http://www.bjj.boneandjoint.org.uk/content/96-B/1/19.abstract

Quality assessment of guidelines on thromboprophylaxis in orthopaedic surgery

1. S. Sabharwal, MBBS, MRCS, MSc, SpR in Trauma and Orthopaedics, North West Thames Rotation and Honorary Surgical Research Fellow 1 ; 
2. S. Gauher, MBBS, BSc, National Medical Director’s Clinical Fellow2;
3. S. Kyriacou, MBBS, MRCS, SpR Trauma and Orthopaedics 3 ; 
4. V. Patel, MBBS, MRCS, Surgical Research Fellow 1; 
5. I. Holloway, FRCS(T&O), Consultant Orthopaedic Surgeon2; and 
6. T. Athanasiou, MD, PhD, FRCS, FETCS, Professor of Cardiovascular Sciences and Cardiac Surgery; Lead of Surgical Quality and Epidemiology1

+Author Affiliations

1. 1Imperial College London, Department of Surgery and Cancer, 10th Floor QEQM building, St Mary’s Hospital, London W2 1NY, UK.
2. 2Northwick Park Hospital, The North West London Hospitals NHS Trust, Watford Road, Harrow HA1 3UJ, UK.
3. 3Imperial College, London, North West Thames Rotation, Department of Surgery and Cancer, 10th Floor QEQM building, St Mary’s Hospital, London W2 1NY, UK.

1. Correspondence should be sent to Mr S. Sabharwal; e-mail:sanjeeve.sabharwal@ic.ac.uk

Abstract

We evaluated the quality of guidelines on thromboprophylaxis in orthopaedic surgery by examining how they adhere to validated methodological standards in their development. A structured review was performed for guidelines that were published between January 2005 and April 2013 in medical journals or on the Internet. A pre-defined computerised search was used in MEDLINE, Scopus and Google to identify the guidelines. The AGREE II assessment tool was used to evaluate the quality of the guidelines in the study.

Seven international and national guidelines were identified. The overall methodological quality of the individual guidelines was good. ‘Scope and Purpose’ (median score 98% interquartile range (IQR)) 86% to 98%) and ‘Clarity of Presentation’ (median score 90%, IQR 90% to 95%) were the two domains that received the highest scores. ‘Applicability’ (median score 68%, IQR 45% to 75%) and ‘Editorial Independence’ (median score 71%, IQR 68% to 75%) had the lowest scores.

These findings reveal that although the overall methodological quality of guidelines on thromboprophylaxis in orthopaedic surgery is good, domains within their development, such as ‘Applicability’ and ‘Editorial Independence’, need to be improved. Application of the AGREE II instrument by the authors of guidelines may improve the quality of future guidelines and provide increased focus on aspects of methodology used in their development that are not robust.

Cite this article: Bone Joint J 2014;96-B:19–23.

Footnotes

• No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
  This article was primary edited by J. Scott and first-proof edited by D. Rowley.

• Received August 1, 2013.
• Accepted October 25, 2013.

• ©2014 The British Editorial Society of Bone & Joint Surgery

AAOS. NEWS

http://newsroom.aaos.org/media-resources/news/winter-sports-helmet-safety.htm

NEWS

Let AAOS be your source for bone and joint health information!  Whether you are looking for clinical news, story ideas, spokespeople or statistics, our News Room will be a frequently updated destination for media, members and patients. 

Just as it is AAOS members’ goal is to keep this nation in motion; it is the goal of the AAOS PR department  to support the flow of accurate information about musculoskeletal health to your audiences. We look forward to working with you to do just that. Contact us and let us know how we can help.

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April 17, 2013 Healthcare community responds to Boston Marathon tragedy An article in MedPage Today looks at the Boston Marathon bombings from the aspect of emergency preparedness. The author states that coordination and integration among hospital staff are keys to handling a large scale trauma event. A spokesperson for Tufts Medical Center notes that existing relationships between emergency department staff and first responders helped the network of various emergency systems work smoothly and efficiently. (more)

FDA issues a Class I Recall on Stryker Orthopaedics

April 05, 2013 Measuring the Value of Health Care Procedures and Treatments How can you measure the value of orthopaedic care?  Frequently Asked Qustions surrounding the latest research, "Modeling the Indirect Economic Implications of Musculoskeletal Disorders and Treatment," published in Cost Effectiveness and Resource Allocation.  (more)

January 17, 2013 FDA Safety Communication on Metal-on-Metal Hip Implants

http://www.healio.com/orthopedics/arthroscopy/news/online/%7B742f2f24-a532-475c-9759-ff492803d4a5%7D/researchers-urge-caution-for-arthroscopic-debridement-of-labral-tears-in-older-patients

Researchers urge caution for arthroscopic debridement of labral tears in older patients 

Wilkin G. J Bone Joint Surg. 2014;doi:10.2106/JBJS.L.01710.

Arthroscopic acetabular labral debridement in patients aged 45 years or older was linked with a 17% reoperation rate at a mean of 21.3 months and minimal overall improvement in joint-specific outcome measures, according to researchers with The Ottawa Hospital in Ottawa.

