RESUMEN
Hyponatraemia is common in hospitalised patients. In recent years the relationship between hyponatraemia and bone metabolism, falls and fractures has become more established. This study evaluates the prevalence of hyponatraemia (plasma sodium<135mmol/l) in 3897 patients undergoing operative treatment for hip fracture and the relationship between hyponatraemia and mortality in these patients. Hyponatraemia was an independent risk factor for increased post-operative mortality on multivariate analysis. Median age at admission was 83 years. Hyponatraemia was present in 19.1% of patients with hip fracture on admission, 29.5% of patients in the first 24h post-operatively and 20% of patients at discharge. There was a significant association between hyponatraemia and time from admission to surgery indicating that patients admitted with hyponatraemia waited longer. The median follow-up time was 863 (range 0-4352) days. There were 2460 deaths (63.1% of the original 3897 patients) prior to the censor date. A total of 1144 patients (29.4% of the original 3897 patients) died within 12 months of discharge. Median time to death for patients with and without hyponatraemia on admission was 34 months (SE 1.7 months) and 41 months (SE 2.5 months) respectively (p=0.003). Median time to death for patients with and without hyponatraemia within 24h post-operatively was 35 months (SE 2.5 months) and 42 months (SE 1.7 months) respectively (p=0.004). Following elimination of other independent variables associated with increased mortality, hyponatraemia on admission was associated with an increased risk of death (adjusted HR 1.15, p=0.005). Post-operative hyponatraemia was also associated with an increased risk of death (adjusted HR 1.15, p=0.006). Trends suggested that hyponatraemia within 48h of discharge was associated with an increased risk of death (adjusted HR 1.15, p=0.636). Hyponatraemia is common in elderly patients with hip fractures both at initial presentation and during admission. In this vulnerable patient group, hyponatraemia may delay time to definitive surgery and is a potentially reversible cause of increased post-operative mortality. Every effort should be made to identify and correct hyponatraemia in hip fracture patients.
Asunto(s)
Fracturas de Cadera/mortalidad , Hiponatremia/mortalidad , Anciano de 80 o más Años , Biomarcadores/sangre , Femenino , Fracturas de Cadera/sangre , Fracturas de Cadera/cirugía , Mortalidad Hospitalaria , Hospitalización , Humanos , Hiponatremia/sangre , Hiponatremia/diagnóstico , Masculino , Periodo Posoperatorio , Guías de Práctica Clínica como Asunto , Valor Predictivo de las Pruebas , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Reino Unido/epidemiologíaRESUMEN
This study examines stress radiograph use in SER IV ankle fracture fixation; the efficacy of external rotation (ERST) and lateral hook (LHST) stress tests with incidence of subsequent fixation failure secondary to syndesmotic diastasis. 154 skeletally mature patients were admitted to our unit with ankle fractures in 12 months. 42 non-SER fractures and 32 SER fractures treated without ORIF were excluded, as were 14 which featured a syndesmotic screw in the primary ORIF. The remaining 66 SER IV fixations were included in the final sample (17 men, 49 women; median age 49 years). No stress test was performed in 51.5% of cases without a single subsequent failure in these fixations. ERST was the more commonly performed test (incidence 30.3%); negative predictive value (NPV) 0.95. Incidence of LHST was 18.2%; NPV 0.83. Both tests were performed in 6.1% of cases; NPV 0.75. The incidence of failure secondary to syndesmotic diastasis was 6.1% (4/66). Notably, there were no failures in the cases where no stress test was performed. Use of either or both external rotation and lateral hook stress tests resulted in failures to detect syndesmotic diastasis with consequent failure of fixation. This study suggests that syndesmotic injuries are not missed due to an absence of a stress test but that stress tests are not sufficiently sensitive or correctly interpreted. Clinical judgement in cases where syndesmotic injury is not present appears accurate. If syndesmotic injury is clinically suspected, apply caution and insert a syndesmotic screw rather than relying on stress test results.
Asunto(s)
Fracturas de Tobillo/fisiopatología , Prueba de Esfuerzo/métodos , Fijación Interna de Fracturas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Fracturas de Tobillo/cirugía , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Rotación , Supinación , Adulto JovenRESUMEN
The prevalence of Parkinson's disease is expected to rise. We evaluated the short-term clinical outcomes following primary Total Knee Arthroplasty (TKA) in a group of patients with Parkinson's disease in a case controlled study. Within the review period 32 TKAs were implanted in patients with Parkinson's disease and 33 TKAs were implanted in an age-matched control group (mean age: 73 years). Pre-operatively there were no between-group differences in Knee Society Score, Pain score, Knee Society Function Score or range of movement. Knee Society Score (KSS) improved in both groups post-operatively with no significant between-group differences (p = 0.707). Pain score also improved in both groups. There was no functional improvement following TKA in the Parkinson group. Total Knee Arthroplasty provided excellent pain relief in patients with Parkinson's disease with an acceptable complication profile, although functional ability did not improve.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Enfermedad de Parkinson/cirugía , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/cirugía , Dolor Postoperatorio/epidemiología , Rango del Movimiento Articular , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Lateral ankle ligaments are injured by hyperinversion of the foot. Foot position is controlled by the lower limb muscles. Awareness of foot position is impaired by wearing shoes. We aimed to determine the influence of wearing shoes upon muscle activity. Sixty-two healthy subjects underwent the same measurements, barefoot and with standardized shoes in a random order. Electromyography (EMG) was recorded from the peroneus longus muscle in response to sudden and unanticipated inversion of the ipsilateral foot. Following foot inversion, the EMG signal showed an initial peak muscle contraction followed by a sustained smaller contraction. Both changes were significantly greater in shoes compared to the barefoot condition for all tested degrees of inversion. Muscle contraction following sudden inversion of the foot was significantly greater when wearing shoes. This greater muscular contraction may be an intrinsic mechanism to oppose the increased moment created by the inverted foot/shoe condition, and hence, may counter balance the increased tendency to injure the lateral ankle ligaments created by wearing shoes.