Aims. The principles of evidence-based medicine (EBM) are the foundation of modern medical practice. Surgeons are familiar with the commonly used
The aim of this study was to determine whether early surgical treatment results in better neurological recovery 12 months after injury than late surgical treatment in patients with acute traumatic spinal cord injury (tSCI). Patients with tSCI requiring surgical spinal decompression presenting to 17 centres in Europe were recruited. Depending on the timing of decompression, patients were divided into early (≤ 12 hours after injury) and late (> 12 hours and < 14 days after injury) groups. The American Spinal Injury Association neurological (ASIA) examination was performed at baseline (after injury but before decompression) and at 12 months. The primary endpoint was the change in Lower Extremity Motor Score (LEMS) from baseline to 12 months.Aims
Methods
The aim of this trial was to assess the cost-effectiveness of a soft bandage and immediate discharge, compared with rigid immobilization, in children aged four to 15 years with a torus fracture of the distal radius. A within-trial economic evaluation was conducted from the UK NHS and personal social services (PSS) perspective, as well as a broader societal point of view. Health resources and quality of life (the youth version of the EuroQol five-dimension questionnaire (EQ-5D-Y)) data were collected, as part of the Forearm Recovery in Children Evaluation (FORCE) multicentre randomized controlled trial over a six-week period, using trial case report forms and patient-completed questionnaires. Costs and health gains (quality-adjusted life years (QALYs)) were estimated for the two trial treatment groups. Regression was used to estimate the probability of the new treatment being cost-effective at a range of ‘willingness-to-pay’ thresholds, which reflect a range of costs per QALY at which governments are typically prepared to reimburse for treatment.Aims
Methods
The present study aimed to investigate whether patients with inflammatory bowel disease (IBD) undergoing joint arthroplasty have a higher incidence of adverse outcomes than those without IBD. A comprehensive literature search was conducted to identify eligible studies reporting postoperative outcomes in IBD patients undergoing joint arthroplasty. The primary outcomes included postoperative complications, while the secondary outcomes included unplanned readmission, length of stay (LOS), joint reoperation/implant revision, and cost of care. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model when heterogeneity was substantial.Aims
Methods
The aim of this study was to assess medium-term improvements following total hip arthroplasty (THA), and to evaluate what effect different preoperative Oxford Hip Score (OHS) thresholds for treatment may have on patients’ access to THA and outcomes. Patients undergoing primary THA at our institution with an OHS both preoperatively and at least four years postoperatively were included. Rationing thresholds were explored to identify possible deprivation of OHS improvement.Aims
Methods
Introduction. Rising incidence of fracture neck of femur (NOF) are associated with rising geriatric population. Majority of patients are suffering from comorbid factors. Impaired renal function is a common comorbid factor and most of the time it is attributed to an acute renal impairment following the fracture and surgery. Objective of this study was to identify the effect of renal comorbid factors and their probable relative risk for a fracture and compare the results with Asian and European data. Specific objective was to identify a possibility of presence of pretraumatic subclinical chronic renal failure among fractured Sri Lankans. Methodology. Data were collected from fractured patients (N=200) and non-fracture sample for a period of one year. Variables studied were, serum calcium, serum phosphate, blood hemoglobin level, blood urea and serum creatinine. Data were analyzed using binary logistic and multiple regressions, principal component
Introduction. Spinal aBMD only explains 50–80% of vertebral strength, and the application of aBMD measurements in isolation cannot accurately identify individuals who are likely to eventually experience bone fracture, due to the low sensitivity of the test. For appropriate treatment intervention, a more sensitive test of bone strength is needed. Such a test should include not only bone mineral density, but also bone quality. Quantitative computed tomography-based finite element methods (QCT/FEM) may allow structural analyses taking these factors into consideration to accurately predict bone strength (PBS). To date, however, basic data have not been reported regarding the prediction of bone strength by QCT/FEM with reference to age in a normal population. The purpose of this study was thus to create a database on PBS in a normal population as a preliminary trial. With these data, parameters that affect PBS were also analyzed. Methods. Participants in this study comprised individuals who participated in a health checkup program with CT at our hospital in 2009. Participants included 217 men and 120 women (age range, 40–89 years). Exclusion criteria were provided. Scan data of the second lumber vertebra (L2) were isolated and taken from overall CT data for each participant obtained with simultaneous scans of a calibration phantom containing hydroxyapatite rods. A FE model was constructed from the isolated data using Mechanical Finder software. For each of the FE models, A uniaxial compressive load with a uniform distribution and uniform load increment was applied. For each participant, height and weight were measured, BMI was calculated. Simple linear regression analysis was used to estimate correlations between age and PBS as analyzed by QCT/FEM. Changes in PBS with age were also evaluated by grouping participants into 5-year age brackets. One-way analysis of variance was used to compare average PBS for participants in each age range. Mean PBS in the 40–44 year age range was taken as the young adult mean (YAM). The ratio of mean PBS in each age group to YAM was calculated as a percentage. A multivariate
