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1.
Matthew R. Walker Ashraf N. El Naga Omar H. Atassi Christopher H. Perkins Scott A. Mitchell 《Injury》2019,50(3):686-689
Objectives
Hip dislocations are highly morbid injuries necessitating prompt reduction and post-reduction assessment for fracture and incarcerated fragments. Recent literature has questioned the need for initial pelvic radiographs for acute trauma patients, resulting in computed tomography (CT) scans as the initial evaluation. This study investigates the relationship between choice of pre-reduction imaging and treatment of acute hip dislocations.Design
Retrospective Case-Control.Setting
Single Academic Level I Trauma Center.Methods
All acute hip dislocations from 2011 to 2016 were reviewed. Exclusion criteria were diagnosis of dislocation at another facility, death prior to reduction, emergent surgical or ICU intervention, and periprosthetic dislocation. Patients were grouped by those with only a radiograph prior to reduction, Group I, versus those with a pre-reduction CT scan, Group II. The primary outcomes were time to reduction and the acquisition of a second CT scan.Results
Of the 123 hip dislocations identified, 35 patients were excluded, mostly for transfer with a known dislocation. Group I included 29 patients and Group II included 59 patients. The mean time to reduction was 74?min in Group I and 129?min in Group II for a difference of 55?min (p?<?0.001). The rate of repeat CT scan was 0 in Group I versus 48 (81%) in Group II (p?<?0.001).Conclusion
Initial trauma pelvic radiography prior to CT is still important in the setting of suspected hip pathology to decrease time to hip reduction and unnecessary radiation exposure.Level of evidence
Prognostic Level III. 相似文献2.
Ichiro Tonogai Fumio Hayashi Yoshihiro Tsuruo Koichi Sairyo 《Foot and Ankle Surgery》2019,25(2):193-197
Background
The aims of this study were to identify the artery feeding the fifth metatarsal and determine how bunionette osteotomy could injure this vessel.Methods
The nutrient artery entering the fifth metatarsal was investigated in 10 adult cadaveric lower limbs by barium injection and enhanced computed tomography.Results
The nutrient artery entered the medial aspect of the fifth metatarsal around the junction of the middle and proximal thirds obliquely from a distal direction (mean?angle 36°) in the coronal plane in all cases; in the axial plane, the point of entry and direction of the artery was medial-plantar (mean?angle 49°).Conclusions
This report revealed direction and location of the nutrient artery entering the fifth metatarsal. 相似文献3.
Federico Coccolini Marco Ceresoli Yoram Kluger Andrew Kirkpatrick Giulia Montori Fracensco Salvetti Paola Fugazzola Matteo Tomasoni Massimo Sartelli Luca Ansaloni Fausto Catena Ionut Negoi Monica Zese Savino Occhionorelli Sergei Shlyapnikov Christian Galatioto Massimo Chiarugi Zaza Demetrashvili Rao Ivatury 《Injury》2019,50(1):160-166
Introduction
No definitive data describing associations between cases of Open Abdomen (OA) and Entero-atmospheric fistulae (EAF) exist. The World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) thus analyzed the International Register of Open Abdomen (IROA) to assess this question.Material and methods
A prospective analysis of adult patients enrolled in the IROA.Results
Among 649 adult patients with OA 58 (8.9%) developed EAF. Indications for OA were peritonitis (51.2%) and traumatic-injury (16.8%). The most frequently utilized temporary abdominal closure techniques were Commercial-NPWT (46.8%) and Bogotà-bag (21.9%). Mean OA days were 7.9?±?18.22. Overall mortality rate was 29.7%, with EAF having no impact on mortality. Multivariate analysis associated cancer (p?=?0.018), days of OA (p?=?0.003) and time to provision-of-nutrition (p?=?0.016) with EAF occurrence.Conclusion
Entero-atmospheric fistulas are influenced by the duration of open abdomen treatment and by the nutritional status of the patient. Peritonitis, intestinal anastomosis, negative pressure and oral or enteral nutrition were not risk factors for EAF during OA treatment. 相似文献4.
