RESUMEN
A retrospective case series that included 253 free-ranging birds of prey admitted to a rehabilitation center was conducted to describe the treatment and outcome of antebrachial fractures. Medical records from birds of prey belonging to 21 species admitted with antebrachial fracture between 1989 and 2015 at the University of California, Davis, were reviewed. Species distribution on admission, treatment, outcome, and complications were described by fracture category and species. Among 134 birds treated after initial triage on the day of admission, 4 bone/ wing categories were identified: 83 birds had an ulnar fracture only; 18 birds had a radial fracture only; 28 birds had a concomitant fracture of the radius and ulna on the same wing; and 5 birds had bilateral antebrachial fractures. Logistic regressions were performed to determine which factors were associated with a positive outcome within each of these 4 categories. Among birds having only an ulnar fracture, those with a closed fracture were significantly more likely to be released than birds with open fractures (P = .03; odds ratio = 5.43, 95% confidence interval: 1.29-28.12). In addition, birds with a fracture of the middle third of the ulna were significantly more likely to be released than birds diagnosed with a single fracture of the proximal third of the ulna (P = .02; odds ratio = 4.54, 95% confidence interval: 1.35-16.64). No significant prognostic factor was detected in other fracture categories.
Asunto(s)
Miembro Anterior/lesiones , Fracturas Óseas/veterinaria , Rapaces/lesiones , Animales , Eutanasia Animal/estadística & datos numéricos , Fracturas Óseas/complicaciones , Fracturas Óseas/rehabilitación , Fracturas Óseas/terapia , Hospitales Veterinarios , Hospitales de Enseñanza , Modelos Logísticos , Pronóstico , Fracturas del Radio/mortalidad , Fracturas del Radio/rehabilitación , Fracturas del Radio/terapia , Fracturas del Radio/veterinaria , Estudios Retrospectivos , Fracturas del Cúbito/mortalidad , Fracturas del Cúbito/rehabilitación , Fracturas del Cúbito/terapia , Fracturas del Cúbito/veterinariaRESUMEN
BACKGROUND: The prevalence of obesity in the United States has increased in recent decades. The aim of this study was to evaluate the influence of obesity in patients undergoing primary total elbow arthroplasty. METHODS: From 1987 to 2006, 723 primary semiconstrained, linked total elbow arthroplasties were performed in 654 patients. The average patient age (and standard deviation) at the time of surgery was 62.3 ± 13.7 years, with 550 total elbow arthroplasties (76%) performed in women. Total elbow arthroplasties were used to treat inflammatory conditions in patients undergoing 378 total elbow arthroplasties (52%) and to treat acute traumatic or posttraumatic conditions in patients undergoing 310 total elbow arthroplasties (43%). Patients were classified as non-obese (having a body mass index of <30 kg/m2) in 564 total elbow arthroplasties (78%) and as obese (having a body mass index of ≥30 kg/m2) in 159 total elbow arthroplasties (22%). The median duration of follow-up was 5.8 years (range, zero to twenty-five years). Survivorship of total elbow arthroplasty was estimated with use of the Kaplan-Meier method. The effect of obesity on risk of total elbow arthroplasty revision was estimated with use of Cox regression models, adjusting for age, sex, body mass index, and indication. RESULTS: A total of 118 revisions (16%) were performed. The ten-year survival rate for total elbow arthroplasty revision for any reason was 86% (95% confidence interval, 82% to 89%) in non-obese patients compared with 70% (95% confidence interval, 60% to 79%) in obese patients (p < 0.05). The ten-year survival rate for total elbow arthroplasty revision for mechanical failure was 88% (95% confidence interval, 84% to 91%) in non-obese patients compared with 72% (95% confidence interval, 61% to 81%) in obese patients (p < 0.05). Severely obese patients (those with a body mass index of 35 to <40 kg/m2) had a significantly higher risk of total elbow arthroplasty revision for any reason (hazard ratio, 3.08 [95% confidence interval, 1.61 to 5.45]; p < 0.05) and mechanical failure (hazard ratio, 3.10 [95% confidence interval, 1.47 to 5.89]; p < 0.05) compared with non-obese patients. CONCLUSIONS: Obesity adversely influences the performance of elbow replacement after primary total elbow arthroplasty. Obese patients being considered for elbow replacement surgery should be counseled accordingly.
Asunto(s)
Artroplastia de Reemplazo de Codo/estadística & datos numéricos , Obesidad/complicaciones , Factores de Edad , Artroplastia de Reemplazo de Codo/métodos , Artroplastia de Reemplazo de Codo/mortalidad , Índice de Masa Corporal , Prótesis de Codo/estadística & datos numéricos , Métodos Epidemiológicos , Femenino , Humanos , Fracturas del Húmero/mortalidad , Fracturas del Húmero/cirugía , Masculino , Persona de Mediana Edad , Obesidad/mortalidad , Tempo Operativo , Cuidados Posoperatorios , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Falla de Prótesis , Reoperación/mortalidad , Reoperación/estadística & datos numéricos , Factores Sexuales , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/mortalidad , Fracturas del Cúbito/mortalidad , Fracturas del Cúbito/cirugíaRESUMEN
Between May 2001 and May 2005, all 8834 adults admitted to our hospital with fractures to the limbs and pelvis were prospectively entered onto a database. Information was cross-referenced with the Office of National Statistics, and all patients who died during the study period were identified. Mortality rates were adjusted for age, gender and type of injury and cause of death was identified from hospital records. Neck of femur fractures accounted for 32% of admissions. Younger patients were more likely to be male and older patients more likely to be female. Overall 30-day and 1-year mortalities were 4.5 and 13%, respectively. Increased mortality was associated with age, male gender and fractures of the femur or pelvis.