A guideline for placement of an infra-acetabular screw based on anatomic landmarks via an intra-pelvic approach

Background: Due to demographic changes, more and more fracture patterns involving anterior acetabular structures occur. The infra-acetabular screw is seen a useful tool to increase stability in fixation of the acetabular cup. However, the exact position of this screw in relation to anatomic landmarks which are intra-operatively palpable via an intra-pelvic approach has not yet been determined. Methods: This biomorphometric experimental study references the ideal screw position of an infra-acetabular screw to anatomic landmarks palpable via an intra-pelvic approach. Therefore, we created a computer tomography-based 3D-model of 40 patients (20 women, 20 men) who received a computer tomography (CT) scan of the pelvis for any other reason than an acetabular fracture. Results: The entry point of an ideal infra-acetabular was of high constancy. At mean, this point was 10.2 mm caudal and 10.4 mm medial of the ilio-pubic/ilio-pectineal eminence. This reference is independent of age, gender, or physical dimensions. However, we found gender-dependent differences for the angulation and the length of the screw. Conclusions: This study provides a comprehensive guideline to determine the ideal entry point for an infra-acetabular screw via an intra-pelvic approach. The entry point is located 10.2 mm caudal and 10.4 mm medial of the ilio-pubic/ilio-pectineal eminence

Telemedizinische Rehabilitationsplanung: Das Aachener Modell

Die telemedizinische Rehabilitationsplanung stellt eine sinnvolle und ohne größeren Aufwand in den klinischen Alltag zu integrierende Ergänzung der alterstraumatologischen Behandlung dar. Seit der Einführung des Aachener Modells TIRA (telemedizinische intersektorale Rehabilitationsplanung) im Mai 2014 ist die Verlegeplanung deutlich spezifischer und gleichzeitig aufgrund des Abgleichs mit den Scoringergebnissen transparenter geworden. Dies ist sicherlich der Hauptgrund dafür, dass frühzeitige Rückverlegungen hierdurch vermieden werden konnten. Von dieser interdisziplinären Zusammenarbeit scheinen insbesondere Patienten mit eingeschränkter kognitiver Leistungsfähigkeit und postoperativem Delir zu profitieren. Für eine weitergehende wissenschaftliche Aufarbeitung reichen aufgrund des heterogenen Patientengutes die aktuellen Fallzahlen noch nicht aus

Incidence of symptomatic venous thromboembolism in 2372 knee and hip replacement patients after discharge: data from a thromboprophylaxis registry in Montreal, Canada

Andréa Senay,1,2 Milanne Trottier,3 Josée Delisle,2,4 Andreea Banica,2,4 Benoit Benoit,2,4 G Yves Laflamme,2,4 Michel Malo,2,4 Hai Nguyen,4 Pierre Ranger,2,4 Julio C Fernandes2–4 1Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada; 2Department of Orthopaedic Surgery, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada; 3Faculty of Medicine, Université de Montréal, Montréal, QC, Canada; 4Department of Orthopaedic Surgery, Hôpital Jean-Talon, Montréal, QC, Canada Background: Low-molecular-weight heparin (LMWH) is a recommended anticoagulant for thromboprophylaxis after major orthopedic surgery. Dabigatran etexilate is an oral anticoagulant recognized as noninferior to LMWH. We aimed to assess the incidence of symptomatic venous thromboembolic events (VTEs) after discharge in patients who underwent joint replacement, using a hospital registry. Patients and methods: Patients who underwent total knee and hip arthroplasty between September 2011 and March 2015 were selected. Subcutaneous enoxaparin (30 mg twice daily) was given during hospitalization. At discharge, patients received either enoxaparin 30 mg twice daily/40 mg once daily or dabigatran 220 mg/150 mg once daily. Patients were seen or called at 2, 6, and 12 weeks after surgery. Outcomes were the number of VTEs, including deep venous thrombosis, pulmonary embolism, and the number of major/minor bleeding events after discharge. Results: After discharge, 1468 patients were prescribed enoxaparin and 904 dabigatran (1396 total knee arthroplasty and 976 total hip arthroplasty patients). Mean age was 66±10 years, and 60% were female. The cumulative incidence of VTEs during the 12-week follow-up was 0.7%. One patient sustained a VTE during the switch window. Seven patients sustained a pulmonary embolism (0.3%). There was no statistical difference between the total knee arthroplasty and total hip arthroplasty groups. The incidence of major and minor bleeding events during follow-up was 0.3% and 30.3%, respectively. These events had a higher incidence in the dabigatran group compared to the enoxaparin group after discharge (p<0.05), but not between knee and hip replacement groups for major bleeding events. Conclusion: A pharmaceutical prophylaxis protocol using LMWH and dabigatran during the post-discharge period resulted in low incidences of VTE and equivalence between treatments. However, the increased number of major and minor bleeding events in patients taking dabigatran is of concern regarding the safety and needs to be evaluated using analyses adjusted for risk factors. Keywords: arthroplasty, prophylaxis, enoxaparin, dabigatran, venous thromboembolism, pulmonary embolis