RESUMEN
This study reviews the results of subtrochanteric femur fractures treated with a retrograde nail at a level 1 trauma center. Sixteen patients with 17 fractures were followed up until union. The average Injury Severity Score (ISS) was 19, and average knee range of motion was 127 degrees. Four patients required dynamization of their nail, and three healed over a prolonged period of time. Two patients required exchange nailing: one after failure of union after dynamization and one with a broken nail that was revised to an antegrade nailing. The average varus deformity was 5.06 degrees and only 35% of fractures healed in greater than 5 degrees of varus, with an average time to union of 22.4 weeks (range, 6-54 weeks). Antegrade nailing remains the treatment of choice for the vast majority of subtrochanteric femur fractures. However, retrograde femoral nailing may be an effective treatment option for some subtrochanteric fractures in a selected group of patients.
Asunto(s)
Fijación Intramedular de Fracturas/métodos , Fracturas de Cadera/cirugía , Adolescente , Adulto , Clavos Ortopédicos , Femenino , Estudios de Seguimiento , Fijación Intramedular de Fracturas/instrumentación , Fracturas de Cadera/diagnóstico por imagen , Humanos , Puntaje de Gravedad del Traumatismo , Articulación de la Rodilla/fisiología , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/diagnóstico , Selección de Paciente , Radiografía , Rango del Movimiento Articular , Estudios Retrospectivos , Factores de TiempoRESUMEN
OBJECTIVES: To evaluate the efficacy and patient satisfaction of office removal of tibial external fixators and to compare the cost of this procedure with the cost of removal of fixators in the operating room. DESIGN: A visual analog scale (VAS) and a questionnaire were answered by all patients after office external fixator removal. The treatment, complications, and costs were compared with those of patients having external fixator removal in the operating suite. SETTING: An urban orthopaedic trauma office with a Level I trauma center. PARTICIPANTS: Two similar groups of patients; thirty fixators removed in the office and twenty-nine fixators removed in the operating room. INTERVENTION: Office or operating room removal of tibial external fixators and application of a sterile dressing. A visual analog scale was answered by those patients who had office removal. MAIN OUTCOME MEASUREMENTS: Patient satisfaction and pain rating (VAS) with office removal of external fixators. Comparison of costs, infections, time in fixator, and surgical interventions between the office and operating room groups. RESULTS: Group I had thirty fixators (twenty-nine half-pin fixators) removed in the office. Group II had twenty-nine fixators removed in the operating room. Duration of time in the frame was not statistically different. Antibiotic usage during the fixator treatment period was 69 percent in both groups. On the visual analog scale, twenty-four members (80 percent) of the office fixator removal group rated the pain during removal as less than 25 percent of maximal, including nine (30 percent) who rated the removal as causing no pain. Cost analysis revealed an average cost of $248 for the office group versus $2,160 for the operating room group (p < 0.001). CONCLUSIONS: Due to the cost savings and patient satisfaction, without compromising clinical care, the office is our preferred location for tibial half-pin external fixator removal.
Asunto(s)
Atención Ambulatoria/economía , Ahorro de Costo/estadística & datos numéricos , Fijadores Externos/economía , Quirófanos/economía , Satisfacción del Paciente/estadística & datos numéricos , Fracturas de la Tibia/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Atención Ambulatoria/normas , Estudios de Evaluación como Asunto , Honorarios Médicos , Femenino , Precios de Hospital , Humanos , Masculino , Persona de Mediana Edad , Visita a Consultorio Médico/economía , Ohio , Quirófanos/normas , Fracturas de la Tibia/economía , Resultado del TratamientoRESUMEN
Fractures of a normal humeral shaft secondary to muscular violence have been uncommonly reported in the literature since the early 1900s. These injuries have been associated with throwing javelins, hand grenades, and baseballs. We report a case of a similar injury occurring in a healthy young amateur baseball pitcher. Pertinent anatomy, pathomechanics, and electromyographic study results are discussed.