Objective
Symptomatic distal interlocking screws in retrograde femoral nailing are common due the difficulties of imaging the trapezoidal femur. Screws appearing to have appropriate length on imaging may possibly be prominent, creating symptoms. Screw trajectory may influence the degree of this radiographic error. We hypothesize that external rotation of screw trajectory will increase measurement error of screw length.Design
Retrospective.Setting
Urban Level I Tertiary Trauma Center.Participants
283 patients with Computer Tomography (CT) scans of the native knee were retrospectively identified. Simulation was done of the trajectory of an interlock at 20?mm and 40?mm proximal to the nail entry point, which represent common screw positions associated/not associated respectively, with removal. The distance between the radiographic medial cortex and the tip of the transverse screw was calculated (D). The angle (Ψ) between the transverse trajectory and a modified trajectory aimed at the most medial cortex to avoid radiographic measurement error was calculated. Geometric modeling was utilized to calculate the measurement error (D) in the event of accidental external rotation. The angle of the medial slope was also measured (Θ).Intervention
Review of CT imaging of normal distal femora.Main Outcome Measurements
CT measurements of distal femora.Results
The mean distance (D) at 20/40?mm was 4.21 [95%CI 4.02–4.402] and 2.03?mm [95%CI 1.78–2.83], respectively (p?<?0.0001). The mean angle (Ψ) between the transverse and modified trajectory at 20/40?mm was 12° [95%CI 11.5–12.5] and 9.60° [95%CI 9–10.2], respectively (p?<?0.0001). External rotation by a similar amount nearly triples the measured difference (D). The measured medial slope was significantly increased as screws were placed more proximal (Θ20 mm 46.5 vs Θ40 mm: 48.7?°, p?<?0.00001).Conclusion
The distance between the perceived medial cortex and the tip of the most transverse screw is 4.21?mm and could account for painfully prominent screws. In more proximal screws this distance is decreased. Internal rotation of the screw trajectory 12° can reduce this distance (D), which has implications in nail design. External rotation, amplifies this difference nearly three-fold. Surgeons should avoid external rotation of the aiming arm to prevent prominent screws. 相似文献5.
Joey P. Johnson Justin Kleiner Avi D. Goodman Joseph A. Gil Alan H. Daniels Roman A. Hayda 《Injury》2019,50(3):708-712
Introduction
Young patients with femoral neck fractures are optimally treated with reduction and stable fixation, while patients over the age of sixty-five are often treated with arthroplasty. This study analyzes in-hospital outcomes associated with total hip arthroplasty, hip hemiarthroplasty and internal fixation for treatment of femoral neck fractures in patients aged 45–64.Methods
Records of patients between the ages of 45–64, from 2002 to 2014, sustaining femoral neck fractures and treated with internal fixation, hip hemiarthroplasty or total hip arthroplasty were obtained from the Nationwide Inpatient Sample (NIS). Examined variables were age, sex and Charlson Comorbidity Index (CCI). Outcome measures included hospital length of stay (LOS), complications, and inpatient hospitalization charge.Results
From 2002–2014 74,678 femoral neck fractures were available for analysis. THA use increased from 5.3% of operatively managed fractures in 2002 to 22.3% of operatively managed fractures in 2014 (p?<?0.0001). Patients undergoing THA had higher hospital cost, higher in hospital complication rates and longer length of stay than patients undergoing internal fixation (p?<?0.0001). The in-hospital mortality for patients undergoing a hip hemiarthroplasty was higher (1.2%) than either total hip arthroplasty (0.2%) or internal fixation (0.5%) (P?=?0.007).Conclusion
This study demonstrates that the use of total hip arthroplasty in treatment of femoral neck fractures in patients from the age of 45–64 increased 4.2-fold over the study period. This treatment is associated with increased hospital cost, length of stay and complications. Additionally, as age increased in our study population, there was a stepwise increase in the use of arthroplasty, and it appears that hemiarthroplasty is being used with a different patient population. 相似文献6.
