Orthopedic surgery

Periprosthetic fractures of the distal femur above a total knee arthroplasty present a challenging surgical problem for orthopedic surgeons. Numerous operative and nonoperative treatment options exist including casting, Rush rods, supracondylar nails, and plate fixation. Potentially significant complications are associated with all current treatment alternatives. Plate or nail constructs frequently achieve limited distal fixation, leading to loss of fixation and varus angulation. This complication was not observed with the Less Invasive Stabilization System (LISS). In addition, our early results demonstrate the superiority of LISS treatment with low infection rates, no requirement for acute bone grafting, and secure fixation allowing for immediate postoperative mobilization. LISS fixation may offer a superior surgical treatment option for periprosthetic distal femur fractures. Key words: periprosthetic fractures, less-invasive stabilization system, total knee arthroplasty, percutaneous plating, minimally invasive percutaneous plate fixation.

Objectives: The American Academy of Orthopedic Surgeons and the Orthopedic Trauma Association have released guidelines for the provision of orthopedic trauma services such as adequate stipends, designated operating rooms, ancillary staff, and guaranteed reimbursement for indigent care. One recommendation included a provision for hospital-based physician assistants (PAs). Given current reimbursement arrangements, PA collections for billable services may not meet their salary and benefit expenses. However, their actions may indirectly affect emergency room, operating room, and hospital reimbursement and patient care itself. The purpose of our study is to define the true impact of hospitalbased PAs on orthopaedic trauma care at a level II community hospital.

Hypothesis: Surgical stabilization of displaced clavicle fractures was once considered to have rare indications. Our purpose was to present the clinical and economic effects of surgical management using data collected from operative and nonoperative patients. Methods: Our fracture database was queried from patients with displaced midclavicular fractures. Radiographs and charts were reviewed, and questionnaires were distributed. Results: Operative patients had less chronic pain (6.1% vs 25.3%), less cosmetic deformity (18.2% vs 32.5%), less weakness (10.6% vs 33.7%), less loss of motion (15.2% vs 31.3%), and fewer nonunions (0% vs 4.8%). Operative patients missed fewer days of work (8.4 days vs 35.2 days) and required less assistance (3 days vs 7 days) for care at home. Mean income lost was $321.69 versus $10,506.25. Operative patients had a mean emergency department bill of $2,060.51 versus $1,871.92 and had a mean hospital bill of $8,520.30 versus $3,692.65, and anesthesia charges averaged $946.11. Operative patients required less physical therapy, and the mean physical therapy cost was $971.76 versus $1,820. Nonoperative patients required more pain medication ($43.22 vs $45.98). Overall, the cost was $12,976.94 for operative patients and $18,068.27 for nonoperative patients. Conclusions: Patients with displaced clavicle fractures benefit clinically and financially from stabilization. They have less chronic pain, less deformity, less weakness, and better range of motion. They return to work sooner, take less pain medication, and require less physical therapy. Their initial hospital bill is higher because of surgical charges but is balanced by less income loss, resulting in a cost savings of $5,091.33 in operative patients. Level of evidence: Level III, Retrospective Case-Control Design, Treatment Study.

Despite significant advances in critical care management, flail chest remains a clinically significant finding, with a mortality rate of up to 33%. Nonsurgical management is associated with prolonged ventilator support, pneumonia, respiratory difficulties, and lengthy stays in the intensive care unit, as well as chronic pain from nonunion and malunion of the bony thorax. Treatment with aggressive pulmonary toilet, ventilator support, and different modalities of pain control remains the benchmark of care. However, several recent randomized controlled studies of surgical intervention of flail chest have demonstrated an improvement in the number of ventilator days, intensive care unit and hospital stays, incidence of pneumonia, and respiratory function and hospital costs, as well as faster return to work. The success of these surgical constructs compared with those of historical attempts at open fixation is largely the result of modern plating technology and improvement in surgical app...

We retrospectively studied the clinical and economic impact of a cost-containment program using high quality generic 7.3-mm screws for fixation of femoral neck fractures and pelvic ring injuries at a level II trauma center. Included in the study were 174 patients with femoral neck fractures or posterior pelvic ring injuries. These injuries were managed with 203 conventional and 178 generic implants. Study results showed no significant differences in age, sex, American Society of Anesthesiologists status, or fracture pattern; no differences in operative time, estimated blood loss, or complication rates; no increase in varus collapse, shortening, screw cutout, screw deformation, loosening, or conversion to arthroplasty; and no differences in hospital complications of deep venous thrombosis, pulmonary embolism, urinary tract infection, or pressure sores. Overall, our hospital realized a 70% reduction in implant costs, resulting in calendar-year savings of $50,531. At our institution, u...

Periprosthetic fractures of the distal femur above a total knee arthroplasty present a challenging surgical problem for orthopedic surgeons. Numerous operative and nonoperative treatment options exist including casting, Rush rods, supracondylar nails, and plate fixation. Potentially significant complications are associated with all current treatment alternatives. Plate or nail constructs frequently achieve limited distal fixation, leading to loss of fixation and varus angulation. This complication was not observed with the Less Invasive Stabilization System (LISS). In addition, our early results demonstrate the superiority of LISS treatment with low infection rates, no requirement for acute bone grafting, and secure fixation allowing for immediate postoperative mobilization. LISS fixation may offer a superior surgical treatment option for periprosthetic distal femur fractures. Key words: periprosthetic fractures, less-invasive stabilization system, total knee arthroplasty, percutaneous plating, minimally invasive percutaneous plate fixation.

Canad. J. Public Health, 88: 99-104,1997 PURPOSE: To examine kidney cancer incidence and mortality patterns since 1969 in Canada. METHOD: Linear regression of the log rates was used to estimate secular trends by age group and sex, and age-periodcohort models were fitted to examine changes in kidney cancer and renal adenocarcinoma incidence rates. RESULTS: A substantial increase in incidence rates was observed among those 35 years and older, with average increases of 2.5% or more annually for both sexes. Age-period-cohort modelling suggested that much of this increase resulted from a period effect. Changes in mortality were much more modest, especially among those aged 0-34, for whom mortality rates actually declined by a n average of 4.2% and 5.