RESUMEN
We present the case of an isolated extensor hallucis longus compartment syndrome following a diaphyseal fibular fracture. Our subject underwent syndesmotic fixation and experienced ongoing pain post-procedure. This was associated with an isolated loss of power in extension of the hallux. A diagnosis of an isolated extensor hallucis longus compartment syndrome followed. Our case highlights the vulnerability of this muscle belly to ischemia and reiterates the value of complete clinical examination in the postoperative patient.
RESUMEN
Secondary pharmaceutical measures are effective in all age groups for the prevention of osteoporotic fractures. This prospective study determines the demographics of 566 consecutive osteoporotic hip fractures presenting to a Level 1 Trauma Center. We examine the efficacy of simple treatment recommendations for pharmaceutical treatment of osteoporosis and the factors determining general practitioner and patient compliance with these recommendations in a community setting. One out of four patients (24.5%) had sustained a previous fragility fracture. Mean age was 80 years. Twenty five percent were resident in a nursing home and only 10% were taking anti-resorptive therapy preoperatively. In hospital mortality was 6%, and 39% of recruited patients were dead at 12 months. By this time more than half the survivors were resident in a nursing home. The compliance with anti-resorptive therapy had increased to over 70% consequent to our simple recommendations. Significant differences in GP and patient compliance were observed between nursing home and own residence dwellers. This study demonstrates the efficacy of a simple clinical practice intervention in increasing patient and GP compliance with secondary fracture prevention measures. We also discuss many of the confounding issues determining this compliance.
Asunto(s)
Fracturas de Cadera/prevención & control , Osteoporosis/tratamiento farmacológico , Cooperación del Paciente , Anciano , Anciano de 80 o más Años , Medicina Familiar y Comunitaria , Femenino , Fracturas de Cadera/etiología , Humanos , Masculino , Osteoporosis/complicaciones , Estudios Prospectivos , RecurrenciaRESUMEN
We conducted a retrospective, clinical and radiological study of fixation with a single screw in slipped upper femoral epiphysis. Forty children (53 hips) who had a slipped upper femoral epiphysis were managed by in-situ pinning with a single cannulated screw. The average age of these patients was 12.7 years and their average weight was above the 50th centile at the time of diagnosis. There were three acute slips, eight acute-on-chronic slips and 35 chronic slips. They were followed for an average of 2 years. Fifty-eight percent of patients had an excellent clinical result, 36% a good result, 4% a fair result and 2% a poor result. The complication rate was 5.3%. Our experience with single cannulated screw fixation of slipped upper femoral epiphysis is encouraging. No complications resulted from the choice of the fixation device.