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1.  Hip arthroplasty after failed fixation of trochanteric and subtrochanteric fractures 
Acta Orthopaedica  2012;83(5):493-498.
Background and purpose
Hip arthroplasty is an option for elderly patients with osteoporosis for the treatment of failure after fixation of trochanteric and subtrochanteric fractures, either as a total hip arthroplasty (THA) or as a hemiarthroplasty (HA). We analyzed the reoperation rate and risk factors for reoperation in a consecutive series of patients.
Methods
All patients (n = 88) operated from 1999 to 2006 with a THA (n = 63) or an HA (n = 25) due to failure of fixation of a trochanteric fracture (n = 63) or subtrochanteric fracture (n = 25) were included. Background data were collected from the patient records. A search was performed in the national registry of the Swedish National Board of Health and Welfare in order to find information on all reoperations. The follow-up time was 5–11 years.
Results
The reoperation rate was 16% (14/88 hips). A periprosthetic fracture occurred in 6 patients, a deep prosthetic infection in 5 patients, and a dislocation of the prosthesis in 3 patients. Standard-length femoral stems had an increased risk of reoperation (11/47) compared to long stems (3/41) (HR = 4, 95% CI: 1.0–13; p = 0.06).
Interpretation
The high reoperation rate reflects the complexity of the surgery. Using long femoral stems that bridge previous holes and defects may be one way to reduce the risk for reoperation.
doi:10.3109/17453674.2012.688724
PMCID: PMC3488176  PMID: 22574819
2.  Recovery after Minor Traffic Injuries: A Randomized Controlled Trial 
PLoS Clinical Trials  2007;2(3):e14.
Objectives:
To assess the efficacy of an acute multidisciplinary group intervention on self-perceived recovery following minor traffic-related musculoskeletal injuries.
Design:
Open, randomized controlled trial.
Setting:
A large inner-city hospital.
Participants:
127 patients (≥15 y) with traffic-related acute minor musculoskeletal injuries and predicted to be at risk for delayed recovery were randomized into an intervention group (n = 65) or a control group (n = 62).
Intervention:
Four 1½-h sessions in open groups with the aim of providing information about injuries in general, calling attention to the importance of self-care and promoting physical activity. In addition, both groups received standard medical care by regular staff.
Outcome measures:
The main outcome measure was self-reported recovery at 12 mo. Secondary outcome measures were ratings of functional health status (SF-36, SMFA), pain and mental distress on visual analog scales, and self-reported duration of sick leave.
Results:
At 12 mo, there was a 21.9 percentage point difference: 52.4% of the patients in the intervention group and 30.5% in the control group reported self-perceived recovery (95% confidence interval for the difference 5%–38%; p = 0.03). There were no statistically significant differences between the groups regarding the secondary outcome measures.
Conclusion:
A simple group intervention may accelerate the self-perceived recovery in selected patients. As we did not find evidence of improvements in the secondary outcome measures, the clinical significance of the treatment benefit remains to be defined.
Editorial Commentary
Background: Worldwide, road traffic accidents contribute substantially to the number of deaths and also to the burden of disability. However, there is a lack of research into road traffic accidents as compared to other causes of ill-health. In particular, minor injuries resulting from traffic accidents are not well-studied even though some people with such injuries might be unwell for a long period of time. Support programs that provide people who have had minor traffic-related injuries with psychological help, physical training, and other types of interventions might help people to recover more quickly. However, there is little evidence that would help to answer this question. In the trial reported here, the researchers aimed to find out whether a support program would increase the chance of recovery in people who had experienced minor traffic-related injuries and who were thought to be less likely to recover. Trial participants were randomized to receive either standard medical care or to receive standard care and also to attend a series of workshops where surgeons, psychiatrists, pain specialists, and other staff gave advice about healing, pain management, exercises, and other aspects of self-care. The primary outcome of the trial was whether participants considered themselves to have recovered, 12 mo after the injury.
What the trial shows: 127 patients were recruited into the study, 62 of whom were assigned to receive standard care only and 65 of whom were assigned to also attend the support workshops. Most participants assigned to the support arm did attend all of the workshop sessions. Patients assigned to attend the support workshops were more likely to report that they had recovered as compared to patients receiving standard care only, and this difference seemed quite substantial. However, there were no statistically significant differences between these two groups in the trial's secondary outcome measures. These secondary measures included scores on rating scales which attempt to measure physical and mental distress and coping ability and the amount of sick leave taken.
Strengths and limitations: Although the trial was fairly small, it did recruit enough participants to detect an effect in the primary outcome measure, recovery at 12 mo. Additionally, a large proportion of the participants randomized to attend support sessions did actually attend the sessions, and follow-up for the primary outcome measure was virtually complete. Limitations of this study include low follow-up of patients for the secondary outcome measures in the trial. This meant that there was low power to detect clinically relevant changes in these outcome measures. Finally, although many patients were eligible for the trial, only a small proportion could be successfully contacted after being discharged from hospital, and it is possible that those people who did agree to participate were more motivated to recover than patients in general who have these injuries.
Contribution to the evidence: Most evidence relating to the benefits of support programs such as these have evaluated their effects in patients who have whiplash injuries rather than general traffic-related injuries. However, the results from this trial are compatible with those of similar trials in patients with whiplash injuries and suggest that support programs such as these may be beneficial in patients at risk of not recovering well from their injuries.
doi:10.1371/journal.pctr.0020014
PMCID: PMC1829405  PMID: 17380190

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