Bracing, a strategy employed by humans and robotic devices, can be generally described as a parallel mechanical link between the actor, the environment, and/or the workpiece that alters the mechanical impedance between the tool and workpiece in order to improve task performance. In this study we investigated the potential value of bracing in the context of bone milling to treat cam-type femoroacetabular impingement (FAI) lesions. The goal of this study was to evaluate whether a proposed bracing technique could enable a user to perform a cam resection more accurately and quickly than a currently employed arthroscopic technique. Test samples consisted of white urethane plastic reproductions of a commercially available adult proximal femur, which were laser scanned to obtain ground-truth surface information. A black cam lesion was then cast onto the surface of the femur in the anterosuperior region of the femoral neck, creating a clear visual resection boundary for the simulated osteochondroplasty. Test subjects were 4 adult males (25 +/− 3 years) with no surgical experience. Test conditions included two binary factors: (1) Braced vs. Unbraced – The braced case introduced a spherical bearing tool support mounted in the approximate anterolateral arthroscopic portal position. (2) Speed vs. Accuracy – The subject was instructed to perform the resection as quickly as possible or as accurately as possible with a moderate regard for time. Following the removal of the lesion, femurs were laser scanned to acquire the post-resection surface geometry, with accuracy being reported as RMS deviation between the pre- and post-resection scans over the anterosuperior neck region.Introduction
Materials/Methods
We describe the impact of a targeted performance
improvement programme and the associated performance improvement
interventions, on mortality rates, error rates and process of care
for haemodynamically unstable patients with pelvic fractures. Clinical
care and
The fractures of the hip are a main problem of health care. These fractures will be multiply by 2 in 2025 and 3 in 2050. In the population of old people, 1/3 of the women and 1/9 of the men will have a fracture of their hip. Some authors used the name of “EPIDEMIC”. The aima of the INPECH project (Indicators of the Performance for the comparison between hospital) was to check if the comparison of performances of clinical teams, on the basis of indicators chosen by themselves, allowed to improve their performances. It was an experimentation of a volonteer processes of comparison of performance between 3 multidisciplinary teams. The study followed some stages:
in every hospital, description of the process of care of the hip fractures with a choice of indicators of performance (difficulties of the care percepted by the professionals, possibilities of improvement, feasibility of the record of the indicators during the whole process) a first meeting of concertation with the three hospitals where a common choice of 20 indicators was done: 5 factors of adjustement corresponding to the prefracture status, 10 factors of the processes and 5 factors recorded at 3 months postoperatively a first period of inclusion (433 patients of more than 65 years-old) a second meeting of confrontation in order to analyze the results of the first inclusion period and to have exchange between the different teams about the disparities - the age, the autonomy and the mobility of the patients did not differ between the hospitals - the preoperative time was significantly different: 0.7 to 3.6 days - the time of the first get up (2 to 4 days), of the first social demand 3 to 7 days), of the hospitalization in surgery (9 to 14 days) and the rate of transfert in rehabilitation centers varied significantly between the centers. - At three months, the mortality, the levels of dependance and of autonomy were not significantly different. Each team had a reflexion about the opportunities of improvement and the actions to begin A second period of inclusion was realized in order to objectivize if the proposed improvements allowed a real change of our professional practices. (423 patients) The analysis of this second inclusion authorized a real change in our professional practices and showed the efficacy of the indicators which were improved. This study had permitted to show qualitative differences of care of hip fractures between the hospitals. The confrontation between the teams had authorized a positive reflexion of some of our professional practices and the improvement was underlined by the second series of inclusion.
