Browsing by Subject "INTERNAL-FIXATION"

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  • Tiihonen, R.; Alaranta, R.; Helkamaa, T.; Nurmi-Lüthje, I.; Kaukonen, J.-P.; Lüthje, P. (2019)
    Background and Aims: Reoperations after operative treatment of hip fracture patients may be associated with higher costs and inferior survival. We examined the acute hospital costs, long-term reoperation rates, and survival of patients with a new hip fracture. Materials and Methods: A total of 490 consecutive new hip fracture patients treated at a single center between 31 December 2004 and 6 December 2006 were analyzed retrospectively. Fractures were classified according to Garden and AO. All medical records were checked manually. The costs of reoperations were calculated using the diagnosis-related groups (DRG)-based prices. Survival analysis was performed using the life-table method. The follow-up time was 10 years. Results: In all, 70/490 patients (14.3%) needed reoperations. Of all reoperations, 34.2% were performed during the first month and 72.9% within 1 year after the primary operation. The hemiarthroplasty dislocation rate was 8.5%, and mechanical failures of osteosynthesis occurred in 6.2%. Alcohol abuse was associated with a heightened risk of reoperation. The mean direct costs of primary fracture care were lower than the mean costs of reoperations (euro7500 vs euro9800). The mortality rate at 10 years was 79.8% among non-reoperated patients and 62.9% among reoperated patients. Conclusions: According to our hypothesis, the cost per patient of reoperation in acute care was 31% higher than the corresponding cost of a primary operation. Reoperations increased the overall immediate costs of index fractures by nearly 20%. One-third of all reoperations were performed during the first month and almost 75% within 1 year after the primary operation.
  • Ovaska, Mikko; Nuutinen, Timo; Madanat, Rami; Makinen, Tatu J.; Söderlund, Tim (2016)
    It is a common practice that patients have a scheduled follow-up visit with radiographs following ankle fracture surgery. The aim of this study was to evaluate whether an early outpatient visit ( A change in treatment plan was observed in 9.8% of operatively treated ankle fracture patients. The mean age of the patients was 48 years and the mean follow-up time was 64 months. Of the changes in treatment plan, 91% were exclusively due to clinical findings such as infection. Only three of 878 patients required a change in their treatment plan based merely on the findings of the radiographs taken at the outpatient visit. Only 37% of the patients requiring a change in their postoperative management had solicited an unanticipated visit before the scheduled outpatient visit due to clinical problems such as infection or a cast-related issue. Our study showed that every tenth operatively treated ankle fracture patient requires a change in their treatment plan due to a clinical problem such as infection or a cast-related issue. Although at hospital discharge all patients are provided with written instructions on where to contact if problems related to the operated ankle emerge, only one third of the patients are aware of the clinically alarming symptoms and seek care when problems present. Our findings do not support obtaining routine radiographs at the early outpatient visit in an ankle fracture patient without clinical signs of a complication. (C) 2016 Published by Elsevier Ltd.
  • Lont, Tonis; Nieminen, Jyrki; Reito, Aleksi; Pakarinen, Toni-Karri; Pajamäki, Ilari; Eskelinen, Antti; Laitinen, Minna K. (2019)
    Background and purpose Low-energy acetabulum fractures are uncommon, and mostly occur in elderly patients. Determining the optimal operative treatment for such fractures is challenging. Here we investigated whether acutely performed total hip arthroplasty plus posterior column plating (THA) reduced complications and reoperations compared with open reduction and internal fixation (ORIF) in elderly patients with acetabular fractures.Patients and methods We retrospectively reviewed the records of 59 patients, > 55 years of age, with complex acetabular fractures, caused by low-energy trauma, treated between January 2008 and September 2017. Of these patients, 34 underwent acute THA, and 25 ORIF alone. Patient and implant survival were compared between groups using Kaplan-Meier survival analysis and Cox multiple regression. Functional outcomes assessed by Oxford Hip Score (OHS) were compared between the THA patients and those 9 ORIF patients who underwent secondary THA due to posttraumatic hip osteoarthritis (OA) during follow-up.Results Overall patient survival was 90% (95% CI 82-98) at 12 months, and 64% (CI 47-81) at 5 years. Of 25 ORIF patients, 9 required secondary THA due to posttraumatic OA. Large fragments on the weight-bearing acetabular dome upon imaging predicted ORIF failure and secondary THA. The acute THA group and secondary THA group had similar 12-month OHS.Interpretation Acute THA including a reinforcement ring resulted in fewer reoperations than ORIF alone in elderly patients with acetabular fractures. These findings support acute THA as first-line treatment for complex acetabular fractures in elderly patients.