Journal of Bone and Joint Surgery-british Volume最新文献

{"title":"PRE VERSUS POST-OPERATIVE INITIATION OF WARFARIN THERAPY IN PATIENTS UNDERGOING TOTAL HIP AND KNEE ARTHROPLASTY","authors":"C. Cipriano, Nicholas J Erdle, Kai Li, B. Curtin","doi":"10.4172/2167-7921.1000156","DOIUrl":"https://doi.org/10.4172/2167-7921.1000156","url":null,"abstract":"Background The optimal strategy for postoperative deep venous thrombosis (DVT) prophylaxis remains among the most controversial topics in hip and knee arthroplasty. Warfarin, the most commonly used chemical anticoagulant, initially causes transient hypercoagulability; however the optimal timing of treatment with respect to surgery remains unclear. Our purpose was to evaluate the effects of pre- versus postoperative initiation of warfarin therapy with a primary endpoint of perioperative change in hemoglobin (pre- minus post-operative level), with secondary endpoints of postoperative International Normalized Ratio (INR), drain output, and bleeding/thrombotic events. Methods A quasi-experimental study design was employed, under which patients were assigned to begin taking warfarin the night prior to surgery or the night following surgery based on day of the week seen in clinic. An a priori power analysis was conducted in order to ensure appropriate enrollment to detect a 0.5 g/dL difference in perioperative change in hemoglobin between groups, given an alpha level of 0.05 and beta of 0.80. Based on the results, the study included all primary, elective total hip and knee arthroplasties performed by a single surgeon over a 12 month period. Fifteen patients were excluded (7 chronic anticoagulation, 3 hip fractures, 2 medical contraindications, 3 simultaneous procedures), leaving 165 cases (108 hips, 57 knees) available for study. Of these, 73 received warfarin preoperatively (49 hips, 24 knees) and 92 postoperatively (59 hips, 33 knees). Warfarin was dosed according to a standard nomogram in both groups. INR (on postoperative days 1 and 2), perioperative decrease in hemoglobin (difference between level preoperatively and on postoperative days 1 and 2), and drain outputs were compared between groups using a student t test. Adverse events (transfusions, hematomas, epidural complications, and pulmonary embolus) were compared using two-tailed Fischer9s exact test. Results No statistically significant difference in perioperative hemoglobin change was observed between treatment groups on either postoperative day 1 (mean 3.279 versus 3.377, p=0.6824) or 2 (mean 4.0 versus 4.12, p=0.6831). As expected, the preoperative warfarin group demonstrated higher INRs on both postoperative days 1 (mean 1.18 versus 1.12, p=0.0023) and 2 (mean 1.46 versus 1.31, p=0.0006). Of note, preoperative warfarin dosing was also associated with significantly lower drain outputs (mean 185.4 versus 268.7, p=0.0025). 9 transfusions (4 preoperative dosing, 5 postoperative dosing), 3 hematomas (1 preoperative dosing, 2 postoperative dosing), and 1 pulmonary embolus (preoperative dosing) occurred, but no significant difference could be detected given the numbers available for study. Conclusions Initiation of warfarin pre- rather than postoperatively was not associated with a significant difference in perioperative hemoglobin change, although a significant reduction in drain output was obs","PeriodicalId":15048,"journal":{"name":"Journal of Bone and Joint Surgery-british Volume","volume":"1 1","pages":"85-85"},"PeriodicalIF":0.0,"publicationDate":"2015-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74884204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"THE ORTHOPAEDIC CONSEQUENCES OF CHILDHOOD MENINGOCOCCAL SEPTICAEMIA","authors":"T. Edwards, L. Bowen, F. Bintcliffe, J. Aird, F. Monsell","doi":"10.4172/2572-2050.1000109","DOIUrl":"https://doi.org/10.4172/2572-2050.1000109","url":null,"abstract":"The aim of this study is to use a defined population of patients with meningococcal septicaemia to calculate the incidence of orthopaedic complications. Medical records and radiographs were analyzed retrospectively for all patients admitted to the Paediatric Intensive Care Unit (PICU) of the Bristol Royal Hospital for Children from 01/01/2001 to 31/12/2012 with meningococcal septicaemia. Of the 130 patients with meningococcal septicaemia alive at discharge, 10 developed orthopaedic sequelae, representing an overall incidence in this patient population of 7.7%. 