检索结果-内蒙古大学图书馆

Fractures of the lateral malleolus - a retrospective before-and-after study of treatment and resource utilization following the implementation of a structured treatment algorithm

引用

BMC MUSCULOSKELETAL DISORDERS 2022年第1期23卷 401-401页

作者： Rydberg, Emilia Moller Skoglund, Jonas Brezicka, Hampus Ekelund, Jan Sundfeldt, Mikael Moller, Michael Wennergren, David Univ Gothenburg Sahlgrenska Acad Inst Clin Sci Gothenburg Sweden Sahlgrens Univ Hosp Dept Orthopaed Gothenburg Sweden Ctr Registers Vastra Gotaland Gothenburg Sweden

Background In 2015 a study of isolated lateral malleolar fractures (AO/OTA44-B1) treated at Sahlgrenska University hospital (SU) during two consecutive years revealed large-scale variation in the choice of treatment and planned follow-up. The study resulted in the development of a structured treatment algorithm (TA) for ankle fractures. We investigated the effects of this well-implemented TA on the classification, treatment and follow-up of lateral malleolar fractures. Methods The current study is an uncontrolled, non-randomized, retrospective before-and-after study comparing a group of AO/OTA44-B1 fractures treated at SU before the introduction of the TA for ankle fractures (1 April 2012 to 31 March 2014) with a group treated after the introduction of the TA (1 September 2017 to 31 August 2019). Results In all the studied parameters regarding treatment for AO/OTA44-B1 fractures, a statistically significant change was seen after the introduction of the TA. Surgical treatment reduced from 32% (95% CI 27.5 - 36.5) pre-TA to 10% (95% CI 6.9 - 13.1) post-TA, while the number of patients permitted full weight-bearing increased from 41% (95% CI 36.3 - 45.7) to 84% (95% CI 80.1 - 87.9). Conclusions A thoroughly implemented treatment algorithm can reduce the number of surgical treatments for stable ankle fractures. The current study demonstrates that a structured treatment algorithm can standardize the management of ankle fractures and make decisions less dependent on the surgeon's discretion.

关键词： Ankle Fracture Swedish Fracture Register Fracture management treatment algorithm

来源：评论

学校读者我要写书评

暂无评论

Study protocol ROTATE-trial: anterior cruciate ligament rupture, the influence of a treatment algorithm and shared decision making on clinical outcome- a cluster randomized controlled trial

引用

BMC MUSCULOSKELETAL DISORDERS 2022年第1期23卷 117-117页

作者： de Vos, Floris H. Meuffels, Duncan E. de Mul, Marleen Askari, Marjan Ista, Erwin Polinder, Suzanne Waarsing, Erwin Bierma-Zeinstra, Sita M. Reijman, Max Erasmus MC Univ Med Ctr Dept Orthopaed & Sports Med Rotterdam Netherlands Erasmus Univ Erasmus Sch Hlth Policy & Management Rotterdam Netherlands Erasmus MC Univ Med Ctr Dept Internal Med Sect Nursing Sci Rotterdam Netherlands Erasmus MC Univ Med Ctr Dept Publ Hlth Rotterdam Netherlands Erasmus MC Univ Med Ctr Dept Gen Practice Rotterdam Netherlands

Background Anterior cruciate ligament (ACL) rupture is a very common knee injury in the sport active population. There is much debate on which treatment (operative or non-operative) is best for the individual patient. In order to give a more personalized recommendation we aim to evaluate the effectiveness and cost-effectiveness of a treatment algorithm for patients with a complete primary ACL rupture. Methods The ROTATE-trial is a multicenter, open-labeled cluster randomized controlled trial with superiority design. Randomization will take place on hospital level (n = 10). Patients must meet all the following criteria: aged 18 year or older, with a complete primary ACL rupture (confirmed by MRI and physical examination) and maximum of 6 weeks of non-operative treatment. Exclusion criteria consists of multi ligament trauma indicated for surgical intervention, presence of another disorder that affects the activity level of the lower limb, pregnancy, and insufficient command of the Dutch language. The intervention to be investigated will be an adjusted treatment decision strategy, including an advice from our treatment algorithm. Patient reported outcomes will be conducted at baseline, 3, 6, 12 and 24 months. Physical examination of the knee at baseline, 12 and 24 months. Primary outcome will be function of the knee measured by the International Knee Documentation Committee (IKDC) questionnaire. Secondary outcomes are, among others, the Tegner activity score, the Knee injury and Osteoarthritis Outcome Score (KOOS) and the 9-item Shared Decision Making Questionnaire (SDM-Q-9). Healthcare use, productivity and satisfaction with ((non-)operative) care are also measured by means of questionnaires. In total 230 patients will be included, resulting in 23 patients per hospital. Discussion The ROTATE study aims to evaluate the effectiveness and cost-effectiveness of a treatment algorithm for patients with a complete primary ACL rupture compared to current used treatment strate