The pathogenesis of knee osteoarthritis is complex and involves many correlated factors that can be measured with gait analysis. Important biomechanical factors may lie in the interrelationships between variables. This study demonstrated the use of a multidimensional gait data analysis technique that simultaneously considered multiple time varying and constant measures. The gait patterns of normal and knee osteoarthritic subjects were successfully separated with a misclassification error rate of <
6%. One of the most discriminatory features identified an important knee osteoarthritis difference during the loading response phase of the gait cycle. The objective of this study was to detect biomechanical factors of knee osteoarthritis with a multidimensional gait data analysis technique. A multidimensional gait data analysis technique detected a very discriminatory feature that described a knee osteoarthritis difference during the loading response phase of the gait cycle. The combination of variables involved in the loading response feature may be important to the onset and development of knee osteoarthritis. Discriminatory gait features associated with knee osteoarthritis were identified with a misclassification error rate of <
6%. In a very discriminatory feature, the loading response phase of the gait cycle was completely isolated as important. Body mass index (BMI) was the greatest contributing factor to the loading response feature. Three-dimensional gait analysis was performed on fifty elderly patients with severe knee osteoarthritis and sixty-three elderly asymptomatic subjects. Three components of knee joint angles, moments and forces were calculated. Body mass index (BMI), radiographic measures and stride characteristics were also measured. A multivariate
Background: The osteolysis in revision total knee arthroplasty was observed. The purpose of this study was to compare the prevalence and characteristics of osteolysis recognized in revision total knee arthroplasties between the failed mobile bearing and fixed bearing knees. Methods: Eighty revision total knee arthroplasties were done between 1995 and 1998. The primary prosthesis that failed included thirty-four mobile bearing (Low Contact Stress) knees and forty-six fixed bearing knees of vary prostheses. At the time of revision surgery, all the interfaces between bone and prosthesis or cement were routinely checked and recorded for evidence of osteolytic resorption of bone. Preoperative radiographs were assessed independently by two authors for evidence of focal or severe periprosthetic osteolysis. The presence of the lesion was recorded. The demographic data included age and body weight was reviewed. The interval between the primary and revision surgery was recorded. The revision technique was reviewed. A
Introduction: Proximal humeral fractures are common in the elderly osteoporotic population. Surgical management of such fractures with traditional internal fixation techniques is often challenging due to poor bone quality. Fixation with intramedullary devices theoretically offers better fixation, but with increased risk of shoulder pain and decreased range of motion. We undertook a study to compare outcome following fixation of such fractures with either an intramedullary nail (Polarus), standard Clover Leaf plate (AO), or Philos Locking plate (AO). Method: All patients admitted for surgical management of a proximal humeral fracture were entered into the study. 10 patients were treated using a Philos plate (Group 1), 5 with a Clover Leaf plate (Group 2), and 10 with a Polarus nail (Group 3). Post-operative assessment included radiological evaluation, clinical assessment of range of motion compared to the non-injured arm, assessment of pain severity (visual analogue scale), and functional assessment (DASH score). Non-parametric
Introduction. Different subclinical neurological dysfunction has been reported in adolescent idiopathic scoliosis (AIS), including poor postural control and asymmetric otolith vestibulo-ocular responses when compared with normal controls. The objective of this pilot study is to establish whether abnormal MRI morphoanatomical changes arise in the CNS (brain and vestibular system), among left-thoracic versus right-thoracic AIS when compared with normal adolescent controls, with use of advanced computerised
Purpose. To characterize the knee kinematic profiles of total knee arthroplasty patient knees intraoperatively, before implant insertion, using principal component analysis. Method. Ninety-two patientsreceived Stryker Triathlon total knee arthroplasty (TKA) implants. The Stryker surgical navigation system was used for all surgeries. The system was used to define rigid bodies representing the femur and tibia, and to track the three-dimensional movement of the knee joint during surgery. Each knee was moved through a passive range of knee flexion/extension before and after implantation of the arthroplasty components. The frontal plane (medial-lateral) movement of the knee joint through a range of 10 to 120 degrees of flexion before implantation was calculated for each knee using the joint coordinate system (referred to as the pre-implant knee kinematic curve). Visual inspection of these patterns indicated three predominant curve types: a backward S shape, a backward C shape and a valgus to varus shape. Each curve was subjectively categorized into one of these three categories. Principal component analysis (PCA), a multivariate
The June 2014 Hip &
Pelvis Roundup360 looks at: Modular femoral necks: early signs are not good; is corrosion to blame for modular neck failures; metal-on-metal is not quite a closed book; no excess failures in fixation of displaced femoral neck fractures; noise no problem in hip replacement; heterotopic ossification after hip arthroscopy: are NSAIDs the answer?; thrombotic and bleeding events surprisingly low in total joint replacement; and the elephant in the room: complications and surgical volume.
The June 2013 Spine Roundup360 looks at: the benefit of MRI in the follow-up of lumbar disc prolapse; gunshot injury to the spinal cord; the link between depression and back pain; floating dural sack sign; short segment fixation at ten years; whether early return to play is safer than previously thought; infection in diabetic spinal patients; and dynesis.
The April 2013 Oncology Roundup360 looks at: the margin for error; new money for old risks; hindquarter amputation; custom tumour jigs; preserving the tibial epiphysis; how long is long enough?; genomics and radiation-induced bone tumours; and India ink.