Olivier Wegelin Leonie Exterkate Marloes van der Leest Jean A. Kummer Willem Vreuls Peter C. de Bruin J.L.H.Ruud Bosch Jelle O. Barentsz Diederik M. Somford Harm H.E. van Melick 《European urology》2019,75(4):582-590
Background
Guidelines advise multiparametric magnetic resonance imaging (mpMRI) before repeat biopsy in patients with negative systematic biopsy (SB) and a suspicion of prostate cancer (PCa), enabling MRI targeted biopsy (TB). No consensus exists regarding which of the three available techniques of TB should be preferred.Objective
To compare detection rates of overall PCa and clinically significant PCa (csPCa) for the three MRI-based TB techniques.Design, setting, and participants
Multicenter randomised controlled trial, including 665 men with prior negative SB and a persistent suspicion of PCa, conducted between 2014 and 2017 in two nonacademic teaching hospitals and an academic hospital.Intervention
All patients underwent 3-T mpMRI evaluated with Prostate Imaging Reporting and Data System (PIRADS) version 2. If imaging demonstrated PIRADS ≥3 lesions, patients were randomised 1:1:1 for one TB technique: MRI-transrectal ultrasound (TRUS) fusion TB (FUS-TB), cognitive registration TRUS TB (COG-TB), or in-bore MRI TB (MRI-TB).Outcome measurements and statistical analysis
Primary (overall PCa detection) and secondary (csPCa detection [Gleason score ≥3 + 4]) outcomes were compared using Pearson chi-square test.Results and limitations
On mpMRI, 234/665 (35%) patients had PIRADS ≥3 lesions and underwent TB. There were no significant differences in the detection rates of overall PCa (FUS-TB 49%, COG-TB 44%, MRI-TB 55%, p = 0.4). PCa detection rate differences were ?5% between FUS-TB and MRI-TB (p = 0.5, 95% confidence interval [CI] ?21% to 11%), 6% between FUS-TB and COG-TB (p = 0.5, 95% CI ?10% to 21%), and ?11% between COG-TB and MRI-TB (p = 0.17, 95% CI ?26% to 5%). There were no significant differences in the detection rates of csPCa (FUS-TB 34%, COG-TB 33%, MRI-TB 33%, p > 0.9). Differences in csPCa detection rates were 2% between FUS-TB and MRI-TB (p = 0.8, 95% CI ?13% to 16%), 1% between FUS-TB and COG-TB (p > 0.9, 95% CI ?14% to 16%), and 1% between COG-TB and MRI-TB (p > 0.9, 95% CI ?14% to 16%). The main study limitation was a low rate of PIRADS ≥3 lesions on mpMRI, causing underpowering for primary outcome.Conclusions
We found no significant differences in the detection rates of (cs)PCa among the three MRI-based TB techniques.Patient summary
In this study, we compared the detection rates of (aggressive) prostate cancer among men with prior negative biopsies and a persistent suspicion of cancer using three different techniques of targeted biopsy based on magnetic resonance imaging. We found no significant differences in the detection rates of (aggressive) prostate cancer among the three techniques. 相似文献7.
Aims
The anatomical safe zone for intra-medullary nail insertion through the tibial plateau is small, insertion outside of this area risks damage to intra-articular structures and poor fracture reduction. The purpose of this retrospective study was to determine if the new supra-patella (SP) approach confers improved nail insertion accuracy, when compared with the standard infra-patella (IP) technique.Patients and Methods
Two hundred cases were included in the study (SP 95, IP 105). Insertion accuracy was assessed on AP and lateral radiographic imaging, and measured as the distances between the central axis of the proximal nail and the ideal entry point.Results
The median distance from the ideal entry point was 4.4?mm (SP) and 5.1?mm (IP) (p?=?0.046) in the coronal plane, and 4.0?mm (SP) and 3.7?mm (IP) (p?=?0.527) in the sagittal plane. A narrower range in measurements was observed in the SP technique in both sagittal and coronal planes, 17.8?mm vs 28.6?mm, and 19.7?mm vs 30.3?mm respectively.Conclusion
We found that the SP technique achieved significantly improved nail insertion accuracy in the coronal plane. Insertion accuracy was equivocal between the two techniques in the sagittal plane. A narrower range in entry points was observed in the SP cohort in both planes suggesting improved control in nail insertion using this technique. 相似文献8.