9 patients required an amputation, mostly in the lower limb, 16/22 (72.7%). 48 growth plate abnormalities were identified in 8 patients. 39 (81.3%) The most commonly affected was the distal tibia (38.5%). 10 ankles were identified as having a varus malalignment. 6 patients had documented leg length discrepancy Using a clearly defined denominator this study has identified an incidence of orthopaedic sequelae following meningococcal septicaemia of 7.7%. The National Institute for Clinical Excellence (NICE) suggested that the incidence of growth disturbance is approximately 3%. This study highlights the underestimation of orthopaedic complications following meningococcal septicaemia. Close follow up of at risk patients should be considered to reduce the potential impact of these debilitating injuries.","PeriodicalId":15048,"journal":{"name":"Journal of Bone and Joint Surgery-british Volume","volume":"5 1","pages":"15-15"},"PeriodicalIF":0.0,"publicationDate":"2015-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84120709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exam Corner – December 2014","authors":"V. Khanduja","doi":"10.1302/0301-620X.96B12.35367","DOIUrl":"https://doi.org/10.1302/0301-620X.96B12.35367","url":null,"abstract":"The FRCS (Tr & Orth) examination has three components: MCQs, Vivas and\u0000 Clinical Examination. The Vivas are further divided into four sections\u0000 comprising Basic Science, Adult Pathology, Hands and Children’s\u0000 Orthopaedics and Trauma. The Clinical Examination section is divided into Upper\u0000 and Lower limb cases. The aim of this section in the Journal is to focus\u0000 specifically on the trainees preparing for the exam and to cater to all the\u0000 sections of the exam. The vision is to complete the cycle of all relevant exam\u0000 topics (as per the syllabus) in four years.","PeriodicalId":15048,"journal":{"name":"Journal of Bone and Joint Surgery-british Volume","volume":"40 1","pages":"1715-1716"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77695376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exam Corner – November 2014","authors":"V. Khanduja","doi":"10.1302/0301-620X.96B11.35206","DOIUrl":"https://doi.org/10.1302/0301-620X.96B11.35206","url":null,"abstract":"The FRCS (Tr & Orth) examination has three components: MCQs, Vivas and\u0000 Clinical Examination. The Vivas are further divided into four sections\u0000 comprising Basic Science, Adult Pathology, Hands and Children’s\u0000 Orthopaedics and Trauma. The Clinical Examination section is divided into Upper\u0000 and Lower limb cases. The aim of this section in the Journal is to focus\u0000 specifically on the trainees preparing for the exam and to cater to all the\u0000 sections of the exam. The vision is to complete the cycle of all relevant exam\u0000 topics (as per the syllabus) in four years.","PeriodicalId":15048,"journal":{"name":"Journal of Bone and Joint Surgery-british Volume","volume":"45 1","pages":"1571-1572"},"PeriodicalIF":0.0,"publicationDate":"2014-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82798645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exam Corner – October 2014","authors":"V. Khanduja","doi":"10.1302/0301-620X.96B10.35002","DOIUrl":"https://doi.org/10.1302/0301-620X.96B10.35002","url":null,"abstract":"The FRCS (Tr & Orth) examination has three components: MCQs, Vivas and Clinical Examination. The Vivas are further divided into four sections comprising Basic Science, Adult Pathology, Hands and Children’s Orthopaedics and Trauma. The Clinical Examination section is divided into Upper and Lower limb cases. The aim of this section in the Journal is to focus specifically on the trainees preparing for the exam and to cater to all the sections of the exam. The vision is to complete the cycle of all relevant exam topics (as per the syllabus) in four years.","PeriodicalId":15048,"journal":{"name":"Journal of Bone and Joint Surgery-british Volume","volume":"29 1","pages":"1427-1428"},"PeriodicalIF":0.0,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83684165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RAPID