Introduction:. Most of the published papers on AI based diagnosis have focused on the algorithm's diagnostic performance in a ‘binary’ setting (i.e. disease vs no disease). However, no study evaluated the actual value for the clinicians of an AI based approach in diagnostic. Detection of Traumatic thoracolumbar (TL) fractures is challenging on planar radiographs, resulting in significant rates of missed diagnoses (30-60%), thus constituting a field in which a
Although wait-times for hip fracture surgery have been linked to mortality and are being used as quality-of-care indicators worldwide, controversy exists about the duration of the wait that leads to complications. Our objective was to use new population-based wait-time data to emprically derive an optimal time window in which to conduct hip fracture surgery before the risk of complications increases. We used health administrative data from Ontario, Canada to identify hip fracture patients between 2009 and 2014. The main exposure was the time from hospital arrival to surgery (in hours). The primary outcome was mortality within 30 days. Secondary outcomes included a composite of mortality or other medical complications (MI, DVT, PE, and pneumonia) also within 30 days. Risk-adjusted cubic splines modeled the probability of each complication according to wait-time. The inflection point (in hours) when complications began to increase was used to define ‘early’ and ‘delayed’ surgery. To evaluate the robustness of this definition, outcomes amongst propensity-score matched early and delayed patients were compared using percent absolute risk differences (% ARDs, with 95% confidence intervals [CIs]). There were 42,230 patients who met entry criteria. Their mean age was 80.1 (±10.7) and the majority were female (70.5%). The risk of complications modeled by cubic splines consistently increased when wait-times were greater than 24 hours, irrespective of the complication considered. Compared to 13,731 propensity-score matched patients who received surgery earlier, 13,731 patients receiving surgery after 24 hours had a significantly higher risk of 30-day mortality (N=898 versus N=790, % ARD 0.79 [95% CI 0.23 to 1.35], p = .006) and the composite outcome (N=1,680 versus N=1,383, % ARD 2.16 [95% CI 1.43 to 2.89], p < .001). Overall, there were 14,174 patients (33.6%) who received surgery within 24 hours and 28,056 patients (66.4%) who received surgery after 24 hours. Increased wait-time was associated with a greater risk for 30-day mortality and other complications. The finding that a wait-time of 24 hours represents a threshold defining higher risk may inform existing hip fracture guidelines. Since two-thirds of patients did not receive surgery within this timeframe,
The February 2015 Trauma Roundup. 360 . looks at: Evaluating the syndesmosis in ankle fractures; Calcaneal fracture management an ongoing problem; Angular stable locking in low tibial fractures did not improve results; Open fractures: do the seconds really count?; Long-term outcomes of tibial fractures; Targeted
Introduction. Motion analysis is a validated method of assessing technical dexterity within surgical skills centers. A more accessible and cost-effective method of skills assessment is to use a global rating scale (GRS). We aimed to perform a validation experiment to compare an arthroscopic GRS against motion analysis for monitoring orthopaedic trainees learning simulated arthroscopic meniscal repairs. Methods. An arthroscopic meniscal repair task on a knee simulator was set up in a bioskills laboratory. Nineteen orthopaedic trainees with no experience of meniscal repair were recruited and their performance assessed whilst undertaking a standardized meniscal repair on 12 occasions. An arthroscopic GRS, assessing parameters such as “depth perception,” “bimanual dexterity,” “instrument handling,” and “final product analysis” was used to evaluate technical skill. Performance was assessed blindly by watching video recordings of the arthroscopic tasks. Dexterity analysis was performed using a motion analysis tracking system which measured “time taken,” “total path length of the subject's hands,” and “number of hand movements”. Results. Motion analysis objectively defined the learning curves and demonstrated significant
The primary aim of this paper was to outline the processes involved in building the Partners Arthroplasty Registry (PAR), established in April 2016 to capture baseline and outcome data for patients undergoing arthroplasty in a regional healthcare system. A secondary aim was to determine the quality of PAR’s data. A tertiary aim was to report preliminary findings from the registry and contributions to quality improvement initiatives and research up to March 2019. Structured Query Language was used to obtain data relating to patients who underwent total hip or knee arthroplasty (THA and TKA) from the hospital network’s electronic medical record (EMR) system to be included in the PAR. Data were stored in a secure database and visualized in dashboards. Quality assurance of PAR data was performed by review of the medical records. Capture rate was determined by comparing two months of PAR data with operating room schedules. Linear and binary logistic regression models were constructed to determine if length of stay (LOS), discharge to a care home, and readmission rates improved between 2016 and 2019.Aims
Methods
There is not adequate evidence to establish whether external
fixation (EF) of pelvic fractures leads to a reduced mortality.
We used the Japan Trauma Data Bank database to identify isolated
unstable pelvic ring fractures to exclude the possibility of blood
loss from other injuries, and analyzed the effectiveness of EF on
mortality in this group of patients. This was a registry-based comparison of 1163 patients who had
been treated for an isolated unstable pelvic ring fracture with
(386 patients) or without (777 patients) EF. An isolated pelvic
ring fracture was defined by an Abbreviated Injury Score (AIS) for
other injuries of <
3. An unstable pelvic ring fracture was defined
as having an AIS ≥ 4. The primary outcome of this study was mortality.
A subgroup analysis was carried out for patients who required blood
transfusion within 24 hours of arrival in the Emergency Department
and those who had massive blood loss (AIS code: 852610.5). Propensity-score
matching was used to identify a cohort like the EF and non-EF groups.Aim
Patients and Methods