Atypical subtrochanteric fractures, bisphosphonates, blinded radiological review.
| Related Articles |
Atypical subtrochanteric fractures, bisphosphonates, blinded radiological review.
ANZ J Surg. 2012 Dec;82(12):908-12
Authors: Warren C, Gilchrist N, Coates M, Frampton C, Helmore J, McKie J, Hooper G
Abstract
BACKGROUND: Recent reports have suggested that a certain type of subtrochanteric and diaphyseal femoral fractures maybe associated with bisphosphonate (BP) therapy. We assessed the association between BP use in atypical and typical femoral fractures in a retrospective study and also looked at the rate of coding errors.
METHODS: All cases between July 2003 and June 2008 with International Classification of Disease, 10th revision discharge codes for femoral fractures (S72.2 subtrochanteric and S72.3 fracture of shaft of femur) were reviewed. Cases were excluded if there was significant trauma, underlying bone disease or coding error. The remaining cases' films were assessed by an independent, blinded, single radiologist to assess for atypical features (thickened cortices, transverse fractures, medial cortical spike) with additional exclusion criteria of periprosthetic fractures and bone pathology. Odds ratios were calculated comparing BP use in atypical and typical fractures.
RESULTS: Six atypical fractures were found in the study period. Compared with the 65 typical fractures, there was an association between BP use and atypical fractures (odds ratio 5.5) but it did not reach statistical significance (0.97-31). Atypical femoral fractures accounted for <0.1% of total fracture admissions during this period. There was a 20% rate of miscoding.
CONCLUSION: This study shows a nonsignificant trend towards alendronate/BP use and atypical femoral fractures compared with typical femoral fractures. These fractures were rare <0.1% and the benefit and treatment of osteoporosis with BPs currently seems likely to outweigh the perceived risks. Individual case and radiology review is important as coding errors were frequent.
PMID: 22943522 [PubMed - indexed for MEDLINE]
Risk factors for contra-lateral hip fracture in elderly patients with previous hip fracture.
| Related Articles |
Risk factors for contra-lateral hip fracture in elderly patients with previous hip fracture.
Injury. 2013 May 17;
Authors: Chang JD, Yoo JH, Reddy P, Lee SS, Hwang JH, Kim TY
Abstract
INTRODUCTION: Contra-lateral hip fractures in elderly patients with a previous hip fracture increase the incidence of complications and socioeconomic burden. The purpose of this study was to identify the risk factors that contribute to the occurrence of contra-lateral hip fracture in elderly patients. MATERIALS AND METHODS: Among 1093 patients treated for a hip fracture, 47 patients sustained a contra-lateral hip fracture. These patients were compared with 141 patients with a unilateral hip fracture (controls). RESULTS: The incidence of contra-lateral hip fracture was 4.3% among the 1093 patients treated for a hip fracture at our institute. A contra-lateral hip fracture occurred within 2 years of initial fracture in 66%, and subsequently, the annual incidence rate decreased. A similar fracture pattern was noted in 70% of patients who sustained an intertrochanteric fracture. In terms of preoperative factors, respiratory disease (OR 2.57, P=0.032) and visual impairment (OR 2.51, P=0.012) were higher in patients with a contra-lateral hip fracture than in controls, and for postoperative factors, the proportions of patients with postoperative delirium (OR 2.91, P=0.022), late onset of rehabilitation (OR 1.05, P=0.023), and poor ambulatory status at 3 months (OR 1.34, P=0.002) were also significantly higher in patients than in controls. CONCLUSIONS: Postoperative delirium and underlying visual impairment and respiratory disease could be risk factors of contra-lateral fracture in elderly patients. Early and active rehabilitation after surgery is important to prevent the occurrence of contra-lateral hip fracture in the elderly.
PMID: 23688407 [PubMed - as supplied by publisher]
Megaprosthetic reconstruction for periprosthetic or highly comminuted fractures of the hip and knee.
| Related Articles |
Megaprosthetic reconstruction for periprosthetic or highly comminuted fractures of the hip and knee.
Eur J Orthop Surg Traumatol. 2013 May 21;
Authors: Lundh F, Sayed-Noor AS, Brosjö O, Bauer H
Abstract
OBJECTIVES: To present the experience of a tertiary referral hospital in the management of a case series with hip or knee fractures by using modular megaprosthesis. PATIENTS AND METHODS: Seventeen consecutive patients with highly comminuted fractures of the knee (n = 2), periprosthetic fractures of knee (n = 10) or hip (n = 5) were included. Fractures were managed with modular megaprosthesis (including total hip in 2 cases). Postoperative complications like infection and instability and outcome measures like return to previous mobility and living were recorded. RESULTS: The mean age at time of surgery was 77 years (25-91), and mean follow-up was 44 months (13-98). We had no intra-operative complications. There were 3 deep periprosthetic infections, 1 hip and 2 knee. In the hip group, including total femur patients, we had 2 dislocations (2/7), both managed with closed reduction. No aseptic loosening was seen. 15/17 patients regained walking ability, and 16 were discharged to independent living. Nine patients have died at the time of follow-up. CONCLUSIONS: In these often old and physically compromised patients with highly comminuted fractures or complicated periprosthetic fractures, modular megaprosthesis could be a good surgical option. It can provide immediate stability and allow early mobilization.