MOBILISATION FOLLOWING TOTAL HIP AND KNEE ARTHROPLASTY","authors":"B. Dower, K. J. M. Intyre, G. Grobler, M. Nortje","doi":"10.17159/2309-8309/2017/V16N2A8","DOIUrl":"https://doi.org/10.17159/2309-8309/2017/V16N2A8","url":null,"abstract":"Background Rapid mobilisation programs, or “fast track” protocols, are aimed at shorter hospital stays. We found a limited local experience with these programs in total hip arthroplasty in South Africa, and decided to introduce a pilot study at our institution. Purpose This pilot study is aimed at the feasibility and safety of a RM program in the private sector setting, as well as a review of the pertinent literature. Methods 40 patients who met inclusion criteria underwent THR and TKR according to a specific protocol. Key aspects of the protocol included: minimum use of opiates, high volume pericapsular local block at time of surgery, no urinary catheter, mobilisation within 6 hrs of surgery and no high care admission. Target Discharge was 3 days. Patients were followed up retrospectively and outcomes included; length of stay, intra- and post-operative complications, subjective patient experience, re-admissions and re-operations. Results 36 patients, (90 %), were discharged by day 3, 4 patients were discharged at day 4. Mean stay 2,8 days, shortest 2 days, and longest 4 days. 3 elderly female patients required catheterization for urinary incontinence, on the first night post surgery. No complications were experienced. The problems that prevented discharge within 3 days were post operative pain and orthostatic hypotension. There were no re-admissions or re-operations. One TKR required manipulation at 6 weeks. 5 patients required changes of dressings at home within one week post surgery. All the patients in this study were extremely satisfied. Conclusion A rapid mobilisation program is relatively easy to implement although extra paramedical staff input is required. The results of this pilot study show that the protocol was effective and safe, as well as showing a significant hospital cost reduction. The obvious saving of costs are encouraging us to implement the protocol on a wider scale. Appendix Lorem ipsum dolor sit amet, ligula suspendisse nulla pretium, rhoncus tempor placerat fermentum, enim integer ad vestibulum volutpat. Nisl rhoncus turpis est, vel elit, congue wisi enim nunc ultricies sit, magna tincidunt. Maecenas aliquam maecenas ligula nostra, accumsan taciti. Sociis mauris in integer, a dolor netus non dui aliquet, sagittis felis sodales, dolor sociis mauris, vel eu libero cras. Interdum at. Eget habitasse elementum est, ipsum purus pede porttitor class, ut adipiscing, aliquet sed auctor, imperdiet arcu per diam dapibus libero duis. Enim eros in vel, volutpat nec pellentesque le NO DISCLOSURES","PeriodicalId":15048,"journal":{"name":"Journal of Bone and Joint Surgery-british Volume","volume":"38 1","pages":"36-36"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79472497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exam Corner – September 2014","authors":"V. Khanduja","doi":"10.1302/0301-620X.96B9.34876","DOIUrl":"https://doi.org/10.1302/0301-620X.96B9.34876","url":null,"abstract":"The FRCS (Tr & Orth) examination has three components: MCQs, Vivas and\u0000 Clinical Examination. The Vivas are further divided into four sections\u0000 comprising Basic Science, Adult Pathology, Hands and Children’s\u0000 Orthopaedics and Trauma. The Clinical Examination section is divided into Upper\u0000 and Lower limb cases. The aim of this section in the Journal is to focus\u0000 specifically on the trainees preparing for the exam and to cater to all the\u0000 sections of the exam. The vision is to complete the cycle of all relevant exam\u0000 topics (as per the syllabus) in four years.","PeriodicalId":15048,"journal":{"name":"Journal of Bone and Joint Surgery-british Volume","volume":"34 1","pages":"1283-1284"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74608356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AMPUTATION RATE FOLLOWING TIBIAL FRACTURES WITH ASSOCIATED POPLITEAL ARTERY INJURIES","authors":"M. Roussot, M. Held, S. Roche, S. Maqungo","doi":"10.17159/2309-8309/2016/V15N3A4","DOIUrl":"https://doi.org/10.17159/2309-8309/2016/V15N3A4","url":null,"abstract":"Purpose