RESUMEN
BACKGROUND: In recent literature, the increasing number of medical litigations, both in terms of the number of cases being filed and the substantive costs associated with lawsuits, has been described. This study aims to provide an overview of the profile of litigation for orthopedic and trauma surgery to describe the differences and the development of the number of cases over time. PATIENTS AND MATERIALS: A retrospective review of all litigations between 2000 and 2017 was conducted using the institutional legal database. The causes of litigation were documented and classified into seven major categories. In addition to plaintiff characteristics, the litigation outcomes and the differences between emergency and elective surgery were analyzed. RESULTS: A total of 230 cases were evaluated. The mean age of the plaintiffs was 44.6 ± 20.1 years, and 56.8% were female. The main reasons for litigation were claimed inappropriate management (46.1%), misdiagnosis (22.6), and poor nursing care (8.3%). Significantly more litigations were filed against surgeons of the orthopedic subspecialty compared with trauma surgeons (78%; p ≤ 0.0001). There were significantly fewer litigations per 1000 cases filed overall in 2009-2017 (65% less; p = 0.003) than in 2000-2008. CONCLUSION: Our results could not confirm the often-stated trend of having more litigations against orthopedic and trauma surgeons. Although the absolute numbers increased, the number of litigations per 1000 patients treated declined. Patients who underwent elective surgery were more likely to file complaints than emergency patients.
Asunto(s)
Mala Praxis , Procedimientos Ortopédicos , Ortopedia , Cirujanos , Humanos , Femenino , Adulto Joven , Adulto , Persona de Mediana Edad , Masculino , Procedimientos Ortopédicos/efectos adversos , Bases de Datos FactualesRESUMEN
OBJECTIVE: Use of distal femur replacement implants in advanced bone defects after multiple bone-damaging revision surgery on the knee joint. INDICATIONS: Advanced femoral bone defects (AORI IIb and III defects) in revision arthroplasty of the knee joint. CONTRAINDICATIONS: Persistent or current joint infection, general infection, defect and/or nonreconstructable insufficient extensor apparatus. SURGICAL TECHNIQUE: Standard access including existing skin scars, arthrotomy, removal of cement spacer if necessary and removal of multiple tissue samples; preparation of tibia first to define the joint line, then preparation of the femur. Determining the resection height of the remaining femur corresponding to the preoperative planning. Gradual drilling using flexible medullary drills and then preparation by femoral rasps. Two stem systems are available for coupling to the distal femur (MUTARS). First there is the standard MUTARS stem (available lengths of 90, 120 and 160â¯mm); if longer shafts are required, so-called revision shaft (RS) stems are necessary (stems available in 150, 200 and 250â¯mm). In case of extensive femoral defects extension sleeves in different lengths can be used to reconstruct the femur. After preparation the implant position and the joint line height is checked. POSTOPERATIVE MANAGEMENT: Full weight bearing, in case of existing bony defects possibly partial load of a maximum of 10â¯kg für 6 weeks; regular wound control; limitation of the degree of flexion only with weakened or reconstructed extensor apparatus. RESULTS: Between February 2015 and August 2018, a total of 34 distal femurs were implanted. In 19 patients, the implantation was performed after septic and aseptic loosening of a knee prosthesis. All patients had an intraoperative AORI III defect of the femur. Of the 19 patients who underwent a distal femur implantation, 7 had to be revised due to a persistent infection; 4 of these 7 patients had to be revised several times and, finally, had a conversion to a knee arthrodesis. One patient had to undergo a revision with a stem change due to a secondary aseptic loosening of the cemented stem. The mean follow-up period was 11.2 months (range 4-29 months). The follow-up included clinical examination, KSS (Knee Society Score) and Xray analysis. A significant improvement in range of motion from 65⯱ 16° to 83⯱ 14° (pâ¯< 0.01) was noted. The KSS improved significantly from 69⯱ 9 points preoperatively to 115⯱ 15 points postoperatively. Four patients complained of persistent symptoms during exercise after 9 months; femoral shaft pain was denied by all patients. After about 11 months, an implant survival rate of 73.7% was observed in the patient collective.