PMID: 23689913 [PubMed - as supplied by publisher]
Dabigatran, a direct thrombin inhibitor, can be a life-saving treatment in heparin-induced thrombocytopenia.
| Related Articles |
Dabigatran, a direct thrombin inhibitor, can be a life-saving treatment in heparin-induced thrombocytopenia.
ARYA Atheroscler. 2013 Jan;9(1):112-114
Authors: Mirdamadi A
Abstract
BACKGROUND: Several studies have emphasized thrombosis associated with thrombocytopenia as a potentially fatal complication of heparin. A number of agents are used for this condition. As a new oral, reversible direct thrombin inhibitor, dabigatran has been approved for short-term thromboprophylaxis after elective hip and knee replacement surgery. We present a case of dabigatran administration in a patient with femoral fracture.
CASE REPORT: A 67-year-old woman referred to the orthopedic ward of Shariati Hospital (Isfahan, Iran) due to femoral fracture following an accident. Immediately after surgery, she was found to be suffering from deep vein thrombosis (DVT) in her lower extremity despite sufficient prophylaxis by enoxaparin. Laboratory data showed severe thrombocytopenia. Considering the clinical history, an initial diagnosis of heparin-induced thrombocytopenia was made. Doppler ultrasound confirmed the diagnosis. Heparin was thus replaced with dabigatran which increased platelet count to the normal range and improved DVT.
CONCLUSION: Dabigatran can be a life-saving treatment in heparin-induced thrombocytopenia. However, it is contraindicated in patients with renal dysfunction since it may cause potentially catastrophic results.
PMID: 23690810 [PubMed - as supplied by publisher]
Fracture of Ceramic Liner and Head in a Total Hip Arthroplasty with a Sandwich Type Cup.
| Related Articles |
Fracture of Ceramic Liner and Head in a Total Hip Arthroplasty with a Sandwich Type Cup.
Case Rep Orthop. 2013;2013:291691
Authors: Reátegui D, García S, Bori G, Gallart X
Abstract
Due to its advantages, ceramic-on-ceramic bearings have been widely used in young patients for almost 30 years. Long-term survivorship, low wear, and low biological reactivity to particles are some of its characteristics. Even though this material has had a lot of improvements, the risk of fracture is one of the concerns. There have been reports of fracture of ceramic in the acetabular liner and head but no fractures of both in the same patient. We report a case of a fracture in a sandwich type acetabular liner and the ceramic head in a patient involving ankylosing spondylitis. It occurred three years after the operation and with no history of direct trauma. We decided to change the bearing surfaces to metal polyethylene without removing the metal back. The patient is satisfied by the clinical results after a 5-year followup.
PMID: 23691392 [PubMed - as supplied by publisher]
Hip Fractures in Persons with Stroke.
| Related Articles |
Hip Fractures in Persons with Stroke.
Stroke Res Treat. 2013;2013:954279
Authors: Andersson AG, Seiger A, Appelros P
Abstract
Background. Our aim was to determine the incidence of hip fractures within two years after stroke, to identify associated factors, to evaluate which test instruments that best could identify people at risk, and to describe the circumstances that prevailed when they sustained their hip fractures. Method. A total of 377 persons with first-ever stroke were followed up for a 24-month period. Stroke severity, cognition, and associated medical conditions were registered. The following test instruments were used: National Institutes of Health Stroke Scale, Mini-Mental State Examination, Berg Balance Scale, Timed Up & Go, and Stops Walking When Talking. Result. Sixteen of the persons fractured their hip within the study period, which corresponds to an incidence of 32 hip fractures per 1000 person-years. Persons with fractures more often had impaired vision and cognitive impairment and more had had previous fractures. Of the investigated test instruments, Timed Up & Go was the best test to predict fractures. Conclusion. The incidence of hip fractures in persons with stroke was high in this study. Persons with previous fractures, and visual and cognitive defects are at the greatest risk. Certain test instruments could be used in order to find people at risk, which should be targeted for fall preventive measures.
PMID: 23691433 [PubMed - as supplied by publisher]
Use of medical tourism for hip and knee surgery in osteoarthritis: a qualitative examination of distinctive attitudinal characteristics among Canadian patients.
  | Related Articles |
Use of medical tourism for hip and knee surgery in osteoarthritis: a qualitative examination of distinctive attitudinal characteristics among Canadian patients.
