosis of carpal tunnel syndrome. Surgical correlation

Introducción. El estudio neurofisiológico (ENF) como técnica de elección para el diagnóstico del síndrome del túnel carpiano (STC) ha demostrado repetidamente su utilidad y eficacia. Más recientemente se han incorporado técnicas de imagen como la ecografía (ECO), que aporta valiosos datos en cuanto a la morfología normal del nervio mediano en el canal carpiano y sus cambios patológicos. Nuestro objetivo ha sido comparar los resultados de ambos estudios, ENF y ECO, en un número reducido de pacientes de nuestra casuística con el fin de comprobar su diferente utilidad en el diagnóstico del síndrome. Pacientes y métodos. 60 pacientes diagnosticados de STC, en los que se estudió la conducción nerviosa de ambos nervios medianos y cubital mediante electrodos de superficie, así como estudio ecográfico de ambas muñecas mediante transductores lineales 5-10 Hz y 5-12,5 MHz. Resultados. Según el grado de afectación se utilizaron escalas de gravedad para ambas pruebas y los resultados se compararon estadísticamente mediante análisis de regresión, test de Pearson y test t pareado, que demostraron una ausencia de correlación entre ambas pruebas. Conclusión. La falta de correlación evidenciada entre ambas pruebas en los diferentes estudios estadísticos utilizados indica que ambas son herramientas útiles en el diagnóstico de STC. Los datos neurofisiológicos aportan información acerca de la funcionalidad del nervio y la ECO, por su parte, informa de sus alteraciones morfológicas en condiciones patológicas y las posibles lesiones o variantes anatómicas causantes del síndrome, por lo que consideramos que ambas pruebas no son excluyentes, sino complementarias

Introduction. Electrophysiological study has been for long time the elected approach for the diagnosis and clinical evaluation of carpal tunnel syndrome (CTS). More recently, echography and other imaging techniques have been introduced in current medicine for their potential in the anatomical evaluation of the neural compression. To asses the usefulness of both diagnostic procedures we have compared the findings obtained by electrophysiological and echographic approaches in a group of 60 CTS patients with different degrees of the disease. Patients and methods. In all patients the conduction velocity was evaluated in the median and cubital nerves using surface electrodes. For echography lineal transductors of 5-10 Hz and 5-12.5 MHz were employed. Results. The patients were distributed for each test on a scale depending of the severity of the alterations detected by the corresponding technique and both files were subsequently compared by regression analysis, Pearson test and paired-test. No correlation was detected in any of the statistical test. Conclusions. The lack of correlation between the results of both proofs emphasizes the usefulness of the two diagnostic approaches in CTS. While electrophysiological study provides information about nerve function, ecography unravels the morphological alterations accounting for the syndrome, therefore being non-excluding complementary approaches