Background
The response to first-line, platinum-based treatment of muscle-invasive bladder cancer has not improved in 3 decades.Objective
To identify genes that influence cisplatin resistance in bladder cancer.Design, setting, and participants
We performed a whole-genome CRISPR screen in a bladder cancer cell line to identify genes that mediate resistance to cisplatin.Outcome measurements and statistical analysis
Targeted validation was performed in two bladder cancer cell lines. The top gene candidate was validated in a publicly available bladder cancer dataset.Results and limitations
From the CRISPR screen, we identified MSH2 as the most significantly enriched gene and mismatch repair as the most significantly enriched pathway that promoted resistance to cisplatin. Bladder cancer cells with knockdown of MSH2 showed a reduction in cisplatin-mediated apoptosis. MSH2 loss did not impact the sensitivity to other chemotherapies, including the cisplatin analog oxaliplatin. Bladder tumors with low MSH2 protein levels, quantified using reverse-phase protein array, showed poorer survival when treated with cisplatin- or carboplatin-based therapy; these results require future validation using immunohistochemistry. Additionally, results are retrospective from patients with primarily high-grade tumors; thus, validation in a controlled clinical trial is needed.Conclusions
We generated in vitro evidence that bladder cancer cell lines depleted of MSH2 are more resistant to cisplatin. We additionally found an association between low MSH2 in bladder tumors and poorer patient survival when treated with platinum-based chemotherapy. If successfully validated prospectively, MSH2 protein level could assist in the selection of patients for chemotherapy.Patient summary
We report the first evidence that MSH2 protein level may contribute to chemotherapy resistance observed in muscle-invasive bladder cancer. MSH2 has potential as a biomarker predictive of response to platinum-based therapy. 相似文献9.
Introduction
The subscale motor score of Glasgow Coma Scale (msGCS) and the Abbreviated Injury Score of head region (HAIS) are validated prognostic factors in traumatic brain injury (TBI). The aim was to compare the prognostic performance of a HAIS-based prediction model including HAIS, pupil reactivity and age, and the reference prediction model including msGCS in emergency department (ED), pupil reactivity and age.Methods
Secondary analysis of a prospective epidemiological study including patients after severe TBI (HAIS?>?3) with follow-up from the time of accident until 14 days or earlier death was performed in Switzerland. Performance of prediction, based on accuracy of discrimination [area under the receiver-operating curve (AUROC)], calibration (Hosmer-Lemeshow test) and validity (bootstrapping with 2000 repetitions to correct) for optimism of the two prediction models were investigated. A non-inferiority approach was performed and an a priori threshold for important differences was established.Results
The cohort included 808 patients [median age 56 {inter-quartile range (IQR) 33–71}, median motor part of GCS in ED 1 (1–6), abnormal pupil reactivity 29.0%] with a death rate of 29.7% at 14 days. The accuracy of discrimination was similar (AUROC HAIS-based prediction model: 0.839; AUROC msGCS-based prediction model: 0.826, difference of the 2 AUROC 0.013 (?0.007 to 0.037). A similar calibration was observed (Hosmer-Lemeshow X2 11.64, p?=?0.168 vs. Hosmer-Lemeshow X2 8.66, p?=?0.372). Internal validity of HAIS-based prediction model was high (optimism corrected AUROC: 0.837).Conclusions
Performance of prediction for short-term mortality after severe TBI with HAIS-based prediction model was non-inferior to reference prediction model using msGCS as predictor. 相似文献10.
Marthe Løvf Sen Zhao Ulrika Axcrona Bjarne Johannessen Anne Cathrine Bakken Kristina Totland Carm Andreas M. Hoff Ola Myklebost Leonardo A. Meza-Zepeda A. Kathrine Lie Karol Axcrona Ragnhild A. Lothe Rolf I. Skotheim 《European urology》2019,75(3):498-505
Background
Most primary prostate cancers are multifocal with individual tumors harboring different aggressiveness; however, the genomic heterogeneity among these tumors is poorly understood.Objective
To better understand the biological basis for clinical variability among different lesions, we sought to comprehensively characterize the heterogeneity of somatic gene mutations in multifocal prostate cancer.Design, setting, and participants
High-coverage whole-exome sequencing of 153 frozen tissue samples, taken from two to three distinct tumor foci and one non-cancerous area from each of 41 patients, covering a total of 89 tumor foci.Outcome measurements and statistical analysis
State-of-the-art bioinformatics tools for mutation calling and copy number determination from whole-exome sequencing data.Results and limitations
We found a very high degree of interfocal heterogeneity among tumors, that is, 76% of pairwise-compared tumor foci from the same prostatectomy specimen had no point mutations in common and DNA copy number changes were rarely shared across cancer foci. The few point mutations shared across tumor foci were seldom in cancer-critical genes.Conclusions
In this first large genomic heterogeneity study of primary prostate cancer, we observe that different tumor foci within the same patient are genetically distinct, only rarely sharing any somatic gene mutations, including those in cancer driver genes. This heterogeneity affects how genomics-based management of prostate cancer can be implemented, as information from all tumor foci is necessary to draw valid conclusions about the cancer's genomic alterations.Patient summary
Most primary prostate cancers consist of multiple tumors within the same organ, but little is known about their relationships. We have compared the sets of gene mutations among such tumors and found that they only exceptionally have any in common. This will influence treatment decisions in the future as each tumor's mutations will render it unique and have to be considered to gain the best treatment results. 相似文献11.