Geoffrey Wilkin, MD, and colleagues studied the WOMAC, SF-12 and modified Harris Hip Scores (mHHS) of 41 patients who were at least 45 years of age at the time of arthroscopic acetabular labral debridement.

There were seven reoperations, of which six involved conversion to hip arthroplasty or resurfacing. Study results showed the hip arthroscopy group showed improvements ranging from 15.4 points to 6.1 points in their mean WOMAC pain and function scores, SF-12 physical component summary score and mHHS. However, changes in the WOMAC stiffness and SF-12 mental component summary scores were not significant. Postoperative mHHS showed good or excellent outcomes in 13 patients.

“The results in the present series of patients suggest that arthroscopic labral debridement has a much lower overall clinical benefit in patients who are 45 years of age or older than in younger patients,” the researchers wrote in their study. “Since it remains difficult to predict which patients are likely to derive clinical benefit and since the overall benefit was small, arthroscopic debridement of acetabular labral tears in older patients should be approached with caution.”

Disclosure: Beaule is a consultant for Medacta, CORIN, Smith & Nephew, Maquet and Wright Medical Technology. He received royalties from CORIN, Medacta and Wright Medical Technology, stock options from Wright Medical Technology and travel accommodations from CORIN, Medacta and Smith & Nephew.

Hospital de Dénia. Nueva técnica: artroscopia de cadera

Publicado el 24/01/2014

Madrid, 24 ene ( efesalud.com ). El doctor Vicente Concejero López deja la sala de operaciones después de una intervención quirúrgica y dedica unos minutos al vídeoblog de traumatología para hablar de un "gran desconocido": el dolor rotuliano, alias 'el agujero negro de la ortopedia', la causa más frecuente de consulta dentro de las patologías de la rodilla.

"Cuando un paciente nos describe el tormento que siente en su rodilla -dice-, bilateralidad y comienzo insidioso (síntomas no evidentes) son manifestaciones específicas del dolor rotuliano, semejantes a un dolor de cabeza, como si fuera migraña articular".

Y para el doctor Concejero la solución a ese problema "no pasa por un quirófano", salvo que el enfermo padezca inestabilidad franca de rodilla, una luxación recidivante (patología recurrente, típica del paciente joven, más frecuente en la mujer) o anomalías anatómicas concretas, como rótula alta, ya que "la cirugía se impone con demasiada frecuencia y el simple dolor rotuliano no es un motivo suficiente para operar, al igual que no se abriría una cabeza para extirpar una migraña".

Vicente Concejero valora, por tanto, que el tratamiento debe de ser conservador, a base de un esmerado cuidado de la rodilla "potenciando los músculos o protegiendo el cartílago -con fármacos-, además de evitar las sentadillas (flexionar repetidamente las piernas manteniendo el cuerpo recto), los saltos múltiples, la práctica del 'step' o subir, y lo que es peor, bajar cuestas".

El enfermo "se adapta al dolor y no mejora -enfatiza- porque, entre otras cosas, los síntomas son cíclicos. El paciente se resignará, entonces, a épocas de empeoramiento y disfrutará de épocas de mejoría, ambas de duración variable".

A pesar de esta frecuencia, "los traumatólogos ignoran las causas del dolor rotuliano -afirma Concejero-. No sabemos por qué la rodilla duele o no duele". Un argumento que le vale al doctor para asegurar que "los médicos disponen de cientos de proyecciones radiológicas que ambicionan tener un valor diagnóstico... y no es así".

Como ejemplos válidos en estos casos, el especialista de la Clínica CEMTRO considera que "una artroscopia es francamente inútil o que una intervención quirúrgica que seccione una aleta rotuliana abre la puerta a cirugías repetidas que conducen a una rodilla arruinada", concluye.

http://youtu.be/0kZHa-D4kVg

http://sipse.com/novedades/son-mas-frecuentes-en-hombres-fracturas-oseas-33517.html

Son más frecuentes en hombres fracturas óseas 

Aunque pueden presentarse fracturas en húmero, pelvis o columna, las más comunes son en tibia y peroné: especialista

Lunes, 27 May, 2013 16:05

La recuperación de los pacientes depende de la calidad de vida y las enfermedades que padezcan. (Tomás Álvarez/SIPSE)

Susana Mariscal/SIPSE
CANCÚN, Q.Roo.- Las lesiones óseas o fracturas del aparato músculo esquelético tienen su propia personalidad, pero se presentan más en hombres y son más constantes en tibia y peroné aunque también hay de pelvis o columna cervical.Ello depende de la edad de la persona, la calidad ósea, su circulación, enfermedades crónicas, la actitud del paciente y principalmente el acudir con el especialista indicado, señaló Ricardo Abel López Martínez, jefe de la división de Ortopedia y Traumatología del Instituto Mexicano del Seguro Social (IMSS). 

En el área de ortopedia son ocho médicos especialistas que atienden diariamente un promedio de 30 pacientes en un lapso de cinco horas; a esa atención se suman  los que tienen hospitalizados, más los espontáneos que llegan. De estas atenciones en el 80% de los casos son también atendidos por el cirujano plástico por lesiones de tendones o de la piel, en caso de fracturas expuestas.  