We aim to determine the amputation rate and identify predictors of outcome in patients with tibial fractures and associated popliteal artery injuries at a level 1 trauma unit draining a large geographical region. Material and methods All patients with popliteal artery injuries and tibial fractures treated at a level 1 trauma unit between 1999 and 2010 were assessed retrospectively regarding amputation rates and prognostic factors and tested for significance with a Z-test of proportions. Results Thirty consecutive patients were reviewed with a mean age of 30.5 years and a male preponderance of 73.3%. Motor vehicle accidents (MVAs) and gunshot wounds (GSWs) constituted the mechanism of injury in 17 patients (56.7%) and 11 patients (36.7%) respectively. Twenty-one cases were polytrauma patients. Intra and extra-articular metaphyseal fractures (AO 41 A-C) were seen in 19 patients and diaphyseal fractures (42 A-C) in 7 patients. Primary amputation was performed in 7 patients and delayed amputation in 10 patients giving an overall amputation rate of 56.7%. Amputation rates in MVAs and GSWs were similar (57.9% and 54.5% respectively). Delays from injury to revascularization of more than 6 hours, delays from hospital admission to revascularization of more than 2 hours and initial clinical assessment of non-viability were associated with higher rates of limb loss of 60.9%, 62.5% and 60% respectively. Signs of threatened viability together with delay from admission to theatre more than 2 hours showed the highest amputation rate of 68,4%. These results are trends and not statistically significant with 95% confidence interval. Conclusion More than half of the patients with these injuries required amputation. Predictors of amputation remain elusive; however, these results suggest that initial presentation of a threatened limb in the context of a tibial fracture may necessitate intervention within the first 2 hours of presentation in order to improve the outcome NO DISCLOSURES","PeriodicalId":15048,"journal":{"name":"Journal of Bone and Joint Surgery-british Volume","volume":"25 1","pages":"13-13"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88181834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exam Corner – August 2014","authors":"V. Khanduja","doi":"10.1302/0301-620X.96B8.34674","DOIUrl":"https://doi.org/10.1302/0301-620X.96B8.34674","url":null,"abstract":"The FRCS (Tr & Orth) examination has three components: MCQs, Vivas and\u0000 Clinical Examination. The Vivas are further divided into four sections\u0000 comprising Basic Science, Adult Pathology, Hands and Children’s\u0000 Orthopaedics and Trauma. The Clinical Examination section is divided into Upper\u0000 and Lower limb cases. The aim of this section in the Journal is to focus\u0000 specifically on the trainees preparing for the exam and to cater to all the\u0000 sections of the exam. The vision is to complete the cycle of all relevant exam\u0000 topics (as per the syllabus) in four years.","PeriodicalId":15048,"journal":{"name":"Journal of Bone and Joint Surgery-british Volume","volume":"83 1","pages":"1139-1140"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77528107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exam Corner – July 2014","authors":"V. Khanduja","doi":"10.1302/0301-620X.96B7.34527","DOIUrl":"https://doi.org/10.1302/0301-620X.96B7.34527","url":null,"abstract":"The FRCS (Tr & Orth) examination has three components: MCQs, Vivas and\u0000 Clinical Examination. The Vivas are further divided into four sections\u0000 comprising Basic Science, Adult Pathology, Hands and Children’s\u0000 Orthopaedics and Trauma. The Clinical Examination section is divided into Upper\u0000 and Lower limb cases. The aim of this section in the Journal is to focus\u0000 specifically on the trainees preparing for the exam and to cater to all the\u0000 sections of the exam. The vision is to complete the cycle of all relevant exam\u0000 topics (as per the syllabus) in four years.","PeriodicalId":15048,"journal":{"name":"Journal of Bone and Joint Surgery-british Volume","volume":"11 1","pages":"995-996"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75092040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}