Christina Liu Arvind Von Keudell Michael McTague Edward K. Rodriguez Michael J. Weaver 《Injury》2019,50(3):727-732
Background
It is common practice when placing cannulated screws within the femoral head when treating femoral neck fractures to avoid the thread-forms from crossing the fracture line. Despite the widespread use of cannulated screws in internal fixation of femoral neck fractures, there is no study to our knowledge that describes the ideal length of thread-forms.Purpose
The purpose of this study is to determine the thread length that will maximize purchase within the femoral head while minimizing risk of crossing the fracture line. Additional analysis was conducted to identify factors associated with the maximal possible length of treads in minimally and non-displaced femoral neck fractures.Methods
We performed a retrospective study of all patients treated for a minimally or non-displaced femoral neck fracture from April 1, 2004 through December 31, 2017. Only patients who had received a pre-operative CT or MRI scan were included. Fixation was then templated using radiographs and the distance from the subchondral bone to the fracture line was then measured.Results
The study included 127 patients. The average estimated length of lag screw threads was 33.2?±?6.67?mm, with lower quartile of 29.1?mm and higher quartile of 37.2?mm. The median was 32.0?mm and most frequently encountered estimate was 29?mm. Estimated lag screw size did not differ significantly based on age or BMI, but both height (p?<?0.001) and race (0.04) were positively correlated with estimated lag screw size and males had longer measurements compared to females, 37.2?±?7.0?mm vs 31.4?±?5.7?mm (p?<?0.001), respectively.Conclusion
In conclusion, we propose an additional lag screw thread form with length 26.0?mm to capture 90% of femoral neck fractures. 相似文献12.
C. González-Ruiz de León J. García-Rodríguez N. Pérez-Castro C. Vigil-Díaz M.L. Pérez-Haro J.M. Fernández-Gómez 《Actas urologicas espa?olas》2019,43(1):32-38
Introduction
New imaging studies have appeared in recent years for the diagnosis and follow-up of metastatic urological tumours.Material and methods
A total of 41 patients were reviewed with suspected recurrence of a urothelial or kidney tumour, analysing the diagnostic performance of PET-CT scans undertaken between 2013 and 2016.Results
We collected 17 urothelial tumours and 24 renal tumours, with a median follow-up of 30 months. A total of 39.3% of the urothelial tumours were high grade and 29.3% of the kidney tumours were clear cell Fuhrman II. As a whole, the imaging studies detected recurrences in 34 patients. CT was positive in 83% of the patients, while the PET scan was positive in 75.6%, CT/PET coincidence was 50%. The PET scan detected further disease in 41% of the cases compared to 5% by CT. This resulted in a change of therapeutic strategy in 40% of the patients. Sensitivity, specificity, positive predictive value and negative predictive value for the CT and the PET scans were 92% and 92%, 57% and 100%, 92% and 100%, and 57% and 70% respectively.Conclusion
The PET scan showed similar sensitivity for urological tumours to the standard imaging techniques but with higher specificity, positive predictive value and negative predictive value. This led to a change in treatment strategy for 40% of the patients in our series. The PET scan will probably become the standard test in the extension and follow-up studies of most urological tumours. 相似文献13.