关键词： Anterior cruciate ligament rupture treatment algorithm Shared decision making Cost-effectiveness

来源：评论

学校读者我要写书评

暂无评论

High rate of maintaining self-dependence and low complication rate with a new treatment algorithm for proximal humeral fractures in the elderly population

引用

JOURNAL OF SHOULDER AND ELBOW SURGERY 2020年第6期29卷 1127-1135页

作者： Rikli, Daniel Feissli, Sandra Mueller, Andreas M. Steinitz, Amir Suhm, Norbert Jakob, Marcel Audige, Laurent Univ Hosp Basel Dept Orthoped Surg & Traumatol Spitalstr 21 CH-4031 Basel Switzerland Schulthess Klin Res & Dev Shoulder & Elbow Surg Zurich Switzerland Univ Hosp Basel Inst Clin Epidemiol & Biostat Basel Switzerland

Background: We modified our treatment algorithm for proximal humeral fractures in elderly patients in 2013 to a more conservative approach avoiding locking plates. This study assesses the impact of this change on patient self-dependence. Methods: We carried out an observational comparative study including both retrospectively and prospectively collected data. For the former, 147 isolated proximal humeral fracture patients older than 65 years were treated between 2011 and 2013 at our hospital and included in a historical group. The revised treatment algorithm was applied in a similar non-concurrent, comparative patient group (n = 160) prospectively enrolled between 2015 and 2017. The primary outcome was any loss of self-dependence, with secondary outcomes including documentation of shoulder functional scores, quality of life, and adverse events. Results: Historical and prospective patients had similar baseline characteristics. Nonoperative treatment was performed in 53 historical patients (36%) and 83 prospective patients (78%). Prospective patients were 1.6 times less likely to lose some level of self-dependence (risk ratio, 0.62;95% confidence interval, 0.25-1.5;P = .292), and the local adverse event risk dropped from 12.2% to 5.7% (P = .078). Mean shoulder function and quality of life were similar between the 2 groups. Conclusion: By applying our revised algorithm, a higher proportion of elderly patients maintained their premorbid level of self-dependence and returned to their previous social environment. (C) 2019 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

关键词： Elderly patients shoulder proximal humeral fracture nonoperative management internal fixation treatment algorithm self-dependence

来源：评论

学校读者我要写书评

暂无评论

Traumatic Composite Bone and Soft Tissue Loss of the Leg: Region-Specific Classification and treatment algorithm

引用

INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED 2020年第6期51卷 1352-1361页

作者： El-Rosasy, Mahmoud A. Ayoub, Mostafa A. Tanta Univ Fac Med Dept Orthopaed Surg & Traumatol Tanta Egypt

