Fractura subtrocantérica tras fijación percutánea con tornillos de fracturas no desplazadas en el cuello femoral : presentación de tres casos y revisión de la literatura

Objective. To show 3 cases of subtrochanteric fracture as complication of screw fixation for femoral neck undisplaced fractures. Material and methods. We present 3 cases of subtrochanteric fractures after screw fixation of valgus impacted femoral neck fractures. In all cases, intramedulary nailing was the treatment choice for this complication. Results. One year after the surgery all fractures healed without needing additional procedures and all patients walked pain-free. Discussion. The results of percutaneous fixation of undisplaced fractures of the femoral neck using cannulated screws are good in aged patients. Subtrochanteric fracture is a rare complication. Most authors attribute it to wrong surgical technique. These errors represent weakening and more direct transmission of forces on the lateral cortex. We provide several advices to avoid the failure. Conclusions. The best way to avoid this complication is an appropriate surgical technique. The treatment of choice, if present, is the intramedullary nailin

International lower limb collaborative (INTELLECT) study: a multicentre, international retrospective audit of lower extremity open fractures

Trauma remains a major cause of mortality and disability across the world1, with a higher burden in developing nations2. Open lower extremity injuries are devastating events from a physical3, mental health4, and socioeconomic5 standpoint. The potential sequelae, including risk of chronic infection and amputation, can lead to delayed recovery and major disability6. This international study aimed to describe global disparities, timely intervention, guideline-directed care, and economic aspects of open lower limb injuries

Reduction in inappropriate hospital use based on analysis of the causes

<p>Abstract</p> <p>Background</p> <p>To reduce inappropriate admissions and stays with the application of an improvement cycle in patients admitted to a University Hospital. The secondary objective is to analyze the hospital cost saved by reducing inadequacy after the implementation of measures proposed by the group for improvement.</p> <p>Methods</p> <p>Pre- and post-analysis of a sample of clinical histories studied retrospectively, in which the Appropriateness Evaluation Protocol (AEP) was applied to a representative hospital sample of 1350 clinical histories in two phases. In the first phase the AEP was applied retrospectively to 725 admissions and 1350 stays. The factors associated with inappropriateness were analysed together with the causes, and specific measures were implemented in a bid to reduce inappropriateness. In the second phase the AEP was reapplied to a similar group of clinical histories and the results of the two groups were compared. The cost of inappropriate stays was calculated by cost accounting. Setting: General University Hospital with 426 beds serving a population of 320,000 inhabitants in the centre of Murcia, a city in south-eastern Spain.</p> <p>Results</p> <p>Inappropriate admissions were reduced significantly: 7.4% in the control group and 3.2% in the intervention group. Likewise, inappropriate stays decreased significantly from 24.6% to 10.4%. The cost of inappropriateness in the study sample fell from 147,044 euros to 66,642 euros. The causes of inappropriateness for which corrective measures were adopted were those that showed the most significant decrease.</p> <p>Conclusions</p> <p>It is possible to reduce inadequacy by applying measures based on prior analysis of the situation in each hospital.</p