RESUMEN
OBJECTIVES: To estimate 1-year mortality rates in elderly patients who undergo operative treatment for distal femur fractures and identify potential risk factors for mortality. DESIGN: Retrospective chart review. SETTING: Level 1 and Level 2 trauma centers. PATIENTS/PARTICIPANTS: Two hundred eighty-three elderly patients (average age 76.0 years ± 9.8) who sustained distal femur fractures between 2002 and 2012. INTERVENTION: Fracture fixation of the distal femur. MAIN OUTCOME MEASURE: Survival up to 1 year after surgery. RESULTS: The 1-year mortality rate for distal femur fractures in elderly patients was 13.4%. There were no statistically significant differences in overall mortality between native bone and periprosthetic fractures, intramedullary nail or open reduction internal fixation, or across Orthopaedic Trauma Association fracture classifications. Overall patient mortality was significantly higher at 30 days (P = 0.036), 6 months (P = 0.019), and 1 year (P = 0.018), when surgery occurred more than 2 days from the injury. Mean Charlson Comorbidity Index scores were significantly lower in survivors versus nonsurvivors at all time intervals (30 days, P = 0.023; 6 months, P = 0.001 and 1 year P ≤ 0.001). A time to surgery of more than 2 days, regardless of baseline illness, did not result in improved survivability at 1 year. CONCLUSIONS: Overall mortality for distal femur fractures was 13.4% in the elderly population. A surgical treatment more than 2 days after injury was associated with increased patient mortality. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Asunto(s)
Fracturas del Fémur/mortalidad , Fijación de Fractura/mortalidad , Anciano , Anciano de 80 o más Años , Femenino , Fracturas del Fémur/epidemiología , Fracturas del Fémur/cirugía , Fijación de Fractura/métodos , Humanos , Masculino , Persona de Mediana Edad , Fracturas Osteoporóticas/epidemiología , Fracturas Osteoporóticas/mortalidad , Fracturas Osteoporóticas/cirugía , Fracturas Periprotésicas/epidemiología , Fracturas Periprotésicas/mortalidad , Fracturas Periprotésicas/cirugía , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Tiempo de Tratamiento/estadística & datos numéricosRESUMEN
INTRODUCTION: This study compared bone transport to acute shortening/lengthening in a series of infected tibial segmental defects from 3 to 10cm in length. METHODS: In a retrospective comparative study 42 patients treated for infected tibial non-union with segmental bone loss measuring between 3 and 10cm were included. Group A was treated with bone transport and Group B with acute shortening/lengthening. All patients were treated by Ilizarov methods for gradual correction as bi-focal or tri-focal treatment; the treating surgeon selected either transport or acute shortening based on clinical considerations. The principle outcome measure was the external fixation index (EFI); secondary outcome measures included functional and bone results, and complication rates. RESULTS: The mean size of the bone defect was 7cm in Group A, and 5.8cm in Group B. The mean time in external fixation in Group A was 12.5 months, and in Group B was 10.1 months. The external fixation index (EFI) measured 1.8 months/cm in Group A and 1.7 months/cm in Group B (P=0.09). Minor complications were 1.2 per patient in the transport group and 0.5 per patient in the acute shortening group (P=0.00002). Major complications were 1.0 per patient in the transport group versus 0.4 per patient in the acute shortening group (P=0.0003). Complications with permanent residual effects (sequelae) were 0.5 per patient in the transport group versus 0.3 per patient in the acute shortening group (P=0.28). CONCLUSIONS: While both techniques demonstrated excellent results, acute shortening/lengthening demonstrated a lower rate of complications and a slightly better radiographic outcome. Bone grafting of the docking site was often required with both procedures. LEVEL OF EVIDENCE: Level III; Retrospective comparative study.
Asunto(s)
Curación de Fractura/fisiología , Fracturas no Consolidadas/cirugía , Técnica de Ilizarov , Osteogénesis por Distracción , Osteomielitis/cirugía , Fracturas de la Tibia/cirugía , Adulto , Anciano , Alargamiento Óseo , Trasplante Óseo , Femenino , Fracturas no Consolidadas/complicaciones , Fracturas no Consolidadas/diagnóstico por imagen , Fracturas no Consolidadas/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Osteomielitis/diagnóstico por imagen , Osteomielitis/fisiopatología , Radiografía , Estudios Retrospectivos , Infección de la Herida Quirúrgica , Fracturas de la Tibia/complicaciones , Fracturas de la Tibia/diagnóstico por imagen , Fracturas de la Tibia/fisiopatología , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: To evaluate the ability of orthopaedic trauma subspecialists to predict early bony union in femoral and tibia shaft fractures. MATERIALS AND METHODS: Eight orthopaedic trauma subspecialists prospectively predicted the probability of bony union at 6 and 12 weeks post-operatively for an aggregate of 48 femoral and tibial shaft fractures treated at a Level 1 trauma centre. An additional orthopaedic trauma subspecialist was blinded to treating surgeon and adjudicated healing at 18 weeks. The Squared-Error Skill Score (SESS) determined the likelihood of accurate forecasting for bony union. RESULTS: Nine patients were lost follow-up, resulting in 39 fractures (81.25% retention) including 20 femoral and 19 tibial fractures. Fourteen fractures were open, 15 were not-yet united at final follow-up. SESS values were 0.25-0.77. The ability to predict union (sensitivity) was 1.000. The ability to predict nonunions (specificity) was 0.330-0.500. The probability of a correct predicted union was 0.727 and correct predicted nonunion at final follow-up was 1.000. AO/OTA type A fractures pattern predictions were highly accurate. As body mass index increased, predictions trended toward decreased accuracy (p=0.06). Tobacco use, age, gender, associated injuries, open fractures, and surgeons' years in clinical practice were not associated with accuracy of predictions. CONCLUSIONS: At 12-weeks post-operatively orthopaedic trauma subspecialists can confidently predict the union state in this patient population. This data is most useful in the nonunion patient, directing early intervention, thereby decreasing patient disability and discomfort.