BACKGROUND: The management of traumatic composite bone and soft tissue loss (TCBSTL) requires a classification system and decision-making algorithm for the purpose of description, prognosis and choice of treatment method. PATIENTS AND METHODS: between the year 2000 and 2017 a series of 254 cases of TCBSTL were treated using distraction histogenesis and external fixation techniques. The tissue loss was due to either the initial injury or debridement of infection. Adjunctive procedures included split thickness skin grafting and ICBG when indicated. A classification system was designed by the author. The classification is based on factors that influence management and prognosis;(1) stability of the host bone (intact tibia or a well-fixed fracture), (2) presence or absence of infection in the fracture site, (3) size of bone defect, and (4) contamination (infection) of the medullary cavity. A flowchart and decision-making algorithm was subsequently developed. RESULTS: Ilizarov external fixator was used in all cases. Ten cases (4%) had combined Masquelet - Ilizarov technique. One hundred seventy five cases (68.9%) had gradual distraction-compression (GDC) technique;while 79 cases (31.1%) had acute shortening and re-lengthening (ASRL) technique. Seventy-two cases (28.3%) had autogenous iliac crest bone graft (ICBG). All cases (100%) had complete clinical and radiological fracture union. All patients completed the follow up that ranged from 24 to 118 months (mean 43.3 +/- 23). The results were satisfactory in 212 cases (83.5%) and unsatisfactory in 42 (16.5%) cases due to residual leg length discrepancy, joint stiffness, and persistent pain. DISCUSSION: the proposed classification is simple, applicable, recallable and includes most scenarios of reconstructable TCBSTL. The classification provides a basis for communication, description and evaluation of such cases. The algorithm, based on our classification, provides a guideline for management without over/under treatment. (C

关键词： Leg fracture Bone and soft tissue loss Classification treatment algorithm

来源：评论

学校读者我要写书评

暂无评论

treatment algorithm for Hyaluronic Acid-Related Complication Based on a Systematic Review of Case Reports, Case Series, and Clinical Experience

引用

CRANIOMAXILLOFACIAL TRAUMA & RECONSTRUCTION 2020年第4期13卷 313-328页

作者： Aviv, Uri Haik, Josef Weiss, Nathaniel Berl, Ariel Ofir, Hagit Nardini, Gil Cleary, Michelle Kornhaber, Rachel Harats, Moti Sheba Med Ctr Dept Plast & Reconstruct Surg IL-52621 Tel Hashomer Israel Tel Aviv Univ Sackler Sch Med Tel Aviv Israel Univ Tasmania Coll Hlth & Med Sydney NSW Australia Univ Notre Dame Inst Hlth Res Fremantle WA Australia Kaplan Med Ctr Dept Plast & Reconstruct Surg Rehovot Israel

Study Design: Systematic review of hyaluronic acid (HA)-related complications. Objective: To systematically review all available literature including case reports and case series to identify a pattern for the management of vascular compromise resulting in facial skin ischemia and ocular manifestations following HA injection. Methods: This review was based on a systematic search of 3 electronic databases PubMed, CINAHL, and Scopus for all available literature including case series and case reports from database inception to July 2019. Only a total of 52 case reports/series were eligible for review and included 107 patients. Results: The reviewed literature available was comprised from case reports/series and indicated that management of both impending skin necrosis and visual disturbances is variable with no repetitive pattern of action. Yet, successful management is time dependent as early interventions stopped progression and, in some cases, even reversed adverse effects. Conclusion: Results found no universal protocol for achieving optimal results for adverse effects and as such, we present a step-by-step algorithm for the emergency management of complications following HA injection.

关键词： hyaluronic acid complications treatment algorithm systematic review

来源：评论

学校读者我要写书评

暂无评论

A clinicoradiological classification and a treatment algorithm for traumatic triceps tendon avulsion in adults

引用

Chinese Journal of Traumatology 2021年第5期24卷 266-272页

作者： Balaji Zacharia Antony Roy Department of Orthopedics Govt.Medical CollegeKozhikkode673008KeralaIndia Department of Arthroscopy Canga HospitalCoimbatore641043TamilnaduIndia