BMC Health Serv Res. 2012;12:417
Authors: Crooks VA, Cameron K, Chouinard V, Johnston R, Snyder J, Casey V
Abstract
BACKGROUND: Medical tourism is the term that describes patients' international travel with the intention of seeking medical treatment. Some medical tourists go abroad for orthopaedic surgeries, including hip and knee resurfacing and replacement. In this article we examine the findings of interviews with Canadian medical tourists who went abroad for such surgeries to determine what is distinctive about their attitudes when compared to existing qualitative research findings about patients' decision-making in and experiences of these same procedures in their home countries.
METHODS: Fourteen Canadian medical tourists participated in semi-structured phone interviews, all of whom had gone abroad for hip or knee surgery to treat osteoarthritis. Transcripts were coded and thematically analysed, which involved comparing emerging findings to those in the existing qualitative literature on hip and knee surgery.
RESULTS: Three distinctive attitudinal characteristics among participants were identified when interview themes were compared to findings in the existing qualitative research on hip and knee surgery in osteoarthritis. These attitudinal characteristics were that the medical tourists we spoke with were: (1) comfortable health-related decision-makers; (2) unwavering in their views about procedure necessity and urgency; and (3) firm in their desires to maintain active lives.
CONCLUSIONS: Compared to other patients reported on in the existing qualitative hip and knee surgery literature, medical tourists are less likely to question their need for surgery and are particularly active in their pursuit of surgical intervention. They are also comfortable with taking control of health-related decisions. Future research is needed to identify motivators behind patients' pursuit of care abroad, determine if the attitudinal characteristics identified here hold true for other patient groups, and ascertain the impact of these attitudinal characteristics on surgical outcomes. Arthritis care providers can use the attitudinal characteristics identified here to better advise osteoarthritis patients who are considering seeking care abroad.
PMID: 23170924 [PubMed - indexed for MEDLINE]
The significance of an asymmetric extension gap on routine radiographs after total knee replacement: A new sign and its clinical significance.
 | Related Articles |
The significance of an asymmetric extension gap on routine radiographs after total knee replacement: A new sign and its clinical significance.
Bone Joint J. 2013 Apr;95(4):472-7
Authors: Liebs TR, Kloos SA, Herzberg W, Rüther W, Hassenpflug J
Abstract
We investigated whether an asymmetric extension gap seen on routine post-operative radiographs after primary total knee replacement (TKR) is associated with pain at three, six, 12 and 24 months' follow-up. On radiographs of 277 patients after primary TKR we measured the distance between the tibial tray and the femoral condyle on both the medial and lateral sides. A difference was defined as an asymmetric extension gap. We considered three groups (no asymmetric gap, medial-opening and lateral-opening gap) and calculated the associations with the Western Ontario and McMaster Universities osteoarthritis index pain scores over time. Those with an asymmetric extension gap of ? 1.5 mm had a significant association with pain scores at three months' follow-up; patients with a medial-opening extension gap reported more pain and patients with a lateral-opening extension gap reported less pain (p = 0.036). This effect was still significant at six months (p = 0.044), but had lost significance by 12 months (p = 0.924). When adjusting for multiple cofounders the improvement in pain was more pronounced in patients with a lateral-opening extension gap than in those with a medial-opening extension gap at three (p = 0.037) and six months' (p = 0.027) follow-up.
PMID: 23539698 [PubMed - indexed for MEDLINE]
Mid-flexion laxity is greater after posterior-stabilised total knee replacement than with cruciate-retaining procedures: A computer navigation study.
| | Related Articles |
Mid-flexion laxity is greater after posterior-stabilised total knee replacement than with cruciate-retaining procedures: A computer navigation study.
Bone Joint J. 2013 Apr;95(4):493-7
Authors: Hino K, Ishimaru M, Iseki Y, Watanabe S, Onishi Y, Miura H
Abstract
There are several methods for evaluating stability of the joint during total knee replacement (TKR). Activities of daily living demand mechanical loading to the knee joint, not only in full extension, but also in mid-flexion. The purpose of this study was to compare the varus-valgus stability throughout flexion in knees treated with either cruciate-retaining or posterior-stabilised TKR, using an intra-operative navigation technique. A total of 34 knees underwent TKR with computer navigation, during which the investigator applied a maximum varus-valgus stress to the knee while steadily moving the leg from full extension to flexion both before and after prosthetic implantation. The femorotibial angle was measured simultaneously by the navigation system at every 10° throughout the range of movement. It was found that posterior-stabilised knees had more varus-valgus laxity than cruciate-retaining knees at all angles examined, and the differences were statistically significant at 10° (p = 0.0093), 20° (p = 0.0098) and 30° of flexion (p = 0.0252).
PMID: 23539701 [PubMed - indexed for MEDLINE]
D5 Creation