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Level of Evidence III, Retrospective comparative study.
To evaluate the complication rate of total knee arthroplasty (TKA) in octogenarian patients and identify predictive factors.
The study comprised 70 octogenarians and 70 non-octogenarian patients as control group, all submitted to TKA. We analyzed the medical records of these patients, seeking for complications during the first postoperative year. Regarding the risk factors, we evaluated age, sex, race, American Society of Anesthesiologists score, body mass index, smoking, hypertension and diabetes mellitus.
In the control group, the incidence of complications was 7.1%. Whereas in the octogenarian group it was significantly higher, reaching 34.3% (OR 6.8; 95% CI 2.4-19.1). We found no association to sex, skin color, and comorbidities. Age is an independent risk factor for postoperative complications. Our data may help patients to acknowledge the risks of undergoing primary TKA and physicians to assess and adjust perioperative risk.
The incidence of postoperative complications is significantly higher in octogenarians.
The incidence of postoperative complications is significantly higher in octogenarians. Level of Evidence III, Case-control study.
To establish the association between initial and residual angulation of the distal interphalangeal joint (DIJ) in mallet finger treated conservatively.
An observational, prospective, descriptive and analytical research developed with uncomplicated closed mallet finger patients between January and December 2017. Chidamide manufacturer A total of two measurements of the DIJ were done, at the initial trauma and 6 weeks after conservative treatment. All measurements were ranked according to the Crawford Classification and Relative Risk was measured.
In total, 43 patients were studied, in which 53.48% of outcomes obtained were excellent. The sample was divided in two groups; one with less than 30º of DIJ initial angulation, which had 28% of residual angulation. The second group with more than 30º presented 72.22% of residual angulation. The Relative Risk to present a residual angulation in patients that had 30º of DIJ initial angulation was 2.99 (CI 95%) with p = 0.0059.
It is suggested that patients with an initial DIJ angulation more than 30º are more likely to present residual angulation with conservative treatment. Level of Evidence IV, Case series.
It is suggested that patients with an initial DIJ angulation more than 30º are more likely to present residual angulation with conservative treatment. Level of Evidence IV, Case series.
To evaluate if the levels of serum total protein and serum albumin are risk factors for surgical complications of free flap limb reconstruction.
Consecutive inclusion of all patients undergoing microsurgical flaps for limb reconstruction of complex injuries. We recorded epidemiological and laboratory data, including total proteins and fractions, for descriptive and analytical statistics.
Our study analyzed one microsurgical flap from 35 patients that underwent complex injuries of the limbs. In total, 23 patients were men, and mean age of all patients was 35 years. After statistical analysis, no influence of pre or postoperative hypoalbuminemia was observed on the incidence of complications. Patients with hypoalbuminemia had a higher length of stay than those with normal albumin levels (p = 0.008).
We observed that 71% of patients had hypoalbuminemia in early postoperative period and we suggest a nutritional support for patients requiring complex traumatic limb reconstruction. Hypoalbuminemia in patients subjected to microsurgical flaps for the treatment of complex traumatic limb injuries did not influence the complications that required surgical reintervention; However, it was associated with prolonged hospital stay.
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We observed that 71% of patients had hypoalbuminemia in early postoperative period and we suggest a nutritional support for patients requiring complex traumatic limb reconstruction. Hypoalbuminemia in patients subjected to microsurgical flaps for the treatment of complex traumatic limb injuries did not influence the complications that required surgical reintervention; However, it was associated with prolonged hospital stay. Level of Evidence II, Retrospective study.
Brachial plexus injury can lead to significant functional deficit for the patient. Elbow flexion restoration is a priority in surgical treatment. Free functional muscle transfer is an option for early or late treatment failure. This study evaluated patient characteristics and elbow flexion muscle strength after gracilis functioning muscle transfer.
Medical records of 95 patients operated from 2003 to 2019 were analyzed and the following variables recorded age, gender, nerve transfer used to motorize the gracilis muscle, time between trauma and surgery, age at surgery and elbow flexion strength after a minimum of 12 months following functioning muscle transfer.
87 patients were included, averaging 30 years of age (17 to 57 years). Fifty-five achieved elbow flexion muscle strength ≥ M3 (55/87, 65%), with a mean follow-up of 37 months. The nerves used for activation of the transferred gracilis were 45 spinal accessory, 10 intercostal, 8 median n. fascicles, 22 ulnar n. fascicles and 2 phrenic nerves.
Functional muscle transfer is a viable surgical procedure for elbow flexion in chronic traumatic brachial plexus injuries in adults.
Functional muscle transfer is a viable surgical procedure for elbow flexion in chronic traumatic brachial plexus injuries in adults. Level of Evidence II, Retrospective study.
Dupuytren's disease is a genetic disorder related to the proliferation of myofibroblasts. The pluripotent property of stem cells present in adipose tissue inhibits myofibroblast proliferation. Our study sought to evaluate the effect of stem cell-rich fat grafts in patients that underwent limited fasciotomy.
We studied 45 patients, in a single-blind, prospective, randomized clinical trial. All patients underwent limited fasciotomy. In one group, fat graft was injected.
The total passive extension deficit results did not exhibit a significant difference. Fat group exhibited worse functional score at 6 months and 1 year postoperatively, such as higher complication rates (43%), when compared with control group (8%), and more pain at 6 weeks follow-up.
Fat grafting associated with limited fasciotomy promotes worse functional results compared to conventional limited fasciotomy in the short term. However, long-term results and recurrence rates should be further assessed. Level of Evidence II, Prospective comparative study.