Triceps tendon avulsion(TTA)is an uncommon injury,and there are no classifications or treatment guidelines *** study aims to describe a clinicoradiological classification and treatment algorithm for traumatic TTA in *** functional outcome of surgical repair has been evaluated too.;A retrospective analysis of adult patients with traumatic TTA treated in our institution between 2012 and 2017 was *** only included complete TTA *** below 15 years,open injuries,associated fractures,and partial TTA were *** data were obtained from hospital *** intraoperative findings were correlated with the clinicoradiological presentation for classifying *** functional outcome was analyzed using the Mayo Elbow Performance index and Hospital for Special Surgery elbow *** test was used to assess the statistical significance.;There were 15 patients included,including 11 males and 4 *** mean age was(31.5±9.15)years,and the mean follow-up was(22.4±8.4)*** on outstretched hand was the mode of *** 6 patients,diagnosis was missed on the initial *** were classified as Type 1:palpable soft-tissue defect without bony mass;Type 2:palpable soft-tissue defect with a wafer-thin/comminuted bony fragment on X-ray;Type 3:palpable soft-tissue defect with a bony mass and a large bony fragment on X-ray without extension to the articular surface;and Type 4:an olecranon fracture with less than 25%of the articular *** algorithm for treatment was recommended,*** suture repair/suture anchor for Type 1,transosseous suture repair for Type 2,and tension band wiring or steel wire sutures for Types 3 and *** the patients achieved good to excellent outcome:the mean Mayo Elbow Performance index was 100 and Hospital for Special Surgery score was 98.26±2.60 on final follow-up.;Our clinicoradiological classification and treatment algorithm for TTAs is *** treatment results in excellent functions o

关键词： Wounds and injuries Triceps tendon avulsion Injuries around elbow Classification of triceps avulsion treatment algorithm

来源：评论

学校读者我要写书评

暂无评论

The traumatic acromion fracture: review of the literature, clinical examples and proposal of a treatment algorithm

引用

ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY 2019年第5期139卷 651-658页

作者： Hess, Florian Zettl, Ralph Welter, JoEllen Smolen, Daniel Knoth, Christoph Cantonal Hosp Frauenfeld Dept Orthopaed Surg & Traumatol Pfaffenholzstr 4 CH-8501 Frauenfeld Switzerland Etzelclin Pfaffikon SZ Freienbach Switzerland

Purpose Traumatic acromion fractures are rare and typically occur in patients with multiple fractures, which often delays diagnosis. Limited guidance exists on the treatment of these fractures. We present a review of the literature from the last 20years and describe our experience in treating five patientstwo conservatively and three with open reduction and internal fixations (ORIF). Methods We used the U.S. National Library of Science database, MEDLINE (R), to search for all pertinent publications from January 1999 to December 2017. Included were retrospective or prospective studies, including case series and case reports, describing treatment for traumatic acromion fractures and clinical and/or radiological outcomes. For our case reports, we present five patients with traumatic acromion fractures who were treated at our institution between 2013 and 2017. Results Through our review of 14 publications, we found that current recommendations are often based on a limited number of cases. No gold standard to treat these fractures exists. Most authors recommend anatomic reconstruction, especially for dislocated fractures, persistent symptomatic non-unions or additional injuries to the superior shoulder suspensory complex. There is no clear trend in terms of the operative technique. With regard to our five clinical examples that were all initially treated conservatively, two were successful and three eventually required reconstruction with ORIF. Based on the findings of this review, we proposed a treatment algorithm for traumatic acromion fractures. Conclusions A classification system providing clear guidance on treatment options is needed. Although the non-union rate with conservative treatment is relatively high, it is not always painful or limiting to shoulder function, especially in elderly or less active patients. Fixation seems to be a more suitable treatment option for active patients who are more likely to require revision of symptomatic non-unions.

关键词： Scapular fracture Acromion fracture Os acromiale Anatomic reconstruction Shoulder function treatment algorithm

来源：评论

学校读者我要写书评

暂无评论

Tongue reduction in Beckwith-Wiedemann syndrome: outcome and treatment algorithm

引用

INTERNATIONAL JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY 2019年第1期48卷 9-16页

作者： Naujokat, H. Moeller, B. Terheyden, H. Birkenfeld, F. Caliebe, D. Krause, M. F. Fischer-Brandies, H. Wiltfang, J. Univ Hosp Schleswig Holstein Dept Oral & Maxillofacial Surg Campus KielArnold Heller Str 3 D-24105 Kiel Germany Univ Hosp Schleswig Holstein Dept Anesthesiol & Intens Care Med Campus Kiel Kiel Germany Univ Hosp Schleswig Holstein Dept Pediat Campus Kiel Kiel Germany Univ Hosp Schleswig Holstein Dept Orthodont Campus Kiel Kiel Germany