Asunto(s)
Fémur , Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Humanos , Articulación de la Rodilla , Prótesis de la Rodilla , Reoperación , Resultado del TratamientoRESUMEN
OBJECTIVE: Optimal reconstruction of acetabular anatomy and primarily stable bridging even of large bone defects in hip revision surgery by intraoperative cementless application of highly modular components of the MRS-TITAN Comfort (MRS-C) system according to the augment-and-modular-cage principle. INDICATIONS: Acetabular defect situations in hip revision surgery, hereditary/acquired acetabular deformities, severe secondary hip osteoarthritis. CONTRAINDICATIONS: Extended periacetabular defects of the dorsal pillar, pelvic discontinuities, persisting posttraumatic or periprosthetic infections, lack of intraoperative bony anchorage options. SURGICAL TECHNIQUE: Conventional positioning. Flexible selection of approach (posterolateral, anterolateral or transgluteal) to the hip joint, if possible using a previous approach. Implant removal, preparation and intraoperative acetabular defect evaluation. Optional impaction bone grafting for biological downsizing. Selection of modular components and augments depending on the defect. Preparation of the obturator foramen for anchorage of the caudal flange. Optional preparation of the os ilium for additional fixation of the cage with flanges. Fixation with polyaxial screws and selection of version/inclination of the cup component. Selection of the inlay (polyethylene/ceramic). POSTOPERATIVE MANAGEMENT: Partial weight-bearing with 20â¯kg body-weight for 6 weeks with crutches. Prophylaxis for deep vein thrombosis and heterotopic ossification. Additional adapted antibiotic therapy in cases of infection. RESULTS: A minimum 1year follow-up of 42 patients showed significant improvements of Harris Hip Scores (pâ¯< 0.0001), adequate reconstruction of the physiologic center of rotation (x-ray controlled in the vertical plane, referenced to the contralateral side), and a clear reduction of preoperative leg length discrepancies. No significant changes in range of motion. No implant-associated complications noted. Based on the short follow-up results, the implant proves as suitable for reconstruction of even large acetabular bone defects.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Reoperación , Acetábulo , Artroplastia de Reemplazo de Cadera/métodos , Humanos , Falla de Prótesis , Resultado del TratamientoRESUMEN
BACKGROUND: The influence of trauma-related kinematics on the injury pattern of the cervical spine is currently not considered in the available classification systems, only the force vector. Whether the strength of the trauma has an additional influence on the number and complexity of the injuries and whether this can be classified, has not yet been finally investigated. OBJECTIVE: What influence do different kinematics apart from the traumatic force vector have on injuries of the cervical spine? MATERIAL AND METHODS: Based on the AOSpine classification system for the upper and subaxial cervical spine, data from 134 trauma patients from a first level trauma center were retrospectively analyzed. Analogue to the S3 guidelines on polytrauma, patients were assigned to six trauma groups and the injuries were classified on the basis of computed tomography (CT) cross-sectional imaging. RESULTS: A higher trauma energy had a significant impact on the number of cervical spine injuries (pâ¯= 0.005). In low velocity accidents C2 was the most frequently injured vertebra (51%; pâ¯= 0.022) and high velocity accidents showed more C7 fractures (37%; pâ¯= 0.017). Furthermore, upper cervical spine injuries occurred more often in low energy trauma and older female patients (e.g. falling from a standing position). Subaxial cervical spine involvement was found significantly more often in high velocity accidents and younger male patients (pâ¯= 0.012). CONCLUSION: Exact knowledge of the trauma mechanism is helpful in the primary treatment of an injured person. Injury patterns can be better estimated and the appropriate diagnostics can be initiated. The results underline the importance of immediate cervical spine immobilization even after minor trauma. In high velocity trauma, patients more often suffer from lower cervical spine injuries, especially C7. Due to the accumulation of multilevel spinal injuries in high velocity trauma, radiographic imaging of the whole spine is advisable.