Background
Differing mortality rates according to day of hospital admission is an area of debate, where a supposed increased rate of mortality with weekend admissions has been termed “the weekend effect”. We sought to identify the 30-day mortality rates in major trauma patients attending our Major Trauma Centre (MTC) and the underlying reasons for these.Methods
A retrospective review of data retrieved from the Trauma Audit and Research Network (TARN) database was undertaken for all patients attending between January 2013 and July 2015 with an Injury Severity Score of 9 or higher. 30-day mortality rates were calculated according to day of attendance.Results
1424 patients met the inclusion criteria. There was no significant difference in 30-day mortality between weekend attendances (7.8%) compared to those on a weekday (7.7%). 30-day mortality was highest in patients attending on Fridays (10.8%) and lowest in those attending on Sundays (5.5%). A significantly higher 30-day mortality rate was seen in patients attending on a Friday or Saturday (10.4%) compared to those attending Sunday to Thursday (6.6%) (RR 1.548). Patients with a head injury as their most serious injury on a Friday or Saturday were more likely to have GCS?<?9 (34.7% vs 24.4%) and more likely to die (22.7% vs 12%) than those attending Sunday to Thursday.Conclusion
There is no significant difference in 30-day mortality when directly comparing weekday to weekend attendances. There is a significantly higher mortality on Friday and Saturday compared to remainder of the week which appears to be explained by a greater severity of head trauma.Implications
This study provides no evidence of a "weekend effect" in this MTC but the increased severity of and mortality from head injury identified on Friday and Saturday is a public health concern which warrants further investigation. 相似文献14.
Henry D. Mitcheson Suvajit Samanta Karen Muldowney Cathy A. Pinto Beatriz de A. Rocha Stuart Green Nathan Bennett Paul N. Mudd Tara L. Frenkl 《European urology》2019,75(2):274-282
Background
Antimuscarinics have shown modest efficacy with unwanted side effects in patients with overactive bladder (OAB). Efficacy of vibegron, a new β3-adrenergic receptor agonist, for OAB is unknown.Objective
To evaluate the efficacy of once-daily oral vibegron in OAB patients (primary), and its safety, tolerability, and efficacy when administered alone or concomitantly with tolterodine (secondary).Design, setting, and participants
International, phase IIb, randomized, double-blind, placebo- and active comparator–controlled, two-part superiority trial (2011–2013) in OAB-wet or OAB-dry patients aged 18–75 yr (NCT01314872).Interventions
Part 1: once-daily oral vibegron monotherapy (3 [V3], 15 [V15], 50 [V50], or 100 [V100] mg), tolterodine extended release 4 mg (TER4), or placebo for 8 wk, or combination V50/TER4 for 4 wk and then V50 for 4 wk; part 2: V100/TER4, V100, TER4, or placebo for 4 wk.Outcome measurements and statistical analysis
Average daily micturitions at week 8 of part 1 (primary); urge incontinence episodes, total incontinence episodes, and urgency episodes (secondary).Results and limitations
Overall, 1395 patients were randomized. From baseline to week 8, V50 and V100 significantly decreased average daily micturitions (least square mean difference [95% confidence interval], ?0.64 [?1.11, ?0.18]; p = 0.007 and ?0.91 [?1.37, ?0.44]; p < 0.001, respectively) and the number of urge incontinence episodes (?0.72 [?1.11, ?0.33] and ?0.71 [?1.10, ?0.32], respectively; both p < 0.001) versus placebo. All vibegron doses were well tolerated. The incidence of dry mouth was higher with TER4 than with vibegron monotherapy. Results are limited by the relatively short treatment duration.Conclusions
Once-daily V50 and V100 improved OAB symptoms; vibegron was well tolerated as monotherapy and concomitantly with tolterodine. Further development is warranted.Patient summary
Antimuscarinics, commonly used to treat overactive bladder, produce modest efficacy and unwanted side effects. In this study, a different type of drug (vibegron) was efficacious and safe, alone or with an antimuscarinic (tolterodine). 相似文献15.