Beckwith-Wiedemann syndrome is a rare congenital overgrowth disorder with macroglossia being one of the cardinal symptoms. In pronounced cases, macroglossia can lead to airway obstruction, musculoskeletal alterations and functional deficits. Surgical tongue reduction is performed at varying ages and with different techniques. This study evaluated perioperative complications, as well as long-term aesthetic and functional outcomes, in a large cohort. A total of 68 patients, treated either surgically or conservatively, were included. Depending on the severity of macroglossia, patients were divided into three groups to determine the treatment algorithm. Complications after surgical tongue reduction were prolonged intubation and revision due to dehiscence or haematoma. In the long term, no patient suffered from impaired sense of taste or paresthesia, although the shape of the tongue was disproportional in 85%. With the present treatment algorithm, operative tongue reduction exerts a positive influence on skeletal, dentoalveolar and functional development with sufficient long-term outcome and high grade of satisfaction of the patients. Supportive therapy in an interdisciplinary centre is of fundamental importance for both surgical and conservative treatment.

关键词： Beckwith-Wiedemann syndrome macroglossia tongue reduction treatment algorithm

来源：评论

学校读者我要写书评

暂无评论

Pediatric Osteochondral Lesions of the Talus: A Systematic Review and treatment algorithm

引用

Foot & Ankle Orthopaedics 2023年第4期8卷

作者： Hanson Liu Jacob Varghese Praveen Sritharan Karim Gaber Waleed Kishta

来源：评论

学校读者我要写书评

暂无评论

Posterolateral Fractures of the Tibial Plateau Revisited: A Simplified treatment algorithm

引用

The Journal of Knee Surgery 2020年第9期35卷 959-970页

作者： Vincenzo Giordano Robinson Esteves Pires Frederico Silva Pimenta Túlio Vinícius de Oliveira Campos Marco Antônio Percope de Andrade Peter V. Giannoudis Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro Hospital Municipal Miguel Couto Rio de Janeiro RJ Brazil Clínica São Vicente Rede D'or São Luiz Rio de Janeiro RJ Brazil Departamento de Ortopedia Universidade Federal de Minas Gerais Belo Horizonte MG Brazil Academic Department of Trauma & Orthopaedic Surgery School of Medicine University of Leeds Leeds United Kingdom

High-energy fractures of the proximal tibia with extensive fragmentation of the posterolateral (PL) quadrant of the tibial plateau are challenging to manage. Herein, we present a review of the literature on the patterns and options of approach and fixation of the PL fragment of the tibial plateau to optimize the treatment of this specific injury pattern. We searched PubMed (1980–May 2020) to identify and summarize the most relevant articles evaluating both the morphology and treatment recommendations, including the choice of approach and fixation strategy, for the PL tibial plateau fracture. We found PL fragment can present in several patterns as a pure split, split depression, contained pure depression, and noncontained depression (rim crush), which are mostly determined by the position of the knee and the force magnitude applied during the course of the accident. Based on previous concepts described by Schatzker and Kfuri, we suggest a simplified treatment algorithm highlighting the two concepts (buttressing and containment) used for plating the PL tibial plateau fragments. Based on the available current evidence, we propose an algorithm for these two morphological types of PL tibial plateau fracture. Shear-type fractures need buttressing (the “rule of thumb”), whereas noncontained peripheral rim-type fractures need peripheral repair and containment. Contained pure depression fractures are not frequent and need percutaneous-assisted elevation and subchondral rafting, either controlled by fluoroscopy or arthroscopically. It is believed that such an approach would simplify their assessment and preoperative planning and would assist the clinicians to appreciate and manage more consistently these complex injuries.

关键词： tibial plateau tibial plateau fracture posterolateral corner treatment algorithm treatment strategy

来源：评论

学校读者我要写书评

暂无评论

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

请选择保存的检索档案：

请选择收藏分类：

通借通还

建议与咨询 留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

请选择保存的检索档案： 新增检索档案 确定 取消

请选择收藏分类： 新增自定义分类 确定 取消

通借通还

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

请选择保存的检索档案：

请选择收藏分类：