Asunto(s)
Fracturas del Fémur/cirugía , Fijación Intramedular de Fracturas , Curación de Fractura/fisiología , Fracturas Abiertas/cirugía , Fracturas no Consolidadas/cirugía , Fracturas de la Tibia/cirugía , Centros Traumatológicos , Adolescente , Adulto , Anciano , Niño , Femenino , Fracturas del Fémur/complicaciones , Fracturas del Fémur/fisiopatología , Fracturas Abiertas/fisiopatología , Fracturas no Consolidadas/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Reproducibilidad de los Resultados , Fracturas de la Tibia/complicaciones , Fracturas de la Tibia/fisiopatología , Resultado del Tratamiento , Estados Unidos , Adulto JovenRESUMEN
This study purpose is to analyze outcomes of modern intramedullary (IM) nails with a locked distal screw versus periarticular locking plates for peri-prosthetic supracondylar femur fractures in TKA. Ninety-five consecutive fractures in 91 patients were retrospectively reviewed. Fixation included 29 knees with a retrograde IM nail and 66 periarticular locked plates. Six patients died and 4 were lost to follow-up. There were 2 (9%) nonunions in the IM nail group and 12 non-unions/delayed-unions (19%) in the locked plate group (P = 0.34). A mean of 5.0 distal screws was used in locked plates versus 3.8 distal screws in the IM nails (P < 0.001). Despite a greater quantity of screws in the distal fragment, the failure rate of locked plating was twice that of IM nail fixation.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Clavos Ortopédicos , Placas Óseas , Fracturas del Fémur/cirugía , Fijación Intramedular de Fracturas/métodos , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/efectos adversos , Tornillos Óseos , Femenino , Fracturas del Fémur/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Falla de Prótesis , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Treatment of large segmental defects using conventional autogenous iliac crest bone graft can be limited by volume of cancellous bone and donor site morbidity. The reamer-irrigator-aspirator (RIA) technique allows access to a large volume of cancellous bone graft containing growth factors with potency equal to or greater than autograft material from the iliac crest. The purpose of this study was to evaluate the effectiveness of RIA-harvested autogenous bone graft for treating large segmental defects of long bones.
Asunto(s)
Trasplante Óseo/métodos , Fijación de Fractura/métodos , Fracturas de la Tibia/cirugía , Recolección de Tejidos y Órganos/instrumentación , Adulto , Diseño de Equipo , Femenino , Estudios de Seguimiento , Curación de Fractura , Humanos , Estudios Prospectivos , Radiografía , Irrigación Terapéutica/instrumentación , Fracturas de la Tibia/diagnóstico por imagenRESUMEN
OBJECTIVE: The purpose of this study was to compare the effects of bone morphogenetic protein, bone morphogenetic protein with autogenous bone graft (ABG), and ABG alone on the healing of a large bone defect in the canine tibia. METHODS: Fifteen 45- to 55-lb canines were randomly assigned to 1 of 5 treatment groups, 3 per group. The groups included (1) recombinant human bone morphogenetic protein (rhBMP-2, 0.43 mg/mL)/absorbable collagen sponge (ACS) + collagen/ceramic matrix (CCM), (2) rhBMP-2 (0.22 mg/mL) ACS + CCM, (3) rhBMP-2 (0.43 mg/mL) ACS + ABG, (4) rhBMP-2 (0.22 mg/mL) ACS + ABG, and (5) ABG alone. A 5-mL defect was created in the right tibia and fixed with a 4.5 mm locking plate and 1 of the grafts described above implanted. X-rays were taken biweekly for 12 weeks and evaluated for radiographic union. Representative histology was also examined. RESULTS: All defects treated with rhBMP-2 (any combination) healed at 6.0 +/- 0.9 weeks. None of the ABG alone-treated defects were healed at 12 weeks. Dogs receiving rhBMP-2/ACS + CCM healed at 5.7 +/- 0.8 weeks, whereas rhBMP-2/ACS + ABG defects healed at 6.3 +/- 0.8 weeks. Histology showed healing consistent with 12-week radiologic results. CONCLUSIONS: Large segmental defects in canine tibiae can be effectively healed with stable fixation and rhBMP-2/ACS + ABG or CCM. These conclusions may offer insight into the clinical treatment of segmental defect nonunions in the human.