Pueden presentarse fracturas del húmero (hueso del brazo) pelvis o columna, pero las más comunes son de tibia y peroné, por una del húmero llegan a atender seis de la tibia, que pueden ser fracturas simples o con lesiones mayores que se complican por arterias o nervios.

Explicó que en ocasiones en la radiografía se ve sencilla la lesión y hay otras que en la radiografía se ven muy escandalosas o feas pero que no afectaron más allá, por lo que sólo requiere de un tratamiento cómo una férula o un yeso colgante; pero se da la contraparte, “no necesariamente una fractura simple tiene un tratamiento simple”.

López Martínez apuntó que una simple caída de menos de un metro de altura puede provocar una lesión que deje al paciente con rigidez en su extremidad.Mucho depende de la situación de la persona, si hay sobrepeso, o se trata de un adulto mayor que tiene una serie de limitantes como hipertensión, diabetes, su circulación, su calidad ósea,  pues a esa edad puede presentar osteoporosis, que a diferencia de un joven, aún cuando se trata de la misma fractura y se aplique el mismo tratamiento el resultado no siempre será el mismo. 

Comentó que recientemente atendieron a un paciente que tuvo una caída de una altura de 80 centímetros, sin embargo se le hizo polvo la pierna, no evolucionó de manera satisfactoria y el hueso no pegó, sino que le quedó rígido.

Otro aspecto que se debe de tomar en cuenta además de la edad y calidad ósea es que la persona desde un principio recurra con el especialista indicado y no haga un recorrido de especialidades o de profesionales de áreas similares como son los quiroprácticos, médicos del deporte, masajistas, sobadores o hueseros, los cuales no tienen el entrenamiento y conocimiento total en traumatismos.Cuando la persona procede de esta forma sólo está dificultando su tratamiento y en ocasiones llegan a agravar más la lesión. 

“Muchos buscan opciones esperando que les digan lo que quieren oír, y no la realidad, hay mucha desinformación de cuidado de fracturas y visión que tienen del servicio de salud pública, buscan una gotita de esperanza pero a veces complica la situación”. 

Aparte de ello se enfrentan a la actitud negativa que asumen todos los pacientes que enfrentan alguna enfermedad de este tipo, lo cual es una especie de etapa de duelo donde son presas de la ira, desesperación que también llega a retrasar la intervención o afecta en la recuperación.

CÓMO ALIVIAR EL DOLOR DE ‪#‎COXIS‬

Publicación de Xtensal Training in Wellness.

http://www.ncbi.nlm.nih.gov/pubmed/23992991#!

Arthroscopy. 2013 Sep;29(9):1579-88. doi: 10.1016/j.arthro.2013.05.027.

Evidence-based status of microfracture technique: a systematic review of level I and II studies.

Goyal D, Keyhani S, Lee EH, Hui JH.

Author information

Abstract

PURPOSE:

Although many newer cartilage repair techniques have evolved over the past 2 decades, microfracture is still being advocated as the first line of treatment. Therefore it is timely to conduct a comprehensive review of the literature to assess and report on the current status of Level I and II evidence studies related to microfracture techniques.

METHODS:

A literature search was carried out for Level I and II evidence studies on cartilage repair using the PubMed database. All the studies that dealt with microfracture techniques were selected.

RESULTS:

Fifteen studies that involved microfracture techniques met the inclusion criteria of this review article, with 6 long-term and 9 short-term studies. These studies compared the clinical outcomes of microfracture with those of other treatments such as autologous chondrocyte implantation and osteochondral cylinder transfers. The majority of the studies reported poor clinical outcomes, whereas 2 studies reported the absence of any significant difference in the results. Small-sized lesions and younger patients showed good results in the short-term. However, osteoarthritis and treatment failures were observed at later postoperative periods of 5 to 10 years.

CONCLUSIONS:

The use of microfracture for the treatment of small lesions in patients with low postoperative demands was observed to result in good clinical outcomes at short-term follow-up. Beyond 5 years postoperatively, treatment failure after microfracture could be expected regardless of lesion size. Younger patients showed better clinical outcomes.

LEVEL OF EVIDENCE:

Level II, systematic review of Level I and II studies.

Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

PMID:

 

23992991

 

[PubMed - indexed for MEDLINE]

Evidence-Based Status of Microfracture Technique: A Systematic Review of Level I and II Studies. Goyal D, Keyhani S, Lee EH, Hui JHPhttp://www.ncbi.nlm.nih.gov/pubmed/23992991

Francesco UboldiMedical Doctor at Orthopedic Institute G.Pini

The use of microfracture for the treatment of small lesions in patients with low postoperative
demands was observed to result in good clinical outcomes at short-term follow-up. Beyond 5 years postoperatively,
treatment failure after microfracture could be expected regardless of lesion size. Younger patients showed
better clinical outcomes.

Evidence-Based Status of Microfracture Technique: A Systematic Review... ncbi.nlm.nih.gov

PubMed comprises more than 23 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.