Bilateral rotator cuff tears requiring repair are not uncommon. Typically, these tears have been treated with staged surgeries. However, in appropriately selected cases, single-stage repair is preferable because it reduces costs, the number of admissions, total hospitalization, and rehabilitation time. It can also reduce patient suffering by providing relief with a single procedure. The authors compared 10 patients with a mean age of 55 years who had bilateral symptomatic rotator cuff tear and underwent single-stage bilateral arthroscopic cuff repair (group A) with 17 patients with a mean age of 55 years who had unilateral symptomatic rotator cuff tear and underwent unilateral arthroscopic cuff repair (group B). Clinical assessment was performed preoperatively and at 3, 6, and 12 months postoperatively with the visual analog scale, the University of California Los Angeles (UCLA) score, and the Korean shoulder score. Overall function, pain, and strength were improved significantly in both groups. Although the difference in visual analog scale score between both groups decreased during follow-up, this score was significantly lower in group B (P=.026). At initial follow-up, the UCLA score was higher in group A. However, at the last follow-up, this score was significantly higher in group B (P<.001). The Korean shoulder score was significantly higher in group A at all follow-up times (P<.001). The study findings showed that single-stage bilateral rotator cuff repair is a preferable option in appropriately selected patients. It can provide satisfactory results without additional complications, and it does not lead to longer hospitalization or rehabilitation than unilateral repair.
Purpose:The purpose of this study was to compare the clinical and radiologic results of arthrodesis between anterior approach and transfibular approach arthrodesis in ankle arthritis. Materials and Methods:There were 61 cases of ankle arthritis treated by anterior or transfibular ankle arthrodesis in our hospital from April 2008 to March 2012. We investigated 29 cases (27 patients) who underwent ankle arthrodesis with an anterior approach (15 cases) and transfibular approach (14 cases), and were followed for over two years. Clinically, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, pain visual analogue scale (VAS), and subjective satisfaction degrees were evaluated. In addition, ankle coronal and sagittal alignments were evaluated using plain radiographs at 6 and 24 months, postoperatively.Results: Clinically, preoperative mean AOFAS score and VAS was 41.3 and 6.4, and were changed to 58.9 and 3.3 postoperatively in the anterior approach group. In the transfibular approach group, preoperative mean AOFAS score was 36.6 and VAS was 7.1, and they were changed to 54.9 and 3.4 postoperatively. However, no significant differences in the clinical results were observed between the two groups (p=0.297). Duration of attaining union was 8.1 weeks in the anterior approach group and 10.4 weeks in the transfibular approach group. Complications were delayed union in one case, nonunion in three cases, cancellous screw breakage in three cases, and complex regional reflex syndrome in one case. Conclusion:After transfibular ankle arthrodesis as treatment of ankle osteoarthritis, the tendency for valgus angulation of the ankle at the final follow-up was observed and 6.5 mm cancellous screw breakage occurred frequently. Therefore, in order to achieve better stability, it is necessary to use 6.5 mm cannulated screws rather than 6.5 mm cancellous screws for ankle arthrodesis.
PurposeThere are many methods to reduce massive bleeding during total knee arthroplasty (TKA). In our study, tranexamic acid and neutral drainage were used to decrease total blood loss.Materials and MethodsThe study was performed on 97 TKA patients from March 2012 to January 2013. In the study group, tranexamic acid was administered and neutral drainage was applied. The study group had group I (unilateral, n=29) and group III (bilateral, n=17). The control group had group II (unilateral, n=35) and group IV (bilateral, n=16).ResultsIn group I, the drainage volume on the 1st and 2nd postoperative days and the total drainage decreased with statistical significance (p<0.05). Between group III and group IV, group III had less drainage volume. In group III, the drainage volume on the 1st postoperative day and total drainage volume decreased statistically significantly (p<0.05). Between groups I and II, total blood loss showed no statistically significant difference, whereas between groups III and IV, the value was significantly different.ConclusionsIntravenous administration of tranexamic acid with neutral drainage for 3 postoperative hours is a recommendable method because it can be helpful in reducing total blood loss in bilateral TKA.
