Managing periprosthetic fractures: perspectives on periprosthetic pelvic fractures

Periacetabular periprosthetic fractures are rare but potentially disastrous for the longevity of the adjacent implants, leading to multiple revision surgeries. It is of paramount importance to identify and treat intraoperative fractures, which will lead to satisfactory results. Postoperative fractures may be managed operatively or nonoperatively depending on the patient's pain and function, the fracture pattern, and the stability of the acetabular component

Trends in incidence and outcomes of revision total hip arthroplasty in Spain: A population based study

<p>Abstract</p> <p>Background</p> <p>To analyze changes in incidence and outcomes of patients undergoing revision total hip arthroplasty (RTHA) over an 8-year study period in Spain.</p> <p>Methods</p> <p>We selected all surgical admissions in individuals aged ≥ 40 years who underwent RTHA (ICD-9-CM procedure code 81.53) between 2001 and 2008 from the Spanish National Hospital Discharge Database. Age- and sex-specific incidence rates, Charlson co-morbidity index, length of stay (LOS), costs and in-hospital mortality (IHM) were estimated for each year. Multivariate analyses were conducted to asses time trends.</p> <p>Results</p> <p>32, 280 discharges of patients (13, 391 men/18, 889 women) having undergone RTHA were identified. Overall crude incidence showed a small but significant increase from 20.2 to 21.8 RTHA per 100, 000 inhabitants from 2001 to 2008 (p < 0.01).</p> <p>The incidence increased for men (17.7 to 19.8 in 2008) but did not vary for women (22.3 in 2001 and 22.2 in 2008). Greater increments were observed in patients older than 84 years and in the age group 75-84. In 2001, 19% of RTHA patients had a Charlson Index ≥ 1 and this proportion rose to 24.6% in 2008 (p < 0.001). The ratio RTHA/THA remained stable and around 20% in Spain along the entire period</p> <p>The crude overall in-hospital mortality (IHM) increased from 1.16% in 2001 to 1.77% (p = 0.025) in 2008. For both sexes the risk of death was higher with age, with the highest mortality rates found among those aged 85 or over. After multivariate analysis no change was observed in IHM over time. The mean inflation adjusted cost per patient increased by 78.3%, from 9, 375 to 16, 715 Euros from 2001 to 2008.</p> <p>After controlling for possible confounders using Poisson regression models, we observed that the incidence of RTHA hospitalizations significantly increased for men and women over the period 2001 to 2008 (IRR 1.10, 95% CI 1.03-1.18 and 1.08, 95% CI 1.02-1.14 respectively).</p> <p>Conclusions</p> <p>The crude incidence of RTHA in Spain showed a small but significant increase from 2001 to 2008 with concomitant reductions in LOS, significant increase in co-morbidities and cost per patient.</p

Proteínas de choque térmico en las artroplastias totales de rodilla

Tesis de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 30-06-2005Depto. de CirugíaFac. de MedicinaTRUEpu

Nuestra experiencia con impresión 3D doméstica en Cirugía Ortopédica y Traumatología. Hazlo tú mismo

ResumenLa impresión 3D posibilita la traslación de una planificación virtual a modelos tangibles. El uso hospitalario de las impresoras 3D comercializadas para uso doméstico facilita la obtención de forma autónoma (do it yourself) de reproducciones realistas al mínimo coste.ObjetivoExponer nuestra metodología para la traslación clínica de la impresión 3D doméstica al campo de la Cirugía Ortopédica y Traumatología, definir sus indicaciones y aplicaciones específicas de acuerdo con la experiencia clínica.Material y métodosEstudio analítico observacional prospectivo de 63 casos intervenidos en nuestro servicio desde el año 2014, mometo desde el que la impresión 3D doméstica está incluida en el proceso asistencial. Variables como el grado de satisfacción percibida por los pacientes, la precisión, el tiempo o la exposición a radiaciones ionizantes durante la intervención son analizadas.ResultadosSe define un flujo de trabajo hasta la obtención del modelo impreso en 3D mediante el uso de programas de libre acceso e impresoras 3D domésticas, con una mejoría en todas las variables incluidas en el estudio.ConclusionesLa impresión 3D doméstica tiene numerosas aplicaciones en Cirugía Ortopédica y Traumatología. La experiencia clínica ha permitido definir un flujo de trabajo con unos resultados clínicos satisfactorios.Abstract3D printing allows translation of a virtual planning to tangible models. Domestic 3D printers in hospital facilitate obtaining autonomously («do it yourself») realistic reproductions at minimum cost.ObjectiveTo describe our methodology for clinical translation of domestic 3D printing in Orthopedic Surgery and Traumatology, define indications and specific applications according to clinical experience.Materials and methodsA prospective observational analytical study of 63 patients treated in our service from 2014 in which domestic 3D printing is included in the care process. Variables such as degree of satisfaction perceived by patients, accuracy, time or exposure to ionizing radiation during surgery are analyzed.ResultsA workflow is defined to obtaining 3D printed model using freely available programs and domestic 3D printers, and variables included in the study improved.ConclusionsDomestic 3D printing has numerous applications in Orthopedic Surgery and Traumatology. Clinical experience has allowed defining a workflow with satisfactory clinical results

Orthopaedic trauma residency programs:Perspectives from different countries across the world

The ability to manage the myriad of musculoskeletal conditions successfully requires multiple years of training. Access to and completion of orthopaedic surgical training entails an often grueling, highly regulated path to certification to practice. Although the world is more connected than ever, the question is whether the local certification criteria for medical specialists leads to a generic residency program and a similar training in all countries. This report from eight nations on five continents details the distinctive features of that training, including the number of positions available, the examinations required, the gender distribution of residents, and available possibilities once the residence period is complete. This analysis shows a wide variation in the orthopaedic trauma training program worldwide, with emphasis on different skills per country

Overview of fracture liaison services in the UK and Europe:standards, model of care, funding, and challenges

Fragility fractures represent a growing global problem, including in the United Kingdom and European countries. Reports demonstrate the benefits of national guidance and organized fragility fracture programs through fracture liaison services to deliver care to patients who sustain these injuries. The challenge of assembling multidisciplinary teams, providing routine screening of appropriate patients, and monitoring therapies where there is a known compliance problem, remains an obstacle to the success of fragility fracture treatment programs to all. Efforts should continue to introduce and maintain fracture liaison services through coordinated national approaches and advanced systems

Managing periprosthetic fractures: perspectives on periprosthetic pelvic fractures

Abstract. Periacetabular periprosthetic fractures are rare but potentially disastrous for the longevity of the adjacent implants, leading to multiple revision surgeries. It is of paramount importance to identify and treat intraoperative fractures, which will lead to satisfactory results. Postoperative fractures may be managed operatively or nonoperatively depending on the patient's pain and function, the fracture pattern, and the stability of the acetabular component