RESUMEN
The original version of this article unfortunately contained a mistake. The spelling of the name 'Valerio Bochicchio' was incorrect.
RESUMEN
To estimate the effect of delay to surgery for hip fracture on 30-day mortality using a risk adjustment strategy to control for the effect of demographic and clinical confounders. This observational study was carried out on all patients admitted with a hip fracture and discharged between January 2004 and December 2007 from a teaching hospital. Gender, age, time to surgery, mortality and medical comorbidities were derived from hospital discharge records (SDO), while International Normalised Ratio (INR) and American Society of Anaesthesiologists (ASA) score were retrieved from clinical records. Backward stepwise logistic regression was used to identify potential confounders in the relationship between time to surgery and mortality. A final multivariate logistic regression analysis was carried out controlling for the effect of confounders. In the 1320 patients who underwent surgery (mean age = 83 years, % female = 76.8%), time to surgery was two days or less in 746 (56.5%) patients and 30-day mortality was 3.5%. The interventions included partial or total hip replacement (N=820, 62.1%) and reduction and internal fixation (N=500, 37.9%). Multivariate logistic regression analysis showed that patients with a time to surgery greater than two days had a 2-fold increase in 30-day mortality after adjusting for age, gender, and comorbidity (OR=1.992, 95% CI 1.065-3.725). In a second model also including ASA score the odd ratio decreased to 1.839 (95% CI 0.971-3.486). Patients with a hip fracture should have surgery within two days from admission in order to reduce 30-day mortality.
Asunto(s)
Artroplastia de Reemplazo de Cadera/mortalidad , Fijación Interna de Fracturas/mortalidad , Fracturas de Cadera/mortalidad , Fracturas de Cadera/cirugía , Anciano de 80 o más Años , Comorbilidad , Femenino , Hospitales de Enseñanza , Humanos , Italia/epidemiología , Masculino , Complicaciones Posoperatorias , Pronóstico , Tasa de Supervivencia , Factores de Tiempo , Resultado del TratamientoRESUMEN
The aim of our study was to construct an algorithm for the pre-operative diagnosis of infection in total knee arthroplasty. We analyzed the currently used parameters in a consecutive series of 31 patients with failed implants. An outcome of at least 2 years was prospectively considered to validate our algorithm. Patient history, imaging, laboratory studies, histology, pre- and intra-operative cultures were considered. The optimal cutoffs of the inflammation tests for diagnosing infection were determined by constructing the receiver operating-characteristic curves. Sensitivity, specificity and accuracy of these tests as infection markers were determined. The combination of at least two tests with values higher than the cutoffs is reliable for predicting the infection. Scintigraphy, needle-aspirate cell count and culture can integrate the pre-operative evaluation. Doubtful cases can be clarified by microbiological and histological analyses. As a result an algorithm helpful to identify the cause of loosening has been developed. In our opinion, adherence to this algorithm could contribute to preoperatively define a rational surgical and antibiotic treatment strategy.
Asunto(s)
Algoritmos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Índice de Severidad de la Enfermedad , Infección de la Herida Quirúrgica/diagnóstico , Adulto , Anciano , Sedimentación Sanguínea , Proteína C-Reactiva/análisis , Falla de Equipo , Femenino , Fibrinógeno/análisis , Humanos , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Fragmentos de Péptidos/análisis , Valor Predictivo de las Pruebas , ReoperaciónRESUMEN
We report a very rare association of a physeal fracture of the medial clavicular growth plate with a fracture of the adjacent clavicle in a 14-year-old boy who fell on his shoulder while playing football. Clinical, radiographic and computed tomographic (with three-dimensional reconstruction) features are described. Open reduction, internal fixation of the lateral fracture (with a reconstructive plate) and suture of the periosteum were performed.