Background and Purpose:Little is known about the prevalence of falls and the related risk factors in patients who have undergone surgery following a hip fracture. This prospective cohort study aims to assess the relationship between potential risk factors and fall incidence in this patient population. There is an increased risk of recurrent falls and hip fractures in elderly who has suffered the first hip fracture. Identification on potential recurrent fallers at early stage is thus important for improving health outcomes in these individuals as well as reducing the economic burden on the public health care system. Methods: This was a prospective cohort study. Sixty-six older adults (age S65 years) who had sustained a hip fracture and were referred to Tung Wah Eastern Hospital for rehabilitation post-surgery participated in the study. After completion of the inpatient rehabilitation program, fall risk factors were assessed by using the Physiological Profile, and the guidelines on fall prevention adopted by the Hong Kong Hospital Authority. Follow-up information on falls and related injuries was collected on a monthly basis by telephone interview. Mann-Whitney U tests (for continuous and ordinal variables) and Chi-square tests (for nominal variables) were used to compare the variables of interest between fallers and non-fallers. For those variables that showed a significant between-group difference, receiver operating characteristic (ROC) curves were constructed to determine the optimal cutoff score. Univariate logistic regression analyses were then conducted to identify the odds ratio of each fall-related risk factor. Results: A new fall incident was reported by 8 patients during the follow-up period. Seven of them had one fall and one of them had two falls. Logistic regression analyses revealed that age (OR 5.7;95% CI: 1.05 e 30.87), ankle dorsi-flexor muscle strength (OR 7.235; 95% CI: 1.325 e 39.497), knee extensor muscle strength (OR 7.88; 95% CI: 1.438 e 43.139), visual acuity (OR 8.6; 95% CI: 1.564 e 47.303), postural sway while standing on foam with eyes open (OR 10.562; 95% CI: 1.228 e 92.397), Maximum Balance score (OR 6.67; 95% CI: 1.225 e 36.283), were significant predictors of falls. In addition those who had received extended rehabilitation had lower risk of falls than those who had not received any extended rehabilitation (OR 6.36; 95% CI: 1.16 e 34.81). Conclusion: Advanced age, lower extremity muscle strength, visual acuity, standing balance were significant intrinsic factors that contributed to falls among those patients who had recently undergone a hip surgery following the first hip fracture. In addition, those extended rehabilitation also had lower risk of falls than those who had not received the same service. The results point to the potential importance of training leg muscle strength and balance in our rehabilitation programs, in order to prevent falls in this patient population.Background and Purpose: Associated reactions (ARs) may be a significant clinical problem if increased levels of ...
The purpose of this study was to analyze the results of treating subtrochanteric femoral fractures with proximal femoral nail antirotation (PFNA). Materials and Methods: Twenty five consecutive patients diagnosed with subtrochanteric femoral fractures underwent intramedullary fixation using PFNA and followed-up for over 12 months. According to the Seinsheimer's classification, there were 2 type IIA, 9 type IIB, 2 type IIIA, 3 type IV and 9 type V. According to the AO classification, there were 10 type A, 9 type B and 6 type C. There were 16 cases of closed reduction group and 9 cases of limited open reduction group. Retrospectively, radiological outcomes were assessed at the union period, change of neck shaft angle, tip-apex distance, Cleveland index, sliding of lag screw and complication. Results: Union was achieved in 23 of 25 cases, over an average of 17 weeks. Limb length shortening below 2 cm occurred in 7 patients. The Cleveland index was shown in 80% of 5, 6, 8 and 9 zone; the tip apex distance was 19.6 mm; the mean sliding distance was 4.4 mm; and the mean change of femur neck and shaft angle was varus 3 degree at the final follow-up. Complications included 3 cases of delayed union and 2 cases of nonunion. Conclusion: With its early bony union, ambulation, rehabilitation and low complication, PFNA is a useful and reliable choice for the treatment of subtrochanteric fractures of the femur. Limited open reduction and additional fixation such as cable grip are recommended if it is difficult to obtain anatomical reduction by closed reduction.
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