RESUMEN
The incidence of acetabular fractures in the geriatric population is growing, yet the optimal treatment algorithm remains a controversial topic among orthopaedic surgeons. This review highlights key studies published over the past 5 years on the outcomes of various treatment options for geriatric acetabular fractures. Topics include surgical timing, mortality and risk factors, nonoperative treatment, open reduction internal fixation, and acute total hip arthroplasty.
Asunto(s)
Acetábulo , Fracturas de Cadera , Acetábulo/cirugía , Anciano , Fijación Interna de Fracturas/efectos adversos , Fracturas de Cadera/epidemiología , Fracturas de Cadera/cirugía , Humanos , Reducción Abierta/efectos adversos , Resultado del TratamientoRESUMEN
The population of Hawai'i is uniquely connected to the Ocean and to open water sports. Shoulder injuries, particularly those to the rotator cuff, are among the most common injuries sustained to athletes participating in ocean sports such as surfing, paddling, and swimming. In addition, rotator cuff injuries increase in prevalence with advanced age. As a consequence, the number of patients in Hawai'i who present with an injury to the subscapularis tendon will continue to rise. However, limited research has been done to delineate the involvement of subscapularis injuries in this population. This article covers the anatomy and function of the subscapularis, the epidemiology and classification of tears in this tendon, and the management of tears. The anatomy section will cover innervation, vascular supply and insertional anatomy of the subscapularis tendon. The function of the subscapularis in regards to both stability and motion of the glenohumeral joint will be examined. The focus of the article will then shift to the tears of the subscapularis, starting with an in depth look at the epidemiology and classification of these tears. The article will then cover the different imaging modalities and their utility in regards to subscapularis tears. Finally, the operative and non-operative management and indications for each modality will be discussed in detail.
Asunto(s)
Lesiones del Manguito de los Rotadores , Articulación del Hombro , Traumatismos de los Tendones , Hawaii , Humanos , Manguito de los Rotadores/cirugía , Lesiones del Manguito de los Rotadores/epidemiología , Lesiones del Manguito de los Rotadores/terapia , Traumatismos de los Tendones/cirugíaRESUMEN
Counseling patients regarding when to return to driving following a foot and ankle procedure can be difficult, and 6 to 9 weeks is often recommended based on brake reaction times quoted in the literature. However, patients are ultimately responsible for the decision to drive. We aimed to determine when patients actually return to driving following outpatient foot and ankle surgery, what influences their decision, and whether any adverse events were experienced. Thirty-seven patients who underwent a right-sided foot and ankle procedure by a single orthopedic surgeon in an outpatient surgery center between September 2016 and December 2017 were recruited retrospectively for this study. Seventeen patients met inclusion criteria and participated in a telephone survey that inquired about their experiences and attitudes regarding return to driving following right-sided foot or ankle surgery. Of the patients surveyed, 100% drove a motor vehicle as their primary mode of transportation. Ten patients (59%) recalled having a discussion with the surgeon regarding when to resume driving, of which only 4 (23.5%) returned to driving at the suggested time they remembered. One patient (6%) returned to driving 2 weeks sooner, and 1 patient (6%) returned to driving 4 weeks later than recommended. No patient reported experiencing a driving-related adverse event. This study suggests that despite surgeons' recommendations, patients are returning to driving sooner than traditionally recommended. The surgeon's advice regarding when to return to driving may not be as influential as a patient's own self-assessment of their readiness to operate a vehicle after outpatient foot and ankle surgery.
Asunto(s)
Tobillo , Conducción de Automóvil , Tobillo/cirugía , Humanos , Pacientes Ambulatorios , Tiempo de Reacción , Estudios RetrospectivosRESUMEN
We study the impact of a public school choice lottery in Charlotte-Mecklenburg schools on college enrollment and degree completion. We find a significant overall increase in college attainment among lottery winners who attend their first choice school. Using rich administrative data on peers, teachers, course offerings and other inputs, we show that the impacts of choice are strongly predicted by gains on several measures of school quality. Gains in attainment are concentrated among girls. Girls respond to attending a better school with higher grades and increases in college-preparatory course-taking, while boys do not.
Asunto(s)
Infecciones por Chlamydophila/diagnóstico , Chlamydophila pneumoniae , Prótesis de Cadera/efectos adversos , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Mycobacterium chelonae , Infecciones Relacionadas con Prótesis/diagnóstico , Antibacterianos/administración & dosificación , Prótesis de Cadera/microbiología , Humanos , Masculino , Persona de Mediana Edad , Prótesis e ImplantesRESUMEN
A retrospective review of 10 patients admitted to 4 regional hospitals between 1987 and 1997 in whom acute septic hip arthritis was diagnosed was performed to compare presentation, laboratory and radiographic findings, treatment, and outcome. Patients presented with fever, hip or groin pain, and an inability to bear weight. Most patients manifested a leukocytosis, and all patients had an elevated erythrocyte sedimentation rate. Hematogenous septic hip arthritis is rare. The consequences of a missed diagnosis are serious and include death. Clinical examination combined with appropriate laboratory and radiographic studies leads to prompt diagnosis and treatment.