Christina Marie Joseph Chandrasekaran Gunasekaran Abel Livingston Hepsy Chelliah Thilak Samuel Jepegnanam P.R.J.V.C. Boopalan 《Injury》2019,50(3):784-789
Background
Contrary to acute posterior cruciate ligament (PCL) bony tibial avulsions, surgical management of chronic injuries is technically challenging and appears to be controversial. We sought to assess the outcome of a novel screw post augmentation technique in neglected cases.Methods
16 patients were followed up in a tertiary single-center retrospective study. The bony fragment was fixed using a lag screw with a spiked washer and an additional screw post through an open posterior approach. The pre- and postoperative knee range of movement (ROM), laxity, and modified Tegner–Lysholm (TL) scores were compared.Results
The median time from injury to surgery was 10 weeks (range, 3–260). The mean clinical follow-up time was 24.25?±?9.21 months. At the final follow-up, the mean knee ROM flexion was 130°?±?11.55° with no extension lag. 3 patients had grade 1 laxity. The TL grade was predominantly excellent, and the overall median score improved from 76 preoperatively to 95 postoperatively (p?<?0.0004). Bony union was achieved in all cases.Conclusion
The described screw post fixation technique results in an excellent outcome for these rare injuries.Level of evidence
Level IV, case series. 相似文献16.
17.
Objective
To analyse whether early post-operative full weight bearing following syndesmotic ankle fixation affected radiographic outcomes suggestive of diastasis.Design
Retrospective comparative cohort study over a two year period.Setting
Level 1 trauma centrePatients/Participants
152 consecutive patients sustaining an unstable ankle fracture requiring syndesmotic stabilisation were included. Exclusions were 49 patients who had trimalleolar fixation without syndesmosis screws, one patient who had concomitant ankle and talar fracture. Five patients were lost to follow up and eleven patients were followed up in other centres. A total of 86 patients were analysedIntervention
Protected or full weight bearing.Main Outcome Measurement
The primary outcome measure was early diastasis. The secondary outcomes were late diastasis, wound complications and re-operation. Analysis of variance was used for the predictor variable of weight bearing status. We assumed a priori that p values of less than 0.05 were significant.Results
Median age was 36 (IQR 30), with 54 males and 32 females. Median follow up was 12 weeks (IQR 6). There was no significant difference when comparing weight bearing status and change in radiographic measurements intra-operatively compared to 6 and 12 week follow up radiographs (tibiofibular clear space p?=?0.799, tibiofibular overlap p?=?0.733 and medial clear space p?=?0.261).Conclusion
After surgical stabilization of an unstable syndesmotic injury, full weight bearing did not lead to syndesmotic diastasis in the early post-operative period. Full weight bearing is recommended following ankle fixation which includes syndesmotic fixation. 相似文献18.
Background
Few methods have been described for measuring hindfoot alignment from an anteroposterior view. The objective of this study was to compare two methods of angular measurement based on the views of Meary and Saltzman.Methods
Thirty asymptomatic volunteers were included. Four radiographs were performed: the views of Meary and Saltzman with parallel feet and with the Fick correction. The reproducibility was determined by the inter- and intraobserver variability (ICC).Results
Meary’s method revealed a mean valgus angulation of 3.9° (SD 3.47°). The reliability was extremely variable with a mean ICC of 0.59. The best reproducibility was obtained with Meary’s method with and without Fick correction.Conclusion
The results of this study show that the reliability of the angular measurements depends on the radiographic view and measurement method chosen. The lateral Fick correction did not counteract the influence of tibial rotation. The same method should be used consistently. 相似文献19.
Silvia Valverde José Luis Sánchez García José Antonio Pereira Manel Armengol Manuel López-Cano 《Cirugía espa?ola》2019,97(2):97-102
Background
Incisional hernias are a frequent complication, and their prevention includes proper closure of the abdominal wall.Methods
A prospective study was conducted at a third-level hospital after the introduction of a midline laparotomy closure protocol. An objective measurement of the suture length to incision length ratio was made. and the postoperative results were analyzed.Results
127 patients were included and 34 of them (26.8%) had received a technically deficient closure. Incisional hernia was described in 20.5% of cases. An improvement in the quality of the abdominal wall closure was demonstrated over time.Conclusion
The abdominal wall closure was deficient in nearly one- quarter of the laparotomies performed at a third-level medical center. A protocol improved the quality of the laparotomy closure. 相似文献20.
Marcus M. Ilg Marta Mateus William J. Stebbeds Uros Milenkovic Nim Christopher Asif Muneer Maarten Albersen David J. Ralph Selim Cellek 《European urology》2019,75(2):329-340